Pathology IV Flashcards
Cingulate (subfalcine) herniation under the falx cerebri may compress which structure …
anterior cerebral artery - contralateral lower leg symptoms
Central/downward transtentorial hernation displaces …
theb brainstem
Complications of central/download transtentorial hernation
Brainstem is displaced and there is rupture of paramedian basilar artery branches -> Duret hemoorrages and death
Uncal transtentorial hernation early symptoms
Ipsilateral blown pupil and down and out eye (CNIII), contralateral hemiparesis
Uncal transtentorial hernation late symptoms
coma
Kernohan phenomenon
What is Kernohan phenomenon
the uncal herniation causes compression of kernohans notch on the opposite side, leading to paralysis on the ipsilateral side to the herniation and contralateral blown pupil) — misleading to which side the herniation is on
Cerebellar tonsillar hernation complications
Compression of the brain stem -> coma and death
which area is affected in spinal muscle atrophy?
anterior horns of spinal cord
presentation of spinal muscle atrophy?
LMN lesions only; symmetric weaknes
Floppy baby syndrome
Hypotonia and tongue fasciculations
What causes spinal muscle atrophy?
An autosomal recessive mutation in SMN1
ALS presentation
combined UMN and LMN degeneration with no sensory or bowel/bladder defects
-dysarthria, dysphagia, asymmetric limb weakness, fasciiculations, atrophy, spastic gait, etc.
treatment of ALS
riluzole
there may be a defect in WHAT causing ALS
superoxide dismutase 1
When there is complete occlusion of the ASA, what is spared?
dorsal columns and lissauer tract.
Also the artery of adamkiewics supplies the ASA below T8
Presentation of complete occlosuion of ASA
UMN deficits above the below and LMN at the level of the lesion. Loss of pain and temperature below the lesion. Dorsal columns spared.
What is tabes dorsalis?
degeneration of dorsal colums due to tertiary syphilis
What causes tabes dorsalis?
Tertiary syphilis
Presentation of tabes dorsalis?
progressive sensory ataxia (loss of proprioception->poor coordination)
+romberg sign and absent DTRs
Syringomyelia pathophs
syrinx expands and damages anterior whtie commisure of spinothalamic tract
presentation of syringomyelia
loss of pain and temp in a cape-like distribution
What parts of the spinal cord are damaged in B12 deficiency?
spinocerebellar tracts, lateral corticospinal and dorsal columns
Presentation of B12 deficiency
ataxic gait, parasthesia, impaired position/vibration sense
Cauda equina syndrome cause
herniation of spinal roots L2 and below, due to tumour or slipped disc
presentation of cauda equina syndrome
radicular pain, absent knee and ankle reflexes, loss of bladder and anal sphinctor control and saddle anesthesa
What is conus medullaris syndrome ?
perianal anesthesia bilaterally, and impotance
How does poliomyelitis effect the spinal cord?
destruction of cells in the anterior horn of spinal cord
CSF findings in poliovirus
increased WBCs and slight increased protein with no change in glucose
What is brown-sequard syndrome?
Damage to half of the spinal colum from something like a stabbing
-‘hemisection of spinal cord’
brown-sequard syndrome presentation
- ipsilateral loss of all sensation at level of lesion (on the same half)
- ipsilateral LMN signs at the level of the lesion
- ipsilateral UMN signs below the level of the lesion
- ipsilateral loss of proprioception, vibration, light touch, etc.
- contralateral loss of pain, temp, crude touch
What causes friedreich ataxia (genetics)?
autosomal recessive trinucleotide repeat (GAA) on chromosome nine, which encodes frataxin (iron-binding protein)
Pathophys of friedreich ataxia?
gene mutation leads to impaired mitochdondrial function and degeneration of lateral corticospinal tract (spastic paralysis) spinocerebellar tract (ataxia) dorsal columns and dorsal root ganglia
presentation of friedreich ataxia
Usually presents in adolescence with staggering gait, falling, nystagus, dysarthria, pes cavus, hammer toes, diabetes mellitus, hypertrophic cardiomyopathy
how does friedreich ataxia present in childhood?
with kyphoscoliosis
cause of death in people with friedreich ataxia
cardiotrophic cardiomyopathy
CN V motor lesion presentation
jaw deviates toward side of lesion (unopposed force from opposite pterygoid)
CN X lesion
uvula deviates away from lesion (weak side collapses)
CN XI lesion
weakness turning head to contralateral side. Shoulder droop on ipsilateral side
CNXII lesion
LMN - tongue deviates toward side of lesion
treatment of bells palsy
corticosteroids + acyclovir
