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Medicine > Correlation Of Physical Signs - Talley Neuro > Flashcards

Correlation Of Physical Signs - Talley Neuro Flashcards

1
Q

How will a Middle Cerebral Artery thrombosis present?

A 
Main branch 
- UMN Face, 
ARM > leg 
- Homonymous Hemianopia
- Dysphasia OR non dominant hemisphere signs 
- Cortical sensory loss

Perforating artery internal capsule infarction
UMN face
UMN arm>leg

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2
Q

How will a Posterior Cerebral Artery Thrombosis present?

A

Main branch thrombosis- infarction of thalamus and occipital cortex

  • Hemianaesthesia (loss of all modalities)
  • Homonymous Hemianopia (complete)
  • Colour Blindness
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3
Q

How will an Anterior Cerebral Artery Thrombosis present?

A
  • UMN
  • LEG > arm
  • cortical sensory loss of LEG only (if corpus callosum affected)
  • Urinary incontinence
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4
Q

How will a Vertebral/Basilar (brain stem) thrombosis present?

A
  • Crossed motor/sensory (eg left face, right arm)
  • Bilateral extremity motor/sensory
  • Hornets Syndrome
  • Cerebellar signs
  • Lower cranial nerve signs
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5
Q

Upper motor neurone signs?

Where is the lesion?

A

The lesion has interrupted a pathway at a level ABOVE the anterior horn cell

Eg: cerebral cortex, internal capsule, Cerebral pedicels, brain stem or spinal cord

SIGNS:

  • Greater weakness of aBductors and EXtensors in the Upper limb
  • Flexors and ABductors in the Lower limb
    Why? Usually this pathway mediates voluntary contraction of antigravity muscles
  • Spasticity = increased tone is present
  • Clonus
  • INcreased reflexes (except for superficial reflexes)
  • There is an extensory (babinski) plantar response
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6
Q

Causes of Hemiplegia?

A

Upper motor neuron lesion affecting projection of pathways from the CONTRALATERAL motor cortex

Internal carotid artery stoke if there is an area of the internal capsule or hemisphere
Haemorrhagic strokes

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7
Q

What signs could be caused by a lesion in the vertebrobasilar artery?

A
  • cranial nerve palsies
  • cerebellar signs
  • Horners syndrome
  • sensory loss
  • bilateral upper motor neuron signs
  • this is due to close proximity of structures in the brainstem
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8
Q

What is Lateral Medullary Syndrome?
What does it cause?
What are the signs?

A

Occlusion of the vertebral or posterior inferior cerebellar or lateral medullary arteries

Causes: Crossed neurological signs

Signs:
- cerebellar signs (ipsilateral)
- Horners Syndrome ( ipsilateral)
- Lower cranial nerves ( IX, X)- palate and -
vocal cord weakness (ipsilateral)
- Facial sensory loss of pain (ipsilateral)
- Arm and leg sensory loss of pain (contralateral)
- No upper motor neurone weakness

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9
Q

Signs of a lower motor neurone lesion

A

-Weakness = more distal than proximal

Flexor and extensors are equally involved

wasting

Tone is reduced

Reflexes are reduced and plantar response is normal or absent

Fasciculations

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10
Q

What area is affected to cause a lower motor neuron lesion?

A
  • interruption of the reflex arc

- lesion of spinal motor neurons, motor root or peripheral nerve

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11
Q

What kind of signs does a spinal cord compression cause?

A

Lower motor neurone signs at the level of the lesion

Upper motor neurone signs below that level

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12
Q

Pain and temperature loss one side of the face and opposite side of the body = ?

A

Lateral medullary syndrome

Occlusion of the vertebral or posterior inferior cerebellar or lateral medullary arteries

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13
Q

Bilateral loss of all forms of sensation below a specific level= ?

A

Spinal Cord Lesion

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14
Q

Only pain and temperature affected bilaterally below a specific level = ?

A

Anterior spinal cord lesion

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15
Q

Unilateral Loss of pain and temperature below a specific level = ?

A

partial unilateral spinal cord lesion on OPPOSITE side to signs = Brown- sequard syndrome

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16
Q

What is Brown Sequard syndrome ?

