Ch. 8 & 9 Lesions Of The Spinal Cord And Brainstem

Front 1

6 symptoms of LMN lesions

Back 1

1. flaccid paralysis
2. atrophy
3. areflexia
4. hypotonia
5. fasiculations
6. fibrillations

Front 2

Poliomyelitis
1. prototypic disease of what?
2. caused by a...
3. results in..

Back 2

1. LMNs (alpha MNs in ventral horn, esp for lower limbs)
2. enterovirus
3. flaccid paralysis

Front 3

3 examples of LMN diseases

Back 3

1. poliomyelitis
2. Werdnig-Hoffmann disease
3. Kugelberg-Welander

Front 4

2 examples of UMN lesion locations

Back 4

1. cortical neurons that give rise to corticospinal and corticobulbar tracts
2. pyramidal tract lesions (corticospinal and corticobulbar tracts)

Front 5

3 ipsilateral motor deficits of a lateral corticospinal tract lesion

Back 5

UMN
1. spastic hemiparesis w/ mm weakness
2. hyperreflexia
3. clasp-knife spasticity

Front 6

Dorsal column syndrome
1. 2 causes
2. ipsilateral senosry deficits

Back 6

1. subacute combined degeneration (B12) and tabes dorsalis (neurosyphilis)
2. tactile discrimination, proprioception, vibration, asteregonosis, dystaxia, Romberg sign

Front 7

Lesions to which tracts cause leg dystaxia...
1. ipsilateral
2. contralateral
3. what test is difficult to perform

Back 7

1. dorsal spinocerebellar
2. ventral spinocerebellar
3. heel to shin

Front 8

Lateral spinothalamic tract lesion
1. loss off..
2. on which side
3. at what level

Back 8

1. pain and temp
2. contralateral (crosses in V. commissure)
3. 1 level below lesion

Front 9

Herpes Zoster
1. what is it?
2. where does it occur?
3. limited to...
4. symptoms

Back 9

1. viral infaction causing an acute inflammatory rxn
2. dorsal root or CN ganglia
3. one dermatome
4. pain, itching, burning

Front 10

Guillan Barre (acute idiopathic polyneuritis)
1. usually follow...
2. results from...
3. causes...
4. symptoms
5. effect on CSF

Back 10

1. infectious illness
2. cell-mediated immunologic rxn directed at peripheral nn.
3. mostly motor fiber demyelination and wallerian degeneration
4. ascending LMN symmptoms: weakness, flaccid paralysis, areflexia
5. increases protein, but no impact on cell count

Front 11

Amyotrophic lateral sclerosis (ALS; Lou Gehrig's)
1. prototypic disease for
2. causes

Back 11

1. combined UMN and LMN
2. progressive bulbar palsy/muscular atrophy (LMN) and pseudobulbar palsy/primary lateral sclerosis (UMN)

Front 12

Ventral spinothalamic tract lesion
-loss of..
-which side?
-starting at what level

Back 12

1. crude touch
2. contralateral
3. 3-4 levels below lesion

Front 13

Epiconus syndrome
1. which segments?
2. damages...
3. causes loss of..
4. what is absent?

Back 13

1. L4-S2
2. ventral horns and long tracts
3. voluntary bladder control, lower limb motor function (thigh rotation)
4. Achilles reflex

Front 14

Cauda equina syndrome
1. involves which spinal roots?
2. causes...
3. may result from..
4. often produces..

Back 14

1. L3-Co
2. paralytic bladder, saddle anesthesia, motor disability, and loss of Achillies reflex (conus medullaris + epiconus)
3. intervertebral disk herniation
4. severe spontaneous radicular pain

Front 15

Filum terminale (tethered cord) syndrome
1. results from
2. 3 symptoms

Back 15

1. thickened, shortened filum terminale adering to sacrum (puts traction on conus medullaris)
2. sphicter dysfunciton, gait disorders, feet deformities

Front 16

Subacute combined degeneration
1. also known as
2. associated w/
3. affects what 3 tracts (what losses?)
4. what does it do to them?

Back 16

1. Vit B12 neuropathy
2. pernicious anemia
3. dorsal columns (prop, vib); spinocerebellar (limb ataxia); corticospinal (UMN spasticity)
4. demyelinates

Front 17

Friedreich hereditary ataxia
1. how do you get it?
2. similar to subacute combined degeneration how?
3. what else is involved? (symptom)
4. commonly leads to...

