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Drooping eyelid, where the upper eyelid falls to a position that is lower than normal. It is an ocular motor disturbance that is the initial symptom of myasthenia gravis in two-thirds of patients, and found in almost all patients within 2 years.

Extraocular muscles

Include the superior rectus, inferior rectus, lateral rectus, medial rectus, superior oblique and inferior oblique muscles, which work in unison to move the eye and are often affected by myasthenia gravis.

cholinesterase inhibitor

slow the enzymatic breakdown of acetylcholine so that more accumulates in the synapses and its effect is prolonged.


It measures the electrical impulses of muscles at rest and during contraction and are used to evaluate muscle weakness or paralysis.

autoimmune disease

Occurs when the body's immune system attacks the body's own cells. Autoimmune diseases include rheumatoid arthritis, Guillain-Barre syndrome, multiple sclerosis and myasthenia gravis.


thymus plays a major role in the development of the immune system, and this role is complete by birth. Abnormalities with the thymus are often found in myasthenia gravis, with 10% of patients having thymic tumors (usually benign). Thymectomy, the removal of the thymus gland, is recommended for all patients with thymic tumors and often for patients under 60 with moderate to severe myasthenia gravis weakness.


Difficulties with chewing and swallowing


Difficulties in articulating speech.

hypoactive gag reflex

underactive response to contact of a foreign body with the mucous membrane of the throat. A normal gag reflex results in retching or gagging.


loss of tissue resulting from disease or lack of use.

muscle fasciculations

muscle twitching. It is the result of minor local muscle contractions or the uncontrollable twitching of a single muscle group served by a single motor nerve fiber or filament.


excessive secretion of saliva.


an abnormality in neuromuscular activity characterized by rapidly alternating muscular contraction and relaxation. Unlike muscle fasciculations (usually caused by lower motor neuron pathology), this causes large motions that are usually initiated by a reflex.

lower motor neuron (LMN) disease

a cluster of motor symptoms associated with pathology of the alpha motor neuron and peripheral pathways to muscles. Symptoms include flaccidity, hypoactive stretch reflex, fasciculations, muscle weakness and muscle atrophy

upper motor neuron (UMN) disease

a cluster of motor symptoms associated with damage to central nervous system structures that normally impose inhibitory influences on brainstem nuclei that control gamma innervation to muscle spindles. Symptoms include spasticity (hypertonicity) and hyper-reflexia.

Naso-gastric tube

used for feeding and administering drugs; clear plastic tube inserted through the nose, down the back of the throat, and into the stomach

PEG tube

after endoscopic placement, with patient sedated, food and medication are delivered directly to the stomach


enteral feeding system in which the upper gastrointestinal tract is bypassed completely, and food & medication are delivered into the jejunum, rather than the stomach.

Bulbar palsy

a form of motor neuron disease characterized by dysfunction of the muscles controlled by the cranial nerves of the lower brain stem (the "bulb") -- specifically, the glossopharyngeal nerve (IX), vagus nerve (X), and hypoglossal nerve (XII).

Pseudobulbar palsy

in addition to cranial nerve impairments affecting paralysis of the lips and tongue, the person demonstrates "psudobulbar affect, which is characterized by emotional lability (inappropriate laughing and crying)


producing or increasing perspiration.


rapid heart rate, especially above 100 beats per minute in an adult.


putting a tube into a hollow organ or passageway, such as the trachea.


the fluid that circulates through the ventricles of the brain, the cavity of the spinal cord, and the subarachnoid space that acts a buffer against shock. CSF can be tested for the diagnosis of a variety of neurological diseases. Usually, it is obtained by a procedure called lumbar puncture in an attempt to count the cells in the fluid and to detect the levels of protein and glucose.


a process in which a person's blood is removed, the plasma separated, and the blood put back into the body to build new antibodies for immunity. When used early in the disease process of GBS, plasmapheresis has been beneficial. It decreases death rates, lowers the probability of permanent problems, and shortens the length of the illness.

nerve conduction studies

measure nerve conduction velocity to determine how well individual nerves can transmit electrical signals.


measures the electrical impulses of muscles at rest and during contraction and are used to evaluate muscle weakness or paralysis


Double vision or the simultaneous awareness of two images of the same object that results from a failure of the two eyes to work in a coordinated fashion. Covering one eye would erase one of the images.

