Neuroscience Case Studies KINS 8210. Scenario 1.
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Mr. Jones has been bothered by stiffness in his right leg for a week or so. He went out to his backyard to get into his hot tub, thinking that the warm bubbly water would relax his tense muscles. When he went to get into the water, he scalded the skin on his left foot and ankle because he did not initially notice how hot the water actually was. He did notice the temperature when he reached down with his left arm to stabilize himself as he climbed further into the tub. He then had to turn down the temperature wand wait awhile before he could continue. A long soak in the hot tub did help his stiffness but the burn is still there.
That gets us close to the answer, but doesn't explain why Mr. Janus retains the abilities of pain & touch sensation and motor control in the right arm. We have to look further into the segmental anatomy of the spinal cord. Ah, ha! We see that damage to the anterolateral spinal cord below the brachial plexus may result in interruption of the ascending anterolateral pathways and the decending motor output pathways while preserving the ascending sensory pathways from the arms.
Ms. Georgia is a cashier at a local grocery story. She likes her job because she gets to see all the townspeople on a regular basis. Her job requires her to stand all day; this has not been a problem until lately. She recently has been noticing difficulty with standing on her feet all day. First of all, when she tries to step into her cubicle, she feels like she is dragging her right leg after her like a sack of potatoes. Then she feels like she’s standing on a stump all day after she gets it into place. Luckily, her right side is farthest from the customers and the conveyor on which the food travels, so she can lean away from the problem, and use her counter for support. Her other concern is that she has gotten several cuts on her left leg lately , from the metal corners under her counter where the grocery bags are stored. She hasn’t noticed these injuries until she takes off her hose and realizes they are ruined.
Peter likes to play golf. Usually he is a very competitive member of his foursome, but his game has been off lately. He has been unable to maintain his well-practiced grip on his favorite clubs (particularly with his right hand), causing the club to slip out of alignment as he begins his swing. Additionally, as all great golfers know, maintaining visual contact with the ball is critical to accurate placemlent of the ball on the green. Peter has begun to complain that he sometimes sees two balls, and that occasionally he swings at the ‘wrong’ one. He has been unable to keep his eyes on the ball as he swings and he has not been able to watch it as it sails to its destination. Today has been particularly hot, and the foursome are all becoming fatigued as they near the final hole. It’s at this point that one of the partners notices that Peter’s left eye is crossed.
Ms. Pearl is a makeup specialist for a major department store. Recently, she has been having trouble at the store; she has found herself losing her balance as she cruises around the counters; she also can't locate customers when they call to her for assistance. She has also had difficulty finding items on shelves, often reaching for an item she sees, and missing the jar or bottle. Additionally, she has had to avoid lifting open bottles from the counter with her left hand because when she does, the bottle begins to shake, and spills all over the place. She used to look forward to eating out for lunch, but lately she has lost interest in eating, complaining that the food is prepared poorly and is cooked too much, making it hard to chew. Problems at home have also begun. She has had a problem getting her own makeup on evenly. The left blush and eye shadow seems darker, and has to be redone several times. Her left chin and forehead also seem to sag. When she puts on her pantyhose, the right leg never seems to be properly adjusted. This is especially embarrassing when she wears textured hose.
Difficulty adjusting the hose on her right leg. OK, I'm willing to admit when an answer stumps me. Several friends who wear hose regularly tell me that one uses proprioception and touch to evaluate the 'evenness' of one's hose when dressing. In that case, these pathways will travel to the brain on the right side of the body, crossing over to the left side of the brain in the lower medulla and continuing as the medial lemniscus on to the thalamus.