Neurological System Case Study – #1
Mrs. Smith is an 85 year female with a history of Hypertension, diabetes and osteoarthritis. Her daughter who cares for her reports that she became suddenly confused beginning last night. She knows her daughter but has been unable to remember her grandchildren’s names. She continuously asks her daughter “What are those kids doing in our house?” .Her mother was in and out of bed all night and slept very little. Her daughter does say that her mother seemed better this morning, but on the way to your office she became more confused again. Review of systems is significant for a dry cough for the past few days. She has not had a fever. Her appetite has been poor. Her exam is normal except for some fine crackles in her left lung base. Mrs. Smith’s daughter says” My dad had Alzheimer’s and now it looks like I am going to have to go through that with my mother”
What are the possibilities for change in Mrs. Smith’s current mental status?
Aging – As one ages, the nervous system and a lot of structural, cellar and other functional changes occur. Some changes include the reduction in the number of neurons and , formation of intracellular neurofibrillary tangles (Huk, Gademann & Friedmann, 2012).
decreased vascular density
increased permeability of blood brain barrier
What is your top differential diagnosis? Give 3 reasons why you chose that diagnosis.
My top differential diagnosis is Mrs. Smith has delirium considering her advancing age as it only happened the previous night. Her lack of eating likely resulted in her sleep and wake cycle and alertness reduction. Dry cough and crackles could mean she is sick which normally affects people with delirium.
How can you differentiate depression, dementia and delirium?
Depression – Sadness and despair is witnessed when someone is depressed. Loss of appetite and reduction of interest in activities that one is interested in are also some of the signs. Psychological counselling and use of the right drugs can cure this.
Dementia – Progressive failure of cerebral functions that includes memory, alterations in behavior and language. Takes months to years.
Delirium – Associated with diseases thyroid disorder, fluid-electrolyte imbalance, hypoxia, UTI, hypoglycemia. It happens within hours to a few days and the persons sleep wake cycles and attention is impaired
Explain to Mrs. Smith’s daughter what treatment is needed and what you think her prognosis is.
Mrs. Smith needs historical examination, physical examination and laboratory test that would include EEG, blood, urine, radiology study and CSF (Williams & Hopper, 2015). Once the cause f delirium is established, we can then go treat her to first get rid of the disease.
Neurological System Case Study – #2
A 40 year old male comes to see you for follow up. He states that he had a seizure at home yesterday and was taken to the emergency room. He is accompanied by his wife who witnessed the seizure. He states he has never had a seizure in the past.
1) What would you ask him and his wife regarding the seizures, and why?
I personally would begin by asking questions about his health history, medication and changes in lifestyle if any. Increase in the levels of stress gives vital information. I would ask about recent injuries, the lineup of events before the seizure and ask for detailed description of the seizure.
2) What would be the most important parts of a physical exam in this patient and why?
Patient examination would focus on cognitive skills, neurological status, other vital signs and rule out infection. A neurological exam should be performed since in some situations this will suggest focal lesion. Impaired level is consciousness might suggest a post-ictal state or delirium or drowsiness can be observed after a seizure episode. Reversible conditions such as hypoglycemia, infection or hypotension are likely to be provoked in patients with first seizures (Aggarwal & Sung, 2009).
3) What lab or radiology tests would you want to do and why? He tells you he has no insurance so be sure to defend the importance of a particular test.
- EEG – This provides useful information about seizure type and the likelihood of recurrence (Huk, Gademann & Friedmann, 2012).
- MRI – provides more conclusive results in regards to seizure etiology.
- Urine test – This will help rule out UTI, drug exposure,
Aggarwal, B. B., & Sung, B. (2009). Pharmacological basis for the role of curcumin in chronic diseases: an age-old spice with modern targets. Trends in pharmacological sciences, 30(2), 85-94.
Williams, L. S., & Hopper, P. D. (2015). Understanding medical surgical nursing. FA Davis.
Huk, W. J., Gademann, G. F., & Friedmann, G. (2012). Magnetic Resonance Imaging of Central Nervous System Diseases: Functional Anatomy—Imaging Neurological Symptoms—Pathology. Springer Science & Business Media.