Qwerty
• Diagnosed HIV Stage 4 on treatment (LTE)
• CMV retinitis
• Central facial palsy (flattening of R nasolabial fold)
- paresis of the lower half of one side of the face
- damage to upper motor neurons of the facial nerve.
- The facial motor nucleus has dorsal and ventral divisions that contain lower motor neurons supplying the muscles of the upper and lower face, respectively. The dorsal division receives bilateral upper motor neuron input (i.e. from both sides of the brain) while the ventral division receives only contralateral input (i.e. from the opposite side of the brain).
- Thus, lesions of the corticobulbar tract between the cerebral cortex and pons and the facial motor nucleus destroy or reduce input to the ventral division, but ipsilateral input (i.e. from the same side) to the dorsal division is retained. As a result, central facial palsy is characterized by hemiparalysis or hemiparesis of the contralateral muscles of facial expression, but not the muscles of the forehead
• Weakness of the left upper and lower extremities for 3 days
-
• (+) low grade fever of more than 1 week duration prior to onset of neuro deficit
• Recurring headache
• (-) vomiting but nauseous
• CD4+ count of 24 2 months ago
• (-) diabetes, asthma, TB
• Used to smoke 1 pack of cigarettes per day; occasional alcoholic drinker
• Multiple flat, hyperpigmented lesions on his arms, legs and trunk
• (+) flattening of the right nasolabial fold
• Neuro examination revealed
▪ Slurring of speech
▪ Central facial palsy, pupils 2 mm OU, BRTL
▪ 2-3/5 motor power on the left side
▪ Hemihypesthesia on the left (approximately 20-30%)
▪ (+++) DTRs on the left, (+) Kernig’s, (+) Brudzinki’s sign
Upper motor neuron • Corticospinal neuron • Corticonuclear neuron
Cerebral cortex (pyramidal tract) –>
• CMV retinitis
• Central facial palsy (flattening of R nasolabial fold)
- paresis of the lower half of one side of the face
- damage to upper motor neurons of the facial nerve.
- The facial motor nucleus has dorsal and ventral divisions that contain lower motor neurons supplying the muscles of the upper and lower face, respectively. The dorsal division receives bilateral upper motor neuron input (i.e. from both sides of the brain) while the ventral division receives only contralateral input (i.e. from the opposite side of the brain).
- Thus, lesions of the corticobulbar tract between the cerebral cortex and pons and the facial motor nucleus destroy or reduce input to the ventral division, but ipsilateral input (i.e. from the same side) to the dorsal division is retained. As a result, central facial palsy is characterized by hemiparalysis or hemiparesis of the contralateral muscles of facial expression, but not the muscles of the forehead
• Weakness of the left upper and lower extremities for 3 days
-
• (+) low grade fever of more than 1 week duration prior to onset of neuro deficit
• Recurring headache
• (-) vomiting but nauseous
• CD4+ count of 24 2 months ago
• (-) diabetes, asthma, TB
• Used to smoke 1 pack of cigarettes per day; occasional alcoholic drinker
• Multiple flat, hyperpigmented lesions on his arms, legs and trunk
• (+) flattening of the right nasolabial fold
• Neuro examination revealed
▪ Slurring of speech
▪ Central facial palsy, pupils 2 mm OU, BRTL
▪ 2-3/5 motor power on the left side
▪ Hemihypesthesia on the left (approximately 20-30%)
▪ (+++) DTRs on the left, (+) Kernig’s, (+) Brudzinki’s sign
Upper motor neuron • Corticospinal neuron • Corticonuclear neuron
Cerebral cortex (pyramidal tract) –>