Answer Happy

History of Present Illness
A 73 year old African American female is brought to
the ER via ambulance. She was found lying on the floor of her
kitchen by her daughter. Patient is awake but unable to
speak or move her left extremities. Daughter reports she has
witnessed her mother have two short spells of numbness and
clumsiness with her left hand over the past three months. She
urged her mother to see her family physician but does not believe
she has followed through. Medication for hypertension and NSAIDs
for arthritis were brought to ER by the daughter, who states
she believes her mother is hoarding her medication and not taking
it as often as prescribed.
Past Medical History
Arthritis in right hip requiring occasional use of quad
cane for walking long distances; had hysterectomy at age 46
for endometriosis.
Family and Social History
Patient is widowed and lives alone. She is a retired school bus
driver. Daughter reports she is active in her church and tends a
large vegetable garden each year. Multiple family members are
hypertensive, but history is negative for neurological
diseases.
Physical Examination
Patient is awake and calm. She is unable to answer any
questions and does not follow any commands for moving left
extremities and does not spontaneously move left extremities.
Follows all commands with right extremities, and muscle strength
appears normal for her age. Her blood pressure was
168/108.
Diagnostic Tests
MRI of head shows area of cerebral hemorrhage on right
side of brain. X-rays of head, spine, and hips were negative
for fractures.
Diagnosis
Right CVA with left hemiplegia
Plan of Treatment
Questions:
1. The patient’s daughter reported that her mother has had
short spells of numbness and clumsiness with the left hand.
Review the conditions described in the Neurology Vocabulary and
suggest a possible name with definition for these episodes.
2. Describe why do you think taking skeletal X-rays was a
necessary part of this patient’s evaluation?