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160 Cards in this Set
- Front
- Back
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In peripheral lesion, what is decreased?? |
Muscle strength, tone and trophy. And deep tendon reflexes |
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In peripheral lesion, what is absent?? |
Pyramidal signs Sensory loss: absent or present in the distribution of one nerve root, plexus or peripheral nerve in c |
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In central lesion, what is decreased? |
Muscle strength |
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In central lesion, the muscle trophy is..? |
Normal (decreased in the chronic phase) |
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In central lesion, the muscle tone.. |
Is increased! Spasticity |
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How is the pyramidal signs in central lesion? |
Present!! |
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How is the sensory loss in central lesion? |
Absent or present in the hemi, para or tetra patterns, or in niveau pattern if spinal cord is affected. |
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What is nuclear lesion (bulbar palsy)? |
Lesion of the motor nucleus of a cranial nerve, it’s axon or it’s NMJ |
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Which CN are affected in bulbar palsy? |
Cn 9, 10,11,12 Sx like atrophy and flaccidity |
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X palsy |
Soft palate paralysis Nasal speech, dysphagia |
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Supranuclear lesion (pseudobulbar palsy)? |
Lesion of the corticobulbar tract of cranial nerve. |
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Which CN are affected in pseudobulbar palsy? |
Cn 5,7,9,10,11,12 Sx of spasticity and hyperreflexia |
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Clinical features of pseudobulbar palsy |
VII palsy- no face expression Spastic dysarthria (Donald duck voice) Dysphagia Spastic tongue Pseudobulbar effect = uncontrollable laughing/crying V palsy- exaggerated jaw jerk reflex |
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What is anterior territory stroke? |
Stroke involving the territory of the internal carotid system (ACA, MCA) |
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What are the sx of Anterior territory stroke? |
Contralateral hemiparesis Contralateral hemisensory loss Contralateral homonymous hemianopia Aphasia Contralateral hemineglect Gaze deviation toward lesion Amaurosis fugax |
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Amaurosis fugax |
Sudden painless loss of vision Last for second to minutes, recover spontaneously Usually unilateral |
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Posterior territory stroke symptoms?? |
Ipsilateral limb ataxia Ipsilateral Horner syndrome Cn involvement Contralateral or bilateral hemiparesis and hemisensory loss Homonymous hemianopia Cortical blindness |
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Which symptoms are present in the cranial involvement of posterior territory stroke? |
Ipsilateral diplopia and facial sensory loss Lmn facial palsy Vertigo Dysphagia Dysarthria |
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What is cortical blindness? |
Blindness with an otherwise normal ophthalmological examination |
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What are brainstem alternating syndromes? |
Syndromes characterized by ipsilateral cranial nerve sx and contralateral limb sx |
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What does Weber syndrome (ventral midbrain syndrome) affect? |
Ventral midbrain : due to PCA obstruction Ipsilateral oculomotor nerve: ptosis, mydriasis, inferolateral gaze deviation Ipsilateral corticospinal tract: contralateral hemiparesis or plegia Contralateral Parkinsonism |
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Wallenberg syndrome (lateral medullary syndrome) is..? |
The infarction of lateral part of medula oblongata due to posterior inferior cerebelar artery obstruction!! |
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What does Wallenberg syndrome affect? |
Ipsilateral vestibular nuclei and nucleus ambiguus (9,10,11) Spinal trigeminal nucleus Sympathetic fibers > ipsi Horner syndrome Ipsilateral cerebelar peduncle > ipsi hemiataxia Ipsi lateral spinothalamic tract: contralateral hypoesthesia and decreased temperature sensitivity |
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Affection of nucleus ambiguus causes..? |
Cn 9,10,11 Dysphagia Hoarseness Hiccups |
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What is dissociated sensory loss? |
Pattern of sensory loss caused by lesion of a single tract, resulting in the loss of either the spinothalamic tract or the dorsal column But not both! |
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Which syndrome does lesion of spinothalamic with intact dorsal Column occurs? |
