Neurology Flashcards
What is Gertsmann Syndrome?
When there is a lesion (stroke, tumour, etc) in the dominant angular gyrus (part of the parietal lobe), causing a constellation of acalculia (unable to do calculations), agraphia (unable understand drawing of a number on hand), L-R disorientation, and finger agnosia.
Which lobe would a lesion be if they had isolated gait apraxia?
Frontal lobe
If a patient has resurfacing of primative reflexes (pout, glabella tap, grasp), where does it suggest there is damage?
Frontal lobe
Foster Kennedy syndrome is what?
Raised intracranial pressure, optic nerve atrophy, anosmia, and personality change from a frontal lobe lesion pressing dowen on the cribiform plate
A patient presents with alexia. Where is their lesion?
Occipital lobe
Where is the lateral geniculate nucleus?
It’s in the thalamus
What is Broca’s aphasia, and where is Broca’s region?
Broca’s region is in the dominant (usually left) frontal lobe. Leads to expressive aphasia - paucity of words.
What is Wernicke’s aphasia, and were is Wernicke’s region?
Wernicke’s regions is in the dominant (usually left) temporal lobe. Receptive aphasia. Don’t understand what is being said, or really what they are saying.
What area is impacted to create a conduction aphasia?
Conduction aphasia points to a lesion impacting the arcuate fascilus which is a tract conntecting Broca’s region in the dominant frontal lobe to Wernicke’s region in the dominant temporal lobe.
What path is taken by upper motor neuron axons (cortex to spine), and where to the decussate?
The upper motor neuron cell bodies are located in the motor cortex, which is a band of the cortex at the posterior of the frontal lobe. The axons from these cells bundle together to form the central semiovale, then the corona radiata, and then the internal capsule (still in the cerebrum, getting tighter together tas the progress down towards the spinal cord). As the internal capsule travels into the midbrain is gets a different name - Crus cerebri. Then as it moves into the pons it becomes known as the ‘Basis Pontis’. Then as it reaches the medulla it becomes known as the ‘pyramids’. At the lower part of the medulla it DECUSSATES the Finally, it enters the spinal cord and becomes known as the corticospinal tract.
What path is taken by sensory neurons resonsible for pain, temperature and crude touch? Where do they synapse and where dothey decussate?
Cell bodies start in the parietal lobe, then synapse at the thalamus. Second order sensory neurons have cell bodies in the thalamus that project to through the midbrain, pons and medulla to the spinal cord ipsilaterally - spinothalamic tract. They then decussate at the spinal level nearest to the part of the body they are going to innervate and synapse with peripheral sensory nerves in the lateral aspect of the spional cord.
Is there 1 thalmus, or 2 thalamuses?
It gets called ‘the thalamus’ (singular), but it’s actually 2 mirror image structures (one for the left brain and one for the right) with symmetry across the midline. Each lobe is a concentration of nuclei that participate in modifiying processing of language, memory, motor, sensory, arousal, and visual function. There is some amount of redundancy across the lobes. So, if nuclei involved in arousal are impacted by a lesion on
the left side of the thalamus, the nuclei on the right with the same function would prevent obtundation.
What path is taken by sensory neurons responsible for proprioception, vibration and fine (discriminitive) touch? Where do they synapse and where to they decussate?
Cell bodies start in the parital lobe, axons project to the thalamus. Second order neurons project axons through the midbrain, pons and to the medulla where they decussate. Note that this is dfferent tot her spinothalamic tract which doesn’t decussate until the spinal level. The third order sensory neurons have denditic processes that extend down through the spinal cord and exit through the dorsal aspect of the spinal cord, then have a cell body in the dorsal root ganglion. The axon then projects to the tissue.
What is the role of the anterio nuclei of the thalamus?
Language and memory function
What is the role of the lateral nuclei of the thalamus?
Motor and sensory function
What is the role of the medial nuclei of the thalamus?
Arousal and memory function
What is the role of posterior (pulvinar) nuclei of the thalamus?
Visual function
Where, classically, is a lesion located if a patient presents with hemisensory loss involving the face, upper limbs and lower limbs?
In the contralateral thalamus
What are the cerebellar hemspherical signs?
Ipsilateral:limb ataxia, dysmetria, intenion tremor, dysdiadochokinesia, nystagmus
What happens if you have lesion in your cerebellar vermis? (the medial part of the cerebellar)
Trunkal ataxia and nystagmus
What are the components of the brainstem in order?
From superior to inferior: mdibrain -> pons -> medulla
Rule of 4s: what are the cranial nerve nuclei located in the midbrain?
Cranial nerves 3 and 4. Note that nerves 1 and 2 have their nuclei in the brain itself, superior to the midbrain.
Rule of 4s: what are the four structures in the midline of the brain that begins with M?
Motor pathay (corticospinal tracs), medial lemnisus (dorsol column), medial longitudinal fasciculius, and motor CN nuclei (CN 3,4, 6, 12)
Rule of 4s: what are the four structres on the sides (lateral) of the brainstem that begin with S?
Spinocerebellar pathways, spinothalamic pathways, sensory nucleus of the 5th CN, sympathetic tract