20 Aug Neurological Disorders Response
10428Respond to this discussion post:
Jason Hardman (He/Him)
Aug 17, 2022 at 6:23 PM
Case #1: For over 15 years, James, aged 64, has had severe, intermittent headaches. These headaches are characterized by an intense burning pain on one side of his head, accompanied by tearing in his eye and a runny nose. When they strike, the attacks typically occur several times a day and usually last about an hour. James can be headache free for months at a time, but the attacks always return.
Describe the pathology of a headache.
Headaches are a common neurologic disorder. It can be associated with serious brain disease, such as brain tumor, meningitis, giant cell arteritis, and cerebrovascular disease (secondary headaches). Primary headaches are typically chronic and recurring with no structural abnormalities, systemic disease and include migraines, cluster, paroxysmal hemicrania, and tension headaches. Symptoms can vary depending on the type of headache. But someone may experience pain in head or face. This can be throbbing, constant, sharp, or dull. There are many causes for headaches and migraines. Headaches can run in people’s families. Headaches can be triggered by eating certain foods, exposure to allergens, secondhand smoke, strong odors from household chemical or perfumes. Headache pain can be a result from signals interacting among the brain, blood vessels and surrounding nerves. During a headache, an unknown mechanism activates a specific nerve that affects muscles and blood vessels. These nerves send a pian signal to the brain (Cleveland Clinic, 2020).
Based on the different etiologies for headaches which of those fit this patient’s situation?
Based on the different etiologies for headaches, James’s symptoms are suggestive of for cluster headaches. Considering his symptoms, gender, age, and situation. Cluster headaches are seen more in males than females. Onset is generally at ages 20-50, given that James is 64 years old and has been dealing with it for 15 years, put him in that age bracket. Cluster headaches consist of serve headaches on one side of the head. Other symptoms typically are occur one the same side the patient is experiencing pain. Symptoms may include red or teary eyes, runny or stuffy nostrils, flushing or sweating face (McCance & Huether, 2018).
What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
Additional aspects of James history and physical exam would include understand the different types of headaches, risk factors and family history. We could order CT, MRI, EEG to help confirm differential diagnosis. Additional we would assess for family history, any precipitating factors, other symptoms that happened with or before the headaches, including nausea, vomiting or any hypersensitivities (McCance & Huether, 2018).
Based on the history provided and using the following diagnostic tool https://headaches.org/resources/the-complete-headache-chart/(Links to an external site.) as a quick reference of the guideline, you diagnose migraine without aura. List the evidence that supports your diagnosis.
There is good evidence that supports the diagnosis of migraine without an aura. This includes patient that describe their pain as intense burning on one side of their head. Migraine without auras present on one side of the head. They are often describe as throbbing accompanied by with nausea, vomiting, cold hands, sensitivity to sound and light (NHF, 2020).
Case #2: Mr. Smith is a new patient with a history of recent stroke approximately 3 months ago. He was hospitalized in another state, but you don’t have his records now. The patient’s wife is extremely anxious and worried about him because he hasn’t been “acting right”. She wants him checked out. She does not think he had hypertension but adds “he does not like to go to doctors.”
Regarding the patient’s available history, create a detailed plan of care for this patient.
Plan of care for Mr. Smith is a bit limited because we don’t have his records. We can anticipate recommendation for blood pressure control and antiplatelet medication. For blood pressure medications, we could use ACE inhibitors, calcium channel blockers, and beta-blockers. For antiplatelet medication we could use clopidogrel or aspirin. We could test for hyperlipidemia and based on these findings we could prescribe a statin. We would recommend rehab for this patient if they have any deficient (McCance & Huether, 2018).
In recognition of the morbidity of recurrent brain ischemia, the evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or TIA can be found in the current AHA/ASA Recommendations for Antithrombotic Therapy for Noncardioembolic Stroke or TIA https://www.ahajournals.org/doi/pdf/10.1161/str.0000000000000024(Links to an external site.). Based on these current guidelines what goals would you recommend for this patient to insure prevention of another brain ischemic event?
Advance for prevention of future strokes including management of hypertension. Treatment for hypertension is one of the most important interventions for secondary prevention for ischemic stroke. Modification of serum lipid biomarkers such as LDL is an also important in reducing risk for another stroke. Weight loss can also play an important role in overall health but also in lower risk factors for stroke. It recommended to maintain regular exercise. Avoid smoking and implement proper nutrition and sleep (Kernan et al., 2014).
Reference
Cleveland Clinic. (2020) Headaches. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9639-headaches
National Headache Foundation (2020) The complete headache chart. National Headache Foundation. https://headaches.org/resources/the-complete-headache-chart/
Kernan, W. N., Ovbiagele, B., Black, H. R., Bravata, D. M., Chimowitz, M. I., Ezekowitz, M. D., … Wilson, J. A. (2014). Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke, 45(7), 2160-2236. doi: 10.1161/str.0000000000000024
McCance, K., & Huether S. (2018) Pathophysiology – the biologic basis for disease in adults and children. Elsevier. 8th. https://ambassadored.vitalsource.com/reader/books/9780323583473/epubcfi/6/2[%3Bvnd.vst.idref%3Did_cover]!/4/4[pcover]/2%4050:79
Unit Resources:
McCance, K. & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children. 7th Edition. Elsevier Mosby: St. Louis, MO. ISBN: 978-0323088541.
Chapter 16 – Pain, Temperature Regulation, Sleep, and Sensory Function
Chapter 17 – Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function
Chapter 18 – Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular
Alzheimer’s Association (2019). Inside the brain: A tour of how the mind works. [Website]. Retrieved from http://www.alz.org/alzheimers_disease_4719.asp
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
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