Dr. McDreamy and Dr. McSteamy had been on duty for the last 12 hours and things were not slowing down. They were nearing the end of the first year of their medical residency in the emergency department of Children’s Hospital of Oakland. Suddenly, a call came over the radio. Paramedics were bringing in a young man with injuries sustained in a diving accident. A minute later, the doors to the department burst open and the paramedics wheeled in a young man. The senior paramedic, Dave Sunny, reported that the patient was swimming at the local quarry and did a forward flip into the water, striking some submerged rocks.
"Which part of his body struck the rocks?" asked Dr. McSteamy.
"He was in a tucked-position when he hit the rocks, lacerating the right side of his head and neck and upper back. The patient indicated he had severe pain upon impact and loss of sensation and movement in his arm and leg. He may have lost consciousness, but he's not sure. He also complains of a severe headache, dizziness, and nausea. When we arrived at the scene we immobilized, stabilized and transported him immediately," Dave explained.
Looking at the patient, Dave continued. "His name is Reel Winner, and he's 22 years of age. His vital signs include slightly lowered blood pressure (100/70), heart rate of 75 beats per minute, respiration normal, and he is conscious and alert."
As the patient was being prepped for examination, Dr. McSteamy stated "After seeing the head wound and the amount of blood loss, and hearing his complaints, I want to confirm my suspicion that this patient has a brain injury."
Dr. McDreamy disagreed: "I think that the other signs and symptoms indicate a spinal cord injury, and that's what we should investigate."
The following table summarizes the findings of the evaluation, which included a physical exam, X-rays, magnetic resonance imaging (MRI), and neurological tests.
Table 1: Summary of Diagnostic Testing for Reel Winner
General Examination :
X-Ray and MRI Examination :
1. Compare and contrast
the structure and functions of the Central Nervous System and the Peripheral
3. Based upon the findings presented, which
doctor made the correct initial prediction?
4. Based upon previous knowledge of brain
function, what results from the testing were consistent with a brain injury?
5. Based upon previous knowledge of spinal
cord function, what results from the testing were consistent with a spinal
Based upon previous knowledge of CNS
function, what results could be consistent with both types of injury?
*adapted from: Brain vs. Spinal Cord: A Directed Case Study in CNS Injury by:
· Tom Cappaert, Department of Physical Education and Sport, Central Michigan University