export_neuroanatomy Flashcards by Ahana Sen

Occulomotor

CN III 1. edinger-westphal nucleus - GVE - pupillary light reflex 2. oculomotor nucleus - GSE located in the cerebral peduncles supplies many of the eye muscles (except superior obi and lat rectus)

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Occulomotor anatomy

_parasympathetic outside, muscle nerves inside -emerges from stem between posterior cerebral and runs under PCOM

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Trochlear anatomy and what happens if lesion

superior oblique; only one that decussates and dorsal aspect of brainstem Damage=vertical diplopia; compensate by tilting to unaffected side. can happen from facial trauma

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Abducens

-Lateral rectus -Without cannot abduct; have diplopia - Can be damaged by ^ICP - When damaged in BStem lesion can cause facial weakness (bc of facial nucleus that it goes around)

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cavernous sinus

* watershed where venous blood drains * lateral wall: CN III, IV, V 1 , V 2 * Internal Carotid * CN VI (Abducens) floating unprotected in the middle, more prone to intracranial pressure damage

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NF-I

Chromosome 17 *Glioma & ependymoma Bone abnormalities, Optic Nerve Tumors, lisch nodules, learning disabilities, {large head, short stature, cafe au laid spots}

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NF-II

Ch22q12 -meningioma & glioma * Bilateral 8th nerve masses 1st degree relative with u/l 8th nerve masses or relative with at least 2 of the following: meningioma, glioma, schwannoma, juvenile cataract

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VonHippel-Lindau

3p25 AD genetics CNS, retinal *hemangioblastomas, *cc renal carcinoma, pheocytochroma, pancreatic neuroendocrine tumors, pancreatic cysts, endolymphic sac tumors, epididymal papillary cystadenomas.

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Li-Fraumeni family cancer syndrome

* Develop tumors while young and in multiple organs * 50% develop cancer by age 30 and 90% by age 70 * have inherited a germ-line p53 mutation (all cells have one mutant p53 allele * just one cell needs to mutate the second p53 allele and cancer develops

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Tolosa Hunt Syndrome

Idiopathic granulomatous disease of the cavernous sinus

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Pineal Gland

-tumor- Germinomas> pinealoma -Usually silent until affect midbrain causing visual defects (esp upgaze, same as in PSP)

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Frontal Eye fields

-Direct saccades to the contralateral side -Stroke- deviation ipsis; seizure, deviation contra

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Horner’s Syndrome

-Ptosis, miosis, anhydrosis -Lesion in sympathetic pathway -Common in carotid dissection or vertebral atery dissection ( Wallenburg syndrome)

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Miosis

Sympathetic problem; if pupils are too dilated, parasympathetic problem ( CNIII)

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Internuclear Ophthalmoplegia

lesion of the MLF; problem adducting one eye and abducting nystagmus in other -Common in MS

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MLF

Connects CNIII in midbrain to contralateral CNVI in pons –> conjugate gaze

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Optic Neuritis and treatment

-Blurry vision, pain, often subtle color (red) loss - IV steroids ( ie salumedrol) to delay occurrence of 2ndary demyelination; 3 days with oral taper _Severe relapse–> plasmapheresis

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Marcus Gunn Pupil

-Afferent pupillary defect (APD) -same size pupils, defected one dilates with light; normal consensual is preserved

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MS-imaging

-lesions-classic, enhancing new lesions; classic Dawson’s fingers (periventricular white matter lesions) -Old lesions = “black holes” -Atrophy - Spinal cord lesions cause more disability

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MS signs

-Uhthoff’s phenomena: worse with heat - Lhermitte’s- worse with bending neck (cervical spinal cord pathology)

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-demyelinating -Low Vit D/EBV -Genetic -F:M (3:1)

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MS Presentation

-Optic neuritis, sensory deficits, weakness, diplopia, ataxia; not common for psych problems/aphasia

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MS prognosis

good: white race, female gender, younger age, sensory symptoms at onset, full recovery from initial attack, fewer relapses in the years after diagnosis, and fewer lesions on baseline MRI. Note that patients diagnosed at a younger age reach disability milestones at an earlier age, however.