A

Hemisection of the spinal cord

= Loss of pain and temperature on the OPPOSITE side of the lesion

= Loss of vibration and proprioception on the SAME side as the lesion

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17
Q

Glove and stocking loss of sensation = ?

A

Peripheral Neuropathy

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18
Q

Loss of position and vibration sense only = ?

A

Posterior column lesion

19
Q

Saddle Sensory Loss = ?

A

Cauda Equina Lesion

20
Q

Tunnel Vision:

What could cause this?

A

glaucoma

retinal abnormalities such as papilloedema, acute ischaemia in migraine

21
Q

Enlarged Blind Spot
Where is the lesion?
What could cause this?

A

Optic Nerve Head enlargement

22
Q

Central Scotoma
Where is the lesion?
What could cause this?

A

Between the optic nerve to the chiasm

caused by :
demyelination
- MS causes unilateral or asymmetrical bilateral central scotoma

toxins (alcohol) = symmetrical bilateral

vascular = unilateral

Gliomas of optic nerve = Unilateral

23
Q

Unilateral Field Loss
Where is the lesion?
What could cause this?

A

Optic Nerve Lesion

cause: vascular tumour

24
Q

Bitemporal Hemianopia
Where is the lesion?
What could cause this?

A

Optic Chiasm lesion
cause:
from a pituitary tumour

25
Q

Homonymous Hemianopia

A

Lesion = between optic tract to occipital cortex

Incomplete lesion leads to macular sparing

26
Q

Upper Quadrant Homonymous Hemianopia

A

Temporal lobe lesion

27
Q

Lower Quadrant Homonymous Hemianopia

A

Parietal Lobe Lesion

28
Q

What causes internuclear opthalmoplegia?

A

Lesion of the Medial Longitudinal Fasciculus

If bilateral and in a young person then most common cause is MS

29
Q

Jerky HORIZONTAL Nystagmus

causes?

A

1) vestibular lesion
- acute = away from the side of lesion
- chronic = towards lesion

2) Cerebellar lesion
- unilateral disease = towards the side of lesion

3) Toxic causes
- such as phenytoin and alcohol

4) internuclear opthalmoplegia

30
Q

Jerky VERTICAL Nystagmus

Causes?

A

Brainstem Lesion

upbeat = lesion in the midbrain or floor of the fourth ventricle

Down beat = foramen magnum lesion

can also be caused by alcohol

31
Q

Pendular Nystagmus

Causes?

A

Can be retinal or congenital

32
Q 
If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Unilateral
III
IV
V
VI
A

Cavernous Sinus

33
Q 
If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Unilateral
V
VII
VIII
A

Cerebellopontine angle lesion

34
Q 
If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Unilateral
IX
X
XI
A

Jugular foramen Lesion

35
Q 
If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Bilateral
X
XI
XII
A

If lower motor neurone signs = Bulbar Palsy

If Upper motor neurone signs = Pseudobulbar palsy

36
Q

What sign would you expect from a lateral optic chiasm lesion?

A

Incomplete contralateral hemianopia

37
Q

What would you suspect if you observed a patient when told to look ahead they have one eye is rotated up and in

A

Trochlear nerve palsy

38
Q

What would you suspect?

When told to look laterally, one eye stays forwards

A

Abducens nerve palsy

39
Q

ABduction of the eye is controlled by which muscle and nerve?

A

Lateral rectus

Abducens (CN VI)

40
Q

ADDuction of the eye is controlled by which muscle and nerve?

A

Medial Recturs

Oculomotor Nerve (CN III)

41
Q

In the ABducted eye,

what controls Elevation and Depression?

A 
Elevation = Superior Rectus (Oculomotor nerve CN III)
Depression = Inferior Rectus (Oculomotor Nerve CN III)
42
Q

In the ADDUcted eye

what controls Elevation and Depression?

A 
Elevation = Inferior oblique ( Occulomotor CN III)
Depression = Superior Oblique (Trochlear  CN IV)
43
Q

In upper paralysis of the facial nerve what muscles of the face are effected?

A
  • only contralateral muscles of the lower face (eyebrow sparing)
44
Q

In lower paralysis of the facial nerve what muscles of the face are effected?

A
  • ALL IPSILATERAL muscles are affected

Medicine (9 decks)

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