Basic Human Neuroanatomy
A Clinically Oriented Atlas 
Case 19 Answers

1.  Indicate the structures involved by the pathologic process to produce each of the signs and symptoms in this patient.

Signs or Symptoms
Syncope

Ataxia, veer to R

Dysphonia, palate to L,

dysphagia 

R  miosis, ptosis



Dec. pain, R  face


Dec. pain, L  body


R  cerebellar signs 


Site of Lesion
Diffuse brain stem ischemia

R  inferior cerebellar peduncle


R  nucleus ambiguus



Descending sympathetics, R  lateral brain stem field


R  spinal tract of V


R  spinothalamic tract


R  inferior cerebellar peduncle

2.  The findings in this case constitute a classic neurologic syndrome.  Indicate the location of the neurologic lesion and the name of the syndrome.
            Lateral medullary syndrome.  Lateral medulla, upper 1/2

3.  In general, what type of pathologic process do you think is involved in this case?  If vascular, indicate the appropriate vessel.

            Vascular.  PICA territory (often Vertebral A.)

Pathologic Dx
R  PICA/Vertebral A. occlusion, causing R  lateral medullary syndrome


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


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