Clinical Neuroanatomy

Front 1

Lesion: Tearing of the middle meningeal artery

Back 1

Consequence: Epidural hematoma
Biconcave disk
Does not cross suture lines
Arterial: rapid
Midline shift and herniation through tentorium

Front 2

Lesion: Tearing of the bridging superior cerebral veins

Back 2

Consequence: Subdural hematoma
Crescent shape
Crosses suture lines
Venous: slowly developing
Midline shift and herniation through tentorium

Front 3

Lesion: ruptured aneurysm in circle of willis

Back 3

Consequence: Subarachnoid hemorrhage
Arterial: rapidly developing
"Worst headache of my life"

Front 4

Lesion: meningioma

Back 4

Consequence: slowly developing mass effect
Tumor of arachnoid cap cells

Front 5

Lesion: bacterial meningitis

Back 5

Consequence: clouding of pia-arachnoid

Front 6

CSF pathways

Back 6

Choroid plexus in lateral ventricles--> interventricular foramen of munro--> third ventricle--> cerebral aqueduct of Sylvius--> fourth ventricle--> formina of Magendie and Luschka--> subarachnoid space--> arachnoid villi--> superior sagittal sinus

Front 7

Consequence: Congenital obstructive/noncommunicating hydrocephalus

Back 7

Potential lesion sites:
1) Congenital stenosis of cerebral aqueduct
2) Interventricular foramen of Munro
3) Foramina of Luscha
4) Foramin of magendie
5) Arnold-CHiari malformation

Front 8

Consequence: normal pressure/ non obstructive/ communicating hydrocephalus

Back 8

Cause: decreased CSF absorption at arachnoid granulations due to inflammation and scarring

Front 9

Lesion: stroke of opthalmic artery

Back 9

Consequence: monocular blindness

Front 10

Lesion: stroke of Middle Cerebral Artery (MCA)

Back 10

Consequence: contralateral motor and sensory deficits in face and arm >leg and aphasia if in left hemisphere
- MCA supplies lateral surface of the frontal, parietal and temporal lobes

Front 11

Lesion: stroke of Anterior Cerebral Artery (ACA)

Back 11

Consequence: contralateral motor and sensory deficits in leg>arm and face
- ACA supplies medial surface of frontal and parietal lobes

Front 12

Aphasias:
a) Comprehension/ Receptive
b) Production/ Expressive
c) Conduction/ inability to repeat

Back 12

Lesion:
a) wernicke's area
b) Broca's area
c) arcuate fasciculus

Front 13

Lesion: perforating/ ganglionic arteries

Back 13

Consequence: contralateral motor and sensory deficits in the face=arm=leg--> hemiplegia
- supply deep structures such as internal capsule
**ONLY place where a lesion will affect all these modalities equally**

Front 14

Lesion: occlusion of Posterior inferior cerebellar artery (PICA) (branch of vertebral artery)

Back 14

Consequence: Lateral medullary/ Wallenberg's syndrome
- alternating hemianesthesia
- spinothalamic tract--> contralateral loss of pain and temp from body
- spinal nucleus and tract of CNV--> ipsilateral loss of pain and temp from face
- descending hypothalamospinal autonomic fibers--> ipsilateral horner's syndrome (mioisis, ptosis, anhydrosis)
- cerebellar connections--> ipsilateral limb ataxia
- nucleus ambiguus and CN IX, X--> dysphagia, dysphonia, dyspnea and ispilateral loss of gag reflex; uvula deviates away from weak side
- solitary nucleus and tract--> ipsilateral ageusia

Front 15

Deviation of uvula in:
a) Supranuclear/hemisphere lesion
b) CN X lesion

Back 15

Uvula deviates away from weak side:
a) toward to lesion side if supranuclear
b) away from lesion side if at or below nucleus of CN X

Front 16

Deviation of tongue in:
a) Supranuclear/ hemisphere lesion
b) CN XII lesion

Back 16

Tongue deviates toward the weak side:
a) away from lesion side if supranuclear
b) toward lesion side if at or below nucleus of CN XII

