Symtoms correlated to brainareas Flashcards
Schmidt syndrome
CN X and XI = vagospinal syndrom
- unilateral vocal cord, sternocleidomastoideal, soft palate, larynx and trapezius paralysis.
Jacksons syndrome
CN X, XI o XII palsy
- unilateral paralysis of sternocleidomastoideus, soft palate, larynx, vocal cords, trapezius and tongue.
( men obs, denne jackson är nog mer känd för Jacksonian EP.)
Tapia syndrome
= Matadors disease = CN X and XII palsy
* hoarsness of voice
* dysphagia secondary to incoordination of tongue.
* Food bolus propulsion
* unilateral arophy and paralysis of tongue
* sometimes paralysis of SCM and trapezius.
not affecting soft palate.
Causes of Tapia syndrome?
- oral intubation
- metastases
- rarely associated to carotid or vertebral dissection.
Villarets syndrome
AKA posterior retropharyngeal syndrome
AKA nervous syndrome of the posterior retroparotid space.
CN IX, X, XI o XII + sympathetics
= Collet Sicard syndrome + horner syndrome.
= Collet Sicard syndrome with sympathetic involvement.
Etiologies of Villarets syndrome
parotid tumors, metastases, external carotid aneurysm and osteomyelitis of the skull base
Collet-Sicard syndrom
CN IX, X, XI and XII. No symp. involvement.
More likely w lesions outside the skull.
IF caused by IV lesion it would have to be so large that it would usually produce brainstem compression….—Long tract finding (not incl in the syndrome)
* unilateral paralysis of palate, vocal cords, SCM, trapezius, tongue.
*Loss of taste in post 1/3 of tongue,
*Anesthesia of soft palate, larynx and pharynx.
Etiologies to Collet-Sicard syndrome
- Condylar and Jeffersons fractures
- Internal carotid dissection
- Primary and metastatic tumors
- Lyme disease
- Fibromuscular dysplasia
What structures pass through the Jugular foramen?
From medial (foramen magnum) side to lateral:
Inferior Jugular Vein, CN XI, X, IX, Inferior Petrosal Sinus.
AND! posteriolaterally there is a large compartment passing the sinus sigmoideus!
What structure passes through the sigmoid segment of foramen jugulare?
Inferior jugular vein
What structures passes through the interjugular segment of foramen jugularis?
CN XI, X and IX.
What structures passes through the petrosal segment of foramen jugulare?
Inferior petrosal sinus.
What structures passes through Pars vascularis of foramen jugulare?
Inferior jugular vein, CN XI and CN X. + branching Arnolds nerve
What structures passes through Pars Nervosa of foramen jugulare?
CN IX and Inferior petrosal sinus.
Through what opening in the skull base is CN XII exiting?
The hypoglossal canal.
What is the function of CN IX from jugular foramen?
loss of taste, and sensation of posterior third of tongou
What is the signs of CN X injury in the jugular foramen?
paralysis of vocal cords, palate, anesthesia of pharynx and larynx.
What is the function of CN XI -accessorius- from foramen jugulare
weak trapezius and SCM
what would a lesion of CN XII in the hypoglossal canal cause?
tongue paralysis and atrophy
What symtom in the face is seen from compression of the sympathics?
Horner syndrome
What encompasses Horners syndrome?
Ipsilateral ptos, miosis, anhidrosis in the face (if not only sympathetics running along ICA is involved because the hidrosis sympathics run with ECA).
what constitutes the foramen jugularis?
It is a opening inbetween the petrous part of the temporal bone, and the lateral side of the occipital bone. Usually there is a bony spine from the petrous part dividing it in two parts.
What separates foramen jugulare from the carotid canal?
Only the carotid ridge.
Parinauds syndrome
= dorsal midbrain syndrome AKA pretectal syndrome
“A supranuclear paralysis of vertical gaze resulting from damage to the mecencephalon”
- supranuclear upward gaze palsy (sunset sign)
- lid retraction (colliers sign)
- convergence palsy
- acommodation palsy
+ less common associations, see another card.
What does a supranuclear upward gaze palsy mean physiologically?
Upgaze palsy affecting both voluntary saccadic and pursuit movements, with perservation of vestibulo-ocular or oculocephalic (dolls eyes) reflexes in most cases. Horizontal eye movement spared.
Colliers sign
lid retraction -bilateral or unilateral (midbrain lesion)
What is Millard Gubler syndrome?
VII and VI palsy + contralateral hemiplegia
Where is the injury situated in a Millard Gubler syndrome?
lesion in base of pons. Affecting both nerves (VI and VII) and the corticospinal tract.
Where is the injury situated if the pt has ipsilateral facial palsy, ipsilateral inability to look laterally and contralateral hemiplegia?
base of pons. = Millard Gubler syndrome
What is Benedikts syndrome?
Webers syndrome + red nucleus lesion.
This means:
* CN III lesion w relatively pupil sparing
* contralateral hemiparesis BUT NOT the arm which has hyperkinesia, ataxia and coarse intention tremor
Where is a benedikts syndrome situated (what structures does it involve)?
Midbrain tegmentum plus red nucleus, brachium conjunctivum and fascicles of CN III.
What is Webers syndrome?
CN III palsy w contralateral hemiparesis. see lacunar strokes p 1334.
third nerve palsies from parenchymal lesions may be relatively pupil sparing.
Cerebellar mutism
AKA mutism w subsequent dysarthria
Speechlessness that follow various cerebellar injuries; trauma, cerebellit etc etc. Most often child after surgery. Unkown what structure causes this. ( på beito sade de vermis?)
