Notes from the Office of Dr. Strange
**Patient: James Buchanan "Bucky" Barnes
**Chief Complaint:**
The patient presents with persistent headaches, nausea, tremors in the right hand, and recent onset of seizures.
**History of Present Illness:**
Mr. Barnes reports worsening headaches over the past several weeks, accompanied by episodes of nausea and occasional dizziness. He also notes a tremor in his right hand, which has progressively worsened. Recently, he experienced a seizure, prompting a referral by Dr. Raynor for further evaluation.
**Medical History:**
- Complex post-traumatic stress disorder (CPTSD) related to extensive combat experience, imprisonment, and exposure to Hydra's experimental treatments.
- Status as a super soldier with enhanced physical capabilities due to the Super Soldier Serum.
- History of significant physical trauma, including injuries sustained during military service and subsequent events.
**Social History:**
Mr. Barnes is a veteran with a complex medical and psychological history, including prolonged exposure to trauma and severe psychological stressors.
**Family History:**
Limited information is available
**Current Medications:**
None reported. Patient is a super soldier causing resistance to pharmaceuticals.
**Allergies:**
No known drug allergies reported.
**Physical Examination:**
- Vital signs within normal limits.
- Neurological examination reveals:
- Mild impairment in short-term memory recall.
- Right-sided tremor, particularly noticeable during fine motor tasks.
- Normal muscle strength and reflexes bilaterally.
- No focal neurological deficits appreciated.
**Assessment and Plan:**
- **Initial Impression:**
- Mr. Barnes presents with a constellation of symptoms concerning for a neurological disorder. Differential diagnosis includes:
- Intracranial mass lesion (e.g., glioblastoma).
- Neurodegenerative disorder.
- Post-traumatic sequelae.
- **Immediate Plan:**
- Order CT scan of the brain to further evaluate for structural abnormalities, given contraindication for MRI due to the presence of a vibranium arm.
- Perform EEG (electroencephalogram) to assess brain wave activity and detect any abnormal patterns suggestive of seizure activity.
- Obtain blood tests, including complete blood count (CBC), comprehensive metabolic panel (CMP), and inflammatory markers to rule out metabolic causes and assess overall health status.
- **Additional Considerations:**
- Discuss findings with the patient, considering the impact of CPTSD and super soldier status on his symptoms and overall health.
- Refer to additional specialists as needed for further evaluation or treatment
- Initiate symptomatic management as needed (e.g., antiepileptic medications for seizure control, pain medication for headaches).
- Continued psychological support and counseling, acknowledging the complex interplay of neurological and psychological factors.
**Follow-Up:**
Arrange a follow-up appointment to discuss imaging and EEG results and formulate a definitive treatment plan incorporating a multidisciplinary approach to address both neurological and psychological aspects.
Dr. Stephen Strange, MD, PhD
Neurosurgeon