Neuro Stephens Midterm Flashcards
The ____ has a role in motor and sensory to the leg and foot so if the blood supply to it is occluded (supplied by the ACA artery and also the superior sagittal sinus could be involved) than the patient will lose motor and/or sensory in the ____lateral leg and foot
MCA occlusions result in sensory and/or motor deficits in the ___lateral upper limb and head
PCA occlusions can result in ___lateral ____
Paracentral lobule, contralateral
Contralateral
Contralateral homonymous hemianopia
Most of the time, the superior sagittal sinus empties into the ____ sinus and the ___ sinus empties into the left transverse sinus
Right transverse sinus, Straight sinus
****** If an ____ lesion occurs there will be spastic paralysis, hyPERtonia, hypERreflexia, disuse atrophy and a + babinskis sign/clonus
A ____ lesion will cause flaccid paralysis, atonia, areflexia, fasciculations, and atrophy
So once again, a + babinskis sign means it must be a ____ lesion
UMN
LMN
UMN
If a spinal cord injury occurs, the patient most likely first goes into ____ where they will have bilateral loss of all sensation and reflexes below the level of the lesion
If the lesion is above ____, transient Horner’s syndrome (Ptosis and mydriasis) can occur
Following spinal shock if the lesion was above S2, then the ____ tract can be disrupted leading to ____ bladder and if the dorsal roots or posterior funiculus was disrupted then ____ bladder can result
Spinal shock
T1
LRTS, Reflex, Atonic
A ____ stroke can lead to supra-nuclear facial palsies due to the corticobulbar fibers being affected
If one half of the spinal cord is damaged, it is called ___ syndrome and this causes ___ loss of pain and temp and ____ loss of proprioception and 2 pt tactile
Lacunar
Brown-Sequard syndrome, contralateral, ipsilateral
One will lose pain and temp in the contralateral side if the ____ pathway is lesioned ____ sensory dermatomes BELOW the lesion
____ is the loss of sensibility (weather it is pain/temp or proprioception/2pt-tactile) on one ENTIRE side of the body
Hemianalgesia seems to be for pain and Hemianesthesia is for tactile?**
^***BUT NOT SURE
_____ is loss of sensory/motor to the lower extremities and quadriplegia is the entire body
LSST, 2
Hemianesthesia
Paraplegia
A lesion to the LSTT at the level of the spinal cord will cause ____lateral loss of _____ 2 levels below the lesion
A lesion to the ____ lemniscus, which is the continuation of the LSST in the brainstem, will give hemianesthesia of pain and temp on the ____lateral side of the lesion
A lesion to the posterior columns (FG for ___ limbs and FC for ____ limbs) at the level of the spinal cord will cause _____lateral loss of _____ below the lesion
A lesion to the ____ lemniscus, which is a continuation of the posterior columns in the brainstem, will give hemianesthesia of proprioception and 2pt tactile on the ____lateral side of the lesion
Contralateral, pain and temp
Spinal, contralateral
Lower, Upper, Ipsilateral, proprioception and 2pt tactile
Medial, contralateral
A LCST lesion will cause _____ spastic paresis/paralysis below the level of the lesion
A lesion to the Corticospinal tract (CST), which is the tract in the brainstem before the LCST and ACST split, will cause hemiplegia or spastic paralysis to the entire ____lateral side
Ipsilateral
Contralateral
An ____ motor neuron lesion will cause hypOrelfexia and an ____ motor neuron lesion will cause hypERreflexia/Clonus/Babinskis sign
A ____ motor neuron lesion will also cause spastic paralysis and a ___ motor neuron lesion will cause flaccid paralysis
LMN, UMN
UMN, LMN
AKA spastic - HypERreflexia
Flaccid - HypOreflexia
Name the 5 parts of the brainstem and what they correlate to
Telencephalon - Cerebrum (aka cerebellar cortex) Diencephalon - Thalamus/Hypothalamus Mesencephalon - Midbrain (brainstem) Metencephalon - Pons (brainstem) Myelencephalon - Medulla
If the Dorsal root is lesioned, one will lose ALL ____ information coming into that level, and since the pain and temp LSST goes up and down 2 spinal cord levels, you would also lose pain and temp 2 levels above and 2 levels below
