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
A patient with ataxia tends to fall toward the right. On which side of the cerebellum is the lesion?
Right
Truncal ataxia and dysarthria are symptoms of a lesion in what part of the brain?
Cerebellar vermis
Given the following symptoms, what is the area of the lesion and specific artery affected:
Contralateral paralysis and sensory loss of face and upper limb
Aphasia (if in dominant hemisphere), hemineglect (if in nondominant hemisphere)
Middle cerebral artery
Motor and sensory cortices — upper limb and face
Temporal lobe (wernicke area); frontal lobe (broca area)
Given the following symptoms, what is the area of the lesion and specific artery affected:
Contralateral paralysis and sensory loss — lower limb
Anterior cerebral artery
Motor and sensory cortices — lower limb
Given the following symptoms, what is the area of the lesion and specific artery affected:
Contralateral paralysis and/or sensory loss of face and body
Absence of cortical signs (neglect, aphasia, visual field loss, etc.)
Lenticulostriate a.
Striatum, internal capsule
Given the following symptoms, what is the area of the lesion and specific artery affected:
Contralateral paralysis — upper and lower limbs
Decreased contralateral proprioception
Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)
Anterior spinal artery
[this is medial medullary syndrome]
Lateral corticospinal tract, medial lemniscus, caudal medulla—hypoglossal nerve
Given the following symptoms, what is the area of the lesion and specific artery affected:
Vomiting, vertigo, nystagmus; decreased pain and temp sensation from ipsilateral face and contralateral body; DYSPHAGIA, HOARSENESS, decreased gag reflex, ipsilateral Horner syndrome; ataxia, dysmetria
Posterior inferior cerebellar artery (PICA)
[this is lateral medullary (Wallenberg) syndrome]
Lateral medulla — vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle
Given the following symptoms, what is the area of the lesion and specific artery affected:
Vomiting, vertigo, nystagmus, PARALYSIS OF FACE, decreased lacrimation and salivation, decreased taste from anterior 2/3 tongue
Ipsilateral loss of pain and temp of face, contralateral loss of pain and temp of body; ataxia and dysmetria
Anterior inferior cerebellar artery
[this is lateral pontine syndrome]
Lateral pons — cranial nerve nuclei (vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei), spinothalamic tract, sympathetic fibers; middle and inferior cerebellar peduncles
Given the following symptoms, what is the area of the lesion and specific artery affected:
Preserved consciousness, vertical eye movement, and blinking
Quadriplegia, loss of voluntary facial, mouth, and tongue movements
Basilar artery
[Locked in syndrome]
Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedian pontine reticular formation
Given the following symptoms, what is the area of the lesion and specific artery affected:
Contralateral hemianopia with macular sparing
Posterior cerebral a.
Occipital cortex, visual cortex
What area/tract of the spinal cord is associated with pressure, vibration, fine touch, and proprioception?
Ascending dorsal column
What area/tract of the spinal cord is associated with pain and temp?
Lateral spinothalamic tract
What area/tract of the spinal cord is associated with crude touch and pressure?
Anterior spinothalamic tract
What area/tract of the spinal cord is associated with voluntary movement of contralateral limbs?
Descending lateral corticospinal tract
Syndrome characterized by paralysis of conjugate vertical gaze due to a lesion in superior colliculi (e.g., stroke, hydrocephalus, pinealoma)
Parinaud syndrome
A lesion in what area of the brain causes internuclear ophthalmoplegia?
Medial longitudinal fasciculus
[multiple sclerosis —> bilateral MLF lesions]
What type of lesion:
Ipsilateral paralysis of lateral gaze and/or internal strabismus + contralateral spastic hemiplegia
Alternating abducens hemiplegia
What syndrome is described below:
External strabismus, pupillary dilation, complete ptosis
CL loss of proprioception and 2-point tactile from body/limbs
Lesions of red nucleus, fibers of superior cerebellar peduncle and midbrain tegmentum leading to ipsilateral oculomotor palsy; contralateral motor dysfunction (tremor, ataxia, choreiform movements), varying degrees of spasticity
Benedikt’s syndrome
Syndrome usually due to thrombosis of posterior choroidal or thalamogeniculate branches of posterior cerebral artery, leading to state of constant, diffuse, spontaneous pain without appropriate external stimulus as well as extreme mood swings from laughter to sobbing; may also have contralateral crawling ant sensations, hemiparesis, homonymous hemianopia, or auditory deficits
Dejerine-Roussy syndrome (Thalamic syndrome)
