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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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 ...
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.