Flashcards in Lesions Deck (26)
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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