If the Anterior horn is lesioned, you will lose LMN innervation (aka hyporeflexia) on the ______ side of the lesion, ONLY at that spinal cord level)
Sensory (pain, temp, proprioception, 2pt tactical, etc)
Ipsilateral
*** WILL BE TESTED ON SO KNOW THIS*******
Transection of the spinal cord above S2 disrupts the ____ tract to the ___ nucleus, and the patient is therefore unable to voluntarily void their bladder (urinary retention occurs)
^** After ____, the bladder reflex man return without voluntary control and the patient will have automatic reflex voiding or a ___ bladder
If a lesion to the dorsal roots of S2-S4 or dorsal funiculi of S2-S4 occurs, ___ results and this causes a ___ bladder and increased bladder capacity; but voluntary voiding is still possible, but incomplete
LRST, SAN
Spinal Shock, reflex
Atonic Bladder, flaccid
A unilateral transverse lesion or hemisection of the spinal cord is called Brown-Sequard syndrome a results from a lesion to 3 things, which include destruction of the ___, ___, and ___
So proprioception (Posterior column) and motor paralysis (LCST) occurs on the \_\_\_ side and the loss of pain and temperature on the \_\_\_ side *************************
Posterior columns, LCST, and LSTT
Ipsilateral, contralateral
***** If a patient has ipsilateral hemianalgesia (loss of pain) of the face and contralateral hemianalgesia (loss of pain) of the body, ___ has occured
^** This is because you destroy the primary fibers in the descending tract of V and the secondary fibers in the ___ since it runs right next to it
So once again, which two things are involved in an alternating analgesia?
Alternating analgesia
Spinal lemniscus
Descending tract of V and SL (they are very close to each other)
If one has a lesion to the descending tract of 5, they will lose _____ sensations on the ____lateral side
If one has a lesion to the Trigeminal lemniscus, they will lose ALL sensory information to the face on the _____lateral side of the lesion
Pain and Temp, Ipsilatera
Contralateral
****The ___ connects the occulomotor nucleus with the Abducens nucleus and is important for ____***
^** So a MLF lesion would disturb horizontal gaze and is called ______ and patients have an abnormal response to horizontal gaze in the ___ direction of the lesioned side
A unilateral lesion of the MLF results in the loss of adduction of the ___ eye and a nystagmus of the ____lateral aka abducting eye
So just to recap, lets say you have a unilateral lesion of the MLF on the RIGHT side… When the patient turns their eyes towards the right, both eyes are able to due so aka the right eye is able to abduct and the left eye is able to adduct….. However, horizontal gaze AWAY from the side of the lesion is NOT normal so when the patient turns their eyes to the left, the IPSILATERAL eye (aka the right eye) can NOT ADDUCT, and the left eye can abduct, but there is a nystagmus
^** Also it is named according to the side of the NON-___ducting eye (aka you name it ipsilaterally), so in the case described above, since the RIGHT eye is the eye that can not adduct, it would be a RIGHT-Internuclear Ophthalmophlegia
MLF (Medial Longitudinal Fasciculus), horizontal gaze
Internuclear Ophthalmoplegia, opposite
Ipsilateral, contralateral
ADDUCTING
The fibers that innervate the somatic motor nuclei of the face, head, and neck come from the ___ fibers
These fibers make up the corticobulbar tract (CBT), which inneravte the brainstem cranial nerve motor nuclei
*** So the CST is for motor of the axial and limb musculature and the CBT is for motor of the head/neck/face
**The fibers decussate in the lower pons and are uncrossed CBT at and above the level of the ___ nerve, and are crossed at or below the level of the ___ nerve***
A lesion of the CBT above the decussation results in ____ cranial nerve palsies (such as supranuclear facial palsy) because the fibers have not yet crossed yet
A lesion of the CBT below the decussation can result in ___ cranial nerve palsies because the fibers have crossed
Corticobulbar fibers
Trigeminal nerve, abducens nerve
Contralateral
Ipsilateral
