Case 51 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 51 Answers

1. Do the findings on the right side of the body indicate an upper motor neuron or lower motor neuron lesion?

UMN

2. Do the findings involving the left side of the face indicate an upper motor neuron or lower motor neuron lesion?

LMN

3. Considering the entire clinical picture, what specific structure(s) is (are) involved to produce the patient’s left facial weakness?

Left facial nucleus, facial nerve fibers within the pons, or facial nerve (VII) outside the CNS

4. Considering the entire clinical picture, what specific structure(s) is (are) involved to produce the patient’s mild right hemiparesis, hyperreflexia, and extensor plantar reflex?

Left corticospinal tract above the pyramidal decussation in the lowermost medulla, but sparing the corticonuclear (corticobulbar) fibers to the right facial nucleus

5. Where is this patient’s neurological lesion located?

Left lower third of the pons, involving the corticospinal fibers in the basilar
(anterior) part of the pons and either the facial nucleus or the exiting facial nerve fibers

6. In general, what type of pathologic process was involved in this case?

Vascular. Ischemic infarct of the left lower pons due to occlusion of one or more of the penetrating (pontine) branches of the basilar artery.

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

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