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Regional anatomy - case studies of the spinal region

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´╗┐Jun Wang NAECM2011-118007 Regional Anatomy Lab ?Assignment 1 Case 1 Case Summary: Lymph node biopsy was performed on a patient to obtain a sample of her left deep cervical nodes. Following the surgery, the patient complained of weakness in her left shoulder, which is then closely examined to confirm her inability to raise the point of her shoulder. However, the patient?s new symptom was not associated with numbness in her shoulder, back or neck. Terms: Lymph node biopsy: Lymph nodes are part of the body's immune system, where produce and harbor infection-fighting white blood cells (lymphocytes) that attack and can be attacked by both infectious agents and cancer cells. For that reason, physicians do a needle biopsy to remove a portion of a lymph node and examine under the microscope to find evidence of these problems. Deep cervical nodes: are a group of lymph nodes situated around or near the internal jugular vein. Includes two groups, superior and inferior, based on the point where the omohyoid muscle crosses the vein. Case Discussion: In class, our group discussed about Case 1. Our first question was to identify which nerve has been cut during the biopsy that would cause the symptoms developed. After looking up the anatomical location of both deep cervical lymph nodes and all the major nerves neighboring, we were able to determine it was the Accessory nerve (CN XI) ...read more.


This procedure is also referred as a spinal tap. Lethargy: the quality or state of being drowsy, dull, listless and unenergetic. Case Discussion: In class, our group discussed about Case 2. Our first question was how to locate the puncture site. We learned that on average, the spinal cord ends at the L1 ? L2 level. To insure the safety and not puncturing the spinal nerves, it is suggested to insert the needle between L3 to L4 or L4 to L5. The land mark used to locate the site is the superior iliac crests. The line connecting the left and right iliac crest points usually passes through the spinous process of the L4 vertebra, thus, by feeling the indentation of the interlaminar spaces, we can locate the puncture site. The next question we discussed was why the syringe needle is inserted in the midline and with the median plane and what structures that the needle traverses before entering the lumbar cistern. We learned that at the level of the lumbar cistern the nerve roots are suspended in CSF and fixed by dural sleeves laterally. Thus, it is necessary to insert the needle through the interlaminar space in the midline to avoid damage to nerve roots. The layers that the needle must pass through before reaching to CSF containing subrachnoid spaces are: skin, superficial fascia, supraspinous ligament, interspinous ligament, ligament flava, epidural space, dura mater, subdural space and arachoid mater. ...read more.


The dens can then impact the spinal cord, injuring or severing it. In this case, although the patient's spinal cord was not severed, impact from the dens caused a spinal cord hematoma resulting in quadriplegia. Next we discussed the reasons for physicians to immobilize the patient?s spinal before transporting to hospital. It is because after trauma, especially for any vertebra fracture that has the potential to injure the spinal cord, fixing the spine can prevent uncontrolled movement of potentially fractured vertebrae. Vertebral fracture can cause spinal cord injury; spinal cord injury then can cause paralysis or death. Conclusion: Through learning the materials from the lectures about human back and its associated clinical cases, I learned that spinal cord acted as a nerve highway that transmits signals from the controlling center brain to every part of the body. Its especial structure maximized the protection against tension and forces, at the same time, allowed for the wide distribution of the nerves spread to all organs of the body. Upon damaging to the supporting structure, the spinal vertebrae will cause various distresses on the nerves it protects. Physicians based on the specific symptoms and its association with the functions of nerves, were able to identify the causes and provide treatments. In this course, I was most fascinated by the lumbar puncture and it?s widely usage in diagnoses and therapeutic treatments Reference CMU lab manual for student. Gray?s Anatomy book http://www.wikipedia.com http://medinfo.ufl.edu/year2/neuro/lock/neuroexam/accessry.html http://antranik.org/central-nervous-system-spinal-cord/ www.spinal-injury.net/ http://medical-dictionary.thefreedictionary.com www.webmd.com www.apparelyzed.com/spinalcord.html ...read more.

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