When evaluating a 15 year-old for knee pain, it is important to collect data about the specifics of the pain, such as location, type (dull, sharp or burning), duration and whether there are any associated factors (such as posture during activity). Additionally, the patient’s medical history should be assessed in order to determine if there is an underlying condition that may be causing or contributing to the knee pain. This can include previous injury/surgery, diabetes or other metabolic disorders and inflammatory conditions. The physical exam should include inspection of both knees for signs of effusion/swelling, redness/warmth indicating infection or inflammation and deformities. Palpation should evaluate tenderness on palpation over various structures around the knee joint such as muscles tendons and ligaments. Special maneuvers such as McMurray’s test can also be used to assess for meniscal tears (Stambough et al., 2019). Further testing may be required depending on initial findings which could include imaging studies such as x-rays to evaluate joint alignment and MRI scans for soft tissue pathology.
Using these assessments helps differentiate between mechanical causes of knee pain from inflammatory causes or referred sources of pain from elsewhere in body. Five possible differential diagnosis for this case study are anterior cruciate ligament (ACL) tear/injury; patellar tendonitis; osteoarthritis; Osgood Schlatter disease – a traction apophysitis affecting tibia tubercle; juvenile rheumatoid arthritis – an autoimmune disorder affecting joints due to production of autoantibodies against self proteins (Murphy & Laxmanan 2018).
al aspect it can be seen that in organic amnesia the memory disorder seems to preserve personal identity, basic semantic knowledge and procedural skills, while psychogenic amnesia includes the loss of personal identity and very basic semantic and procedural abilities (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). In the neuroradiological sense, organic amnesia seems to have a physical cause that is consistent with cerebral damage affecting cortical and/or subcortical areas known to be important in memory, while in psychogenic amnesia damage to the cerebral areas important in memory does not have a clinical or neuroradiological basis (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). Looking at the neuropsychological aspect it is easy to see that in organic amnesia there is documented impairment in declarative episodic memory with preservation of other memory functions and general intelligence, while in psychogenic amnesia declarative episodic memory is affected along with general intellectual dysfunction (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). In the psychopathological sense, organic amnesia shows no predisposing psychiatric conditions before the onset of the condition, while in psychogenic amnesia a psychopathological condition is existent before the onset of the condition (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). Although psychogenic and organic amnesia are on opposite sides of the same spectrum it is easy to see that they revolve around the same concepts.
Regardless of what type of amnesia a patient may have it all has to start somewhere. The cause of amnesia seems to have a wide range and is unique to each patient. It can range from a traumatic event in psychogenic amnesia to traumatic brain injury in organic amnesia. In one article it was outlined that amnesia could be caused by various circumstances including aneurysms, anoxia, cerebrovascular accidents, herpes simplex encephalitis, and even Wernicke-Korasakoff syndrome in the case of organic amnesia (Duff, Wszalek, Tranel, and Cohen, 2008). Another article even mentions how amnesia in various patients have been caused by fencing accidents, bilateral lesions, car accidents, and even lesions of other cortical areas (Siegert and Warrington, 1996). It has also been documented that psychological trauma can trigger the onset of amnesia in a psychogenic sense. In this case the fear of not being able to pay a friend back on an agreed date lead to the loss of memory for a 38-year-old man in which he was unable to remember any event after that date (Kumar, Rao, Sunny, and Gangadhar, 2007). It was later found that he had no evidence of brain injury, but showed psychological stress immediately before his problems revealed itself (Kumar, Rao, Sunny, and Gangadhar, 2007). Moving forward into various case studies and the depiction of Anterograde Amnesia in Before I Go To Sleep, it is important to understand all of the topics encompassed in amnesia that has been discussed.
Case Studies
The most compelling evidence that can be found on the effects of Anterograde Amnesia on someone’s life is the actually cases studies of individuals living with the condition. Through the case study of H.M. psychologists were able to determine important key brain structures that seemed to play a role in memory (Draaisma, 2013). In the case studies of N.A., R.B., and T.W. the world was able to see just how each physical accident lead to Anterograde Amnesia with differing degrees of Retrograde Amnesia (Siegert and Warrington, 1996). For Angie, Anterograde Amnesia did not stop her from achieving her goals, but did present her with a few challenges here and there. Leonard, on the other hand, was not as lucky as Angie and seemed to explore a more criminal path as a result of his amnesia. Although, these individuals differ in how the condition developed and what has happened to them since the condition, it is easy to see that they their lives, in some way, has been changed because of their condition.
The first case study that is important to mention is the case of Henry Molaison who is also known as the famous H.M. (Draaisma, 2013). In 1953, H.M.’s life changed forever when he underwent a surgery to treat his epilepsy which lead to major memory loss (Draaisma, 2013). During this surgery subcortical parts were removed from both hemispheres of the brain (Siegert and Warrington, 1996). The study on H.M. brought to light many discoveries when it came to the brain. Throughout this case it was discovered that the amygdala and the hippocampus were important brain structures when it came to memory processes (Draaisma, 2013). This study also provided the world with proof that there was a distinction between short-term and long-term memory where short-term memory stores information for what is being worked on no
