Basic Human Neuroanatomy
A Clinically Oriented Atlas 
Case 157 Answers

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

Lower motor neuron

2.  List all of the possible structures that could be involved by the pathologic process to produce each of the abnormal signs and symptoms experienced by this patient.

a.  Deafness, vertigo, and pain, AD
Right labyrinth, right vestibulocochlear nerve (VIII), right cochlear nuclei

b.  Diplopia
Unknown (transient)

c.  Right lower motor neuron facial weakness, decreased taste on the anterior
two-thirds of the tongue on the right 

Right facial nerve (VII) proximal to the chorda tympani branch

d.  Decreased pain and light touch sensation of the right side of the face

Right maxillary and ophthalmic divisions of V, right trigeminal ganglion or root, or right spinal tract of V

3.  Is the involvement in this patient likely to be intrinsic to or extrinsic to the central nervous system?  Is the pathologic process in this case localized or multifocal? 

Extrinsic.  Multifocal

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

Viral cranial polyneuropathy, due to HSV-1 (proven by CSF PCR)

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

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