| Course | PA 528 Comprehensive Clinical Module Neurology |
|---|---|
| Week | 8 |
| Paper type | Neuroimaging request brief |
| Length | About 720 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 528 Week 8
Neuroimaging Request Brief: MRI of the Right Perirolandic Cortex With and Without Gadolinium After B.T.'s New Focal Seizures, Cleared First for an MR-Conditional Pacemaker and Written Around One Answerable Question
Student Name
Chamberlain University
PA 528: Comprehensive Clinical Module Neurology
Instructor Name
Month Day, Year
Neuroimaging Request Brief: MRI of the Right Perirolandic Cortex With and Without Gadolinium After B.T.'s New Focal Seizures, Cleared First for an MR-Conditional Pacemaker and Written Around One Answerable Question
Safety Before Anything Else
Implanted device: dual-chamber pacemaker placed in 2021 for sick sinus syndrome. The device and leads are MR-conditional according to the manufacturer's card in B.T.'s wallet and the device clinic's record; no abandoned leads; implanted more than six weeks ago. Plan, following the HRS consensus statement: device clinic to program an MRI mode before the scan and restore settings after, with monitoring of rhythm and oxygen saturation throughout and staff able to treat an arrhythmia present (Indik et al., 2017). B.T. depends partly on pacing, so an asynchronous pacing mode will be chosen by the device team. No other metal: B.T. worked as a bus driver, never as a welder or machinist, and has no shrapnel or aneurysm clips.
Kidney function for contrast: eGFR 58 mL/min/1.73 m2 last week. A macrocyclic gadolinium agent is acceptable at this level.
The Clinical Summary
Ischemic stroke in the right middle cerebral artery superior division in March, with residual left arm weakness. Two seizures in May beginning with tingling and jerking of the left hand, one evolving to a bilateral convulsion, with 40 minutes of worse left arm weakness after it. Prior MRI in March showed the acute infarct. On apixaban since March for atrial fibrillation found on device records, as the secondary prevention guideline recommends after a cardioembolic stroke (Kleindorfer et al., 2021).
The Target
The right frontal and parietal cortex around the central sulcus, at and beyond the edges of the March infarct, and the whole brain for comparison.
The Question
Is there a new lesion in or near the right perirolandic stroke, such as bleeding into the infarct, a new infarct, or a mass, that explains the new focal seizures, or only the expected scar of the March stroke?
Reasons Attached to Choices
MRI rather than CT: MRI shows small new infarcts, old and new blood products and subtle masses far better than CT, and B.T.'s device allows it under the conditions above. Susceptibility-weighted images: to look for blood products in the infarct, important because B.T. takes an anticoagulant. Diffusion-weighted images: to look for a new infarct. With and without gadolinium: to look for enhancement that might suggest a mass or abnormal vessels rather than scar. The guideline on a first unprovoked seizure supports brain imaging as part of the evaluation of adults with a first seizure (Krumholz et al., 2015).
What a Normal Result Would Mean
A study showing only mature scarring where the March infarct was, with no new blood, no new infarct and no enhancing mass, would support a diagnosis of late post-stroke seizures arising from the scar. That would not mean the seizures need no treatment; a late seizure after stroke carries a high risk of recurrence, and the neurologist has already started levetiracetam. It would mean that no new process needs separate treatment, that apixaban can continue, and that no repeat imaging is needed unless the seizure pattern changes.
What an Abnormal Result Would Change
Bleeding into the infarct would require reviewing the anticoagulant. A new infarct would prompt a check of whether apixaban is being taken correctly. An enhancing mass would lead to a neurosurgical opinion. Each finding has a plan, which is why the scan is worth the device preparation.
Urgency
Routine within two weeks, since B.T. is stable on levetiracetam and has had no further seizures. Same-day CT would replace it if B.T. developed a new deficit, severe headache or a seizure that did not stop.
Communication With the Device Clinic
The device clinic was contacted the day the request was written. The clinic confirmed the model numbers, booked a technician for the scan slot and asked radiology to use a scanner and settings within the device's labeling. B.T. was told to bring the device card and to expect the pacemaker check before and after.
