This material is for group discussion on Clinical Neuroanatomy. Lecturer : dr. Gregory Budiman, M.Biomed Medical Faculty, University of Indonesia

1. CASE STUDY ON CLINICAL NEUROANATOMY ANSWERS TO CASE STUDIES Lecturer : dr. Gregory Budiman, M.Biomed Medical Faculty, University of Indonesia

5. Spinothalamicus Fasciculus gracilis dan cuneatus The damaged pathways Sensory: -Spinothalamic tract (pain, temperature, tenderness to the touch) derived from the right side of the body. -Fasciculus gracilis and cuneatus (proprioceptive and discriminative) derived from the right side of the body.

6. LMN LMN UMN Motor: -Lower motor neurons to the muscles at segments C4-T1. -Corticospinal tract to the muscles below segment T2 on the right side.

8. DISCRIMINATIVE EXAMINATION OF TWO POINTS: -Left leg could discriminate the two points pressed on the skin -Right leg could not discriminate the two points pressed on the skin.

9. HORNER SYNDROME: PUPILLARY CONSTRICTION, PTOSIS, ENOPHTALMUS - Damage of sympathethic innervation to the head area at the superior cervical ganglions has caused ptosis and enophthalmus. -Damage of sympathethic innervation leads to excessive parasympathetic work causing pupil constriction.

10. Sympathetic innervation to the head region : Ggl cervicalis superior m. Levator palpebrae m. Dilatator pupillae Gld. lacrimalis Plexus caroticus Gld.parotis Gld submandibularis Gld. sublingualis Cornu intermediolateralis Segmen T1

15. Location of lesion: area pretectal (pupil argyll Robertson).

18. THE POSSIBILITY OF LESION FORMATION: -At cerebral cortex, due to the same locations of the facial and hand muscle paralysis. -The damaged area is the vascularized area of a. cerebri media.

19. M Orbicularis Oculi is bilaterally innervated whereas the facial muscles under the orbital area are contralaterally innervated .

20. TYPES OF PARALYSIS: - Facial muscles, the type of paralysis: UMN -Reflex of cornea: positive, normal. -Arm muscles,the type of paralysis: UMN, reflex of biceps: ++++ -Both were exposed to UMN damage in the motoric area of the cerebral cortex.

23. LMN LMN UMN SITES OF LESIONS: - At the brainstem (pons), on the right side due to the paralysis of the facial muscle paralysis on the right side. -The paralysis of the extremity muscles on the left side a hemiplegi alternans.

24. THE DAMAGED PATHWAYS: -Corticospinal tracts going to the left arm and leg. -Corticobulbar tracts going to medulla oblongata (Nucl.N.XII) on the left side. -Lower motor neurons, nucleus n. VII. TYPES OF PARALYSIS: -Facial muscles: type of paralysis: UMN -Tongue muscles: (N.XII) type of paralysis: UMN -Leg and arm muscles,type of paralysis: UMN.