Evoked potentials

Recordings of the nervous system's electrical response to the stimulation of the specific sensory pathways. A person's recorded responses are displayed on an oscilloscope and analyzed on a computer that allows comparison with normal response times. Demyelination results in a slowing of response time.


A group of immune system proteins that are produced and released by cells infected by a virus, which inhibit viral multiplication and modify the body's immune response.

Ocular motility

moving or having power to move the eyes


Rapid, involuntary movements of the eyes in the horizontal or, occasionally, the vertical direction.


The incoordination and unsteadiness that result from the brain's failure to regulate the body's posture and the strength and direction of limb movements. Ataxia is most often caused by disease activity in the cerebellum.


A disturbance of coordination, caused by lesions in the cerebellum. A tendency to over- or underestimate the extent of motion needed to place an arm or leg in a certain position as, for example, in overreaching for an object.

Intention tremor

Rhythmic shaking that occurs in the course of a purposeful movement, such as reaching to pick something up or bringing an outstretched finger in to touch one's nose.

Vibratory perception

The process of perceiving a vibration stimulus

Tandem gait

A test of balance and coordination that involves alternately placing the heel of one foot directly against the toes of the other foot.

Optic neuritis

Inflammation or demyelination of the optic (visual) nerve with transient or permanent impairment of vision and occasionally pain.

Cerebellar ataxia

of muscle coordination caused by disorders of the cerebellum


Abnormal increase in muscle tone, manifested as a spring-like resistance to moving or being moved


producing or increasing perspiration.


rapid heart rate, especially above 100 beats per minute in an adult.


a process in which a person's blood is removed, the plasma separated, and the blood put back into the body to build new antibodies for immunity.

Complete spinal cord injury

produces total loss of all motor and sensory function below the level of injury. Almost one half of all spinal cord injuries are this type

Halo vest

Is a metal ring attached to the skull with screws. It hold the neck in place as it heals.

Indwelling catheter

a catheter is inserted into the bladder to drain or collect urine. One end of the indwelling catheter remains inside the bladder. A small, inflated balloon at the tip of the catheter inside the bladder keeps the end of the catheter from slipping out. Urine flows from the bladder through the catheter and collects in a drainage bag. If the patient is not bedridden, this drainage bag can be worn on the leg, where it can be hidden under a skirt or slacks. If the patient is bedridden, the drainage bag usually is attached to the lower portion of the hospital bed (near the floor). This position allows gravity to help the urine drain downward.

Normal saline

the first step in treatment of SCI is hydration with normal saline. Saline expands the extracellular fluid volume, increases the glomerular filtration rate, and increases the excretion of calcium in the urine. Saline administration alone can control hypercalcemia in some patients, but it needs to be used for the duration of the increased mobilization from bone, which could last weeks.

Pulse oximeter

non-invasive method of continuously monitoring blood O2 saturation; device is clipped to the patient's earlobe or finger tip. It uses beams of light to test how much oxygen is latched onto the hemoglobin in the blood cells and measures how much of the light is absorbed. This tells how much oxygen is in the bloodstream, because how much light is absorbed will change depending on much oxygen is present. Advanced oximeters can also measure how much carbon dioxide is in the blood.

Orthostatic hypotension

a condition which results in a decreased blood pressure when a person rises to sitting or standing from a reclined position

Autonomic dysreflexia

an abnormal triggering of the autonomic nervous system. It occurs after a spinal cord injury. Persons at risk for this problem generally have injury levels above T6.


a steroid-type anti-inflammatory drug, is given intravenously during the first 24 hours of a spinal cord injury to help reduce inflammation and swelling, and the destruction of tissue around the spinal cord.

Brown-Sequard syndrome

a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side..

Foley catheter:

a thin, sterile tube inserted into the bladder to drain urine. Because it can be left in place in the bladder for a period of time, it is also called an indwelling catheter.

Spinal shock

a state of transient reflex depression of cord function below the level of injury with associated loss of all sensorimotor functions. An initial increase in blood pressure is noted due to the release of catecholamines, followed by hypotension. Flaccid paralysis, including of the bowel and bladder, is observed. These symptoms tend to last several hours to days until the reflex arcs below the level of the injury begin to function again.

