Question

Case 4 Presentation: A 15-year old male patient was admitted to the ER because an inability to swallow his breakfast. He had been discharged from the hospital 36-hours prior following two weeks of recovery from a motor vehicle accident that resulted in a compound tib-fib fracture, as well as other broken bones.

Neurological E*am: Touch discrimination of the left forehead is impaired and mild temperature sensation in the right hand is absent. Gag reflex is not present upon tactile stimulation of the soft palate. No other motor, sensory, or behavioral findings were present in the neurological e*am. History: The patient had been previously diagnosed (at 12 years of age) with an atrial septal defect (ASD) of the heart. No family history is of consequence to this case.

Diagnosis and treatment/medications?

Answer 1

Here there are 2 points to be noted. The first one is "Touch discrimination of the left forehead is impaired" and the second one is the absence of pharyngeal reflex. Both these show that there are 2 nerve palsies that have happened as a result of RTA. The first one of Glossopharyngeal nerve palsy resulting in an inability to swallow. The second one is trigeminal nerve past as tactile sensation in face us impaired. Medications such as corticosteroids which are anti inflammatory as to lessen the inflammation at the site of the cranial nerves causing palsy shall be used.