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Danijela

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Hi everyone. We have received a report of my partner's examination at the local MND clinic.

It outlines a number of things (diagnosis is "limb onset motor neuron disease" with upper an lower motor neuron signs in one limb only, although EMGs show involvement elsewhere).

I would be grateful if anyone could clarify what the following sentence suggests: "Examination today of cranial nerves was normal". Also, "There was no abnormality on abdominal examination and there was no cervical or axillary lymphadenopathy". I have tried Google but am none the wiser. Many thanks.

Danijela
 

rose

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Danijela,

Here is a helpful link about cranial nerves:
http://www.gwc.maricopa.edu/class/bio201/cn/cranial.htm

If you hover the cursor over the listing of the nerves, the corresponding part of the diagram of brain changes color to highlight which nerve it is.

These are lower motor neurons and are housed in the brain stem. There are also the same number of pairs of upper motor neurons up in the motor cortex of the brain. All of these (upper and lower) are the cranial nerves. The upper motor neurons communicate directly with the lower motor neurons, telling it the action needed, and then the lower motor neuron communicates directly with the muscle, making the movement.

Even if the EMG comes back normal for bulbar areas tested (usually the tongue) the neurologist's exam can find problems with cranial nerves due to weakness that is detected in the face, how the person swallows, talks, etc. during the exam. If this is noted, its often referred to as "central nerve #__ weakness. (so that's really good that the exam seems to have found no abnormalities with both Upper and Lower MN's).

If your partner's jaw jerk was brisk, or hyper, this too is a sign of upper motor involvement, and is from cranial nerve #5, the trigeminal nerve. Its not a bulbar nerve though, so people that have no or minimal bulbar involvement with motor neuron disease can still have a brisk/hyper jaw jerk, its not a bulbar sign, but just an upper motor neuron problem indication.

The word "bulbar" is referring to the bulbar section of the brain stem where the (lower motor neuron) cranial nerves are housed. Usually with motor neuron disease, only the cranial nerves in this section are affected (nerves 7-12 skipping the 8th).

I hope this helps sort some of your questions out. Hopefully another member will be able to shed some light on the other parts of the report that you sited. If Wright is around he'll be sure to respond.

take care :)
 

olly

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Vagus / senses aortic blood pressure
slows heart rate
stimulates digestive organs
taste

i was intrested in this nerve.
over the past couple of years since bulbar symptoms started i have had hypotention and on ecg tests done a year ago slow heart rate.
i have had (syncopes)blackouts because of this,sometimes before doing so i break out in a cold sweat and i have had a rapid thumping pulse in the area at the bottom of my neck inbetween were the shoulder blades meet.
is this were the aortic pulse is?
i went to a tilt clinic but my ecg was not good that day so they did not do the test.
anybody got any ideas? wright?
 

Danijela

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Thanks Rose. That was a good (visual) link and I liked the way the different areas were highlighted. Your explanation of cranial nerve involvement was also very helpful. Had a quick look at your profile page, at some photos you have posted. My partner's remark was "she has got very nice lips", so there you go :). Wishing you all the best. Danijela
 

rose

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Caroline, all I know is that its that nerve that seems to give me the most trouble. Its motor function is voice, (which was the first problem I noticed) soft palate and swallowing. The top part of the esophagus is mixed muscle fiber, so that is partially motor function, and now that I've got the slowed digestion past that point, I realize that more of my Vagus nerve is affected than just its motor function! I feel really bad that you've noticed trouble with your heart rate! I've said to more than one person that I really hope this part of me is left alone, and I certainly don't want it for you either. Have you ever looked at illustrations of where that nerve goes? man it travels just about everywhere in the body. (and I didn't know it was involved in taste, I have diminished taste for some things too, have gotten so used to it that I don't even think about it anymore)
 

rose

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Danijela,

I'm glad the information was helpful. I like that it is interactive. Somewhere on that guy's site he has a cranial nerve quiz that is kind of fun to take.

(and thank your man for me for his compliment;-))
 

olly

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hi rose.
i will look at some info on that nerve.
a few years back when this started with my blood pressure /heart rate they started to suspect cerebeller/multi system atrophy as this causes orthostatic hypotention.
but once again the mri was normal.
i still have bad episodes and nearly past out one day last week but no blackouts for a long time now.
thanks:)
 
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