Introduction / Background
This interrupted case study in circulatory and nerve physiology follows the story of Lynn, who is married and has a young child. Lynn’s husband travels on business and so, for much of the time, she is left alone to take care of their daughter. Lynn is anxious and short-tempered. She is also overweight and appears frustrated with her life. Recently, she has been experiencing stabbing pain on the right side of her face. Lynn becomes disoriented while driving and crashes into a tree. Students are given signs, symptoms, and medical data relating to Lynn’s condition, which they are asked to interpret as they try to solve the case.
The case was developed for use in a one-semester animal physiology course taken by sophomore and junior science majors. It could also be used in an anatomy and physiology course as well as a general biology course. The case is best used when the class is studying circulation, and after neurophysiology has been covered.
Objectives
Upon completion of this case, student will be able to:
- describe the effect of high blood pressure on the integrity of blood vessels.
- draw a simple spinal reflex, and differentiate between sensory motor, and inter-neurons.
- understand the function of the trigeminal nerve.
- describe the link between high blood pressure and an aneurysm.
- demonstrate the effect of compression on action potential production.
- relate inappropriate action potentials in sensory neurons with the sensation of pain.
Classroom Management
The case takes about 75 minutes to complete and can be done in a single class period or it can be presented over a number of class meetings. I prefer to do the case in one session because, in my hands, students seem to stay up-to-speed and become more engaged and involved if they perform all components at one time.
Students are divided into groups of five or six. In their groups, they discuss and answer the questions associated with each part of the case, which are then in turn discussed by the class as a whole.
Board Management
In my class I have a large white board that is divided into four areas. Student input and ideas are put up on the board as follows:
- The first area is used to list Lynn’s symptoms (Parts I and II).
- The second area is used for the diagram of the spinal reflex (Part III).
- The third area is used to list student’s suggestions for tests (Parts III and IV).
- The fourth area lists the student speculations for Lynn’s problems (Parts I through IV).
Entries are made throughout the case as information is provided. Speculations are entered in the fourth area as they arise. If a certain speculation loses favor, the original group is asked if it is reasonable to delete their entry. If they (and the class) agree, an “x” is placed next to the entry. The entry is not erased because it may be reconsidered at a later date.
Case Management
Students are given each part of the case in sequence. For each part, they are asked to read the passage, discuss the material, and answer the questions. They are told how much time they have for each part of the case study and are permitted to use books, the Internet, and their notes in answering the questions. After the prescribed time period (5 to 15 minutes), the class is called together to share ideas, with the questions forming the basis for discussion. Groups take turns going first, and different members of each group are called upon for input; in this way, all students have a chance to participate in the case study.
In addition, each group is given a two-sided mini-whiteboard. Groups make notes, draw diagrams on these boards (the spinal reflex circuit in Part III), and are asked to hold them up to share with the class.
Summary of the Case Sections
Part I – Good Morning
Lynn is a young mother and is the primary caregiver for her daughter when her husband is away on business. Lynn is anxious and short-tempered. She is also overweight and appears frustrated with her life.
Part II – The Accident
Lynn becomes disoriented while driving and hits a tree. She is taken to the hospital where some preliminary tests are performed by a nurse.
Part III – Ow!
Lynn’s husband, John, hits his funny bone while the young family waits in the Emergency Room. Lynn is amused, but then grabs the right side of her face in pain.
Part IV – The Results
The doctors perform a series of tests on Lynn including a spinal tap to draw a sample of cerebrospinal fluid and an X-ray of her head immediately after a contrast dye is injected into her carotid artery. Students are asked to interpret the results.
Part V – The Doctor
The conference between Lynn, John, and the doctor reveals the source of Lynn’s problem and the procedure required to alleviate the pressure imposed on the trigeminal nerve by the enlarged artery.
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.
References
- Cerebral aneurysm:
- http://www.ninds.nih.gov/disorders/cerebral_aneurysm/detail_cerebral_aneurysm.htm
- Trigeminal nerve:
- http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/h_n/cn/cn1/cn5.htm
- Trigeminal neuralgia:
- http://www.endthepain.org/
- http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446
- http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/trigeminal_neuralgia.htm
- Microvascular decompression:
- http://www.mayfieldclinic.com/PE-MVD.htm
- Stenting:
- Mericle, R.A., G. Lanzino, A. Wakhloo, L.R. Guterman, and L. Hopkins. 1998. Stenting and secondary coiling of intracranial internal carotid artery aneurysm: Technical case report. Neurosurgery 43(5): 1229-33.
- http://journals.lww.com/neurosurgery/pages/articleviewer.aspx?year=1998&issue=11000&article=00130&type=abstract
- Video of surgical procedures:
- http://video.google.com/videosearch?hl=en&q=microvascular+decompression&um=1&ie=UTF-8&ei=focASsD5MKSFlAeP38XyBw&sa=X&oi=video_result_group&resnum=4&ct=title#
Acknowledgements: This case was published with support from the National Science Foundation under CCLI Award #0341279. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.
Date Posted: September 15, 2009.
Originally published at http://www.sciencecases.org/face_pain/notes.asp
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