Neuropsychology Flashcards
1
Q
Unimodal (Homotypic) Association Cortex
AKA Secondary Association Cortex
A
- Characteristics:
- Modality specific: neurons respond almost entirely to a single sensory modality
- Information processed here comes from the primary sensory (idiotypic) area for that modality
- Lesions = deficits specific to that sensory modality
- Components:
- Upstream: areas 1 synapse away from the primary sensory area
- Downstream: 2+ synapses away from primary sensory area
2
Q
Heteromodal Association Cortex
AKA Tertiary Association Cortex
A
- Constituent neurons are not restricted to a single sensory modality
- Instead, respond to inputs from multiple unimodal (secondary) areas and other heteromodal areas
- Lesion = multimodal deficits, involve disruption of inputs from more than one functional area
3
Q
Major anatomical areas subserving language functions
A
- Heschl’s gyrus: primary auditory cortex
- Broca’s area: posterior aspect of the inferior frontal operculum
- Wernicke’s area: middle, posterior aspects of the superior temporal gyrus banding Heschl’s gyrus
- Major association fibers and streams
- Arcuate fasciculus: connects Wernicke’s and Broca’s
- Ventral/dorsal streams
- Supramarginal and angular gyri in left parietal
4
Q
Wernicke-Geschwind model of language processing
A
- Hearing/speaking:
- Primary auditory cortex > secondary auditory (Wernicke’s) > (via arcuate fasciculus) > motor/premotor cortex and Broca’s > primary motor cortex > output
- Broca’s is not just about producing speech, it’s also about planning the motor component
- Reading/writing:
- Primary visual cortex > other visual association areas > angular gyrus (tertiary association) > secondary auditory (Wernicke’s) > (via arcuate fasciculus) > secondary motor cortex (Broca’s) > primary motor cortex > output
5
Q
Role of different temporal lobe regions in language processing
A
- Middle, inferior temporal areas = naming
- Posterior inferior = general naming
- Temporal pole (anterior temporal) = proper noun retrieval
- Inferotemporal areas = object categorization
- Superior temporal gyrus and bounded cortex = socio-emotional processing
- Lateralized between hemispheres
- Ventral processing stream provides visual input for temporal function
6
Q
Broca’s Aphasia
A
- AKA expressive or nonfluent aphasia
- Slow, effortful, poorly articulated speech
- Speech is sparse, hesitant, missing function words (agrammatism)
- Naming and repetition are impaired
- Paraphasias are rare, comprehension is intact
- Disturbance in speech planning/production
- Caused by lesion to the pars operculum and aspects of the pars triangularis of the left inferior frontal gyrus
7
Q
Wernicke’s Aphasia
A
- AKA receptive or fluent aphasia
- Disturbance in comprehension
- Normal verbal output (fluency is normal)
- Output is nonsensical, consisting of paraphasic errors, jargon, and neologisms
- Reading/writing/naming/repetition are impaired
- Inability to classify phonemes into meaningful morphemes and lexical semantics
- Caused by lesion to posterior portion of superior temporal gyrus and some cortical tissue banding Heschl’s gyrus
8
Q
Transcortical Motor Aphasia
A
- Just like Broca’s but repetition is intact
- Nonfluent speech with preserved repetition (normal comprehension)
- Naming is variable
- Damage is often anterior and/or superior to Broca’s (watershed)
9
Q
Transcortical Sensory Aphasia
A
- Just like Wernicke’s but repetition is intact
- Impaired speech comprehension, intact fluency and repetition
- Naming is impaired
- Disorder of semantic processing
- Lesion: middle and inferior temporal gyri and sometimes inferior occipitotemporal junction
10
Q
Conduction Aphasia
A
