Revision session notes Flashcards
Where is the site for lumbar puncture normally?
Between vertebrae L3/L4.
If a lumbar puncture obtained red CSF, what would this suggest?
Subarachnoid haemorrhage.
or pierced a vein
If a lumbar puncture obtained cloudy CSF, what would this suggest?
Meningitis.
When would you not perform a lumbar puncture, and why?
If the patient had a raised ICP.
|»_space; herniation of the brain
At what levels of the spinal cord are lateral grey horns present?
T1-L2 and S2-S4.
What information do the lateral grey horns carry?
Sympathetic innervation.
What pathway is most commonly affected by a posterior spinal artery occlusion?
Dorsal column pathway.
-ipsilateral
What tract does sensory information from the face travel in?
Trigeminothalamic tract.
What pathways does sensory information from the body travel in?
Spinothalamic tract and dorsal column pathway.
Which part of the cortex does the trigeminothalamic tract go to?
Lateral cortex.
Which part of the cortex do the spinothalamic and dorsal column pathways go to?
Medial cortex.
What type of information does the spinothalamic pathway carry?
Pain, temperature, some touch and pressure.
- modalities essential to survive
- but slower conductance
What type of information does the dorsal column pathway carry?
Discriminative touch, proprioception, some pressure.
- modalities that increase detail
- but faster conductance
Where do the 1* fibres of the dorsal column pathway synapse?
At the level of the closed medulla.
CASE STUDY
Loss of vibration, touch, proprioception, pain and temperature in both lower limbs.
-Where is the lesion?
Below T6 - lumbar total transection of the spinal cord.
CASE STUDY
Right lower limb - loss of pain and temperature.
Left lower limb - loss of fine touch and proprioception.
-Where is the lesion?
Left hemisection below T6.
What information does the trigeminothalamic tract carry?
Pain, temperature, proprioception, discriminative touch from face.
-different modalities go to different part of the trigeminal nucleus
Which cranial nerves are involved in the trigeminothalamic tract? (4)
- Trigeminal (V)
- Facial (VII)
- Glossopharyngeal (IX)
- Vagus (X)
Which nucleus in the thalamus does sensory information from the body go to?
VPL.
think VPL on bum
Which nucleus in the thalamus does sensory information from the face go to?
VPM.
Which trigeminal nucleus is more medial?
Motor is Medial.
Which part of the trigeminal nucleus does pain and temperature from the face go to?
Caudal end of the spinal nucleus.
pain in the ass
Which part of the trigeminal nucleus does crude touch from the face go to?
Rostral end of the spinal nucleus.
medulla
What is Wallenberg syndrome?
AKA lateral medullary syndrome.
-lesion in lateral medulla due to acute infarction (vessel occlusion)
Which sensory pathways does Wallenberg syndrome affect?
- Spinothalamic tract (contralateral body)
- Spinal tract of tigeminal nucleus (ipsilateral face)
Why doesn’t Wallenberg syndrome affect the dorsal column pathway?
The dorsal column pathway is very close to the midline/deep.
Which part of the trigeminal nucleus does discriminatory touch from the face go to?
Chief/pontine nucleus.
the chief is discriminative
Do fibres carry discriminatory touch information ascend/descend along the brainstem?
No, they enter straight into the pontine nucleus.
Which part of the trigeminal nucleus does proprioception from the face go to?
Mesecephalic nucleus.
What is unique about 1* fibres carrying proprioception from the face?
They have a cell body in the mesecephalic nucleus, but don’t synapse in it.
-they synapse medially, near the motor nucleus
Where do 2* fibres carrying proprioception from the face go?
- Some go the thalamus (VPM)
- Some go straight to muscles of mastication
Which body regions are only present in the sensory gyrus, not the motor gyrus? (2)
- Abdomen
- Genitalia
What body parts are more lateral on the post central gyrus?
Abdomen, tongue, etc.
What body parts are more medial on the post central gyrus?
Feet, genitalia, etc.
Brain imaging: what is a lateral lens-shaped bleed called, and what causes it?
Lentiform bleed.
- sign of epidural haemorrhage
- middle meningeal artery rupture
What normally cause a subarachnoid haemorrhage?
Anterior/posterior communicating artery aneurysm.
What is the key symptom of a subarachnoid haemorrhage?
Thunderclap headache.
What often causes a subdural haemorrhage in elderly?
Tearing of veins crossing the dural space.
-very gradual onset symptoms
What is a contrecoup head injury?
Injury on the opposite side of the head to trauma.
