Case of a man who shaved only on right side of face
1. 70-year-old man was brought to OPD three months ago by his son, with a complaint that he had stopped shaving on left side of face for one week. He was also not using his left hand even though he had no weakness in that hand.
1. 70-year-old man was brought to OPD three months ago by his son, with a complaint that he had stopped shaving on left side of face for one week. He was also not using his left hand even though he had no weakness in that hand.
2. This abnormal "behavior" started all of a sudden.
When his family members pointed this oddity, he retorted by saying, the left side of face did not belong to him.
Even when he was presented with water or tea from left side, he would stretch his right hand to receive them.
When his family members pointed this oddity, he retorted by saying, the left side of face did not belong to him.
Even when he was presented with water or tea from left side, he would stretch his right hand to receive them.
3. Family members were taken aback by his "odd behavior" and decided to seek medical opinion.
His BP was 170/110 mmHg and blood sugar was normal.
He had no known medical illness. #MedTwitter #neurotwitter
His BP was 170/110 mmHg and blood sugar was normal.
He had no known medical illness. #MedTwitter #neurotwitter
4. Examination revealed normal strength and sensations in his limbs and face. His vision was also normal.
He could not perceive objects or people standing on his left side.
On showing his left hand to him, he remarked "the hand is not mine and belongs to someone else".
He could not perceive objects or people standing on his left side.
On showing his left hand to him, he remarked "the hand is not mine and belongs to someone else".
5. It was now clear that he was suffering from left-sided #hemineglect.
This neglect affected his own body parts on left side as well the surroundings/environment on his left hand side.
Suspecting a disease in right side of #brain, #MRI brain was ordered.
This neglect affected his own body parts on left side as well the surroundings/environment on his left hand side.
Suspecting a disease in right side of #brain, #MRI brain was ordered.
6. MRI Brain showed #infarct (blood clot) in right parietal cortex. This could fully explain his left hemineglect.
He was started on anti-platelets, statins and BP-lowering drugs.
He was also advised #rehabilitation.
At a recent follow up, he had shown considerable improvement
He was started on anti-platelets, statins and BP-lowering drugs.
He was also advised #rehabilitation.
At a recent follow up, he had shown considerable improvement
7. Take home message *Neglect of own body parts or surroundings on one side (usually left side) is caused by a disease in right side of brain.
*If symptoms start all of a sudden, it could be due to #stroke.
Rapid diagnosis and prompt medical treatment can help in quick recovery
*If symptoms start all of a sudden, it could be due to #stroke.
Rapid diagnosis and prompt medical treatment can help in quick recovery
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