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A 50 year old man with alcohol withdrawal
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A 50 year old man is brought to the ED after being found on the street confused and staggering. The
paramedics and ED staff recognize him as having been seen in the ER previously for alcohol withdrawal
and injuries sustained while intoxicated. He is awake, disoriented to place and time, and speaks fluently.
There is weakness of abduction of the right eye and nystagmus in all directions of gaze. He cannot walk
without assistance and falls easily to the right or left. Tone in the legs is normal and reflexes are normal
at the knees and absent at the ankles, with flexor plantar responses bilaterally.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you treat this patient? How would you
monitor his condition and its treatment? What is the prognosis?A 50 year old man with alcohol withdrawal.
Case 3
A 50 year old man is brought to the ED after being found on the street confused and staggering. The
paramedics and ED staff recognize him as having been seen in the ER previously for alcohol withdrawal
and injuries sustained while intoxicated. He is awake, disoriented to place and time, and speaks fluently.
There is weakness of abduction of the right eye and nystagmus in all directions of gaze. He cannot walk
without assistance and falls easily to the right or left. Tone in the legs is normal and reflexes are normal
at the knees and absent at the ankles, with flexor plantar responses bilaterally.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you treat this patient? How would you
monitor his condition and its treatment? What is the prognosis?A 50 year old man with alcohol withdrawal.
(Click here for assignment help)