Examine the photograph shown below
This image is not from the college paper, but is reproduced without any permission whatsoever from this blog post by A. Lewis. Hang in there.
a) List three likely anatomical sites of lesions that can result in these eye signs
b) Give two associated clinical features that would help determine the site of the lesion?
a) List three likely anatomical sites of lesions that can result in these eye signs
Any three anatomical sites of the lesion:
• Hemispheric lesion (hemispherectomy, massive hemispheric CVA, thalamic CVA)
• Brainstem lesion (brainstem infarct, multiple sclerosis, brainstem tumour or encephalitis)
• Central cord lesion (syringomyelia, glioma, ependymoma, traumatic)
• T1 root lesion (Pancoast tumour, cervical rib, brachial plexus avulsion, aortic or subclavian aneurysm
• Sympathetic chain (laryngeal, pharyngeal, thyroid or parathyroid surgery, carotid artery lesion, malignancy at base of skull)
b) Give two associated clinical features that would help determine the site of the lesion?
Any two of:
• distribution of loss of sweating
• distribution of loss of pain and temperature sensation
• motor deficit
• signs of central cord syndrome
• wasting of small muscles of hand and clubbing
• cervical LNs
• Signs of head / neck surgery/trauma
• Subclavian artery bruit
This question is well revised from Table 10-12 of the most recent edition of Talley and O'Connor, which I have fancifully reinterpreted below:
|
In brief, one could answer the question in the following manner:
a) three likely anatomical sites of lesions:
b) two associated clinical features that would help determine the site:
This could be really over-done. For example, in the cranial nerves section, there is a much longer list:
Causes of Horner's |
Associated clinical findings: |
Cluster headache |
|
Cortical stroke (hemispheric) |
|
Brainstem stroke (lateral medullary syndrome) |
|
Cavernous sinus pathology |
|
Syringobulbia |
|
Syringomyelia |
|
Spinal injury or infarction |
|
Malignancy in the apex of the lung |
|
Thyroid cancer |
|
Neck trauma or surgery |
|
Lower trunk brachial plexus injuries |
|
Carotid aneurysm or dissection |
|
Clinical Examination of the Critically Ill Patient, 3rd edition by L.I.G. Worthley - which can be ordered from our college here.
Clinical Examination: whatever edition, by Talley and O'Connor. Can be acquired any damn where.