Neuroanatomy

Question 1

paramedian branch occlusion leads to (what syndrome?)

Answer 1

medial brainstem syndrome (paramedian syndrome)

Question 2

occlusion of unilateral vertebral arteries leads to (what syndrome?)

Answer 2

lateral brainstem syndrome

Question 3

The four rules of 4 (for brain stem)

Answer 3

1) 4 structures in midline starting with M 2) 4 structures to the side that start with S 3) 4 cranial nerves in medulla, 4 CN in pons, and 4 in the Pons, 4 above the Pons (2 in the Pons) 4) 4 motor nuclei in the midline (CN 3, 4, 6, 12) and 4 CN nuclei in lateral brainstem (5,7,9, 11) *know that the medial nuclei are able to be divided by 12.

Question 4

what are the 4 medial tracts in the midline of brain stem? what are there associated deficits?

Answer 4

1) corticospinal tract (deficit: is contralateral motor loss of arm and leg) 2) Medial leminiscus *at the brainstem (deficit: contralateral loss of sensation and propioception) 3) Medial Longitudinal Fasiciculus (MLF) (deficit: ispilateral internuclear opthlamegia- failure to adduct toward the nose and nystagmus in ipsilateral eye when looking laterally) 4) Motor nucleus and tract (of CN 3,4, 6, 12)- ipsilateral loss of the that cranial nerve

Question 5

What the 4 lateral tracts in the brainstem? What are the associated deficits?

Answer 5

1) Dorsalspinocerebellar tract (deficit: ipsilateral ataxia and incoordination of arm and leg) 2) spinothalamic or anterolateral tract (deficit: contralateral loss of pain and temperature in arms and legs and rarely but the trunk) 3) sensory nucleus of 5th cranial nerve (Trigeminal) (deficit: ipsilateral loss of pain and temperature in face in distribution of CN 5-this nucleus is a long vertical structure that extends in the lateral aspect of the pons down into the medulla) 4) Hypothalmoreticulospinal Tract (sympathetic pathway) (deficit: ipsilateral loss of sympathetics (ptosis, anhidrosis, miosis- small pupil [Horner’s Syndrome]

Question 6

The 4 cranial nerves in the medulla are What are their deficits?

Answer 6

-CN 9-12 CN 9- Glossopharyngeal deficit: ipsilateral loss of pharyngeal sensation loss of gag reflex difficulty swallowing impairment of taste dysfunction of parotid gland CN 10- Vagus deficit: ipsilateral palatal weakness, pharyngeal paralysis (the muscle weakened), Loss of parasympathetics visceral motor to Heart and GI (“can’t pump and can’t take a dump”) CN 11- Spinal Accessory deficit: Can’t shrug shoulders (weakened trapezius and Sternocleidomastoid) CN 12- Hypoglossal deficit: UMN lesion: tongue deviation away from lesion LMN lesion: tongue deviation toward lesion

Question 7

4 cranial nerves in the pons. What are the associated deficits?

Answer 7

-CN 5, 6, 7,8 CN5- trigeminal deficit: ipsilateral reduction/loss of pain, temperature and light touch on the face CN 6- Abducens deficit: ipsilateral weakness of abduction of eye by lateral rectus muscle (internal strabismus) CN 7- Facial deficit: ipsilateral facial weakness (be cognizant of funny wiring of facial on forehead) CN 8- Vestibulocochlear deficit: ipsilateral hearing loss nausea, vomiting, balance problems and nystagmus

Question 8

The 4 cranial nerves above the Pons

Answer 8

CN 1,2,3,4 CN 1- Olfactory deficit: Impaired sense of smell CN 2- Optic deficit: visual field deficits CN 3 - Oculomotor (in the midbrain) deficits: eye turned slightly “down and out”, loss of pupillary light reflex, ptosis, dilated pupil CN 4- Trochlear (in the midbrain) deficits: weakness of Superior Oblique, unable to look down with eyes, may hear patient says they have to turn there head down and out to prevent from falling.

Question 9

Lesions of the occipital lobe cause what

Answer 9

visual field defects in eye with macula sparring (you can see what I show you if I aim it at your fovea).

Question 10

Parietal Lobe consists of

Answer 10

Postcentral gyrus

Superior parietal Lobule

Inferior Parietal Lobule

Question 11

Postcentral Gyrus function

Lesion causes

Answer 11

somatosensory cortex

loss of epicritic sensation contralateral to body

Question 12

Superior Parietal Lobule

Lesion causes?

Answer 12

associated with guiding movement

Apraxia (can’t perform object or tool utilization, because you cant keep limb together

Question 13

Inferior Parietal Lobule

Lesions:

Answer 13

In the left hemisphere deals with speech language

Involves Supramarginal gyrus and Angular gyrus:

• supramarginal gyrus which is part of wernicke area (which is )
• Angular gyrus provides information from visual to Wernicke so it promote further comprehension of language needed to understand language in terms of reading and writing
  lesion: Alexia (can’t recognize words) with agraphia