**Unilateral lesion of the corticobulbar fibers to the facial nucleus results in paralysis of the ____, ___ quadrant of the face***
This is called _____
^** WILL BE TESTED ON
Contralateral lower
Supranuclear Facial Palsy
***1) _____ complete deafness occurs from a unilateral lesion of the cochlear nerve
2) **A unilateral lesion to the central auditory pathway results in _____ diminution of hearing, BUT it is more prominent in the ____ ear ******* (This can occur via the LL, IC, Brachium of IC, or MGB)
^** LL = Lateral Lemniscus
1) Ipsilateral
2) Bilateral, contralateral
The nucleus ambiguus contains ____ neurons for the ____, ____, and ____ cranial nerves and therefore controls the soft palate, pharynx, larynx, and upper esophagus
A unilateral lesion will cause paralysis of all palatine muscles on the ___lateral side (except for the tensor palatinin innervated by CN 5) and one will see dysphagia (difficulty swallowing), dysphonia (horse voice), nasal speech, deviation of the uvula ____ the affected side, and the ___ reflex will be affected
Motor, 9/10/11
Ipsilateral, away (aka uvula deviates away from lesion or towards the normal side), GAG
The motor nucleus of 7 (VII) innervate the muscles of facial expression and the stapedius
If there is a lesion, the ___ lateral muscles of facial expression will undergo atrophy and this is called ____
^** One will also lose the ____
**** Don’t confuse this with bilateral upper extremity paralysis aka _____
** Also don’t confuse Bell’s palsy, which causes the entire side of one face to droop versus Supranuclear facial palsy which causes only the contralateral lower side of the lesion to droop
Ipsilateral, Bells palsy
Corneal reflex
Bells cruciate palsy
THE NEXT CARDS WILL BE CASES WE COVERED
ACA thrombosis results in sensory and/or motor loss to the ___lateral ____
A cervico-mandibular fracture of the atlas can lead to ___ insufficiency that will cause ____
Contralateral, lower limbs
Vertebro-basilar ???????
*** Remember, if you lesion ANY cranial nerve, it will be ipsilateral and also remember, the lesion is at the level of the highest CN so a patient presents with symptoms indicative of a CN 3 and CN 7 defect, the lesion will be at the level of CN 3 (since it is the highest)
1) Contralateral spastic hemiplegia (loss of motor to entire side of body) = ____ lesion
2) Ipsilateral spastic paralysis below lesion = ____ lesions
3) Ipsilateral loss of proprioception/2pt tactile/vibratory sensations below the level of the lesion = ____ lesion
4) Contralateral hemianesthesia (loss of proprioception/2pt tactile/vibratory sensations to entire body) = ____ lesion
5) Contralateral analgesia (loss of pain) and thermal anesthesia 2 sensory dermatomes below level of lesion = ____ lesion
6) Contralateral hemianalgesia (pain and temp) of the body = ____ lesion
7) Ipsilateral hemianalgesia (pain) and thermal hemianesthesia (temp) to face = ____ lesion
8) Contralateral loss of all sensory input to face = ____ lesion
9) Internuclear opthalmoplegia = ___ lesion (these are named Ipsilaterally)
10) Supranuclear facial palsy and other cranial palsies
11) Ipsilateral cranial nerve palsy
1) CST
2) LCST
3) PC
4) ML
5) LSST
6) SL
7) Descending tract of V
8) TL
9) MLF
10) CBT (Above decussation)
11) CBT (Below decussation)
Miosis = pupil ____ and Mydriasis = pupil _____
Horner’s syndrome, which can result from a lesion above the ___ spinal cord level, can lead to ____lateral ptosis of the upper eyelid, miosis, enophthalmos, anhydrosis and blushing
Constriction, dilation
^** Think myDDDDDDriasis = DDDDDDilation
T1, Ipsilateral
Know the RULES OF 4*****
And then know which arteries would be associated with
1) Medial Medullary syndrome
2) Medial Pontine syndrome
3) Medial midbrain syndrome aka ____s syndrome
4) Paramedian midbrain syndrome aka ____s syndrome
5) Lateral meduallry syndrome aka _____s syndrome
6) Lateral pontine syndrome
1) VA or ASA
2) Basilar
3) PCA, Weber
4) PCA, Benedikt
5) PICA, Wallenberg
6) AICA or Superior Cerebellar artery
An acoustic neuroma aka Pontocerebellar Angle Syndrome) will include the Vestibulocochlear nerve (CN 8) leading to
