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MEDICAL NEUROSCIENCE 2009
TEAM BASED LEARNING SESSION 2: NEUROLOGIC LOCALIZATION
Application Exercise Handout
Case 1
Unconsciousness, left sided weakness and dysconjugate gaze.
A 75 year old man with a history of hypertension was found unconscious on the floor.
At the emergency room his vital signs were normal and he was lying with his eyes closed. He
occasionally moved his right extremities. His left leg was externally rotated at the hip. With expiration,
his right cheek appeared to puff out more than his left, and his right forehead appeared less furrowed. He
did not respond to his name being called or to being shaken. When pricked with a pin on either side of his
body he grimaced and tried to brush off the stimulus with his right arm. In grimacing, only the left corner
of his mouth lifted.
When his eyelids were held open, his right eye deviated to the left while his left eye stared straight
ahead (see a - below). When his head was rapidly turned to the left his right eye moved to the middle and
stopped while his left eye moved fully to the right (see b - below). When his head was quickly turned to
the right, both eyes moved conjugately to the left (see c - below). When his head was rotated up and
down, both eyes moved appropriately (in the opposite direction to the movement). There was eyelid
closure on the left but not on the right when either the right or left cornea was touched. The gag reflex was
present on both sides. Tone was increased on the patient's left side, tendon reflexes were brisk, and
Babinski's sign was present.
right left
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MEDICAL NEUROSCIENCE 2009
TEAM BASED LEARNING SESSION 2: NEUROLOGIC LOCALIZATION
Application Exercise Handout
Write your localization on the Post-it paper (15 words or less), along with your Team number, and
tape it to the white board down front. We will coalesce the 18 Team localizations into 5 choices,
allow you time to discuss each of the 5 choices within your Team, THEN vote.
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