Case Studies
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 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 a 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 patient’s tumor did not respond to the therapy, and he died 4 months after the onset of 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?