Right Horner

1
Right Horners Syndrome-Where can the lesion(s)
be?
2

• Representative of Case History 2
• Guillain-Barré Syndrome (GBS)
• acute inflammatory demyelinating polyneuropathy
• disorder of the peripheral nerves
• attack of the myelin sheath of nerves by
  antibodies or white blood cells
• rapid onset of ascending paralysis
• begins with weakness and/or abnormal sensations
  of the legs and arms
• breathing muscles may be so weakened
• following gastrointestinal or respiratory viral
  infections
• palpitations (sensation of feeling heartbeat),
  difficulty beginning to urinate, incomplete
  bladder emptying, incontinence (leaking of
  urine), constipation, and muscle contractions

3
Representative of Case History 1 DUCHENNES
MUSCULAR DYSTROPHY

• marked enlargement of calves
• hyperlordosois
• decreased tendon reflexes
• normal sensation

Gowers Sign
4

• in A, patient is attempting to raise eyelids as
  high as possible
• In B, same patient has had an iv injection of
  Tensilon, an acetylcholinsterase inhibitor.
  Eyelids go higher for a while

Representative of Case History 2 MYASTHENIA
GRAVIS
B
A
5
Note relationships of cranial nerves to major
vessels and think about the effects of
aneurisms!!!!
6
Lateral Medullary Syndrome (Wallenbergs) Think
of the neurological deficits!! This is one of
your Case Vignettes!!! What side is the lesion
on? Remember, the lesion is bigger than the
white area.
7
Representative of Case History 5
Amytropic Lateral Sclerosis
Why are the spinal nerves smaller (shrunken) on
the right cord??? Is there both upper and lower
motor neuron disease? Is this also called Lou
Gehrig Disease? Are there fasciculations?
8
Schwannoma of right CN VIII-You have a similar
Case Vignette What are some of the neurological
deficits?
9
Parkinsons Disease! Which brain has the least
number of nigra cells containing melanin pigment?
10
What are the big white bundles surrounding the
4th ventricle? The melanin containing black
spots is/are the locus coeruleus (contains
nor-epi cells). We cover it in the third
module. What pathways are affected by the
lesion? Does it looks like level 7 without the
myelin stained??
11
Schwannoma of CN VIII. What problem(s) will
this person have? This is similar to one of your
Case Vignettes!! What side is the lesion one??
12
Bells Palsey. What side is affected? Can she
wrinkle her forehead on the right?
13
Central VII
Peripheral VII
14
Ectropion-drooping lower lid Lagophthalmos-inabil
ity to close upper lid What CNs are involved in
the corneal reflex?
15
Could the lesion be in cortex, midbrain, pons, or
medulla?
,

16
Where is the lesion????????
17
Where could the lesion be?? Medulla? Pons? Midbra
in? Cortex? Which side??
18
Inability to abduct the left eye! Where could
the lesion be???
19
Lid down and eye rotated down and out! Where
could the lesion be??
20
Left head tilt (not rotation!!)! Where could the
lesion be??
21
Right eye cant go all the way down (ventral) and
in (adduction) look at right eye in lower right
frame)!!