Clinical neuroanatomy

Question 1

Where do spinothalamic tracts decussate?

Answer 1

cross over 1-2 segments above within spinal cord

Question 2

Where do posterior columns decussate?

Answer 2

travel up spinal cord and cross over within medulla

Question 3

Where do corticospinal tracts decussate?

Answer 3

at medulla

Question 4

Which info does spinothalamic tract carry?

Answer 4

pain/temp

Question 5

Which info does posterior column carry?

Answer 5

vibration/proprioception

Question 6

What is the difference between UMN and LMN in terms of location?

Answer 6

UMN starts in motor cortex and terminates in brainstem motor nuclei or anterior horn cell within spinal cord

LMN starts at motor nucleus within brainstem and terminates in muscle

Question 7

State three patterns of weakness in UMN lesion

Answer 7

increased tone (clasp knife)
little atrophy
brisk tendon reflexes
ankle clonus
extensor plantar response

Question 8

State three patterns of weakness in LMN lesion

Answer 8

wasting/fasciulations
reduced tone
absent/decreased reflexes
no clonus seen
flexor plantar response

Question 9

Name two signs/symptoms associated with cerebral cortex lesion?

Answer 9

contralateral sensory disturbance and weakness

Question 10

Damage to internal capsule?

Answer 10

hemiplegia- face/arm/leg

Question 11

Damage to thalamus?

Answer 11

hemi-sensory disturbance

Question 12

Damage to midbrain?

Answer 12

occulomotor disorder

Question 13

Damage to pons?

Answer 13

facial weakness, sensory disturbance, vertigo, deafness

Question 14

Damage to medulla?

Answer 14

dysphagia, dysarthria (speech difficulty), dysphonia, weakness/wasting of tongue

Question 15

How will a lesion to the brainstem affect cranial nerve palsies, hemiparesis, and sensory loss?

Answer 15

crossed signs

ipsilateral cranial nerve palsies and contralateral spastic hemiparesis + sensory loss

Question 16

What is the most common cause of cauda equina syndrome?

Answer 16

lumbar disc herniation

Question 17

Name three causes for spinal cord syndrome

Answer 17

infection, tumour, trauma

Question 18

What lesion of the spinal cord arises in brown-sequard syndrome?

Answer 18

hemi-section

Question 19

What is the sensory pattern in brown-sequard syndrome?

Answer 19

light touch, vibration and proprioception lost ipsilaterally

pain/temp lost on contralateral side

Question 20

How are motor function and reflexes affected in brown sequard syndrome?

Answer 20

ipsilateral spastic hemiparesis

ipsilateral brisk reflexes

Question 21

Name two pathologies which affect the posterior columns

Answer 21

Vit B12 deficiency
Vit E deficiency
Fiedreich’s ataxia
Tabes dorsalis

Question 22

How does posterior column pathology present?

Answer 22

loss of vibration and proprioception

sensory ataxia

Question 23

Which sign is positive in posterior column pathology?

Answer 23

romberg’s sign

Question 24

What are bulbar symptoms?

Answer 24

linked to impairment of function of the glossopharyngeal nerve (CN IX), the vagus nerve (CN X), the accessory nerve (CN XI), and the hypoglossal nerve (CN XII).

Question 25

How does motor neuron disease present?

Answer 25

asymmetric limb weakness, bulbar symptoms

Question 26

How is a diagnosis of motor neurone disease made?

Answer 26

clinical, EMG changes support diagnosis

Question 27

What does having respiratory/bulbar symptoms imply for the prognosis of motor neurone disease?

Answer 27

poorer prognosis

Question 28

What is the prognosis of motor neurone disease?

Answer 28

2-3 years median survival

Question 29

List three examples of mononeuropathy

Answer 29

``` radial nerve ulnar nerve median nerve common peroneal nerve mononeuritis multiplex ```

Question 30

What is known as Saturday night palsy?

Answer 30

radial nerve

Question 31

Which muscles does the median nerve supply?

Answer 31

LOAF

Question 32

Which nerve is associated with foot drop?

Answer 32

common peroneal nerve

Question 33

What is mononeuritis multiplex?

Answer 33

Mononeuritis multiplex is a painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas

Question 34

What are two causes of mononeuritis multiplex?

Answer 34

``` diabetes lymphoma RA Lupus HIV Sarcoidosis ```

Question 35

What is the pattern of weakness in length dependent axonal neuropathy?

Answer 35

starts in toes/feet symmetrical slowly progressive

Question 36

List three causes of length dependent axonal neuropathy

Answer 36

``` diabetes alcohol vitamin deficiency Drugs HIV, hep B and C Myeloma Charcot marie tooth renal failure HYPOTHYROIDISM ```

Question 37

Name two vitamin deficiencies assocaited with length dependent axonal neuropathy

Answer 37

B6, thiamine, folate, B12

Question 38

Name one drug associated with length dependent axonal neuropathy

Answer 38

amiodarone | isoniazid

Question 39

List two organisms that cause GBS

Answer 39

campylobacter CMV EBV

Question 40

What is the treatment of GBS?

Answer 40

IV immunoglobulin | steroids

Question 41

List three blood tests you would conduct to investigate neuropathy

Answer 41

``` FBC Glucose U+Es LFTs TFTs B12/folate ```