Right Horner’s Syndrome-Where can the lesion(s) be?
Representative of Case History #2
Guillain-Barré Syndrome (GBS)
•acute inflammatory demyelinating polyneuropathy •disorder of the peripheral nerves•attack of the myelin sheath of nerves by antibodies or white blood cells•rapid onset of ascending paralysis•begins with weakness and/or abnormal sensations of the legs and arms•breathing muscles may be so weakened•following gastrointestinal or respiratory viral infections•palpitations (sensation of feeling heartbeat), difficulty beginning to urinate, incomplete bladder emptying, incontinence (leaking of urine), constipation, and muscle contractions
Representative of Case History #1
DUCHENNES MUSCULAR DYSTROPHY
Gower’s Sign
•marked enlargement of calves•hyperlordosois•decreased tendon reflexes•normal sensation
•in A, patient is attempting to raise eyelids as high as possible
•In B, same patient has had an iv injection of Tensilon, an acetylcholinsterase inhibitor. Eyelids go higher for a while
A B
Representative of Case History #2
MYASTHENIA GRAVIS
Note relationships of cranial nerves to major vessels and think about the effects of aneurisms!!!!
Lateral MedullarySyndrome (Wallenberg’s)
Think of the neurological deficits!! This is one of your Case Vignettes!!!
What side is the lesion on?
Remember, the lesion is bigger than the white area.
Why are the spinal nerves smaller (shrunken) on the right cord??? Is there both upper and lower motor neuron disease? Is this also called Lou Gehrig Disease? Are there fasciculations?
Representative of Case History #5Amytropic Lateral Sclerosis
Schwannoma of right CN VIII-You have a similar Case VignetteWhat are some of the neurological deficits?
Parkinson’s Disease! Which brain has the least number of nigra cells containing melanin pigment?
What are the big white bundlessurrounding the 4th ventricle?The melanin containing “black spots” is/are the locus coeruleus (contains nor-epi cells). We cover it in the third module.
What pathways are affected by the lesion? Does it looks like level 7 without the myelin stained??
Schwannoma of CN VIII. What problem(s) will this person have? This is similar to one of your Case Vignettes!!
What side is the lesion one??
Bells Palsey. What side is affected?
Can she wrinkle her forehead on the right?
Central VII Peripheral VII
Ectropion-drooping lower lid
Lagophthalmos-inability to close upper lid
What CNs are involved in the corneal reflex?
Could the lesion be in cortex, midbrain, pons, or medulla?,
Where is the lesion????????
Where could the lesion be??
Medulla?Pons?Midbrain?Cortex?
Which side??
Inability to abduct the left eye!
Where could the lesion be???
Lid down and eye rotated down and out!Where could the lesion be??
Left head tilt (not rotation!!)!Where could the lesion be??
Right eye can’t go all the way down (ventral) and in (adduction); look at right eye in lower right frame)!!
