Module 8 Nursing Paper

Module 08 Case Study : CNS Movement Disorders Part I — " Harry " Harry

is in his mid -‐ 40’s. He has come to his doctor reporting general

weakness, particularly in his lower extremities. When he enters the

doctor’s office, he is obviously clumsy “Gee, I guess I shouldn’t have

that th ird martini at lunch,” he jokes . However, the physician’s

assistant (PA) who takes him back to the examination room notices that

his speech is slurred. In taking his medical history, the PA notes

that Harry has had a six -‐ month -‐ long p roblem with extreme

fatigue and he has lost significant weight. In fact, his upper body

appears to have nearly wasted away. When asked why he came in, Harry

tells the PA that he has had difficulty in combing his hair, writing,

cli mbing stairs, and climbing up and down out of his truck. His arms

have become increasingly weak, and he has also experienced increasing

trouble getting dressed (zipping and buttoning his jeans is beyond

him). As the PA speaks with Harry, he notices that Harry’s tongue is

moving st rangely; it keeps writhing and twitching. During the

physical examination, Harry gags on the tongue depressor (when it is

only touching his lips!) and he has difficulty swallowing. He also

shows an abnormal Babinski reflex: his toes fan out when the bottom of

his foot is stroked. While the remainder of his reflexes is normal,

Harry shows pronounced muscle weakness and abnormal spasticity —

mostly in his legs, but also in his arms, though to a lesser degree.

Based on the report from his PA, the doctor decides to order a series

of tests, including an MRI and EMG. While the MRI comes back normal,

the EMG is quite abnormal; it indicates denervation. A blood test

indicates an abnormally high level of glutamate. Part I I — " Keith "

Keith is a 35 -‐ year -‐ old male Caucasi an. While he had had a

seemingly normal childhood and graduated high school with a 3.9 GPA,

things began to slide downhill after that. His grades began...