novel episode I - medkorat.in.th episode I.pdf · hemiparesis, hemianesthesia (contralateral)...
Transcript of novel episode I - medkorat.in.th episode I.pdf · hemiparesis, hemianesthesia (contralateral)...
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1
LOCALIZATION
NEUROLOGY
EPISODE I CORTICAL SIGNS AND BRAIN STEM
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Motor pathway
(Corticospinal tract) Upper motor
neuron
Lower motor
neuron
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CORTICOSPINAL TRACT
CORTEX
INT. CAPSULE
MOTOR DECUSSATION
BRAIN STEM
SPINAL CORD
X
UPPER MOTOR
NEURON LESION
X
X
X
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SPINOTHALAMIC
TRACT
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CORTEX
INT. CAPSULE
MOTOR DECUSSATION
BRAIN STEM
SPINAL CORD
UPPER MOTOR
NEURON LESION
SPINOTHALAMIC TRACT
CORTICOSPINAL TRACT
X
X
X
X
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UPPER MOTOR NEURON :
contralateral facial palsy below upper eyelid
LOWER MOTOR NEURON
ipsilateral facial palsy
FACIAL PALSY
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HEMISPHERIC LESION
CORTICAL and SUBCORTICAL
MOTOR : contralateral hemiparesis UMN type
FACE : contralateral UMN type facial palsy
SENSORY : contralateral hemianesthesia
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8
EPISODE I
CORTICAL SIGNSCORTICAL SIGNS AND BRAIN STEM
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CORTICAL vs
SUBCORTICAL
CORTICAL SIGNS
PATTERN of WEAKNESS
CONSCIOUSNESS
EYE DEVIATION
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DOMINANT HEMISPHERE
� Right handed: Left
(95%)>>>Right
� Left handed: Left (60%),
Right (40%)
� Language: aphasia
� Learn motor skills: apraxia
CORTICAL LESION: DOMINANT
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NON DOMINANT HEMISPHERE
� Rhythm and music
Amusia, loss of prosody,
monotonal voice
� Visuospatial analysis
Dressing and
Constructional apraxia
� Attention deficit
Neglect
CORTICAL LESION: NON DOMINANT
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DRESSING APRAXIA
� Not true apraxia (bad term)
� Disorder of visuo-spatial perception
that difficulty dressing
� Lesion at right parietal lobe
CONSTRUCTIONAL APRAXIA
� Disorder of visuospatial perception
� Inability to copy or construct complex figure
� Test by ask patient to copy a complex figure
� Lesion at right parietal lobe
CORTICAL LESION: NON DOMINANT
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DOMINANT PARIETAL LOBE
aphasia, apraxia, Gerstman’s syndrome:
(left-right confusion, acalculia, finger agnosia, agraphia)
NON DOMINANT PARIETAL LOBE
impaired 2-point discrimination, sensory inattention, astereognosia,
agraphesthesia, sensory extinction
dressing apraxia, constructional apraxia, neglect
CORTICAL SIGNS
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Pattern of weakness :
face, arm > leg
Consciousness :
impair if face, arm, leg involved
Eye deviation :(Frontal eye field, AREA 8)
deviate to lesionSeizures :
suggest cortical
CORTICAL LESION
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Absent of specific cortical deficits :
Pattern of weakness :
face, arm = leg
Consciousness :
no impair though face, arm, leg involved
Eye deviation :(Frontal eye field, AREA 8)
no eye deviate
Involuntary movement : parkinsonism, chorea, dystonia, hemiballism
SUBCORTICAL LESION
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Cranial nerves abnormalities
Mid brain : dipolpia Pons : decrease facial sensation
facial palsy, vertigo, deafness
Medulla : dysarthria, dysphagia
Long tract findings :hemiparesis, hemianesthesia (contralateral)
Horner’s, cerebellar sign (ipsilateral)
BRAIN STEM
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17
EPISODE I
BRAIN STEMCORTICAL SIGNS AND BRAIN STEM
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MEDULLARY SYNDROME
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LATERAL MEDULLARY SYNDROME
Ipsilateral
Impair sensation of face
Ataxia of limb, nystagmus, nausea, vertigo
Horner’s syndrome
Dysphagia, hoarseness, vocal cord paralysis
Contralateral
Sensory loss of arm and leg spare face
posterior inferior cerebella artery (PICA)
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MEDIAL MEDULLARY SYNDROME
Ipsilateral
Paralysis and atrophy of tongue
Ataxia of limb, nystagmus, nausea, vertigo
Contralateral
Paralysis of arm and leg spare face
penetrating branch of vertebral or lower basilar artery
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PONTINE SYNDROME
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LATERAL PONTINE SYNDROME
anterior inferior cerebella artery (AICA)
Ipsilateral
Impair sensation of face
Ataxia of limb, nystagmus, nausea, vertigo
Horner’s syndrome
Facial palsy LMN type
Deafness or tinnitus
Contralateral
Sensory loss of arm and leg spare face
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MEDIAL PONTINE SYNDROME
penetrating branch of basilar artery
Ipsilateral
Diplopia in lateral gaze
Ataxia of limb, nystagmus, nausea, vertigo
Contralateral
Paralysis of arm and leg spare face
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MIDBRAIN SYNDROME
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LATERAL MIDBRAIN SYNDROME
superior cerebella artery (SCA)
Ipsilateral
Ataxia of limb, nystagmus, nausea, vertigo
Horner’s syndrome
Contralateral
Sensory loss of arm, leg and face
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MEDIAL MIDBRAIN SYNDROME
penetrating branch of basilar artery
Weber’s syndrome: lesion at cerebral peduncleCN III palsy + contralateral hemiparesis (include face)
Benedikt’s syndrome: lesion at red nucleusCN III palsy + contralateral abnormal movement
Nothnagel’s syndrome: lesion at superior cerebellar peduncle
CN III palsy + ipsilateral cerebellar ataxia
Claude’s syndrome: all syndrome
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Circumferential branch: PICA, AICA, SCA
Penetrating branch
VERTEBROBASILAR SYSTEM
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BRAIN STEM
TRACT
Corticospinal
Cerebella
Spinothalamic
Spinal tract of CN V
Sympathetic pathway (Horner’s Syndrome)
CRANIAL NERVE
Midbrain: CN III, IV
Pons: CN V,VI, VII, VIII
Medulla: CN IX, X, XI, XII
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CORTICOSPINAL TRACT
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SPINOTHALAMIC TRACT
Abnormal sensation
at contralateral side
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SPINAL TRACT of CN V
Abnormal
facial sensation at
ipsilateral
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SYMPATHETIC TRACT
Horner’s syndrome at
Ipsilateral
M= Meiosis
E = Enophthalmos
A = Anhydrosis
T = pTosis
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CEREBELLA
Cerebella sign at
Ipsilateral
ataxia
FNF
Heel to Knee
RAM
Scanning speech