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Medicine II: Neurology > Localization > Flashcards

Localization Flashcards

1
Q

What are the characteristics of a UMN lesion?

A 
weakness or sensory loss
spasticity
no atrophy
no fasiculations
brisk reflexes
\+ Babinski
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2
Q

What are the characteristics of a LMN lesion?

A 
weakness or sensory loss
\+ atrophy
\+ fasiculations
decreased reflexes
- Babinski
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3
Q

Where do UMN lesions occur?

A

cerebrum
subcortical area (white/gray matter)
brain stem
spinal cord

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4
Q

Where do LMN lesions occur?

A 
anterior horn cells (inside spinal cord)
roots
plexus
nerves
neuromuscular junction
muscle
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5
Q

What are considered long tracts?

A

corticospinal tract
dorsal column/medial lemniscus
spinothalamic tract
autonomics

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6
Q

Which tracts cross at the medulla?

A

corticospinal and posterior column

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7
Q

Where does the spinothalamic tract cross?

A

level of innvervation (spinal level)

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8
Q

What are the signs of a corticospinal tract lesion?

A

weakness, spasticity, incresed reflexes, babinski

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9
Q

What sensory aspects does the spinothalamic tract account for?

A

pain and temp

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10
Q

What sensory aspects does the posterior column account for?

A

position, vibration and fine touch

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11
Q

What are the principals of long tract localization?

A

level and lateralization

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12
Q

If there is a lesion in the brain where is the lateralization?

A

contralateral (motor and sensory)

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13
Q

If there is a lesion in the spinal cord, where is the lateralization?

A

ipsilateral: corticospinal (motor) and posterior column (sensory)
contralateral: spinothalamic (pain and temp)

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14
Q

What are the responsibilities of the frontal lobe?

A

planning and controlling voluntary movement on the contralateral side; concentration, attention, executive function, motivation, behavior

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15
Q

What are the responsibilities of the temporal lobe?

A

emotion, memory (hippocampus and amygdala)

primary auditory cortex

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16
Q

What are the responsibilities of the wernike’s area?

A

receptive language, superior dominant temporal lobe and the posterior inferior parietal lobe

meaning is assigned to written and spoke word

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17
Q

What are the responsibilities of the broca’s area?

A

expressive language, dominant frontal lobe

production of written and spoken language

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18
Q

What are the responsibilities of the frontal parietal lobe?

A

perception and interpretation of sensory info from contralateral side of the body;

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19
Q

What are the responsibilities of the occipital lobe?

A

perception of visual information

visual impulses are conducted from the eyes to primary visual cortex

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20
Q

What are the responsibilities of the subcortical area?

A

internal capsule: contralateral pure motor weakness
thalmus: contralateral hemisensory loss
basal ganglia: contralateral movement

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21
Q

What are the responsibilities of the brain stem?

A

brain stem lesions cause CN palsies ipsilateral to the lesion and contralateral motor deficits

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22
Q

Dx of a CN III lesion:

A

down and out

mydriasis- dilated pupil

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23
Q

T/F: each optic nerve contains visual information from both the right and left visual fields

A

True

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24
Q

Where to the nasal retinal fields cross?

A

chiasm

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25
Q

What happens if there is a lesion in the cerebellum?

A

hemisphere lesions result in ataxia/incoordination on the same side as the lesion

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26
Q

What is the result of a vermis lesion?

A

drunken sailor gait

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27
Q

What happens in brown-sequard syndrome?

A

same side as lesion: UMN weakness, loss of position and vibration
side opp lesion: loss of pain and temp

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28
Q

What happens in central cord syndrome (syringomyelia)?

A

lesion interupts fibers crossing to enter spinothalamic tracts and fibers mediating tendon stretch reflex. As it enlarges it affects the intermediolateral columns (autonomic function) and the lateral corticospinal tracts

SEE SPINAL CORD CARDS

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29
Q

What happens if there is a lesion at the nerve root?

A

radiculopathy, LMN weakness and semsory loss with one myotome/dermatome

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30
Q

What are the dermatomes to remember?

A

C6
T4
T10
L4

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31
Q

What happens if there is a lesion at the plexus?

A

plexopathy, LMN weakness and numbness in one limb that spans more than one root and more than one names nerve

32
Q

Localization of LMN lesions of upper extremities:

A 
deltoid- C5 - axillary nerve
biceps- C6 - musculocutaneous nerve
brachoradialis- C6 - radial nerve
triceps- C6 - radial nerve
1st doral interossius- T1 - ulnar nerve
Abd. pollicis brevis- T1 - median nerve
33
Q

What is significant about a lesion within the muscle?

A

proximal weakness is greater than distal, normal to decreased reflexes

34
Q

What level does the spinal cord end?

A

L1-L2

35
Q

If CN and long tract signs are on contralateral sides what do we think of?

A

lesion in brain stem

36
Q

If the patient has diploplia where is the lesion?

