Neuro IV Flashcards
Location of Broca’s area
Inferior frontal gyrus of frontal lobe.
Broca’s
1) speech fluidity
2) comprehension
3) repetition
1) confluent
2) intact
3) Impaired
Wernicke’s
1) speech fluidity
2) comprehension
3) repetition
1) fluent
2) Impaired
3) impaired
Wernicke area
Superior temporal gyrus of temporal lobe
Conduction aphasia
1) speech fluidity
2) comprehension
3) repetition
1) Fluent
2) intact
3) impaired
what causes conduction aphasia?
Lesion to arcuate fascicles.
Global aphasia
1) speech fluidity
2) comprehension
3) repetition
1) nonfluent
2) impaired
3) impaired
* broca’s, wernickes, arcuate all affected.
transcortical motor aphasia?
Lesion in frontal lobe around Broca area but sparing Broca area
transcortical motor aphasia
1) speech fluidity
2) comprehension
3) repetition
1) nonfluent
2) intact
3) intact
transcortical sensory aphasia?
Temporal lobe area around Wernicke’s affected, but WErincke’s spared.
transcortical sensory aphasia
1) speech fluidity
2) comprehension
3) repetition
1) fluent
2) impaired
3) intact
transcortical mixed aphasia?
Broca and Wernicke areas and arcuate fascicles remain intact; surrounding watershed areas affected
transcortical, mixed aphasia
1) speech fluidity
2) comprehension
3) repetition
1) nonfluent
2) impaired
3) intact
What is kluver-bucy associated with?
HSV-1 encephalitis
Frontal lobe lesion presents with
1) disinhibition
2) deficits in concentration, orientation, judgment
What do reemergence of primitive reflexes suggest?
frontal lobe lesion
Lesion to nondominant parietal cortex presents with…
hemispatial neglect syndrome
hemispatial neglect syndrome?
Agnosia of the *contralateral side of the world.
Lesion to dominant parietal cortex presents with…
Gerstmann syndrome -agraphia, acalculia, finger agnosia, left-right disorientation.
Where is the reticular activating system?
midbrain
Presentation of lesion to reticular activating system?
Reduced levels of arousal and wakefulness (eg, coma)
What can precipitate wernicke’s?
Giving glucose without B1 to a B1-deficient patient.
Lesion to basal ganglia presents with…
tremor at rest, chorea, athetosis
Damage to cerebellar hemisphere presents with..
1) intention tremor
2) limb ataxia
3) loss of balance
* Hemispheres are laterally located and affect lateral limbs.
What is cerebellar degeneration associated with?
chronic alcoholism
presentation of lesion to cerebellar vermis
truncal ataxia, dysarthria
Presentation of bilateral lesion to hippocampus..
Anterograde amnesia–(no new memories)
Presentation of lesion to paramedic pontine reticular formation…
Eyes look away from side of lesion.
Presentation of lesion to frontal eye fields…
Eyes look toward lesion
Homunculus look likes..
FA 465
What functions are located near the mouth near bottom of homunculus?
1) vocalization
2) salivation
3) mastication
Cerebral perfusion
Relies on pressure gradient between MAP and ICP.
CPP and causes of decreased
Cerebral perfusion pressure.
Hypotension or increased ICP.
Calculating CPP
MAP - ICP
Decreased ICP w with hyperventilation mechanism
hyperventilation –> decreased PCO2 –> vasoconstriction –> decreased cerebral blood flow –> decreased ICP.
Cutoff for CPP and hypoxemia
Hypoxemia increases cerebral perfusion pressure only when PO2 drops to below 50 mm Hg.
Relation of CPP to PCO2
CPP is linear to PCO2 until PCO2 exceeds 90 mmHG, at which point CPP doesn’t increase anymore.
ACA/MCA/PCA distribution
FA 466
What are the watershed zones
1) between ACA and MCA distribution
2) between PCA/MCA distribution
* think of the boundaries between the colored diagram in FA.
How does watershed hypoperfusion present?
1) Upper leg/upper arm weakness
2) Defects in higher-order visual processing.
