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4. NEUROLOGY > Clinical Neuroanatomy > Flashcards

Clinical Neuroanatomy Flashcards

1
Q

What is the cause of Central Scotoma?

A

Optic nerve pathology ie optic neuritis, optic nerve compression

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2
Q

What is the cause of bitemporal hemianopia?

A

Optic chiasm pathology ie pituitary tumour, craniopharyngioma

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3
Q

What is the cause of incongruous homonymous hemianopia?

A

Optic tract pathology ie pituitary tumour, meningioma

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4
Q

What is the cause of complete macular-splitting homonymous hemianopia?

A

Optic radiation pathology ie MCA stroke (TACI or PACI)

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5
Q

What is the cause of superior quadrantic hemianopia?

A

Temporal lobe pathology ie Space-occupying lesion, temporal lobectomy

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6
Q

What is the cause of inferior quadrantic hemianopia

A

Parietal lobe pathology eg space occupying lesion

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7
Q

What is the cause of homonymous hemianopia (+/- macular sparing)?

A

Occipital lobe pathology eg occipital lobe infarct or haemorrhage, space occupying lesion

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8
Q

What could cause CN III palsy? What symptoms would be associated?

A

Aneurysm, diabetes, cavernous sinus lesion, tentorial herniation

Fixed dilated pupil, complete ptosis, all movements paralysed except abduction (VI) and intorsion on down gaze (IV)

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9
Q

What could cause CN IV palsy? What symptoms would be associated?

A

Head injury

Failure to depress during adduction, positive Bielschowsky test.

(pupil and eyelid normal).

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10
Q

What could cause CN VI palsy? What symptoms would be associated?

A

Diabetes, idiopathic, raised ICP

Failure of abduction, pupil and eyelid normal

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11
Q

What could cause internuclear opthalmoplegia (INO)?

What symptoms would be associated?

A

Lesion in median longitudinal fasciculus e.g. MS

Failure of adduction on attempted conjugate gaze, nystagmus in abducting eye, normal adduction on vergence. Painless.

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12
Q

What could cause Parinaud? What symptoms would be associated?

A

Dorsal midbrain lesion eg pineal tumour

Failure of vergence and vertical gaze (up>down). Fixed dilated pupil.

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13
Q

What could cause ocular myasthenia? What symptoms would be associated?

A

Thyoma or idiopathic

Fatiguable extraocular movements, painless. Pupil normal but may have ptosis, eyelid fatiguable

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14
Q

When checking pupillary reflexes, what could dilated pupil, small pupil, or RAPD each be signs of?

A

Dilated - impaired parasympathetic function eg CN III palsy (often marked ptosis)

Small - impaired sympathetic function eg Horner’s (with mild ptosis)

RAPD - optic nerve disease eg MS

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15
Q

How can complete CN III palsy be assessed for?

A

Dilated pupil, absent light response, accommodation reflex absent.

Brisk construction with 0.1% pilocarpine. Weakness of medial, inferior and superior rectus, and inferior oblique. Complete ptosis.

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16
Q

How can Horner’s syndrome be assessed (eye signs)?

A

Constricted pupil, normal light response & accommodation.

Failure to dilate with cocaine. Mild ptosis, no extraocular muscle weakness.

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17
Q

How can Holmes-Adie pupil be assessed for?

A

Dilated with absent light response. Slow, incomplete accommodation response.

Brisk constriction with 0.1% pilocarpine, normal eye movements with no ptosis. Absent tendon reflexes

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18
Q

How can complete Argyll-Robertson pupil be assessed for?

A

Small irregular pupil, absent light response, no response to atropine. Bilateral ptosis if associated with tabes dorsalis.

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19
Q

How can Holmes-Adie pupil be assessed for?

A

Dilated pupil, absent light reflex & slow, incomplete accommodation reflex.

Brisk constriction with 0.1% pilocarpine, normal eye movements with no ptosis, absent tendon reflexes

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20
Q

How can Argyll-Robertson pupil be assessed for?

A

Small, irregular pupil with absent light reflex

Slow accommodation reflex

No response to atropine, bilateral ptosis if associated with tabes dorsalis

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21
Q

For each cranial nerve, which are motor, sensory or both?

