Neurology Case Studies: Diagnosis, Management, and Evaluation

This document presents a comprehensive analysis of four neurology case studies. Each case explores different neurological conditions and challenges. The analysis includes lesion localization, differential diagnosis, patient evaluation techniques (such as CT scans, EEG, and memory-related tasks), and management strategies, including medication, counselling, and educational support. The cases cover a range of conditions including movement disorders (potential early onset Parkinson’s), seizure disorders (paroxysmal dystonia), sleep disorders (REM sleep behavior disorder), and dementia. The document emphasizes the importance of communication, positive support, and the need for thorough evaluation in diagnosing and managing neurological disorders. It also considers the impact of neurological conditions on a patient's quality of life and the potential for long-term complications.

Running head: NEUROLOGY
NEUROLOGY
Name of the Student
Name of the University
Author Note

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Case 1:
a. Lesion localization is the factor of the understanding and analysis of the symptoms
considering the nervous and the physiological anatomy. Hence, in this case the patient is
experiencing a sudden tendency to drag after a certain of run in the left foot. The patient
diagnosis also highlighted that the left afferent papillary defect and mild hyperreflexia in her left
lower extremity is present. Hence, the lesion localization is found to be in the hypothalamus as
the hyperreflexia is the primary cause of the situation of the patient and hypothalamus controls
the reflexes of the body (Rao and Schiandicola 2018). On the other hand, the left afferent
papillary defect is also the factor which is dependent on the hypothalamus. Hence, it can be
stated that the hypothalamus of the person is affected in this case and the lesion is suggested to
be localized in the hypothalamus (Giustina et al. 2017). Moreover, as the effects have been
seemed to affect the left side of the body thus, the affected brain part or the specific zone of the
lesion is found to be in the right lobe of the hypothalamus.
b. In this case it can be found that the patient is experiencing some movement disabilities.
Moreover, the nervous control over the muscles of different parts of the body has also been seen
to be affected. Hence, in this context it can be related to the condition of early onset Parkinson’s
disease. The condition of the nervous disorder development affecting the movement of the
affected person can be observed in this case and as per the condition the movement disabilities
can be highlighted for the patient (Ferguson, Rajput and Rajput 2016). On the other hand, the
hyperreflexia can also be developed due to spinal cord injury (Chowdary and Gilbertson 2018).
Thus, the differential diagnosis in this case can be referred to the early onset Parkinson’s disease
as well as any kind of spinal cord injury.

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c. The patient evaluation would be done with the help of the communication with the patient.
Thus, it can be stated that the patient reported symptoms should be recorded and analyzed with
priority as based on these the assessment and the identification of the condition can be done.
Based on the patient’s statement the condition of the patient can be marked as the hypothalamus
related issue. In order to develop a proper knowledge about the issue a CT scan can be conducted
for the better assessment of the situation (Pritchard et al. 2017). Moreover, the left afferent
papillary defect can be assessed or evaluated by the swinging light test.
d. The patient management in this situation can be done with the help of effective
communication with the patient. The communication and understanding development with the
patient are required with higher priority. Moreover, the patient should be provided with positive
support and assurance about the improvement of the situation with proper treatment. Thus,
counselling can be marked as one of the most effective process in this situation to manage the
patient (Kamate and Detroja 2019).
e. The patient should be provided with education about the effective ways to handle this situation
and symptoms. The process of the symptom management and also reduction of other risk factors
would be the primary focus of the counselling. Hence, the counselling implemented for the
patient would be educational counselling (Lau, Brennan and Gardiner 2018).
Case 2:
a. In this case the patient suddenly experienced a tonic clonic seizure in a pet shop. Moreover,
the patient had two more seizure attacks as well. These conditions can be developed due to the
neurological movement disorder or dystonia. In dystonia the person experience repetitive muscle
contraction and eventually twisting and repetitive movements and abnormally fixed posture
(Balint et al. 2018). However, in this case the patient had repetitive seizure attacks. Hence, this

