Takeaway
Sometimes benign symptoms can herald more serious problems. Being ready and willing to reconsider initial impressions is crucial for accurately discovering the underlying etiology.
Lifelong Learning in Clinical Excellence | February 5, 2025 | 1 min read
By Gokul Krishnan, MBBS, MD, Kasturba Medical College Manipal, India & Carolina Musri, MD, Johns Hopkins Medicine
A young man presented to the ED with severe vomiting after eating at a restaurant. Initially, the symptoms were attributed to acute gastritis and managed conservatively. However, following the vomiting episode, the patient developed new-onset hiccups, dysphagia, and hoarseness of voice that progressively worsened to the point where he could no longer swallow oral medications.
A speech-language pathologist (SLP) was consulted for further evaluation. Based on the specific pattern of focal deficits, the SLP suspected that the patient’s symptoms might indicate an intracranial pathology rather than a simple gastroenterological issue. Subsequent imaging revealed a lateral medullary syndrome, likely caused by vertebral artery dissection triggered by the intense retching episodes. The patient was then managed accordingly. The SLP noted how their broad approach, avoiding tunnel vision, helped “crack the case.”
This patient encounter highlights the importance of thinking outside the box, maintaining a broad differential, and being open to the possibility of unexpected diagnoses. The more expansive our approach, the more likely we are to arrive at an accurate diagnosis. Utilizing the support of ancillary staff timely and judiciously is also imperative for a favorable outcome.
Here’s what was learned:
1. Timely and efficient engagement of support staff when appropriate is crucial. It’s important to promptly request a consult from the ancillary team when deemed necessary.
2. Developing a broad and open-minded approach is key to arriving at accurate diagnoses.
3. Engage in conversations with all others with genuine interest and actively listen. People are often eager to share their valuable experience. Just as teaching is an art, so too is the art of learning, and it requires practice.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.