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Neuroanatomy Lab > CASE STUDIES > Flashcards

CASE STUDIES Flashcards

1
Q

Double vision indicates ____ involvement

A

eye muscle; so cn 3, 4, 6

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2
Q

Dysarthria- difficulty speaking due to problems with

A

muscles of speech.

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3
Q

Internal strabismus on the left indicates

A

same side abduscens involvement

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4
Q

what controls the corneal reflex?

A

sensory arm – trigem

motor arm – facial

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5
Q

Normal irritaiton of cornea after being touched indicates

A

trigem is normal

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6
Q

Normal irritation of cornea + diminished cornea reflex indicates

A

X facial nerve

normal trigem n.

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7
Q

Forehead invovlement in faical paralysis (i.e. full facial paralsyis) indicates

A

LMN facial nerve dysfunction

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8
Q

damage what structure can impair the facial nucleus

A

the pons

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9
Q

what controls jaw reflex?

A

sensory - trigem

motor - trigem

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10
Q

What would a positive babinski be?

A

. Plantar reflexes extensor

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11
Q

Weakness on Right

and

Cranial nerve dysfunction on left would indicate

A

Lesion occured before the decussation of the pyramids in the medulla

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12
Q

Drooling and inability to close the eye indicates LMN lesion to

A

facial nerve or nucleus

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13
Q

Lateral Pontine syndrome

is caused by obstruction of?

What are symptoms?

A

1. pontine branches off basilar

2. AICA

sx

contralateral - pain and temp loss

ipsilateral - 1. full facial paralysis,

  1. internal strabismus (abduscens)
  2. loss of pain and temp from face (spinal trigem)
  3. ipsilateral hearing loss
  4. ipsilateral horners
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14
Q

How to differentiate AICA vs. pontine branches of basialr with lateral pointine syndrom

A

AICA would have cerebellar signs

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15
Q

Roaring in the ears suggests ___

A

elevated blood pressure

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16
Q

What are the two originals of horizontal nystagmaus? how do you differentiate?

A
  1. vestibulocochlear – nystagmus beats AWAY from the X
  2. cerebellum – nystamgus is either towards or mixed
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17
Q

hearing loss in left ear

A

either left CN 8 X or Left vestibulocochlear X

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18
Q

inability to completel close left side of mouth

A

LMN of left facial n.

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19
Q

Less muscle tone in extremeis suggests

A

LMN rather than UMN

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20
Q

Loss of corneal reflex and protopathic sensation over the left side of the face can be explained by lesion to the spinal tract of CN V

where could lesion be?

A

pons or medulla

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21
Q

What are the causes of nystagmus?

A

X CN 8 nerve

X CN 8 nucleus (pons or medulla)

X cerebellum (particularly flocculus or vermis)

X input to the cerebellum

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22
Q

Both pupils were the same size and were reactive to light indicates

A

Normal CN 2 and 3

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23
Q

No muscle weakness indicates

A

corticospinal tracts are intact

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24
Q

Intetion tremor indicates

A

cerbellar injury

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25
Q

Nonintention tremor indicates

A

basal ganglia problems

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26
Q

Patient leanig to one side standing or walking could mean

A

motor problems or incoordination

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27
Q

Cerebellar hypotonia on right helps localize to the ___ side

A

right

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28
Q

Rght pupil smaller than left indicates ___ involvement

A

right CN 3

or possibly horners

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29
Q

ptosis of the right eye indicates ___

A

CN 3 palsy on the right

or possibly horners

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30
Q

ptosis and constricted pupil but normal pupillary eye reflex suggests

A

horners syndrome

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31
Q

Horners + cerebellar signs point to stroke of the ___ artery

A

Superior cerbellar artery

supplies the upper areas of the medial and lateral cerebellum, superior peduncle, and rostral part of pons (including ALS and HRST)

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32
Q

Drooped eyelid suggests ___ involvement

A

CN III

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33
Q

How to determine if ptosis is caused by Horners vs. CN III lesion?

A

Horners – pupil is constricted (loss of symps to the eye)

CN III X – pupil is dilated

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34
Q

Down and out eye position indicates

A

CN III palsy

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35
Q

Slurred speech can indicated

A
  1. X faical nerve
  2. X hypoglossal
36
Q

define myadriasis

A

dilation of the pupil

37
Q

what controls the pupillary light reflex

A

sensory – optic nerve

motor – oculomotor

38
Q

Describe how UMN lesion can cause facial paralysis? What side will the sx be on in an injury

A

If the right corticobulbar tract innervting CN 7 is cut… the facial paralysis on the left (opposite) side

