Why do Robert’s symptoms increase in the first two days? Why is he given glucocorticoids?Discuss.

Directions: Read the following case studies and provide a minimum of a one page paper for each that aIDresses the issues.

1. Where’s My Hand?

Robert is a 67 y.o. male who has a history of hypertension.  He is a retired executive and can be found in his garden on most days.  One day as he is working in his garden, he begins to notice numbness in his right hand.  He tries to finish, but the numbness is spreading.  He goes into the house and tries to talk to his wife, but is unable to get the words out.  She calls 911 and he is rushed to the hospital.  He is admitted to the hospital with a Cerebrovascular Accident.

Over the next two days, Robert’s symptoms increase.  He is given glucocorticoids, but not tissue plasminogen activator (tPA).  He is also put on oxygen.  After 3-4 days, Robert is once again able to speak a few words, but his right upper and lower extremities are flaccid.

1. a) Why do Robert’s symptoms increase in the first two days?  Why is he given glucocorticoids?
2. b) Based on the fact that Robert was not given tPA, what is the most likely cause of the CVA?
3. c) Which side of the brain was involved in this CVA? How do you know? What does “flaccid” mean and will Robert’s extremities stay flaccid if he does not gain the ability to move them?
4. d) There will be a team approach to Robert’s recovery.   Describe the role that the physical therapist, occupational therapist, speech-language pathologist, and social worker will play in Robert’s recovery.  Give at least 2-3 examples of what each of these people will do for him.

2. The Weak Leg

Lynn is a 38 y.o. mother of two, a 10 y.o. girl and a 2 y.o. boy.  She is active and has always enjoyed good health.  For the past two weeks, Lynn has been having problems with her right lower extremity during her daily walks.  She has noticed that she is tending to catch her toe more, especially toward the end of the walk.  It is also harder for her to go upstairs.  A physical therapist friend does a manual muscle test on her lower extremities and finds that the left lower extremity tests normal at 5/5, but that the hip and knee muscles of Lynn’s right lower extremity only test at 3/5.  The physical therapist recommends Lynn see a neurologist, which she does.

The neurologist performs several diagnostic tests and does two MRIs over the next few weeks.  The findings of the tests include the following.

MRI:  Evidence of 4-5 plaques in the spinal cord.

Visual Evoked Potential (VEP):  Slowed response time.

Blood Tests:  Normal.

Cerebral Fluid Analysis:   Oligoclonal bands present.

Elevated IgG antibodies.

After approximately 1 month and several other tests, Lynn is given a diagnosis.  She is told to expect exacerbations and remissions.  Lynn is given glucocorticoids to take during exacerbations.

1. a) What is Lynn’s likely diagnosis?  Which of the findings of the medical tests support this diagnosis?  Which of the findings is the most conclusive for this disease?
2. b) What causes this disease?  What happens to the nerves in this disease?  Are there cognitive deficits?
3. c) Does it affect men or women more often?  Is it common?
4. d) Why is Lynn given glucocorticoids to take during exacerbations, what will they do for her?
5. e) How will this disease progress over the next few years?  What is the prognosis?