Week 4 Clinical Cases

Question 1

If a patient cannot screw up his left eye, where is the likely lesion and what muscle has been paralysed?

Answer 1

• lesion at left zygomatic branch of facial nerve

- paralysis of orbicularis oculi

Question 2

Which muscle is injured if a patient cannot frown or raise their eyebrows?

Answer 2

occipitofrontalis

Question 3

If a patient has a lesion in the trigeminal nerve, is it possible that they wouldn’t be able to cry?

Answer 3

yes
the lacrimal gland is innervated by the lacrimal nerve, which is the smallest branch of the ophthalmic nerve, a branch of the trigeminal nerve

Question 4

Which muscle of mastication is responsible for the jaw-jerk reflex?

Answer 4

masseter

Question 5

What does the facial nerve innervate?

Answer 5

• muscles of facial expression
• stapedius muscle
• chorda tympani: taste from anterior 2/3rds tongue + secretomotor parasympathetic to sublingual and submandibular salivary glands
• GPN: secretomotor to lacrimal gland

Question 6

What is hoarseness a result of?

Answer 6

• damage to the recurrent laryngeal nerve - a branch of the vagus nerve
• recurrent laryngeal supplies vocal cords

Question 7

which nerve innervates the muscles that elevate the soft palate?

Answer 7

vagus nerve

Question 8

Give a clinical sign of injury to the vagus nerve?

Answer 8

deviation of uvula toward the unaffected side

Question 9

What would be the clinical signs of a pontine lesion?

Answer 9

• right sided motor dysfunction (pyramidal tract involvement)
• left sided facial paralysis
• internal squint (paralysis of lateral rectus)

Question 10

How can you spot a subdural haematoma on a CT of the brain?

Answer 10

there is a characteristic crescent shape that causes midline shift

Question 11

What is hemiparesis?

Answer 11

weakness of one entire side of body

Question 12

What is the most common pathological cause of locked in syndrome?

Answer 12

occlusion of the basilar artery forming an infarct in the ventral pons