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Diagnosis of MS

Diagnosis depends on having two attacks with clinical evidence or supportive evidence including typical MRI or oligoclonal bands in the CSF. Oligoclonal bands are immunoglobulin patterns seen in the CSF of 90% of MS patients. They can be seen in a variety of other inflammatory disorders.

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MS course

-Remitting/relapsing (90% time)-\> 2ndary progressive - Primary progressive (10%)

INF-b/Glatiramer Acetate

-INF:Avonex, Rebif, Betaseron -GA: capoxone -MS injection; flu-like SE

Tysabri (Natalizumab)

prevents t-cells from crossing BBB

Fingolimod (Gilyena)

-first oral med -prevents Tcell egress from LN -Bradycardia/macular edema

Aubagio (teriflunimode)

-2nd oral med -category x in pregnancy; Gi upset/reversible alopecia

Dimethyl Fumarate \* (Tecfidera)

-3rd oral -Originally for psoriasis in Germany

Novantrone

-Only for 2ndary progressive form of illness -Chemo, possibility of cardiotox/leukemia

EDSS

- Disability in MS; sometimes underestimates morbidity b/c only way to get over 4 is by having ambulation problems

Neuromyelitis Optica

-Devic's disease -De-myelinating, characterized by optic neuritis -Contiguous spinal cord lesion for 3 levels. -generally more severe than MS, F\>\>\>\>M; hispanics/AA's -oral immunosupressants as tx -Intractable hiccups/n/v; (area postrema)

Trigeminal Neuralgia

-brief, shock like pain over V2, V3 region. Can be triggered by mild stimuli. -Often mistaken for dental disease -Tx: carbamazepine, & other antiepileptcs (phenytoin, neurontin), clonazepam, and baclofen - Artery or vein touching the trigeminal nerve root; ultimatemately sugary might be needed

Trigeminal Nerve

-sensory and muscles of mastication - pons,lower BS-\> meckel's cave-\> TG ganglion

CNV-course

-After ganglion, splits into 3; bilateral somatic sensation to face -Afferent for corneal reflex

Bell's Palsy and treatment

-Problem with CNVII; facial droop, increased sound, -TX: oral steroid/ antiviral ( acyclovir) against herpes virus. Protect Eye.

Ramsey-Hunt Syndrome

Herpes zoster infection of CNVII, CNVIII; painful rash in the ear canal and dysfunction of the affected nerves

CNVII and what diseases give b/l CN VII damage

-Muscles of facial expression; stepedius, submandibular/sublingual glands. taste from ant 2/3 of tongue - b/l nerve palsies commonly from lyme disease/sarcoidosis -

CNVII nucleus

-Nucleus in the pons -nuc/nerve itself lesion-ipsi facial droop - above the nucleus-\> contra droop, superior face

CNVIII

-hearing is bilateral ; usually unilateral loss does not mean deafness -Damage to b/l auditory cortex= pure word deafness;its can hear, speak, and write but does not recognize spoken

Weber's test

-Tuning fork on forehead -Louder with conductive hearing loss

Rinne's Test

- Near ear and behind on bone -sensorineural loss with conduction better on air

components of 3 semicircular canals

-3 orthagonal canals -utricle- horizonatal -saccule-verticle \*otoliths

Central Causes of Vertigo

-Migraine -MS -Mal de Debarquement Syndrome -Cerebellar hemorrhage and infarct - Vertebobasillar insuff - Vertebral artery dissection -Neoplasm

Meniere's Disease

-Episodes of u/l hearing loss, sense of ear fullness, and episodes of vertigo - Pt's may feel like they are thrown to the ground -cause:rupture of membranous labyrinth, endolymphic distention and death of hair cells in cochlea tx-salt restriction.diuretics

Benign positional vertigo

episodes of vertigo provoked by changes in head position--usually lying down on affected ear -\> Dix0 Hallpike manever-help dix this -Epley maneuver-put metrical back into posterior semicircular canal

Ototoxic drugs

aspirin, aminoglycosides, ("-mycins"), loop diuretics (ie furosemide), cisplatin/carboplatin

Vestibular nueritis

-u/l vestibular dysfunction and may be associated with nausea, vomiting, and previous URI.