- Impaired repetition with constant phonemic paraphasias
- Phonemic paraphasia: substitution, addition, omission of a phoneme (table becomes tadle)
- Preserved fluency and comprehension
- Impaired communication (speech sound patterns and motor production)
- Basically: can talk and understand, but have problems repeating things
- Naming and writing are variable
- Lesion: arcuate fasciculus or the supramarginal gyrus (usually inferior parietal lesion)
- “Transfer deficit between Broca’s and Wernicke’s”
11
Q
Global Aphasia
A
- Everything is impaired
- Naming, repetition, fluency, comprehension
- Writing is impaired
- Paraphasic errors are common
- May be able to respond to basic commands
- Lesion: very large left lesion, major MCA infarct
12
Q
Anomia
A
- Fluency, repetition, and comprehension are good
- Naming is impaired
- Word retrieval deficit, so paraphasias are uncommon
- Tends to be residual of many aphasias as the acute phase transitions to recovery
- So, little localization value
- Lesion: generally involve LEFT inferior temporal regions
13
Q
Alexia with agraphia
A
- Impaired reading and writing
- Non-aphasic (naming, comprehension, fluency intact)
- Lesion: both left supramarginal and angular gyri) (posterior inferior temporal)
14
Q
Alexia without agraphia
AKA pure alexia, pure word blindness
A
- Impaired reading with intact writing
- Non-aphasic (naming, comprehension, fluency intact)
- Pts engage in compensatory serial letter numbering strategy to put together words
- Can copy words/sentences but cannot read them
- Fundamentally is a disconnection syndrome from left to right
- Prevents direct visual input of info from right hemisphere to the left angular gyrus
- Lesion: left PCA infarct, destroying mesial aspects of left occipital lobe and splenium of corpus callosum
15
Q
Primary Acalculia
A
- Impaired number processing, particularly for calculations
- Not explained by alexia/agraphia
- There’s a discrete location for numerical processing and sequencing
- Lesion: left inferior parietal lobule in intraparietal sulcus (both left supramarginal and angular gyri)
16
Q
Left Parietal Region for Skilled Motor Movements
A
- Premotor region contains movement lexicon (praxicon: mapped categories of movement for specific actions)
- Must be linked to meaning in order to provide for purposeful movement
- Connections between motor regions and posterior parietal and temporal regions provide meaningful linkage to purposeful movements
- Damage to these systems = apraxia
17
Q
Ideomotor Apraxia
A
- Inability to make gestures or use objects to command
- Pts make “body part as tool” errors (like scissor symbol)
- Improved with actual object but still impaired
- Pts make “body part as tool” errors (like scissor symbol)
- Spatial and temporal errors when pantomiming
- Posture of hand/fingers is incorrect for object
- Incorrect movement and/or speed with object
- Lesion: left inferior parietal lobe
- Damage to praxicon; movement formulas are damaged
18
Q
Ideational Apraxia
A
- Inability to sequence movements (order)
- Lesion: LEFT frontal damage, primarily seen in dementias
- Frontal lobe planning problem
19
Q
Conceptual Apraxia
A
- Inability to select the correct movement for a given action/object
- Lesion: possibly left tempoparietal junction, may also be left frontal
20
Q
Body Schema and Extrastriate Body Area
A
- Body Schema
- Proprioception; representation of one’s own body in space (body awareness)
- Also, nociception, vestibular, auditory, etc.
- Extrastriate body area (EBA) is Brodmann area 19
- In anterior region of the occipital lobes bilaterally (bordering posterior temporal and inferior parietal)
- Responds to stationary and moving human body parts (but NOT the face!)
