Neuroanatomy Clinicals PDF

All Neuroanatomy Clinicals Clinical Reference Info 1-Types of Paralysis Snell's, pg.166 1. Hemiplegia: Paralysis of 1 side of body 2. Monoplegia: Paralysis of 1 limb 3. Diplegia:...

All Neuroanatomy Clinicals Clinical Reference Info 1-Types of Paralysis Snell's, pg.166 1. Hemiplegia: Paralysis of 1 side of body 2. Monoplegia: Paralysis of 1 limb 3. Diplegia: Paralysis of 2 corresponding limbs (Arms or legs) 4. Paraplegia: Paralysis of 2 lower limbs 5. Quadriplegia: Paralysis of all limbs 2-Tabes Dorsalis Snell's, pg.165 Location: Posterior Sensory Root (spinal cord) (imp) Cause: Syphilis Tracts involved: All sensory tracts 1. Dorsal column 2. Antero Lateral Spinothalamic Symptoms: 1. Stabbing pain in lower limbs 2. Paresthesia in lower limbs 3. Hypersensitivity of skin to touch, heat and cold 4. Ataxia and hypotonia in lower limbs 5. Loss of tendon reflex 3-Upper Motor Lesion Snell's, pg.166 (UML) and Lower UML LML Motor Lesion (LML) Location In CNS above Level of vertebrae (vvv.imp) nerve vertebrae and PNS Power Slight decrease Severe decrease Size Slight decrease Severe decrease Tone Hypertonia/Rigi Hypotonia/Flaccid dity/Spasticity ity (Clonus) Reflex Hyperreflexia Hyporeflexia Babinski Sign Foot Dorsiflexes Foot Plantarflexes Fasciculation Absent Present 4-Complete Cord Snell's, pg.168 Location: Complete Spinal Cord section Transection syndrome (imp) Cause: Fracture of Vertebral Column Tracts Involved: All Sensory and All Motor Symptoms:  Tracts At Level of Below Level of Lesion Lesion Corticospinal LML Bilateral UML Bilateral Paralysis Paralysis (Hypotonia, (Hypertonia, Hyporeflexia, Hyperreflexia, Babinski Sign Babinski sign Plantarflexes) Dorsiflexes) Dorsal Column Bilateral Loss of Bilateral Loss of and all Sensations all Sensations Anterolateral Spinothalamic 5-Anterior Cord Snell's, pg.168 Location: Anterior Spinal Cord section Syndrome (imp) Cause: Anterior Spinal Artery damaged Tracts Involved: All Motor Tracts and All Sensory tracts Except Dorsal Column Symptoms: Tracts At Level of Below Level of Lesion Lesion Corticospinal LML Bilateral UML Bilateral Paralysis Paralysis (Hypotonia, (Hypertonia, Hyporeflexia, Hyperreflexia, Babinski Sign Babinski sign Plantarflexes) Dorsiflexes) Anterolateral Bilateral Loss of Bilateral Loss of Spinothalamic Pain and Pain and temperature temperature Dorsal Column Normal Normal 6-Central Cord Snell's, pg.168 Location: Center of Spinal Cord section Syndrome Cause: Hyperextension (imp) Tracts Involved: Portion of All Motor Tracts and All Sensory tracts Symptoms: Tracts At Level of Below Level of Lesion Lesion Corticospinal LML Bilateral UML Bilateral Paralysis Paralysis  (Hypotonia, (Hypertonia, Hyporeflexia, Hyperreflexia, Babinski Sign Babinski sign Plantarflexes) Dorsiflexes) Sacral Sparing Anterolateral Bilateral Loss of Bilateral Loss of Spinothalamic Pain and Pain and temperature temperature Sacral Sparing 7-Brown-Sequard or Snell's, pg.170 Location: Half of Spinal Cord section Cord Hemi section Syndrome Cause: Commonly damaged (Most vvv.imp) Tracts Involved: Ipsilateral All Motor Tracts, Ipsilateral All Sensory tracts and Contralateral Spinothalamic Symptoms: Tracts At Level of Below Level of Lesion Lesion Corticospinal LML Ipsilateral UML Ipsilateral Paralysis Paralysis (Hypotonia, (Hypertonia, Hyporeflexia, Hyperreflexia, Babinski Sign Babinski sign Plantarflexes) Dorsiflexes) Anterolateral Bilateral Loss of Contralateral Spinothalamic Pain and Loss of Pain and temperature temperature Dorsal Column Ipsilateral loss Ipsilateral loss of Fine touch, of Fine touch, vibration, etc. vibration, etc. 8-Syringomyelia Snell's, pg.170 Location: Center at commissures of Spinal Cord section (imp) Cause: Developmental Abnormality Tracts Involved: Spinothalamic Tracts and Anterior