Podcast
Questions and Answers
What is the primary initial step in the approach to localizing CNS lesions?
What is the primary initial step in the approach to localizing CNS lesions?
- Cranial nerve examination
- History taking (correct)
- Motor examination
- Sensory examination
Which aspect of the motor examination is NOT specifically mentioned for identifying lower motor neuron lesions?
Which aspect of the motor examination is NOT specifically mentioned for identifying lower motor neuron lesions?
- Power assessment
- Coordination testing (correct)
- Tone evaluation
- Reflex observation
How can one localize a cortical lesion through patient symptoms?
How can one localize a cortical lesion through patient symptoms?
- By evaluating gait and balance
- By analyzing the type of aphasia presented (correct)
- By observing the motor reflexes exhibited
- By assessing sensory inputs like pain and touch
In a comprehensive neurological examination, which aspect is crucially highlighted for assessing consciousness?
In a comprehensive neurological examination, which aspect is crucially highlighted for assessing consciousness?
Which of the following is essential for localization of CNS lesions in terms of sensory examination?
Which of the following is essential for localization of CNS lesions in terms of sensory examination?
What primary sensory modalities remain intact despite sensory loss of stereognosis and graphesthesia in a patient with right side impairment?
What primary sensory modalities remain intact despite sensory loss of stereognosis and graphesthesia in a patient with right side impairment?
In individuals with a lesion in the non-dominant hemisphere, which of the following symptoms is typically demonstrated?
In individuals with a lesion in the non-dominant hemisphere, which of the following symptoms is typically demonstrated?
Which type of motor neuron involvement characterizes left hemiplegia resulting from a right hemispheric lesion?
Which type of motor neuron involvement characterizes left hemiplegia resulting from a right hemispheric lesion?
What cognitive deficit might be observed in a patient with a right hemisphere lesion that affects visual-spatial tasks?
What cognitive deficit might be observed in a patient with a right hemisphere lesion that affects visual-spatial tasks?
How can one evaluate a patient's perception of neurological deficits in the context of right hemisphere lesions?
How can one evaluate a patient's perception of neurological deficits in the context of right hemisphere lesions?
In cortical dysfunction, which of the following is a possible manifestation in a patient with a dominant hemisphere lesion?
In cortical dysfunction, which of the following is a possible manifestation in a patient with a dominant hemisphere lesion?
What condition might be characterized by a patient's denial or neglect associated with a right hemisphere lesion?
What condition might be characterized by a patient's denial or neglect associated with a right hemisphere lesion?
Which statement accurately describes the physiological consequences of lesions affecting afferent fibers versus efferent fibers?
Which statement accurately describes the physiological consequences of lesions affecting afferent fibers versus efferent fibers?
What is the primary common cause of unilateral lesions in the posterior limb of the internal capsule?
What is the primary common cause of unilateral lesions in the posterior limb of the internal capsule?
What type of paralysis occurs as a result of damage to the posterior limb of the internal capsule?
What type of paralysis occurs as a result of damage to the posterior limb of the internal capsule?
Which sensory loss is associated with damage to thalamocortical fibers due to a unilateral lesion?
Which sensory loss is associated with damage to thalamocortical fibers due to a unilateral lesion?
What visual impairment results from damage to the optic radiation due to a subcortical lesion?
What visual impairment results from damage to the optic radiation due to a subcortical lesion?
Which of the following symptoms is NOT typically associated with lateral medullary syndrome?
Which of the following symptoms is NOT typically associated with lateral medullary syndrome?
Which cranial nerve effects occur due to crossed lesions in medullary syndrome?
Which cranial nerve effects occur due to crossed lesions in medullary syndrome?
Which statement accurately describes Wallenberg’s syndrome?
Which statement accurately describes Wallenberg’s syndrome?
What effect does damage to the vestibular nuclei have in lateral medullary syndrome?
What effect does damage to the vestibular nuclei have in lateral medullary syndrome?