Autonomic hyperreflexia:

An abnormal reaction of the autonomic (involuntary) nervous system, seen in patients with spinal cord injury, to over-stimulation. This reaction may include high blood pressure, change in heart rate, skin color changes (pallor, redness, blue-grey coloration), and profuse sweating. Stimuli which are otherwise tolerated in healthy people (such as filling of the urinary bladder) create an excessive response from the patient's nervous system.

Essential tremor

A type of involuntary, rhythmic contraction of muscles producing the appearance of trembling or quivering; occurs generally in persons older than 70 years old; is often confused with the resting tremor associated with Parkinson's Disease.

Resting tremor

a coarse, rhythmic tremor, 3-5 Hz frequency, usually confined to hands and forearms, that appears when the limbs are relaxed, and disappears with active limb movements; characteristic of Parkinson's Disease

Cogwheel rigidity

Rigidity of a muscle that gives way in a series of little jerks upon being passively stretched, analogous to the ratcheting movement when a spring-loaded rod drops into the successive notches of a cog.

Festinating gait:

Shuffled walk which is difficult to initiate; the trunk is flexed, legs are flexed at the knees and hips, but stiff; steps are short and progressively more rapid.

Bromocriptine (Pardolel):

a synthetic dopamine agonist; has direct stimulatory effect on dopamine type-2 receptors.


Stiffness in the limbs or trunk resulting in decreased ROM


Reduced amplitude and speed of movement; literally slow (brady) movement (kinesia).


A monoamine oxidase type B (MAO-B) inhibitor that slows the breakdown of dopamine in the brain and may also block its reuptake at the synapse

L-dopa (levadopa)

A metabolic precursor of dopamine, and the first medication introduced to provide dopamine replacement therapy in Parkinson's patients.


a combination of Carbidopa and Levodopa (L-Dopa), the metabolic precursor of Dopamine. Carbidopa blocks peripheral dopa-decarboxylase, the enzyme that converts levodopa to dopamine within the blood-brain barrier. With the levodopa-carbidopa combination, more levodopa reaches the brain and is converted to dopamine. This eliminates the need for large doses of Levodopa at frequent intervals. The lower dosage, also reduces or eliminates many of the side effects attributed to the Dopamine formed in extra cerebral tissue.


an anticholinergic agent used to reduce stiffness and improve muscle control in Parkinson's disease.

Lead-pipe rigidity

Diffuse muscular rigidity resembling the resistance to bending of a metal pipe.

Kyphotic posture

Abnormal accentuation of the thoracic curve and flattening of the cervical and lumbar curves


temporary, involuntary, inability to move


Involuntary movements that generally appear on the side of the body most severely affected by Parkinson's disease, usually the side on which the first symptoms appeared. This phenomenon usually occurs after several years of using levodopa.

Deep brain stimulation

Procedure in which electrical signals are transmitted to a specific brain region from a neurostimulator that has been surgically implanted; typically used to reduce dyskinesias in advanced Parkinson's Disease.

Emotional lability

rapid and sizeable mood change that can be easily provoked and can rapidly disappear; is due to a weakening of frontal cortico-subcortical mechanisms underlying cognitive control of emotional reactions


neuroleptic drugs used for treatment of psychosis; serious side effects include tardive dyskinesia and sedation

Modulation of tone and volume

ability to control inflections of the pitch and "loudness" of one's speech


facial expression, usually of disgust or disapproval

Dystonic posturing

sustained muscle contractions resulting in abnormal, tonic positions of the neck and limbs


jerky, irregular, relatively rapid involuntary movement involving muscles of the face or extremities; the movement seems to flow from one body part into another; although involuntary and purposeless, these movements are sometimes incorporated into deliberate movement patterns


sudden, involuntary jerking of a muscle or group of muscles


brief, rapid, purposeless, simple or complex involuntary movements that are virtually identical to one another; they are repetitive but not rhythmic


slow, writhing, continuous, uncontrollable movement of the arms and legs


sustained muscle contraction often causing twisting or abnormal postures (dystonic postures)


a type of chorea; consists of continuous violent flinging movements on one side of the body; affects the arm more than the leg

Botox injections

a solution of botulinum toxin is injected to a peripheral nerve to block acetylcholine release at the neuromuscular junction; some nerve terminals remain unaffected so that the injected muscle can still contract, but with less force

Internal carotid artery stenosis

a narrowing of the internal carotid artery, usually as a result of atherosclerotic blockage.

subdural hematoma

a collection of blood on the surface of the brain, beneath the the dura mater. Subdural hematomas are usually the result of a serious head injury.

