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124 Cards in this Set
- Front
- Back
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Irritative lesions of the ____ may cause seizures that begin as focal twitching and spread [in a somatotopic manner, reflecting the organization of the homunculus] to involve large muscle groups [Jacksonian epilepsy]
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motor centers
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Destructive lesions of the motor cortex [area __] produce contralateral flaccid paresis, or paralysis, of affected muscle groups
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4
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Spasticity is more apt to occur if area __ is also ablated
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6
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Irritative lesions of the ____ produce paresthesias [eg, numbness, abnormal sensations of tingling, electric shock, or pins and needles] on the opposite side of the body.
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primary sensory cortex
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Irritative lesions of area ___ can produce such visual hallucinations as flashes of light, rainbows, brilliant stars, or bright lines.
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17
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Destructive lesions can cause contralateral homonymous defects of the visual fields.
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Area 17
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This can occur without destruction of macular vision, a phenomenon called "macular sparing." Which area?
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area 17
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Injury to areas __ and ___ can produce visual disorganization with defective spatial orientation in the homonymous halves of the visual field.
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18 and 19
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Irritation of the region in or near the ___ area in humans causes buzzing and roaring sensations
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primary auditory receptive
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Damage to area __ in the dominant hemisphere produces a syndrome of pure word deafness [in which words cannot be understood although hearing is not impaired], also called Wernicke's aphasia.
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22
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Most common site for Subarachnoid Hemorrhage
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Junction of an Anterior Communicating Artery with an Anterior Cerebral Artery 40%
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Most common site for ARTERIOSCLEROTIC PLAQUE
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Internal carotid [near bifurcation]
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Occluded artery (branch of ACA)? Paresis of face and arm
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Medial striate
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Occluded artery (branch of ACA)? Apathy with some memory loss
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Orbital/frontopolar
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Occluded artery (branch of ACA)? Paresis and hypesthesia of face and arm; may see abulia, mutism, or inability to reach across field
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Callosomarginal
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Occluded artery (branch of ACA)? Ideomotor alexia [anterior lesion] Tactile anomia [posterior lesion]
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Pericallosal
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Occluded artery (branch of MCA)? Prefrontal syndrome
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Orbitofrontal
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Occluded artery (branch of MCA)? Broca’s aphasia
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Left precentral
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Occluded artery (branch of MCA)? Motor aprosodia
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Right precentral
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Occluded artery (branch of MCA)? Loss of motor function [possibly sensory as well] in face and arm
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Central
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Occluded artery (branch of MCA)? Hemineglect
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Inferior parietal
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Occluded artery (branch of MCA)? Hemianopia
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Either angular branch
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Occluded artery (branch of MCA)? Alexia
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Left angular
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Occluded artery (branch of MCA)? Wernicke’s aphasia
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Right angular
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Occluded artery (branch of MCA)? Receptive aprosodia
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Right Temporal
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Occluded artery (segment of MCA)? Hemiplegia, hemihypesthesia, hemianopia
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Either Stem
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Occluded artery (segment of MCA)? global aphasia
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Left Stem
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Occluded artery (segment of MCA)? sensory neglect
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Right Stem
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Occluded artery (segment of MCA)? Paresis and hypesthesia of face and arm, dysarthria
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Either Upper Division
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Occluded artery (segment of MCA)? Broca’s aphasia
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Left Upper Division
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Occluded artery (segment of MCA)? hemineglect or expressive aprosodia
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Right Upper Division
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Occluded artery (segment of MCA)? Hemianopia; possibly agitated state
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Either Lower Division
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Occluded artery (segment of MCA)? Wernicke’s aphasia, alexia, ideomotor apraxia
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Left Lower Division
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_____ arteries most often affected in stroke and in Charcot-Bouchard microaneurysms [result from chronic hypertension]
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Lateral striate
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Occluded artery (segment of PCA)? Hemianopsia
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Either stem
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Occluded artery (segment of PCA)? Alexian visual field
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Left stem
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Occluded artery (segment of PCA)? Cortical blindness, possibly amnesia
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Both stems
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Occluded artery (branch of PCA)? Ipsilateral CN3 palsy and contralateral hemiplegia
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Midbrain Branch
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Occluded artery (branch of PCA)? Contralateral numbness, possibly hemianopia, thalamic syndrome
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Thalamus Branch
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Occluded artery (branch of PCA)? Contralateral ballism
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Subthalamic Nucleus Branch
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Occluded artery (branch of PCA)? Alexia in contralatera visual field
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Corpus Callosum Branch
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Location of LACUNAR LESIONS? Dysarthria, clumsy hand; possibly dysphagia
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Genu of Internal Capsule
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Location of LACUNAR LESIONS? Pure motor hemiparesis
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Posterior limb of Internal Capsule
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Location of LACUNAR LESIONS? Pure sensory syndrome, possibly with sensory ataxia
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Ventral posterior nucleus of Thalamus
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Site of BASAL GANGLIA LESIONS? Involuntary, continuous muscle contractions that lead to rotatory movements and abnormal postures of hand, an arm, neck , or face [Athetosis is a localized dystonic movement].
