DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
A patient present to a neurologist with a spastic left hemiparesis and extensive plantar reflex on the left.The right side of patient's face is numb and the jaw deviates to the left upon prostrusion.Where is the most likely location of lesion?
A.Cervival spinal cord on the left
B.Right cerebral hemispher
C.Right cerebellopontine angle
D.Right midbrain
E.Right rostral pons
Please explain the answer.
(I am interested to know why there are bilateral signs in the head- jaw on left and facial numbness on right)
-Thanks.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
A.is wrong because it can't affect the face.
B.is wrong because it can't cause left trigeminal palsy.
C.is wrong because it doen't cause long tract lesion
D and E.doen't explain the left trigeminal palsy....
if i have to choose I would choose E.
|
| sturge_weber
Forum Guru
Topics: 77
Posts: 1,042
|
is it e
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
how u explain the left deviation of the jaw?
|
| Doc2378
Forum Guru
Topics: 46
Posts: 688
|
Ok...I agree the lesion is in the LEFT rostral pons (choice E) knocking off
A. Descending Corticospinal tracts: leading to CONTRALATERAL spastic paralysis
B. Motor nucleus of Trigeminal nerve (LMN lesion): IPSILATERAL jaw deviation
C. Ascending PAIN and TEMPERATURE fibres from right face: Loss of pain and temperature from RIGHT face
(remember the pain and temperature fibres are special in that they first synapse in the ipsilateral nucleus of V in ventrolateral pons -> descend down ipsilaterally to Spinal nucleus of V in caudal medulla -> cross the midline -> and climb up on the contralateral side in VENTROLATERAL PONS -> MIDBRAIN -> VPM nucleus of Thalamus -> Area 3, 1, 2
Anyone else?
___________________
Courage does not always ROAR. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow" - Mary Anne Radmacher
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
hey choice E is right pons not left.how would that affect the left trigeminal?
|
| Doc2378
Forum Guru
Topics: 46
Posts: 688
|
 ...my bad!
___________________
Courage does not always ROAR. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow" - Mary Anne Radmacher
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
I think the question is wrong may be the jaw deviates to the right not to the left.that makes more sense
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
hey drvirgo what is the answer?
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
I don't have the answer (yet)... It was posted by someone in another forum...
if its cortex, then all signs should be contralateral.
If its pons (Brainstem) then CN signs on the same side (head/face) and long tract findings on the opposite side of body.
NONE of the choices make sense.
I will post the right answer as soon as I find out, because this question is a pain in the ---. 
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
the one who posted it in the other forum doesn't have the answer too???
|
| Doc2378
Forum Guru
Topics: 46
Posts: 688
|
Hey was wondering if someone here can expand specifically on that loss of pain and temp of face due to trigeminal....is it an ipsilateral loss or a contralateral one...
I know that mastication and general sensation from face is almost always ipsilateral ...
Also, am i correct in generalising that a cranial nerve lesion anywhere would lead to an ipsilteral loss (exception for a Facial nerve coticobulbar, where its contralateral lower face)
Thanks guys
___________________
Courage does not always ROAR. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow" - Mary Anne Radmacher
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
loss of pain and temp of the face can be unilateral if spinal nucleus is affected,and can be contralateral if spinothalamic tract is lesioned
|
| sturge_weber
Forum Guru
Topics: 77
Posts: 1,042
|
well if body is affected on one side and the face on the other side , the lesion is in the brainstem
if face and body on the same side then the lesion is in the cortex
hope u were asking this only
|
| zaidsuror
Forum Elite
Topics: 61
Posts: 238
|
u can add to sturge weber's principlpes:
to localalize the site of the pathology:
midbrain :III and IV
PONS: A/ROSTRAL:TRIGEMINAL NUCLEAS
B/CAUDAL VII AND VIII
MEDULLA: IX ,X AND XII
THE XI nucleas is located in the spinal cord (c1-c6)
___________________
footsteps on the sands of time are not made by sitting around.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
The answer was posted as E.
But I still have some doubt:
All brainstem lesions present with ispilateral signs of head and neck, and contralateral signs of the body.
If the lesion is in the right pons, then there should be facial numbness on the right, and the jaw should deviate to the RIGHT (toward the weak side) because it is the right V-3 that moves the right mandible to the left. So if there is a lesion on the right, how can it deviate toward the left -it should deviate toward the side of the lesion or weakness, because it is that side that is controlling it.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
|
| |
| | | | | | | | | | | | | | | | |
