Clinical correlations - Notes (all sections) Flashcards Preview

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Flashcards in Clinical correlations - Notes (all sections) Deck (135)
1

Damage to dorsal and ventral cochlear nuclei sx

deafness in ipsilateral ear

2

deafness in ipsilateral ear

X dorsal and ventral cochlear nuclei in medulla X auditory portion of CN 8

3

damage to vestibular nuclei (in medulla)

nystagmus, vertigo, problems with balance

4

loss of gag reflex on the affected side

CN 9 X

5

CN 10 damage sx

1. hoarseness due to loss of control of larynx

2. problems swallowing

3. asymmetry of soft palate

6

Why is bilateral loss of CN 10 devastating?

choking (nucleus ambiguus) loss of parasymp. control to the heart and gastrointestinal tract (nucleus ambiguus and dorsal motor nucleus of CN 10).

7

CN 11 damage sx

1. inability to elevate ipsilateral shoulder 2. difficulty to turn head 3. fasciulation and atrophy of sternomast. and trapezius

8

CN 12 damage sx

1. deviation of tongue towards side of weakness 2. paralysis of ipsilateral tongue muscles 3. fasciulations and atrophy of tongue muscles ipsilaterally

9

Loss of discrete somesthetic infromation on same side of the lesion

damage to both the DORSAL FUNICULUS and DORSAL PART OF LATERAL FUNCIULUS

10

Before they cross, axons of the anterolateral system usually pass through the ____

lissauer's tract

11

Axons of the anteriolateral system cross in the _____

anterior white commisure

12

dissociated sensory loss is a symptom of dmaage to the ____

spinal cord pain and temp is on one side, fien touch, vibration, and joint position on another

13

damage to this pathway anywhere at its length can cause horners syndrome

hypothalmoreticulospinal pathway

14

termination of the hypothalmoreticulospinal pathway

interomediolateral cell column

15

cause of flaccid muscle, hypothonia, hyporeflexic, fascuulations

lesion of peripheral nerve, or early UMN X

16

UMN injury involves damage to the

brains descending motor pathways

17

what can happen early with UMN injury?

flaccid paralysis, then become hyperreflic and hyerptonic (spastic paralysis)

18

positive bainksi response is seen with

UMN injury

19

The Babinski response (positive Babinski reflex) is seen again with ____ tract damage

corticospinal, since the corticospinal tract is no longer surpressing spinal reflex

20

Pinealoma sx?

- Problems sleeping - Tinnitis (? X inferior olive) - Papilledemia (hydrocephalus by blocking the cerebral aqueduct)

21

ddK is _____ injury

lateral cerebellar

22

nystagmus, balance problems, wide based gait can be explained by ____ injuey

medial cerebellar injury

23

intention tremor is ____ injury

lateral cerebellar

24

pupillary light reflex is mediated by ____ areas

pretectal areas

25

upward gaze requires an intact _____

posterior commisure

26

what can cause loss of pupillary light reflex and loss of accommodation reflexes?

loss of both pretectal regions

27

pupillary light reflex requires damage to

both prectatal regions or damage to LMN occulomotor nerve

28

deafness in one ear

CN VIII peripherally meaning medulla

29

completel paralysis of the face

LMN CN 7 meaning pons

30

internal strabismus

LMN CN 6 meaning pons

31

External strabismus

LMN CN 6 meaning pons

32

You should never shift a dx ____ to accomodate additional reported sx.

caudally (down) --- (so X usually is at the level of the highest sx)

33

If sx are in the head, this usually rules out ____

spinal cord injury EXCEPT with horners

34

If symptoms persist overtime and are unilateral it is likely caused by a ____

tumor

35

Diseases or tumors are usually bilateral?

disease

36

If the lesion is in the spinal cord, then what can be said about all sensory and motor sx?

they are on the same side as the X, except with pain and temperature

37

If lesion is in the brainstem, the lesion is on the SAME side as the ____

highest symptom; lower sx will be on the opposite side

38

if the X is in the FOREBRAIN, all sensory and motor sx are on the ____ of the body as the X.

OPPOSITE... except for olfactory

39

if the X is in the FOREBRAIN, all sensory and motor sx are on the ____ of the body as the X.

