Section 1 Part 1: Overview, What to Know and Case Study 1

Question 1

What is the main trick of localization of a lesion?

Answer 1

To separate the unique symptoms that are good pointers (sememntal symptoms) from the fairly unspecific ones

Question 2

What is the order to determining the character of a pathology?

Answer 2

1- Find the level
2- Determine which side the pathology is
3- Determine how broad the pathology is

Question 3

In general, are a patients symptoms described by a single lesion or multiple lesions?

Answer 3

A single continuous lesion

Question 4

What rules out a spinal cord lesion?

Answer 4

Symptoms of the head (like facial weakness)

Exception: Horner’s

Question 5

What rules out a pathology that is strictly peripheral?

Answer 5

Increased tone

Question 6

What is the rule for determining the level of the lesion?

Answer 6

Shift your diagnosis rostrally to accommodate additional reported symptoms. Do NOT shift down (caudally)

Question 7

If the symptoms occur suddenly, what is the most probably cause?

Answer 7

Usually caused by a stroke, except in cases with obvious trauma.

Question 8

What are the two types of stroke?

Answer 8

Hemorrhagic or ischemic (thrombus)

Question 9

If the symptoms progress gradually and are unilateral, what is the most common cause?

Answer 9

Usually caused by a tumor

Question 10

What symptom is often associated with a tumor?

Answer 10

Increased intracranial pressure

Question 11

If the symptoms progress gradually and are bilateral (with no increased intracranial pressure), what is the most common cause?

Answer 11

A disease propress is the most likely cause

Question 12

What side of the body are symptoms on with a spinal cord lesion?

Answer 12

All sensory and motor systems are on the same side as the lesion, except loss of pain and temperature

Question 13

What side of the body are symptoms on with a brainstem lesion?

Answer 13

The lesion is on the same side as the highest symptom (the one which located the level) and lower symptoms will occur on the opposite side

Question 14

What side of the body are symptoms on when the lesion is in the forebrain?

Answer 14

All sensory and motor systems are on the opposite side of the body. The exception is olfactory loss.

Question 15

What side of the body are symptoms on when the lesion is in the cerebellum?

Answer 15

All symptoms are on the same side as the lesion

Question 16

When describing somatosensory loss, how do you describe the symptoms?

Answer 16

You reduce ALL descriptive words into ONE symptom.

Example: Loss of pain, position sense, temperature, joint sense….get combined into sensory loss of the left trunk and limbs.

Question 17

How are motor symptoms characterized?

Answer 17

1- Failure to move (lesion of descending motor pathway)
2- Tremor, incoordination (lesion of cerebellum)
3- Involuntary, uncontrollable movement (lesion of the basal ganglia)

Question 18

When a patient has difficulty expressing themselves yet understands and can carry out commands, where is the lesion?

Answer 18

Brocha’s area (Left Hemisphere, Inferior Frontal Gyrus). So the patient has Brocha’s aphasia.