Medicine Marrow Pg No 687-696 (Neurology)
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Questions and Answers

What is a primary symptom of Ataxic Hemiparesis?

  • Vision problems
  • Tremors
  • Numbness
  • Clumsy hands (correct)

    • Dysarthria is a symptom that can occur with Ataxic Hemiparesis.

    True

    What type of damage leads to contralateral weakness in Ataxic Hemiparesis?

    Corticospinal damage

    Ataxic Hemiparesis can be associated with damage to the _____, leading to clumsy hands.

    <p>Cortex</p> Signup and view all the answers

    Match the lesions with their effects:

    <p>Lesion at basis pons = C/L cerebellar findings Corticopontocerebellar damage = C/L weakness Corticospinal damage = Clumsy hands</p> Signup and view all the answers

    Which structure is NOT identified in the anterior view of the midbrain?

    <p>Cerebellum</p> Signup and view all the answers

    The optic nerve and optic chiasma are both located in the midbrain region.

    <p>False</p> Signup and view all the answers

    What is the primary function of the levator palpebrae superioris muscle according to its anatomical description?

    <p>To elevate the upper eyelid</p> Signup and view all the answers

    The __________ is a key structure within the midbrain involved in the coordination of visual and auditory responses.

    <p>tectum</p> Signup and view all the answers

    Match the following brainstem structures with their functions:

    <p>Red nucleus = Motor coordination Substantia nigra = Dopamine production Cerebral peduncles = Connect motor pathways Tegmenjtum = Sensory pathways processing</p> Signup and view all the answers

    Which of the following clinical features is associated with dorsal midbrain lesions?

    <p>Convergence retraction nystagmus</p> Signup and view all the answers

    Argyll Robertson pupil is characterized by an absent accommodation reflex.

    <p>False</p> Signup and view all the answers

    What is the most common tumor associated with dorsal midbrain syndromes?

    <p>Pinealoma</p> Signup and view all the answers

    Wallenberg's syndrome is also known as __________ syndrome.

    <p>lateral medullary</p> Signup and view all the answers

    Match the following clinical features with their corresponding syndromes:

    <p>Sunset sign = Dorsal midbrain syndrome Skew deviation of eyes = Dorsal midbrain syndrome Loss of pain and temperature sensation = Lateral medullary syndrome Ataxia = Lateral medullary syndrome</p> Signup and view all the answers

    Which cranial nerves are spared in a brainstem stroke?

    <p>1, 2, 3, 6, 11, 12</p> Signup and view all the answers

    A patient with a brainstem stroke will experience normal motor functions.

    <p>True</p> Signup and view all the answers

    What symptoms are caused by involvement of the vestibular nucleus of the VIII nerve?

    <p>Ataxia, Tinnitus, vertigo, Dizziness, Oscillopsia, Nystagmus.</p> Signup and view all the answers

    The cervical sympathetic chain is responsible for producing symptoms such as ________ and ________.

    <p>Tachycardia, Horner's syndrome</p> Signup and view all the answers

    Match the following structures with their clinical features:

    <p>Spinal nucleus of V nerve = Impaired taste on anterior 2/3rd of tongue Nucleus Tractus Solitarius of VII Nerve = Dysphagia, Nasal regurgitation Nucleus ambiguus of IX &amp; X Nerve = Pain, numbness, impaired sensations on one-half of face Dorsal nucleus of vagus(X) nerve = Autonomic symptoms</p> Signup and view all the answers

    Which of the following is a symptom of Horner's syndrome?

    <p>Ptosis</p> Signup and view all the answers

    A brainstem stroke causes a contralateral loss of pain and temperature sensation.

    <p>True</p> Signup and view all the answers

    What is the primary feature associated with damage to the cervical sympathetic chain?

    <p>Autonomic symptoms.</p> Signup and view all the answers

    What is the hallmark presentation for a brainstem stroke?

    <p>Corticospinal decussation leading to contralateral hemiplegia and ipsilateral cranial nerve palsy</p> Signup and view all the answers

    A lesion in the internal capsule results in contralateral upper motor neuron 7th nerve palsy.

    <p>True</p> Signup and view all the answers

    Name the three primary parts of the brainstem.

    <p>Midbrain, Pons, Medulla</p> Signup and view all the answers

    The ______ tract is responsible for motor function originating in the cortex and terminating at the spinal cord.