SAME

40

X to the ___ can cause prosposagnosia

inferior temporal lobe

41

bilateral X to parahippocampal gyrus and uncus can lead to?

amnesia

42

bilateral X to heschl's gyrus would produce

inability to understand spoken language

43

unilateral X to hescls gyrus would produce

little sx

44

what could cause inaiblity to understand spoken lanauged?

bilateral X to heschls gyrus OR left auditory cortex and corpus callosum X

45

lesion in the optic chiasm causes?

a loss of vision in the temporal half of both visual fields: bitemporal hemianopsia

46

what does X in optic nerve cause?

loss of vision in affected eye, loss of pupillary reflex

47

what does X in the optic tract cause?

A lesion of the right optic tract causes a complete loss of vision in the left hemifield: contralateral “homonymous” hemianopsia.

48

what sx to X of the precentral gryus?

paresis (weakness) and movement deficits on the OPPOSITE side of the body

49

what are sx to X of the postcentral gyrus?

somatic sensory deficits (e.g. loss of touch, limb position) on the OPPOSITE side of the body.

50

X to the superior and middle frontal gyri?

premtoor area; forms of apraxia, if in dominant hemisphere the ability to write is impaired

51

X to the superior parietal lobule causes what sx?

it is controlled with guiding movement sx are apraxia, inability to bring object under control of movement

52

X to the inferior parietal lobule can cause ___

the inability to read (since angualr gyrus is the gateway for visual info to reach wernickes)

53

X to the inferior frontal gyrus

contians brocas area, leads to the inability to generate fluent speech

54

how to test for CN 4 palsy?

have pt look nasal, if he cannot look down he may have trochlear nerve palsy. may also have double vision in nasal position.

55

unilateral LMN CN 7 X symptoms

motor deficits in half the face on the affected side

56

lesions to what notably impact the ability to write

superior and middle frontal lobes (premotor areas)

57

What supplies blood to brocas area?

MCA

58

What supplies blood to the areas of the temporal lobe involved in memory?

PCA

59

What supplies blood to the leg and foot areas of primary motor and primary somatosensory?

aca

60

what supplies blood to the primary visual cortex

PCA

61

cause of socotomas

X in the occipital lobe (in half of the visual field contralateral to vision)

62

sx of occipital lobe X

scotoma (blind spots) in half of the visual field opposite the lesions

63

pt gets lost in his own home, displays neglect to one half of his body

inferior parietal lobule

64

deep, compulsive repretitive behaviors may be due to damage to the

prefrontal cortex, often seen with personality changes

65

wallenbergs syndrome is seen with ___ occulusion

PICA

66

sx with PICA occulsion

Wallenburg’s syndrome: vertigo, loss of balance, ipsilateral “cerebellar signs”, loss of facial pain sensation, hoarseness

67

sx with Basilar branch occulusion

paralysis and loss of sensation in the face, body and limbs; can also affect eye movements and cause diplopia

68

sx with AICA occulusion

ipsilateral cerebellar signs, facial paralysis, ipsilateral hearing loss, loss of pain and temp over face ispilaterally

69

what occuluded vessels can you see ispilateral cerebellar signs?

aica, pica, superior cerebellar

70

sx with superior cerebellar stroke

ipsilateral cerebellar signs, contralateral pain and temperature loss, Horner’s

71

what sx with unilateral PCA stroke

blindness in the visual field OPPOSITE to the affected side, alexia (left side).

72

what sx with bilateral pca stroke

if bilatera,l as with “top of the basilar” occlusion: bilateral blindness, memory loss, somatosensory loss, coma & death

73

sx with posterior communicating stroke

contralateral paresis, coma & death

74

sx with aca stroke

contralateral paralysis and sensory loss in leg and foot; sometimes, apraxia

75

sx with MCA stroke

contralateral apralysis and sensory loss apraxia aphasia partial blindness

76

rigidity signals ___ damage

basal gang.

