Rule of 4s

Question 1

Cortical lesions present as …

Arteries:

Answer 1

focal loss (localized to one extremity)

MCA or ACA

Question 2

Eye down and out means lesion in…

Answer 2

CN III

Question 3

Eye can’t look down or medially means lesion in…

Answer 3

CN IV

Question 4

CN V lesion means

Answer 4

Ipsilateral facial numbness

Question 5

CN VI lesion means

Answer 5

cannot abduct ipsilateral eye

Question 6

CN VII lesion means

Answer 6

ipsilateral facial weakness/droop

Question 7

CN VIII lesion means

Answer 7

ipsilateral deafness

Question 8

CN IX lesion means

Answer 8

ipsilateral pharynx numbness

Question 9

CN X lesion means

Answer 9

ipsilateral palate weakness

Question 10

CN XI lesion means

Answer 10

ipsilateral shoulder weakness

Question 11

CN XII lesion means

Answer 11

ipsilateral tongue weakness, deviate to side of lesion

Question 12

Motor pathway (CST) lesion

Answer 12

contralateral weakness

Question 13

Medial lemniscus lesion

Answer 13

contralateral normal sensory loss

Question 14

Medial longitudinal fasciculus lesion

Answer 14

ipsilateral ophthalmoplegia

Question 15

Motor nucleus and nerve (CNT)

Answer 15

motor loss on 3,4,6,12 muscles

Question 16

Spinocerebellar lesion

Answer 16

ipsilateral ataxia (no coordination)

Question 17

Spinothalamic lesion

Answer 17

contralateral pain and temp loss

Question 18

Sensory nucleus of CNS lesion

Answer 18

ipsilateral pain/temp loss in face

Question 19

Sympathetic

Answer 19

ipsilateral horner’s