First Aid Neurology

Question 1

ACA blood supply to functional areas and ACA strokes

Answer 1

leg - motor, sensory
language dominant hemisphere: broca’s area
prefrontal cortex: Functions in volition, motivation, and planning and organizing of complex behaviour.

ACA stroke deficits: (Right) leg motor cortex and sensory loss.
PFC/dom motor areas: grasp reflex, frontal lobe behavioral abnormalities, transcortical aphasia

Question 2

MCA blood supply to functional areas:
L/R superficial divisions
Lenticulostriate

Answer 2

Left superficial branch: Broca’s area, Wernicke’s area, right motor/sensory head, neck, trunk, arm

Right superficial branch: left motor/sensory head, neck, trunk, arm

Lenticulostriate branches:

• striatum (caudate/putamen) - receive cortical inputs via BG –> D/indirect motor initiation and control
• Globus pallidus - output BG to thal and substantia nigra
• Internal capsule

Question 3

MCA stroke types: superficial and lenticulostriate

Answer 3

superficial: (MCA infarct opp loss) motor/sensory head, neck, trunk, arm (L MCA-maybe nonfluent aphasia (broca), fluent aphasia (Wernicke’s)
lenticulostriate: (R/L) pure upper-motor hemiparesis due to damage to the basal ganglia (globus pallidus and striatum) and the genu of the internal capsule on the (R/L) side. Larger infarcts extending to the cortex may produce cortical deficits such as aphasia

Question 4

PCA blood supply to functional areas: superficial and deep branches

Answer 4

PCA superficial branch:

• occipital lobe –Primary and secondary visual areas. Functions in the sensation and interpretation of visual inputs
• splenium corpus collosum (R/L visual areas share)

PCA deep branch:

• Thalamus –Relay center for descending and ascending information. Functions in the integration between cerebral cortex and the rest of the central nervous system.
• Internal capsule –Contains descending fibers of the lateral and ventral corticospinal tracts.

Question 5

PCA strokes: left and right

Answer 5

Left PCA infarct: Right homonymous hemianopsia due to damage to left visual cortex in the occipital lobe. Extension to the splenium of the corpus collusom (alexia without agraphia). Larger infarcts w/internal capsule and thalamus hemisensory loss + right hemiparesis (disruption of the ascending and descending information)

Right: Left homonymous hemianopsia (damage to right visual cortex in the occipital lobe). Larger infarcts-internal capsule + thalamus (left hemisensory loss + left hemiparesis due to disruption of the ascending and descending information)

Question 6

NT synthesis locations: 
Ach
DA
GABA
NE
SER

Answer 6

Ach - Basal nucleus of Meynert
DA - ventral tegmentum, SNpc
GABA - Nucleus accumbens
NE - Locus ceruleus
SER - Raphe nucleus

Question 7

Aphasia:
locations -brocas/Wernicke’s
conduction aphasia
“trans aphasia” trend

Answer 7

Broca - inf frontal gyrus of frontal lobe
Wernicke - superior temporal gyrus of temporal lobe

Conduction aphasia - fluent speech, intact comprehension, impaired repetition
“trans aphasia” trend = repetition is intact

Question 8

Infarcts : nondom parietal vs dom parietal

Answer 8

Nondominant parietal: hemispatial neglect (agnosia of contralateral side of world)

Dominant parietal: agraphia, acalculia, finger agnosia, L/R disorientation

Question 9

Anterior Spinal Artery infarct / Medial Medullary Syndrome (paramedian branches ASA +/or VA’s)

Answer 9

lateral CS tract = contralateral paralysis U/LE
medial lemniscus = dec contralateral proprioception
caudal medulla = ipsilateral hypoglossal N dysfunction

Question 10

PICA infarct / Lateral Medullary Syndrome (Wallenberg)

Answer 10

nystagmus, dec pain/temp sense ipsilateral face + contralateral body, *dysphagia (nucleus ambiguous), *hoarsenss

Question 11

AICA infarct / Lateral pontine syndrome

Answer 11

Paralysis of face

Question 12

Basilar Artery infarct

Answer 12

Involves medulla, pons, lower midbrain

-lock in syndrome

Question 13

PCA infarct

Answer 13

• areas: occipital lobe, visual cortex

- Sx: contralateral hemianopia with macular sparing

Question 14

Intracranial hemorrhage (brief):
Epidural hematoma
Subdural hematoma
SAH
Intraparenchymal hemorrhage

Answer 14

Epidural hematoma (MMA-maxillary A branch, lens, doesn't cross suture)
Subdural hematoma (bridging veins, crescent, crosses suture)
SAH (use nimodipine to prevent 4-10 day vasospasm after hemorrhage)
Intraparenchymal hemorrhage (systemic HTN, amyloid angiopathy, reperfusion injury ---in BG and internal capsule)

Question 15

Poliomyelitis - SC lesions

Answer 15

Anterior horn cells (ALS = ant horn cells + corticospinal tracts)
**asymmetric weakness

Question 16

Fredreich ataxia

Answer 16

AR, repeat (GAA) ->fraxtin ->mitochondria
Sx: muscle weakness, loss DTRs, vibratory sense, proprioception = staggering gait, falls
Other Sx: DM, HCM (death), childhood kyphoscoliosis

Question 17

Landmark dermatomes: C6, T4, T10, L1, L4, S2/3/4

Answer 17

C6 = thumbs up looks like 6
T4 = "teat pore"
T10 = bellybut"ten"
L1 = "IL" (inguinal ligament
L4 = "Down on all 4's" = kneecaps
S2/3/4 = "keep penis off the floor" (erection, sensation penile and anal zones)

Question 18

Visual field defects - quadrantic anopia: temporal + parietal lobes

Answer 18

upper quadrantic anopia = temporal lobe infarct/lesion

lower quadrantic anopia = parietal lobe infarct/lesion

Question 19

Herniation syndrome:
1 - Cingulate
2 - Transtentorial
3 - Uncal
4 - Cerebellar tonsillar

Answer 19

1 - Cingulate - under falx cerebri (compress ACA)
2 - Transtentorial (Downward) - displace brainstem, rupture paramedian basilar artery branches -> death
3 - Uncal (medial temporal lobe) herniation - compress ipsilarteral CN III (blown pupil, down and out gaze), ipsilateral PCA
4 - Cerebellar tonsillar herniation into foramen magnum = coma and death, compress brainstem