Clinical Implications (rebby) Flashcards
4D’s of Brainstem Dysfunction
Dysphagia
Dysarthria
Diplopia
Dysmetria
Blockage of PCA or Basilar artery causes ________ Syndrome
Anteromedial Midbrain Syndrome (Weber’s)
Patient presents with
* CL hemiparesis
* IL loss of eye movements, paralysis of eyelid, dilated pupil
* CL loss of motor coordination, Lability, Ataxia
What are the primary structures affected? What is the syndrome?
- Corticospinal Tract
- Oculomotor Nerve Nucleus
- Red Nucleus
Anteromedial Midbrain Syndrome (Weber’s)
What are 2 symptoms of CN III palsy?
- Ptosis (droopy eyelid)
- Eye deviated down and out
Blockage of AICA leads to ________________ Syndrome
Lateral Inferior Pontine Syndrome
Patient presents with
* IL hearing loss
* Dysequilibrium
* IL horner’s syndrome
* IL facial pain
* Decreased tears & salivation
* CL pain and temp sensation lost
* IL weakness of facial expressions
What is the syndrome?
Lateral Inferior Pontine syndrome
Name the 7 primary structures affected with Lateral Inferior Pontine Syndrome
- Cochlear Nucleus
- Vestibular Nucleus
- Impaired sympathetics
- Trigeminal Nerve
- Salivatory Nucleus
- Spinothalamic Tract
- Facial Nerve
Bell’s Palsy is damage to what CN?
CN VII
Horner’s Syndrome is what 3 things?
Ptosis-eyelid drooping
Miosis-excessive constriction
Anhidrosis- little/no sweat
Thrombosis or stenosis of basilar artery will affect ________ bilaterally and cause ________ syndrome
Ventral Pons
Locked-In Syndrome
Patient presents with
* Paralysis below the head
*Paralysis of facial, swallowing, chewing, talking muscles
* inability to abduct eyes
What structures are affected?
B corticospinal tracts
B corticobulbar tracts
B abducens nerve nuclei
Which of the following is not affected in Lateral Inferior Pontine Syndrome?
A. Vestibular Nucleus
B. Impaired sympathetics
C. Vagus Nerve nucleus
D. Salivatory Nucleus
C. Vagus Nerve nucleus
this is a primary affected structure in Wallenberg Syndrome
Which of the following is not affected in both Lateral Inferior Pontine syndrome and Wallenberg?
A. Solitary Nucleus
B. Salivatory Nucleus
C. Trigeminal Nerve
D. Spinothalamic Tract
A. Solitary Nucleus
only in Wallenberg
Blockage of Anterior Spinal Artery leads to ______ Syndrome
Medial Medullary Syndrome
Patient presents with
* IL tongue protrusion
*CL loss of vibration, proprioception, light touch
*CL hemiparesis
What structures are affected? What is the syndrome?
Hypoglossal Nucleus
DCML
Pyramids
Medial Medullary Syndrome
Blockage of PICA leads to _____ Syndrome
Wallenberg/Lateral Medullary Syndrome
Which of the following is not a clinical manifestation of Wallenberg Syndrome?
A. Increased HR
B. Ataxia
C. Horner’s syndrome
D. Can’t abduct eyes
D. Can’t abduct eyes
this is a manifestation of Locked In syndrome –> B abducens
In the thalamus, when relay sensory neurons disrupt CONTRALATERAL sensation, what sensation is most commonly affected?
Proprioception
What is a common clinical implication of a thalamic lesion?
Lateropulsion aka Pusher syndrome aka Contraversive Pushing
In Pusher Syndrome, does the patient push to the strong or weak side?
Weak side
Push with strong side towards the weaker side & accompanied by POSTERIOR push
What type of tumor makes up 10-17% of intracranial neoplasms? (in hypothalamus)
Pituitary adenomas
Larger pituitary adenomas can push on surrounding structures (of the hypothalamus) such as _______ _______ and cause _______ _______
Optic chiasm
Bitemporal hemianopsia
When there is too much Basal Ganglia inhibition of motor thalamus, PPN, and midbrain locomotor region, this will cause __________
Hypokinesia
In Parkinson’s, there is ______ (decreased/increased) dopamine from SNc leading to ________ (under/over) activity of GPi
Decreased
Over
fill in the blank with (overactivity/underactivity)
Overactivity of GPi in Parkinson’s leads to _______ in motor thalamus
Underactivity (bradykinesia and hypokinesia)
fill in the blank with (moreinhibition/less inhibition)
Overactivity of GPi in Parkinson’s leads to _______ in Pedunculopontine nucleus
Less inhibition (rigidity trunk and girdle muscles)
fill in the blank with (overactivity/underactivity)
Overactivity of GPi in Parkinson’s leads to _______ in Midbrain locomotor region
Underactivity (freezing and festinating gait)
What are the 2 subtypes of Parkinson’s?
Postural Instability Gait Difficulty
Tremor Dominant Subtype
When there is too little Basal Ganglia inhibition, that causes ________
Hyperkinetic disorders
In hyperkinetic disorders, there is (more/less) inhibition by the GPi
Less inhibition
because
Hyperkinetic disorders affect _____ (which motor pathway)
No-Go/Indirect pathway
In hyperkinetic disorders, there’s a _____ of inhibitory neurons in putamen and caudate, so ____ input to GPe
Loss
Less (inhibitory)
So GPe inhibits Subthalamic Nucleus (MORE) which excites GPi less so GPi has less inhibition
Dystonia increases with _____ and decreases/completely vanishes with ____
Activity and/or emotional stress
Sleep
Injury to Paramedian Pontine Reticular Formation (PPRF) causes loss of
Horizontal Gaze center
Injury to Rostral interstitial nucleus in midbrain RF causes loss of
Vertical Gaze Center
Injury to Medial Longitudinal Fasciculus causes loss of
coordinated activation of B neural circuits
Injury to Vestibular n will cause loss of which 2 reflexes?
