Lesson 24

Question 1

Types of cranial nerve lesions

Answer 1

Isolated: Trigeminal neuralgia, dependent muscle paralysis

Coordinated: Oculomotor alterations (III and VI)

Question 2

Trochlear nerve

Answer 2

Diplopia when reading and going down stairs

Question 3

Facial nerve

Answer 3

Peripheral facial paralysis

Question 4

Vagus nerve

Answer 4

Alteration of the veil of the palate

Question 5

Accessory nerve

Answer 5

Difficulty in head rotation

Question 6

CN I exploration

Answer 6

Explore with pleasant and unpleasant odoriferous substances that are not irritating to not cause damage to the patient.

Question 7

CN II exploration

Answer 7

Visual acuity assessment

Question 8

CN III exploration

Answer 8

Pupils: symmetry, size, shape, reactivity.

Extrinsic ocular moticility

Question 9

CN I signs of injury

Answer 9

• Anosmia, dysosmia,
• Hyposmia, hyperosmia.
• Meningiomas of the ophthalmic sulcus - Rupture or the cribriform plate from head trauma

Actually many surgeons lose capacity to smell because every day you smell the worst things in the world and putting chemicals like mints in the nose to stop smelling, overstimulating the nerve. All the senses in the body have to go through the thalamus.

Question 10

CN II signs of injury

Answer 10

Blindness and decreased visual acuity

Question 11

CN III signs of injury

Answer 11

Ptosis in resting eye deviated outward and downward.

Midriais (pupular dilation) if it’s parasympathetic fibers are injured

Question 12

CN IV signs of injury

Answer 12

Eye at rest deviated outward and
upward. Produces vertical diplopia
that increases when looking down,
reading, or going down stair

Question 13

CN IV exploration

Answer 13

Extrinsic ocular motility (superior
oblique)

Question 14

CN V exploration

Answer 14

Sensory: three branches (sensitivity of
the face) Corneal reflex. Motor:
temporal masseters and pterygoids
(chewing and lateralization of the jaw)

Question 15

CN V signs of injury

Answer 15

Facial hypoalgesia and weakness of
the corresponding muscles

Question 16

CN VI exploration

Answer 16

Extrinsic Ocular Motility (external
rectus)

Question 17

CN VII exploration

Answer 17

Motility of the facial muscles

Question 18

CNVII signs of injury

Answer 18

Central or peripheral

Question 19

CNVIII exploration

Answer 19

Cochlear and vestibular
function is assessed

Question 20

CNVIII signs of injury

Answer 20

Hearing loss (auditory nevus
injury). Vertigo (vestibular
injury)

Question 21

CNIX and X exploration

Answer 21

They are explored together,
assessing the sensitivity and
motility of the soft palate.
Nausea reflex

Question 22

CNIX and X signs of injury

Answer 22

Deviation of the uvula and
palate to the injured side

Question 23

CN XI exploration

Answer 23

Sternocleidomastoid and
upper trapezius

Question 24

CN XI signs of injury

Answer 24

Parasia of the involved
muscles

Question 25

CN XII exploration

Answer 25

Tongue motility

Question 26

CN XII signs of injury

Answer 26

Tip deviation to the injured side

Question 27

Concept of symptoms of the spinal cord

Answer 27

A spinal cord injury is characterized by the involvement of the nerve elements of the spinal cord. Common causes are: Penetrating wounds, trauma, fractures, bruises

Question 28

Complete spinal cord injury

Answer 28

The nerves below the point of injury cannot communicate at all with the brain anymore. Leads to paralysis below the location of the injury. This type of lesion show two different phases: * Medullar shock phase * Medullar automatism phase

Question 29

Medullar shock phase and medullary

Question 30

Brown-Sequard syndrome

Answer 30

A lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side This type of injury leads to: * Loss of voluntary motor control on the same side as the spinal cord injury. * Loss of the sensation of proprioception on the same side of the injury. * Abolition of pain and temperature sensations on the opposite side (because the lateral spinothalamic fibers cross in front of the ependymal duct)

Question 31

Anterior cord syndrome

Answer 31

Involves complete motor paralysis and loss of temperature and pain perception distal to the lesion. * This syndrome is caused by compression of the anterior spinal artery This syndrome implies: - Complete motor paralysis, - Complete loss of temperature and pain perception distal to the lesion, - Since posterior columns are spared, light touch, vibration, and proprioceptive input are preserved.

