EMQs in Clinical Medicine.pdf - Peshawar Medical College

Abnormal movements – answers 95
33 Cranial nerve lesions
Answers: C I J H K
C
I
J
H
K
A 55-year-old man presents with unilateral weakness, wasting and
fasciculation of the tongue. On examination the tongue deviates to the
left on protrusion.
Tongue deviates to the side of the lesion.
A 44-year-old man presents with progressive perceptive deafness,
vertigo, unilateral facial weakness and loss of sensation on that side of
the face. Imaging reveals the presence of a cerebellopontine tumour.
Cerebellopontine tumours often present clinically as a result of impingement
on cranial nerves in the cerebellopontine angle.
A patient complains of a hoarse voice, difficulty in swallowing and
choking when drinking fluids. Examination reveals visible weakness of
elevation of the palate, depression of palatal sensation and loss of the
gag reflex.
Cranial nerve IX and X lesions rarely occur in isolation and can also
accompany nerve XI and XII lesions after infarction in the brain stem or
as a result of pathology around the jugular foramen.
A 28-year-old man presents after surgery with an inability to rotate
the head to the right and to shrug the left shoulder.
Accessory nerve is the motor supply to trapezius and sternocleidomastoid.
The latter muscle allows rotation of the head to the opposite side.
A 35-year-old woman with multiple sclerosis complains of diplopia.
Examination reveals inability to abduct pupil on one side.
Diplopia in multiple sclerosis can result from demyelination of cranial
nerves associated with eye movements, i.e. III, IV and VI.
34 Abnormal movements
Answers: L D G A F
L
D
A jerky tremor of outstretched hands in an alcoholic with decompensated
liver disease.
This is elicited by asking the patient to ‘stretch out your arms and cock
your wrists back’.
Non-rhythmic jerky purposeless movements in the hands of a
55-year-old man.
Huntington’s disease is an autosomal dominant condition resulting
from a trinucleotide repeat mutation on the short arm of chromosome 4.