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Clinical Neuro - 4

cerebellar syndromes

Brain area involved in Wallenberg's syndrome? dorsolateral medulla; cerebellum
What usually causes Wallenberg's syndrome? occlusion of the posterior inferior cerebellar artery, but because blood supply is variable can also be caused by occlusion of the parent vertebral artery.
What nuclei/tracts are involved in Wallenberg's syndrome? descending sympathetic pathways; spinothalamic tract/spinal lemnicscus (positioned lateral to medial lemniscus); descending tract & nucleus of CN V; lower vestibular nuclei; inferior cerebellar peduncle; CN IX & CN X
What are classic symptoms of Wallenberg's syndrome? ipsilateral horner's syndrome; contra. loss of pain/temp. sensation on body; ipsilateral loss of pain/temp. sensation on face; severe vertigo, nausea, nystagmus & vomiting; ipsi ataxia of limbs; intractable hiccups/ difficulty swallowing
What areas does the PICA supply? the lateral medullary wedge and the overlying cerebellum
From what artery does the PICA arise? vertebral a.
What are the ipsilateral neurologic signs of PICA syndrome? (3) cerebellar hemisphere signs (ataxia) reduced corneal reflex Horners' syndrome (miosis, ptosis, anhidrosis)
What are the contralateral neurologic signs of PICA syndrome? loss of pain & temperature sensation
What type of nystagmus usually indicates central cause? bidirectional jerk nystagmus - direction of the fast component changes with eye movement
What type of nystagmus usually indicates peripheral cause? unidirectional - fast component always to one side
What area of brain is most likely afffected in severe alcoholism? anterior cerebellum, rostral vermis
Classic clinical neurologic signs in anterior cerebellar lobe syndrome? mild truncal ataxia; unsteady broad-based gait (unable to tandem walk;) lower extremity dystaxia mild/no arm dystaxia; absence of dysarthria & nystagmus
Distribution of cerebellar signs in cerebellar hemisphere syndrome? unilateral upper and lower extremity; unilateral trunk; unilateral head and neck (but may be contra to body)
Distribution of cerebellar signs in rostral vermis syndrome? anterior lobe; bilateral lower extremity and trunk; arms and cranial nerves spared
Distribution of cerebellar signs in caudal vermis syndrome? flocculonodular lobe; primarily in trunk; upper and lower extremity, as well as head and neck is spared
Distribution of cerebellar signs in pancerebellar syndrome? bilateral arms and legs, trunk and cranial
Dystaxia, predominantly in the legs, sparing the cranial nerve musculature, is the __________ syndrome? Rostral vermis (anterior lobe) syndrome
Dystaxia of stance and gait (axial), with little or no extremity dystaxia is the ____________ syndrome? Caudal vermis (flocculonodular) syndrome
Cerebellar signs bilaterally in all musculature, cranial, axial, and appendicular, is the _______________ syndrome? Pancerebellar
Lateralized cerebellar signs limited to one half of the body is the __________ ____________ syndrome? Cerebellar hemisphere
What are the four major clinical signs of the cerebellar syndrome? Dystaxia, dysarthria, nystagmus, hypotonia
What type of gait is present in cerebellar dysfunction? Swaying, broad-based stance and gait
Turning the head to the right may occlude which vertebral artery? the left
What 2 types of lesions can be determined from abnormal findings on vertebral basilar artery insufficiency manueuver? physiologic cerebellar lesion; vascular cerebellar lesion
Describe nystagmus from hypoxic left cerebellum (due to right rotation)? increased activity of L cerebellum drives eyes slowly to the right, with fast refixation to the left (left beating nystagmus)
Describe nystagmus from transneural degeneration of right cerebellum (due to right rotation)? head rotation exceeds metabolic rate and causes right cerebellar escape which drives eyes slowly to the left, with fast refixation to the right (right beating nystagmus)
Created by: jasonsmithdc