Correlation Of Physical Signs - Talley Neuro Flashcards Preview

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Flashcards in Correlation Of Physical Signs - Talley Neuro Deck (44):
1

How will a Middle Cerebral Artery thrombosis present?

Main branch
- UMN Face,
ARM > leg
- Homonymous Hemianopia
- Dysphasia OR non dominant hemisphere signs
- Cortical sensory loss

Perforating artery internal capsule infarction
UMN face
UMN arm>leg

2

How will a Posterior Cerebral Artery Thrombosis present?

Main branch thrombosis- infarction of thalamus and occipital cortex

- Hemianaesthesia (loss of all modalities)
- Homonymous Hemianopia (complete)
- Colour Blindness

3

How will an Anterior Cerebral Artery Thrombosis present?

- UMN
- LEG > arm
- cortical sensory loss of LEG only (if corpus callosum affected)
- Urinary incontinence

4

How will a Vertebral/Basilar (brain stem) thrombosis present?

- Crossed motor/sensory (eg left face, right arm)
- Bilateral extremity motor/sensory
- Hornets Syndrome
- Cerebellar signs
- Lower cranial nerve signs

5

Upper motor neurone signs?
Where is the lesion?

The lesion has interrupted a pathway at a level ABOVE the anterior horn cell

Eg: cerebral cortex, internal capsule, Cerebral pedicels, brain stem or spinal cord

SIGNS:

- Greater weakness of aBductors and EXtensors in the Upper limb

- Flexors and ABductors in the Lower limb
Why? Usually this pathway mediates voluntary contraction of antigravity muscles

- Spasticity = increased tone is present

- Clonus

- INcreased reflexes (except for superficial reflexes)

- There is an extensory (babinski) plantar response

6

Causes of Hemiplegia?

Upper motor neuron lesion affecting projection of pathways from the CONTRALATERAL motor cortex

Internal carotid artery stoke if there is an area of the internal capsule or hemisphere
Haemorrhagic strokes

7

What signs could be caused by a lesion in the vertebrobasilar artery?

- cranial nerve palsies
- cerebellar signs
- Horners syndrome
- sensory loss
- bilateral upper motor neuron signs

- this is due to close proximity of structures in the brainstem

8

What is Lateral Medullary Syndrome?
What does it cause?
What are the signs?

Occlusion of the vertebral or posterior inferior cerebellar or lateral medullary arteries

Causes: Crossed neurological signs

Signs:
- cerebellar signs (ipsilateral)
- Horners Syndrome ( ipsilateral)
- Lower cranial nerves ( IX, X)- palate and -
vocal cord weakness (ipsilateral)
- Facial sensory loss of pain (ipsilateral)
- Arm and leg sensory loss of pain (contralateral)
- No upper motor neurone weakness

9

Signs of a lower motor neurone lesion

-Weakness = more distal than proximal

Flexor and extensors are equally involved

wasting

Tone is reduced

Reflexes are reduced and plantar response is normal or absent

Fasciculations

10

What area is affected to cause a lower motor neuron lesion?

- interruption of the reflex arc
- lesion of spinal motor neurons, motor root or peripheral nerve

11

What kind of signs does a spinal cord compression cause?

Lower motor neurone signs at the level of the lesion

Upper motor neurone signs below that level

12

Pain and temperature loss one side of the face and opposite side of the body = ?

Lateral medullary syndrome

Occlusion of the vertebral or posterior inferior cerebellar or lateral medullary arteries

13

Bilateral loss of all forms of sensation below a specific level= ?

Spinal Cord Lesion

14

Only pain and temperature affected bilaterally below a specific level = ?

Anterior spinal cord lesion

15

Unilateral Loss of pain and temperature below a specific level = ?

partial unilateral spinal cord lesion on OPPOSITE side to signs = Brown- sequard syndrome

16

What is Brown Sequard syndrome ?

