From your reading of the Case study, explain the rationale why pupil dysfunction is ipsilateral while limb movement is contralateral
What will be an ideal response?
Suggested response: Voluntary muscle movement is controlled by an area in each of the frontal lobes called the motor cortex. Impulses travel from these areas down two neural pathways, one left and one right, towards the spinal cord. These pathways are referred to as the corticospinal tracts or the pyramidal tracts. Once the tracts reach the level of the medulla, they cross over to the other side of the spinal cord and continue on to the muscle to be innervated. This is referred to as the decussation of pyramids. Because of this crossing over of the tracts, movement initiated in the motor cortex of the left front lobe will cause movement on the right side of the body, i.e. contralateral. Pupil constriction/dilation is controlled by cranial nerves III (oculomotor). These nerves originate in the left and right side of the midbrain and, unlike the corticospinal tracts, do not cross over to the other side. Hence, the left CN III innervates the left pupil and the right CN III the right pupil, i.e. ipsilateral.
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What will be an ideal response?
Continuous positive airway pressure (CPAP) has been ordered for a patient in the intensive care unit in an effort to defer intubation
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