    <p>Corticospinal</p> Signup and view all the answers

    Match the following brainstem structures with their respective functions:

    <p>Medial longitudinal fasciculus = Internuclear ophthalmoplegia Spinothalamic tract = Pain and temperature sensation Cranial Nuclei 3, 4, 6, 12 = Eye and facial movement Spinal nucleus of trigeminal nerve = Sensory fibers for facial sensation</p> Signup and view all the answers

    What is characterized by weakness of both arms but sparing of the legs?

    <p>Brachial diplegia</p> Signup and view all the answers

    Jackson Syndrome causes weakness in the limbs.

    <p>False</p> Signup and view all the answers

    What is the site of lesion for Avellis Syndrome?

    <p>Tegmentum of medulla</p> Signup and view all the answers

    In crossed hemiplegia, there is _____ lower motor neuron cranial nerve palsy.

    <p>ipsilateral</p> Signup and view all the answers

    Match the following syndromes with their features:

    <p>Avellis Syndrome = I/L LMN X CN palsy, C/L pain and temperature loss Jackson Syndrome = I/L LMN XII CN Palsy</p> Signup and view all the answers

    Which structure is responsible for processing auditory information in the pons?

    <p>Cochlear Nucleus</p> Signup and view all the answers

    The Basilar Artery supplies the majority of blood to the pons.

    <p>True</p> Signup and view all the answers

    What syndrome is characterized by 1/L LMN Facial Nerve Palsy?

    <p>Millard-Gubler Syndrome</p> Signup and view all the answers

    The sixth cranial nerve palsy occurs in _____ Syndrome.

    <p>Raymond</p> Signup and view all the answers

    Match the following syndromes with their clinical features:

    <p>Millard-Gubler Syndrome = 1/L LMN Facial Nerve Palsy Raymond Syndrome = 1/L Sixth Nerve Palsy + C/L Hemiplegia Ataxic Hemiparesis = Contralateral weakness and clumsy hands 6th Nerve Palsy = Palsy affecting eye movement</p> Signup and view all the answers

    Which of the following clinical features is associated with the XII Nerve nucleus in Medial Medullary Syndrome?

    <p>1/L 12th nerve palsy</p> Signup and view all the answers

    C/L loss of posterior column sensations occurs in Medial Medullary Syndrome.

    <p>True</p> Signup and view all the answers

    What syndrome is characterized by 1/L adduction weakness and C/L abduction nystagmus?

    <p>Internuclear ophthalmoplegia</p> Signup and view all the answers

    Damage to the medial longitudinal fasciculus results in __________.

    <p>internuclear ophthalmoplegia</p> Signup and view all the answers

    Match the following syndromes with their descriptions:

    <p>One and a half syndrome = 1/L adduction and absence of C/L adduction Eight and a half syndrome = VII Nerve palsy + One and a half syndrome Fifteen and a half syndrome = B/L VII Nerve palsy + One and a half syndrome Medial Medullary Syndrome = C/L hemiplegia and 1/L tongue atrophy</p> Signup and view all the answers

    Which of the following features is associated with Foville Syndrome?

    <p>C/L Hemiplegia</p> Signup and view all the answers

    Locked-in Syndrome results in the ability to perform voluntary movements and communicate verbally.

    <p>False</p> Signup and view all the answers

    List one clinical feature of Top of Basilar Occlusion.

    <p>Visual hallucinations</p> Signup and view all the answers

    The five D's associated with posterior stroke include dizziness, dysarthria, dysphagia, diplopia, and __________.

    <p>dystaxia</p> Signup and view all the answers

    Match the syndrome with its corresponding clinical features:

    <p>Foville Syndrome = 1/L LMN Facial Nerve palsy Marie-Foix Syndrome = 1/L Ataxia ASH Syndrome = C/L Hemiplegia Locked-in Syndrome = Quadriplegia</p> Signup and view all the answers

    Which syndrome involves 1/L 3rd nerve palsy and C/L Hemiplegia?

    <p>Weber's Syndrome</p> Signup and view all the answers

    Benedikt's Syndrome is a combination of both Weber's and Claude's Syndromes.

    <p>True</p> Signup and view all the answers

    What is a clinical feature associated with Claude's Syndrome?

