Anatomy Flashcards
(297 cards)
1
Q
Pt presents with….Dx?
1. Deviation of the protruded tongue to the left
2. Dysarthria
3. Loss of proprioception, 2-point tactile discrimination and vibratory sensations on the right side of the body
4. Paralysis of both right limbs
5. Hypertonia and hyperreflexia of both right limbs
6. Right Babinski sign
A
A12H + ML
2
Q
Pt presents with…Dx?
- sudden high-pitched ringing in rt ear
- dizziness
- rt facial pain
- collapsed
1. Nystagmus on right lateral gaze
2. Partial ptosis of the right eye
3. Constriction of the right pupil
4. Right deafness
5. Intention tremor and dysmetria on the right
6. Loss of pain/temperature sensations on the right side of face and left side of body
7. Positive Romberg sign to the right
8. CT angiography showed significant arteriosclerotic disease
What clinical structures are involved as well?
A
Cerebellopontine angle syndrome (due to vascular origin)
Right sided SL, Descending tract of V, CN 7, 8
cerebellum
(horners due to LRST)
3
Q
Pt presents with…Dx?
- sudden paralysis of his right hand
1. Internal strabismus of the left eye
2. Right hemiparesis
3. Hypertonia and hyperreflexia in the right limbs.
Also: What side is the lesion? Where is the lesion level?
A
Alternating abducens hemiplegia (A6H)
Left sided lesion
pontomedullary junction
4
Q
Pt presents with…dx?
- External strabismus, complete ptosis, and fixed and dilated pupil of the right eye
- Drooping of the corner of the mouth on the left side
- Deviation of the uvula to the right
- Left hemiparesis with hypertonia, hyperreflexia and Babinski.
also: what level is the lesion?
A
Alternating oculomotor hemiplegia (Weber’s) on the right
Mesencephalon
5
Q
Pt presents with…Dx?
- Internal strabismus of the right eye
- Inability to completely close the right eye
- Inability to wrinkle the forehead on the right side
- Paralysis of the lower facial muscles on the right side
- Irritation of the right eye, which was red and dry
- Hemiparesis of the left limbs with Babinski
also: what level is the lesion?
A
Millard-gubler’s syndrome
bells palsy + abducens palsy + spastic hemiplegia=Millard-gublers syndrome
6
Q
Pt presents with…Dx?
- severe post-nasal drip for several years
- Before admission the drainage increased and became yellowish in color. Pt felt chilly
- On admission, generalized convulsion and became semi-comatose
- Fever, edema of scalp, distension of scalp veins
- bilaterally papilledema
- bilateral weakness and paresthesia below the thighs
- bilateral Babinski’s
- responded to commands, cant speak clearly
- opacification of frontal sinuses
- dx via angiography
A
Superior sagittal thrombosis with infection
(paracentral lobule bilaterally)
note: couldn’t speak clearly because of the infection not due to neuro issues
7
Q
Pt presents with…Dx?
Sudden onset of:
1. Complete anesthesia of the left side of the face
2. Deviation of the jaw to the left when protruded
3. Inability to bite down on the left side
4. Right spastic hemiplegia
A
Alternating trigeminal anesthesia (A5H)
8
Q
Pt presents with…Dx?
- sudden onset of dysesthesia over left side of body w/ sudden dizziness
- DM and HTN controlled
- distraught
- restless and agitated
- couldn’t sit because of discomfort in the left leg, which was kept constantly in motion
- pain diminished on the L side of body (NOT THE FACE)
- burning pain in the left leg
- similar pain in the left arm with annoying stimuli such as taking a shower
A
Thalamic syndrome
PCA
9
Q
Pt presents with…Dx?
CC: double vision and shaking of the left arm and leg during work
-complete ptosis and external strabismus of the rt. eye
-fixed and dilated rt. pupil
-loss of pain and temp sensations on the left side of face
-loss of proprio, 2-pt tactile and vibratory sensations on the left side of the body
-loss of pain and temperature sensations on the left side of the body
-resting tremor of the left limbs
A
Right Benedikts syndrome
lesion of the central midbrain tegmentum
(ML SL TL CN III)
Mesencephalon/Diencephalon and involving red nucleus
10
Q
In cross sections of the brainstem, the penetrating arteries have a _____-_____ pattern of distribution. A thrombosis or embolus of one of these arteries would therefore result in a ____-_____ region of infarction.
A
wedge-shaped
11
Q
T/F: The mesencephalon (midbrain) is associated with the cerebral aqueduct, the metencephalon (pons) is associated with the 4th ventricle, and the myelencephalon (pyramids) is associated with the posterior columns
A
True!
12
Q
What are the 7 major ascending and descending pathways in the brainstem? What does each do?
A
- SL: p/t from opposite 1/2 of the body
- ML: proprio, vibratory, 2-pt tactile from opp 1/2 of the body
- TL: p/t and crude tactile from opp 1/2 of the face
- LL: auditory info from opposite ear
- Medial longitudinal fasciculus: vestibular influences to the CN III, IV, VI, assoc with horizontal gaze, MS, and internuclear opthalmoplegia
- CST: contralateral spastic hemiplegia
- CBT: lesion above decussation leads to contralateral paralysis or paresis of the mimetic mm of the lower half of face (supranuclear facial palsy)
13
Q
The red nucleus is only present at the level of the ______ ______.
A
Superior colliculus
14
Q
Which pathway in the brainstem is located next to the midline adjacent to the 4th ventricle?
A
Medial longitudinal fasciculus
15
Q
Lesions of the MLF result in ________ _________, which patient’s have an abnormal response to _________ ____ in the direction opposite the side of the lesion.
A
Internuclear opthalmoplegia
horizontal gaze
16
Q
Impairment of the MLF results in loss of________ of the ipsilateral eye and a nystagmus of the _________ eye.
A
adduction
abducting
17
Q
TQ: What are the 3 impt dysfunctions regarding the MLF?
A
- horizontal gaze
- internuclear opthalmoplegia
- Multiple sclerosis
18
Q
The corticospinal tract is always ______
A
anterior
19
Q
The corticobulbar fibers decussate in the lower pons between the levels of the trigeminal (V) and abducens (VI) nerves. These are fibers that allow you to__________ swallow, cough, open mouth, frown etc. Therefore, these fibers are/are not relevant if obtunded or inattentive.
A
volitionally
are not relevant if obtunded or inattentive
20
Q
Unilateral lesions of the corticobulbar fibers ABOVE the level of the decussation leads to contralateral spastic paralysis or paresis of the _____ muscles of the _____ half of the face (___________ _______ ______). This can also affect the abducens, hypoglossal, and nucleus ambiguus nuclei.
Lesions below the decussation result in _______ CN palsies.
A
mimetic muscles of the lower half of the face
(supranuclear facial palsy)
ipsilateral
21
Q
Uncrossed CBT: lesion at and above ________ n.
Crossed CBT: lesion at and below _______ n.
A
uncrossed: trigeminal
crossed: abducens
22
Q
The upper quadrant of the face is affected/unaffected by unilateral lesions of the corticobulbar fibers.
Unilateral lesion of the corticobulbar fibers in the facial nucleus result in paralysis of the _________(ipsil/contral) lower quadrant of the face.
A
unaffected
contralateral
23
Q
The CBF pass through the _____ of the internal capsule. The _________ ______of the internal capsule carries corticospinal fibers
A
genu of the internal capsule
The posterior limb
24
Q
lesion of the descending nucleus of V results in…
A
Ipsilateral loss of pain and temperature from 1/2 of the face
25
The level of a brainstem lesion may be determined by identifying the coordinates of the _________ affected cranial n.
highest
26
What two nerves are at the level of the midbrain (mesencephalon)?