77

what is akinesia? what damage does it signify?

difficulty initiating movement

78

signs of increase intercranial presure

- retinal vessels of optic nerve enorged -- optic nerve becomes DILATED (papilledema) - headache -nausea vomitting cognitive impariment LOC

79

with increase intercranil pressure FRONTAL LOBE FUNCTION is often compromised causing

unsteady gait where the foot barely leaves the floor (magnetic gait) incontinence

80

In multiple sclerosis, the ____ content of CSF is disproportionately increased

gamma globulin (protein)

81

what do X of the posterior limb cause?

dramatic symptoms of sensory loss and paralysis.

82

what does loss of epicritic sense entail?

loss of 1. sterogenesis (cant recognize tactile shapes in hand) 2. position sense - can lead to shuffling gait, reaching inaccuracies 3. loss of vibration - insesntive to high frequency stimulation 4. simpe touch intact but sensitivity decreased

83

what deep white matter tract connects brocas, wernickes, and the auditory cortex

superior longitudinal fasiculus

84

____ interconnects orbital frontal cortex-based reward and punishment centers with temporal lobe-based memory representations.

uncinate fasciculus

85

damage to the posterior comissure could lead to problems with

pupillary light reflex and upward gaze

86

same side loss of protopathic can be seen with X to ___

ALS 1. dorsal root axons 2. lissaeurs tract or dorsolateral fasciulus 3. dorsal horn

87

opposite side loss of protopathic can be seen with X to ___

ALS - 1. anterolateral tract in spinal cord 2. ALS synapsing in the brainstem 3. VPL, DM, intalaminar in thalamus 4. post central gyrus

88

loss of protopathic sx include

Reduced pain Reduced sense of warming or cooling skin Simple touch intact but reduced in sensitivity

89

positive babinksi indicates ___ sign

UMN

90

no muscle atrophy indicates UMN or LMN sign?

UMN

91

dorsal peripheral nerve damage causes

loss of sensation and then weakne mvoement then atrophy and fasciulations as the muscle are dying

92

Weakness or outright paralysis cof central descending tracts will cause

first hypotonia (sudden loss of descending connections) then hypertonia

93

LMN weakness is weakness of the

peripheral motor nerve

94

UMNC weaknes is weakness of the

central motor pathways

95

the entire ipsilateral face is paralyzed with

LMN facial nerve damage (to nuclei or nerve)

96

UMN damage to facial nerve will cause

lower quadarant to be damaged on the opposite side

97

UMN damage of CN 7 includes damage to the

forebrain, corticobulbar tract damage rostral to the pons

98

when the motor cortex or cingulate area is damaged, or the cortico-bulbar pathway on one side of the brain is damaged rostral to the facial nucleus, the remaining____ axons can compensate so little deficit is noted.

cortico-bulbar

99

Ipislateral loss of epicritic sense can occur from X of the

Dorsal column/lemniscal sys.

1. dorsal root axons

2. gracile or cuneate fasiculus (spinal cord)

3. gracile or cuneate nuceli (medulla)

100

Contralateral loss of epicritic sense can occur from X of the

1. medial lemniscus going up the medulla, pons, midbrain to thalamus

2. VPL in thalamus

3. post central gyrus

101

what does loss of epicritic sense include?

loss of

1. sterogenesis (cant recognize tactile shapes in hand)

2. position sense - can lead to shuffling gait, reaching inaccuracies

3. loss of vibration - insesntive to high frequency stimulation

3. simpe touch intact but sensitivity decreased

 

102

why is EPICRITIC information coming into the spinal cord suspectible to injury?

it comes in as large diameter dorsal root axons -- vulnerable to insult from ischemia, toxicity, bacteria, etc

 

so: early sx of peripheral nerve disease shows as epicritic

 

103

ipsilateral loss of protopathic informaiton is seen witn

ALS

1. dorsal root axons

2. lissaeurs tract or dorsolateral fasciulus

3. dorsal horn

104

spinocerebellar carries ___ information from the ___

proprioceptive (muscle and joint position) from the trunk and limbs

105

ipislateral loss of propathic from head and neck

caused by X of 

1. spinal tract of CN 5

2. spinal n. of 5 in the medull

106

contralateral loss of propathic from head and neck

caused by X of 

1. after the spinal nulceus in the medulla (where it crosses) so a pons or midbrain region

