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Amygdala Lesion

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Kluver-Bucy Syndrome- hyperoraliity, hypersexuality, disinhibited behavior)

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Frontal Lobe Lesion

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Disinhibited and defects in concentration, orientation, and judgment; may have reemergence of primitive reflexes

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Right Parietal Lobe Lesion

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Spatial neglext syndrome (agnosia) of contralateral body

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Lesion in Reticular Activating System

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Midbrain lesion- reduce levels of arousal and wakefulness

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Bilateral Mammillary Bodie Lesions

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Wericke- confusion, ophthalmoplegia, ataxia Korsakoff- memory lofee, confabulations, personality changes

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Basal Ganglia Lesion

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tremor at rest, chorea, or athetosis

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Cerebellar Hemisphere Lesion

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ipsilateral- intentional tremor, limb ataxia,

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Cerebellar Vermis Lesion

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truncal ataxia, hemiballismus

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Subthalamic nucleus Lesion

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contralateral hemiballismus

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Hippocampus Lesion

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antergrade amnesia- inability to make new memories

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Paramedian Pontine Reticular Formation Lesion

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Eyes look away from the side of the lesion

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Frontal Eye Field Lesion

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Eyes look toward lesion

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Central Pontine Myelinolysis

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acute paralysis, dysarthria, dysphagia, diplopia, and loss of consciousness. Cause-rapid correction of hyponatremia

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Broca's Aphasia

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Damage to inferior frontal gyrus leading to: nonfluent aphasia with intact comprehension

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Wernicke's Aphasia

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Damage to superior temporal gyrus leading to: fluent aphasia with impaired comprehension

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Global Aphasia

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Damage to both Broca and Wernicke areas leading to: Nonfluent aphasia with impaired comprehension

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Conduction Aphasia

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Damage to Arcuate Fasciculus (connections between Broca and Wernicke area) leading to: poor repetition but fluent speech and intact comprehension

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Obstruction of Anterior Spinal Artery

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Medical Medullary Syndrome Contralateral hemiparesis Contralateral loss proprioception Ipsilateral paralysis of heypoglossal nerve

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Obstruction of Posterior Inferior Cerebellar Artery

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Lateral Medullary Syndrome (Wallenberg): Contralateral hemibody pain/temp loss [Ipsilateral CN 9, 10] Ipsilateral dysphagia (hoarsness) loss gag reflex vertigo diplopia and nystagmus Ipsilateral Horner's Syndrome Ipsilateral loss of facial pain and temperature Ipsilateral ataxia

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Obstruction of Anterior Inferior Cerebellar Artery

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Lateral Inferior Pontine Syndrome: ipsilateral facial paralysis ipsilateral cochlear nucleus vestibular nystagmus ipsilateral loss of facial pain and themperature ipsilateral dystaxia (loss MCP and ICP)

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Obstruction of Posterior Cerebral Artery

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Contralateral hemianopsia with macular sparing

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Obstruction of Middle Cerebral Artery

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Contalateral face and arm paralysis and sensory loss aphasia (if dominate side) or hemineglect gaze toward lesion (frontal eye fields defect)

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Obstruction of Anterior Cerebral Artery

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Contalateral leg and foot paralysis and sensory loss

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Obstruction of Anterior Communicating Artery

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visual field defects (most common site of aneurysum)

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Obstruction of Posterior Communicating Artery

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CN III palsy

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Obstruction of Lateral Striate

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Devision of MCA whihc supplies internal capsule, caudate, putamen, globus pallidus. Leading to: Pure Motor Hemiparesis

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Obstruction of Basilar Artery

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Locked-in Syndrome with intact CN III

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Poliomyelitis

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Infection of poliovirus which leads to destruction of anterior horn cells of spinal cord (LMN signs) muscle weakness, atrphy, fasiculations, hyporeflexia

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Werding-Hoffman Disease

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Infantile spinal muscular atrphy (AR) 'floppy baby' and death usualy by 7mo. destruction of anterior horn cells of spinal cord (LMN signs) muscle weakness, atrphy, fasiculations, hyporeflexia

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AML (Amyotrphic lateral sclerosis)

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Defect in Superoxide dismutase I (SODI) leads to Damage to anterior horn cells(LMN) and corticospinal tracts (UMN). Lost of motor function and eventual atrophy with no damage to sensory, cognitive or oculomotor function. Tx: Riluzole may lengthen survival by decrease presynaptic glutamate

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Multiple Sclerosis

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asymmetric lesions in white matter (mostly the cervial region) from dymylination- scanning speech, intertion tremor, nystagmus

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Tabes Dorsalis

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Degeneration of dorsal columns and dorsal roots due to 3* syphilis resuling in impaires proprioception and locomotion ataxia. Charcots joints (loss of pian leads to destructions and deformity), lightning pain, Argyll Robertson pupils, absence of DTRs, positive Romberg, sensory ataxia

