Civil Engineer Flashcards
History: 56 year old male civil engineer, felt suddenly unstable and dizzy. Almost fell in excavation. His hand and fingers felt numb. Persistent hiccups and nauseous and vomited. What could be the source of the lesion for numbness in just his hand and fingers?
Cannot say…very unlikely that just his hand and fingers are numb
On examination: Poorly controlled type II diabetes. Blood pressure 150/95. Pulse 96/min. Respiration 18/min. What are some factors in his life contributing to arteriosclerosis?
Obesity, smoking, alcohol, cocaine, HTN
Cranial Nerve Functions: 1. pupils (R/L) 2mm/4mm reacting to light 1.5mm/2.5mm. This could be caused by a lesion where?
lesion in the sympathetic pathway
patient could not walk in a straight line heel to toe with a consistent tendency to veer to the right. Lesion where could cause this?
Lesion in the vestibular system
Name the symptoms in this patient that point to a Horner’s Syndrome?
Right partial ptosis
what other symptoms did this patient display?
Decreased sensation to pain and temperature over the right side face: ipsilateral lesion CN V
Singultus (hiccups): reticular formation
Dysarthria: difficulty with articulation
Dysphagia: CN IX,X
Palate did not elevate on the right: lesion to the left corticobulbar fibers, right CN X, or right nucleus ambiguus
what sensory-motor where found on examination?
Normal strength, tone and bulk
Muscle stretch reflexes normal in arms and legs
flexor plantar response
decreased pain and temperature perception over left arm, trunk, and leg: right ALS
Tandem gait not possible, veering to the right: right vestibular nucleus.
In this patient where is the infarction?
dorsolateral medulla oblongata–> occlusion of the right vertebral artery
what is the dx for this patient?
Right Wallenberg’s syndrome (aka dorsolateral medulla oblongata syndrome)—> occlusion of the posterior inferior cerebellar artery or right vertebral artery
Crossed somatosensory symptoms
Horner’s Syndrome
