A patient is referred for neurological examination. she is 47 year old female wi
ID: 3513980 • Letter: A
Question
A patient is referred for neurological examination. she is 47 year old female with the high blood pressure and stroke.she was unconcious at the time of admission, and after about 15 days in the hospital, she is now getting dischargrd .you notice most of her functions getting normal but when she started to walk on her own she got unbalanced on her right side and bumped on the door. you prevented her from falling but you cancelled her discharge and sent her bak for CT scanning . Explain the compete neurological basis of his condition. diagram required.
please use Human Anatomy & physiology by Elaine N. Marieb
Katja Hoehn
Explanation / Answer
Female patient 47 years old with hypertension and stroke is unable to walk properly and is presented with imbalanced gait after 15 days of her discharge on the right side of her body.
As the patient is hypertensive the etiology for her neurological deficit in balancing could be because of
1.ATHEROSCLEROSIS- On the left cerebrum due to the formation of fibro fatty plaques in the intimal layers of the left cerebral artery leading to neurologic paraperesis on her right side of the body.
2.HAEMORRHAGIC - Haemorrhagic stroke due to rupture of the left cerebral artery or the communicating artery leading to decreased blood flow on the left cerebrum which causes paralysis or paresis on the right side of her body.
3.EMBOLIC-This might because of the dislodged emboli in the circulation reaching the cerebral arteries and settled in the brain circulation.
4.CEREBELLUM-This is the major organ which controls the balance of the body movements.Any obstruction to the flow of blood in SUPERIOR CEREBELLAR ARTERY, or ANTERIOR INFERIOR CEREBELLAR ARTERY OR POSTERIOR INFERIOR CEREBELLAR ARTERY leads to decreased blood supply to the cerebellum and this impedes its function.
The patient along with balance might also lost the proproception function due to which she is not able to perceive her feet contact with the ground and also the baroception of the patient is affected.Cerebellum also helps in equillibrium.
The CT scan of the patient reveals mild defects or mild degenerative changes on the cerebellum or defects in cerebellar circulation is noted
The major part of neurological assessment apart from assessing the sensory and motor skills of the patient is
the CEREBELLAR ASSESSMENT- where the patients ability to perform the following activities are tested
1.Eye movements are tested to rule out nystagmus.
2.The patient is asked to perform Finger to nose and ankle dragging over tibia tests to rule out dysmetria.
3.The patients gait is observed to rule out ataxic movements during walking,her balancing and equillibrium with the atmosphere is noted.
4.The patient is asked to place her hands in the air or asked to write something so as to observe the tremors on fine movements.
5.The patient is asked to speak so as to observe whether her speech is slurred or normal.
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