Syndromes Flashcards
Dejerine’s Medial Medullary
-ventromedial medulla
-ipsi CNXII palsy
-contra hemi
Alexia without agraphia
Wallenburgs lateral medullary (PICA)
vestibular, ICP, nuc ambiguus, spinal trigeminal tract, spinothalamic, descending sympathetic
- vertigo, ataxia
- paralysis of ipsi palate and vocal cord
- loss of pain and temp sensation: ipsi face, contra body
- ipsi horners, loss of facial sweating
Avellis
Lat medulla
- ipsi palate and vocal cord
- loss of pain/temp sensation: ipsi face, contra body
Millard Gubler
Pons
- Ipsi LMN facial paralysis, contra hemi
- ipsi weakness of eye abduction (CNVI)
Foville’s
dorsomedial pons
- Ipsi LMN facial paralysis
- ipsi congugate gaze paralysis
Raymond’s
ventral pons
- ipsi abducens palsy, contra hemi
- bilaterally is locked in/basilar artery thrombosis cause
Weber’s (PCA)
- ipsi oculomotor palsy
- contra hemi
Parinaud’s e.g. pineal tumour presses on..
..post commisure, pre tectal area, sup colluculi
- paralysis of conjugate upgaze
- with convergence retracting nystagmus
Benedikt’s
- Webers+red nucleus and contra cerebellum fibres
- ipsi occulomotor palsy
- contra hemiparesis
- tremor
Claude’s (PCA-midbrain)
- Ipsi oculomotor palsy
- contra cerebellar ataxia
Nothnagel’s (+SCP)
- ipsi oculomotor palsy
- ipsi cerebellar ataxia
Lateralpontine/Marie Fox (AICA)
(like Wallenburg but 7&8)
- vertigo,ataxia
- loss of pain/temp sensation: ipsi face, contra body
- ipsi central deafness
Brown Sequard
- ipsi hemi and loss of proprioception
- contra loss of pain/temp
Hemimedullary Reinhold (vertebral)
- CNXII ipsi palsy, conta hemi
- vertigo, ataxia
- ipsi palate and vocal cord paralysis
- ipsi Horner’s
- loss of facial sweating
Top of the basilar S.
- causes bilateral thalamic ischemia
- visual/occulomotor deficit
- behavioural abnormalities
- drowsy/dreamlike state
Artery of Percheron Infarct aka
this is a variant when both medial thalami are supplied by branches off one trunk of PCA
Paramedian Thalamic S.
- altered mental status
- vetical gaze palsy
- memory impairment
Destructive unilateral frontal lesion patient looks
towards the lesion
Unilateral frontal lobe seizure patient looks
away from the lesion
Gerstmann’s
- Dominant (L) Inf parietal lobule (39+40)
- agraphia, dyscalcula, finger agnosia/anomia
- L/R disorientation
Dejerine-Roussy S. (thalamic stroke VP)
- central thalamic pain s.
- allodynia and dysaesthesia replace numbness
Cavernous sinus s. (CSS) -tumours, aneurysm, stroke..
- opthalmoplegia, proptosis
- ocular and conjunctivial congestion
- trigeminal sensory loss
- Horner’s syndrome
Ramsay Hunt s. / Herpes Zoster Oticus
- shingles affecting CNVII geniculate ganglion
- facial palsy
- external ear blisters
Central Cord S e.g. syringomyelia, neck trauma..
loss of motion and sensation in arms and hands (brachiofacial)
Dandy Walker
- congen. no medial/lat apertures
- large 4th ventriccle, small cerebellum
- developmental delay, poor tone/balance/coordination
- jerky eye movements, vision/hearing impairments
- seizures
Arnold Chiari malformation
posterior fossa contents in cervical spine
can have downbeat nystagmus
Anterior Chord s.
ischemia of ant spinal artery/artery of adamkiewicz
- complete motor paraysis
- loss of pain/temp sensation distal to lesion
Talk and Die s
- pterion fracture, ruptured MMA
- extradural haemotoma
Recurrent artery of heubner stroke (distal part of medial striate artery off ACA)
disrupts ant limb of internal capsule supply
- contra brachiofacial weakness
- chorea
Ant Choroidal artery s.
