Case Summary Of [C L I E N T DATE

08/31/1965 05/15/2009 05/15/2009 05/15/2009

N A M E] SOURCE DME Ma'iso" 6o$"ty &/2$la"ce

DESCRIPTION
Date of Birth DME Physical Therapy Note re Pt pic!i"# $p a sli"#% Date of &cci'e"t (o)a EM* +eport, -po" arri.al )e fo$"' a se/i )hich )as faci"# "orth o" Pit0er +oa' )ith a 1eo Metro i/2e''e' i" the fro"t of the se/i% 3$r Patie"t )as the 'ri.er of the 1eo4 he )as sitti"# i" the passe"#er si'e of the car tal!i"# the la) e"force/e"t% Patie"ts5 f$lly 6ooperati.e &lert 3rie"te'% Patie"t states that the se/i hit hi/ )hile he )as tra.eli"# )est o" 92"' a"' p$she' hi/ 'o)" Pit0er +oa' for appro7% 150 feet% Pt 'e"ies a"y local "ec! pai" or short"ess of 2reath% Pt states he has so/e ri#ht te/poral pai" ( "ote a s/all a2rasio"% Pt also has so/e lo)er 2ac! pai" )hich is "or/al for hi/% ( place' a 6,6ollar o" hi/ 2$t he ref$se' a left 2$"'le 2ra"ch% Pt has all p$lse4 /o.e/e"t a"' se"satio" i"tact% Pt )as place' o" the cot a"' i"to 208% &ll .ital si#"s are sta2le4 208 to M6M9% ( "ote' that the 'ri.er co/part/e"t )as i"tr$'e' 2y at least 2 feet% Pt "o) co/plai"s of left sho$l'er pai"% *eco"'ary e7a/ )as $"re/ar!a2le% 6are t$r"e' o.er to M69 De2% &r/ *li"# -"i.ersal ,,,, 2ill for 05/15/2009 ser.ice

05/28/2009 08/03/2009

Impression: 1: Basilar artery a"e$rys/ locate' at the 2asilar s$//it appare"tly i"corporati"# the ori#i"s of the poster cere2ral arteries% 2: 3ther tha" the 2asilar artery a"e$rys/4 M+( of the 2rai" is "or/al% Indications: Pro2a2le tip of the 2asilar a"e$rys/ o" prior M+(% MRI of Brain: No co/parati.e st$'ies a.aila2le% Findings: ;e"tric$lar syste/ is "or/al% There is "o e.i'e"ce of /ass4 /ass,effect4 he/orrha#e or e7tra a7ial collectio"% No 'iff$sio" restrictio" to s$##est ac$te i"farctio"% Brai"ste/ a"' posterior fossa are $"re/ar!a2le% Pit$itary #la"' a"' s$prasellar re#io" are "or/al% Para"asal si"$ses are clear% 3r2its are "or/al% There is a" a"e$rys/ at the 2asilar tip )hich is characteri0e' 2elo)% 3ther)ise4 there are "or/al i"tra cra"ial flo) .oi's% No re#io" of $"e7pecte' e"ha"ce/e"t is see"% MRA Head: <i"'i"#s There is a" a"e$rys/ at the 2asilar tip /eas$ri"# 1%5 7 1%2 7 1%0c/ i" cra"ioca$'al4 tra"s.erse a"' &P 'i/e"sio"s respecti.ely that pro=ects 'irectly s$periorly% The "ec! /eas$res appro7i/ately 1%0c/% The a"e$rys/ i".ol.es 2oth posterior cere2ral artery ori#i"s4 left #reater tha" ri#ht% The .is$ali0e' i"ter"al caroti' a"teries are "or/al i" cali2er )itho$t focal ste"osis% The 2ilateral a"terior a"' /i''le cere2ral arteries are "or/al i" cali2er )itho$t focal ste"osis or a"e$rys/% The .erte2ral a"' posterior cere2ral arteries are "or/al i" cali2er )itho$t focal ste"osis or a"e$rys/% -(96 ;isit *$//ary Comments: Patie"t has 2ee" fo$"' to ha.e a si#"ifica"t tip of the 2asilar a"e$rys/% This )as fo$"' i"ci'e"tally% Immediately referred for Eval with Dr. James B. Worrell &'/issio" Principal Diagnosis &sy/pto/atic Basilar Tip &"e$rys/% Brief History: The Pt ha' a car acci'e"t i" May 09 a"' a 6T sho)e' a 10// 2asilar tip a"e$rys/% 9e is asy/pto/atic fro/ the a"e$rys/ 2$t )ill ha.e it electi.ely coile'% Neuro E am: &lert a"' 3rie"te' 734 .is$al fiel's are "or/al4 se"satio" i"tact4 face sy//4 heari"# "or/al4 palate raises e@$ally4 to"#$e /i'li"e4 stre"#th 5/5 4 +efle7es 2A thro$#ho$t4 Ba2i"s!i "e#ati.e4 hoff/a"5s "e#ati.e4 3peratio"s/Proce'$res Perfor/e' *te"t

