Lecture 31, 32: Brainstem Syndromes and Lesions of the Spinal Cord Flashcards
Motor information in brainstem is largely…
Anterior
Sensory information in brainstem is largely…
Posterior
First 3 CNs are in the…Hallmark CN of this region?
Midbrain; CN 3
Principle cranial nerves of pons?
CN 6, CN 7
Hallmark CNs of medulla
CN 9, 11, 12
What is special about CN5?
Stretches through the brainstem so doesn’t help with localization
What do we mean by “Crossed Signs”
Lesion on one side presents ipsilateral on face and contralateral on body
One side: 3rd nerve palsy; Other side: hemiplegia. Lesion?
Lesion in midbrain corticospinal tract where III nerve emerges. Weber Syndrome.
One side: cannot abduct; Other side: hemiplegia. Lesion?
Lesion in anterior pons where VI nerve emerges. Raymond Syndrome.
One side: right facial weakness; Other side: hemiplegia. Lesion?
Lesion in lower anterior pons. Millard-Gubler Syndrome.
Wallenberg Syndrome (presentation, symptoms and lesion localization, note CNs affected)
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)
Define dysarthria
Problem with speech mechanics/articulation, leads to slurred speech
Dysarthria w/ lingual quality; One side: tongue weakness; Other side: body weakness. Lesion?
Lesion in anterior medulla. Jackson Syndrome.
Locked-in Syndrome. What CN is spared?
Quadriplegic, aphonic, no horizontal eye movements, blinking intact; CN III spared (blinking)
Monoplegia
Paralysis of one limb
Diplegia
Paralysis of both upper or both lower limbs
Paraplegia
Paralysis of both lower limbs
Hemiplegia
Paralysis of upper limb, torso, and lower leg on one side of the body
Quadriplegia
Paralysis of all four limbs
In a spinal cord lesion, you find UMN findings where? Including…(2)
Below the lesion; Hyperreflexia and Babinski sign
Myelopathy
Spinal cord disease
Two types of myelopathies
Compressive and noncompressive
Compressive myelopathies include problems inside or outside the spinal cord? Give some examples (4)
Outside; Cervical spondylosis epidural damage (neoplasm, abscess, hemorrhage); herniated disc; posttraumatic compression
Neurogenic bladder and two types
Overactive (spastic contraction leads to frequency and small amounts of urine) and underactive (overflow/retention)
What are some other autonomic disturbances of the spinal cord? (3)
Bowel, BP, sweating
Four types of high cervical pathology
Syrinx, chiari malformation, cordoma/meningioma, rheumatoid arthritis
Syringomyelia first affects, what does this cause? What happens later? What tract?
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)
Syringobulbia. Serious complication?
Syringomyelia in brainstem; decompensation
Syringomyelia and bublia can be related to…(2)
Congenital/trauma
What is a complete spinal cord transection?
Transverse myelopathy
Transverse myelitis is usually a…describe acute/later presentation
Inflammatory disorder. Acute: spinal scock; Later: UMN
Spinal shock
Presents with flaccid/areflexic responses
Brown Sequard syndrome is…
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
Posterolateral column disease common cause and classic symptoms
B12 deficiency; ataxic gait, paresthesia, proprioception abnormal
Combined anterior horn cell and pyramidal tract disease (motor neuron disease) one liner
Progressive diffuse LMN signs with UMN dysfunction
Conus syndrome. What is preserved?
Bilateral saddle anesthesia (S3-S5), urinary retention and incontinence with lax anal tone, impotence; muscle strength in legs largely preserved
Cauda equina syndrome. What is preserved?
Severe lower back/radicular pain and asymmetric leg weakness; sacral sparing
Disc herniation mechanics. What posture often makes it worse? What sign elicits it? Most common surgery.
Nucleus pulposus herniates out through annulus fibrosus; sitting often makes it worse; straight leg raising; laminectomy
Spondylolisthesis common name and definition
Slipped disc; anterior/posterior displacement of a vertebrae
Spinal stenosis common location, effect, and causes (broadly, 3)
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
Acute viral myelitis causes…
Transverse myelitis
Tabes dorsalis. Sign? Symptoms?
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
What is the most common pathogen that causes epidural abscess? Where does the infection usually originate?
Staphylococcus; skin/soft tissue
Three primary spinal tumor locations, which is most common?
Extradural/epidural = most common (b/t meninges and spine bones); intradural extramedullary (within meninges); intramedullary (inside the cord)
Extradural tumor usually arise from…Clinical course
Bone; quick decompensation (some low back pain, then sudden paralysis = medical emergency)
Intradural extramedullary tumors include which two tumor types…Common?
Meningioma, schwannoma; no, rare
Traumatic spinal cord disease preferentially affects…
Males >30 years old
Hangman’s fracture
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)
Central cord syndrome and individuals typically affected. Looks like?
Spinal cord damages starts centrally, involves spinothalamic tract initially (thermo/pain); edlerly; syringomylia
What does anterior spinal artery infarct look like? What is spared?
Weakness (CST) and pain/temperature loss (spinothalamic tracts); posterior columns still working
What is a spinal cord arteriovenous malformation (AVM)? When do they cause problems?
Tortuous/malformation arterial or venous problem (or aneurysm) that can lead to spontaneous bleeding, which can cause acute problems.