- Engaged during planning, execution, imagination of goal directed movements
- Critical to perception of body
21
Q
Autopagnosia
A
- Inability to identify one’s own body parts or those of others
- Not a language disorder
- Body schema disorder
- Left hemisphere disorder
22
Q
Finger Agnosia
A
- Inability to name, show, or localize fingers on command
- Use of fingers is normal though
- Lesion: LEFT occipitoparietal
- (both left supramarginal and angular gyri)
23
Q
Right-left disorientation
A
- Inability to identify right/left side of one’s own body or the body of another
- Lesion: LEFT parieto-occipito-temporal
- (both left supramarginal and angular gyri)
- Body schema disorder
24
Q
Gerstmann’s Syndrome
A
- Finger agnosia,
- L/R disorientation
- Agraphia
- Acalculia
- But usually occurs in context of a ton of other deficits from large lesion, so controversial
- Lesion: left angular gyrus and posterior lobe
- (both left supramarginal and angular gyri)
25
Achromatopsia
* Inability to perceive color (pure color blindness) in absence of other visual processing problems
* May be dyschromatopsia, varying hues and shades possible
* Can affect some object identification (banana vs pickle)
* Usually restricted to one visual field (rarely bilateral)
* Often co-occurs with other disorders
* Lesion: posterior lingual and fusiform gyri (they border the calcarine sulcus)
* Ventral occipitotemporal
* More common in superior quadrant defects
* 70% bilateral lesions, 20% R-sided, 10% L-sided
26
Akinetopsia
* Inability to perceive motion, but without deficits in object form perception
* Pts perceive object as static and "freezing" and reappearing in different places
* Cannot judge distances or quantities well (like, pouring coffee)
* Palinopsia = trailing of an image, may be present in mild cases
* Lesion: Mt/V5 of the temporo-occipital junction
* Medial superior temporal area of the dorsal visual steam
* Tends to be bilateral
* Can also be caused by systemic issues like seizures
27
Apperceptive Visual Agnosia
AKA Visual Form Angosia
* Impaired perception of the basic components of object form, particularly with regard to shape
* Pts cannot link different aspects of object perception into a coherent whole (shape, form, depth)
* Results in inability to identify the target object
* Often presents with several other disorders
* Lesion: bilateral occipital, occipitotemporal, posterior inferior temporal (including posterior lingual and fusiform gyri)
* Disruption of **ventral visual stream**
* Also a result of carbon monoxide poisoning
28
Associative Visual Agnosia
* Inability to link semantic meaning/concept of an object to its visual form
* In the context of otherwise intact perception, sensory function, and preserved ability to ID objects in other sensory modalities
* Cannot identify visually presented stimuli, cannot demonstrate use
* BUT can sometimes ID it if it's used
* BUT can draw what they cannot identify
* Disorder is "post perceptual"; occurs in a later stage of processing result in failure of semantic representation leading to a defect in visual identification
* Lesions: diffuse but always involve bilateral lateral occipitotemporal cortices, interruption of inferior longitudinal fasciculus
* Some fusiform gyrus involvement
* Left-sided lesions may be critical
* Different from apperceptive agnosia and anomia:
* Must be a nonverbal recognition defect
* Anomic pts cannot name objects but can still recognize them; agnosics cannot do either
29
Prosopagnosia
* Inability to recognize familiar faces, including their own
* Can recognize that they're seeing a face and give accurate descriptions of facial features
* **Not a perceptual deficit; an identification deficit**
* Lesion: bilateral fusiform gyri
30
Balint's Syndrome
* Posterior syndrome; **dorsal stream**
* Acquired visual disturbance resulting in inability to perceive entirety of visual field with fractioned recognition of parts and associated defects of visually guided reaching and voluntary shifting of gaze
* **Ocular apraxia**: impaired voluntary gaze
* **Optic ataxia**: impaired hand/eye coordination, cannot grab objects
* **Simultanagnosia**: inability to perceive/attend to more than one stimulus
* Lesion: bilateral posterior parietal regions involving parietooccipital junction and the intraparietal sulcus
