Lesions Flashcards Preview

Neurology > Lesions > Flashcards

Flashcards in Lesions Deck (26)
Loading flashcards...
1

Bulbar palsy clinical presentation

LMN weakness of muscles supplied by cranial nerves with cell bodies within the medulla: IX, X, XII
Tounge: wasted, flaccid, fasciculating, fast movements
Dysphagia?
Soft palate elevation?
Quiet, nasal speech?
Jaw jerk/gag reflex absent?

2

Pseudobulbar palsy clinical presentation

Bilateral UMN disease of medullary cranial nerves
Tongue: stiff/spastic, slow movements, no wasting
Dysphagia?
Normal soft palate elevation
Gravelly 'donald duck' speech / slurred high pitched dysarthria
Exaggerated jaw jerk
Mood disturbances

3

Causes of bulbar palsy

Degenerative: motor neurone disease
Vascular: stroke
Inflammatory: Guillain-barre
Infective: botulism
Neoplastic: brainstem tumours
Congenital

4

Causes of pseudobulbar palsy

Degenerative: MND
Vascular: stroke
MS
Head trauma

5

Frontal cerebral hemisphere lesion presentation

Intellectual impairment, personality change
Urinary incontinence
Mono/hemiparesis
Broca's aphasia (if left frontal)

6

Left temporo-parietal cerebral hemisphere lesion presentation (dominant hemisphere)

Agraphia: inability to write
Alexia: word blindness
Acalculia: inability to calculate
Wernicke's aphasia
Contralateral sensory neglect

7

Right temporo-parietal cerebral hemisphere lesion presentation

Failure of face recognition
Contralateral sensory neglect

8

Occipital cerebral hemisphere lesion presentation

Visual field defects
Visuospatial defects

9

Lateral cerebellar lesion presentation

Ipsilateral pathological signs
Broad, ataxic gait: test heel-toe walking, +ve Rhomberg test suggests sensory (rather than cerebellar) ataxia
Titubation: rhythmic head tremor
Dysarthria: slurred, staccato speech
Nystagmus: towards the side of the lesion
Dysmetric saccades: inability to change eye focus
Upward drift (if pronator drift also present = UMN pathology also)
Rebound phenomenon
Hypotonia: decreased in pure cerebellar disease
Mild hyporeflexia
Dysmetria: imprecise coordination
Dysdiadochokinesis: clumsy rapid alternating movements

10

Cerebellar examination investigations

Full neurological exam
TFTs
Antineuronal antibodies
MRI brain

11

Midline cerebellar lesion presentation

Rolling, broad, ataxic gait
Difficulty standing/sitting unsupported
Cannot perform Rhomberg's with eyes open/closed
Vertigo/vomiting if extension into 4th ventricle

12

Causes of bilateral cerebellar dysfunction

Alcohol
Drugs: phenytoin, anti-epileptics
Paraneoplastic cerebellar degeneration: antineuronal antibodies present, common with breast/SCC of lung
Severe hypothyroidism

13

Causes of unilateral cerebellar dysfunction

MS
Stroke
Tumour: acoustic neuroma, meningioma

14

Components of the basal ganglia

Corpus striatum: caudate nucleus, globus pallidum, putamen
Subthalamic nucleus
Substantia nigra
Parts of the thalamus

15

Basal ganglia lesion presentation

Bradykinesia progressing to akinesia: slowness of movement/loss of power of voluntary movement
Muscle rigidity
Involuntary movements...
Tremor
Dystonia: spasms
Athetosis: writhing involuntary movements of hands/face/tongue
Chorea: jerky involuntary movements
Hemiballismus: violent involuntary movements, proximal muscles of one arm

16

Clinical syndromes resulting from basal ganglia pathology

Parkinsonism
Huntingtons
Hemiballismus

17

Causative lesion of a central scotoma

Macula lesion e.g. diabetic maculopathy

18

Causative lesion of monocular loss of vision

Ipsilateral optic nerve lesion

19

Causative lesion of bitemporal hemianopia/quadrantopia

Optic chiasm lesion
Affects the nasal fibres from each eye
Superior bitemporal quadrantanopia: pressure from below chiasm (e.g. pituitary tumour)
Inferior bitemporal quadrantanopia: pressure from above the chiasm (craniopharyngoma, carotid aneurysm, meningioma)

20

Causative lesion of homonymous hemianopia

Contralateral optic tract lesion

21

Causative lesion of homonymous quadrantanopia

Contralateral optic radiation lesion...
Temporal lesion: superior homonymous quadrantopias
Parietal lesion: inferior homonymous quadrantopias

PITS = parietal inferior, temporal superior

22

Causative lesion of macular sparing homonymous hemianopia/quadrantanopia

Defect in visual cortex (occipital lobe)

23

What are the symptoms of a S1 lesion?

S1- ankle plantar flexion and hip extensors
Sharp/searign pain in buttock, thigh, foot, toes
Numbness in foot or toes
Weakness in the leg and foot muscles- foot drop

24

What are the symptoms of a C5 root lesion?

C5- control the deltoids and the biveps

25

Ulnar nerve palsy

Loss of sensation in ring and little fingers
Loss of coordination of fingers
Tingling or burning sensation in hand
Loss of grip strength

26

Radial nerve palsy

Numbness from the triceps down to the fingers
Problems extending wrist or fingers
Pinching and grasping problems
Wrist drop