Prognosis after cerebellar mutism?
Most get better but its rare to be fully back.
What is cerebellar mutism SYNDROME?
Its cerebellar mutism +
ataxia + hypotonia + irritability
What is posterior fossa syndrome?
cerebellar mutism syndrome +
CN deficits + neurobehavioural changes + urinary incontinence or retention
What is cerebellar syndrome?
ataxia, dysmetria and nystagmus
What is the incidence of cerebellar mutism following surgery for cerebellar tumors?
11-29%
Clinical characteristics of cerebellar mutism?
* onset time
* duration
*% w sequele
Onset between 1-6 days postop.
Limited duration 4d-4mo
long term linguistic sequele 98.8% of pt.
What does the term “ cerebellar diaschisis” mean?
“shocked all through” - cerebellar mutism har been linked to disruption of cerebello-cerebral circuits such as the dentatethalamocortical tract.
What is Foster Kennedy syndrome?
Classical triad:
* ipsilateral anosmia
* ipsilateral central scotoma
* contralateral papilledema
occasionally ipsilateral proptosis will also occur.
Why is ipsilateral central scotoma seen in foster Kennedy syndrome?
Due to pressure on the optic nerve and secondary optic atrophy.
Anton-Babinski syndrome
Unilateral asomatognosia.
may be obscured by aphasia if occuring on dominant side.
* anosognosia
* apathy
* allocheiria
* dressing apraxia
* extinction
* inattention to an entire visual field with deviation of head, eyes and body to unaffected side. ( w or wo hemianopsia)
location of Anton-Babinski syndrome
parietal (usually detected if situated on non-dominant side)
Frontal lobe unilateral
may go without detectable findings
Frontal lobe bilateral
apathy and abulia
deletion of frontal Brodman area 8
impaired gaze towards contralateral side - the patient look towards the lesioned side.
irritative lesions (eg seizures) in frontal Brodman area 8
activation of gaze towards contralateral side.
Where is the injury in Foster Kennedy syndrome
Olfactory groove lesion
eg medial third sphenoid wing tumor
What are the signs of Foster Kennedy syndrome
- Ipsilateral anosmia
*Ipsilateral SCOTOMA
*CONTRA lateral papilledema (due to ICP)
What executive functions are situated in the frontal lobe?
Planning, prioritizing, organising, suppressing impulses, understanding consequences of decisions.
lesions in the olfactory groove may lead to this syndrome
Foster Kennedy syndrome
injuries to the prefrontal lobes may result in
diffficulties:
*planning
*prioritizing
*organizing thoughts
*suppressing impulses
*understanding consequenses of decisions
Injuries to either side of the parietal lobe may lead to:
- cortical sensory syndrome
- sensory extinction
- contralateral homonymous hemianopsia
- contralateral neglect
Injuries specific for the dominant parietal lobe?
- Aphasias
- Gerstmanns syndrome
- Bilateral astereognosis
Injuries specific to the non-dominant parietal region
- topographic memory loss
- anosognosia
- dressing apraxia
- integration of visual and proprioceptive sensation to allow manipulation of body and object and for certain constructional activities.
Describe classical findings of Gerstman syndrome
Dominant parietal lobe injury -
*Agraphia w/o alexia
*Left-right confusion
*Digit Agnosia
*Acalculia
Findings in Injuries to occipital lobe
homonymous hemianopsia
injuries to cerebellar hemisphere
ataxia in ipsilateral limb
What is pathology is seen in injuries to cerebellar vermis
truncal ataxia
Syndrome where injuries to the pineal region is seen?
Parinaud s syndrome
Another name of the Wallenberg syndrome?
The lateral medullary syndrome
What main structure is involved in the Wallenberg syndrome?
According to litterature it is PICA, but in reality VA is probably causing the typical symtoms more often.
What symtoms are seen in Wallenberg syndrome?
- injury to nucleus ambiguus give ipsilateral palatal, pharyngeal and vocal cord paralysis
- Additionally: ipsilateral FACIAL numbness, contralateral TRUNCAL numbness, ipsilateral horners syndrome, vertigo, nausea, vomiting and occasionally hick-ups.
What is vermian split syndrome?
- Nystagmus
- Gait disturbance
- Oscillation of head and neck
- truncal ataxia
- Equilibrium disturbance
!!! Peds - CEREBELLAR MUTISM!!!
Describe Horners syndrome
Minskat sympatikuspåslag
* liten pupill (mios)
* Ptos (lätt)
* Nedsatt svettning ansiktshalvan
* Rodnad och tempstegring i huden
Signs of Foster Kennedy syndrome?
- Ipsilateral optic nerve atrophy and central scotoma
- contralateral papill edema
sometimes ipsilateral anosmia
What CN are affected in Vernets syndrome?
- Vagus nerve
- Accessory nerve
- Glossopharyngeal nerve
What is nystagmus retractorius?
WHat is a cortical sensory syndrome?
lesion in postcentral gyrus causing
* loss of position sense
* loss of passive movement sense
* inability to localize tactile, thermal or noxious stimuli
* asterognosi
* agraphestesi
* lost 2p discrimination
* easy fatigability of sensory perceptions
* difficulty distinguishing simultaneous stimulations
* prolongation of superficial pain with hyperpathia - nociceptive stimuli evolve, exaggravated levels of pain.
* touch hallucinations
Why are lids retracted in perinaud s syndrome?
The cause is thought to be due to damage to the levator inhibitory fibers at the posterior commissure.
