Read the following:
Dr. Melissa Jones and Dr. Laurie Blake were beginning their first-year residencies at Novac Memorial Hospital. They had been close friends throughout medical school and were looking forward to helping each other through the challenges of clinical work. They had just completed a 16 hour shift and were sitting down to enjoy a cup of bitter vending machine coffee when nurse Cassidy burst into the break room.
“I wouldn’t get too comfortable” said nurse Cassidy. “A call just came in…paramedics are bringing in a 19 year old male with neuro injuries. Better drink up and get back to ER.”
The young doctors intercepted the paramedics wheeling in the teen. His eyes were wide open and he struggled to speak with the neck brace anchoring is head.
“19 year old male, BP 100/70, pulse 102 bpm, respirations elevated, conscious and alert. Head wound with significant loss of blood. Took a running dive into the shallow area of a pool. Friends hauled him out. Likely unconscious, loss of sensation and movement in right upper and lower extremities. We immobilized and stabilized him at the scene.”
“So, what do you think?” said Dr. Jones. “I think we should rule out brain injury first” said Dr. Blake.
“Actually, I disagree,” said Dr. Jones. “I think we should work up the spinal cord first.”
“We’ll do both,” said Dr. Blake. “Let’s get going.”
The following table summarizes the ﬁndings of the evaluation, which included a physical exam, x-rays, magnetic resonance imaging (MRI), and neurological tests.
Table 1. Summary of Diagnostic Testing for ER Patient
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
Numbness on the right cheek
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
Numbness on the medial portion of the right hand and forearm
Abnormal response of patellar, Achilles (hyper) reﬂexes in the right lower extremity
Positive Babinski sign on the right foot
Inability of patient to turn head to the right along with weak right trapezius muscle
Weakness of right masseter muscle
• 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
Answer the following questions.
Which of the test results indicated a brain injury and why?
Which of the tests results indicated a spinal cord injury and why?
Which (if any) test results indicated both brain and spinal cord injuries (be sure to explain your rationale)?
Are there any cranial nerves involved? Describe which cranial nerves could be involved.