Front 17

Lesion: internal auditory artery (branch of basilar artery)

Back 17

Consequence: vertigo and ipsilateral deafness

Front 18

Lesion: Posterior cerebral artery supply to midbrain

Back 18

Consequence: Ventral/ Weber's syndrome of the midbrain
- alternating occulomotor hemiplegia
- Corticospinal/corticobulbar tracts--> contralateral hemiplegia and paralysis of lower face
- CN III (occulomotor)--> ipsilateral palsy resulting in diplopia, external strabismus and paralysis of medial and upward eye movmts, ptosis, mydriasis, loss of light and accommodation reflexes

Front 19

Lesion: Posterior cerebral artery branch to diencephalon

Back 19

Consequence: Thalamic syndrome of Dejerine Roussy
- Initially: contralateral hemisensory loss in head and body
- later: dysesthesia, thalamic pain, emotional instability

Front 20

Lesion: posterior cerebral artery branch to temporal/occipital lobes

Back 20

Consequence: visual field deficits; hemianopsia

Front 21

Lesion: stroke of Anterior Cerebral Artery (ACA)

Back 21

Consequence: contralateral motor and sensory deficits in leg>arm and face
- ACA supplies medial surface of frontal and parietal lobes

Front 22

Aphasias:
a) Comprehension/ Receptive
b) Production/ Expressive
c) Conduction/ inability to repeat

Back 22

Lesion:
a) wernicke's area
b) Broca's area
c) arcuate fasciculus

Front 23

Lesion: perforating/ ganglionic arteries

Back 23

Consequence: contralateral motor and sensory deficits in the face=arm=leg--> hemiplegia
- supply deep structures such as internal capsule
**ONLY place where a lesion will affect all these modalities equally**

Front 24

Lesion: occlusion of Posterior inferior cerebellar artery (PICA) (branch of vertebral artery)

Back 24

Consequence: Lateral medullary/ Wallenberg's syndrome
- alternating hemianesthesia
- spinothalamic tract--> contralateral loss of pain and temp from body
- spinal nucleus and tract of CNV--> ipsilateral loss of pain and temp from face
- descending hypothalamospinal autonomic fibers--> ipsilateral horner's syndrome (mioisis, ptosis, anhydrosis)
- cerebellar connections--> ipsilateral limb ataxia
- nucleus ambiguus and CN IX, X--> dysphagia, dysphonia, dyspnea and ispilateral loss of gag reflex; uvula deviates away from weak side
- solitary nucleus and tract--> ipsilateral ageusia

Front 25

Deviation of uvula in:
a) Supranuclear/hemisphere lesion
b) CN X lesion

Back 25

Uvula deviates away from weak side:
a) toward to lesion side if supranuclear
b) away from lesion side if at or below nucleus of CN X

Front 26

Deviation of tongue in:
a) Supranuclear/ hemisphere lesion
b) CN XII lesion

Back 26

Tongue deviates toward the weak side:
a) away from lesion side if supranuclear
b) toward lesion side if at or below nucleus of CN XII

Front 27

Lesion: internal auditory artery (branch of basilar artery)

Back 27

Consequence: vertigo and ipsilateral deafness

Front 28

Lesion: Posterior cerebral artery supply to midbrain

Back 28

Consequence: Ventral/ Weber's syndrome of the midbrain
- alternating occulomotor hemiplegia
- Corticospinal/corticobulbar tracts--> contralateral hemiplegia and paralysis of lower face
- CN III (occulomotor)--> ipsilateral palsy resulting in diplopia, external strabismus and paralysis of medial and upward eye movmts, ptosis, mydriasis, loss of light and accommodation reflexes

Front 29

Lesion: Posterior cerebral artery branch to diencephalon

Back 29

Consequence: Thalamic syndrome of Dejerine Roussy
- Initially: contralateral hemisensory loss in head and body
- later: dysesthesia, thalamic pain, emotional instability

