Brain vs. Spinal Cord:

A Directed Case Study in CNS Injury

By

Patrick Field, Department of Biological Sciences, KeanUniversity

Tom Cappaert, Department of Physical Education andSport, Central Michigan University

Dr. Green and Dr. Carter were nearing the end of thefirst year of their medical residency in the emergency department ofCounty General Hospital. It had been a long year and a long week.They had been on duty for the last 12 hours and things were notslowing down.

“What are your plans for the weekend, Ken?” Dr. Greenasked. “Sleep, what else?” Dr. Carter replied.

“I hope things slow down a bit,” Dr. Green said tohimself.

Suddenly, a call came over the radio. Paramedics werebringing in a young man with injuries sustained in a divingaccident. A minute later, the doors to the department burst openand the paramedics wheeled in a young man.

“What gives?” Dr. Green asked.

The senior paramedic, Jim Morrison, reported that thepatient was swimming at the local quarry and did a forward flip intothe water, striking some submerged rocks.

“Which part of his body struck the rocks?” asked Dr.Carter.

“He was in a hyperflexed-tucked-position when he hit therocks, lacerating the right side of his head and neck and upperback. The patient indicated he had severe pain upon impact and lossof sensation and movement in his arm and leg. He may have lostconsciousness, but he’s not sure. He also complains of a severeheadache, dizziness, and nausea. When we arrived at the scene weimmobilized, stabilized and transported him immediately,” Jimexplained.

Looking at the patient, Jim continued. “His name is MikeSmith, and he’s 22 years of age. His vital signs include slightlylowered blood pressure (100/70), heart rate of 75 beats per minute,respiration normal and he is conscious and alert.”

As the patient was being prepped for examination, Dr.Carter and Dr. Green discussed how they should approach theirevaluation. Dr. Carter started by saying, “After seeing the headwound and the amount of blood loss, and hearing his complaints, Iwant to confirm my suspicion that this patient has a braininjury.”

Dr. Green disagreed: “I think that the other signs andsymptoms indicate a spinal cord injury, and that’s what we shouldinvestigate.”

The following table summarizes the findings of theevaluation, which included a physical exam, x-rays, magneticresonance imaging (MRI), and neurological tests.

Table 1. Summary of Diagnostic Testing for MikeSmith

Sensory Testing

•Decreased sensation to touch, pressure, and vibrationin the right upper/lower extremities •Decreased temperature discrimination (cold vs. warm) inthe left upper/lower extremities

Motor Testing

• Decreased strength and movement of the rightupper/lower extremities during muscle testing • Decreased strength and movement of left abdominalmuscles • Absence of triceps and biceps reflexes in the rightupper extremity • Abnormal response of patellar, Achilles (hyper)reflexes in the right lower extremity • Positive Babinski sign on the right foot • Abnormal cremasteric reflex in the right groinregion

General Examination

• Abnormal pupil response of right eye(constriction) • Other vital signs within normal limits • Cognitive testing normal (counts backward from 100 by7s; 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 theC7-T2 region •Spinal cord appears to be intact

Based upon your previous knowledge of brain function,which results from the testing are consistent with a brain injuryand why?

need help answering the question.