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Semiology 02/06 > Lesson 24 > Flashcards

Lesson 24 Flashcards

1
Q

Types of cranial nerve lesions

A

Isolated: Trigeminal neuralgia, dependent muscle paralysis

Coordinated: Oculomotor alterations (III and VI)

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2
Q

Trochlear nerve

A

Diplopia when reading and going down stairs

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3
Q

Facial nerve

A

Peripheral facial paralysis

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4
Q

Vagus nerve

A

Alteration of the veil of the palate

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5
Q

Accessory nerve

A

Difficulty in head rotation

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6
Q

CN I exploration

A

Explore with pleasant and unpleasant odoriferous substances that are not irritating to not cause damage to the patient.

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7
Q

CN II exploration

A

Visual acuity assessment

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8
Q

CN III exploration

A

Pupils: symmetry, size, shape, reactivity.

Extrinsic ocular moticility

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9
Q

CN I signs of injury

A
  • Anosmia, dysosmia,
  • Hyposmia, hyperosmia.
  • Meningiomas of the ophthalmic sulcus - Rupture or the cribriform plate from head trauma

Actually many surgeons lose capacity to smell because every day you smell the worst things in the world and putting chemicals like mints in the nose to stop smelling, overstimulating the nerve. All the senses in the body have to go through the thalamus.

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10
Q

CN II signs of injury

A

Blindness and decreased visual acuity

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11
Q

CN III signs of injury

A

Ptosis in resting eye deviated outward and downward.

Midriais (pupular dilation) if it’s parasympathetic fibers are injured

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12
Q

CN IV signs of injury

A

Eye at rest deviated outward and
upward. Produces vertical diplopia
that increases when looking down,
reading, or going down stair

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13
Q

CN IV exploration

A

Extrinsic ocular motility (superior
oblique)

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14
Q

CN V exploration

A

Sensory: three branches (sensitivity of
the face) Corneal reflex. Motor:
temporal masseters and pterygoids
(chewing and lateralization of the jaw)

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15
Q

CN V signs of injury

A

Facial hypoalgesia and weakness of
the corresponding muscles

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16
Q

CN VI exploration

A

Extrinsic Ocular Motility (external
rectus)

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17
Q

CN VII exploration

A

Motility of the facial muscles

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18
Q

CNVII signs of injury

A

Central or peripheral

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19
Q

CNVIII exploration

A

Cochlear and vestibular
function is assessed

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20
Q

CNVIII signs of injury

A

Hearing loss (auditory nevus
injury). Vertigo (vestibular
injury)

21
Q

CNIX and X exploration

A

They are explored together,
assessing the sensitivity and
motility of the soft palate.
Nausea reflex

22
Q

CNIX and X signs of injury

A

Deviation of the uvula and
palate to the injured side

23
Q

CN XI exploration

A

Sternocleidomastoid and
upper trapezius

24
Q

CN XI signs of injury

A

Parasia of the involved
muscles

25
Q

CN XII exploration

A

Tongue motility

26
Q

CN XII signs of injury

A

Tip deviation to the injured
side

27
Q

Concept of symptoms of the spinal cord

A

A spinal cord injury is characterized by the involvement of the nerve elements of the spinal cord.

Common causes are:
Penetrating wounds, trauma, fractures, bruises

28
Q

Complete spinal cord injury

A

The nerves below the point of injury cannot communicate at all with the brain anymore.

Leads to paralysis below the location of the injury.

This type of lesion show two different phases:
* Medullar shock phase
* Medullar automatism phase

29
Q

Medullar shock phase and medullary

A
30
Q

Brown-Sequard syndrome

A

A lesion in the spinal cord which results in weakness or paralysis
(hemiparaplegia) on one side of the body and a loss of sensation
(hemianesthesia) on the opposite side

This type of injury leads to:
* Loss of voluntary motor control on the same side as the spinal cord injury.
* Loss of the sensation of proprioception on the same side of the injury.
* Abolition of pain and temperature sensations on the opposite side
(because the lateral spinothalamic fibers cross in front of the ependymal
duct)

31
Q

Anterior cord syndrome

A

Involves complete motor paralysis and loss of temperature and pain perception distal to the lesion.
* This syndrome is caused by compression of the anterior spinal artery

This syndrome implies:
- Complete motor paralysis,
- Complete loss of temperature and pain perception distal to the
lesion,
- Since posterior columns are spared, light touch, vibration, and
proprioceptive input are preserved.