Front 30

Lesion: posterior cerebral artery branch to temporal/occipital lobes

Back 30

Consequence: visual field deficits; hemianopsia

Front 31

Unpaired artery in the circle of willis

Back 31

Anterior communicating artery

Front 32

Lesion: anterior spinal artery

Back 32

Consequence: anterior cord syndrome
- similar to complete transection BUT touch, pressure, vibration and proprioception are intact because posterior columns are not affected

Front 33

Lesion: Dorsal root compression

Back 33

Consequence: Ipsilateral
- parasthesia
- pain
- anesthesia
- hyporeglexia or areflexia
in affected dermatomes

Front 34

Lesion: ventral root compression

Back 34

Consequence: Ipsilateral
- paresis OR
- flaccid paralysis
- hyporeflexia or areflexia
- atrophy
in affected myotomes

Front 35

Lesion: Complete transection of spinal cord

Back 35

Consequence: bilateral
- anesthesia with a sensory level
- initial period of flaccid paralysis
- later devp of UMN signs: spastic paralysis, hyperreflexia, pathologic reflexes
- loss of voluntary bladder/bowel control

Front 36

Lesion: Hemisection (Brown- Sequard)

Back 36

Conseqeunce:
- ipsilateral anesthesia at the level of the lesion
- Ipsilateral loss of touch, pressure, vibration and proprioception below the lesion
- Contralateral loss of pain and temp at a level one or two segments below the lesion
-Ipsilateral LMN signs at the level of the lesion
- Ipsilateral UMN signs below the lesion

Front 37

Lesion: central cord syndrome or syringomyelia

Back 37

Consequence:
- bilateral band of analgesia and thermanesthesia in the limbs corresponding to the spinal segments affect
If extended into ventral horn--> LMN symptoms at the level of the lesion

Front 38

Organization of nuclei in the brainstem

Back 38

Motor--> Medial to sulcus limitans
Sensory--> lateral to sulcus limitans

Front 39

Medial lemniscus

Back 39

Carries touch, pressure, vibration and proprioception from contralateral side of body

Front 40

Spinothalamic tract

Back 40

Carries pain and temp from contralateral side of body

Front 41

Corticospinal tract

Back 41

Carries movement commands to the contralateral body

Front 42

Corticobulbar tract

Back 42

Carries movement commands to the contralateral lower face

Front 43

Lesion: lesion of cortex, internal capsule, or corticobulbar tract

Back 43

Consequence:
- contralateral paralysis of lower face only

Front 44

Lesion: CN VII nucleus or nerve

Back 44

Consequence:
- ipsilateral flaccid paralysis of upper and lower face
- Inability to close eye
- arreflexia

Front 45

Lesion: Hemisphere/supranuclear/ internal capsule

Back 45

Consequence: contralateral
- hemiplegia
- lower facial paralysis
- sensory deficits (?)
- tongue deviates away from lesion
- uvula deviates toward lesion
- ipsilateral sternocleidomastoid/trapezius weakness

Front 46

Lesion: brainstem/nuclear lesion

Back 46

Consequence:
- alternating syndromes
- ipsilateral CN deficits (LMN flaccid paralysis and sensory loss)
- contralateral hemiplegia (UMN spastic paralysis) and sensory deficits in body
-

Front 47

Lesion: occlusion of vertebral or anterior spinal arteries

Back 47

Consequence: medial medullary syndrome
- Alternating hypoglossal hemiplegia
- corticospinal tract--> contralateral hemiparesis
- medial lemniscus--> contralateral tactile and kinesthetic deficits
- hypoglossal nucleus--> ipsilateralflaccid paralysis of tongue, dysarthria, dysphagia,
- tongue deviates toward weak side (toward the lesion)

Front 48

Thalamic nuclei
A) Ventral anterior (VA)
B) Ventral lateral (VL)
C) Ventral posterolateral (VPL)
D) Ventral posteromedial (VPM)
E) dorsal tier nuclei
F) Medial nuclear group
G) Anterior nuclear group
H) diffuse projection nuclei

