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Clinical Case Study

Clinical Case Study

Nervous System
Prepared by Marc Walters, M.D., Portland Community College

History of Present Illness: Gene Matson, a 75 year old male, was brought to the hospital by his son following the acute onset of left-sided numbness and weakness that began one hour prior to admission. His son stated that two weeks prior to admission Gene had a single, 12-hour episode of garbled speech and left-sided face and arm weakness. Following the first episode the right carotid angiogram pictured below was performed.

QUESTIONS
Answer the questions below to demonstrate your knowledge.
Answers are available in the Instructor Resources section of this site.

This activity contains 6 questions.

Past Medical History

History of moderate hypertension treated with calcium channel blockers. History of hypercholesterolemia. Mr. Matson smoked one pack of cigarettes per day for forty years, and drank approximately four beers per day for several years.

Physical exam: Temperature: 37°C. Pulse: 72. Respirations: 12. BP 170/100

Neurological exam: Showed left-sided hemiplegia (paralysis on one side) and hemianesthesia (numbness on one side).

What are the pertinent aspects of the patient's past medical history that are risk factors for his current medical problem?

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Damage to which lobe(s) accounts for the patient's sensory and motor deficits?

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Give an anatomical explanation for why damage to the right side of the brain may cause sensory and motor problems on the contralateral (opposite) side of the body.

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Is there a surgical procedure that might have prevented the current episode? If so, what is the procedure called?

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Relate the findings in the angiogram to the patient's past and present neurological problems in terms of:
a. how the vascular lesion could lead to neurological problems.
b. what specific blood vessel in the brain must have been affected by the process in "a" to account for his symptoms.

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What abnormality does the angiogram show? Describe the lesion and the vessels in which it is located.

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Pearson

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