Damages int capsule, thalamus, optic chiasm…
- contra brachiofacial weakness
- contra hemianopia
- contra hemianaesthesia
Anton’s / Visual Anosognosia
Bilateral occipital lobe damage
- cortical blindness
- pateint adamant they can see
Neglect s.
- right parietal lesion
- hemispatial neglect, hemiinattention
- (+/- anosognosia)
Trigeminal neuralgia / Tic Doloureux e.g. tumour, MS, blood vessels pressing on root…
- lancinating pain in CNV teritorry
- the suicide disease
Bell’s Palsy
- swollen/compressed CNVII e.g. herpes zoster
- LMN facial paralysis, no sparing
- crocodile tears, aberant reinervation lacrimal/salivary glands
Balint’s S. (parietal lobe lesions)
- oculomotor ataxia (cant move eyes to object)
- optic ataxia (cant reach for what your looking at)
- visual simulatgnosia (cant percieve whole field)
Jacksonian Seizures
focal motor seizures spreading from distal limb to ipsi face along motor homunculus
Akinetic Mutism (bilateral frontal lesions eg. ACA
cant move/speak but follow observer with eyes and are diverted by sound
-coma vigil - lights on, no one home, not paralysed but cant will themselves to move
Tolosa Hunt S.
inflammation at orbital apex/granulatomous inflamm of cavernous sinus
- painful opthalmoplegia/extraocular palsies
- severe unilateral headaches
Babinski - Nageotte S. (dorsolateral medulla, e.g syphylis) -CNXII spared
- ipsi cerebellar ataxia
- conta hemi
- ipsi Horner’s s.
Cestan- Chenais S. same as Babinski-Nageotte but
(-conta hemi, ipsi Horner’s s. ) NO cerebellar ataxia as post spinocerebellar tract is spared
Central Pontine Myelinolysis (CPM) e.g. caused by
- too rapid correction of hyponatremia pulls water from brain cells
- quadriplegia
- bulbar weakness, dysphagia, dysarthria
Brissaud Sicard S. (small pontine stroke)
CNVII motor nucleus and corticospinal tract
-ipsi facial cramps, contra hemi
Gasperini S. (pontine lesion)
(abducens, facial and trigeminal nucleus and tract)
- abducens and facial nerve palsy
- pain/temp sensation loss: ipsi face, contra body
Conus Medullaris
- sudden, bilateral
- ankle reflexes affected
- more low back pain
- urinary retention, overflow incontinence
Cauda Equina
- gradual, unilateral, ankle and knee jerk affected
- more radicular pain, numbness at saddle area
- loss of sensation in specific dermatomes
- urinary retention presents much later
INO-internuclear opthalmoplegia
- lesion (brainstem infarction, MS..) in MLF
- affected eye has imparied adduction
- contra eye adducts with nystagmus
One and a Half S.
