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Neuroanatomy Lab > Clinical correlations - Notes (all sections) > Flashcards

Clinical correlations - Notes (all sections) Flashcards

1
Q

Damage to dorsal and ventral cochlear nuclei sx

A

deafness in ipsilateral ear

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2
Q

deafness in ipsilateral ear

A

X dorsal and ventral cochlear nuclei in medulla X auditory portion of CN 8

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3
Q

damage to vestibular nuclei (in medulla)

A

nystagmus, vertigo, problems with balance

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4
Q

loss of gag reflex on the affected side

A

CN 9 X

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5
Q

CN 10 damage sx

A
  1. hoarseness due to loss of control of larynx
  2. problems swallowing
  3. asymmetry of soft palate
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6
Q

Why is bilateral loss of CN 10 devastating?

A

choking (nucleus ambiguus) loss of parasymp. control to the heart and gastrointestinal tract (nucleus ambiguus and dorsal motor nucleus of CN 10).

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7
Q

CN 11 damage sx

A
  1. inability to elevate ipsilateral shoulder 2. difficulty to turn head 3. fasciulation and atrophy of sternomast. and trapezius
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8
Q

CN 12 damage sx

A
  1. deviation of tongue towards side of weakness 2. paralysis of ipsilateral tongue muscles 3. fasciulations and atrophy of tongue muscles ipsilaterally
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9
Q

Loss of discrete somesthetic infromation on same side of the lesion

A

damage to both the DORSAL FUNICULUS and DORSAL PART OF LATERAL FUNCIULUS

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10
Q

Before they cross, axons of the anterolateral system usually pass through the ____

A

lissauer’s tract

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11
Q

Axons of the anteriolateral system cross in the _____

A

anterior white commisure

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12
Q

dissociated sensory loss is a symptom of dmaage to the ____

A

spinal cord pain and temp is on one side, fien touch, vibration, and joint position on another

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13
Q

damage to this pathway anywhere at its length can cause horners syndrome

A

hypothalmoreticulospinal pathway

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14
Q

termination of the hypothalmoreticulospinal pathway

A

interomediolateral cell column

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15
Q

cause of flaccid muscle, hypothonia, hyporeflexic, fascuulations

A

lesion of peripheral nerve, or early UMN X

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16
Q

UMN injury involves damage to the

A

brains descending motor pathways

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17
Q

what can happen early with UMN injury?

A

flaccid paralysis, then become hyperreflic and hyerptonic (spastic paralysis)

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18
Q

positive bainksi response is seen with

A

UMN injury

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19
Q

The Babinski response (positive Babinski reflex) is seen again with ____ tract damage

A

corticospinal, since the corticospinal tract is no longer surpressing spinal reflex

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20
Q

Pinealoma sx?

A
  • Problems sleeping - Tinnitis (? X inferior olive) - Papilledemia (hydrocephalus by blocking the cerebral aqueduct)
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21
Q

ddK is _____ injury

A

lateral cerebellar

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22
Q

nystagmus, balance problems, wide based gait can be explained by ____ injuey

A

medial cerebellar injury

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23
Q

intention tremor is ____ injury

A

lateral cerebellar

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24
Q

pupillary light reflex is mediated by ____ areas

A

pretectal areas

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25
Q

upward gaze requires an intact _____

A

posterior commisure

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26
Q

what can cause loss of pupillary light reflex and loss of accommodation reflexes?

A

loss of both pretectal regions

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27
Q

pupillary light reflex requires damage to

A

both prectatal regions or damage to LMN occulomotor nerve

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28
Q

deafness in one ear

A

CN VIII peripherally meaning medulla

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29
Q

completel paralysis of the face

A

LMN CN 7 meaning pons

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30
Q

internal strabismus

A

LMN CN 6 meaning pons

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31
Q

External strabismus

A

LMN CN 6 meaning pons

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32
Q

You should never shift a dx ____ to accomodate additional reported sx.

A

caudally (down) — (so X usually is at the level of the highest sx)

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33
Q

If sx are in the head, this usually rules out ____

A

spinal cord injury EXCEPT with horners

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34
Q

If symptoms persist overtime and are unilateral it is likely caused by a ____

A

tumor

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35
Q

Diseases or tumors are usually bilateral?

A

disease

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36
Q

If the lesion is in the spinal cord, then what can be said about all sensory and motor sx?

A

they are on the same side as the X, except with pain and temperature

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37
Q

If lesion is in the brainstem, the lesion is on the SAME side as the ____

A

highest symptom; lower sx will be on the opposite side

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38
Q

if the X is in the FOREBRAIN, all sensory and motor sx are on the ____ of the body as the X.

