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Step 1: Neuro Gold

Blood Brain Barrier Isolates brain from body. Components include endothelial cells, basement membrane and astrocytic end feet. Circumventricular organs [area postrema, median eminence of the hypothalamus, neurohypophysis, pineal gland] lack a blood-brain barrier.
Myopathies Associated with proximal symmetric weakness, but no sensory loss
Peripheral neuropathies Cause distal asymmetric weakness with atrophy, fasciculations, sensory loss and pain. Peripheral neuropathies are most commonly caused by diabetes and alcoholism
Polyneuropathies Sensory loss in a stocking/glove pattern
Guillain-Barre syndrome Ascending symmetric muscle weakness 1-3 weeks following a viral respiratory or GI infection (campylobacter)
Amyotrophic lateral sclerosis Most common motor neuron disease, gives rise to both upper AND lower motor neurons signs.
Multiple sclerosis Weakness, blindness, sensory loss that resolve and return progressively worse. The diagnosis of multiple sclerosis requires two separate symptoms at two different times, or lesions separated in time and space.
Radiculopathies cause pain/loss in a dermatomal pattern
Myasthenia gravis Disease @ the NMJ, distinguished by fatiguability, show fatigue with repetitive stimulation of their muscles
Upper motor neurons found mainly in the cerebral cortex; DO NOT directly innervate skeletal muscle. Upper motor neuron lesions = spastic paralysis, hyper-reflexia (muscle stretch reflexes are 3-4/4), Babinski sign, Hoffman sign.
Lower facial paralysis damage to the corticobulbar tract in the pons or higher (e.g. internal capsule or crus cerebri).
Lower motor neurons innervate skeletal muscle and are located in the spinal cord and brainstem. Lower motor neuron lesions = flaccid paralysis, hyporeflexia (muscle stretch reflexes are 0-1/4.)
Spinal shock Sudden trauma to the spinal cord results in spinal shock (temporary flaccid paralysis, hyporeflexia, sensory loss and loss of bladder tone) – hyper-reflexia develops over a period of days to weeks
Occlusion of the artery of Adamkiewicz results in anterior spinal artery syndrome = bilateral weakness, loss of pain and temperature and hyper-reflexia below the lesion
Cauda equina syndrome weakness and sensory loss in the lower extremities, radicular pain, saddle anesthesia and urinary incontinence.
Spinal cord sensory levels • C6=thumb • C7=middle finger • C8=little finger • T4=nipple • T6=xiphoid • T10=umbilicus • L4=medial knee • L5=big toe • S1=little toe
Muscle stretch reflexes • C5=biceps • C6=brachioradialis • C7=triceps • L4=quadriceps • S1=Achilles
Muscle stretch reflexes measurements • 0 = absent • 1 = trace or only with reinforcement • 2 = normal • 3 = brisk • 4 = clonus
Babinski sign Scrap sole of the foot, flexion of toes is normal; extension = upper motor neuron lesion
Bing sign Stab dorsum of foot with pin, normally plantar flex; dorsiflexion = upper motor neuron lesion
Abdominal reflex scratch abdominal skin, absent in UM neuron lesion
Cremaster reflex absent in UM neuron lesion
Hoffman sign scrape tip of 3rd digit, thumb and 2nd digit flex in UM neuron lesion
Anal wink scratch perineum to elicit contraction of external anal sphincter
Syringomyelia/Hyromelia cavitation of the central spinal cord, impinges the anterior white commissure producing bilateral loss of pain and temperature in a dermatome distribution
Brown Sequard syndrome hemisection of the spinal cord producing ipsilateral UMN paralysis and loss of discriminative touch and contralateral loss of pain and temperature
Anterior cord syndrome results from compression of anterior spinal artery, affects the neurons of the anterior horn, spinothalamic tract and lateral corticospinal tract
Tabes dorsalis loss of posterior columns (discriminative touch, proprioception and vibration)
Subacute combined degeneration B12 deficiency, peripheral neuropathy that can progress to cord (posterior columns and lateral corticospinal tracts)
MEDIAL medullary syndrome contralateral hemiparesis (corticospinal tract), ipsilateral deviation of tongue on protrusion (hypoglossal nucleus or nerve) & contralateral loss of discriminative touch, proprioception & vibration (medial lemniscus); blockage of ant spinal artery
LATERAL medullary syndrome ipsilateral loss of pain/temperature on face, contralateral loss of pain/temperature on body, nystagmus, dizziness/nausea, hoarseness, ipsilateral sagging palate, dysphagia, loss of taste, ataxia, Horner syndrome; post. infer. cerebellar art
Tonsillar herniation central apnea, hypertension, hyperventilation, loss of consciousness
Perinaud syndrome paralysis of vertical gaze (vertical gaze center), obstructive hydrocephalus (pinealoma).
Foville syndrome contralateral [spastic] hemiparesis (corticospinal tract), diplopia, paralysis of abduction (CN VI), ataxia (middle cerebellar peduncle), contralateral loss of discriminative touch, proprioception and vibration; paramedian branches of basilar
Gubler syndrome contralateral [spastic] hemiparesis (corticospinal tract), ipsilateral facial paralysis (facial nerve or nucleus), ipsilateral loss of pain and temperature on face (CN V), contralateral loss of pain and temperature on body; paramedian branches of basilar
Midpontine base syndrome contralateral [spastic] hemiparesis (corticospinal tract), paralysis of jaw muscles (CN V), loss of sensation on face (CN V), ataxia (middle cerebellar peduncle); paramedian and short circumferential branches of basilar.
