Hemisphere
Open ended question: What is the difference in communication from the left verses the right hemisphere of the brain
LEFT:
● Language and speech
Broca’s area: speech motor planning
Wernicke’s area: language comprehension
RIGHT:
● Nonverbal communication
○ Inferior frontal gyrus: produces nonverbal communication - Same location of Broca’s, however on the right hemisphere
○ Temporoparietal junction: interprets nonverbal signals (body language) - Same location of Wernicke’s, however on the right hemisphere
A follow up patient asks "who are you?! take this off!" and is easily aggitated during each session after a TBI. What level of Ranchos Los Amigos are they most likely?
A. I
B. III
C.V
D. IV
D. IV
Fill in the blank: MCA Motor Symptoms
__________(which side) hemiparesis of arm/face, sometimes leg if deep branches are affected (internal capsule carrying LE motor tracts affected)
Contralateral
Which tracts control the limbs?
A. Lateral Corticospinal, Rubrospinal
B. Medial Corticospinal, Lateral Corticospinal
C. Reticulospinal, Medial Corticospinal
D. Medial Vestibulospinal, Lateral Vestibulospinal
A. Lateral Corticospinal, Rubrospinal
Lateral Motor Tract (limbs): Lateral Corticospinal, Rubrospinal
Medial motor tract (postural & girdle): Medial Corticospinal, Reticulospinal, Medial Vestibulospinal, Lateral Vestibulospinal
Fill in the blank regarding the Dorsal column medial lemniscus
○ Superficial sensations: _____touch
■ Patient needs to identity ____they are being touched
○ Deep sensations: ______, proprioception, ______
○ Cortical integrations possible with this pathway: two point discrimination,
stereognosis, graphesthesia, barognosis
light, WHERE,
vibration, kinesthesia
Open ended question: what is the difference between the left and right hemisphere regarding Spatial Perception of visual fields
○ Right hemisphere attends to both right and left
environments
■ Lesion here: left unilateral neglect
○ Left hemisphere only attends to the right
environment
■ Lesion here: normally no deficits, as the right
side can attend to both sides
Post TBI, a patient can now carry over new learned tasks, attend to family, and compelte a task for about 30 minutes of attention before fatigue. What level Ranchos Los Amigos are they most likely at?
A. VII
B. VI
C.V
D. IV
A. VII
Fill in the blank: MCA Sensory Symptoms
________________(which side) hemisensory loss of face/arm > leg
Other systems:
________________(which side) homonymous hemianopia
Contralateral for both
Which tract travels ONLY contralaterally?
A. Medial Corticospinal
B. Medial Vestibulospinal
C. Rubrospinal
D. Lateral Corticospinal
C. Rubrospinal
Explanation: because its origin, the red nucleus in the midbrain, sends its fibers across the midline to innervate the opposite side of the spinal cord, meaning it influences motor function on the contralateral side of the body; this decussation allows for coordinated movement control between the brain hemispheres and the limbs on the opposite side.
The anterolateral system (ALS), also called the spinothalamic tracts carry information about noxious stimuli, temperature stimuli, and deep touch. What does the anterior pathway specifically differentiate? What does the lateral pathway specifically differentiate?
A. left vs right
B. proprioception vs. kinesthesia
C. dull/sharp
D. light touch
C. dull/sharp
Anterior pathway
■ Superficial sensation: crude touch/dull
● Patient identifies non-specific stimulus, but not where
○ Lateral pathway
■ Superficial sensation: temperature, sharp/pain
open ended question: In the LEFT hemisphere, normal function provides impulses for behavior and emotion. What happens when a lesion is present?
In the RIGHT hemisphere?
Left Lesion: Cautious, hesitant to try new tasks
Right Lesion: Impulsive, overestimates abilities, confabulations
the circle of willis is formed from which arteries?
A. superior cerebellar artery and anterior inferior cerebelalr artery
B. anterior and posterior communicating arteries
C. anterior inferior cerebelalr artery and posterior inferior cerebelalr artery
D. pontine arteries
B. anterior and posterior communicating arteries
Fill in the blank: PICA - also called _________Syndrome
Motor systems:
__________(which side) ataxia, CN 9-12 deficits possible emiparesis of arm/face, sometimes leg if deep branches are affected (internal capsule carrying LE motor tracts affected)
Wallenberg, Ipsilateral
which tract is responsible for fractionation of movement and fine motor control?
A. Lateral Vestibulospinal
B. Reticulospinal
C. Lateral Corticospinal
D. Medial Corticospinal
C. Lateral Corticospinal
How are the following cotrical integrity scores interpreted?
5/5 correct Pt. does distinguish between sharp and dull without hesitation and reports it is the same intensity as that on an intact area of the body
3-4/5 correct OR with 5/5 correct reports the feeling is different than that of the intact area of the body (intensity may be lesser or greater than normal)
0-2/5 correct OR pt. does not distinguish between the sharp and dull ends of the testing tool or pt. has no feeling of being touched
Normal, Impaired, Absent
open ended question: In the LEFT hemisphere, normal cognitive processing is linear processing. What happens if a lesion is present?
(Note: linear thinking is mathematics, thinking in words, while the right brain was connected to intuition, art, nonverbal communication and the imagination)
Lesions: loss of linear processing, neglecting details
Post TBI, patient can turn to or away from painful stimuli/auditory stimuli, blink to light etc. What level Ranchos Los Amigos are they most likely at?
A. I
B. II
C. III
D. IV
C. III
Fill in the blank: AICA Sensory Systems
_______________(which side) loss of pain and temp to body, _______________(which side) loss of DCML to face
contralateral, ipsilateral
which tract is responsible for Automatic gait, anticipatory posture, adjusts tone in body?
A. Lateral Vestibulospinal
B. Reticulospinal
C. Lateral Corticospinal
D. Medial Corticospinal
B. Reticulospinal
A lesion to one side on the spinal cord - hemicord lesion ("cut in half"), leads to __________ loss contralaterally and ___________ loss ipsilaterally below injury.
pain and temperature loss, motor, vibration/position sense loss
open ended question: In the RIGHT hemisphere, normal cognitive processing is holistic processing. What happens if a lesion is present?
(Note: linear thinking is mathematics, thinking in words, while the right brain was connected to intuition, art, nonverbal communication and the imagination)
Lesion: only focuses on details, loss of holistic processing
Loss of fractionation of movement usually occurs with damage to what part of the brain?
A. Frontal lobe
B. Temporoparietal association cortex
C. Primary sensory cortex
D. Primary motor cortex
D. Primary motor cortex: voluntary movement
Nystagmus, vertigo, deafness, and tinnitus are other symptoms that can be experienced by a ______ stroke.
A. PICA
B. ACA
C. AICA
D. SCA
C. AICA
which tract is responsible for Maintain COG over BOS using extensors in response to gravity?
A. Lateral Vestibulospinal
B. Reticulospinal
C. Lateral Corticospinal
D. Medial Corticospinal
A. Lateral Vestibulospinal
A lesion to the central cord (sparing anterior horn cells), leads to __________ (side) loss causing ___________ (sensory loss) limbs above injury