    <p>C/L Ataxia and Tremor</p> Signup and view all the answers

    In Benedikt's Syndrome, the affected structures include the CN-3 Fibres, Corticospinal tract, and the __________.

    <p>Red nucleus</p> Signup and view all the answers

    Match the following syndromes with their clinical features:

    <p>Weber's Syndrome = 1/L 3rd nerve palsy, C/L Hemiplegia Claude's Syndrome = 1/L 3rd nerve palsy, C/L Ataxia + Tremor Benedikt's Syndrome = 1/L 3rd nerve palsy, C/L Hemiplegia, C/L Ataxia + Tremor None of the above = No correct features listed</p> Signup and view all the answers

    Study Notes

    Ataxic Hemiparesis

    • Ataxic Hemiparesis is similar to dysarthria with clumsy hands.
    • Associated symptoms:
      • Clumsy hands
      • Dysarthria (difficulty speaking)
    • Neural pathways involved:
      • Cortex → Thalamus → Red nucleus ↔ Pons → Pyramid (corticospinal tract)
      • Cortex → Corticopontocerebellar fibres → Cerebellum
      • Cerebellum → Spinocerebellar fibres
    • Effects of lesions:
      • Lesion at basis pons:
        • CPC (Corticopontocerebellar) damage: causes C/L (contralateral) cerebellar findings
        • CS (Corticospinal) damage: causes C/L weakness

    Brainstem Stroke

    • Pathogenesis:
      • Large vessel infarction: Thrombosis/Artery to artery infarction
      • Cardiac embolism: Rare
    • Clinical Features:
      • Higher mental functions: normal
      • Cranial Nerves:
        • Spared: 1, 2, 3, 6, 11, 12
      • Structures involved:
        • Spinal nucleus of V nerve: pain, numbness, impaired sensations on one-half of face
        • Vestibular nucleus of VIII Nerve: ataxia (ipsilateral), tinnitus, vertigo, dizziness, oscillopsia, nystagmus
        • Nucleus Tractus Solitarius of VII Nerve: impaired taste on anterior 2/3rd of tongue
        • Nucleus ambiguus of IX & X Nerve: dysphagia, nasal regurgitation
        • Dorsal nucleus of vagus(X) nerve:
        • Cervical Sympathetic chain: autonomic symptoms (tachy/bradycardia, arrhythmias, orthostatic hypotension, erectile dysfunction, abnormal sweating, Horner's syndrome (ptosis, miosis, anhydrosis, enophthalmos, loss of ciliospinal reflex)
    • Note:
      • Cervical sympathetic chain: 1st order neuron
      • Central Horner syndrome (Wallenberg syndrome)
    • Motor system: normal
    • Sensory system:
      • Spared: Posterior column (midline)
      • Involved: Spinothalamic tract: C/L loss of pain and temperature
    • Cerebellum:
      • Spinocerebellar Fibres: I/L cerebellar symptoms (Ataxia)

    Anterior view of midbrain, Pons and medulla

    • The image displays an anatomical representation of the midbrain, pons, and medulla oblongata.
    • It showcases various structures and their connections within the brainstem.
    • Key components:
      • Superior and inferior colliculi
      • Tectum
      • Tegmentum
      • Optic nerve
      • Optic chiasma
      • Optic tract
      • Oculomotor nerve
      • Trochlear nerve
      • Motor and sensory roots of the trigeminal nerve
      • Cerebral peduncles
      • Red nucleus
      • Substantia nigra
      • Floor of the fourth ventricle

    Posterior view

    • Highlights further anatomical details of the brainstem region.
    • Levator Palpebrae Superioris: Single nucleus, supplies bilateral muscles. (at the level of superior colliculus)

    DORSAL MIDBRAIN SYNDROMES

    • Etiology: Tumour: Pinealomas (most common)
    • Clinical Features:
      • Location of Lesion: Dorsum of midbrain
      • Structures Involved: Pretectal nucleus, Periaqueductal gray matter
      • Clinical Features: Vertical gaze palsy (up gaze palsy), Sunsetting sign (Look downwards), Argyll Robertson Pupil (ARP), Accommodation reflex present, Light reflex absent, Collier's sign: Overshoot of levator palpebrae superioris (LPS) retraction, Pseudo abducent pupil, Convergence retraction nystagmus (Overactive convergence center), Skew deviation of eyes, 3rd nerve palsy, C/L Ataxia
    • Note: Parinaud's oculoglandular syndrome: Associated with Tularemia (Francisella tularensis)
    • Cerebellar peduncle connections:
      • Superior → Midbrain
      • Middle → Pons
      • Inferior → Medulla