Anterior cord syndrome Central cord syndrome Conus medullaris syndrome Loss of pain and temperature sensation |
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Lesion of dorsal column with intact spinothalamic tract |
Occurs in posterior cord syndrome Loss of fine touch, vibration and proprioception |
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In homonymous vision loss... |
Same region is lost on both eyes |
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In Heteronymous vision loss.. |
Opposing regions are lost |
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In Hemianopia.. |
Loss of half of the vision field |
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What is damaged in complete unilateral vision loss? |
Retina or optic nerve Pré chiasma |
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What is damaged in Bitemporal heteronymous hemianopia? |
Middle part of optic chiasm!!! |
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Lesion of the lateral part of the optic chiasm? |
Ipsilateral nasal hemianopia |
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In Binasal heteronymous hemianopia .. |
Lesion of both lateral parts of optic chiasm |
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Lesion of the optic tract?? |
Contralateral homonymous hemianopia |
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Lesion for contralateral homonymous upper quadrantanopia? |
Anterior part of optic radiation and lower part of calcarine fissure |
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Contralateral homonymous hemianopia with central sparing?? |
Lesion of occipital lobe!! Loss of ipsilateral nasal and contralateral temporal visual fields. But central vision remains intact. |
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What is gaze palsy?? |
Limitation of voluntary moving both eyes in the same direction across midline. Can be nuclear or supranuclear |
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In supranuclear gaze palsy... |
Movement can still be elicited by reflex eye movements (oculocephalic, caloric test) Lesion in cortical or connections between them |
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In nuclear gaze palsy..... |
Movement can’t be elicited by reflex. Lesion on brainstem!!! |
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Etiology of horizontal gaze palsy? |
Most common Stroke in pons |
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Causes of vertical gaze palsy? |
Stroke in midbrain Pinealoma multiple sclerosis |
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Etiology of Downward gaze palsy?? |
Progressive Supranuclear palsy |
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Internuclear ophthalmoplegia... |
Lesion of one or both medial longitudinal fasciculi!! Can be considered supranuclear gaze palsy |
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Etiology of internuclear ophthalmoplegia?? |
Multiple sclerosis Stroke Brainstem tumor! |
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Clinical feature of internuclear ophthalmoplegia?? |
Impaired adduction of ipsilateral eye Abduction nystagmus of contralateral eye One or both eyes can be affected |
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How is the innervation of facial muscles? |
Upper half by fibers of both hemispheres Lower from contralateral hemisphere. |
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Etiology of central facial palsy? |
Stroke and tumor |
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Etiology if peripheral facial palsy?? |
Idiopathic bells Lyme disease Otitis media Trauma |
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Symptoms of central facial palsy?? |
All on contralateral side Frowning, eye closing, normal blinking Drooping corner of mouth Nasolabial fold disappear |
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Symptoms of peripheral facial palsy? |
Ipsilateral side sx Frowning, eye closing, abnormal blinking Can’t close eyes Pain in ear, hyperacusis Disappear nasolabial fold |
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Most common causes of myoclonus? |
Phys: hiccups Juvenile myoclonic epilepsy Hypoxic brain injury Metabolic encephalopathy (hep/renal) |
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What is chorea and ballismus? |
Chorea: continuous, irregular involuntary movement (dance) Ballismus: flapping, irregular involuntary movement |
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Ataxia means..? |
The disturbance of voluntary movement coordination. Sensory ataxia : transmission of proprioception info Cerebelar ataxia: disturbance of the structures responsible for mov coordination. |
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Name the symptoms of cerebelar ataxia. |
Hypotonia Asynergy Dysmetria Nystagmus Intentional tremor Positive Romberg test |
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What are the causes for cerebelar ataxia? |
