E1 Lundy-Ekman Review Questions Ch 18

Front 1

Case 1:
ZZ, a 54-yom reports sudden and complete loss of ability to move his legs. No trauma occurred.
-Pain and temperature sensation have been lost bilaterally below T9. All sensations are intact above T9.
-Localized touch, vibration, and position senses are intact throughout the entire body.
-Motor examination reveals bilateral paralysis below T9. The motor system is normal above T9.

Question:
1. Which vertical systems are involved?
2. Where is the lesion?
3. What is the likely etiology?

Back 1

B/c the anterior spinal artery supplies the anterior 2/3 of the cord, occluding this artery interrupts upper motor neurons and spinal tract neurons conveying nociceptive and temp info., resulting in the deficits seen. The posterior spinal arteries supply the dorsal columns, so vibration and position senses are unaffected.

Front 2

Case 2
LZ, a 72-yow, awoke 3 days ago with severe weakness and loss of sensation on the left side of her body and lower face. All sensory and motor functions on the right side are w/i normal limits.
-sensory testing reveals responsiveness only to deep pinch on the left side.
-she cannot move any joint on the left side independent of the movement of other joints. When she attempts to reach forward, no flexation occurs at the shoulder; instead, her shoulder elevates, and elbow flexion increases.
-In sitting or assisted standing, she does not bear weight on the left. She cannot walk, even w/ assistance. She steps forward w/ the right lower limb, then lurches forward and attempts to continue stepping w/ the right lower limb, dragging the left lower limb.
-Her gaze tends to be directed toward the right. Even w/ cuing or loud noises on the left side, she does not turn her head or eyes to the left of the midline. She seems unaware of the left side of her body.
-Her ability to converse is normal.

Question:
1. Which vertical systems are involved?
2. Where is the lesion?
3. What is the likely etiology?

Back 2

Vertical tracts: all sensations and voluntary mvmnt are affected on one side of the body. Lack of attention to the left side of the body (neglect of the left limbs, lack of response to stimuli on the left side) indicates a cortical lesion. B/c at the cortical level all vertical systems project contralaterally, the lesion is in the right cortex. The sudden onset suggests a vascular etiology. The artery supplying the lateral part of the sensorimotor cortex is the middle cerebral artery. B/c the lower limb is affected, the lesion involves the deep branches of the middle cerebral artery.

Front 3

Case 3:
MZ, a 9-mob, has an enlarged cranium and is being assessed for possible developmental delay.
-sensation is normal
-MZ cannot sit unsupported. In supported sitting, he is unable to hold his head in neutral for more than 10 seconds. He moves very little. In supine position, his limbs tend to flop out to the side, and he does not turn from back to side.
-HIs gaze is directed downward.

Question:
1. Which vertical systems are involved?
2. Where is the lesion?
3. What is the likely etiology?

Back 3

The vertical tract sign is the motor deficit; the sensory system is unaffected. In conjugation w/ the enlarged cranium and eye position, the motor signs indicate hydrocephalus.

Front 4

1. What are the functions of the CSF?

Back 4

The CSF provides H2O, some aa and ions to the extracellular fluid and protects the CNS by absorbing some of the impact when the head receives a blow. CSF may also remove metabolites from the extracellular fluid

Front 5

2. Where is the CSF located?

Back 5

CSF is located in the ventricles and the subarachnoid space

Front 6

3. Why is there a difference in pattern of progression b/t an epidural hematoma and a subdural hematoma?

Back 6

An epidural hematoma arises from arterial bleeding. B/c arteries bleed quickly, the signs and symptoms develop rapidly. In contrast, subdural hematoma is produced by venous bleeding. Veins bleed slowly, causing slow progression of the signs and symptoms

Front 7

4. In an infant, an abnormally large head size, inactivity, insufficient feeding, and downward gaze of both eyes may indicate what disorder?

Back 7

An enlarged head, difficult feeding, downward looking eyes, and inactivity in an infant may indicate hydrocephalus

Front 8

5. Can hydrocephalus occur in adults?

Back 8

Hydrocephalus can occur in adults, but the head does not enlarge b/c bone growth has stopped, and thus the signs and symptoms differ from hydrocephalus in infants.

Front 9

6. What is the watershed area?

Back 9

the watershed area is the region on the lateral cerebral hemisphere that receives blood from small anastomoses linking the ends of the cerebral arteries. The watershed area is susceptible to insufficient blood flow.

Front 10

7. What is transient ischemic attack?

Back 10

A TIA is a brief, focal loss of brain function that lasts less than 24 hrs. the neurolgic deficit must be completely resolved w/i 24 hrs

Front 11

8. What is a lacuna?

Back 11

Lacuna is a small cavity that remains after the necrotic tissue is cleared following an infarct in a small artery

Front 12

9. A partial occlusion of which artery can result in tetraplegia, loss of sensation, coma, and cranial nerve signs?

Back 12

A partial occlusion of the basilar artery may result in tetraplegia, loss of sensation, coma, and cranial nerve signs b/c the basilar artery supplies both the left and right sides of the medulla and pons; thus interference w/ its blood flow deprives the descending upper motor neuron axons and the ascending sensory axons, as well as the reticular formation, cranial nerve nuclei, and cranial nerves of adequate perfusion

Front 13

10. Hemiplegia an hemisensory loss that are more sever in the lower limb than in the upper limb and face indicate that what part of the brain is affected? What artery supplies this region?

Back 13

More sever hemiplegia and hemisensory loss in the lower limb indicates that the lesion is in the medial sensorimotor cortex and adjacent subcortical white matter. This region is supplied by the anterior cerebral artery

Front 14

11. neglect, poor understanding of spacial relationships, and impairment of nonverbal communication are signs of damage to what part of the brain? Which artery supplies this region?

Back 14

Neglect, problems comprehending space, and impaired nonverbal communication occur w/ damage to the area analogous to Wernicke's area in the hemisphere that is nondominant for language (usually the right hemisphere). This area is supplied by the middle cerebral artery

Front 15

12. If hemiplegia and hemisensory loss affect the upper and lower limbs and the face equally, where is the lesion? Branches of what major artery supply this region?

Back 15

Hemisensory loss and hemiplegia affecting the limbs and face equally indicate a lesion in the internal capsule, supplied by deep branches of the middle cerebral arteries

Front 16

13. Eye movement paresis w/ sparing of lateral and inferomedial eye movements combined w/ contralateral hemiplegia indicates a lesion located where?

Back 16

The loss of eye movements combined w/ contrallateral hemiplesia indicates a lesion of the anterior midbrain, supplied by branches of the posterior cerebral artery.

Front 17

14. What arteries supply the watershed area?

Back 17

Distal branches of the anterior, middle, and posterior cerebral arteries supply the watershed area

Front 18

15. What is an arteriovenous malformation?

Back 18

An anteriorvenous malformation is an abnormal connection b/t arteries and veins, w/ thin-walled vessels larger than capillaries connecting the vessels. Arteriovenous malformations are developmental defects

Front 19

16. What is an aneurysm?

Back 19

An aneurysm is a dilation of the wall of an artery or vein. Aneurysm are prone to rupture b/c their walls are thinner than normal vessel walls.

Front 20

17. What is a uncal herniation?

Back 20

An uncal herniation is displacement of the uncus medially, so that the uncus protrudes though the tentorium cerebelli and compresses the midbrain

Front 21

18. What is a PET scan?

Back 21

a positron emission tomography (PET) scan is a computer-generated image reflecting the metabolic activity throughout biological tissues. PET scans of the CNS record the relative activity and inactivity of areas in the brain or spinal cord