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A 71 y/o male with a history of hypertension presents to the ER complaining of dizziness, nausea, vomiting, headache and difficulty sitting and standing. His wife reported that he had slurred speech and shaking of his left arm. He was ataxic on left finger-nose and heel-shin testing, but normal on the right. He had great difficulty performing the tandem gait and had a positive Rhomberg test, and stumbled to the left (a clinician asks a patient to close their eyes The essential features of the test are as follows: the subject stands with feet together, eyes open and hands by the sides, the subject closes the eyes while the examiner observes for a full minute. If the patient falls, they have a positive Rhomberg sign). His somatosensory modalities were intact. Eye exam revealed slight bilateral papilledema. This case refers to this and  the next 5 questions (11-16). Dizziness, nausea, vomiting and ataxia are tell tale:

What could be causing the papilledema? (feedback)

A 59 year old man was brought to the emergency room by his wife because he “suddenly couldn’t feel anything”. Examination revealed absence of discriminative touch, vibration sense and proprioception from his right upper and lower extremities. There was also absence of pain and temperature sensation from the right side of his face and left side of his body. A motor examination revealed weakness in turning his head toward the left and in shrugging the right shoulder. Horner’s syndrome was also present on the right. The next 3 questions concern this case. This case refers to the next 3 questions (1-4). What is suggested by the absence of discriminative touch, vibration sense and proprioception from the right upper and lower extremities?

This case applies to this and the following question. A 26-year-old male was brought by ambulance to the ER after having been in an automobile accident. During examination the patient was completely lucid-alert and oriented to person, place, and time. A CT scan showed a large, lens-shaped fluid collection along the inner surface of the left temporal and parietal bones. A fracture of the left temporal bone could also be seen. Some time later, after the CT scan was taken one of the nurses noted that the patient was some what agitated and had a decreased level of consciousness. Further examination revealed that the patient’s left pupil was fixed and dilated and that the right arm and leg were weak with increased reflexes. What does the fixed dilated pupil on the left suggest?

Identify the structure outlined in blue, be specific.

A 78-year-old man presents with the complaints of: -> double vision and -> weakness of the right arm and leg. You notice that: -> the left pupil is dilated and there is left ptosis (eyelid droop). -> When you shine a light into the left eye, the right pupil constricts but the left remains dilated. You also observe that the left eye is deviated down and outward. There is also right body hemiparesis, hyperreflexia, and Babinski sign is present. When you ask this patient to stick out his tongue, his tongue will ___________.

A 26-year-old male was brought by ambulance to the ER after having been in an automobile accident. During examination the patient was completely lucid-alert and oriented to person, place, and time. A CT scan showed a large, lens-shaped fluid collection along the inner surface of the left temporal and parietal bones. A fracture of the left temporal bone could also be seen. Some time later, after the CT scan was taken one of the nurses noted that the patient was some what agitated and had a decreased level of consciousness. Further examination revealed that the patient’s left pupil was fixed and dilated and that the right arm and leg were weak with increased reflexes. What is most likely given that the patient’s right arm and leg are weak with increased reflexes and the decreased level of consciousness?

This case applies to this question and the following 2 questions. A patient is brought to the ER because of left arm weakness. On exam, the patient demonstrates: -> left lower facial paresis, but he can wrinkle his brow, -> a right gaze preference (i.e., eyes deviate to right), -> speech is relatively normal. Evaluation of strength reveals: -> moderate weakness of the left arm but normal strength in all other extremities. Additionally, the patient shows: -> diminished fine touch, proprioception, pain and temperature sensitivity for the left arm and face. Pick the most likely site of the lesion from the figure below.

A 22-year-old male is brought to the ER with knife wounds and the following symptoms: -> initial flaccid paralysis of his right arm and leg, -> deficits in proprioception and vibratory sensation on his right side below the level of C6, and -> decreased pain and temperature sensation on his left side below the level of C4. A lesion in what anatomical structure explains the 2 dermatomal difference between the level of fine touch loss and loss of pain and temperature sensation?

A 60-year-old female with a history of myocardial (blood vessels that feed the heart muscles) blockages suddenly develops the following symptoms:  -> She has difficulty smiling on the right side; her right eyelid cannot be closed, and her right brow cannot be raised. -> Facial pain and temperature are lost on the right. -> Taste near the tip of the tongue is diminished on the right. -> Pain and temperature sensation is lost on the left arm and leg. -> She reports dizziness, nausea, impaired balance, and poor coordination on the right. Fine touch and proprioception of the body are normal. Loss of taste on the anterior tongue is due to damage in what area (include laterality)?