Case 142 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 142 Answers

1. Considering this patient’s history and physical examination, how precisely can the neurologic lesion be localized in this case?

Not very precisely. Long tract signs do not localize well. Right corticonuclear & corticospinal tracts above the lower third of the pons (see slide #1).

2. Indicate the possible anatomical locations of the pathologic process in this case. What is the most likely anatomical location of the lesion, including the side of involvement?

Right precentral gyrus, posterior limb of internal capsule (3^rd quarter), crus cerebri, basilar (anterior) part of the pons. Right basilar part of the pons.

3. The findings in this case represent a classic neurologic syndrome. What is the name of that syndrome, and what is its usual cause?

Dysarthria-clumsy hand syndrome. Lacunar infarct in the posterior limb of the internal capsule (3^rd quarter) or basilar part of the pons. Some authors feel that this syndrome is usually due to a pontine lesion.

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

Vascular -- due to a lacunar (small) infarct in the basilar (anterior) part of the pons on the right.

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

References:
1. Fisher CM. Neurology 1967;17:614-617.
2. Fisher CM. Neurology 1982;32:871-876.
3. Koppel BS, Weinberger G. Eur Neurol 1987;26:211-215.
4. Glass JD, Levey AI, Rothstein JD. Ann Neurol 1990;27:487-494.
5. Jickling GC, Stamova B, Ander BP, et al. Ann Neurol 2011;70:477-485.
6. Bezerra DC, Sharrett AR, Matsushita K, et al. Neurology 2012;78:102-108.

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