Question

An 80-year-old man has been a heavy smoker for 60 years. His wife died few years ago and he had been sitting at home afterwards. He said he was too tired and used to taking care of his wife. The sons and daughters persuaded him to go out for a walk as he had been sitting in chairs for years and he refused to go out for a walk. When he talked, he mixed up some languages. For example, he could not understand Cantonese suddenly and he replied in English. One day, this man fell on the floor but he said he had no problem without any dizziness. Few days after his fall, he suddenly lost his temper and broke some glassware at home. The sons and daughters were worried and sent him to emergency room in Tuen Mun Hospital. The doctor had conducted a series of tests for him, including chest X-ray, CT scan, blood test and blood pressure, and the results were all within normal range. He was then transferred to Castle Peak Hospital. A psychiatrist conducted neuropsychological tests for him, including MMSE test and Trail Making test. It was found that he had low score in MMSE and concluded that he had mild symptom of Alzheimer disease with frontal lobe dysfunction. The psychiatrist also injected sedative drugs to him and prescribed aspirin. Few days later, this man could not get up again and became paralyzed. He was resubmitted to Tuen Mun Hospital for CT scan. It was found that he had haemorrhage in the right frontal lobe.

(c) Why could not the first CT scan identify haemorrhage when the patient was showing symptoms of brain dysfunction? Give TWO possible reasons for the current situation.

(d) What is the pathological condition diagnosed in second CT scan? Identify FOUR factors from the given information above that increased the risk of causing the pathological conditions diagnosed in second CT scan. Explain your answer.

Answer 1

C. At first time there was alzehmers disease, and brain depression which causes the symptoms of brain dysfunction. Hence CT scan did not showed any hemorrhage.  

The two reasons may be.

As the patient is elderly and was a smoker for 60years and recently his wife has died. So the reason of brain dysfunction may be due to alzehmers disease, brain depression or less oxygen supply to brain called transient ischemic attack TIA.

d.

pathological condition is brain hemorrhage in right frontal lobe.

Four factors that may have caused this pathological condition are.

1. Aspirin given

Low-dose aspirin irreversibly blocks the formation of thromboxane A2 in platelets, by blocking cyclooxygenase enzyme.This produces an inhibitory effect on platelet aggregation.hence blood clot is not formed and there may be the leakage of blood called internal bleeding.

2.hypertension due to stress.

3.sedatives given which worsens depression and anxiety.

4. Alzehmers disease is also a risk factor for stroke.