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    Anatomy clinical cases

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    1. George, a 20-year old man, injured his jaw and lost several teeth in a bar room brawl.
    Several weeks later he began to experience sharp stabbing pain in his lower jaw. After
    visiting the dentist, he was told that he had trigeminal neuralgia. What is this condition
    and how is it treated?

    2. While working in the emergency room you receive two patients who were in an
    automobile accident. One is dead on arrival, having suffered a transaction of the spinal
    cord at the level of C2. The other patient suffered a similar injury, but at the level of C5,
    and is still alive. Explain briefly in terms of phrenic nerve origin and function why one
    injury was fatal and the other was not.

    3. Ms. Johnson, an automobile whiplash victim, has been suffering spinal shock, but is
    looking forward to complete recovery. One night on evening rounds, her nurse
    discovered her in a fetal position, her body drenched with sweat. She was incontinent of
    feces and urine and her blood pressure was dangerously high. After a while she was
    stabilized. How could these events happen and what is this response called?

    4. Richard has been under great stress and has complained of migraine headaches for
    weeks. He tried all kinds of drugs, with little effect. When he was at the end of his rope,
    a friend suggested yoga and meditation. Having nothing to lose, he tied them and after
    several months, felt like a new person. How could these practices help him?

    5. Mrs. Oberhaus needs surgery to correct a severe case of Raynaud's disease, affecting one
    of her hands. What surgical procedure will be performed? After the surgery, will she
    more likely to suffer from anhidrosis (lack of sweating) or hyperhidrosis (profuse
    sweating) in the affect hand?

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    Solution Preview

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    1) Trigeminal neuralgia is caused by the trigeminal or 5th cranial nerve. The nerve is called trigeminal because it has three major branches that provide innervation (sensations) to the upper, middle and lower portions of the face. In Gorge's case, the pain is probably caused by the mandibular or lower branch that provides innervation to the lower jaw, teeth, gums and bottom lips.
    Classic symptoms are episodes of extreme sudden burning or electric shock type, stabbing sensations that last a few seconds and disappear. These episodic pains can continue to appear during days, weeks or months at a time and sometimes disappear for months or years. The attacks can be sporadic or occur in quick succession.
    The usual treatment options are anticonvulsant medicine like carbamazapine, oxcarbazepine, clonazepam, phenytoin or valproic ...

    Solution Summary

    The solution includes answering the questions on each clinical case on topics like trigeminal neuralgia, cervical lesions at C2 and C7, autonomic hyperreflexia, tension headache and sympathectomy.