Nervous System Case Study

Case Study 1 Questions

Part 1

Question 1 Describe the three causes of CVAs and the characteristic onset signs and symptoms associated with each. What do you think is most likely in this case?

There are several causes of cerebrovascular accidents. According to Tadi and Lui (2021), the primary causes of CVA include arteriosclerosis, hypertension, and emboli formation. Arteriosclerosis causes plaque formation that leads to narrowing of arteries and eventual complete block of blood flow. Hypertension leads to hemorrhagic stroke due to the bursting of arteries, while an embolus causes ischemic stroke due to artery blockage. In the case study, the causes include high blood pressure and arteriosclerosis.

Question 2 What predisposing factors for CVA can you identify for Mr. Q?

The predisposing factors for CVA for Mr. Q include smoking, uncontrolled high blood pressure, and diabetes. Mr. Q had a blood pressure of 220/110 Hg mm, indicating high systolic and diastolic blood pressure.

Question 3 Describe the pathological changes that caused the following initial signs and symptoms: slurred speech, right-sided weakness, facial asymmetry, hypertension.

The most significant signs and symptoms in the case study were slurred speech, right-sided weakness, facial asymmetry, and hypertension. Slurred speech was due to damage on the left hemisphere that affected Wernicke’s areas for speech production. Facial asymmetry and right-sided weakness were due to damage to the nerves serving the right side of the face. Hypertension was due to narrowed arteries.

Question 4 Thinking about these pathological changes, discuss two interventions that can help correct the pathology and return Mr. Q to a more homeostatic state.

To reverse the current presentation, immediate interventions are required. Tadi and Lui (2021) state that IV thrombolysis and reperfusion therapy are crucial in acute stroke to remove the embolus and regain adequate oxygen delivery to brain tissue.

Part 2

Question 1 Based on his description of symptoms, what do you think Mr. Q was experiencing when he had the intermittent episodes of symptoms prior to today?

Based on Mr. Q’s description, he was experiencing a transient ischemic attack. According to the National Institute of Neurological Disorders and Stroke (2021), a transient ischemic attack lasts a short period, causing a brief interruption to the blood supply, and it is often a warning sign that the individual is at a greater risk of a debilitating stroke.

Question 2 How do these episodes differ from a CVA? Discuss the cause of each type of episode and expected signs and symptoms.

Transient ischemic stroke signs usually resolve on their own without any intervention, unlike an acute ischemic stroke. Right-side tingling was due to intermittent blood delivery to the left hemisphere, affecting the facial nerve on the right side of the face. Besides, the speech troubles can be associated with intermittent blockage of blood supply to Wernicke’s speech production area.

Question 3 If Mr. Q had a brain tumor, would his signs and symptoms have been different? Choose one location of a brain tumor and describe the focal and general signs you would expect as the tumor grows.

A brain tumor would have caused increased intracranial pressure, not present in the current case study. A tumor in the cerebellum would have caused significant balance and gait challenges.

Question 4 Mr. and Mrs. Q want to know how long it is going to take for him to get back to normal. How will you answer them? What factors might influence the degree of functional recovery he can expect to achieve?

According to Tadi and Lui (2021), the recovery after a stroke is multifactorial, but most individuals improve within three to six months. Factors involved include infarct location, patient age, stroke severity, and complications like pulmonary embolism.

Case Study 2 Questions

Question 1 Describe the pathophysiologic changes associated with bacterial meningitis in regard to each of the following manifestations the patient exhibits: severe headaches, neck pain, nuchal rigidity, limited hip motion, seizures, and increased intracranial pressure.

Ms. J’s symptoms are associated with bacterial meningitis, and they include severe headaches caused by brain inflammation, neck pain and nuchal rigidity caused by meninges inflammation, limited hip motion due to stiffness along the spinal cord area, seizures due to low perfusion, and increased intracranial pressure due to cortical microvascular permeability with diffuse cerebral edema (Runde et al., 2021).

Question 2 Which of these manifestation(s) is (are) most significant in the diagnosis of bacterial meningitis? Why are there no focal signs present? What signs indicating increased intracranial pressure might you expect?

The most significant manifestation is identified through a lumbar puncture. The cerebrospinal fluid test results in high protein and low glucose levels in bacterial meningitis. Increased intracranial pressure may lead to seizures and headaches.

Question 3 What are the causes of meningitis? Which microbe is most likely to be the cause in this case

The microbe likely to cause the condition is bacteria. The bacteria may cross the blood-brain barrier, and the most common microbes include S. pneumonia and N. meningitides.

Question 4 Discuss the transmission of bacterial meningitis and recommendations to protect other students and family. Think about her living situation and exposures and include these factors in your answer.

The transmission of bacterial meningitis is usually through the nasopharynx region. Runde et al. (2021) observe that abnormal communication between subarachnoid space and the nasopharynx is likely to be caused, primarily transmitted from a throat infection. Considering that Miss Jane lives in a dormitory, it is crucial to avoid sharing oral hygiene items, practice coughing and sneezing into a handkerchief, and ensure handwashing to prevent infections.

Question 5 Once the lumbar puncture is complete and the CSF is analyzed, what do you expect to see in the lab report?

Once the CSF is analyzed, the results are likely to show high protein and low sugar levels.

Question 6 Discuss the treatments available to help return this patient to a more homeostatic state. What is her prognosis? What are some possible long-term complications?

The patient requires timely administration of antibiotics to prevent morbidity and mortality risk. Runde et al. (2021) emphasize that it is paramount to begin immediate empiric treatment with vancomycin and ceftriaxone, considering that bacterial meningitis has a mortality rate of up to 15%. Long-term complications include seizures, speech problems, problems with memory, and lack of balance and coordination.

References

National Institute of Neurological Disorders and Stroke. (2021). Transient ischemic attack. https://www.ninds.nih.gov/Disorders/All-Disorders/Transient-Ischemic-Attack-Information-Page

Runde, T.J., Anjum, F., & Hafner, J.W. (2021). Bacterial meningitis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470351/

Tadi, P., & Lui F. (2021). Acute stroke. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535369/