clinical neuroanatomy

Question 1

Function of frontal lobes and where in particular is responsible

Answer 1

Motor control: motor strip
Motor planning: premotor cortex
Planning, motivation, behavioural control: pre-frontal
Emotional control: orbitofrontal cortex

Question 2

Function of parietal lobes

Answer 2

somatosensory function 
Visuospatial function (right dominant)

Question 3

Function of temporal lobes

Answer 3

language
Auditory cortex
Memory (hippocampus and medial and temporal lobes)
Amotions (amygdala)

Question 4

Function of occipital lobes

Answer 4

Visual processing

Question 5

What is Broca’s area

What will lesions here cause

Answer 5

Lies in front of motor strip at base of frontal lobe

-LEsions in this area cause a non-fluent effortful type speech but with better comprehension

Question 6

What is Wernicke’s area

What will lesions here cause

Answer 6

sits of top of superior temporal lobe

Fluent speech but paraphasia (speech nonsense) and poor comprehension

Question 7

What lesion will cause a bitemporal hemianopia

Answer 7

Pituitary macroadenoma lifting chasm

Question 8

Lesions behind chiasm causing what

Answer 8

Hemianopia

Question 9

What can cause a hemianopia

Answer 9

Posterior cerebral artery stroke in occipital lobe

Question 10

If lesions affect only part of the pathway, what can be caused

Answer 10

Quadratantopia

Question 11

What nuclei are in midbrain and what does midbrain control

Answer 11

3+4 nuclei

vertical eye movements

Question 12

What nuclei are in pons and what does pons control

Answer 12

6,7 nuclei and horizontal eye movements

Question 13

What nuclei are in medulla and what does medulla control

Answer 13

vestibular nuclei
10+12 nuclei
respiratory and cardiac centres
Pyramidal decussation

Question 14

What do lesions in the medial longitudinal fasciculus cause (these are in the midbrain)

Answer 14

intranuclear ophthalmoplegia

Question 15

What is the motor pathway like (starting from the motor cortex)

Answer 15

Fibres in the motor cortex gather in the corona radiata

Funnel down through internal capsule

Travel down brain stem through the medulla and crosses over to the other side to form the lateral corticospinal tract

Question 16

What lesions will cause a contralateral hemiparesis and why

Answer 16

lesions in:

1) cortex
2) corona radiata
3) internal capsule
4) pyramidal tract in brainstem

Because this s before there is a crossing over of the motor fibres in the medulla so everything is on the opposite side.

Question 17

What lesions will cause an ipsilateral hemiparesis and why

Answer 17

Corticospinal tract in lateral spinal cord

This is after the motor fibres have crossed over

Question 18

which do strokes of the middle cerebral artery and lenticulostriate branches cause

Answer 18

Hemiplegia

Question 19

what are upper motor neurone

Answer 19

From cortex to corticospinal tract

Question 20

Why are signs of upper motor neurone disease due to

Answer 20

Hyper-excitability to inputs to anterior horn cells

Question 21

Signs of upper motor neurone disease

Answer 21

Increased Tone + Clonus
Exaggerated tendon reflexes
Extensor Plantar response
Pyramidal pattern weakness

Question 22

What’re lower motor neurone

Answer 22

from anterior horn to muscle

Question 23

What are signs of lower motor neurone diseases due to

Answer 23

Loss of trophic effect on muscle

Question 24

Signs of lower motor neurone

Answer 24

Wasting
Fasciculation
Lost reflexe
Weakness

Question 25

What are the two main sensory columns and what do they do

Answer 25

``` Dorsal columns (touch, vibration , joint position) Spinothalamic tract (pain and temperature) ```

Question 26

How do the dorsal column fibres travel

Answer 26

Travel in dorsal root into dorsal column Synapse in medulla then cross to thalamus

Question 27

What is significant about blood supply to dorsal column

Answer 27

Blood supply is different from rest of spinal cord. SO in infarcts you can be weak but still have retained joint position sense

Question 28

What does spinothalamic tract do

Answer 28

Pain and temperature

Question 29

how do pain and temperature fibres travel

Answer 29

They start in dorsal root and synapse in dorsal column. Then cross spinal cord to the lateral spinothalamic tract then synapse in thalamus then in the cortex.

Question 30

What does a complete cord lesion cause

Answer 30

Sensory level (complete loss in sense)

Question 31

What does a half cord lesion cause

Answer 31

Brown squared syndrome - Loss of light touch and joint position sense on same side (ipsilateral) - Loss of pain and temperature contralaterally

Question 32

What does a central cord lesion cause

Answer 32

Loss of pain and too bilaterally over a restricted area (cape over shoulders and going down arms) but no loss in dorsal column

Question 33

what can middle cerebral artery infarcts cause

Answer 33

contralateral Hemisensory loss | -damage sensory cortex, white matter tracts and internal capsule

Question 34

What can lesion in thalamic area cause

Answer 34

Pure sensory stroke (contralateral)- no motor loss, only hemisensory loss

Question 35

What can pure cordial lesions cause

Answer 35

Damage only fine discrimination so only able to feel light touch

Question 36

How to tell difference between UMN and LMN lesion in the face

Answer 36

UMN spares the forehead so it is not paralysed. Therefore the whole forehead is creased LMN lesion affects entire face so there can be complete facial paralysis on one side (e.g. Bell's palsy)

Question 37

what are the lesion sites which can cause upper motor neurone dysarthria (difficulty swallowing)

Answer 37

1) Cortex 2) Corona radiata 3) internal capsule 4) brainstem corticospinal tract 5) vagus and hypoglossal nuclei

Question 38

what can bilateral UMN pathway lesions cause | -symptoms

Answer 38

Pseudobulbar palsy | -slow stiff speech and brisk jaw jerk: bilateral strokes

Question 39

what are lower motor neurone symptoms that cause dysarthria

Answer 39

Slurry speech, poor palate elevation, risky swallow and no brisk jaw jerk

Question 40

Other causes of dysarthria

Answer 40

- Diffuse cranial neuropathy: Gillian Barre syndrome - Neuromuscular junction: myasthenia or botulism - Muscle disorders: forms of dystrophy and inclusion body myositis - Cerebella disease (scanning/staccato speech)