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On Call Neurology > Anatomic Localization > Flashcards

Anatomic Localization Flashcards

1
Q

General principles of lesion: cortex?

A

Localization in the Upper Motor Neuron (Pyramidal) System

Principle: Tone Is Increased, Causing Spasticity and Hyperreflexia

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2
Q

General principles of lesion: corona radiata?

A

Localization in the Upper Motor Neuron (Pyramidal) System

Principle: Tone Is Increased, Causing Spasticity and Hyperreflexia

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3
Q

General principles of lesion: internal capsule?

A

Localization in the Upper Motor Neuron (Pyramidal) System

Principle: Tone Is Increased, Causing Spasticity and Hyperreflexia

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4
Q

General principles of lesion: brain stem?

A

Localization in the Upper Motor Neuron (Pyramidal) System

Principle: Tone Is Increased, Causing Spasticity
and Hyperreflexia

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5
Q

General principles of lesion: spinal cord?

A

Localization in the Upper Motor Neuron (Pyramidal) System

Principle: Tone Is Increased, Causing Spasticity
and Hyperreflexia

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6
Q

General principles of lesion: anterior horn?

A

Localization in the Lower Motor Neuron System

Principle: Tone Is Decreased, Causing Flaccidity
and Hyporeflexia

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7
Q

General principles of lesion: root/plexus?

A

Localization in the Lower Motor Neuron System

Principle: Tone Is Decreased, Causing Flaccidity
and Hyporeflexia

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8
Q

General principles of lesion: nerve?

A

Localization in the Lower Motor Neuron System

Principle: Tone Is Decreased, Causing Flaccidity
and Hyporeflexia

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9
Q

General principles of lesion: neuromuscular junction?

A

Localization in the Lower Motor Neuron System

Principle: Tone Is Decreased, Causing Flaccidity
and Hyporeflexia

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10
Q

General principles of lesion: muscle?

A

Localization in the Lower Motor Neuron System

Principle: Tone Is Decreased, Causing Flaccidity
and Hyporeflexia

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11
Q

General principles of lesion: midbrain?

A

Localization within the brain stem

Principle: specific cranial nerve involvement guides localization

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12
Q

General principles of lesion: pons?

A

Localization within the brain stem

Principle: specific cranial nerve involvement guides localization

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13
Q

General principles of lesion: pontomedullary junction?

A

Localization within the brain stem

Principle: specific cranial nerve involvement guides localization

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14
Q

General principles of lesion: medial medullar (rare)?

A

Localization within the brain stem

Principle: specific cranial nerve involvement guides localization

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15
Q

General principles of lesion: lateral medulla (wallenberg syndrome)?

A

Localization within the brain stem

Principle: specific cranial nerve involvement guides localization

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16
Q

General principles of lesion: hemicord (brown-sequard syndrome)?

A

Localization in the Spinal Cord

Principle: Localization Is Assisted by the Combination of Tracts Involved

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17
Q

General principles of lesion: anterior cord?

A

Localization in the Spinal Cord

Principle: Localization Is Assisted by the Combination of Tracts Involved

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18
Q

General principles of lesion: central cord?

A

Localization in the Spinal Cord

Principle: Localization Is Assisted by the Combination of Tracts Involved

19
Q

General principles of lesion: posterior cord?

A

Localization in the Spinal Cord

Principle: Localization Is Assisted by the Combination of Tracts Involved

20
Q

General principles of lesion: foramen magnum?

A

Localization in the Spinal Cord

Principle: Localization Is Assisted by the Combination of Tracts Involved

21
Q

General principles of lesion: conus medullaris?

A

Localization in the Spinal Cord

Principle: Localization Is Assisted by the Combination of Tracts Involved

22
Q

General principles of lesion: cauda equina?

A

Localization in the Spinal Cord

Principle: Localization Is Assisted by the Combination of Tracts Involved

23
Q

Signs and symptoms of cortex lesion?

A

signs:
- differential weakness of limbs and face
- sensory symptoms
- language, visual or attentional alterations

symptoms:

  • fractionated weakness (e.g. arm greater than face and leg)
  • cortical and primary sensory loss
  • aphasia, hemianopia, or hemineglect
  • cognitive dysfunction
24
Q

Signs and symptoms of corona radiata lesion?

A

signs:
- differential weakness of limbs and face

symptoms:

  • fractionated weakness
  • primary sensory loss
25
Q

Signs and symptoms of internal capsule lesion?

A

symptoms:
- weakness only

signs:
-face, arm and leg affected equally and densely

26
Q

Signs and symptoms of brain stem lesion?

A

symptoms:
- unilateral or bilateral weakness
- diploplia, vertigo, dysarthria, or weakness

signs:

  • dense hemiparesis
  • ocular or oropharyngeal dysphagia
  • motor posturing
27
Q

Signs and symptoms of spinal cord lesion?

A

symptoms:

  • difficulty with gait + walking
  • urinary incontinence

signs:

  • no face involvement
  • spastic quadriparesis (cervical) or paraparesis (thoracic)
  • sensory level
28
Q

Signs and symptoms of anterior horn?

