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Clin Med- Neuro in a Nutshell**

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kelseyfmeyer's version from 2015-11-30 13:48

Nutshell-- (mentioning location indicates where the lesion would be)

Question Answer
when is MENTATION normal but BEHAVIOR abnormal?FOREBRAIN lesion!!!
FOREBRAIN--> is MENTATION affected?NO!!! should be normal (only decreased if diffuse dz) (mentation is a brainstem thing)
FOREBRAIN--> is behavior affected?YES, should be abnormal
FOREBRAIN--> are CNs affected?NO (CNs are a brain stem thing)
FOREBRAIN--> is strength affected in the thoracic AND/OR pelvic limbs?NO to either/both
FOREBRAIN--> is ataxia present in the thoracic AND/OR pelvic limbs?NO to eather/both
FOREBRAIN--> are postural reactions in the thoracic and/or pelvic limbs affected?they could be normal to decreased
FOREBRAIN--> are reflexes in thoracic/pelvic limbs affected?NO
FOREBRAIN--> is tone in thoracic/pelvic limbs affected?NO
in what lesion location do you see HEMINEGLECT?FOREBRAIN LESION (because they just "think/perceive" that the other half isnt there)
Is there circling in a forebrain lesion? if so, which way?YES circling, circling TOWARD the lesion (smart enough to tell you which side bc forebrain)
are there sensory deficits in forebrain lesions? if so, in what way?yes, CONTRALATERAL sensory deficits
what will ALWAYS localize you to the forebrain?seizures
CEREBELLUM--> is mentation affected?no
CEREBELLUM--> is behavior affected?no
CEREBELLUM--> are CNs affected?MAYBE! Can be WNL OR! there can be a maybe absent menace response, and there might be anisocoria
CEREBELLUM--> is strength in the thoracic/pelvic limbs affected?no!! no weakness or paralysis, cerebellum just smooths out movements
CEREBELLUM--> is there ataxia in the thoracic/pelvic limbs?cerebellar ataxia in both
CEREBELLUM--> are postural reactions in the thoracic/pelvic limbs affected?normal to inc (exaggerated and bouncy probably because cerebellum is for smoothing out stuff and its not working)
CEREBELLUM--> are reflexes in the thoracic/pelvic limbs affected?could be normal to inc (exaggerated and bouncy probably because cerebellum is for smoothing out stuff and its not working)
CEREBELLUM--> is tone in the thoracic/pelvic limbs affected?normal to increased (exaggerated and bouncy probably because cerebellum is for smoothing out stuff and its not working)
in what lesion location do you see INTENTION TREMORS?cerebellum!!!
where do the upper motor neurons live?in the BRAINSTEM
in cerebrum, lesions are __lateral, and in the brainstem they are __lateralcerebrum=contralateral, brainstem=ipsilateral
BRAINSTEM--> is mentation affected?YES
BRAINSTEM--> is behavior affected?no
BRAINSTEM--> are CNs affected?YES, CNs III-XII (everything but smelling and seeing bc those are weird)
BRAINSTEM--> is strength in the thoracic/pelvic limbs affected?will see UMN weakness or paralysis in all 4 legs (dec to absent, UMN) (motor signals from brain getting stopped at lesion)
BRAINSTEM--> is there ataxia in the thoracic/pelvic limbs?YES--> PROPRIOCEPTIVE ATAXIA because that is where those tracks are running through to get up to the brain (goes all the way to the cerebrum/cerebellum which means it totally has to pass through the brainstem)
BRAINSTEM--> are postural reactions in the thoracic/pelvic limbs affected?they will be decreased to absent in all 4 legs (pathways for this run through the brainstem)
BRAINSTEM--> are reflexes in the thoracic/pelvic limbs affected?normal to inc in all 4 legs (UMN reflexes-- the UMN inhibition in the spinal cord isnt working so the reflexes are exaggerated)
BRAINSTEM--> is tone in the thoracic/pelvic limbs affected?it is normal OR INCREASED (because UMN are damaged so UMN signs=lack of inhibition=spastic, tight mm)
Which place has a lesion to cause an alteration in mentation? what are the 5 types of mentation, from normal to dead?BRAINSTEM!! BAR-->obtunded-->stuporous-->comatose--> dead
what is the purpose of the UMN?it INHIBITS!!!!!!! lower motor neurons
what is happening with a UMN sign?UMN sign means there is DAMAGE to the UMNs which means that they ARENT inhibiting, which means that you get exaggerated and spastic signs in the limbs
why, in a brainstem lesion, is there WEAKNESS but the reflexes are INCREASED?the motor pathways on the way down to the muscles are impaired by the lesion in the brainstem, so there is weakness. REFLEXES however, are only going up to the spinal cord and back down, and the UMNs are damaged so they arent inhibiting the response so the reflex is exaggerated
Brainstem lesions look a lot like what other lesion? what are the differences though?brainstem can look a lot like a C1-5 lesion, BUT brainstem will have mentation and CN impairment
C1-5--> is mentation affected?no
C1-5--> is bh affected?no
C1-5--> are CNs affected?no
C1-5--> is strength in the thoracic/pelvic limbs affected?YES, decreased or absent (pUMN weakness or paralysis) (motor pathway down to limbs is affected by lesion on the way down)
