CIS Spinal Cord and Visual System Flashcards by Sarah Gillen

Important system in arousal, alertness, attention, and sleep; is essential for cortical activation and the ability to examine a conscious patient

ARAS

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Pt presents with poor peripheral vision, but can see things directly in front of them. Also c/o weight gain and problems recalling recent events. What is the diagnosis?

Bitemporal hemianopsia with Korsakoff’s syndrome

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Korsakoff’s syndrome indicates involvement of what anatomical struture?

Mammillary bodies

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Supranuclear facial palsy results from lesion in what system?

Corticobulbar tract

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Spastic paralysis, +babinskis, hyperreflexia, etc. are symptoms seen when what system is involved?

CST

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The optic tract sits close to what brain structure, causing the spastic paralysis that may be seen with visual symptoms?

Cerebellar peduncle

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Difference in function between frontal and occipital eye fields

Frontal eye fields = volitional eye movement

Occipital eye fields = non-volitional eye movement

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______ syndrome may present with large acoustic neuromas causing unsteadiness in walking and weakness in muscles of one side of the face. This is d/t this type of syndrome affecting CNs ____, ____, and _____

Cerebellopontine

V, VII, and VIII (as well as cerebellum)

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Patterns of alternating hemianalgesia may be indicative of either of what 2 conditions? What are the differentiating presentations?

Cerebellopontine syndrome (CPA) —> deafness

Lateral medullary syndrome —> swallowing difficulties

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Spastic paralysis indicates involvement of the CST. What anatomical structure does the CST pass through that causes these symptoms?

Middle 3/5 of cerebellar peduncle

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Internal strabismus is indicative of _____ n. palsy which is indicated at the level of the _____ junction

Abducens; pontomedullary

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What is the boxcar sign?

A “squaring” of the lateral ventricles d/t atrophy of the caudate nucleus

Indicative of Huntington’s disease

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Examination of a conscious patient assesses function of the:

A. Basal ganglia
B. Limbic system
C. Cerebellum
D. Thalamus
E. ARAS and cerebral cortex

E. ARAS and cerebral cortex

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Complete anesthesia of the right side of the face, loss of blink reflex on the right, and paralysis of the right temporalis and masseter muscles indicates impairment of which of the following?

A. Corticobulbar fibers
B. Descending tract of V
C. Ophthalmic n.
D. Trigeminal motor nucleus
E. Trigeminal n.

E. Trigeminal n.

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Complete anesthesia of the right side of the face, loss of blink reflex on the right, and paralysis of the right temporalis and masseter muscles indicates impairment of the trigeminal n. This deficit pattern indicates involvement of which of the following?

A. Corticobulbar fibers
B. Descending tract of V
C. Medial lemniscus
D. Nucleus ambiguus
E. Trigeminal n.

B. Descending tract of V

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A deficit in the descending tract of CN V indicates involvement of which of the following?

A. Corticospinal tract
B. Main sensory nucleus of V
C. Mesencephalic tract of V
D. Spinal lemniscus
E. Trigeminal n.

D. Spinal lemniscus

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The secondary axon conveying pain and temperature from the right side of the face is located in which of the following?

A. Descending tract of V
B. Main sensory nucleus of V
C. Spinal lemniscus
D. Trigeminal lemniscus
E. Trigeminal n.

D. Trigeminal lemniscus

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Complete deafness of the right ear indicates involvement of which of the following?

A. Lateral lemniscus
B. Cristae ampullaris
C. Inferior geniculate body
D. Vestibular nuclei
E. Vestibulocochlear n.

E. Vestibulocochlear n.

[specifically the cochlear division]

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A 64 y/o male with hx of HTN was examined in the ED for sudden hearing loss. Exam revealed bilateral diminution of hearing that was more pronounced in left ear. This indicates involvement of which of the following?

A. Brachium of superior colliculus
B. Cochlear nucleus
C. Lateral lemniscus
D. Primary auditory cortex
E. Vestibulocochlear n.

C. Lateral lemniscus

An 83 y/o female had a brief syncopal episode with a fall. Radiographs indicated a spiral fracture of right humerus. Since she had hx of minor strokes, head MRI and neuro exam were performed. She could not comprehend spoken commands though her ability to speak and write was intact. No motor findings were noted. This condition is best described as which of the following?

A. Agraphia and alexia
B. Auditory agnosia
C. Broca’s aphasia
D. Conduction aphase
E. Fluent paragrammatical aphasia

B. Auditory agnosia

Nasal hemianopia indicates a lesion of which of the following?