36o""or Me'ical *$pply -(964 Dr% >a/es ?orrell

09/21/2009

-(96 Dr% >a/es B% ?orrell Dr% >oh" 6halo$p!a -(96 Dr% Patricia Da.is

09/22/2009

assiste' coili"# of 2asilar tip a"e$rys/% Ta!e" for coili"#4 tra"sferre' post proce'$re to the *(6- for o2ser.atio"4 )as tra"sferre' to 6=c the follo)i"# 'ay a"' )as 'ischar#e' after a" $"e.e"tf$l hospital co$rse to ho/e o" 09/2B/2009% Data +e.ie) &"#io#ra/ sho)s coile' 2asilar tip a"e$rys/% 6o"'itio" o" 'ischar#e "e$ro i"tact4 tolerati"# #e"eral 'iet4 a/2$lati"# )itho$t 'iffic$lty% 09/22/2009 !perati"e Report: Procedure Dia#"ostic cere2ral a"#io#ra/ a"' ste"t assiste' coil e/2oli0atio" of a 2asilar s$//it a"e$rys/ ;essels ("=ecte' Bilateral co//o" caroti' arteries4 2ilateral i"ter"al caroti' arteries4 2ilateral s$2cla.ia" arteries4 2ilateral .erte2ral arteries4 a"' 2ilateral co//o" iliac arteries% &ccess +i#ht co//o" fe/oral artery )ith a 6 <re"ch 35c/ sheath4 9e/ostasis <re"ch 23c/ sheath )as s$t$re' i" place 6o"trast 150cc of (so.$e,300 &"esthesia 1e"eral a"' 1C li'ocai"e local 5cc% Medications: 9epari" 5000 $"its (;4 Nitropaste 3D tra"s'er/ally% #ec$ni%ue: Pt )as 2ro$#ht to the "e$roa"#io#raphy s$ite o" ris!s/2e"efits proce'$re )ere 'isc$sse'% ("for/e' )ritte" a"' oral co"se"t )as o2tai"e' fro/ Pt% Pt place' i" s$pi"e positio" a"' a ti/eo$t )as perfor/e' prior to the proce'$re% The s!i" o.er the 2ilateral #roi"s )as clea"e' a"' preppe' i" $s$al sterile fashio"% &" 18 #a$#e "ee'le )as $se' Esi"#le )all tech"i@$e: to access the ri#ht co//o" fe/oral artery a"' a 6 <re"ch4 35// sheath )as a'.a"ce' i"to positio" o.er the Be"tso" )ire% 3000 $"its of (; hepari" )as a'/i"istere' to the Pt% & Ter$/o #$i'e )ire a"' s$2tractio" i/a#es i" /$ltiple pla"es a"' pro=ectio"s )ere o2tai"e' a"' 'escri2e' 2elo)% & 5 <re"ch 90c/ E".oy strai#ht #$i'i"# catheter )as $se' for the e"'o.asc$lar s$r#ical portio"% <ollo)i"# the proce'$re he/ostasis )as achie.e' 2y s$t$ri"# a 6 <re"ch 23c/ sheath i" place% Pt tolerate' the proce'$re )ell% Dr% 6halo$p!a )as prese"t for the e"tire proce'$re a"' scr$22e' i" for the e"tire e"'o.asc$lar portio"% Diagnostic cere&ral angiogram: The ri#ht s$2cla.ia" arterty )as selecte' a"' i"tracra"ial r$"s