Please look at this patient's tongue and proceed with the examination.What would you do next and what are your differential diagnosis ?
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9 comments:
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 voice
b- bulbar polimyelitis:look for wasting of the tongue, fasciculations, limbs wasting and deformities
c- 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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