Correlation Of Physical Signs - Talley Neuro Flashcards
How will a Middle Cerebral Artery thrombosis present?
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
How will a Posterior Cerebral Artery Thrombosis present?
Main branch thrombosis- infarction of thalamus and occipital cortex
- Hemianaesthesia (loss of all modalities)
- Homonymous Hemianopia (complete)
- Colour Blindness
How will an Anterior Cerebral Artery Thrombosis present?
- UMN
- LEG > arm
- cortical sensory loss of LEG only (if corpus callosum affected)
- Urinary incontinence
How will a Vertebral/Basilar (brain stem) thrombosis present?
- Crossed motor/sensory (eg left face, right arm)
- Bilateral extremity motor/sensory
- Hornets Syndrome
- Cerebellar signs
- Lower cranial nerve signs
Upper motor neurone signs?
Where is the lesion?
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
Causes of Hemiplegia?
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
What signs could be caused by a lesion in the vertebrobasilar artery?
- 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
What is Lateral Medullary Syndrome?
What does it cause?
What are the signs?
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
Signs of a lower motor neurone lesion
-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
What area is affected to cause a lower motor neuron lesion?
- interruption of the reflex arc
- lesion of spinal motor neurons, motor root or peripheral nerve
What kind of signs does a spinal cord compression cause?
Lower motor neurone signs at the level of the lesion
Upper motor neurone signs below that level
Pain and temperature loss one side of the face and opposite side of the body = ?
Lateral medullary syndrome
Occlusion of the vertebral or posterior inferior cerebellar or lateral medullary arteries
Bilateral loss of all forms of sensation below a specific level= ?
Spinal Cord Lesion
Only pain and temperature affected bilaterally below a specific level = ?
Anterior spinal cord lesion
Unilateral Loss of pain and temperature below a specific level = ?
partial unilateral spinal cord lesion on OPPOSITE side to signs = Brown- sequard syndrome
What is Brown Sequard syndrome ?
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
Glove and stocking loss of sensation = ?
Peripheral Neuropathy
Loss of position and vibration sense only = ?
Posterior column lesion
Saddle Sensory Loss = ?
Cauda Equina Lesion
Tunnel Vision:
What could cause this?
glaucoma
retinal abnormalities such as papilloedema, acute ischaemia in migraine
Enlarged Blind Spot
Where is the lesion?
What could cause this?
Optic Nerve Head enlargement
Central Scotoma
Where is the lesion?
What could cause this?
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
Unilateral Field Loss
Where is the lesion?
What could cause this?
Optic Nerve Lesion
cause: vascular tumour
Bitemporal Hemianopia
Where is the lesion?
What could cause this?
Optic Chiasm lesion
cause:
from a pituitary tumour
Homonymous Hemianopia
Lesion = between optic tract to occipital cortex
Incomplete lesion leads to macular sparing
Upper Quadrant Homonymous Hemianopia
Temporal lobe lesion
Lower Quadrant Homonymous Hemianopia
Parietal Lobe Lesion
What causes internuclear opthalmoplegia?
Lesion of the Medial Longitudinal Fasciculus
If bilateral and in a young person then most common cause is MS
Jerky HORIZONTAL Nystagmus
causes?
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
Jerky VERTICAL Nystagmus
Causes?
Brainstem Lesion
upbeat = lesion in the midbrain or floor of the fourth ventricle
Down beat = foramen magnum lesion
can also be caused by alcohol
Pendular Nystagmus
Causes?
Can be retinal or congenital
If the following Cranial nerves were involved in signs, where do you suspect the lesion is? Unilateral III IV V VI
Cavernous Sinus
If the following Cranial nerves were involved in signs, where do you suspect the lesion is? Unilateral V VII VIII
Cerebellopontine angle lesion
If the following Cranial nerves were involved in signs, where do you suspect the lesion is? Unilateral IX X XI
Jugular foramen Lesion
If the following Cranial nerves were involved in signs, where do you suspect the lesion is? Bilateral X XI XII
If lower motor neurone signs = Bulbar Palsy
If Upper motor neurone signs = Pseudobulbar palsy
What sign would you expect from a lateral optic chiasm lesion?
Incomplete contralateral hemianopia
What would you suspect if you observed a patient when told to look ahead they have one eye is rotated up and in
Trochlear nerve palsy
What would you suspect?
When told to look laterally, one eye stays forwards
Abducens nerve palsy
ABduction of the eye is controlled by which muscle and nerve?
Lateral rectus
Abducens (CN VI)
ADDuction of the eye is controlled by which muscle and nerve?
Medial Recturs
Oculomotor Nerve (CN III)
In the ABducted eye,
what controls Elevation and Depression?
Elevation = Superior Rectus (Oculomotor nerve CN III) Depression = Inferior Rectus (Oculomotor Nerve CN III)
In the ADDUcted eye
what controls Elevation and Depression?
Elevation = Inferior oblique ( Occulomotor CN III) Depression = Superior Oblique (Trochlear CN IV)
In upper paralysis of the facial nerve what muscles of the face are effected?
- only contralateral muscles of the lower face (eyebrow sparing)
In lower paralysis of the facial nerve what muscles of the face are effected?
- ALL IPSILATERAL muscles are affected