A

OPPOSITE… except for olfactory

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39
Q

if the X is in the FOREBRAIN, all sensory and motor sx are on the ____ of the body as the X.

A

SAME

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40
Q

X to the ___ can cause prosposagnosia

A

inferior temporal lobe

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41
Q

bilateral X to parahippocampal gyrus and uncus can lead to?

A

amnesia

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42
Q

bilateral X to heschl’s gyrus would produce

A

inability to understand spoken language

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43
Q

unilateral X to hescls gyrus would produce

A

little sx

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44
Q

what could cause inaiblity to understand spoken lanauged?

A

bilateral X to heschls gyrus OR left auditory cortex and corpus callosum X

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45
Q

lesion in the optic chiasm causes?

A

a loss of vision in the temporal half of both visual fields: bitemporal hemianopsia

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46
Q

what does X in optic nerve cause?

A

loss of vision in affected eye, loss of pupillary reflex

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47
Q

what does X in the optic tract cause?

A

A lesion of the right optic tract causes a complete loss of vision in the left hemifield: contralateral “homonymous” hemianopsia.

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48
Q

what sx to X of the precentral gryus?

A

paresis (weakness) and movement deficits on the OPPOSITE side of the body

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49
Q

what are sx to X of the postcentral gyrus?

A

somatic sensory deficits (e.g. loss of touch, limb position) on the OPPOSITE side of the body.

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50
Q

X to the superior and middle frontal gyri?

A

premtoor area; forms of apraxia, if in dominant hemisphere the ability to write is impaired

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51
Q

X to the superior parietal lobule causes what sx?

A

it is controlled with guiding movement sx are apraxia, inability to bring object under control of movement

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52
Q

X to the inferior parietal lobule can cause ___

A

the inability to read (since angualr gyrus is the gateway for visual info to reach wernickes)

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53
Q

X to the inferior frontal gyrus

A

contians brocas area, leads to the inability to generate fluent speech

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54
Q

how to test for CN 4 palsy?

A

have pt look nasal, if he cannot look down he may have trochlear nerve palsy. may also have double vision in nasal position.

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55
Q

unilateral LMN CN 7 X symptoms

A

motor deficits in half the face on the affected side

56
Q

lesions to what notably impact the ability to write

A

superior and middle frontal lobes (premotor areas)

57
Q

What supplies blood to brocas area?

A

MCA

58
Q

What supplies blood to the areas of the temporal lobe involved in memory?

A

PCA

59
Q

What supplies blood to the leg and foot areas of primary motor and primary somatosensory?

A

aca

60
Q

what supplies blood to the primary visual cortex

A

PCA

61
Q

cause of socotomas

A

X in the occipital lobe (in half of the visual field contralateral to vision)

62
Q

sx of occipital lobe X

A

scotoma (blind spots) in half of the visual field opposite the lesions

63
Q

pt gets lost in his own home, displays neglect to one half of his body

A

inferior parietal lobule

64
Q

deep, compulsive repretitive behaviors may be due to damage to the

A

prefrontal cortex, often seen with personality changes

65
Q

wallenbergs syndrome is seen with ___ occulusion

A

PICA

66
Q

sx with PICA occulsion

A

Wallenburg’s syndrome: vertigo, loss of balance, ipsilateral “cerebellar signs”, loss of facial pain sensation, hoarseness

67
Q

sx with Basilar branch occulusion

A

paralysis and loss of sensation in the face, body and limbs; can also affect eye movements and cause diplopia

68
Q

sx with AICA occulusion

A

ipsilateral cerebellar signs, facial paralysis, ipsilateral hearing loss, loss of pain and temp over face ispilaterally

69
Q

what occuluded vessels can you see ispilateral cerebellar signs?

A

aica, pica, superior cerebellar

70
Q

sx with superior cerebellar stroke

A

ipsilateral cerebellar signs, contralateral pain and temperature loss, Horner’s

71
Q

what sx with unilateral PCA stroke

A

blindness in the visual field OPPOSITE to the affected side, alexia (left side).

72
Q

what sx with bilateral pca stroke

A

if bilatera,l as with “top of the basilar” occlusion: bilateral blindness, memory loss, somatosensory loss, coma & death

73
Q

sx with posterior communicating stroke

A

contralateral paresis, coma & death

74
Q

sx with aca stroke

A

contralateral paralysis and sensory loss in leg and foot; sometimes, apraxia

75
Q

sx with MCA stroke

A

contralateral apralysis and sensory loss apraxia aphasia partial blindness

76
Q

rigidity signals ___ damage

A

basal gang.

77
Q

what is akinesia? what damage does it signify?