A 
I = sensory
II = sensory
III = motor
IV = motor
V = both
VI = motor
VII = both
VIII = sensory
IX = both
X = both
XI = motor
XII = motor

Severus snape meets malfoy but mad bellatrix stays behind bushes misusing magic

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22
Q

What is the role of CN V? 5

A

Sensory: ophthalmic, maxillary & mandibular - sensory part of corneal reflex is ophthalmic (Va). (Note: motor corneal reflex = facial nerve)

Motor: mandibular = temporalis, masseter & pterygoids.

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23
Q

What is the role of CN VII? 7

A

Motor: facial expression muscles & stapedius & chorda tympani (taste anterior 2/3 tongue).

If UMN lesion, frontalis and orbicularis oculi have preserved strength due to BILATERAL innervation.

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24
Q

What is the role of CN VIII? 8

A

Auditory + vestibular nerves

Assess with Rinne’s (sensorineural vs conductive) and Weber’s test (lateralises to side with conductive loss)

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25
Q

What is the the role of CN IX?

A

Palatal sensation + afferent for gag reflex

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26
Q

What is the role of CN X?

A

Motor to palate (elevation) and larynx

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27
Q

What is a bulbar palsy? What is it caused by?

A

Impaired function of CNs 9, 10, 11, 12, due to LMN lesion (medulla oblongata or lesions of the lower cranial nerves outside the brainstem).

Caused by: Guillain-Barre syndrome, myasthenia gravis, dermatomyositis, motor neuron disease, brainstem stroke

28
Q

What is a pseudobulbar palsy? What is it caused by?

A

Damage of motor fibers traveling from cerebral cortex to lower brain stem (UMN lesion)

Caused by: cerebrovascular disease involving deep hemispheric white matter, MS & MND

29
Q

What are the physical signs of a bulbar palsy?

A

Nasal dysarthria, dysphonia, dysphagia, wasting & fasciculation of tongue

Associated features:
Wasting & fasciculation of masticatory muscles (MND)
Fatiguable dysarthria (MG)
Facial weakness (GBS)

30
Q

What are the physical signs of a pseudobulbar palsy?

A

Dysarthria with ‘strained’ voice, dysphagia, small tongue with slow tongue movements, emotional lability, brisk jaw jerk, snout & rooting reflexes

Associated features:
Other signs of bilateral cerebellar damage e.g. extensor plantar responses

31
Q

What is the role of CN XI?

A

Trapezius and sternocleidomastoid

32
Q

What is the role of CN XII?

A

Tongue movements

tongue deviates towards side of lesion

33
Q

What are the signs of an UMN lesion?

A

Wasting occurs late - mild wasting due to disuse

No fasciculations
Spasticity

Weakness: flexors stronger than extensors in upper limbs, extensors stronger than flexors in lower limbs

Exaggerated deep tendon reflexes, ankle or patellar clonus

Absent superficial reflex (e.g. abdominal reflex)

Extensor plantar reflex

34
Q

What are the signs of a LMN lesion?

A

Wasting occurs early - severe neurogenic wasting

Fasciculations (with fibrillation on EMG)
Hypotonia

Weakness: may follow distribution of single peripheral nerve(s) or be predominantly distal in polyneuropathy

Absent / reduced deep tendon reflex

Superficial reflexes may be absent if relevant muscles paralysed

Flexor plantar reflex, or may be absent if relevant muscles paralysed

35
Q

What tone would you expect to see in pyramidal and extrapyramidal patterns?

A

Pyramidal = spasticity (velocity dependent increase in tone)

Extrapyramidal = lead pipe rigidity (diffuse increase in tone)

36
Q

What type of lesions would cause hypotonia?

A

LMN lesion and cerebellar disease

37
Q

What nerve and nerve root is responsible for shoulder abduction?

A

Axillary nerve (deltoid muscle)

C5

38
Q

What nerve and nerve root is responsible for elbow flexion?

A

Musculocutaneous nerve (biceps)

C5/6

39
Q

What nerve and nerve root is responsible for elbow extension?

A

Radial nerve (triceps)

C7

40
Q

What nerve and nerve root is responsible for finger flexion?

A

Anterior interosseous nerve i.e. median nerve
(flexor digitorum superficialis [FDS])

Ulnar nerve (flexor digitorum profundus [FDP])

C7/8

41
Q

What nerve and nerve root is responsible for finger extension?

