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This 59y/o white male presented with a chief complaint of slurred speech.
He had recently undergone a work-up for "palpitations" without angina.
A Holter monitor study revealed non-sustained ventricular tachycardia.
He was admitted to SB Hospital for an angiogram and an angioplasty with
a stent placed in his right coronary artery. Upon awakening from the procedure,
he felt groggy and had slurred speech noted by the nursing staff. These
signs were attributed to sedation from the procedure. The next morning
he was discharged home feeling well. At approximately 3 PM that afternoon
while shopping with his wife, he noted that his tongue felt larger than
usual and difficulty speaking clearly. He also had difficulty writing a
check because he was unable to make his hand do what he wanted. He came
to the Emergency Room where he was noted to be dysarthric and to have clumsiness
of his right hand. His past medical history is significant for hypertension
and hypercholesterolemia.
Questions:
- What is the name of this syndrome?
- What are two sites where lesions can cause an isolated clumsy hand and dysarthria?
- Name four "lacunar syndromes".
- What is the pathophysiology of a lacune?
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