Question

Application Question 1

PATIENT A:

A 38-year-old woman exhibited breathy, hoarse voice quality following surgery for cervical disc herniation. She was told this was a temporary effect of intubation.

1. What cranial nerve(s) is/are implicated? Explain your answer based on symptoms.

2. Explain how this nerve was injured given the above explanation.

3. What other symptoms would you expect to see based solely on your answer to #1?

PATIENT B: A 70-year-old man had a stroke affecting the right side of the brainstem from the lower pons to the lower medulla.

4. Which cranial nerves would be affected? List them by name and number.

5. For each nerve listed in #3, describe the deficits you would expect the patient to exhibit.

6. His lesion extended from the midline to the lateral edges of the brainstem. What pathways would be affected and what additional signs/symptoms would you expect?

PATIENT C: A 20-year-old man fell from a roof and hit his back on a wrought-iron fence during the fall. He has bilateral loss of sensation from the waist down.

7. Which part of his spinal cord appears to be injured? Explain your answer

8. Why was there no loss of movement?

Answer 1

1)glossopharyngeal and vagus

Patients with deficits in the glossopharyngeal or vagus nerves may present with dysphagia, dysphonia, dyspnea, or a combination of these symptoms.

Hoarseness usually refers to a scratchy or rough sound.

Breathiness refers to abnormal escape of air throughout the voice production.

The most common cause of these are acute laryngitis from short-term vocal abuse or an upper respiratory tract infection.

2) Endotracheal intubation

It is a routine procedure performed by anaesthesiologists worldwide.

It has some complications, one of the worst being loss of voice or aphonia.

The hypoglossal nerve is the twelfth cranial nerve, and is a pure motor nerve that is involved in the movements of the tongue and infrahyoid muscles. Hypoglossal nerve palsy induces palsy in the ipsilateral lingual muscles, causing tongue deviation and articulation disorder.

The reasons could be;

.Compression on the cricoid cartilage during intubation will anatomically fix the superficially distributed hypoglossal nerve at the mandible angle, and if the intubation is performed in this condition, the nerve may be hyperextended.

.Fixing the tube in an abnormal location, excessive cuff pressure, the inflation of the cuff in the larynx rather than in the trachea, or extubating while the cuff is inflated may cause hypoglossal palsy.

3) symptoms can be Dysphagia, dysphonia, and dyspnea.