C1-5--> is there ataxia in the thoracic/pelvic limbs?YES--> PROPRIOCEPTIVE ATAXIA in both because those tracks are running through this area to get up to the brain
C1-5--> are postural reactions in the thoracic/pelvic limbs affected?they will be decreased to absent in all 4 legs (pathways interrupted for both limbs)
C1-5--> are reflexes in the thoracic/pelvic limbs affected?normal to inc in all 4 legs (UMN reflexes-- the UMN inhibition in the spinal cord isnt working so the reflexes are exaggerated)
C1-5--> is tone in the thoracic/pelvic limbs affected?it is normal OR INCREASED (because UMN are damaged so UMN signs=lack of inhibition=spastic, tight mm)
what is tetraparesis/tetraplegia?Tetraparesis= weak on all four limbs(could be Ambulatory or nonambulatory). Tetraplegia= paralyzed on all four limbs
C6-T2--> is mentation affected?no
C6-T2--> is bh affected?no
C6-T2--> are CNs affected?no
C6-T2--> is strength in the thoracic/pelvic limbs affected?YES! In the thoracic limbs you will see LMN weakness/paralysis, and in the pelvic limbs you will see UMN weakness/paralysis
C6-T2--> is there ataxia in the thoracic/pelvic limbs?yes! proprioceptive ataxia in both (pathway disrupted for both limbs)
C6-T2--> are postural reactions in the thoracic/pelvic limbs affected?yes, they will be decreased to absent in both sets of limbs (pathways interrupted for both limbs)
C6-T2--> are reflexes in the thoracic/pelvic limbs affected?in the THORACIC limb, the reflexes will be decreased due to LMN damage. In the pelvic limb, reflexes will be normal to increased due to UMN damage
C6-T2--> is tone in the thoracic/pelvic limbs affected?yes! In the THORACIC limb, tone will be decreased to absent due to LMN damage. In the pelvic limb, tone will be normal to increased due to UMN damage
where is the lesion to cause the "2 engine gait"?C6-T2
T3-L3--> is mentation affected?no
T3-L3--> is bh affected?no
T3-L3--> are CNs affected?no
T3-L3--> is strength in the thoracic/pelvic limbs affected?THORACIC limbs will be NORMAL. PELVIC limbs have UMN paresis or paralysis
T3-L3--> is there ataxia in the thoracic/pelvic limbs?Normal thoracic limbs, proprioceptive ataxia in the hind limbs
T3-L3--> are postural reactions in the thoracic/pelvic limbs affected?thoracic limb normal. pelvic limbs decreased to absent
T3-L3--> are reflexes in the thoracic/pelvic limbs affected?thoracic limbs normal, pelvic limbs normal to increased due to UMN damage
T3-L3--> is tone in the thoracic/pelvic limbs affected?thoracic limbs normal, tone is normal to inc in pelvic limbs
lesion location when you see paraparesis/plegia?T3-L3
What do LMNs do?Cells that tell the limbs when/how to move
what do UMNs do?They give direction to the LMNs (inhibit or facilitate)
what are UMN signs (what does this mean?)(means that you are seeing the result of damaged UMNs) there is UMN PARESIS OR PARALYSIS--> this has to do with STRENGTH (just bc umn doesnt mean they arent weak or paralyzed, it's just a different kind of paresis or paralysis), Normal or exaggerated spinal reflexes, Increased muscle tone (rigidity, spasticity), Mild muscle atrophy due to disuse
what are LMN signs (what does this mean?)(means that you are seeing the result of damaged LMNs) there is LMN PARESIS OR PARALYSIS--> this has to do with STRENGTH. There will be Weak or absent spinal cord reflexes, Decreased muscle tone (flaccid), and Marked early muscle atrophy
L4-S3--> is mentation affected?no
L4-S3--> is bh affected?no
L4-S3--> are CNs affected?no
L4-S3--> is strength in the thoracic/pelvic limbs affected?thoracic are normal, pelvic are LMN paralysis/paresis
L4-S3--> is there ataxia in the thoracic/pelvic limbs?thoracic limbs normal, proprioceptive ataxia in the ling limbs
L4-S3--> are postural reactions in the thoracic/pelvic limbs affected?thoracic is normal, pelvic limbs is decreased to absent
L4-S3--> are reflexes in the thoracic/pelvic limbs affected?thoracic limb normal, pelvic limb are decreased to absent (LMN)
L4-S3--> is tone in the thoracic/pelvic limbs affected?thoracic limb normal, pelvic limb are decreased to absent (LMN)
when do you see a "bunny hopping" gait?L4-S3 lesion
what should you know about the signs of lesions in a L4-S3 lesion?Can see specific sciatic vs. femoral distribution of signs
explain the sciatic vs femoral distribution of signsFemoral nerve will have L4-6 segments specifically, and you can test the femoral nerve/these segments with the patellar reflex. Sciatic nerve will have L6-S1 segments specifically, and you can test this nerve/segments with the gastrocnemius and cranial tibial reflex
*What is patellar pseudohyperreflexia? when do you see this?the patellar reflex is predominated by the femoral nerve. The sciatic nerve actually provides a little bit of antagonism on the femoral nerve/patellar reflex. If you have a lesion only affecting the sciatic nerve, which is L6-S1 (entire pelvic limb is L4-S3), then the inhibitory affect of the sciatic is gone and there will be an exaggerated patellar reflex.
