CASE STUDIES Flashcards
Double vision indicates ____ involvement
eye muscle; so cn 3, 4, 6
Dysarthria- difficulty speaking due to problems with
muscles of speech.
Internal strabismus on the left indicates
same side abduscens involvement
what controls the corneal reflex?
sensory arm – trigem
motor arm – facial
Normal irritaiton of cornea after being touched indicates
trigem is normal
Normal irritation of cornea + diminished cornea reflex indicates
X facial nerve
normal trigem n.
Forehead invovlement in faical paralysis (i.e. full facial paralsyis) indicates
LMN facial nerve dysfunction
damage what structure can impair the facial nucleus
the pons
what controls jaw reflex?
sensory - trigem
motor - trigem
What would a positive babinski be?
. Plantar reflexes extensor
Weakness on Right
and
Cranial nerve dysfunction on left would indicate
Lesion occured before the decussation of the pyramids in the medulla
Drooling and inability to close the eye indicates LMN lesion to
facial nerve or nucleus
Lateral Pontine syndrome
is caused by obstruction of?
What are symptoms?
1. pontine branches off basilar
2. AICA
sx
contralateral - pain and temp loss
ipsilateral - 1. full facial paralysis,
- internal strabismus (abduscens)
- loss of pain and temp from face (spinal trigem)
- ipsilateral hearing loss
- ipsilateral horners
How to differentiate AICA vs. pontine branches of basialr with lateral pointine syndrom
AICA would have cerebellar signs
Roaring in the ears suggests ___
elevated blood pressure
What are the two originals of horizontal nystagmaus? how do you differentiate?
- vestibulocochlear – nystagmus beats AWAY from the X
- cerebellum – nystamgus is either towards or mixed
hearing loss in left ear
either left CN 8 X or Left vestibulocochlear X
inability to completel close left side of mouth
LMN of left facial n.
Less muscle tone in extremeis suggests
LMN rather than UMN
Loss of corneal reflex and protopathic sensation over the left side of the face can be explained by lesion to the spinal tract of CN V
where could lesion be?
pons or medulla
What are the causes of nystagmus?
X CN 8 nerve
X CN 8 nucleus (pons or medulla)
X cerebellum (particularly flocculus or vermis)
X input to the cerebellum
Both pupils were the same size and were reactive to light indicates
Normal CN 2 and 3
No muscle weakness indicates
corticospinal tracts are intact
Intetion tremor indicates
cerbellar injury
Nonintention tremor indicates
basal ganglia problems
Patient leanig to one side standing or walking could mean
motor problems or incoordination
Cerebellar hypotonia on right helps localize to the ___ side
right
Rght pupil smaller than left indicates ___ involvement
right CN 3
or possibly horners
ptosis of the right eye indicates ___
CN 3 palsy on the right
or possibly horners
ptosis and constricted pupil but normal pupillary eye reflex suggests
horners syndrome
Horners + cerebellar signs point to stroke of the ___ artery
Superior cerbellar artery
supplies the upper areas of the medial and lateral cerebellum, superior peduncle, and rostral part of pons (including ALS and HRST)
Drooped eyelid suggests ___ involvement
CN III
How to determine if ptosis is caused by Horners vs. CN III lesion?
Horners – pupil is constricted (loss of symps to the eye)
CN III X – pupil is dilated
Down and out eye position indicates
CN III palsy
Slurred speech can indicated
- X faical nerve
- X hypoglossal
define myadriasis
dilation of the pupil
what controls the pupillary light reflex
sensory – optic nerve
motor – oculomotor
Describe how UMN lesion can cause facial paralysis? What side will the sx be on in an injury
If the right corticobulbar tract innervting CN 7 is cut… the facial paralysis on the left (opposite) side
Involvement of both corticobulbar and corticospinal suggests disruption of ___
crus cerebri
In the brainstem, the lesion is one the ____ side of the hgihest sx
same
For All lesions in the forebrain
all sensory and motor sx are on the ___ side
opposite except for olfaction
Olfactory loss due to lesion in the cortex is on the ___ side
same
metal status changes suggests ___ damage
forebrain/telencephalon
Pupullary light/acodomation reflex suggests ___ damage
midbrain
Loss of upward gaze localizes symptoms to the ___
midbrain (posterior commisure)
External strabismus suggests ___ involvement
oculomotor
____ is usually bilateral
disease process
Normal visual field rules out
CN 2 x
unable to accomodate idnicates difficulty with __ muscle
medial rectus
Gaze induced nystagmus indicates ___involvement.
