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MBBS IV - Junior Clerkship WCS > JC21, 22 - Where is the lesion I & II > Flashcards

JC21, 22 - Where is the lesion I & II Flashcards

1
Q

S/S of extrapyramidal system lesion

A

Movement disorders:

  • Miscoordination of movement
  • Akinesia/ Bradykinesia
  • Stiffness/ Rigidity (Lead-pipe and cogwheel)
  • Tremor
  • Dysphagia
  • Postural Instability
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2
Q

S/S of cerebellar lesion (9)

A

Intention tremor

Dysmetria (past-pointing)
• Finger-nose test
• Heel-shin test

Dysdiadochokinesia

Dysarthria
• Slowed, slurred or scanning speech

Nystagmus
• Nystagmus on horizontal or vertical conjugate gaze
• Nystagmus towards the side of lesion

Wide-based gait

Truncal or limb ataxia
• Ataxia refers to lack of voluntary coordination of muscles
• Unable to perform tandem gait (heel-toe walking) despite normal strength

Pronator drift and rebound test
• Slow pronation of wrist and upward drift on pronator drift test
• Overshoot and bounce on rebound test

Romberg test
• Unsteadiness with eyes open

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3
Q

S/S of peripheral nerve lesion

A

Motor and sensory dysfunction

Paresthesia, numbness

LMN signs: flaccid paralysis, muscle wasting, loss of tone, loss of power, areflexia

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4
Q

Spinal nerve levels that form brachial and lumbosacral plexus

A

Brachial plexus = C5 – T1
• Anterior (ventral) rami of C5 through T1 nerve roots

Lumbosacral plexus = L1 – S4
• Anterior (ventral) rami of L1 through S4 nerve roots
• Lumbar plexus = L1 – L4
• Sacral plexus = L4 – S4

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5
Q

Spinal nerve levels that form the sympathetic nervous system

A

Sympathetic nervous system
• Emerges from thoracic and lumbar spinal cord from T1 – L2

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6
Q

Components of the parasympathetic nervous system

A

• Emerges from brainstem from CN III/ VII, IX, X (3, 7, 9, 10) (AND)
o CN III/ VII/ IX carry parasympathetic fibers to structures within H&N only
o CN X carry parasympathetic fibers to thoracic and abdominal viscera

• Emerges from sacral spinal cord from S2 – 4
o Innervate inferior abdominal viscera, pelvic viscera and arteries of erectile tissues in perineum
o e.g. Bladder emptying = S2 – 4 (Pelvic splanchnic nerve)

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7
Q

Define possible locations of UMN lesions and LMN lesions

A
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8
Q

UMN vs LMN lesion

  • Structures involved
  • Distribution
  • Muscle tone
  • Reflex
A
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9
Q

UMN vs LMN lesion

  • Muscle wasting
  • Classical signs
A
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10
Q

Frontal lobe

  • Function
  • Effects of damage on cognition/ behavior, physical control
  • Positive phenomenon
A
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11
Q

Parietal lobe (Dominant side)

  • Function
  • Effects of damage on cognition/ behavior, physical control
  • Positive phenomenon
A

(Astereognosis - cannot tell shapes/ size/ objects by touch
Agraphesthesia - Impaired ability to recognize letters or numbers drawn by an examiner’s fingertip on the patient’s skin
Agraphia - cannot write)

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12
Q

Parietal lobe (Non-Dominant side)

  • Function
  • Effects of damage on cognition/ behavior, physical control
  • Positive phenomenon
A
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13
Q

Parietal lobe (Non-Dominant side)

  • Function
  • Effects of damage on cognition/ behavior, physical control
  • Positive phenomenon
A
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14
Q

Temporal lobe

  • Function
  • Effect of damage on cognition and motor control
  • Positive phenomenon
A
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15
Q

Occipital lobe

  • Function
  • Effect of damage on cognition, motor control
  • Positive phenomenon
A
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16
Q

4 types of dysphasia

A

Receptive
Expressive
Conductive
Nominal

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17
Q

Describe the nature and location of 4 types of dysphasia

A
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18
Q

How to distinguish left-sided and right-sided lesions

A
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19
Q

Components of the pyramidal system

A

Corticospinal and corticobulbar tract

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20
Q

Outline the course of the corticospinal tract

A
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21
Q

Outline the course of the corticobulbar tract

A
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22
Q

Components of the basal ganglia?