Back 48

A) Motor output from globus pallidus
B) Motor ouput from dentate nucleus
C) somatic sensation from the body
D) somatic sensation from the head
E) integration of somativ, visual and auditory sensation
F) affective behavior
G) limbic system
H) arousal and sleep

Front 49

Methalamus nuclei
a) Medial geniculate
b) lateral geniculate

Back 49

a) auditory (think music)
b) Visual

Front 50

Lesion: Midline vermal lesion of the cerebellum

Back 50

Consequence: truncal ataxia with wide based gate
- positive romberg
- fall toward lesion
- nystagmus

Front 51

Lesion: lateral hemisphere cerebellar lesion

Back 51

Consequence: limb ataxia
-hypotonia and hyporeflexia
- delay in initiation of movmt
- initiation tremor
- movement decomposition
- limb dysmetria (can't finger-nose)
- dysdiadochokinesis (can't rapidly alternate hand)
- Dysarthria and scanning speech

Front 52

Corpus striatum: Direct pathway

Back 52

"GO"
activation of putamen--> increased inhibition of Gpi--> decreased inhibition of thalamus--> increased stimulation of motor cortex
-- D1 dopamine receptors are ACTIVATING

Front 53

Corpus striatum: Indirect pathway

Back 53

"STOP"
Stimulation of putamen--> increased inhibition of GPe--> decreased inhibition of STN--> increased stimulation of GPi--> increased inhibition of thalamus--> decreased stimulation of motor cortex
-- D2 dopamine receptors are INHIBITING

Front 54

Lesion: stroke/destruction of subthalamic nucleus

Back 54

Consequence: decreased inhibitory control over indirect pathway--> increase in excitation--> hyperkinesis, hemiballisumus

Front 55

Lesion: degeneration of dopaminergic neurons in Substania Nigra pars compacta (eg. parkinsons)

Back 55

Consequence: decreased facilitation of direct pathway, decreased inhibition of indirect pathway--> decrease in excitation of motor cortex--> rigidity, dystonia, akinesia, bradykinesia

Front 56

Lesion: huntington's/wilson's disease degeneration of indirect pathway

Back 56

Consequence: chorea and athetosis

Front 57

Lesion: damage to primary somatic sensory cortex in postcentral gyrus

Back 57

Consequence: impairment of fine somatic sensation, deficit in position in movment sense; tactile snes and pain not abolished

Front 58

Lesion: damage to primary visual cortex in calcarine sulcus

Back 58

Consequence: hemianopsia

Front 59

Lesion: damage to primary auditory cortex in transverse temporal gyri of Heschl

Back 59

Consequence: difficulty in localzing contralateral sounds; subtle hearing loss

Front 60

Lesion: damage to somatic sensory association cortex in superior parietal lobule

Back 60

Consequence:
Right-->contralateral neglect
Left--> apraxia (inability to perform learned movements in the absence of paralysis)

Front 61

Lesion: bilateral damage to ventral visual "what" pathway in inferior occipital and temporal areas

Back 61

Consequence: visual agnosia and prosopagnosia

Front 62

Lesion: damage to dorsal visual "where" pathway in middle temporal gyrus, supramarginal and angular gyri

Back 62

Consequence: visual neglect in the contralateral half of the visual field

Front 63

Lesion: damage to planum temporal in the lateral fissure, lateral surface of superior temporal gyrus (auditory association cortex)

Back 63

Consequence:
Right--> auditory agnosia
Left--> (wernicke;s) sensory aphasia

Front 64

Lesion: damage to primary motor area in precentral gyrus

Back 64

Consequence:
Contralateral initial flaccid paralysis--> mild spasticity; worse for fine skilled movements

Front 65

lesion: damage to premotor cortex, SMA in area 6

Back 65

Consequence: apraxia

Front 66

LEsion: frontal eye field damage

Back 66

Consequence: inability to look voluntarily at contralateral side

Front 67

Lesion: damage to broca's area in inferior temporal gyrus

Back 67

Consequence: expressive/motor aphasia