lesions Flashcards by Mimi Burkhart

damaged oculomotor nerve (midbrain)

IPSILATERAL oculomotor palsy
diplopia
dilated pupil

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damaged cerebellothalamic fibers (midbrain)

CONTRALATERAL ataxia,
tremor
red nucleus hyperkinesias

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damaged corticonuclear fibers (midbrain)

CONTRALATERAL facial weakness lower face
tongue deviation to contralateral side on protrusion
IPSIlateral trapezius and sternoCM weakness

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damaged occulomotor fibers (midbrain)

IPSILATERALoculomotor paralysis
diplopia,
dilated pupil

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damaged cortico spinal fibers (midbrain

contralateral hemiplegia

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lesion to subthalamic nucleus deficits?

HEMIBALLISUMUS(corticospinal)

= rapid and unpredictable flailing of contralateral extremities; movements are usually more obvious in UE

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occlusion of lenticulostriate branches to internal capsule: deficits

CONTRALATERAL hemiplegia (corticospnal)
loss or decreased pain, temp, proprio (thalamocortical fibers thru posterior capsule)
maybe: partial CONTRALATERAL paralysis of facial muscles/tongue (genu/corticonuclear fibers)

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occlusion of distal brances of MCA: deficits

CONTRALATERAL motor and sensory loss of UE, trunk, face (precentral, postcentral gyri)
deviation of eyes to ipsilateral side (frontal eye fields)

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occlusion of distal branches of ACA:deficits

motor and sensory losses in contralateral foot, leg, thigh (ant. post. paracentral gyrus)

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antrior watershed infarct: where? deficits?

ACA/MCA junction
contralateral hemiparesis (usually leg)
expressive language
behavioral changes

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posterior watershed infarct: where? deficits?

MCA/PCA junction
visual deficits
language problems

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anterior choroidal artery syndrome: deficits?

HOMOnymous hemianopsia (optic tract)
LOWER portions of basal nuclei
hemiplegia, hemianesthesia (LOWER aspects of internal capsule)

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clinical presentation of parkinsons

stooped posture
resting tremor
rigidity
shuffling or festinating gait
trouble maintaining mvmt (a-, hypo-, or bradykinesia)
dimentia (later)

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medial midbrain lesion damages what STRX, what blood vessel

corticspinal fibers in crus cerebri
occulomotor nerve
maybe corticobulbar fibers
maybe substantia nigra, but usually no noticeable deficits
paramedian branches of PCA

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deficits of lesion to corticospinal fibers in crus cerebri?

blood vessel to area?

CONTRALATERALhemiplegia of UE, trunk, LE (from occlusion of paramedian branches of PCA)

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deficits of lesion to occulomotor nerve ?

blood to area?

IPSILATERAL paralysis of eye movement: eye is “DOWN AND OUT”
pupil dilated, fixed
paramedian branches of PCA

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deficits of lesion to corticobulbar fibers in crus cerebri?

in tongue deviating to OPPOSITE side of lesion upon protrusion
paralysis of lower half of facial muscles on CONTRALATERAL side

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central midbrain lesion damages what structures

oculomotor nerve
red nucleus and CBELLOthalamic fibers
maybe ML
maybe ventral trigeminothalamic fibers

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deficits of lesion to red nucleus and CBELLOthalamic fibers/

CONTRALATERALataxia

- tremor of CBELLAR origin

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pineocytoma can impinge?

superior colliculi
cerebral aquaduct
trochlear/occulomotor nerve
MLF

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deficits of pineocytoma?

paralysis of upward gaze (superior colliculi)
hydrocephalus (cerebral aquaduct)
failure of eye mvmt (trochlear/occulomotor nerve)
nystagmus (MLF)

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initial signs of uncal herneation

dilation of pupils (uni or bipolar)
slow reaction to light
followed by weakness of occulomotor movement

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progressive symptoms of uncal herniation

fully dilated pupils
eyes deviate laterally b/c of unapposed abducens nerves
weakness on CONTRALATERAL side (crtocospinal fibers in crus)

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symptoms of an especially large or bilateral supratentorial lesion

decorticate rigidity

= flexion and adduction of UE; extention of LE with internal rotation and plantar flexion

