01 Kutkot Kokote Flashcards
a single discrete neuroanatomical locus that can account for all the signs and symptoms
focal lesion
involves more than one locus, but loci remain discrete
multifocal lesion
indicates widespread dysfunction of a part of the nervous system
diffuse localization
negative symptoms
reduction of function (weakness, numbness) complete loss (paralysis, analgesia)
positive symptoms
brief and very intense/paroxysmal (seizures)
episodic and recurrent (hemifacial spasm)
loss of function that may be defined on examination
deficit
spell
transient and self-limited abnormality
sudden/ abrupt/ acute onset
seconds to hours
can be vascular, traumatic, or physiologic
subacute onset
days to weeks
can be infectious, toxic, or metabolic
insidious, gradual onset
months to years
can be degenerative, neoplastic, or nutritional
recurrent-remittent onset
episodic attacks with recovery in between
chronic progressive onset
months to years
implies gradual deterioration
umn weaknesses
due to interruption of corticospinal/bulbar tracts increased tone (spastic) increased reflexes (+) babinski (-) atrophy (-) fasciculation
lmn weaknesses
due to involvement of spinal anterior horn (or CN) itself and all distal parts dec tone dec reflexes (-) babinski (+) atrophy (+) fasciculation
in central lesions ___ is interrupted and ___ is weak
corticobulbar fibers, contralateral lower face
in peripheral lesions ___ is interrupted and ___ is weak
nucleus/CN itself, ipsilateral forehead and lower face
tract for position and vibration sensation
ipsilateral posterior column
tract for pain, non-discriminating touch, and temp
contralateral spinothalamic tract
transient monocular blindness is also known as __ and caused by ___
amaurosis fugax, thromboembolism of the retinal artery
cerebellar truncal ataxia
manifests as broad based gait or titubation
associated with involvement of vermis
middle peduncle of cerebellum is:
Largest peduncle, largest pathway, largest part of the pons, ends in the largest lobe of cerebellum
Lateralest
Latest phylogenetically
Simplest (pontocerebellar fibers)
rules of 4 in the brainstem: 4 structures in midline
motor pathway
medial lemniscus
medial longitudinal fasciculus
motor nucleus and nerve
rules of 4 in brainstem: 4 motor nuclei in midline
CN 3, 4, 6, 12
rules of 4 in the brainstem: 4 structures to the side
spinocerebellar pathway
spinothalamic tract
sensory nucleus of cn V
sympathetic pathway
rules of 4 in brainstem: CNs
4 cn in medulla (9, 10, 11, 12)
4 cn in pons (5, 6, 7, 8)
4 cn above pons (1, 2, 3, 4)
t/f generalized impaired attention and cooperation are specific signs
false
what is being tested in memory?
(james) papez circuit
He-Man Ate a Cat EH
musical component of languaage
prosody
anomia points to a damage in ___
left arcuate nucleus
repetition deficit points to __
transcortical aphasia
dejerine syndrome invovles the __
left posterior cerebral artery
agraphia or dysgraphia points to a lesion in ___
left parietal region (supramarginal gyrus)
Gesrtmann’s syndrome symptoms
right-left confusion
agraphia
acalculia
finger agnosia
loss of ability to plan or complete motor actions that rely on semantic memory
ideomotor apraxia
inability to select and carry out an appropriate motor program
ideational or conceptual apraxia
constructional apraxia
inability to draw or construct simple configurations
difficulty making precise movements with arm/legs
limb-kinetic apraxia
(rezso) balint’s syndrome symptoms
oculomotor apraxia
simultagnosia
optic ataxia
an abnormality in attention to one side of the universe that is not due to a primary sensory or motor disturbance
hemineglect
deficit of self-awareness
anosognosia
brief oscillations of pupillary size that normally occur in response to light
hippus
marcus gunn pupil
when pupils fail to constrict fully
aka relative afferent pupillary defect
hallmark of optic nerve disease
adie’s pupil
slow and prolonged accomodation
poor or absent response to light
affected pupil is larger then becomes smaller over time
argyll robertson pupil
quick accomodation
absent response to light
bilateral small pupils
associated with neurosyphilis
laws of diplopia
false image is always hazier
false image appears peripheral to true image
false image projects in the opposite direction of the eye deviation
false image projects toawrd the normal direction of pull of paretic muscle
5 major eye movement systems
saccades (frontal) fixation (occipital) smooth pursuit (occipital) vergence (occipital) counter rolling (vestibular and neck proprioceptive)
horizontal gaze center
paramedian pontine reticular formation
vertical gaze center
rostral interstitial nucleus of the mlf
signs and symptoms of mlf syndrome
sx: diplopia and oscillopsia
si: heterotropia and monocular nystagmus
appear only when the patient attempts to look away from the side of interruption of the mlf
parinaud’s syndrome
dorsal compression of the midbrain that will selectively impair upward vertical eye movements
when the eyeballs automatically rotate upward and outward but closure of the orbicularis oculi muscle obscures it
bell’s phenomenon
in ___ lesions the eyes move toward the lesion
in ___ lesions the eyes move away from the lesion
destructive
irritative
auditory pathways (aclima)
auditory nerve cochlear nuclei superior olivary complex lateral lemniscus inferior colliculus medial geniculate body auditory complex
HINTS 2 step eye exam
head impulse (right and leftward)
nystagmus (gaze testing)
test of skew (alternate cover test)
INFARCT stroke findings
impulse normal (bilaterally normal) fast-phase alternating (direction changing) relaxation on cover test (skew deviation)
wernicke vs broca’s aphasia
wernicke: can articulate but cannot understand (hamburger)
broca’s: can understand but not articulate (wuhdaudau)
only truly objective sensory test
joint position sense
a to-and-fro, 5-8 cycles per second rhythmic oscillation of a body part elicited by a quick stretch
clonus
