Brain Lesions

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Brain Lesions
2013-11-30 18:48:00
brain lesions neurology usmle first aid high yield

Brain lesions
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  1. Lesion to posterior inferior cerebellar artery (PICA)
    Medial medullary syndrome

    • Damage to:
    • 1. Medullary pyramids - contralateral spastic paralysis (body)
    • 2. Medial Lemniscus - contralateral loss of proprioception, vibration (body)
    • 3. Hypoglossal nerve - ipsilateral paralysis of hypoglossal nerve (tongue deviates to side of lesion)
  2. Lesion to posterior inferior cerebellar artery (PICA)
    Lateral medullary syndrome (Wallenberg)

    • Damage to:
    • 1. Lateral spinothalamic tract - contralateral loss of pain and temperature (body)
    • 2. Spinal trigeminal nucleus - ipsilateral loss of pain and temperature (face)
    • 3. Descending sympathetic fibers - Horner's syndrome (ipsilateral ptosis, miosis, anhydrosis)
  3. Lesion to anterior inferior cerebellar artery (AICA)
    Lateral pontine syndrome

    • Damage to:
    • 1. Lateral spinothalamic tract - contralateral loss of pain and temp (body)
    • 2. Facial nucleus & facial nerve (CN VII) - ipsilateral paralysis of face (LMN), ipsilateral loss of lacrimation and salivation, ipsilateral loss of taste from anterior 2/3 of tongue, loss of corneal reflex
    • 3. Lesion of middle and inferior cerebellar peduncle - ipsilateral gait and limb ataxia
    • 4. Descending sympathetic trunk - Horner's syndrome (ipsilateral ptosis, miosis, anhydrosis)
  4. Lesion to posterior cerebral artery (PCA)
    Contralateral heminopia with macular sparing
  5. Lesion to middle cerebral artery (MCA)
    • Contralateral face and arm paralysis and sensory loss
    • Aphasia (dominant hemisphere)
    • Spatial hemi-neglect syndrome (non-dominant hemisphere)
  6. Lesion to anterior cerebral artery (ACA)
    Contralateral leg and foot paralysis and sensory loss
  7. Lesion to anterior communicating artery
    • Most common site of berry aneurysms
    • May compress optic chiasm (bitemporal heminopia)
  8. Posterior communicating artery
    • 2nd most common site of berry aneurysms
    • causes CN III palsy (eyes look down and out)
  9. Lesion to basilar artery
    • Causes "locked-in" syndrome
    • CN III typically intact.
  10. Biconvex lens shaped collection of blood
    Epidural hematoma

    • Rupture of middle meningeal artery (branch of maxillary artery)
    • Usually secondary to fracture of temporal bone
    • Loss of consciousness -> lucid interval -> coma -> death
    • Can cause transtentorial herniation and CN III palsy.
  11. Crescent shaped collection of blood
    Subdural hematoma

    • Rupture of bridging veins
    • Slow bleeding -> delayed onset of symptoms
    • Associated with elderly, alcoholics, blunt trauma, shaken baby, whiplash
  12. Central bleeding
    • Rupture of aneurysm (usually berry aneurysm) or Arterio-venous malformation (AVM)
    • Increased risk of berry aneurysm in Marfan's, Ehlers-Danlos, ADPKD
    • "worst headache of my life"
    • blood or yellow (xanthochromic) spinal tap
  13. Lesion to Broca's area (inferior frontal gyrus)
    Broca's aphasia

    • Non-fluent aphasia with intact comprehension
    • Ex: ""

    Broca's broken boca
  14. Lesion to Wernicke's area (superior temporal gyrus)
    Wernicke's apahasia

    • Fluent aphasia with impaired comprehension
    • Ex: "Work gun sky fly red?"

    • Wernicke's word salad
    • Wernicke = what?
  15. Lesion to both Wernicke's and Broca's area
    Global aphasia

    non-fluent aphasia with impaired comprehension
  16. Lesion to arcuate fasciculus
    Conduction aphasia

    • Poor repetition but fluent speech with intact comprehension
    • Arcuate fasciculus connects Broca's and Wernicke's areas.
  17. Supraoptic nucleus
    Makes ADH
  18. Paraventricular nucleus
    Makes oxytocin
  19. Lateral nucleus of hypothalamus
    • Stimulates hunger
    • Lesion: anorexia
    • Inhibited by leptin
  20. Ventromedial nucleus of hypothalamus
    • Stimulates satiety
    • Lesion: hyperphagia (craniopharyngioma can lesion)
    • Stimulated by leptin
  21. Anterior nucleus of hypothalamus
    • Cools you down, parasympathetic
    • Lesion: hyperthermia
  22. Posterior nucleus of hypothalamus
    • Heats you up, sympathetic
    • Lesion: poikilothermia - (cold blooded)
  23. Suprachiasmatic nucleus of hypothalamus
    Circadian rhythm
  24. Leptin
    • Stimulates ventromedial nucleus (satiety)
    • Inhibits lateral nucleus (hunger)