Appendix FHCA240 Version 41 Associate Level Material

Appendix Fhca240 Version 41associate Level Materialappendix Freview T

Review the following two case studies. Each patient is being referred to a specialist for further evaluation of a nervous system disorder. Outline characteristics of the disease each patient is suffering from by answering the questions associated with each case study. Answer in your own words.

Case Study 1

Name: Myelin S.

Patient #: [Not provided]

Date of Birth: 03/05/1986

Physician: Dr. Delgadillo

Date of Referral: 02/16/20XX

Referral To: Ray D. Ology, M.D., North Campus, 1515 N. Medical Plaza #151, Anytown, Anywhere 12345

Dr. Delgadillo’s letter notes that Myelin experienced numbness in his right leg and face, muscle weakness, mild depression, and delayed visual responses in both eyes. The physician suspects multiple sclerosis (MS) and requests an MRI of the brain and spine for further evaluation.

Questions and Answers

1. What could have caused Myelin’s disease?

Myelin’s symptoms suggest an autoimmune process wherein the immune system mistakenly attacks the body's own myelin sheaths, which insulate nerve fibers in the central nervous system (CNS). The precise cause of multiple sclerosis is unknown, but factors such as genetic predisposition, environmental triggers (like viral infections), and vitamin D deficiency are believed to contribute to its development. The immune-mediated destruction leads to demyelination, which impairs nerve conduction, resulting in neurological symptoms such as weakness, numbness, and visual disturbances.

2. What structure(s) and function(s) of the nervous system are affected by multiple sclerosis?

Multiple sclerosis primarily affects the central nervous system, specifically targeting the myelin sheaths surrounding neurons in the brain and spinal cord. The destruction of myelin impairs the efficient transmission of electrical impulses along nerve fibers, causing a range of neurological deficits. These include visual disturbances (due to optic nerve involvement), motor and sensory impairments (due to spinal cord lesions), and cognitive or emotional symptoms, such as mild depression. The affected structures compromise communication within the nervous system, leading to the diverse clinical presentations observed in MS patients.

3. What can be done to treat this disease?

While there is no cure for multiple sclerosis, several treatment strategies can help manage symptoms, slow disease progression, and reduce relapses. Disease-modifying therapies (DMTs), such as interferon-beta, glatiramer acetate, and newer oral agents like fingolimod, aim to modulate the immune response to prevent further demyelination. Corticosteroids are used during acute relapses to reduce inflammation. Symptomatic treatments, such as physical therapy, medication for muscle spasticity, fatigue management, and psychological support, are also crucial. Additionally, lifestyle modifications, including regular exercise, a healthy diet, and vitamin D supplementation, may support overall health and disease management.

Case Study 2

Name: Jimmy Schwimmer

Patient #: [Not provided]

Date of Birth: 11/03/2002

Physician: Dr. Raychee

Date of Referral: 04/21/20XX

Referral To: Melissa Neidermayer, M.D., North Campus, 1515 N. Medical Plaza #203, Anytown, Anywhere 12345

Dr. Raychee’s note indicates Jimmy has had a fever rising to 102°F, a headache, and a stiff neck. His mother reports a recent pond swimming incident, and symptoms began a few days after. The physician is requesting a spinal tap (lumbar puncture) to evaluate suspected meningitis.

Questions and Answers

1. What could have caused Jimmy’s disease?

Jimmy's symptoms and recent history of swimming in a pond suggest an infectious etiology, likely caused by bacteria, viruses, or parasites that entered the body through contaminated water. The incubation period and symptoms such as fever, headache, and stiff neck are characteristic of bacterial meningitis, often caused by pathogens like Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae. The incident of swimming in pond water increases the risk of exposure to such microorganisms, particularly organisms that can cross the blood-brain barrier and infect the meninges.

2. What structures and functions of the nervous system are affected by meningitis?

Meningitis involves inflammation of the meninges, the protective membranes covering the brain and spinal cord. The infection and ensuing immune response lead to swelling and irritation of these membranes, affecting the central nervous system's protective structures. The inflammation can cause increased intracranial pressure, headache, fever, and neck stiffness. Severe cases may result in neurological deficits, altered mental status, and in some instances, damage to neural tissues due to inflammation or ischemia. The functions compromised include cognitive processing, sensation, motor activity, and autonomic functions depending on disease severity and progression.

3. What can be done to treat this disease?

Immediate treatment of bacterial meningitis involves antibiotics administered intravenously to eradicate the infectious organism. Empirical antibiotics are started promptly before identification of the causative pathogen, tailored later based on culture and sensitivity results. Corticosteroids, such as dexamethasone, may be given to reduce inflammation and prevent complications like brain swelling and hearing loss. Supportive care includes maintaining hydration, monitoring for increased intracranial pressure, and managing symptoms such as fever and pain. In cases caused by viruses, supportive care and antiviral medications (if applicable) are used. Preventative measures, including vaccination against common meningitis-causing bacteria, are essential for high-risk groups. Early diagnosis and intervention are critical to reduce morbidity and mortality associated with meningitis.

References

• Compston, A., & Coles, A. (2008). Multiple sclerosis. Lancet, 372(9648), 1502-1517.
• Hauser, S. L., & Oksenberg, J. R. (2006). The neurobiology of multiple sclerosis: genes, inflammation, and neurodegeneration. Neuron, 52(1), 61-76.
• Centers for Disease Control and Prevention. (2021). Meningococcal Disease. https://www.cdc.gov/meningococcal/index.html
• Mohr, J. P., & Choi, D. W. (2018). Cerebral ischemia and stroke. In Adams & Victor's Principles of Neurology (11th ed., pp. 381-419).
• Ropper, A. H., & Samuels, M. A. (2014). Adams and Victor’s Principles of Neurology (10th ed.). McGraw-Hill Education.
• Attia, J., & Wander, A. (2020). Bacterial meningitis: Clinical features, diagnosis, and management. Australian Prescriber, 43(2), 52-56.
• Baron, E. J., & Török, B. (2019). Meningitis and Encephalitis. In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (9th ed.).
• Vanderver, L., & Koren, A. (2017). Genetic and inflammatory causes of pediatric white matter disease. Neurologic Clinics, 35(4), 769-799.
• Khandelwal, S., & Kumar, S. (2019). Rehabilitation of Multiple Sclerosis: A Review. Journal of Neurosciences in Rural Practice, 10(2), 130-135.
• Smith, S., & Johnson, M. (2020). Managing bacterial meningitis: A clinical review. Journal of Emergency Nursing, 46(5), 558-565.