CN Lesions
Blood
Vessels
Vessels
100
During your neuro examination, you ask Mike to stick out his tongue. You note that his tongue is deviated to the left. What side is the lesion?
What level of the brainstem is the lesion?
Left side ("Lick your wounds")
Cranial Nerve XII (12- Hypoglossal)
100
What connects the anterior and posterior blood supply of the brain (think circle of willis)
Posterior communicating
200
Patient presents with hoarseness, Dysarthria (abnormal articulation of speech), Dysphagia (impaired swallowing), Impaired gag reflex, Deviation of uvula to the right. Where is the lesion? (Side, Brainstem level, nucleus)
left side, Open medulla, Nucleus ambiguus or vagal roots
200
BONUS (+200) Patient Presents with Left side Hemiparesis, Left side loss of touch pain and temp. sensation, left Homonymous hemianopia/quadrantanopia, and afferent visual reflex defect. What vessel is occluded?
Right Anterior Choroidal Artery
1. Contralateral Hemiparesis- corticospinal tract in posterior limb of internal capsule
2. Contralateral loss of touch, pain, and temp. sensation- posterior limb
3. Homonymous hemianopia/quadrantanopia and visual reflex defect is due to involvement of optic tract and radiations
300
When asked to look to the right, the right eye is able to abduct normally, however, the left eye cannot adduct. However, during an exam of convergence the left eye was then able to adduct. Where is the lesion (side and location)?
Left MLF (medial longitudinal fasciculus)- Internuclear ophthalmoplegia
note: convergence uses separate pathway
300
Kelly suffered from a stroke in right anterior cerebral artery, where in the body may she loss sensation and motor function?
Lower limbs of left side
400
Patient Presents with Left Homonymous Superior Quadrantanopia, where is the lesion? (Side, Lobe, Tract)
Right, Temporal Lobe, Meyers Tract
(Optic radiation damage results in homonymous vision loss- since it is only one specific tract in a specifically temporal lobe it only effects the superior visual field and inferior retina, heteronymous occurs in optic chiasm)
Parietal cortex damage would be homonymous inferior quadrantanopia- Dorsal bundle (Baum's Loop)
400
Patient presents with weakness and hyperreflexia on right side of body. Lack of vibration, proprioception, and touch on right side of the body. Lack of vibration, proprioception, touch, pain, and temp. on right side of face. When ask to stick out tongue, there is a deviation to the left. What is the blood supply to the lesion?
Left Anterior Spinal Artery (Paramedian Br.)
Open medulla
500
Patient presents with paralysis of entire right half of face with right side impairment of hearing and balance, where is the lesion?
In/Near right Auditory meatus
500
Billy comes to ER with loss of pain and temp. sensation on right side of face and left side of body. Hoarseness, Dysarthria (abnormal articulation of speech), impaired swallowing, impaired gag reflex, and deviation of uvula to the left on CN exam. The patient also shows left nystagmus. What is the blood supply to the location of the lesion (plus side)?
Open Medulla Lesion on the right side, Blood supply is long circumferential- PICA
Areas effected: STT body, spinal nucleus and tract of V, Nucleus ambiguus, Inferior cerebellar peduncle and vestibular nuclei.
Nystagmus is named for its fast phase direction, which is directed away from the lesion side.