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28 Cards in this Set

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normal pupillary light reflex
elicited by shining light into one eye causing its pupil to constrict (direct response) and that of the other eye (consensual response).
Involves retinal ganglion cells projecting to pretectal area (rostral to superior colliculus), which then projects bilaterally to Edinger-Westphal nucleus of CN III.
left optic nerve lesion
both pupils constrict when light is shined in right eye, but neither constricts when light shined in left eye
right cranial nerve III lesion
left pupil constricts when light shined in either eye, right pupil fails to constrict when light shined in either eye
relative afferent pupillary defect
both pupils initially constrict, after moving flashlight from normal to affected eye, pupillary dilation occurs due to reduced afferent input resulting from optic nerve lesion
near reflex
occurs when viewing a nearby object; pupillary constriction, lens accomodation (thickens), and convergence of the eyes (adduction)
dissociation of light and near reflexes
Pupillary constriction occurs with the near reflex, but the light reflex is absent due to selective disruption of pupillary light reflex pathway at superior colliculus or pretectal area.
Due to neurosyphilis (Argyll Robertson pupil), Parinaud's syndrome (pineal tumor compressing the dorsal midbrain, also impairing upward gaze)
Horner's syndrome
from a lesion of the cervical sympathetic nerves (pupillodilators), a three neuron circuit.
Signs = miosis (constricted pupil), anhidrosis (absence of sweating ipsilateral face), mild ptosis (paralysis of superior tarsal muscle, typically partial or mild).
nystagmus
repetitive, oscillatory, jerky eye movements due to imbalance of vestibular or brain stem control of eye movement.
Horizontal nystagmus from a vestibular lesion consists of a slow component toward the side of the lesion, and a fast component in the other direction.
monocular diplopia
seeing double with one eye closed; caused by ocular disorder (dislocated lens or detached retina) or psychiatric disorder, NOT neurological disease
binocular diplopia
seeing double with both eyes open, seeing normally with either eye closed.
Caused by lesions of the brain stem (CN III,IV,or VI, cerebellum or extraocular muscles)
internuclear ophthalmoplegia (medial longitudinal fasciculus, MLF syndrome)
inability of adducting eye to pass the midline on the side of the lesion, nystagmus of abducting eye, intact convergence.
Typical of MS in younger patients, ischemic infarction in older patients.
trigeminal, upper motor neuron lesion
bilateral weakness of muscles of mastication, with a hyperactive jaw jerk
trigeminal, lower motor neuron lesion
jaw deviates to one side of the lesion where the masseter muscle is atrophic
superior orbital fissure syndrome and lesion of the cavernous venous sinus
sensory loss in ophthalmic division of CN V, plus paresis of CN III,IV,and VI
trigeminal neuralgia
episodic, lightninglike jabs of pain, usually in maxillary or mandibular branches of CN V due to tortuous blood vessels or MS lesions.
Treated with carbamazepine.
facial, upper motor neuron lesion
lesion involving the motor cortex and its corticobulbar tract controlling CN VII, which causes only paralyis of lower 2/3 of the contralateral face, forehead moves normally
facial, lower motor neuron lesion
nuclear and peripheral (infranuclear) lesions of CN VII cause paralysis of entire ipsilateral half of the face
facial, lower motor neuron lesion near the stylomastoid foramen
paralysis of all ipsilateral facial muscles
facial, lower motor neuron lesion in the facial canal of the temporal (petrous) bone
ipsilateral facial muscle paralysis, loss of taste over anterior two thirds of tongue if chorda tympani branch affected, hyperacusis if branch to stapedius is affected
facial, lower motor neuron lesion in cerebellopontine angle of posterior fossa
often caused by acoustic neuroma (tumor of CN VIII), paralysis of ipsilateral facial muscles, loss of taste, deafness and tinnitus
facial, lower motor neuron lesion of pontine
paralysis of ipsilateral facial muscles, ipsilateral weakness of lateral gaze from involvement of PPRF and adjacent CN VI
Bell's palsy
sudden, non-traumatic onset of isolated peripheral CN VII palsy. Due to inflammation of facial nerve w/in petrous bone from possible viral infection. Tx w/corticosteroid.
lesions to glossopharyngeal and vagus nerves
clinically difficult to test seperately, impaired speech and swallowing. ipsilateral drooping of palatal arch, uvula points to normal side. gag reflex decreased, hoarseness.
spinal accessory nerve lesion
causes weakness of ipsilateral sternocleidomastoid and trapezius muscles
hypoglossal nerve lesion
UMN-few pts w/protruded tongue deviating away from the involved cerebral hemisphere
LMN-weakness in ipsilateral tongue, deviation to side of lesion, atrophy, fasciculations, and fibrillations ipsilaterally
crossed brain stem disorders
corticospinal decussates in lower medulla;lesion of brain stem may cause ipsilateral cranial nerve deficit and a contralateral limb weakness of UMN type
spinothalamic decussates in spinal cord; lesion in medulla can cause pain and temp deficit of contralateral body, with pain and temp deficit of ipsilateral face
medial midbrain syndrome (Weber syndrome)
caused by occlusion of a branch of the posterior cerebral artery, ipsilateral CN III lesion and contralateral hemiplegia (cerebral peduncle involved)
lateral medullary syndrome (Wallenberg syndrome)
caused by occlusion of the vertebral or posterior inferior cerebellar artery (PICA).