E3: Neuroanatomy Flashcards
Patient presents after skiing and hit a tree. He became unconscious, but then had a lucid interval. Over the next hour, the patient deteriorated quickly. On CT, there is a lens shaped bleed. What should you be suspicious of?
Epidural hematoma
Is an epidural bleed venous or arterial?
Arterial (middle meningeal artery)
Is a subdural hematoma venous or arterial?
Venous (bridging veins)
If a patient tells you they are having the worst headache of their life, What should you be suspicious of?
Subarachnoid hemorrhage
What arteries join to form the basilar artery?
The vertebral arteries
Where do the vertebral arteries branch from?
The subclavian arteries
What is the main function of the circle of Willis?
Connects the anterior and posterior circulations, as well as the left and the right sides
What nerves are inside the cavernous sinus?
- All nerves that control EOMs ( CN III, IV, VI)
- All divisions of CN V except V3 (decreased facial sensation)
**internal carotid also in cavernous sinus
What are the symptoms of a carotid-cavernous sinus fistula?
- Eye pain and double vision
- Proptosis
- chemosis
- EOM paralysis
- Decreased facial sensation
- Orbital bruit
What does the lateral spinothalamic tract control?
Pain and temperature
What does the posterior spinal cord tract control?
Vibration and proprioception
What does the lateral corticospinal tract control?
Voluntary movement
What is the clinical presentation of Conus medullaris and Cauda equina?
-Pain and weakness, severe radicular pain, flaccid LE paralysis, saddle anesthesia, and bowel/bladder problems
A patient presents with aphasia, neglect, hemianopia, UMN hemiparesis, hemisensory involving the face and arm OR the leg. Where is the lesion?
The cortex
A patient presents with dense hemiplegia of the face, arm, and leg equally as well as some abnormal movements. Where is the lesion?
Subcortical structures (internal capsule and basal ganglia)
Patient presents with truncal or limb ataxia and dysmetria. Where is the lesion?
Cerebellum
A patient presents with CN palsies and crossed signs. Where is the lesion?
Brain stem
Patient presents with paraparesis, sensory level, B/B involvement, and saddle anesthesia. Where is the lesion?
Spinal cord
Patient presents with fasiculations and motor denervation, but no sensory involvement. Where is the lesion?
Lower motor neuron
Patient presents with distal weakness and sensory involvement in a stocking-glove distribution, areflexia or hyporeflexia. Where is the lesion?
Peripheral nerve
Patient presents with muscle fatigability, but no sensory involvement and normal DTRs. Where is the lesion?
The NMJ
The patient presents with proximal muscle weakness without sensory involvement. Where is the lesion?
the muscle
List the cranial nerves.
Olfactory Optic Oculomotor Trochlear Abducens Trigeminal Facial Vestibulocochlear Glossopharyngeal Vagus Spinal accessory Hypoglossal
A patient has bitemporal hemianopsia. Where is the lesion?
Optic chasm
Patient has right monocular blindness. Where is the lesion?
Right optic nerve
What are the cranial nerves responsible for EOMs?
III, IV, VI
What cranial nerve is responsible for sensation to face, muscles of mastication, and sensory limb of corneal reflex?
CN V
What CN is responsible for muscles of facial expression and the motor limb of the corneal reflex?
CN VII
What CNs are responsible for the pupillary reflex?
CN II and III
What CNs are responsible for the Corneal reflex?
CN V1 and VII
What CNs are responsible for the vestibule-ocular reflex?
CN VIII-VI and III
Will and UMN lesion have spasticity or rigidity?
Spasticity
-velocity dependent
What kind of lesion has velocity independent cogwheel rigidity?
Basal ganglia lesion
What are the nerve roots involved in the biceps reflex?
C5 and C6
What nerve roots are involved in the brachioradialis reflex?
C6
What nerve roots are involved in the triceps reflex?
C7
What nerve roots are involved in the patellar reflex?
L4
What nerve roots are involved in the achillles tendon reflex?
S1
What is an abnormal babinski?
Toes curling upwards and fanning
Patient has spastic weakness, hyper-reflexia, and positive babinski. Where is the lesion?
UMN
Patient has flaccid weakness, hypo-reflexia, atrophy, and fasciculations. Where is the lesion?
LMN
If there is cortical infarct and the patient has weakness in their face and arm more than their leg, where is the infarct?
The MCA
If there is a cortical infarct and the patient has weakness to their leg more than their arm and face, where is the infarct most likely?
ACA
