Nervous System assignment

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 hes 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 hes 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 thats 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 patellae Achilles (hyper) reflexes in the right lower extremity -Positive Babinski sign on the right foot -Abnormal cremasteric reflex in the right groin regionGeneral 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 radiogram was performed and showed a narrowing of the carotid at about mid-way.Questions: 1. What abnormality does the radiogram show? What kind of lesion a “narrowing” may represent? 2. Relate the findings in the radiogram to the patients 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 hyperparathyroidism 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 170/100Neurological exam: Showed left-sided hemiplegia (paralysis on one side) and anesthesia (numbness on one side)Question: 1. What are pertinent aspects of the patients past medical history that are risk factors for his current medical problem? 2. Damage to which lobe(s) accounts for the patients 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 contra lateral (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?