Cortical Localization

Question 1

encephalopathy refers to a _________ lesion

Answer 1

encephalopathy refers to a CORTICAL or SUBCORTICAL lesion

Question 2

myelopathy = _______ lesion

Answer 2

myelopathy = spine lesion

Question 3

What is the lesion? (what caused it)

Answer 3

VITAMINS D

Vascular
Inflammatory
Traumatic, Toxic
Autoimmune
Metabolic, Medication induced
Iatrogenic
Neoplastic
Psychiatric, Seizure 
Degenerative

Question 4

importance of lesion localization

Answer 4

• to narrow differential diagnosis
• determine what tests to order
• to determine operative practices (past)

Question 5

components of a neurological exam

Answer 5

• cognitive exam
• cranial nerve exam
• motor exam, reflex exam
• sensory exam
• cerebellar exam
• other (gait, special tests)

Question 6

clues that the lesion is cortical

Answer 6

• behavior, personality changes
• language disorders
• visual field deficits in BOTH eyes
• higher cortical sensory deficits
• apraxia (cannot perform learned task)
• neglect
• hemiparesis (PART of side)
• hemiesthesia (PART of side)
• seizure

Question 7

clues that the lesion is subcortical

Answer 7

• pure motor deficits (whole side)
• pure sensory deficits (whole side)
• movement disorders
• absence of cortical deficits

Question 8

clues that the lesion is bulbar

Answer 8

• crossed signs (sensory, motor)
• cranial nerve deficits
• vestibular (nausea, vomiting)
• visual field deficits (PCA territory)
• cerebellar signs
• bilateral signs

Question 9

clues that the lesion is myelopathic (spinal)

Answer 9

• bilateral (not necessarily symmetrical) motor, sensory
• no involvement above neck
• combination of UMN, LMN
• bowel, bladder dysfunction
• autonomic dysfunction

Question 10

tools to localize cortical

Answer 10

• CST
• ascending sensory tracts
• optic pathways
• language pathways
• special localization syndromes

Question 11

what to check during a motor exam (voluntary)

Answer 11

• tone
• bulk
• strength
• reflexes
• associated features

Question 12

UMN signs

Answer 12

• hypertonia
• no atrophy
• weakness
• brisk reflexes
• babinski/myoclonus

Question 13

LMN signs

Answer 13

• hypotonia
• muscle wasting
• weakness
• depressed reflexes
• fasciculations

Question 14

clues lesion is motor cortical

Answer 14

• contralateral hemiparesis (not whole side)
• upper motor neuron signs
• cortical deficits (hemisphere specific)
• associated sensory deficits

Question 15

ascending sensory tracts

Answer 15

• pain
• pinprick
• light touch
• vibration
• proprioception

Question 16

clues lesion is sensory cortical

Answer 16

• contralateral hemiesthesia (not whole side)
• associated motor deficits
• higher cortical sensory deficits
• –astereognosis
• –2 point discrimination
• –agraphesthesia

Question 17

astereognosis

Answer 17

• close eyes
• feel object
• determine what it is

Question 18

agraphesthesia

Answer 18

• close eyes
• scratch # on palm when eyes closed
• determine which #

Question 19

optic pathway is the only pathway to _____________

Answer 19

optic pathway is the only pathway to CROSS FROM FRONT TO BACK

• great to localize a lesion axially
• different visual fields will help localize

Question 20

if there is a visual field deficit in one eye only, the problem is ________________

Answer 20

if there is a visual field deficit in one eye only, the problem is ANTERIOR TO THE OPTIC CHIASM
-no need to image the brain

Question 21

if the patient has “tunnel vision,” the problem is ________________

Answer 21

if the patient has “tunnel vision,” the problem is AT THE OPTIC CHIASM

Question 22

if there is the same partial visual field deficit in both eyes, the lesion is _______________

Answer 22

if there is the same partial visual field deficit in both eyes, the lesion is POSTERIOR TO THE OPTIC CHIASM (in the cortex)
-image the brain

