Introduction / Background
Purpose of case: In order to determine the type of central nervous system (CNS) injury that is being described in a summary of diagnostic testing, students will have to use previous knowledge of the differences between symptoms and signs of brain and spinal cord injury (cerebral hemisphere damage and hemisection of the spinal cord).
Where the case has been used: Upper-level neuroscience courses and rehabilitation courses that cover the neuroanatomy of the CNS and the symptoms of different types of CNS injury.
Student population: Students within programs that involve neurological rehabilitation will benefit from this case: Occupational Therapy, Physical Therapy, Sports Medicine, and Pre-Medicine.
Objectives
To distinguish the differences in symptoms and signs between brain (cerebral hemisphere) and spinal cord injury (hemisection of the cord) using previous knowledge.
To determine what type of CNS injury is present by recognizing the symptoms and signs in a diagnostic summary.
To determine the symptoms and signs of an alternate CNS injury that is not being described in the case study using similar diagnostic methods.
To be used as a review of previous CNS material and a tool to bring different sections of neuroanatomy together in a clinical context.
Blocks of Analysis
Previous knowledge that is required to complete this case study includes:
General knowledge of the components and functions of the CNS and the peripheral nervous system (PNS).
The general neuroanatomy and functions of the somatosensory and motor systems within the CNS and PNS.
The anatomy and function(s) of a simple reflex arc and of more complex reflexes that utilize brain integration. Previous knowledge should include examples of reflexes used for clinical diagnosis.
The functions of the sensory and motor regions of the cerebral cortex and the concept of having right and left hemispheres: each hemisphere receives sensory information from the opposite side of the body (contralateral) and each hemisphere controls the musculature of the contralateral side of the body.
The anatomy of the cross section of a spinal cord segment, including which region receives sensory input from the trunk and limbs and which region generates motor output for the trunk and limbs.
The student should be familiar with the functions of the spinal tracts within the spinal cord: (1) most sensory information from the trunk and limbs is transmitted within the sensory region of the same side (ipsilateral) of the spinal cord (i.e., dorsal column-medial lemniscal ) and the exceptions (i.e., lateral spinothalamic); (2) muscles and glands in the limbs are controlled by motor neurons that originate from the ipsilateral side of the spinal cord (lateral corticospinal); and (3) trunk musculature and glands are controlled by motor neuron pools originating from the contralateral side of the CNS (i.e., anterior corticopsinal).
The specific neurological symptoms and signs that accompany the different types of CNS injury (i.e., Brown-Sequard Syndrome, Horner’s Syndrome, spinal shock). The student should know the difference between the symptoms of upper motoneuron damage and lower motoneuron damage.
Classroom Management
Pre-class assignments: Lectures that effectively cover the material mentioned for previous knowledge is extensive. For classes that meet approximately 90 minutes at a time, a minimum of four to five classes is recommended.
How to run the case in the classroom (90-minute period minimum): This case makes use of a case method known as the "Directed Case Method." Using a previous body of knowledge, students read a case, discuss the case in small groups (four to five students), and answer the discussion questions. Like all closed-ended cases, there is a single solution to each question. The instructor should give a short introduction to the case that includes any pertinent information (five minutes minimum). The duration of time for distributing the case, forming groups of students, reading/discussing the case, and answering the discussion questions is about 45 to 50 minutes. The remaining time should be used for classroom discussion. This task can be accomplished by either asking for volunteers to answer a particular question or asking each group (representative) to contribute to the answer. Students should be able to use all diagnostic information when discussing the answers to the case questions. The blackboard or an overhead can be used to illustrate the answers from the discussion.
Answer Key
Answers to the questions posed in the case study are provided in a separate answer key to the case. Those answers are password-protected. To access the answers for this case, go to the key. You will be prompted for a username and password. If you have not yet registered with us, you can see whether you are eligible for an account by reviewing our password policy and then apply online or write to answerkey@sciencecases.org.
Reference
- Lundy-Ekman, L. Neuroscience Fundamentals for Rehabilitation 2nd ed., W.B. Saunders Co., 2002.
Date Posted: 10/01/01 nas; last revised 12/05/06 nas.
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Originally published at http://www.sciencecases.org/cns_injury/cns_injury_notes.asp
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