One day til the weekend!

Some days are just rotten and today was just like that! When I got into work I spoke to the physio cos I've been trying to shadow her for the last 5 weeks, and still no joy! She told me to have a coffee and then the patients would be ready for their sessions. Just as I was walking along the ward after another delicious coffee, I caught the end of the ward round and Nicolas said.... Oh Naomi, Dr Vignon wanted you to speak to this patient and make a diagnosis, he's got some great signs... so my plans to hang out with Sophie doing exercises were thwarted again and instead off I went to speak to this patient who had just been admitted

I spoke to the patient who gave me a 2 day history of his head spinning and feeling as if his legs wouldn't hold him. He pretty much denied everything else, although he did say he had been a bit sick. Oh and he was so tired/ill that he fell asleep mid-sentence (his sentence, not mine.)

So far, vertigo and some kind of weakness is all I have. When I examined him, it was fairly normal, and very importantly his neuro exam was symmetrical, and nothing glaringly obvious. Now I start to panic, as the patient falls alseep again and I don't really want to wake him up *again*, especially when I'm really not sure what's going on.

I wrote up what I had and it seemed fairly clear that he'd had some kind of stroke, but Nicolas wanted more precision. What did you see in his eyes? he said. I really didn't get it at all. He took me back to this poor patient and showed the most glaringly obvious ptosis (eyelid drooping) and nystagmus (google it) in the world! Well, possibly not in the world but it was fairly certain. His miosis lore difficult to elicit but it was definitely there, and in fact he had a clear cut Horner's syndrome. He was also coughing up stuff (difficulty swallowing) and had some ipsilateral pain alteration on his face and contralateral on his body.... How to tie all this together? Wallenberg's syndrome of course!! (Readers I hope you are looking at the screen as blankly as I was looking about 11:30am today).

After asking Dr Google, I realised that this was in fact Lateral Medullary Syndrome, something we were told is not core, but apparently is in France. Actually, I didn't feel quite so bad after I'd looked at the notes, as the GP, admitting doctor and A&E reg had not brought it together. But still, I felt pretty rubbish.

You know, you always think you can skip pain and temperature testing in a neuro exam- well you can't!

One more day til the weekend and island adventures!!

xxx