LOCALIZATION

To come up with an initial localization based on neurologic symptoms and signs.

What is the initial step derived from neurologic symptoms and signs?

There is still no substitute for accurate neurologic history and examination.

What remains irreplaceable in neurologic localization?

Recognize the Functional Impairment.

What is the first step in neurologic localization?

Identification of the Site of the nervous system which explains the functional impairment.

What step follows recognizing functional impairment in neurologic localization?

Defining the likely Aetiology resulting in the dysfunction at the site.

After identifying the site, what is the next step in neurologic localization?

Interpretation of the Investigations to identify the final diagnosis.

What is the final step in the process of neurologic localization?

Localization * Time course.

Differential Diagnosis is calculated using what formula?

Hard Signs.

What type of signs are impairments in basic motor, sensory, and reflex behaviors directly attributable to damage in a specific brain region?

Soft Signs.

What type of signs are minor, subtle abnormalities in areas like motor coordination, sensory integration, or sequencing of complex movements?

Cortical Brain.

What is one division of the neuroaxis?

Subcortical area.

Besides cortical brain, brainstem, cerebellum, and spinal cord, what is another neuroaxis division?

Brainstem.

What neuroaxis division includes the midbrain, pons, and medulla?

Cerebellum.

What neuroaxis division is associated with ataxia?

Spinal Cord.

What neuroaxis division can present with sensory level or paraparesis/quadriparesis?

Root.

What neuroaxis division is associated with radicular pain?

Peripheral Nerve.

What neuroaxis division can show signs like numbness or weakness?

Neuromuscular Junction.

What neuroaxis division is associated with fatigability?

Tuberomammillary nucleus.

What structure related to consciousness is listed under the Cortical Brain neuroaxis?

Nucleus basalis of Meyer.

What structure related to consciousness is associated with the basal forebrain?

Substantia nigra.

What brainstem grey matter component is involved in regulating basal ganglia function and also listed as a structure related to consciousness?

Hypothalamus.

What structure listed under Cortical Brain is located near the Tuberomammillary nucleus?

Raphe nuclei.

What serotonergic structure related to consciousness is listed under the Cortical Brain neuroaxis?

Locus coeruleus.

What noradrenergic structure related to consciousness is listed under the Cortical Brain neuroaxis?

Ventral tegmental area.

What dopaminergic structure related to consciousness is listed?

Lateral reticular tegmental and pedunculo-pontine nuclei.

What cholinergic structures related to consciousness are listed?

Broca's area (BA 44/45).

What area is primarily associated with language production?

superior temporal gyrus (STG).

What structure is involved in the dorsal and ventral pathways for language?

premotor cortex.

What structure does the dorsal pathway I from the pSTG lead to?

Dorsal Pathway I.

What language pathway goes from pSTG to premotor cortex?

Ventral Pathway I.

What language pathway goes from STG to BA 45 via EFCS?

Ventral Pathway II.

What language pathway involves semantic knowledge and visual object input?

Dorso-Ventral / Ventro-Dorsal Pathways.

What pathway types connect semantic knowledge/concepts with action sequences/movement patterns?

Right side inferior parietal lobe.

Damage to what brain region causes the most severe spatial attention problems?

Cingulate (Retrosplenial) Cortex.

What part of the limbic system is listed as part of the simplified network for learning and memory?

Hippocampus.

What structure listed as part of the learning and memory network is a common site for memory formation?

Parahippocampal Region.

What brain region is listed along with the hippocampus and cingulate cortex in the learning and memory network?

Gerstmann Syndrome.

What syndrome associated with cortical function includes acalculia, left-right confusion, agraphia, and finger agnosia?

Acalculia.

What symptom is listed as part of Gerstmann Syndrome?

Left-right confusion.

What disorientation symptom is listed as part of Gerstmann Syndrome?

Agraphia.

What writing difficulty is listed as part of Gerstmann Syndrome?

Finger agnosia.

What inability to identify fingers is listed as part of Gerstmann Syndrome?

Primary auditory cortex (Heschl's gyrus).

What area of the brain is revealed when the lateral fissure is retracted and is involved in initial auditory processing?

Wernicke’s area.

What area associated with language comprehension is near the auditory cortex?

Retina.

What structure in the eye is the origin of the optic nerve?

Optic nerve.

A lesion at this site causes loss of vision in the same, single eye.

Optic chiasm.

A lesion at this site causes bitemporal hemianopia.

Optic tract.

A lesion at this site causes contralateral homonymous hemianopia.

Lateral geniculate body.

What structure in the thalamus receives input from the optic tract?

Optic radiation.

What fibers connect the lateral geniculate body to the visual cortex?

Visual cortex (area 17).

What area of the brain is the final destination for visual information originating from the retina?

Geniculo—Calcarine tract.

Lesions in the superior part of this tract cause lower contralateral quadrantanopia.

Macula.

Lesions sparing this area in the visual pathway result in contralateral homonymous hemianopsia with macular sparing.