How will MSA stroke present?
1) contralateral paralysis and sensory loss of face and upper limb.
2) Aphasia if in dominant (usually left) hemisphere).
3) hemineglect if lesion affects non dominant (usually right) side.
ACA supplies
motor and sensory cortices for lower limb.
How will ACA stroke present?
Contralateral paralysis and sensory loss in lower limb.
Lenticulostriate artery supplies…
Striatum + IC
lenticulostriate artery stroke presentation?
1) contralateral paralysis and/or sensory loss of face and body
2) Absence of cortical signs (eg, neglect, aphasia, visual field loss).
Common scenario of lenticulo-striate artery stroke.
Lacunar infarct in a patient with unmanaged HTN.
ASA supplies
1) lateral corticospinal tract
2) medial lemniscus
3) caudal medulla-hypoglossalq nerve
Medial medullary syndrome presentation
1) contralateral paralysis–upper and lower limbs
2) decreased contralateral proprioception
3) tongue deviates ipsilaterally (ipsilateral hypoglossal dysfunction)
Cause of Medial medullary syndrome
Infarct of paramedic branches of ASA and/or vertebral arteries.
PICA supplies…
lateral medulla–vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle.
Lateral medullary (Wallenberg) syndrome presentation
Vomiting + vertigo + nystagmus + decreased pain and temp sensation from ipsilateral face and contralateral body
- dysphagia
- hoarseness
- decreased gag reflex
- ipsilateral Horner syndrome
- ataxia
- dysmetria
Pathognomonic findings for Wallenberg syndrome…
Nucleus ambiguus effects
AICA supplies
lateral pons–cranial nerve nuclei (vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei), spinothalamic tract, CS tract, sympathetic fibers.
- middle and inferior cerebellar peduncles
What effects are pathognomic to AICA lesions?
Facial nucleus effects
Lateral pontine syndrome presentation
1) vomiting, vertigo, nystagmus, ***paralysis of face, decreased lacrimation, salivation, decreased taste from anterior 2/3 of tongue.
2) ipsilateral decrease in pain and temp of face, decreased contralateral pain and temp sensation of body
3) ataxia, dysmetria
Basilar artery supplies
Pons, medulla, lower midbrain, CS and corticobulbar tracts, ocular cranial nerve nuclei,
parmedian pontine reticular formation.
Basilar artery stroke presentation…
1) “Locked-in syndrome”
preserved consciousness + vertical eye movement, blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements.
PCA stroke presentation
Contralateral hemianopia with macular sparing.
Medial lemniscus
part of dorsal column pathway. after dorsal column fibers decussate in medulla, remaining fibers are medial lemniscus.
Thalamic stroke
Code: Henry, guide: Giant Kai thaler with headband on standing on shore (thalamus code)/thalamic stroke. Half his body is an ice cube + full of magnets/damage to ventral posterior lateral nucleus or ventral posterior medial nucleus resulting in complete contralateral sensory loss (both upper and lower extremities). A lesion in the thalamus can disrupt ALL sensory information from both the body and the face. He’s stumbling around + a big taxi on shore/proprioceptive defects may cause unsteady gait.
o Location: Lunch spot by silver pond
Lateral pontine syndrome
Code: Pon outside, lateral to tent/lateral pontine syndrome. President Ike Eisenhaur in back eating a PICA/stroke of AICA. Facial nucleus effects are specific to AICA lesions. Right side of face frozen + drooling everywehere + has antlers on + left side of body in ice cube + anterior 2/3s tongue cut off + face drooping/presentation = vomiting + vertigo + nystagmus + **paralysis of face + decreased lacrimation + salivation + decreased taste from anterior 2/3 of tongue + decreased ipsilateral pain and temperature of face + decreased contralateral pain and temperature of the body.
o Location: Drying room
Asomatognosia
/lack of knowledge about one’s own body. /lesion of nondominant right parietal lobe. /hemiasomatognosia occurs with hemineglect. Patients will deny that half of their body actually belongs to them.
