Case 158 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 158 Answers

1. Is the weakness of the left side of the face of the upper motor neuron or lower motor neuron type?

Lower motor neuron

2. Why was this patient having difficulty swallowing food?

Due to her glossopharyngeal (IX) and vagus (X) nerve deficits

3. Was the involvement in this case intrinsic to or extrinsic to the central nervous system?

Extrinsic

4. Is the pathologic process in this patient localized or multifocal?

Multifocal

5. List the structures that were involved by the pathologic process to produce each of the abnormal signs and symptoms experienced by this patient.

a. Diminished right gag reflex

Right glossopharyngeal nerve (IX) in the subarachnoid space

b. Right palate weakness

Right vagus nerve (X) in the subarachnoid space

c. Left LMN facial weakness

Left facial nerve (VII) proximal to the internal acoustic meatus

6. In general, what type of pathologic process do you think is involved in this case?

Neoplastic – Meningeal metastases (carcinomatous meningitis) producing cranial polyneuropathies (ie, multiple cranial nerve palsies)

7. What diagnostic procedure(s) would you undertake at this point?

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