TBL syndromes Flashcards
Upper Motor Signs
Positive Babinski
Hyperflexia
Hypertonia
Lower Motor Signs
Negative Babinski Hypoflexia Hypotonia Fasciculation (random twitching) Atrophy
Peripheral Neurological Syndromes
Neuropathy- dysfunction of nerves
Polyneuropathy- diffuse dysfunction of peripheral nerves
Mononeuropathy- dysfunction of single nerve
Radiculopathies- spinal nerve root dysfunction
Myopathy Syndrome
Diffuse skeletal muscle weakness
SYMMETRIC BILATERAL PROXIMAL LIMB WEAKNESS
Median Neuropathy (C5-T1)
THUMB ABDUCTION, thumb flexion, thumb
opposition
Sensation of all anterior & distal posterior
skin of thumbs, index fingers, middle fingers,
and lateral halves of ring fingers
Ulnar Neuropathy (C8-T1)
Adduction and abduction of all fingers
except thumb abduction; little finger
opposition; flexion of ring and little fingers
Sensation of anterior & posterior medial
hands including the little fingers and medial
halves of the ring fingers
Radial Neuropathy (C5-T1)
Finger and wrist extension
Sensation of the lateral posterior hands and
the proximal posterior skin of the thumbs,
index fingers, middle fingers, and the lateral
halves of the ring fingers; brachioradialis
reflexes
Seventh Cervical Radiculopathy
Elbow extension, wrist and finger extension
Sensation of the posterior forearms, hands,
and middle fingers; triceps reflexes
Sixth Cervical Radiculopathy
Shoulder abduction, elbow flexion
Sensation of the lateral forearms, lateral
hands, thumbs, and index fingers; biceps &
brachioradialis reflexes
Peroneal Neuropathy
Foot dorsiflexion, toe extension, foot
eversion
Sensation of the lateral lower legs and the
medial and superior feet
Lateral Femoral Cutaneous Neuropathy
Abnormal sensation of the lateral thighs
Fifth Lumbar Radiculopathy
Hip abduction, knee flexion, foot
dorsiflexion, toe extension, foot inversion &
eversion
Sensation of the lateral upper & lower legs
and medial & superior feet; difficult to elicit
stretch reflexes of the medial hamstrings
First Sacral Radiculopathy
Hip extension, knee flexion, foot plantarflexion, toe flexion Sensation of the posterior upper & lower legs AND lateral & inferior feet; Achilles reflexes
Polyneuropathy
Symmetric distal limb weakness; lower
motor signs
Sensory loss of distal limbs
Neuromuscular Junctionopathy
Same symptoms as myopathy, drooping eyelid (ptosis) ophthalmoparesis.
Possible Dysarthria, dysphagia, dysphonia
Myelopathy
Syndrome of Spinal cord tracks
Lower Sacral Myelopathy and cauda equina syndrome
Dysfunction of cauda equina and lower sacral spinal cord.
Dysfunction to perineum, bladder, bowel and genitals
Legs not involved
Lumbosacral Enlargement Myelopathy
Affect myotomes of legs and include sacral myelopathy
Thoracic Myelopathy
Causes a horizontal line on abdomen, where below line you have dysfunction
Distal muscles weaker than promixal
Cervical enlargement Myelopathy
Deficits of thoracic myelopathy as well as deficits in myotomes of the arms
6th- lower motor neuron to biceps and myotome, UMN to tricepts
Upper Cervical Myelopathy
Dysfuncticuase horiztonal line encircling neck with somatosensory and UMN abnormality to below.
Look for Pronator Drift, clumsy quick motor movement. Respiratory weakness
Unilateral Myelopathy (Brown Sequard)
1)Ipsilateral lower motor abnormality at site of lesion
2)UMN abnormality of all ipsilateral myotomes below lesion
3) Loss of Vibration, Proprioceptin, Fine tounch ipsilateraly below lesion
4) loss of pain/ temp and crude touch, 2 below contalaterally
5)
Anterior Myelopathy
Due to anterior spinal blockage
1) Bilateral LMN loss to ventral horn
2) Loss of spinothalmic tract 2 below lesion
3) Initial Shock, then UMN sydrome takes over
4) Autonomic Functions lost below lession
Posterior Myelopathy
due to posterior spinal artery blockage
1) Dorsal Column lost.
2) total IPSILATERAL anesthesia at level.
3) possibly affect to descending motor
Medial Cerebellar Syndrome
Symptoms-
1) Ataxia, dysarthria, vertigo, nystagmus, nausea
Lateral Cerebellar Syndrome
Ataxia
Dysmetria
intentional tremor of ipsilateral limb
Medulla Structures
Anterior- Pyramids
Lateral- Olives
Middle- Nucleus Ambiguis
CN 9,10,11,12
Pons
Basil Pons
CN- 5, 6, 7, 8
Midbrain
Anterior- Cerebral Peduncle
Posterior- SC colliculi
CN 3, 4
Brainstem Blood Pathways
Medulla- Vertebral and Anterior Spinal, PICA
Pons- Basilar, AICA, SCA
Midbrain- PCA and PCA
Lateral Cerebellar Syndrome
Ataxia
Dysmetria
intentional tremor of ipsilateral limb
Medulla Structures
Anterior- Pyramids
Lateral- Olives
Middle- Nucleus Ambiguis
CN 9,10,11,12
Pons
Basil Pons
CN- 5, 6, 7, 8
Midbrain
Anterior- Cerebral Peduncle
Posterior- SC colliculi
CN 3, 4
Accessory Neuropathy Syndrome
Unilateral dysfunction to ipsilateral SCM and trapezius
SCM strenght is tested contralateral
T is tested with ipsilateral shoulder raise
Pupillary Dark reflex
3 neurons help dilate pupil via sympathetic innervation.
