Lesions

Question 1

Glossopharyngeal n. lesion

Answer 1

Diminished taste posterior tongue; loss of stylopharyngeus contraction ipsilaterally — gag reflex affected

Question 2

Vagus nerve root lesion

Answer 2

Dysphagia, dysarthria, weak palate, uvula deviates to contralateral side

Question 3

Nucleus ambiguus lesions

Answer 3

Contralateral palatal arch weakness and drooping

Ipsilateral uvula deviation

Question 4

Hypoglossal nucleus lesion

Answer 4

Contralateral tongue deviation

Question 5

Hypoglossal nerve lesion (LMN)

Answer 5

Ipsilateral tongue deviation, muscle paralysis and atrophy

Question 6

Abducens n. lesion

Answer 6

Often d/t medial pontine syndrome

Ipsilateral flaccid paralysis of LR, opposite eye still adducts

Question 7

Lesion to abducens nucleus

Answer 7

Ipsilateral LR paralysis + failure of contralateral eye to abduct (because both motor neuron and interneuron affected)

=LMN lesion + internuclear ophthalmoplegia

Question 8

Lesions rostral to facial motor nucleus

Answer 8

Supranuclear facial palsy — contralateral lower half of face droop

Question 9

Facial nerve root lesion

Answer 9

Bell’s palsy - ipsilateral

Question 10

Oculomotor nerve/nucleus lesion

Answer 10

Ipsilateral paralysis of EOM (except SO and LR)

Diplopia, mydriasis, loss of accommodation

Question 11

Accessory nerve root lesion

Answer 11

Ipsilateral shoulder droop, scapular winging, can’t turn head to opposite side against resistance

[similar findings with cervical cord damage or internal capsule damage]

Question 12

Trochlear nerve root lesion

Answer 12

Ipsilateral SO paralysis

Question 13

Trochlear nerve lesion in midbrain (MLF)

Answer 13

Contralateral SO paralysis, ipsilateral INO

Question 14

Uncal herniation NOT involving kernohan’s notch causes limb weakness on which side?

Answer 14

Contralateral

[if affecting kernohans would be ipsilateral + respiratory compromise]

Question 15

Falx herniation symptoms

Answer 15

Headache + contralateral leg weakness

Question 16

ACA occlusion

Answer 16

Sensory and motor deficits of bilateral UEs, worse in distal muscles

Question 17

PICA occlusion

Answer 17

Lateral medullary syndrome

Contralateral loss of pain/temp over body with ipsilateral loss of pain/temp on face

Question 18

PCA occlusion

Answer 18

D/t thrombosis or uncal herniation —> ischemia of visual cortex

Contralateral homonymous hemianopsia with macular sparing

Question 19

Which nucleus is affected with phantosmia

Answer 19

Medial dorsal thalamic nucleus

Question 20

Lenticulostriate hemorrhage on right side

Answer 20

Left spastic hemiparesis of extremities
Left facial paralysis
Left tongue deviation
Right uvula deviation
Variable R deficits of SCM/trap

Question 21

Horner’s syndrome is related to ipsilateral damage of what tract

Answer 21

Lateral reticulospinal

Question 22

Lesions to AWC

Answer 22

Bilateral analgesia (usually upper extremities)

Question 23

Unilateral damage to cochlear nerve or cochlear nucleus

Answer 23

Ipsilateral monaural deafness

Question 24

Unilateral damage at/above superior olivary nucleus in auditory pathway

Answer 24

Hearing issues on contralateral side

Question 25

Which type of aphasia may be induced by MCA occlusion

Answer 25

Wernicke’s

Question 26

Conduction aphasia is related to damage in what area

Answer 26

Arcuate fasciculus and left parietal region [poor speech repetition]

Question 27

Associative visual agnosia is usually d/t occlusion of what a?

Answer 27

PCA —> infarct of occipital lobe + posterior corpus callosum

Question 28

Destruction of primary spinal trigeminal tract and secondarily in spinal lemniscus

Answer 28

Ipsilateral hemianalgesia of face Contralateral hemianalgesia of body [called alternating hemianalgesia]

Question 29

Unilateral trigeminal n. damage + corticospinal tract destruction in pons

Answer 29

Ipsilateral trigeminal anesthesia and paralysis Contralateral spastic hemiplegia [called alternating hemiplegia of trigeminal]

Question 30

Lesion to posterior limb of internal capsule

Answer 30

Contralateral complete hemiparesis of face, upper extremity, and lower extremity [damaged lenticular striate artery]

Question 31

Lesion of spinothalamic path

Answer 31

Loss of pain/temp on contralateral side 1-2 levels below lesion

Question 32

Brown sequard syndrome = hemisection of spinal cord

Answer 32

Complete loss of p/t 1-2 levels below (Lissauers tract) Ipsilateral tactile/proprioceptive loss below lesion Ipsilateral loss of all sensation at level of lesion Motor losses vary

Question 33

Syringomyelia

Answer 33

Loss of p/t bilaterally in shawl-like distribution

Question 34

Lesions to ACA vs. MCA vs. PCA

Answer 34

ACA —> tactile loss over CL LE MCA —> tactile loss over CL UE + face PCA —> tactile loss over CL body and head

Question 35

Lesions to primary somatosensory cortex affect what side of the body

Answer 35

Contralateral

Question 36

Lesions to fasciculus cuneatus or gracilis

Answer 36

Ipsilateral tactile loss at+below, sensory ataxia