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Emma H&N II > Cortical Localization > Flashcards

Cortical Localization Flashcards

1
Q

encephalopathy refers to a _________ lesion

A

encephalopathy refers to a CORTICAL or SUBCORTICAL lesion

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2
Q

myelopathy = _______ lesion

A

myelopathy = spine lesion

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3
Q

What is the lesion? (what caused it)

A

VITAMINS D

Vascular
Inflammatory
Traumatic, Toxic
Autoimmune
Metabolic, Medication induced
Iatrogenic
Neoplastic
Psychiatric, Seizure 
Degenerative
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4
Q

importance of lesion localization

A
  • to narrow differential diagnosis
  • determine what tests to order
  • to determine operative practices (past)
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5
Q

components of a neurological exam

A
  • cognitive exam
  • cranial nerve exam
  • motor exam, reflex exam
  • sensory exam
  • cerebellar exam
  • other (gait, special tests)
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6
Q

clues that the lesion is cortical

A
  • behavior, personality changes
  • language disorders
  • visual field deficits in BOTH eyes
  • higher cortical sensory deficits
  • apraxia (cannot perform learned task)
  • neglect
  • hemiparesis (PART of side)
  • hemiesthesia (PART of side)
  • seizure
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7
Q

clues that the lesion is subcortical

A
  • pure motor deficits (whole side)
  • pure sensory deficits (whole side)
  • movement disorders
  • absence of cortical deficits
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8
Q

clues that the lesion is bulbar (brain stem)

A
  • crossed signs (sensory, motor)
  • cranial nerve deficits
  • vestibular (nausea, vomiting)
  • visual field deficits (PCA territory)
  • cerebellar signs
  • bilateral signs
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9
Q

clues that the lesion is myelopathic (spinal)

A
  • bilateral (not necessarily symmetrical) motor, sensory
  • no involvement above neck
  • combination of UMN, LMN
  • bowel, bladder dysfunction
  • autonomic dysfunction
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10
Q

tools to localize cortical

A
  • CST
  • ascending sensory tracts
  • optic pathways
  • language pathways
  • special localization syndromes
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11
Q

what to check during a motor exam (voluntary)

A
  • tone
  • bulk
  • strength
  • reflexes
  • associated features
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12
Q

UMN signs

A
  • hypertonia
  • no atrophy
  • weakness
  • brisk reflexes
  • babinski/myoclonus
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13
Q

LMN signs

A
  • hypotonia
  • muscle wasting
  • weakness
  • depressed reflexes
  • fasciculations
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14
Q

clues lesion is motor cortical

A
  • contralateral hemiparesis (not whole side)
  • upper motor neuron signs
  • cortical deficits (hemisphere specific)
  • associated sensory deficits
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15
Q

ascending sensory tracts

A
  • pain
  • pinprick
  • light touch
  • vibration
  • proprioception
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16
Q

clues lesion is sensory cortical

A
  • contralateral hemiesthesia (not whole side)
  • associated motor deficits
  • higher cortical sensory deficits
  • –astereognosis
  • –2 point discrimination
  • –agraphesthesia
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17
Q

astereognosis

A
  • close eyes
  • feel object
  • determine what it is
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18
Q

agraphesthesia

A
  • close eyes
  • scratch # on palm when eyes closed
  • determine which #
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19
Q

optic pathway is the only pathway to _____________

A

optic pathway is the only pathway to CROSS FROM FRONT TO BACK

  • great to localize a lesion axially
  • different visual fields will help localize
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20
Q

if there is a visual field deficit in one eye only, the problem is ________________

A

if there is a visual field deficit in one eye only, the problem is ANTERIOR TO THE OPTIC CHIASM
-no need to image the brain

21
Q

if the patient has “tunnel vision,” the problem is ________________

A

if the patient has “tunnel vision,” the problem is AT THE OPTIC CHIASM

22
Q

if there is the same partial visual field deficit in both eyes, the lesion is _______________

A

if there is the same partial visual field deficit in both eyes, the lesion is POSTERIOR TO THE OPTIC CHIASM (in the cortex)
-image the brain

23
Q

components of the aphasia examination

A
  • comprehension
  • fluency
  • repetition
  • naming
24
Q

T/F: we have specialized regions for language/speech and for reading/writing

A

False. Only have specialized region for language/speech.
-no specialized region for reading/writing or math

