Neuroanatomy Review Flashcards
During a professional 10-round, boxing match, a 22 year old male received three direct blows to his left side of his head region. After the first blow, he immediately collapsed to the mat, but he slowly got up, received a standing 10 count and the round continued. At the end of that round, he received a second, staggering blow just before the ring. In his corner, the ringside physician cleared him to continue the fight. He received a third direct blow to same region and fell to the mat. He was unconscious and unresponsive; his left pupil was dilated. He was transported to a trauma center and neurosurgery was performed to control the bleeding from some bridging veins. He remained in a persistent vegetative coma state one month later. These findings indicate a diagnosis of which of the following?
A. Cerebral hemorrhage B. Epidural hematoma C. Falx herniation D. Subdural hematoma E. Tonsillar herniation
D. Subdural hematoma
During the neuro exam for the gag reflex, the patient does not sense the tongue depressor touching the oropharyngeal mucosa, but shows palatal elevation when phonating (“ahhhhhh”) and no dysphonia. These findings indicate involvement of which of the following?
A. Chorda tympani nerve B. Glossopharyngeal nerve C. Recurrent laryngeal nerve D. Trigeminal nerve E. Vagus nerve
B. Glossopharyngeal n.
IX = oropharyngeal sensation: gag reflex X = laryngoscopy, dysphona, dysphagia
Spastic hemiplegia indicates involvement of which of the following?
A. Corticospinal tract B. Lateral reticulospinal tract C. Spinal lemniscus D. Genu of internal capsule E. Ventral roots
A. Corticospinal tract
CST are upper motor neurons. A lesion of the CST results in contralateral spastic hemiplegia: hyperreflexia, hypertonia, paralysis and disuse atrophy
Lesions of the ventral roots causes a lower motor neuron paralysis of the associated motor dermatome: atonia, areflexia, fasciculation, and flaccid paralysis
Spinal lemniscus lesion —> contralateral loss of pain/temp (body)
Genu of internal capsule —> corticobulbar fibers: lesion = contralateral supranuclear facial palsy
Supranuclear facial palsy indicates involvement of which of the following?
A. Facial nerve B. Corticobulbar tract C. Corticospinal tract D. Posterior limb of internal capsule E. Rubrospinal tract
B. Corticobulbar tract
Corticobulbar fibers originate in the head reagion of precentral gyrus, course through the genu of the internal capsule and cerebral peduncles as uncrossed CBT. Unilateral lesions of uncrossed CBT result in contralateral supranuclear facial palsy
The corticobulbar fibers decussate in the lower pons and descend in the lower brainstem as crossed CBT. Unilateral lesions below the decussation may result in some ipsilateral CN palsies
Proprioceptive and 2-point tactile discrimination loss below the L3 dermatome indicates involvement of which of the following?
A. Dorsal roots B. Fasciculus gracilis C. Medial lemniscus D. Spinal lemniscus E. Ventral posterior medial nucleus
B. Fasciculus gracilis
Bilateral atonia, areflexia and flaccid paralysis involving the C7-T1 motor dermatomes indicates involvement of which of the following?
A. Anterior horn neurons B. Anterior white commissure C. Dorsal roots D. Lateral corticospinal tract E. Posterior limb of internal capsule
A. Anterior horn neurons
[these findings are characteristic of a lower motor neuron (LMN) paralysis]
Hemianalgesia and thermal hemianesthesia (body) indicates involvement of which of the following?
A. Dorsal roots B. Medial lemniscus C. Posterior limb of internal capsule D. Spinal lemniscus E. Ventral posterior medial nucleus
D. Spinal lemniscus
Alternating hemianalgesia indicates involvement of which of the following?
A. Descending tract of V B. Lateral lemniscus C. Medial lemniscus D. Trigeminal lemniscus E. Trigeminal nerve
A. Descending tract of V (8 and 12)
A lesion of V itself would result in complete anesthesia (face) and paralysis of the muscles of mastication
Bilateral diminution of hearing with a more prominent loss in one ear indicates involvement of which of the following?
A. Lateral geniculate body B. Lateral lemniscus C. Posterior limb of internal capsule D. Superior colliculus E. Vestibulocochlear nerve
B. Lateral lemniscus
Unilateral lesions of the lateral lemniscus, inferior colliculus, brachium of the inferior colliculus and medial geniculate body result in bilateral diminution of hearing with a more prominent hearing loss in the contralateral ear
On horizontal gaze to the right, the left eye does not adduct and the right eye shows nystagmus, this indicates involvement of which of the following:
A. Abducens n. B. Medial longitudinal fasciculus C. Oculomotor nerve D. Superior colliculus E. Vestibulocochlear n.
B. Medial longitudinal fasciculus
This is called left internuclear ophthalmoplegia (named for the side of the non-adducting eye)
Left homonymous hemianopia indicates involvement of which of the following?
A. Loop of Meyer B. Medial geniculate body C. Optic chiasma D. Optic tract E. Primary visual cortex
D. Optic tract
Contralateral homonymous hemianopia. Unilateral lesions of the LGN, complete optic radiations or visual cortex result in a contralateral homonymous hemianopsia
Internal strabismus indicates involvement of which of the following?
A. Abducens nerve B. Oculomotor nerve C. Trochlear nerve D. Superior colliculus E. Medial longitudinal fasciculus
A. Abducens nerve
Characteristic lesion associated with hemiballismus movement disorder
Contralateral subthalamic nucleus (e.g., lacunar stroke)
Syndrome and brain area associated with agraphia, acalculia, finger agnosia, left-right disorientation
Gerstmann syndrome; parietal cortex
Syndrome and brain area associated with confusion, ophthalmoplegia, ataxia, memory loss (anterograde and retrograde), confabulation, and personality changes
Wernicke-Korsakoff syndrome; bilateral mammillary bodies
