ND Assignment 6.docx - ND Assignment 6 Case 6.1:...

ND Assignment 6
Case 6.1: 27-year-old man riding his motorcycle is hit by a motor vehicle traveling at 55 mph. Although
he was wearing his helmet and was initially alert and oriented with multiple abrasions and scalp
lacerations, en route to the hospital with paramedics his level of consciousness began to decline and he
became more difficult to arouse. Upon waking, he was oriented to person, place, and time and followed
simple commands. There is mild weakness on his right upper and lower extremities (4/5). His reflexes
are asymmetric with right patellar reflex (3) and an extensor-plantar response (Babinski reflex) is present
on the right. X-ray shows no fractures and on his way to CT he becomes progressively unresponsive and
only opens his eyes to painful stimuli. He can talk, but is disoriented. His pupils are asymmetric with right
at 6mm and left at 4mm.
Questions Case 6.1: what is the most likely lesion given the time course and waxing and waning
consciousness? What is the difference between hemiparesis and hemiplegia? What scale describes levels
of consciousness, and where would this subject be on the scale initially, while en route to ER, and to the
CT? Why is this not likely a purely vascular accident? Why are his pupils asymmetric later in the course of
the day?
Hemiparesis is a slight weakness — such as mild loss of strength — in a leg, arm, or face. It can also be
paralysis on one side of the body. Hemiplegia is a severe or complete loss of strength or paralysis on
one side of the body. The Glasgow Coma Scale uses a score to identify the level of consciousness, from
1 to 15, with 15 being a normal state of consciousness. This scale takes into account verbal, motor, and
eye responses to stimuli in determining the overall score. This not likely a purely vascular accident
because there was a head injury. Unequal pupils (anisocoria) may be physiological, pathological or
pharmacological. Importantly, anisocoria can indicate underlying disease of the eye, orbit, brain, neck
or chest.
Case 6.2: 68-year-old man presents with acute onset left-sided weakness one morning and could not get
out of bed? He went to sleep otherwise healthy, but was confused and could not move his left side of
the body. He is right handed.
Questions Case 6.2: is this a vascular accident or slowly growing mass effect? How would you distinguish
if this lesion is in the cervical spinal cord, right brainstem, thalamus, internal capsule, or frontoparietal
lobe? Which blood vessels would be involved in each of the above locations to produce the left-sided
hemiparesis? If the lesion is in the cortex, which blood vessel would be involved to produce the given
symptoms? What kind of effects would you expect on the production and comprehension of speech in
this right-handed patient?

not always the case. In people who are right-handed, the speech and language center is located in the