| Neuro Case Studies |
Pathophysiology case study week 7: Neurological
Question #1
Brett reached into a clogged snow blower to clear the chute while it was still running. He completely severed one finger and partially severed another on his left hand. After lengthy surgery to reattach his fingers, he has regained much of his motor ability but has lost some of his sensory function. What factors are involved that affect the regeneration of Brett’s neurons and neuron function?
Clinical answer:
For regeneration of neurons (getting sensory feeling back), his type of injury involves the PNS neurons that were involved, rather than CNS neurons, so the chances of his neurons regenerating increase.
Nerve generation depends on
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The herniation of the disc occurs when the nuclear tissue if forced out of the center portion of the disc. The tissue of the nucleus can cause the annulus to rupture when placed under an extreme amount of pressure. This pressure can be caused by a fall, car accidents, blunt force trauma, or degenerative condition. The pain that a patient feels from a herniated disc is most likely caused from the pressure that the nucleus places against spinal nerves.
Possible symptoms of a herniated disc include pain that radiates through the back and possible down the arms or legs, depending on the location of the herniation. There can also be noted numbness and weakness of the arms and neck. Some people may not even know that they have a herniated disc because not all cases present with leg or back pain. Other signs and symptoms of a herniated disc may include muscle spasms or deep muscle pain. In extreme cases, a patient may present with weakness in both legs and/or the loss of bladder control and bowel control. This is a serious problem called cauda equine syndrome and requires immediate medical attention.
Treatment for a herniated disc can include either surgical or non-surgical options. There are many tests that can be performed such as x-rays, CT scans, MRIs, myelograms, and nerve tests. All of these tests can be performed to help diagnose the location and degree of herniation. Some of the non-surgical treatments include
Further studies in 1998 investigating the re-mapping component in the brain were conducted by researchers at the University of Toronto and The Toronto Hospital. The study recruited amputees who experienced phantom pain for surgery to map the sensory areas in the brain. During the mapping process, the conscious patients reported sensations they felt when certain areas of the thalamus were stimulated. Patients reported phantom sensations when areas of the thalamus were stimulated that formally were innervated by neurons from the missing arm, and also when areas on the stump were stimulated that activated these reorganized regions in the brain. Neurons were shown to continue to carry out their original roles, but with different sources of activation (7).
Axel and skeleton frame injuries are something that are very common in the world of sports. The National Football Ledge(NFL) has a foundation of physical impact and is very strenuous on the axel and skeletal frame. Thoracic disc herniations in the one of the most common injuries the NFL and it requires the greatest amount of time to recover which is 189 days. Thou the injury is very high in football nearly 15 percent of American suffer from Thoracic Disc Herniation. Degeneration the most common cause of Thoracic disc herniation “As a disc's annulus ages, it tends to crack and tear. These injuries are repaired with scar tissue. Over time the annulus weakens, and the nucleus may squeeze (herniate) through the damaged annulus. Spine degeneration
Your friend’s dog, Spot, jumped onto a table with a terrarium housing your pet salamander, Lizzie. Unfortunately, the table tipped over and Spot has suffered a head injury which damaged the primary motor cortex. Lizzie lost most of the distal right forelimb in the accident. Please answer the following questions regarding the nervous system and regeneration, in a .docx, .pptx, or .pdf format.
DOI: 06/23/2011. This is a case of 41-year-old male maintenance worker who sustained injury to the low back while taking off a sliding door of a patio. As per OMNI notes, patient is diagnosed with lumbar disc disorder with myelopathy. MRI of the lumbar spine dated 6/28/15 revealed recurrent left paramedian L4-5 disc herniation with caudal extrusion of a 10 mm fragment into the left L5 lateral recess. As per office notes dated 7/25/16, the patient is status post redo left L5-S1 discectomy performed on 4/20/16. It was also noted that the patient had a prior L5 laminotomy several years ago. He subsequently did well. However, he had recurrence of his pain. Pain is radiating into his left leg worse on the right leg. This was unresponsive to conservative
The disc then begins to collapse, causing the space between each vertebra to become smaller and smaller. This shifting of vertebra causes abnormal pressure on the articular
You can get a herniated disc from becoming older. Aging allows these discs to be less flexible and be more vulnerable to breakage. The more common cause of Herniated Disc is by injury to the spine. For example, this can happen when someone picks up a heavy box and suddenly feels a pop in their lower back. A person who suffers from a herniated disc will experience pain, numbness, and sometimes weakness along the the tracks of the nerves.
Spinal stenosis may cause no signs or symptoms in some patients and in others extreme pain. Some signs and symptoms include back pain, burning pain in the buttocks or legs, numbness or tingling in the buttocks or legs, weakness in the legs, and “foot drop.” These symptoms are often relieved if the patient leans forward or sits down (AAOS, 2013).