Muscles (Myopathy)--> is mentation affected?no
Muscles (Myopathy)--> is bh affected?no
Muscles (Myopathy)--> are CNs affected?no
Muscles (Myopathy)--> is strength in the thoracic/pelvic limbs affected?decreased in both sets of limbs-- muscles are weak because of a mm problem
Muscles (Myopathy)--> is there ataxia in the thoracic/pelvic limbs?no, neither has ataxia (no sensory problems)
Muscles (Myopathy)--> are postural reactions in the thoracic/pelvic limbs affected?postural reactions are normal in both set of limbs (no sensory problems)
Muscles (Myopathy)--> are reflexes in the thoracic/pelvic limbs affected?reflexes are all normal- reflexes are a nerve thing and myopathy is a mm prob
Muscles (Myopathy)--> is tone in the thoracic/pelvic limbs affected?tone IS affected. You can either see hypertrophy if if the myopathy is acute, or atrophy if the myopathy is chronic, or CONTRACTURE if the myopathy is very chronic
Muscles (Myopathy)--> is there pain?there may or may not be pain
when would you see a patient being easily fatiguesin a myopathy
when do you see Tremors/fasciculations?myopathy (mm fasciculation=mm)
you see "walking on eggshells" gait in all 4 limbs in what kinda lesion?myopathy (eggshells stuck in your muscles)
Neuromuscular Junction (Junctionopathy)--> is mentation affected?no
Neuromuscular Junction (Junctionopathy)--> is bh affected?no
Neuromuscular Junction (Junctionopathy)--> are CNs affected?no
Neuromuscular Junction (Junctionopathy)--> is strength in the thoracic/pelvic limbs affected?DEC to ABSENT in both sets of limbs, because there is a problem with the LMNs being able to affect the mm (so LMN signs)
Neuromuscular Junction (Junctionopathy)--> is there ataxia in the thoracic/pelvic limbs?normal (proprioceptive paths still intact/ sensory nerves not affected)
Neuromuscular Junction (Junctionopathy)--> are postural reactions in the thoracic/pelvic limbs affected?normal (these pathways are still intact/ sensory nerves not affected)
Neuromuscular Junction (Junctionopathy)--> are reflexes in the thoracic/pelvic limbs affected?decreased to absent (LMN path not working right)
Neuromuscular Junction (Junctionopathy)--> is tone in the thoracic/pelvic limbs affected?decreased to absent (LMN path not working right)
difference between a junctionopathy and a neuropathy?neuropathy will have sensory nerve involvement
Nerves (Neuropathy)--> is mentation affected?no
Nerves (Neuropathy)--> is bh affected?no
Nerves (Neuropathy)--> are CNs affected?maybe...depends on which nerves are affected in the neuropathy
Nerves (Neuropathy)--> is strength in the thoracic/pelvic limbs affected?they will be decreased to absent (LMN)
Nerves (Neuropathy)--> is there ataxia in the thoracic/pelvic limbs?could be normal or there could be proprioceptive ataxia, depending on sensory nerve involvement
Nerves (Neuropathy)--> are postural reactions in the thoracic/pelvic limbs affected?could be normal OR decreased to absent, depending on the involvement of sensory nerves?
Nerves (Neuropathy)--> are reflexes in the thoracic/pelvic limbs affected?decreased to absent (LMN)
Nerves (Neuropathy)--> is tone in the thoracic/pelvic limbs affected?decreased to absent (LMN)
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