Exam #3: Lesions III

Question 1

What are the four general functions of the basal ganglia?

Answer 1

1) Inhibiting involuntary movement at rest
2) Disinhibiting voluntary movement
3) Accelerating voluntary movements
4) Stopping movements upon completion

Question 2

Once you have identified that there is a basal ganglia deficit, accompanied by behaviroal deficit, what structure is implicated?

Answer 2

Head of the caudate

Question 3

What are the MRI signs of Huntington’s Disease?

Answer 3

• Atrophy of the Head of the Caudate with enlarged lateral ventricles
• Loss of corticostriatal fibers that leads to cortical atrophy

Question 4

What is the name for the pathognmenoic presentation of Huntington’s Disease?

Answer 4

Chorea

• ***Note that patients also have:
• Dystonia
• Torticolis
• Blepharospasm
• Athetosis
• Hemiballismus

Question 5

What is dystonia?

Answer 5

Constant contraction of a muscle

Question 6

What is Torticolis?

Answer 6

“Twisted neck”

Question 7

What is a blepharospasm?

Answer 7

Involuntary blinking and holding of the eyes shut

Question 8

What type of tremor is seen in PD?

Answer 8

“pill-rolling”

Question 9

What are the characteristics of PD?

Answer 9

• Pill-rolling tremor
• Difficulty initiating movement
• Reptilian stare–lack of blinking

Question 10

What is the general sequence of structures in the basal ganglia?

Answer 10

Cortex
Striatum
Pallidum
Thalamus

Question 11

What is a surgical intervention for PD?

Answer 11

Pallidotomy

Question 12

What are the major functions of the cerebellum?

Answer 12

1) Integration of equilibrium & locomotion
2) Integration of head & eye movements (MLF)
3) Coordinating voluntary movements

Question 13

What tract sends cortical information to the cerebellum (via the pons)?

Answer 13

Corticopontocerebellar pathway

Question 14

What pathway runs from the cerebellum to the cortex?

Answer 14

Dentorubrothalamic tract

Question 15

What are the tracts that make adjustments to ongoing movements?

Answer 15

Vestibulospinal

Rubrospinal

Question 16

What type of deficits are seen in cerebellar lesions?

Answer 16

IPSILATERAL deficits

Question 17

Where does the corticopontocerebellar tract cross-over?

Answer 17

Pons

Question 18

If you lesion the cerebellum directly in the midline, which direction will the patient fall?

Answer 18

Equal amount of chance to fall to EITHER side

Question 19

What arteries supply the cerebellum?

Answer 19

AICA

PICA

Question 20

What part of the brain must AICA go around?

Answer 20

Pons

*****AICA sends a few arteries to the pons (laterally) as it goes around it–at the pontomedullary junction

Question 21

What part of the brain must PICA go around?

Answer 21

Brainstem

**PICA sends a few arteries to the brainstem (laterally)

Question 22

Where does the superior cerebellar artery send bracnhes?

Answer 22

Midbrain

• Supplies the superior cerebellum, but as it travels to the cerebellum, it also supplies the midbrain

Question 23

What type of lesion should you suspect if you see mixed brainstem & cerebellar signs?

Answer 23

Infarct of the superior cerebellar artery

Question 24

What are the hallmarks for SCA Syndrome?

Answer 24

• Ipsilateral Dysmetria
• Contralateral pain & temperature loss
• Contralateral superior oblique paralysis
• Ipsilateral Horner’s Syndrome

Question 25

What are the symptoms of Horner’s Syndrome?

Answer 25

• Upper lid ptosis
• Constricted pupil
• Flushed, dry face