Back 17

1. autosomal recessive inheritance
2. degenerates dorsal columns, spinocerebellar, and corticospinal tracts
3. Cerebellum/purkinje fibers (ataxia)
4. cardiomyopathy, pes cavus, kyphoscoliosis

Front 18

Syringomyelia
1. destroys..
2. interrupts (symptoms)
3. what other characteristic symptom?
4. distribution of sensory loss

Back 18

1. ventral commissure
2. crossing spinothalamic fibers (bilat pain and temp loss)
3. atrophy of hand muscles
4. cape-like

Front 19

Multiple sclerosis
1. most common what?
2. what kind of lesions?
3. most commonly affects what segments?

Back 19

1. demyelinating diseas
2. asymmetrical lesions of white matter
3. cervical segments

Front 20

Charcot-Marie-Tooth
1. aka
2. most common what?
3. affects what two areas? (Symptoms)

Back 20

1. peroneal muscular atrophy (stork legs)
2. inherited neuropathy
3. dorsal columns (loss of prop, vib) and ventral horns (atrophy)

Front 21

Intervertebral disk herniation
1. causes what kind symptoms?
2. occurs where 90% of the time?
3. and the other 10%?

Back 21

1. spinal root symptoms: parasthesia, pain, sensory loss, hyporeflexia, mm weakness
2. L4-L5 or L5-S1
3. C5-C6 or C6-C7

Front 22

Cervical spondylosis w/ myelopathy
1. most common what?
2. what causes it?
3. how does it present?

Back 22

1. observed myelopathy
2. calcified disk material exuded into spinal canal compressing the spinal cord
3. stiff neck, arm pain and weakness, spastic legs, dystaxia

Front 23

Hypothalamospinal tract
1. results in...
2. if transected above..

Back 23

1. Horner syndrom
2. T2

Front 24

Dorsal horn destruction
1. symptoms
2. on which side?
3. distributed along?

Back 24

1. anesthesia and areflexia
2. ipsi
3. dermatomal distribution

Front 25

Complete transection
1. at C1-C3
2. C4-C5
3. below T1
4. above C5
5. four other symptoms

Back 25

1. exitus lethalis
2. quadriplegia
3. paraplegia
4. loss of voluntary breathing (phrenic nucleus)
5. spastic paralysis, anesthesia, anhidrosis, loss of voluntary bladder control

Front 26

Anterior/Ventral spinal artery occlusion
1. 4 tracts it destroys (symptoms?)
2. also causes...
3. usually spares...

Back 26

1.V. horn (flaccid paralysis at level); corticospinal (spastic paralysis below level); spinothalamic (loss of pain and temp); spinocerebellar (cerebellar symptoms masked by paralysis)
2. bilateral horner syndrome
3. dorsal columns

Front 27

Conus medullaris syndrome
1. what segments?
2. destroys...
3. causes...
4. absence of...

Back 27

1. S3-Co
2. sacral parasymp nucleus
3. paretic bladder, fecal incontinence, impotence
4. lower limb muscle deficits

Front 28

Back 28

1. fasciculus gracilis
2. fasciculus cuneatus
3. dorsal spinocerebellar
4. lateral corticospinal
5. lateral spinothalamic
6. ventral spinocerebellar
7. ventral white commissure
8. ventral corticospinal

Front 29

Back 29

A. poliomyelitis
B. multiple sclerosis
C. tabes dorsalis
D. ALS (Lou Gehrig's)
E. Brown Sequard
F. ventral spinal artery occlusion
G. subacute combined degeneration (Vit B12 neuropathy)
H. syringomyelia
I. Charcot-Marie-Tooth
J. dorsal spinal artery occlusion

Front 30

Back 30

Medial medullary syndrome (anterior spinal a.)
1. corticospinal tract (contra hemiparesis)
2. medial lemniscus (contra loss of vib/prop)
**3. hypoglossal n. (ipsi flaccid paralysis of tongue)

Front 31

Back 31

Lateral medullary (PICA; Wallenburg) syndrome
1. vestibular nuclei (nystagmus, nausea, vertigo)
2. inf cerebellar peduncle (dystaxia)
3. nucleus ambiguus (larynx/pharynx paralysis; loss of gag reflex)
4. spinothalamic tract (contra body pain/temp)
5. spinal trigeminal tract (ipsi face pain/temp)
6. ipsi Horner syndrome

