“UNIVERSIDAD ESTATAL DE GUAYAQUIL”

FACULTAD DE CIENCIAS MEDICAS

ESCUELA DE MEDICINA

Neuroanatomía

Docente: Dr. Pablo Ulloa

Estudiante: Daniel Aldaz Carvajal

CASOS CLÍNICOS

Grupo 8

Ciclo l 2020-2021
 An 87-year-old woman is brought to the emergency department after she is found
unconscious inside her home. Paramedics state that the oven was on, but the pilot light had
gone out and the apartment was filled with natural gas. The woman is resuscitated, and
examined by a neurologist. Examination shows no abnormalities other than a deficient
sense of smell. A CT scan of the head shows a mass in the olfactory groove area. The
axons likely compressed by this mass project to which of the following structures?

- A. Insu[a

`' 8. Nucleus ambiguus

\ C. Piriform cortex

D. Postcentral gyrus

E. Precentral gyrus

1. COAL ES LA RESPUESTA CORRECTA

Cc~ Cork€x ?`"apY`Tn€/7

2. POR QUE ES LA RESPUESTA CORRECTA

# \" coylete Pbv`\Fotrm€ eb fu felt+i de[ Cotdi^r-o det\t€

Se ob\clu el set\±{ao 6el c>\Fciho qo€ petrmjit 8`i+eder u>

0{stinSt!`t+ ®leTeS dti mube priosjcfo.i ¢ ct| cillemr£`c. eJ}ha

8©r`Q Se p.ro!o}O eL)kei co.mp.ren3i'o'h ae cLdort€,,6 Q,h eL9fo BOJiQ.

3. POR QUE LAS DEMAS NO SON CORRECTAS EXPLIQUE TODAS

A-IT\suunct`-es onLQ. hoTinzohu po\.pep+i\dgr , nol{@y\€ iiu.drA

que_ vet con e,l ac`so

B-O|.c\eo Anbiquo.` esdrn c;Lsocj,.icAde3 cil hGL,bho uj G to J€ QfuGo`;

D+-C`Ircunyohocso-n Po5+ce.r\{+al.` @g>he c„cowoGcto'^ cma+o.

•,thcc^ &eA ld'boha giv\^;,c--tr\

€ ~ C-:ro ?recetryJrce;I o` e> ¢y\ Pltesu€ dQA (o. buto` FToii+cL\

de\ cete_isto, don6e Se ubican coylebeT reluc{onu±cn

Cc>h e\ mo v\m\ey\`o

COY`ch9;c6-u"Qonu cle e,`ke ScJ Te lcic{or\cRh con e^

c!fJ,SO / /
examination reveals an inability to elevate the right eye from the abducted position. Which
of the following additional findings would most likely be seen in this patient?

` A. A constricted right pupil in the absence of a light stimulus

\ 8. A partial drooping of the right eyelid

C. Inability to abduct the right eye

` D. Inability to blink the eye in response to touching the cornea

`\ E. Inability to depress the right eye from the adducted position

1. CIJAL ES LA RESPUESTA CORRECTA

Bo-Co\r±u @ourdch clel pe~rpeAo de+echo¢

2. pORQUEESIAREspuESTfc,coRRcu[cffckenTh pO, pry`€cLcO de le>

ff \u tlp\op,-cl
•mu~s cufo) eK{raoct`lcL`ea , Pemdielz\6o Ft)er^ao €,h cob`+cb rviu~^`-

cu\p3 ©To6octey\lo ha cci\^da peg+clad c}€J perpa!.n

a a+ e GLo
3. POR QUE LAS DEMAS NO SON CORRECTAS EXPLIQUE TODAS

Ao`P¢P;lu 6erecjtQ cons{+eh`6cir d> ct proc@,bo uoryhch c!€ (a

pupbuL aonoth`vncooo wtos`T) `
C¢ -rnen9acl6ot &e CLbolecLt e\ Ojo !€Y`echo;~Se Conoc£` corho
en6o +ro ®i-ci,

9. £t\cupcLcu!ou! pQTu 6epr`tmir el coo 6ercho c+eJs!e (a

pe sic.to-n ou±dcc':o't\.-No eb S``ndett`ru dr. Q)\u 6,iplop\-c\.

o. In enpcuc; 6tle Qcn`+ci deciT ev\ re2i©ue,)+c^ ci +oc`cir

(u coTne.c^, Trpi`Co d€ iin doloT Ocolo`r
 A 54-year-old man with a history of chronic otitis media comes to the physician because of
gradually progressing hearing loss and discharge from the right ear. An MRl shows
evidence of a cholestea{oma in the middle ear. After diagnosis, surgery is performed to
remove the cholesteatoma. The surgery resulted in injury to a nerve that passes through
the middle ear cavity. Following the procedure, the patient notes significant improvement
in his otologic symptoms; however, he begins to notice increasingly severe symptoms of
dry mouth, Salivation from which of the following glands is most likely to be impaired as a
result of the surgery?