    LATERAL MEDULLARY SYNDROME (AKA Wallenberg's / PICA Syndrome)

    • Etiology: Vascular origin: v segment of vertebral artery ↓ Posterior Inferior cerebellar Artery (PICA)
    • Relevant Anatomy:
      • Brain → Brainstem → Spinal cord
      • Rostral: Midbrain
      • Central: Pons
      • Caudal: Medulla

    BRAINSTEM STROKE

    • Relevant Anatomy: Brain → Brainstem → Spinal cord
    • Rostral: Midbrain
      • Central: Pons
      • Caudal: Medulla
    • Hallmark Presentation:
      • Crossed Hemiplegia: C/L hemiplegia + I/L LMN Cranial Nerve (CN) palsy (Corticospinal decussation) (Lesion of cranial nerve nucleus)
    • Note:
      • Hallmark presentations:
        • Cortical lesion: Aphasia
        • Internal capsule lesion: C/L UMN 7th Nerve palsy
    • Structures:
      • Midline: 4m
      • Motor nuclei of CN: 3, 4, 6, 12
      • Medial longitudinal fasciculus: INO (Internuclear ophthalmoplegia)
      • Medial Lemniscus (Posterior column): After decussation at medulla
      • Motor tract: Corticospinal tract
      • Lateral: 45
        • Spinothalamic tract
        • Spinocerebellar fibers
        • Sympathetic fibers: Horner's syndrome
        • Spinal nucleus of trigeminal nerve: Sensory fibers up to ca

    Pontine Syndromes

    • Key Structures:
      • Cochlear Nucleus
      • Lateral Vestibular Nucleus
      • Medial Vestibular Nucleus
      • Abducens Nucleus
      • Nucleus Prepositus Hypoglossi
      • Pontine Reticular Formation
      • Median Sulcus of 4th Ventricle
      • Root of CN VI
      • Spinal Nucleus of the Trigeminal Nerve
      • Root of CN VII
      • Facial Nucleus
      • Lateral Lemniscus
      • Superior Olivary Nucleus
      • Central Tegmental Tract
      • Medial Lemniscus
      • Raphe Nucleus
      • Middle Cerebellar Peduncle
      • Pontocerebellar Fibers
      • Corticospinal Tract
      • Pontine Nuclei
      • Basilar Sulcus of the Pons
    • Other labeled areas:
      • Tegmentum
      • Lateral Pons
      • Basipons
    • Blood Supply:
      • Basilar Artery (majority)
      • Lateral pons: Anterior Inferior Cerebellar Artery (AICA) + Basilar Artery
    • Syndromes:
      • Millard-Gubler Syndrome: 1/L LMN Facial Nerve Palsy
      • Raymond Syndrome (SH Syndrome):
        • 1/L Sixth Nerve Palsy
        • C/L Hemiplegia

    Medial Medullary Syndrome (AKA Dejerine Syndrome)

    • Structures involved:
      • XII Nerve nucleus: 1/L 12th nerve palsy; paralysis with atrophy of one-half of tongue
      • Corticospinal tract: C/L Hemiplegia
      • Medial Longitudinal Fasciculus: 1/L Internuclear ophthalmoplegia
      • Medial Lemniscus: C/L loss of posterior column; touch and proprioception lost.
    • Diagram Description:
      • The document includes a diagram that illustrates the location of various structures in the brainstem, including the medial longitudinal fasciculus (MLF), the nuclei of cranial nerves III, VI, and XII, and the corticospinal tract.
      • Arrows indicate connections between these structures.
    • Lesions:
      • Medial longitudinal fasciculus: results in internuclear ophthalmoplegia, 1/L adduction weakness and C/L abduction nystagmus
      • MLF + PPRF: leads to "One and a half syndrome" characterized by 1/L abduction and 1/L adduction, and absence of C/L adduction. C/L abduction intact.
      • VII Nerve palsy + One and a half syndrome: termed "Eight and a half syndrome".
      • B/L VII Nerve palsy + One and a half syndrome: referred to as "Fifteen and a half syndrome".
    • Note: 1/L = Left, C/L = Right