Alcohol, stroke, phenytoin, measles, prion, celiac disease Neurodegenerative (multiple system atrophy) Vit def B1, E |
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What are the symptoms in sensory ataxia? |
Positive Romberg test Decreased joint position and vibration sensation Decreased deep tendon reflexes If you close the eyes or darkness it’s worse!! |
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Causes for sensory ataxia? |
Severe polyneuropathy Vit b12 def HIV CIDP ( chronic inflammatory demyelination polyneuropathy) Tabes dorsalis (syp) |
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In peripheral (harmonic vestibular syndrome) vertigo, what is the direction and type of nystagmus? |
Direction: never changes, slow towards affected ear Type: horizontal or combined horizontal and rotational!!! |
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In peripheral vertigo... |
Romberg test patient falls towards opposite side of nystagmus. Nausea is common Posture instability in affected side, walking preserved. Tinnitus, hearing loss |
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In peripheral vertigo... |
Romberg test patient falls towards opposite side of nystagmus. Nausea is common Posture instability in affected side, walking preserved. Tinnitus, hearing loss |
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In central (disharmonic vestibular syndrome) vertigo how is the direction and nystagmus type? |
Direction; change based on gaze Type: any direction, pure vertical or rotational |
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In peripheral vertigo... |
Romberg test patient falls towards opposite side of nystagmus. Nausea is common Posture instability in affected side, walking preserved. Tinnitus, hearing loss |
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In central (disharmonic vestibular syndrome) vertigo how is the direction and nystagmus type? |
Direction; change based on gaze Type: any direction, pure vertical or rotational |
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In central Vertigo... |
Severe instability, walking is difficult Romberg test patient falls towards same side of the nystagmus. No extra sx |
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What is present only in central vertigo? |
Ataxia Diplopia Dysphagia Weakness Other neuro sx |
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Types of muscle tone? |
Hypotonia Spasticity : resistance to passive mov. UMN les Rigidity: resistance in the whole movement. Cogwheel rigidity: muscles jerk Paratonia: resistance decrease when patient is distracted. Dementia, anxious |
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Name the types of tremors. |
Postural: physiological Essential: hereditary AD Intention: cerebelar injury Resting: Parkinsonism, neuroleptic drugs Psychogenic Flapping (asterix) |
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Name the types of gait disturbances. |
Antalgic, steppage gait Trendelenburg gait Spastic, scissoring gait Vestibular Sensory and cerebelar ataxic gait Hypokinetic, dyskinetic Apraxic, psychogenic gait |
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What is apraxia? |
Normal motor function but decreased cortical function. Difficulty in performing targeted, voluntary mov |
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Name the types of apraxia |
Ideational Ideomotor Constructional Apraxic gait |
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What is aphasia? |
Patient unable to speak or understand speech. But they are alert, can hear... |
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What is aphasia? |
Patient unable to speak or understand speech. But they are alert, can hear... |
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Types of aphasia?? |
Broca (motor) Wernicke (sensory) Global - damage of both broca and wernicke Anomic aphasia- can’t remember names of objects |
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What is agnosia? |
Person receives sensory stimuli normally but is unable to recognize them. Cortical damage |
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What is agnosia? |
Person receives sensory stimuli normally but is unable to recognize them. Cortical damage |
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Types of agnosias?? |
Visual Prosopagnosia: faces Tactile |
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Neglect syndromes? |
Hemineglect: Impaired ability to perceive and respond stimuli from one side. Due to damage to the non dominant hemisphere (left usually) Sensory, motor, hemispatial neglect (patient can’t draw the affected side of the clock) |
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Name the characteristic signs of Parkinsonism |
Rigidity Bradykinesia, bradydiachokinesia Hypokinetic gait Postural instability Resting tremor |
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Etiology of Horner syndrome? |
