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Old 08-03-2012
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Question Sinus infection with neurological complications

A 41-year-old man comes to the clinic because of a 2-day history of a progressively worsening headache. He was diagnosed with a sinus infection and given a prescription for amoxicillin 1 week ago. However, the patient did not fill his prescription and has not started treatment. Physical examination shows swelling around the left eye. He cannot laterally abduct the left eye or right eye. Mydriasis is noted in both eyes. Which of the following is most likely to be seen in this patient?

a) Decreased ability to raise eyebrows
b) Decreased sense of smell
c) Decreased movement of the tongue
d) Decreased taste in the posterior tongue
e) Decreased sensation over the upper lip
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E.....cavernous sinus thrombosis may be....upper lip sensation---->V2 of CN V
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cavernous sinus thrombosis ,cranial nerves III, IV,VI and the ophthalmic and maxillary divisions of CN V traverse the cavernous sinus .all of these CN course in the lateral wall of the sinus except for CN VI which courses through the middle of of the sinus ,as a result CN VI is affected first with the other nerves being affected later

a) Decreased ability to raise eyebrows-CN VII,FACIAL
b) Decreased sense of smell-CN I ,OLFACTORY
c) Decreased movement of the tongue-CN XII,HYPOGLOSSAL
d) Decreased taste in the posterior tongue-CN IX,GLOSSOPHARYNGEAL
e) Decreased sensation over the upper lip -CN V TRIGEMINAL, V2 MAXILLARY
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Yes , E

To add another question , Aneurysm of a vessel in this region will give rise to which defect in the visual field:

A. Homonymous Hemianopsia
B. Binasal Hemianopsia
C. Bitemporal hemianopsia
D. Central Scotoma
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e) Decreased sensation over the upper lip[/QUOTE]
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Quote:
Originally Posted by rapiddo View Post
Yes , E

To add another question , Aneurysm of a vessel in this region will give rise to which defect in the visual field:

A. Homonymous Hemianopsia
B. Binasal Hemianopsia
C. Bitemporal hemianopsia
D. Central Scotoma
Binasal hemianopia, as temporal fibres are compressed, in internal carotid artery aneurysm...
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Quote:
Originally Posted by rapiddo View Post
Yes , E

To add another question , Aneurysm of a vessel in this region will give rise to which defect in the visual field:

A. Homonymous Hemianopsia
B. Binasal Hemianopsia
C. Bitemporal hemianopsia
D. Central Scotoma
It could be either A or C depending on whether its compressing the optic chiasm or the optic tract. Visual field losses in IC aneurysms are variable and uncommon because the aneurysm should grow really big before it can compress the optic nerve
The typical presentation is ophthalmoplegia and sensory abnormalities in the trigeminal nerve distribution, not a visual field defect.
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Default correct answer :)

The answer is e) Decreased sensation over the upper lip

The patient has a cavernous sinus thrombosis, which commonly is due to sinus infections. Cranial nerves III, IV, V, and VI course through the cavernous sinus. The V2 branch of cranial nerve V provides sensation to the upper lip, and so this would most likely be affected.
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Old 08-04-2012
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Default my answer :)

I will go with D) Central Scotoma

My explanation:

Aneurysm of a vessel in this region will give rise to which defect in the visual field:

A. Homonymous Hemianopsia -> one of the optic tracts is compressed (unilateral distal ICA aneurysm)
B. Binasal Hemianopsia -> bilateral temporal fibers compression - I assume the ICA aneurysm we're talking about is unilateral, so I exclude this option
C. Bitemporal hemianopsia -> midline chiasma lesion (eg. ACommA aneurysm) - carotid artery is lateral to the chiasma so I exclude this option
D. Central Scotoma -> unilateral damage to nerve fiber layer/blood vessels by a proximal ICA aneurysm (carotid-ophtalmic region) - I just think that it's more common location for the anuerysm than in distal ICA (option A)

@rapiddo - what's the answer?
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Answer is Binasal Hemianopsia

The reason there was binasal hemianopsia in the option was because the original question suggested the two eyes were affected.
If its just one side of the cavernous sinus that had the internal carotid aneurysm, then it will be nasal hemianopsia of the same side.

Central Scotoma results from Macular degeneration.

Thanks a lot Cassandra for all the good questions you post.
I always have something to look forward to when visiting this site. I'm sure I'm not just speaking for myself...

Quote:
Originally Posted by Casandra View Post
I will go with D) Central Scotoma

My explanation:

Aneurysm of a vessel in this region will give rise to which defect in the visual field:

A. Homonymous Hemianopsia -> one of the optic tracts is compressed (unilateral distal ICA aneurysm)
B. Binasal Hemianopsia -> bilateral temporal fibers compression - I assume the ICA aneurysm we're talking about is unilateral, so I exclude this option
C. Bitemporal hemianopsia -> midline chiasma lesion (eg. ACommA aneurysm) - carotid artery is lateral to the chiasma so I exclude this option
D. Central Scotoma -> unilateral damage to nerve fiber layer/blood vessels by a proximal ICA aneurysm (carotid-ophtalmic region) - I just think that it's more common location for the anuerysm than in distal ICA (option A)

@rapiddo - what's the answer?
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