Lesions

Question 1

*Vascular lesions on the Anterolateral system

Answer 1

Vascular supply to ALS originates from the arterial vasocorona via sulcal branches of anterior spinal artery
Lesions = patchy loss of pain, thermal, touch on contralateral side of body about 2 segments below lesion

Question 2

*Anterolateral cordotomy

Answer 2

Complete loss of pain, thermal and touch sensations

Question 3

*Spinal cord hemisection (Brown-Sequard): Contralateral

Answer 3

Loss of pain and thermal sensations all over body. Begins aout 2 segments below level of lesion (ALS damage)

Question 4

*Spinal cord hemisection: Ipsilateral

Answer 4

Loss of discriminative tactile, vibratory and proprioception below lesion (posterior column damage).
Motor loss with paralysis of extremities

Question 5

*Syringomyelia

Answer 5

Cysts in central gray matter that impinge the Anterior white commissure (which contains ALS fibers).
At c4-c5, bilateral loss of nondiscriminative tactile, pain and thermal sensation. Starts several segments below the lesion. Cape like distribution (shoulder to nipple level and arms - looks like a cape)

Question 6

*Herpes zoster:

Answer 6

Viral DNA lays dormant in the nervous system. Virions travel down peripheral process and produce skin irritation in the dermatome. Diminished sense in affected areas. Postherpetic neuralgia

Question 7

*Medullary syndrome:

Answer 7

Vascular lesions or tumors in the brainstem can impinge the ALS fibers and affect discriminative touch and nociception

Question 8

*Lateral lesion for medullary syndrome

Answer 8

Wallenberg syndrome. Usually caused by vascular lesion to PICA which supplies the territory of the anterolateral system and the spinal trigeminal nucleus/tract
Contralateral loss of pain and temp with ipsilateral loss of pain and temp over face

Question 9

*Medial lesion for medullary syndrome

Answer 9

Contralateral loss of discriminative touch and vibratory sense. Dissociated sensory loss
Pain and thermal sensations are intact

Question 10

*Unilateral trigeminal nerve lesion:

Answer 10

Brainstem lesions destroy primary fibers in spinal trigeminal tract (descending tract) and secondary fibers in spinal lemniscus
Ipsilateral hemianalgesia of face and contralateral hemianalgesia of body

Question 11

*Alternating analgesia/hemianesthesia

Answer 11

Brainstem lesions destroy primary fibers in spinal trigeminal tract (descending tract) and secondary fibers in spinal lemniscus
Ipsilateral hemianalgesia of face and contralateral hemianalgesia of body

Question 12

*Alternating trigeminal hemiplegia:

Answer 12

Unilateral destruction of trigeminal nerve and CST in pons

Ipsilateral anesthesia, paralysis and contralateral spastic hemiplegia

Question 13

*Damage to trigeminal nerve or central nuclei:

Answer 13

Primary deficits include ipsilateral loss of pain, thermal or tactile sensations of face and scalp, oral cavity and teeth. Ipsilateral paralysis of mastication muscles
Also loss of afferent limb of corneal reflex

Question 14

*Vascular lesions on the Anterolateral system

Answer 14

Vascular supply to ALS originates from the arterial vasocorona via sulcal branches of anterior spinal artery
Lesions = patchy loss of pain, thermal, touch on contralateral side of body about 2 segments below lesion

Question 15

Lower motor neuron lesions usually presents with ….

Answer 15

Flaccid paralysis, wasting, hyporeflexia, hypotonia and fasciculations (muscle twitches)

Question 16

Upper motor neuron signs

Answer 16

Loss of the direct corticospinal tract and loss of regulation from the indirect brainstem motor control pathways

Question 17

Symptoms of upper motor neuron signs:

CST problems:

Indirect pathways modulation problems:

Answer 17

Loss of distal extremity strength
Babinski sign (inverted plantar reflex

Hypertonia (spastic or rigid)
Hyperreflexia (clonus)
Clasp knife phenomenon and spasticity
Pronator drift)

Question 18

Clues in LMN lesions

Answer 18

Clinical signs ipsilateral to lesion

Question 19

Decorticate posture:

Answer 19

bent arms, clenched fists, and legs held out straight, feet extended and inverted
Lesion above the level of the red nucleus

Question 20

Decerebrate posture:

