drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
A case with a history of a tendency to fall on one side but the tongue deviating to the other side. Where is the lesion???
|
| reet
Forum Fanatic
Topics: 152
Posts: 1,411
|
UMN leison
___________________
Live as u were to die tommorow. Learn as if u were to live forever.
|
| drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
is thr anything more specific? I figured the falling bit for a cerebellar lesion maybe....but wht abt the tongue deviation....medial medullary syndrome?? how do u put it together?
|
| reet
Forum Fanatic
Topics: 152
Posts: 1,411
|
hypoglossal( CNXII ) nucleus lies medially in medulla and VESTIBULAR( CN VIII )nucleus lies LATERALLY in medulla. at the same MID-OLIVARY LEVEL.
NO IDEA,,, if both medial and lateral medullary syndromes...are there???
Edited by reet on 01/19/06 - 01:39 PM
___________________
Live as u were to die tommorow. Learn as if u were to live forever.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
XII Nucleus is in the medulla
but isn't VIII nucleus in the Lateral Pons (not medulla)??
This is how I remember it:
Midbrain: III and IV
Pons: V, VI, VII, VIII
Medulla: IX, X, XII
Medial are: III, VI, XII
Lateral are: all others.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
this ws a Q on the exam...
falling to one side is mostly due to a Cerebellar lesion. I think CN VIII wud show vertigo and dizziness rather than a specific 'fall to one side'.
but still cant figure out how CN XII and cerebellar lesion can happen together. anyone?
|
| sturge_weber
Forum Guru
Topics: 77
Posts: 1,042
|
well falling to one side could also mean weakness of one side, and tongue deviates to the other side, means brainstem lesion at the level of the medulla, yes medial medullary syndrome could be the possible as hypoglossal with corticospinal tracts on one side could also cause weakness and falling hence i think its more of corticospinal tract rather than cerebellar lesion
correct me if its wrong
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
In medial medullary syndrome, loss of the CST produces contralateral spastic hemiparesis of the body, (can this make a person fall to that side?) and tongue deviates to the side of the lesion. This sounds like the best answer.
Do you remember the choices?
My only other creative guess is a tumor of the cerebellum that compresses XII somehow? Is this even possible? (just a random thought)...
In cerebellar lesion, the person would just have loss of balance.
In VII nerve lesion, they would have hearing loss, but lesion of vestibular nucleus would cause vomiting, vertigo, nystagmus, (usually at the level of lateral pons), and there is no XII nucleus here, and no CST, because thats located medially.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| zaidsuror
Forum Elite
Topics: 61
Posts: 238
|
U know what if i received such a patent particularly if he was young and with no history suggestive of trauma or predisposing factors for vascular lesion(thrombotic or haemorrhagic)i would think this is a lesion distributed in place .assymetric and random .MAYBE ITS MULTIPLE SCLEROSIS ,ALL WE NEED TO DO IS DO AN MRI AND FIND OUT.
___________________
footsteps on the sands of time are not made by sitting around.
|
| krsna
Forum Senior
Topics: 1
Posts: 211
|
in medial medullary syndrome the dorsal column- medial lemniscus is also involved disrupting the proprioceptive flow to cerebellum and hence the ipsilateral ataxia
|
| linaorvos
Forum Elite
Topics: 47
Posts: 258
|
Could it be inf.alternating hemiplegia?? CN XII+ CST= ipsilat.cranial n sign+ contralat.hemiplegia?
I'm not sure....
|
| Harry Potter
Forum Junior
Topics: 1
Posts: 46
|
posiible explanations:
1. Medial medullary with medial medulllary sundrome with ipsilateral tongue weakness and contralteral sensory ataxia
2. Non vascular pathology like space occupying lesion the posterior fossa-involving cerbelleum and opposite side hypoglossal nerve-some creeping lesions
3. 2 different site lesions- MS is ver unlikely to produce LMN type tongue weakenss (presuming the weakness in LMN)
4. Carotid diseas with aneurysm can have small infarct int he same side with contralateral ataxia and aneurysm pressing the nerve- hypoglossal is one of possibly compressible nerves with carotid aneurysm.
i hope I have successfully confused every body.
HP
|
| Harry Potter
Forum Junior
Topics: 1
Posts: 46
|
posiible explanations:
1. Medial medulllary sundrome with ipsilateral tongue weakness and contralteral sensory ataxia
2. Non vascular pathology like space occupying lesion the posterior fossa-involving cerbelleum and opposite side hypoglossal nerve-some creeping lesions
3. 2 different site lesions- MS is ver unlikely to produce LMN type tongue weakenss (presuming the weakness in LMN)
4. Carotid diseas with aneurysm can have small infarct int he same side with contralateral ataxia and aneurysm pressing the nerve- hypoglossal is one of possibly compressible nerves with carotid aneurysm.
i hope I have successfully confused every body.
HP
|
| enthu
Forum Junior
Topics: 14
Posts: 42
|
In cerebellar lesion the person will fall towards the side of the lesion with eyes open..but if its not mentioned that eyes are open we can also think of dorsal column medial lemniscus lesion in which pt stumbles with eyes closed...so along with XII nerve lesion it gives the medial medullary syndrome.
|
|
| |
| | | | | | | | | | | | | | |
Similar forum topics