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Neuro Case Study

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A 60-year-old man is brought to the ER by ambulance because of slurred speech and left side weakness. His wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms. He is right-handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50.

  • He currently is unable to move his left arm and leg.
  • He had an episode of amaurosis fugux (blindness)in his right eye one month ago that lasted for 5 minutes.
  • Around 3 months ago his wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes.
  • He is taking a baby aspirin a day an ACE inhibitor, and statin as well.
  • He does have a history of alcohol use and smoking in the past but stopped after his heart attack.
  • His blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, O2 sat is 97% on room air.
  • Although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side.
  • The neck is supple, there is no jugular vein distension, and there are no bruits.
  • The lungs are clear heart sounds regular without murmurs, and abdomen is normal.
  • The limbs are not well perfused distally.
  • The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick.
  • He shows loss of awareness and attention with respect to objects or stimuli on his left side.
  • He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well.
  • There is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation.
  • He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.
    • What are two questions you would ask this patient?
    • Identify the subjective data for this patient.
    • Identify the objective data for this patient.
    • What Social Determinants of Health would be relevant for this patient?
 
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Neuro Case Study

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atient 1 – Two individuals come to the emergency department with head injuries. One, 25 years old, has just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other, 65 years old, has increasing confusion after a fall that happened earlier in the week.

a. Differentiate the pathophysiology of extradural hematoma and subdural hematoma.

b. Identify the patient in the above scenario requiring immediate emergency surgical intervention and provide rationale for your choice.

Patient 2 – An 38 year old was driving his 1970 Chevy Corvette to a Milwaukee Brewers baseball game when a deer jumped out in front of him on the highway. He swerved his car and hit a telephone pole instead. His head hit the windshield and he suffered severe head trauma.

a. Describe the most likely specific type of head injury he suffered.

b. Outline the treatment plan for this patient.

 

References have to be in the last 5 years

 
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