Nervous System Case Study

Case Study 1 Two physicians are finishing their rounds when a paramedic brings a patient in the emergency room. The senior paramedic, Jim Morrison, reported that the patient was swimming at the local quarry and did a forward flip into the water, striking some submerged rocks. “Which part of his body struck the rocks?” asked Dr. Carter. “He was in a hyperflexed-tucked-position when he hit the rocks, lacerating the right side of his head and neck and upper back. The patient indicated he had severe pain upon impact and loss of sensation and movement in his arm and leg. He may have lost consciousness, but he’s not sure. He also complains of a severe headache, dizziness, and nausea. When we arrived at the scene we immobilized, stabilized and transported him immediately,” Jim explained. Looking at the patient, Jim continued. “His name is Mike Smith, and he’s 22 years of age. His vital signs include slightly lowered blood pressure (100/70), heart rate of 75 beats per minute, respiration normal, and he is conscious and alert.” As the patient was being prepped for examination, Dr. Carter and Dr. Green discussed how they should approach their evaluation. Dr. Carter started by saying,”After seeing the head wound and the amount of blood loss, and hearing his complaints, I want to confirm my suspicion that this patient has a brain injury.” Dr. Green disagreed: “I think that the other signs and symptoms indicate a spinal cord injury, and that’s what we should investigate.” The following table summarizes the findings of the evaluation, which included a physical exam, X-rays, magnetic resonance imaging (MRI), and neurological tests.
Summary of Diagnostic Testing for Mike Smith
Sensory Testing -Decreased sensation to touch, pressure, and vibration in the right upper/lower extremities -Decreased temperature discrimination (cold vs. warm) in the left upper/lower extremities
Motor Testing -Decreased strength and movement of the right upper/lower extremities during muscle testing -Decreased strength and movement of left abdominal muscles -Absence of triceps and biceps reflexes in the right upper extremity -Abnormal response of patellar, Achilles (hyper) reflexes in the right lower extremity -Positive Babinski sign on the right foot -Abnormal cremasteric reflex in the right groin region
General Examination -Abnormal pupil response of right eye (constriction) -Other vital signs within normal limits -Cognitive testing normal (counts backward from 100 by 7s; knows name, date, place) X-Ray and MRI Examination -No fractures present in the skull -Fracture in the 7th cervical vertebra -Significant swelling present in the spinal canal in the C7-T2 region Spinal cord appears to be intact
Which of the Doctors (Carter or Green) are correct with the diagnosis. Please, explain why you chose one or the other.

Case Study 2: Gene Matson, a 75-year old male, was brought to the hospital by his son following the acute onset of left-side numbness and weakness that began one hour prior to admission. His son stated that two weeks prior to admission Gene had a single, 12-hour episode of garbled speech and left-side and arm weakness. Following the first episode, the right carotid angiogram was performed and showed a narrowing of the carotid at about mid-way.
Questions: 1. What abnormality does the angiogram show? What kind of lesion a “narrowing” may represent? 2. Relate the findings in the angiogram to the patient’s past and present neurological problems in terms of: a. How the vascular lesion could lead to neurological problems. b. What specific blood vessel in the brain must have been affected by the process “a” to account for his symptoms.
Past medical history of Mr. Matson: The patient has a history of moderate hypertension treated with calcium channel blockers. History of hypercholesterolemia also. Mr. Matson smoked one pack of cigarettes per day for forty years, and drank approximately four beers per day for severe years.
Physical Exam: Temperature: 37 degrees Celsius Pulse 72 Respiration rate: 12 Blood pressure 170/100
Neurological exam: Showed left-sided hemiplegia (paralysis on one side) and hemianesthesia (numbness on one side)

Question: 1. What are pertinent aspects of the patient’s past medical history that are risk factors for his current medical problem? 2. Damage to which lobe(s) accounts for the patient’s sensory and motor deficits? 3. Give an explanation for why the damage to the right side of the brain may cause sensory and motor problems on the contralateral (opposite) side of the body. 4. Is there a surgical procedure that might have prevented the current episode? if so, what is the procedure called?