perfor/e' 'e/o"strate' a 2asilar s$//it a"e$rys/ /eas$ri"# appro7i/ately 10// at its5 lar#est 'i/e"sio" pre'o/i"a"tly i"corporati"# the left posterior cere2ral artery is )ell% No other a"e$rys/ or a2"or/ality of the ri#ht .erte2ral artery4 2asilar artery or 2ilateral poster cere2ral arterties )as i'e"tifie'% The ri#ht co//o" caroti' artery )as selecte' a"' cer.ical r$"s sho)e' a "or/al ri#ht caroti' 2if$rcatio"% The ri#ht i"ter"al caroti' artery )as selecte' a"' i"tracra"ial r$"s sho)e' a "or/al 'istal ri#ht i"ter"al caroti' artery% M6& a"' &6& )itho$t e.i'e"ce of ste"osis4 a"e$rys/4 or &;M% & .ery s/all ri#ht posterior co//$"icati"# artery )as prese"t )ith /i"i/al co"tri2$tio" to the ri#ht P6& territory% The left co//o" caroti' artery )as selecte' a"' cer.ical r$"s sho)e' a "or/al left caroti' 2if$rcatio"% The left i"ter"al caroti' artery )as selecte' a"' i"tracra"ial r$"s sho)e' a "or/al 'istal left i"ter"al caroti' artery4 M6& a"' &6& )itho$t e.i'e"ce of ste"osis4 a"e$rys/ or &;M% &#ai"4 a .ery s/all left posterior co//$"icati"# artery )as prese"t )ith /i"i/al co"tri2$tio" to the left P6& territory% The left s$2cla.ia" artery )as selecte' a"' i"tracra"ial r$" re.eale' the pre.io$sly 'escri2e' 2asilar s$//it a"e$rys/s% No other a2"or/alities of the left .erte2ral4 2asilar artery4 or 2ilateral poster cere2ral arterties )as i'e"tifie'% The 'ia#"ostic catheter )as re/o.e'% E"'o.asc$lar s$r#ery 2000 a''itio"al $"its of (; hepari" )as a'/i"istere' the Pt a"' 3D of "itropaste )ere applie' to the Pt5s chest% & 5 <re"ch 90c/ strai#ht E".oy #$i'i"# catheter )as $se' to select the left .erte2ral artery% & re"e#a'e hi#h flo) /icrocatheter )as $se' to select the left posterior cere2ral artery )ith the ai' of a *y"chro soft a"' Tra"se"' EF /icro,)ire% & Ne$rofor/ 3// 7 20// ste"t )as prepare' i" the $s$al sterile /etic$lo$s fashio"% The ste"t )as tra"sferre' i"to the +e"e#a'e 9i,<lo /icrocatheter% The ste"t )as 'eploye' )itho$t /i#ratio" or co/plicatio" pro=ecti"# fro/ the 'istal 2asilar artery to the left posterior cere2ral artery% 6o"trol r$" follo)i"# ste"t 'eploy/e"t 'i' "ot 'e/o"strate a"y e.i'e"ce of

-(96 Dr% 6halo$p!a a"' Dr% 9aya!a)a Dr% 6alliso"