3, 4
27
What nerve is at the level of the pons?
5
28
What nerves are at the level of the pontomedullary sulcus (metencephalon) ?
6,7,8
29
What nerves are at the level of the medulla (myelencephalon)?
9, 10, 11, 12
30
T/F: The size of the lesion may be determined by the number and location (dorsal, ventral, lateral or medial) of the central pathways involved.
True!
| motor=anterior, pain/temp lateral, proprio=midline, MLF=posterior
31
The genu of the internal capsule contains....
Corticobulbar fibers, supranuclear facial palsy
32
The posterior limb of the internal capsule contains...
CST, contralateral spastic hemiplegia
33
Lesion of the optic radiations leads to...
contralateral homonymous hemianopia
34
The ________ is the major node between viscerosensory and memory structures and the hypothalamas and septal area.
amygdala
35
- Corticobulbar fibers pass through the middle 3/5 of the cerebral peduncle, descending in the upper pons (level of the trigeminal n. into the middle cerebellar peduncle)
- Between the trigeminal n. and the lower pons the corticobulbar tract decussates, and descends to _____ _____ ______ in the brainstem, which leads to various alternating hemiplegias
somatic motor nuclei
36
Which four cranial nerves exit the brainstem adjacent to the corticospinal tract. As a result, a brainstem infarction may yield ipsilateral CN deficits and contralateral motor paralysis or paresis (alternating ______ hemiplegia)
(CN + CST)
3, 5, 6, 12
| Ex: Alternating oculomotor hemiplegia
37
Substantia nigra is assoc. with which disease?
parkinsons
38
Pt presents with...Dx?
- ipsilateral paralysis of the mm. of the tongue, ipsilateral atrophy of tongue mm.
- contralateral spastic hemiplegia
Alternating hypoglossal hemiplegia
| Ex: Rt A12H=tongue deviates to the right, L spastic hemiplegia
39
At what level of the brain is alternating hypoglossal hemiplegia?
medulla
40
Pt presents with...Dx?
- ipsilateral paralysis of the mm. of the tongue, ipsilateral atrophy of tongue mm.
- contralateral spastic hemiplegia
- some ipsilateral spastic paralysis
Alternating Hypoglossal Hemiplegia with destruction of the contralateral CST
(Ex: tongue right, spastic hemiplegia on L, with spastic paralysis on R)
41
Pt presents with...Dx?
- ipsilateral paralysis of the mm. of the tongue, ipsilateral atrophy of tongue mm.
- contralateral spastic hemiplegia
- contralateral loss of proprio, 2-pt tactile discrimination, and vibratory sensations from the body
Alternating Hypoglossal Hemiplegia and destruction of the ipsilateral Medial Lemniscus
(Ex: tongue right, spastic hemiplegia and loss of 2 pt tactile on L...pain and temp ok so mm. cramps may occur)
42
Pt presents with...Dx?
- ipsilateral paralysis of lateral gaze, and/or internal strabismus
- contralateral spastic hemiplegia
Alternating abducens hemiplegia
| Ex: Rt A6H, right CN 6=paralysis of lateral gaze, spastic paralysis on L
43
At what level of the brainstem is A6H affecting?
pontomedullary sulcus on the side of the infarct
44
Pt presents with...Dx?
- ipsilateral paralysis of lateral gaze, and/or internal strabismus
- contralateral spastic hemiplegia
- ipsilateral facial palsy, loss of taste sensations from the ant. 2/3 of the tongue, decreased lacrimation, hyperacusis
Millard-Gubler's Syndrome (A6H+ CN 7)
(ex: rt millard-gubler syndrome=right CN 6 paralysis of lat gaze aka internal strabismus/eye looks inward, right CN 7=bell's palsy, L spastic hemiplegia)
45
Pt presents with...Dx?
- ipsilateral paralysis of lateral gaze, and/or internal strabismus
- contralateral spastic hemiplegia
- contralateral loss of proprio, 2-pt, vibratory sensations from the body
- internuclear opthalmoplegia (paralysis of horizontal gaze)
- dysphagia
- dysarthria
Syndrome of foville
-A6H + dorsal extension into the ML, MLF, CN 7, crossed corticobulbar fibers-->Nucleus ambiguus and hypoglossal nucleus
Ex: right syndrome of foville=spastic hemiplegia and loss of proprio on L, internal strabismus on the right, may have bell's
46
At what level is the lesion of syndrome of foville?
CN 6!
| HIGHEST CN =LEVEL
of LESION=6!!!
Not 10, 12
47
Pt presents with...Dx?
- loss of all sensation from half the face and scalp
- paralysis of the ipsilateral mm. of mastication
- contralateral spastic hemiplegia
Alternating trigeminal hemiplegia
| Ex: Rt A5H=spastic paralysis on the L, trigeminal palsy on the right
48
What is the level of the lesion of A5H?
Midpons
49
Pt presents with...Dx?
- loss of all sensation from half the face and scalp
- paralysis of the ipsilateral mm. of mastication
- contralateral spastic hemiplegia
- contralateral loss of proprio, 2-pt, from body and limbs
- paralysis of the mimetic mm on the lower 1/2 of the face
- dysphagia
- deviation of tongue
Alternating Trigeminal Hemiplegia with a Dorsal Extension
A5H, ML, UNcrossed corticobulbar fibers=contralateral CN nuclei including abducens nucleus, facial nucleus (supranuclear facial palsy), hypoglossal nucleus, and nucleus ambiguus
(right A5H + Dorsal extension=L spastic hemiplegia with L loss of proprio, L lower quad palsy, RIGHT trigeminal palsy)
50
Pt presents with...Dx?
- ipsilateral external strabismus, pupillary dilation, complete ptosis
- contralateral spastic hemiplegia
- contralateral resting tremor
- supranuclear facial palsy
Alternating Oculomotor Hemiplegia (Weber's syndrome)
CN III, CST, substantia nigra (tremor), UNcrossed corticobulbar tract)
51
Pt presents with...Dx?
- dysphagia, dysarthria, hoarseness, paresis of the ipsilateral palatal mm. (deviation of the uvula)
- contralateral loss of pain and temperature sensations from the body
Lesion of the Nucleus Ambiguus and the Spinal Lemniscus
Ex: dysphagia and deviation of uvula to the L= right lesion
(may extend into the: medial lemniscus to result in contralateral proprio, 2-pt hemianesth; solitary nucleus resulting in ipsilateral anesthesia of the palate and pharynx, loss of taste from 1/2 tongue and pharynx (gag reflex))
52
```
Pt presents with...Dx?
-Alternating hemianalgesia:
contralateral hemianalgesia
& ipsilateral loss of pain and temperature sensations from the face
-dysphonia
-loss of gag reflex
-asynergia or hypotonia
-nystagmus
```
Lateral Medullary Syndrome (Wallenberg Syndrome, Syndrome of the PICA)
(SL, Descending tract of V, glossopharyngeal and vagus nn., nucleus ambiguus, spinocerebellar tracts, vestibular nuclei)
53
Pt presents with...Dx?
- deafness and vestibular disturbances
- bell's palsy
- alternating hemianalgesia (loss of pain and temp on ipsil face and contral body)
- ataxia, intention tremor, dysmetria, or dysdiadochokinesia
```
Cerebellopontine Angle (CPA) Syndrome
(acoustic neuroma)
```
(CN VIII, 7, descending trat of V, SL, cerebellar peduncles)
54
Pt presents with...Dx?
- external strabismus, pupillary dilation, complete ptosis
- contralateral loss of proprio and 2 pt from body
- contralateral tremor, ataxia, and/or choreiform movements
Benedikt's syndrome
(lesion of midbrain tegmentum)
(CN III, ML, red nucleus/SCP)
55
Pt presents with...Dx?
