Clinical correlations - Notes (all sections) Flashcards
Damage to dorsal and ventral cochlear nuclei sx
deafness in ipsilateral ear
deafness in ipsilateral ear
X dorsal and ventral cochlear nuclei in medulla X auditory portion of CN 8
damage to vestibular nuclei (in medulla)
nystagmus, vertigo, problems with balance
loss of gag reflex on the affected side
CN 9 X
CN 10 damage sx
- hoarseness due to loss of control of larynx
- problems swallowing
- asymmetry of soft palate
Why is bilateral loss of CN 10 devastating?
choking (nucleus ambiguus) loss of parasymp. control to the heart and gastrointestinal tract (nucleus ambiguus and dorsal motor nucleus of CN 10).
CN 11 damage sx
- inability to elevate ipsilateral shoulder 2. difficulty to turn head 3. fasciulation and atrophy of sternomast. and trapezius
CN 12 damage sx
- deviation of tongue towards side of weakness 2. paralysis of ipsilateral tongue muscles 3. fasciulations and atrophy of tongue muscles ipsilaterally
Loss of discrete somesthetic infromation on same side of the lesion
damage to both the DORSAL FUNICULUS and DORSAL PART OF LATERAL FUNCIULUS
Before they cross, axons of the anterolateral system usually pass through the ____
lissauer’s tract
Axons of the anteriolateral system cross in the _____
anterior white commisure
dissociated sensory loss is a symptom of dmaage to the ____
spinal cord pain and temp is on one side, fien touch, vibration, and joint position on another
damage to this pathway anywhere at its length can cause horners syndrome
hypothalmoreticulospinal pathway
termination of the hypothalmoreticulospinal pathway
interomediolateral cell column
cause of flaccid muscle, hypothonia, hyporeflexic, fascuulations
lesion of peripheral nerve, or early UMN X
UMN injury involves damage to the
brains descending motor pathways
what can happen early with UMN injury?
flaccid paralysis, then become hyperreflic and hyerptonic (spastic paralysis)
positive bainksi response is seen with
UMN injury
The Babinski response (positive Babinski reflex) is seen again with ____ tract damage
corticospinal, since the corticospinal tract is no longer surpressing spinal reflex
Pinealoma sx?
- Problems sleeping - Tinnitis (? X inferior olive) - Papilledemia (hydrocephalus by blocking the cerebral aqueduct)
ddK is _____ injury
lateral cerebellar
nystagmus, balance problems, wide based gait can be explained by ____ injuey
medial cerebellar injury
intention tremor is ____ injury
lateral cerebellar
pupillary light reflex is mediated by ____ areas
pretectal areas
upward gaze requires an intact _____
posterior commisure
what can cause loss of pupillary light reflex and loss of accommodation reflexes?
loss of both pretectal regions
pupillary light reflex requires damage to
both prectatal regions or damage to LMN occulomotor nerve
deafness in one ear
CN VIII peripherally meaning medulla
completel paralysis of the face
LMN CN 7 meaning pons
internal strabismus
LMN CN 6 meaning pons
External strabismus
LMN CN 6 meaning pons
You should never shift a dx ____ to accomodate additional reported sx.
caudally (down) — (so X usually is at the level of the highest sx)
If sx are in the head, this usually rules out ____
spinal cord injury EXCEPT with horners
If symptoms persist overtime and are unilateral it is likely caused by a ____
tumor
Diseases or tumors are usually bilateral?
disease
If the lesion is in the spinal cord, then what can be said about all sensory and motor sx?
they are on the same side as the X, except with pain and temperature
If lesion is in the brainstem, the lesion is on the SAME side as the ____
highest symptom; lower sx will be on the opposite side
if the X is in the FOREBRAIN, all sensory and motor sx are on the ____ of the body as the X.
OPPOSITE… except for olfactory
if the X is in the FOREBRAIN, all sensory and motor sx are on the ____ of the body as the X.
SAME
X to the ___ can cause prosposagnosia
inferior temporal lobe
bilateral X to parahippocampal gyrus and uncus can lead to?
amnesia
bilateral X to heschl’s gyrus would produce
inability to understand spoken language
unilateral X to hescls gyrus would produce
little sx
what could cause inaiblity to understand spoken lanauged?
bilateral X to heschls gyrus OR left auditory cortex and corpus callosum X
lesion in the optic chiasm causes?
a loss of vision in the temporal half of both visual fields: bitemporal hemianopsia
what does X in optic nerve cause?
loss of vision in affected eye, loss of pupillary reflex
what does X in the optic tract cause?
A lesion of the right optic tract causes a complete loss of vision in the left hemifield: contralateral “homonymous” hemianopsia.
what sx to X of the precentral gryus?
paresis (weakness) and movement deficits on the OPPOSITE side of the body
what are sx to X of the postcentral gyrus?
somatic sensory deficits (e.g. loss of touch, limb position) on the OPPOSITE side of the body.
X to the superior and middle frontal gyri?
premtoor area; forms of apraxia, if in dominant hemisphere the ability to write is impaired
X to the superior parietal lobule causes what sx?
it is controlled with guiding movement sx are apraxia, inability to bring object under control of movement
X to the inferior parietal lobule can cause ___
the inability to read (since angualr gyrus is the gateway for visual info to reach wernickes)
X to the inferior frontal gyrus
contians brocas area, leads to the inability to generate fluent speech
how to test for CN 4 palsy?
have pt look nasal, if he cannot look down he may have trochlear nerve palsy. may also have double vision in nasal position.