Neurolocalization

Question 1

What clinical signs indicate cerebellar disease?

Answer 1

-Intention tremors
-Hypermetria
-Ataxia
-Incoordination
-Postural deficits/proprioceptive deficits
+/- lack of menace, central paradoxical vestibular disease, ventro-lateral strabismus that changes with head movement.

Question 2

What clinical signs indicate brainstem lesion(s)?

Answer 2

-Altered states of consciousness (reticular activating system) such as obtundation, stupor, coma
-Multiple cranial nerve deficits or peripheral nerve lesions
-Central vestibular disease
-Visual impairment/blindness
-Cardiovascular, respiratory, sleep disorders
-Gait deficits, ataxia
-Postural deficits (proprioception)

Question 3

What clinical signs indicate forebrain dysfunction?

Answer 3

-Altered mentation
-Seizures
-Head pressing, yawning, compulsive walking
-Sexuality
-Visual impairment, blindness
-Motor movement. NOT ATAXIC
-Proprioception/postural deficits

Question 4

What clinical signs indicate cauda equina dysfunction?

Answer 4

Loss of control of tail, anal sphincter, bladder, or penis.
NOT ataxic. (SC ends at S2)

Question 5

What clinical signs indicate generalized spinal cord dysfunction?

Answer 5

Ataxia: grade 1-5, thoracic v pelvic, R vs L
Paralysis, paresis
Dysmetria
Proprioceptive deficits (fasciculus gracilis + cuneatus connections)
Altered spinal reflexes
UMN or LMN signs: Upper is spastic and exaggerated, Lower is weak and muted reflexes or knuckling
Cauda equina signs

Question 6

What clinical signs indicate vestibular disease?

Answer 6

Seen with central and peripheral: head tilt, nystagmus, strabismus (fixed is CN, dynamic is vestibular), ataxia, proprioceptive deficits.
Signs worsen when eyes are covered.

Question 7

What clinical signs indicate a central source of vestibular disease?

Answer 7

Vertical nystagmus, positional nystagmus, consistently have proprioceptive deficits

Question 8

What clinical signs indicate a peripheral source of vestibular disease?

Answer 8

NO proprioceptive deficits, often accompanied by facial nerve signs from THO, horizontal or rotary nystagmus, non-positional nystagmus, normal mentation