Question

A 73-year-old woman is brought to the emergency department by her son after developing hoarseness and nausea. The neurologic examination reveals a weak gravelly voice, a Horner syndrome on the left, and a loss of pain and thermal sensation on the right side of the body and on the left side of the face. MRI shows a small hemorrhage on the left side of the medulla.

1. The loss of pain and thermal sensation on the right side of the body is most likely the result of damage to which of the following?

a. Medial lemniscus

b. Spinal trigeminal tract

c. Anterolateral system

d. Anterior (ventral) trigeminothalamic tract

e. Internal arcuate fibers

2. This patient has a Horner syndrome on the same side (left) as the facial sensory loss. Damage to which of the following fibers would most likely result in this sign?

a. Hypothalamospinal fibers

b. Reticulospinal fibers

c. Vestibulospinal fibers

d. Spinohypothalamic fibers

e. Reticulothalamic fibers

Answer 1

1. The loss of pain and thermal sensation on the right side of the body is most likely the result of damage to the Anterolateral system

Because Pain from the "body" is carried by the spinothalamic/anterolateral system,

2. This patient has a Horner syndrome on the same side (left) as the facial sensory loss. Damage to Hypothalamospinal fibers would most likely result in this sign

Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms that are similar to the symptoms caused by Horner syndrome.