Topic > Differential Diagnosis of Mr. B - 1343

Question 1:1) Left sided headache2) Right sided weakness (strength 4/5)3) Bruising on right arm and leg4) Lethargic5) Decreased fluidity of spontaneous speech6) Unsteadiness/stumbling7) Increased reflexes in the right arm and leg8) Right Babinski sign9) Falls (in the last month)10) Alcohol abuseQuestion 2: (main source used: BASIC MOTOR PATH)Mr.'s condition B appears to involve the corticospinal tract, as it is in the control of motor function in the body and plays a role within the somatosensory pathway. “Corticospinal tract” is the name of the primary motor pathway, which begins in the precentral gyrus in the cortex and ends in the spinal column. The precentral gyrus represents the majority of the tract, but other cortical areas also contribute. The corticospinal tract begins from the axons of pyramidal neurons in layer V of the primary motor cortex. Once these axons leave the pyramidal cells, they enter the white matter just below layer VI of the primary motor cortex. The “corona radiata” is located deeper in the brain and is where white matter merges to form a large body of axons. The "corona radiata" penetrates into the deep nuclei of the brain, dividing the caudate and the putamen: at this point the axons become the "internal capsule". This "internal capsule" is particularly vulnerable to strokes. Sensory information travels through the internal capsule up from the thalamus to the cortex, while motor information travels through it down to the spinal column. It has a front and a hind limb: sensory and motor information travels through the hind limb. The internal capsule is located in the midbrain, where the axons are called "cerebral peduncles" or "brain stems" - which contain all the descending axons that go to the brainstem or spine. Unlike the inner capsule, they are mostly one-way and almost all are southbound. Ascending axons take other routes to reach the thalamus. Once the midbrain gives way to the pons, two things can happen to the peduncle: many of the axons of the cortex that were directed to the pons synapse will descend and make synapses or the remaining corticospinal axons fragment within the pons: they are no longer visible as a narrow bundle, although they can be seen as numerous smaller bundles. In the medulla, the fibers come together again as "pyramids". The pyramids run the entire length of the medulla – large uninterrupted axon tracts on the ventral surface. The fibers of the pyramid cross at the beginning of the cervical spine, a phenomenon known as "Decussation" of the pyramids.