i",ste"t thro/2osis or platelet a##re#atio"% The re"e#a'e /icrocatheter )as the" rea'.a"ce' thro$#h the pre.io$sly place' ste"t a"' i"to the ri#ht posterior cere2ral artery% & seco"' Ne$rofor/ 3// 7 20// ste"t )as prepare' i" $s$al sterile /etic$lo$s fashio" a"' tra"sferre' i"to the e/pty /icrocatheter% &#ai" the ste"t )as a'.a"ce' to the tip of the /icrocatheter )ith the ai' of the Ne$rofor/ p$sher )ire s$pporte' 2y a Tra"se"' EF /icro,)ire% The ste"t )as 'eploye' )itho$t co/plicatio" /i#ratio" pro=ecti"# fro/ the 'istal 2asilar artery i"to the ri#ht posterior cere2ral artery 2reati"# a G co"fi#$ratio" )ith the pre.io$sly place' ste"t% & co"trol r$" perfor/e' fro/ the #$i'i"# catheter follo)i"# ste"t 'eploy/e"t 'i' "ot 'e/o"strate a"y e.i'e"ce of i",ste"t platelet a##re#ratio" or /i#ratio"% The +e"e#a'e 9i,<lo /icrocatheter re/o.e' a"' a" *H 10 /icrocatheter )as a'.a"ce' thro$#h the #$i'i"# catheter i"to the 2asilar arterty4 thro$#h the ste"t a"' i"to the a"e$rys/% 3pti/al )or!i"# pro=ectio"s of the a"e$rys/ )ere as follo)s (" the & pla"e +&3 5 a"' cra"ial 94 a"' i" the B pla"e +&3 100 a"' ca$'al 8% The a"e$rys/ )as pro#ressi.ely occl$'e' )ith the follo)i"# 'etacha2le coils4 i" the follo)i"# or'er 360 1D6 18%9// 7 20c/4 360 1D610 *+4 8// 7 20c/4 360 1D6 10 soft *+ 9// 7 20c/4 360 1D6 10 soft *+ 8// 7 20c/% 360 1D6 10 soft *+ 6// 7 11c/4 360 1D610 soft *+ 5// 7 9c/4 a"' 1D610 -ltrasoft B// 7 6c/% ("ter/itte"t co"trol r$"s perfor/e' '$ri"# the coili"# proce'$re 'e/o"strate' pro#ressi.e e/2oli0atio" of the a"e$rys/ )ith "o i/pi"#e/e"t of the coil /ass o" the pare"t .essels or ste"t% &''itio"ally "o e.i'e"ce of i",ste"t thro/2osis or platelet a##re#atio" )as see"% &fter place/e"t of the fi"al coil the *y"chro /icro, )ire )as rei"tro'$ce' a"' the /icrocatheter a"' 2oth )ere re/o.e' fro/ the a"e$rys/% & fi"al sta"'ar' To)"e5s a"' lateral pro=ectio" or 'e/o"strate' e7celle"t e/2oli0atio" of the a"e$rys/ )ith )i'ely pate"t G co"fi#$ratio" ste"t a"' "o e.i'e"ce of 'istal e/2oli or filli"# 'efect% The #$i'i"# catheter )as re/o.e' a"' the sheath )as p$lle' 2ac! to the 2if$rcatio" the co//o" iliac arteries% & r$"off perfor/e' 'e/o"strate' "or/al 2ilateral co//o" iliac4 e7ter"al iliac4 a"' co//o" fe/oral arteries )ith "o e.i'e"ce of ste"ois or filli"# 'efect% The sheath )as e7cha"#e' o.er a Be"tso" )ire for a 6 <re"ch 23c/ sheath )hich )as s$t$re' i" place% 09/2B/2009 09/28/2009 -(96 Dischar#e *$//ary Patie"t ("str$ctio"s 6oile' Basilar Tip &"e$rys/ 6T 9ea' Reason for Exam 9ea'aches% Pt /e"tio"s history of rece"t i"tra.asc$lar cor' i"sertio" i" the re#io" of the circle of ?illis for a"e$rys/ prior treat/e"t% 1% Tra"sa7ial 5// 6T i/a#es )ere o2tai"e' thro$#ho$t the hea' )itho$t co"trast e"ha"ce/e"t% 2% ;ery 'e"se /etallic 'e"sities are see" i" the 2ase of the s!$ll at the le.el of the circle of ?illis s$prasellar re#io" associate' )ith co"si'era2le strea! artifacts a"' o2sc$ratio" of the a"ato/y of this le.el% The re/ai"i"# hea' sectio"s other)ise appear $"re/ar!a2le )itho$t si#"s of ac$te 2lee's4 i"farctio"s or he/ato/as% No /ass lesio"s or /i'li"e shift co$l' 2e 'e/o"strate'% E+ Physicia" +ecor' 9ea'ache 9istory of hea'ache si"ce 2ac! i"=$ry 2 years a#o ha' a"e$rys/ coil repair last T$es'ay i" (o)a 6ity% 9e calle' (o)a 6ity starte' o" Pre'"iso"e this a/% 9ea'ache still prese"t% E+ N$rsi"# +ecor' 9ea'ache *$''e" o"set )ith s)eats4 co/plai"s of .isio" a"' 'i00y% &''itio"al <i"'i"#s &/2$lates i" hol'i"# o"to )all as if he )ill fall o.er if he lets #o so/e)hat sta##eri"# #ait% *tates 'octor fro/ (o)a 6ity sho$l' ha.e calle' $s a"' that he "ee's a 6T of his hea'% Bloo' Test 6o/prehe"si.e Meta2olic Pa"el 1l$cose 316 ra"#e is 80,100I *o'i$/ 133 ra"#e is 138,1B5I 6hlori'e 98 ra"#e is 98,108I Total Protei" 8%3 ra"#e is 6%B,8%2I &HT *1PT 100 ra"#e is 30,65% 10/1B/2009 E/er#e"cy N$rsi"# +ecor' 9ea'ache 6o/plai"s of pai" sho$l'er to te/ple% -ri"e sa/ple o2tai"e'4 Pt states Jit )ill pro2a2ly sho) all the 'r$#s that ( ha.e ta!e"D% -ri"e Dr$# *cree" Ne#ati.e E+ Physicia" +ecor' 9ea'ache