Which type of eye movement is affected by oculomotor nerve palsy?
Which type of eye movement is affected by oculomotor nerve palsy?
What effect does trochlear nerve palsy have on a patient’s vision?
What effect does trochlear nerve palsy have on a patient’s vision?
Which symptom is associated with abducent nerve palsy?
Which symptom is associated with abducent nerve palsy?
Why does oculomotor nerve palsy lead to pupil dilation?
Why does oculomotor nerve palsy lead to pupil dilation?
In the presence of trochlear nerve palsy, which compensatory action do patients often adopt?
In the presence of trochlear nerve palsy, which compensatory action do patients often adopt?
Which artery's involvement is primarily associated with contralateral motor and sensory clinical features affecting the face and upper limb?
Which artery's involvement is primarily associated with contralateral motor and sensory clinical features affecting the face and upper limb?
What is the result of a lesion in the anterior cerebral artery?
What is the result of a lesion in the anterior cerebral artery?
What sensory function is specifically lost with cortical lesions affecting higher sensory processing?
What sensory function is specifically lost with cortical lesions affecting higher sensory processing?
What describes patients with subcortical visual dysfunction?
What describes patients with subcortical visual dysfunction?
Which condition is characterized by an inability to recognize objects?
Which condition is characterized by an inability to recognize objects?
What behavioral changes are associated with lesions in the prefrontal association area?
What behavioral changes are associated with lesions in the prefrontal association area?
Hypersexuality is a dysfunction associated with which area of the brain?
Hypersexuality is a dysfunction associated with which area of the brain?
Which cognitive function is affected by apraxia?
Which cognitive function is affected by apraxia?
What results from damage to the left frontal eye field?
What results from damage to the left frontal eye field?
Which syndrome is characterized by failure to abduct the eye ipsilaterally to the lesion and failure to adduct both eyes?
Which syndrome is characterized by failure to abduct the eye ipsilaterally to the lesion and failure to adduct both eyes?
What effect does irritation of the frontal lobe, such as in epilepsy, typically have on eye movement?
What effect does irritation of the frontal lobe, such as in epilepsy, typically have on eye movement?
What is the primary role of the medial longitudinal fasciculus (MLF) in eye movement?
What is the primary role of the medial longitudinal fasciculus (MLF) in eye movement?
What is one of the outcomes of damage to the paramedian pontine reticular formation (PPRF)?
What is one of the outcomes of damage to the paramedian pontine reticular formation (PPRF)?
What condition could lead to diplopia due to improper overlapping of images?
What condition could lead to diplopia due to improper overlapping of images?
What movement is impaired in a patient with internuclear ophthalmoplegia?
What movement is impaired in a patient with internuclear ophthalmoplegia?
Which cranial nerve is primarily responsible for eye abduction?
Which cranial nerve is primarily responsible for eye abduction?
Flashcards
CNS Lesion Localization
CNS Lesion Localization
The ability to determine the location of a neurological problem within the central nervous system.
History Taking
History Taking
This includes gathering information about the patient's medical history, symptoms, and any prior injuries or conditions.
Neurological Examination
Neurological Examination
Thorough assessment of motor function, sensation, coordination, reflexes, and cranial nerve activity.
Dermatomes
Dermatomes
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Aphasia Assessment
Aphasia Assessment
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Astereognosis
Astereognosis
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Agraphaesthesia
Agraphaesthesia
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Visual-spatial problem
Visual-spatial problem
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Neglect
Neglect
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Denial
Denial
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Hemiplegia
Hemiplegia
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Hypertonia
Hypertonia
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Hyperreflexia
Hyperreflexia
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Hyperphagia
Hyperphagia
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Hemiplegia (excluding upper face)
Hemiplegia (excluding upper face)
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Hemorrhagic Stroke
Hemorrhagic Stroke
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Thrombotic Stroke
Thrombotic Stroke
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Lenticulostriate Stroke
Lenticulostriate Stroke
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Corticospinal Tract
Corticospinal Tract
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Somatosensory Loss
Somatosensory Loss
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Homonymous Hemianopia
Homonymous Hemianopia
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What is the cortical homunculus?