Labyrinthitis

-like vestibular neuritis but with hearing tinnitus

CNIX

-w/ CNX, innervates muscles of pharynx, larynx (nuc ambiguous) Lesion-\> dysphagia, dysarthria - CNIX: taste post 1/3 tongue (tonsils, pharynx, middle ear, posterior 1.3 tongue)

CNX

-parasympathetic to many organs

Reticular Formation

-Poorly defined area of 100 small neural networks throughoutt bstem. -Multiple connections through cortex-\> motor control, sleep and consciousness, pain mod, and habituation

Central Pontine myelinolysis

-demyelinatingw/ rapid correction of longstanding hyponatremia -Most commonly in alcoholica, chronically malnourished, medically ill. -Presents: variably with coma, acute quadraparesis, locked-in syndrome, and signs of bulbar dysfunction. poor prognosis

BSTEM and cranial nerves

Midbrain: CN III & IV Pons: CN V, VI, VII, VIII Medulla: CN IX,X, XI, XII

Brain Stem

-Basal Ganglia -Sensory & Motor between cortex and cerebellum -reticular activation system, nuclei ( Da, 5HT, NE)

Bstem Injury

-"Crossed findings"- ipsi CN., Contralateral S&M -Typically w/ dizziness/vertigo, ataxia, nausea, imbalance, double vision, nystagmus, dysarthria, dysphagia

Cervical Spondylosis

Legs almost cross in front of each other, mild weakness of hip flexors, brisk deep tendon, b/l up going toes

Dorsal Columns/ Medial leminicus

Proprioception/ vibration ipsi; Gracilus fasciculus ( more medial) from legs; Cuneatus fasciculus ( more lateral) from arms - Ipsi to medulla, cross and here they are medial leminicus -VPL/M thalami--\> 1mary sensory in cortex

Corticospinal

Descending; motor to same side of body - pyramidal tract, majority crosses here - Anterior horn; ventral nerve root

Corticospinal --path

motor frontal lobe-\>posterior Int capsule-\> cerebral peduncle in midbrain -\> in pons-\> pyramids of medulla where they decussate (after ipsi, snake eyes)

Spinothalamic

Pain & temp from opposite of the body. Ascending -rise 2 levels before crossing - Ventral posterior lateral thalami (body) - ventral posterior medial thalami ( head) -Then 1mary sensory of the cortex (parietal lobe)

Upper Motor Neuron signs

-^ tone, spasticity, pathological reflexes like Babinski -bebefit from baclofen, botox into muscles

Lower Motor Neuron Signs

decreased tone, reflexes, atrophy, fasciculations

Hemicord (Brown Sequard)

-Loss of propioception, vibration, Weakness ipsi - Loss of P&T contra

Central Cord

-Loss of P&T in "shawl" (ST being effected in middle as it crosses) - Weakness if possible if anterior horn effected -syrinx/syringomelia most common (most commonly caused by chiari malformation

Anterior Cord Syndrome

-Weakness b/l -Loss of P&T b/l -Preservation of propioception/vibration - Occlusion of anterior spinal artery (occurs in its become hypotensive or surgery on abdominal aorta)

Posterior Cord syndrome

loss of propioception--intense pain/burning sensation in limbs

Complete Cord transection

-Weakness and loss of all sensation below the lesion

Cauda Equina Syndrome

-10 nerve fiber pairs & single coccygeal -usually disc at L4-5, L5-S1 -numbness in genitals, buttocks, and anus due to sacral nerve compression (saddle anesthesia) -extremity weakness , often asymmetric -decreased knee reflexes - Bowel and bladder retention (later)

