Neurological Case Study - Case #1
Adapted from “Advances in MS: A Case-Based Approach to Management,” developed by B.A. Singer, MD
Add answers to questions. All questions will be numbered to help keep it organized. If you want to add new questions, GOOD. Give your question a number also.
Joe comes into your clinic with a complaint of worsening balance over the past 2 months. He is a 29-year-old man who works as a bus driver for Bis-Man transportation. He is left-handed. He lives with David, his domestic partner, and his biological daughter Cindy (7 years old) in a two-story house in beautiful downtown Mandan. Joe's insurance company is BC/BS of ND. Joe started smoking when he was 16, smoking a pack a day until he was 22. When Cindy was born, he cut back and now smokes about 1 pack/week.
Three years ago, he went to his primary care physician complaining of numbness on the left side of his face. The numbness was intermittent, and lasted for 3 months. A year later, he complained of tingling in his left upper extremity. This lasted for about 4 months. Six months, he developed double vision that lasted for 1 month.
1. What other information would you be interested in finding out? Who would you find it out from? Add letters as needed.
A. How active is he now? Is he exercising? (Joe)
B. I would want to know if Joe has a family history of cancer. (Carley)
C. I would ask Joe if he recalls any specific event or activity occurring when the symptoms began. (Betsy)
D. I would ask Joe if he knows his Cholesterol levels? And if he has any family history of high blood pressure or high cholesterol? (Amanda)
E. I would ask Joe if he noticed any changes in any reflexes such as bowl and bladder? (Sara G.)
F. Joe, what did the doc tell you? (I would probably have to get more information from his physician) -John
G. I would ask Joe if there was anything that made this symptoms get better (Kelly) or anything that reproduces or brings on his symptoms. (Dani)
H. I would ask Joe if he has reoccurring headaches? (Drew)
I. What medications you are currently taking? (Dani)
J. Have any of your symptoms ever prevented you from sleeping at night? (Kristen)
K. Because of your balance have you had any falls or hit your head at all? (Denise)
L. I would ask Joe, why are you coming to see the PT now? (Melissa)
M. I would ask Joe if he has ever had a stroke, or if anyone in his family has ever had a stroke. (Bo)
O. I would ask Joe if his balance is worse at a certain time of the day? (Laura)
P. I would ask Joe if he has had trouble with his eyes before or if he wears glasses/contacts? (Marleigh K.)
Q. To inquire about his safety and that of those around him, I would ask Joe how his symptoms affect his job as a bus driver. (Mandy)
R. I would ask Joe if he experienced any balance problems before he has started experiencing the numbness/tingling sensations? (Megan)
S. I would ask Joe if the balance issues are related to more of a dizziness issue or if he feels like it's a muscular weakness problem. (Ben)
T. I would ask Joe if he has had any major sinus infections in the past 2 months and if so, is this when he started to notice his balance getting worse? (Colby)
U. I would ask Joe if he has noticed any mood changes or depression since the incident (Erin)
V. Have you tried doing anything to help your symptoms? (Amber)
W. I would ask Joe if he ever experiences pain associated with his balance issues and/or his numbness and tingling. (Tyler)
X. Do bright lights bother you or has your doctor ever mentioned optic neuritis to you?(Luke)
Y. Do you have diabetes or has anyone in your family ever been diagnosed with diabetes? (Tiff)
Z. Have you had any ear infections recently or before your balance symptoms? (Britt)
AA. Have you traveled outside the country in the past 4 years? (Jordan)
BB. Joe, do you have HIV? (Brittany)
CC. Joe, during your month of experiencing double vision, was there anything specific that worsened or alleviated your eyesight? (Liz)
DD. Have you been to PT before in the last three years and did it help/worsen the symptoms? (Marley)
EE. Double vision along with neuropathy could be indicative of many pathologies including uncontrolled Diabetes. To help rule some of these other conditions out, I would ask: When was the last time you had your blood sugar checked? Do you recall having an infection shortly prior to the first episode of muscle weakness? (Steph)
FF. I would ask Joe how this has affected his life, and what he expects out of physical therapy?(Steve)
Question 24 - DonaldLAllen - 05 Mar 2012 20:07
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Question 5 - DonaldLAllen - 13 Feb 2012 16:26