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condition can be referred as the paroxysmal dystonia as the repetitive seizure attacks had been
seen (Li et al. 2018). Thus, the differential diagnosis of the patient’s condition can be referred to
the dystonia and specifically paroxysmal dystonia. However, the assessment of the patient is
required for the immediate care delivery according to the actual situation. Hence, the brain
imaging process for better knowledge development regarding the condition of the patient and
also planning the treatment of the patient is required with higher priority (Rosenow et al. 2016).
b. The evaluation of the patient should be focused on the communication of the other personnel
around the patient in the pet shop primarily. Based on their information and also the focus on the
medical history of the patient the character of the seizures and the condition of the brain of the
patient can be identified. However, the electroencephalography (EEG) is the process for the
identification of the electric impulses of the brain and the nature of these impulses as well.
Hence, this can be stated that the process of the EEG and other brain imaging system would be
implemented for the assessment and the evaluation of the patient’s condition (Chowdhury et al.
2018). Moreover, after the normalization of the situation the paramedics should communicate
with the patient for the understanding and the identification of the causes and the effects of the
epileptic attack. On the other hand, the evaluation should also involve the family members
so the information regarding the epileptic attack history and the aftermath of the attacks
can be analyzed as well.
c. In this case of patient management the factor of the medication is very much important. The
paramedics should implement anticonvulsant medicines to reduce the effects of the epileptic
tonic clonic seizure attack which affects both sides of the brain and develops due to disruption of
the electric impulse in the brain as well. Hence, it can be marked that the process of the patient
management is primarily focused on the medication. However, the patient should be provided

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with positive situations, reduction of stress. Moreover, at the time of the attack the patient should
be provided with cushion head, the cloth of the patient should be loosened around the neck and
most importantly the do not stop or prevent the movements of the patient are the most important
factors which are related to the management of the patient condition (Bradley, Lindsay and
Fleeman 2016).
Case 3:
a. In this case the patient is experiencing the dream related violating conditions. However, there
is no definite cause of dream related violence found, this condition can be related to the REM
sleep behavior disorder. This condition can be related to different degenerative neurological
conditions as well. The rapid eye movement (REM) is one of the sleeping disorders (Iranzo et al.
2017). This condition can also enable the chances of the Parasomnia which is also a sleeping
disorder develop due to the arousal of REM and non-rapid eye movement (NREM) (Schenck and
Howell 2019). Thus, the differential diagnosis of the condition of the patient refer to the
condition development of the sleeping disorder due to the negative factor of the sleeping
behavior issues. Moreover, the diagnosis of the electric impulse in the brain of the patient can
properly identify the present issue properly. However, the violating behavior at the time of sleep
can be related to the social stresses as well and the stresses can develop the earlier mentioned
condition as well. Hence, the proper assessment of the brain function is recommended (Louis
2017).
b. The evaluation of the patient would be dependent on the observation and the communication
with the patient. The actions of the patient would be considered for the understanding of the
patient’s condition and also the mental status of the patient. Moreover, for the better
understanding the patient the care personnel should conduct the brain imaging techniques such as

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CT scan, MRI or EEG for the understanding of the brain functionality and also the actions.
These, imaging techniques can properly identity the structure disparity in the brain and the
subsequent effects related to the situation or even the electric impulses of the brain. On the other
hand, near-infrared spectroscopy can be used for the dream imaging for the specific
understanding of the dreams and the functionality of the brain at the time of dreaming as well.
All these factors can be used for the evaluation of the person’s condition (Sikka et al. 2018).
c. The patient management would be done with the proper communication and also focusing on
the positive aspects of the patient’s behavior. The patient should be provided with anti-stress
medicines in order to reduce the stress of the patient which can help in the reduction of the
violence of the patient at the time of sleeping. On the other hand, the counselling of the patient
should be considered for the management of the patient. The counselling should be focused on
the positive behavioral improvement of the patient that is the rehabilitation counselling would be
effective in this process (Grabara 2019).
d. The situation of the patient showed that the negative stressors are affecting the quality of life
of the patient. This condition if not handled properly the patient can develop high level of
depression and subsequently dementia and schizophrenic condition as well. Hence, the
neurological disorders can impact on the future life of the patient drastically if any kind of
dementia especially the Alzheimer’s disease would develop. These neurological disorders can
develop as the patient is an older adult and also in the verge of entering the most vulnerable age
for dementia development (Karageorgiou et al. 2017).
Case 4:
a. In this case it can be highlighted that the patient affected due to the age primarily. The
condition refers to the development of dementia in a severe situation. However, the context of

