CASE STUDIES Flashcards by brittany gouse

Double vision indicates ____ involvement

eye muscle; so cn 3, 4, 6

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Dysarthria- difficulty speaking due to problems with

muscles of speech.

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Internal strabismus on the left indicates

same side abduscens involvement

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what controls the corneal reflex?

sensory arm – trigem

motor arm – facial

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Normal irritaiton of cornea after being touched indicates

trigem is normal

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Normal irritation of cornea + diminished cornea reflex indicates

X facial nerve

normal trigem n.

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Forehead invovlement in faical paralysis (i.e. full facial paralsyis) indicates

LMN facial nerve dysfunction

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damage what structure can impair the facial nucleus

the pons

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what controls jaw reflex?

sensory - trigem

motor - trigem

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What would a positive babinski be?

. Plantar reflexes extensor

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Weakness on Right

and

Cranial nerve dysfunction on left would indicate

Lesion occured before the decussation of the pyramids in the medulla

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Drooling and inability to close the eye indicates LMN lesion to

facial nerve or nucleus

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Lateral Pontine syndrome

is caused by obstruction of?

What are symptoms?

1. pontine branches off basilar

2. AICA

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

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How to differentiate AICA vs. pontine branches of basialr with lateral pointine syndrom

AICA would have cerebellar signs

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Roaring in the ears suggests ___

elevated blood pressure

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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

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hearing loss in left ear

either left CN 8 X or Left vestibulocochlear X

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inability to completel close left side of mouth

LMN of left facial n.

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Less muscle tone in extremeis suggests

LMN rather than UMN

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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

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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

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Both pupils were the same size and were reactive to light indicates

Normal CN 2 and 3

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No muscle weakness indicates

corticospinal tracts are intact

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Intetion tremor indicates

cerbellar injury

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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

1. X faical nerve 2. 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