A
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23
Q

Weber syndrome

  • Area of infarct
  • Arteries involved
  • Clinical manifestation
A

Weber syndrome
• Site of lesion = Anterior cerebral peduncle in midbrain
• Midbrain stroke syndrome due to occlusion of paramedian branches of PCA or basilar bifurcation perforating arteries

• Characterized by ipsilateral oculomotor nerve palsy and contralateral hemiparesis
o (Ipsilateral) LMN CN III palsy
o (Contralateral) UMN CN VII palsy (Corticobulbar tract)
o (Contralateral) Hemiplegia (Corticospinal tract)

24
Q

Pattern of midbrain lesion

A
  • CN III – IV palsy
  • Contralateral UMN hemiparesis (Corticospinal tract)
25
Q

Parinaud syndrome

  • Site of lesion
  • Causes
  • Clinical manifestation
A

Parinaud syndrome
• Site of lesion = Dorsal midbrain (tectum)
• Constellation of neuroophthalmologic findings seen with dorsal midbrain lesions including abnormalities of vertical gaze and convergence

• Caused by multiple sclerosis, pinealoma or vascular lesion
• Clinical manifestation
o Loss of vertical gaze
o Nystagmus on attempted convergence
o Pseudo-Argyll Robertson pupil (bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light (i.e., they do not react))

26
Q

Outline clinical manifestation of pontine lesions

A
  • CN V – VIII palsy
  • Contralateral UMN hemiparesis (Corticospinal tract)
  • Cerebellar signs (Cerebellar peduncle)
  • Dysconjugate eye movements (Paramedian pontine reticular formation (PPRF))
  • Internuclear ophthalmoplegia (INO) (Medial longitudinal fasciculus (MLF)
27
Q

Outline clinical manifestation of medulla oblongata lesion

A

Medulla oblongata lesions
• CN V, IX – XII palsy
• Contralateral UMN hemiparesis (Corticospinal tract)
• Cerebellar signs (Cerebellar peduncle)

28
Q

Wallenberg syndrome

  • Site of lesion
  • Causes
A

Lateral medullary syndrome (Wallenberg syndrome)
• Site of lesion = Lateral medulla

• Causes of Wallenberg syndrome
o Brainstem infarction due to occlusion of vertebral artery and its lateral medullary penetrating arteries or PICA (< 15%) (from local thrombotic occlusion, cardioembolism or arterial thromboembolism from vertebral artery dissection)
o Brainstem hemorrhage
o Brainstem demyelination (multiple sclerosis)
o Leukoencephalopathy with brainstem involvement (hypertension, drugs, autoimmune disease)

29
Q

Clinical manifestations of Lateral medullary syndrome

A

o (Ipsilateral) LMN CN V palsy (Loss of all sensory modalities or paraesthesia of face) plus (Contralateral) Loss of pain and temperature sensation or paraesthesia in trunk and limbs (Spinothalamic tract)

o (Ipsilateral) LMN CN IX, X palsy (Dysphagia/ Dysarthria/ Hoarseness of voice due to vocal cord paralysis/ Uvula deviation/ Loss of gag reflex  Aspiration pneumonia or hiccups)

o (Ipsilateral) LMN CN XI palsy

o (Ipsilateral) Cerebellar signs (Cerebellar ataxia with nystagmus towards the side of lesion) (Inferior cerebellar peduncle and cerebellar connections)

o (Ipsilateral) Horner’s syndrome (Descending sympathetic fibres injury)

o Vestibulocerebellar disturbance* (almost always present) leading to vertigo, nystagmus, vomiting and ipsilateral limb ataxia (Vestibulospinal tract)

30
Q 
# Define the location of conus medullaris and cauda equina 
Define the clinical manifestations of lesion at either location
A

 Conus medullaris
• Termination of spinal cord with its pia mater
• Ends at the level of L1/2
• Lesion at conus medullaris = Mixed UMN and LMN lesions

