Post MVA Case Paper

A 21 year old male patient was taken to the hospital after being involved in a one vehicle-motorcycle accident. The individual complained of pain in his lower back and suffered numerous abrasions and contusions along with loss of sensation and motor control in his legs. A complete neurological exam was performed in order to fully assess the patient. The exam revealed that the patient demonstrated nearly normal to normal strength in both flexing, extending the elbows, wrists, and when flexing his middle finger and abducting his little finger on both hands. It was noted, however, that he had no movement when medical personnel tested his ability to flex his hips, extend his knees, and dorsiflex his ankles. Stretch reflexes involving the biceps, brachioradialis, and triceps muscles were found to be normal, while those involving the patella and ankle were absent. Finally, the patient was found to have normal sensitivity to pin prick and light touch in areas of his body above the level of his inguinal region, but not below that region of the body .

He has had two falls recently. They both occurred when he first got out of bed in the morning and started to walk without taking those few seconds to orient himself. One of them resulted in him hitting the bureau. The other one did not result in any injury. He has not had any closed head trauma with the falls and the falls have not worsened in the vertigo. He does have a history of skull fracture 60 years ago due to a motor vehicle accident, at which point, he was in a coma for 18 days. He has amnesia for most of that time. He is unable to tell me if there were any cognitive or movement sequela from that. He does have cervical stenosis with an MRI of the neck over four years ago at Holy Family. He denies any previous brain imaging other than the recent MRI. He does not have a magnetic gait. His gait is not wide based. There is no truncal instability. There is no hesitancy in his gait. There is no

Mary’s left UE is WNL with a strength of 4-/5, but her right UE is 2/5 with an AROM of 0-35 degrees in glenohumeral flexion and abduction. Mary has 2/5 muscle strength in elbow flexion and extension with poor grip strength. Mary has decreased endurance and becomes fatigued after two minutes of simple self-care tasks. Mary’s sensation was tested on BUE. She also completed the stereognosis test for her left and right sides. Mary’s left side was intact, but her right side scored 1/5 accuracy. Mary has minimal-moderate decreased pain sensation and localization of touch inferior to her elbow on the right side. She requires maximum assistance during functional mobility. Mary is at a high risk for skin breakdown due to decreased mobility and sensory deficits with

NEUROLOGICAL: No dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

Based on the EMG/nerve conduction study report dated 09/28/16 by Dr.Weir, the patient fell of a golf cart and struck his head with loss of consciousness. Since that time, he has had neck pain, thoracic pain and low back pain, radiating to the

The case is about a 34 year old male. He was experiencing weakness in the left side of his body. After a neurological examination, the medical staff found that he had left visual field deficit, a left arm drift and also impairment positon sensation in his left foot (www.balt.fr).

The patient is a 99-year-old female who presents from the Daughters of Miriam after sustaining a fall the morning of presentation. The patient states she was trying to get out of bed which is very difficult for her due to her Parkinson's disease the next thing she knows she was falling. She denies any trauma to her head, back, her hips. She denies any lightheadedness, dizziness or chest tightness. Her medical history is significant for hypertension and chronic atrial fibrillation for which she is on anticoagulation, coronary artery disease, history of bilateral breast cancer and Parkinson's disease. The neurologic exam reveals that she has a tremor in the upper extremities and she has rigidity. The neurologic evaluation is increasing

The patient, a single 33-year-old female has a job requiring the use of her hands for typing. Upon entering the room, the patient had poor posture and an unsteady gait. After she took a seat, rapid and jerky involuntary movements began to occur and there were also problems speaking and swallowing when she tried to take a sip of water. The patient also mentioned that she was depressed because understanding what was happening to her was something she couldn’t comprehend. Another thing that was noted was that the patient kept on saying that she couldn’t remember when asked a few questions.

The Patient was awake, alert, oriented times 4 (to person, place, time, and situation), no acute distress, and denied any allergies. During this assessment the patient was position in sitting position, and the patient was inspected from head to toe, and the skin was normal, warm, dry, intact, and within ethnicity. The hair groomed within the age appropriate and not greasy. The head was normocephalic and atraumatic. During the skull palpation, patient denies any pain, any no lesions noted. The patient had the eye’s glasses on, and the vision was 20/20. The pupils were equal, round and reactive to light. The patient extraocular movements were intact, and normal conjunctiva noted. The patient ears, nose, mouth, and throat were all in normal states.

He came to the neurologist to have testing done on what the doctors described as, a “lazy, left leg”. In my opinion, it seems he has suffered from a CVA, and is demonstrating an unconscious, loss of awareness of his hemiplegic leg. He took a nap in the hospital, and woke up in a panic, when he found what he thought was a cold, severed leg in bed with

First let me say that I would not stereotype my patient due to has advanced age by assuming that he might have some cognitive deficit. The technique that I use to assesses a patients understand of instructions is to tell them that I am checking on how well the physicians gave their instructions. This technique serves two purposes it hopefully helps prevent the patient from feeling embarrassed, and secondly it demonstrates their level of understanding of the instructions. In this case, if during to course of my assessment I had a concern about my patient's cognitive status I might want to perform a Mini-Cog exam to assess further my patients needs. If I discover that he, in fact, had a deficit, I would immediately report it to the physician because they might want to do further assessments and possible interventions such as an OT referral and possible pharmacological interventions.

Fitzgerald, M.J. Turlough FitzGerald, Gregory Gruener, Estomih Mtui (2012). Clinical neuroanatomy and neuroscience (6th ed.). [Edinburgh?]: Saunders/Elsevier. p.

I would soon learn that this patient is unable to perform this task and it would give me a better look at what testing to run next to properly diagnose him. I also might run some tests to test his memory out. I believe this will also help to point me in the right direction when trying to diagnose him.

3. Hypothesis: Based on his age, the strenuous lifting that he does in his job, I suspect that he has herniated Nucleus Pulposus from either L2 to L4. The compression of the dorsal divisions of the ventral rami of his lumbar spine is causing his femoral nerve to not properly work on his right leg.

Neurologic: Patient is alert, awake and oriented x 4, the speech is clear and able to communicate effective. Pupils are equal, round, reactive to light and accommodation. Patient Glasgow coma is 15. Patient hearing is bilateral grossly intact. Responded well to sharp and dull touch stimuli of the face. Limited shoulder movement due to pain while turning the head or change of position. 2/4 bilateral in Achilles, patellar, biceps and brachioradial is. Good muscle tone and strength of 4/5 in the hamstrings. Positive graphesthesia and stereognosis. Good finger to nose coordination and heel to shin on the left side, and limited on the affected on the right side though unlimited on the left side. Short term and long-term memories are intact, Patient did not show any interest in learning new