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Globus Pallidus
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Site of BASAL GANGLIA LESIONS? Hemiballismus [proximal flinging movement of limbs; violent]
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Subthalamic Nucleus
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Site of BASAL GANGLIA LESIONS? [chorea] Overshooting; spontaneous, abrupt, alternating irregular movements. Varies from restlessness with little gesticulation to hesitant dance-like gait impairment to violent hyperkinesia
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Putamen
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Site of BASAL GANGLIA LESIONS? Huntington’s Chorea
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Caudate and Putamen
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Site of BASAL GANGLIA LESIONS? Parkinson’s Disease
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Subbstantia Nigra
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Site of HYPOTHALAMIC LESIONS? Decreased blood pressure, heart rate; Increased GI motility and secretion; Bladder contraction; Pupillary constriction; Decreased body temperature
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Anterior Hypothalamus [preoptic area]
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Site of HYPOTHALAMIC LESIONS? Increased blood pressure, heart rate; Vasoconstriction of skin vessels; Decreased peristalsis; Pupillary dilation; Increased blood glucose; shivering; eccrine sweating
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Posterior Hypothalamus [lateral nuclei]
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Site of HYPOTHALAMIC LESIONS? Increased water intake
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Lateral Hypothalamus [zona incerta]
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Site of HYPOTHALAMIC LESIONS? Decreased food intake, docile
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Medial Hypothalamus [ventromedial nucleus]
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Site of HYPOTHALAMIC LESIONS? Fear or rage
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Amygdala
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Site of lesion? Vertical gaze palsy; impaired convergence; retractional nystagmus. May see strabismus with diplopia. Sensation of movement of surroundings with walking or movement of head. No central paralysis. Pupils may be constricted but reactive or dilated and non-reactive to light.
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Midbrain (BASILAR ARTERY SYNDROME)
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Site of lesion? Visual field defects. May see somnolence, dream-like scenic hallucinations, memory impairment, disorientation, psychomotor hyperactivity.
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Thalamus, part of temporal and occipital lobes (BASILAR ARTERY SYNDROME)
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Site of ANTERIOR MIDBRAIN [PEDUNCLE] lesion? Ipsilateral oculomotor paralysis, dilated pupil unreactive to light
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Intramesencephalic fibers of the oculomotor nerve
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Site of ANTERIOR MIDBRAIN [PEDUNCLE] lesion? Contralateral central paralysis and facial paralysis [supranuclear facial palsy]; spasticity; may see dysarthria [supranuclear hypoglossal palsy]
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Pyramidal tract
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Site of ANTERIOR MIDBRAIN [PEDUNCLE] lesion? Rigidity
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Substantia nigra
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Site of MEDIAL MIDBRAIN [TEGMENTUM] lesion? Ipsilateral oculomotor paralysis; dilated pupil unreactive to light
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Intramesencephalic fibers of the oculomotor nerve
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Site of MEDIAL MIDBRAIN [TEGMENTUM] lesion? Contralateral impairment of touch, position, vibration sense
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Medial lemniscus
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Site of MEDIAL MIDBRAIN [TEGMENTUM] lesion? Contralateral tremor
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Red nucleus
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Site of MEDIAL MIDBRAIN [TEGMENTUM] lesion? Rigidity
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Substantia nigra
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Site of MEDIAL MIDBRAIN [TEGMENTUM] lesion? Contralateral ataxia
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Superior cerebellar peduncle
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Site of DORSAL MIDBRAIN [TECTUM] lesion? Overactive levator palpebrae superioris muscle [retraction]. Over time, pupils dilate and do not react to light but do constrict upon convergence.
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Oculomotor nuclei
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Site of DORSAL MIDBRAIN [TECTUM] lesion? Supranuclear palsy of upward conjugate gaze [eyes move upward passive deflection of the head but not voluntarily]. Covergence nystagmus with lid retraction on upward gaze.
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Medial longitudinal fasciculus
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Site of DORSAL MIDBRAIN [TECTUM] lesion? Trochlear nerve palsy.