- paralysis of upward gaze
- paralysis of the consensual light reflex
Parinaud's syndrome
(lesion of the superior colliculus, which controls upward gaze, if destroy post. commissure=loss of consensual light reflex)
56
Pt presents with...Dx?
- constant spontaneous pain without appropriate stimulus
- extreme mood swings
- feels like ants crawling on half of the body
- may show contralateral hemiparesis, homonymous hemianopia, or auditory deficits as well
Thalamic syndrome (Dejerine-Roussy syndrome) due to thrombosis of the PCA
57
As the _______develops from Hensen's node, it induces the overlying ectoderm to form a neural plate
notocord
58
TQ: Day 15 is important because....
it is the beginning of gastrulation (formation of notocord + 3 layers)
59
The ____ _____ gives rise to the future brain and spinal cord.
neural plate
60
When does the neural plate form the neural tube?
Day 18-26
61
By day 20, a midline sulcus appears, called the ______ _____, which is created in part by the development of the adjacent neural folds.
neural groove
62
By day 22, the neural folds have elevated and bridged over the neural groove to fuse. Somites assist in the formation of the neural tube. By day 26, the _____ and ______ _________ close to form the future brain and spinal cord.
rostral and caudal neuropores
63
________ is a vertebral column defect with exposure of primitive spinal cord and/or nerves
Rachischisis
64
______ ______ ______ is a vertebral column defect with herniation of meninges or neural tissue. Usually presents as cystic, midline, hairy mass in lumbar region. Failure of the roof plate of the neural tube to induce the development of the spinal processes
Spinal bifida occulta
65
________: vertebral column defect with herniation of meninges
Meningocele
66
_____________: vertebral column defect with herniation of meninges, spinal cord, and/or nerves
Meningomyelocele
67
```
What is the timeline after fertilization?
Day 1:
Day 3:
Day 6:
Day 9:
Day 15*:
Day 21:
Day 23:
```
```
Day 1: Zygote
Day 3: Morula (ball of embryonic cells)
Day 6: Implantation of embryoblast
Day 9: Blastocyst
Day 15*: Gastrulation
Day 21: Neurolation
Day 23: Folding/closing of neural tube
```
68
As the primitive streak regresses, the ______ forms.
notocord
69
TQ: The prechordal area >> _______ ________ >> ______
prechordal plate
BRAIN
70
What does the epiblast form? (3)
notocord
mesoderm
endoderm
71
Notocord induces the formation of the neural plate >> neural plate >> _____ ____
neural tube
72
The notocord induces cells in the overlying neural tube to form the ____ ___ and ____ ______ and has a significant role in the development of ventral and dorsal roots.
floor plate
| motor neurons
73
______ ________:
- Primary induction by the notocord
- secondary induction by neural tissues
Ventral induction
74
_____ ________:
| -Epidermal ectoderm influences neural tube to form roof and alar plates, and affect neural crest before they migrate
Dorsal induction
75
The anterior and posterior neuropores close at day __
26
76
_____ ____:future white matter of the spinal cord
marginal zone
77
___________ ____: future grey matter of the spinal cord
intermediate (mantle) zone
78
The mantle layer is divided into ____ and _____ plates by sulcus limitans
alar and basal plates
79
The alar plate will form the ____ (sensory/afferent) horn of the spinal cord
dorsal
80
The basal plate will form the ____(motor/efferent) horn of the spinal cord
ventral
81
_____ ____ cells form:
- schwann and satellite cells (neurinomas, neuromas, schwannomas)
- craniospinal ganglia
- autonomic ganglia
- adrenal medulal
neural crest cells
82
______ form:
- neurons
- bipolar
- pseudounipolar
- multipolar
- medulloblastomas (33%)
neuroblast
83
_____ form:
- astrocytes
- oligodendrocytes
- microglia
- glioblastomas (50%)
- Astrocytomas (20-30%)
glioblasts
84
- At 3 months, the fetal spinal cord extends throughout the entire length of the vertebral column.
- At 5 months, the fetus conus medullaris is at the level of the ____ _____ _____.
- As a neonate, the conus medullaris is at the level of the _____ _____ _____.
1st sacral vertebra
| 3rd lumbar vertebra
85
Where is the conus medullaris as an adult?
At the level of the L1-2 interspace
86
At week 4, flexures divide the neural tube into _______ ____ _____.
primary brain vesicles
87
What are the three primary brain vesicles?
proencephalon (forebrain)
mesencephalon(midbrain)
rhombencephalon (hindbrain)
88
After 5 weeks, the brain is divided into secondary brain vesicles:
- Proencephalon divides into the __________ and the __________
- The mesencephalon remains unchanged
- The rhombencephalon is subdivided into the __________ and ___________ by the development of the pontine flexure
telencephalon, diencephalon
metencephalon, myelencephalon
89
The lateral ventricle lies in the ___________
telencephalon
90
The third ventricle lies in the ____________
diencephalon
91
The cerebral aqueduct lies in the _________
mesencephalon
92
The fourth ventricle lies in the __________
metencephalon
93
The central canal lies in the ____________
myelencephalon
94
___________ may be due to congenital stenosis of a portion of the ventricular system, fetal infections (CMV, toxo), or Hurler's
Hydrocephalus
95
Pt presents with....dx?
- meningomyelocele
- elongated vermis herniates through foramen magnum
- aqueductal stenosis, hydrocephalus, syringobulbia/myelia, or polio
Arnold-Chiari malformation
96
Pt presents with..dx?
- internal hydrocephalus secondary to obstruction of medial and lateral apertures
- absence of vermis
- post. cranial fossa continuous with 4th ventricle
Dandy-Walker malformation
97
________ involves varying degrees of cranial or cervical rachischisis....meroanencephaly
Absence of the brain=day 26
Anencephaly
98
Pt presents with...dx?
- herniation of the meninges and brain tissue
- usually with arnold chiari
- may have hydrocephalus
Meningoencephalocele
99
Herniation of meninges, brain, and ventricle
meningohydroencephalocele
100
Pt presents with...dx?
| -absence of forebrain with defect of frontal and parietal bones from failure of neural tube to close
cranial rachischisis
101
General neural function development:
- 5 wks: none
- 6-8 wks: tactile sensitivity
- By wk 12: all skin sensitive except head
- Basic reflexes develop in a _________ direction
craniocaudal
102
What are the 4 stages of neuronal circuitry?
- presynaptic stage (motor, sensory, interneurons develop axons)
- closure of the primary reflex circuit
- connections with longitudinal and lateral inputs
- completion of circuits and myelination
103
- PNS myelination starts in the motor roots and followed by dorsal roots
- spinal cord myelination starts in the ___th week and continues in a craniocaudal direction.
11th
104
What trimester does myelination of the brain start? initially involves sensory tracts (visual)..
3rd
105
By 40 wks, the ________ tracts are myelinated to the level of the medulla
pyramidal
106
```
9 yo pt presents with...Dx?
CC: severe headache, double vision, trouble walking, N/V
-Bilateral papilledema
-Bilateral paresis of lateral gaze
-tilting of head to the left
-Romberg test pos to the left
-Wide-based ataxia of the trunk
CT/MRI scans confirmed the diagnosis
```
medulloblastoma of the 4th ventricle
| increased ICP, cerebellum issues
107
4 yo pt presents with...dx?
- vomiting
- unsteady in walking
- irritable
- loses balance and falls frequently
- truncal ataxia and nystagmus
- wide-based gait with staggering
Medulloblastoma
108
16 yo pt presents with...dx?