Conus Medullaris

-Lesion L1-L2 - Symmetrical weakness -Knee preserved;ankle jerks affected -Bladder/bowel incontinence early & impotence

ALS and it's treatment

Motor neurons of brain, CN, and anterior horn cells EEG: fasciculations, fibrillations, sharp waves TX: riluzole

B12 deficiency

- damage of CS tract and dorsal columns - ^methylmalonic acid/ homocysteine -Megaloblastic anemia, hypersegmented neutrophils--\> psychiatric "megaloblastic madness" -seen in people with pernicious anemia, strict vegetarians, an post gastric bypass. Takes many years

Cerebellar Dysfunction

-Ataxia- -Hypotonia -Tremor -gait -Ocular motor -Scanning speech

Cerebellar dysfunction (causes)

- toxins (dilantin, ETOH, etc..) -primary neurodenerative - olivopontocerebellar atrophy -Paraneoplastic deg of cerebellum occurs with gyn cancers. anti YO antibodies -spinocerebellar ataxias (genetic) -Vasc disorders

Cerebellum path

-Double crossed- ipsi - midline-\>axial muscle dysfunction lateral-\> limb ataxia

# reversed prompt CN III 1. edinger-westphal nucleus - GVE - pupillary light reflex 2. oculomotor nucleus - GSE located in the cerebral peduncles supplies many of the eye muscles (except superior obi and lat rectus)

Occulomotor

# reversed prompt \_parasympathetic outside, muscle nerves inside -emerges from stem between posterior cerebral and runs under PCOM

Occulomotor anatomy

# reversed prompt superior oblique; only one that decussates and dorsal aspect of brainstem Damage=vertical diplopia; compensate by tilting to unaffected side. can happen from facial trauma

Trochlear anatomy

# reversed prompt -Lateral rectus -Without cannot abduct; have diplopia - Can be damaged by ^ICP - When damaged in BStem lesion can cause facial weakness (bc of facial nucleus that it goes around)

Abducens

# reversed prompt \* watershed where venous blood drains \* lateral wall: CN III, IV, V 1 , V 2 \* Internal Carotid \* CN VI (Abducens) floating unprotected in the middle, more prone to intracranial pressure damage

cavernous sinus

# reversed prompt Chromosome 17 \*Glioma & ependymoma Bone abnormalities, Optic Nerve Tumors, lisch nodules, learning disabilities, {large head, short stature, cafe au laid spots}

NF-I

# reversed prompt - Ch22q12 -meningioma & glioma \* Bilateral 8th nerve masses 1st degree relative with u/l 8th nerve masses or relative with at least 2 of the following: meningioma, glioma, schwannoma, juvenile cataract

NF-II

# reversed prompt 3p25 AD genetics CNS, retinal \*hemangioblastomas, \*cc renal carcinoma, pheocytochroma, pancreatic neuroendocrine tumors, pancreatic cysts, endolymphic sac tumors, epididymal papillary cystadenomas.

VonHippel-Lindau

# reversed prompt \* Develop tumors while young and in multiple organs \* 50% develop cancer by age 30 and 90% by age 70 \* have inherited a germ-line p53 mutation (all cells have one mutant p53 allele \* just one cell needs to mutate the second p53 allele and cancer develops

Li-Fraumeni family cancer syndrome

# reversed prompt Idiopathic granulomatous disease of the cavernous sinus

Tolosa Hunt Syndrome

# reversed prompt -tumor- Germinomas\> pinealoma -Usually silent until affect midbrain causing visual defects (esp upgaze, same as in PSP)

