Problem
Case I
A 26-year-old man was previously (2 weeks prior) in a motor vehicle accident (MVA) with a closed head injury. Recovery was uneventful, and the patient was dismissed from the hospital. The patient returned to work 2 days ago. The patient's wife called the office to state that she awakened this morning to find her husband having seizure type of activity. The patient was responsive but appeared confused. The patient was transported to a hospital. Vital signs were temperature, 98.4° F; pulse 72; respirations 18; and blood pressure 116/78. The patient was responsive but not oriented to time, place, or person, appearing postictal. An EEG was ordered, as was a cerebral CT scan. The patient was diagnosed with seizure activity (epilepsy) secondary to the cerebral trauma received in the previous MVA. The patient was placed on antiseizure medication and admitted for observation.
A. What is the significance of the cerebral trauma to the onset of seizure activity?
B. Explain what type of epileptic seizure this patient is experiencing.
C. Describe three other types of epileptic seizures.
D. Which other diagnostic tests might be ordered?
E. What treatment might be given to this patient?
Case II
The wife of a 67-year-old man called the office and reported that her husband awoke this morning with weakness and numbness of the right side. He had difficulty getting out of bed and complained of intermittent episodes of dizziness. He also was experiencing difficulty speaking. The patient has a history of hypertension and is taking enalapril (Vasotec) and propranolol (Inderal). The wife was advised that her husband should be seen in an emergency care facility, and an ambulance was called for transport. On examination in the emergency facility, the patient was found to have diminished strength in the right hand and foot, diminished movement in the right arm and leg, and slurred speech. Vital signs were temperature 98.6°; pulse 106; and irregular respirations 22; and blood pressure 172/96. Oxygen therapy was started. Reflexes were diminished, as was pain response on the right side, including the extremities. A cerebral MRI scan, CT scans, an EEG, skull radiographs, and an ECG were ordered. The ECG showed atrial fibrillation. Approximately 6 hours post onset, the symptoms began to resolve, with improvement in feeling and movement of the right extremities. Speech slowly became less slurred. The patient was diagnosed as having a transient ischemic attack (TIA) and was scheduled for follow-up evaluation. He was started on anticoagulant therapy.
A. Explain the difference between TIA and CVA.
B. What is the significance of the elevated blood pressure?
C. In what area of the brain would the diminished circulation and subsequent reduce oxygenation be anticipated?
D. Why would anticoagulant therapy be prescribed?
E. What is the importance of the ECG results indicating atrial fibrillation?