click below
click below
Normal Size Small Size show me how
Clinical Neuro - 4
cerebellar syndromes
Question | Answer |
---|---|
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) |