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bales lesion packet


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What defecits are caused by syringomyelia?
ALS: pain and temperature

cross over cannot occur on either side
What defecits are caused by trouble with the posterior spinal artery?
loss of ALS and fasciculus gracilis and cuneatus:

no pain, temperature, descriminative touch, and proprioception

Also lose: lissaeur's tract: loss of pain and temperature of upper limb.

could also be caused by a tumor
What defecit is caused by anterior spinal artery problems?
anterior and lateral cortiocspinal : UMN: spastic paralysis below the lesion

ventral horn (LMN) flaccid paralysis

ALS (contralateral )pain and temperature

fasciculus gracilis (ipsilateral) touch and proprioception

ventral white commisure: touch and proproception lower limb defecit
Describe the effects of the lateral medullary syndrome. What causes it? What is sometimes included?
caused by proximal PICA or vertebral artery block.

vestibular: balance, nausea, nystagmus, diplopia, hiccup: bilateral b/c affects both eveys! effect actually comes from one side

Inferior cerebellar peduncle: ataxia: ipsilateral

ALS: pain and temperature to body: contralateral

trigeminal: pain and temperature to face and head: ipsilateral

sometimes cochlear N is included: hearing loss: ipsilateral

nucleous ambigous: dysphagia, palate paralysis, dysphonia, efferent limb of gag reflex-no gag reflex: ipsilateral

hypothalamospinal: interupt sympathetic nerves; leads to horner's syndrome:miosis, anhydrosis, ptosis
What causes tonsillar herniation? What is the result?
caused by bilateral compression above the tentorium cerebelli

tonsils squeeze the brainstem

leads to ischemia of the reticular cardiac and respiratory centers

leads to cardiac and respiratory arrest and ultimately death

bilateral : )
Name 3 pontine syndromes
medial (paramedian) pontine syndrome(caused by paramedian branch damage (off basilar))

Lateral pontine syndrome: damage of basilar-long circumferential aa

Locked in syndrome
What is damaged in medial pontine syndrome?
medial lamniscus: proprioception and touch contralateral

corticospinal : contralateral spastic paralysis of upper and lower limbs

abducens: CN 6 lateal rectus is paralyzed ipsilaterally

PPRF-parapontine reticular formation: loss of congugate lateral gaze center ipsilaterally

facial N FIBERS may or may not be included leading to facial paralysis ipsilaterally
What is damaged in lateral pontine syndrome?

ALS: pain and temperature to contralateral body

middle and superior cerebellar peduncles: ataxia ipsilateral

trigeminal chief nucleus: facial sensory (hypoasthesia?) ipsilaterally

sometimes Medial lemniscus: contralateral lower limb touch and conscious proprioception loss.

Ventral trigeminothalamic tract (VTT) analgesia of face: contralateral

MOTOR: trigeminal motor: ipsilateral chewing trouble.
What is damaged in locked in syndrome? What is another name for it?
bilateral basilar (ventral) pons

corticospinal: quadrapelegia (both sides are damaged)

corticobulbar: mute w/ facial paralysis (both sides damgaed= bilateral)

abducens N: lateral gaze palsy (both sides damaged=bilateral)
What happens when the distal PICA is damaged?
vestibulocerebellum is damaged which mimics a peripheral vestibular problem: vertigo, nausea, nystagmus
Name 4 midbrain syndromes.
paramedian midbrain syndrome, medial midbrain syndrome=WEBER!, Uncal herniation, dorsal midbrain syndrome=PARINAUD's
What is damaged in paramedian midbrain syndrome?
superior cerebellar peduncle: limb ataxia ipsilaterally

sometimes red nucleus: subtle effects

occulomotor nucleus AND fibers : paralysis of eye movement ipsilaterally
What is the difference between paramedian and medial (WEBER) midbrain syndromes?
weber includes corticospinal tract which causes spastic paralysis contralaterally.

otherwise both have scp = limb ataxia and oculomotor fiber and nucleus damage
What deficits occur as a result of uncal herniation? Where does the hernia occur?
through the tentorial notch

causes CN III compression: PS to eyeball unopposed Symp.= dilated pupil

crus cerebri compression = weakness of body muscles. compresses corticospinal tract

usually bilateral b/c compression is bilateral
What is damaged in Parinaud's or dorsal midbrain syndrome?

What causes it ?
MOTOR: superior colliculus is damaged: upward gaze paralysis THEN complete vertical gaze

MUCH later: trochlear, occulomotor, MLF go = normal eye movements cease and nystagmus occurs

cerebral aqueduct is compressed leading to hydrocephalus

caused by a pineal tumor or other compression from above.

Usually bilateral compression and therefore bilateral symptoms
What deficits result from anterior cerebral artery damage?
parasagital and superiormost postcentral and precentral gyrus leading to anasthesia and paralysis in lower limb contralaterally

micturition center: reduced inibition of bladder
What deficits are caused by damage to the posterior cerebral artery?
occipital region leads to homonomyous hemianopsia with or without macular sparing

thalamic syndromes
What deficits are caused by damage to the SUPERIOR division of the middle cerebral artery?
anasthesia and paralysis of hand and face contralaterally due to damage of middle and lower pre and postcentral gyri

damage to broa's area causes aphasia
What deficits are caused by damage to the INFERIOR division of the middle cerebral artery?
damage to meyer's loop leads to superior quadrantanopia contralaterally

Wernike's area: impaired comprehension with fluent but non sensical speech

sometimes central scotoma: blind spot in macula
What deficits are caused by damage at the origin of the middle cerebral artery?
get same deficits as superior and inferior MCA problems as well as:

genu and posterior limb of the internal capsule leading to hemipeligia and hemianasthesia of face, upper, and lower limb contralaterally


basal ganglia damage which will be masked by above

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