Neuro Case Study
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.
After reading the case scenario, please respond to the following questions:
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?
Please be sure to validate your opinions and ideas with citations and references in APA format.
Sample Solution
Questions for the Patient: 1.Do you remember what you were doing before you went to bed last night? 2.Have there been any other episodes similar to this one in the past? Subjective Data: The patient's wife stated they went to bed at 11pm and woke up at 5am when she noticed his symptoms; he has a history of coronary artery disease, hypertension, hypercholesterolemia, a heart attack at age 50, and 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 has a history of alcohol use and smoking in the past but stopped after his heart attack.
Objective Data:The blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, O2 sat is 97% on room air; pupils are equal and reactive; ocular movements are intact but unable to turn eyes voluntarily toward left side; neck is supple without jugular vein distension or bruits; lungs clear with regular heart sounds without murmurs; abdomen normal with not well perfused limbs distally; neurologic examination reveals alert and oriented but does not recognize sick when spoken too quickly or softly with loss of awareness and attention towards objects or stimuli on left side only mild dysarthria with fluent speech understanding commands very well with mild weakness on left face as well as homonymous hemianopsia no nystagmus ptosis tongue or uvula deviation unable to move left arm leg hyperreflexia great toe upgoing.
Social Determinants of Health Relevant for this Patient: Age (60), Gender (Male), Race/Ethnicity (Unknown), Employment Status (Unknown), Financial Resources (Unknown), Education Level(Unknown). Additionally Social Determinants such as access to healthcare services may be relevant - Has the patient been receiving regular check-ups which have detected previous conditions such as Coronary Artery Disease? Does he have adequate health insurance coverage should hospitalization be necessary? These would all need further questioning by medical professionals if appropriate.