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free120/Block 3/Question#9 (reveal difficulty score)
A 72-year-old woman is brought to the ...
Area labeled 'C' πŸ” / πŸ“Ί / 🌳
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 +8 
submitted by βˆ—benwhite_dotcom(622),
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d_holles  It seems to me that the brain stem problems can all be answered using the Rule of 4s rather than memorizing the actual brain stem histology. +15  
llamastep1  Yeah I think so too! With the right CN12 palsy you already know it has to be medial (factor of 12) and that would be enough to answer this question. The hemiparesis just confirms that its a medial lesion (starts with M). I know many of us like to really understand the concepts not just use these "tricks" but hey if it works it works. +5  
tekkenman101  Except how do you rule out E? The hypoglossal nerve is damaged too and E is medial... +1  
bgreen27  The way I ruled out E was by the hemiparesis, which pointed me towards the pyramids. +1  



 +1 
submitted by βˆ—diabetes(29),
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fi we konw tath lrsdao oumocnl negdcaisn is amdlei nda aescdsute ni aemldul dan daencs clynlraataoetlr htne ew lilw eoshco c

cbreland  I was struggling with if the UMN would have crossed yet, but from what I remember, the cortospinal tract crosses at the bottom of the medulla. Also the CN XII has ipsilateral lesions ("Tongue licks the lesion") so that helped think through this problem. +2  



 -1 
submitted by canyon_run(5),
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I atnc’ msee ot dfin a siilmar ieagm olnnie taht csdrseieb exyctla ahwt eht ertoh easra are vengicr.o yAn h?pel

benwhite_dotcom  See this image (Fig.6) from https://teachmeanatomy.info/neuro/brainstem/medulla-oblongata/ A and D, for example, would reflect lesions that cause what is called lateral medullary syndrome (Wallenberg syndrome). +2  
canyon_run  Thank you! Would E then be the inferior vestibular nucleus based on that linked image? Also, is hypoglossal involved in the stem because of damage to the nerve fibers themselves rather than the nucleus? +2  
benwhite_dotcom  I think the level in the teachmeanatomy link is a bit off from the NBME image. I assume the NBME is showing E as the hypoglossal nucleus (https://en.wikipedia.org/wiki/Hypoglossal_nucleus). Yes, it’s the fibers. The nucleus is ventral. +1  



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