What is the cortical homunculus?
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What are the clinical features of a middle cerebral artery stroke?
What are the clinical features of a middle cerebral artery stroke?
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What are the clinical features of an anterior cerebral artery stroke?
What are the clinical features of an anterior cerebral artery stroke?
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What is the effect of a subcortical lesion on sensory processing?
What is the effect of a subcortical lesion on sensory processing?
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What is agnosia, and where does it occur?
What is agnosia, and where does it occur?
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What is apraxia, and where does it occur?
What is apraxia, and where does it occur?
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What are the effects of a lesion in the prefrontal association area?
What are the effects of a lesion in the prefrontal association area?
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What are the effects of a lesion in the limbic association area?
What are the effects of a lesion in the limbic association area?
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Oculomotor Nerve Palsy: Adduction Impairment
Oculomotor Nerve Palsy: Adduction Impairment
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Oculomotor Nerve Palsy: Pupil Dilation
Oculomotor Nerve Palsy: Pupil Dilation
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Oculomotor Nerve Palsy: Ptosis
Oculomotor Nerve Palsy: Ptosis
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Oculomotor Nerve Palsy: Diplopia
Oculomotor Nerve Palsy: Diplopia
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Abducent Nerve Palsy: Abduction Impairment
Abducent Nerve Palsy: Abduction Impairment
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Binocular vision
Binocular vision
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Diplopia
Diplopia
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Frontal eye field
Frontal eye field
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Medial longitudinal fasciculus (MLF)
Medial longitudinal fasciculus (MLF)
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Nystagmus
Nystagmus
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One-and-a-half syndrome
One-and-a-half syndrome
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Internuclear ophthalmoplegia (INO)
Internuclear ophthalmoplegia (INO)
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Paramedian pontine reticular formation (PPRF)
Paramedian pontine reticular formation (PPRF)
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Study Notes
Localization of CNS Lesions
- Objectives for students include learning how to locate CNS lesions, understanding the importance of anatomy and neurophysiology in localization, recognizing neurological syndromes, localizing cortical lesions from aphasia types, and localizing CNS lesions from eye movements.
Approach to Localize the Lesion
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History: General condition (consciousness, gait, orientation to place, person, and time), speech (normal or aphasia/dysarthria), sensory examination (pain, temperature, touch, and joint positions), and motor examination (tone, power, reflexes, coordination). Cranial nerve examination is crucial, as it helps identify brainstem lesions.
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Examinations: General condition, consciousness, gait, orientation to place, person, and time, speech, sensory examination (pain, temperature, touch, dermatomes), motor examination (tone, power, reflexes, coordination), cranial nerve examination.
The Level of the Lesion in a Patient with Hemiplegia
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Lesions can be in cortical or subcortical areas (e.g., thalamus, internal capsule, basal ganglia). Differentiation between left- and right-sided cortical lesions uses speech and dominance differences.
- Cortical lesions: aphasia or nondominant hemisphere dysfunction (depending on involved hemisphere).
- Subcortical lesions: internal capsule, basal ganglia, thalamic dysfunction.
- Brainstem lesions: cranial nerve signs, often with crossed hemiplegia.
- Spinal cord lesions: facial involvement is absent with paralysis on the same side.
- Corticonuclear and corticospinal fibers are crossed; cranial nerves affect the same side, and corticospinal fibers affect the opposite.
Cortical Lesions (Dominant vs. Non-Dominant Hemisphere)
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Dominant Hemisphere (Usually Left):
- Right hemiplegia (upper motor neuron type).
- Sensory loss of sterognosis and graphesthesia; intact primary sensations (e.g., pain, vibration).
