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Y3 MOD Neurology > Neurolocalisation > Flashcards

Neurolocalisation Flashcards

1
Q

What are the functions of the forebrain?

A
  • Thinking!!!!
  • Behaviour
  • Vision, hearing
  • Conscious perception of touch, pain, temperature, body position
  • Fine motor activity
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2
Q

What are some signs of forebrain lesions?

A
  • Disorientation, confusion, depression
  • Contralateral blindness
  • Normalish gait, circling, head turn, head pressing
  • Decreased postural responses in contralateral limbs
  • Seizures!!
  • Behavioural changes
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3
Q

What are the functions of the brainstem?

A
  • Basic functions that keep us alive!
  • No decision making processes
  • Regulatory centres for cardiovascular system and breathing
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4
Q

What are some signs of brainstem lesions?

A
  • Depression, stupor, coma
  • Cranial nerve deficits
  • Vestibular signs
  • Paresis of all or ipsilateral limbs
  • Decerebrate rigidity
  • Decreased postural responses
  • Respiratory or cardiac abnormalities
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5
Q

What are the functions of the cerebellum

A
  • Control motor activity!
  • Regulator not initiator!
  • Coordinates and smoothes out movement induced by UMN system
  • Inhibits the vestibular system
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6
Q

What are some signs of cerebellar lesions

A
  • Normal mentation
  • Ipsilateral abnormal menace
  • Vestibular signs
  • Ataxia, broad stance, hypermetria
  • Intention tremors
  • Decerebellate rigidity
  • Delayed initiation and then often hypermetric postural responses
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7
Q

What are the functions of the vestibular system?

A
  • Maintain balance!

- Maintain position of the eyes, neck, trunk and limbs relative to position and movement of the head at all times

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8
Q

Where are vestibular receptors and nuclei located?

A
  • Receptors in inner ear transmit information to Cn VIII (Peripheral)
  • Vestibular nuclei in brainstem under some control from cerebellum (Central)
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9
Q

What are the main signs of vestibular system lesions?

A
  • Head tilt (contralateral in cerebellar lesions)
  • Nystagmus
  • Ataxia with leaning and falling, less commonly tight circling
  • Positional strabismus
  • Paradoxical head tilt
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10
Q

How can the lesion causing nystagmus be localised?

A
  • Try and figure out which is the fast phase and which is the slow phase (direction they are going in)
  • Lesion on the side of the slower phase
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11
Q

Describe the signs of central vestibular lesions

A
  • Possible paresis
  • Possible proprioceptive defects
  • CN V-XII may be affected
  • Vertical nystagmus
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12
Q

Describe the signs of peripheral vestibular lesions

A
  • No paresis or proprioceptive defects
  • Alert mentation
  • Cranial nerve VII may be affected
  • Horizontal nystagmus
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13
Q

What is a paradoxical head tilt?

A

Head tilt contralateral to lesion

+ Some signs of cerebellar disease

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14
Q

If reflexes are normal to increased in both the TLs and PLs where is the spinal lesion located?

A

C1-C5

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15
Q

If the reflexes are reduced in the TLs but normal to increased in the PLs where is the spinal lesion located?

A

C6-T2

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16
Q

If the reflexes are reduced in the PLs but normal in the TLs where is the spinal lesion located?

A

L4-S3

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17
Q

If the reflexes are normal in the TLs but normal to increased in the PLs where is the spinal lesion located?

A

T3-L3

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18
Q

How can the spinal cord be divided into two based on which limbs are affected?

A
  • C1-T2 – all legs affected

* T3-S3 – pelvic limbs affected

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19
Q

What are the 3 severities of spinal lesions to show how they are affected?

A
  • Ataxia
  • Paresis
  • Paralysis
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20
Q

What is an UMN?

A

Efferent neuron that originates in the brain and synapses with a LMN, modulating its activity

21
Q

What is a LMN?

A
  • Efferent neuron connecting CNS with effector organ (muscle or gland)
  • Cell body in spinal cord GM or within the nucleus of a CN and its axon becomes the PN
22
Q

Where are lower motor neurones located for TLS and PLs?

A 
TLs = cervical intumescence ( C6-T2 ) 
PLs = lumbosacral intumescence (L4-S3)
23
Q

Describe the path of the reflex

A

Skin stimulus detected by pain receptors -> sensory neurone -> relay neurone (grey mater) -> motor neurone -> muscle fibres

24
Q

What are the signs of a C1-C5 spinal lesion?

A
  • Tetra or hemiparesis/plegia
  • Normal spinal reflexes in all limbs
  • Horner’s syndrome, respiratory difficulties, urinary retention
25
Q

What are the signs of a C6-T2 spinal lesion?

A
  • Tetra or hemiparesis/plegia; possible
  • Reduced spinal reflexes in thoracic limbs
  • Reduced muscle tone, muscle atrophy in TLs
  • Possibly reduced/absent cutaneous trunci reflex
  • Nerve root signature, Horner’s syndrome, respiratory difficulties, urinary retention
26
Q

What are the signs of a T3-L3 spinal lesion?