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the episodic memory and the memory processing is affected in this situation. Thus, this condition
can be affecting the hippocampus of the brain which is responsible for the development and
processing of brain. Thus, the middle temporal lobe can be marked as the deficit area for the
development of the condition of the patient. Moreover, this situation is directly related to the age
of the person as well as the neurological negative situation development which is degeneration of
brain cell in the hippocampus area. Thus, the this earlier mentioned area facing the deficit which
develops the negative condition of episodic memory loss and inappropriate memory processing
(Wager and Barrett 2017).
b. The patient in this case is an elderly person and the person is experiencing short term memory
loss issue. This issue can be dementia. However, the patient’s differential diagnosis can refer to
other factors related to the condition. The patient can be affected with mild cognitive impairment
or age-associated cognitive impairment (Valdés Hernández et al. 2020). These types of cognitive
impairments are different from the dementia condition and also can be considered for the patient
diagnosis as well as the patient is generally forgetting the most recent activities. Moreover, the
patient is also confused and could not manage to identify the specific factors. Thus, it can be
stated that the possibility of mild cognitive impairment or age-associated cognitive impairment
should be considered for the patient.
c. The evaluation of the patient is also dependent on the analysis of the patient’s self efficacy in
memory processing and also cognition level of the patient. Hence, the patient should be assessed
with the help of some memory related and cognition related tasks. On the other hand, the patient
would also be evaluated with the help of the brain imaging techniques which can effectively
identify the deficits in the brain or the area which is affected and the relation of the affected area
with memory processing. It will also effectively help in understanding the actual issue of the

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patient. Autopsy of the brain of the patient can also be implemented for the identification of
biochemical functionality along with the anatomical issues (Plank, Søgaard and Goldberg 2016).
d. The patient management in this case would be focused on stress reducing medication
implementation and also effective communication with the patient. Counselling of the patient
can effectively help the patient to cope with the situation as well. Hence, rehabilitation and
educative counselling would help in the situation of the patient management (Pitoni 2018).
e. The patient and the family counselling would be focused on the dos and don’ts in this
situation. The care personnel would suggest some effective ways for the management of the
memory of the patient. Moreover, the counselling will also help in the process of the stress
reduction for the patient which is effective in the factor as well. Thus, this counselling can be
marked s the educational counselling which should be implemented properly (Lau, Brennan and
Gardiner 2018).
f. RbAp48 is protein of hippocampus and the deficiency of this protein is related to the
development of memory loss situation. It has been found that with age the RbAp48 protein
deficiency occurs and affects the memory of a person. In this case, it can be stated that the
autopsy of the patient can reveal the abnormality of the level of RbAp48 protein (Kosmidis et al.
2018)
Case 5:
a. In this case the patient can be found with negative social interaction issues. Moreover, the
factor of the patient’s actions highlight that the patient is affected with negative impact on the
memory processing of the patient and also negative emotional actions. Thus, the patient’s
condition can be marked as the emotional disbalance and also the improper memory processing
issues. Thus, the localization of the deficit can be found in the middle temporal lobe issues.

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Hence, it can be stated that the patient’s amygdala and the hippocampus is affected and the
deficits can be found in the area. Based on this context it can be stated that the process of the
emotional disbalance is related to the amygdala and it also affect the memory processing of the
patient as the hippocampus is also affected (Benbrika et al. 2019).
b. In this case the patient showed emotional imbalance along with negative cognitive condition
as well. Thus, the differential diagnosis for this condition can be marked as the electrolyte
imbalance in the brain and also the brain functional impairment. Moreover, this condition can be
related to negative issue such as stroke which can develop the blood flow and electrolyte
imbalance in the brain (Laksmidewi 2017). These issues can be marked as cause of the
development of the situation for the patient. Thus, the differential diagnosis here refers to the
stroke or any other kind of disruption in the physiological functioning leading to cognitive
impairment development.
c. The evaluation of the patient can be done with the cognition scale based questionnaire. The
questionnaire would be focused on the level of the cognition of the patient and the scoring of the
patient’s answers can determine the cognition level of the patient. On the other hand, the brain
imaging techniques will be effective in the determination of the deficit or abnormality of the
brain parts especially the hippocampus and amygdala. Thus, these processes can be effective in
the evaluation of the patient (Castelnuovo et al. 2016).
d. Regular counselling and also anti-stressor medicines should be prescribed for the patient.
These processes would be effective for the improvement of the situation of the patient. Thus, the
management of the patient would be done with the help of the rehabilitation counselling. On the
other hand, developing positive environmental and social condition would be effective for the

