”Tract & Field” (Neuroanatomy)
This pathway carries vibration and proprioception from body to cortex.
What is the dorsal column–medial lemniscus (DCML) pathway?
Immediate loss of reflexes and flaccid paralysis below a spinal lesion is called this.
What is spinal shock?
First-line imaging for acute neurological decline after head trauma.
What is a non-contrast head CT?
With suspected herniation, position the patient’s head like this to aid venous outflow.
What is elevating the head of bed to ~30–45°?
Transient recovery of consciousness after trauma before rapid deterioration is called this.
What is a lucid interval?
These sensory fibers ascend 1–2 levels then cross in the anterior white commissure.
What are spinothalamic (pain/temperature) fibers?
The three components of the Cushing reflex.
What are hypertension, bradycardia, and irregular respirations?
CT shows a biconvex (lentiform) extra-axial collection that does not cross sutures.
What is an epidural hematoma?
Name one osmotic therapy used to temporize elevated ICP while awaiting definitive management.
What is IV mannitol (or hypertonic saline)?
Bilateral motor weakness with loss of pain/temperature but preserved vibration/proprioception below a lesion.
What is anterior cord syndrome?
This artery supplies the anterior two-thirds of the spinal cord; its major lower thoracic–lumbar feeder is called this.
What is the anterior spinal artery; and what is the artery of Adamkiewicz?
Flexion/compression trauma causing ischemia to the anterior two-thirds of the cord produces this syndrome.
What is anterior cord syndrome?
CT shows a crescentic extra-axial collection that crosses sutures and may present subacutely.
What is a subdural hematoma?
Target this MAP range for ~5–7 days after acute traumatic SCI to preserve cord perfusion.
What is MAP 85–90 mmHg?
After cervical hyperextension, classically seen in older adults, this syndrome presents with arm > leg weakness.
What is central cord syndrome?
These superficial fibers on CN III are compressed first in uncal herniation.
What are the parasympathetic pupillomotor fibers?
Bilateral funduscopic finding due to raised intracranial pressure impairing axoplasmic flow at the optic disc
What is bilateral papillary edema?
A patient presents 12 hours after a thunderclap headache with a negative non-contrast CT. The next best test is this.
What is a lumbar puncture (to assess RBCs/xanthochromia)?
Definitive treatment for an epidural hematoma causing mass effect and herniation signs.
What is emergent surgical evacuation (craniotomy)?
A fixed, dilated ipsilateral pupil with “down-and-out” eye position and contralateral hemiparesis points to this.
What is uncal (transtentorial) herniation compressing CN III (+/- cerebral peduncle)?
A lesion just below the red nucleus interrupts this tract, helping produce extensor (decerebrate) posturing.
What is the rubrospinal tract?
Downward transtentorial herniation can shear pontine perforators, causing these secondary brainstem hemorrhages.
What are Duret hemorrhages?
In a right T10 hemisection, specify which side loses vibration/proprioception, and which side loses pain/temperature below the lesion (after 1–2 levels).
What is ipsilateral (right) vibration/proprioception loss and contralateral (left) pain/temperature loss?
This temporary ventilatory strategy lowers ICP by cerebral vasoconstriction; the typical PaCO₂ target is approximately this range.
What is brief controlled hyperventilation to ~PaCO₂ 30–35 mmHg?
Identify the posturing and localization: arm extension/pronation with neck/back extension in coma.
What is decerebrate posturing localizing to lesions through the midbrain/upper pons (below the red nucleus)?