Medical Case Studies – Diagnosis and Treatment Strategies

Medical Case Studies – Diagnosis and Treatment Strategies

Case 1

The most likely cause of the above symptoms in M.G. is meningitis. Meningitis is an infection caused by pathogens, such as viruses, bacteria, and fungi, that cause meningitis. Pathogenesis of meningitis starts with the colonization of the mucosa by the pathogen that has been inhaled. The pathogen penetrates the bloodstream, multiplies, and induces inflammation (Aksamit et al., 2021). The host has its defense mechanisms, including releasing neutrophils and stimulating inflammation. It then penetrates the central nervous system and multiplies in the subarachnoid spaces, thus increasing blood-brain barrier permeability. Proteins in the plasma pass through the wall of the brain, causing an increase in intracranial pressure and cerebral edema. It causes damage to the neurons in the brain.

Diagnostic tests for meningitis in this scenario necessitate a spinal tap to collect cerebrospinal fluid. Elevated white blood cells, low blood sugar, and a high number of neutrophils indicate meningitis. Random blood sugar testing, ESR, or CRP in case of inflammation will be elevated, and gram staining will be done to identify the specific causative agent, such as streptococcus pneumonia.

Meningitis complications include the infection spreading throughout the body, causing diseases such as pneumonia, which may be detected with an x-ray, and endocarditis, which can be detected with an ECG. Another complication of meningitis is hydrocephalus, which causes pressure in the brain, headaches, and reduces brain activity, resulting in lethargy and delirium. A motor test for rigidity in the neck or brain function tests can be used to check for any abnormality in the cerebrum or nervous system. Loss of consciousness should also be noted during the examination.

Treatment of meningitis involves identifying the causative agent first, then administration of drugs. Antibiotics like ceftriaxone can be administered. Corticosteroids can also be used because of the secondary symptoms resulting from damage as the body tries to fight the infection.

Case 2

Questions that would be asked from the relatives in J.S.’s condition include:

In case of thrombotic stroke:

1. What is the age of the patient? It is because it mainly occurs in older people, especially those with comorbidities.
2. Does she have any history of drug and substance abuse? Alcohol intake increases the risk of deep vein thrombosis, while smoking can cause coronary thrombosis, thus increasing the risk of thrombotic stroke.

In case of embolic stroke:

1. Does she have any heart condition? Some states, such as atrial fibrillation, increase the risk of embolic stroke because of stasis in the left atrium, which later leads to the formation of brain emboli.

In case of Hemorrhagic stroke:

1. Does she have any abnormality in the arteries and veins? Blood vessel anomalies can cause bleeding in the brain, thus damaging the brain.
2. Has she ever been diagnosed with hypertension? Hemorrhagic stroke is mainly caused by high blood pressure because it increases pressure in the blood vessels’ walls, thus causing them to rupture.

According to the patient’s description, she could have suffered ischemic damage on the brain’s left hemisphere because the patient was leaning on the right side due to a loss of function in the brain’s left hemisphere, which is in charge of the body’s right side. The common symptoms of an ischemic stroke are dizziness, bladder incontinence, difficulty perceiving speech and speaking, numbness, and confusion (Feske et al., 2021). The eyes are usually functioning, which shows that the activity of the posterior cerebral is regular.

Medical therapies to manage current stroke and how to prevent the occurrence of another stroke include:

• Immediate procedures of the endovascular vessels involve treating the blocked vessels to reduce the chance of disability.
• Carotid endarterectomy to remove the obstruction in the carotid artery.
• IV medications, such as anticoagulants, to dissolve the clot.
• Surgery to remove malformation in the blood vessels reduces the risk of rupture that leads to stroke.

Case 3

Parkinson’s disease causes an imbalance of neurotransmitters, which interferes with brain functioning. According to the history, F.P. was diagnosed with this condition five years ago, and he might experience some motor difficulties such as imbalance, tremors, and bradykinesia, which is typical for this disease.

Dopamine is lower in the brain in patients with Parkinson’s disease, and they may experience difficulties transmitting signals that coordinate body movements (Bloem et al., 2021). Levodopa is a dopamine precursor used to treat this condition by causing an interaction with the decarboxylase enzyme to form dopamine.

While in the hospital, the patient could have experienced difficulty speaking with others, depression, and sleep disturbance since he has a history of Parkinsonism and seizures. Due to an enlarged prostate gland, he could also have experienced frequent urination because of a weak urinary system.

If F.P. has seizure episodes, his breathing rate, level of consciousness, and jerking movement of the upper and lower limbs should be assessed. Anti-seizure medications such as valproic acid and phenytoin may be administered.

