Idara C.Eshiet

A 50 year old woman had a sudden onset of dizziness and vomiting. Her family noticed that her left eyelid appeared to be drooping and she was taken to see a doctor. The neurologic exam demonstrated loss of pain and temperature sensation from her right side of the body but there was analgesia on the left side of her face. Though there was normal proprioception and vibratory sensation bilaterally she still had an ataxic gait with falling toward the left side. There was no indication of spastic paralysis or Babinski's signs.

An 80 year old woman suddenly fell to the floor and was unable to rise. She found that her left arm and leg were paralyzed and her speech was “ slurred”. Neurologic examination some months later showed that she had a spastic paralysis of her left limbs with increased tone and exaggerated deep tendon reflexes. Motor examination of the face was normal, however upon protrusion, the tongue pointed toward her right side; the right side of her tongue was atrophic. The sensory exam indicated that pain and temperature was bilaterally normal from the body and face but there was loss of proprioception from the left lower extremity. Examination of other cranial nerves was normal.

1. Where is the lesion located? 2. What side is it located? 3. Damage to which structure is responsible for the spastic paralysis? 4. The loss of proprioception reflects damage to which tract? 5. What is the blood supply to the medial medulla?