Tract Lesions

Question 1

Effects of a lesion in the brain or spinal cord on the spinothalamic tract

Answer 1

Pain and temperature loss on the contralateral side

Question 2

Effects of a lesion in the first order neuron on the dorsal column medial lemniscus tract

Answer 2

Ipsilateral loss of touch, vibration and conscious proprioception

Question 3

Lesion in second or third neuron on the dorsal column medial lemniscus tract

Answer 3

Contralateral loss of touch, vibration and conscious proprioception

Question 4

Lesion in trigeminal thalamic tract

Answer 4

Contralateral losses of pain, temperature, touch, vibration and proprioception

Question 5

Lesion in spinocerebellar tract

Answer 5

Ipsilateral loss of non-conscious proprioception

Question 6

Which order neurons would be affected for contralateral loss of pain and temperature

Answer 6

2nd and 3rd order neurons of spinothalamic tract

Question 7

Corticospinal lesion effects when it is above the medulla level

Answer 7

contralateral hemiplegia and hemiparesis

Question 8

Corticospinal lesion effects when it is below medulla level

Answer 8

Ipsilateral hemiplegia and hemiparesis

Question 9

Effects of an UMN lesion in the corticobulbar tract

Answer 9

Pseudobulbar palsy for all nuclei bilaterally innervated. Deficits for nerves with single innervation and facial nerve has contralateral lower facial paralysis

Question 10

Signs of lower motor neuron lesion

Answer 10

Hypotonia, areflexia, hypotenoa, atonia, flaccid muscle or paralysis, fasciculations, muscle atrophy

Question 11

Signs of upper motor neuron lesion

Answer 11

Hypertonia, hyperreflexia, spasticity, positive babinski sign, clonus

Question 12

Features of Horner’s syndrome

Answer 12

Ptosis, meiosis, anhydrosis

Question 13

Causes of Horner’s syndrome

Answer 13

Interuption to sympathetic nerve supply, pancoast tumour, stroke and carotid artery dissection

Question 14

What is pseudobulbar palsy

Answer 14

Bilateral lesion affecting corticobulbar tracts - UMN lesion of speech and swallow as bilateral cortical respresentation

Question 15

Anatomy effected in pseudobulbar palsy

Answer 15

Motor cortex to motor nuclei of CN9, 10 and 12 in medulla

Question 16

Features of pseudobulbar palsy

Answer 16

Spastic tongue, slow thick ‘hot potato’ speech, brisk jaw jerk reflex, emotional lability, other UMN features in limbs possible

Question 17

Causes of pseudobulbar palsy

Answer 17

Vascular such as internal capsule stroke. degenerative such as MNS, supranuclear palsy. Degenerative such as upper brainstem tumours, autoimmune such as MS. Traumatic

Question 18

What is bulbar palsy

Answer 18

LMN lesion affecting cranial nerves 9, 10 and 12

Question 19

Features of bulbar palsy

Answer 19

Impaired speech and swallowing, absent/normal jaw jerk reflex, absent gag reflex, flaccid fascicularing tongue, quiet nasal speech and signs suggesting cause

Question 20

Causes of bulbar palsy

Answer 20

Motor neuron disease, myasthenia gravis, GB syndrome, brainstem stroke such as lateral medullary syndrome and syringobulba

Question 21

What is brown sequard syndrome

Answer 21

Anatomical disruption of nerve fibre tract in 1/2 spinal cord

Question 22

Causes of brown sequard syndrome

Answer 22

Cord trauma, neoplasms, disc herniation, demyelination, infective or inflammatory lesion, epidural haematomas

Question 23

Tracts affected in brown sequard syndrome

Answer 23

Disruption of descending lateral corticospinal, ascending dorsal column and ascending spinothalamic

Question 24

Symptoms of brown sequard syndrome

Answer 24

Ipsilateral hemiplegia, loss of proprioception and vibration, contralateral loss of pain and temperature sensation

Question 25

Management of brown sequrd syndrome

Answer 25

Depends on cause

Question 26

What is Bells palsy

Answer 26

Idiopathic syndrome affecting facial nerve

Question 27

Symptoms of bells palsy

Answer 27

Acute onset of unilateral LMN focal weakness, sparing extraocular movements and muscles of mastication. Mild-moderate post auricular otalgia, altered taste, dry eye, dry mouth, hyperacusis

Question 28

Treatment of bells palsy

Answer 28

Oral steroids, 50ng OM for 10 days followed by taper. Management of dry eyes ect

Question 29

Differential of Bells palsy

Answer 29

Ramsay Hunt syndrome

Question 30

Causes of spinal cord pathology

Answer 30

Compression, herniated disc, tumour, abscess, haematoma, malformations, infections and infarctions

Question 31

Possible effects of C5 lesion

Answer 31

Resp paralysis and quadraplegia

Question 32

Possible effects of a C5-6 lesion

Answer 32

Paralysis of legs and hands, weakness of upper limb movements, loss of biceps jerk and brachioradialisis deep tendon reflexes

Question 33

Possible effects of a C6-7 lesion

Answer 33

Paralysisof legs, wrists and hands, but shoulder and elbow flexion possible

Question 34

Feature of spastic hemiparesis

Answer 34

Unilateral spastic hypertonia, hyperreflexia, ankle clonus, upgoing plantars. Pyramidal patterns of weakness, circumduction of affected limb on gait

Question 35

Peripheral causes of spastic hemiparesis

Answer 35

Lesion in hemicord such as MS, and cord compression

Question 36

Central causes of spastic hemiparesis

Answer 36

Lesion in contralateral cerebral hemisphere - MS, SOL, stroke or hemiplegic cerebral palsy

Question 37

Features of spastic paraparesis

Answer 37

Lower limb spastic hypertonia, ankle conus, pyramidal weakness, hyperreflexia and upgoing plantars, scissoring gait

Question 38

What can cause paralysis and Horner’s syndrome

Answer 38

Possible effects of C8-T1 lesion

Question 39

What lesion can cause paralysis of legs

Answer 39

Possible effects of T1 and below lesion

Question 40

Causes of Spinal cord compression

Answer 40

Trauma, neoplasia, disk prolapse, epidural haematoma, infection and spondylosis

Question 41

Features of spinal cord compression

Answer 41

Acute UMN signs and sensory disturbance below lesion. Deep and localised pain often present along with stabbing radicular sensory disturbance at lesion level. Bladder/bowel control involved often