- total lateral gaze palsy on one side
- INO on other eye
- unilateral lesion to paramedian pontine reticular formation and to ipsilateral MLF
Argyl Robertson Pupil
- tertiary syphylis, pupils are bilaterally small
- can accomodated to close object but not react to light
Holmes Adie Pupil
- more in females, post gang parasymp fibre damage
- mydriasis, doesnt contrict to light
- loss of deep tendon reflexes
Marcus Gunn Pupil/RAPD
- lesion in optic nerve (glaucoma, MS, retinal disease)
- decreased pupillary response in affected eye
Devic’s Disease/NMO-Neuromyelitic Optica
- immunological attacks on optic and cervical cord
- demyelination -> loss of vision
Medical CNIII palsy
-(vascular/diabetic) pupil sparing as the parasympathetic fibres are spared as these are located peripherally so are affected last
2 causes of a surgical/compressive CNIII lesion
- external lesion impinging on parasymp fibres
- post communicating artery lesion
Cushing’s triad
- intercranial HT
- arterial HT
- reflex bradycardia
Hakim’s Triad
- normal pressure hydrocephalus
- incontinence, dementia, gait ataxia
Physiological anisocoria
-1 pupil bigger than other
Pain asymbolia in anterior cingulotomy is done by…
and causes…
- bilateral lesion for chronic depression/pain/OCD#
- feels pain but doesnt care
Ventricular Shunt placement
- right frontal
- left parieto-occipital (protects visuospatial)
non-targeted brain biopsy
-at right frontal lobe
Charcot’s artery of brain haemorrhage (60%)
-lateral lenticulostriate usually HT
Fetal post. communicating artery is…
origins from
- PCOM is larger than PCA, occurs in 1/3rd people
- originates from the ICA
Wernicke’s encephalopathy
- vit B1/thiamine deficiency, opthalmoparesis, nystagmus, ataxia, korsakoff’s psychosis
- confabulation
Abnormal cutaneous plantar reflex=
Babinski’s, upgoing plantars, sign of UMN lesion
Primitive Reflexes
- frontal pathology
- palmomental, suckling/rooting, paratonia
Striae of Gennari
- white myelinated band in V1
- layer IV (int granule)
Giant Cells of Betz
- layer 5 of cortex (int pyramidal)
- grey matter, only in paracentral lobule
Common HT haemorrhage sites
- 60% putamen
- 10% basal pons
- 10% cerebellum
Common C of Willis aneurysm sites
- Ant communicating Artery 35%
- Internal carotid branched 30%
- MCA branches 25%
Subacute combined degeneration of spinal cord aka
Lichtheim’s Disease
- B12, vit E or copper deficiency
- degeneration of post and lateral columns of cord
- affects dorsal columns and cortiospinal tract
Motor neurone disease/ALS
-combined upper and LMN signs
Abulia
- apathy, loss of initiative/drive, passivity
- follows ACA stroke or bifrontal tumour
behavioural disinhibition lesion site
-frontal esp orbital lesions
Lesion sites that can cause apraxia (motor planning to perform tasks):
- left post. parietal Cx
- SLF
- left frontal
- genu of corpus callosum
Agnosia
-cant recognise in a specific modality
Decorticare posturing
- upper limbs flex
- sign of severe brain damage
Decerebrate posturing
- upper limbs extend
- sever lower brainstem lesion at rubrospinal tract
Midline cerebellar lesions cause
truncal ataxia
Lateral cerebellar lesions cause..
also … can cause this too
..dysarthria/clumsy hand
..also lacular infarct of basal pons can cause this too
Transtentorial herniation
-CNIII compression (sluggish pupil –> blown)
Tonsilar herniation is
-coning due to increased ICPresuure, avoid lumbar puncture with supratentorial mass lesions
Hemiballismus cause
subthalamic nucleus stroke
Fusiform gyrus lesions
- Left:
- Right:-
- Left: dyslexia
- Right: prosopagnosia
Sommer’s sector of Hippocampus
CA1: autobigrophical and detailed memory recall
-esp vulnerable to hypoxic/ischemic injury
3 Causes of anosmia
- ant cranial fossa fracture
- olfactory groove meningioma
- PD
Astereognosia is..
caused by lesion at
cant recognise objects by exploratory touch
.parietal association cx (5)
Acoustic Neuroma/Schwannoma of the CPA:
-CN affected, symptoms
affects CNVII and CNVIII
Causes ataxia
1st symptom is hearing loss, then tinitis
Emotional incontinence (crying/laughing) caused by
pseudopulbar palsy in corticobulbar tract
Downbeat nystagmus due to lesion at …. or …..
cervicomeddullary junction or cerebral aqueduct
Rest/pill rolling tremor is due to…
vs intention tremor is due to…
rest. .PD
intention. .cerebellar
Stamp and stick gait in
tabes dorsalis (dorsal column demyelination) syphyslis
Sup sagittal sinus thrombosis sign
is a delta sign on CT that is contrast enhanced
Gelastic seizures are…
caused by….
sudden involuntary laughter/crying
due to lesion/haemorrhage in hypothalamus
Posterior disconnection Syndrome of Dejerine (left PCA stoke)
- lesion to splenium of CC
- alexia without agraphia
- L. occipital lobe and splenium infarcted but R is intact so can see but cant communicate via splenium with language areas so words not recognised
Meningiomas.. .