VOR and Optokinetic Reflex
Injury to Frontal eye field will cause loss of CL _______ and ________, and loss of connection with CL ________
saccades, smooth pursuit
PPRF
Injury to Parieto-occipital-temporal cortex will cause loss of (CL/IL) smooth pursuit
IL
whereas frontal eye field does CL smooth pursuit and saccades
Injury to Parieto-occipital-temporal cortex may affect the cortex connection to what 3 locations?
vestibular nucleus
cerebellum
PPRF
Lesion to superior colliculus (optic tectum) causes
Increased latency and reduced accuracy, frequency, and velocity of saccades
How will injury to basal ganglia affect the visual system?
Deficits in initiation of eye movements
How will injury to cerebellum affect the visual system?
Deficits in correct execution of eye movements
Lesion to L optic nerve
Loss of vision to L eye
Lesion to optic chiasm
Bitemporal (heteronomous) hemianopsia
Lesion to L optic tract
R homonymous hemianopsia
Lesion to L Meyer’s Loop
R superior homonymous quadrantanopsia
Lesion to L V1
R homonymous hemianopsia with macular sparing
Lesion to primary auditory cortex causes
Loss of conscious hearing
Lesion to secondary auditory cortex results in …
Inability to compare sounds with memories of sounds and categorize them
How will a lesion to superior colliculus affect the auditory system?
Inability to orient head and eyes toward sound
Lesion to Wernicke’s area means…
Inability to comprehend speech
If SCC signals are not reciprocal, there is impaired ______, ______, and/or ______
Postural control
Eye movements
Nausea
When the pt has a vestibular disorder, _____ is essential for adaptations in postural/balance systems
Vestibulocerebellum
Lesion of R posterior parietal cortex causes _______
Altered perceptions of personal and extrapersonal space
L hemi neglect
Lesion to descending pathway of vestibular system…
Balance deficits –> impacts movement abilities/control especially in low-light or uneven surface conditions
Vestibular + visual systems linked for ….
Postural control & eye movements
Vestibular + auditory systems linked due to….
Geography and sharing same CN
T/F: Cerebellar dysfunction causes abnormal muscle strength and tone
False
If cerebellar dysfunction DOES cause abnormal tone, it is hypo/hyper
Hypotonia
Lesion to any/all areas in cerebellum causes ______
Ataxia: jerky, uncoordinated movements of trunk/neck, limbs
Lesion to vestibulocerebellum causes
Nystagmus: bouncy eye movements
&
Unsteadiness, truncal ataxia, dysequilibrium
Lesion to cerebrocerebellum causes
Ataxic finger movements
& Dysarthria: slurring of speech
Lesion to spinocerebellum causes
Dysarthria
Explosive Speech
Limb ataxia
* Dysdiadochokinesia
* Dysmetria (ACTION & INTENTION TREMOR)
Loss of check/rebound
Movement decomposition
What is problem with rapid alternating movements?
Dysdiadochokinesia
What is tendency to under/overshoot when moving to a target?
Dysmetria
What is shaking of limb during movement called?
Action tremor
What tends to occur due to delays in agonist burst of activity + in antagonist’s ability to brake?
Intention tremor
What is it called when there is a quick removal of resistance that causes an exaggerated response?
Loss of check/rebound
What is it called when you attempt to move one joint at a time?
Movement decomposition
What is loss of joint position sense?
Sensory ataxia
DCML disruption & can improve with visual aid
What is an agnosia?
Despite having intact vision or hearing, inability to recognize object or sound
Agnosia is a disorder of ____ visual stream
Ventral
Prosopagnosia is …
Inability to recognize faces visually
Disorder of secondary auditory cortex
Auditory agnosia = can’t associate meaning to what you hear
Anosagnosia is …
Inability to recognize deficits
a reasoning problem
Disorder of secondary somatosensory cortex
Astereognosia = even with intact light touch sensation, can’t describe object in hand
Optic ataxia is a disorder of ____ visual stream
Dorsal
Optic ataxia is …
an inability to use visual info to direct movements
Damage to PPC causes
Hemineglect
Right or Left Hemineglect is more common
Left neglect
due to Right hemispheric lesion
Damage to primary motor cortex leads to ____, ____, and _____
Loss of fractionated movements
Weakness
Dysarthria
Lesion to supplementary motor area (acute & long term)…
Acutely: hemiparesis, hemiplegia
Long term: anti-phase hand movements
anti-phase is when muscles contract in alternating fashion (aka hands moving to same side so opposite muscles on each arm are contracting)
Lesion to premotor cortex causes issues with _____, _____, and _______
Speech and automaticity of reaching/grasping
Movement sequences
Posture (axial control) and gait
Damage to inferior frontal gyrus can cause…
Broca’s Aphasia can be included here (motor of speech)
Damage to motor planning areas causes preservation. What is that?
Uncontrolled repetition of movement/speech
Remember: Mr. Egg story and how he could not put down his poached egg
What is apraxia?
Motor planning deficits
What is magnetic gait?
when the patient has difficulty lifting up their feet and so they have a shuffle or festinating gait
What is Ideational apraxia?
Inability to use objects appropriately, esp when sequence is necessary
What is Ideomotor apraxia?
Inability to develop movement sequence, esp to command or to mimic activity
but can do it automatically
If someone has true apraxia, how would you describe their gait?
Magnetic gait
What are the 4 A’s for cerebral cortex disorders?
Aphasia: language/communication disorder
Apraxia: motor planning deficits
Agnosia: can’t identify sound/sight
Astereognosis: can’t describe object in hand
