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M2 Pathology > Neurolocalisation (Overview + Where in the CNS) > Flashcards

Neurolocalisation (Overview + Where in the CNS) Flashcards

1
Q

State the structures involved in the general motor pathway.

State the result of a break in the motor axis

A

General motor pathway:
UMN –> LMN –> NMJ –> muscle

Break in the motor axis = weakness

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2
Q

State the 2 components of extrapyramidal components.

State the result of a lesion in one or both of the components.

A

Extrapyramidal components
1. basal ganglia
2. cerebellum

Result of lesion in extrapyramidal component = not strictly weakness but imprecise movement if cerebellum

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3
Q

State some conditions (6) confined to the CNS

A
  1. troke
  2. epilepsy
  3. multiple sclerosis
  4. dementia
  5. parkinson disease
  6. encephalitis
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4
Q

State some conditions confined to PNS (5)

A
  1. brachial neuritis
  2. peripheral nueropathies in GBS
  3. mononeuritis multiplex
  4. myasthenia gravis
  5. myositis
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5
Q

State some conditions that can affect both CNS and PNS (4)

A
  1. vitamin B12 deficiency
  2. vasculitidis (including sjogrens)
  3. syphilis / HIV
  4. freidreichs ataxia
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6
Q

Recall the structures involved in
(1) Motor axis
(2) Extrapyramidal system

A

(1) MOTOR AXIS
UMN –> LMN –> NMJ –> muscles

(2) EXTRAPYRAMIDAL SYSTEM
- basal ganglia
- cerebellum

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7
Q

State the components of the motor axis and their locations (CNS/PNS)

A

UMN - CNS
Basal ganglia - CNS
Cerebellum - CNS
LMN - CNS (only cell body) and PNS (majority)
NMJ - PNS
Muscle - PNS

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8
Q

State the 3 functions of the reflex arc

A
  1. prevents overstretching of muscle
  2. helps maintain posture
  3. generates tone
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9
Q

Explain the features of UMN and LMN lesion with reference to:
1. inspection
2. tone
3. power
4. reflexes
5. plantars
6. coordination
7. others

A

UMN LESION
- Inspection = pyramidal posture
- Tone = clasp-knife rigidity
- Power = pyramidal pattern weakness
- Reflexes = brisk
- Plantars = upgoing plantar
- Coordination = compromised
- Others = spastic gait, hoffman reflex, clonus

LMN LESION
- Inspection = wasting and fasciculations
- Tone = flaccid or normal
- Power = weak
- Reflexes = absent
- Plantars = downgoing plantar
- Coordination = compromised
- Others = foot drop

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10
Q

With regard to LMN lesions,
- Reflex arc is ____ ____
- Inspection =
- Tone =
- Power =
- Reflexes =
- Plantars =
- Coordination =
- Others =

Name the example of this LMN lesion.

A

With regard to LMN lesions,
- Reflex arc is COMPLETELY BROKEN
- Inspection = WASTING + FASCICULATIONS
- Tone = FLACCID OR NORMAL
- Power = WEAK
- Reflexes = ABSENT
- Plantars = DOWNGOING
- Coordination = COMPROMISED
- Others = FOOT DROP

CHARCOT-MARIE TOOTH SYNDROME

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11
Q

With regard to UMN lesions,
- ____ level of ____ of reflex arc is ____
- Inspection =
- Tone =
- Power =
- Reflexes =
- Plantars =
- Coordination =
- Others =

A

With regard to UMN lesions,
- HIGHER level of MODULATION of reflex arc is LOST
- Inspection = PYRAMIDAL POSTURE
- Tone = CLASP-KNIFE RIGIDITY
- Power = PYRAMIDAL PATTERN WEAKNESS
- Reflexes = BRISK
- Plantars = UPGOING
- Coordination = COMPROMISED
- Others = SPASTIC GAIT, HOFFMAN REFLEX, CLONUS

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12
Q

Cord lesion in anterior half of the spinal cord at level T12 can result in
1. ____ signs at that level.
2. ____ signs below that level

A

Cord lesion in anterior half of the spinal cord at level T12 can result in
1. LMN signs at that level.
2. UMN signs below that level

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13
Q

State the 3 elements of movement

A
  1. power
  2. coordination
  3. quantity
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14
Q

State the important cord levels and outlets (4)

A

C3-5 - phrenic N (keep the diaphragm alive)
C5-T1 - brachial plexus
L1-S4 - lumbosacral plexus
S2-4 - sphincteric supply (keep the shit off the floor)

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14
Q

State the structures in the cerebral hemispheres and structures in the brainstem

A

CEREBRAL HEMISPHERE
1. grey matter (cortex)
2. white matter
3. basal ganglia

BRAINSTEM
1. midbrain - CN III and CN IV nucleus, gaze centres, reticular formation of reticulospinal tract
2. pons - CN V, CN VI, CN VII, CN VIII nuclei, gaze centre (horizontal PPRF), long tracts
3. medulla - CN IX, X, XII nuclei, cerebellar connections

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15
Q

Brain has a ____ cross section –> lesion in brain is likely to affect ____ side(s) (____)

Spinal cord has a ____ cross section –> lesion in the spinal cord is likely to affect ____ side(s) (____ or ____)
- As cord carries ____ ____, cord lesions result in ____ symptoms

A

Brain has a LARGE cross section –> lesion in brain is likely to affect ONE side(s) (CONTRALATERAL HEMIPARESIS)

Spinal cord has a SMALL cross section –> lesion in the spinal cord is likely to affect BOTH side(s) (PARAPERESIS or QUADRUPARESIS)
- As cord carries SPHINCTERIC EFFERENTS, cord lesions result in UROLOGICAL symptoms

hemiparesis = weakness in one side
paraperesis = weakness in both legs only
quadruparesis = weakness in all 4 limbs

16
Q

With reference to spinal cord, state the results of a cervical and thoracic cord lesion

A

CERVICAL CORD LESION
- quadruparesis = weakness in all 4 limbs
- bilateral incontinence (due to sphincteric supply at level of S2-S4)

THORACIC CORD LESION
- paraperesis = weakness in bilateral legs
- bilateral incontinence (due to sphincteric supply at level of S2-S4)

17
Q

RECALL:
State the structures involved in the different parts of the brainstem.