A

difficulty initiating movement

78
Q

signs of increase intercranial presure

A
  • retinal vessels of optic nerve enorged – optic nerve becomes DILATED (papilledema) - headache -nausea vomitting cognitive impariment LOC
79
Q

with increase intercranil pressure FRONTAL LOBE FUNCTION is often compromised causing

A

unsteady gait where the foot barely leaves the floor (magnetic gait) incontinence

80
Q

In multiple sclerosis, the ____ content of CSF is disproportionately increased

A

gamma globulin (protein)

81
Q

what do X of the posterior limb cause?

A

dramatic symptoms of sensory loss and paralysis.

82
Q

what does loss of epicritic sense entail?

A

loss of 1. sterogenesis (cant recognize tactile shapes in hand) 2. position sense - can lead to shuffling gait, reaching inaccuracies 3. loss of vibration - insesntive to high frequency stimulation 4. simpe touch intact but sensitivity decreased

83
Q

what deep white matter tract connects brocas, wernickes, and the auditory cortex

A

superior longitudinal fasiculus

84
Q

____ interconnects orbital frontal cortex-based reward and punishment centers with temporal lobe-based memory representations.

A

uncinate fasciculus

85
Q

damage to the posterior comissure could lead to problems with

A

pupillary light reflex and upward gaze

86
Q

same side loss of protopathic can be seen with X to ___

A

ALS 1. dorsal root axons 2. lissaeurs tract or dorsolateral fasciulus 3. dorsal horn

87
Q

opposite side loss of protopathic can be seen with X to ___

A

ALS - 1. anterolateral tract in spinal cord 2. ALS synapsing in the brainstem 3. VPL, DM, intalaminar in thalamus 4. post central gyrus

88
Q

loss of protopathic sx include

A

Reduced pain Reduced sense of warming or cooling skin Simple touch intact but reduced in sensitivity

89
Q

positive babinksi indicates ___ sign

A

UMN

90
Q

no muscle atrophy indicates UMN or LMN sign?

A

UMN

91
Q

dorsal peripheral nerve damage causes

A

loss of sensation and then weakne mvoement then atrophy and fasciulations as the muscle are dying

92
Q

Weakness or outright paralysis cof central descending tracts will cause

A

first hypotonia (sudden loss of descending connections) then hypertonia

93
Q

LMN weakness is weakness of the

A

peripheral motor nerve

94
Q

UMNC weaknes is weakness of the

A

central motor pathways

95
Q

the entire ipsilateral face is paralyzed with

A

LMN facial nerve damage (to nuclei or nerve)

96
Q

UMN damage to facial nerve will cause

A

lower quadarant to be damaged on the opposite side

97
Q

UMN damage of CN 7 includes damage to the

A

forebrain, corticobulbar tract damage rostral to the pons

98
Q

when the motor cortex or cingulate area is damaged, or the cortico-bulbar pathway on one side of the brain is damaged rostral to the facial nucleus, the remaining____ axons can compensate so little deficit is noted.

A

cortico-bulbar

99
Q

Ipislateral loss of epicritic sense can occur from X of the

A

Dorsal column/lemniscal sys.

  1. dorsal root axons
  2. gracile or cuneate fasiculus (spinal cord)
  3. gracile or cuneate nuceli (medulla)
100
Q

Contralateral loss of epicritic sense can occur from X of the

A
  1. medial lemniscus going up the medulla, pons, midbrain to thalamus
  2. VPL in thalamus
  3. post central gyrus
101
Q

what does loss of epicritic sense include?

A

loss of

  1. sterogenesis (cant recognize tactile shapes in hand)
  2. position sense - can lead to shuffling gait, reaching inaccuracies
  3. loss of vibration - insesntive to high frequency stimulation
  4. simpe touch intact but sensitivity decreased
102
Q

why is EPICRITIC information coming into the spinal cord suspectible to injury?

A

it comes in as large diameter dorsal root axons – vulnerable to insult from ischemia, toxicity, bacteria, etc

so: early sx of peripheral nerve disease shows as epicritic

103
Q

ipsilateral loss of protopathic informaiton is seen witn

A

ALS

  1. dorsal root axons
  2. lissaeurs tract or dorsolateral fasciulus
  3. dorsal horn
104
Q

spinocerebellar carries ___ information from the ___

A

proprioceptive (muscle and joint position) from the trunk and limbs

105
Q

ipislateral loss of propathic from head and neck

caused by X of

A
  1. spinal tract of CN 5

  1. spinal n. of 5 in the medull
106
Q

contralateral loss of propathic from head and neck

caused by X of

A
  1. after the spinal nulceus in the medulla (where it crosses) so a pons or midbrain region
  2. in the vpm
107
Q

loss of proprocpetive from face on the same side can be due to

A

X trigmeminal nerve

X mescephalic nucleus of 5

X menscephalic tract of CN 5

X motor n. of 5 in the pons

X cerebellum

108
Q

loss of chewing on the same side can be caused by

A

X motor n. of 5 in the pons

X trigeminal nerve

109
Q

corticobulblar controls hypoglossal cranial nerve ncueli mostly

A

contralaterally

110
Q

corticobulblar controls facial cranial nerve ncueli mostly

A

both

111
Q

The bilateral projections from the surviving CB can sustain considerable movement on both sides of the patient

