Question

CASE SCENARIO: A 50-year old woman was rushed to the Accident and Emergency (A&E) Unit after she complains of severe headache, stiff neck, double vision associated with slurring of speech and left sided hemiparesis. Series of laboratory work-up have been made and based on the result of her CT scan and MRI, an aneurysm was detected.

Guide Questions:

1. Based on the data provided, what do you think is the SPECIFIC condition the client is suffering from? Describe briefly the characteristic of the specific type of condition you have identified.

2. How does aneurysm develop? Describe the prognosis of the condition if the aneurysm has ruptured.

3. Other than the presenting symptoms manifested by the client, state 4 more symptoms that the client might develop as a consequence of her condition. Rationalize briefly each symptom.

Answer 1

Ans 1. The client is suffering from a stroke. Stroke is a condition of cutting off of blood to the brain leading to the brain cells starved of oxygen, it can be because of any clot or rupture of blood vessels in the brain. Depending upon the problem in the blood vessels supplying the brain, stroke can be of 2 types---

• Ischemic stroke -- Blockage of the blood vessel
• Hemorrhagic stroke -- Rupture of the blood vessel

Type of condition: Ischemic stroke.

Characteristic of the type of the condition diagnosed---

• Because the aneurysm is present and not ruptured (as not specified in the question), then there would be no bleeding condition leading to an ischemic stroke.
• As the blockage of the vessel, mainly the artery is present there will be loss of oxygen for the time being.
• Blurred vision, stiff neck, headache, double vision, slurring of speech, hemiparesis all are the characteristic sign of stroke.
• Presence of an embolism.

Ans 2. An aneurysm is an abnormal dilation of a blood vessel and is caused by weakness in the vessel wall. So anything causing weakness to the vessel wall can lead to an aneurysm. As we know blood exerts pressure over the blood walls, so when a blood vessel wall weakens, it struggles to carry that pressure of the blood, leaving the radius of the blood vessel to increase. And resulting in the development of an aneurysm, the most common cause being hypertension, atherosclerosis.

Prognosis of the condition if the aneurysm has ruptured --

• It would be a much serious condition, both to treat and to recover.
• It presents with bleeding in the brain, leading to the worst headache.
• It can further lead to the more fatal condition causing subarachnoid hemorrhage, seizures, hydrocephalus in rare conditions.
• Depending upon the extent of bleeding, and the time taken to reach the hospital can lead to permanent problems like slurred speech, difficulty concentrating and thinking, muscle weakness, etc.
• Often the patients won't able to recover fully from the condition and lead to permanent neurological deficits.

Ans 3. Other 4 symptoms that can be manifested ---

1) Trouble walking -- There would be difficulty in walking or standing as the part of the brain, especially the cerebellum area is affected leading to incoordination. And the part of the brain is deprived of oxygen or overflow with blood it leads to the death of brain cells and confusion to the brain that what is happening.

2) Dizziness -- As the part of the brain, particularly a brainstem or cerebellar, is deprived of oxygen and the blood, there would be difficulty in seeing things and thinking things, leading to dizziness as the part of the brain that integrates and process these functions, is now affected.

3) Drooping of the face -- This is the first sign that should be looked for, in case of stroke diagnosis, it occurs when the damage to the brain cell is occurred by the involvement of the vessel providing blood/oxygen to the facial muscles.

4) Difficulty to raise the arm -- Stroke often causes paralysis or weakness of one or more muscle in the arm or shoulder. And it gets difficult to raise the arm when a stroke is being detected because of the area being affected with loss of oxygen because of the involved vessels being clotted or overflow of the blood.