A

Posterior interosseous nerve i.e. radial nerve (extensor digitorum communis [EDC])

C7

42
Q

What are the LOAF muscles and their nerve supply?

A

Intrinsic muscles of the hand that are supplied by the median nerve: T1 nerve root

Medial two lumbricals (L)
Opponens pollicis (O)
Abductor pollicis brevis (A)
Flexor pollicis brevis (F)

43
Q

Which intrinsic hand muscles are supplied by the ulnar nerve? Which nerve root(s) involved?

A 
Palmar interossei (adduction)
Dorsal interossei (abduction)
Adductor pollicis
Abductor digiti minimi
Flexor digiti minimi

C8 + T1

44
Q

Which nerve roots supply the following reflexes?

  1. Biceps
  2. Brachioradialis/supinator
  3. Triceps reflexes
A

Biceps = C5/6

Brachioradialis / supinator = C6

Triceps = C7 / C8

45
Q

What nerve and nerve root is responsible for hip flexion?

A

Direct plexus and femoral nerve (iliopsoas)

L1/2

46
Q

What nerve and nerve root is responsible for hip extension?

A

Inferior gluteal nerve (gluteus maximus)

L5/S1

47
Q

What nerve and nerve root is responsible for knee flexion?

A

Sciatic nerve (hamstrings)

L5 / S1

48
Q

What nerve and nerve root is responsible for knee extension?

A

Femoral nerve (quadriceps)

L3 / L4

49
Q

What nerve and nerve root is responsible for ankle dorsiflexion?

A

Deep peroneal i.e. common peroneal nerve (tibialis anterior)

L4 / L5

50
Q

What nerve and nerve root is responsible for ankle plantar flexion?

A

Tibial nerve (gastrocnemius and soleus)

S1 / S2

51
Q

What nerve and nerve root is responsible for ankle eversion?

A

Superficial peroneal nerve (peronei)

L5 / S1

52
Q

Which nerve roots supply the following reflexes?

  1. Knee reflex
  2. Ankle reflex
A 
Knee = L3 / L4
Ankle = S1 / S2
53
Q

What would median nerve compression at the wrist cause?

A

Weakness of APB, oppens pollicis

Sensory loss of thumb, index, middle and half of ring finger

No reflex changes

54
Q

What would ulnar nerve compression at the elbow cause?

A

Weakness of ADM, 1st dorsal interosseous

Sensory loss of little and half of ring finger

No reflex changes

55
Q

What would radial nerve compression at the upper arm cause?

A

Weakness of wrist and long finger extensors

Sensory loss of anatomical snuff box

Variable loss of triceps reflex

56
Q

What would common peroneal nerve compression at the neck of the fibula cause?

A

Weakness of tibialis anterior, peronei

Sensory loss of lateral aspect of calf / dorsum of foot

No reflex changes

57
Q

What would C7 root compression cause?

A

Weakness of triceps and wrist extensors

Sensory loss central strip of forearm

Loss of triceps reflex

58
Q

What would L5 root compression cause?

A

Weakness of extensor hallucis longus, ankle dorsiflexion, and hip abduction

Sensory loss dorsum of foot

No reflex changes

59
Q

What would S1 root compression cause?

A

Weakness of gastrocneumius, soleus

Sensory loss sole of foot

Loss of ankle reflex

60
Q

Go through arm dermatomes

A

(Check on google images)

61
Q

Go through leg dermatomes

A

(Check on google images)

62
Q

Go through torso dermatomes

A

(Check on google images)

63
Q

What would a complete spinal lesion cause?

A

LMN symptoms at site of lesion
UMN symptoms below lesion

Sensory loss at sensory level (may be below site of lesion)

Bladder involvement

64
Q

What would a Brown-Sequard lesion cause?

A

Ipsilateral UMN symptoms below the site of lesion

Contralateral loss of spinothalamic (pain, temp) and ipsilateral loss of dorsal column (vibration) below lesion

Variable bladder involvement

65
Q

What would a central cord lesion cause?

A

LMN symptoms at site of lesion
UMN symptoms below lesion

Loss of spinothalamic (pain, temp), relative preservation of dorsal column modalities, sensory level may be ‘suspended’

Variable bladder involvement

4. NEUROLOGY (13 decks)

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