-(96 Dr% >oh" 6ahlo$p!a &'air 6o$"ty 9ealth *yste/

&'air 6o$"ty 9ealth *yste/ &'air 6o$"ty 9ealth *yste/ &'air 6o$"ty 9ealth *yste/ &'air 6o$"ty 9ealth *yste/ &'air 6o$"ty 9ealth *yste/ &'air 6o$"ty 9ealth

10/15/2009 10/15/2009

C$ief Complaint' 9ea'ache4 2ac! of hea' to 2ilateral te/ples4 )as 9 "o) 8% !nset(Duration si"ce *epte/2er% Recent Head In)ury: 6a"5t sleep '$e to hea'ache% 9a' cere2ral a"e$rys/ si"ce *epte/2er% Tol' )o$l' ha.e hea'ache for 2 )ee!s or the rest of life% 11/03/2009 ;isit *$//ary Persiste"t hea'ache% 6o"cer"s of o.er,a"esthesia re2o$"'i"# hea'ache co/2i"e' )ith 2aseli"e hea'ache% 9e is o" steroi' taperi"# for possi2le post,coil s)elli"#% Proce'$re )as 'o"e 09/22/2009% Htr to clie"t % J( )a"te' to let yo$ !"o) that )e #ot yo$r la2 )or! 2ac! a"' t)o of yo$r la2 .al$es are o$t of li"e% (t 'oes sho) that yo$ ha.e a" $"'erlyi"# 'ia2etes $"relate' to the cortiso"e that yo$ too! for a )hile a"' also that yo$r tri#lyceri'es are @$ite ele.ate'% Go$r tri#lyceri'ies o" the la2 )ere 13804 a"' )e reco//e"' they 2e "o hi#her tha" 150% ( a/ #oi"# to se"' yo$ so/e /e'ici"e to try to ta!e care of 2oth of these pro2le/s% Go$ ha.e a follo),$p appt% the first part of Dece/2er4 a"' ( )o$l' li!e to see yo$ 2ac! the" to rechec! so/e of these thi"#s% 3ptha/olo#y C$ief Complaint: N?P *tat$s post 2asilar artery ste"ti"#4 co/plai"s fro/ 'istorte' .isio" PE+ +P% BB y/o referre' for e.al$atio" of 'istorte' .isio" after 2asilar artery ste"ti"# a"' coili"#% Pt i".ol.e' i" a M;& o" 05/15/2009K%/il' hea'aches at that poi"t4 a"' "o loss of co"scio$s"ess% Ta!e" to E+ a"' 6T )as 'o"e )hich )as $"re/ar!a2le e7cept for fi"'i"# of a 10// 2asilar tip a"e$rys/% *te"ti"# a"' coili"# o" 09/22/2009% E.er si"ce s$r#ery4 he co"ti"$es to ha.e co"sta"t hea'aches that is 8/10 i" se.erity% &2le to sleep 3 ho$rs a "i#ht% Tyle"ol for it 8 12 ta2s per 'ay% 9is hea'ache is occipital a"' so/eti/es /o.es a"teriorly to the hea'/face% Thro22i"# i" "at$re% 9e ha' a" episo'e )he" he )as 'ri"!i"# his coffee '$ri"# )hich he sa) e.erythi"# as 2lac! circles a"' for a fractio" of a seco"' he felt s$per li#ht hea'e'4 2$t there )as "o loss of co"scio$s"ess% Di00i"ess /ost of the ti/e a"' li#hthea'e'"ess a"' 2l$rre' .isio" )he" loo!i"# at close o2=ects4 /ai"ly i" the left eye% ?he" he loo!s at his o)" ha"'4 he sees a fi"#er 2et)ee" the fi"#ers i"'icati"# 'o$2le .isio"% 9e states 2 )ee!s prior to s$r#ery4 he passe' a 6DH e7a/ "o) thi"!s if he too! it "o)4 he )o$l' fail the .isio" portio" of it% 9e ha' a trial of steroi's for 10 'ays t)ice )hich 'i' "ot help% Ti""it$s i" 2oth ears that co/es a"' #oes% 6a""ot tell if all these sy/pto/s happe" at the sa/e ti/e or "ot%