Vestibulo -> Vomiting, vertigo, nystagmus away from lesion
Cochlear -> Hearing loss
___ nerve will also be injured leading to _____lateral facial paralysis (aka weak muscles of mastication)
____ nerve will also be injured leading to parasthesia (loss of pain and temp) on the ____lateral side of the face and loss of the corneal reflex in the left eye
** So just to recap, the CNs 5, 7, and 8 are affected ****
Facial, ipsilateral
Trigeminal, Ipsilateral
A pineal tumor AKA Dorsal Midbrain (Parinaud) syndrome will cause problems with the _____ leading to paralysis of _____ gaze and bilateral papillary abnormalities
^** So if you see a VERTICAL GAZE PALSY it is pretty much 100% Parinauds syndrome located in the posteiror midbrain
** You will also see Pseudo Argyll Robertson pupil
Parinauds syndrome can also cause the cerebral aqueduct will be occluded leading to _____ hydrocephalus
Superior colliculus, vertical
Non-communicating
Alternating hemiplegias (aka loss of motor aka spastic hemiplegia) means that you would have to destroy the ___ to mess up motor on one side of the body, and the an ____lateral cranial nerve palsy would also be present (3, 5, 6, or 12)
CST, Ipsilateral
1) A Unilateral lesion of the optic nerve results in ____ monocular blindness
^** AKA take out right optic nerve, become blind in your right eye
2) If you lesion the lateral aspect of the optic chiasma bilaterally, ____nymous blindness in the ___ fields of each eye occur…
^**If it is a unilateral lesion, lets say out the right side of the optic chiasma, then ____-___ hemianopia of the ___ eye occurs
**3) If a midline lesion to the medial portion of the optic chiasma occurs, you get ___ hemianopia and lose sight in both left and right ____ visual fields ***
^*** Can occur via a pituitary adenoma
4) Unilateral lesions of the lateral geniculate body, or complete optic radiations, results in a ____, ____nymous hemianopsia… So if you take out the right LGB, you lose vision in your left temporal and left nasal fields and therefore this is called a ___ hemianopia
**5) Unilateral lesion of the loop of meyer results in a homonymous deficit called a ____ so lets say you cut the right loop of meyer, it is a ____ (since you lose vision in your upper left temporal and nasal visual fields *** and commonly can occur from an _____ tumor
1) Ipsilateral
2) Heteronymous, nasal,
Left-nasal, right
3) Bitemporal, Temporal
4) Contralateral, homonymous, left homonymous
5) Contralateral superior quadrantanopia, left superior quadrantanopia
Anterior temporal lobe tumor
If you take out your primary visual cortex, it results in a ___
So for example, if you take out your right primary visual cortex you get a ____ with ___
^** So anytime you see a incongruent hemianopia or macular sparing, think cortical lesion of the primary visual cortex****
Incongruent contralateral homonymous hemianopia with macular sparing
Left homonymous hemianopia with macular sparing
Pupillary constriction is a parasympathetic light reflex that is centrally processed through the ___, however this is NOT used in the accommodation pathway
For the consensual light reflex, the fibers cross over to the contralateral eye at the ___
Pretectum
Posterior commissure
Interruption of the pupillary dilation response results in ___ syndrome characterized by ___, ___, and ____
Horners, Slight ptosis/miosis/anhydrosis
Accommodation is a ____ mediated visual response, originating in the ___ eye field of the ___ lobe and results in convergence of vision, pupil constriction, and thickening of the lens
So the ___ eye field is for volitional (voluntary) eye movements, however there is also a ___ eye field involved in nonvolitional eye movements
Cortically, frontal, frontal
Frontal, Occipital
Atlantoaxial dislocations can lead to _____ insufficiency can lead to hypoxia, convulsive seizures, and decerebrate rigidity
Followed by confusion, “pins and needle sensation”, head turned to the left, etc…
So if someone fractures the transverse processes of their atlas, realize it is a vertebro-basilar insufficiency
Vertebro-basilar
What 3 things does the Trigeminal nerve do?
