lesions Flashcards
damaged oculomotor nerve (midbrain)
- IPSILATERAL oculomotor palsy
- diplopia
- dilated pupil
damaged cerebellothalamic fibers (midbrain)
- CONTRALATERAL ataxia,
- tremor
- red nucleus hyperkinesias
damaged corticonuclear fibers (midbrain)
- CONTRALATERAL facial weakness lower face
- tongue deviation to contralateral side on protrusion
- IPSIlateral trapezius and sternoCM weakness
damaged occulomotor fibers (midbrain)
- IPSILATERALoculomotor paralysis
- diplopia,
- dilated pupil
damaged cortico spinal fibers (midbrain
contralateral hemiplegia
lesion to subthalamic nucleus deficits?
HEMIBALLISUMUS(corticospinal)
= rapid and unpredictable flailing of contralateral extremities; movements are usually more obvious in UE
occlusion of lenticulostriate branches to internal capsule: deficits
- CONTRALATERAL hemiplegia (corticospnal)
- loss or decreased pain, temp, proprio (thalamocortical fibers thru posterior capsule)
- maybe: partial CONTRALATERAL paralysis of facial muscles/tongue (genu/corticonuclear fibers)
occlusion of distal brances of MCA: deficits
- CONTRALATERAL motor and sensory loss of UE, trunk, face (precentral, postcentral gyri)
- deviation of eyes to ipsilateral side (frontal eye fields)
occlusion of distal branches of ACA:deficits
- motor and sensory losses in contralateral foot, leg, thigh (ant. post. paracentral gyrus)
antrior watershed infarct: where? deficits?
- ACA/MCA junction
- contralateral hemiparesis (usually leg)
- expressive language
- behavioral changes
posterior watershed infarct: where? deficits?
- MCA/PCA junction
- visual deficits
- language problems
anterior choroidal artery syndrome: deficits?
- HOMOnymous hemianopsia (optic tract)
- LOWER portions of basal nuclei
- hemiplegia, hemianesthesia (LOWER aspects of internal capsule)
clinical presentation of parkinsons
- stooped posture
- resting tremor
- rigidity
- shuffling or festinating gait
- trouble maintaining mvmt (a-, hypo-, or bradykinesia)
- dimentia (later)
medial midbrain lesion damages what STRX, what blood vessel
- corticspinal fibers in crus cerebri
- occulomotor nerve
- maybe corticobulbar fibers
- maybe substantia nigra, but usually no noticeable deficits
- paramedian branches of PCA
deficits of lesion to corticospinal fibers in crus cerebri?
blood vessel to area?
- CONTRALATERALhemiplegia of UE, trunk, LE (from occlusion of paramedian branches of PCA)
deficits of lesion to occulomotor nerve ?
blood to area?
- IPSILATERAL paralysis of eye movement: eye is “DOWN AND OUT”
- pupil dilated, fixed
- paramedian branches of PCA
deficits of lesion to corticobulbar fibers in crus cerebri?
- in tongue deviating to OPPOSITE side of lesion upon protrusion
- paralysis of lower half of facial muscles on CONTRALATERAL side
central midbrain lesion damages what structures
- oculomotor nerve
- red nucleus and CBELLOthalamic fibers
- maybe ML
- maybe ventral trigeminothalamic fibers
deficits of lesion to red nucleus and CBELLOthalamic fibers/
- CONTRALATERALataxia
- tremor of CBELLAR origin
pineocytoma can impinge?
- superior colliculi
- cerebral aquaduct
- trochlear/occulomotor nerve
- MLF
deficits of pineocytoma?
- paralysis of upward gaze (superior colliculi)
- hydrocephalus (cerebral aquaduct)
- failure of eye mvmt (trochlear/occulomotor nerve)
- nystagmus (MLF)
initial signs of uncal herneation
- dilation of pupils (uni or bipolar)
- slow reaction to light
- followed by weakness of occulomotor movement
progressive symptoms of uncal herniation
- fully dilated pupils
- eyes deviate laterally b/c of unapposed abducens nerves
- weakness on CONTRALATERAL side (crtocospinal fibers in crus)
symptoms of an especially large or bilateral supratentorial lesion
decorticate rigidity
= flexion and adduction of UE; extention of LE with internal rotation and plantar flexion
symptoms of an intratentorial lesion
decerebrate rigidity
= UE and LE extended, toes point inward, pronated forearm, head and neck extended
opisthotonos symptoms
EXTENDED head and neck
midline optic chiasm lesion
- BITEMPORAL hemianopia
- may have relative afferent pupillary defect (RAPD)
lateral optic chiasm lesion
- BINASAL hemianopia
- may have RAPD
optic tract lesion
- HOMOnymous hemianopia on ipsilateral side
- may have RAPD
total optic radiation lesion
- ipsilateral HOMOnymous hemianopia (also in lesion or total primary visual cortex)
cuneus lesion
- ipsilateral INFERIOR homonymous quadrantopia
lingual gyrus lesion
- ipsilateral SUPERIOR homonymous quadrantopia
optic nerve lesion
- ipsilateral blindness in that eye
- loss of pupillary light reflex in both eyes when light is shined into the blinded eye
what is enopthalmos
- a slight sinking of the eyeball into the orbit
- often MENTIONED for patients with Horner’s, but not always SEEN
lesion of the abducens root: muscle, and movement?
