Please help me answer the following questions. Do not attempt to answer question

Question

Please help me answer the following questions. Do not attempt to answer question unless you can answer all questions. Thank you

Stroke:

A 56-year-old right-handed hypertensive, type II diabetic was admitted to his local hospital with complaints of occipital headache, right hand tingling, right limb ataxia, hoarse voice, severe dysphagia, nausea, vomiting, and vertigo. The retired English teacher’s blood pressure was elevated but no focal weakness was noted on examination. The following day he was transferred to a tertiary care university-based hospital. A magnetic resonance imaging scan performed on the day of admission revealed a right lateral medullary infarct with a right vertebral artery occlusion. Bilateral aspiration pneumonia was confirmed on chest x-ray.

a) Which complaints, signs and symptoms are indicative of medulla involvement?

b) Which centers are located in medulla?

c) Strokes of hemispheres cause signs and symptoms on the opposite site of the body. Why not in this case?

d) Which will be indicative of swallowing problems?

e) Which will be indicative of dysphagia?

f) Our patient is able to converse but the vocal quality was breathy. Why?

g) How should this patient be treated to prevent aspiration pneumonia?

Explanation / Answer

The vertebral artery and its branches supply the medulla and inferior surface of the cerebellum before forming the basilar artery. The basilar artery supplies the brainstem from medulla upwards and divides eventually into posterior cerebral arteries as well as posterior communicating arteries which run forward to join the anterior circulation (circle of Willis). The clinical features includes vertigo, ataxia, paresis and paraesthesia. The branches of the basilar artery can be classified as posterior cerebral arteries, long circumflex branches, and paramedian branches. a) Clinical symptoms include swallowing difficulty, or dysphagia, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia, and possibly palatal myoclonus. B) The medulla contains the cardiac, respiratory, vomiting, and vasomotor Centre and therefore deals with the autonomous function of breathing, heart rate, and blood pressure. C) Lateral medullary infarction often involve the inferior cerebellar penance, Medial lemniscal and spinocerebellar afferents fibres that travel within the inferior cerebellar peduncle on their way to the cerebellum. These nucleus and tracts are located in the most dorsal and lateral region of the medulla. The contralaterlal signs and symptoms of stroke generally occurs in other areas of infraction which generally affects the motor tract (pyrimidal tract) that generally decussate (crossing) in the medulla. D) The lateral medullary syndrome, also known as Wallenberg's syndrome, involving the nuclei of cranial nerve 9th and 10th. The involvement of the nucleus ambiguous causes ipsilateral vocal cord paralysis and a hoarse voice as well as ipsilateral weakness of the palate and phalanx, palate elevation on the phonation is asymmetrical, with the Uvula drawn into the intact side, and the patient experience dysphagia

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