Pineal Gland

# reversed prompt -Direct saccades to the contralateral side -Stroke- deviation ipsis; seizure, deviation contra

Frontal Eye fields

# reversed prompt -Ptosis, miosis, anhydrosis -Lesion in sympathetic pathway -Common in carotid dissection or vertebral atery dissection ( Wallenburg syndrome)

Horner's Syndrome

# reversed prompt Sympathetic problem; if pupils are too dilated, parasympathetic problem ( CNIII)

Miosis

# reversed prompt lesion of the MLF; problem adducting one eye and abducting nystagmus in other -Common in MS

Internuclear Ophthalmoplegia

# reversed prompt Connects CNIII in midbrain to contralateral CNVI in pons --\> conjugate gaze

MLF

# reversed prompt -Blurry vision, pain, often subtle color (red) loss - IV steroids ( ie salumedrol) to delay occurrence of 2ndary demyelination; 3 days with oral taper \_Severe relapse--\> plasmapheresis

Optic Neuritis

# reversed prompt -Afferent pupillary defect (APD) -same size pupils, defected one dilates with light; normal consensual is preserved

Marcus Gunn Pupil

# reversed prompt -lesions-classic, enhancing new lesions; classic Dawson's fingers (periventricular white matter lesions) -Old lesions = "black holes" -Atrophy - Spinal cord lesions cause more disability

MS-imaging

# reversed prompt -Uhthoff's phenomena: worse with heat - Lhermitte's- worse with bending neck (cervical spinal cord pathology)

MS signs

# reversed prompt -demyelinating -Low Vit D/EBV -Genetic -F:M (3:1)

# reversed prompt -Optic neuritis, sensory deficits, weakness, diplopia, ataxia; not common for psych problems/aphasia

MS Presentation

# reversed prompt good: white race, female gender, younger age, sensory symptoms at onset, full recovery from initial attack, fewer relapses in the years after diagnosis, and fewer lesions on baseline MRI. Note that patients diagnosed at a younger age reach disability milestones at an earlier age, however.

MS prognosis

# reversed prompt Diagnosis depends on having two attacks with clinical evidence or supportive evidence including typical MRI or oligoclonal bands in the CSF. Oligoclonal bands are immunoglobulin patterns seen in the CSF of 90% of MS patients. They can be seen in a variety of other inflammatory disorders.

Diagnosis of MS

# reversed prompt -Remitting/relapsing (90% time)-\> 2ndary progressive - Primary progressive (10%)

MS course

# reversed prompt -INF:Avonex, Rebif, Betaseron -GA: capoxone -MS injection; flu-like SE

INF-b/Glatiramer Acetate

# reversed prompt prevents t-cells from crossing BBB

Tysabri (Natalizumab)

# reversed prompt -first oral med -prevents Tcell egress from LN -Bradycardia/macular edema

Fingolimod (Gilyena)

# reversed prompt -2nd oral med -category x in pregnancy; Gi upset/reversible alopecia

Aubagio (teriflunimode)

# reversed prompt -3rd oral -Originally for psoriasis in Germany

Dimethyl Fumarate \* (Tecfidera)

# reversed prompt -Only for 2ndary progressive form of illness -Chemo, possibility of cardiotox/leukemia

Novantrone

# reversed prompt - Disability in MS; sometimes underestimates morbidity b/c only way to get over 4 is by having ambulation problems

EDSS

# reversed prompt -Devic's disease -De-myelinating, characterized by optic neuritis -Contiguous spinal cord lesion for 3 levels. -generally more severe than MS, F\>\>\>\>M; hispanics/AA's -oral immunosupressants as tx -Intractable hiccups/n/v; (area postrema)

Neuromyelitis Optica

# reversed prompt -brief, shock like pain over V2, V3 region. Can be triggered by mild stimuli. -Often mistaken for dental disease -Tx: carbamazepine, & other antiepileptcs (phenytoin, neurontin), clonazepam, and baclofen - Artery or vein touching the trigeminal nerve root; ultimatemately sugary might be needed

Trigeminal Neuralgia

# reversed prompt -sensory and muscles of mastication - pons,lower BS-\> meckel's cave-\> TG ganglion

Trigeminal Nerve

# reversed prompt -After ganglion, splits into 3; bilateral somatic sensation to face -Afferent for corneal reflex

CNV-course

# reversed prompt -Problem with CNVII; facial droop, increased sound, -TX: oral steroid/ antiviral ( acyclovir) against herpes virus. Protect Eye.