31
Ocular Apraxia
* Defect in voluntary direct gaze/volitional eye movement
* Pt unable to intentionally look at something
* Failure to initiate saccadic eye movement; are chaotic and random
* Lesion: may involve higher control of superior colliculi
32
Ocular Ataxia
* Defect in visually-guided movement
* Pt is unable to use vision to accurately coordinate movements to grasp or manipulate objects in visual space
* May be restricted to a hemifield or one arm/hand, or can be bilateral and both limbs
* Preserved object identification
* Lesion: parietal-occipital junction (dorsal stream (where))
33
Simultanagnosia
* Inability to attend to/perceive/recognize/ID more than one visually presented stimulusInability to perceive individual parts of a whole
* **Left hemisphere sees details**, right hemisphere sees global
* Reading is impaired
* Akin to neglect (spatial) rather than attentional defect
* Pts extinguish previously presented objects with presentation of new objects
* Lesion: bilateral parietooccipital junction and inferior intraparietal sulcus
34
Posterior regions considered to be heteromodal association cortex
* Superior parietal lobule
* Intraparietal sulcus
* Inferior parietal lobule
* Supramarginal gyrus
* Angular gyrus
* Middle temporal gyrus
* Superior temporal sulcus
35
Unilateral Neglect
* Spatial disorder from right posterior damage
* Pt fails to report, respond, orient to, explore, or direct attention toward a hemispace contralateral to lesion
* Not a result of any sensory, motor, motivation, or other impairment
* Can occur in all 3 domains; auditory, visual, and tactile
* Can occur in dimensions/frames:
* Egocentric spatial deficits:
* Vision-centered: reference to visual fields
* Head-centered: reference to mid-sagittal plan of head
* Body-centered: reference to mid-sagittal plan of body
* Allocentric spatial deficits:
* Neglect half of any object regardless of it location in relation to the body space
* Ex: neglect half of food on plate
* Neglect portions of allocentric space while intact to egocentric space
* Lesions: right parieto-occipital-temporal area and right frontal involvement
* Right inferior parietal, posterior superior temporal involving right angular and supramarginal gyri
* Frontal: disconnection between right prefrontal and right posterior heteromodal
36
Intentional (motor) neglect
* Failure to respond to a stimulus despite being aware of it
* Mostly right frontal (sometimes left frontal)
37
Extinction to bilateral simultaneous stimulation
* Seen as denser neglect resolves
* Pt can orient to contralesional but when presented with bilateral stim, only respond to ipsalesional
38
Other functions affected by neglect
* Left hemisphere functions
* Spatial agraphia/alexia
* Spatial acalculia
* Sleep and dreaming
* REM movements stop at midline
* Neglect half of space in dreams
* Imagery and memory
* Neglect left half of objects in mental imagery
* Neglect left half of scenes/events from memory
* Spatial allochiria
39
Spatial Allochiria
* Unilateral neglect
* Transposition of details in neglected hemispace into the non-neglected hemispace
* Stim from left hemispace is manifested in right hemispace
* Occurs in drawing or description of objects
* Also occurs in tactile stimulation; sensation to left is felt on opposite body in homologous region
* Also occurs in audition; auditory stim is heard in opposite hemispace
40
Anosognosia
* Lack of awareness of deficit, denial of illness,
* Awareness disorder; disrupts self-awareness
* Not a disorder of memory, language, motor, motivation, or attention
* Presentation:
* Behaviors are inconsistent with patient report (pt that's no clapping will say they're clapping)
* Confabulation
* Implicit awareness
* Lesion: right parietal-occipital-temporal area
* Right posterior-inferior parietal and posterior temporal, and right dorsolateral prefrontal (Including insula)
* Disconnection between right posterior and right frontal is implicated
41
Anosodiaphoria
* Lack of concern for a deficit
* Manifestation of neglect and anosognosia
* Lesion: right parietal-occipital-temporal area;
* Right posterior-inferior parietal and posterior temporal, and right dorsolateral prefrontal (Including insula)
* Disconnection between right posterior and right frontal is implicated
