Dr. Ann Gina has a patient presenting with family complaints of cognitive dysfunction and left upper hemiparesis.
Dr. Gina gives the patient, Mrs. Ima Hart, a full physical examination and cognitive screening. She records the following notes in her chart:
The patient underwent a CABG in November, 2015. She falls asleep easily and sleeps through the night.
The increased difficulty remembering names, concentrating, and shortened attention span that she presented with following CABG surgery has not cleared; rather, the patient and the family have noticed an increase and persistence in the cognitive dysfunction.
The tingling and numbness in her left shoulder and hand also persist. Both the patient and her family noted that these symptoms were present following surgery and have remained.
Her family wants her license revoked due to the memory, concentration, and attention issues.
Vitals: Wt. 160 P56 BP 112/72 R 16 Temp. 97.3
Objective:
Chest: Clear to percussion and auscultation;
Slow but steady gait;
Sense: Normal vibratory sense in lower extremities; reduced sensation evident in left upper extremity;
Motor: Symmetric strength and tone with the exception of the left shoulder and hand. Pain in left shoulder and arm during ROM.
Cerebral: Mild confusion and decreased memory.
Your Challenge:
- What does Dr. Ann Gina attribute the aforementioned cognitive complaints to? Hint: Think about the surgical procedure and the bypass machine.
- What would have caused her left upper extremity weakness and sensation? Hint: Think about the surgical procedure and what neuropathy could occur.
- What further testing could be done?
- What treatment if any would be prescribed?
Be sure to include at least 2 links that support your findings.
At the end of your initial post, select 10 medical terms related to this body system, dissect them into their component parts, and provide their meanings. 🙂
Expert Solution Preview
Introduction: In this scenario, a patient named Mrs. Ima Hart presents with cognitive dysfunction and left upper hemiparesis after undergoing a CABG surgery. The challenge is to identify the possible causes of her symptoms, suggest further testing, and prescribe appropriate treatment.
1. The cognitive complaints presented by Mrs. Ima Hart are attributed to the use of the bypass machine during the CABG surgery. The machine is known to cause microemboli, which can lead to cognitive dysfunction and neurocognitive deficits in some patients. The cognitive effects of the machine can manifest immediately after surgery or can develop slowly over time, as in Mrs. Hart’s case.
Further reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221935/
https://www.ahajournals.org/doi/full/10.1161/circ.102.suppl_3.iii-379
2. The left upper extremity weakness and sensation experienced by Mrs. Ima Hart could be due to a brachial plexus injury that occurred during the CABG surgery. This type of neuropathy is a rare but known complication of the procedure. The brachial plexus is a network of nerves that provides sensation and movement to the arm and hand, and injury to this network can lead to weakness and numbness in the affected limb.
Further reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781530/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234092/
3. Further testing for Mrs. Ima Hart could include imaging studies such as magnetic resonance imaging (MRI) of the brain to further evaluate her cognitive dysfunction, or electromyography (EMG) and nerve conduction studies to assess the extent of her brachial plexus injury. Neuropsychological testing could also be considered to provide a more detailed evaluation of her cognitive function.
Further reading:
https://www.merckmanuals.com/professional/neurologic-disorders/neurologic-diagnostic-procedures/imaging-of-the-central-nervous-system
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310284/
4. Treatment for Mrs. Ima Hart’s cognitive dysfunction could include cognitive rehabilitation therapy and medications such as cholinesterase inhibitors that can improve memory and concentration. Treatment for her brachial plexus injury could include physical therapy and pain management, and in some cases, surgery may be necessary.
Further reading:
https://www.healthline.com/health/dementia/medications-for-memory-concentration
https://www.hopkinsmedicine.org/health/conditions-and-diseases/brachial-plexus-injury/treatment
Medical terms related to this body system:
1. Hemiparesis – hemi (half) + paresis (partial paralysis)
2. CABG – coronary artery bypass graft (surgery)
3. Neuropathy – neuro (nerve) + -pathy (disease)
4. Brachial plexus – brachi (arm) + plexus (network of nerves)
5. Microemboli – micro (small) + emboli (clots)
6. Cholinesterase inhibitors – choline (a neurotransmitter) + -esterase (an enzyme that breaks down choline)
7. EMG – electromyography (test to assess muscle and nerve function)
8. Cognition – cognit (knowledge) + -ion (action/state)
9. Confusion – con- (together) + fus- (pour)
10. Percussion – per- (through) + -cuss (strike)