State the effects of lesions at each part of brainstem with relation to the structures mentioned.

A

(1) MIDBRAIN
- CN III + CN IV nuclei - cranial nerve deficit (double vision)
- Vertical gaze centres (riMLF) - gaze palsies (opthalmoplegia + vertigo)
- Reticular formation - loss of consciousness + cheyne stoke breathing (increasing duration of breathing)

(2) PONS
- CN V + CN VI + CN VII + CN VIII nuclei - cranial nerve deficit
- Horizontal gaze centres (PPRF) - gaze palsies (opthalmoplegia + vertigo)
- Long tracts - locked in syndrome (if bilateral damage), UMN signs and weakness (contralateral hemiparesis), sensory symptoms

(3) MEDULLA
- CN IX + CN X + CN XII nuclei - cranial nerve deficit
- Cerebellar connections - ataxia and vertigo

sympathetic outflow = horner syndrome

18
Q

State the levels in the brainstem where each cranial nerve exits

A

MIDBRAIN - 3, 4

PONS - 5, 6, 7, 8

MEDULLA - 9, 10, 12

19
Q

State the presentations associated with lesion in midbrain

A

LESION IN MIDBRAIN
1. CN III + CN IV nuclei - cranial nerve deficits (diplopia)
2. Vertical gaze centres (riMLF) - gaze palsies (ophthalmoplegia + vertigo)
3. Reticular formation - loss of consciosness + chyne stoke breathing (continuous increasing duration between each breath)

20
Q

State the presentations associated with lesion in pons

A

LESION IN PONS
- CN V + CN VI + CN VII + CN VIII nuclei - cranial nerve deficit
- Horizontal gaze centres (PPRF) - gaze palsies (ophthalmoplegia + vertigo)
- Long tracts - weakness and sensory symptoms + locked in syndrome (if bilateral lesions)

21
Q

State the presentations associated with lesion in medulla oblongata

A

LESION IN MEDULLA OBLONGATA:
- CN IX + CN X + CN XII - cranial nerve deficits
- Cerebellar connections (spinocerebellar and cerebellocortical tracts) - ataxia and vertigo

22
Q

State the presentation associated with lesions in the cerebral hemisphere

A

LESION IN THE CEREBRAL HEMISPHERE
1. UMN lesion and contralateral hemiparesis
2. Cognitive issues
3. Visual field deficits

Recap: UMN lesions
- Inspection = PYRAMIDAL POSTURE
- Tone = CLASP-KNIFE RIGIDITY
- Power = PYRAMIDAL PATTERN WEAKNESS
- Reflexes = BRISK
- Plantars = UPGOING
- Coordination = COMPROMISED
- Others = SPASTIC GAIT, HOFFMAN REFLEX, **CLONUS*

23
Q

State the difference in presentation of subcortical and cortical lesions.

A

SUBCORTICAL LESIONS
- in white matter
- UMN lesion + contralateral hemiparesis + sensory deficits

CORTICAL LESIONS
- in grey matter
- UMN lesion + contralateral hemiparesis + sensory deficits + cognitive issues + visual field defects

24
Q

State the 4 higher cognitive functions the cortex is involved in, state their corresponding dominant/non-dominant hemisphere and presentation of their deficits.

A
25
Q

State the presentation associated with lesions in the cerebellum

A

LESIONS IN THE CEREBELLUM
- no UMN signs
- if lesion is in cerebellar hemisphere –> ipsilateral limb ataxia (upper and lower)
- if lesion is in cerebellar vermis –> truncal ataxia

OTHER SIGNS
- nystagmus
- dysmetric saccades
- broken pursuit
- cerebellar dysathria
- finger nose dysmetria
- dysdiadochokinesis (inability to rapid alternating muscle movements)
- ataxia
- broad base gait

26
Q

With regard to anterior cord syndrome, state the
1. affected tracts
2. cause
3. presentation

A

With regard to anterior cord syndrome, state the
1. affected tracts = spinothalamic, lateral tracts (+/-)
2. cause = anterior spinal artery occlusion –> spinal infarct
3. presentation = loss of pain and temperature, LMN signs at level of lesion, UMN signs below level of lesion

27
Q

With regard to posterior cord syndrome, state the
1. affected tracts
2. cause
3. presentation

A

With regard to posterior cord syndrome, state the
1. affected tracts = DCML tract, lateral tracts
2. cause = b12 deficiency OR syphilis (tabes dorsalis) OR copper deficiency
3. presentation = loss of proprioception and vibration sensation, LMN at level of lesion, UMN signs below level of lesion

28
Q

With regard to brown-sequard syndrome, state the
1. affected tracts
2. presentation

A

With regard to brown-sequard syndrome, state the
1. affected tracts = ipsilateral DCML, contralateral spinothalamic, ipsilateral corticospinal (lateral tracts)
2. presentation = loss of proprioception and vibration, loss of pain and temperature sensations, ipisilateral UMN weakness

M2 Pathology (20 decks)

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