Ipsilateral versus Contralateral Neuro Lesions - USMLE Forums
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Old 03-12-2012
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Hammer and Otoscope Ipsilateral versus Contralateral Neuro Lesions

It's always confusing (ipsilateral, toward) and (contralateral, away) physical signs in neurologic lesions.

Here's an attempt to collect these signs in one thread:
  • Hypoglossal Nerve Palsy: Tongue deviated toward the side of the lesion, except in UMN.
  • Vagus Nerve Palsy: Uvula deviates away but the palate droops on the same side.
  • In Sensorineural Deafness: Weber lateralizes away from the affected ear.
  • Accessory Nerve Palsy: Sternomastoid is weak in turning away from the lesion but you can't shrug the shoulder on the affected side.
  • Facial Nerve Palsy: in UMN lesions there's loss of motor function of contralateral (away) lower half of the face.
  • Cerebellar lesions: The body sways towards the side of the lesion in Romberg's test.
  • Nystagmus (fast component): Ipsilateral in cerebellar lesions but contralateral in vestibular lesions.
  • Caloric test: away from the cool water.
  • Horizontal Gaze Palsy: Eyes deviates to the contralateral side in frontal cortex lesions and to the ipsilateral in PPRF lesions.
  • Jaw jerk: The chin deviates toward the lesion side.
  • Abducens nerve palsy: You will have ipsilateral medial strabismus.
  • Oculomoter Nerve Palsy: You will have ipsilateral lateral and down strabismus.
  • Descending hypothalamics lesion: Always ipsilateral Horner syndrome.

Please feel free to correct me and to add to the list.
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Old 03-13-2014
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Default Correction

Depends on if it is a trocherlar nucleus problem, or a trochlear nerve problem. Remember, CN4 exists dorsally then decussates immediately. Meaning the left CN4 nucleus is for the right SO muscle. Thus, you would turn you head towards the lesion (to left), but say your CN4 nerve is out, then right SO isn't working so you turn your head to the left (away from lesion)... may want to look this up, but I am pretty sure it's right
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Clinical-Signs, Neuroanatomy-

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