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Brain and Behavior > Lecture 31, 32: Brainstem Syndromes and Lesions of the Spinal Cord > Flashcards

Lecture 31, 32: Brainstem Syndromes and Lesions of the Spinal Cord Flashcards

1
Q

Motor information in brainstem is largely…

A

Anterior

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2
Q

Sensory information in brainstem is largely…

A

Posterior

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3
Q

First 3 CNs are in the…Hallmark CN of this region?

A

Midbrain; CN 3

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4
Q

Principle cranial nerves of pons?

A

CN 6, CN 7

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5
Q

Hallmark CNs of medulla

A

CN 9, 11, 12

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6
Q

What is special about CN5?

A

Stretches through the brainstem so doesn’t help with localization

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7
Q

What do we mean by “Crossed Signs”

A

Lesion on one side presents ipsilateral on face and contralateral on body

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8
Q

One side: 3rd nerve palsy; Other side: hemiplegia. Lesion?

A

Lesion in midbrain corticospinal tract where III nerve emerges. Weber Syndrome.

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9
Q

One side: cannot abduct; Other side: hemiplegia. Lesion?

A

Lesion in anterior pons where VI nerve emerges. Raymond Syndrome.

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10
Q

One side: right facial weakness; Other side: hemiplegia. Lesion?

A

Lesion in lower anterior pons. Millard-Gubler Syndrome.

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11
Q

Wallenberg Syndrome (presentation, symptoms and lesion localization, note CNs affected)

A

Slurred speech, imbalance, numbness (pain/temperature). One side: facial numbness, depressed gag; Other side: body numbness; cerebellar ataxia; lesion in posterior medulla (affecting CN IX, X, XI and V nucleus)

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12
Q

Define dysarthria

A

Problem with speech mechanics/articulation, leads to slurred speech

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13
Q

Dysarthria w/ lingual quality; One side: tongue weakness; Other side: body weakness. Lesion?

A

Lesion in anterior medulla. Jackson Syndrome.

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14
Q

Locked-in Syndrome. What CN is spared?

A

Quadriplegic, aphonic, no horizontal eye movements, blinking intact; CN III spared (blinking)

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15
Q

Monoplegia

A

Paralysis of one limb

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16
Q

Diplegia

A

Paralysis of both upper or both lower limbs

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17
Q

Paraplegia

A

Paralysis of both lower limbs

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18
Q

Hemiplegia

A

Paralysis of upper limb, torso, and lower leg on one side of the body

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19
Q

Quadriplegia

A

Paralysis of all four limbs

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20
Q

In a spinal cord lesion, you find UMN findings where? Including…(2)

A

Below the lesion; Hyperreflexia and Babinski sign

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21
Q

Myelopathy

A

Spinal cord disease

22
Q

Two types of myelopathies

A

Compressive and noncompressive

23
Q

Compressive myelopathies include problems inside or outside the spinal cord? Give some examples (4)

A 
Outside; Cervical spondylosis
epidural damage (neoplasm, abscess, hemorrhage); herniated disc; posttraumatic compression
24
Q

Neurogenic bladder and two types

A

Overactive (spastic contraction leads to frequency and small amounts of urine) and underactive (overflow/retention)

25
Q

What are some other autonomic disturbances of the spinal cord? (3)

A

Bowel, BP, sweating

26
Q

Four types of high cervical pathology

A

Syrinx, chiari malformation, cordoma/meningioma, rheumatoid arthritis

27
Q

Syringomyelia first affects, what does this cause? What happens later? What tract?

A

Crossing spinothalamic fibers in a segment –> cape-like sensory loss, LMN: local weakness of muscles and hyporeflexia; followed by UMN (corticospinal tract) symptoms (spaticity and hyporeflexia)

28
Q

Syringobulbia. Serious complication?

A

Syringomyelia in brainstem; decompensation

29
Q

Syringomyelia and bublia can be related to…(2)

A

Congenital/trauma

30
Q

What is a complete spinal cord transection?

A

Transverse myelopathy

31
Q

Transverse myelitis is usually a…describe acute/later presentation

A

Inflammatory disorder. Acute: spinal scock; Later: UMN

32
Q

Spinal shock

A

Presents with flaccid/areflexic responses

33
Q

Brown Sequard syndrome is…

A

Hemisection of the spinal cord. Ipsilateral loss of proprioception and weakness and contralateral loss of pain/temp (2 levels below); LMN signs at lesion level

34
Q

Posterolateral column disease common cause and classic symptoms

A

B12 deficiency; ataxic gait, paresthesia, proprioception abnormal

35
Q

Combined anterior horn cell and pyramidal tract disease (motor neuron disease) one liner

A

Progressive diffuse LMN signs with UMN dysfunction

36
Q

Conus syndrome. What is preserved?

A

Bilateral saddle anesthesia (S3-S5), urinary retention and incontinence with lax anal tone, impotence; muscle strength in legs largely preserved

37
Q

Cauda equina syndrome. What is preserved?

A

Severe lower back/radicular pain and asymmetric leg weakness; sacral sparing

38
Q

Disc herniation mechanics. What posture often makes it worse? What sign elicits it? Most common surgery.

A

Nucleus pulposus herniates out through annulus fibrosus; sitting often makes it worse; straight leg raising; laminectomy

39
Q

Spondylolisthesis common name and definition

A

Slipped disc; anterior/posterior displacement of a vertebrae

40
Q

Spinal stenosis common location, effect, and causes (broadly, 3)

A

Lumbar spine; claudication of cauda equnia causing lower back pain that gets worse while walking (blood supply to cauda equina is compressed –> legs steal blood); congenital, degenerative, trauma

41
Q

Acute viral myelitis causes…

A

Transverse myelitis

42
Q

Tabes dorsalis. Sign? Symptoms?

A

Form of tertiary neurosyphilis in which the nerves of the dorsal (or posterior) columns degenerate; Romberg; shooting pain in legs and loss of sense of position, vibration, and discriminative touch

43
Q

What is the most common pathogen that causes epidural abscess? Where does the infection usually originate?

A

Staphylococcus; skin/soft tissue

44
Q

Three primary spinal tumor locations, which is most common?

A

Extradural/epidural = most common (b/t meninges and spine bones); intradural extramedullary (within meninges); intramedullary (inside the cord)

45
Q

Extradural tumor usually arise from…Clinical course

A

Bone; quick decompensation (some low back pain, then sudden paralysis = medical emergency)

46
Q

Intradural extramedullary tumors include which two tumor types…Common?

A

Meningioma, schwannoma; no, rare

47
Q

Traumatic spinal cord disease preferentially affects…

A

Males >30 years old

48
Q

Hangman’s fracture

A

Spondylolisthesis where C2 vertebrae is displaced anteriorly to C3 due to C2 pedicle fracture –> DEATH due to vessel/airway obstruction (why you DON’T move someone with a possible spinal cord injury)

49
Q

Central cord syndrome and individuals typically affected. Looks like?

A

Spinal cord damages starts centrally, involves spinothalamic tract initially (thermo/pain); edlerly; syringomylia

50
Q

What does anterior spinal artery infarct look like? What is spared?

A

Weakness (CST) and pain/temperature loss (spinothalamic tracts); posterior columns still working

51
Q

What is a spinal cord arteriovenous malformation (AVM)? When do they cause problems?

A

Tortuous/malformation arterial or venous problem (or aneurysm) that can lead to spontaneous bleeding, which can cause acute problems.

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