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symptoms of an intratentorial lesion

decerebrate rigidity | = UE and LE extended, toes point inward, pronated forearm, head and neck extended

opisthotonos symptoms

EXTENDED head and neck

midline optic chiasm lesion

- BITEMPORAL hemianopia | - may have relative afferent pupillary defect (RAPD)

lateral optic chiasm lesion

- BINASAL hemianopia | - may have RAPD

optic tract lesion

- HOMOnymous hemianopia on ipsilateral side | - may have RAPD

total optic radiation lesion

- ipsilateral HOMOnymous hemianopia (also in lesion or total primary visual cortex)

cuneus lesion

- ipsilateral INFERIOR homonymous quadrantopia

lingual gyrus lesion

- ipsilateral SUPERIOR homonymous quadrantopia

optic nerve lesion

- ipsilateral blindness in that eye | - loss of pupillary light reflex in both eyes when light is shined into the blinded eye

what is enopthalmos

- a slight sinking of the eyeball into the orbit | - often MENTIONED for patients with Horner's, but not always SEEN

lesion of the abducens root: muscle, and movement?

- ipsilateral lateral rectus muscle - loss of lateral gaze - when looking straight ahead, lesioned eye will deviate SLIGHTLY toward midline

lesion of abducens root: complaint

- diplopia | - especially when trying to look toward the lesioned size in the HORIZONTAL plane

caudal basilar pontine lesion: symptoms

- alternating hemiplegia (paralysis of lateral rectus on ipsilateral side; paralsis of body on contralateral side) - diplopia

internuclear ophthalmoplegia symptoms

- loss of medial gaze

internuclear ophthalmoplegia lesion?

lesion in the MLF on the SAME side as the paralysis

lesion of abducens nucleus: damages?

- ALPHA motor neurons to ipsilateral lateral rectus muscle | - interneurons that terminate on alpha motor neurons in the contralateral oculomotor nucleus

lesion of abducens nucleus: symptoms

- loss of horizontal gaze in both eyes TOWARD lesion side - normal horizontal gaze in both eyes AWAY lesioned side - basically internal opthalmoplegia lesion plus abducens root lesion

one and a half syndrome: symptoms

- loss of medial and lateral voluntary eye mvmt on one side | - loss of medial mvmt on the contralateral side

one and a half syndrom: damages?

- abducens nucleus on one side - the MLF right next to affected nucleus - usually also affects paramedian pontine reticular formation aka "horizontal gaze center"

radiculopathy

- results from spinal nerve root damage - radiating pain in a dermatomal patern - weakness - hyporeflexia

symptoms of cauda equina syndrome

- weakness of LE - saddle anesthesia ( sensory deficits ) - urinary retention (decreased sphincter tone) - decrease in sexual fxn - sciatica

broca's aphasia symptom and location

- inferior frontal gyrus (areas 44/45) - motor, expressive, nonfluent aphasia - NO vocal paralysis - patients are well aware of their deficits

telegraphic speech

- associted with broca's aphasia | - familiar single wordes or short phrases with left out words

wernicke aphasia

- supramarginal (area 40) and angular gyri (area 39( - sensory, receptive, or fluent aphasia - speek freely, but words may not make sense - may not be aware of their deficits

paraphasia

- "word salad" | - associated with wernicke

structures that may be affected in uncal herniation

- CBellum - uncus (temporal lobe) - hypothalamus - optic tract

aneurysms affecting the occulomotor nerve

aneurysm of basilar bifurcation | aneurysm of posterior communicating/PCA intersection

third nerve injury deficits

- dilated pupil - loss of most eye mvmt - diplopia

angterior choroidal artery syndrome (strx)?

optic tract and crus cerebri

damage to vestibular nuclei(medulla)

- nystagmus, - vertigo - nausea

damage to nucleus ambiguous (medulla)

- dysphagia, - hoarseness - deviation of uvula to contralateral side

spinal trigeminal tract nucleus

- ipsilateral loss of pain and thermal sense on face

conductive deafness

caused by problems of external ear or disorders of the middle ear

middle ear causes of conductive deafness

- otitis media | - otosclerosis

nerve deafness is from

diseases involving cochlea or the cochlear portion of the vestibulocochlear nerve

central deafnes results from

damage to the cochlear nuclie or their central connections

damage to cochlear part of the eighth nerve can be from __ and result in ___

vestibular schwaanoma - tinnitus and or deafness - presbyacusis (hard time hearing high pitch sound)

auditory agnosia is? | it can be from?

difficulty understanding and/or interpreting sounds | damage to secondary auditory cortex in the temporal lobe

lesions Flashcards

(62 cards)