Case studies Flashcards
What are causes of spinal cord lesions?
- Multiple sclerosis
- Motor Neurone Disease (ALS,PLS)
- Trauma
- Tumour
- Infection
- Compression (disc)
List the 3 main tracts to think about when discussing spinal cord lesions
- corticospinal tracts
- dorsal columns medial lemniscus
- spinothalamic
Corticospinal tract
- voluntary motor
- descending
- 90% decussate at pyramids
Dorsal columns medial leminscus
- proprioception
- vibration
- fine touch
- decussate in medulla
Spinothalamic tract
- pain
- temperature
- crude touch
- itch
- decussate at level of action
Dorsal columns
- deep touch
- proprioception
- vibration
Lateral spinothalamic tract vs Ventral spinothalamic tract
Lateral
• pain
• temperature
Ventral
• crude touch, itch, tickle
Posterior cord syndrome
- lesion of posterior columns
* loss of vibration and position sense everywhere except face
Anterior cord syndrome
- lesion of lateral corticospinal tract (UMN), Anterior horn cells (LMN) and anterolateral pathways (pain and temp)
- loss of pain ant temp AND motor loss everywhere except for face
What is central cord syndrome (small lesion)?
- affects middle part of dorsal columns
* pain and temp loss on lateral aspect of arms
What is central cord lesion (large lesion)?
• loss everything everywhere except force and genitals
What happens in transverse cord lesion?
• loose everything below it
What happens with a hemicord lesion?
Ipsilateral:
• motor
• vibration and positions sense loss
Contralateral:
• pain and temp loss
Why is there a babinski reflex?
UMN lesion
-return of primitive reflex
What are the connections and the function of the cerebrocerebellum?
Dentate -> motor cortex -> corticospinal
• planning and timing for smooth and ordered complex movements
What are the connections and function of the Spinocerebellum?
Interposed
- > motor cortex -> corticospial
- > red nucleus -> rubdrospinal
• corrects and smooths movement
What are the connections and function of the vestibulocerebellum?
Fastigial
- > vestibular nuclei -> vestibulospinal
- > reticular formation -> reticulospinal
• posture and tone
List some basic symptoms of cerebellar lesions?
- ipsilateral signs
- vertigo, dizziness, nausea, vomiting
- ataxia (truncal and appendicular)
- nystagmus
- tremor when moving
- gait issues
- balance and coordination issues
- headache
What can cause a cerebellar lesion?
- stroke, infarct
- tumour
- toxic (alchohol, drugs)
- trauma
- infection
What are the consequences of midline cerebellar lesions?
- vermis or floculonodular lobes
- truncal ataxia
- nystagmus
- vertigo
- nausea
What are the consequences of lateral cerebellar lesions?
- lateral to the vermis
* appendicular ataxia
Retrobulbar neuritis
- optic nerve affected behind eyeball
- optic disc appears normal
- patient sees nothing and the doctor sees nothing
- most frequent type in adults
- often in MS
Papillitis
- optic nerve head affected
- hyperaemia and oedema of optic disc
- maybe with peripapillary flame-shaped haemorrhages
- most common type in kids
Neuroretinitis
- concomitant swelling of optic nerve head (papillitis) and macula
- macular star (exudate)
- least common type
- rare from demyelination
- from viral infection
What is the consequence of a lesion of the right optic tract?
Left homonymous hemianopia
What is the consequence of a lesion the right optic radiations?
Left homonymous hemianopia
What is the consequence of a longitudinal section of the optic chiasm?
bitemporal hemianopia