Secondary prevention

treatment for the purpose of preventing recurrence of a medical condition the patient has already sustained (e.g.- after a TIA or stroke, interventions designed to prevent a future stroke)

Anticoagulant therapy

medications that prevent the blood from clotting or prevent existing clots from getting larger.

Antiplatelet agents:

medications that inhibit platelet function. Aspirin, or acetylsalicylic acid (ASA), remains the most clinically effective, most widely used, and least expensive antiplatelet agent currently available.

Carotid endarterectomy

surgical procedure in which atherosclerotic plaque is removed from the inner lining of a carotid artery.

Mitral Valve Replacement

the surgical removal of a damaged or dysfunctional mitral valve in the heart and replacing it with a mechanical valve or a pig valve. Damage to the mitral valve can occur from a congenital defect, the natural process of aging, infection, or from a heart attack

Coumadin (Warfarin)

an anticoagulant; inhibits the ability of blood to clot, or coagulate; prevents new clots from forming or existing clots from getting larger; prescribed for people with certain conditions to prevent a first or recurrent stroke.

International Normalized Ratio

World Health Organization (WHO) and the International Committee on Thrombosis and Hemostasis for reporting the results of blood coagulation (clotting) tests. All results are standardized using the international sensitivity index for the particular thromboplastin reagent and instrument combination utilized to perform the test.

Ischemic changes

findings on CT scan, associated with brain changes caused by a lack of blood flow

effacement of the insular ribbon

loss of definition of the gray- white interface in the lateral margins of the insula ("insular ribbon"); occurs within less than less than 6 hours of a stroke of the middle cerebral artery (MCA); insular ribbon is supplied by the insular segment of the (MCA) and its claustral branches.

effacement of the lentiform nucleus

thinning of the larger and external nucleus of the corpus striatum which includes the outer reddish putamen and two inner pale yellow globular masses constituting the globus pallidus -- also called lenticular nucleus

hyperdense middle cerebral artery sign

weakening in an area of the middle cerebral artery (MCA) caused by an embolus or atherosclerotic calcifications; this finding can sometimes be seen at the time of early CT scanning; correlates with angiographically proven thrombus and is associated with poorer patient outcome.

NIH Stroke Scale

an 11-item clinical evaluation instrument widely used in clinical trials and practice to assess neurologic outcome and degree of recovery from stroke.

Partial gaze palsy

gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis are not present.


blindness or reduction in vision in one half of the visual field due to damage of the optic pathways in the brain. The person experiencing it has difficulty seeing one side of their surrounding environment, or will report that one side appears different from the other. Patients with hemianopia can readily learn to compensate for the disorder by turning their eyes and head to scan the entire environment.


a disorder of formulating and/or understanding language

Extinction to bilateral simultaneous tactile stimulation:

inability to detect a tactile stimulus when there is a competing stimulus presented to the opposite body side; the person has no difficulty detecting the same stimulus when it is presented in isolation

Thrombolytic therapy

a drug (enzyme) that break ups or dissolves blood clots, which cause both heart attacks and stroke. Since 1996, tPA (tissue plasminogen activator) has been approved by the Food and Drug Administration (FDA) for the treatment of occlusive stroke and heart attack. There is strong research evidence that, if administered within the first 3 hours of a stroke, it may reduce permanent disability.

Intravenous Activase

a tissue plasminogen activator; in 2007 - the only FDA approved thrombolytic therapy

Mechanical embolism removal

catheter-based extraction of an embolus; this technique may be used alone (in patients with contraindications to thrombolysis) or in conjunction with thrombolytic therapy.


of and inattention to one side of the body and its surrounding visual space


treatment with anticoagulant medications to reduce natural clotting factors and, thus, decrease the blood's clotting ability; used to prevent future myocardial infarction, stroke, deep venous thrombosis


an anticoagulant administered by intravenous (IV) injection or continuous IV.

