Localisation Flashcards
How does internal carotid artery occlusion present?
Like MCA
How does ACA occlusion present?
Weak, numb CL leg (and arm)
Face is spared
How does MCA occlusion present?
CL hemiparesis, hemisensory loss (face and arm particularly)
CL homonymous hemianopia
Cognitive change - dysphasia, visuo-spatial disturbance
How does PCA occlusion present?
VFDs and poor visual functioning
- CL homonymous hemianopia (macula sparing), agnosia
Aphasia
Memory problems
How does vertebrobasilar occlusion present?
Hemianopia, cortical blindness, diplopia Vertigo, nystagmus, ataxia Dysarthria, dysphasia Hemi/quadriplegia UL/BL sensory symptoms, hiccups, coma
What is lateral medullary syndrome?
Infarction of the brainstem (vertebral artery/posterior cerebellar artery):
Vertigo, vomiting, dysphagia (swallowing), nystagmus, IL ataxia,
Soft palate paralysis, IL horner’s syndrome
Sensory loss (pin prick) - IL face, CL body
What is locked in syndrome?
Pontine artery occlusion:
Unable to move, retain full cognition
What artery occlusions result in ‘dizzy+’ conditions?
SCA - dizzy
AICA - dizzy + deaf
PICA - dizzy + dysphagia + dysphonia
What spinal levels do common reflexes test for?
S1-2 = ankle L3-4 = knee C5-6 = biceps C7-8 = triceps
What are focal cortical signs?
4 As - aphasia, apraxia, agnosia, …anopia
Memory and personality involvement
UMN: increased tone, brisk reflexes, plantar extensors
May have motor/sensory involvement if PMC/PSC are involved
What are focal cerebellar signs?
DDANISH Dysdiadokinesia - rapid pro/supination Dysmetria Ataxia (bi/ipsi) Nystagmus Intention tremor Speech Hypotonia
Ipsilateral
What are focal brainstem signs?
Hemiparesis/sensory loss, brisk reflexes, plantar extensors
CN:
III, IV, VI = diplopia (double vision)
V = decreased facial sensation
VII = drooping face
VIII = deaf, dizzy
IX, X, XII = dysarthria (unclear articulation), dysphagia
XI = decreased neck and shoulder strength
What information do dorsal columns carry?
Deep touch
Proprioception
Vibration
Where do dorsal columns cross?
At the medulla
What information does the ventral corticospinal tract carry?
Gross motor
Where does the ventral corticospinal tract cross?
At spinal cord
What information does the lateral corticospinal tract carry?
Fine motor
Where does the lateral corticospinal tract cross?
At the medulla
What information does the spinothalamic tract carry?
Ventral - light touch
Lateral - pain, temperature
Where does the spinothalamic tract cross?
At the spinal cord
What are the causes of anterior spinal cord lesions?
Anterior spinal artery infarct
Trauma
How do anterior spinal cord lesions present?
Loss of pain, temperature and motor
Preserved vibration and proprioception
What are the causes of posterior spinal cord lesions?
Low B12
Friedrich’s ataxia
How do posterior spinal cord lesions present?
Loss of vibration, proprioception and reflexes
Preserved pain and temperature
What are the causes of lateral spinal cord lesions?
Brown-Sequard
What are the symptoms of lateral spinal cord lesions?
CL loss of pain and temperature
IL loss of vibration, proprioception and motor
What are the symptoms of central spinal cord lesions?
BL loss of pain and temperature
Syringomyelia - cape distribution
How do spinal root lesions present?
Sensory (dorsal) - asymmetrical loss of a dermatome
Motor (ventral) - asymmetrical loss of a myotome, reduced/absent reflexes
How does peripheral neuropathy present?
Distal weakness
Sensory loss
Weak/absent reflexes
Plantar flexion
What is the innervation of the deltoid?
C5-6 - axillary
Shoulder abduction
What is the innervation of the biceps?
C5-6 - musculocutaneous
Flexion at the elbow
What is the innervation of the triceps?
C6-8 - radial
Extension at the elbow
What is the innervation of the ECR?
C5-6 - radial
Dorsiflexion at the wrist
What is the innervation of the abductor pollicis brevis?
C8-T1 - median
Abduction of the thumb
What is the innervation of the interossei?
C8-T1 - ulnar
Abduction of fingers
What is the innervation of the iliopsoas?
L1-3 - femoral
Hip flexion
What is the innervation of the quadriceps?
L2-4 - femoral
Knee extension
What is the innervation of the hamstrings?
L5-S2 - sciatic
Knee flexion
What is the innervation of the tibialis anterior?
L4-5 - deep peroneal
Ankle dorsiflexion
What is the innervation of the gastro/soleus?
S1-2 - tibial
Ankle plantarflexion
What are the signs of UMN damage?
Increased wasting, brisk reflexes, plantar extensors
What are the signs of LMN damage?
Muscle wasting, fasciculation, decreased tone. reduced/absent reflexes, plantar flexors
What nerve is affected first by raised ICP?
CNVI