Hemisection of the spinal cord

= Loss of pain and temperature on the OPPOSITE side of the lesion

= Loss of vibration and proprioception on the SAME side as the lesion

17

Glove and stocking loss of sensation = ?

Peripheral Neuropathy

18

Loss of position and vibration sense only = ?

Posterior column lesion

19

Saddle Sensory Loss = ?

Cauda Equina Lesion

20

Tunnel Vision:
What could cause this?

glaucoma
retinal abnormalities such as papilloedema, acute ischaemia in migraine

21

Enlarged Blind Spot
Where is the lesion?
What could cause this?

Optic Nerve Head enlargement

22

Central Scotoma
Where is the lesion?
What could cause this?

Between the optic nerve to the chiasm

caused by :
demyelination
- MS causes unilateral or asymmetrical bilateral central scotoma

toxins (alcohol) = symmetrical bilateral

vascular = unilateral

Gliomas of optic nerve = Unilateral

23

Unilateral Field Loss
Where is the lesion?
What could cause this?

Optic Nerve Lesion
cause: vascular tumour

24

Bitemporal Hemianopia
Where is the lesion?
What could cause this?

Optic Chiasm lesion
cause:
from a pituitary tumour

25

Homonymous Hemianopia

Lesion = between optic tract to occipital cortex

Incomplete lesion leads to macular sparing

26

Upper Quadrant Homonymous Hemianopia

Temporal lobe lesion

27

Lower Quadrant Homonymous Hemianopia

Parietal Lobe Lesion

28

What causes internuclear opthalmoplegia?

Lesion of the Medial Longitudinal Fasciculus

If bilateral and in a young person then most common cause is MS

29

Jerky HORIZONTAL Nystagmus
causes?

1) vestibular lesion
- acute = away from the side of lesion
- chronic = towards lesion

2) Cerebellar lesion
- unilateral disease = towards the side of lesion

3) Toxic causes
- such as phenytoin and alcohol

4) internuclear opthalmoplegia

30

Jerky VERTICAL Nystagmus
Causes?

Brainstem Lesion

upbeat = lesion in the midbrain or floor of the fourth ventricle

Down beat = foramen magnum lesion

can also be caused by alcohol

31

Pendular Nystagmus
Causes?

Can be retinal or congenital

32

If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Unilateral
III
IV
V
VI

Cavernous Sinus

33

If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Unilateral
V
VII
VIII

Cerebellopontine angle lesion

34

If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Unilateral
IX
X
XI

Jugular foramen Lesion

35

If the following Cranial nerves were involved in signs, where do you suspect the lesion is?
Bilateral
X
XI
XII

If lower motor neurone signs = Bulbar Palsy
If Upper motor neurone signs = Pseudobulbar palsy

36

What sign would you expect from a lateral optic chiasm lesion?

Incomplete contralateral hemianopia

37

What would you suspect if you observed a patient when told to look ahead they have one eye is rotated up and in

Trochlear nerve palsy

38

What would you suspect?
When told to look laterally, one eye stays forwards

Abducens nerve palsy

39

ABduction of the eye is controlled by which muscle and nerve?

Lateral rectus

Abducens (CN VI)

40

ADDuction of the eye is controlled by which muscle and nerve?

Medial Recturs

Oculomotor Nerve (CN III)

41

In the ABducted eye,
what controls Elevation and Depression?

Elevation = Superior Rectus (Oculomotor nerve CN III)
Depression = Inferior Rectus (Oculomotor Nerve CN III)

42

In the ADDUcted eye
what controls Elevation and Depression?

Elevation = Inferior oblique ( Occulomotor CN III)
Depression = Superior Oblique (Trochlear CN IV)

43

In upper paralysis of the facial nerve what muscles of the face are effected?

- only contralateral muscles of the lower face (eyebrow sparing)

44

In lower paralysis of the facial nerve what muscles of the face are effected?

- ALL IPSILATERAL muscles are affected