Case Study
The Neurologic System
By Janice, Margaret and Tanya
Question # 1
Could Mr. C.'s foot numbness be related to his stroke?
What other causes could there be for this pattern of
numbness? (From the last unit, remember his history of
alcohol intake, Type 2 diabetes and colorectal cancer.)
No we do not think the numbness is related to his stroke
because it is present in both feet. Numbness in the feet can be
caused by anything that upsets the nerve cell's delicate
chemistry. Such diseases include diabetes, vitamin deficiencies,
liver or kidney disease, cancer, Lyme disease and many drugs.
In this country, diabetes is the most common cause of foot
numbness, the numbness usually occurs when sugars are out of
control. We think Mr.C has peripheral neuropathy.
What is Peripheral Neuropathy(PN) ?
• Peripheral neuropathy describes damage to the peripheral
nervous system, the vast communications network that
transmits information from the brain and spinal cord (the
central nervous system) to every other part of the body.
Peripheral nerves also send sensory information back to the
brain and spinal cord, such as a message that the feet are cold
or a finger is burned. Damage to the peripheral nervous system
interferes with these vital connections. Like static on a
telephone line, peripheral neuropathy distorts and sometimes
interrupts messages between the brain and the rest of the body.
Taking a closer look at PN
Peripheral neuropathy(PN) affects 10 to 20 million people
in the U.S, including ten per cent of all people who have
diabetes. This condition has numerous causes and can be
associated with diseases such as HIV, alcoholism, and lupus,
and may result from treatments for other medical conditions,
such as cancer and chemotherapy.
Cancers and benign tumors (Mr.C has reoccurring CA) can
infiltrate or exert damaging pressure on nerve fibers. Toxins can
also cause peripheral nerve damage. Certain anticancer drugs,
anticonvulsants, antiviral agents, and antibiotics have side effects
that can include peripheral nerve damage, thus limiting their longterm use. (Mr. received chemotherapy in the past).
Mr. C. History
If you recall Mr. C has had chemo in the past for his colon
cancer , he is a type two diabetic with “sugars’’ out of control
and does have a history of excessive alcohol use. Also he now
has CA of the liver.
Diabetes Mellitus is characterized by chronically high blood
glucose levels (which Mr. C has) and is a leading cause of
peripheral neuropathy in the United States.
Peripheral neuropathy may be either inherited or
acquired. Causes of acquired peripheral
neuropathy include physical injury (trauma) to a
nerve, tumors, toxins, autoimmune responses,
nutritional deficiencies, alcoholism, and vascular
and metabolic disorders. Systemic diseases
disorders that affect the entire body often cause
peripheral neuropathy. These disorders may
include metabolic and endocrine disorders. Nerve
tissues are highly vulnerable to damage from
diseases that impair the body's ability to transform
nutrients into energy, process waste products, or
manufacture the substances that make up living
tissue.
Characteristics displayed !
• Diabetes Mellitus
• Alcoholism
• leads to blood vessel
constriction.
• Vascular damage and blood
diseases.
• decrease oxygen supply to
the peripheral nerves
• lead to serious damage to or
death of nerve tissues.
• cause widespread damage to
nerve tissue.
• Thiamine deficiency causes
painful neuropathy of the
extremities.
Question #2
Given Mr. C.'s age (70) and multiple medical conditions, you
wonder if he could have a subdural hematoma. Why would he
now, when it is weeks after the head injury?
.
Mr. C probably had a right sided stroke previously as he has
left sided weakness.
Effects of right hemisphere strokes
• Weakness or paralysis on the left side of your body
• Vision problems.
• Problems distinguishing distance, depth, between up and down, or
between front and back. This can make it hard to pick up objects,
button a shirt, or tie your shoes.
• Problems understanding maps.
• Problems with short-term memory. You may be able to remember
something that happened several years ago, but not something you did a
few minutes ago.
• Forgetting or ignoring objects or people on your left side (this is called
neglect). You may even ignore your own left arm or leg.
• Judgment difficulties, such as acting impulsively or not realizing your
own limitations.
Subdural hematomas
Can occur after a very minor head injury, especially in the elderly. These
may go unnoticed for many days to weeks, and are called "chronic"
subdural hematomas.(as in Mr.C's case) With any subdural hematoma, tiny
veins between the surface of the brain and its outer covering (the dura)
stretch and tear, allowing blood to collect. This collection of blood then
forms over the surface of the brain. In a chronic subdural collection, blood
leaks from the veins slowly over time
.
A subdural hematoma is more common in the elderly because of normal
brain shrinkage that occurs with aging. This shrinkage stretches and
weakens the bridging veins. These veins are more likely to break in the
elderly, even after a minor head injury. Mr. C reported that he fell and his
head hit the floor prior to leaving the hospital. This could have likely
caused a subdural hematoma. Mr. C may also be on anticoagulant therapy
from his previous stroke which could worsen the hematoma.
Subdural Hematomas
Risks include:
• Chronic heavy alcohol use
• Chronic use of aspirin,
anti-inflammatory drugs
such as Ibuprofen or blood
thinning (anti-coagulant)
medication
• Diseases associated with
blood clotting problems
• Head injury
• Old age
Symptoms :
• Confusion
• Decreased memory
• Difficulty speaking or
swallowing
• Difficulty walking
• Headache
• Seizures
• Weakness or numbness of
arms, legs, face
A subdural hematoma is an emergency condition!
• Emergency surgery may be needed to reduce pressure within
the brain. This may involve drilling a small hole in the skull,
which allows blood to drain and relieves pressure on the brain.
Large hematomas or solid blood clots may need to be removed
through a procedure called a craniotomy, which creates a
larger opening in the skull.
• Medicines used to treat a subdural hematoma depend on the
type of subdural hematoma, the severity of symptoms, and
how much brain damage has occurred. Diuretics and
corticosteroids may be used to reduce swelling. Anticonvulsion medications such as phenytoin may be used to
control or prevent seizures.
Please feel free to ask questions or add to
our discussion
Thank You Group E
References
Engehard, H., Sinson, G.P., & Reiter, T.G. (2007). Subdural hematoma. Retrieved
January 26, 2007 from http://emedicine.medscape.com/article/247472overview.
http://www.heartandstroke.com
Gould, B. (2006). Pathophysiology for the Health Profession (3rd ed). Philadelphia:
Elsevier Inc.
McCance, K. L., Huether, S.D. (2006). Pathophysiology: the biologic basis for
disease in adults and children (5th ed.) Mosby. St. Louis, MS
Cancersymptoms.org (2009). Causes of cancer-related peripheral neuropathy.
Retrieved
January 26, 2009 from
http://www.cancersymptoms.org/peripheralneuropathy/causes.shtml
National Institute of Neurological Disorders and Stroke (2008). Peripheral neuropathy
fact sheet. Retrieved January 26, 2009 from
http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.
htm#115873208