Lecture 31, 32: Brainstem Syndromes and Lesions of the Spinal Cord Flashcards Preview

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Flashcards in Lecture 31, 32: Brainstem Syndromes and Lesions of the Spinal Cord Deck (51):
1

Motor information in brainstem is largely...

Anterior

2

Sensory information in brainstem is largely...

Posterior

3

First 3 CNs are in the...Hallmark CN of this region?

Midbrain; CN 3

4

Principle cranial nerves of pons?

CN 6, CN 7

5

Hallmark CNs of medulla

CN 9, 11, 12

6

What is special about CN5?

Stretches through the brainstem so doesn't help with localization

7

What do we mean by "Crossed Signs"

Lesion on one side presents ipsilateral on face and contralateral on body

8

One side: 3rd nerve palsy; Other side: hemiplegia. Lesion?

Lesion in midbrain corticospinal tract where III nerve emerges. Weber Syndrome.

9

One side: cannot abduct; Other side: hemiplegia. Lesion?

Lesion in anterior pons where VI nerve emerges. Raymond Syndrome.

10

One side: right facial weakness; Other side: hemiplegia. Lesion?

Lesion in lower anterior pons. Millard-Gubler Syndrome.

11

Wallenberg Syndrome (presentation, symptoms and lesion localization, note CNs affected)

Slurred speech, imbalance, numbness (pain/temperature). One side: facial numbness, depressed gag; Other side: body numbness; cerebellar ataxia; lesion in posterior medulla (affecting CN IX, X, XI and V nucleus)

12

Define dysarthria

Problem with speech mechanics/articulation, leads to slurred speech

13

Dysarthria w/ lingual quality; One side: tongue weakness; Other side: body weakness. Lesion?

Lesion in anterior medulla. Jackson Syndrome.

14

Locked-in Syndrome. What CN is spared?

Quadriplegic, aphonic, no horizontal eye movements, blinking intact; CN III spared (blinking)

15

Monoplegia

Paralysis of one limb

16

Diplegia

Paralysis of both upper or both lower limbs

17

Paraplegia

Paralysis of both lower limbs

18

Hemiplegia

Paralysis of upper limb, torso, and lower leg on one side of the body

19

Quadriplegia

Paralysis of all four limbs

20

In a spinal cord lesion, you find UMN findings where? Including...(2)

Below the lesion; Hyperreflexia and Babinski sign

21

Myelopathy

Spinal cord disease

22

Two types of myelopathies

Compressive and noncompressive

23

Compressive myelopathies include problems inside or outside the spinal cord? Give some examples (4)

Outside; Cervical spondylosis
epidural damage (neoplasm, abscess, hemorrhage); herniated disc; posttraumatic compression

24

Neurogenic bladder and two types

Overactive (spastic contraction leads to frequency and small amounts of urine) and underactive (overflow/retention)

25

What are some other autonomic disturbances of the spinal cord? (3)

Bowel, BP, sweating

26

Four types of high cervical pathology

Syrinx, chiari malformation, cordoma/meningioma, rheumatoid arthritis

27

Syringomyelia first affects, what does this cause? What happens later? What tract?

Crossing spinothalamic fibers in a segment --> cape-like sensory loss, LMN: local weakness of muscles and hyporeflexia; followed by UMN (corticospinal tract) symptoms (spaticity and hyporeflexia)

28

Syringobulbia. Serious complication?

Syringomyelia in brainstem; decompensation

29

Syringomyelia and bublia can be related to...(2)

Congenital/trauma

30

What is a complete spinal cord transection?

Transverse myelopathy

31

Transverse myelitis is usually a...describe acute/later presentation

Inflammatory disorder. Acute: spinal scock; Later: UMN

32

Spinal shock

Presents with flaccid/areflexic responses

33

Brown Sequard syndrome is...

Hemisection of the spinal cord. Ipsilateral loss of proprioception and weakness and contralateral loss of pain/temp (2 levels below); LMN signs at lesion level

34

Posterolateral column disease common cause and classic symptoms

B12 deficiency; ataxic gait, paresthesia, proprioception abnormal

35

Combined anterior horn cell and pyramidal tract disease (motor neuron disease) one liner

Progressive diffuse LMN signs with UMN dysfunction

36

Conus syndrome. What is preserved?

Bilateral saddle anesthesia (S3-S5), urinary retention and incontinence with lax anal tone, impotence; muscle strength in legs largely preserved

37

Cauda equina syndrome. What is preserved?

Severe lower back/radicular pain and asymmetric leg weakness; sacral sparing

38

Disc herniation mechanics. What posture often makes it worse? What sign elicits it? Most common surgery.

Nucleus pulposus herniates out through annulus fibrosus; sitting often makes it worse; straight leg raising; laminectomy

39

Spondylolisthesis common name and definition

Slipped disc; anterior/posterior displacement of a vertebrae

40

Spinal stenosis common location, effect, and causes (broadly, 3)

Lumbar spine; claudication of cauda equnia causing lower back pain that gets worse while walking (blood supply to cauda equina is compressed --> legs steal blood); congenital, degenerative, trauma

41

Acute viral myelitis causes...

Transverse myelitis

42

Tabes dorsalis. Sign? Symptoms?

Form of tertiary neurosyphilis in which the nerves of the dorsal (or posterior) columns degenerate; Romberg; shooting pain in legs and loss of sense of position, vibration, and discriminative touch

43

What is the most common pathogen that causes epidural abscess? Where does the infection usually originate?

Staphylococcus; skin/soft tissue

44

Three primary spinal tumor locations, which is most common?

Extradural/epidural = most common (b/t meninges and spine bones); intradural extramedullary (within meninges); intramedullary (inside the cord)

45

Extradural tumor usually arise from...Clinical course

Bone; quick decompensation (some low back pain, then sudden paralysis = medical emergency)

46

Intradural extramedullary tumors include which two tumor types...Common?

Meningioma, schwannoma; no, rare

47

Traumatic spinal cord disease preferentially affects...

Males >30 years old

48

Hangman's fracture

Spondylolisthesis where C2 vertebrae is displaced anteriorly to C3 due to C2 pedicle fracture --> DEATH due to vessel/airway obstruction (why you DON'T move someone with a possible spinal cord injury)

49

Central cord syndrome and individuals typically affected. Looks like?

Spinal cord damages starts centrally, involves spinothalamic tract initially (thermo/pain); edlerly; syringomylia

50

What does anterior spinal artery infarct look like? What is spared?

Weakness (CST) and pain/temperature loss (spinothalamic tracts); posterior columns still working

51

What is a spinal cord arteriovenous malformation (AVM)? When do they cause problems?

Tortuous/malformation arterial or venous problem (or aneurysm) that can lead to spontaneous bleeding, which can cause acute problems.

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