Lecture 31, 32: Brainstem Syndromes and Lesions of the Spinal Cord

Question 1

Motor information in brainstem is largely…

Answer 1

Anterior

Question 2

Sensory information in brainstem is largely…

Answer 2

Posterior

Question 3

First 3 CNs are in the…Hallmark CN of this region?

Answer 3

Midbrain; CN 3

Question 4

Principle cranial nerves of pons?

Answer 4

CN 6, CN 7

Question 5

Hallmark CNs of medulla

Answer 5

CN 9, 11, 12

Question 6

What is special about CN5?

Answer 6

Stretches through the brainstem so doesn’t help with localization

Question 7

What do we mean by “Crossed Signs”

Answer 7

Lesion on one side presents ipsilateral on face and contralateral on body

Question 8

One side: 3rd nerve palsy; Other side: hemiplegia. Lesion?

Answer 8

Lesion in midbrain corticospinal tract where III nerve emerges. Weber Syndrome.

Question 9

One side: cannot abduct; Other side: hemiplegia. Lesion?

Answer 9

Lesion in anterior pons where VI nerve emerges. Raymond Syndrome.

Question 10

One side: right facial weakness; Other side: hemiplegia. Lesion?

Answer 10

Lesion in lower anterior pons. Millard-Gubler Syndrome.

Question 11

Wallenberg Syndrome (presentation, symptoms and lesion localization, note CNs affected)

Answer 11

Slurred speech, imbalance, numbness (pain/temperature). One side: facial numbness, depressed gag; Other side: body numbness; cerebellar ataxia; lesion in posterior medulla (affecting CN IX, X, XI and V nucleus)

Question 12

Define dysarthria

Answer 12

Problem with speech mechanics/articulation, leads to slurred speech

Question 13

Dysarthria w/ lingual quality; One side: tongue weakness; Other side: body weakness. Lesion?

Answer 13

Lesion in anterior medulla. Jackson Syndrome.

Question 14

Locked-in Syndrome. What CN is spared?

Answer 14

Quadriplegic, aphonic, no horizontal eye movements, blinking intact; CN III spared (blinking)

Question 15

Monoplegia

Answer 15

Paralysis of one limb

Question 16

Diplegia

Answer 16

Paralysis of both upper or both lower limbs

Question 17

Paraplegia

Answer 17

Paralysis of both lower limbs

Question 18

Hemiplegia

Answer 18

Paralysis of upper limb, torso, and lower leg on one side of the body

Question 19

Quadriplegia

Answer 19

Paralysis of all four limbs

Question 20

In a spinal cord lesion, you find UMN findings where? Including…(2)

Answer 20

Below the lesion; Hyperreflexia and Babinski sign

Question 21

Myelopathy

Answer 21

Spinal cord disease

Question 22

Two types of myelopathies

Answer 22

Compressive and noncompressive

Question 23

Compressive myelopathies include problems inside or outside the spinal cord? Give some examples (4)

Answer 23

Outside; Cervical spondylosis
epidural damage (neoplasm, abscess, hemorrhage); herniated disc; posttraumatic compression

Question 24

Neurogenic bladder and two types

Answer 24

Overactive (spastic contraction leads to frequency and small amounts of urine) and underactive (overflow/retention)

Question 25

What are some other autonomic disturbances of the spinal cord? (3)

Answer 25

Bowel, BP, sweating

Question 26

Four types of high cervical pathology

Answer 26

Syrinx, chiari malformation, cordoma/meningioma, rheumatoid arthritis

Question 27

Syringomyelia first affects, what does this cause? What happens later? What tract?

Answer 27

Crossing spinothalamic fibers in a segment –> cape-like sensory loss, LMN: local weakness of muscles and hyporeflexia; followed by UMN (corticospinal tract) symptoms (spaticity and hyporeflexia)

Question 28

Syringobulbia. Serious complication?