Bell's Palsy

# reversed prompt Herpes zoster infection of CNVII, CNVIII; painful rash in the ear canal and dysfunction of the affected nerves

Ramsey-Hunt Syndrome

# reversed prompt -Muscles of facial expression; stepedius, submandibular/sublingual glands. taste from ant 2/3 of tongue - b/l nerve palsies commonly from lyme disease/sarcoidosis -

CNVII

# reversed prompt -Nucleus in the pons -nuc/nerve itself lesion-ipsi facial droop - above the nucleus-\> contra droop, superior face

CNVII nucleus

# reversed prompt -hearing is bilateral ; usually unilateral loss does not mean deafness -Damage to b/l auditory cortex= pure word deafness;its can hear, speak, and write but does not recognize spoken

CNVIII

# reversed prompt -Tuning fork on forehead -Louder with conductive hearing loss

Weber's test

# reversed prompt - Near ear and behind on bone -sensorineural loss with conduction better on air

Rinne's Test

# reversed prompt -3 orthagonal canals -utricle- horizonatal -saccule-verticle \*otoliths

3 semicircular canals

# reversed prompt -Migraine -MS -Mal de Debarquement Syndrome -Cerebellar hemorrhage and infarct - Vertebobasillar insuff - Vertebral artery dissection -Neoplasm

Central Causes of Vertigo

# reversed prompt -Episodes of u/l hearing loss, sense of ear fullness, and episodes of vertigo - Pt's may feel like they are thrown to the ground -cause:rupture of membranous labyrinth, endolymphic distention and death of hair cells in cochlea tx-salt restriction.diuretics

Meniere's Disease

# reversed prompt episodes of vertigo provoked by changes in head position--usually lying down on affected ear -\> Dix0 Hallpike manever-help dix this -Epley maneuver-put metrical back into posterior semicircular canal

Benign positional vertigo

# reversed prompt aspirin, aminoglycosides, ("-mycins"), loop diuretics (ie furosemide), cisplatin/carboplatin

Ototoxic drugs

# reversed prompt -u/l vestibular dysfunction and may be associated with nausea, vomiting, and previous URI.

Vestibular nueritis

# reversed prompt -like vestibular neuritis but with hearing tinnitus

Labyrinthitis

# reversed prompt -w/ CNX, innervates muscles of pharynx, larynx (nuc ambiguous) Lesion-\> dysphagia, dysarthria - CNIX: taste post 1/3 tongue (tonsils, pharynx, middle ear, posterior 1.3 tongue)

CNIX

# reversed prompt -parasympathetic to many organs

CNX

# reversed prompt -Poorly defined area of 100 small neural networks throughoutt bstem. -Multiple connections through cortex-\> motor control, sleep and consciousness, pain mod, and habituation

Reticular Formation

# reversed prompt -demyelinatingw/ rapid correction of longstanding hyponatremia -Most commonly in alcoholica, chronically malnourished, medically ill. -Presents: variably with coma, acute quadraparesis, locked-in syndrome, and signs of bulbar dysfunction. poor prognosis

Central Pontine myelinolysis

# reversed prompt Midbrain: CN III & IV Pons: CN V, VI, VII, VIII Medulla: CN IX,X, XI, XII

BSTEM and cranial nerves

# reversed prompt -Basal Ganglia -Sensory & Motor between cortex and cerebellum -reticular activation system, nuclei ( Da, 5HT, NE)

