1. Indicate the specific structures that could possibly be involved by the pathologic process to produce each of the symptoms in this patient, based on the patient’s history.
a. Left hand numbness
Left PNS lesion, dorsal roots (C6-8), left or right spinal cord, right medial lemniscus or spinal lemniscus, right VPL nucleus of the thalamus, right postcentral gyrus
b. Burning pain on the right side of the face
Right trigeminal ganglion/root, spinal tract of V, left VPM nucleus of the thalamus, left postcentral gyrus
c. Unsteadiness
Many possible areas including the cerebrum, brain stem, cerebellum, and spinal cord
d. Dysarthria, dysphagia
Many possible areas including the cerebrum, brain stem, cerebellum, PNS, neuromuscular junction
2. How would you describe this patient’s right facial pain?
Neuropathic, dysesthetic, consistent with so-called “central pain”
3. Indicate the specific structures that could possibly be involved by the pathologic process to produce each of the signs or symptoms in this patient, based on both the patient’s history (symptoms) and the examination (signs).
a. Ataxia, unsteadiness
Right inferior cerebellar peduncle
b. Dysarthria, dysphagia
Right nucleus ambiguus
c. Decreased pain on the right side of the face. Burning pain on the right side of the face.
Right spinal tract of V
d. Left hand numbness
Right spinothalamic tract or spinal lemniscus
4. The findings in this case constitute a classic neurologic syndrome. Indicate the location of the neurologic lesion, the main structure involved in this case, and the name of the syndrome.
Upper half of the right lateral medulla. Right spinal tract of V.
Lateral medullary syndrome (partial example).
5. In general, what type of pathologic process do you think is involved in this case? Be as specific as possible.
Vascular. PICA territory (often Vertebral A.), probably a very small penetrating branch
6. What diagnostic procedure(s) would you undertake at this point?
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