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Trochlear nucleus
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Site of DORSAL MIDBRAIN [TECTUM] lesion? Hydrocephalus, papilledema
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Acqueduct
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Site of MID VENTRAL PONS lesion? Contralateral central paralysis sparing the face
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Pyramidal tract
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Site of MID VENTRAL PONS lesion? Ipsilateral facial hyperesthesia, weakness of muscles of mastication
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Intrapontine fibers of trigeminal nerve
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Site of MID VENTRAL PONS lesion? Ipsilateral ataxia
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Middle cerebellar peduncle
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Site of LACUNAR LESION? Contralateral central paralysis more pronounced in the legs and possibly sparing the face
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Pyramidal tract
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Site of LACUNAR LESION? Ipsilateral ataxia with dysarthria and dysphagia; may also see a “clumsy” hand
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Middle cerebellar peduncle
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Site of SUPERIOR PONTINE TEGMENTUM lesion? Ipsilateral facial hyperesthesia; paralysis of muscles of mastication
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Trigeminal nucleus and fibers
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Site of SUPERIOR PONTINE TEGMENTUM lesion? Ipsilateral ataxia, intention tremor
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Superior cerebellar peduncle
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Site of SUPERIOR PONTINE TEGMENTUM lesion? Contralateral impairment of touch, position, and vibration sense
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Medial lemniscus
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Site of SUPERIOR PONTINE TEGMENTUM lesion? Contralateral loss of pain and temperature sensation
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Spinothalamic tract
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Site of SUPERIOR PONTINE TEGMENTUM lesion? Ipsilateral loss of conjugate movement [loss of optokinetic and vestibular nystagmus but vetibulo-ocular reflex intact]
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Paramedian pontine recticular formation
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Site of SUPERIOR PONTINE TEGMENTUM lesion? Contralateral paralysis sparing the face.
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Pyramidal tract
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Site of CAUDAL PONTINE TEGMENTUM lesion? Contralateral central paralysis sparing the face
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Pyramidal tract
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Site of CAUDAL PONTINE TEGMENTUM lesion? Ipsilateral facial palsy
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Facial nerve nucleus and fibers
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Site of CAUDAL PONTINE TEGMENTUM lesion?
Ipsilateral abducens paralysis [eyes drift away from the lesion]; loss of vestibulo-ocular reflex |
Abducens nerve fibers
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Site of CAUDAL PONTINE TEGMENTUM lesion? Ipsilateral Horner syndrome
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Central sympathetic pathway
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Site of CAUDAL PONTINE TEGMENTUM lesion? Loss of ipsilateral conjugate movement
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Paramedian pontine reticular formation
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Site of CAUDAL PONTINE TEGMENTUM lesion? Contralateral loss of touch, position, and vibration sense
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Medial and lateral lemniscus
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Site of CAUDAL PONTINE TEGMENTUM lesion? Contralateral loss of pain and temperature sensation
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Lateral spinothalamic tract
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Site of MEDIAL MEDULLARY LESIONS? Ipsilateral hypoglossal paralysis
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Hypoglossal nucleus and fibers
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Site of MEDIAL MEDULLARY LESIONS? Contralateral central paralysis [flaccid] sparing the face
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Pyramidal tract
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Site of MEDIAL MEDULLARY LESIONS? Contralateral loss of touch, position, vibration sense with intact pain and temperature sensation
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Medial lemniscus
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Site of MEDIAL MEDULLARY LESIONS? Upbeat nystagmus
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Medial longitudinal fasciculus
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Site of LATERAL MEDULLARY LESIONS lesion? Ipsilateral analgesia/thermanesthesia with sparing of the face and absence of corneal reflex
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Spinal nucleus of trigeminal nerve
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Site of LATERAL MEDULLARY LESIONS lesion? Ipsilateral hearing loss
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Cochlear nucleus
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Site of LATERAL MEDULLARY LESIONS lesion? Ipsilateral paralysis of pharynx and larynx with tongue movement intact
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Nucleus ambiguus
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Site of LATERAL MEDULLARY LESIONS lesion? Impaired sense of taste
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Solitary nucleus
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Site of LATERAL MEDULLARY LESIONS lesion? Tachycardia and dyspnea
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Dorsal nucleus of vagus nerve
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Site of LATERAL MEDULLARY LESIONS lesion? Nystagmus away from the lesion while falling to the side of the lesion
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Inferior vestibular nucleus
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Site of LATERAL MEDULLARY LESIONS lesion? Ipsilateral tremor of the soft palate and pharynx
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Central tegmental tract
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Site of LATERAL MEDULLARY LESIONS lesion? Ipsilateral Horner’s syndrome
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Central sympathetic pathway
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Site of LATERAL MEDULLARY LESIONS? Singulitis
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Reticular formation
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Site of LATERAL MEDULLARY LESIONS? Ipsilateral ataxia and intention tremor
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Inferior cerebellar peduncle
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Site of LATERAL MEDULLARY LESIONS? Ipsilateral hypotonia
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Anterior spinocerebellar tract
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Site of LATERAL MEDULLARY LESIONS? Contralateral loss or pain and temperature sensation while preserving touch, position, and vibration sense
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Lateral spinothalamic tract
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Complete ___ palsy is associated with loss of conjugate gaze. Best seen when staring straight ahead. The unaffected eye is straight; the affected eye is pulled laterally.
