Unit 6 Discussion Neurologic Disorders. Due 2.13.23

Unit 6 Discussion Neurologic Disorders. Due 2.13.23

Read the following case study and answer the posed questions

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.

 

1. Describe the pathology of a headache.   

2. Based on the different etiologies for headaches which of those fit this patients situation?

3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?  

4. 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.

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.”

1. Regarding the patient’s available history, create a detailed plan of care for this patient.

2. 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?

Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position.

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.

Answers

Case #1:

For over 15 years, James, aged 64, has had severe, intermittent headaches. These headaches are

characterized by 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.

Pathology of Headaches

Current knowledge suggests that a neuronal dysfunction leads to changes intracranially and

extracranially that account for migraine, including the four different phases of premonitory symptoms,

aura, headache, and postdrome. “ Migraine is thought to be a neurovascular pain syndrome with altered

central neuronal processing (activation of brain stem nuclei, cortical hyperexcitability, and spreading

cortical depression) and involvement of the trigeminovascular system (triggering neuropeptide release,

which causes painful inflammation in cranial vessels and the dura mater).” (Silberstein, 2018). There are

two different types of headaches primary and secondary. Primary headaches have no underlying cause

and make up the majority of headaches. Primary headaches include tension, migraine, cluster, atypical

face pain, trigeminal neuralgia, and benign paroxysmal headaches. Exogenous disorders typically cause

secondary headaches. Causes of secondary headaches include intracerebral bleeding, raised intracranial

pressure, infection, inflammatory disease, post-herpetic neuralgia, and referred pain.

Different Etiologies

Based on James’s symptoms, gender, and age, the headaches that best fit his situation are cluster

headaches. Cluster headaches are typically seen more in males than females. According to McCance &

Huether (2015), onset generally is at the age of 20-50, and given that James is 64 years old and has been

dealing with these for 15 years, this puts him right in the age range. “Cluster headache consists of severe

headaches on one side of the

head.

It is associated with symptoms that occur on the same side of the

head that the pain is taking place on, and which can include red or teary eye, runny or stuffy nostrils, and

flushing or sweating of the face” (American Migraine Foundation, 2019).

History and Physical

“Clinicians must be skilled in their understanding of different types of headaches, risk factors, family

history, and clinical features. Differential diagnosis is confirmed with CT, MRI, and EEG” (McCance, &

Huether, 2015, p 608). Additional information needed so that a proper diagnosis can be obtained,

includes family history, precipitating factors, any other symptoms that happen with or before the

migraine, such as nausea, vomiting, and hypersensitivity.

Evidence that Supports Migraine without Aura

Evidence that supports the diagnosis of Migraine without aura includes that the patient describes his

pain as an intense burning on one side of his head. Migraine without aura present on one side of the

head.

Reference

American Migraine Foundation. (2019). Understanding Cluster Headache. Retrieved from

Understanding Cluster Headache

McCance, K. L., & Huether, S. E. (2015). Pathophysiology: the biologic basis for disease in adults and

children. St. Louis: Mosby.

Silberstein, S. D. (2018). Migraine – Neurologic Disorders. Retrieved from

https://www.merckmanuals.com/professional/neurologic-disorders/headache/migraine

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.”

Detailed Plan of Care

The plan of care based on the limited information presented will include education on stroke prevention

and things to look for that might indicate that another event is about to happen. The patient should be

started on a medication for hypertension and antiplatelet medication. Types of blood pressure

medication that would work well include ACE inhibitors, calcium channel blockers, and beta-blockers.

Antiplatelet therapy with either Clopidagrel or Aspirin. Testing for hyperlipidemia is recommended, and

based on finding a statin may need to be initiated as well. Rehabilitation if all functions haven’t returned

to baseline. “Functional recovery is based on the restitution of brain tissue and on the relearning of and

compensation for lost functions” (Lui, & Nguyen, 2018).

Recommendations for Prevention of another Brain Ischemic Event

Advice for prevention will consist of management of hypertension. “Treatment of hypertension is

possibly the most important intervention for secondary prevention of ischemic stroke” (Kernan,

Ovbiagele, Black, Bravata, Chimowitz, Ezekowitz, Wilson, 2014). Modification of serum lipid biomarkers

such as LDL is an essential component in risk reduction strategy for survivors of ischemic stroke. Weight

reduction, obesity can increase the risks of having another stroke. Physical inactivity can increase patient

risk of stroke, and for those patients who have already experienced a stroke, they may find it hard to

participate in regular physical activity recommendations. “Several studies have shown that aerobic

exercise and strength training will improve cardiovascular fitness after stroke” (Kernan, Ovbiagele, Black,

Bravata, Chimowitz, Ezekowitz, Wilson, 2014). Other recommendations include smoking cessation,

proper nutrition, and testing for sleep apnea.

References

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