Mr XYZ is a 53 yearz male. he is business man by profession.
he was brought to the emergency department by his family menberz for sudden loss consciousness after an episode of vomitting.
Mr XYz is a known case of type 2 diabetes mellitus. but he is not taking any medications. he was in usual state of health till taking his dinner. just after taking his dinner the patient had an episode of progectile vomitting. it was of small volume containing food. after that he lost consciousness.
his past history ravealed stroke which was 3 yearz back.
on examination
BP 170/90.
HR 90beats/min.
unconscious male who is dyspneac.
neurologic exam
unconscious.
b/l upper limbs reflexes were of grade 1 (hporeflexia)
b/l lower limbs reflexes were of grade 3 (hyperreflexia)
tone upperlimbs was hypo.
tone of lower limb was hyper.
corneal reflex were absent both sides.
primitive reflexes were absent.
dolls eye were absent.
signs of meningeal irritation absent.
labs
BSR was of 170mg/dl
what you suspect.
where is the lession.

Cudnt tell the exact location.
But it is in the brain.

yes you are right but this was a real patient i examined him as he was diagnosed.
you are right lesion lies in the brain think of any brain are that will give same presentatin clue lis in the case. Review your clinacal neuroanatomy you will find.

okayy friends patient name in this case is not his orignal name but its a real patient that i saw in in ward and examined him by my self.
comments and answer are awaited

Actually this is tough case for me. coz its been long since i studied anatomy.
The lesion could be in the brain stem.

its not that much tough bec we all are in the same class. 4th year.
you are right that it may be in brain stem but how can you explain two diffrent form of presentations of upper and lower motor neuron lesion

The respiratory centre is involved. oops, i forget the differences btw the upper motor neuron and lower lesion. Hmm I think in upper motor lesion the reflexes will be exagerrated. Leewani please correct me if i am wrong.