Answer 28

Syringomyelia in brainstem; decompensation

Question 29

Syringomyelia and bublia can be related to…(2)

Answer 29

Congenital/trauma

Question 30

What is a complete spinal cord transection?

Answer 30

Transverse myelopathy

Question 31

Transverse myelitis is usually a…describe acute/later presentation

Answer 31

Inflammatory disorder. Acute: spinal scock; Later: UMN

Question 32

Spinal shock

Answer 32

Presents with flaccid/areflexic responses

Question 33

Brown Sequard syndrome is…

Answer 33

Hemisection of the spinal cord. Ipsilateral loss of proprioception and weakness and contralateral loss of pain/temp (2 levels below); LMN signs at lesion level

Question 34

Posterolateral column disease common cause and classic symptoms

Answer 34

B12 deficiency; ataxic gait, paresthesia, proprioception abnormal

Question 35

Combined anterior horn cell and pyramidal tract disease (motor neuron disease) one liner

Answer 35

Progressive diffuse LMN signs with UMN dysfunction

Question 36

Conus syndrome. What is preserved?

Answer 36

Bilateral saddle anesthesia (S3-S5), urinary retention and incontinence with lax anal tone, impotence; muscle strength in legs largely preserved

Question 37

Cauda equina syndrome. What is preserved?

Answer 37

Severe lower back/radicular pain and asymmetric leg weakness; sacral sparing

Question 38

Disc herniation mechanics. What posture often makes it worse? What sign elicits it? Most common surgery.

Answer 38

Nucleus pulposus herniates out through annulus fibrosus; sitting often makes it worse; straight leg raising; laminectomy

Question 39

Spondylolisthesis common name and definition

Answer 39

Slipped disc; anterior/posterior displacement of a vertebrae

Question 40

Spinal stenosis common location, effect, and causes (broadly, 3)

Answer 40

Lumbar spine; claudication of cauda equnia causing lower back pain that gets worse while walking (blood supply to cauda equina is compressed –> legs steal blood); congenital, degenerative, trauma

Question 41

Acute viral myelitis causes…

Answer 41

Transverse myelitis

Question 42

Tabes dorsalis. Sign? Symptoms?

Answer 42

Form of tertiary neurosyphilis in which the nerves of the dorsal (or posterior) columns degenerate; Romberg; shooting pain in legs and loss of sense of position, vibration, and discriminative touch

Question 43

What is the most common pathogen that causes epidural abscess? Where does the infection usually originate?

Answer 43

Staphylococcus; skin/soft tissue

Question 44

Three primary spinal tumor locations, which is most common?

Answer 44

Extradural/epidural = most common (b/t meninges and spine bones); intradural extramedullary (within meninges); intramedullary (inside the cord)

Question 45

Extradural tumor usually arise from…Clinical course

Answer 45

Bone; quick decompensation (some low back pain, then sudden paralysis = medical emergency)

Question 46

Intradural extramedullary tumors include which two tumor types…Common?

Answer 46

Meningioma, schwannoma; no, rare

Question 47

Traumatic spinal cord disease preferentially affects…

Answer 47

Males >30 years old

Question 48

Hangman’s fracture

Answer 48

Spondylolisthesis where C2 vertebrae is displaced anteriorly to C3 due to C2 pedicle fracture –> DEATH due to vessel/airway obstruction (why you DON’T move someone with a possible spinal cord injury)

Question 49

Central cord syndrome and individuals typically affected. Looks like?

Answer 49

Spinal cord damages starts centrally, involves spinothalamic tract initially (thermo/pain); edlerly; syringomylia

Question 50

What does anterior spinal artery infarct look like? What is spared?

Answer 50

Weakness (CST) and pain/temperature loss (spinothalamic tracts); posterior columns still working

Question 51

What is a spinal cord arteriovenous malformation (AVM)? When do they cause problems?

Answer 51

Tortuous/malformation arterial or venous problem (or aneurysm) that can lead to spontaneous bleeding, which can cause acute problems.