This is a 79-year-old right-handed married female, who I am now hospitalizing for evaluation of recurrent episodes of numbness and weakness of left upper extremity.
This patient relates to having two episodes occurring during the last week of June; both of these occurred while she was eating breakfast around 7:30 AM. She developed sudden onset, without warning, of complete paralysis as well as numbness of the left arm, which lasted for 10 to 15 minutes. There was no speech impairment, no involvement of the face or leg, and no associated headache. These symptoms completely returned to normal. She denies associated chest pain, shortness of breath, or tachycardia with these spells, and there was no jerking of the extremities. About 2 days later, she again had a similar spell. She has not had any further episodes since that time.
Patient's history is significant for hypertension since age 35. She had no previous history of heart disease or diabetes. Two years ago she was seen by Dr. Smith for left putamen hemorrhage. Patient was also found to have right meningioma arising near the petrous region. She describes about 8 episodes over the past 10 years when her right peripheral vision blacked out briefly. She could not recall whether either eye was affected or if this was the right peripheral vision. The last such episode was about 4 months ago.
This past winter she also had about a 2-week period when the right foot seemed to drag. There has been no recent head injury, and there is no prior history of seizures.
Recent carotid Doppler study performed showed moderate calcified plaque in the right carotid bulb but no significant lesion. No flow could be found in the left internal carotid artery, suggesting left internal carotid artery occlusion. Calcified plaque was also noted in the left carotid bulb. Repeat CT scan of the head again showed the old area of infarction involving the left basal ganglia. There was an enhancing lesion starting in the right tentorial region and extending upward into the right parietal area, having the appearance of a meningioma. This is basically unchanged from the previous scan.
CPT Code: ____________________

Question

This is a 79-year-old right-handed married female, who I am now hospitalizing for evaluation of recurrent episodes of numbness and weakness of left upper extremity.
This patient relates to having two episodes occurring during the last week of June; both of these occurred while she was eating breakfast around 7:30 AM. She developed sudden onset, without warning, of complete paralysis as well as numbness of the left arm, which lasted for 10 to 15 minutes. There was no speech impairment, no involvement of the face or leg, and no associated headache. These symptoms completely returned to normal. She denies associated chest pain, shortness of breath, or tachycardia with these spells, and there was no jerking of the extremities. About 2 days later, she again had a similar spell. She has not had any further episodes since that time.
Patient's history is significant for hypertension since age 35. She had no previous history of heart disease or diabetes. Two years ago she was seen by Dr. Smith for left putamen hemorrhage. Patient was also found to have right meningioma arising near the petrous region. She describes about 8 episodes over the past 10 years when her right peripheral vision blacked out briefly. She could not recall whether either eye was affected or if this was the right peripheral vision. The last such episode was about 4 months ago.
This past winter she also had about a 2-week period when the right foot seemed to drag. There has been no recent head injury, and there is no prior history of seizures.
Recent carotid Doppler study performed showed moderate calcified plaque in the right carotid bulb but no significant lesion. No flow could be found in the left internal carotid artery, suggesting left internal carotid artery occlusion. Calcified plaque was also noted in the left carotid bulb. Repeat CT scan of the head again showed the old area of infarction involving the left basal ganglia. There was an enhancing lesion starting in the right tentorial region and extending upward into the right parietal area, having the appearance of a meningioma. This is basically unchanged from the previous scan.
  CPT Code: ____________________

Quizplus · Accepted Answer

The Answer of This is a 79-year-old right-handed married female, who I am now hospitalizing for evaluation of recurrent episodes of numbness and weakness of left upper extremity.
This patient relates to having two episodes occurring during the last week of June; both of these occurred while she was eating breakfast around 7:30 AM. She developed sudden onset, without warning, of complete paralysis as well as numbness of the left arm, which lasted for 10 to 15 minutes. There was no speech impairment, no involvement of the face or leg, and no associated headache. These symptoms completely returned to normal. She denies associated chest pain, shortness of breath, or tachycardia with these spells, and there was no jerking of the extremities. About 2 days later, she again had a similar spell. She has not had any further episodes since that time.
Patient's history is significant for hypertension since age 35. She had no previous history of heart disease or diabetes. Two years ago she was seen by Dr. Smith for left putamen hemorrhage. Patient was also found to have right meningioma arising near the petrous region. She describes about 8 episodes over the past 10 years when her right peripheral vision blacked out briefly. She could not recall whether either eye was affected or if this was the right peripheral vision. The last such episode was about 4 months ago.
This past winter she also had about a 2-week period when the right foot seemed to drag. There has been no recent head injury, and there is no prior history of seizures.
Recent carotid Doppler study performed showed moderate calcified plaque in the right carotid bulb but no significant lesion. No flow could be found in the left internal carotid artery, suggesting left internal carotid artery occlusion. Calcified plaque was also noted in the left carotid bulb. Repeat CT scan of the head again showed the old area of infarction involving the left basal ganglia. There was an enhancing lesion starting in the right tentorial region and extending upward into the right parietal area, having the appearance of a meningioma. This is basically unchanged from the previous scan.
  CPT Code: ____________________

This Is a 79-Year-Old Right-Handed Married Female, Who I Am