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oculomotor
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___ palsy will show the affected eye UP and medially while the unaffected eye is straight
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Trochlear
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____ palsy will show the affected eye pulled medially while the unaffected eye is straight.
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Abducens
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_____ involves a lesion of the medial longitudinal fasciculus. Manifest on lateral gaze [contra-lateral eye does not respond].
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Intranuclear ophthalmoplegia
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Upward gaze lesions may be ___ or ___.
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pontine or supra-tentorial
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___ nerve lesions are associated with paresis of frontalis muscle, paresis at the corner of the mouth, paresis of the platysma, lagging lid closure.
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Facial
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A ____ lesion in the cord can affect the decussating fibers of the spinothalamic tract from both sides without affecting other ascending or descending tracts. As a result, these lesions can produce dissociated sensory abnormalities with loss of pain and temperature sensibility in appropriate dermatomes but with preserved vibration and position sense [e.g., in syringomyelia].
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small central
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A_____ lesion in the cord involves, in addition to the pain and temperature pathways, portions of adjacent tracts, adjacent gray matter, or both. Thus, there can be lower motor neuron weakness in the segments involved, together with upper-motor-neuron dysfunction and, in some cases, loss of vibratory and position sense at levels below the lesion.
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large central
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A ___ lesion affects the ___ columns, leaving other parts of the spinal cord intact. Proprioceptive and vibratory sensation are involved, but other functions are normal [e.g., tabes dorsalis]
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dorsal column, dorsal
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An irregular ____ lesion [e.g., penetrating wound or compression of the cord] involves long pathways and gray matter; functions below the level of the lesion are abolished.
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peripheral
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Complete hemisection of the cord produces a ____.
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Brown–Séquard syndrome
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A tumor of the ____ involves the first-order sensory neurons of a segment and can produce pain as well as sensory loss. Deep tendon reflexes at the appropriate level may be lost because of damage to Ia fibers.
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dorsal root [such as a neurofibroma or schwannoma]
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A tumor of the ____ or the___ may compress the spinal cord against a vertebra, causing dysfunction of ascending and descending fiber systems
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meninges [primary or metastatic] or bone [extramedullary masses]
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1.May only see decreased alertness or behavioral change
2. May see contralateral weakness and sensory loss, visual defects, language distrubance, or impaired spatial perception 3. Ipsilateral pupillary dilatation with loss of light reactivity |
Subarachnoid Hemorrhage
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site of LIMBIC SYNDROMES? Delerium, acute confusional state
Disturbance of consciousness, attention, perception. Fluctuating. Visual hallucinations. Disturbance of affect. |
Bilateral mediobasal temporal lobe [hippocampus, amygdala], hypothalamus
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site of LIMBIC SYNDROMES? Pathologic laughing and crying
Uncontrollable. |
Internal capsule, basal ganglia, thalamus, corticonuclear tract
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site of LIMBIC SYNDROMES? Aggressive, violent behavior; fits of rage
Out of proportion. |
Mediobasal temporal lobe [amygdala]
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site of LIMBIC SYNDROMES? Memory deficit, transient global amnesia
Only short-term memory and sense of time impaired |
Mamillary bodies; mediobasal temporal lobe
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site of LIMBIC SYNDROMES? Disturbed sexuality
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Septal area; hypothalamus
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site of LIMBIC SYNDROMES? Apathy, indifference, akinetic mutism
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Bilateral septal area, cingulate gyrus
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Quadriplegia, aphoria, inability to swallow, horizontal gaze palsy [including absence of caloric response], loss of corneal reflex
Eyelid and vertical eye movements, sensation, wakefulness, and spontaneous breathing remain intact. |
LOCKED IN SYNDROME
Ventral pons [corticobulbar and corticonuclear tracts] bilaterally; abducens nucleus, pontine paramedian reticular formation, fibers of trigeminal nerve |
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Affect the most precise movements of the extremities
Asynergy Dysdiadochkinesia Dysmetria Decomposition Hypotonia and pendular patellar tendon reflex |
SPINOCEREBELLAR AND CEREBROCEREBELLAR INJURY
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