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DPT 520 > Brainstem Disorders > Flashcards

Brainstem Disorders Flashcards

1
Q

what is involved in a MEDIAL BS lesion?

A

motor tracts

MLF

medial lemniscus

motor nuclei (divide into 12)
- CN 3, 4, 6, 12

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2
Q

what is involved in a LATERAL (side) BS lesion?

A

sympathetic (hypothalamospinal) tract -Horner’s syndrome

spinothalamic tract

spinocerebellar tract

sensory nuclei (don’t divide into 12)
- CN 5, 7, 8, 9, 10

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3
Q

if there is a lesion to the lateral corticospinal tract or DCML above the caudal medulla, where is the loss? why?

A

contralateral signs bc the damage is after the decussation

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4
Q

if there is a lesion to the lateral cortiocospinal tract or DCML below the caudal medulla, where is the loss? why?

A

ipsilateral signs bc the damage is b4 the decussation

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5
Q

if there is any BS damage to the spinothalamic tract, where is the loss? why?

A

contralateral signs bc of the immediate decussation so damage is after decussation

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6
Q

if there is a lesion of the L rostral anteromedial medulla, what is the loss?

A

paresis of the R hand and foot

loss of light touch and proprioception on the R side of the body

paresis on the L side of the tongue

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7
Q

how do you differentiate the involvement of the motor tract or the motor cranial neurons?

A

ask the pt to close their eyes

hypertonicity vs hypotonicity

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8
Q

what supplies blood to the midbrain?

A

posterior cerebral artery

basilar artery

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9
Q

what supplies blood to the pons?

A

anterior inferior cerebellar artery (AICA)

basilar artery

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10
Q

what supplies blood to the medulla?

A

posterior inferior cerebellar artery (PICA)

vertebral artery

anterior spinal artery

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11
Q

what are the cardinal signs of BS dysfxn? (KNOW THIS)

A

the 4 Ds:
1) dysphagia
2) dysarthria
3) diploplia
4) dysmetria

disorders of vital fxns

disorders of consciousness

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12
Q

why does BS dysfxn cause dysphagia and dysarthria?

A

the CNs are in the pons and medulla of the BS

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13
Q

why does BS dysfxn lead to diploplia?

A

CN 3, 4, 6 control eye movement and they are in the BS

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14
Q

damage to what structure in the BS can cause disorders of consciousness?

A

reticular formation

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15
Q

what is vertebrobasilar artery insufficiency?

A

causes transient symptoms of BS ischemia reproduced with cervical extension and rotation

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16
Q

vertebrobasilar artery insufficiency is characterized by poor blood flow to what part of the brain?

A

the posterior brain

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17
Q

what are the symptoms associated with BS ischemia?

A

abrupt onset of neurologic symptoms (dizziness, weakness, incoordination, and somatosensory dysfxn)

sustained ischemia=Wallenberg syndrome, loss of consciousness

18
Q

what is the most common BS stroke?

A

Wallenburg syndrome

lateral medullary lesion

19
Q

what is Wallenburg syndrome?

A

a LATERAL medullary lesion

PICA affected

very parasympathetic

spinal trigeminal tract: loss of nociception and temp from the ipsilateral face

spinothalamic tract: loss of nociception and temp from contralateral body

spinocerebellar tract: ipsilateral ataxia

descending sympathetic tract: ipsilateral Horner’s syndrome

20
Q

does Wallenburg have contra or ipsi s/s?

A

both

21
Q

what CNs are involved in Wallenburg syndrome?

A

5, 7, 8, 9, 10, 12

22
Q

what are the CN s/s associated with Wallenburg syndrome?

A

vertigo, nystagmus, problems swallowing and speaking, hoarse voice, digestion issues, inability to slow the HR

23
Q

what CNs are involved in AICA syndrome?

A

5, 7, 8

24
Q
A
25
Q

what is AICA syndrome

A

lateral caudal pons lesion

AICA affected

spinal trigeminal tract: loss of nociception and temp from the ipsilateral face

spinothalamic tract: loss of nociception and temp from contralateral body

spinocerebellar tract: ipsilateral ataxia

descending sympathetic tract: ipsilateral Horner’s syndrome

26
Q

what is the 2nd most common BS stroke?

A

lateral caudal pons lesion

27
Q

are the s/s of AICA syndrome ipsi or contra?

A

both

28
Q

what are the CN s/s associated with AICA syndrome?

A

loss of efferent limb of corneal reflex and stapedius reflex (sounds are louder), lack of tears and salivation, unilateral deafness, vertigo, nystagmus, nausea, vomiting

29
Q

what is an anteromedial midbrain stroke?

A

the most common midbrain stroke

involved the basilar artery

contra signs (except CN 3)

med lemniscus: contra loss of sensation

red nucleus: motor dysfxn obscured by ataxia; pathologic laughing/crying

motor tracts (corticopontine): contra cerebellar ataxia; (corticospinal and corticobrainstem): contra paresis of the body and lower face

MLF: internuclear opthalmoplegia obscured by CN 3 lesion

30
Q

what is internuclear opthalmoplegia?

A

damaged connection bw CN 6 and 3

31
Q

what CNs are involved in anteromedial midbrain stroke?

A

3

32
Q

what are the CN signs associated with an anteromedial midbrain stroke?

A

pupil dilation from lack of pupillary sphincter innervation

inability to focus on near objects

unable to move eye up, down, or in

double vision

33
Q

what structures may be involved in disorders of consciousness?

A

cerebrum (thalamic or hypothalamic) and BS (reticular formation)

34
Q

what is a coma?

A

unarousable state

no response to strong stim

lost vital fxns (vent is necessary)

35
Q

what is a vegetative state?

A

cycle of sleeping and waking (can yawn and vocalize)

unresponsive wakeful state

complete loss of consciousness w/o alteration of vital fxns (don’t need a vent)

36
Q

what is a minimally conscious state?

A

respond to very painful stim and follow very easy instructions

some signs of consciousness

in and out of consciousness

37
Q

tumors in the cerebellum or BS cause an increase in what?

A

intracranial pressure

38
Q

what are the symptoms associated with increased ICP?

A

headache, nausea, vomiting, CN dysfxn, and/or hydrocephalus

possible ataxia

39
Q

what is the most common BS tumor?

A

acoustic neuroma

40
Q

what is an acoustic neuroma?

A

a benign tumor of the Schwann cells surrounding CN 8

unilateral vestibular lesion

DPT 520 (13 decks)

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