If there is a stoke in Broca/Wernicke, no other part of the cortex can take over.
If a stroke causes alexia (reading), another region can theoretically take over

25
Q

motor aphasia

A

Broca’s aphasia

  • unable to form words
  • “broke”, labored speech
26
Q

sensory aphasia

A

Wernicke’s aphasia

  • can talk freely, but makes no sense (“were”-“nick”)
  • no comprehension of what you say or what they are saying
  • “what?”
27
Q

transcortical motor aphasia

A

-looks like Broca’s aphasia, but CAN repeat

  • can repeat
  • cannot initate own
  • adj to Brocas in mid frontal gyrus
28
Q

transcortical sensory aphasia

A

-looks like Wernicke’s but CAN repeat

  • can repeat
  • cannot understand
29
Q

global aphasia

A
  • no understanding
  • no naming
  • no repeating
  • no expression

usually due to a larger vessel (proximal occlusion)

30
Q

conduction aphasia

A
  • arcuate fasciculus

- inability to repeat

31
Q

propasognosia

A

-inability to identify faces

-sometimes mistaken for delirium or dementia
-poss via bilateral temporal lobe injury
(facial recognition center: underside of temporal and occipital lobes on both sides of the cortex)

32
Q

conditions that affect the temporal lobe bilaterally

A
  • herpes encephalitis

- seizures

33
Q

split brain syndrome

A
  • corpus callosum affected
  • disconnect between both sides of brain

Due to:

  • epilepsy surgery
  • tumor
  • EtOH abuse
34
Q

right brain

A
  • emotional
  • mathematical
  • “big picture”
  • nonverbal
  • procedural memory
  • perceiving
35
Q

left brain

A
  • verbal
  • arithmetical
  • perceives details
  • declarative memory
  • confabulatory
36
Q

Balint Syndrome

A

BILATERAL PARIETAL LESIONS

  • simultanagnosia: inability to perceive visual field as a whole (name objects in kitchen but not situation)
  • oculomotor apraxia: difficulty fixating the eyes
  • optic ataxia: inability to move hand to a specific object using vision
  • fail to apprehend all but 1 of simultaneously presented objects at the same location
  • –object based, not location based
  • –multicolored dots seen if connected by lines
37
Q

Gerstmann Syndrome

A

dominant parietal lobe

  • agraphia
  • acalculia
  • finger agnosia
  • right left confusion
38
Q

non-dominant parietal signs

A
  • denial of deficits (anosagnosia)
  • visual, tactile, auditory extinction
  • spatial disorganization
  • neglect of left space
39
Q

simultognosia

A
  • able to name objects all over the picture

- cannot describe what is happening

40
Q

frontal lobe syndrome signs

A
  • problems with sequences tasks (Stroop test)
  • grasp reflexes
  • paratonia (Gegenhalten)
  • suck and snout reflex
  • perseveration (repeat self, locked in idea)
  • Luria test (pattern repeat)
41
Q

orbital frontal signs

A
  • violent

- hypersexual

42
Q

posterior frontal signs

A
  • apathetic

- akinetic mutism

43
Q

dorsolateral frontal signs

A
  • executive function loss

- speech problems

44
Q

We have about _________ neurons, and __% are in the cerebellum

A

We have about 84 BILLION neurons, and 50% are in the cerebellum

  • cerebellum is only 10% of brain mass
  • supression, pruning occurs
45
Q

supression

A

the cortex (frontal lobe) suppresses infant reflexes that we were born with. only see those reflexes in an adult if the frontal lobe is injured so inhibition of these reflexes is stopped

46
Q

we are born with _______ neurons, but by adulthood we have ________ neurons

A

we are born with 160 BILLION neurons, but by adulthood we have 84 BILLION neurons

-due to pruning

47
Q

Anton syndrome

A
  • bilateral occipital lobe injury
  • CORTICAL BLINDNESS
  • cannot see, but will flinch when confronted
  • confabulation: can see but cannot interpret signal so brain makes something up
  • headache, psychosis

-unawareness and denial of cortical blindness

48
Q

facial recognition center

A

underside of temporal and occipital lobes on both sides of the cortex

Emma H&N II (49 decks)

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