new_n_lost
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A 67 year old known hypertensive presents with sudden onset of a drooping right eyelid and slurred speech. Examination revealed the tongue deviated to the right.A Horner's syndrome on the right was diagnosed. Further examination showed a loss of pain sensation of the left side.The physician also noted a poor visual acuity from both eyes. Which area of the brain is involved in ischaemia
a) spinal cord at the level of C2
b) dorsolateral medulla
c) anterior pons
d) right side of midbrain
e) left side of midbrain
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| oldkidontheblock
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B
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| keepgoing
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ya b
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| keepgoing
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hoRNER SYNDROME(CN 10th sysmpathatic flow) plus tongue deviation(CN 12TH)--location of nerves -->medulla
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| keepgoing
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and pain on contralateral side-- STT -->dorsolateral in medulla...
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| shalini.ravi
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why is there decreased visual acuity? cervical sympathetic fibers will not affect visual acuity right?
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| keepgoing
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Hmm what is ur ans then?
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| indidoc1
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shalini.ravi wrote:
why is there decreased visual acuity? cervical sympathetic fibers will not affect visual acuity right?
Horner synd----Miosis.. n i m not sure but i think the ciliary body's also messed up.
Agree wth B
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| new_n_lost
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| new_n_lost
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b) dorsolateral medulla
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| nature
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hi! would you please give more explanation about answer dorsolateral medulla?
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| Jackofknives
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A 67 year old known hypertensive presents with sudden onset of a drooping right eyelid and slurred speech. Examination revealed the tongue deviated to the right.A Horner's syndrome on the right was diagnosed. Further examination showed a loss of pain sensation of the left side.The physician also noted a poor visual acuity from both eyes. Which area of the brain is involved in ischaemia
The options isolate the ischemia to the brain stem, so that’s where we ll look at.
Slurred speech
Tongue doesn’t work properly.
Tongue deviated to the right
Right hypoglossal nerve nucleus affected.
LoP – left
Lesion of spinal trigeminal tract and nucleus, which register nociceptive/thermo signal of the face and supretentoral dura
Note – this could very well be ispilateral as in this case because 1st order neuron body is located as the trigeminal ganglion and project it’s fibre in a descending manner to the medulla and spinal cord where it then decussate. The lesion is likely to be above the place of decussation.
Horner – right
Lesion of the right hypothalamospinal tract
Poor visual acuity – both eyes
Due to horner’s syndrom
Drooping right eyelid
Ptosis – again horner.
If you don’t know the detailed anatomy the brain stem and where every single nucleus is at, well to answer this question you just have to know one thing. Tongue doesn’t work properly – hypoglossus nerve lesion – where is it at? Not in the spinal cord bc that is too low, not in the pons and midbrain bc that’s way to high. Only answer left is (b)
PS. Hypoglossus nerve - CN12 - has a pretty distinct pathway, projecting out of the medulla in the sulcus between oliva and pyramid. One of it's kind.
Edited by Jackofknives on 04/03/07 - 03:43 AM
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