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نشبة دماغية 2


نشبة دماغية 2


حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 61-year-old man with a history of hypertension has been in excellent
health until he presents with vertigo and unsteadiness lasting for 2 days. He
then develops nausea, vomiting, dysphagia, hoarseness, ataxia, left facial
pain, and right-sided sensory loss. There is no weakness. On examination, he
is alert, with a normal mental status. He vomits with head movement. There
is skew deviation of the eyes, left ptosis, clumsiness of the left arm, and titubation.
He has loss of pin and temperature sensation on the right arm and leg
and decreased joint position sensation in the left foot. He is unable to walk.
1. Magnetic resonance imaging (MRI) in this patient might be expected
to show which of the following?

a. Basilar artery tip aneurysm
b. Right lateral medullary infarction
c. Left lateral medullary infarction
d. Left medial medullary infarction
e. Right medial medullary infarction
2. The dysphagia in this case is secondary to involvement of which of the
following structures?

a. Nucleus solitarius
b. Nucleus and descending tract of CN V5
c. Nucleus ambiguus
d. Lateral spinothalamic tract
e. Inferior cerebellar peduncle

3. Occlusion of which of the following arteries typically produces this
syndrome?

a. Basilar artery
b. Vertebral artery
c. Superior cerebellar artery
d. Anterior inferior cerebellar artery (AICA)
e. Anterior spinal artery

by

Quote:
c. Left lateral medullary infarction
Quote:
c. Nucleus ambiguus

posterior inferior cerebellar artery(PICA)

ما بعرف ليش مو موجود ضمن الاحتمالات!!!

wallenberg syndrome

the best's picture
the best
طالب دراسات عليا

Quote:
posterior inferior cerebellar artery(PICA)

it comes from the vertebral artery...so answer is b.

Fouad's picture
Fouad
بعد التخرج

1- The answer is c. Wallenberg, or lateral
medullary, syndrome
is due to infarction involving some or all of the structures
located in the lateral medulla, including the nucleus and descending
tract of the fifth nerve, the nucleus ambiguus, lateral spinothalamic tracts,
inferior cerebellar peduncle, descending sympathetic fibers, vagus, and
glossopharyngeal nerves. The patient with Wallenberg syndrome has ipsilateral
ataxia and ipsilateral Horner syndrome. The trigeminal tract damage
may produce ipsilateral loss of facial pain and temperature perception and
ipsilateral impairment of the corneal reflex. The lateral spinothalamic damage
produces pain and temperature disturbances contralateral to the injury
in the limbs and trunk. Dysphagia and dysphonia often develop with damage
to the ninth and tenth nerves.
2. The answer is c. The nucleus ambiguus, located
in the ventrolateral medulla, contains the motor neurons that contribute to
the ninth (glossopharyngeal) and tenth (vagus) cranial nerves. The motor
neurons of the nucleus ambiguus innervate the striated muscles of the larynx
and pharynx as well as provide the preganglionic parasympathetic supply to
thoracic organs, including the esophagus, heart, and lungs. Injury to this
nucleus and its pathways causes hoarseness and dysphagia.
3. The answer is b. Most cases of lateral medullary
infarction are due to occlusion of the vertebral artery
. Several small
branches of the distal vertebral artery supply the lateral medulla. In some
cases, occlusion of the posterior inferior cerebellar artery (PICA) causes
this syndrome.
The PICA is the last large branch of the vertebral artery, and,
when it is occluded, there may also be infarction of the inferior cerebellum
accompanying that of the medulla
qusei
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