Clinical Vignette A 40-year-old right-handed man with a past medical history significant for hypertension presented to the emergency department (ED) via ambulance with sudden-onset right hemiparesis. He did not take antithrombotic medications. His initial blood pressure was 184/93 mm Hg. The…
While in recent years ischemic stroke has dropped to the fifth most frequent cause of death in the United States, it remains a leading cause of morbidity, mortality, and long-term disability worldwide with a devastating impact on patients, families, and…
The brain and meninges are supplied by arteries derived from the common carotid artery (CCA) and vertebrobasilar system ( Fig. 14.1 ). The right CCA usually originates from the brachiocephalic trunk, whereas the left CCA originates directly from the aortic…
Coma Clinical Vignette A 57-year-old man with coronary artery disease develops severe chest pain and heaviness on exertion, then loses consciousness while working in the garden with his wife. Emergency Medical Services is called immediately and arrives at the scene…
Clinical Vignette A 62-year-old man with hypertension and diabetes mellitus type 2 was brought to the emergency department via Emergency Medical Services for evaluation of acute onset of obtundation. Over the course of approximately 1 minute, he changed from being…
Cranial Nerve XI: the Spinal Accessory Nerve Cranial nerve (CN) XI, or the spinal accessory nerve (SAN), serves primarily as the motor nerve for the sternocleidomastoid (SCM) and trapezius muscles in the neck and shoulder. It has an intriguing functional…
Cranial Nerve IX: Glossopharyngeal Nerve and Swallowing The glossopharyngeal nerve is a mixed nerve, containing both sensory and motor fibers along with parasympathetic, special sensory, and visceral sensory components. The motor component is fibers to the stylopharyngeus muscle, as well…
Auditory Nerve Clinical Vignette A 68-year-old man presented with sudden onset of unilateral right-sided hearing loss. He stated that this was preceded by several months of constant ringing in his right ear. He had a history of hypertension and type…
Clinical Vignette A 62-year-old judge became aware of subtle weakness of his left lower face that he first noted while shaving. Two months later, he noted that he could no longer close his left eyelid fully and was having increasing…
Clinical Vignette A 58-year-old retired town clerk presented with a 2-week history of numbness over her left chin and adjacent lower lip as well as vague pain in the left jaw. She explained that the area feels “Novacaine-like,” exactly like…