- difficulty walking and balancing over 12 mo
- loss of hand/eye coordination
- rheumatic fever during childhood with some severe nerve deafness
- loss of proprio, 2pt in all limbs
- paresis of lower limbs with slight hypotonia and hyporeflexia
- bilateral babinski
- horizontal nystagmus
- slow lurching ataxic gait
- bilateral intention tremor, dysmetria, dysdiadochokinesia
- bursts of laughter
- CT and CSF normal
Friedreich's ataxia
| deafness not related but bursts of laughter are related to the dz
109
Pt presents with...dx?
- clumsiness and difficulty walking worsening over last few years
- poorly nourishes
- confused and disoriented to time
- broad, ataxic gait
- dysmetria on finger to nose, dysdiadochokinesia
- uncoordinated movements on heel to shin test
- no muscle weakness
alcohol degeneration
(Chronic indigestion of ethanol may cause a cortical atrophy of the anterior lobe of the cerebellum, and, in some advanced cases, the neocerebellum and dentate nucleus. In the later stages of the disease, the patient presents with severe ataxia of the lower extremities and trunk, and a relatively minor involvement of the upper limbs. The disease may be seen in conjunction with other conditions such as Korsakoff's syndrome)
110
Pt presents with...Dx?
- trembling hands and limb stiffness
- masked facial expression and stare
- shuffling gate
- difficulty initiating movements
- pill-rolling tremors of both hands
- bilateral rigidity of the limbs
Parkinsons disease
111
_______ _______is a subcortical degeneration disorder involving the substantia nigra, globus pallidus, upper brainstem nuclei (mainly RF), and occasionally the postganglionic sympathetic neurons.
Parkinson's disease
112
Parkinson's disease or symptoms may be brought on by a number of different causes; three of the major ones are what?
postencephalitic, arteriosclerotic, and drug-induced.
113
Pt presents with...dx?
- bradykinesia
- tremor during rest
- rigidity
- postural embarrassment
- masked face with reptilian gaze and glabellar reflex
- autonomic effects
- cognitive changes
Parkinson's disease
114
AR disease of adolescence and early adulthood leading to neuronal necrosis and deterioration of the cerebellum and posterior column
Friedreich's ataxia
115
Pt presents with...Dx?
- severe depression during the previous year
- balance unsteady
- jerky movements with the hands -facial grimacing and rapid tongue movements
- general hypotonia and hyporeflexia
Huntington's chorea
116
- Autosomal dominant motor disorder
- patient begins to develop early symptoms, the most common of which is depression.
- Common features include dementia, chorea and behavioral disturbances.
- The disease steadily deteriorates until the patient dies 10-15 years after onset.
- The principal areas of degeneration are the corpus striatum and the cerebral cortex.
Huntington's chorea
117
_______due to degeneration of the striatum. It is characterized by slow, involuntary, writhing, worm-like movements of the limbs and face.
(may be a result of brain damage at birth, Rh incompatibility, or vascular insufficiency)
Athetosis
| Post-infarction Hemiplegic Athetosis
118
Pt presents with...dx?
- involuntary movements in right arm
- violent flinging movements of right upper limb originating at the shoulder and the elbow
- upper limb muscles appear flaccid and hypotonic between movements
unilateral hemiballismus and parkinson's symptoms
119
- due to unilateral lesions of the subthalamus
- results in contralateral movement dysfunction characterized by wild, violent, flailing (-ballism=throwing) movements of the proximal musculature of bother the upper and lower ext.
- may be due to a reduction or loss of inhibition (via glycine) upon the globus pallidus by the subthalamus
- It is an example of a release phenomenon.
Hemiballism
120
Lesions in the superior parietal lobe of the dominant hemisphere disturb the sensory- spatial hologram and results in_______, which is the inability to perform certain complex learned motor acts in the absence of any paralysis, ataxia, sensory changes, or deficiencies of understanding (confusion).
apraxia
121
- may result in a specific disorder of articulation in which basic language, grammar and word choice, are intact
- In severe form there are distorted, unintelligible speech sounds that cannot be accurately transcribed by the listener.
dysarthria
| moderate to severe forms
122
The vestibular system is a special proprioceptive system that primarily influences ______ and ______ limb muscle tone and the ________ system
postural (axial) and proximal limb muscle tone
oculomotor system
123
Where are vestibular receptors (neuroepithelial cells) located?
cristae ampullaris of the semicircular ducts
124
What are the vestibular receptors innervated by?
bipolar neurons of the vestibular nerve
125
_____ _____ consists of bipolar neurons whose long axons form the vestibular nerve.
Scarpa's ganglion (vestibular ganglion)
126
The vestibular nerve enters the brainstem at the pontomedullary sulcus, courses under the ICP and terminates in one of the four vestibular nuclei or in the ________________. Some primary fibers enter the cerebellum via the ____________ ____ (medial portion of the ICP)
vestibulocerebellum
juxtarestiform body
127
After entering the brainstem, the central process of the primary vestibular neuron bifurcates into ascending and descending branches and terminates in the:
________ _____
________ _____
______-______ _____
vestibular nuclei
fastigial nuclei
flocculo-nodular lobe
128
After the fibers from the vestibular nuclei decussate and bifurcate, the ascending component forms the ______ ________ ______ and the descending component forms the _______ _____________ ____
medial longitudinal fasciculus (MLF)
medial vestibulospinal tract (MVST)....primarily uncrossed fibers
129
The ascending MLF terminates in the oculomotor, trochlear, and abducens nuclei (vestibulo-ocular pathway). Therefore, the MLF is the critical link in the oculomotor system and has a role in __________ ____
horizontal gaze
130
The descending MVST terminates in the cervical level of the spinal cord and is a key link in coordinating the positioning of the ____ relative to the eye movements
head
131
The MLF conveys reciprocal connections between the abducens nucleus and the __________ ________ nucleus
contralateral oculomotor
132
The ______ _________ _____ originates from the lateral vestibular (Deiter's) nucleus, descends in the lateral funiculus of the spinal cord, and terminates in the ipsilateral IG of ALL spinal levels
lateral vestibulospinal tract (LVST)
133
Secondary fibers (vestibulocerebellar fibers) from the vestibular nuclei project through the juxtarestiform body, and terminate bilaterally in the _______ nuclei and the _______-______ lobe.
fastigial nucleus
| flocculo-nodular lobe
134
Vestibular efferents: ________ axons from the vestibular nuclei terminate on the neuroepithelial cells and decrease the firing of the receptors and attenuate incoming vestibular info
inhibitory axons
135
Some vestibular nuclei project into the _________ ___________, which affect the somatic motor system (posture), and provide a mechanism for visceral autonomic effects assoc w/ vestibular stimulation.
Reticular formation
136
The vestibulocerebellum is made up of what? (2) It is the oldest part of the cerebellum and present in vertebrates that only have axial mm. (fishes)
flocculo-nodular lobe
| fastigii nucleus
137
T/F: The fastigial nucleus (a deep cerebellar nucleus) is considered a displaced vestibular nucleus
TRUE
138
These fibers originate in the fastigial nucleus and terminate in the ipsilateral vestibular nuclei
Direct Fastigiobulbar Tract
139
What originates in the fastigial nucleus, decussates in the cerebellar commissure and bifurcates into ascend. and descend. limbs.
Indirect fastigiobulbar tract (uncinate fasciculus)
140
What exits the cerebellum via the juxtarestiform body of the ICP and terminates in the vestibular nuclei and RF?
Descending limb of the uncinate fasciculus
141
In lesions involving the flocculus or acoustic neuroma you get ________ impairment
postural
142
TQ In doll's eyes maneuver, side to side movement of the head results in what?
horizontal movement of the eyes in the opposite direction so that the pt is looking foward
143
T/F: Doll's eyes maneuver is contraindicated in a pt with cervical injury,
True!
