Neurophysiology Case

A 46-year-old female complained of weakness on the entire left half of her face, which quickly led to
facial paralysis on that side. She was unable to wrinkle her forehead, smile, show her teeth, or puff
out her cheek on the affected side. She was also unable to close her left eye. A temporary patch
protected the exposed eye. Taste perception was distorted over the left anterior portion of the
tongue. There was complete recovery of the facial paralysis and taste distortion within two months.

1. The cranial nerve involved in this individual is the nerve.

2. This condition is known as .

3a. Why was there facial paralysis on the left half of her face?

3b. Why was she unable to smile?

3c. Why did she need a patch over her left eye?

4. Why was her taste distorted?

5. Compare this disorder to the major disorder associated with cranial nerve V.

6. Describe the normal functions of both of the cranial nerves discussed above.

Match the drug category on the left with the indication or disorder on the right.

1. Anticonvulsants Cerebrovascular insufficiency

2. Cholinergics Mild, moderate, severe pain

3. Narcotic and opioid analgesics Myasthenia gravis

4. Vasodilators Seizures
A 30-year-old female has had several episodes, each separated by several months, in which she
experiences brief periods of physical weakness, clumsiness of the legs and hands, visual
disturbances, and mood swings. Her weakness is most prominent in her lower extremities. CT scans
show evidence of multiple lesions in the white matter of the brain and spinal cord. During her last
episode, there were increasing neurological deficits due to an increasing number of disseminated
lesions. Prednisone (60 mg/day for five to seven days) was prescribed and helped her return to as
normal and active a life as possible.

1. What is the demyelinating disease affecting this individual?

2. What is myelin? What is its function?

3. How does the prednisone help this individual?

4. How are nerve cells ensheathed with myelin in the CNS? In the PNS?

Match the drug category on the left with the indication or disorder on the right.

1. Anticonvulsants Cerebrovascular insufficiency

2. Cholinergics Mild, moderate, severe pain

3. Narcotic and opioid analgesics Myasthenia gravis

4. Vasodilators Seizures
A 52-year-old male complained of episodic experiences (1/day) of brief (1 or 2 minute) loss
of contact with his surroundings, during which time he had a glassy stare, uttered
unintelligible sounds and did not understand what was being said around him. Each episode
was preceded by a sinking feeling in his stomach. His blood work indicated normal
electrolytes and normal serum glucose. His EEG showed interictal bilateral temporal and left
frontal lobe spikes appearing at about 3/second. Skull X-rays and CT scan were normal. The
cause of these episodes was diagnosed as idiopathic. Drug therapy was begun with
carbamazepine (Tegretol) at low doses, increasing over the week to the standard
therapeutic dosage of 200 mg four times each day. Blood levels of 8µg/mL indicated that his
effective therapeutic level had been reached, and the brief episodic experiences
disappeared.
1. What is the disorder of this individual?
2. What are the major classifications of this disorder?
3. Define ictal/interictal.
4. Why were the skull X-ray and CT scan performed?
Match the drug category on the left with the indication or disorder on the right.

1. Anticonvulsants Cerebrovascular insufficiency

2. Cholinergics Mild, moderate, severe pain

3. Narcotic and opioid analgesics Myasthenia gravis

4. Vasodilators Seizures