EXSC 224 Midterm: Exam 1- Sample Case Studies

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1. James was crossing the street when he was struck by a car. When he arrived at the
hospital the ER physician was able to determine that James suffered a partial
transection on the right side of his spinal cord at T12. Would James perceive pain in
his right hand? How about his Right foot? Justify your answers.
Yes, he could perceive pain in his right hand because the injury is below the cervical
spinal nerves, so the arms and hands will be unaffected. He could also feel pain in his
right foot because the pain/temperature tracts ascend down the contralateral side of
the spinal cord. He would only lose touch in his right foot.
2. Matilda went to bed after a long day of hiking. She woke up in the morning with
splitting headache. When she tried to get out of bed she noticed that she had extreme
weakness in her left arm and leg. However, she could feel the sheets on her bed. After
several months of therapy she still had significant weakness on her left side, but also
experienced spastic paralysis which was very noticeable in her arm. Was this an
upper or lower motor neuron injury? Where do you think the injury occurred? Justify
you answer.
This was an upper neuron injury. Since she has touch, but not movement, and touch
travels on the same side of the spinal cord as movement, it’s probably not a spinal
cord injury. The injury most likely took place in the motor cortex, such as a stroke.
3. Mr Reinhard woke up one morning in the hospital and was able to move only the
limbs on the right side of his body. He could feel touch but not pain on the left side.
What level was the injury? Would he experience spastic or flaccid paralysis on the
affect side?
The level of the injury was somewhere in the C2-C4 range, since the arm is also
affected. Since the entire left side is affected, it suggests and upper neuron injury and
he will therefore experience spastic paralysis.
4. Mrs Smith fell down the stairs and was rushed to the hospital. She was in a great deal
of pain except her left leg, where she had no pain or touch and was unable to
voluntarily move her muscles. Interestingly she could feel pain and touch and
voluntarily move her Right leg. Please describe the injury. Would experience spastic
or flaccid paralysis in this limb?
The injury must have been a lower neuron injury because she lost motor, pain and
temperature, and touch on one leg, but not in the other. She would experience flaccid
paralysis of the leg.
5. A stroke is a neurological injury due either to a blockage or a rupture to a blood
vessel supplying one or more portions of the brain. Explain how this sudden decrease
in blood flow and nutrients (including oxygen) can lead to neuron death.
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