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Medicine II: Neurology > Localization > Flashcards

Localization Flashcards

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1
Q

What are the characteristics of a UMN lesion?

A 
weakness or sensory loss
spasticity
no atrophy
no fasiculations
brisk reflexes
\+ Babinski
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2
Q

What are the characteristics of a LMN lesion?

A 
weakness or sensory loss
\+ atrophy
\+ fasiculations
decreased reflexes
- Babinski
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3
Q

Where do UMN lesions occur?

A

cerebrum
subcortical area (white/gray matter)
brain stem
spinal cord

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4
Q

Where do LMN lesions occur?

A 
anterior horn cells (inside spinal cord)
roots
plexus
nerves
neuromuscular junction
muscle
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5
Q

What are considered long tracts?

A

corticospinal tract
dorsal column/medial lemniscus
spinothalamic tract
autonomics

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6
Q

Which tracts cross at the medulla?

A

corticospinal and posterior column

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7
Q

Where does the spinothalamic tract cross?

A

level of innvervation (spinal level)

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8
Q

What are the signs of a corticospinal tract lesion?

A

weakness, spasticity, incresed reflexes, babinski

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9
Q

What sensory aspects does the spinothalamic tract account for?

A

pain and temp

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10
Q

What sensory aspects does the posterior column account for?

A

position, vibration and fine touch

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11
Q

What are the principals of long tract localization?

A

level and lateralization

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12
Q

If there is a lesion in the brain where is the lateralization?

A

contralateral (motor and sensory)

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13
Q

If there is a lesion in the spinal cord, where is the lateralization?

A

ipsilateral: corticospinal (motor) and posterior column (sensory)
contralateral: spinothalamic (pain and temp)

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14
Q

What are the responsibilities of the frontal lobe?

A

planning and controlling voluntary movement on the contralateral side; concentration, attention, executive function, motivation, behavior

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15
Q

What are the responsibilities of the temporal lobe?

A

emotion, memory (hippocampus and amygdala)

primary auditory cortex

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16
Q

What are the responsibilities of the wernike’s area?

A

receptive language, superior dominant temporal lobe and the posterior inferior parietal lobe

meaning is assigned to written and spoke word

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17
Q

What are the responsibilities of the broca’s area?

A

expressive language, dominant frontal lobe

production of written and spoken language

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18
Q

What are the responsibilities of the frontal parietal lobe?

A

perception and interpretation of sensory info from contralateral side of the body;

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19
Q

What are the responsibilities of the occipital lobe?

A

perception of visual information

visual impulses are conducted from the eyes to primary visual cortex

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20
Q

What are the responsibilities of the subcortical area?

A

internal capsule: contralateral pure motor weakness
thalmus: contralateral hemisensory loss
basal ganglia: contralateral movement

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21
Q

What are the responsibilities of the brain stem?

A

brain stem lesions cause CN palsies ipsilateral to the lesion and contralateral motor deficits

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22
Q

Dx of a CN III lesion:

A

down and out

mydriasis- dilated pupil

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23
Q

T/F: each optic nerve contains visual information from both the right and left visual fields

A

True

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24
Q

Where to the nasal retinal fields cross?

