Cases Neuroscience

Case 4 A 45 year old woman with a history of hypertension experienced a brief "blackout". She had complained of severe headaches, nausea, dizziness and a roaring sound in the left ear during the previous day. She also had difficulty walking and called a cab to take her to the hospital. The physician found her mentally alert and communicative, the external auditory canals were clear and she was physically normal except for an elevated blood pressure of 165/105. Strength in her extremities was generally normal. Her speech was fluent and full of meaning though dysarthric. Nystagmus was present. There was a facial paralysis (upper and lower) on the left side which also had diminished sensation. There was impaired pain and temperature sense from the right side of the body. Hearing was diminished on the left side. On the left, the eye drooped and the pupil was constricted.

Case3 A 39 year old man awoke with a horizontal diplopia especially on right gaze. 5 days later, a Hess chart examination performed by an ophthalmologist showed paresis of the lateral rectus muscle. On admission 19 days after onset, the patient showed a mild paresis of the right abducens nerve and a subtle weakness of his left leg with moderate hyperreflexia in the left upper and lower limbs. Babinski’s reflex was positive and abdominal reflex was absent on the left side, no facial weakness or deviation of the tongue on protrusion was found. All other general and neurological exams were normal.

Syndrome X 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.