42
Asomatagnosia
* Failure to acknowledge ownership of a limb
* Manifestation of neglect and anosognosia
* Lesion: right parietal-occipital-temporal area;
* Right posterior-inferior parietal and posterior temporal, and right dorsolateral prefrontal (Including insula)
* Disconnection between right posterior and right frontal is implicated
43
Somatoparaphrenia
* Denial of ownership of a limb or another part of body
* Manifestation of neglect and anosognosia
* Lesion: right parietal-occipital-temporal area;
* Right posterior-inferior parietal and posterior temporal, and right dorsolateral prefrontal (Including insula)
* Disconnection between right posterior and right frontal is implicated
44
Misoplegia
* Emotional attributions (generally hatred) toward a paralyzed limb
* Manifestation of neglect and anosognosia
* Lesion: right parietal-occipital-temporal area;
* Right posterior-inferior parietal and posterior temporal, and right dorsolateral prefrontal (Including insula)
* Disconnection between right posterior and right frontal is implicated
45
Alexithymia
* Failure to identify one's emotional state
* Profound difficulty in describing the way one is feeling
* Paucity of dreaming; imagery is devoid of content
* Rigid interpersonal interactions
* Lesion: right temporal
* May also be a disconnection syndrome
46
Aprosodia
* Affective disorder of communication
* This is how the right hemisphere is contributing to language in the left
* Prosody and emotional inflection in speech
* Flat, bland expression
* Lesions in right temporal lobe, right inferior frontal (homologue of Broca's), will have an expressive aprosodia
* Receptive aprosodia: they can't understand prosody in language
47
Major prefrontal cortex functions
* Centralized control: control, integration of internal/external environments via cognitive control of sensory systems, internal states, motor/behavioral output
* Executive functions: attention, memory, language, organization, planning, decision making, judgment
* Socio-emotional functions: emotion regulation, volitional control, self- and other-awareness, moral reasoning
48
3 Major Prefrontal Regions
* Dorsolateral prefrontal cortex (dlPFC)
* Connects to posterior parietal cortices, superior temporal sulcus
* Orbitofrontal cortex (OFC)
* Inputs from sensory modalities and outputs to limbic regions
* Ventromedial prefrontal cortex (vmPFC)
* Inputs from dlPFC, posterior cingulate, mesial temporal
* Outputs to limbic regions and brainstem
49
Dorsolateral Prefrontal Cortex
* Central modulation of attention, working memory
* Online monitoring and active manipulation of info
* Strategic cognitive control
* Lesion asymmetry:
* Left dlPFC
* Mood fluctuations, generally depressed
* Propositional language impairments, poor fluency
* Large lesions = Broca's aphasia, left upper extremity hemiparesis with lower right facial droop, possible gaze deviation if FEF is involved
* Right dlPFC
* Sometimes euphoria
* Otherwise, affect is restricted but pt is unconcerned
* Non-propositional language impairments; emotional expression is diminished
* Large lesions = expressive aprosodia, right upper extremity hemiparesis, gaze deviation if FEF is involved
50
Ventrolateral Prefrontal Cortex
* Regulation of encoding and retrieval of info from posterior association cortices
* Mediates selection of goal-relevant info
* Acts as an attentional gateway; how are frontal lobes going to use incoming info
51
Dysexecutive Syndrome
* Lesion: lateral aspect of prefrontal cortex
* Deterioration of attention and working memory
* Poor monitoring and decreased control over active processes
* Poor temporal, spatial context for goal-directed behavior
* Impaired organization, planning, sequencing, strategizing
* Poor cognitive flexibility and control of response choice
* Impaired abstract conceptual reasoning for verbal, nonverbal
52
Ventromedial Prefrontal Cortex
* Modulatory control of emotional valence (and possibly a role in emotional output)
* Volitional control and motivation
* Contextual appraisal of socio-emotional information
* Goal selection and decision making for complex and abstract choices
* Organization of the temporal aspects of behavior (foresight and planning)
53
Apathetic/Abulic Syndrome