A

chiasm

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25
What happens if there is a lesion in the cerebellum?
hemisphere lesions result in ataxia/incoordination on the same side as the lesion
26
What is the result of a vermis lesion?
drunken sailor gait
27
What happens in brown-sequard syndrome?
same side as lesion: UMN weakness, loss of position and vibration side opp lesion: loss of pain and temp
28
What happens in central cord syndrome (syringomyelia)?
lesion interupts fibers crossing to enter spinothalamic tracts and fibers mediating tendon stretch reflex. As it enlarges it affects the intermediolateral columns (autonomic function) and the lateral corticospinal tracts SEE SPINAL CORD CARDS
29
What happens if there is a lesion at the nerve root?
radiculopathy, LMN weakness and semsory loss with one myotome/dermatome
30
What are the dermatomes to remember?
C6 T4 T10 L4
31
What happens if there is a lesion at the plexus?
plexopathy, LMN weakness and numbness in one limb that spans more than one root and more than one names nerve
32
Localization of LMN lesions of upper extremities:
``` deltoid- C5 - axillary nerve biceps- C6 - musculocutaneous nerve brachoradialis- C6 - radial nerve triceps- C6 - radial nerve 1st doral interossius- T1 - ulnar nerve Abd. pollicis brevis- T1 - median nerve ```
33
What is significant about a lesion within the muscle?
proximal weakness is greater than distal, normal to decreased reflexes
34
What level does the spinal cord end?
L1-L2
35
If CN and long tract signs are on contralateral sides what do we think of?
lesion in brain stem
36
If the patient has diploplia where is the lesion?
brainstem
37
Where are the cerebellar lesion signs?
ipsilateral to the lesion
38
If there is a focal seirzue where is the lesion?
cortical
39
If there is nonfluent aphasia where is the lesion?
anterior frontal (broca)
40
If there is a fluent aphasia where is the lesion?
posterior temporal (wernike)
41
If there is focal back pain, a spinal cord sensory level, and incontinence, where is the lesion?
spinal cord
42
What type of lesion is associated with a stocking glove pattern?
peripheral nerve disease
43
What are gray matter disorders associated with?
early cog disturbances, movement disorders, seizures
44
What are white matter disorders associated with?
long tract disorders of motor, sensory, visual and cerebellar pathways
45
If the symptoms are progressive and symmetric what is the most likely cause?
metabolic or degenerative disorders
46
What does a rapid onset of a neurological complaint, occurring with in seconds or minutes usually indicate?
vascular even, seizure or migraine
47
The onset of sensory symptoms that begin in one extremity and spreads within seconds is indicative of what?
a seizure
48
What is the function of the "limbic lobe"?
includes cingulate gyrus and parahippocampal gyrus emotional response and drive behaviors
49
What is the function of the cerebellum?
timing and sequencing of voluntary muscular activity controls muscle tone, balance and equilibrium
50
What is the function of the basal ganglia?
learned motor activity, controls appropriate muscle tone fore given planned movements also important for initiating movement
51
What is the function of the brain stem?
contains nuclei for CN, sleep wake cycle, regulates consiousness, controls balance and equilibrium
52
What are the aspects of a MSE?
``` LOC attention speech and language orientation memory cognition visuospatial skills mood/personality ```
53
What can affect the MSE?
age, education and cultural background
54
What are the five levels of consciousness?
``` awake and alert lethargic or somnolent obtunded stuporous comatose ```
55
What happens if there is a lesion in the cerebrum (cortical)?
hemispheric lesions with in the crebral cortex may produce UMN weakness/paralysis and/or sensory deficits in the contralateral face, arms and legs
56
Left or right sided cortical lesion:
impaired two point discrimination, tonic deviation of eyes to side of the lesion
57
Left hemisphere lesion:
aphasia, apraxia (inability to carry ou motor commands)
58
Right hemisphere lesion:
contructional apraxia (difficulty drawing from memory or copying simple drawings), left hemisphere neglect, flattened affect
59
Occipital lobe lesion:
cortical blindness, visual agnosia; preservation of pupillary light reflexes
60
What happens if there is a lesion in the cerebrum (subcortical)?
UMN weakness or sensory loss affecting contralateral body. Often produces PURE motor or PURE sensory loss. NOT BOTH. ex: lacunar stroke
61
What happens if there is a lesion in the cerebrum (global)?
widespread, bilateral loss of cortical neurons, deficits in cognitive functioning, disorientation, alterations to consciousness and attention primative reflexes ex: AD, b12 def
62
Lesion in the cerebellum:
ataxia, intention tremor, disequilibrium, nystagmus, dysmetria
63
Lesion in the basal ganglia:
involuntary muscle movements, dystonic muscle contraction, parkinsonism
64
What is the most commonly encountered for of dystonia attributable to ?
reaction to anti-psychotic drugs (phenothiazines)
65
Lesion in the brain stem:
ipsilateral cranial nerve deficit with motor and/or sensory deficits in the contralateral trunk and extremities. paresis or paralysis in UMN pattern (hyper-reflexia, babinski) horners syndrome
66
Lesion in the spinal cord:
sensory deficit and muscle weakness (both often symetrical) below level of lesion. Sensory deficit is anterior and posterior.
67
Peripheral neuropathy:
some combination of LMN muscle weakness and sensory changes
68
Radiculopathy:
peripheral nerve injury localized to spinal nerve roots. Pain and sensory changes in the distribution of the affected nerve root (dermatomal pattern). LMN muscle weakness.
69
LMN
``` weakness atrophy fasiculations decreased reflexes decreased tone ```
70
Brainstem lesions cause cranial nerve palsies ipsilateral to lesion and contralateral motor deficits.
hint
71
one eye out
optic nerve
72
lateral aspects of eye
chiasm
73
right or left
tract
74
corner
tract
75
top or bottom
visual cortex
76
LMN affects wrinkling and smiling
fact

Medicine II: Neurology (12 decks)

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