Brain Stem

# reversed prompt -"Crossed findings"- ipsi CN., Contralateral S&M -Typically w/ dizziness/vertigo, ataxia, nausea, imbalance, double vision, nystagmus, dysarthria, dysphagia

Bstem Injury

# reversed prompt Legs almost cross in front of each other, mild weakness of hip flexors, brisk deep tendon, b/l up going toes

Cervical Spondylosis

# reversed prompt Proprioception/ vibration ipsi; Gracilus fasciculus ( more medial) from legs; Cuneatus fasciculus ( more lateral) from arms - Ipsi to medulla, cross and here they are medial leminicus -VPL/M thalami--\> 1mary sensory in cortex

Dorsal Columns/ Medial leminicus

# reversed prompt Descending; motor to same side of body - pyramidal tract, majority crosses here - Anterior horn; ventral nerve root

Corticospinal

# reversed prompt motor frontal lobe-\>posterior Int capsule-\> cerebral peduncle in midbrain -\> in pons-\> pyramids of medulla where they decussate (after ipsi, snake eyes)

Corticospinal --path

# reversed prompt Pain & temp from opposite of the body. Ascending -rise 2 levels before crossing - Ventral posterior lateral thalami (body) - ventral posterior medial thalami ( head) -Then 1mary sensory of the cortex (parietal lobe)

Spinothalamic

# reversed prompt -^ tone, spasticity, pathological reflexes like Babinski -bebefit from baclofen, botox into muscles

Upper Motor Neuron signs

# reversed prompt decreased tone, reflexes, atrophy, fasciculations

Lower Motor Neuron Signs

# reversed prompt -Loss of propioception, vibration, Weakness ipsi - Loss of P&T contra

Hemicord (Brown Sequard)

# reversed prompt -Loss of P&T in "shawl" (ST being effected in middle as it crosses) - Weakness if possible if anterior horn effected -syrinx/syringomelia most common (most commonly caused by chiari malformation

Central Cord

# reversed prompt -Weakness b/l -Loss of P&T b/l -Preservation of propioception/vibration - Occlusion of anterior spinal artery (occurs in its become hypotensive or surgery on abdominal aorta)

Anterior Cord Syndrome

# reversed prompt loss of propioception--intense pain/burning sensation in limbs

Posterior Cord syndrome

# reversed prompt -Weakness and loss of all sensation below the lesion

Complete Cord transection

# reversed prompt -10 nerve fiber pairs & single coccygeal -usually disc at L4-5, L5-S1 -numbness in genitals, buttocks, and anus due to sacral nerve compression (saddle anesthesia) -extremity weakness , often asymmetric -decreased knee reflexes - Bowel and bladder retention (later)

Cauda Equina Syndrome

# reversed prompt -Lesion L1-L2 - Symmetrical weakness -Knee preserved;ankle jerks affected -Bladder/bowel incontinence early & impotence

Conus Medullaris

# reversed prompt Motor neurons of brain, CN, and anterior horn cells EEG: fasciculations, fibrillations, sharp waves TX: riluzole

ALS

# reversed prompt - damage of CS tract and dorsal columns - ^methylmalonic acid/ homocysteine -Megaloblastic anemia, hypersegmented neutrophils--\> psychiatric "megaloblastic madness" -seen in people with pernicious anemia, strict vegetarians, an post gastric bypass. Takes many years

B12 deficiency

# reversed prompt -Ataxia- -Hypotonia -Tremor -gait -Ocular motor -Scanning speech

Cerebellar Dysfunction

# reversed prompt - toxins (dilantin, ETOH, etc..) -primary neurodenerative - olivopontocerebellar atrophy -Paraneoplastic deg of cerebellum occurs with gyn cancers. anti YO antibodies -spinocerebellar ataxias (genetic) -Vasc disorders

Cerebellar dysfunction (causes)

# reversed prompt -Double crossed- ipsi - midline-\>axial muscle dysfunction lateral-\> limb ataxia

Cerebellum path