Front 32

Medial pontine syndrome
1. results from..
2. affected structures (resultant deficits)

Back 32

1. occlusion of paramedian branches of basilar artery
2.
**a)abducent nerve (ipsi LR)
b) corticobulubar tracts (contra weakness of lower face)
c) corticospinal tracts (contra hemiparesis of body)
d)middle cerebellar peduncle (ipsi ataxia)
e) medial lemniscus (contra prop/vib)

Front 33

Lateral inferior pontine (AICA) syndrome

Back 33

**1. facial nucleus (ipsi facial mm, taste ant 2/3)
2. cohclear nuclei (unilateral deafness)
3. vestibular nuclei (nystagmus, nausea, vertigo)
4. spinal trigmeninal tract (ipsi face pain/temp)
5. middle and inferior cp (dystaxia)
6. spinothalamic tracts (contra body pain and temp)
7. ipsi Horner syndrome

Front 34

Lateral super/mid pontine syndrome (short circumferential branch or SCA)

Back 34

**1. trigeminal motor and main sensory nuclei (mm. of mastication, jaw deviates to paretic side, facial hemianesthesia)
2. cerebral peduncles (ipsi dystaxia)
3. spinothalamic and trigeminothalamic tracts (pain/temp from body and face)
4. ipsi Horner syndrom
5. medial lemniscus (contra loss of prop/vib from lower extremities)

Front 35

Locked in syndrome (pseudocoma)
1. what is it?
2. what does it cause?
3. how do these people communicate?

Back 35

1. infarction at base of superior pons
2. infarction of corticobulbar and corticospinal tracts (quadriplegia and loss of lower cranial nerves)
3. by blinking their eyes

Front 36

Dorsal midbrain (Parinaud) syndrome
1. common cause
2. affects what structures (resultant deficits)

Back 36

1. pinealoma
2. superior colliculis/pretectal area (paralysis of up & down gaze, pupillary disturbances, no convergence) and cerebral aqueduct (hydrocephalus)

Front 37

Paramedian midbrain (Benedikt) syndrome (paramedia branches of PCA)

Back 37

**1. oculomotor nerve (ipsi eye looks down and out, ptosis, fixed dilated pupil)
2. Red nucleus (contra dystaxia w/ intention tremor)
3. Medial lemniscus (contro prop/vib)

Front 38

Medial midbrain (Weber) Syndrome (PCA and circle of willis aneurisms)

Back 38

1. oculomotor nerve roots (ipsi eye down and out, ptosis, fixed dilated pupil)
2. corticobulbar tracts (contra weakness of lower face, tongue, and palate-7, 9, 10)
3. contra hemiparesis of body

Front 39

Acoustic Neuroma (Scwannoma)

Back 39

**1. CN VIII (cochlear n = deafness; vestibular n = nystagmus, nausea, vertigo)
**2. CN VII (facial weakness)
3. spinal trigeminal tract (CN V; anesthesia of ipsi face)

Front 40

Internuclear Ophthalmoplegia (INO)
1. aka
2. results from...
3. frequent sign of...
4. causes...
5. what else causes these signs?

Back 40

1. medial longitudinal fasciculus (MLF) syndrome
2. lesion of MLF in medial pontine tegmentum
3. multiple sclerosis
4. MR palsy on lateral gaze and nystagmus in abducting eye w/ normal convergence
5. abducent nucleus lesion (+ LR paralysis)

Front 41

Jugular Foramen (Vernet) Syndrome
Affects what three cranial nerves?

Back 41

1. glossopharyngeal-CN IX (loss of afferent gag relfex, taste post 1/3)
2. vagal-CN X (laryngeal paralysis w/ dyphagia and hoarseness, paltal paralysis w/ loss of efferent gag reflex
3. accessory-CN XI (SCM and trapezius weakness w/ shoudler drop)

Front 42

Subclavian Steal syndrome
1. results from...
2. what happens to blood flow?
3. what clinical signs?

Back 42

1. thrombosis of L subclavian artery proximal to vertebral a.
2. blood is shunted retrograde down the vertebral a. into the L subclavian a.
3. transient weakness and claudication of left arm on exercise and vertigo/dizziness