1700 MCQ’S for NEET- PG,FMGE/MCI EXAM PREPARATIONS:

EXAMPLES:

 Loss of Pain & Temp on right side of the body à Lat Medullary Syndrome

Additional
Information
Lateral Medullary Syndrome was originally believed to be the result of
occlusion of the posterior inferior cerebellar artery. It is now recognised that
the picture described may also result from partial occlusion of the basilar
artery or occlusion of proximal arteries such as one vertebral artery.
The terms posterior inferior cerebellar artery stroke and lateral medullary
syndrome are synonyms. It may also be referred to by the eponym
“Wallenberg’s syndrome”.
The syndrome is produced by a wedge-shaped infarction of the lateral medulla
and inferior surface of the cerebellum.
The clinical features of lateral medullary syndrome can be divided into those
resulting from brainstem or cerebellar dysfunction:
Cerebellar features:
• ipsilateral limb ataxia
• vertigo
• nystagmus to the side of the lesion – due to damage to the vestibulo-ocular
connections
Brain stem features:
• sudden onset of dizziness and vomiting – due to the involvement of
vestibular and vagal nuclei respectively
• dysphagia and dysarthria – due to lesion to the nucleus ambiguus and vagal
nuclei
• ipsilateral Horner’s syndrome
• ipsilateral facial sensory loss – pain and temperature
• ipsilateral pharyngeal and laryngeal paralysis – cranial IX and X palsies
• contralateral sensory loss – pain and temperature of the limbs and trunk.

1700 MCQ’S for NEET- PG,FMGE/MCI EXAM PREPARATIONS

paralysiS of the third cranial nerve affects the medial, superior, and inferior
recti, and inferior oblique muscles.
The eye is incapable of movement upwards, downwards or inwards, and at
rest the eye looks laterally and downwards owing to the overriding influence of the lateral rectus and superior oblique muscles respectively.

The reduced response of levator palpebrae superioris results in ptosis – a drooping of the upper eyelid.
A third nerve palsy with pupillary sparing is often termed a medical third palsy and often has an ischaemic or diabetic aetiology.

Full assessment of oculomotor nerve function involves testing of movement,
reaction to light, and accommodation. If all of these are normal, “PERLA” may
be written in the notes – pupils equal, reactive to light and normal accommodation.

1700 MCQ'S for NEET- PG,FMGE/MCI EXAM PREPARATIONS

A pt was lying down on the operating table in a position with his arms hanging
down for 3 hours. Soon after he woke up, he complains of numbness and
weakness in that hand and has limited wrist movement/wrist drop and sensory
loss over dorsum of that hand, weakness of extension of the fingers and loss of
sensation at the web of the thumb. What structure is likely to be damaged?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. Axillary nerve
e. Suprascapular nerve.

à ‘crutch palsy‘ – due to compression of the nerve above the spiral groove by
crutches as the weight is borne in the axilla
à ‘Saturday night palsy’ – due to compression of the nerve in the upper part of
the arm as a result of resting the medial side of the arm against a sharp edge
such as the back of a chair for a prolonged period. The person is usually
intoxicated. It may also be seen after surgery when the anaesthetized patient
is allowed to hang over the edge of the operating theatre table.
à humeral fracture
à rarely, dislocation of the elbow
The clinical features of radial nerve palsy (weakness) depend upon the site of
the injury.
Lesions in or above the axilla result in paralysis and wasting of all the muscles
innervated. Clinically, this is manifest as:
à weakness of forearm extension and flexion – triceps and brachioradialis
à wrist drop and finger drop – paralysis of the extensors of the wrist and digits
à weakness of the long thumb abductor and extensor muscles
à sensory loss on the dorsum of hand and forearm appropriate to the
cutaneous distribution – see radial nerve anatomy.

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Source : DR.NIGAM WHO HELPING ALL MEDICOS..