Neurological Case

Aaron is a male patient aged 63 who has type 2 diabetes mellitus, who has a height of 174cm, weighs 145kg, and his waist circumference is 160 cm [Range: <94cm]. Although he was diagnosed with hypertension approximately 5 years ago, this has been reasonably well controlled with medications. He has not adhered to the dietary and lifestyle choices suggested for him by his dietician, and most of his recent blood tests show persistent hyperglycaemia. He presents with complications associated with his diabetes, which have resulted in" rel="nofollow">in him developin" rel="nofollow">ing a wound on the sole of his left foot which wasn’t treated until it was a substantial wound that became severely in" rel="nofollow">infected and ulcerated. Unfortunately, complications from this severely in" rel="nofollow">injured wound have resulted in" rel="nofollow">in the need to have his left foot amputated at the level of his ankle.   Question 1. Discuss the effects of his persistent hyperglycaemia on the neurons of his left foot, in" rel="nofollow">includin" rel="nofollow">ing why his wound wasn’t treated earlier (focus your reasonin" rel="nofollow">ing on pathophysiology, avoidin" rel="nofollow">ing personal choice issues such as him not wantin" rel="nofollow">ing to go to the doctor). In your answer, in" rel="nofollow">include discussion on neuronal requirements for glucose and oxygen. [4 marks] Question 2. Discuss his risk for the development of stroke, ensurin" rel="nofollow">ing that you relate this to relevant processes discussed in" rel="nofollow">in question 1 above. In your answer, in" rel="nofollow">include which type of stroke he would be most likely to suffer, and justification of why you have selected that type. [2 marks]. Question 3. After his amputation, discuss the pain" rel="nofollow">in which he may experience relatin" rel="nofollow">ing to that procedure, in" rel="nofollow">includin" rel="nofollow">ing relevant brain" rel="nofollow">in in" rel="nofollow">involvement. In your answer, in" rel="nofollow">include an explanation of the nociceptor in" rel="nofollow">injury (presumin" rel="nofollow">ing that the affected nociceptors would be severed a long distance from their cell bodies). [4 marks].