2. in the vpm 

107

loss of proprocpetive from face on the same side can be due to

X trigmeminal nerve

X mescephalic nucleus of 5

X menscephalic tract of CN 5

X motor n. of 5 in the pons 

X cerebellum

108

loss of chewing on the same side can be caused by

 X motor n. of 5 in the pons

X trigeminal nerve 

109

corticobulblar controls hypoglossal cranial nerve ncueli mostly

contralaterally

110

corticobulblar controls facial  cranial nerve ncueli mostly

both

111

  The bilateral projections from the surviving CB can sustain considerable movement on both sides of the patient

 

Usually only the___ and ___ are affected by a unilateral CB lesion

tongue and face (CN 7)

112

damage to the corticospinal in the brainstem therefore impairs movement mainly on the ____ side of the body. 

opposite

 

since mostly lateral corticopsinal which crosses and the pyrmida decessations

113

unilateral patholgoy of the corticobulbar tract sx

will weaken movement of the head and neck opposite of the X

does not significantly weakend since most cn actually get bilateral input from CB

114

damage to lateralc orticiospinal tract occurs with

X to the tract below the pyramids decussations in the medulla

115

In the few surgical case studies of isolated CS damage (lesion of the medullary pyramid), the sx were

modest: temporary weakness, permanent Babinski’s sign, and permanent loss of independent finger movements.

 

mostly the pyramidal tracts are damaged with the brainstem tracts so sx area outright pralysis

116

Frontal lobe lesions often cause ___ 

severe paralysis because the precentral (motor) and premotor areas of cortex contribute to both direct and indirect motor pathways

117

damage to a Brainstem-spinal pathways at the level of the medulla wiill cause

problems with movement on the opposite side of the body

118

damage to a Brainstem-spinal pathways at the level of the spinal caord wiill cause

problems with mvoement on the same side of the body

119

damage to the temporal lobe could damage ___ visual field

upper visual field

120

Consequently damage to the parietal lobe or superior bank of visual cortex can result in scotomas in the _____ visual field.

lower

121

loss of endinger westphalnucleus will lead to a

dilated pupil that fails to constrict to light

122

if pt has hearing loss in one ear it must be to

CN 8 or cochlear nuclei

123

what lesions could results in an inability to understand spoken language 

X hescls gyrus in both hemispheres, damage to the left auditory cortex, damage to corpus callosum (since heschls on right and left communicate through this)

124

damage to optic nerve -- effect on pullairy light reflex 

+ light in pislateral eye

Damaged optic nerve – light in ipsilateral eye =
NO direct, NO consensual

125

damage to optic nerve -- effect on pullairy light reflex

+ light in contralateral eye

Both direct and consensual INTACT

126

damage to occulomotor nerve/EW nucelus 

+ light in ipsilateral eye effects

= NO direct, but the consensual is INTACT

127

Damaged oculomotor nerve /EW nucleus

+ light in contralateral eye =

 

Direct INTACT, NO consensual

128

Damage to medial midbrain (ie. Bilateral Pretectal nuclei and/or both EW nuclei) 

 

NO direct, NO consensual

129

C

input?

what does damage to this cause?

inferior cerebellar peduncle

receives input from opposite infeiror olive nulcei in medulla

often seen with PCA stroke. damage causes

1. ataxia

2. intention tremor to the ipsilateral side of the body

3.lean towards side of the lesion

4. clumsiness of ipsilateral hand

130

Damage to the _____ medulla rostral to the pyramidal decussation will result in motor loss on the OPPOSITE side of the body.

ventral

131

132

damage to the corticobulbar tracts will have ____ effects on cranial nerves

contralateral * except for hypoglossal

 

The bulk of cortibobulbar axons control cranial nerve nuclei on opposite side the origin of these axons in the cortex

133

ROmberg's sign

what is it 

what causes it

loss of balance more proncounced when patients eyes are closed

seen with vestibular nuclei damage in the pons

134

X facial nucelus in the pons

1. paralysis of ipsilateral facial muscles

2. drying of cornea due to loss of parasymps of lacrimal 

3. loss of corneal reflex

4. painful sensitivity to sound due to weakness of stapedius

135

 lesions to corticobulbar axons projecting to the facial nucleus

contralateral facial paralysis below the forehead