Revision session notes

Question 1

Where is the site for lumbar puncture normally?

Answer 1

Between vertebrae L3/L4.

Question 2

If a lumbar puncture obtained red CSF, what would this suggest?

Answer 2

Subarachnoid haemorrhage.

or pierced a vein

Question 3

If a lumbar puncture obtained cloudy CSF, what would this suggest?

Answer 3

Meningitis.

Question 4

When would you not perform a lumbar puncture, and why?

Answer 4

If the patient had a raised ICP.

|&raquo_space; herniation of the brain

Question 5

At what levels of the spinal cord are lateral grey horns present?

Answer 5

T1-L2 and S2-S4.

Question 6

What information do the lateral grey horns carry?

Answer 6

Sympathetic innervation.

Question 7

What pathway is most commonly affected by a posterior spinal artery occlusion?

Answer 7

Dorsal column pathway.

-ipsilateral

Question 8

What tract does sensory information from the face travel in?

Answer 8

Trigeminothalamic tract.

Question 9

What pathways does sensory information from the body travel in?

Answer 9

Spinothalamic tract and dorsal column pathway.

Question 10

Which part of the cortex does the trigeminothalamic tract go to?

Answer 10

Lateral cortex.

Question 11

Which part of the cortex do the spinothalamic and dorsal column pathways go to?

Answer 11

Medial cortex.

Question 12

What type of information does the spinothalamic pathway carry?

Answer 12

Pain, temperature, some touch and pressure.

• modalities essential to survive
• but slower conductance

Question 13

What type of information does the dorsal column pathway carry?

Answer 13

Discriminative touch, proprioception, some pressure.

• modalities that increase detail
• but faster conductance

Question 14

Where do the 1* fibres of the dorsal column pathway synapse?

Answer 14

At the level of the closed medulla.

Question 15

CASE STUDY
Loss of vibration, touch, proprioception, pain and temperature in both lower limbs.
-Where is the lesion?

Answer 15

Below T6 - lumbar total transection of the spinal cord.

Question 16

CASE STUDY
Right lower limb - loss of pain and temperature.
Left lower limb - loss of fine touch and proprioception.
-Where is the lesion?

Answer 16

Left hemisection below T6.

Question 17

What information does the trigeminothalamic tract carry?

Answer 17

Pain, temperature, proprioception, discriminative touch from face.
-different modalities go to different part of the trigeminal nucleus

Question 18

Which cranial nerves are involved in the trigeminothalamic tract? (4)

Answer 18

• Trigeminal (V)
• Facial (VII)
• Glossopharyngeal (IX)
• Vagus (X)

Question 19

Which nucleus in the thalamus does sensory information from the body go to?

Answer 19

VPL.

think VPL on bum

Question 20

Which nucleus in the thalamus does sensory information from the face go to?

Answer 20

VPM.

Question 21

Which trigeminal nucleus is more medial?

Answer 21

Motor is Medial.

Question 22

Which part of the trigeminal nucleus does pain and temperature from the face go to?

Answer 22

Caudal end of the spinal nucleus.

pain in the ass

Question 23

Which part of the trigeminal nucleus does crude touch from the face go to?

Answer 23

Rostral end of the spinal nucleus.

medulla

Question 24

What is Wallenberg syndrome?

Answer 24

AKA lateral medullary syndrome.

-lesion in lateral medulla due to acute infarction (vessel occlusion)

Question 25

Which sensory pathways does Wallenberg syndrome affect?

Answer 25

• Spinothalamic tract (contralateral body)

- Spinal tract of tigeminal nucleus (ipsilateral face)

Question 26

Why doesn’t Wallenberg syndrome affect the dorsal column pathway?

Answer 26

The dorsal column pathway is very close to the midline/deep.

Question 27

Which part of the trigeminal nucleus does discriminatory touch from the face go to?

Answer 27

Chief/pontine nucleus.

the chief is discriminative

Question 28

Do fibres carry discriminatory touch information ascend/descend along the brainstem?

Answer 28

No, they enter straight into the pontine nucleus.

Question 29

Which part of the trigeminal nucleus does proprioception from the face go to?

Answer 29

Mesecephalic nucleus.

Question 30

What is unique about 1* fibres carrying proprioception from the face?

Answer 30

They have a cell body in the mesecephalic nucleus, but don’t synapse in it.
-they synapse medially, near the motor nucleus

Question 31

Where do 2* fibres carrying proprioception from the face go?

Answer 31

• Some go the thalamus (VPM)

- Some go straight to muscles of mastication

Question 32

Which body regions are only present in the sensory gyrus, not the motor gyrus? (2)

Answer 32

• Abdomen

- Genitalia

Question 33

What body parts are more lateral on the post central gyrus?

Answer 33

Abdomen, tongue, etc.

Question 34

What body parts are more medial on the post central gyrus?

Answer 34

Feet, genitalia, etc.

Question 35

Brain imaging: what is a lateral lens-shaped bleed called, and what causes it?

Answer 35

Lentiform bleed.

• sign of epidural haemorrhage
• middle meningeal artery rupture

Question 36

What normally cause a subarachnoid haemorrhage?

Answer 36

Anterior/posterior communicating artery aneurysm.

Question 37

What is the key symptom of a subarachnoid haemorrhage?

Answer 37

Thunderclap headache.

Question 38

What often causes a subdural haemorrhage in elderly?

Answer 38

Tearing of veins crossing the dural space.

-very gradual onset symptoms

Question 39

What is a contrecoup head injury?

Answer 39

Injury on the opposite side of the head to trauma.