Dysphagic diet

diet designed to prevent aspiration in patients with swallowing dysfunction

Duplex Doppler scanning

ultrasonic imaging that provides for non-invasive assessment of arterial and venous circulation in the lower limb; duplex assessment provides a measurement of blood velocity through a vessel

Deep venous thrombosis

blood clot (thrombus) in a deep vein, usually in the lower leg or thigh; serious risks include obstruction to circulation and pulmonary embolism

Subarachnoid hemorrhage

bleeding into the subarachnoid space (area between the arachnoid membrane and the pia mater); most common cause is trauma; spontaneous subarachnoid hemorrhages are usually the result of a ruptured aneurysm

Intracranial pressure monitor

device used in intensive care units for patients who have sustained head trauma, brain hemorrhage, brain surgery, or any other condition with risk of brain swelling; inserted by a neurosurgeon


anticonvulsant drug, used to treat people with chronic seizure disorders, and to prevent seizure activity in patients with acute brain injuries


an osmotic diuretic medication, administered intravenously, to reduce acutely raised intracranial pressure in patients with acute brain injury


medication used to prevent vasospasm and resulting ischemia resulting from subarachnoic hemorrhage; administered orally or through intravenous infusion

Cerebral angiography

imaging procedure in which contrast dye is injected into one or both of the carotid and/or vertebral arteries; and x-rays are taken of the dye as it courses through the cerebral artery distribution

Arteriovenous malformation

a defect of the circulatory system; generally believed to arise during embryonic or fetal development or soon after birth.


surgical procedure for occluding blood vessels abnormal blood vessels; used to control or prevent abnormal bleeding, shut down vessels that support a growing tumor (not applicable to this case) or destroy an AVM; Under X-ray guidance, a catheter is guided from the femoral artery in the leg up into the area to be treated.


exhibiting loss of the ability to comprehend the meaning of written or printed words and sentences; inability to read.

Right homonymous hemianopia

loss of the right half of the visual field in both eyes.

Apperceptive visual agnosia

impaired visual recognition of objects, faces, colors, words, and gestures; a disorder of visual perception, rather than acuity.


computerized axial tomography is a cross-sectional X-ray enhancement technique that greatly benefits diagnosis with high-resolution video images, some in three dimensions.

The Mini Mental State Examination

is a widely used method for assessing cognitive mental status. The evaluation of cognitive functioning is important in clinical settings because of the recognized high prevalence of cognitive impairment in medical patients.


Inability to recall names of objects. Persons with this problem often can speak fluently but have to use other words to describe familiar objects.


An inability to perform mathematical computations.


Inability to perform skilled, functional movements even when strength and coordination are intact. The primary impairment is in the person's capacity to plan and execute a skilled movement sequence. It is most evident when the person attempts to perform new tasks


Progressive decline of cognitive function (cognition) due to changes in the brain caused by disease or trauma. Cognitive functions that may be affected by dementia include decision making, judgment , memory, spatial orientation, thinking, reasoning, and verbal communication.


A cholinesterase inhibitor used for the treatment of mild to moderate Alzheimer's disease.

Global aphasia:

An acquired language disorder involving severe impairments in both comprehension and production of spoken and written language.

Topographical disorientation:

Inability to find one's way in spatial situations, associated with right parietal lobe dysfunction. Even in familiar environments, the person easily becomes lost and has difficulty remembering how to get from one place to another.


a surgical procedure in which a cut or opening is made in the trachea. The surgeon inserts a tube into the opening to bypass an obstruction, allow air to get to the lungs, or remove secretions. Surgical operation that creates an opening into the trachea with a tube inserted to provide a passage for air; performed when the pharynx is pathologically obstructed .


defined as a sleeplike state with total absence of awareness of self and the environment, even after vigorous external stimulation


the surgical procedure in which the skull (cranium) is opened to remove tumors, aneurysms, blood clots and abscesses.

Nasogastric tube:

a clear plastic tube that is inserted through the nose, down the back of the throat, through the esophagus and into the stomach. This tube can be used initially to remove air and digestive juices from the stomach. It is also used as a feeding tube for the comatose patient. This tube is uncomfortable, but not painful.