Idiopathic most Pan coast tumor Cns tumor Brainstem stroke Int carot art dissection |
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Etiology of Horner syndrome? |
Idiopathic most Pan coast tumor Cns tumor Brainstem stroke Int carot art dissection |
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Horner triad??? |
Anhidrosis Ptosis of upper eyelid Miosis |
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C4 above lesion |
Respiratory paralysis |
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C4 above lesion |
Respiratory paralysis |
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Th1 or above? |
Tetraparesis |
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Th6 above? |
Potential for neurogenic shock |
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S2/th1 lesion? |
Paraparesis |
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Complete cord transection clinical |
Injury to all regions of spinal cord. Trauma, myelitis Bilateral absence of sensory and motor function below lesion Loss of autonomic function blw lesion (bladder incontinence, constipation) |
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Brown sequard (hemicord) syndrome pathomechanism? |
Spinothalamic crosses in anterior white commissure- contralateral affected Dorsal columns cross in medula- ipsilateral affected |
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Clinical features of brown sequard syndrome? |
Ipsilateral loss of dorsal column Contralateral loss of spinothalamic Ipsilateral spastic paralysis Normal autonomic function |
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Types of spinal cord lesions |
Complete cord transection Brown sequard syndrome Central cord syndrome Posterior cord syndrome Anterior cord syndrome |
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Etiology of central cord syndrome |
Syringimyelia Hyper extension injury |
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Central cord syndrome pathomechanism |
Most common in cervical Spinothalamic cross anterior commis. Lies in the center. = sensory loss of the dermatomes crossing at the level. Corticospinal tract of upper extremities run close to the center. |
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Etiology of posterior cord syndrome? |
Cervical spondylosis MS B12 def Tabes dorsalis syph |
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Causes of anterior cord syndrome? |
Anterior spinal artery syndrome (aortic surgery, aortic dissection) Hyper flexion injury |
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Cause of conus syndrome? |
Disc herniation Spinal fracture Conus is the termination of spinal cord (L1) |
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Conus syndrome sensory symptoms? |
Perianal or saddle anasthesia Dissociated sensory loss (impaired spinothalamic, intact dorsal) |
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Conus syndrome sensory symptoms? |
Perianal or saddle anasthesia Dissociated sensory loss (impaired spinothalamic, intact dorsal) |
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Conus syndrome vegetative symptoms? |
Early onset Bladder incontinence Fecal incontinence Impotence |
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Conus syndrome motor symptoms? |
Weakness of lower limb Fasciculation of Lowe limb Absence Achilles reflex but patelar is normal |
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Cauda esquina etiology |
Disc herniation Trauma Nerve roots are compressed |
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Cauda esquina etiology |
Disc herniation Trauma Nerve roots are compressed |
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In cauda equina syndrome what are the sensory symptoms? |
Saddle anasthesia Sensory loss in the distribution of the affected nerve roots No dissociated sensory loss |
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Cauda esquina etiology |
Disc herniation Trauma Nerve roots are compressed |
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In cauda equina syndrome what are the sensory symptoms? |
Saddle anasthesia Sensory loss in the distribution of the affected nerve roots No dissociated sensory loss |
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Cauda equina motor sx and vegetative sx? |
Veg is the same as conus, but the onset is Late. Motor: weakness of Lower limb Both Achilles and patelar reflex are absent |
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Brachial plexus lesions |
C5-th1 Shoulder injury Compression |
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Erb duchenne palsy |
C5-C6, most common Paresis deltoid, biceps and forearms Sensory loss on radial side of upper arm and shoulder Absent biceps and radial reflexes |
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Erb duchenne palsy |
C5-C6, most common Paresis deltoid, biceps and forearms Sensory loss on radial side of upper arm and shoulder Absent biceps and radial reflexes |
