| Identifier |
past_medical_history_part3 |
| Title |
Past Medical History Part 3 |
| Creator |
Andrew G. Lee, MD; Jared Alexander |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JA) Class of 2021, Baylor College of Medicine, Houston, Texas |
| Subject |
History; Diagnosis; Interview |
| Description |
Summary: ● Be specific! Don't just write "TIA/Stroke" - More information can help determine if deficit is old vs. new ○ What kind of stroke? ○ On what side? ○ Which vascular distribution? ● Ex: Patient with right homonymous hemianopsia ○ Important to know they had previous stroke where the CAT scan showed left posterior cerebral artery ischemic infarction ● Don't rely on radiology reports ○ Often simply say "no acute intracranial injury" or "no acute change." ● In summary: Need enough information to determine if their complaint is old or new. ○ TIA = Tell what patient had/when they had it. ○ Stroke = Tell where lesion was and which side. ○ Do the same for all intracranial lesions: ■ Meningioma - which side? Where? Symptomatic? ■ Aneurysm - Where? Ruptured/unruptured? |
| Transcript |
Today we'll be doing Past Medical History III. You heard about how we want to know cancer and cancer staging. We need to know about vasculopathic risk factors and how much control we have. Today we're going to be doing the vascular things because when residents tell me about ischemic events, they just say TIA/stroke and that's not enough information. We need to know what kind of transient ischemia did we have. Was it a hemispheric TIA? "I was paralyzed on one side, I couldn't speak." Was it a diplopia event or was it amaurosis fugax? And writing "stroke" is the same as a lay person writing stroke. We need to know which side was the stroke. Which vascular distribution? Because if you don't tell me this information, I won't know how much is old and how much is new. So, for example, if someone has a right homonymous hemianopsia and they're complaining about blurred vision wouldn't you like to know that they already had a stroke two years ago and that the CAT scan showed a left posterior cerebral artery ischemic infarction. You might be saying well can't we just look at the report, and the problem with the radiology reports is they often read as "no acute intracranial injury," "no acute change," and the patient doesn't realize that the problem is old, and so unless you know that their old stroke was left posterior cerebral artery you might think that this right homonymous hemianopsia is new. So, the behavior changes I'll be asking from you in terms of past medical history for vascular things is TIA - tell me what they had/when they had it. And stroke - tell me where the lesion was and which side. And as an aside, you should be doing the same thing for all intracranial lesions. So please don't just write "meningioma." Which side was the meningioma? Where was the meningioma? Was it symptomatic? Or aneurysm, "they had an aneurysm." Where was the aneurysm? Which side? Was it ruptured or non-ruptured? So, we need to have details about structural lesions like stroke, meningioma, and aneurysm that include lateralization, which side it was on, and localization. Because what we are really trying to do is, you're trying to figure out is whatever they're complaining about, is it old? And is there a lesion from the past that can explain the present? |
| Date |
2019-10 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6qc4v2k |
| Setname |
ehsl_novel_lee |
| ID |
1469317 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6qc4v2k |