144
TQ For doll's eyes maneuver, when the head turns right, the right eye should ________ and the left should ________. If the left eye remains neutral, then we have a left CN ___ palsy.
adduct
abduct
CN 6 palsy
(you can figure out the other situations using common sense)
145
What is doll's eye testing?
vestibular reactions
146
How can we test for the vestibuloocular response?
oculocaloric testing
147
In an unconscious pt, injection of cold water into the external auditory meatus results in_________ gaze _______ the side of the stimulus
horizontal gaze towards the side of the stimulus
148
Stimulus: caloric testing of the right ear, right eye has no response, left eye adducts. What does this indicate?
Right CN 6 palsy
149
The vestibular system has a very strong influence on _____ mm.
axial
150
Pts with INO have an abnormal response to horizontal gaze in the direction ________ the side of the lesion
opposite
151
TQ A unilateral lesion of the MLF superior to abducens nucleus results in a ___________ disturbance of horiz gaze ( loss of ________ (MR) of the ipsilateral eye and a nystagmus of the _________eye)
contralateral
adduction
abducting
152
Lesion of crossed fibers from the abducens area to the oculomotor nucleus results in loss of ________ of the ipsilateral MR
adduction
153
Destruction of descending fibers from the oculomotor nucleus to the abducens area results in the nystagmus of the ________ (contralateral) eye
abducting
154
INO is named for what?
side of oculomotor impairment
155
TQ If horizontal eye movement to the right is normal and you cant look left (right eye doesn't adduct and left eye shows nystagmus) then it is a _______ INO due to a lesion of the _______ MLF
right INO
| right MLF
156
If horizontal eye movement to the left is normal and you cant look right (left eye doesn't adduct and right eye shows nystagmus) then it is a _______ INO due to a lesion of the _______ MLF
left INO
| left MLF
157
PPRF stands for what?
Paramedian pontine reticular formation
158
The PPRF includes a ______ ____ _____
lateral gaze center
159
Pt presents with paresis or paralysis of horizontal gaze toward the same side of the lesion, and a gaze preference away from the side of the lesion
unilateral lesion of the PPRF
160
Pt unable to move both eyes in a conjugate horizontal gaze to the right with a gaze preference to the left
Right PPRF lesion
161
T/F: In a PPRF lesion, there is a destruction of the ipsilateral abducens nucleus and contralateral oculomotor nucleus (cant look towards lesions)
TRUE
162
What comprises the central core of white matter in the cerebellum?
Corpus medullares
163
The corpus medullares has 4 pairs of deep cerebellar nuclei, which are?
fastigial nucleus
globose nucleus
emboliform nucleus
**dentate nucleus
164
TQ Which deep cerebellar nucleus is a large, convoluted cup-shaped nucleus that gives rise to the vast majority of the efferents from the neocerebellum?
dentate nucleus
165
What is the source of output from the cerebellum to brainstem?
the deep cerebellar nuclei
| NOT THE CORTEX!
166
TQ What is the chief efferent from the cerebellum via the SCP?
dentate nucleus
167
What afferents to the cerebellum course through the ICP? (6)
DDT Always Ruins Olives
- Dorsal spinocerebellar tract (DSCT)
- Direct arcuate fibers (cuneocerebellar tract)
- Trigeminocerebellar tract
- Arcuocerebellar fibers
- Reticulocerebellar fibers
- Olivocerebellar fibers
168
TQ Which tract conveys unconscious, precise proprio info from the lower 1/2 of the body/extrem via ICP to the cerebellum?
DSCT
169
TQ Which tract conveys unconscious, precise proprio info from the upper 1/2 of the body/extrem via ICP to cerebellum?
Direct Arcuate Fibers (cuneocerebellar tract)
170
Which tract conveys general proprio from the head via ICP to the cerebellum? (and may include some fibers form the subnuclei rostralis and interpolaris of descend. V )
Trigeminocerebllar tract
171
Which tract conveys general sensory modalities via the ICP to the cerebellum. Where does it originate?
Reticulocerebllar fibers
lateral reticular nuclei
172
Which tract represents a large bundle of afferent fibers that originate in the ION and terminates via ICP as climbing fibers in the contralateral cerebellar hemispheres?
Olivocerebellar fibers
173
The olivocerebellar fibers go to the purkinje cells and climb the proximal portion of the dendritic tree and excite the inhibitory neuron to decrease the inhibitory effect of the purkinje cell. Therefore output from the cerebellar cortex via the purkinje cell nuclei is _______ to the deep cerebellar nuclei
inhibitory
174
TQ: Finger to nose test is an example of how the output from the cerebellar cortex _______ the deep cerebellar nuclei by way of the purkinje cells
inhibits
175
The ION receives direct input from the _______ _____ ______, which consists of ascending and descending fibers of the reticular nuclei
central tegmental fasciculus (CTF)
176
The central tegmental fasciculus originates in the red nucleus, periaqueductal gray, and midbrain tegmentum. This tract is a critical link between the _____________ system and the ________.
Extrapyramidal system
cerebellum
177
What pathway is the following?
PAG, RN, midbrain tegmentum=central
tegmental fasciculus>>descend to ION>>ION olivocerebellar
fibers>>DCN & cerebellar cortex>>cerebellar
cortex back to DCN to turn down motor activity>> SCP with red nucleus>>dorsal thalamus>>cerebellar cortex
Rubroolivocerebellar pathway
| motor sys->cerebellum
178
What forms the middle cerebellar peduncle?
pontocerebellar fibers
179
The corticopontine fibers terminate in the _______ (ips/contra) pontine nuclei, which project to the cortex of the _________(ips/contra) cerebellar hemispheres. These pontocerebellar fibers form part of an important feedback loop between the motor cortex and cerebellum
ipsilateral
| contralateral
180
What is the corticopontocerebellar circuit starting with the motor cortex?
Motor cortex>corticopontine fibers>pontine nucleus>pontocerebellar fibers>cerebellar cortex (purkinje cells=dendritic tree inhib)>dentate nucleus>red nucleus>thalamus>motor cortex
181
The _____ ____ _____ forms the middle layer of the cerebellar cortex. They are large inhibitory neurons that have elaborate dendritic trees.
purkinje cell layer
182
TQ All information entering the cerebellar cortex eventually converges upon _____ ____, which are the ONLY efferent from the cerebellar cortex and terminate in the deep cerebellar nuclei
purkinje cells
183
What is the function of the cerebellar cortex?
adjust or modify the output of the motor systems to a level appropriate to the incoming proprio and tactile info.
184
T/F: The cerebellum initiates motor activity
FALSE is does NOT initiate motor activity
185
T/F: ALL efferent fibers form the cerebellar cortex are purkinje axons
TRUE
186
What are the most direct afferents to the cerebellar cortex?
climbing fibers (terminals of olivocerebellar fibers from the ION)...excite the purkinje fibers!
187
What forms the motor movement pattern?
subcortical loop structures: putamen, caudate, SN, subthalamic nucleus
188
What is the general motor system loops?
cortex>subcortical structures>dorsal thalamus>cortex
189
What system is responsible for recalling movement patterns?
limbic system
190
The _____ ____ is what gives personality movement, such as the way you walk
frontal lobe
191
The motor system exemplifies the evolutionary process of ______________, whereby ever more systems depend upon the cerebral cortex to perform their sophisticated functions
encephalization
192
T/F: In broca's aphasia the pt gets more agitated as you ask questions and in Wernicke's they continue talking
True
193
Although these fibers do not affect the LMN's as strongly as the direct corticobulbar fibers, they may play a role in the recovery from infarction involving the direct corticobulbar fibers
Indirect corticobulbar fibers (corticoreticulobulbar fibers: terminate in reticular formation)
194
Why do you have recovery of dysphagia after stroke rehab?
