B&B Anatomy clinical correlates

Question 1

What happens when you block cerebral aqueuct or foramen of Monroe?

Answer 1

You get build up of CSF and hydrostatic pressure

HYDROCEPHALUS

Question 2

Uncal Herniation

Answer 2

d

Question 3

Wernicke’s Aphasia

Answer 3

d

Question 4

Broca’s aphasia

Answer 4

d

Question 5

Left Hemisphere vs. Right hemisphere lesion

Answer 5

language vs. prosody

Question 6

Uncontrolled hypertension leads to hemorrhagic stroke here
Thromboembolus or cardiac arrest would lead to ischemic stroke here first
What is this structure?
What would be the symptoms

Answer 6

Lenticulostriate arteries
(are at the very end of MCA branching chain)
Supply internal capsule AND striatum
Symptoms: loss of contralateral sensation and contralateral motor weakness

Question 7

What is the mechanism of tetanus?

Answer 7

Tetanus toxin inhibits Renshaw cells from releasing glycine, a neurotransmitter that inhibits alpha motor neurons
Thus, the muscles become spastic (UMN signs)

Question 8

LMN lesion signs

Answer 8

Flaccid paralysis that is ipsilateral at level of lesion

• hyporeflexia
• Fasciculations
• Atrophy
• Fibrillations (seen on electromyography)

Question 9

Polio

Answer 9

Loss of LMN in ventral horn

so like LMN disease (flaccid paralysis)

Question 10

UMN lesion signs

Answer 10

Spastic paresis (NOT paralysis but WEAKNESS)

• contralateral to the lesion or ipsilateral (depending on level of lesion)
• hyperreflexia
• positive Babinski sign (toes extended upward…normal until 2 years of age)

Question 11

Horners

Answer 11

Descends T1-L2 all the way down to S2-S4

Question 12

Lesion of dorsal columns

Answer 12

vibration, proprio, two point touch

Question 13

Tabes dorsalis

Answer 13

Caused by neurosyphilis
typically fucks up your fasciculus gracilis
Three P’s
Paresthesias (from less proprioceptive sense)
Pain (because the small fibers not affected by syphilis are more sensitive to pain)
Polyuria (loss of bladder function)

ALSO

Argyl-Roberston Pupils (near response intact, light response fucked up)

Question 14

Romberg test

Answer 14

Positive romberg test = something is wrong with your proprioception NOT something with cerebellum
Actually used as a distinguishing factor…if patient is Romberg positive, the it is NOT a cerebellar lesion

Question 15

Lesion of spinothalamic (anterolateral) system

Answer 15

leads to CONTRALATEARL pain and temp loss because off crossing and ventral commisure of spinal cord

Question 16

Syringomyelia

Answer 16

Cavitation of CENTRAL CANAL (so it is fucking with your ventral commisure lol)
Acutely: bilateral loss of pain and temp (because both sets of fibers cross at commisure)
Chronically: bilateral flaccid paralysis from syringomylia compression LMN
-could countinue to expand to compress errything

Question 17

Micturition: bilateral lesion to medial frontal cortex

Lesion ABOVE pons

Answer 17

Infantile bladder (Complete loss of both sensory and motor neurons)

Question 18

Lesion between pontine micturition center and sacral cord

Answer 18

Spastic bladder (loss of UMN)

Question 19

Lesion from sacral cord to cauda equina

Answer 19

Flaccid or atonic bladder (loss of sensory neurons that tell detrusor to contract)
High risk of infection

Question 20

Brown-Sequard Syndrome

Answer 20

Lesion or compression of one half of spinal cord
Ipsilateral paresis/UMN signs and loss of proprioception at and below lesion
-contralateral loss of pain and temp
-loss of sensory dermatome at level of lesion
(two ipsilateral long tract and one contralateral long tract sign)

If patient has hemisection at Cervical level, then Horner’s also present
If patient has hemisection below S1, spastic bladder also present
If T1-L2, no spastic bladder because that shit is bilateral

Question 21

Spinal Shock

Answer 21

Can occur with hemisection or complete transection of spinal cord
Goes from paralysis/areflexia –> spasticity/hyperreflexia

Question 22

Stroke of the anterior spinal artery

Answer 22

Loss of supply to ventrolateral parts of the cord
After period of spinal shock (LMN signs)
-patients have bilateral spastic weakness
-bilateral loss of pain and temp

Question 23

What eye defect might you get with Tabes dorsalis?

Answer 23

Argyl-Roberston Pupils (near response intact, light response fucked up)

Question 24

Lesion of Facial nerve vs. lesion of corticobulbar fibers on one side

Answer 24

Lesion of facial nerve = IPSILATERAL Hemi-Face is weak

Lesion of unilateral corticobulbar fibers = only contralateral lower half is weak (intact blink reflex)

Question 25

Lesion of MLF leads to

Answer 25

Internuclear opthalmoplegia

• loss of horizontal gaze
• MLF is particularly susceptible to Multiple sclerosis

Question 26

CN III lesion

Answer 26

ptosis, dilation, down and out
ALSO
Loss of near response! (because you can’t constrict)
Loss of light response!

Question 27

CN IV lesion

Answer 27

Extorted eye so patient will tilt head to the side contralateral to the lesion in order to intort the eye and allow for conjugate gaze

Question 28

CN VI lesion

Answer 28

internal strabismus

Question 29

CN XII lesion

Answer 29

atrophy of tongue, paralysis on one half and deviation to the side IPSILATERAL of the lesion

Question 30

Superior Salivatory Nucleus lesion

Answer 30

loss of lacrimation that results in a dry eye

Question 31

Lesion of motor fibers of CN V

Answer 31

Jaw protrusion to the side of the lesioin

Question 32

Lesion of CN VII

Answer 32

Bell’s palsy on ipsilateral face…hyperacusis, paralysis of facial expression muscles

Question 33

Lesion to nucleus ambiguus

Answer 33

dysphagia, uvula deviated to side contralateral to lesion, weakness in laryngeal muscles

Question 34

Lesion of XII

Answer 34

SCM and trapezius deficits

Question 35

Lesion of spinal trigeminal nuclei

Answer 35

Lead to loss of pain and temp from ipsilateral face

Question 36

Lesion of the ventral trigeminothalamic tract

Answer 36

Loss of pain and temp CONTRALATERAL face
Also, since medial lemnicus runs with trigeminothalamic tract, there would be contralateral loss of proprioception/vibration in upper/lower body

Question 37

What do lesions in Papez circuit lead to?

Answer 37

dirsuption in consolidation and recall of memories

Question 38

What happens when you lesion Meyer’s loop?

Answer 38

Contralateral upper quadrantopsia (pie in the sky scotoma)