Vestibular neuroma tumor in the vestibular division of CN VIII; affects balance and hearing first (ipsilateral hearing loss), CN VII later, maybe CN V
Locked in syndrome bilateral lesion of basilar pons; only CN III and IV are intact, vertical eye movements and blinking are intact
Weber syndrome contralateral hemiparesis, diplopia, dilated pupil (CN III), paralysis of lower face, deviation of tongue to contralateral side, weakness of ipsilateral SCM and trapezius, tremor (substantia nigra); branches from posterior cerebral artery.
Uncal hernation diplopia, dilated pupil (CN III), contralateral hemiparesis (corticospinal tract), paralysis of lower face, deviation of tongue to contralateral side, weakness of ipsilateral SCM and trapezius (corticonuclear tract).
Weber test tests bone conduction; normally localize to midline – with sensorineuronal loss, localize to good ear; with conductive hearing loss, localize to bad ear
Rinne test compares air and bone conduction; air conduction is normally better than bone conduction; with sensorineuronal loss, air>bone; with conductive hearing loss, bone>air
Anisocornia (unequal pupils) lesion to CN III or sympathetics; a dilated pupil indicates injury to CN III.
VISUAL PATHWAY LESIONS • Lesion to retina or optic nerve – ipsilateral blindness • Chiasm – bitemporal hemianopsia • Tract – contralateral homonymous hemianopsia • Radiations – contralateral homonymous hemianopsia, maybe quadrantanopia (“pie in the sky”)
Marcus Gunn pupil a pupil that appears to dilate with direct stimulation of light on a swinging light test; indicates lesion to optic nerve
Argyll-Robertson pupil seen in tabes dorsalis and is characterized by eyes that can accommodate but with weak or absent pupillary light reflex.
Decorticate posturing UL flexed, LL extended [rubrospinal tract intact];
Decerebrate posturing all limbs in extension [rubrospinal tract damaged]
Reticular formation functions mainly in muscle tone and state of consciousness
Meniere's syndrome episodic vertigo, tinnitus and hearing loss; caused by excess endolymph in the scala media
Benign positional vertigo outbursts of vertigo and nystagmus with particular positions of the head; caused by free otoliths in the semicircular canals
Parkinson's characterized by loss of pigmented dopaminergic neurons in the substantia nigra, a 3-5 Hz resting tremor, bradykinesia and rigidity and Lewy bodies.
Huntington's (characterized by choreiform movements and cognitive decline) – degeneration of neostriatum, especially caudate nucleus.
Wilson disease Impaired copper metabolism, Kayser-Fleischer rings in cornea; tremor, dysarthria and rigidity
BALLISMUS lesion to subthalamic nucleus; hemiballismus = subthalamic nucleus on opposite side.
Cerebellar disease Ataxia and an intention tremor. Lesions of the cerebellar hemisphere impair movement on the ipsilateral side of the body.
Rhomberg test in sensory ataxia patient sways considerably with eyes closed; in cerebellar ataxia they sway with eyes open.
Friedreich's ataxia degeneration of posterior columns and spinocerebellar tracts
Blockage of MCA superior div produces motor and sensory symptoms involving the contralateral face [lower facial paralysis], upper limb and trunk (lower extremity is spared); on the left will produce expressive (Broca’s) aphasia
Blockage of MCA inferior div contralateral homonymous hemianopsia; on left receptive (Wernicke’s) aphasia
Blockage of anterior choroidal artery produces contralateral hemiparesis (corticospinal tract) and contralateral homonymous hemianopsia (optic tract).
Blockage of lenticulostriate arteries produces contralateral hemiparesis and hemianesthsia (posterior limb of internal capsule).
Blockage of anterior cerebral artery motor and sensory symptoms involving the contralateral trunk and lower limb (upper limb and face are spared) with frontal lobe signs (magnetic gate, personality changes, release of primitive reflexes [grasp, root, suck])
Blockage of posterior cerebral artery produces visual symptoms – contralateral homonymous hemianopsia, macular sparring is possible; may infarct thalamus (thalamogeniculate and thalamoperforating) = contralateral homonymous hemianopsia/somatosensory loss
Broca’s aphasia indicated by impaired comprehension, repetition, naming and speech output (left inferior frontal gyrus – pars triangularis and opercularis).
Dysarthria; aphasia Dysarthria is a defect in the way speech sounds; aphasia is a defect in the use of language.
Wernicke's aphasia characterized by fluent speech full of nonsense words and phrases (left temporal / parietal lobe).
Conductive aphasia results from damage to the arcuate fasciculus and is characterized by poor repetition
stroke in anterior watershed area expressive aphasia and lower limb affects
strokes in the posterior watershed area produce receptive aphasia and visual loss.
Apraxia indicates the loss of the ability to perform a learned and familiar motor task
Agnosia indicates the inability to recognize a familiar object regardless of intact sense
Gertsmann syndrome indicated by acalculia, agraphia, finger agnosia and left-right confusion. It is caused by damage to the angular gyrus in the dominant hemisphere.
Kluver Bucy indicated by docility, placidity, hypersexuality, hyperorality and hypermetamorphosis. It is caused by bilateral lesions of the amygdala.
Created by: 092309



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