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1. Clin Med III > 3- Clinical Neuroanatomy > Flashcards

3- Clinical Neuroanatomy Flashcards

1
Q

Pt presents s/p head trauma. Hx reveals he initially “seemed okay” (lucid interval) but has since rapidly deteriorated. What brain injury should you be concerned for and what might you note on CT w/o contrast?

A

Epidural hematoma affecting middle meningeal artery (fast + dangerous)

CT = lens shape

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2
Q

Pt presents w/ hx of non-direct head trauma (ex whiplash). Reports HA, confusion, speech problems, and drowsiness over the next 2-3 weeks following injury. CT w/o contrast reveals a cresent shape. What are you concerned for?

A

Subdural hematoma affecting bridging veins (slow bleed- venous)

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3
Q

Pt presents with sudden onset HA described as “worst HA of life”. On exam pt rapidly deteriorates and becomes comatose. What are you concerned for?

A

Subarachnoid hemorrhage, aneurysm (fast bleed)

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4
Q

Pt presents w/ neural complaint. CT w/o contrast shows “crab of death”. What are you concerned for?

A

Subarachnoid hemorrhage, aneurysm

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5
Q

CT showing effacement of ventricles is commonly due to what?

A

Mass effect

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6
Q

CT showing enlarged temporal horns is indicative of what?

A

Blocking of ventricles/ buildup of CSF

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7
Q

What provides the anterior blood supply to the brain?

A

Carotids

(R from brachiocephalic/ aorta, L from aorta)

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8
Q

What provides the posterior blood supply of the brain?

A

Vertebral arteries

(join to form basilar arteries, arise from subclavian arteries)

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9
Q

What connects both the anterior + posterior AND L + R blood circulations of the brain?

A

Circle of Willis

(compensatory capabilites)

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10
Q

Pt presents with ophthalmoplegia (eye movement paralysis, CN III, IV, VI) or decreased facial sensation (CN V1/V2). You are concerned for a lesion/ pathology in what part of the brain?

A

Cavernous sinus

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11
Q

Pt presents with eye pain and double vision. On PE you note an orbital bruit. Other PE findings may include: proptosis, chemosis, extra-ocular movement paralysis, and decreased facial sensation. What are you concerned for?

A

Carotid- cavernous fistula

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12
Q

How might a deficit in the anterior cerebral artery (ACA) present?

A

LE manifestation

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13
Q

Pt presents with deficits to face/ arm > leg (MCA) OR leg > face/ arm (ACA). You should be concerned for a lesion where?

A

UMN- cortical lesion

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14
Q

Pt presents with equal deficits to face, arm and leg. You should be concerned for a lesion where?

A

UMN- subcortical lesion

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15
Q

The center of the cerebellum is responsible for coordination where?

A

Head and trunk

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16
Q

The lateral portion of the cerebellum is responsible for coordination where?

A

Extremities

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17
Q

CNs II-XII have what type of innervation?

A

Ipsilateral (same side)

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18
Q

What CNs originate from the midbrain?

A

II, III, IV

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19
Q

What CNs originate from the pons?

A

V, VI, VII

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20
Q

What CNs originate from the junction of the pons and medulla?

A

VIII

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21
Q

What CNs originate from the medulla?

A

IX, X, XI, XII

22
Q

Voluntary motor control has what type of innervation?

A

Contralateral

23
Q

What are “crossed signs” and where are you concerned for a lesion if noted on PE?

A

Ipsilateral CN deficits and contralateral body weakness

Lesion in spinal cord

24
Q

Lateral spinothalamic spinal cord tract is responsible for what?

A

Pain and temp (sensory)

25
Q

Posterior spinal cord tract is responsible for what?

A

Vibration and proprioception (sensory)

(ex. (+) Romberg test)

26
Q

Lateral corticospinal spinal cord tract is responsible for what?

A

Voluntary movement

27
Q

Pt presents with LE pain/ weakness/ paralysis, saddle anesthesia, and B/B dysfunction. You are concerned for a lesion where and what is the management?

A

Conus medullaris/ cauda equina (spinal cord)

Emergencies! - immediate neuroimaging and decompression

28
Q

Pt presents with aphasia, neglect, and hemianopia. Where are you concerned for a brain lesion?

29
Q

Pt presents with abnormal movements (chorea, ballism, tremor, cogwheeling). Where are you concerned for a brain lesion?

A

Subcortical structures (internal capsule, basal ganglia)

30
Q

Pt presents with truncal vs limb ataxia and dysmetria (ex. unable to move finger to nose). Where are you concerned for a brain lesion?

A

Cerebellum

31
Q

Pt presents with muscle fasciculations with NO sensory involvement. Where are you concerned for a lesion?

32
Q

Pt presents with distal weakness and sensory involvement, stocking-glove presentation, areflexia, or hyporeflexia. Where are you concerned for a lesion?

A

Peripheral nerve

33
Q

Pt presents with fatiguability, no sensory involvement, and normal DTRs. Where are you concerned for a lesion?

34
Q

Pt presents with proximal weakness that is symmetric and NO sensory involvement. What are you concerned for?

35
Q

Pt presents with monocular blindness. Where are you concerned for a lesion?

A

Ipsilateral optic nerve

36
Q

Pt presents with bitemporal hemianopia. Where are you concerned for a lesion?

A

Optic chiasm

37
Q

Pt presents with homonymous hemianopia. Where are you concerned for a lesion?

A

Contralteral optic tract

38
Q

Pt presents with homonymous quadrantanopia. Where are you concerned for a lesion?

A

Contralateral parietal lobe

39
Q

Pt presents with macular sparing. Where are you concerned for a lesion?

A

Contralateral occipital lobe

40
Q

Pt presents with inability to fully close 1 eyelid. Where are you concerned for a lesion?

41
Q

Pupillary reflex involves which 2 CNs?

42
Q

Corneal reflex involves which 2 CNs?

43
Q

Vestibulo-ocular reflex involves which 2 CNs?

A

VIII, V1/3

44
Q

Gag reflex involves which 2 CNs?

45
Q

If pt has a lesion to CN XII, what direction will the tongue deviate towards?

A

Towards the side of the lesion

(“lick your lesion”)

46
Q

Spasticity is what type of movement?

Spasticity, hyper-reflexia, and (+) Babinski indicate a lesion where?

A

Velocity dependent (more tone w/ faster movement)

UMN lesion

47
Q

Rigidity (Cogwheel rigidity) is what type of lesion and where does it indicate a lesion?

A

Velocity independent (same tone regardless of speed)

Basal ganglia lesion

48
Q

Biceps, brachioradialis, and triceps DTRs involve what main spinal nerve roots?

A

Biceps- C5, C6

Brachioradialis- C6

Triceps- C7

49
Q

Patellar and achilles tendon DTRs involve what main spinal nerve roots?

A

Patellar- L4
Achilles tendon- S1

50
Q

Flaccid weakness, hypo-reflexia, atrophy and fasciculations indicate a weakness/ lesion where?

51
Q

Loss of reflexes, sensation, and coordination in a stocking glove pattern is known as what?

A

Length-dependent peripheral neuropathy

(at the terminals of the longest nerves, a/w DM)

52
Q

Aphasia, apraxia, and agnosia are a/w a lesion where?

1. Clin Med III (29 decks)

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