The indirect corticobulbar fibers taking over the direct corticobulbar fibers
195
T/F: Indirect CBT fibers ameliorate s/s of CBT lesions
true!
196
These special fibers originate in the frontal and occipital eye fields and terminate in the superior colliculus and PPRF as part of the oculomotor system.
Aberrant corticobulbar (corticomesencephalic) fibers
197
T/F: Due to the aberrant corticobulbar fibers, you can have lesions of the CBT that don't effect the eys
true!
198
Lesions in the parieto-occipito-temporal (POT) cortex in the superior parietal lobe of the dominant hemis disturb what? result in?
sensory-spatial hologram
apraxia
199
What are the two types of apraxia?
Ideomotor apraxia
| Ideational apraxia
200
What is ideomotor apraxia?
inability to perform a given act correctly although old, habitual motor acts are still intact (such as piano skills)
201
What is ideational apraxia?
loss of the ability to formulate the ideational concepts necessary to perform a motor activity. The pt can perform the isolated tasks but not a series of them
202
A pt is unable to perform the following in the correct order or at all:
folding a letter, putting it in envelope, sealing, and stamping it
Dx?
Ideational apraxia
203
The extrapyramidal system (EPS) is involved in what?
crude, stereotyped, movements of axial/proximal limb mm such as swinging the arms while walking
204
How does the EPS initiate movement patterns?
subcortical loops
205
What provides the framework for all focal motor activity?
EPS
206
What is the principal subcortical loop?
```
All areas of the cortex>>
striatum>>
GP SN>>
Ventral lateral, Vental Anterior>>
All areas of the cortex
```
207
A small accumulation of gray matter b/t the putamen and caudate below the ant. limb of the internal capsule
Nucleus accumbens
208
What nucleus plays a role in the motivational and emotional aspects of movement?
nucleus accumbens
209
Corticorubrospinal pathway
```
premotor cortex>>
dentate nucleus>>
red nucleus>>
VA nucleus>>
premotor cortex
```
(some descending red nucleus fibers form part of the CST and also output to the RF...staging tone of the mm)
210
The dorsal and ventral division of the ansa lenticularis have very similar connections to the _____ ______
globus pallidus
211
All cortical areas go to the ______
striatum
212
Dorsal and ventral divisions of the ansa lenticularis projects to the VA and VL thalamic nulcei. The VA projects to the _________ _____ while the VL projects to the ________ _____ ____.
premotor cortex
| primary motor cortex
213
The development of the internal capsule subdivided the efferents from the GP into divisions, including the_____ and______ ansa lenticularis
dorsal and ventral
214
TQ: _____-_____ ____ are non-dopaminergic fibers that originate from the pars reticularis of the SN and project to the VA & VL thalamic nuclei.
nigro-thalamic fibers
215
TQ____-_____ ____ are dopaminergic fibers that originate in the pars compacta of the SN and terminate in the caudate and putamen (striatum).
nigro-striatal fibers
216
TQ What fibers are destroyed in parkinson's dz?
nigro-striatal fibers
217
TQ Destruction of the inhibitory GABAnergic fibers in the striatonigral fibers are involved in __________ _____
huntington's chorea
218
TQ
Strianigral fibers:
____nergic fibers assoc with _________ ______
Strianigral fibers:
GABAnergic
huntington's chorea
219
TQ
Nigrostriatal fibers:
____nergic fibers assoc with
_______ ______
Nigrostriatal fibers:
Dopaminergic fibers
Parkinson's dz
220
The SN>>striatum via nigrostriatal fibers from the ___ _______
pars compacta
221
Unilateral lesions of the subthalamus or its connections result in ________ hemiballism (loss of glu inhib on GP), characterized by violent, involuntary, flinging movements of the limbs.
contralateral
222
The pallidothalamic and nigrothalamic fibers are primarily _________ upon these specific motor thalamic nuclei.
inhibitory
223
Connections of the EPS with limbic sys:
hippocampus, amygdala, entorhinal cortex, temporal lobe>>________ _________>>putamen>>GP SN>>VAN>>ant cingluate gyrus>>orbitofrontal area>>putamen etc
nucleus accumbens
224
T/F As the CNS evolved, the RF developed as well. The RF retains its primitive role in reflex activities such as intersegmental conditioned reflexes, but now it processes, integrates, modifies, and initiates a variety of sensory, motor, behavioral, and cognitive functions.
True!
225
The _____ _______ contains the principal discharge pathways for the olfactory/limbic systems and the hypothalamus. Therefore, it plays an important role as mediator of somatic and visceral motor components of autonomic, emotional, and behavioral responses
reticular formation
226
Somatic motor response (postural changes) and visceral responses (HR pupils, etc) are both __________ mediated. This is why you stand up straighter and heart races when someone says something to you that gets you going.
hypothalamically
227
The limbic system sets the ______ ____ for individuals.
emotional tone
228
_________ (prefrontal lobe) determines the emotional tone appropriateness (should you start a fight? Is he bigger than you?)...if damaged can impair our judgement-->fight
neocortex
229
T/F: 1:1 relationship b/t olfactory input and the limbic system so therefore smell can lead to behaviors/reactions and why there is favorable vs. unfavorable smell
True
230
The _______ ______ is the mediator of limbic responses
reticular formation
231
If no RF in place, then no EEGs! aka you are ____ _____
brain dead
232
What connects the septal area of limbic lobe with the hypothalamus?
medial forebrain bundle
233
The tuberal region of the hypothalamus contains what 2 centers?
satiety center/punishing center
| feeding center/pleasure center
234
Lesions of the mammillary body result in what?
memory impairment called Korsakoff's syndrome
235
What are two important links in the papez circuit creating memory?
mammillary body and the dorsomedial thalamic nucleus
236
What is the papez circuit from the neocortex?
```
neocortex>>
entorhinal cortex>>
hippocampus>>
mammillary bodies>>
ant. nucleus of the thalamus>>
cingulate gyrus>>
parahippocampus>>
neocortex
```
237
S/S assoc. with what?
- Obesity/anorexia
- Personality changes
- Diabetes insipidus
- Temperature maintenance problems
- Hormonal problems
lesion of the hypothalamus
238
The "50 first dates" is due to what syndrome?
korsakoff's syndrome (impairment of recent memory and confabulations)
239
T/F: Eventually, the development of the limbic system and neocortical areas preempted the need for a stimulus to trigger an affective feeling. Breaking this link allowed humans to have affective feelings that are quite separate and independent of a particular sensation from the sensory environment.
True!
240
Primary olfactory cortex=______ ___=uncus and parahippocampus
entorhinal cortex
241
_______ ______ ____=re-enforces smell and goes to the orbitofrontal cortex
Medial olfactory stria (MOS)
242
________ ________ ____->temporal cortex, hippocampus, amygdala aka strong input into
LIMBIC (amygdala, hippocampus) and neocortical area (temporal cortex)
Lateral olfactory stria (LOS)
| seizure activity out of this area...temporal lobe and amygdala may be removed
243
What terminates in the primary olfactory cortex (lateral olfactory gyrus, periamygdala and rostral parahippocampus), and connects directly to the amygdala. This is the principal pathway for the awareness of olfactory stimuli.
Lateral olfactory stria (LOS)
244
What is the chief input into the hippocampus, and apparently acts as a critical integrator and mediator of information to the hippocampus?