* Lesion: bilateral ventral, mesial aspects of frontal lobes, including anterior cingulate
* Diminished capacity to respond to emotionally salient events
* Anhedonia
* Lack of curiosity
* Poor ability to respond to reward/punishment; do not learn from mistakes
* Impaired decision making, planning, goal-oriented direction
* \*\*If OFC involvement, may also have lack of empathy
* Lesion: dorsal-mesial involvement
* Apathy: reduction of goal-directed behavior
* Abulia: loss of initiative or drive and lack of speech, thought, motor function
* Akinetic mutism: extreme apathetic/abulic state with basically no spontaneous activity
* Other features of this syndrome:
* Generally intact cognitively
* Socio-emotional knowledge is normal but they have trouble using it
* Large lesions involving orbitofrontal and ventro-mesial cortex results in more socially-disturbed presentation
54
Orbitofrontal Cortices
* Empathy and self-context; role of the self in relation to others
* Impulse control and regulation of salient drives/motivations
* Social comportment and online monitoring
* How a person carries themselves, dressing properly, behaving in a civilized manner
55
Disinhibition Syndrome
* Prominent personality changes
* Lack of impulse control; pt may be wildly inappropriate
* Insensitive, lacking empathy or remorse
* Terrible interpersonal skills
* Impaired insight
* Pathological features:
* Hoarding
* Inappropriate sexual behaviors
* Stimulus-bound and utilization behaviors may become prominent
* Patients reflexively use whatever is in sight
* Lesion: orbitofrontal cortex
56
Agraphesthesia
* Inability to recognize written letters/numbers traced on skin
* Postcentral gyrus lesion
57
Astereognosis
* Inability to identify an object by touch only
* Postcentrral gyrus lesion
58
Tactile Agnosia
* Cannot recognize or name object by touch
* Lesion to ventrolateral parietal lobe
59
Constructional Apraxia
* Difficulty with simple drawing, assembling blocks
* Lesion to dorsomedial parietal lobe
60
M1 Infarct Signs
* Hemiparesis of lower half of contralateral face
* Hemiparesis of contralatera upper and lower extremities
* Sensory loss from contralateral face and arm, minor leg
* Ataxia of contralateral extremities (minor leg)
* Lack of muscle control/coordination
* Gaze preference to side of lesion
* Contralateral visual field defects
* LEFT: Speech impairments (global aphasia)
* RIGHT: perceptual impairments (hemispatial neglect)
61
Superior M2 Infarcts
* Hemiparesis of the lower half of contralateral face
* Hemiparesis of contralateral upper extremities (no leg!)
* Sensory loss from contralateral face and arm (no leg!)
* Ataxia of contralateral upper extremity
* Lack of motor control/coordination
* Gaze preference to side of lesion
* LEFT: Broca's aphasia
* \*No visual loss
62
Inferior M2 Infarct Signs
* Contralateral tactile agnosia
* Contralateral visual field defects
* LEFT:
* Wernicke's aphasia
* Gerstmann's syndrome
* Agraphia, acalculia, R/L disorientation, finger agnosia
* RIGHT: perceptual impairments
* Hemispatial neglect, constructional apraxia
63
M3 Infarct Signs
Specific to territory in pie-slice shaped wedge of infarction
64
ACA Infarct Signs (A2)
* Hemiparesis of the contralateral leg, pelvic floor
* Incontinence
* Sensory loss from contralateral leg, perineum
* Ataxia of contralateral leg (motor control/coordination)
* Apraxia (difficulty motor planning)
* Slowness and lack of spontaneity
* Akinetic mutism
* No effort to communication (superior PFC)
65
PCA Cortex Infarct Signs
* Contralateral visual field defects
* Cortical blindness if bilateral
* Visual form agnosia
* Memory and naming deficits, disorientation
* LEFT: alexia with agraphia
* Alexia: inability to read
* Agraphia: inabiity to write
* RIGHT: Prosopagnosia
66
Central PCA Infarct Signs
* Thalamic syndromes
* Involuntary movements
* Chorea
* Intentional tremor
* Hemiballismus
* lesion in subthalamic nucleus
* Hyperkinetic disorder like the choreas, but affecting more proximal limb movements
* Very intense movements
* Contralateral hemiparesis
* 3rd nerve palsy: down + out
67
Holmes' Tremor
* Wing-beating
* Damage to myoclonic triangle (red nucleus triangle with IOC and cerebellum)
68
Dysarthria
Speech problem: midline cerebellum (vermis)
69
Tremor when moving vs at rest
