DIAG 2740 Chapter 5 Case Studies

DIAG 2740 Chapter 5 Case Studies - Chapter 5 Case Studies...

Info iconThis preview shows pages 1–3. Sign up to view the full content.

View Full Document Right Arrow Icon
Chapter 5 Case Studies #1 An Elderly Man With Headaches and Unsteady Gait Chief Complaint An 82 year old man came to his doctor with right sided headaches and difficulty walking. History The patient was in a motor vehicle accident 3 months ago. He did not hit his head or lose consciousness, but the car was “demolished.” He was examined in the emergency room and no abnormalities were found, so he was released. Ever since he has complained of general fatigue and right sided headache , especially over the last two weeks. The headaches are worse at night, often keeping him awake. He also recently stumbled several times while walking due to left sided weakness. Physical Examination General appearance: thin elderly man in no acute distress Vital signs: Temp = 97º, Pulse = 86, BP = 146/80, Respiration = 18 Head: no evidence of trauma Neck: supple with no bruit Lungs: clear Heart: regular rate, no murmurs, gallops, or rubs Abdomen: normal bowel sounds, soft, non-tender Extremities: normal Neurological exam: Mental status: alert and oriented x3. Fluent speech, with good naming and repetition. Able to count down from 100 by sevens (test of attention and calculation) Cranial Nerves : Pupils are equal, round, and reactive to light (II and III). Extraocular movements intact (III, IV, VI). Visual fields (II) full, but with extinction on the left with simultaneous stimulation. Facial sensation intact (V). Facial symmetry (VII) normal. Gag reflex (IX and X) normal. Normal sternomastoid strength (XI). Tongue midline (XII). Moto r: Pronator drift of left arm. Mild weakness of left arm and leg. Normal strength on right side. Sensory : Intact except for left extinction on double simultaneous stimulation. Reflexes : biceps, brachioradialis, triceps and patella all grade 2. Achilles grade1. Right plantar reflex is normal, left foot shows Babinski sign. Gait : patient takes short steps, but with good speed. Able to perform tandem gait. ` Coordination : not tested Localization and differential diagnosis 1. Based on the signs and symptoms shown in bold what is the general location of the patient’s lesion? Is it intracranial or extracranial? Is it left or right sided? 2. Given the recent history of motor vehicle accident in an elderly man what is the most likely cause of his deficits?
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Case # 2 Altered Mental Status Following Head Injury Chief Complaint A 67 year old man was found at the bottom of a flight of stairs, lethargic and smelling of alcohol. History Little information could be obtained from the patient. He was discovered at the base of a staircase, intoxicated and with a posterior scalp laceration and was brought to the ER. Initial Physical Examination General appearance: an unkempt man lying on a stretcher Vital signs: Temp = 98º, Pulse = 90, BP = 176/89, Respiration = 20 Head: Scalp laceration over right occipital area, normal tympanic membranes Neck: in a cervical collar placed by EMTs Lungs: clear Heart: regular rate, with no gallops, rubs, or murmurs
Background image of page 2
Image of page 3
This is the end of the preview. Sign up to access the rest of the document.

Page1 / 6

DIAG 2740 Chapter 5 Case Studies - Chapter 5 Case Studies...

This preview shows document pages 1 - 3. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online