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Friedreich's Ataxia

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Autosomal-recessive trinucleotide repead (GAA) with defect in frataxin which impairs mitochondria. Leadinf to staggering gait, falls, nystagmus, dysarthria, pes cavus, hammer toes, hypertrophis cadiomyopathy, kyphoscoliosis

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Brown-Sequard Syndrome

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Hemisection of spinal cord: ipsilateral UMN (corticospinal tract) below lesions ipsilateral loss of tactile, vibrations and proprioception (dorsal column) below lesion Contralateral pain and temp loss (spinothalamic tract) below lesion ipsilateral loss of all sensations at lesion LMN signs at level of lesion

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Pernicious Anemia

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Deficiency in B12 leads to neuropathy- damage of dorsal columns and corticospinal tract. Proprioception defect leads to ataxic gait, hyperreflexia, impaired position and vibratory senses

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Guillian-Barre Syndrome

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Peripheral nerve irritation to the epineurium leads to sensory and LMN losses

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Decorticate Posturing

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Flexion of the wrists and elbows and extension of the ankles and knees. Typically form cerebral hemisphere stroke (2* to carotid artery occlusion)

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Decerebrate Posturing

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Extension of a upper and lower extremities. Midbrain stroke or evolution of damage down to brainstem

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Horner's Syndrome

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Sympathectomy (damge from hypothalamus, intermediolateral column to superior cervical ganglion) associated with lesions above T1 Ptosis, anhidrosis, flushing, miosis (constriction)

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Frontal Lobe Lesion

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Primitive reflexes reappear Moro- startling class's abduction and extension of arms Rooting- stroke of check turns head towards Suckling- sucking with roof if mouth touched Palmar-curling fingers when palm stroked Babinski- dorsiflexsion when plantar surface stroked

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CNXII Lesion (LMN)

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Tongue deviates toward side of the lesion (due to decussaton before medulla to contralateral hypoglossaal nucleus

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CN V Motor Lesion

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Jaw deviates towards side of the lesion due to bilateral input to lateral pterygoid

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CN X Lesion

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Uvula deviates (since weak side collapse) away from side of the lesion

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CN XI Lesion

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(loss of SCM on side of lesion) Weakness turning head to contralateral side of lesion and shoulder drop on side of lesion

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CN III Lesion

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Eye looks down and out; ptosis, mydriasis (dilated pupils), loss of lens accommodation

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CN IV Lesion

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Eye drifts upward causing vertical diplopia (problems reading or going down stairs)

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CN VI Lesion

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Medially directed eye

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Unilateral Anopsia

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Defect in ipsilateral optic nerve

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Bitemporal Hemianopsia

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Compression/defect in optic chasm

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Unilateral Homonymous Hemianopsia

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Defect in unilateral optic tract or lateral geniculate body

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Unilateral Upper Quadianopsia

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Defect in contalateral temporal lobe inferior horn of the lateral ventricle (the Myer's Loop)

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Unilateral Lower Quadianopsia

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Defect in contalateral parietall lobe internal capsule (the dorsal optic radiation)

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Unilateral Hemianopsia with Macular Sparing

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Occipital lobe lesion (typically PCA) Macula is spared due to due blood supply with MCA in this area of the occipital lobe

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Central Scotoma

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Macular degeneration Dry/atrophic- slow progression due to fatty deposits Wet- rapid degeneratioin due to neovascularization

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Internuclear Ophthalamoplegia

answer

MLF syndrome- Lesion to medial longitudinal fasciculus, defect in lateral gaze. Common defect seen in multiple sclerosis. MLF lesion-> contralaternal lateral gaze Ipsilateral eye medial rectus palsey Contralateral eye beating nystagmus towards lesion

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Pendular Nystagmus

answer

Eyes move equal speeds in both directions, commonly is congenital or present after prolonged blindness

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Cold Caloric Test

answer

Nystagmous response to col water in the ear. Slow component toward stimulation (brain stem) followed by the fast in opposite directions (cerebral)

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Uncal Hernistion

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-Ipsilateral dilated pupils and ptosis (CN III streching) -countralateral Homonymous Hemianopsia (compression of ipsilateral PCa) -ipsilateral paresis (compression of contralateral crus cerebri) -duret hemorrhage of paramedian artery

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Pure Motor Stroke

answer

Posterior limb of the internal capsule

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Sensory Motor Stroke

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Involvement of thalamus

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Anxiety NT defects

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Increase NE Decrease GABA Decrease serotonin (5-HT)

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Depression NT defects

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Decrease NE Decrease dopamine Decrease serotonin (5-HT)

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Alzheimer's dementia NT defect

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Decrease Ach

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Huntingtons disease NT defect

answer

Decrease GABA Decrease Ach

question

Schizophrenia Nzt defect

answer

Increase dopamine

USMLE Neurology- Lesions and Stroke Syndromes – Flashcards

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