CPC: Brainstem Flashcards
1
Q
What is the protein in Lewy bodies?
A
alpha-synuclein
2
Q
What is the protein in oligopontocerebellar atrophy?
A
alpha-synuclein in glial cells
3
Q
Case presentation:
- 24yo fem
- neck pain x several days
- post-trauma difficulty speaking (slurred), hypersalivation, diff. swallowing x this a.m.
- L face and R body feel strange
- poor L arm coordination
- unsteady on feet
- dizzy, nausea, vomiting
A
x
4
Q
Sensory exam pertinents:
- decreased pinprick and temp sensation on Left side of face
- decreased pinprick and temp sensation on right arm and leg
A
- CN5- spinal nucleus of V
- ALS for trigeminal = ipsilateral (L sided lesion)
- ALS for body = contralateral (L sided lesion)
5
Q
CN exam pertinents:
- CN2 = R side pupil is bigger but reactive
- CN3, 4, 6 = left ptosis, R beating nystagmus in 1a position
- CN9, 10 = uvula deviates to the R, palate asymmetric
A
- CN3 = blown pupil on L L ptosis –> descending pathways from hypothalamus to the spinal cord pass thru the lateral medulla –> Horner’s syndrome
- CN 8 = R beating nystagmus = beating away from the side of the lesion (L lesion) –> vestibular nucleus defect
- CN9/10 = deviates to R = (L-sided lesion)
- CNs seem to be concentrated in the medulla
6
Q
Coordination and Gait exam:
- unsteady tandem and casual gait
- dysmetria and slight intention tremor in L arm
- dysmetria and slight intention tremor in L leg
- positive Romberg- pt falls to the L
A
- unsteady tandem = ataxia (cerebellum, inferior cerebellar peduncle)
- dysmetria in L arm = ataxia (cerebellum, inferior cerebellar peduncle- ipsilateral)
- dysmetria in L leg = ataxia (cerebellum, inferior cerebellar peduncle- ipsilateral)
- Romberg- fall towards the lesion (L sided lesion- cerebellar)
7
Q
Damage to the inferior cerebellar peduncle = ?
A
- x ipsilateral spinocerebellar fibers
- x climbing fibers from opposite inferior olivary nucleus (ION) –> ipsilateral cerebellar dysfunction
8
Q
Cerebellar lesions give _____ s/s.
A
ipsilateral
9
Q
nucleus ambiguous function
A
skeletomotor of vagus nerve (X) (muscles of the larynx/pharynx)
10
Q
Nystagmus can be caused by a CN___ lesion. It will cause beating opposite of the damage.
A
8
11
Q
lateral medullary syndrome aka Wallenburg syndrome
A
- CONTRALATERAL pain/temp defects in body (spinothalamic-ALS tract)
- IPSILATERAL pain/temp defects of face (trigeminal spinal nucleus)
- IPSILATERAL CN defects s/s = dysphagia (nucleus ambiguous- CN9, X),
- slurred speech (nucleus ambiguous- CN9, X)
- ataxia (cerebellum, inferior cerebellar peduncle)
- facial pain (trigeminal spinal nucleus)
- vertigo (CN8), nystagmus (CN8)
- Horner’s syndrome (hypothalamospinal tract/SNS damage)
- diplopia (CN3,4,6)
- palatal myoclonus (CNX)
- absent corneal reflex (trigeminal spinal nucleus)
- caused by = occlusion of the vertebral artery or PICA
12
Q
Case 2:
- 31yo fem
- progressive HA, nausea, blurry vision x 3mos.
- worse in the a.m., holocranial
- worsened by cough, strain, lifting
- pt from El Salvador
A
x
13
Q
If you hear “HA, nausea, blurry vision,” immediately think _____.
A
elevated ICP
14
Q
Case 2 PE:
- problems with orientation
- problems repeating
- dysarthria
- 25/30 MSE score
A
- problems with orientation –> delirium? encephalopathy?
- problems repeating –> conduction aphasia?
- dysarthria –> large ddx
15
Q
Case 2 CN exam:
- decreased visual acuity
- fundoscopic exam positive for:
- bilateral optic disc swelling/elevation
- enlargement of the blind spot
- blurring of optic margins
- venous engorgement and bleeding
A
–> papilledema, elevated ICP. But what’s the cause??