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Dejerine-klumpke palsy |
C8-th1 Paresis of wrist, finger flexors and small muscles of the hand Sensory loss of ulnar half hand and forearm Associated with Horner syndrome |
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Lumbar plexus lesion |
Th12-l4, trauma Paresis of hip flexors and knee extensors Sensory loss of outer thigh |
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Lumbar plexus lesion |
Th12-l4, trauma Paresis of hip flexors and knee extensors Sensory loss of outer thigh |
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C5 root lesion |
Sensory: radial upper arm Motor: deltoid m, biceps Biceps reflex lost |
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Lumbar plexus lesion |
Th12-l4, trauma Paresis of hip flexors and knee extensors Sensory loss of outer thigh |
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C5 root lesion |
Sensory: radial upper arm Motor: deltoid m, biceps Biceps reflex lost |
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C6 root lesion |
Sensory: radial upper and lower arm. Thumb and lateral half index f Motor: brachioradialis, biceps Biceps reflex loss |
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C7 root lesion |
Sensory: middle finger, half of second and fourth Motor: triceps, wrist pronator Triceps reflex loss |
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C7 root lesion |
Sensory: middle finger, half of second and fourth Motor: triceps, wrist pronator Triceps reflex loss |
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C8 root lesion |
Sensory: ulnar part of lower arm, little finger and medial half of ring Motor: muscle of hand Triceps reflex loss |
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L4 root lesion |
Sensory: outer side of thigh, inner calf and ankle M: quadriceps, tibialis anterior Patelar reflex |
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L4 root lesion |
Sensory: outer side of thigh, inner calf and ankle M: quadriceps, tibialis anterior Patelar reflex |
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L5 root lesion |
S: lateral knee, anterior shin, first 2 toes M: extensor halucis longus |
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L4 root lesion |
Sensory: outer side of thigh, inner calf and ankle M: quadriceps, tibialis anterior Patelar reflex |
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L5 root lesion |
S: lateral knee, anterior shin, first 2 toes M: extensor halucis longus |
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S1 root lesion |
S: Back of thigh, outer calf and ankle, 3,4,5 toes M: peroneal muscle, triceps durar Achilles reflex loss |
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Median nerve lesion |
S: middle of palm, lateral half of fourth finger M: thumb opposition,flexion, abduction, flexion of 3 and 4 fingers |
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Carpal tunnel syndrome |
Most common cause of median nerve lesion. Tinel sign: applying pressure to the palmar side of wrist causes paraesthesia in the median nerve area. |
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Carpal tunnel syndrome |
Most common cause of median nerve lesion. Tinel sign: applying pressure to the palmar side of wrist causes paraesthesia in the median nerve area. |
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Carpal tunnel syndrome etiology and Tx |
Obesity Female > male Diabetes Pregnancy Repetitive movement Tx: splitting, glucocorticoid, surgical decompression |
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Etiology of ulnar nerve lesion |
Cubital tunnel syndrome Guyon canal syndrome |
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Motor sx of ulnar nerve lesion |
Claw hand deformity : thumb add, 4,5 fingers flexion Atrophy of hypothenar and interosseous muscles |
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Froment sign? |
Patient holds a paper with thumb and index. Try to pull Positive if patient flexes the thumb to compensate. ( uses flexor pollicis longus instead median nerve ) |
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Cubital (elbow ) tunnel syndrome etiology |
Repeated leaning on elbow Prolonged flexion Diabetes |
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Radial nerve lesion is due to? |
Fracture of humerus Long term compression (falling asleep on the arm) |
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Radial nerve lesion sensory and motor sx? |
S: radial half of dorsal of the hand M: atrophy of finger extensors , drop hand |
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Radial nerve lesion sensory and motor sx? |
S: radial half of dorsal of the hand M: atrophy of finger extensors , drop hand |
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Radial tunnel syndrome |
Rare!!! Pain and weakness of wrists extensors No sensory sx ;) |
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Peroneal nerve lesion |
Or common fibular nerve Due to fracture of fibular head Dislocation of knee |
