Clinical Correlates

Question 1

anterior spinal stroke

Answer 1

all motor neuron cell bodies/tractsare solely dependent on the anterior spinal artery

Question 2

conduction aphasia?

Answer 2

stroke of the middle cerebral artery that causes a poor connection between Broca’s area (speech production) to Warnike’s area (speech comprehension)

• *RARE, acquired
• *usually involves arcuate fasciculus
• *intact auditory comprehension, but poor speech repetition, impaired word-finding ability, especially with longer train of thought

Question 3

split brain?

Answer 3

=severed corpus callosum

**connection between the two hemispheres of brain is GONE; can do two things independantly

Question 4

damage to corticospinal tract UNM and LMN can have damage where?

Answer 4

*damage to precentral gyrus, internal capsule, cerebral peduncles, pons, medullary pyramids, or descending tracts

Question 5

damage to corticospinal tract (LMN)

Answer 5

paralysis or paresis, muscle atrophy, areflexia (all lesions we talked about last semester)

Question 6

damage to corticospinal tract (UMN)

Answer 6

• affects contralateral side for lesions proximal to pyramidal decussation; ipsilateral side for lesions distal to decussaion for crossed fibers in lateral tract
• initial paralysis (hypotonia) most severe in limbs

Question 7

what follows after UMN syndrome?

Answer 7

1) babinski sign

2) spasticity= hyperflex, hyperreflexia, clonis

Question 8

babinski sign

Answer 8

scrap along bottom of foot
normal= toes flex down
babinski sign= toes extend up or fan out
***this is a NORMAL response until 2 years old because neurons are not myelinated yet

Question 9

brown sequardsyndrome

Answer 9

*hemisection= knocked out half of spinal cord (tumer or penetrating wound)

Question 10

Parkinson’s disease pathophysiology and definition

Answer 10

is a hypokinetic disorder

• too much indirect, not enough direct
• *loss of dopaminergic neurons of the substantia nigra; idiopathic
• encephalitis lethargica, head trauma, or carbon monoxide or manganese toxins

Question 11

Huntington’s Disease pthophysiology

Answer 11

is a hyperkinetic disorder (too much direct, not enough indirect)

• *death of spiny neurons in the striatum, loss of cerebral cortical neurons
• autosomal dominant disorder (CAG repeat on chromosome 4), onset is 25-40 yrd
• other causes: rheumatic chorea, drug induced and lupus

Question 12

Torticollis

Answer 12

abnormal contraction of SCM affecting ONE side; can be congenital due to damage of CN11 or muscle itself
*constant contraction to one side

Question 13

How can you tell which SCM is affected with torticollis?

Answer 13

If the right SCM is affected, the head will be TURNED to the CONTRALATERAL side (left)

Question 14

If torticollis is untreated. What happens?

Answer 14

result in plagiocephaly = flat spot on the back of the head; if baby couldn’t change the position of his head, he would develop a flat spot and need a helmet
*can inject botox to relieve tension in muscles or do physical therapy

Question 15

What muscle does Torticollis affect if it is caused by a lesion to the CN11? Why? Test how?

Answer 15

trapezius

• *because the innervation to the SCM happens very high up and deep next to major arteries (like carotids) so you’d be worried about other things if that happened! Injuries typically occur in superficial posterior triangle and therefore only affect the innervation to trapezius
• *test by shrugging shoulders; the side that DOESN”T shrug is affected

Question 16

Arteriogram common anatomical variation off the arch of aorta?

Answer 16

Instead of having three branches off the aorta (brachiocephalic, left common carotid, and subclavian); it’s fairly common to have FOUR with the 4th branch being the vertebral artery
*vertebral can come off of arch even though it should be coming off of subclavian

Question 17

a patient says they ‘see spots’ when they turn their head, possible cause?

Answer 17

compression of vertebral arteries Between C1 and cranium

*Vertebral arteries help supply blood to the occipital lobe of the brain (primary visual cortex)

Question 18

inion

Answer 18

• bump from occipital protuberance

- you would inject nerve blocks on either side of the inion in order to block pain from Occipital Neuralgia

Question 19

What is Occipital Neuralgia? treatment?

Answer 19

• Common cause of headaches at back of head
• Entrapment and/or inflammation of greater occipital nerve
• Treatment: Occipital nerve blocks at inion, decompression surgery, massage, rhizotomy

Question 20

what is Rhizotomy?

Answer 20

severing a nerve altogether

-absolute last mode of treatment for Occipital Neuralgia

Question 21

What is Brown-Sequard Syndrome?

Answer 21

is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

Question 22

Unilateral loss of all modalities at the ___ of lesion for Brown-Sequard Syndrome

Answer 22

site

Question 23

Brown-Sequard Syndrome with ipsilateral root/segmental signs?

Answer 23

• contralateral impairment of pain and temperature
• ipsilateral pyramidal weakness and impaired joint position sense and accurate touch localisation
• *(Pyramidal = pyramidal tracts, i.e. corticospinal – loss of motor function on ipsilateral side at and below level of lesion)

Question 24

ASA infarct territoy includes the? What is within that area?

Answer 24

anterolateral 2/3rd of the spinal cord in section
*within this territory lies the lateral and anterior corticospinal tracts (motor) and spinothalamic tracts (pain and temperature)

Question 25

Ischemia to the section in question with ASA infarct would produce?
Patient indications?

Answer 25

bilateral flaccid paraplegia (if lesion is below cervical region) OR bilateral flaccid quadriplegia if in cervical region
**patient would likely have bladder/bowel/sexual dysfunction and loss of pain and temperature at and below lesion site

Question 26

what is hydrocephalis?

Answer 26

ventricles get too big and there is too much CSF in brain