Overview
During the nervous system module, we have spent time exploring both the physiology of neurons and nerve tissues and the gross anatomy of the major divisions of the nervous system of the human body. To explore some of the clinical applications of managing injuries, disorders, and diseases of the nervous system (especially trauma to the spinal cord) we will complete another Case Study/Discussion activity.
During this case study, you will need to read the instructions and patient history below: Nervous System Case Study Summer 2024.docx
This contains a detailed description of the injury and the results of numerous assessments in the hospital. These assessments evaluate structural and functional injuries to nervous tissue and physiology. The case study focuses on an adventurer who has suffered a spinal injury as the result of a car accident. The short answer questions should allow you to assess how their symptoms and possible injuries are related to the structures and physiology of the nervous, skeletal and muscular systems.
For the assignment, you are required to answer all the questions at the end of the case study. Each question could be answered in a short sentence or two, but please read the question carefully and address it thoroughly. Please type your answers in a word document and submit to CANVAS here:
Do not include the questions or the case study in your word document. Including the questions or case study information will result in exaggerated Turnitin Similarity Index scores. This assignment should be done individually, and not from prepared answers (try to avoid regurgitating what the internet says) or group sharing. To add emphasis here, this is your own answers to the questions. Please refrain from trying to find common answers from the internet or your peers. If you are plagiarizing or cheating in anyway, then you will receive a ZERO on the assignment and be refer to academic affairs for further sanctions (up to F in the course).
The Case Study will be graded for accuracy and completeness of the answers to 5 multi-part questions.
The rubric used for previous case studies will be used here (each question can earn full, partial or NO credit).
The total assignment is 10 pts.
The case study will be due on Sunday at 11:59pm. NO Late submissions.
Case Study Nervous System: Joe Collins, a 68-year-old herpetologist, was driving his jeep through SE Asia looking for King Cobras. He crashed at high speed. He was wearing a lap-belt style seatbelt only. Paramedics arriving at the scene found him conscious and in a state of shock. He could not feel or control his legs fully. His head was sore, and had a bloody nose. He describes an intense pain in the neck (above his shoulders), but not the rest of his body. He was alert and could communicate with the paramedics and described the moments before the crash and his current condition. No obvious signs of concussion, and he could answer questions appropriately. He complained that he could not feel his legs. His pupils were equal and reactive to light. The only other injuries were a complete, compound break of the right femur near the knee and scrapes to his arms, hands and face. Joe could not feel the break to his femur (he was aware that it was broken due to the blood and protruding bone fragments).
His vital signs revealed a blood pressure of 115 / 104, heart rate of 87 beats per minute, respirations of 23 per minute. The blood loss from the fracture was minimal due to the rapid application of a tourniquet and bandaging by a good Samaritan and then by the EMTs. He was immobilized and transported via ambulance to the nearest hospital, this took approximately 4 hours from time of crash to arrival at the trauma center.
At the hospital, Joe was examined for reflex responses. His Biceps brachii m. and Triceps brachii had normal reflex response. Both of his legs were non-responsive to stimuli and had no reflex response for Quadriceps femoris or Gastrocnemius m., nor the soles of his feet. His sense of feeling (perception of sensory stimuli) ended at an imaginary line drawn across his chest approximately intersecting the navel (umbilicus) (i.e. everything below felt numb). He had some sensation on his thighs but could not localize touch or describe texture with any consistency. He was able to feel the need to urinate but was catheterized at the hospital. He was able to raise his shoulders and tighten his Biceps brachii m. slightly in each arm and could raise both arms against gravity. His lower extremities were flaccid, despite attempts to move them.
Vital signs were taken again at the hospital and were as follows: blood pressure= 103 / 64; heart rate= 74; respiratory rate= 29 (with shallow breathing). His oral temperature was 100.5 degrees F. His color was gray, and his skin was warm and dry to the touch.
A fractured vertebra was detected using _____, which also showed decreased lung volume upon inhalation. Blood tests were normal, except for respiratory acidosis (blood pH = 7.25).
Based on diagnostic evidence and imaging a fracture in the _ region of Joe’s vertebrae was detected.
Joe was transferred to intensive care and his condition was stabilized. A physical examination four days later revealed normal vital signs and no change in his arm strength or sensation, but also marked spasms and exaggerated stretch reflexes of the lower extremities. He also had urinary incontinence which required the placement of a Foley catheter connected to a urine collection bag.
Questions:
- Complete the two blanks: What imaging technique would best be used to detect a fractured vertebra? Which vertebral region is Joe’s injury located? (2pts)
- Why did Joe lose all sensation from the umbilicus down? Why might he still be able to detect some sensation on his thighs, but could not control the leg? (2pts)
- At no point was Joe’s respiration impacted, what is the primary muscle of respiration? What cranial nerve (name and number) innervates the primary muscle of respiration? (2pt)
- Where (which vertebra?) do the nerve roots contribute neurons to the nerve in Q3? Why was it not impacted by Joe’s fracture? (2pts)
- Why did Joe suffer from urinary incontinence? Address this in terms of voluntary and involuntary muscle control. (2pts