Page 1 of 426
Summary Week 1Reflection - NR603 / NR-603 / NR 603
(Latest) : Advanced Clinical Diagnosis and Practice
Across the Lifespan Practicum - Chamberlain
He complains of neck pain and severe burning in his shoulders
and arms. His physical examination reveals weakness of his
upper extremities. What type of spinal cord injury does this
patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B .....ANSWER.....Central Cord Syndrome
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the central cord syndrome involves loss of motor function that is
more severe in the upper extremities than in the lower
extremities, and is more severe in the hands. There is typically
hyperesthesia over the shoulders and arms. Anterior cord
syndrome presents with paraplegia or quadriplegia, loss of
lateral spinothalamic function with preservation of posterior
column function. Brown-Séquard syndrome consists of weakness
and loss of posterior column function on one side of the body
distal to the lesion with contralateral loss of lateral spinothalamic
function one to two levels below the lesion. Complete cord
transection would affect motor and sensory function distal to the
lesion. Cauda equina syndrome typically presents as low back
pain with radiculopathy.
A 37-year-old man fell from a ladder as he finished hanging the
Christmas lights on his house. The right side of his head hit the
alley cement, and he lost consciousness for about 1 minute; he
,Page 3 of 426
woke up with a headache, but he had no other complaints. A few
hours later, the patient is brought to the emergency room by his
neighbor because of an intense headache, confusion, and left
hand hemiparesis. On examination, the patient has a bruise
located over the right temporal region, mydriasis, and right
deviation of the right eye, papilledema, and left extensor
plantar response. An emergency CT scan of the head without
contrast reveals a lens-shaped hyper-density under the right
temporal bone with mass effect and edema. What is the most
likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
, Page 4 of 426
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1 .....ANSWER.....Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of
the middle meningeal artery. Although a lucid interval ranging
from minutes to hours followed by altered mental status and
focal deficits is typical for epidural hematoma, this clinical
picture is only encountered in up to 1/3 of the patients. The
collection of blood between the skull and dura mater causes an
evident mass effect with ophthalmic nerve palsy and the
contralateral hemiparesis. Surgical evacuation of the clot via burr
holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the
bridging veins that connect the cerebrum to the venous sinuses
within the dura. This venous hemorrhage will result in a gradual
Summary Week 1Reflection - NR603 / NR-603 / NR 603
(Latest) : Advanced Clinical Diagnosis and Practice
Across the Lifespan Practicum - Chamberlain
He complains of neck pain and severe burning in his shoulders
and arms. His physical examination reveals weakness of his
upper extremities. What type of spinal cord injury does this
patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B .....ANSWER.....Central Cord Syndrome
,Page 2 of 426
the central cord syndrome involves loss of motor function that is
more severe in the upper extremities than in the lower
extremities, and is more severe in the hands. There is typically
hyperesthesia over the shoulders and arms. Anterior cord
syndrome presents with paraplegia or quadriplegia, loss of
lateral spinothalamic function with preservation of posterior
column function. Brown-Séquard syndrome consists of weakness
and loss of posterior column function on one side of the body
distal to the lesion with contralateral loss of lateral spinothalamic
function one to two levels below the lesion. Complete cord
transection would affect motor and sensory function distal to the
lesion. Cauda equina syndrome typically presents as low back
pain with radiculopathy.
A 37-year-old man fell from a ladder as he finished hanging the
Christmas lights on his house. The right side of his head hit the
alley cement, and he lost consciousness for about 1 minute; he
,Page 3 of 426
woke up with a headache, but he had no other complaints. A few
hours later, the patient is brought to the emergency room by his
neighbor because of an intense headache, confusion, and left
hand hemiparesis. On examination, the patient has a bruise
located over the right temporal region, mydriasis, and right
deviation of the right eye, papilledema, and left extensor
plantar response. An emergency CT scan of the head without
contrast reveals a lens-shaped hyper-density under the right
temporal bone with mass effect and edema. What is the most
likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
, Page 4 of 426
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1 .....ANSWER.....Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of
the middle meningeal artery. Although a lucid interval ranging
from minutes to hours followed by altered mental status and
focal deficits is typical for epidural hematoma, this clinical
picture is only encountered in up to 1/3 of the patients. The
collection of blood between the skull and dura mater causes an
evident mass effect with ophthalmic nerve palsy and the
contralateral hemiparesis. Surgical evacuation of the clot via burr
holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the
bridging veins that connect the cerebrum to the venous sinuses
within the dura. This venous hemorrhage will result in a gradual