Corticospinal Fibers Symptoms: Tracts At Level of Below Level of Lesion Lesion Anterior LML Ipsilateral UML Ipsilateral Corticospinal Paralysis of Paralysis of  Trunk and small Trunk and small hand muscles hand muscles Anterolateral Bilateral Loss of Normal Spinothalamic Pain and temperature Dorsal Column Normal Normal 9-Arnold-Chiari Snell's, pg.215 Congenital anomaly in which medulla and Malformation tonsils of cerebellum herniate through (v.imp) foramen magnum into vertebral canal CSF doesn’t circulate causing internal hydrocephalus Medulla and cranial nerve 9,10,11,12 effected 10-Lateral Medullary Snell's, pg.215 Location: Lateral side of medulla Syndrome (vvv.imp) Cause: Posterior Inferior Cerebellar Artery (PICA) or vertebral artery damaged Nucleus/Tracts Damaged and Symptoms: 1. Nucleus Ambiguous: Dysphagia and dysarthria due to paralysis of laryngeal muscles 2. Nucleus of spinal tract of trigeminal: Analgesia of ipsilateral side of face 3. Descending Sympatetic Fibers: Ipsilateral Horner's Syndrome 4. Vestibular Nucleus: Vertigo, Nausea, Nystagmus 5. Inferior cerebellar peduncle: Ipsilateral cerebellar signs 6. Spinal Lemniscus: Contralateral Loss of pain and temperature and crude touch 11-Medial Medullary Snell's, pg.215 Location: middle of medulla Syndrome (vvv.imp) Cause: Vertebral Artery Damaged Nucleus/Tracts Damaged and Symptoms: 1. Corticospinal/Pyramidal Tract: Contralateral Hemiparesis (difficulty or inability to move) 2. Dorsal Column Medial Lemniscus: Contralateral Loss of tactile discrimination, vibration, fine touch, proprioception, etc. 3. Hypoglossal Nerve: Ipsilateral paralysis of tongue and tongue deviates to paralyzed side 12-Weber Syndrome Snell's, pg.217 Location: Front region of midbrain (vvv.imp) Cause: Posterior Cerebral artery (Basilar Artery) Nucleus/Tracts Damaged and Symptoms: 1. Oculomotor Nerve (Cranial Nerve No.3): Ipsilateral Ophthalmoplegia, Eyeball deviated to right because medial rectus muscle paralyzed, ptosis because Levater Palpbre superioris paralyzed 2. Edinger-Westphal Nucleus: Light Accommodation Reflex Gone 13-Benedict Syndrome Snell's, pg.217 (Similar to weber) (vvv.imp) Location: Middle Region of Midbrain Cause: Posterior Cerebral artery (Basilar Artery) Nucleus/Tracts Damaged and Symptoms: 1. Medial Lemniscus: Contralateral Hemianesthesia 2. Red Nucleus (Rubrospinal): Contralateral involuntary Limb movement 14-Cerebellar Disease Snell's, pg.241 Damage to any side of cerebellum always gives (v.imp) ipsilateral symptoms Acute damage is more dangerous than chronic as CNS doesn’t have time to adapt General Symptoms: 1. Hypotonia 2. Change in posture and gait 3. Ataxia (Disturbance of voluntary movement) 4. Dysdiadochokinesia (Inability to perform postural movements 5. Disturbances of Reflexes 6. Nystagmus (also in Lateral Medullary Syndrome) 7. Dysarthria (also in Lateral Medullary Syndrome) Types of Syndromes: 1. Vermis Syndrome: Symptoms seen mainly in trunk and head 2. Cerebellar Hemisphere: Symptoms seen mainly in Limbs and Phonation 15-Aphasia Snell's, pg.292 Types: (viva) 1. Expressive Aphasia: Broca's Motor Speech Area damaged, ability of speech is lost 2. Receptive Aphasia: Wernicke’s Sensory Speech Area damaged, ability to understand speech is lost 3. Global Aphasia: Expressive and receptive Aphasia together, Wernicke and Broca both damaged 16-Schizophrenic Snell's, pg.306 Symptoms: 1. Disordered thinking 2. Emotional withdrawal 3. Blunted effect 4. Paranoid delusions 5. Auditory Hallucinations Treatment: Dopamine receptor blockers, but also effects basal ganglia system 17-Kluver-Bucy Snell's, pg.306 Cause: Amygdaloid Complex Destruction Syndrome (v.imp) Symptoms: 1. Decreased Anger 2. Decreased Fear 3. Decreased Restlessness 4. Increased Appetite 5. Increased Sexual Activity 18-Basal Nuclei