Generally, when herniation occurs at the lower levels of the lumbar spine, as it is in the case of patient G.J., the nerves in the lower back become irritated causing a condition called lumbar radiculopathy. Lumbar radiculopathies characterize by excruciating pain that shoots down the buttocks along the legs. Low back ache often precedes pain in the lower limbs. Radicular pain worsens with movement at the level of the waist, sneezing, and coughing. Urinary and bowel incontinence may be present in severe cases (Degenerative Disc Disease & Sciatica Symptoms, Causes, Treatment,
During this process the part of the axon distal to the site of injury begins to degenerate and break apart. The cell body increases in size, causing protein and RNA metabolism to increase assisting in the repair process. Myelin is altered into fat and phagocytized by macrophages. Since the nerve has loss of continuity the muscle will atrophy. In some severe cases, degeneration may extend proximal to the site of the lesion as well as distally. An influx of calcium into the axon is required for the sealing over process. Hours after the injury has occurred, the distal ends of the lacerated axon seal over and become inflamed with Schwan cells, fibroblasts and other growth factors allow for anterograde and retrograde axonal transport to continue for several days (Campbell). Additionally, as part of the degeneration process it has been seen that certain growth associated genes such as, growth associated protein-43 (GAP-43) mRNA, brain derived neurotropic factor (BDNF) and its receptor TrkB mRNA are elevated after injury to peripheral nervous tissue. The use of brief electrical stimulation has been shown to enhance and accelerate the expression of TrkB and BNDF thus, resulting in a positive effect on nerve regeneration (Al-majed and Geremia). Several mechanisms have been found to explain the role of electrical stimulation in promoting nerve regeneration. It is seen that electrical stimulation can employ its effects through elevating cAMP levels, expression of neurotrophic factors and regeneration-associated genes as well as having a direct impact on Schwann cells.
Roughly, 80% of the population will experience lower back pain once in their lifespan, while two-thirds of the population will experience neck pain. As ludicrous as it might appear, the ugly truth about slipped disc complications is that they are increasing at an alarming rate. Back pain and neck pain are the most common reasons of immobility in individuals under 45 years old. It is now very ubiquitous and not only found in elderly, or after a traumatic happening. A slipped disc can happen throughout the entire spine but is most common in the cervical and lumbar area. Inappropriate posture, unwarranted or protracted axial weight-bearing activities are the culprits; in other words, extended sitting or lifting and carrying of hulking objects that cause uneven distribution of weight across your spinal joint or the spinal discs. Over the time, axial loading (sitting or carrying weighty loads) can dehydrate your spinal disc. Dehydration of the
How do you know whether you have sciatica and not another problem? Sciatica's most telltale sign is that it only affects one side of the body. Its symptoms include constant pain in one of your legs or half of the buttocks. It is rare to have symptoms on both sides. The pain is often worse when sitting, and it makes it difficult to rise from your seat, let alone try to walk. It may also be difficult to move your leg or wiggle your toes, and you may feel numb or weak in the affected region or have trouble bending the knee.
There is evidence to suggest that improved motor recovery occurs when the brain uses the original neural system to control the movement as this is shown to represent "true" recovery. Whereas, if new networks were to form in the unaffected hemisphere of the brain, motor recovery will be reduced. As a result of using these new networks, fine motor control is lost and employment of compensatory movement strategies are associated with a poorer functional outcome (Nudo, 2007). The recovery of motor skills following a stroke, like walking, relies on the brain’s ability
Merzenich and Kaas amputated monkeys' fingers and expected to find no nervous response in the part of the homunculus whose bodily analog no longer existed. Instead, this region of the cerebral cortex fired when the fingers next to the amputation site were stimulated. Their conclusion was that preexisting axon branches that had innervated the region were "unmasked," which allows for nervous response without any new neuronal growth. This idea upheld Hubel and Wiesel's concept of the "hardwired" brain, in which the cerebral cortex's map is set at birth. Ramachandran also had a similar idea of "hidden circuitry," arguing that phantom limb sensation could not be the result of new neuronal growth as the sensation's onset was often as soon as a month or two after amputation, which be enough time for the brain to remap but not for new cells to develop.
The injuries of nervous system affect many people every year and is estimated that spinal cord injuries alone affect 10,000 each year. Nerve regeneration can be achieved by production of new neurons, glia, axons, myelin, or synapses. There are differences between the functional mechanisms of peripheral nervous system (PNS) and the central nervous system (CNS). PNS has an intrinsic ability for repair and regeneration while CNS usually is incapable of self-repair and regeneration. There is currently no treatment for recovering human nerve function after injury to the CNS. Although, PNS has self-regeneration capacity, much research still needs to be performed for optimizing the environment for maximum regrowth. Injury to PNS immediately elicits the migration of phagocytes, Schwann cells, and macrophages to the lesion site in order to clear away debris such as damaged tissue [56-60].
Evaluation of the prognosis of recovery of the nerve injury should be first established before management could be done conservatively or using a surgical approach.