I’VE BEEN OUT OF TOWN

As a parent, you absolutely dread that call from your child indicating he or she has a problem—maybe a huge problem.  On April 25^th of this year we received a call from our oldest son.  He was taking a late lunch at a local restaurant in downtown Chattanooga when he suddenly collapsed, fell backwards and hit his head on the sidewalk.  An onlooker rushed over to help him and quickly decided he needed a visit to Memorial Hospital emergency room.  Something just did not feel right.  He called us on the way to the ER. Once in the ER and after approximately five (5) hours and one CAT Scan later, the attending physician informed us that our son had a great deal of fluid collecting at the top of his brain and there was a great deal of swelling.  The decision was made by them to move him to Erlanger Hospital.  Erlanger has better facilities for neurological surgery if that became necessary.  At 1:32 A.M. Wednesday morning we received word that our son had a tumor at the base of his brain stem.  It was somewhat smaller than a tennis ball and in all probability, had been growing for the last ten years.  Surgery was necessary and quickly to avoid a stroke or a heart attack.  The tumor was pressing on the spinal cannel and nerve bundles.  Much delay at this point would be catastrophic.  It is amazing to me that there were no signs of difficulty prior to his fall.  Nothing to tell us a problem existed at all.

Erlanger referred us to the Semmes-Murphy Clinic in Memphis where all documentation from Memorial and Erlanger had been sent.  Founded one hundred (100) years ago by Eustace Semmes, MD, and Francis Murphey, MD, Semmes-Murphey Neurologic & Spine Institute has been a leader in the development of technology and procedures that improve the quality of care for patients with neurological and spine disorders. This continuing leadership has made the Semmes-Murphey name instantly recognizable to physicians across the country and the world, many of whom refer their patients here for treatment.  Dr. Madison Michael performed the eight (8) hour surgery nine (9) days ago to remove the tumor.  He is a miracle worker.  The surgery was successful but with lingering issues needing to be addressed as time allows and physical therapy dictates. Our son has lost hearing in his left ear, double vision, some atrophy in his extremities, and loss of stability.  There was also great difficulty in swallowing for three days after surgery and at one time we felt there might be the need for a feeding tube insertion.  That proved not to be the case since he eventually passed the swallow test.  That test is as follows:

• Water
• Applesauce
• Jell-O-like substance
• Oatmeal
• Solid food

He did eventually pass.

We have a long road of recovery ahead of us but there is optimism he can regain most, if not all of his cognitive and physical abilities.  We do suspect the hearing is gone and will never return, but he is alive.

CRANIAL NERVES:

Our brain is a remarkably delicate and wonderful piece of equipment.  The ultimate computer with absolutely no equal.  Let’s take a look.

The cranial nerves exist as a set of twelve (12) paired nerves arising directly from the brain. The first two nerves (olfactory and optic) arise from the cerebrum, whereas the remaining ten emerge from the brain stem. This is where our son’s tumor was located so the surgery would have to be performed by one of the very best neurosurgeons in the United States.  That’s Dr. Michael.

The names of the cranial nerves relate to their function and they are also numerically identified in roman numerals (I-XII). The images below will indicate the specific location of the cranial nerves and the functions they perform.

You see from above the complexity of the brain and what each area contributes to cognitive, mobility and sensory abilities.  Remarkably impressive central computer.

The image below shows the approximate location relative to positioning of the nerve bundles and the functions those nerves provide.

 

 

Doctor Michael indicated the nerves are like spider webs and to be successful those nerves would have to be pushed away to allow access to the tumor.   The digital below will indicate the twelve (12) nerve bundles as follows:

Olfactory–This is a type of sensory nerve that contributes in the sense of smell in human beings. These basically provide the specific cells that are termed as olfactory epithelium. It carries the information from the nasal epithelium to the olfactory center in brain.

Optic–This is a type of sensory nerve that transforms information about vision to the brain. To be specific this supplies information to the retina in the form of ganglion cells.

Oculomoter–This is a form of motor nerve that supplies to different centers along the midbrain. Its functions include superiorly uplifting the eyelid, superiorly rotating the eyeball, construction of the pupil on the exposure to light and operating several eye muscles.

Trochlear–This motor nerve also supplies to the midbrain and performs the function of handling the eye muscles and turning the eye.

Trigeminal–This is a type of the largest cranial nerve in all and performs many sensory functions related to the nose, eyes, tongue and teeth. It basically is further divided in three branches that are ophthalmic, maxillary and mandibular nerve. This is a type of mixed nerve that performs sensory and motor functions in the brain.

Abducent–This is a type of motor nerve that supplies to the pons and performs the function of turning the eye laterally.

Facial–This motor nerve is responsible for different types of facial expressions. This also performs some functions of sensory nerve by supplying information about touch on the face and senses of tongue in mouth. It is basically present over the brain stem.

Vestibulocochlear–This motor nerve is basically functional in providing information related to balance of head and sense of sound or hearing. It carries vestibular as well as cochlear information to the brain and is placed near the inner ear.

Glossopharyngeal–This is a sensory nerve which carries sensory information from the pharynx (initial portion of throat) and some portion of tongue and palate. The information sent is about temperature, pressure and other related facts. It also covers some portion of taste buds and salivary glands. The nerve also carries some motor functions such as helping in swallowing food.

Vagus–This is also a type of mixed nerve that carries both motor and sensory functions. This basically deals with the area of the pharynx, larynx, esophagus, trachea, bronchi, some portion of heart and palate. It works by constricting muscles of the above areas. In sensory part, it contributes in the tasting ability of the human being.

Spinal accessory–As the name intimates this motor nerve supplies information about the spinal cord, trapeziusand other surrounding muscles. It also provides muscle movement of the shoulders and surrounding neck.

Hypoglossal–This is a typical motor nerve that deals with the muscles of tongue.

CONCLUSION: I do not wish anyone gain this information as a result of having gone through this exercise.  It’s fascinating but I could have gone a lifetime not needing to know.  Just my thoughts.