Diagnostic challenge

Franco was a 78-year-old Italian man with a lifelong fondness for the grape who also happened to have diabetes. He was just about controlled with metformin, running blood sugars around 7 to 10. Last year, while in Mexico, he had an episode of syncope and was hospitalized for 2 days. He’d become disoriented, had difficulty swallowing and speaking for 48 hrs, and showed some transitory right-handed weakness. It’s not uncommon to meet circumstances where a full neurological examination is recommended. But a really thorough exploration of the nervous system takes hours. What can be done in the real world to screen quickly for neurological problems? Quite a lot, if you eliminate the nonessential. Platelet-rich plasma (PRP) therapy has been in the news recently with publicized cases of professional football and baseball players undergoing the treatment. Notable athletes such as Tiger Woods and figure skater Patrick Chan have had PRP. Woodbine racehorses get it too. The use of PRP use has an extensive history, going back to 1987 in cardiac surgery. Many physicians have never received adequate instruction on diseases of the aorta. This area was certainly ignored during my training, but with the advent of echocardiography and CT scanning, we’ve since learned a great deal. Thoracic aortic disease is usually asymptomatic until a life-threatening event occurs. Aortic aneurysms are potentially a time bomb waiting to happen.