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patient. Hence, the family of the patient should be provided with educational counselling (Tible
et al 2017).
e. The patient would be helped with the proper consideration of the communication and
socialization of the patient. Thus, development of the interaction skills and also positive mental
condition development would be effective as well. Hence, the patient should be provided with
rehabilitation counselling. Moreover, the family members would be provided with the
knowledge of making the situation positive for the patient that is educational counselling (Lau,
Brennan and Gardiner 2018).
f. In this case, it can be found that the patient losing memory mildly and also has cognitive issues
in the socialization process. Thus, the beta-amyloid protein and also RbAp48 protein deficiency
can be found in the autopsy process and these proteins are related to cognition and memory
respectively (Johansson et al. 2019).
Case 6:
a. In this case, it can be found that the child is affected with the motor disorder and also the
cognition delay. Thus, it can be stated that the process of the development is deficit in this case
as the child was born five weeks premature. In this context, it can be highlighted that the process
of the development is lacked and the cerebellum is mostly localized for the deficit. It can be
found that the cerebellum is responsible for the sensory information processing and controlling
the motor response of a person. In this case, the child is affected with the motor response deficit
in the legs. On the other hand, the child is also affected with the cognition delay as well. Hence,
the cerebrum of the brain can also be localized as the deficit as this part of the brain controls the
cognition of a person (Wager and Barrett 2017).

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b. In this case the patient can be affected with the Hereditary motor sensory neuropathy which is
an inherited and progressive disease of the nerves. The weakness and numbness in the nerves and
affecting the muscles of the legs are prominent in this disease (Bird 2019). The patient’s
condition thus, can be referred as this situation as well. Hence, the differential diagnosis of the
condition can be Hereditary motor sensory neuropathy in this scenario.
c. In this case, it has been seen that the patient is affected with the motor issues in the leg and
complete stiffness has been seen in this case. Thus, the sensory based tests would be conducted
in the legs of the patient and also the nervous impulses would be measured in the legs. This
process can help in the evaluation of the situation for the patient. The negative factors and the
severity of the condition can be determined by this process. Moreover, the cognition based tests
would also be effective for the understating of the brain functioning of the patient. Furthermore,
CT scan or other brain imaging techniques can effectively highlight the deficit in the brain parts
which would also help in the planning of the patient treatment process (Sikka et al. 2018).
d. As this is a child patient, positive communication would play a key role in the process of the
management of the patient. Hence, it can be stated that communication with the patient would
play a crucial role in the therapeutic relationship development with the patient and help the child
to overcome the hurdle. Moreover, educational counselling would help the child to learn and
reduce the issues regarding her motor functionality issues (Tible et al 2017).
Case 7:
a. The patient of this case has been found with several issues such as cognition declining,
emotional instability and motor movement issues in some parts of the body. Moreover, the
patient has been seemed to be developing different coloration in the cornea as well. There is
presence of hypersalivation and diminished facial expression as well. These conditions can be

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related to the cerebral palsy situation that is several syndromes due to the immature brain
development (Novak et al. 2017). Thus, the patient can be affected with cerebral palsy which
leads to the development of cognitive impairment and other neurological issues and the
differential diagnosis refers to this situation.
b. The evaluation of the patient can be done with different processes. The primary evaluation
would be cognition level test of the patient with the help of cognition related task and also
cognition related questionnaire based interview of the patient. This factor will reveal the
cognition level of the patient. Other than this the evaluation can also be done with the focus on
the motor skills of the patient. Hence, the patient would be provided with tasks which require
motor skills and this will effectively evaluate and determine the motor skills of the patient
effectively. Moreover, the patient has emotional imbalance which can also be determined by
proper interview. However, the optic nerve related issue of the patient should focus on the
eyesight test of the patient and this would be effective in the understating of the color changing
and other issues related to the eye of the patient. Other than all these the patient should be
evaluated with the help of the brain imaging techniques which can effectively determine the
deficit or the abnormalities of the brain portions (Sikka et al. 2018).
c. The patient management here is dependent on the interaction with the patient. Thus, the proper
communication and also the effective understanding development with the patient would be
considered for the management of the patient. It can be stated that the patient is young and needs
attention. Thus, the patient should be provided with attention. This would effectively reduce the
emotional imbalance of the patient. On the other hand, the patient should be provided with
proper cognitive developmental exercises. This factor would be helpful in the process of
development as well (Tible et al 2017).