Nsp Week 1: Lesion Localization (Gordon)

Front 1

List 5 typical signs of a left (dominant) hemisphere lesion

Back 1

1. Right visual field defect
2. Right hemiparesis
3. Right hemisensory loss
4. Aphasia
5. Left gaze deviation (left gaze preference)

Front 2

List 5 typical signs of a right (non-dominant) hemisphere lesion

Back 2

1. Right gaze deviation/ preference
2. Left hemi-inattention (neglect)
3. Left visual field deficit
4. Left hemiparesis
5. Left hemisensory loss

Front 3

Lethargy/ delirium is usually a result of brain lesions located where?

Back 3

Bicerebral

Front 4

Seizures usually result from brain lesions located in which region?

Back 4

Cortex

Front 5

Memory deficits typically result from brain lesions located in which regions?

Back 5

1. Thalamic
2. Medial temporal

Front 6

Hemibody sensory deficits typically result from brain lesions located in which regions?

Back 6

Contralateral face, arm, leg regions of sensory areas

Front 7

Hemibody motor deficits typically result from brain lesions located in which regions?

Back 7

Contralateral face, arm, leg regions of motor areas

Front 8

Visual field deficits typically result from brain lesions located in which regions?

Back 8

Contralateral quadrant or hemianopsia

Front 9

Language deficits typically result from brain lesions located in which region?

Back 9

Left hemisphere

Front 10

Neglect typically result from brain lesions located in which regions?

Back 10

Right hemisphere

Front 11

Lethargy results from brainstem lesions located in which region?

Back 11

Reticular activating system

Front 12

When a patient presents with depressed consciousness and a lesion is suspected, how can you clinically differentiate between a brainstem or a bicerebral dysfunction?

Back 12

Differentiate using eye movements

Brainstem dysfunction --> ABNORMAL eye movements

Bicerebral dysfunction --> Normal eye movements

Front 13

List 2 signs of a cerebellar lesion

Back 13

1. Ipsilateral limb ataxia (dyscoordination)
2. Truncal or gain ataxia (imbalance)

Front 14

List 5 signs of a spinal cord lesion

Back 14

1. Weakness
2. Numbness
3. Urinary incontinence
4. Constipation
5. Sexual dysfunction

Front 15

Describe the difference between a neurogenic bladder caused by UMN and LMN disorders

Back 15

UMN--> bladder is small, spastic (hypertonic)
LMN --> bladder is large, flaccid (hypotonic)

Front 16

List some symptoms associated with neurogenic bladder caused by UMN disorder

Back 16

1. Urgency
2. Hesitancy
3. Frequency
4. Small volumes

*Bladder is small, spastic

Front 17

If a patient presents with overflow incontinence (dribbling), what is the cause of the neurogenic bladder --a UMN or LMN disorder?

Back 17

Lower motor neuron disorder
(bladders are large, flaccid)

Front 18

List two general causes of complete/ transverse myelopathy

Back 18

1. Transverse myelitis (MS, SLE, infection..)
2. Compressive myelopathy (metastatic cancer, meningioma, disk herniation..)

Front 19

List the signs associated with Brown-Sequard syndrome

Back 19

Ipsilateral --> loss of touch, proprioception, vibration; muscle weakness/ hyperreflexia

Contralateral--> decreased pain, temperature

Front 20

Which areas of the spinal cord are affected in neurosyphilis?

Which senses are lost

Back 20

Posterior columns

*Loss of touch, vibration, proprioception

Front 21

"Tabes dorsalis" affects which portions of the spinal cord?

Back 21

Dorsal columns

(caused by neurosyphilis)

Front 22

Vitamin B12 deficiency will affect which areas of the spinal column?

List some associated signs.

Back 22

Posterior and lateral columns

1. Spastic paraparesis
2. Sensory loss (touch, vibration, proprioception)

Front 23

Anterior spinal artery occlusion will affect which portions of the spinal cord?

List some associated signs

Back 23

Anterior 2/3 of cord
(lateral columns, spinothalamic tract)

1. Spastic paraparesis
2. Loss of pain/temperature sensation

Front 24

Syringomyelia affects which portions of the spinal cord?

List some associated signs

Back 24

Affected portions:
1. Anterior white commissure
2. Anterior horn cells
3. Possibly lateral columns

Signs:
1. Hand weakness and atrophy
2. Cape-distribution pain/temp sensory loss (at level of syrinx)
3. Possible spastic paraparesis (below level of syrinx)

Front 25

In general, what are the different etiologies of axonal and demyelinating peripheral neuropathies?

Back 25

Axonal --> toxic-metabolic/ vascular
Demyelinating --> autoimmune

Front 26

List 2 demyelinating peripheral neuropathies

Back 26

1. Guillain-Barre syndrome (acute)
2. CIDP (chronic)

Front 27

"Subacute combined degeneration" can be caused by..?

Back 27

1. B12 deficiency
2. HIV

Front 28

List some causes of axonal peripheral neuropathy

Back 28

1. Diabetes mellitus
2. HIV
3. Acute intermittent porphyria
4. Lead toxicity
5. Barium salt toxicity
6. Mononeuitis multiplex
7. Lyme disease

Front 29

Will axonal peripheral neuropathy cause an abnormal EMG or NCS?

Back 29

EMG

Front 30

Will demyelinating peripheral neuropathies cause an abnormal EMG or NCS?

Back 30

NCS

Front 31

The biceps reflex occurs at which dermatome level?

Back 31

C5-6

Front 32

The triceps reflex occurs at which dermatome level?

Back 32

C7-8

Front 33

The patellar reflex occurs at which dermatome level?

Back 33

L3-4

Front 34

The ankle reflex occurs at which dermatome level?

Back 34

S1-2

Front 35

List some causes of muscle disease resulting in proximal weakness.

Back 35

1. Thyroid
2. Polymyositis
3. Dermatomyositis
4. Muscular dystrophies
5. Drug induced (steroid, AZT, statin)

Front 36

What is the difference in fatigability between muscle disease and neuromuscular junction disease?

Back 36

Muscle --> no fatigability
NMJ --> fatigable (worse late in the day, after exercise)

Front 37

What is the neurologic localization of extraocular/bulbar weakness?

Back 37

Neuromuscular junction

Front 38

Describe the differences in response to repetitive stimulation of muscle fibers in Myesthenia gravis and Lambert-Eaton syndrome

Back 38

Myesthenia gravis --> decremental response

Lambert-Eaton --> Incremental response

Front 39

List 2 drugs that can induce myasthenia

Back 39

1. Aminoglycosides
2. D-penicillamine

Front 40

Which structures are involved in vertigo?

Back 40

1. Ear
2. CN VIII
3. Brainstem
4. Cerebellum

Front 41

Which structures are involved in cerebellar ataxia (dyscoordination)?

Back 41

1. Cerebellum
2. Cerebellar tracts/ peduncles

Front 42

Sensory ataxia can result from damage to which structures?

Back 42

1. Peripheral nerve
2. Posterior spinal cord