Answer 20

Upper extremity in pronation and extension and lower extremity in extension

Question 21

Complete transection of spinal cord

Answer 21

All sensation 1 or 2 levels below lesion lost due to overlap of dermatomes
Incontinence 
Spinal shock (loss of tendon reflexes) 
UMN signs at levels below the lesion
LMN signs at the level of lesion

Question 22

Hemisection of spinal cord (Brown Sequard)

Answer 22

Pain and temp loss from contralateral side of body and loss of discriminative touch and proprioception on the ipsilateral side
LMN signs at level of lesion (flaccid paralysis)
UMN signs on ipsilateral side of lesion

Question 23

Syringomyelia

Answer 23

Cysts in spinal cord. Affects pain and temp sensation first due to impingement of the anterior white commissure. Cape pattern sensation loss.
Motor also lost (LMN signs if ventral horn is affected or UMN signs if lateral corticospinal tract is affected)

Question 24

Anterior cord syndrome

Answer 24

Damage to anterior spinal cord (usually due to spinal cord infarction, herniation or myelopathy

Question 25

Central cord syndrome

Answer 25

Central spinal cord damage usually due to cervical hyperextension

Question 26

Central Seven Palsy

Answer 26

Corticobulbar tract lesion involving CN VII. Upper face controlled equally by both hemispheres. Lower face is controlled by contralateral hemisphere.
Lesions rostral to CN VII nucleus results in muscle drooping on corner of mouth (contralateral side of lesion)

Question 27

Bell’s palsy

Answer 27

Ipsilateral flaccid paralysis of upper and lower face

Question 28

Spastic cerebral palsy

Answer 28

Spastic movement dysfunction.

Paresis, abnormal reflexes, abnormal postural coordination

Question 29

Amytrophic lateral sclerosis (ALS)

Answer 29

UMNs and LMNs destruction. UMN and LMN signs

CN involvement results in difficulty breathing, swallowing or speaking

Question 30

Polyneuropathy

Answer 30

Progress distal to proximal due to impaired axonal transport or demyelization. Affects sensory, motor and autonomic functions

Question 31

Nature of cerebellar lesions.

Answer 31

Specific to the cerebellum (problem with afferents and efferents)
Voluntary jerky, inaccurate movements, wide based gait

Question 32

Ataxia:

Answer 32

Specific to the cerebellum (problem with afferents and efferents)
Voluntary jerky, inaccurate movements, wide based gait

Question 33

Lesions of the vestibulocerebellum

Answer 33

Disrupts the integration of the vestibular system and flocculonodular lobe.
Nystagmus (beating of the eyes), truncal ataxia and truncal instability

Question 34

Truncal ataxia

Truncal instability

Answer 34

can’t maintain sitting or balance. wide spaced gait

Cannot stand still/rocking, can’t tandem walk

Question 35

Spinocerebellum lesions

Answer 35

Disrupts the connections between the cutaneous and proprioceptive tracts from the spinal cord to vermis region
Wide base gait and truncal ataxia

Question 36

Damage to vestibulocerebellum and spinocerebullum generally result in…

Answer 36

Midline ataxia

Question 37

Midline ataxia

Answer 37

Caused by vestibulo and spinocerebellar disease

Truncal instability. Tremor of trunk (titubation) and gait ataxia

Question 38

Lesions of the cerebrocerebellum

Answer 38

Dysarthria: slurred speech (difficulty articulating)

Gait ataxia - tend to fall toward side of lesion

Question 39

Limb ataxia due to cerebrocerebellar damage:
Dysdiadochokinesia
Dysmetria
Action tremor

Answer 39

• cannot rapidly alternate movements
• cannot move an intended distance
• shaking of limb during voluntary movement

Question 40

Appendicular ataxia

Answer 40

Cerebellar hemisphere dysfunction
Scanning dysarthria (speech ataxia), hypotonia, dysmetria, dysdiadochokinesia, decomposition of movement

Question 41

Cerebellar ataxia

Answer 41

Positive romberg test - Unable to stand with feet together (with or without eyes open)
Normal vibratory, proprioception and ankle reflex

Question 42

Sensory ataxia:

Answer 42

Positive Romberg test - Can stand with feet together and eyes open, but not when closed.
Abnormal vibratory, proprioception and ankle reflex