Question 32

Posterior cord syndrome

Answer 32

Caused by lesions on the posterior portion of the spinal cord, related with sensory tracts because of an infarct in the posterior spinal artery

Question 33

Combined posterior column and corticospinal tract syndrome

Answer 33

It affects long and myelinated nerve tracts like pyramidal tract and posterior cords leading to motor and sensitive alterations

Question 34

SYNDROMES DUE TO ALTERATIONS OF THE BASAL GANGLIA 35 Classification

Answer 34

Alterations of the basal ganglia may produce syndromes due to a deficit or an excess in movement. HYPO KINETIC SYNDROMES * Parkinson’s disease HYPERKINETIC SYNDROMES * Chorea * Hemibalism * Dystonia * Athetosis * Myoclonus

Question 35

Parkinson’s disease

Answer 35

It is the prototype of hypokinetic and hypertonic syndrome The cortico-basal ganglia-thalamo-cortical loop in Parkinson’s disease: - Lack of dopamine levels. - Hypofunction of excitatory pathway. - Hyperfunction of inhibitory pathway.

Question 36

Parkinsonism: causes

Answer 36

Parkinson’ s disease Antidopamine rgic drugs Postencephalit is Toxics

Question 37

Parkinsonism: symptoms

Answer 37

Bradykinesia Slow and insufficient voluntary movements Absent involuntary movements (facial inexpression) Tremor Resting tremor Distal tremor of inferior limbs Rigidity Sustained (lead pipe) rigidity Intermittent (cogwheel) rigidity

Question 38

Parkinsonism: clinical features Non-motor

Answer 38

· Depression · Dementia · Autonomic

Question 39

Characteristics of the patient with Parkinson’s:

Answer 39

* Head and trunk tilted forward. * Holding hands. * Holiday-type march. * Facies completely expressionless, fixed and impassive. * Weak and monotonous oral language. * Clumsy writing

Question 40

Hyperkinetic syndromes

Answer 40

* Hyperkinetic disorders are characterized by excessive motor activity, with involuntary movements that worsen with anxiety and emotional tension, but disappear with sleep. * They are due to a dysfunction of the movement inhibitory pathway, which leads to the situation of hyperkinesia.

Question 41

Chorea

Answer 41

* It is an abnormal involuntary movement disorder,(a kind of dyskinesias). * The term chorea is derived from a greek word meaning dance, due to the quick movements of the feet or hands which are comparable to dancing.

Question 42

Hemiballism

Answer 42

* It is a unilateral form of a very rare movement movement disorder. * It is a type of chorea caused in most cases by a decrease in activity of the subthalamic nucleus of the basal ganglia, resulting in the appearance of flailing, ballistic, undesired movements of the limbs. * It is usually associated with stroke in the contralateral side.

Question 43

Athetosis

Answer 43

* It is a movement dysfunction characterized by involuntary writhing movements. * These movements may be continuous, slow, and rolling. * They may also make maintaining a symmetrical and stable posture difficult. * They are associated with perinatal troubles (hypoxia, trauma).

Question 44

Dystonia

Answer 44

* It is a movement disorder in which a person's muscles contract uncontrollably. * The contraction causes the affected body part to twist involuntarily, resulting in repetitive movements or abnormal postures. * It can affect one muscle, a muscle group, or the entire body

Question 45

Tremor

Answer 45

* It is an unintentional and uncontrollable rhythmic movement of one part or one limb of the body. * It can occur in any part of the body and at any time. * It is usually the result of a problem in the part of the brain that controls muscular movement. RESTING TREMOR Parkinson’s disease ACTION TREMOR Cerebellar lesions POSTURAL TREMOR When holding a position against gravity

Question 46

Myoclonus

Answer 46

It is the sudden, involuntary jerking of a muscle or group of muscles. * Myoclonic twitches or jerks usually are caused by sudden muscle contractions, called positive myoclonus, or by muscle relaxation, called negative myoclonus

Question 47

Nervous tic

Answer 47

There are two types, motor tics and vocal tics. * These short-lasting sudden movements (motor tics) or uttered sounds (vocal tics) occur suddenly during what is otherwise normal behavior. * Tics are often repetitive, with numerous successive occurrences of the same action.

Question 48

Akathisia

Answer 48

It is a movement disorder that makes it hard for the patient to stay still. * It causes an urge to move that cannot be controlled