1) Sensation to the face (forehead, cheek, and jaw)
2) Corneal reflex
3) Motor to the muscles of mastication
What nerves would be affected by a cavernous sinus thrombosis due to infection in the sphenoidal sinus, possible rupture of the ICA, or venous congestion
3, 4, 5 (V1 aka ophthalmic and V2 aka maxillary), and 6
^** So you would get complete ptosis (3)
Loss of cardinal signs of gaze (3, 4, and 6)
Loss of corneal reflex (5)
Paralysis in the left lower limbs and infract seen in the right frontal lobe antero-medial portion would be a ____
ACA thrombosis
Edema with distention of the scalp veins, bilateral papilledema, bilateral weakness and paraesthesia in the lower limbs (pins and needles), and bilateral babinskis sign is most likely a ___
^** The papilledema is from increased ICP
**The bilateral weakness to lower limbs is due to the paracentral lobule being pressed upon on both sides
Superior sagittal thrombosis
If a patient presents with sever pain in the low back and all the symptoms seem to be lateralized to one side, start thinking _____
If the pain is bilateral, start thinking _____
Also, in Cauda Equina the there ____ (is or is not?) sexual dysfunction and in Conus Medullaris there is
** The most common cause of Cauda Equina is a _____ and for Conous medullaris they are _____
^** Remember that we talked about the fact that myxopaplliary ependymomas often are found in the filum terminalis or conus medullaris, but just realize i’m pretty sure they are much more common in the filum terminalles compared to the lipomas which are common in the conus medullaris
Cauda Equina
Conus Medullaris
Is not
Neurofibroma, Lipomas
If a patient presents with muscular fasciculations, hyporeflexia, and no reflexes you will start thinking LMN problems and if the patient has a fever you might consider a viral infection of acute ____
Poliomyelitis
The most common clinical presentation of a spinal cord infract is the ____ which will cause loss of motor and pain/temp
^** No loss of 2pt tactile and proprioception
This is because you take out the anterior horn (for motor function) and the LSTT (for pain and temp)
So if the patient can not move on the right side of their body aka right sided spastic hemiplegia (right anterior horn gone) and loss of pain and temp on the left side of the body (right LSTT that supplies pain and temp contralaterally) you would have a RIGHT ASpA infract
Anterior Spinal Artery (ASpA)
Bilateral loss of proprioception and 2pt tacttile…. You already start thinking about ____ since you must have taken out the entire posterior columns
Now if the patient has a wide slapping gait, loss of reflexes, ____ bladder/retention of urine, along with an argyll-robertson pupil and syphilis it is definitely TD
^** You get the hypotonia because you took out the dorsal roots and you get atonic bladder when you take out the dorsal roots or posterior funiculus
^** You get a reflex bladder if you lesion above S2-S4, usually following spinal shock
Tabes dorsalis
Atonic (not reflex bladder, don’t get confused)
An anterior temporal lobe tumor will compress the _____ resulting in a ____
Loop of meyer, superior quadrantanopia
Which 3 syndromes occur at the level of the midbrain
Webers
Parinauds
Benedikts
If you can no longer look up (aka loss of vertical gaze) this is a rare phenomenon associated with _____ syndrome
One will also see a pseudo Argyll Robertons pupil
*** Here, you have loss of the posterior commisure and superior colliculus
Parinauds sndrome
An A6H + 7 is called ____ syndrome
Alternating hemianalgesia and deafness (due to CN 8 lesion) is called ____ syndrome
Millard Gubler syndrome
CPA (Cerebellopontine syndrome)
Lateral medullary syndrome is also called ____ syndrome aka ____ stroke
Wallenberg, PICA
In syringomyelia, one destroys the ____, _____, ____, and part of the _____
AWC, LCST, Anterior horns, PC
Syringomyelia
WILL BE TESTED ON*******
A disease in which longitudinal cavities form in the cervical region of the spinal cord (upper cord) is called ____ and can occur from a protrusion of the cerebellar tonsils through the foramen magnum… It associated via enlargement of the syrinx
It can result in 4 possible effects, name which 4 things it can effect than answer the question
^** WHICH IS THE MOST IMPORTANT STRUCTURE IT CAN EFFECT?***
1) If the ____ is destroyed, bilateral loss of pain and temperature sensations to the upper extremities can occur (since remember, this is occurring in the cervical regions of the spinal cord)
2) If unilateral or bilateral destruction to the ___ occurs, spastic paralysis, hyperreflexia, hypertonia of the lower extremity can occur
3) If the ___ are destroyed unilaterally or bilaterally, lower motor neuron paralysis (flaccid paralysis, atrophy, areflexia, and atonia) can occur in the associated upper limb musculature
4) If the ___ are destroyed, ipsilateral anesthesia (proprioceptive and 2 pt tactile sensations) below the level of the lesion will occur ****
AWC, LCST, Anterior Horns, Posterior Columns
**AWC**
1) Anterior white commissure
2) Lateral Corticospinal tracts
3) Anterior Horns
4) Posterior Columns
