Brainstem Cases Patient 4

Question 1

Patient #4

Overall Dx

Answer 1

Medial Medullary Syndrome

Damage to Left Medullary Pyramids superior to decussation and to the exit point of CN XII

Bodily impairments are contralateral
Hypoglossal impairment is ipsilateral

Question 2

Tobacco, hypercholesterolemia, hypertension

Answer 2

Stroke

Question 3

“Pins and needles” on right side of body (passed in 10 minutes)

Answer 3

Parathesia is caused by the this could be LEFT MEDULLARY PYRAMIDS as part of the CORTICOSPINAL TRACT
Superior to decussation

Question 4

Weakness in right arm and leg (passed in 10 minutes)

Answer 4

LEFT MEDULLARY PYRAMIDS as part of the CORTICOSPINAL TRACT

Superior to decussation

Question 5

Weakness and heaviness in right arm and leg retured.

Answer 5

LEFT MEDULLARY PYRAMIDS as part of the CORTICOSPINAL TRACT

Superior to decussation

Question 6

OK: pain and temperature

Answer 6

ALS and spinal trigeminal system intact

Question 7

Decreased vibratory sensation decreased in right arm and leg

Decreased discrimination decreased in right hand

Answer 7

LEFT DC-ML damage

Question 8

Tongue deviated to the left and could not move right

Answer 8

LEFT CN XII EXIT POINT
Tongue deviates TOWARDS side of the lesion
Exits between the inferior olive and the pyramid

Question 9

Voice was “thick,” but understandable

Answer 9

LEFT CN XII EXIT POINT

Exits between the inferior olive and the pyramid

Question 10

Babinski on Right

Answer 10

LEFT MEDULLARY PYRAMIDS as part of the CORTICOSPINAL TRACT

Superior to decussation

Question 11

OK: all other cranial nerves

Answer 11

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