neuron 1 travels down to t1 sympathetic chain,
Neuron 2 travels to cervical ganglia
neuron 3 synapse on iris dilator muscle
Upper eyelid elevation
Muscle: Levator papebrae via CN3
minor muscle- superior tarsal via sympathetics
Horner’s Syndrome
Unilateral dysfunction to efferent neuron in sympathetic trunk Symptoms 1) Ptosis 2) flushed face 3) Constricted pupil 4) Lack of sweating
Accessory Neuropathy Syndrome
Unilateral dysfunction to ipsilateral SCM and trapezius
SCM strenght is tested contralateral
T is tested with ipsilateral
CN V
4 trigeminal nuclei at different brainstem levels
Main- Somatosensory and Brachiomotor to ipsilateral face
3 branches- opthalmic, maxilla and mandibular
1) pain and temp- enter at pons, descend to spinal nucleus V, cros and assend to TPV
2) Position, Proprioception, and fine touch, to chief sensory V in pons - then Dessucate to VMP
3) 1a, 1b, II fibers to nucleus Mesencephalon V nucleus in midbrain
4) LMN of muslce of mastication in motor nucleus in Pons- also innervate typani muslce
Hypoglossal Neuropathy
LMN abnormality to ipsilateral tongue muscles
Tongue deviates to weak side
Problems with enunciating “la”
Medial Medulla Syndrome
Lose:
1) Hypoglossal Nuclei
2) Trigeminal sensory (pain, temp) trackt
3) Medial lemniscus tract
4) Pyramidal tract
Results in: loss of LMN to ipsilateral tongue
UMN abnormality to contralateral Dorsal Column
3) loss of pain and temp to contralateral face.
Conductive Hearing Loss
Weber test- lateralizes to bad ear
Rinne- sound louder on mastoid process
Sensorineural hearing loss
Weber- lateralizes to good ear
Rinne- sound louder hearing than on mastoid
Vagus Neuropathy
Dysarthria, dysphonia, dysphagia, nasal regurgitation, weakness in palate elevation, deminished efferent gag reflex, hard to pronounce ka and Ha.
Glossopharyngeal neuropahthy
Somatosensory abnormalities to ipsilateral pharynx, and lowere motor neuron abnormalitiees to stylopharyngeus muslce. Afferent Gag reflex dysfucntion!
Parasympathetic, viscerosensory and tates abnormalities.
Lateral Medullary Syndrome/ Wallenberg!
Due to PICA occulsion
1) Decrease pain, temp to ipsilateral face,
2) decreased pain and temp to contralateral body
3) ipsilateral limb ataxia
4) Ipsilateral Horner’s Syndrome
5) diminished ipsilateral tates (solitary nucleus)
6) vertigo, dysequilibriu, nausea, nystagmus- due to coclear nuclei
7) ipsilateral palate elevation, dysarthrai, dysphagia fue to ambiguus nuclease
Abducens neuropathy
Horizontal diplopia from weakness in lateral rectus muscle- unable to abduct ipsilateral eye
Internuclear ophthalmoparesis
Unilateral dysfunction of MLF causing ipsilateral adduction weakness and preserved convergence
Medial Pontine Syndrome
1) UMN abnormalities to contralateral body
2) DCT to contralateral body
3) axatia from corticopontine tract
4) contralateral face has somatosensory abnormalities
5) anterior lesion- ipsilateral eye abduction
6) posterior- ipsilateral horizontal gaze paresis
Locked In Syndrome
Only Able to move eyes-
Bilateral lesion to basis pontine
Vestibulocochlear Neuropathy
ipsilateral hearing loss, vertigo, nystagmus, due to loss of cochlear nuclei and loss of vestibular nuclei
Facial Neuropathy
LMN abnormality to upper and lower face
Hyperacusis (CN VII helps with one muslce in ear)
Decreased Lacrimation and salivation
Dysfunction to Corneal reflex
taste- solitary nucleus
Salivation/ Lacrimation- superior salivary nuclease
Trigeminal Neuropathy
Loss of facial somatosensory,
LMN loss of mastication and hyperacusis
Lateral Pontine Sydrome
1) somatosensory and LMN loss to ipsilateral face
2) ipsilateral hyperacusis
3) vertigo, dysequilibrium, nausea nystagmus
4) ipsilateral horner’s sydrome
5) loss of pain, temp, to contralateral body
6) ipsilateral ataxia
Oculomotor Neuropathy
Ptosis, anisocoria worsens in light, weakness in elevation and adduction
Down and out,
Trochlear Neuropathy
Depression when adducted, intortion when abducted
Goes up and medially
Medial Midbrain Syndrome
1) ipsilateral oculomotor neuropahty
2) contralateral trochlear neuropahty
3) Ipsilateral/ contralateral ataxia
4)
Lateral Midbrain Syndrome
UMN loss to contralateral lower face and body
Contralalateral ataxia
Somatosensory abnormality to contralateral body, face, arm leg.
