Healthcare Case Study: Analysis of Neurologic Complaints

This case study focuses on a patient admitted to the outpatient department with complaints of a headache in the right temporal area. The analysis explores potential diagnoses, including temporal arteritis (Giant-cell arteritis), and the significance of a positive Romberg test. Differential diagnoses such as polymyalgia rheumatica, migraine headache, and others are considered, with a discussion of necessary diagnostic tests like head CT, MRI, and serum VDRL. The study emphasizes the overlap of symptoms and the need for comprehensive examination, imaging, and laboratory tests to identify the exact illness and implement an effective treatment plan. The document highlights the importance of considering the '5, 4, 3, 2, 1 criteria' for migraine diagnosis and the role of biopsy in clinical decision-making.

Running head: HEALTHCARE
Neurologic Complaints
Name of the Student
Name of the University
Author Note

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Introduction- Neurological complaints involve diseases of the spinal cord, brain and
the nerves that develop connections between the two. There are an estimated 600 types of
diseases that affect the nervous system such as, epilepsy, Parkinson’s disease, brain tumor
and Alzheimer’s disease (Whiteford et al., 2015). This essay will elaborate on a case study
that involves a patient, admitted to outpatient department, following complaint of headache.
Discussion- The patient has presenting complaints of headache in right temporal area,
with a pain severity of 5. This condition can be attributed to the presence of temporal arteritis,
also referred to as Giant-cell arteritis that encompasses inflammation of the blood vessels.
This condition is typically manifested as vasculitis and comprises of flu like symptoms, pain
in the temples, double vision and problems in opening the mouth (Newman et al., 2016).
Common treatment regimen involves administration of corticosteroids like prednisone in high
dosage, with the aim of preventing further deterioration. However, healthcare professionals
have also been found to prescribe acetaminophen such as, tylenol to patients, in order to
provide them temporary relief from the pain, as also reported in this case (Kollampare et al.,
2016). Upon conducting the physical examination, the patient demonstrated positive
Romberg. According to Melillo et al. (2017) this assessment is generally done for
determining the neurological function and balance of a patient, and also helps in assessing
proprioception or sense of positioning of the body. Presence of a positive Romberg suggests
that there is defect in proprioception power, thereby leading to the absence of sensory input,
which eventually made the patient sway and fall to the right side. Although the signs of the
patient were similar to temporal arteritis, a positive Romberg suggests the presence of other
neurological conditions as well.
Differential diagnosis of the patient would comprise of several diseases, whose
symptoms overlap with those reported by the patient. One such condition is polymyalgia
rheumatica that is characterized by aching in proximal regions of the torso and extremities. In

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addition, the patient must also be tested for migraine headache, postherpetic neuralgia, tabes
dorsalis, and friedreich's ataxia. Subjecting the patient to diagnostic tests like head CT, MRI,
CSF examination and serum VDRL will help in determining presence of tabes dorsalis and
postherpetic neuralgia (Jeon, 2015). The latter, a form of neuropathic pain, can also be
diagnosed by conducting immunofluorescence and measurement of antibodies for herpes
zoster. Determination of friedreich's ataxia would encompass electromyogram, nerve
conduction studies, blood tests, and genetic tests, apart from the imaging studies. Taking into
consideration the fact that some symptoms such as, pulsating pain in one side of head overlap
with that of migraine, there is also a need to use the “5, 4, 3, 2, 1 criteria” for determining
whether the patient suffers from migraine attacks (Minen et al., 2016). Removal of small
portion of vessel and testing it for biopsy would facilitate the clinical decision making
process.
Conclusion- Thus, on analyzing the symptoms reported by the patient it can be
suggested that there is an overlap between symptoms of temporal arteritis and other
neurological conditions, thereby calling for the need to conduct comprehensive physical
examination, imaging, and laboratory tests, in order to identify the exact illness, and
implement a treatment plan.

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References
Jeon, Y. H. (2015). Herpes zoster and postherpetic neuralgia: practical consideration for
prevention and treatment. The Korean journal of pain, 28(3), 177.
Kollampare, S., Mackerricher, W., Sudano, D., Grau, R., & Lisse, J. (2016). A Case of
Temporal Artery Dissection in a Patient with Giant Cell Arteritis. J Clin Case
Rep, 6(723), 2.
Melillo, F., Di Sapio, A., Martire, S., Malentacchi, M., Matta, M., & Bertolotto, A. (2017).
Computerized posturography is more sensitive than clinical Romberg Test in
detecting postural control impairment in minimally impaired Multiple Sclerosis
patients. Multiple sclerosis and related disorders, 14, 51-55.
Minen, M. T., Loder, E., Tishler, L., & Silbersweig, D. (2016). Migraine diagnosis and
treatment: a knowledge and needs assessment among primary care
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Newman, K., Ahlman, M. A., Hughes, M., Malayeri, A. A., Pratt, D., & Grayson, P. C.
(2016). Clinical Images: Diagnosis of Giant Cell Arteritis in an Asymptomatic
Patient: PET in GCA. Arthritis & rheumatology (Hoboken, NJ), 68(5), 1135.
Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V., & Vos, T. (2015). The global
burden of mental, neurological and substance use disorders: an analysis from the
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