Spinal Tracts
Hernias
Intracranial bleeding
100
What are the main functions of each spinothalamic tract, dorsal column and corticospinal tract?
Spinothalamic Tract - crude touch (anterior); pain and temperature (lateral)
Dorsal Column - proprioception, fine touch, vibration, pressure
Corticospinal Tract- voluntary movement
100
List the 4 kinds of hernias.
Subfalacine
Uncal
Central
Tonsillar
100
List 4 kinds of brain bleeds.
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Intraparenchymal hermorrhage
200
Where do the each of the following tracts decussate?
Spinothalamic Tract
Dorsal Column
Corticospinal Tract
Spinothalamic - spinal cord at anterior white commissure
Dorsal - medulla
Corticospinal - lower medulla
200
What is a classic sign of increased intracranial pressure associated with brain herniation?
A) Hypertension
B) Papilledema
C) Bradycardia
D) Hypotension
B) Papilledema
200
What is a potential complication of a subdural hematoma?
A) Hydrocephalus
B) Cerebral edema
C) Infection
D) All of the above
Answer: D) All of the above
D) All of the above
300
A 52-year-old female patient presents with a burning sensation and loss of pain sensation in her left leg that began two weeks ago and has gradually worsened. She has a history of diabetes mellitus but denies any recent trauma or infections. On examination, sensory testing reveals significantly diminished ability to feel sharp pain and temperature in the left leg, while sensation remains intact in the right leg. Light touch and proprioception are preserved bilaterally. Motor strength in both legs is normal, but the patient appears cautious while walking due to her sensory deficits. Deep tendon reflexes are also normal. What spinal tract was likely affected?
Spinothalamic tract
300
Match the following:
- Subfalcine Herniation
- Transtentorial Herniation
- Tonsillar Herniation
- Central Herniation
Definitions
A. Displacement of brain tissue downward through the foramen magnum, often compressing the brainstem.
B. Brain tissue herniates under the falx cerebri, potentially compressing the cingulate gyrus and anterior cerebral artery.
C. The uncus of the temporal lobe herniates over the edge of the tentorium, which can compress the oculomotor nerve and midbrain structures.
D. Involves downward displacement of the brain structures along the axis of the brain, affecting both hemispheres.
- Subfalcine Herniation - Brain tissue herniates under the falx cerebri, potentially compressing the cingulate gyrus and anterior cerebral artery (B).
- Transtentorial Herniation - The uncus of the temporal lobe herniates over the edge of the tentorium, which can compress the oculomotor nerve and midbrain structures (C).
- Tonsillar Herniation - Displacement of brain tissue downward through the foramen magnum, often compressing the brainstem. (A)
- Central Herniation - Involves downward displacement of the brain structures along the axis of the brain, affecting both hemispheres. (D)
300
In which type of hemorrhage would you typically see a "lens-shaped" appearance on a CT scan?
A) Subdural hematoma
B) Intracerebral hemorrhage
C) Epidural hematoma
D) Subarachnoid hemorrhage
C) Epidural hematoma
400
A 68-year-old male patient presents with right-sided weakness and difficulty with coordination following a recent stroke. He reports that the symptoms began abruptly while he was gardening. His medical history includes hypertension and hyperlipidemia. On examination, he exhibits weakness in the right arm and leg, rated 3/5 on the Medical Research Council scale, indicating significant motor impairment. Additionally, the patient displays increased muscle tone in both the right arm and leg, suggestive of spasticity. Which tract is likely primarily affected?
Corticospinal tract
400
Which of the following symptoms is most likely to be seen in a patient with uncal herniation?
A) Bilateral lower limb weakness
B) Contralateral homonymous hemianopia
C) Loss of consciousness
D) Nystagmus
B) Contralateral homonymous hemianopia
400
A 75-year-old female patient presents with confusion and increasing drowsiness over the past week. Her daughter reports that she had a minor fall a month ago but did not seek medical attention at that time. Upon examination, the patient is disoriented and shows difficulty following commands, although neurological assessment reveals no focal deficits. However, her decreased level of consciousness raises concerns for potential increased intracranial pressure. A CT scan of the head reveals a crescent-shaped hyperdensity along the cortical surface. What type of brain bleed is suspected?
Subdural hematoma
500
Describe the pathway of the spinothalamic, dorsal and corticospinal tracts.
500
Match hernia with affected artery.
Hernias:
- Subfalcine Herniation
- Tonsillar Herniation
- Transtentorial Herniation
- Central Herniation
Arteries:
A. Middle cerebral artery
B. Posterior cerebral artery
C. Anterior cerebral artery
D. Basilar artery
- Subfalcine Herniation - Anterior cerebral artery (C)
- Tonsillar Herniation - Basilar artery (D)
- Transtentorial Herniation - Posterior cerebral artery (B)
- Central Herniation - Middle cerebral artery (A)
500
A 72-year-old female patient presents to the emergency department with sudden onset of a severe headache and right-sided weakness. She has a history of poorly managed hypertension and is a former smoker. Her daughter reports that the patient experienced confusion and difficulty speaking for about 30 minutes prior to arrival. Neurological examination reveals right-sided hemiparesis and expressive aphasia, with a blood pressure of 180/100 mmHg. A non-contrast CT scan shows a significant hyperdense area in the left frontal lobe. What type of brain bleed is suspected?
Intraparenchymal hemhorrage