Topic 5 Lectorial - Central Nervous System PDF

Topic 5 Lectorial – Central Nervous System (9 cases) Case 1 – The mystery injury A 23 year-old man was rushed to emergency after suffering a stab wound to his back. The wound was bleeding heavily and appeared to be very close to his vertebral column on the left side. The man was stabilised and the...

Topic 5 Lectorial – Central Nervous System (9 cases) Case 1 – The mystery injury A 23 year-old man was rushed to emergency after suffering a stab wound to his back. The wound was bleeding heavily and appeared to be very close to his vertebral column on the left side. The man was stabilised and the wound was treated. However, during his recovery, it was observed that the man showed no response to pinpricks on the right side of his body from just below his nipple. He also showed no response to light touch on the left side of his body from just below his nipple, and seemed to be unaware of the position of his left leg or foot without looking. He was unable to move his left leg against resistance. What spinal tracts must be affected to produce the deficits described? Draw a 'map' of the spinal tracts involved and use this to figure out at what level of the spinal cord the injury/injuries must be. Can a single lesion account for all these effects? Case 2 – The travelling thrombus If a thrombus from the common carotid artery broke off and was carried up the internal carotid, in which cerebral artery would it be most likely to end up and why? Case 3 – Reading the signs An 80 year-old man was brought into the emergency room with the following signs/ symptoms: Sudden-onset weakness of facial, arm, trunk and leg muscles on the right side, with the muscle weakness being much more severe in the face and arm on that side. Right-sided loss of sensation and deviation of the eyes to the left. Inability to speak. What is likely to have caused the sudden onset of these symptoms? Being as specific as you can, identify the likely location of the problem? Explain your reasoning for this location. A few days into recovery, the man starts to develop spasticity in his right arm and leg. When the nurse tries to extend his arm, the resistance to the movement increases. Explain why this is occurring. Case 4 – Territories The most common form of ischaemic stroke results from blockage (occlusion) of the middle cerebral artery. In these strokes, the muscle paralysis produced is much more severe in the upper limbs and face than it is in the lower limbs. Why would this be?  Case 5 – Visual fields The diagram on the left shows the path that light takes in order to be processed as vision, when we view a scene with both our eyes. Where in the nervous system is the problem likely to be, to cause the loss of vision shown on the right? Case 6 – Video evidence You will be shown two videos during the lectorial. Based on what you see and hear in these videos, figure out where in the brain damage has occurred in order to produce the deficits for each patient. Case 7 - Socially unacceptable David suffered damage to a part of his brain as a result of trauma. Before the trauma, David was a motivated, hard-working midwife, who was viewed by his employers as reliable and mature in his behaviour. After the trauma, he became unmotivated and easily distracted. He was unable to keep his job, as he often failed to turn up for his shift, and didn’t finish assigned tasks. He had also lost his ability to problem-solve, and tended to leave the decision making to others when problems arose. The final straw as far as his employer was concerned was that he had started to display inappropriate behaviour, such as swearing loudly in the presence of patients and visitors, and laughing when giving people bad news. Based on this information, which area of the brain is likely to have been damaged by the trauma? Case 8 – Spinal nerve, root or spinal cord? Jarrod has a serious infection in their left foot, but is not reporting any pain. They can move their foot voluntarily, but has a poor withdrawal reflex. Which part of their nervous system is damaged to cause this sign & symptom profile? Case 9 – Whose leg? Two people are being examined by a neurologist for muscle paralysis in one leg. One of them has suffered damage to the spinal nerve at L4, and one has suffered compression of the motor neurons leaving the brain. Based on the clinical information, work out which injury belongs to each patient. Patient A: Stretch reflexes absent Voluntary movement in leg absent No muscle tone in leg Patient B: Stretch reflexes +4 (hyper-reflexia) Voluntary movement in leg absent Excessive muscle tone in leg