Approach to patients with CNS disorders Flashcards

1
Q

Frontal lobe is involved in =

A
Intellectual function
Praxis
Motor function
Inhibition
Bladder continence
Saccadic eye movements 
Broca's area - expression of language
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2
Q

Praxis =

A

Conception and planning of a new action, the performance of an action

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3
Q

Difficulty in activites requiring coordination and movement =

A

Dyspraxia

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4
Q

Internal capsule separates =

A

Thalamus, caudate nucleus and globus pallidus/putamen

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5
Q

In the motor homonculus, what is most lateral?

A

Face - arm

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6
Q

In the motor homonculus what is msot medial?

A

Lower limb

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7
Q

Pre-central gyrus =

A

Primary motor cortex

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8
Q

Post-central gyrus =

A

Primary sensory cortex

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9
Q

Problem with Broca’s area =

A

Expressive dysphasia

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10
Q

Where does the majority of the corticospinal tract decussate?

A

Medullary pyramids

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11
Q

What does the corticospinal tract split into?

A

Lateral, anterior

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12
Q

Lateral corticospinal tract =

A

Distal, fine movements (voluntary)

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13
Q

Anterior corticospinal tract =

A

Proximal muscles

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14
Q

lesion in the right motor cortex/right internal capsule will lead to what?

A

left sided upper motor neurone weakness

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15
Q

Lesion to right cranial nerve nuclei in brainstem causes:

A

Right sided lower motor neurone weakness

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16
Q

Temporal lobe is involved in:

A
Memory
Smell
Auditory cortex
Vestibular
Emotion 
Wernickes
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17
Q

Occipital lobe is involved in:

A

Vision

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18
Q

Lesion in the occipital lobe causes what?

A

Contralateral homonymous hemianopia

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19
Q

Parietal lobe is involved in:

A

Sensory integration

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20
Q

Wernickes area problem =

A

Expressive dysphasia

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21
Q

Dysphasia vs dysarthria =

A
Dysphasia = langusage
Dysarthria = words
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22
Q

Lesion in dominant parietal lobe:

A

Dyslexia
Acalculia
Poor left-right discrimination
Agnosia

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23
Q

Spinothalamic tract carries what modalities:

A

Pain, temperature, crude touch

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24
Q

Spinothalamic tract splits into

A

Anterior (crude touch)

Lateral (pain, temp)

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25
Q

Where does the spinothalamic tract decussate?

A

About 2 spinal levels above entry - early!

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26
Q

DCML carries what modalities

A

Fine touch, pressure, vibration

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27
Q

Fasiculus cuneatus =

A

info from upper body

28
Q

Fasiculus gracillis

A

info from lower body

29
Q

Where does DCML decussate?

A

Medulla

30
Q

Spinocerebellar tract remains

A

Ipsilateral

31
Q

What does the spinocerebellar tract carry

A

Conscious proprioception

32
Q

Why do lesions in the spinocerebellar tract often not show?

A

Damaged with other tracts - weakness usually disguises any loss of coordination

33
Q

Brown-sequard syndrome:

A

Damage to 1 side of spinal cord: ipsilateral posterior column loss
contralateral spinothalamic loss

34
Q

Lesion in cortex, internal capsule or thalamus does what to tracts?

A

full contralateral sensory deficit

35
Q

Weber syndrome is also known as

A

Midbrain syndrome

36
Q

Weber syndrome effects which CN

A

CN III

37
Q

Wallenburg syndrome also known as

A

Lateral medullary syndrome

38
Q

3 zones of cerebellum and functions:

A
cerebrocerebellum = planning movements and motor learning, fine motor
spinocerebllum = postural tone, correcting movements
vestibulocerebellum = balance
39
Q

Acronym to remember features of cerebellar dysfunction:

A

VANISH’D

40
Q

VANISH’D =

A
Vertigo
Ataxia
Nystagmus
Intention tremor 
Slurred speech
Hypotonia
Dysmetria (past-posting), dysdiadochokinesis
41
Q

Most malignant primary brain tumour =

A

Glioblastoma multiforme

42
Q

Features of a complete CN III plasy =

A

Eyes down and out
Mydriasis
Partial ptosis

43
Q

Why is the ptosis in CNIII plasey only partial?

A

Lost levator palpebrase superioris but not Muller’s muscle (which has sympathetic innervation)

44
Q

Horner’s syndrome is due to problems with which nerve supply?

A

Sympathetic

45
Q

Symptoms of horner’s syndrome:

A

Miosis
Ptosis
Anhydrosis
Enopthalmos

46
Q

Causes of horner’s

A

Idiopathic
C8/T1 pathology
Carotid dissection Pancoast tumor

47
Q

Features of a CN IV plasy =

A

eyes cannot look down

48
Q

Features of an CN VI palsy:

A

Eye in, diplopia

49
Q

Diplopia =

A

Double vision

50
Q

CN VI plasy can be indicitive of:

A

Pons lesion, infarction

51
Q

Facial UMN vs LMN lesion:

A

UMN: only bottom half effected, upper face has a dual nerve supply
LMN: both halves effected

52
Q

Bells palsy is a what lesion of what nerve

A

LMN lesion of CN VII

53
Q

Bells palsy effects what parts of face?

A

Both halves on ipsilateral side

54
Q

Plasy of facial nerve features:

A
Ipsilateral wekaness of muscles on top and bottom of face
Incomplete eye closure
Abnormal taste sensation on ant 2/3rds
Hyperacussis 
Decreased lacrimation and saliva
55
Q

Why might CN VII plasy cause hyperacussis?

A

Supplies the stapedius nerve (one of the ossicles)

56
Q

Features of CN XI plasy:

A

difficulty shrugging, paralysis of sternocleidomastoid

57
Q

Features of CN XII plasy:

A
Wasting of tongue
Fasiculations
Weakness of tongue
Tongue deviates to side of lesion
Dysarthria
58
Q

Tongue in LMN lesion points

A

towards side of lesion

59
Q

Tongue in UMN lesion points

A

away from side of lesion

60
Q

Ex of tone pathologies:

A

Cog-wheel
Clasp-knife
Lead pipe

61
Q

2 types of rigiditiy associated with Parkinson’s

A

Cog-wheel

Leadpipe

62
Q

What is used to grade power?

A

MRC scale

63
Q

MRC scale goes from:

A

0-5

64
Q

MRC scale =

A
0- no movement
1- flicker of movement
2- movement with gravity eliminated
3- movement against gravity
4- movement against resistance
5- normal power
65
Q

Examples of LMN lesion areas:

A
anterior horn
nerve root
brachial, lumbar plexus
named nerve
NMJ
muscle
66
Q

Romberg’s test assesses

A

Vestibular function. patient stands with feet together and closes eyes. patient will wobble and lose balance with vestibular dysfunction