A. FP is a 66-year-old man hospitalized for surgical management of an enlarged p

Question

A. FP is a 66-year-old man hospitalized for surgical management of an enlarged prostate. His chart indicates that he has had Parkinson disease for 5 years prior to admission and has been managed with a dopamine precursor (levodopa/carbidopa). He also has a seizure history, having experienced a seizure about 20 years ago as a complication of a motor vehicle accident. He took an anticonvulsant medication for many years but stopped taking it about 3 years ago because he was “tired of taking it” and hadn’t had a seizure since the accident.

Discussion Questions

1. What types of motor difficulties would FP be expected to exhibit related to his Parkinson disease?

2. What is the rationale for managing Parkinson disease with a dopamine precursor?

3. What safety and activities-of-daily-living problems might FP have encountered while hospitalized?

4. If FP experiences seizure activity while in the hospital, what should be assessed during the seizure episode? How would his seizure be managed?

B. MG is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104 °F, lethargy, headache, and stiff neck. Laboratory analysis of a spinal tap demonstrates increased white blood cells in the cerebrospinal fluid (CSF).

Discussion Questions

1.What is the most likely cause of MG’s signs and symptoms?

2.What is the origin and pathogenesis?

3.What other laboratory findings would be consistent with this etiology?

4.What are common complications of this disorder, and how would one assess for their occurrence?

5.What is the usual treatment for this disorder?

Explanation / Answer

1. Parkinson patient have following motir problems:

?2. Parkinsons cause destruction of motor neurons and thus causing motor symptoms. These motor symptoms can be managed through use of dopamine which reverses the motor symptoms.

3. FP might have following ADL problems :

?4. observe motor activity, as posturing (decerebrate/decorticate) and eye deviation may provide clues to the epileptic focus. Mental examination is necessary. Loss of conscious is considered as complete seizure.

management of active seizures begins with administration of benzodiazepines, which is considered first-line therapy. IV options include lorazepam, diazepam, and midazolam. If IV access cannot be obtained, then IM lorazepam or midazolam, or rectal diazepam can be considered.

common regimen is 0.1 mg/kg of lorazepam IV given at 2 mg/min or 0.2 mg/kg of diazepam IV given at 5-10 mg/min. Very large doses of benzodiazepines may be needed.

Phenytoin is usually considered the second-line agent for patients who continue to seize despite aggressive benzodiazepine therapy. The recommended dose is 20 mg/kg IV and can be augmented with another 10 mg/kg IV if the patient is still seizing.

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