- Aphasia: loss of localizing the touch so loss of details of sensation.
-
Non-Dominant Hemisphere (Usually Right):
- Left hemiplegia (upper motor neuron type).
- Sensory loss of sterognosis and graphesthesia; intact primary sensations (e.g., pain, vibration).
- Visual-spatial problems (intact vision, but loss of awareness of things on the left side); neglect and denial (patients may not be oriented to their neurological deficits).
- Speech is usually intact; loss of tone and emotions of speech..
Cortical vs. Subcortical Lesions
- Cortical Dysfunction: Aphasia (dominant hemisphere), neglect/seizure (non-dominant hemisphere) are typical. This can involve various vascular lesion involvements (e.g., middle cerebral artery affecting face and upper limbs, and anterior cerebral artery affecting legs). Sensory dysfunction can involve issues with higher order processing like stereognosis, two-point discrimination, and graphesthesia. Subcortical lesions show issues with primary sensory modalities like pain, vibration, and visual disturbances that can have visual field defects.
Effects of Lesions in Cortical Association Areas
- Parieto-occipitotemporal association area: Agnosia (inability to recognize objects), apraxia (inability to perform skilled, purposeful movements), aphasia (impaired language communication).
- Prefrontal association area: Changes in personality and behavior.
- Limbic association area: Decreased aggression, decreased/lack of emotions, hypersexuality, and hyperphagia (increased appetite).
Effects of Unilateral Lesion in the Posterior Limb of the Internal Capsule (Subcortical Lesion)
- Common Causes: Hemorrhage or thrombosis of the lenticulostriate artery.
- Effects:
- Paralysis/paresis of the opposite side of the body (hemiplegia), excluding the upper half of the face.
- Loss of somatic sensation on the opposite side of the body.
- Damage to the optic radiation leads to temporal hemianopia (damage to the optic tracts often results in homonymous hemianopia).
- Lesion to the auditory radiation can cause diminished hearing.
Brain Stem Lesion
- Most common lesions are medullary syndromes (e.g., lateral and medial medullary syndrome).
- Medullary syndromes are characterized by crossed lesions because of the brain stem's crossover.
Lateral Medullary Syndrome (Wallenberg's Syndrome)
- Result: Occlusion of the posterior inferior cerebellar artery (PICA).
- Characterized by:
- Contralateral loss of pain and temperature (spinothalamic tract).
- Ipsilateral loss of pain and temperature, facial sensations (spinal trigeminal nucleus).
- Vertigo, nausea, vomiting (vestibular nuclei).
- Ipsilateral Horner's syndrome (descending sympathetic).
Medial Medullary Syndrome
- Result: Occlusion of branches of the anterior spinal artery.
- Characterized by:
- Contralateral hemiplegia (damage to pyramidal tracts or corticospinal fibers).
- Contralateral loss of position, vibration, and discriminatory touch (medial lemniscus).
- Ipsilateral tongue deviation and paralysis (hypoglossal nucleus or nerve).
Single Cranial Nerve Lesions (III, IV, VI)
- Oculomotor Palsy: Failure of eye adduction, pupil dilation, ptosis (drooping eyelid), and double vision.
- Abducent Nerve Palsy: Failure of eye abduction, and double vision lateral to the affected eye.
- Trochlear Nerve Palsy: Double vision (diplopia) downward and medially, head tilt away from the affected side to avoid double vision.
Eye Movements
- Eye movement examination is critical for localizing and diagnosing neurological conditions, especially in brainstem lesions. Cranial nerves III, IV, and VI control eye movements.
Aphasia
- Difficulty in understanding and/or producing language. Different types of aphasia have different characteristics.
Internuclear Ophthalmoplegia (IN)
- Damage to the medial longitudinal fasciculus (MLF) interferes with conjugate eye movements. The characteristics and cause can vary.
- Diagnosis is usually possible by assessing eye movements.
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