T19 NS clinical correlations

monocular visual loss - lesion where

ipsilateral opthalmic a.

vertebrobasilar system - supplies

occipital lobe, posterior & inferior temporal lobe, cerebellum, brainstem

vertebrobasilar system occlusion - symptoms

diplopia, dysarthria (slurred speech), dysphagia

weakness of leg > arm - occlusion of what artery

ACA (ant. cerebral a.)

weakness of arm > leg - occlusion of what artery

MCA (middle cerebral a.)

watershed infarcts - cortical border zone infarct affect where

cortex; at border between ACA/MCA & MCA/PCA

ACA stroke - symptoms

contralat. weakness & sensory loss in leg

MCA stroke - symptoms

contralat. weakness & sensory loss in face & arm, hemianopia

hemiparesis - what

weakness of body

hemianopia - what

loss of vision

PCA infarct - symptoms

contralat. homonymous hemianopia (visual loss)

lacunar infarct - caused by

occlusion of lenticulostriate, thalamoperforating, pontine perforating, recurrent artery of heubner

lacunar infarct - symptoms

severe loss of m. strength (if interfere w/ descending pathways)

lacunar lesion at genu of internal capsule - affects

head

paramedian infarct - structures involved

descending motor tracts, medial lemniscus, CN3, CN4, CN6, CN12

lateral infarct - structures involved

cerebellar pathways, CN5, CN7, CN8, CN9, CN10

saccular (berry) aneurysm - most common lesion area

anterior communicating artery

saccular (berry) aneurysm rupture leads to…

subarachnoid hemorrhage

subarachnoid hemorrhage - symptoms

abrupt severe headache

cerebral venous thrombosis (CVT) - most common site

transverse sinus

superior sagittal sinus CVT - symptoms

motor deficits, seizures

transverse sinus CVT - symptoms

intracranial hypertension (headache), cranial nerve palsies, tinnitus (ringing sound)

epidural hematoma - what does it look like under film scan

len-shape hemorrhage

acute brain contusion - what

bruising of brain tissue from direct impact to head

diffuse axonal injury - what

widespread tearing of brain axons caused by traumatic brain injury

diffuse axonal injury - most common cause

rotational acceleration

uncul herniation - compress what structure

midbrain

most common hydrocephalus lesion

cerebral aqueduct

hydrocephalus - symptoms

headache, blurred vision

hydrocephalus - causes

impaired absorption of CSF by arachnoid villi during childhood

decorticate rigidity - posture

arm flexed, legs extend

lesion above red nucleus - what damaged

corticospinal & corticobulbar tract

lesion above red nucleus - decorticate or decerebrate

decorticate

decorticate rigidity - releases what pathways

medullary reticulospinal (flexor bias of arm); pontine reticulospinal & vestibulospinal (extensor bias of leg)

decerebrate rigidity - posture

arms extend, legs extend

lesion below red nucleus - decorticate or decerebrate

decerebrate

decerebrate rigidity - what tracks take over

vestibulospinal and pontine reticulospinal tracts

decorticate or decerebrate rigidity - which one more severe

decerebrate

vestibular-ocular (dull-eye) reflex - normal sign

eye fixation

horner’s syndrome - supply what muscle

smooth m.

third nerve palsy - supply what muscle

skeletal muscle

third nerve palsy - signs

eye deviation, marked ptosis

third nerve palsy - what nerve

oculomotor (CN3) n.

when light shines to eye, pupil constricts or dilates in normal conditions

constrict

argyll robertson pupil - what

pupil constrict when focus on near object (accommodation reflex), pupil do not constrict near light (light reflex)

argyll robertson pupil - lesion where

dorsal midbrain

CN4 disorder - sign

patient tilt their head away from affected side

stroke in right frontal eye field - eye deviate where

to right

stroke in left frontal eye field - eye deviate where

to left

what reflex can suggest brainstem lesion

corneal reflex

corneal reflex - test what cranial nerve

CN5

corneal reflex - normal response

touch one cornea → both eyes blink

corneal reflex - CNV1 damaged

no blinking in either eye

corneal reflex - CNV2 damaged

only opposite eye blinks

herpes zoster - what

virus infection at nucleus of trigeminal nerve

jaw weakness - what muscle affected

lateral pterygoid

jaw deviate to right side - what nerve lesion

right CNV lesion

upper motor neuron lesion - signs

upper face normal, lower face weak

lower motor neuron lesion - signs

entire half of face is weak (bell’s palsy)

right bell’s palsy - lesion where

right LMN CN7 lesion

hearing test - examples

weber test, rinne test

gag reflex - test what nerve

CN9, CN10

gag reflex - CN9 damage

no gag reflex at affected side

gag reflex - CN10 damage

asymmetrical gag response

nucleus ambiguus - what kind of innervation

bilateral innervation

stroke at right cerebral hemisphere - what happens to gag reflex (+ why)

normal; because nucleus ambiguus has bilateral input

brainstem lesion - gag reflex

absent (abnormal)

right uvula deviation - lesion where

left CN10 lesion

tongue deviation - measures

CN12

LMN (brainstem) lesion - tongue deviation

tongue deviates toward side of lesion

UMN (cerebral hemisphere) lesion - tongue deviation

tongue deviate to opposite side of lesion