Mrs. B is an overweight 71 year old female. Upon hospital admission,she had slur
ID: 127173 • Letter: M
Question
Mrs. B is an overweight 71 year old female. Upon hospital admission,she had slurred speech,paresis of her right hand and paralysis of her right leg. Her smile was asymmetric with right sided facial weakness. The family reported that Mrs.B stated that she felt dizzy and was going to lie down. When she awakened one hour later she could no longer stand.Mrs B has a history of smoking moderately for 50 years and use estrogen replacement for 20 years. Her mother had adult onset diabetes and died of breast cancer at age 62; one sister died of a subarachnoid hemorrhage at age 63,and another sister is hemiparietic because of CVA. One brother is hypertensive,and three other younger siblings are apparently healthy. Vitals signs showed a normal temperature, elevated heart rate,normal respiration, but a severely elevated blood pressure.A lumbar puncture was negative for blood with normal protein and glucose levels. A normal EEG was noted.EEG showed localized activity in left hemisphere. A CT showed increased density on the left. Blood chemistry was normal except for elevated glucose. 1) what is your presenting diagnosis and which part of the brain is involved? 2) Justify your diagnosis based on presenting symptoms and diagnostic work up. 3)what risk factors are significant to Mrs. B for this neurological injury?
Mrs. B is an overweight 71 year old female. Upon hospital admission,she had slurred speech,paresis of her right hand and paralysis of her right leg. Her smile was asymmetric with right sided facial weakness. The family reported that Mrs.B stated that she felt dizzy and was going to lie down. When she awakened one hour later she could no longer stand.Mrs B has a history of smoking moderately for 50 years and use estrogen replacement for 20 years. Her mother had adult onset diabetes and died of breast cancer at age 62; one sister died of a subarachnoid hemorrhage at age 63,and another sister is hemiparietic because of CVA. One brother is hypertensive,and three other younger siblings are apparently healthy. Vitals signs showed a normal temperature, elevated heart rate,normal respiration, but a severely elevated blood pressure.A lumbar puncture was negative for blood with normal protein and glucose levels. A normal EEG was noted.EEG showed localized activity in left hemisphere. A CT showed increased density on the left. Blood chemistry was normal except for elevated glucose. 1) what is your presenting diagnosis and which part of the brain is involved? 2) Justify your diagnosis based on presenting symptoms and diagnostic work up. 3)what risk factors are significant to Mrs. B for this neurological injury?
Mrs. B is an overweight 71 year old female. Upon hospital admission,she had slurred speech,paresis of her right hand and paralysis of her right leg. Her smile was asymmetric with right sided facial weakness. The family reported that Mrs.B stated that she felt dizzy and was going to lie down. When she awakened one hour later she could no longer stand.Mrs B has a history of smoking moderately for 50 years and use estrogen replacement for 20 years. Her mother had adult onset diabetes and died of breast cancer at age 62; one sister died of a subarachnoid hemorrhage at age 63,and another sister is hemiparietic because of CVA. One brother is hypertensive,and three other younger siblings are apparently healthy. Vitals signs showed a normal temperature, elevated heart rate,normal respiration, but a severely elevated blood pressure.A lumbar puncture was negative for blood with normal protein and glucose levels. A normal EEG was noted.EEG showed localized activity in left hemisphere. A CT showed increased density on the left. Blood chemistry was normal except for elevated glucose. 1) what is your presenting diagnosis and which part of the brain is involved? 2) Justify your diagnosis based on presenting symptoms and diagnostic work up. 3)what risk factors are significant to Mrs. B for this neurological injury?
Explanation / Answer
1. Since the CT showed increased density the presenting diagnosis is; An Early CT Sign of Ischemic Infarction; due to increased density in a Cerebral Artery. The part of the brain that is involved is left hemisphere.
2. Symptoms of Ischemic Infarction:
Sudden numbness or weakness of the face, arm or leg, especially involving one side of the body.
Sudden confusion, trouble speaking or understanding.
Loss of vision in one or both eyes.
Trouble walking, dizziness, loss of balance or coordination.
Sudden, severe headache with no known cause.
3. Risk factors are significant to Mrs. B for this neurological injury:
High blood pressure
Smoking
• Diabetes.
• High cholesterol
Physical inactivity and obesity
Carotid or another artery disease as the fatty buildup of plaque inside the artery wall may become blocked by a blood clot, causing a stroke.
• Excessive alcohol intake.
Transient ischemic attacks (TIAs) if Recognized and treated TIAs can reduce the risk of a major stroke.
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