Cases-lesion location

Question 1

Patient presents with numbness, problems with proprioception, Romberg sign, gait problems and inability to discriminate touch

Answer 1

DC/ML pathway

Question 2

Patient presents with numbness in the high pain and temperature tolerance. Where is the Lesion?

Answer 2

Spinothalamic pathway

Question 3

Patient presents with ataxia, instability, gate problems, balance problems, vertigo and dizziness. Where is the Lesion?

Answer 3

Spinocerebellar or vestibular pathway

Question 4

Patient presents with a tremor, lack of coordination, balance problems, ataxia, rapid involuntary eye-movement, and an inability to do rapid movements repetitively. What part of the brain is effected?

Answer 4

Cerebellar

Question 5

Patient presents with the resting tremor, personality and emotional changes, decrease body movements. What part of the brain is affected?

Answer 5

Basal ganglia

Question 6

Presents with increased reflexes, increased tone spasticity, and that Babinski sign going up toes. What part of the brain is affected ?

Answer 6

Upper motor neuron

Question 7

Patient presents with decreased reflexes and atrophy. What part of the brain is affected?

Answer 7

Lower motor neuron

Question 8

Patient presents with lower face paralysis on one side. Where in the rain does this indicate there is damage?

Answer 8

Contralateral contricobulbar damage

Question 9

What are parasympathetic signs/symptoms?

Answer 9

Dilated pupils, decrease tears,

Question 10

Patient comes in with a dilated pupil. What structure is likely damaged and at what level?

Answer 10

CN 3 (parasympathetic). The nucleus of the midbrain or PNS (nerve)

Question 11

patient presents with the loss of corneal touch reflex. What structure is the likely damaged and at what level?

Answer 11

CN 5 or CN 7 (or interneurons). Medulla or PNS

Question 12

Patient presents with the loss of a gag reflex. What structure is likely damaged and at what level?

Answer 12

CN 9 or CN 10.

Medulla or PNS

Question 13

Patient presents with loss of upper extremity reflexes. What structure is likely damaged and at what level?

Answer 13

Dorsal and/or ventral root or horn at cervical enlargement; or PNS.
Cervical enlargement or associate spinal nerves

Question 14

Patient presents with loss of lower extremity reflexes. What structure is likely damaged and at what level?

Answer 14

The dorsal and/or ventral root or horn at lumbosacral and enlargement; or associated nerves.
Lumbosacral enlargement or associated nerves

Question 15

Patient presents with eyes latterlly deviated. What structure is likely damaged and at what level?

Answer 15

CN 3

Midbrain or PNS

Question 16

Medially deviated eyes. What structure is damaged and at what level ?

Answer 16

CN6

Pons or PNS

Question 17

Intern nuclear ophthalmoplegia. What structure is likely damaged and at what level?

Answer 17

MLF between pons in midbrain

Pons or midbrain (medial)

Question 18

ptosis. What structures damaged and at what level?

Answer 18

CN 3

Midbrian or PNS

Question 19

Mild ptosis. What structure is damaged and at what level?

Answer 19

Sympathetic system

From hypothal thru CNS and PNS

Question 20

Unilateral hearing loss. What structures damaged and at what level?

Answer 20

Conduction system; CN 8 or cochlear nuclei

Outer or middle ear; sensorineural hearing loss-pons/medulla junction or CN8

Question 21

Tongue atrophy/fasciculations. What structure is damaged and at what level?

Answer 21

CN 12 or nucleus

Nerve or Rostral medulla

Question 22

Hoarseness, paralyzed vocal cords, dysphasia, uvula deviation on saying “ahh” what is the damage structure and I want level?

Answer 22

CN 10 or nuc ambiguous

Nerve or rostral medulla

Question 23

Hemi face paralysis. What structure is damaged and at what level?

Answer 23

CN7 nerve or nucleus

Nerve or caudal pons

Question 24

Patient presents with lower face paralysis. What structure is damaged and at what level?

Answer 24

Corticobulbar tract

Pons or rostral to it

Question 25

Loss of pain and temperature from one side of face and opposite side of the body. What structure is damaged and at what level?

Answer 25

Descending V tract and spinothalamic tract

Lateral medulla rostrally

Question 26

Bilateral dermatomal loss of pain and temperature. What structure damaged and at what level?

Answer 26

Spinothalamic tract as fibers cross midline in cord

Central spinal cord at close to the level of loss

Question 27

Atrophy, decreased reflexes Of upper extremities. What is damaged and at what level?

Answer 27

Ventral horn motor neurons (LMN) for associated spinal nerves
Cervical enlargement ventricle horn or associated nerves

Question 28

Atrophy, decreased reflexes of lower extremities. What structure damaged and at what level?

Answer 28

Ventral horn lumbosacral enlargement or associated nerves

Cervical Enlargement ventral horn or associated nerves

Question 29

Aphasia. What structure is damaged and at what level?

Answer 29

Language cortex or interconnections

Usually cortexes on dominant side