References
Indik, J. H., Gimbel, J. R., Abe, H., Alkmim-Teixeira, R., Birgersdotter-Green, U., Clarke, G. D., Dickfeld, T.-M. L., Froelich, J. W., Grant, J., Hayes, D. L., Heidbuchel, H., Idriss, S. F., Kanal, E., Lampert, R., Machado, C. E., Mandrola, J. M., Nazarian, S., Patton, K. K., Rozner, M. A., . . . Woodard, P. K. (2017). 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm, 14(7), e97-e153. https://doi.org/10.1016/j.hrthm.2017.04.025
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Jr., Turan, T. N., & Williams, L. S. (2021). 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke, 52(7), e364-e467. https://doi.org/10.1161/STR.0000000000000375
Krumholz, A., Wiebe, S., Gronseth, G. S., Gloss, D. S., Sanchez, A. M., Kabir, A. A., Liferidge, A. T., Martello, J. P., Kanner, A. M., Shinnar, S., Hopp, J. L., & French, J. A. (2015). Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 84(16), 1705-1713. https://doi.org/10.1212/WNL.0000000000001487
Reading the PA 528 Week 8 instructions
The final week asks for a compact imaging request. Start with safety: implanted devices, metal, kidney function for contrast and allergies, and the plan that makes the study safe. Write a clinical summary of two or three sentences containing only what changes the reading: deficits with sides, the speed of onset and any prior study. Name the target as a region rather than an organ. Write the question as one sentence a report could answer directly. Give the modality, sequences and contrast choice, each with its reason. State what a normal result would mean and what each abnormal result would change. Set the urgency and say what would make it more urgent. Many sections use a form instead of paragraphs, so follow yours. Cite the safety and clinical guidance you rely on.
Inside the PA 528 Week 8 example
The brief opens with a dual-chamber MR-conditional pacemaker, device clinic programming and monitoring under the HRS consensus, no other metal and an eGFR of 58 allowing a macrocyclic agent. The clinical summary covers the March superior division stroke, two May focal seizures and apixaban for device-detected atrial fibrillation, citing the secondary prevention guideline. The target is the right perirolandic cortex at the infarct's edges. The question asks whether a new lesion or only scar explains the seizures. Reasons are given for MRI over CT, susceptibility and diffusion sequences and gadolinium, citing the AAN first seizure guideline. Normal and abnormal results are each tied to a decision, from continuing apixaban to a neurosurgical opinion. Urgency is routine within two weeks with triggers for same-day CT, and the device clinic coordination is recorded.
Reading the PA 528 Week 8 grading rubric
The marks on this request start with safety. A request that omits an implanted device, metal screening or kidney function loses the most, because the study may not be possible. Faculty then grade the question: a vague request such as rule out pathology earns little, while one answerable sentence earns full credit. The target should be a region. Each choice of modality, sequence and contrast needs a reason, and unexplained choices are marked down. Stating what a normal result would mean is weighted heavily, since it shows the request is worth making. Abnormal results should each lead to a change in plan. Urgency must be set with triggers. Brevity matters on a form, and cited safety guidance completes the expected content.
PA 528 Week 8 help: mistakes that cost points
Imaging requests often lose marks for burying the question and leaving safety to the radiology department. Give us the case and the study you have in mind, and your request would open with device, metal and contrast safety, follow with a short summary and a regional target, and state a single answerable question. Each modality and sequence choice is given a reason. The meaning of a normal result and the change each abnormal result would bring are spelled out. Urgency and escalation triggers are set. If your section uses a request form, the content fits its fields. Verify device details and kidney function from your own case before relying on the safety section.
Get a PA-528 Week 8 example written to your instructions
Send the order form or the assignment sheet, the case as your classroom words it, and the rubric. A custom neuroimaging request brief is written to those fields and returned inside 24-48h, the first one free. Tell us whether your section wants the justification paragraph, because some ask for the form alone and it changes the whole document.
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PA 528 Week 8 questions, answered
Do I need to know what the study will show?
No, and a brief that predicts the result has stepped outside its job. The document commits to a level and a question, not to an answer. An example makes the suspicion explicit as a suspicion, states what would confirm it and what would not, and leaves the report to the person reading the images.
Does the example choose between CT and MRI for me?
It shows a choice being argued, which is what the marking looks at, and it names the one your case supports with a line of reasoning attached. Because this is coursework rather than care, the example is written as a teaching document on an invented case and is not a recommendation for any real patient. Your instructions govern which modality options are on the table.
My section wants the request written on a hospital order form. Can that be matched?
Yes. Send the form, as a file or a photograph, and the example is written into its fields in the order they appear rather than as free prose that you then have to cut apart. Where a field has no counterpart in the case, the example fills it with an explicit note rather than leaving it blank, since blanks are what get marked.
Where can I find a free PA 528 Week 8 sample paper?
The full PA 528 Week 8 imaging request is on this page, an MRI after new focal seizures cleared first for an MR-conditional pacemaker.
What would a normal MRI mean in the PA 528 Week 8 sample?
Only scar from the March stroke would support late post-stroke seizures, so no new process needs treatment and apixaban continues, though the seizures still need medicine.