The Soccer Mom:
\nA Case Study on the Nervous System
\nby
\nJennifer Bolognese, Misti Coronel, Anita Intorre, and
\nPhil Stephens
\nBiology Department
\nVillanova University
\nPart I\u2014At the Soccer Game
\nTirty-two-year-old Phyllis Jackson was sitting on the bench at the side of the soccer field, sipping a bottle of
\nGatorade. Her husband, Steven, sat next to her with a concerned expression.
\n\u201cI\u2019m really worried about you, honey,\u201d he said.
\n\u201cI\u2019m just a little dehydrated; I\u2019ll be fi ne.\u201d
\n\u201cIf this were the first incident, then maybe I\u2019d agree with you. But your boss has been on your case about
\nyour lack of concentration at work, you forgot to pick up the kids from school last week, and quite frankly,
\nyou haven\u2019t exactly been yourself with me lately. Now you\u2019re having fainting spells during games? Something
\ndoesn\u2019t seem right.\u201d
\n\u201cI know things haven\u2019t been going well for me lately, but I don\u2019t know why. I try so hard at work, at home,
\nwith the kids, to be a good wife. So maybe all this stress has made me a little unfocused and disoriented.
\nWhat do you want me to do about it?\u201d Phyllis said, blinking back tears.
\n\u201cI think you should see a doctor,\u201d Steven replied, putting his arm around her and drawing her close. \u201cT e
\nkids are getting worried, too.\u201d
\nPhyllis sighed. \u201cAlright, if it will make you feel better. I really just think I need some time to relax, though.\u201d
\n\u201cWell\u2026 I could drop the kids off at my sister\u2019s tonight; that would give us a little free time\u2026\u201d
\n\u201cTat\u2019s really thoughtful of you. I could definitely use a quiet night at home, maybe even go to bed early.\u201d
\nSteven seemed disappointed.
\nQuestions
\n\uf644. What problems does Phyllis seem to be experiencing?
\n\uf645. Which of these problems could be caused by dehydration?
\n\uf646. Which of these problems might make you consider that there\u2019s something more going on? Why?
\n\uf647. Suppose Phyllis does have a more serious problem. Can you think of any neurological problems
\nthat could be the cause of these symptoms?
\n\u201cThe Soccer Mom\u201d by Bolognese, Coronel, Intorre and Stephens Page 1<\/p>\n
Part II\u2014The Doctor Visit
\n\u201cSo, what seems to be the problem, Mrs. Jackson?\u201d Dr. Warner asked Phyllis.
\n\u201cMy husband wanted me to come in and see you after I fainted during my soccer game Saturday. I\u2019ve also
\nbeen having some problems at work, but I think I\u2019m just stressed.\u201d
\n\u201cWhat kinds of problems have you been having at work?\u201d
\n\u201cIt\u2019s been hard to concentrate on tasks. I\u2019ve also had some problems typing\u2014I\u2019ve been making more errors
\nthan usual, and oftentimes my fingers will go numb.\u201d
\n\u201cI see,\u201d said Dr. Warner, taking a few notes on his clipboard. \u201cAccording to my records you are not on any
\nlong term medication. Have you noticed any problems outside of work?\u201d
\n\u201cWell, my husband has been complaining about our personal life lately. And last week, I completely forgot
\nthat I was supposed to pick up our two daughters after school. I\u2019ve been feeling really tired lately; even my
\ncoordination seems off .\u201d
\n\u201cHow long has this been going on for?\u201d
\n\u201cA few weeks, but this isn\u2019t the first time. Tese problems seem to come and go, but it\u2019s getting to the point
\nwhere I can\u2019t just ignore them anymore. I don\u2019t know, maybe I\u2019m just depressed.\u201d
\n\u201cWhy do you say that?\u201d
\n\u201cMy mother suffered from depression throughout my childhood.\u201d
\n\u201cWell, depression certainly could cause some of the symptoms you\u2019re experiencing,\u201d Dr. Warner said
\nthoughtfully. \u201cIs there a history in your family of any neurological disorders?\u201d
\n\u201cI don\u2019t think so. I have some vague recollection of my grandfather in a wheelchair when I was really young,
\nbut I don\u2019t know what was wrong with him.\u201d
\n\u201cOkay,\u201d said the doctor, nodding. \u201cWell, the few preliminary tests we\u2019ve run show that you are not pregnant,
\nand that you are not going through menopause. I\u2019d like to send you to see Dr. Trush, a friend and colleague
\nof mine. She is a neurologist at the local hospital and she will run a few tests to explore your symptoms a
\nlittle further.\u201d
\nQuestions
\n\uf644. What new signs or symptoms have been revealed?
\n\uf645. Could any of Phyllis\u2019s symptoms be attributed to depression? If so, which?
\n\uf646. What neurotransmitters are thought to be involved in depression?
\n\uf647. What neurological disorders could have put her grandfather in a wheelchair?
\n\uf648. Could any of these neurological disorders explain one or more of Phyllis\u2019 symptoms?
\n\uf649. Could Phyllis have inherited any of these disorders?