' A. Parotid and sublingual glands

` 8. Parctid and submandibular glands

' C. Parotid gland only

' r\ D. Sub|ingual gland only

E. Submandibular and sublingual glands

F. Submandibular gland only

1. CIJAL ES LA RESPUESTA CORRECTA

cG`~ Solo fca qilo'ird,oho poro'l\drzz/

2. POR QUE ES LA RESPUESTACORRECTA

qp`erfufo€Y,V`e°8keQ*::v¥oh`'n.t`::TuPQusuLQP°gf\a~Culn6:Ld°mp;6::_it:iur4,Oaf
Set ci+ec*Q6o , €)&a 9lcu^6uh c`eju 6€ ProJuctr scLl{vcj,

prodsc\\e`Ao e,l sjv\toyvi& de b®cCi` s`e,cc( //

3. POR QUE LAS DEMAS NO SON CORRECTAS EXPLIQUE TODAS

A. C-ldv`duh pc\ ro-J{do u 9L.bllnq;uicLle9 `` lcrfe 9(Gnc)ci(07

&°:euh*Lf`+;% i,:€\bes€£ `&¥*Cifactc°kT^ c+€{ nervio &iHncsc'4,

Do Cdylci't\tuh pci\`®+i!Ch ¥) sLibmon6`boG`re& ` \o,5 c5lundods
So `bmcL`|` `bo(flreD , \reoben \Y\@rvcic`ori 6ezl f\eruL`o Sub m®ndL
buler t e,D{t. no eke Chfecfu6o
Do Solo lu QilQA6ulo SoblihguoJ4r ;n@ruo6o po, `e/ nepr
w`o su6\\v\Soal , co'tio nctu.,o r\o Foi'u c* fee+ct6¢

€ 6lc" !olco subrr`cLndrbeloye;b uj sobl\ngucLleo ~ tea t>cJh

f`\bro) 6di SQnQ)l{o SO`bJnon 6t bu'hoy p+oC€6emi€ ae\ y\@y'uzto

(tncoucL^ , Cuujo rJej`ulo no Foe ctFuto_60

[r solo cAha`nc'ch scbthuLv\6,tbu(cLr--el ne_it`vt`o l\nc}u{ul\

t\o sp ejr\ cocwiru afecicl6o
 A 45-yearold man with a history of vertigo is brought to the emergency department
because of loss of consciousness after a fall. He appears mildly confused but is not in any
acute distress. Physical examination of the head shows blood behind the tympanic
membrane. A CT scan of the head shows a basilar skull fracture, with a fracture fragment
compromising the foramen rotundum. Which of the following will most likely result from the
patient's foremen rotundum injury?

A. Bleeding from the internal carotid artery

a. Bleeding with epidural hematoma formation

C. Ipsilateral deviation of the tongue

D. Sensory defects in the mid face

E. Sensory defects of the forehead

1. CUALES LA RESPUESTACORRECTA

I)O~t)e`Feoto s€T\sO\`:.uleb en Li cQ9-TCEL me6` cizz,?,~

2. POR QUE ES LA RESPUESTACORRECTA

qu pot qup' ,pot d Sorciyvl€h rotond,om o Forclmeft reAon6o /ri,c4$0~

prsc4 eJ nervro Tyio&.Ldr' , cugQ i`@u-vt\O coy\duce \^

\rn ioTtt`Gc,;orh sey\ct+\ua c\e ha co_ra melto ( Pcfty~PcidoJ i\hFe-
t\oT`e" ha me`o\lLu ; dot.Q,o ng POA.+a ci€ feA `rLCAric2 , ct lcp'b`\o

`uoer\`or , e*Ce )
3. POR QUE LAS DEMAS NO SON CORRECTAS EXPLIQUE TODAS

A{,~Salero!o 6q u ArterlQ core L`be \y\key`nLL: la Arte"'u

(ore ltS,a \\ulernd , flo+ie;^e r\u6o qu(``VeJr c®Li ct forG"@yi rofundrm

e8ho"rkeT`{ a ocgr8u PO\' e/\ Clqo\)e``O Yty8QCL&o.

p,¢-Sc|T) 9Tulo Con fc)thcldon 6e h@`lt`cj\+omo epc&urcgJo` ej>+o

sjcej\±€ Cu¢nd® On VO80 ScoJV\9Ut-h€o f€ rompr~ ci'`trp 1¢ ®urLiiFngflid,r€

lb e,l CL*ru'v\ej9.

G.-oeav,Gic`o-n -(pso hale+ch ct ho le^8uo®-es QFechad~ci

ct her,v;o hlpoQbtoso us\° ho eb ctEe~QJlcL&o en `eA+a
Fcocsot(-cl-

6o-t\e€echo s Sey`sor``ciha !e lci tre^+e.-°`n@vucLc¢.oM p®r

ecb,te ddt Ue~w,;© o€tal\mco, ou`o nervto grr&® pay Lth
-+``u`rfu o`r btho\`i`cl SUpQ,nco/'.
 A patient with a history of difficulties in phonation is undergoing laryngeal surgery. During
the surgical procedure, the surgeon controls bleeding by ligating the superior laryngeal
artery. If the nerve that accompanies this artery is damaged, which Of the following
functional !osses will ensue?