    Cruciate Paralysis

    • Site of lesion: Rostral portion of pyramidal decussation (early decussation of upper limb fibers)
    • Presentation:
      • Brachial diplegia: Both arm weakness with sparing of legs
      • Weakness of one arm and opposite leg
    • Note: Crossed hemiplegia: I/L LMN CN palsy + C/L Hemiplegia

    Avellis Syndrome VS Jackson Syndrome

    Feature Avellis Syndrome Jackson Syndrome
    Etiology Infarct, Tumors
    Site of Lesion
    Structures Involved Tegmentum of medulla, X Nerve, Spinothalamic tract Hypoglossal nucleus
    Clinical Features I/L LMN X CN palsy, C/L pain and temperature loss (body) I/L LMN XII CN Palsy
    • Note: No weakness in Jackson syndrome
    • Diagram Description:
      • The document includes a diagram showing a person with a lesion in the brainstem.
      • Arrows illustrate the pathway of nerve fibers, and different areas of the body are highlighted to show the specific effects on each side.
      • The diagram helps to demonstrate the differences in effects between Avellis and Jackson syndrome.

    Brainstem Stroke

    • Clinical Features:
      • Site of Lesion, Vascular Origin: Clinical Feature:
        • Dorsal: Tegmentum: Basilar artery:
          • Foville Syndrome: 1/L LMN Facial Nerve palsy
          • FGH Syndrome:
          • 1/L Conjugate Gaze Palsy (PPRF)
          • C/L Hemiplegia
        • Lateral: Lateral Pons: AICA + Basilar Artery:
          • Marie-Foix Syndrome: 1/L Ataxia (middle cerebellar peduncle)
          • ASH syndrome:
          • C/L Hemiplegia
          • C/L Pain and Temperature (spinothalamic tract)
    • Locked-in Syndrome:
      • Etiology: Bilateral (B/L) extensive Pontine infarction
      • Clinical Features:
        • Alert (Normal Reticular activating system)
        • Quadriplegia: Lesion of corticospinal and corticobulbar fibres
        • Vertical eye movements: Present (Normal midbrain)
    • Top of Basilar Occlusion:
      • Features:
        • Absent visual/occulomotor
        • Bilateral (B/L) medial Temporal Lobe lesion: Behavioral changes, fluctuating alertness, amnesia (loss of memory)
        • Visual hallucinations
    • Presentation of Posterior Stroke (5 D's):
      • Dizziness
      • Dysarthria
      • Dysphagia
      • Diplopia
      • Dystaxia

    Ventral Midbrain Syndromes

    • Etiology: Vascular origin: P segment of Posterior Cerebral Artery (PCA)
    • Syndromes:
      • Weber's Syndrome:
        • Location of lesion: Base of midbrain (Cerebral Peduncle)
        • Structures involved: CN-3 Fibres from nucleus, Corticospinal tract
        • Clinical Features: 1/L 3rd nerve palsy, C/L Hemiplegia
      • Claude's Syndrome:
        • Location of lesion: Tegmentum
        • Structures involved: CN-3 Fibres from nucleus, Red nucleus (Superior cerebellar peduncle → Dentato-rubro-thalamic fibres)
        • Clinical Features: 1/L 3rd nerve palsy, C/L Ataxia + Tremor (Opposite cerebellar fibres)
      • Benedikt's Syndrome (Weber + Claude's):
        • Location of lesion: Extensive tegmentum + Base of midbrain
        • Structures involved: CN-3 Fibres from nucleus, Corticospinal tract, Red nucleus, Substantia Nigra (Nigrostriatal pathway)
        • Clinical Features: 1/L 3rd nerve palsy, C/L Hemiplegia, C/L Ataxia + Tremor, C/L Hemichorea + Hemiathetosis
    • Note:
      • 1/L = 1st left and C/L = Contralateral Left
      • The image contains diagrams of the brain structures involved in each syndrome, but it is not included here in the markdown output.

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    Description

    Test your knowledge on ataxic hemiparesis and its related neurological pathways. This quiz covers symptoms, lesions, and the effects of brainstem strokes, including clinical features and pathogenesis. Assess your understanding of this complex neurological condition.

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