USMLE Forums banner

CNS Lesion Location?

6576 Views 11 Replies 12 Participants Last post by  drkousigan
44. A 67-year-old man is brought to the emergency department 2 hours after the onset of weakness and double vision. He has hypertension and hyperlipidemia treated with metoprolol, captopril, and atorvastatin. His blood pressure is 190/106 mm Hg. Neurologic examination shows left-sided facial weakness including the forehead. There is palsy of left
conjugate gaze, and the left eye fails to adduct on right gaze. Vertical eye movements are intact. Muscle strength is
3/5 in the right upper and lower extremities. Deep tendon reflexes are brisk, and Babinski's sign is present on the right. Which of the following is the most likely location of this patient's lesion?
A) Bilateral thalamic
B) Left frontal
C) Left pontine
D) Right caudate
E) Right midbrain
  • Like
Reactions: 2
1 - 12 of 12 Posts
Neuroanatomy .......Tho not sure , but i think its E . right midbrain ...
S/s looks a bit similar with multiple sclerosis ...
  • Like
Reactions: 1
i think C

In my opinion, since there is involvement of a long tract and cranial nerves we must think of brain stem lesion. In this case since the CST is involved it suggests a medial brain stem lesion and this is coherent together with the abducens nerve lesion signs (gaze palsy to the left) for medial pontine syndrome.
As for the rest of the neurological signs:
- Facial nerve involvement is not uncommon in medial pontine syndrome especially if the lesion is caudally located. (left sided facial weakness)
- as for the last neurological sign: the fact that the left eye fails to adduct when looking towards the right suggests either CN III palsy on the left (which is inconsistent with the patients symptoms) or a left MLF lesion

So, i would choose C. left pontine lesion
even though it doesn't correlate to the last neurological sign (seen in bold) it fits with the rest
  • Like
Reactions: 1
This is a case of cross hemiparesis, typical of brain stem lesion.

3rd nerve nucleus is in pontine and the lesion is left. So yes I agree the answer is C.
  • Like
Reactions: 3
eyes looking toward the side of the lesion..So left..and the CN is in the pons...leftpontine...?
it is a pontine lesion
1 - 12 of 12 Posts
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.