DISCUSSION RESPONSE

A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia

PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.

WEEK 9: Case Study #3

In this week’s case scenario, I chose the third scenario in which the patient presents to the office with dizziness, left arm weakness, fatigue, and mild dysarthria. He is a 50YO African American male with a poorly controlled history of DM2, HTN, and HLD. This immediately leads me to believe that the patient is having a stroke. Some information I am unaware of in the given scenario is how long the symptoms have been presenting for, and if the patient has a history of stroke or any of these symptoms chronically. If the symptoms were acute, I would immediately send the patient via EMS to the hospital for possible tPA treatment and CAT Scan, and blood work. Treatment can also include, “Thrombus retrieval using intra-arterial therapies was demonstrated as being both safe and highly effective in the treatment of acute ischemic stroke,” (Grory and Yaghi, 2018).

If the patient has presented with these symptoms for hours or even days, the window of opportunity has left, and the patient will need chronic anticoagulation treatment and rehabilitation for his symptoms to regain use. I located an article that states that men have a higher incidence of CVA and having Diabetes Mellitus as well, (Pizov and Pizova, 2018). Treatment will also include, “Aspirin due to the role in both primary as well as the secondary prevention of stroke causing reduction in recurrence when aspirin alone was given after 48 hours of stroke,” (Shahbaz, Nasir, Saad, and Usmani, 2016).

Differential Diagnosis:

Myasthenia Gravis: prototype autoimmune disease where the muscle weakness is induced by autoantibodies binding to the postsynaptic region and impairing the function of acetylcholine receptors (AChR), (Gilhus, Romi, Hong, and Skeie, 2018).

Duchennne Muscular Dystrophy (DMD): is a “genetic disorder, which is manifested by weakness along with progressive muscle degeneration due to absence of one critical protein, the dystrophin that preserve the muscle cell unimpaired,” (Arotaritei, Ionite, and Corciova, 2019).

Amyotrophic Lateral Sclerosis (ALS): is a “group of rare neurological diseases that mainly involve the nerve cells (neurons) responsible for controlling voluntary muscle movement,” (Bede, Bokde, Byrne, Elamin, Fagan, and Hardiman, 2012). EMG testing can rule out ALS but usually the disease is very slow progressing and symptoms would appear one by one.

References

Arotaritei, D., Ionite, C., & Corciova, C. (2019). Educational Tool for Mathematical Model of Muscular

Dystrophy. ELearning & Software for Education, 3, 267–272. https://doi-org.ezp.waldenulibrary.org/10.12753/2066-026X-19-174\

Bede, P., Bokde, A. L. W., Byrne, S., Elamin, M., Fagan, A. J., & Hardiman, O. (2012). Spinal cord markers

in ALS: diagnostic and biomarker considerations. Amyotrophic Lateral Sclerosis: Official Publication Of The World Federation Of Neurology Research Group On Motor Neuron Diseases, 13(5), 407–415. https://doi-org.ezp.waldenulibrary.org/10.3109/17482968.2011.649760

Gilhus, N. E., Romi, F., Hong, Y., & Skeie, G. O. (2018). Myasthenia gravis and infectious disease. Journal

Of Neurology, 265(6), 1251–1258. https://doi-org.ezp.waldenulibrary.org/10.1007/s00415-018-8751-9

Grory, B., & Yaghi, S. (2018). Updates in Stroke Treatment. Rhode Island Medical Journal, 101(2), 30–33.

Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=a9h&AN=128350680&site=eds-live&scope=site

Pizov, N. A., & Pizova, N. V. (2018). Acute cerebrovascular accidents and gender. Neuroscience and

Behavioral Physiology, 48(5), 641–645. https://doi-org.ezp.waldenulibrary.org/10.1007/s11055-018-0610-8

Shahbaz, L., Nasir, S., Saad, A., & Usmani, M. S. (2016). Antiplatelet in Cerebrovascular Accident (Cva).

Medical Channel, 22(1), 48–52. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=a9h&AN=118333260&site=eds-live&scope=site