how wrong our presumptions can be!!!

hey all,

Well I am on my neuro prac. I had an outpt appointment this week and it was a 35yo male who suffered a R lat medullary stroke 4 weeks ago. Before I met the pt I had a mental picture of how I thought this pt would present. Major vestibular disturbances, verticality issues ,nystagmus.dizziness etc etc. I just saw the words lat medullary stroke and thought, ok this pt is going to need alot of work given it was only 4 weeks ago. How wrong could I be?

The pt presented with decreased sensation-sharp blunt and hot cold on left side upper and lower limbs. JPS/JMS all fine. Negative VOR/GAZE STABILISATION/NYSTAGMUS/.Sitting balance was perfect with pt able to tolerate ext displacement in all directions.Standing balance -static standing balance was normal,dynamic standng balance was impaired along with SLB on both legs. Fx reach test was above average and the pt performed v well on the Berg Balance.AROM AND mmT WERE ALL R=L AND WNL.Slight alteration of gait pattern was noted.No other objective findings were recorded.The pt's main cmplaints were his dizziness and blurred vision.From the above objective Ax it was clear that the pt's main problems were balance( high level balance) and he was doing rather well. I was astounded about how wrong my picture of this pt would be.Just goes to show, you can never tell how a pt will present.