*yste/

-(96/Dr% M 1le"" &2er"athy -(96/ M 1le"" &2er"athy

11/0B/2009

11/16/2009

Dr% +ei' Ho"#/$ir

K%sees )ell i" the 'ista"ce 2$t $p close he is 2l$rry% 9e also thi"!s he has 'iplopia
o" so/e 'ays% This so$"'s 2i"oc$lar4 altho$#h his .isio" is .ery 2l$rry 3*% 9e also 'escri2es t$""el .isio" at ti/es4 li!e loo!i"# thro$#h circles% &lso "otes that o" *at% his left eye felt li!e it )as 2$r"i"#% 9e ha' ti"#li"# aro$"' his /o$th a"' the ri#ht si'e of his face )as 'roopy% 9e )as a)a!e"e' )ith these sy/pto/s a"' staye' $p for a co$ple ho$rs4 )e"t to 2e' a"' the sy/pto/s )ere #o"e i" the /or"i"# )he" he )o!e $p the follo)i"# /or"i"#%

MY QUESTIONS/CONCERNS
Source Prescriptio" <ol'er Issue There is a ?yeth prescriptio" applicatio" that )o$l' allo) Mr% FFFF to recei.e assista"ce payi"# for +7 fro/ ?yeth% 9e "ee's to co/plete app a"' s$2/it%

E"try 'ate' 11/0B/2009 Htr fro/ This 'octor tells Mr% FFFF he has 'ia2etes4 )hat is N3T the ca$se a"' se"'s hi/ so/e Dr% &2er"athy /e'ici"es% Does "ot /eet the sta"'ar' of care as 'ia2etes ca$ses a lot of 'a/a#e that sho$l' ha.e 2ee" 'eter/i"e' prior to prescri2i"# /e's as treat/e"t optio"s .ary fro/ pills to shots% & 2"' #l$cose test is protocol 2efore 'ia#"osis4 "ot the case here% This 'octor )as a physicia" i" *o$th 6aroli"a% 9is )ife is a "$rse a"' he ha' /ore tha" o"e /alpractice s$it 2efore /o.i"# to (o)a% 6oili"# 6oili"# There are patie"ts that e"' $p )ith 3,B coili"# proce'$res to /a!e the hea'aches or 'o$2le .isio" stop4 'oes a"y of his 'octors ha.e a pla" to assist )ith hea'aches 2eyo"' /e'sL Hoo!i"# at the optha/olo#y "otes Jface )as 'roopyD , so$"'s li!e a stro!e a"' the coili"#

