NURS6411: Module # 12 Neurological Disorders – Case Studies & Answers

 

Module # 12: Case Study Answers

Module # 12: Case Study Answers

Module # 12

Neurological Disorders – Case Studies & Answers

CASE STUDY # 1

ID/CC A 30 year old man is referred to a neurologist because of progressive anesthesia and weakness of both arms, occipital headaches, and a stiff gait.

HPI He has no history of significant trauma in the past.

PE No motor deficits;  lack of pain and temperature  sensation in hands and arms but preserved position and tactile sensation; intact pain and temperature sensation below arms; dorsal columns & proprioceptive sensation spared; thenar muscles of both hands atrophied with contractures of fingers (see pic); areflexia in both upper limbs; brisk deep tendon reflexes in both lower limbs.

MR/CT-spine- see images (arrows)

What is the Diagnosis?

 

CASE STUDY # 2:

ID/CC  A 62 year old man is brought to his family doctor because of rapidly progressive dementia and excessive somnolence.

HPI Five years ago, he received a corneal transplant. His wife states that she has seen a definite change in his personality over the past year.

PE Dementia; myoclonic fasciculations; normal funduscopic exam; no other focal neurologic signs

Labs    LP:  normal CSF profile .  (so don’t think virus, bacteria or fungus)

What is the Diagnosis?

 

CASE STUDY # 3:

ID/CC A 19 year old female Olympic horseback rider is brought into the emergency room with headache, confusion, weakness of the left side of her body, blurring of vision, and projectile vomiting.

HPI Three hours ago, she hit the right side of her head when she fell from a horse during a training exercise.  She lost consciousness for one minute and then appeared to have recovered completely before presenting with the above Sx.

PE  VS:  BP mildly elevated; bradycardia, papilledema; right-sided mydriasis;  deviation of right eyeball outward and downward; left-sided weakness; brisk reflexes on left side; positive Babinski on left side.

What is the Diagnosis? Please be specific

 

CASE STUDY # 4:

ID/CC A 33 year old black male complains of constant bifrontal headache and blurred vision of three weeks duration.

HPI intermittent frontal headaches for the past eight months and he has become irritable and difficult to live with; for the past month he has been extremely drowsy and often sleeps for 30 hours at a time. 10 months ago, he fell from a moving vehicle and lacerated his scalp.

PE Bilateral papilledema; dilated left pupil; right spastic hemiparesis;  deep tendon reflexes on right side are brisk;  right-sided Babinski; no meningeal signs present.

CT-head:  see image

What is the Diagnosis?

Note the white shadow that is pushing the brain to the opposite side.

 

CASE STUDY # 5:

ID/CC A 40 year old female complains of the “worst headache of her life” and double vision.

HPI projectile vomiting, no hx of fever or neck stiffness.

PE papilledema on funduscopic exam; right eye deviated laterally with fixed dilated pupil; other cranial nerves normal, no meningeal signs noted; motor system examination normal

Labs    Routine labs are normal

What is the Diagnosis?

 

CASE STUDY # 6:

ID/CC A 49 year old male who is a known chronic alcoholic is brought to the emergency room with dehydration, jaundice, and fever; blood is drawn for routine tests and an infusion of 5% dextrose is begun, after which he becomes stuporous.

HPI He had been admitted to the ER several times before for alcoholic gastritis and acute intoxication.

PE Patient confused and stuporous; normal fundus; nystagmus; skin and mucosal icterus; spider nevi on neck and upper chest; pitting pedal edema; abdominal distention with shifting dullness; hepatosplenomegaly.

What is the Diagnosis?

 

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CASE STUDY # 7:

ID/CC A 65 year old white male complains of headache that is worse in the morning along with occasional nausea and vomiting for six weeks

HPI     One day prior to presentation, he had an isolated grand mal seizure

PE       Bilateral papilledema; loss of recent memory; brisk deep tendon reflexes on right  side; Babinski on right side

CT/MR – see image

What is the Diagnosis?

 

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CASE STUDY # 8:

ID/CC A 38 year old male visits his family doctor complaining of symmetric muscle weakness that started in the distal part of his legs and has ascended gradually, now involving the trunk and arms

HPI     One week ago he suffered from diarrhea.

PE       Symmetrical proximal muscle weakness and flaccidity in lower limbs; absent deep tendon reflexes; normal sensory exam; normal cranial nerves

Labs    Elevated gamma globulin.

LP:  increased CSF protein concentration without cellular increase; normal glucose.

What is the Diagnosis?

Answers: 

CASE STUDY # 1

ID/CC A 30 year old man is referred to a neurologist because of progressive anesthesia and weakness of both arms, occipital headaches, and a stiff gait.

HPI He has no history of significant trauma in the past.

PE No motor deficits;  lack of pain and temperature  sensation in hands and arms but preserved position and tactile sensation; intact pain and temperature sensation below arms; dorsal columns & proprioceptive sensation spared; thenar muscles of both hands atrophied with contractures of fingers (see pic); areflexia in both upper limbs; brisk deep tendon reflexes in both lower limbs.

MR/CT-spine- see images (arrows)

What is the Diagnosis?

ANSWER

Syringomyelia………

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