Lecture 2: Neuroanatomy review

Question 1

Bilateral atonia, areflexia and flaccid paralysis involving th C7-T1 motor dermatomes indicates involvement of?

Answer 1

Anterior horn neurons

Question 2

Unilateral lesion of the corticobulbar fibers to the facial nucleus results in?

Answer 2

Paralysis of the contralateral LOWER quadrant of the face (supranuclear facial palsy)

Question 3

Supranuclear facial palsy indicates involvement of?

Answer 3

Corticobulbar tract

Question 4

Lesions of the ventral roots causes a ______ paralysis of the associated motor dermatome.

Leads to what finding?

Answer 4

• Lesions of the ventral roots causes a LMN paralysis of the associated motor dermatome.
• Atonia, areflexia, fasciculation, and flaccid paralysis (everything turned down!)

Question 5

Proprioceptive and 2-point tactile discrimination loss below the L3 dermatome indicates involvement of which part of dorsal column?

Answer 5

Fasciculus graciLis = Lower body, Legs

Question 6

Which nucleus is responsible for motor innervation of pharynx, larynx, upper esophagus (i.e., swallowing, palate elevation)?

Which CN’s involved?

Answer 6

Nucleus aMbiguus – Motor – CN IX, X, XI

Question 7

Lesion of the spinal lemniscus results in?

Answer 7

Contralateral loss of pain/temp (body)

Question 8

Lesions of the genu of the internal capsule affect fibers of the _________ tract

Answer 8

Corticobulbar tract –> Supranuclear facial palsy

Question 9

Bilateral atonia, areflexia and flaccid paralysis involving the C7-T1 motor dermatomes indicates involvement of which neurons in the spinal cord?

Answer 9

Anterior horn neurons

Question 10

Lesion to the spinal lemniscus would result in?

Answer 10

Contralateral hemianalgesia and thermal hemianesthesia (loss of temperature and pain)

Question 11

Lesion to the medial lemniscus would result in?

Answer 11

Contralateral loss of proprioceptive, vibratory, and 2-point tactile discrimination

Question 12

Lesion to the trigeminal lemniscus would result in what deficit

Answer 12

Contralateral loss of pain, temperature, and crude tactile sensation from face

Question 13

Alternating hemianalgesia is due to a lesion of?

Answer 13

Descending tract of V and Spinal lemniscus

Question 14

What’s the arrow pointing to?

Answer 14

Trigeminal nerve

Question 15

Thrombosis of the PICA results in?

Answer 15

Lateral Medullary (Wallenberg) Syndrome

Question 16

What is seen clinically in Lateral Medullary (Wallenberg) Syndrome?

Answer 16

• Destruction of spinal lemniscus –> contralateral hemianalgesia
• Destruction of descending tract of V = ipsilateral loss of pain + temp from face
• ALTERNATING HEMIANALGESIA

*Involves PICA!!!

Question 17

Cerebellopontine Angle (CPA) syndrome is due to what?

What symptoms seen?

Answer 17

• Acoustic neuroma (Schwannoma) enlarges and compresses lateral aspect of pons, cerebellum and medulla
• Deafness and vestibular disturbances
• Alternating hemianalgesia

Question 18

Which syndrome is characterized by ipsilateral oculomotor palsy, and contralateral motor dysfunction such as tremor, ataxia, or choreiform movements also contralateral loss of proprioception and 2-point tactile discrimination of the body and limbs?

Lesion is where in brainstem?

Answer 18

Benedikt’s syndrom = lesions of midbrain tegmentum

Question 19

When answering a lesion question what will indicate the level and side of the lesion?

Answer 19

Highest CN involved

*Use the rule of 4’s!

Question 20

Parinaud’s Syndrome is due to what lesion?

How does it present?

Often caused by?

Answer 20

• Lesion of superior colliculus
• Paralysis of upward gaze
• May be due to pineal tumor or varix of the great vein of Galen

Question 21

Which syndrome is characterized by a state of constant spontaneous pain w/o appropriate external stimulus, extreme mood swings, and may also involve contralateral hemihypalgesia (“crawling ant” sensations)?

Answer 21

Thalamic syndrome (Dejerine-Roussy Syndrome)