One
An ischemic stroke affecting the ACA would cause hemiplegia most pronounced in the arms or legs?
Legs
Which spinal tract is associated with conscious proprioception
DCML
The cuneate and gracile nuclei are part of which spinal tract
DCML
The lenticulostriate arteries branch from which artery within the circle of Willis?
MCA
Your patient is unable to visually identify their arm as their own - what is this called and which part of the brain is affected to cause this sign
Agnosia - Non-dominant Parietal sign
Describe the appearance of the following on a CT scan - explain why their appearance differs
Extradural
Subdural
Subarachnoid
Extradural - Biconcave hyperattenuation (Lemon shape) - Dura is strongly attached to suture lines, does not cross the sutures.
Subdural - Concave hyperattenuation (Banana) - limited by dural reflections
Subarachnoid - Hyperattenuation around the circle of Willis - Often arises from aneurism on COW
A patient presents with
1. Right sided hemiparesis and sensory loss (Arms>Legs)
2. Dysarthria
3. Agnosis
Which artery is likely affected
MCA
A patient has had a stroke confirmed on neuroimaging. One of their presenting symptoms is urinary incontinence, which artery is most likely involved based on this information?
ACA
Draw the visual defect which may result from a PCA Stroke
Homonymous hemianopia with macula sparing
A patient presents with bilateral limb paralysis, cerebellar dyscoordination and Cranial nerve lesions III-VIII
Which artery is most likely affected?
Basilar artery
Differentiate Wernicke's and Brocha's dysphasia
Wernicke's (receptive dysphasia) - well articulated non-sensical language
Brocha's (Expressive dysphasia) - comprehension maintained by unable to articulate language
What sensory information does not pass through the Thalamus
Olfactory
Hemiballismus results from a lesion in which region of the brain?
Subthalamic nuclei
The first order neuron of the spinal tract responsible for the sensation of vibration in the middle finger of the right hand will synapse with the second order neuron at which nuclei?
Cuneate
Vibration travels in the DCML - Upper limbs and torso synapse at Cuneate nuclei, lower limbs and torso at the Gracile (Remember: C is before G in the alphabet)
In the DCML pathway, at what level do the second order neurons decassade
In the medulla
Where does the spinothalamic tract decussate
Within 1-2 levels of the spinal nerve
Outline how the UMNs of the corticospinal pathway decussate
75-90% decussate in the medulla to form the lateral corticospinal tract.
10-25% remain ipsilateral and form the anterior corticospinal tract – decussating in the spinal cord.
In the synapse between UMN and LMN what NT is used
Glutamate
Outline how the presentation of an UMN lesion differs to a LMN in the face - explain why
UMN = Sparing of the forehead
LMN = No forehead sparing
List the main four extrapyramidal spinal tracts and briefly explain their functions
Rubrospinal - Aids fine motor control of hand and upper limb
Vestibulospinal - adjustment of movements in response to vestibular input.
Reticulospinal - fine-tuning of automatic movements, posture adjustments, and reflex modulation
Tectospinal - Orienting head movement toward visual stimuli
Patellar tendon reflex is associated with what spinal roots
L3/4
Myotome of brachial reflex
C5/6
Myotome examined by toe walking
S1
Myotome for hip flexion
L2
Finger Abduction myotome