A

brainstem

37
Q

Where are the cerebellar lesion signs?

A

ipsilateral to the lesion

38
Q

If there is a focal seirzue where is the lesion?

A

cortical

39
Q

If there is nonfluent aphasia where is the lesion?

A

anterior frontal (broca)

40
Q

If there is a fluent aphasia where is the lesion?

A

posterior temporal (wernike)

41
Q

If there is focal back pain, a spinal cord sensory level, and incontinence, where is the lesion?

A

spinal cord

42
Q

What type of lesion is associated with a stocking glove pattern?

A

peripheral nerve disease

43
Q

What are gray matter disorders associated with?

A

early cog disturbances, movement disorders, seizures

44
Q

What are white matter disorders associated with?

A

long tract disorders of motor, sensory, visual and cerebellar pathways

45
Q

If the symptoms are progressive and symmetric what is the most likely cause?

A

metabolic or degenerative disorders

46
Q

What does a rapid onset of a neurological complaint, occurring with in seconds or minutes usually indicate?

A

vascular even, seizure or migraine

47
Q

The onset of sensory symptoms that begin in one extremity and spreads within seconds is indicative of what?

A

a seizure

48
Q

What is the function of the “limbic lobe”?

A

includes cingulate gyrus and parahippocampal gyrus

emotional response and drive behaviors

49
Q

What is the function of the cerebellum?

A

timing and sequencing of voluntary muscular activity

controls muscle tone, balance and equilibrium

50
Q

What is the function of the basal ganglia?

A

learned motor activity, controls appropriate muscle tone fore given planned movements

also important for initiating movement

51
Q

What is the function of the brain stem?

A

contains nuclei for CN, sleep wake cycle, regulates consiousness, controls balance and equilibrium

52
Q

What are the aspects of a MSE?

A 
LOC
attention
speech and language
orientation
memory
cognition
visuospatial skills
mood/personality
53
Q

What can affect the MSE?

A

age, education and cultural background

54
Q

What are the five levels of consciousness?

A 
awake and alert
lethargic or somnolent
obtunded
stuporous
comatose
55
Q

What happens if there is a lesion in the cerebrum (cortical)?

A

hemispheric lesions with in the crebral cortex may produce UMN weakness/paralysis and/or sensory deficits in the contralateral face, arms and legs

56
Q

Left or right sided cortical lesion:

A

impaired two point discrimination, tonic deviation of eyes to side of the lesion

57
Q

Left hemisphere lesion:

A

aphasia, apraxia (inability to carry ou motor commands)

58
Q

Right hemisphere lesion:

A

contructional apraxia (difficulty drawing from memory or copying simple drawings), left hemisphere neglect, flattened affect

59
Q

Occipital lobe lesion:

A

cortical blindness, visual agnosia; preservation of pupillary light reflexes

60
Q

What happens if there is a lesion in the cerebrum (subcortical)?

A

UMN weakness or sensory loss affecting contralateral body. Often produces PURE motor or PURE sensory loss. NOT BOTH.

ex: lacunar stroke

61
Q

What happens if there is a lesion in the cerebrum (global)?

A

widespread, bilateral loss of cortical neurons, deficits in cognitive functioning, disorientation, alterations to consciousness and attention

primative reflexes

ex: AD, b12 def

62
Q

Lesion in the cerebellum:

A

ataxia, intention tremor, disequilibrium, nystagmus, dysmetria

63
Q

Lesion in the basal ganglia:

A

involuntary muscle movements, dystonic muscle contraction, parkinsonism

64
Q

What is the most commonly encountered for of dystonia attributable to ?

A

reaction to anti-psychotic drugs (phenothiazines)

65
Q

Lesion in the brain stem:

A

ipsilateral cranial nerve deficit with motor and/or sensory deficits in the contralateral trunk and extremities. paresis or paralysis in UMN pattern (hyper-reflexia, babinski)

horners syndrome

66
Q

Lesion in the spinal cord:

A

sensory deficit and muscle weakness (both often symetrical) below level of lesion. Sensory deficit is anterior and posterior.

67
Q

Peripheral neuropathy:

A

some combination of LMN muscle weakness and sensory changes

68
Q

Radiculopathy:

A

peripheral nerve injury localized to spinal nerve roots. Pain and sensory changes in the distribution of the affected nerve root (dermatomal pattern). LMN muscle weakness.

69
Q

LMN

A 
weakness
atrophy
fasiculations
decreased reflexes
decreased tone
70
Q

Brainstem lesions cause cranial nerve palsies ipsilateral to lesion and contralateral motor deficits.

A

hint

71
Q

one eye out

A

optic nerve

72
Q

lateral aspects of eye

A

chiasm

73
Q

right or left

A

tract

74
Q

corner

A

tract

75
Q

top or bottom

A

visual cortex

76
Q

LMN affects wrinkling and smiling

A

fact

Medicine II: Neurology (12 decks)

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