PLACE: Pinellas County Courthouse
315 Court Street North
DATE: October 11, 2002
TIME: All day
REPORTED BY: TONYA H. MAGEE, RPR
Court Reporter and Notary Public
Sixth Judicial Circuit
4 Anoxic and hypoxic encephalopathies are
5 characterized by multiple small strokes. So depending
6 upon where that stroke is, is where your deficiency is.
7 In your average stroke, the entire side of the body is
8 affected. But in a hypoxic or anoxic episodes, or
9 cerebral palsy, you will see lots of different areas
10 affected. And there may be another injury, a neck
11 injury with her also, which compounds her examination.
12 Q. Compounds what, her condition?
13 A. Her condition, yes. There is a neck injury.
14 There may be a spinal cord injury, also.
15 Q. How were you able to determine a neck injury?
16 A. By physical examination. On physical
17 examination, she has several characteristics that are
18 not typical of a stroke. First, she has very severe
19 neck spasms. That's typical of the body's response,
20 splinting the area to prevent injury to that area.
21 Q. Splinting the area?
22 A. Yeah. If you injure your arm, you will move
23 it. Your muscles will contract around it to keep that
24 area moving. Her muscles around the neck area are
25 heavily contracted to help prevent movement around that
1 area. Later on in the videotape, we actually show that
2 it's almost impossible for her to bend her neck.
3 You can pick her entire body up off the bed
4 just by putting pressure on the back of the neck area,
5 which is not typical in brain injury patients but in
6 neck injury patients. In addition, her sensory
7 examination is nothing like a typical stroke patient or
8 typical anoxic encephalopathy.
9 Q. Are you experienced in treatment of patients
10 with spinal cord injury?
11 A. Yes, I am.
What is interesting is I'm not able to flex
5 the neck. There I tried to bend the neck forward and
6 she doesn't flex forward. What I'm doing to her feels
7 as almost a massage.
8 We are going to come back to that neck a
9 little bit more because I clearly have not completed all
10 of my examination at that time.
Q. Now, her chin does not go down?
18 A. Her chin does not go down. My hand is
19 essentially on the back of the scull here, not on the
20 neck area. She is rigid in the upper spine area, and
21 that goes along with a neck injury. And that's
22 important for several reasons. First one is that there
23 is a change in the neurological exam. We had a person
24 essentially here that has had brain injury and probably
25 also a spinal cord injury.
1 Q. Spinal cord or vertebral injury?
2 A. Vertebral injury, but I also suspect, from
3 other parts of my examination, spinal cord injury along
4 with it.
5 In addition, when you have a neck injury, it
6 causes irritation to the sympathetic nerves that control
7 blood flow into the brain. Much of the blood flow to
8 the brain goes in through that area. So when they're
9 damaged, you narrow the blood flow. There is a
10 restricted blood flow to the brain.