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Peroneal nerve lesion sensory and motor sx? |
S: área between 2nd and 3rd toes M: foot drop - steppage gait Atrophy of tibialis anterior, toe extensors |
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Typical features of polyneuropathies? |
Affects: distal nerves, lower limbs (stocking and glove distribution), Symmetrical distal anasthesia, parastesja or weakness Maybe pain Loss of vibration Normal fecal and urinary functions |
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Name some signs of temporal lobe lesion |
Wernicke aphasia Temporal lobe epilepsy Disturbance of hearing |
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Name the signs of frontal lobe lesion!! ++ |
Personality changes Gegenhalten (Paratonia): resistance to mov Broca aphasia, apraxic gait Infantile behavior: grasp reflex, rooting reflex (touching corner of mouth it moves) Contral umn lesion with muscle weakness Urinary incontinence Ipsilateral conjugate deviation of eyes Akinetic mutism |
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Signs of parietal lobe lesion |
Hemineglect, apraxia Homonymous lower quadrantanopia Contralateral sensory loss Gerstmann syndrome : inability to recognize left and right, agraphia, acalculia |
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Signs of occipital lobe lesion? |
Homonymous hemianopia Cortical blindness Visual hallucinations |
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Types of unconsciousness (Disorders of vigilance/alertness) |
Torpidity: alert but slow Somnolence: superficially sleeping but easily awakened Sopor: awake upon stronger stimuli Stupor: awake by a strong pain Coma: can’t be awakened |
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Name some signs of increased ICP |
Cushing triad Reduced level of consciousness Headache, vomiting Papilloedema Abducent palsy - diplopia |
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Name the types of intracranial herniation |
Subfalcine (cingulate) herniation Uncal transtentorial herniation Central transtentorial herniation Foramen magnum (tonsilar) herniation |
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Name the types of intracranial herniation |
Subfalcine (cingulate) herniation Uncal transtentorial herniation Central transtentorial herniation Foramen magnum (tonsilar) herniation |
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Subfalcine herniation clinical features |
Cingulate gyrus herniates under falx cerebri Compression of ACA- stroke |
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Name the types of intracranial herniation |
Subfalcine (cingulate) herniation Uncal transtentorial herniation Central transtentorial herniation Foramen magnum (tonsilar) herniation |
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Subfalcine herniation clinical features |
Cingulate gyrus herniates under falx cerebri Compression of ACA- stroke |
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Clinical features of uncal transtentorial herniation |
Impaired consciousness, ipsi CN3 palsy Contralateral motor deficit Kernohan’s sign: ipsilateral motor deficit compressed contral cerebral peduncle |
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What is Hutchinson’s pupil? |
Fixed, dilated pupil Seen in uncal transtentorial herniation |
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Uncal transtentorial herniation etiology? |
Often due to unilateral mass effect: Hemorrage, infarct (swelling) Úncus herniates at tentorial incisure |
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What is herniated in central transtentorial herniation? |
Hemispheres, basal ganglia and diencephalon herniates through tentorial notch into the midbrain!!! |
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Clinical features of central transtentorial herniation? |
Impaired consciousness Vein of Galen compression (congestion and cerebral edema) Compression of cerebral aqueduct > obstr hydrocephalus Stretching of Basilar art > rupture |
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Foramen magnum compression of what? |
Cerebral tonsils through for magn Compression of brainstem Impaired consciousness, circulation and respiration (apnea) |
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Glasgow coma scale is used to assess...? |
Neurological status Trauma severity Prognosis of traumatic brain injury Subarachnoid hemorrhage, bacterial meningitis, encephalitis and other neuro diseases |
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Which parameters are evaluated in the Glasgow coma scale? |
Best eye response Best verbal response Best motor response in response to various stimuli Should be teste before intubation!!!! |
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Results scores of GSC? |
GSC score 13-15: mild brain injury GSC score 9-12: moderate brain injury GSC score 3-8: severe brain injury (intubation is indicated) |