 Cauda equina
• Bundles of lumbar and sacral spinal nerves caudal to the termination of spinal cord
• Floats in CSF within the subarachnoid space
• Composed of lumbar, sacral and coccygeal nerve roots from L2 – C0 (10 pairs)
• Lesion at cauda equina = LMN lesion ONLY

31
Q

Spinal cord lesion:

General pattern of UMN and LMN signs at spinal cord level and spinal root level

A
32
Q

Spinal cord lesion:

General pattern of UMN and LMN signs at spinal cord level and spinal root level

A
33
Q

Spinal cord lesion above C5

  • Pattern of deficits
A
34
Q

Spinal cord lesion between C5 and T1

Clinical manifestation

A

Upper limbs: LMN signs
Lower limbs: UMN signs
Respiratory distress (Lesion below C5)
o Intact diaphragmatic function
o Inhale via diaphragm and accessory muscles
o Exhale primarily through passive recoil of chest wall and lungs since primary muscles of exhalation including internal intercostal and abdominal wall muscles are paralyzed

35
Q

Spinal cord lesion between T2 and T12

Pattern of deficit

A

T2 – T12
• Upper limbs: Spared
• Lower limbs: UMN signs

• Sphincter disturbances
o Sympathetic nervous system: Hypogastric nerve (T10 – L2)

• Erectile dysfunction
o Thoracolumbar erection centre (psychogenic erection by visual input) = T11 – L2

36
Q

Spinal cord lesion between L1 and S4

Pattern of deficit

A
  • Upper limbs: Spared
  • Lower limbs: LMN signs

• Sphincter disturbances
o Sympathetic nervous system: Hypogastric nerve (T10 – L2)
o Parasympathetic nervous system: Pelvic splanchnic nerve (S2 – 4)

• Erectile dysfunction
o Thoracolumbar erection centre (psychogenic erection by visual input) = T11 – L2
o Sacral erection centre (reflex erection by tactile stimulus) = S2 – 4

37
Q

Segmental/ Complete transection syndrome of spinal cord

Causes

Pattern of Sensory, Motor and Autonomic deficits

A
38
Q

Brown sequard syndrome

Causes

Pattern of sensory, motor and autonomic deficit

A

Causes: Trauma e.g. knife, bullet; asymmetrical compression from tumor or spondylosis, radiation necrosis

39
Q

Central cord syndrome

Cause

Pattern of sensory, motor and autonomic deficit

A

Clinical features depend on extent:

  • At the level without extension >> bilateral spinothalamic
  • Extends anteriorly >> Anterior horns deficit, LMN at the level only
  • Extends laterally >> Lateral CST deficit, UMN below the level

Causes:

  • Acute: spinal hemorrhage, trauma, transverse myelitis, cervical spondylosis with hyper-extension injury
  • Chronic: syringomyelia, tumor
40
Q

Anterior cord syndrome

Causes

Patterns of sensory, motor and autonomic deficit

A

Causes:

  • DM, Atrial fibrillation, invasive intravascular procedures, acute hypoperfusion
41
Q

Posterior cord syndrome

Causes

Pattern of sensory, motor and autonomic deficit

A
42
Q

Conus medullaris syndrome

Cause

Pattern of sensory, motor and autonomic deficit

A
43
Q

Cauda equina syndrome

Causes

Pattern of sensory, motor and autonomic deficit

A
44
Q

Cauda equina syndrome

Causes

Pattern of sensory, motor and autonomic deficit

A
45
Q

Name all tracts affected by Brown-sequard syndrome

A
46
Q

List all tracts affected by central cord syndrome

A
47
Q

List all tracts affected by anterior cord syndrome

A
48
Q

List all tracts affected by posterior cord syndrome

A
49
Q

Peripheral nerve lesion

  • 2 patterns of lesion
  • General neurological deficit pattern
A
50
Q

NMJ lesion

  • 2 categories
  • Examples
  • General deficit pattern
A
51
Q
A
52
Q
A
53
Q
A
54
Q

Neoplastic causes of spinal cord compression

A
55
Q
A

MBBS IV - Junior Clerkship WCS (131 decks)

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