• A. Loss of sensation in the laryngeal mucosa above the vocal folds

` a. Loss of sensation in the laryngeal mucosa below the vocal folds

I ` C. Loss of sensation in the pharyngeal mucosa

' D. Paralysis of the lateral cricoarytenoid muscle

" E. Paralysis of the thyroarytenoid muscle

1. COAL ES LA RESPUESTACORRECTA

Ao-i)e+drlo 6€ Senc.lotu6,Gl ey\ LQ muco}o `cLr,-ntie~"

p®y` eLy`c;yv\c^ dQ (A;¢ fuerd_¢b vOcQLle/z7

2. POR QUE ES LA RESPUESTACORRECTA

+ io` in,jco3c4` Le{y\`hJi}ec^ e8 \y\ervt®ha pot ho rtjy`O `titkemcj

dq| vieirv.\o lG{r`by`b€o sope+'{®, t cO90 neyv`o eA cELFecfuao ,

@er i;en de lfl se^cjb:u\cLA , 'eJbjq, mucer5c+a 5€ en coe^(rci , sugri'rco~

ci ke ®er be v® cQ__le> `

3. POR QUE LAS DEMAS NO SON CORRECTAS EXPLIQUE TODAS

P)j-Per&lQ 6e se^Gbiul{rd en. fo\ mucoser §cerrnqcJcy 6e_bqjo

drlcb coef±eb vQccELb T` \cb cuej`clS vOcci\Q3 e^dQ^ (^Feri\O,-

c|ho{ ynocr93Q FCAv`ty\q!€CJ z [u niL7Cosa Se en cog,h#`rQ Sufx.`'-

tritor cl be co`orh..
C¢-FtprdlJQ !p s@hcib, \o±ci! eh lu mucosu Farrhctee^ . len

Qm*:gt:etQV&"&qc.®uerv:bo 3;;oC°°Q de tw fcftYinS€ C"` |hert,tflctto

a.~ PcL\ril\`s\| 6al rv\u's cute crtco ontdenot6€o halercL^ `i?e%+ued@
p®r el y`ervL`O hari^y\Q&eo yt.corrorJ€, co¢o n@ru'O no ct2>tQ "

*PQT®tst5 dQ,l Ty\u Scoho +tro in de no\ dso ` `\t\ervcL!o

I ^ ,.,. __ _ _, . .\ _ __ _ _ ^ p¢r
I.1

y`eco"er\d€ z CuSo T\eh`\zi`o no €Sit^

uqFhfrfe`:3utr\-ng%
 A 65-year-old man with a history of hypertensjon, hyperlipidemja, and myocardial infarctjor
is brought to the emergency department after tripping down the stairs this morning. He
reports some disturbances in his vision after waking up this moming that were not present
previously. Visual field testing reveals a right lower quadrantanopia. A CT scan of the heaci
is most likely to show a lesion of which of the fc]llowing?

A. Optic nerve
8. Optic tract
C. Left lateral geniculate nucleus

D. Left parietal lobe

E. Left temporal lobe

Detects

1, -
\
-I
I Ei=
i

i
I,

<,),

`: /..,I.`'.

1. COAL ES LA RESPUESTA CORRECTA

Db~ Lb'ho ho grQj^teth\ lt quLetr)±o

2. POR QUE ES LARESPUESTACORRECTA ~

;atdon\afut:CMbetrn:P;`\,:do,i,noF_:rL°`\coSceo¥GU6upe'perQf:::aceq::`,`o~j`
iud b'buto pcirt€\+cL/ iic(u;ert\o

3. POR QUE LAS DEMAS NO SON CORRECTAS EXPLIQUE TODAS

AeweT`v{O c'p`Lrco.`eh A`\tehc^ctoh9 dud c4Lrnpo vi\sc,7al u7tu

le S{o~h 6e{ neFv,`o aptito no pro6oi-(. ujzic\ Cuci 6yt;inhopsi`G ,€oi;io

U':; leTrL°tryLde%#:. `_ °uh\:ar%*:h e„ e{ {ruc*o ophLCo ca„

uvid hem t`ci yno p5i`ci

c,o~ u\u-c|€o to€n(CDlce!Q L¢ +eYtn{-CB e,A Cowl(ro cjQ p;cegG,q,7eL4

pr`^cfr,rc` d@ ha \n royq4c{'„ u, SL'CZ/ rfeeJj3,c{,a ch [u +e+(y`ce c(dy

:§:`O'\ulo teyy\pcrul i\tq"Jio -uhQ les`04 dot (Obulo

ienapru\ \Ttqu`\i±rto CTlu5u Uytu 6Jci 6ranfur>op5wl supey^i`oj
6e r€chu