A 12-year-old boy began to complain of frequent headaches 4 months before his hospital admission. On the day of his admission, he had a major motor seizure, which his parents observed. During the seizure, he lost bladder and bowel control. On physical examination, he appeared to be in deep postictal sleep. He had no focal neurologic signs. On examination of the optic fundi, no evidence of papilledema was found. Studies Results Routine laboratory work Within normal limits (WNL) Skull X-ray study, No evidence of skull fracture Lumbar puncture, Opening pressure 250 cm H2O (normal: <200 cm H2O), Closing pressure 220 cm H2O (normal: <200 cm H2O), Cerebrospinal fluid (CSF) examination, Blood Negative Color Clear, Cells, Lymphocytes 0-2/mm3(normal: <5/mm3) Polymorphonuclear leukocytes None (normal: none), Protein 120 mg/dL (normal: 15-45 mg/dL), Glucose 50 mg/dL (normal: 50-75 mg/dL), Cytology Questionably malignant cells Serologic test for venereal disease Negative (normal: negative) Electroencephalography (EEG), Focal slowing of wave pattern in the posterior aspect of the cerebrum (normal: regular, rhythmic, electrical waves) Brain scan, Increase in radioactivity in the posterior aspect of the brain (normal: homogenous and minimal uptake of radioactive material) Cerebral angiography, Neovascularity (tumor vessels) in the posterior aspect of the brain, involving the cerebellum and the occipital lobe of the cerebrum (normal: normal carotid vessels and terminal branches) Magnetic resonance imaging (MRI) of the brain, Tumor of the cerebellum extending into the posterior cerebrum Computed tomography (CT) scan of the brain, A soft tissue mass arising out of the cerebellum and invading the occipital lobe of the cerebrum Diagnostic Analysis
The skull X-ray study ruled out the possibility of a skull fracture as the cause of the boy’s problem. Lumbar puncture excluded the possibility of meningitis or subarachnoid hemorrhage; however, the high protein count and questionable positive cytology indicated a possible neoplasm. An EEG located an area of nonspecific abnormality in the posterior an aspect of the brain. Brain scanning, cerebral angiography, and CT scanning indicated a posterior fossa tumor. These tests are mentioned in this case study mostly for historical interest. Under most circumstances, this young boy would have an MRI of the brain early in the diagnostic period. Because of these findings, the patient underwent a craniotomy. In many centers, this young boy would have a nonoperative stereotactic brain biopsy instead of a craniotomy. An invasive medulloblastoma was found to be arising from the patient’s cerebellum and involving the occipital lobe of the cerebrum. The tumor was unresectable. Postoperatively, the patient was given phenytoin (Dilantin) and radiation therapy to the involved area. A chemotherapy regimen was administered. The patients tumor did not respond to the therapy, and he died 4 months after the onset of the disease. Critical Thinking Questions 1. What are the major assessments that the nurse should make during seizure activity? 2. Why is the EEG a priority study for patients with seizure disorders? Include 2 scholarly references less than 5 years.
Sample Solution