cerebellar
CN symptoms + CONTRALATERAL cerebellar sx suggests a lesion where
tegmentum of the midbrain on the side of the CN sx
included axons from the superior cerebellar peduncle after they crossed
* this is called central midbrain syndrome or claudae syndome
oculomotor nerve deficits localize the lesion to the ____.
midbrian
left LMN CN12 injury localizes us to ___
left medulla
Symptoms of medial medullary syndrome
contralateral
- hemiparesis
- epicritic
ipsialteral
- apralysis of tongue with deviation to side of lesion
Problems with voice suggest vagus.
Where is the dorsal motor nucelus of vagus
Medulla
Cranial nerve nuclei in the medulla?
4-4 rule
bottom 4 nuclei are in the medulla
12, 11, 10, 9
(also spinal trigem is here too!)
where is the nculeus ambigous located?
medulla
increased deep tendon reflexes is a sign of
UMN injury
positive babinksi sign suggest injury to the
right corticospinal tract (UMN)
What is brown sequard?
contralateral-
loss of pain and temp same side of lesion
ipsilateral
UMN weakness
loff of position and vibration
difficulty heel walking suggests
weakness of l5
tibialis anterior
extensor hallicus longus
extensor digitalis longus
what are two big signs of a peripheral nerve lesion?
paralysis
and complete loss of sensation
loss of sensation of thumb to middle finger on top of hand (palm down)
radial n. injury
loss of sesantion from pinky to 4th finger on top of the hand
ulnar nerve injury
difficulty performing precision grip suggests
median nerve deficit
– 2nd and 3rd digit finger flexion and thumb opposition
Distal injury means the daamge is
away from the trunk
Homonmous visual field deficit indicates lesion ____
after the optic chiasm
Left sided weakness w/hyperreflexia suggests damage where?
UMN X on the RIGHT side
Left neglect- syndrome caused by ___lesion
right parietal lobe
Left homonymous hemianopia is due to ___
right optic tract damage
absent minded suggest
forebrain apthology
what is the triad of communicating hydrocpehalus?
wet wobbly and wacky (normal pressure hydrocephalus)
increased intraranil pressure can cause ___ hernination
uncal
uncus pushing on the midbrain -> can cause CN 3 deficits
Cortex—>______—-> caudal medulla
internal capsule
somatosensory pathways that end in the VPL
DML and ALS
visual loss + motor deficits suggests ___ stroke
ICA occulsion
block
opthalamic –> blindness in one eye
MCA –> motor sx
signs of peripheral nerve disease
fasiculation and rapid atrophy
signs of radiculopathy
- pain changed locations but confined to muleiple regions
- usually weakness but not atrophy
rule of peripheral nervous disease
kills distal end of axons and moves up towards cell body
bilateral and symmetrical
fasicualtions and atrophy are also signs
commonly injured with foot drop
common fib of sciatic
normal stenth, reflexes, sensations but paralysis
hysteria
Decerebrate posturing indicates
s brain stem damage, specifically damage below the level of the red nucleus
Decorticate posturing indicates that there may be damage to areas including the
cerebral hemispheres, thalamus, internal capsule, midbrain
The initial hemiparesis and hemihypesthesia without cognitive signs point to damage of the
posterior limb of the internal capsule
dysconjugate eye movements suggests
MLF
urinary retention suggests
loss of sensory afferents to bladder
