Localization Cases

Question 1

Ptosis, Small Pupil

KIV CN

Answer 1

Slight Ptosis - LPS Sympathetic slightly
Small Pupil, Miosis - Sympathetic outflow loss;
– Think T1 thoracolumbar outflow

Question 2

Wasting of 1st interosseous
Weakness of
- Finger extension
- Abduction

Sensory forearm lost;

Answer 2

Extension of fingers at MP

• Radial Nerve
• • Myotome T1

Finger Abduction

• Interosseous - Ulnar Nerve - C8, T1
• T1

Sensory
- T1, Medial Cutaneous Sensory

Question 3

Diagnose, Explain and Localize

When Px closes eyes, feel like falling;

• more unsteady on feet;
• Romberg + ve

Upward Plantar, Leg reflexes Brief
Pain and Temp ok; Vibration and Proprioception at feet not ok

Bilateral

Answer 3

Balance

• proprioception
• vestibular
• vision

Since vision okay, either vestibular or PPT bad

CNS lesion, UMN; at Spinal cord
- posterior spinal cord DCLM, B12 deficiency

Question 4

Where and what is used to look eyes horizontally to the left

- list the CN connections

Answer 4

Right frontal cortex;
Pons, PPRF, Horizontal Gaze

CN3 - Medial Rectus - Contralateral CN3
CN6 - LR - Ipsilateral CN6

Question 5

What is observed in Stroke of left frontal cortex for eye movement VS Seizure

Answer 5

Seizure is excitatory - Look away

Stroke is inhibitory - Look towards

Question 6

Guillain Barre Syndrome

• associated post infection
• what it do, localize the lesion

Answer 6

Type II HS

• Campylobacter Jejuni
• Peripheral Neuropathy - including CRANIAL NERVES PNS - hence facial weakness too!
• LMN lesions; it is NERVE because Sensation can be felt - numbness - hence not NMJ/Muscles