Question 23

components of the aphasia examination

Answer 23

• comprehension
• fluency
• repetition
• naming

Question 24

T/F: we have specialized regions for language/speech and for reading/writing

Answer 24

False. Only have specialized region for language/speech.
-no specialized region for reading/writing or math

If there is a stoke in Broca/Wernicke, no other part of the cortex can take over.
If a stroke causes alexia, another region can theoretically take over

Question 25

motor aphasia

Answer 25

Broca's aphasia | -unable to form words

Question 26

sensory aphasia

Answer 26

Wernicke's aphasia - can talk freely, but makes no sense - no comprehension of what you say or what they are saying

Question 27

transcortical motor aphasia

Answer 27

-looks like Broca's aphasia, but CAN repeat - can repeat - cannot initate own

Question 28

transcortical sensory aphasia

Answer 28

-looks like Wernicke's but can repeat - can repeat - cannot understand

Question 29

global aphasia

Answer 29

- no understanding - no naming - no repeating - no expression usually due to a larger vessel (proximal occlusion)

Question 30

conduction aphasia

Answer 30

- arcuate fasciculus | - inability to repeat

Question 31

propasognosia

Answer 31

- inability to identify faces | - sometimes mistaken for delirium or dementia

Question 32

conditions that affect the temporal lobe bilaterally

Answer 32

- herpes encephalitis | - seizures

Question 33

split brain syndrome

Answer 33

- corpus callosum affected - disconnect between both sides of brain Due to: - epilepsy surgery - tumor - EtOH abuse

Question 34

right brain

Answer 34

- emotional - mathematical - "big picture" - nonverbal - procedural memory - perceiving

Question 35

left brain

Answer 35

- verbal - arithmetical - perceives details - declarative memory - confabulatory

Question 36

Balint Syndrome

Answer 36

BILATERAL PARIETAL LESIONS - simultanagnosia: inability to perceive visual field as a whole - oculomotor apraxia: difficulty fixating the eyes - optic ataxia: inability to move hand to a specific object using vision - fail to apprehend all but 1 of simultaneously presented objects at the same location - --object based, not location based - --multicolored dots seen if connected by lines

Question 37

Gerstmann Syndrome

Answer 37

- agraphia - acalculia - finger agnosia - right left confusion

Question 38

non-dominant parietal signs

Answer 38

- denial of deficits (anosagnosia) - visual, tactile, auditory extinction - spatial disorganization - neglect of left space

Question 39

simultognosia

Answer 39

- able to name objects all over the picture | - cannot describe what is happening

Question 40

frontal lobe syndrome signs

Answer 40

-problems with sequences tasks

Question 41

frontal lobe syndrome signs

Answer 41

- problems with sequences tasks (Stroop test) - grasp reflexes - paratonia (Gegenhalten) - suck and snout reflex - perseveration - Luria test (pattern repeat)

Question 42

orbital frontal signs

Answer 42

- violent | - hypersexual

Question 43

posterior frontal signs

Answer 43

- apathetic | - akinetic mutism

Question 44

dorsolateral frontal signs

Answer 44

- executive function loss | - speech problems

Question 45

We have about _________ neurons, and __% are in the cerebellum

Answer 45

We have about 84 BILLION neurons, and 50% are in the cerebellum - cerebellum is only 10% of brain mass - supression, pruning occurs

Question 46

supression

Answer 46

the cortex (frontal lobe) suppresses infant reflexes that we were born with. only see those reflexes in an adult if the frontal lobe is injured so inhibition of these reflexes is stopped

Question 47

we are born with _______ neurons, but by adulthood we have ________ neurons

Answer 47

we are born with 160 BILLION neurons, but by adulthood we have 84 BILLION neurons -due to pruning

Question 48

Anton syndrome

Answer 48

- bilateral occipital lobe injury - CORTICAL BLINDNESS - cannot see, but will flinch when confronted - confabulation: can see but cannot interpret signal so brain makes something up - headache, psychosis -unawareness and denial of cortical blindness