Neurology Flashcards
What tracts are affected in subacute degeneration of the spinal cord?
Dorsal Column and Lateral corticospinal tract
Function of spinothalamic tract?
Transmits pain, temperature, and crude touch sensations
Function of dorsal column?
Responsible for fine touch, proprioception, vibration, and pressure sensations
Where does decussation occur in the spinothalamic tract?
Level of spinal cord entry within the anterior commissure
Spinothalamic tract:
-A lesion will lead to loss of what and where?
Pain and temperature on the CONTRALATERAL side below the lesion
Where does decussation occur in the dorsal column?
At the level of the medulla in the medial lemniscus
A lesion in the dorsal column will result in what?
loss of fine touch, vibration, and proprioception on the ipsilateral side below the level of the lesion.
Function of lateral corticospinal tract?
Controls voluntary motor function, particularly fine movements of the distal limbs
Decussation lateral corticospinal tract?
pyramidal decussation at the medulla, the fibers cross to the contralateral side and form the lateral corticospinal tract.
Lesions affecting the lateral corticospinal tract will result in?
contralateral motor weakness, particularly affecting fine motor skills and dexterity. Upper motor neuron signs (e.g., hyperreflexia, spasticity) are seen
Functions of anterior corticospinal tract?
Controls voluntary motor function, particularly for trunk and proximal limb muscles
where does decussation occur in anterior corticospinal tract?
In the spinal cord, fibers from the anterior corticospinal tract cross at the level of the spinal cord to synapse with lower motor neurons in the anterior horn.
Lesions of the anterior corticospinal tract typically result
weakness and impaired movement of the trunk and proximal muscles on the contralateral side.
Site of lesion in Wernicke and Korsakoff syndrome
Medial thalamus and mammillary bodies of the hypothalamus
site of lesion in Hemiballism
Subthalamic nucleus of the basal ganglia
Site of lesion in Huntington chorea
Striatum (caudate nucleus) of the basal ganglia
Site of lesion in Parkinsons disease?
Substantia nigra of the basal ganglia
Site of lesion in Kluver-Bucy syndrome (hypersexuality, hyperorality, hyperphagia, visual agnosia
Amygdala
Why does Bells Palsy cause hyperacusis?
facial nerve innervates the stapedius muscle (which affects how loud conduction of sound from the tympanic membrane to the cochlea
Triad of Miller Fisher syndrome?
Ataxia
Ophthalmoplegia
Areflexia
Type of dysphasia:
speech non-fluent, comprehension normal, repetition impaired
Brocas
Brocas aphasia area of brain affected?
inferior frontal gyrus in the dominant hemisphere (which is usually on the left side for right-handed individuals).
Mechanism of action of Riluzole for motor neuron disease?
Inhibits glutamate release; modestly extends survival.
Does Amyotrophic lateral sclerosis (ALS) result in UMN or LMN signs?
Both UMN and LMN
Does Progressive muscular atrophy (PMA) result in UMN or LMN signs?
LMN only
Does Primary lateral sclerosis (PLS): result in UMN or LMN signs?
UMN signs only
Internuclear ophthalmoplegia is caused by pathology in what part of the brain?
The medial longitudinal fasciculus is located in the paramedian area of the midbrain and pons
Cranial nerve lesion ? results in down and out eye and Ptosis?
Third nerve Palsy
speech fluent, but repetition poor. Comprehension is relatively intact
Conduction dysphasia
-Arcuate fasciculus affected
non-fluent, laboured and halting speech
Brocas Aphasia
-Inferior frontal gyrus
-Superior division of left MCA
neologisms and nonsense sentences which is fluent
Wernicke’s aphasia
-Lesion in superior temporal gyrus
-Supplied by inferior division of left MCA
First line management of trigeminal neuralgia?
Carbamazepine
Alternative differential to cauda equina syndrome. However, associated with a combination of upper and lower motor neuron signs + hyperreflexia
Conus Medullaris Syndrome
A 65-year-old woman presented with a 12-hour history of sudden-onset gait unsteadiness, vomiting and headache, followed by increasing drowsiness. What is the most likely diagnosis?
Acute cerebellar haemorrhage
Dilated pupil + Sluggish light reflex + Slow accommodation
Homes-Aide Pupil
Brown-Séquard Syndrome
Location of symptoms:
-Damage to corticospinal tract?
-Dorsal column?
-Spinothalamic?
-Ipsilateral
-Ipsilateral
-Contralateral
1st line Tx for moderate to severe restless leg syndrome?
Ropinierole, Pramipexole, rotigotine (Dopamine agonists)
CSF Results Viral Meningitis
-Opening pressure
-Glucose
-Fluid
-Protein
-WCC
-Normal
-60/80% plasma glucose
-Clear
-Normal/raised
-Lymphocytosis
Bacterial Meningitis CSF results
-Appearance
-Glucose
-Protein
-WCC
-Cloudy
-Low (Half plasma levels)
-High > 1 g/l
-Markedly raised polymorphic
Cavernous sinus thrombosis
-What cranial nerves would be affected?
-Cranial nerve 3 (Oculomotor) -> painless diplopia
-Cranial Nerve 4 (Trochlea) -> Ptosis
-Trigeminal V1 and V2 branches only