The entorhinal cortex
245
Olfactory nerves/epith>>MOS>>_____ ____>>>medial forebrain bundle>>________>> reticular formation
septal area
hypothalamus
246
The LOS goes directly into the _________ ____ and the ________, which outputs to septal areas via stria terminalis and the hypothalamus via VAF fibers
entorhinal cortex and the amygdala
247
The amygdala projects to the hypothalamus and septal areas via the ____ ______ ____ and ______ ______
ventral amygdalofugal fibers and stria terminalis
248
The _____ _____ projects from the amygdala to the septal area
stria terminalis
249
The primary olfactory cortex projects to the ________ cortex, which is the chief input to the hippocampus and an important link in the Papez memory circuit
entorhinal
250
TQ pt cant create new memories, may be due to herpes encephalitis
Hippocampal amnesia due to bilateral lesions of the hippocampi
251
Pyramidal cells of the _____ _____ of the hippocampus (Sommer’s sector) are vulnerable to hypoxic or ischemic injury. This can lead to ________ ____
CA1 region
| hippocampal amnesia
252
- imaginary odor, such as burning rubber, rotten egg, sulfar like smell
- mildly pleasant or curious
- disturb the individual
olfactory hallucinations due to lesion of the uncus or amygdala
253
______ refers to the loss of the sense of olfactoin
Anosmia
254
Pt presents with...dx?
- cant recognize objects
- strong oral tendencies
- hypersexual activity
Kluver-Bucy syndrome due to bilateral lesion of the amygdala, uncus, and temporal pole of the hippocampus
255
TQ
____ ________ may lead to any of the following....
-Compression of the oculomotor nerve= Pupillary dilation, external strabismus and complete ptosis
-Compression of the abducens nerve=Gaze is down and in
-Compression of the cerebral peduncle=The herniation pushes the contralateral cerebral peduncle against the sharp edge of the tentorium cerebelli (Kernohan's notch). Spastic hemiplegia on the same side of original lesion.
-Compression of the posterior cerebral artery=Contralateral incongruent homonymous hemianopia with macular sparing
-Compression of the ARAS=Decreasing levels of consciousness
-Stretching of the brainstem blood vessels=Post-traumatic thrombosis of the brainstem may cause Weber's or Benedikt's syndromes.
-Communicating hydrocephalus
=CSF blockage from infratentorial to supratentorial regions
Uncal herniation
256
Sensory and motor systems have become dependent on the development of _____ ____, which can discriminate, analyze, interpret, and respond to stimuli. This upward shifting of functions is called ___________
cortical areas
encephalization
257
What is one of the most important neocortical derivatives? What does this correspond with?
language
| development of the larynx and vocalization
258
The development of the corpus callosum allowed the __________ of a specific function to reside in one hemisphere yet still share its information with the other side.
lateralization
259
What are the two major processes in the evolution of the neocortex?
Encephalization and lateralization
260
What layers of the cortex receive most of the afferents into the cortex? However, only 1% of these afferents are thalamocortical fibers; the remaining afferents are corticocortical fibers.
Layers 3-4
261
TQ -critical link for
the language association areas.
-lesions in this area result in conduction aphasia
Superior longitudinal fasciculus (SLF)
262
-fluent with only minor word finding pauses and paraphasias
-ability to repeat
words or sentences is severely impaired.
Conduction aphasia
263
What interconnects the septal area, cingulate and parahippocampal gyri to the entorhinal cortex?
cingulum
264
TQ What interconnects the base of the association areas of the frontal lobe to the inferior temporal lobe. The latter is connected to the entorhinal cortex.
The uncinate fasciculus (impt b/c connects temporal lobe and entorhinal cortex)
265
What interconnects neocortical areas of the two cerebral hemispheres?
commissural fibers
266
As the fibers of the corpus callosum radiate into the hemispheres they form the ______ ______ in the frontal lobe and the_____ _____ in the occipital lobe.
```
minor forceps
major forceps (connects visual with motor)
```
267
-Patients with this rare, acquired condition are unable to visually recognize objects or pictures.
Visual agnosia
May be due to bilat damage to visual assoc cortex by anoxia
268
- may result from infarction of the left occipital lobe and posterior corpus callosum secondary to occlusion of the posterior cerebral artery
- The lesion disconnects the language area from the visual association cortex
- Although the patient cannot name or describe an object in the visual field, he can recognize and demonstrate its use.
- Visual perception is intact. Most of these patients are also alexic, and agraphic.
Associative visual agnosia
269
What syndrome is characterized by apathy, occasional euphoria, abrupt irritability and socially inappropriate behavior?
Frontal lobe syndrome
270
The primary auditory cortex lesions result in what?
difficulty localizing sounds
271
- Large lesions of this area may result in failure to recognize
the body scheme (denial of body scheme) on the opposite side.
Superior parietal lobule of the somesthetic assoc. cortex
272
What syndrome is due to a lesion of the dominant parietal lobe and is characterized by finger agnosia, right-left disorientation, dysgraphia and dyscalculia.
Gerstmann syndrome
| cant tell R from L, cant write, cant calculate
273
- A lesion of the __________ ____ in the dominant hemisphere results in agnosia
- The patient may be unable to recognize, identify or discriminate somato-sensory (tactile), visual, auditory, smell, or taste information
supramarginal area
274
Pt cannot recognize own body as self is called neglect….lesion of what?
paretio-occipital area
275
Eighty percent of the population is right handed and left dominant. Although the development of handedness is not functionally related to the development of dominance, it is, however, a fair clinical indicator. Wernicke's area is located in the dominant hemisphere in 98% of the cases.
Certain higher cognitive functions such as perception and memory are processed in both hemispheres. Language, speech, writing, analytic functions and the learning of skilled movements are located in the dominant hemisphere. Higher cognitive functions such as non-verbal expressions, creativity, abstraction and spatial discrimination are associated with the non-dominant hemisphere
276
Pt presents with...dx?
- nuchal rigidity
- bruit over left orbit
- complete left oculomotor n. palsy
- hypalgesia of the left opthalmic dermatome
- paresis of the right masseter m.
- left supranuclear facial n. palsy
- deviation of tongue to right
- loss of p/t on L body
- paresis of L arm
- lumbar puncture bloody
carotid-cavernous fistula
277
Pt presents with..Dx? TQ
1. Inability to adduct either eye when testing for horizontal gaze
2. Both eyes could adduct during convergence
3. There was a horizontal nystagmus only in the abducting eye when attempting to look to
either the right or left.
bilateral internuclear opthalmoplegia
may see in MS
278
Pt presents with...dx?
CC: weakness in legs.
-legs felt tired when he stood up too long.
-increased patellar reflexes, but normal Achilles reflexes in both lower limbs.
-Two months later, limbs had continued to weaken until he was unable to walk. Examination at this time revealed spastic paralysis and increased patellar and Achilles reflexes in both lower limbs.
-Babinski signs were elicited bilaterally.
Parasagittal Meningioma of the falx cerebri (compressing the anterior paracentral lobule)
279
Pt presents with...dx?
-CC: intermittent headaches associated with “the stresses of my job.”
-history of intermittent psychotic episodes during which he has bowel and bladder incontinence. Each episode usually lasted 1-2 weeks.
-Two months prior to the clinic visit, noted difficulty in walking especially climbing stairs. This condition had become progressively worse.
-At the clinic he collapsed on the floor and had a generalized seizure.
Neurological examination revealed bilateral weakness, spasticity, hyperreflexia, Babinski signs, and a spastic gait.
-disorganization of thought and made many silly wisecracks during the examination
Parasagittal meningioma
280
TQ What connects the entorhinal cortex to the temporal cortex/hippocampus?
uncinate fasciculus
281
Pt complained of not being able to see objects off to either side. -noted a significant weight gain during that period
- problem with recalling recent events.
- Examination revealed blindness in the temporal fields of both eyes.
- Blood tests and CT scan confirmed the diagnosis.
Korsakoff's syndrome
| bilat destruction of mammillary bodies or pituitary tumors
282
Pt presents with...dx?