Snell's, pg.315 Generally 2 Types: Disorders (vvv.imp) Hyperkinetic (Excessive abnormal movements): 1. Chorea 2. Athetosis 3. Ballismus 4. Parkinson Hypokinetic (Lack or slowness of movements): 1. Parkinson 19-Chorea Snell's, pg.315 Involuntary quick, jerky and nonrepetitive movements (vvv.imp) Huntington Disease: Caused by Autosomal Dominant gene of chromosome 4 Gaba neurons of striatonigral inhibiting pathway degenerate Symptoms are Choreiform movements and progressive dementia  Sydenham Chorea: Streptococcal bacteria similar to basal ganglia so antigens start attacking basal ganglia Symptoms: Choreiform Movements and Rheumatic Fever 20-Hemiballismus Snell's, pg.315 One side limb starts flying about out of control (vvv.imp) Damage to Subthalamus (Does Smooth Movement) 21-Parkinson’s Disease Snell's, pg.315 Both Hyper and Hypokinetic (vvv.imp) Damage to Substantia Niagra Symptoms: 1. Tremor 2. Rigidity (Lead pipe or Cog-wheel) 3. Bradykinesias 4. Postural disturbances 22-Athetosis Snell's, pg.318 Slow, sinuous, writhing Movements (vvv.imp) Damage to Globus Pallidus 23-Thalamic Lesions Snell's, pg.369 Important relay so many tracts can be damaged, sensory loss if VPL and VPM damaged Interthalamic nuclei blocked for complete pain blockage Thalamic hand and choreoathetosis may occur 24-Thalamic hand Snell's, pg.369 Contralateral hand is held in an abnormal posture due to thalamic lesion, wrist is pronated and flexed, metacarpophalangeal joint is flexed and interphalangeal joint is extended 25-Types Of Snell's, pg.429 1. Meningeal Headache: Durra matter damage Headaches giving referred trigeminal nerve pain 2. Cerebral Tumor Headache: Stretching of Dura matter 3. Migraine Headache: multiple reasons causing dilation and constrictions of cerebral arteries 4. Alcoholic headache: Toxic effect on meninges 5. Diseases of teeth, eye or sinus headache: Referred pain by trigeminal 26-Hydrocephalus Snell's, pg.456 Increased CSF volume and pressure in skull due to over (vvv.imp) production or reduced drainage or blockage Types: 1. Communicating: No obstruction and CSF circulates freely through ventricles and subarachnoid space  2. Non-communicating: Obstruction present which prevents circulation between ventricles and Subarachnoid space 27-Lumbar Puncture Between L4-L5 (vvv.imp) Structures Pierced: 1. Skin 2. Superficial Fascia 3. Deep Fascia 4. Vertebral Ligaments 5. Dura Matter 6. Subdural Space 7. Arachnoid Matter 28-Cerebral Artery Snell's, pg.472 Damage to Arteries causes different areas to be Syndrome infarcted (vvv.imp) Artery Lobe Symptom Anterior Paracentral Contralateral Cerebral Lobe Hemiparesis and Hemisensory loss of leg and foot Middle Precentral, Contralateral Cerebral postcentral, Hemiparesis and frontal lobe hemisensory loss of arms and face Posterior Occipital Contralateral Cerebral Lobe homonymous Hemianopia Internal Anterior part Symptoms of middle Carotid of Cerebrum and anterior cerebral Artery Vertebro Brainstem Medial+ Lateral basilar and Occipital Medullary Syndromes Lobe and Benedict + Webber Syndrome Characteristic Epidural/Extra Subdural Sub Arachnoid Cerebral cranial Hemorrhage Hemorrhage Hemorrhage Hemorrhage Site Between Periosteal Between Dura Between Arachnoid Within Cerebrum and meningeal layer matter and matter and pia of dura matter arachnoid matter matter Vessel Anterior branch of Cerebral/Bridging Circle Of Willis Capillaries of Middle Meningeal Vein Cerebrum Artery Cause Blunt Trauma Elderly suddenly Hypertension Hypertension moving head  Symptoms Lucid Interval, Varies Severe and sudden Depends on progressively Headache Location increasing intervals of unconsciousness CT. Scan Lens Shape Cresent Shape Filled Subarachnoid Depends on space location By Bilal Safdar NUMS-CMH Lahore Contact Number for WhatsApp, 03114579803