\n\uf64a. If you were in Dr. Warner\u2019s position, what tests might you suggest to confirm (or not) this
\ndiagnosis?
\n\u201cThe Soccer Mom\u201d by Bolognese, Coronel, Intorre and Stephens Page 2<\/p>\n
Part III\u2014Diagnostic Tests
\nDr. Trush looked over the results of Phyllis\u2019s Magnetic Resonance Imaging (mri) and evoked potential tests.
\nShe was thinking how glad she was that Steven had accompanied Phyllis on this visit as she showed them the
\nMR images of Phyllis\u2019 brain.
\n\u201cTe machine took pictures of Phyllis\u2019 brain in slices. Te dark areas are the brain tissue, Phyllis, and the
\nwhite areas in the middle and around the outside are the cerebrospinal fl uid.\u201d
\n\u201cIs that normal? Am I ok?\u201d Phyllis asked. \u201cAnd what are those little white dots in the tissue?\u201d
\n\u201cTe white dots are what concerned me,\u201d replied the doctor. \u201cSo we did another type of mri, called dark fl uid,
\nso that your cerebrospinal fluid would not show up white.\u201d
\n\u201cBut I still see the white dots in my brain tissue. What does that mean?\u201d
\nTe doctor looked down, knowing that this was never an easy thing to tell a patient.
\n\u201cI am afraid that this indicates that there are plaques or scars in your brain, and that you may have multiple
\nsclerosis.\u201d
\nTears began to form in her eyes as Phyllis squeezed her husband\u2019s hand.
\n\u201cI am afraid that the evoked potential test and the elevated levels of myelin basic protein in you cerebrospinal
\nfluid indicate the same thing.\u201d
\nQuestions
\n\uf644. Test your knowledge of the function of chemical synapses by filling in the flow diagram on the
\nnext page.
\n\uf645. What type of cell is myelin?
\n\uf646. What is the function of myelin in nerve cells?
\n\uf647. In myelinated axons, where are action potentials generated?
\n\uf648. Where, then, are voltage gated sodium channels concentrated in myelinated axons?
\n\uf649. What happens to myelin in people who suffer from multiple sclerosis?
\n\uf64a. Why is there an elevated level of myelin basic protein in the cerebrospinal fl uid?
\n\uf64b. What would be the effect on action potential conduction at a region of axon where the disease had
\nits eff ect?
\n\uf64c. What effect would this have on the coordination of movements if this took place in areas involved
\nin motor control of fi nger movements?
\n\u201cThe Soccer Mom\u201d by Bolognese, Coronel, Intorre and Stephens Page 3
\nAn action potential in an
\nexcitatory presynaptic nerve.
\nAn _____ in the dendrites of
\nthe postsynaptic nerve.
\nThis spreads passively to the
\n___________.
\nDepolarization of this region
\nopens voltage-gated ______
\nchannels.
\nSuffi cient membrane
\ndepolarization to _________
\nopens enough of these
\nchannels to produce an
\naction potential.
\nNon-myelinated axon Myelinated axon
\nThe currents associated with
\nthe action potential spread to
\nthe ______ region of the axon.
\nThe currents associated with
\nthe action potential spread to
\nthe next ________.
\nThe action potential travels
\ndown the axon to the
\n___________.
\n\u201cThe Soccer Mom\u201d by Bolognese, Coronel, Intorre and Stephens Page 4
\nPart IV\u2014The Diagnosis
\nDr. Trush informed Phyllis that she was probably suffering from the relapsing-remitting form of multiple
\nsclerosis (ms), in which relapses of symptoms are separated by periods of remission. ms is a disorder in which
\nthe myelination of axons is degraded due to unknown factors. Te most commonly accepted explanation is
\nthat ms is an autoimmune disorder in which myelin in the central nervous system is attacked by the body\u2019s
\nown immune system. Tere is no known cure for multiple sclerosis.
\nDr. Trush ordered physical therapy, weekly injections of interferon beta, and corticosteroids. In addition,
\nshe suggested that Phyllis and Steven begin marriage counseling to help them deal with the changes in their
\nlifestyle caused by this disorder.
\nQuestions
\n\uf644. During remission, axons affected by the disorder regain their function. If voltage-gated sodium
\nchannels are concentrated in certain regions of the myelinated axon prior to the disease, what do
\nyou think happens to these sodium channels after multiple sclerosis has had its eff ect?
\n\uf645. How would these three treatments (physical therapy, weekly injections of interferon beta, and
\ncorticosteroids) help to control Phyllis\u2019s symptoms?
\nCopyright \u00a9 \uf645\uf643\uf643\uf648 by the National Center for Case Study Teaching in Science.
\nOriginally published \uf643\uf647\/\uf644\uf64c\/\uf643\uf648 at http:\/\/www.sciencecases.org\/soccer_mom\/soccer_mom.asp
\nPlease see our usage guidelines, which outline our policy concerning permissible reproduction of this work.
\n\u201cThe Soccer Mom\u201d by Bolognese, Coronel, Intorre and Stephens Page 5<\/p>\n","protected":false},"excerpt":{"rendered":"
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