- insidious onset of forgetfulness and impaired judgment, with occasional acute episodes of disorientation in time and place. -required frequent assistance with the basic activities of daily living and urinary incontinence. --She could not bathe or groom herself because she could not remember how to do these simple tasks. If she left the house, she would immediately forget where she lived or where she had been.
- marked disorientation in time and space, mixed aphasia, apraxia, pathologic mouth-opening responses, a grasp reflex on the right, and hyperreflexia of all extremities. -CT scan showed marked dilation of the ventricles and subarachnoid space, and indicated the final diagnosis.
Alzheimer's disease
283
Pt presents with..Dx?
CC: pt collapsed in parking lot, hx of HTN
1. Sensory Deficits
• Hemianalgesia and thermal hemianesthesia on the left side of the body and face
• Proprioception/2 pt tactile sensations were absent from the left side of body and
slightly diminished on the left side of the face
• Slow pain sensations were vaguely perceived on the left side of the body and face
2. Left spastic hemiplegia with hyperreflexia and Babinski
3. Inability to smile on the left side
4. Left homonymous hemianopsia
Infarct of the internal capsule
284
Pt presents with...dx?
- one-year history of decreasing interest in caring for her house and personal needs
- uncharacteristic changes in behavior marked by a lack of interest in conversation, unkempt appearance, a lack of concern about family affairs, and total neglect of personal and household cleanliness.
- discontinued attending church, did very little shopping, and no longer made social visits.
- Upon examination at the hospital, pt awake and markedly apathetic. Offered no spontaneous conversation and answered all questions with single word responses.
- slow shuffling gait and had several episodes of incontinence.
- Cranial or spinal nerves were normal.
- The findings of the neurodiagnostic evaluation (MRI scan) were significant.
Frontal lobe syndrome
285
Pt presents with...Dx?
- Wife never wanted to do anything, wouldn't perform her daily chores, and didn't eat properly.
- Pt was easily distracted.
- When asked why her eating habits had changed she explained that food seemed tasteless to her.
- The neurological examination indicated that pt was unable to smell in either nostril.
- During the examination, pt urinated on the floor yet seemed undisturbed or embarrassed by the incident.
Frontal lobe syndrome
286
Pt presents with...dx?
- following acute head trauma, brought to hospital.
- The patient underwent a personality change of the past 12 years, deteriorating more during the last three years.
- He developed progressive memory loss, especially short-term memory.
- Spontaneous movements and speech were markedly reduced and the patient had a loss of bowel and bladder function.
- pt alert, but disoriented especially with respect to time and place.
- examination revealed, slow responses to questions and simple commands with occasional incorrect responses. Naming, spelling, and repetition were intact.
- very little spontaneous behavior, no change in affect, and disinhibition of behavior.
- Pupillary responses and extraocular movements were normal and there was no nystagmus.
- Optic discs were flat and fundi were pale. Other cranial nerves were normal. Pathological reflexes were not present.
- unable to stand without help and could not walk.
- tenderness of the skull over the right temporal region, right periorbital hematoma, and no nuchal rigidity.
- Plain skull films revealed a right temporal fracture. ACAs were depressed and displaced. Post-mortem findings included a giant aneurysm of the ACoA.
Frontal lobe syndrome
287
Pt presents with..dx?
- Pt found wandering aimlessly around the tracks picking his nose with no recollection of the incident.
- When walking to work when he smelled something burning, then he remembered seeing gigantic trains running up and down the highway.
- hallucinating and suffered amnesia and nightmares more frequently.
- A neurological examination revealed a left superior homonymous quadrantanopia.
Temporal lobe tumor
288
Pt presents with...dx?
CC: complaint hearing difficulties.
-difficulty understanding what people said to her even when they talked loud enough for her to hear.
-understood perfectly everything that she read.
-spoke fairly easily,difficulty understanding spoken questions or instructions, and often used the wrong words and phrases in her descriptions.
- six months earlier complained of a buzzing noise in her ears.
Auditory aphasia
289
Pt presents with...dx?
- pt no longer able to read or write.
- no defect in the visual fields or eye movements.
- could recognize and identify objects in both visual fields, but he couldn't read.
- He seemed to understand everything that was said to him, and he responded to questions quite fluently although occasionally he seemed to misuse a word or two.
- When pt given a pencil, paper and a drawing of a sailboat, he became confused and could not determine which fingers to use or decide which hand was right or left.
- Doc said not to worry and pt simply picked up the pencil and drew an accurate copy of the boat.
- When asked to write the word “boat” below the drawing, he was unable to do so.
- Later, tests determined that pt had considerable difficulty working arithmetic problems despite his determination and prior ability to solve them.
Gerstman's syndrome
290
Pt presents with..dx?
- significant history of multiple strokes including some in the parieto-temporal cortex (aphasic zone) of the dominant hemisphere.
- automatic speech patterns (“yes...,” “well...”) are intact, and her intellectual abilities are appropriate for her condition.
- difficulty in understanding speech or pictures; words are used in the wrong order or are omitted; word finding difficulties; neologisms or new word creations; and some perseveration.
Wernicke's aphasia
291
Pt presents with...dx?
- didn't seem to know what to do with himself anymore.” He would wander around the house and often had difficulty finding the front door, although he seemed to be able to “see all right.”
- started to go to bed with his left shoe and sock on. He would also leave the left half of his shirt and trousers on. His left arm and leg were always seen to be hanging off the side of the bed.
- One night wife undressed his left side after he went to sleep only to discover that he neglected to dress his left side when he got up the next morning.
- The man's only complaint was that, although he was an artist, he no longer seemed able to draw anything properly.
Neglect of body scheme secondary to a parietal tumor
292
Pt presents with...dx?
-4-week history of gait disturbance.
-nonspecific dizziness 3 weeks prior to admission and diplopia on lateral gaze one week before examination.
-nauseated and vomiting. Examination revealed:
1. Patient was well developed and well nourished with no acute distress.
2. Dysmetria on right finger-to-nose and heel-to-shin testing.
3. Difficulty with rapidly alternating movements on the right.
4. Wide-based gait.
5. Nystagmus on bilateral lateral gaze.
6. Bilateral papilledema
CT scan confirmed a mass in the right cerebellar hemisphere. Her vomiting and diplopia were relieved after operation. Four months later she had only minimal residual ataxia.
cerebellar medulloblastoma
293
Pt presents with...dx?
- seizure with staring spell and speech interruption followed by convulsions
- normal neuro exam and lab
- soft-tissue density in right nasal cavity and sphenoid, ethmoid, and maxillary sinus
frontal encephalocele with seizure
-encephalocele can present in adulthood as epilepsy
294
Pt presents with...dx?
- right upper extremity weakness after violent coughing spell
- large fluid filled calvarial defect containing herniated brain near the level of the motor cortex
symptomatic left intradiploic encephalocele
295
Pt presents with...dx?
- suddenly developed hemiparesis
- hypotonia and babinksi
- slight dysarthria
- facial weakness of right
- hypesthesia and impaired vibration and position on same side
Ipsilateral hemiparesis after putaminal hemorrhage due to uncrossed pyramidal tract
296
```
Pt presents with...dx?
-chronic severe headache, neck pain, N/V
-bloody CSF
post-op...
-left homonymous hemianopsia
-right homonymous impairment
-distortion of visual fields
-hallicinations
```
right parietal AV anomaly
(subarachnoid hem)
post op
-scar in right parieto-occipito-temporal region
297
Pt presents with...dx?
- altitude sickness followed by...
- personality changes
- apathetic, uncommunicative, expressionless
Acute mountain sickness followed by globus pallidus syndrome
| prone to hypoxia in high altitude
