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8 years ago
The Mysterious Episodes of Mary: A Case Study on Neuroanatomy
Episode 1
Mary Lazarro, a 44-year-old mother of two, made an appointment with her physician
after experiencing a prolonged episode of numbness in her chin and lower lip. Two days
prior to her appointment, she felt a prickling sensation like “pins and needles” at the right
corner of her mouth. The sensation extended to her lower lip and chin. The examination
revealed only a superficial hypoesthesia of the chin and lower lip (numb chin syndrome).
There was no clinical evidence of palpable regional lymph nodes or other systemic or
neurologic abnormalities. Her physician scheduled her for a CT scan of the affected
region. These tests showed no abnormalities in the jaw, neck, or pharynx. The numbness
and hypoesthesia spontaneously disappeared gradually over a few weeks.
Episode 2
Four months later, while eating dinner with her family, Mary felt a stabbing pain in her
upper jaw and teeth that radiated out to the side of her nose. Over the next several days,
she experienced several more episodes of this intense pain. A visit to the dentist revealed
no abnormalities and she was referred to her physician for an evaluation. Prior to her
appointment, she noticed that the symptoms were subsiding as they had previously. Her
physician scheduled an appointment for a complete neurological exam the following
Episode 3
Three nights prior to her scheduled visit to the neurologist, Mary stopped at an
intersection and experienced intense double vision when looking to the right to check for
traffic. The double vision was less intense when looking forward, and her vision when
looking left was unaffected. Her husband noticed that her right eye appeared to be turned
slightly inward when she looked straight ahead. A day later, Mary noticed that the vision
in her left eye started to blur. The neurologist later suggested that the two visual
problems she was experiencing were related. The double vision when looking right was
found to be caused by cranial nerve palsy—a form of muscle paralysis caused by a
dysfunction in one of the cranial nerves. The problem with the left eye was diagnosed as
optic neuritis (inflammation). Both of these signs and symptoms, along with the previous
episodes, pointed to a diagnosis of multiple sclerosis (MS). The neurologist prescribed
oral steroids and ordered an MRI. As with her previous episodes, Mary’s visual
symptoms began to diminish over time.
The results of the MRI, shown below, were consistent with a diagnosis of relapsingremitting multiple sclerosis (RRMS). Relapsing-remitting multiple sclerosis is a form of
MS in which symptoms randomly flare up (Mary’s episodes) and then resolve on their
own. The lesions seen on the MRI on the left were associated with another episode in
which Mary experienced sensory and motor disjunction in her left lower extremity. A
subsequent MRI (image on the right) appeared to show improvement after three months.Short answer questions
1. Related to Episode 1: What is hypoesthesia? How does it differ from paresthesia?
2. Related to Episode 1: Using the flowchart below, identify the part of the human
nervous system that is usually associated with symptoms of hypoesthesia and
3. Related to Episode 1: Which of Mary’s cranial nerves is affected in this episode?
4. Related to Episode 2: Which of Mary’s cranial nerves is affected in this episode?
5. Related to Episode 3: Name all of the cranial nerves that are involved with eye
movements. 6. Related to Episode 3: Which of Mary’s affected cranial nerves is responsible for her
double vision when looking right? Why does she not experience double vision when
looking left?
7. Related to Episode 3: Which of Mary’s affected cranial nerves is responsible for her
blurred vision?
8. Related to Finale: In the MRI images shown in the case, you can see the lesions as
bright “white spots” on the brain. Using what you know about the structure of a
neuron, explain what is causing this spot to appear in the MRI.
9. Related to Finale: Three months later, you can see that the spots in the MRI appear
to be smaller. Using what you know about the structure of a neuron, explain what is
happening to the neurons in the area where the lesions are disappearing
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51 Replies
8 years ago
Did you find a solution for any of these? I need help too Confounded Face Please post something so that I have something to build on!
jokerh1977,  ariday,  bio_man,  chels2013,  gbaker
Answer verified by a subject expert
Posts: 9
8 years ago
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1. Hypesthesia is a diminished sensitivity to tactile stimuli. As compared to paresthesia the full complement of the stimulus is not felt and response generated is not enough.  In paresthesia however, the full complement of the stimulus is felt and an appropriate response generated.
2. The somatic nervous system which belongs to the peripheral nervous system because it responsible for skin innervation.
3. Trigeminal nerve. The specific nerve being affected is the inferior alveolar nerve, one of the terminal branches of the mandibular nerve which is the third division of the trigeminal nerve {cranial nerve five}
4. Maxillary nerve, the second branch of the trigeminal nerve.
5. Cranial nerves III, IV and VI. Oculomotor, trochlear and abducens.
6. The abducens nerve is the one responsible for her double vision when she looks right. She does not experience double vision when looking left because the lesion occurs only on the branch supplying the right eye.
7. Optic nerve which is cranial nerve II
8. The spots are appearing as a result of demyelination of the optic nerve.
9. Remyelination of the optic nerve. Since the Multiple sclerosis is a remitting and relapsing one the optic nerve a time space to under repair by the oligodendrocytes.
This verified answer contains over 210 words.
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Related Topics

7 years ago
How is #3 Trigeminal nerve?
megdog420,  housemusic
7 years ago
#3 is a trigeminal nerve because trigeminal nerves are located within the mouth and chin
7 years ago
Number 2 is Sensory Division not Somatic Nervous System
123loria,  kphoto
6 years ago
Number 2 is Sensory Division not Somatic Nervous System

I don't think it would be the sensory division. Remember, the sensory division deals with AFFERENT signals to the peripheral nervous system. The somatic division deals with EFFERENT signals.

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