A
  • Paraparesis/plegia (normal TLs)
  • Normal muscle tone, no muscle atrophy
  • Normal spinal reflexes in all limbs
  • Possibly reduced/absent cutaneous trunci reflex caudal to the spinal lesion
  • Urinary retention
27
Q

What are the signs of a L4-S3 spinal lesion?

A
  • Paraparesis/plegia; possible monoparesis
  • Reduced spinal reflexes in pelvic limbs, reduced anal tone and perineal reflex in more caudal lesions, reduced muscle tone, muscle atrophy in pelvic limbs
  • Nerve root signature, reduced tail tone sensation in caudal lesions, urinary retention in more cranial lesions or urinary
  • +/- faecal incontinence in caudal lesions
28
Q

Give some examples of how interpreting spinal lesions can lead to the wrong localisation

A
  1. Pain can cause withdrawal to appear reduced
  2. If lesion very subtle (e.g. just causing spinal pain), may not be severe enough to affect reflex pathway
  3. Patellar reflex can become reduced in old age
  4. Spinal shock in acute cases
29
Q

Describe spinal shock

A

Flaccid paralysis with loss of spinal reflexes caudal to lesion in acute SCI
Temporary (hours):
- Anal sphincter reflex 15 min
- Patellar reflex between 30 min and 2h
- Flexor withdrawal reflexes up to 12 hours

30
Q

Neuropathies are caused by?

A

Peripheral nerve lesions

31
Q

Describe the main features of neuropathies

A
  • Reduced spinal or cranial nerve reflexes
  • Can affect 1 nerve e.g. trigeminal tumour, facial paralysis, radial nerve paralysis
  • Can affect a group of nerves e.g. brachial plexus avulsion or tumour
  • Can affect most/all nerves (polyneuropathy)
32
Q

What are some signs of neuropathies affecting groups of nerves?

A
  • Monoparesis/lameness
  • Reduced reflexes in affected limb
  • Possibly unilateral cut-off cutaneous trunci
  • Possibly Horner’s
33
Q

What are some signs of neuropathies affecting most/all nerves?

A
  • Flaccid paresis, with little movement
  • Hallmark is that spinal reflexes are reduced in the front and back limbs as none of the LMNs are working
  • Dogs will have a recued palpebral reflex, lost their bark
34
Q

What are some causes of neuropathies affecting most/all nerves?

A
  • Inflammatory (idiopathic polyradiculoneuritis)
  • Metabolic (Diabetes mellitus, hypothyroidism, etc)
  • Degenerative (breed specific)
35
Q

Junctionopathies are lesions occurring at…

A

The neuromuscular junction:

  • Axon terminal
  • Synaptic cleft
  • Endplate of skeletal muscle
36
Q

What is a myopathy?

A

Any disease that affects the muscles that control voluntary movement in the body

37
Q

What are the signs of myopathies?

A
  • Generalised weakness and/or exercise intolerance – stiff stilted gait; neck ventroflexion
  • Usually no proprioceptive deficits (unless extreme weakness)
  • Usually normal spinal reflexes (unless significant muscle atrophy)
  • Variable muscle tone and bulk
38
Q

What are 3 causes of generalised myopathies?

A
  • Inherited/degenerative
  • Inflammatory/infectious
  • Metabolic
39
Q

VITAMIND is an acronym for neurological causes, what are they?

A
  • Vascular
  • Inflammatory, infectious
  • Trauma, toxic
  • Anomalous
  • Metabolic
  • Idiopathic
  • Neoplasia, nutritional
  • Degenerative
40
Q

What other factors needsto be considered when describing and analysing neuro lesions

A
  • Lateral or symmetrical
  • Focal multifocal or diffuse
  • Acute, subacute or chronic
  • Progressive, static, improving, waxing and waning
  • Painful?
41
Q

A peracute/acute neuro lesions indicates which 3 causes?

A
  • Vascular
  • Trauma/toxic
  • Idiopathic (vestibular)
42
Q

A subacute neuro lesions indicates which 2 causes?

A
  • Inflammatory/infectious

- Degenerative (IVDD)

43
Q

A chronic neuro lesions indicates which possible causes?

A
  • Degenerative
  • Neoplastic
  • Metabolic/nutritional
  • Anomalous
  • Inflammatory/infectious
44
Q

A progressive neuro lesions indicates which 3 possible causes?

A
  • Neoplastic
  • Inflammatory/infectious
  • Degenerative
45
Q

A static/improving neuro lesions indicates which 3 possible causes?

A
  • Vascular
  • Trauma/toxic
  • Idiopathic (vestibular)
46
Q

A waxing/waning neuro lesions indicates which cause?

A

Metabolic

47
Q

A focal and lateralised neuro lesion indicates which causes?

A

Neoplasia

Vascular

48
Q

A multifocal neuro lesion indicates which causes?

A
  • Inflammatory/infectious (most likely)
  • Neoplasia
  • Vascular
  • Trauma
49
Q

A diffuse and symmetrical neuro lesion indicates which causes?

A

Metabolic

Toxic

Y3 MOD Neurology (5 decks)

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