MK is a 57-year-old woman who recently retired and relocated to a farm in the co
ID: 3516728 • Letter: M
Question
MK is a 57-year-old woman who recently retired and relocated to a farm in the country. She decided to take up gardening/farming as a new hobby. About a week ago, she sprayed her plants and garden with pesticides, however, she removed her protective gear because it was “hot and obscured my vision”. The past few days she has had increasing loss of sensation in her hands and feet, impaired coordination of both hands (“clumsy”) and feet (“tripping a lot”), and weakness of grip and pinch. She was referred to a neurologist who diagnosed her with a polyneuropathy secondary to exposure to a toxic substance (pesticide). A diagnostic work-up revealed that MK’s polyneuropathy is a result of demyelination of the peripheral nerves.
What is the pathophysiology associated with demyelinating disorders, i.e., how does the pathology lead to sensory and motor changes?
Is this a CNS or PNS problem and how might that impact her recovery? Discuss the differences that may or may not exist in terms of recovery.
Assuming that MK has learned her lesson and will not expose herself to toxic substances in the future, what is her prognosis in terms of sensorimotor function? Provide a rationale, based on your understanding of neuroscience and your research, to support your answer.
You are now seeing MK for Occupational Therapy in an outpatient clinic. Given her diagnosis, what are some interventions you could implement? Use evidence from your research to support your response.
Explanation / Answer
Demylinating disorders have always been a topic of concers. The basic pathophysipology behind it is involvement of immunity factors and other synaptically acting drugs. They cause direct or Cell mediated injury that activates macrophpages and chemokines. They lead to the resorption of myelin sheath breakdown of responses and causes demyelination. Interference with the neuropathy targets esterase enzyme.
It appears to be a defect of PNS and is applied on the tracts carrying away sensory sugnals or bringing back motor signals. Chances of recovery are better as CNS effects appear to be less marked.
As per the situation it seems to be a loss olf sensorimotor function due to the effects of pesticide. Declining exposure to the source can relieve along with some neuroprotective medication.
The occupational therapy includes: 1. The foremost is to avoid the presence of direct exposure.
2. Secondly the patient should take precautions of medical state.
3. Should not stand for too long.
4. Should not stand up suddenly.
5. Make ergonomic changes at work and take other necessary precautions not underestimating their importance.
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