neuro lesions Flashcards
subacture combined degenration of spinal chord?
Bilateral spastic paresis and loss of fine touch, proprioception.
UMN SX: loss of ankle jerk, brisk knee reflexes, extensor plantar, muscle wasting,
CX: b12
Anterior spinal A occlusion SX?
Bilateral spastic paresis (lateral cortciospinal), loss of pain and temp sensation (lateral spinothalamic)
Freidrich’s ataxia?
Bilateral spastic paresis and loss of fine touch, proprioception. and cerebellar sx - ataxia
MCA occlusion Sx?
upper limb sens more than lower limb sens loss hemianopia, wernicke's facial droop dysphagia
ACA occlusion?
legs sensation loss more than upper limbs. broca’s aphasia, personality/behaviour change
Frontal lobe SX?
Broca’s personality, inhibition, incontinuence, gait, anosmia
parietal lobe SX?
somatosensory loss, writing maths, cant draw clock, inferior quadrantopia, finger agnosia, apraxia,
temporal lobe SX?
wernicke’s aphasia, sup quadrantopia, like foreign language, cant recognise facial expressions,
occipital lobe SX?
visual agnosia, HH - macula sparing, cortical blindness,
cerebellar hemisphere vs vermis sx?
hemisphere: peripheral ataxia
vermis: gait affected
a teenage boy presents with clumsy walking. On examination he has gait ataxia, an intention tremor and loss of lower limb reflexes
friedreich’s ataxia
a 25-year-old man with muscle weakness is reviewed in clinic. On shaking his hand he has difficultly loosening his grip. On examination he has frontal balding, bilateral ptosis and cataracts
Myotonic dystrophy
tuberous sclerosis features
Cutaneous features
depigmented ‘ash-leaf’ spots which fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum (angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
café-au-lait spots* may be seen
Neurological features
developmental delay
epilepsy (infantile spasms or partial)
intellectual impairment
Also
retinal hamartomas: dense white areas on retina (phakomata)
rhabdomyomas of the heart
gliomatous changes can occur in the brain lesions
polycystic kidneys, renal angiomyolipomata
lymphangioleiomyomatosis: multiple lung cysts
Syringomyelia SX?
- Flacid paresis (typically affecting the intrinsic hand muscles)
- Loss of pain and temperature sensation
Neurosyphilis (tabes dorsalis) SX?
- Loss of proprioception and vibration sensation. no motor loss.
Meralgia paraesthetica sX?
lateral femoral cutaneous nerve (LFCN) - Symptoms may be reproduced by deep palpation just below the ASIS (pelvic compression) and also by extension of the hip.
There is altered sensation over the upper lateral aspect of the thigh.
There is no motor weakness.
Posterior cerebral artery SX?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) SX?
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Anterior inferior cerebellar artery (lateral pontine syndrome) SX?
Ipsilateral: facial paralysis and deafness
Basilar artery SX?
locked in syndrome
Lacunar strokes SX?
present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule
Cranial DI Cx?
• idiopathic • post head injury • pituitary surgery • craniopharyngiomas • histiocytosis X • DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome) haemochromatosis
DIDMOD stands for?
• DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
brocas area region?
Due to a lesion of the inferior frontal gyrus. It is typically supplied by the superior division of the left MCA
wernicke’s aphasia area?
(receptive) aphasia Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA
wrist drop
sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals
paralysis of triceps
radial N lesion
This man has ‘Saturday night palsy’ caused by compression of the radial nerve against the humeral shaft, possibly due to sleeping on a hard chair with his hand draped over the back
CX of CN3 palsy
diabetes mellitus
vasculitis e.g. temporal arteritis, SLE
false localizing sign* due to uncal herniation through tentorium if raised ICP
posterior communicating artery aneurysm
pupil dilated
often associated pain
cavernous sinus thrombosis
Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes
other possible causes: amyloid, multiple sclerosis
drugs that worsen MG?
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines
Most common type of brain tumour?
glioblastoma multiforme