Bitemporal hemianopia.

What type of visual field defect is caused by a lesion at the optic chiasm?

Contralateral homonymous hemianopia.

What type of visual field defect is caused by a lesion in the optic tract or lateral geniculate body?

Upper contralateral quadrantanopia.

What type of visual field defect is caused by a lesion in the lower geniculocalcarine tract?

Lower contralateral quadrantanopia.

What type of visual field defect is caused by a lesion in the upper geniculocalcarine tract?

Contralateral homonymous hemianopsia with macular sparing.

What type of visual field defect is seen with occipital lobe lesions affecting the visual cortex?

Parietal lobe.

What lobe houses the dorsal visual stream, determining "Where is it?"

Temporal lobe.

What lobe houses the ventral visual stream, determining "What is it?"

Occipital lobe.

What lobe contains the primary visual cortex?

Dorsal visual stream.

Which visual stream helps determine spatial location ("Where is it?")

Ventral visual stream.

Which visual stream helps determine object identity ("What is it?")

Anterior horn cell to NM junction.

What is the site of lesion for a Lower Motor Neuron (LMN) pathology?

Prominent and early wasting.

What is the typical muscle bulk finding in LMN lesions?

Hypotonia.

What is the muscle tone finding in LMN lesions?

Absent in LMN distribution only.

What is the finding for superficial reflexes in LMN lesions?

Absent.

What is the finding for deep tendon reflexes in LMN lesions?

Flexor.

What is the typical plantar response in LMN lesions?

Contralateral motor/sensory (lower dominant).

What motor/sensory deficits are characteristic of an Anterior Cerebral Artery stroke?

Abulia, dyspraxia, emotional changes.

What behavioral changes can be seen in an Anterior Cerebral Artery stroke?

Contralateral motor/sensory (face + upper dominant).

What motor/sensory deficits are characteristic of a Middle Cerebral Artery stroke?

Aphasia (dominant) or neglect (non-dominant).

What language or spatial issues can be seen in a Middle Cerebral Artery stroke depending on the hemisphere?

Contralateral hemianopia (macular sparing).

What visual field defect is characteristic of a Posterior Cerebral Artery stroke?

Sensory signs/symptoms if lateral thalamus is involved.

Besides hemianopia, what other deficits can occur in a Posterior Cerebral Artery stroke if a specific structure is involved?

Pure motor stroke.

What type of stroke is associated with basal ganglia/internal capsule lesions?

Contralateral quadriplegia, "locked in".

What severe deficits can occur in a Basilar Artery stroke?

No horizontal eye movements.

What eye movement finding is characteristic of a Basilar Artery stroke?

Ipsilateral facial pain/temp loss, contralateral body pain/temp loss.

What pattern of pain and temperature loss is characteristic of a PICA stroke?

Vertigo, dysphagia, hoarseness, nystagmus, ipsilateral cerebellar signs.

What additional brainstem/cerebellar signs are associated with a PICA stroke?

Contralateral paralysis and loss of position sense below the lesion.

What motor and sensory deficits occur with an Anterior Spinal Artery stroke?

Origin from Brain cortex.

Where do pyramidal tracts originate?

Responsible for voluntary movement.

What is the primary function of pyramidal tracts?

Corticospinal Tract.

What pyramidal tract controls voluntary skeletal muscle movement?

Corticobulbar tract.

What pyramidal tract controls voluntary movement of the face, head, and neck?

25% Ipsilateral, 75% contralateral.

What is the crossing pattern of the corticospinal tract?

Innervate both sides equally except for facial nerve (7th) supply lower.

How do corticobulbar tracts typically innervate cranial nerves, and what is the key exception?

Origin from Brainstem.

Where do extrapyramidal tracts originate?

Responsible for involuntary movement.

What is the primary function of extrapyramidal tracts?

Rubrospinal Tract.

What extrapyramidal tract is involved in fine movement control?

Reticulospinal Tract.

What extrapyramidal tract is involved in tone control and automate breathing?

Vestibulospinal Tract.

What extrapyramidal tract is involved in balance and posture?

Rigidity.

What is a hyperkinetic extrapyramidal sign?

Tremors.

What involuntary oscillating movement is an extrapyramidal sign?

Chorea.

What rapid, jerky involuntary movement is a hyperkinetic extrapyramidal sign?

Dystonia.

What sustained or intermittent muscle contractions causing abnormal movements or postures is an extrapyramidal sign?

Parkinsonism.

What hypokinetic extrapyramidal sign includes bradykinesia, rigidity, tremor, and postural instability?

Cranial Nerves 3 and 4.

Which cranial nerves are typically localized to the midbrain (supratentorial part of brainstem in the context of the table)?

Cranial Nerves 5, 6, 7 and 8.

Which cranial nerves are typically localized to the pons?

Cranial Nerves 9, 10, 11 and 12.

Which cranial nerves are typically localized to the medulla?

Superior colliculi.

What midbrain grey matter component is a reflex center for visual reflexes?