Nerve Lesions Flashcards

1
Q

What info does the dorsal-column medial lemniscus (DCML) tract convey?

A

Proprioception, vibration and 2 point touch discrimination

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2
Q

Where does the DCML decussate?

A

Medulla

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3
Q

What info does the spinothalamic tract convey?

A
Pain and temperature (lateral)
Crude touch (anterior)
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4
Q

Where does the spinothalamic tract decussate?

A

At level of entry of spinal cord/ 2 levels above

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5
Q

What info does the spinocerebellar tract convey?

A

Balance and coordination

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6
Q

Where does the spinocerebellar tract decussate?

A

Dorsal don’t, ventral double cross

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7
Q

Name the ascending spinal tracts (3)

A

DCML
Spinothalamic tract
Spinocerebellar tract

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8
Q

Name the descending spinal tracts (3)

A

Corticospinal tract
Rubrospinal tract
Tectospinal tract

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9
Q

What does the corticospinal tract do?

A

Majority of motor functions

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10
Q

Where does the corticospinal tract decussate?

A

Lateral at medulla

Anterior at level of exit on spinal cord

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11
Q

What does the rubrospinal tract do?

A

Rudimentary motor function

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12
Q

Where does the rubrospinal tract decussate?

A

Midbrain

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13
Q

What does the tectospinal tract do?

A

Reflex head/ eye responses

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14
Q

Where does the tectospinal tract decussate?

A

Midbrain

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15
Q

What is myelopathy?

A

Compression of the spinal cord

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16
Q

What is radiculopathy?

A

Compression of the nerve root ‘pinched nerve’

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17
Q

What are the symptoms of myelopathy? (4)

A

Progressive (increasingly weak, clumsy hands)
UMN leg signs
LMN arm signs
Incontinence, hesitancy + urgency are late features

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18
Q

What are the symptoms of radiculopathy? (4)

A

Pain/ electrical sensations in arms/fingers at level of compression
Numbness
LMN weakness
Eventual wasting of muscles innervated by affected root

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19
Q

What are the investigations for myelopathy and radiculopathy?

A

MRI urgent

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20
Q

What is the treatment for myelopathy & radiculopathy?

A

Surgical decompression and dexamethasone

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21
Q

What contralateral sign is present in Brown-Sequard syndrome?

A

Loss of pain and temperature sensation below lesion

22
Q

What ipsilateral signs are present in Brown-Sequard syndrome? (2)

A

Weakness

Loss of proprioception and vibration sense

23
Q

What sign is present at the level of the lesion in Brown-Sequard syndrome? (2)

A

Flaccid paralysis

Loss of all sensation

24
Q

What are the causes of peripheral neuropathy? (5)

A
DAVID
Diabetes
Alcohol
Vitamin deficiency (B12)
Infective (GB)
Drugs (isoniazid)
25
What are some of the risk factors for carpal tunnel syndrome? (4)
Pregnancy Obesity Hypothyroidism Rheumatoid Arthritis
26
What are the symptoms of carpal tunnel syndrome? (3)
Pain + paresthesia in hand = wake and shake Loss of sensation in palm, medial 3 1/2 fingers Wasting of thenar eminence
27
What muscle in particular shows wasting in carpal tunnel syndrome?
Abductor pollicis brevis
28
In carpal tunnel syndrome, when are the pain and paresthesia worse?
Worse at night
29
How do you investigate for carpal tunnel syndrome? (2)
Phalen's (flexing) test | Tinel's (tapping) test
30
How do you treat carpal tunnel syndrome? (3)
Conservative: pain relief, splint at night Hydrocortisone injection Surgical decompression/ cut open flexor retinaculum
31
What are the nerve roots for the sciatic nerve?
L4 - S1
32
What are the causes of sciatica? (4)
Pelvic tumours Fracture to pelvis/ femur Disc prolapse Osteoarthritis
33
What are the symptoms of sciatica? (3)
- Sensory loss or pain in back of thigh/ leg - Foot drop - Loss of sensation below the knee laterally
34
How would you investigate sciatica?
MRI urgent
35
How would you treat sciatica?
Conservative
36
What is the cauda equina?
Bundle of spinal nerves from the level of L1/2
37
What are the symptoms of cauda equina syndrome? (6)
- Lumbosacral pain - Saddle anaesthesia - Areflexia - Fasciculations - Loss of bowel/ bladder control - Urinary retention
38
How would you investigate cauda equina syndrome? (2)
MRI spine | PR (rectal exam)
39
How would you treat cauda equina syndrome? (2)
Surgical decompression | High dose dexamethasone
40
What are the red flags to look out for in cauda equina syndrome? (6)
``` Bilateral sciatica Bilateral flaccid leg weakness Saddle anaesthesia Bladder + bowel dysfunction Erectile dysfunction Areflexia ```
41
What does damage to the right optic nerve cause?
Loss of vision in right eye
42
What does damage to the optic chiasm cause?
Bitemporal hemianopia
43
What does damage to the left optic tract cause
Right homonymous hemianopia
44
What does damage to Meyer's loop on the left (left optic radiation) cause?
Right homonymous superior quadrantanopia
45
What does damage to Baum's loop on the left (left optic radiation) cause?
Right homonymous inferior quadrantanopia
46
What are the clinical features of an oculomotor nerve palsy? (3)
- Tramp's palsy (eye down + out) - Fixed dilated pupil, doesn't react to light - Ptosis
47
What nerve is affected in Bell's palsy?
Facial nerve (CN 7)
48
What are the clinical features of Bell's palsy? (3)
- Drooping of mouth corner - Inability to close eyelid - Smooth, wrinkle-free forehead
49
How do you treat Bell's palsy?
Steroid
50
In CN 9/ 10 lesion, where does the uvula deviate?
Uvula deviates AWAY from lesion
51
In CN 12 lesion, where does the tongue deviate?
Tongue deviated TOWARDS lesion