A

symptoms:
- progressive flaccid weaknesses

signs:

  • wasting, weakness, fasciculations
  • no sensory loss
29
Q

Signs and symptoms root/plexus?

A

Symptoms:

  • single-limb weakness and sensory loss
  • pain in the neck, back or limb

signs:

  • weakness in radicular/plexus distribution
  • EMG shows denervation in affected muscles
30
Q

Signs and symptoms of nerve lesion?

A

Symptoms:

  • focal weakness (mononeuritis)
  • distal weakness (polyneuropathy)

Signs

  • focal or distal weakness
  • atrophy in affected distribution
  • fasciculations
  • hyporeflexia

-slowing or low amplitude on conduction studies; denervation on EMG

31
Q

Signs and symptoms of neuromuscular junction lesion?

A

Symptoms:

  • fluctuating weakness
  • diplopia

Signs:

  • positive edrophonium test
  • decremental response with repetitive stim on EMG

Note:

  • edrophonium is a readily reversible acetylcholinesterase inhibitor
  • prevents breakdown of acetylcholine + competitively inhibits enzyme acetylcholinesterase, mainly at the neuromuscular junction.
32
Q

Signs and symptoms of muscle lesion?

A

Symptoms:

  • proximal weakness
  • difficulty climbing stairs and brushing hair?
  • muscle aches

Signs:

  • proximal weakness
  • polyphasic, low-amplitude motor units on EMG
33
Q

Signs and symptoms of midbrain lesion?

A
  • impaired vertical gaze
  • contralateral motor signs
  • CN 3 palsy (plus contralateral abduction nystagmus suggest ipsilateral INO)
  • CN 4 palsy

(hemiparesis suggests Weber syndrome; ataxia suggests Claude syndrome; tremor or chorea suggests Benedikt syndrome)

34
Q

Signs and symptoms of pons lesion?

A
  • dysarthria
  • dysphagia
  • ataxia
  • contralateral hemiparesis or hemisensory loss
  • ipsilateral facial sensory loss (CN5)
  • ipsilateral gaze palsy (PPRF) or one and a half syndrome (PPRF and MLF)
  • locked in syndrome (bilateral basis pontis; associated with ocular bobbing)
  • horizontal nystagmus (often brachium pontis)
35
Q

Signs and symptoms of pontomedullary junction lesion?

A
  • Vertigo (CN 8)
  • dysarthria
  • horizontal or vertical nystagmus
  • contralateral hemisensory loss and hemiparesis
36
Q

Signs and symptoms of lateral medullar (Wallenberg syndrome)?

A
  • ipsilateral horner syndrome
  • ipsilateral limb ataxia
  • ipsilateral face and contralateral body numbness
  • gait ataxia
  • vertigo, dizziness, nausea (CN 8)
  • dysphagia (CN 9 - 12 palsises)
37
Q

Signs and symptoms and medial medulla (rare)?

A
  • contralateral hemiplegia
  • contralateral posterior column sensory loss
  • ipsilateral tongue weakness (CN 12 palsy)
38
Q

Features of and causes of hemicord (brown-sequard syndrome)?

A

S&S:

  • ipsilateral hemiparesis
  • contralateral spinothalamic sensory loss
  • ipsilateral dorsal column sensory loss
  • sphincter dysfunction

Causes:

  • penetrating trauma
  • extrinsic cord compression
39
Q

Features of and causes of anterior cord?

A

S&S:

  • upper and lower motor paralysis
  • spinothalamic sensory loss
  • sphincter dysfuntion
  • sparing of posterior columns

Causes:
- anterior spinal artery infarction (often involves T4-T8)

40
Q

Features of and causes of central cord?

A

S&S:

  • paraparesis
  • lower motor paralysis; wasting and fasciculations in arms
  • sensory loss in ‘shawl’ distribution (if in cervical region)
41
Q

Features of and causes of posterior cord?

A

S&S

  • proprioceptive and vibratory sensory loss
  • segmental tingling and numbness
  • sensation of constricting “bands”

Causes:

  • vitamin B12 deficiency
  • demyelinations (multiple sclerosis)
  • extrinsic compression
42
Q

Features of and causes of foramen magnum?

A

S&S:

  • spastic quadriparesis
  • neck pain and stiffness
  • C2-C4 and upper facial numbness
  • ipsilateral horner syndrome
  • ipsilateral tongue and trapezius muscle weakness

causes:
- tumor (meningioma, chordoma)
- atlantoaxial subluxation

43
Q

Features of and causes of conus medullaris?

A

S&S:

  • lower sacral saddle sensory loss (S2-S5)
  • sphincter dysfunction; impotence
  • aching back or rectal pain
  • L5 and S1 motor deficits (ankle and foot weakness)

Causes:

  • intrinsic tumor
  • extrinsic cord compression
44
Q

Features of and causes of cauda equina?

A

S&S:

  • sphincter dysfunction
  • paraparesis with weakness in the distribution of multiple roots
  • sensory loss in multiple bilateral dermatomes

causes:

  • extrinsic tumor
  • carcinomatous meningitis
  • arachnoiditis
  • spinal stenosis

On Call Neurology (4 decks)

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