Medulla Pathology Flashcards
What is the effect of a lesion of the spinal nucleus of CN V?
- Loss of ipsilateral pain and temperature to the face
What is the effect of a lesion of the motor nucleus of CN XI?
- Ispi lateral LMNS of the SCM and upper traps
What is the effect of a lesion to the pyramidal tracts at above the level of the motor decussation?
Contralateral UMN hemiplegia
What is the effect of a lesion to the pyramidal tract in the middle of the motor decussation?
Crossed hemiplegia (Between crossing of UE and LE)
- Ipsilateral arm
- Contralateral leg
Does the UE or LE cross first at the motor decussation?
UE
What is crossed - analgesia?
- CN V and Spinothalamic tract involvement
- Ipsilateral face pain and temperature
- Contralateral body pain and temperature
What structures are typically affected in the medulla by an occlusion of the posterior spinal arteries? What is the effect of a lesion?
- The dorsal columns
- Ipsilateral loss of discriminitive sensation/ proprioception
What type of loss occurs with a lesioning of the medial lemniscus in the medulla?
Contralateral:
- Concious proprioception
- Discriminitive touch
What is the effect of a lesioning of the CN XII nucleus?
- LMN loss of ipsilateral tongue
To which direction will the tongue deviate in a lesioning of CN XII?
- To the affected side
What is alternating hypoglossal hemiplegia?
- LMN of ipsilateral tongue (CN XII)
- UMN of contralateral body (Pyramidal tracts)
What artery is responsible typically for alternating hypoglossal hemiplegia?
Anterior spinal artery
What will be the effect of lesioning the spinothalamic tract in the medulla?
- Contralateral loss of pain and temperature to body
What is the effect of a lesioning of the nucleus ambiguus?
- LMN lesion to ipsilateral larynx and pharynx
What are symptoms of a lesion to the nucleus ambiguus?
- Horseness of voice
- Dysarthria
What are 2 clinical tests for nucleus ambiguus lesioning?
- Hold tongue down with depressor, ask patient to say “ahhh”, side that doesn’t rise is lesioned
- Gag reflex
What CN does the “say ‘ahhh’” test assess?
CN X
What CN does the gag reflex test?
CN X and XI
What artery supplies the nucleus ambiguus and spinothalamic tract?
Vertebral
What results from a lesioning/ occlusion of the posterior inferior cerebellar artery?
Death due to a loss of the vital reflexes
What is results from a lesioning/ occlusion of the posterior inferior cerebellar artery?
- Loss of pain + temp to face and contralateral body
- Loss of gag reflex, dysphagia, hoarseness, dysarthria
- Ipsilateral loss of coordination
- Vestibular symptoms such as (nystagmus, nausea, pursuing contralateral moving objects)
- Horner’s syndrome
- Ocular lateropulsion
What arteries and structures are affected in dorsal medullary syndrome?
- Medial branch of PICA
- Vestibular nuclei
- Restiform body/ ICP
What are the signs of dorsal medullary syndrome?
- Ipsilateral limb or gait ataxia
- Vertigo, vomiting, and ipsilateral gaze-evoke nystagmus
What is bulbar palsy?
LMN of any of the cranial nerves
