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PSB3002 – Nelson – Module 1 – Cells and Structures Case Study Worksheet – I Was the Clumsy One


All questions must be answered to earn full credit. Partial work is graded with the posted rubric.

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This case study has 19 required questions (including labeling a figure) and 1 optional video.




Part I – Signs/Symptoms and Initial Diagnosis


1. Stacy’s MRI image results indicate abnormalities of the cerebellum of the brain and spinal cord. In what division of the nervous system are the brain and spinal cord?

2. Fill in the table below by listing the six major brain regions and describing their functions.


Brain Region


Medulla Oblongata  



3. Use Figure 1 to answer the following questions:

a. What sectional plane did clinicians use to obtain this view of the brain and spinal cord (frontal, transverse or sagittal)?

b. What is the normal curvature of the cervical spine, and how does this compare to Stacy’s cervical spine?

c. Note the difference in the location of the cerebellum between Stacy and the healthy image. Clinicians refer to this defect as cerebellar tonsillar herniation of the brain. Use Figure 1 and a credible source to explain why patients with Type I Chiari malformation present with cerebellar tonsillar herniation.

d. Note the white patches on the spinal cord of Figure 1(A). This is an indication of syrinx of the spine (syringomyelia). Use Figure 1 and a credible source to describe the syrinx of the spine and compare it to a healthy spinal cord.

4. Stacy had an abnormal Hoffman’s reflex (finger flexor reflex), which indicates issues with the central nervous system. Clinicians conduct this reflex test by applying pressure to the middle fingernail bed of a patient’s middle finger. An abnormal test is the flexion of any phalange and possible adduction of the thumb. Considering this, answer the questions below.

a. Define neural reflex:

b. **Paste a picture of your labeled diagram here**

c. Indicate on Figure 2 above where Stacy’s abnormal reflex may originate.

d. Hoffman’s reflex test (finger flexor reflex) can be associated with problems involving the corticospinal tract. What type of information travels the corticospinal tract, and how does this relate to Hoffman’s reflex test?

5. Describe syncope and list some common causes.

6. Use the information you have learned from this part of the case study (Part I) and a credible source to describe and list signs/symptoms of type I Chiari malformation.

7. List Stacy’s signs and symptoms that are consistent with a diagnosis of CM. Briefly explain your answer.


Part II – The Doctor Visit and Initial Treatment


1. List Stacy’s signs and symptoms before her surgery. What do her signs/symptoms and MRI scans indicate regarding the progression of her condition?

2. What does C3–T4 mean in the above text?

3. What are the functions of cerebral spinal fluid (CSF), and what is the typical sequence of CSF flow in the CNS?

4. How is the CSF interrupted in Stacy’s central nervous system?

5. How does the interruption of Stacy’s CSF impact the neural tissue of the spinal cord?

6. List the structures that protect the brain from superficial to deep and explain how a full decompression surgery without any protective patches or plates covering the brain could have compromised Stacy’s brain. (Hint: Start with bone and end with pia mater)

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