Stroke Patient that Suffered a Pontine Infarction

Stroke
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Stroke
The onset of neurological dysfunction resulting from abnormalities in the cerebral circulation, also known as stroke, may have catastrophic effects on an individual, including disabilities among adults and loss of life in extreme cases. Such is the case for a 59-year-old American male patient who presented to the emergency room with left-sided weakness, cerebellar ataxic dysarthria, dysphonia, instability, and incoordination. The patient was taken to the emergency department upon waking up with mild weakness on his left side, affecting both his lower and upper limbs. He also experienced unsteadiness on his feet and slurred speech when he was presented to the emergency room. However, the patient did not report or exhibit any sensory symptoms, headache, seizures, or any facial weakness. The patient’s medical history indicates that he was diagnosed with hypercholesterolemia, hypertension, and Type II diabetes mellitus upon turning 50 years old. Treatment for the outlined condition comprised hypoglycemic agents, with medications such as aspirin, metformin, and bezafibrate. A non-contrast brain CT scan on the patient established that he suffered a lacunar infarct, as revealed by a decreased attenuation in the anterior limb of the right internal capsule. Subsequent examinations revealed deteriorating neurological effects, including left-sided facial weakness while smiling, suggesting brainstem pathology. The overall evaluation established a case of acute isolated ischemic pontine infarction. According to the CDC, ischemic strokes account for approximately 87% of all the recorded cases of strokes in the United States. However, pontine infarct strokes account for only 7% of all ischemic cases, thus making for rare events CITATION Cen221 \l 1033 (Centers for Disease Control and Prevention, 2022). Risk factors for pontine ischemic strokes include both small vessel and large vessel diseases CITATION Var14 \l 1033 (Varsou, 2014). The enlargement of the pontine lesions, as is the case for the 59-year-old patient, leads to neurological deterioration evidenced by the outlined signs and symptoms. Provided herein is a detailed evaluation of the patient’s case study, highlighting the implications of the neurological condition on the individual and caregivers while proposing evidence-based treatment plans and appraising how a team approach would help achieve the desired patient outcomes for the condition.
ICF Model-based Discussion of the Condition’s Implications
The patient’s assessment and evaluation at the emergency department and subsequent evaluations in the stroke department reveal diverse implications on his normal body functioning and resultant impairments or disability. Among the body functions affected by the neurological condition include normal motor functioning due to the instability of the patient’s feet as one of the symptoms recorded for the patient. The unsteady feet curtail his ability to move around and carry out his daily operations, such as attending to the duties and responsibilities of his livelihood. He also suffers weakness in his lower and upper limbs, affecting his ability to perform simple actions such as carrying or moving objects from one point to the other. The effects of the neurological conditions on the outlined body functions render him partially impaired or disabled, thus compromising his quality of life. The neurological dysfunctions affect the patient’s participation in normal daily activities such as maintaining interpersonal interactions and relationships with loved ones and co-workers or colleagues. For instance, the patient suffered from slurry speech making it difficult to communicate effectively with loved ones or engage in daily interactions with other people. Difficulties in communication and impaired mobility limit his ability to carry out general tasks such as his occupational demands and thus exposing him to dependency on family members and other individuals in society. Fortunately, the patient did not experience any mental or cognitive dysfunction. It remained possible for him to continue learning and apply acquired knowledge in carrying out activities that require their mental or cognitive input. The neurological condition will negatively affect the patient's community, society, and caregivers. The individual suffering a pontine stroke may depend on his family members and caregivers for support in carrying out basic activities, exposing them to mental health disorders from the developed feelings of helplessness and even loneliness (Creasy et al., 2015). Victims of neurological conditions may also have to use advanced technological appliances to enhance their abilities to perform daily activities and assist with mobility needs. Such appliances may create heavy financial burdens for individuals and their family members or caregivers. Coupled with post-stroke care, the economic burden is exacerbated and a majority of families are often rendered helpless in such situations (Rajsic et al., 2019).
The neurological condition’s implications on the patient’s bodily functions and his ability to carry out normal daily activities are characteristic of the side effects of a pontine stroke. Pontine stroke, also known as a pontine cerebrovascular accident (pontine CVA), is one of the extreme cases of ischemic strokes occurring in the brain stem CITATION Lin09 \l 1033 (Ling, 2009). It affects the metencephalon or pons region of the brain stem and thus affects the central nervous system. The pons region of the brain stem is responsible for controlling various life functions such as muscle coordination, speech, and even vision CITATION Yan20 \l 1033 (Yang, 2020). Abnormalities in the cerebral circulation due to diffusion restriction in the anterior pons make for one of the risk factors for a pontine stroke characterized by the sudden onset of the outlined neurological deficits in a patient CITATION Yan20 \l 1033 (Yang, 2020).
It should be noted that pontine strokes are a rare occurrence and only account for 7% of all ischemic cases (Agarwal et al., 2011). However, they may have progressive symptoms, as witnessed in the case study where the patient develops neurological side effects a few days after the stroke. The deterioration of the neurological effects shows a strong correlation with the enlargement of the pontine lesions in a patient, even in the absence of basilar thrombus (Li et al., 2015).
Treatment Plan
Like any other ischemic stroke, the treatment and management of the patient begin with the stabilization of the airway, breathing, and circulation systems. Since the patient was presented to the emergency room within 4.5 hours of the onset of the symptoms, a thrombolytic therapy using intravenous alteplase would be an appropriate stabilization approach CITATION Xia17 \l 1033 (Xia, 2017). The treatment and management plan then identifies the type of pontine cerebrovascular accident or pontine infarct stroke he is suffering. The next stage of the treatment plan will entail reversing the extent of penumbra tissue adjacent to the infarcted region in the brain stem. The third stage of the plan will involve preventing further complications and deterioration of the neurological complications. The final stage of the treatment and management plan would facilitate the patient’s body functioning improvement. At the initial stage of the treatment plan, the patient went through an examination using the Medical Research Council (MRC) muscle power grading scale to evaluate the severity of the patient’s weakness in the uppe...