Clinical Signs in Neurology by Campbell William W.;

Author:Campbell, William W.;
Language: eng
Format: epub
Publisher: Wolters Kluwer Health
Published: 2016-03-06T16:00:00+00:00

Jackson’s compression test: See Spurling’s maneuver.

Jargon aphasia: Speech rendered unintelligible by paraphasias and neologisms, also described as word salad.

Jaw deviation: Movement of the mandible to one side on opening. Unilateral trigeminal motor weakness causes deviation of the jaw toward the weak side on opening, due to the unopposed action of the contralateral lateral pterygoid. The jaw deviates toward the weak side (see Fig. J.1). Whether this is toward or away from the lesion depends on the specifics of the lesion. Careful observation of jaw opening is often the earliest clue to the presence of an abnormality. It is occasionally difficult to be certain whether the jaw is deviating or not. The relationship of the midline notch between the upper and lower incisor teeth is a more reliable indicator than lip movement. The tip of the nose and the interincisural notches should line up. A straightedge against the lips can help detect deviation. Another useful technique is to draw a vertical line across the midline upper and lower lips using a felt-tip marker. Failure of the two vertical marks to match when the jaw is opened indicates deviation. With unilateral weakness, on moving the jaw from side to side the patient is unable to move the jaw contralaterally. With facial weakness, there may be apparent deviation of the jaw, and of the tongue, because of the facial asymmetry. Holding up the weak side manually sometimes eliminates the pseudodeviation.

Other techniques for examining trigeminal motor function include having the patient protrude and retract the jaw, noting any tendency toward deviation; and having the patient bite on tongue depressors with the molar teeth, comparing the impressions on the two sides and comparing the difficulty of extracting a tongue depressor held in the molar teeth on each side.

Unilateral weakness of CN V–innervated muscles generally signifies a lesion involving the brainstem, Gasserian ganglion, or the motor root of CN V at the base of the skull. Severe bilateral weakness of the muscles of mastication with inability to close the mouth (dangling jaw) suggests motor neuron disease, a neuromuscular transmission disorder, or a myopathy. With significant atrophy of one masseter, a flattening of the jowl on the involved side may be apparent. Temporalis atrophy may cause a hollowing of the temple. Because of bilateral innervation, unilateral UMN lesions rarely cause significant impairment of trigeminal motor function, although there may be mild, transitory unilateral weakness.

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