I have previously established that the case I am working on did not come to me with any imaging. So I’m using the power of intuitive learning from articles in comparison with her symptoms to determine where I believe her strokes occurred. As we all know, the first, second and third rules in neuro pathophysiology is just like real estate: location, location, location! So finding the answer to this problem is important and when there’s no imaging accompanying the case… problematic.
I had previously deduced that my case had a PICA territory stroke.
I have narrowed this down to:
Medio-posterior cerebellum. As indicated by the case exhibiting Wallenberg syndrome and have severe deficits in both voluntary and reactive saccades. Effects of structural and functional cerebellar lesions on sensorimotor adaptation of saccades as originally seen in Experimental Brain Research 2013
Lobule IX, in it’s entirety. As indicated by the patient reporting a spinning sensation AND having spontaneous nystagmus. Motion Perception without Nystagmus– A Novel Manifestation of Cerebellar Stroke
Which being in the center, makes it easy to see how this was a case of small bilateral strokes.
I’m currently in the midst of doing a literature review in preparation to write a case report. If you would like more background information on the case or information about the project, please click here. If you would like to see other article reviews related to this project, please click here.