Vale (Valerie)

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67 appearances 1 recordings 1 series first heard Jul 2026 last heard 31 Jul

Vale (Valerie)’s voice in public audio — every appearance, attributed to the second.

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The Clinical Problem Solvers · Episode 469: SLS – Altered Mental Status · 31 Jul 2026 podcast

When she was asked to describe a complex picture using the NIH

cards that we use for like stroke assessment she could only describe specific parts and not the entire scene together and her motor exam also was altered because it showed four over five strength on both upper and lower extremities on the right and also decreased sensation to find touch on that side and in comparison to her left side which which was preserved just what are you thinking

The MRI showed DWI hyperintensities in the left frontal parietal and occipital lobes.

I should say that they had two hyperintensities on these same sites as well.

And these DWI changes also had ADC correlation.

So what are your final thoughts, Admiral?

Okay, so you guys did an amazing job breaking down this case.

I think from the first aliquot, you got it.

For me, the main teaching point with this case was the importance of tempo.

I think when I was putting this case together, it almost was...

kind of obvious what this was, but reflecting on it in real time, it didn't feel obvious at all.

Like you had a very sick patient that can with like very sudden symptoms, almost like cold stroke, this is a stroke and we should get her somewhere that she can receive thrombolysis treatment.

And it was kind of easy to disregard that backstory of headache.

And then, as you said, this was, at the end of the day, a cerebrovascular complication of bacterial meningitis, which, to my surprise, reading about it, is way more common than I thought.

It actually happens in one in four patients that have meningitis, or rectal meningitis, I should say.

And the most common presentation is, of course, infarction, but you can also have venous thrombosis and bleeds, such as a varaginoid and intracerebral.

So...

keep those in your back pocket because they do happen more often than we think so.

The presence of cerebrovascular complications increases the incidence of unfavorable outcomes for patients, so it should be something that we think about from the get-go because we should prevent these complications from happening.

and we prevent those by asserting dexamethasone early.

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