"ee's a seco"' loo! for a possi2le slo) 2lee'% 6a" yo$ #et hi/ to a"yo"e for a seco"' opi"io"L They are "ot 'oi"# /$ch follo) $p at -(96% 9e is at .ery hi#h ris! for stro!e4 .ery co//o" post coili"#% The &M& is 'isc$ssi"# the ris! le.els of the coil 'e.ices as the post s$r#ical lo"# ter/ o$tco/e is "ot #oo' for 83C of these patie"ts% 9ea' ("=$ry Ne$roco#"iti.e testi"# *ocial *ec$rity Disa2ility Pro#ressi.e ("s$ra"ce &'air 6o$"ty 9ospital +ecor' 09/28/2009 &'air 6o$"ty 9ospital +ecor' 10/15/2009 DME , PT Ma'iso" 6o$"ty Me/orial (o)a Me'icai' 6o"cept$ali0i"# Brai" ("=$ry as a 6hro"ic Disease http //)))%2ia$sa%or#/positio"s%ht/ This Pt% really "ee's a "e$ro pysch test to 2e#i" to 'eter/i"e 'a/a#e fro/ the i"=$ry also "ee's a "e$roco#"iti.e test4 calle' (/P&6T% 9as Mr% FFFF applie' for *ocial *ec$rityL They )ill perfor/ a lot of the testi"# he /i#ht "ee'% (f he has4 re@$est their file% (f "ot4 co"si'er ha.i"# hi/ apply% +e@$est their co/plete file4 i".esti#atio" a"' /e'ical% E+ Physicia" +ecor' 9ea'ache 9istory of hea'ache si"ce 2ac! i"=$ry 2 years a#o ha' a"e$rys/ coil repair last T$es'ay i" (o)a 6ity% *$at &ac+ in)ury, Is $e confused and means accident in -.(/--0, Pt states Jit )ill pro2a2ly sho) all the 'r$#s that ( ha.e ta!e"D )he" the "$rse )as ta!i"# a $ri"e sa/ple% 6larificatio" "ee'e' fro/ Pt% &lso a #oo' ti/e to as! a2o$t prior 'r$# $se as it )o$l' ha.e a" i/pact o" so/e 2rai" iss$es% 05/15/2009 DME Physical Therapy Note re Pt pic!i"# $p a sli"#% ?hy 'i' Pt pic! $p a sli"# i" Des Moi"es o" the 'ate of the acci'e"tL ?as he 2ei"# treate' for a prior i"=$ryL ( 'o "ot see )here these recor's ha.e 2ee" re@$este'% ( see Me'icai' liste' as a pro.i'er of i"s$ra"ce re@$est the e"tire Me'icai' file recor's a"' 2ills%

RESEARCH
(ss$e 6a$se of &"e$rsy/ <i"'i"#s Hists car acci'e"t as the tra$/a that co$l' ca$se a"e$rys/% *ee http //)))%"hl2i%"ih%#o./health/'ci/Diseases/ar//ar/Mca$ses%ht/l What Causes an Aneurysm KKK%%Tra$/a4 s$ch as a car acc!"ent# a$so can "ama%e the aorta &a$$s an" $ea" to TAAs' *ee http //)))%/ayocli"ic%co//health/aortic,a"e$rys//D*00018/D*E6T(3NNca$ses Traumat!c !n(ury' *o/e people )ho are i"=$re' i" falls or /otor .ehicle crashes 'e.elop thoracic aortic a"e$rys/s% OThe 'o)"si'e to coili"#4O +i"#er says4 Ois that )hile the ris! is .ery lo)4 it carries a hi#her rate of a"e$rys/ rec$rre"ce tha" clippi"#% &s a res$lt4 /ai"tai"i"# a )atchf$l eye o" the coile' a"e$rys/4 thro$#h 'ia#"ostic a"#io#raphy4 is i/perati.e%Ohttp //)))%/e'ical"e)sto'ay%co//articles/1300B3%php http //)))%/erc!%co////pe/sec09/ch098/ch098e%ht/l

6oili"# proce'$re .s% clippi"# +is!s of coili"#

Diplopia , Do$2le .isio"