A. Inferior portion of optic n.
B. Lateral aspect of optic chiasm
C. Lateral geniculate body
D. Middle of optic chiasm
E. Optic radiations

B. Lateral aspect of optic chiasm

Incongruent homonymous hemianopia indicates a lesion of which of the following?

A. Loop of meyer
B. Optic chiasm
C. Optic n.
D. Optic tract
E. Primary visual cortex

E. Primary visual cortex

A 30 y/o male is examined by a neurologist who finds the following:

Normal horizontal gaze to the right

Left horizontal gaze showed that right eye did not adduct and left eye had lateral nystagmus

Both eyes could adduct during convergence

These findings indicate involvment of which of the following:

A. Paramedian pontine reticular formation
B. Medial longitudinal fasciculus
C. Abducens n.
D. Vestibular nuclei

B. Medial longitudinal fasciculus

A 30 y/o male is examined by a neurologist who finds the following:

Normal horizontal gaze to the right

Left horizontal gaze showed that right eye did not adduct and left eye had lateral nystagmus

Both eyes could adduct during convergence

These findings are described as which of the following?

A. Abducens palsy
B. Internuclear ophthalmoplegia
C. Oculomotor palsy
D. Vestibular disturbance

B. Internuclear ophthalmoplegia

A 30 y/o male is examined by a neurologist who finds the following: Normal horizontal gaze to the right Left horizontal gaze showed that right eye did not adduct and left eye had lateral nystagmus Both eyes could adduct during convergence These findings indicate a lesion on/in the: A. Bilateral B. Medulla C. Left D. Right

C. Left

A 30 y/o male is examined by a neurologist who finds the following: Normal horizontal gaze to the right Left horizontal gaze showed that right eye did not adduct and left eye had lateral nystagmus Both eyes could adduct during convergence This type of lesion is often bilateral how would the patient present in terms of horizontal gaze to the right vs. to the left?

Horizontal gaze to the right: left eye does not adduct, right eye shows horizontal nystagmus Horizontal gaze to the left: right eye does not adduct, left eye shows horizontal nystagmus

A 60 y/o patient was hospitalized after sudden onset of the following: Complete anesthesia of the left face Deviation of jaw to the left on protrusion Inability to bite down on left side Right spastic hemiplegia These findings indicate involvement of what 2 systems? Where is the lesion (side+level)?

VI and CST Left sided lesion at the level of the metencaphalon (pons)

A 64 y/o patient was brought into the ER with the following symptoms: External strabismus, complete ptosis, and fixed dilated pupil of right eye Left corner of mouth drooping Deviation of the uvula to the right Left hemiparesis with hypertonia, hyperreflexia and babinski What is the cranial nerve involvement, what tracts are involved, and what is the diagnosis?

CN III CST and CBT Supranuclear facial palsy

A 53 y/o male presents after MVA with GCS of 10 (moderate) with C5 fracture, depressed fracture of frontal bone, and right malar laceration+right periorbital ecchymosis without evidence of intracranial or extramedullary hematomas. Irrigation of the right ear resulted in NO abduction of the right eye and adduction of the left eye. Irrigation in the left ear resulted in no abduction of the left eye, and adduction of the right eye. Horizontal nystagmus was not observed. These findings indicate involvement of which of the following? ``` A. Abducens n. B. Oculomotor n. C. Medial longitudinal fasciculus D. Trochlear n. E. Facial colliculus ```

A. Abducens n. [pt has bilateral abducens palsy]

24 y/o female presents with difficulty seeing. She also admits to sleeping a lot more lately and not socializing with friends. Initialy dx was clinically isolated syndrome (CIS). 6 mos later, sclerotic lesions are seen on her MRI. Neuromyelitis optica is ruled out. Horizontal gaze to the left was normal. Horizontal gaze to the right showed no adduction of left eye and horizontal nystagmus of right eye. These findings indicate involvement of which of the following? ``` A. Paramedian pontine reticular formation B. Medial longitudinal fasciculus C. Abducens n. D. Oculomotor n. E. Optic n. ```

B. Medial longitudinal fasciculus

24 y/o female presents with difficulty seeing. She also admits to sleeping a lot more lately and not socializing with friends. Initialy dx was clinically isolated syndrome (CIS). 6 mos later, sclerotic lesions are seen on her MRI. Neuromyelitis optica is ruled out. Horizontal gaze to the left was normal. Horizontal gaze to the right showed no adduction of left eye and horizontal nystagmus of right eye. These findings indicate a lesion on the: A. Left B. Right C. Bilateral D. Unknown