Usually only the___ and ___ are affected by a unilateral CB lesion

A

tongue and face (CN 7)

112
Q

damage to the corticospinal in the brainstem therefore impairs movement mainly on the ____ side of the body.

A

opposite

since mostly lateral corticopsinal which crosses and the pyrmida decessations

113
Q

unilateral patholgoy of the corticobulbar tract sx

A

will weaken movement of the head and neck opposite of the X

does not significantly weakend since most cn actually get bilateral input from CB

114
Q

damage to lateralc orticiospinal tract occurs with

A

X to the tract below the pyramids decussations in the medulla

115
Q

In the few surgical case studies of isolated CS damage (lesion of the medullary pyramid), the sx were

A

modest: temporary weakness, permanent Babinski’s sign, and permanent loss of independent finger movements.

mostly the pyramidal tracts are damaged with the brainstem tracts so sx area outright pralysis

116
Q

Frontal lobe lesions often cause ___

A

severe paralysis because the precentral (motor) and premotor areas of cortex contribute to both direct and indirect motor pathways

117
Q

damage to a Brainstem-spinal pathways at the level of the medulla wiill cause

A

problems with movement on the opposite side of the body

118
Q

damage to a Brainstem-spinal pathways at the level of the spinal caord wiill cause

A

problems with mvoement on the same side of the body

119
Q

damage to the temporal lobe could damage ___ visual field

A

upper visual field

120
Q

Consequently damage to the parietal lobe or superior bank of visual cortex can result in scotomas in the _____ visual field.

A

lower

121
Q

loss of endinger westphalnucleus will lead to a

A

dilated pupil that fails to constrict to light

122
Q

if pt has hearing loss in one ear it must be to

A

CN 8 or cochlear nuclei

123
Q

what lesions could results in an inability to understand spoken language

A

X hescls gyrus in both hemispheres, damage to the left auditory cortex, damage to corpus callosum (since heschls on right and left communicate through this)

124
Q

damage to optic nerve – effect on pullairy light reflex

+ light in pislateral eye

A

Damaged optic nerve – light in ipsilateral eye =
NO direct, NO consensual

125
Q

damage to optic nerve – effect on pullairy light reflex

+ light in contralateral eye

A

Both direct and consensual INTACT

126
Q

damage to occulomotor nerve/EW nucelus

+ light in ipsilateral eye effects

A

= NO direct, but the consensual is INTACT

127
Q

Damaged oculomotor nerve /EW nucleus

+ light in contralateral eye =

A

Direct INTACT, NO consensual

128
Q

Damage to medial midbrain (ie. Bilateral Pretectal nuclei and/or both EW nuclei)

A

NO direct, NO consensual

129
Q

C

input?

what does damage to this cause?

A

inferior cerebellar peduncle

receives input from opposite infeiror olive nulcei in medulla

often seen with PCA stroke. damage causes

  1. ataxia
  2. intention tremor to the ipsilateral side of the body
  3. lean towards side of the lesion
  4. clumsiness of ipsilateral hand
130
Q

Damage to the _____ medulla rostral to the pyramidal decussation will result in motor loss on the OPPOSITE side of the body.

A

ventral

131
Q
A
132
Q

damage to the corticobulbar tracts will have ____ effects on cranial nerves

A

contralateral * except for hypoglossal

The bulk of cortibobulbar axons control cranial nerve nuclei on opposite side the origin of these axons in the cortex

133
Q

ROmberg’s sign

what is it

what causes it

A

loss of balance more proncounced when patients eyes are closed

seen with vestibular nuclei damage in the pons

134
Q

X facial nucelus in the pons

A
  1. paralysis of ipsilateral facial muscles
  2. drying of cornea due to loss of parasymps of lacrimal
  3. loss of corneal reflex
  4. painful sensitivity to sound due to weakness of stapedius
135
Q

lesions to corticobulbar axons projecting to the facial nucleus

A

contralateral facial paralysis below the forehead

Neuroanatomy Lab (36 decks)

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