- usually benign, slow growing, may express progesterone receptors
- arise from arachnoid granulations (lots around dural venous sinuses) These come from arachnoid cap cells
Craniosynostosis
Premature fusion of cranial sutures
Transverse fracture of Petrous temporal bone->CNVII palsy….
as CNVII emerges at CPA to enter petrous portion of temporal bone via int auditory meatus before SM foramen
Cerebellar Cognitive Affective S.
- post lobe cerebellar central hemisphere damage
- personality/behaviour change, language and working memory impaired
Craniopharyngioma
- calcified epithelial tumours often in suprasellar region
- compresses Optic Chiasm from above so causes loss of inf. visual field initially
Ant Medial perforated area:
-from Ant. communicating artery e.g. recurrent artery of Heubner
Ant Lateral perforated area:
-Lenticulostriate (from MCA-M1) most lateral one is Charcot’s artery of microaneuyrsms
Post medial perforated area:
in the interpeduncular fossa are the thalamoperforators
Post lateral perforated area:
-what syndrome would a lesion here cause?
are the thalamogeniculate arteries from PCA going to VPNuclei and geniculates.
Lesion here causes Dejerine-Roussy S.
Lenticulostriate occlusion damage to
- ant limb of IC would cause:
- post limb of IC would cause:
Ant limb: dysarthria and facial weakness
Post limb: pure motor hemiplegia
CNIV palsy, superior oblique. Some patients..
Maximum diplopia when…
- head tilts towards lesion, some tilt away
- Maximum diplopia when…depressing the inturned eye
Corneal reflex afferent and efferent limb
afferent: V1 (common touch sensation)
efferent: V2 (zygomatic and temporal branch)
Fornix lesion would cause:
- anterograde amnesia
- esp no episodic (daily) memories
Uncinate fasiculus lesions may cause…
connects inf frontal lobe and lateral temporal lobe
social anxiety, Alzeimhers, bipolar, major depression
CNVII transection at facial canal/middle ear symptoms:
- LMN ipsi facial paralysis, taste and salivation impaired (chorda tympani)
- hyperacuses (loss of stapedius)
- no loss of lacrimation at sup. petrosal nerve already branched
Weak LR will show diplopia upon:
Where may CNVI be damaged?
far lateral gaze
in cavernous sinus as runs close to ICA here so in an ICA lesion may be affected
What 3 vessels form the int. cerebral veins? Where?
- thalamostriate, choroidal and septal veins
- below fornix in roof of 3rd ventricle in velum interpositum
What joins int cerebral veins to form Great vein of Galen? Where?
L&R Basal veins of Rosenthal from ant. perforated area
-formed by deep middle cerebral vein + ant cerebral vein
Galen -> which sinuses?
-> stright –> left transverse
Where does the central retinal artery originate from?
How does it enter orbit?
opthalmic artery of internal carotid
enters via optic canal
ACA stroke causes
contralateral leg weakness
What is the M1 area 4 in the medial paracentral lobule, anterior to the pars marginalis supplied by?
The paracentral branch of the ACA
Where is the basal cistern?
Where circle of Willis is
Captras syndrome is when
you believe your loved one is replaced by an imposter
Freidrich’s ataxia is an inherited disorder (2-16yrs) that
- affects spinocerebellar tracts hence no smooth motor control
- unsteadiness and clumsiness presnts early, intention tremor later
Brissaud Sicard S.
small pontine stroke affecting CNVII motor nucleus and corticospinal tract
- ipsi facial cramps
- contra hemi
Gasperini S.
pontine lesion affecting abducens, facial and trigeminal nucleus and tract
- abducens and facial nerve palsy
- loss of pain/temp sensation: ipsi face, contra body
The foramen of Loushka drains the 4th ventricle into the
Cerebellomedullary cistern