* Moving: cerebellum, (hemisphere) lesion
* At rest: Parkinson's
70
Dysmetria
Past pointing (cerebellum hemisphere lesion)
71
Dyssnergia
* Jerky movements
* Cerebellum hemisphere lesion
72
Dysdiadochokinesia
* Difficulty making rapidly alterning hand movements
* Cerebellum hemisphere lesion
73
74
Spondylosis
* Arthritic degeneration of vertebra that narrows intervertebral foramina
* New bone can grow in spinal canal
75
Spinal stenosis
Narrowing of spinal cord (SC compressoin)
76
Brown-Sequard Syndrome
* Result of a hemisection of SC
* Symptoms
* **Dorsal column**: ipsilateral loss of 2-point discrimination, vibration, conscious proprioception, kinesthesia
* **Lateral corticospinal tract:** ipsilateral UMN signs
* **Spinothalamic tract:** contralateral loss of pain and temp
77
Central Cord Syndrome
* Lesion develiping within the spinal cord (usually cervical)
* Bilateral loss of pain and temp over a limited area at levels involved (ventral white commissure but NOT STT)
* Sacral sparing (again, NOT STT)
* UMN signs like exaggerated reflexes if it reaches lateral corticospinal tract
* Disproportionally greater motor impairment in upper vs lower extremities
* LMN signs like atrophy if it reaches the ventral horn
* Possibly autonomic if levels T1-T2
* DCML is probably just fine
78
Syringomyelia
* Intrinsic (internal) spinal cord lesion
* Bilateral loss of pain and temp over shoulder and lateral arm (like a cape)
79
Anterior Cord (Spinal Artery) Syndrome
* Complete bilateral motor paralysis below level of lesion
* Complete bilateral loss of pain and temp sensation below the level of lesion
* Sparing of 2-point discrimination, vibration sense, kinesthesia (bc that’s all DC system)
* If this lesion occurs in the cervical cord:
* Loss of CN XI function (paresis/paralysis of SCM and trapezius)
* Respiratory difficulties due to paralysis of diaphragm (phrenic nucleus)
80
Cauda Equina Syndrome
* Results from a pathological process (disc herniation, tumor, etc.) leading to spinal stenosis
* Affects the dorsal and ventral roots forming the cauda equina
* Symptoms:
* Weakness of leg and foot (LMN signs)
* "Saddle anaesthesia" - loss of pain, temp, 2-point touch over S1-S5 dermatomes
* Loss of knee and ankle reflexes - damage to ventral roots
* Urinary retention (flaccid bladder) - due to roots S3 and 4 being affected
* Loss of tone in external anal sphincter due to damage to S3-S5
81
Conus Medullaris Syndrome
* Compression of conus medullaris
* Butt sensory loss only
* Bladder, bowel, and sexual dyfunction
82
Horner's Syndrome
* Damage to Central Tegmental Tract above T1
* Hemi loss of sympathetic function on the ipsilateral side, resulting in:
* Ptosis: droopy eyelid, impairment of Muller's muscle, a smooth muscle adjoining the levator palpebrae superioris muscle (helps to keep eyelid raised)
* Miosis: constricted pupil; impairment of the dilator pupillae muscle
* Anhydrosis: inability to sweat
* Rubrosis: hyperameia - flushed skin
* Enophthalmos: sunken eye; impairment of Landstrom's muscle, microscopic smooth muscle fibers located within the fascia bulbi of the eye which help retain the eye in its normal forward position
83
Dejerne's Syndrome
* AKA medial medullary syndrome
* Anterior spinal atery occlusion in **medulla**
* Symptoms:
* **Pyramids:** Contralateral UMN signs to muscles (LCST)
* **Hypoglossal:** ipsilateral tongue movement (points to lesional side)
* **Medial Lem:** contralateral fine tough + proprioception
84
Wallenberg's Syndrome
* AKA Lateral medullary syndrome
* PICA infarction in medulla
* Symptoms:
* **_R facial pain/temp, L body pain/temp_**
* Nucleus ambiguus: ipsilateral dysphagia, displaced uvula, flaccid vocal ford
* Spinal nucleus and tract of V: ipsilateral pain, temp from face
* Spinothalamic tract: contralateral pain, temp sensation
* Hypothalamospinal tract: Horner's syndrome
* Inferior cerebellar peduncle: ipsilateral ataxia (lack of input from spinocerebellar tracts)
* Vestibular nuclei: vertigo, nausea
* Reticular formation: hiccups
85
Benedikt's Syndrome
* Tremore at rest AND movement
* PChA in midbrain
86
Weber's Syndrome
* PChA
* Cranial Nerve III: ipsilateral D+O eye and contralateral pupil constriction (LMN)
* Corticobulbar fibers: contralateral UMN face
* Corticospinal fibers: contralateral UMN body