A. Left

24 y/o female presents with difficulty seeing. She also admits to sleeping a lot more lately and not socializing with friends. Initialy dx was clinically isolated syndrome (CIS). 6 mos later, sclerotic lesions are seen on her MRI. Neuromyelitis optica is ruled out. Horizontal gaze to the left was normal. Horizontal gaze to the right showed no adduction of left eye and horizontal nystagmus of right eye. The horizontal gaze findings are called: ``` A. Right internuclear ophthalmoplegia B. Right PPRF C. Left internuclear ophthalmoplegia D. Left PPRF E. Strabismus ```

C. Left INO [named according to non-adducting eye, which is ipsilateral to lesion of MLF]

A 43 y/o male s/p MI presents to the ED semi-obtunded prior to going to cath lab for four stents. Post-op MRI revealed small infarct in lower pons adjacent to the midline and ventricle. The neuro exam showed paralysis of horizontal gaze to the right and left. He had diminished proprioception/2-point tactile sensations, and slight astereognosis, and agraphesthesia in both UEs. These findings indicate involvement of which of the following? A. Abducens n. B. Medial longitudinal fasciculus C. Oculomotor n. D. Paramedian pontine reticular formation

D. Paramedian pontine reticular formation

A 43 y/o male s/p MI presents to the ED semi-obtunded prior to going to cath lab for four stents. Post-op MRI revealed small infarct in lower pons adjacent to the midline and ventricle. The neuro exam showed paralysis of horizontal gaze to the right and left. He had diminished proprioception/2-point tactile sensations, and slight astereognosis, and agraphesthesia in both UEs. These findings indicate a lesion on the: A. Right B. Left C. Bilateral D. Unknown

C. Bilateral

A 43 y/o male s/p MI presents to the ED semi-obtunded prior to going to cath lab for four stents. Post-op MRI revealed small infarct in lower pons adjacent to the midline and ventricle. The neuro exam showed paralysis of horizontal gaze to the right and left. He had diminished proprioception/2-point tactile sensations, and slight astereognosis, and agraphesthesia in both UEs. These findings also indicate involvement of which of the following? A. Fasciculus cuneatus B. Medial lemniscus C. Posterior columns D. Spinal lemniscus

B. Medial lemniscus

Cerebellar cortical influences converge on which of the following? ``` A. Deep cerebellar nuclei B. Granule cells C. Parallel fibers D. Stellate cells E. Purkinje cells ```

E. Purkinje cells

A unilateral lesion of the right cerebellar lobe would result in which of the following? A. Bilateral cerebellar deficits B. Contralateral cerebellar deficits C. Ipsilateral cerebellar deficits D. No neurological deficits

C. Ipsilateral cerebellar deficits

Olivocerebellar fibers have strong influence on which of the following? ``` A. Cerebellar glomerulus B. Deep cerebellar nuclei C. Granule cells D. Parallel fibers E. Purkinje fibers ```

E. Purkinje fibers

Unconscious precise proprioceptive info from the UE is conveyed by which of the following? ``` A. Dorsal spinocerebellar B. Central tegmental fasciculus C. Ventral spinocerebellar tract D. Cuneocerebellar tract E. Trigeminocerebellar tract ```

D. Cuneocerebellar tract

The efferent fibers in the superior cerebellar peduncle project to which of the following? A. Ventral posterior lateral nucleus B. Ventral posterior medial nucleus C. Ventral anterior nucleus D. Intralaminar nuclei

C. Ventral anterior nucleus

The cerebral cortex influences the cerebellum via which of the following? ``` A. Pontocerebellar fibers B. Corticopointine fibers C. Olivocerebellar fibers D. Corticobulbar fibers E. Central tegmental fasciculus ```

B. Corticopontine fibers

A 67 y/o male is seen in acute rehab after the inability to demonstrate a voluntary cough. This ability is called: ``` A. Agnosia B. Agraphia C. Apraxia D. Aphonia E. Automatic-voluntary dissociation ```

C. Apraxia

A lesion in the dominant hemisphere resulting in apraxia is frequently associated with which of the following? ``` A. Agnosia B. Agraphia C. Apraxia D. Aphasia E. Alexia ```

D. Aphasia

The motor subcortical loops are subserviant to the: ``` A. Supplemental motor cortex B. Parieto-occipito-temporal cortex C. Frontal lobe D. Primary motor cortex E. Premotor cortex ```

D. Primary motor cortex

Bilateral lesions of the CST in the cerebral peduncles is characteristic of what condition involving both UMNs and LMNs?

ALS