What's Your Diagnosis? Complications of Chronic Neurologic Disease

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Sodium Disorders in the Emergency Department: A Review of Hypernatremia and Hyponatremia correct.

Case Presentation: Emergency Department Management of Patients With Complications of Chronic Neurologic Disease

A 68-year-old man with a history of Parkinson disease presents by EMS to the ED with chest pain…

The patient was given an aspirin by EMS, but he said he missed his routine morning medications.
His Parkinson disease is managed with carbidopa/levodopa 25 mg/100 mg orally 3 times daily. His initial vital signs are: temperature, 37°C; heart rate, 88 beats/min; blood pressure, 130/80 mm Hg; and oxygen saturation, 98% on room air.
He has had 2 electrocardiograms, and both were normal sinus rhythm with no signs of ischemia.
The patient has been waiting in the ED for 8 hours for the results of a second troponin test. He attempts to stand, using his cane, but he falls and sustains a subdural hematoma. Risk management contacts you and inquires whether this adverse event was preventable…

Case Conclusion

Further review found that this patient’s fall and subsequent subdural hematoma were preventable. Because this patient missed his Parkinson medications at home and then while in the ED, he was unable to ambulate safely. Following this event, prehospital and emergency clinicians were educated on the necessity of making sure Parkinson patients’ medications are given on time. The patient’s subdural hematoma was managed conservatively, and he was discharged to a skilled nursing facility.