Tract Lesions

Question 1

Sensory Ataxia

Answer 1

• loss of muscle stretch + reflexes
• procioceptive loss from extremities
• Wide based stance

Question 2

Agnosia

Answer 2

Failure to recognize limb

Question 3

Unilateral Lesion of Trigeminal Nucleus

Presentation

Answer 3

• Loss of jaw jerk reflex
• Atrophy of mastication muscles
• Loss if IL corneal reflex

Question 4

Presentation of Alternating Analgesia

Answer 4

• IL Hemianalgesia of face

- CL Hemianalgesia of body

Question 5

Alternating Trigeminal Hemianalgesia

Answer 5

• IL Anesthesia and paralysis

- CL Spastic Hemiplegia

Question 6

Brown Sequard: Cause

Tract affected?

Answer 6

Hemisection of Spinal chord

ALS
PCML
Corticospinal

Question 7

Brown-Sequard: Clinical Presentation

Answer 7

• CL loss of pain + temp: BELOW segment
• IL loss of discrminative touch: AT segment
• IL UMN signs
• IL LMN signs

Question 8

Syringomyelia: Cause

What structure relevant to the ALS tract is affected?

Answer 8

Cystic cavitation of central gray matter

Anterior white commissure

Question 9

Syringomyelia: Presentation

What if ventral horn is affected?
What if lateral tract is affected?

Answer 9

CL pain + temperature
Cape anesthesia: Bilateral loss of pain and temp

Ventral affected: LMN signs
Lateral: UMN signs

Question 10

Weber’s Syndrome: Cause

Answer 10

Midbrain lesion

Question 11

Weber’s Syndrome: Presentation

Answer 11

IL Oculomotor palsy= down and out eye
CL Hemiplegia

IF CST affected (more lateral): UMN problems
IF CBT affected (more medial): Central 7 palsy

Question 12

Central 7 Palsy Presentation

Answer 12

CL drooping of lower face

Can still wrinkle forehead

Question 13

Where is the lesion located for Central 7?

Answer 13

Above the pons, lesion to CBT

Genu of internal capsule

Question 14

Bell’s Palsy

Answer 14

IL paralysis of whole side of face

Question 15

LMN Signs (6)

What side/ what level?

Answer 15

Flaccid Paralysis
Loss of muscle function
Wasting/Atrophy
Hyporeflexia
Hypotonia
Fasiculations

IL, AT level of lesion

Question 16

UMN Signs

What side/ What level?

Answer 16

Spasticity
Babinski’s Sign
Hyperreflexia
Ridigity

Above pyramids = Contralateral
Below pyramids = Ipsilateral
Spinal cord = Ipsilateral

BELOW lesion

Question 17

Decorticate Posture

Answer 17

C . C. C.
Arms flexed
Lesion above red nucleus

Question 18

Decerebrate Posture

Answer 18

E. E. E.
Arms extended
Lesion between red nucleus and VSN

Question 19

Complete Spinal Cord Transection Presentation

Answer 19

Loss of all sensation 1-2 levels below lesion
UMN below lesion
LMN at lesion
Spinal shock

Question 20

Anterior Spinal Cord Syndrome

Answer 20

Impacts Lateral CST and ALS tracts

Question 21

Central Spinal cord syndrome

Answer 21

Due to cervical hypertension

Question 22

ALS

Answer 22

Destruction of somatic motor neurson

• Myoplastic hyperstiffness, hyperreflexia, Babinski’s (UMN signs)
• Difficulty breathing, speaking, swallowing

Question 23

Polyneuropathy

Answer 23

Damage to sensory motor + autonomic
Progress distal –> proximal
Stocking + glove anesthesia

Question 24

Dejerine Syndrome- Cause

What structures are affected?

Answer 24

Medial Medullary lesion

Hypoglossal Nucleus
Pyramids
Medial Lemniscus

Question 25

Dejerine Presentation

Answer 25

Tongue deviates away from lesion CL UE weakness + UMN signs CL loss of proprioception/ discriminative touch

Question 26

Wallenberg Presentation- Cause What structures are affected?

Answer 26

Lateral Medullary Lesion ``` ALS tract Spinal trigeminal nucleus Nucleus Ambigus Vestibular Nuclei Cerebral Peduncle ```

Question 27

Wallenberg Presentation

Answer 27

``` CL pain and temp loss of body IL pain and temp of face Hoarseness, uvula deviation Nystagmus, vertigo Ataxia ```

Question 28

Genu of Internal Capsule Lesion

Answer 28

CBT affected Uvula deviates IL Tongue deviates CL