32
Q

Posterior cord syndrome

A

Caused by lesions on the posterior portion of the spinal cord, related with sensory tracts because of an infarct in the posterior spinal artery

33
Q

Combined posterior column and corticospinal tract syndrome

A

It affects long and myelinated nerve tracts like pyramidal tract and posterior cords leading to motor and sensitive alterations

34
Q

SYNDROMES DUE TO ALTERATIONS OF THE BASAL GANGLIA
35
Classification

A

Alterations of the basal ganglia may produce syndromes due to a
deficit or an excess in movement.

HYPO KINETIC SYNDROMES
* Parkinson’s disease

HYPERKINETIC SYNDROMES
* Chorea
* Hemibalism
* Dystonia
* Athetosis
* Myoclonus

35
Q

Parkinson’s disease

A

It is the prototype of hypokinetic and hypertonic syndrome

The cortico-basal ganglia-thalamo-cortical loop in Parkinson’s disease:

  • Lack of dopamine levels.
  • Hypofunction of excitatory
    pathway.
  • Hyperfunction of inhibitory
    pathway.
36
Q

Parkinsonism: causes

A

Parkinson’
s disease

Antidopamine
rgic drugs

Postencephalit
is

Toxics

37
Q

Parkinsonism: symptoms

A

Bradykinesia
Slow and insufficient voluntary
movements
Absent involuntary movements
(facial inexpression)
Tremor
Resting tremor
Distal tremor of
inferior limbs
Rigidity
Sustained (lead
pipe) rigidity
Intermittent
(cogwheel) rigidity

38
Q

Parkinsonism: clinical features
Non-motor

A

· Depression
· Dementia
· Autonomic

39
Q

Characteristics of the patient with
Parkinson’s:

A
  • Head and trunk tilted forward.
  • Holding hands.
  • Holiday-type march.
  • Facies completely expressionless,
    fixed and impassive.
  • Weak and monotonous oral
    language.
  • Clumsy writing
40
Q

Hyperkinetic syndromes

A
  • Hyperkinetic disorders are characterized by
    excessive motor activity, with involuntary
    movements that worsen with anxiety and
    emotional tension, but disappear with sleep.
  • They are due to a dysfunction of the movement
    inhibitory pathway, which leads to the situation of
    hyperkinesia.
41
Q

Chorea

A
  • It is an abnormal involuntary movement disorder,(a kind of
    dyskinesias).
  • The term chorea is derived from a greek word meaning dance, due
    to the quick movements of the feet or hands which are
    comparable to dancing.
42
Q

Hemiballism

A
  • It is a unilateral form of a very rare
    movement movement disorder.
  • It is a type of chorea caused in most
    cases by a decrease in activity of
    the subthalamic nucleus of the basal
    ganglia, resulting in the appearance
    of flailing, ballistic, undesired
    movements of the limbs.
  • It is usually associated with stroke in
    the contralateral side.
43
Q

Athetosis

A
  • It is a movement dysfunction characterized by involuntary writhing
    movements.
  • These movements may be continuous, slow, and rolling.
  • They may also make maintaining a symmetrical and stable posture
    difficult.
  • They are associated with perinatal troubles (hypoxia, trauma).
44
Q

Dystonia

A
  • It is a movement disorder in which a
    person’s muscles contract
    uncontrollably.
  • The contraction causes the affected
    body part to twist involuntarily,
    resulting in repetitive movements or
    abnormal postures.
  • It can affect one muscle, a muscle
    group, or the entire body
45
Q

Tremor

A
  • It is an unintentional and uncontrollable rhythmic movement of
    one part or one limb of the body.
  • It can occur in any part of the body and at any time.
  • It is usually the result of a problem in the part of the brain that
    controls muscular movement.

RESTING TREMOR
Parkinson’s disease
ACTION TREMOR
Cerebellar lesions
POSTURAL TREMOR
When holding a position
against gravity

46
Q

Myoclonus

A

It is the sudden, involuntary jerking of a muscle or group of
muscles.
* Myoclonic twitches or jerks usually are caused by sudden muscle
contractions, called positive myoclonus, or by muscle relaxation,
called negative myoclonus

47
Q

Nervous tic

A

There are two types, motor tics and vocal tics.
* These short-lasting sudden movements (motor tics) or uttered
sounds (vocal tics) occur suddenly during what is otherwise normal
behavior.
* Tics are often repetitive, with numerous successive occurrences of
the same action.

48
Q

Akathisia

A

It is a movement disorder that makes it hard for the patient to stay
still.
* It causes an urge to move that cannot be controlled

Semiology 02/06 (6 decks)

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