There is a lt sided LMN 12TH cranial nerve palsy..In order to proceed let us have a look on the anatomical diagnosis according to the site of the lesion:1) Brain stem: causes:a- MND: look for wasting of the tongue, fasciculations, absent jaw jerk, absent and weak lt uvula movement, weak cough, nasal tone of voiceb- bulbar polimyelitis:look for wasting of the tongue, fasciculations, limbs wasting and deformitiesc- syringobulbia: in addition to bulbar palsy there will be dissociated sensory loss in the face, ? Horner's syndrome..d- medial medullary syndrome: look for ipsilateral LMN 12TH nerve palsy & contralateral pyramidal & dorsal column signs..2) lesion in the hypoglossal canal: only the 12TH nerve will be affected, & no other signs..
any easier approach,felt rather complicated.....?
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