Kevin sustained head injuries in an automobile accident. After a hospital stay,
ID: 3511109 • Letter: K
Question
Kevin sustained head injuries in an automobile accident. After a hospital stay, he returned home but needed to take Ambien to help him sleep, and his right arm remained partially paralyzed. His speech was slow and difficult, although his meaning was clear. When his wife saw him sway and stagger when he walked, she accused him of having too much to drink, which he denied. She took him to be examined, and the physician told Kevin to point to his wife. When he attempted this, his arm made oscillatory movements back and forth. The physician stroked the sole of Kevin's bare right foot, and this made his large toe extended upward.
Some of the new terms and concepts you will encounter include: Cerebral lateralization, Broca's and Wernicke's areas, and aphasias Reticular activating system, cerebellum functions, and Babinski's reflex
Kevin suffered paralysis of his right arm, and his speech was affected by the accident.
What is the likely explanation for these two observations?
If his left arm were paralyzed instead, would his speech likely have been affected?
Kevin's speech became slow and difficult after the accident, but it was understandable.
Which language area of the brain was likely affected in the accident?
Which brain area would have been involved if his speech were fluent but nonsensical?
Kevin had coordination problems and swayed when he walked, but denied that he drank alcohol. His arm oscillated when he tried to point.
Damage to what brain region might account for these symptoms?
What medical term is used to describe these symptoms?
After his accident, Kevin took Ambien to help him sleep.
What type of drug is Ambien, and how does it promote sleep?
What drugs use a different mechanism to promote sleep?
Kevin's big toe extended upward when the sole of his right foot was stroked, but his left big toe instead curled in response to the same procedure.
What caused these differing responses?
Explanation / Answer
Kevin suffered paralysis of his right arm, and his speech was affected by the accident.What is the likely explanation for these two observations?
Kevin has right arm paralysis (due to injury in left cerebral hemisphere ) and expressive aphasia, so there is injury in the left cerebrap hemisphere. As there is expressive aphasia it is like the cerebral injury extended to broca's area( area 44 45, posterior to inferior frontal gyrus). So kevin's brain injury is a left frontal lobe, that explains these two conditions.
If his left arm wer paralyzed, then the injury would have been at right cerebral hemisphere, but broca's area is in the left frontal area of brain, so in case of left arm paralysis, speech would mot be affected.
Broca's area is affected, this area is resposible for speech production. Kevin can understand conversation but can not express properly, so the injury area is broca's area at posterior zone of left frontal lobe.
If his speech were fluent but nonsensical, then the injury area would be wernicke's area ( at left superior temporal lobe of brain , area 22) which is responsible for understanding and processing conversation.
Kevin had coordination problems and swayed when he walked, but denied that he drank alcohol. His arm oscillated when he tried to point.
This proves that there is injury in cerebellum too, all these symptoms of incoordination, ocillatory hand movements occurs in cerebellar injury.
Medical term for incoordinated movement, swayed gait, ocillatory hand movement is Ataxia
Ambien(zolpidem) is a sedative drug. It acts by positively modulating GABAA receptor . It binds to the alpha sub-unit of GABAA receptor for modulation.
Olanzapine, orexin antagonist, tricyclic anti-depressant use different mechanism to prmote sleep.
Kevin's big toe extended upward when the sole of his right foot was stroked, but his left big toe instead curled in response to the same procedure:
This is called babinski's sign. it indicates upper motor neuron disease. Thereis an injury in corticospinal patways of CNS. .
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