39
Q

Involvement of both corticobulbar and corticospinal suggests disruption of ___

A

crus cerebri

40
Q

In the brainstem, the lesion is one the ____ side of the hgihest sx

A

same

41
Q

For All lesions in the forebrain

all sensory and motor sx are on the ___ side

A

opposite except for olfaction

42
Q

Olfactory loss due to lesion in the cortex is on the ___ side

A

same

43
Q

metal status changes suggests ___ damage

A

forebrain/telencephalon

44
Q

Pupullary light/acodomation reflex suggests ___ damage

A

midbrain

45
Q

Loss of upward gaze localizes symptoms to the ___

A

midbrain (posterior commisure)

46
Q

External strabismus suggests ___ involvement

A

oculomotor

47
Q

____ is usually bilateral

A

disease process

48
Q

Normal visual field rules out

A

CN 2 x

49
Q

unable to accomodate idnicates difficulty with __ muscle

A

medial rectus

50
Q

Gaze induced nystagmus indicates ___involvement.

A

cerebellar

51
Q

CN symptoms + CONTRALATERAL cerebellar sx suggests a lesion where

A

tegmentum of the midbrain on the side of the CN sx

included axons from the superior cerebellar peduncle after they crossed

* this is called central midbrain syndrome or claudae syndome

52
Q

oculomotor nerve deficits localize the lesion to the ____.

A

midbrian

53
Q

left LMN CN12 injury localizes us to ___

A

left medulla

54
Q

Symptoms of medial medullary syndrome

A

contralateral

  • hemiparesis
  • epicritic

ipsialteral

  • apralysis of tongue with deviation to side of lesion
55
Q

Problems with voice suggest vagus.

Where is the dorsal motor nucelus of vagus

A

Medulla

56
Q

Cranial nerve nuclei in the medulla?

A

4-4 rule

bottom 4 nuclei are in the medulla

12, 11, 10, 9

(also spinal trigem is here too!)

57
Q

where is the nculeus ambigous located?

A

medulla

58
Q

increased deep tendon reflexes is a sign of

A

UMN injury

59
Q

positive babinksi sign suggest injury to the

A

right corticospinal tract (UMN)

60
Q

What is brown sequard?

A

contralateral-

loss of pain and temp same side of lesion

ipsilateral

UMN weakness

loff of position and vibration

61
Q

difficulty heel walking suggests

A

weakness of l5

tibialis anterior
extensor hallicus longus
extensor digitalis longus

62
Q

what are two big signs of a peripheral nerve lesion?

A

paralysis

and complete loss of sensation

63
Q

loss of sensation of thumb to middle finger on top of hand (palm down)

A

radial n. injury

64
Q

loss of sesantion from pinky to 4th finger on top of the hand

A

ulnar nerve injury

65
Q

difficulty performing precision grip suggests

A

median nerve deficit

– 2nd and 3rd digit finger flexion and thumb opposition

66
Q

Distal injury means the daamge is

A

away from the trunk

67
Q

Homonmous visual field deficit indicates lesion ____

A

after the optic chiasm

68
Q

Left sided weakness w/hyperreflexia suggests damage where?

A

UMN X on the RIGHT side

69
Q

Left neglect- syndrome caused by ___lesion

A

right parietal lobe

70
Q

Left homonymous hemianopia is due to ___

A

right optic tract damage

71
Q

absent minded suggest

A

forebrain apthology

72
Q

what is the triad of communicating hydrocpehalus?

A

wet wobbly and wacky (normal pressure hydrocephalus)

73
Q

increased intraranil pressure can cause ___ hernination

A

uncal

uncus pushing on the midbrain -> can cause CN 3 deficits

74
Q

Cortex—>______—-> caudal medulla

A

internal capsule

75
Q

somatosensory pathways that end in the VPL

A

DML and ALS

76
Q

visual loss + motor deficits suggests ___ stroke

A

ICA occulsion

block

opthalamic –> blindness in one eye

MCA –> motor sx

77
Q

signs of peripheral nerve disease

A

fasiculation and rapid atrophy

78
Q

signs of radiculopathy

A
  • pain changed locations but confined to muleiple regions
  • usually weakness but not atrophy
79
Q

rule of peripheral nervous disease

A

kills distal end of axons and moves up towards cell body

bilateral and symmetrical

fasicualtions and atrophy are also signs

80
Q

commonly injured with foot drop

A

common fib of sciatic

81
Q

normal stenth, reflexes, sensations but paralysis

A

hysteria

82
Q

Decerebrate posturing indicates

A

s brain stem damage, specifically damage below the level of the red nucleus

83
Q

Decorticate posturing indicates that there may be damage to areas including the

A

cerebral hemispheres, thalamus, internal capsule, midbrain

84
Q

The initial hemiparesis and hemihypesthesia without cognitive signs point to damage of the

A

posterior limb of the internal capsule

85
Q

dysconjugate eye movements suggests

A

MLF

86
Q

urinary retention suggests

A

loss of sensory afferents to bladder

87
Q
A

Neuroanatomy Lab (36 decks)

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