Case 4

Some manifestations of dementia are confusion, restlessness, memory loss, lack of coordination, and sleep disturbances. Treatable factors that could have led to the deteriorating mental function of S.Y. are disorders of metabolism such as vitamin B12 deficiency, brain tumors, subdural hematomas, elevated intracranial pressure, hypoglycemia, hypothyroidism, neuro-cognitive disorders that are associated with HIV.

Organic brain alterations typical for Alzheimer’s disease are Cerebral amyloid angiopathy, amyloid plaques, neuronal loss, cell death, and chronic inflammation (Chong et al., 2021). Pharmacological management of dementia involves the use of drugs, which are cholinesterase inhibitors such as Rivastigmine, Galantamine, and Donepezil. Ways of preventing exacerbations of behavior by dementia patients are encouraging them to have enough sleep, ensuring the comfort of their environment, reassuring the patient if she appears distracted, and planning exercise or any physical activities for the day.

References

Aksamit Jr, A. J., & Berkowitz, A. L. (2021). Meningitis. CONTINUUM: Lifelong Learning in Neurology, 27(4), 836-854.

Bloem, B. R., Okun, M. S., & Klein, C. (2021). Parkinson’s disease. The Lancet, 397(10291), 2284-2303.

Chong, T. W., Macpherson, H., Schaumberg, M. A., Brown, B. M., Naismith, S. L., & Steiner, G. Z. (2021). Dementia prevention: the time to act is now. The Medical Journal of Australia, 214(7), 302-304.

Feske, S. K. (2021). Ischemic stroke. The American Journal of Medicine, 134(12), 1457-1464.

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Case 1
M.G. 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 M.G.’s signs and symptoms? What is the origin and pathogenesis? What other laboratory findings would be consistent with this etiology?
2. What are common complications of this disorder, and how would one assess their occurrence?
3. What is the usual treatment for this disorder?
Case 2
J.S. is a 72-year-old woman with a long history of atherosclerosis. One afternoon, her grandson found her sitting in a chair staring blankly into space. She was leaning to the right, drooling, and had been incontinent of urine. She was able to focus her eyes on him when he spoke to her, but she was unable to verbalize a response. She was transported to the local hospital and diagnosed with a stroke.
Discussion Questions
1. What questions could be asked of J. S.’s family to help determine the cause of her stroke as thrombotic, embolic, or hemorrhagic (i.e., questions to assess risk factors for each type of stroke)?
2. Based on the scenario described above, which brain hemisphere (left or right) suffered the ischemic damage? What other manifestations of this stroke location would likely be apparent?                                                                                                                    3. What medical therapies might be used to manage this current stroke and/or to prevent another one?
4. What information might be appropriate to give J.S.’s family about the expected recovery process after stroke?
Case 3
F.P. is a 66-year-old man hospitalized for surgical management of an enlarged prostate. His chart indicates that he has had Parkinson’s 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 F.P. be expected to exhibit related to his Parkinson’s disease?
2. What is the rationale for managing Parkinson’s disease with a dopamine precursor?
3. What safety and activities-of-daily-living problems might F.P. have encountered while hospitalized?
4. If F.P. experiences seizure activity while in the hospital, what should be assessed during the seizure episode? How would his seizure be managed?
Case 4
S.Y. is a 90-year-old woman who is a resident of a long-term care facility. She was alert and mentally quite capable until about a year ago when she began to manifest signs and symptoms of dementia. A review of her medical records failed to document a thorough analysis of her dementia, but a diagnosis of “probable Alzheimer’s disease” was recorded.
Discussion Questions
1. What types of motor difficulties would F.P. be expected to exhibit related to his Parkinson’s disease?
2. What is the rationale for managing Parkinson’s disease with a dopamine precursor?
3. What safety and activities-of-daily-living problems might F.P. have encountered while hospitalized?
4. If F.P. experiences seizure activity while in the hospital, what should be assessed during the seizure episode? How would his seizure be managed?
Case 4
S.Y. is a 90-year-old woman who is a resident of a long-term care facility. She was alert and mentally quite capable until about a year ago when she began to manifest signs and symptoms of dementia. A review of her medical records failed to document a thorough analysis of her dementia, but a diagnosis of “probable Alzheimer’s disease” was recorded.
Discussion Questions
1. What are the manifestations of dementia?
2. What other potentially treatable factors might have led to S.Y.’s deteriorating mental function?
3. What are the organic brain alterations that are typical of Alzheimer’s disease?
4. How will her dementia be managed pharmaceutically? What strategies can be implemented by the staff to prevent exacerbations of dementia behaviors?