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416K Nervous System Case Study
You are a neurology therapist at a major urban hospital. A 63 year-old male stroke
victim is brought to you for treatment. This patient suffered a stroke after several
occlusions (blockages) of branches of one of the cerebral arteries. You have the patient
perform a series of cognitive, sensory and motor tests that reveal the following signs and
symptoms:
- loss of the perception of the somatic senses (somatosensation) from the right side of his jaw,
face and tongue
- minor diminishment in somatosensation from his right hand and lower arm
- the patient can recognize he has an object in his right hand by touch, but he has almost no
ability to identify objects by touch when they are hidden from sight
- sensation in his left arm, torso and both legs is unaffected
- flacid paralysis in the muscles on the the right side of his jaw and face
- right hand movements are hesitant and uncoordinated; he can no longer play piano or type
with his right hand; he can no longer move his right ring finger at all
- activity and coordination of other muscle groups appears normal
- understands written and spoken words and can read and write normally, but, his speech is
labored and his enunciation is severely impaired
1. What can the patient no longer feel with his right face? (What are the 'somatic' senses?)
2. A stroke is
a. a sudden, marked change in the pattern of electrical activity leading to
abnormal involuntary movements and unusual sensations.
b. accumulation of abnormal intracellular deposits within neurons of the brain.
c. interruption of the blood supply to a portion of the brain.
d. sudden loss of synaptic connections between the neurons within a portion of
the brain.
3. Even though the death of neurons accompanies a stroke, a stroke patient may partially
regain the cerebral function that was lost. This recovery is likely to involve the
regeneration of neurons by cell division. True or false?
4. Loss of somatosensation on the right side of the patient's jaw, face and tongue
indicates the loss of function in which lobe of the cerebrum?
5. Loss of the ability to interprete the kind of object present in his right hand by touch
alone indicates damage to what area of the patient's cortex?
a. auditory cortex
b. somatosensory association area
c. motor association area
d. primary motor cortex
e. primary somatosensory cortex
416K Nervous System Case Study
6. Loss of coordinated motor function in the right hand indicates the loss of function in
which lobe of the patient's cerebrum?
7. Inability to move the right side of the jaw and face and right ring finger indicates
damage to what area of the patient's cortex?
a. auditory cortex
b. somatosensory association area
c. motor association area
d. primary motor cortex
e. primary somatosensory cortex
8. The difficulties that the patient has with language indicate which area of the cerebrum
was damaged by the stroke?
A. general interpretive area
B. Wernicke's area
C. Broca's area
D. prefrontal cortex
9. Which hemisphere was damaged by the stroke, left or right?
10. If the stroke affected the limbic system you might expect all of the following changes
in mental function EXCEPT?
A. inability to convert short term to long term memories
B. depression of emotions
C. loss of motivated drives
D. loss of motor coordination
11. Look up the cerebral blood vessels in the Atlas of Human Anatomy. Can you identify
a blood vessel that could have been damaged to cause these various symptoms?
12. The patient can feel an object that he is touching with his right ring finger even though
he cannot identify the object by touch. Which spinal nerve is carrying the sensory
information from the ring finger to the spinal cord? (See dermatome map, Plate 150.)
13. Since the patient can identify a touched object when he looks at it, what part of his
brain is he using to recognize the object?
14. The peripheral nervous system somatic motor neurons to the ring finger are unharmed
in this patient. Identify a major nerve to the muscles of the ring finger. (Plate 445)
Compare to the dermatome map Plate 150.