Mrs. B is an overweight 71 year old female. Upon hospital admission,she had slur

Question

Mrs. B is an overweight 71 year old female. Upon hospital admission,she had slurred speech,paresis of her right hand and paralysis of her right leg. Her smile was asymmetric with right sided facial weakness. The family reported that Mrs.B stated that she felt dizzy and was going to lie down. When she awakened one hour later she could no longer stand.Mrs B has a history of smoking moderately for 50 years and use estrogen replacement for 20 years. Her mother had adult onset diabetes and died of breast cancer at age 62; one sister died of a subarachnoid hemorrhage at age 63,and another sister is hemiparietic because of CVA. One brother is hypertensive,and three other younger siblings are apparently healthy. Vitals signs showed a normal temperature, elevated heart rate,normal respiration, but a severely elevated blood pressure.A lumbar puncture was negative for blood with normal protein and glucose levels. A normal EEG was noted.EEG showed localized activity in left hemisphere. A CT showed increased density on the left. Blood chemistry was normal except for elevated glucose. 1) what is your presenting diagnosis and which part of the brain is involved? 2) Justify your diagnosis based on presenting symptoms and diagnostic work up. 3)what risk factors are significant to Mrs. B for this neurological injury?

Explanation / Answer

1). Increased density in the left cerebral hemisphere is an early sign of cerebral ischemia. Means, Mrs. B had cerebral ischemia, which led to hypoxia and affected the left cerebral hemisphere. This affected her right side of the body, i.e. paralysis of the and right hand, leg, facial muscles. Based on her family history, it might be due to diabetes or hypertension (both increase the risk of stroke).

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