Pitting edema:

The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues that are outside of the blood vessels. Pitting edema can be demonstrated by applying pressure to, for example, the skin of a swollen leg, by depressing the skin with a finger. If the pressing causes an indentation in the skin that persists for some time after the release of the pressure


Discoloration caused by the escape of blood into the tissues from ruptured blood vessels marked by a livid black-and-blue or purple spot or area

Increased tone:

When this term is used to describe neuropathology, tone relates to a muscle's responsiveness to quick passive stretch. Hypertonicity and spasticity are often used as synonyms for increased tone. When an examiner tries to passively stretch a muscle, patients with this demonstrate hyper-responsive stretch reflexes and the examiner encounters an unusual degree of resistance to the quick stretch.

Asymmetric tonic neck reflex (ATNR)

A primitive reflex, mediated at the brain stem level. In persons with intact central nervous systems, the ATNR is fully integrated by 4-9 months of age. When present beyond this age, a positive response indicates CNS pathology. The ATNR is elicited when the person turns his head to the Right or Let. A positive response is an increase in muscle tone in extensor muscles of the arm and leg on the "face side" (the side toward which the head has turned) and a decrease in muscle tone of flexor muscles on the "skull side". This effect on muscle tone continues as long as the head is turned.

Symmetric tonic neck reflex (STNR):

A primitive reflex, mediated at the brain stem level. In persons with intact central nervous systems, the STNR is fully integrated by 11 months of age. In normally developing infants, the STNR is a precursor to crawling on hands and knees. When present beyond this age, a positive response indicates CNS pathology. The STNR is elicited when the person flexes or extends his cervical spine. A positive response to neck flexion is an increase in muscle tone in flexors of both arms and extensors of both legs. A positive response to neck extension is an increase in muscle tone in extensors of both arms and flexors of both legs. The effect on muscle tone lasts as long as the neck is flexed or extended.

Tonic labyrinthine reflex (TLR)

A reflex mediated at the brain stem level. In normally developing children, inhibition of the TLR is a gradual process involving the maturation of cerebral systems. The TLR is typically integrated by three and a half years of age. When present in adults, a positive response indicates CNS pathology. The TLR is elicited by the person's total body posture and is mediated by vestibular receptors in the inner ears. A positive response to the prone position (face down) is an increase in muscle tone in flexors of both arms and legs. A positive response to the supine position is an increase in muscle tone in extensors of both arms and legs.

Decerebrate ridgidity:

A condition, associated with injury to the brainstem, characterized by rigid extension of the arms with internal rotation, extension of the legs with internal rotation and downward pointing of the toes, retraction (backward arching) of the head, and overall muscle stiffness. The person holds the arms straight and toward the body, with the wrists turned inward and the fingers clenched in a fist; the legs are held stiffly out and the ankles plantarflexed.

Decorticate posturing:

Patients with decorticate, or flexor, posturing present with increased tone (and resultant posturing) in elbow flexors, forearm pronators, wrist and finger flexors. and leg extensors. Decorticate posturing indicates damage to the the corticospinal tract, While a sign of severe brain damage, decorticate posturing is not as serious as decerebrate posturing.

Rancho Los Amigos Scale:

based on observation of the patient as he responds to environmental stimuli. They provide a clear description of the various behavioral stages a brain injury victim typically experiences as he begins to progress through recovery toward rehabilitation.

Anterograde amnesia:

A form of amnesia where new events are not transferred to long-term memory, so the person will not be able to remember anything that occurs after the onset of this type of amnesia for more than a few moments.

Retrograde amnesia

A form of amnesia where the person will be unable to recall events that occurred before the onset of amnesia.

Open Head Injury

also called a penetrating head injury, results when an object penetrates the skull and enters the brain

Closed Head Injury:

When a person receives an impact to the head from an outside force, but the skull does not fracture or displace

Acceleration injury:

Most head injuries occur because the head is suddenly forced to stop or start moving, or to turn rapidly. Damage of this sort is usually widespread throughout the brain, though some areas are worse affected than others.

Coup-Contrecoup Injury

describes contusions that are both at the site of the impact and on the complete opposite side of the brain. This occurs when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion

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