- ipsilateral lateral rectus muscle
- loss of lateral gaze
- when looking straight ahead, lesioned eye will deviate SLIGHTLY toward midline
lesion of abducens root: complaint
- diplopia
- especially when trying to look toward the lesioned size in the HORIZONTAL plane
caudal basilar pontine lesion: symptoms
- alternating hemiplegia (paralysis of lateral rectus on ipsilateral side; paralsis of body on contralateral side)
- diplopia
internuclear ophthalmoplegia symptoms
- loss of medial gaze
internuclear ophthalmoplegia lesion?
lesion in the MLF on the SAME side as the paralysis
lesion of abducens nucleus: damages?
- ALPHA motor neurons to ipsilateral lateral rectus muscle
- interneurons that terminate on alpha motor neurons in the contralateral oculomotor nucleus
lesion of abducens nucleus: symptoms
- loss of horizontal gaze in both eyes TOWARD lesion side
- normal horizontal gaze in both eyes AWAY lesioned side
- basically internal opthalmoplegia lesion plus abducens root lesion
one and a half syndrome: symptoms
- loss of medial and lateral voluntary eye mvmt on one side
- loss of medial mvmt on the contralateral side
one and a half syndrom: damages?
- abducens nucleus on one side
- the MLF right next to affected nucleus
- usually also affects paramedian pontine reticular formation aka “horizontal gaze center”
radiculopathy
- results from spinal nerve root damage
- radiating pain in a dermatomal patern
- weakness
- hyporeflexia
symptoms of cauda equina syndrome
- weakness of LE
- saddle anesthesia ( sensory deficits )
- urinary retention (decreased sphincter tone)
- decrease in sexual fxn
- sciatica
broca’s aphasia symptom and location
- inferior frontal gyrus (areas 44/45)
- motor, expressive, nonfluent aphasia
- NO vocal paralysis
- patients are well aware of their deficits
telegraphic speech
- associted with broca’s aphasia
- familiar single wordes or short phrases with left out words
wernicke aphasia
- supramarginal (area 40) and angular gyri (area 39(
- sensory, receptive, or fluent aphasia
- speek freely, but words may not make sense
- may not be aware of their deficits
paraphasia
- “word salad”
- associated with wernicke
structures that may be affected in uncal herniation
- CBellum
- uncus (temporal lobe)
- hypothalamus
- optic tract
aneurysms affecting the occulomotor nerve
aneurysm of basilar bifurcation
aneurysm of posterior communicating/PCA intersection
third nerve injury deficits
- dilated pupil
- loss of most eye mvmt
- diplopia
angterior choroidal artery syndrome (strx)?
optic tract and crus cerebri
damage to vestibular nuclei(medulla)
- nystagmus,
- vertigo
- nausea
damage to nucleus ambiguous (medulla)
- dysphagia,
- hoarseness
- deviation of uvula to contralateral side
spinal trigeminal tract nucleus
- ipsilateral loss of pain and thermal sense on face
conductive deafness
caused by problems of external ear or disorders of the middle ear
middle ear causes of conductive deafness
- otitis media
- otosclerosis
nerve deafness is from
diseases involving cochlea or the cochlear portion of the vestibulocochlear nerve
central deafnes results from
damage to the cochlear nuclie or their central connections
damage to cochlear part of the eighth nerve can be from __ and result in ___
vestibular schwaanoma
- tinnitus and or deafness
- presbyacusis (hard time hearing high pitch sound)
auditory agnosia is?
it can be from?
difficulty understanding and/or interpreting sounds
damage to secondary auditory cortex in the temporal lobe
