MSC Neuro 2025 P1
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5.Wallenberg–Zakharchenko(Lateralmedullarysyndrome)
Lesion:dorsolateralmedulla,PICAterritory
Ipsilateral:dysphagia,dysarthria,Horner’s,CN Vloss,CNIX/Xdysfunction
Contralateral: lossofpain/temponbody(spinothalamic)
Maylackmotorhemiparesis
Level |
Syndrome |
Ipsilateral(CN) |
Contralateral(Tract) |
Pons |
Miyar–Gubler |
Facialpalsy(VII) |
Hemiplegia |
|
|
Facialpalsy(VII)+ |
|
|
Fauville |
abducens(VI) |
Hemiplegia |
|
|
Facialpalsy, |
|
|
|
hearingloss,V |
|
|
Gasperini |
loss |
Hemianesthesia |
|
Raymond– |
Gazepalsy+MLF |
|
|
Sestan |
+ataxia |
Hemiparesis |
Midbrain |
Weber |
CN IIIpalsy |
Hemiplegia |
|
Benedikt |
CN IIIpalsy |
Tremor,chorea,athetosis |
|
Claude |
CN IIIpalsy |
Cerebellarataxia |
|
Notnagel |
CN IIIpalsy |
Ataxia,±deafness |
Medulla |
Jackson |
Hypoglossalpalsy |
Hemiparesis |
|
Avellis |
IX,Xpalsy |
Hemiparesis/hemianesthesia |
|
Schmidt |
IX–X–XI–XIIpalsy |
Hemiparesis |
Level |
Syndrome |
Ipsilateral(CN) |
Contralateral(Tract) |
|
Babinski– |
CN IX/X,Horner, |
|
|
Nageotte |
cerebellarsigns |
Sensoryloss |
|
|
CN IX/X+V+ |
|
|
Wallenberg |
Horner |
Contralateralpain/temploss |
ExamPearl:
Alternateorcrossedparalysis=Ipsilateralcranialnervepalsy+Contralaterallongtract (motor/sensory)signs.
Midbrain=CNIIIsigns,
Pons=CNVI/VIIsigns,
Medulla=CNIX–XIIsigns.
39.Syndromesof thefrontal,parietal,temporalandoccipitallobesofthebrain.
SyndromesofBrainLobes
1.FrontalLobeSyndrome
Usuallybilateraldamage.
Symptoms:
Disordersofpraxis,voluntarymovementinitiation,speech(motoraphasia), andwriting(agraphia).
Emotional-volitionalspheredisorder:apathy, abulia(lackofwill),lossof motivation.
Behavioralchanges:perseveration(“stuck”onactions),echolalia, disinhibition, euphoria(moria).
Motorsigns:centralparalysis(hemiplegia),gazeparesis,graspreflex (Yanishevsky/Bechterevreflex).
Posture&gait:frontalataxia(astasia-abasia).
Other:anosmia,hypokinesis,andsometimesepileptic(Jacksonian) seizures.
2.ParietalLobeSyndrome
Lesionsonpostcentral gyrusandadjacentareas.
Symptoms:
Sensoryloss(allmodalities)includinghemianesthesia.
Agnosia:astereognosis(inabilitytorecognize objectsbytouch).
Apraxia(inabilitytoperformcomplexlearnedactions).
Distortedbodyimage: autotopagnosia(cannotrecognizeownbodyparts), anosognosia(denialofillness, especiallyrighthemisphere).
Alexiaandacalculia.
Gerstmannsyndrome(leftangulargyruslesion):fingeragnosia,agraphia, acalculia,right-leftdisorientation.
Lowerquadranticvisualfielddeficits.
Jacksoniansensoryseizures:focalsensorydisturbancesprogressingina “march.”
3.TemporalLobeSyndrome
Areas:superior,middle,inferiortemporalgyri;hippocampus.
Symptoms:
Auditoryagnosia(cannotrecognizesounds).
Temporalataxia(coordinationdeficit).
Upperquadranthomonymoushemianopsia.
Memorydisturbances, confusional/dream-like states.
Sensoryaphasia(Wernicke’saphasia).
Temporallobeepilepsy:psychomotorseizures,auditory/olfactory/gustatory hallucinations.
Vegetative/visceralsymptomsincludingvertigo.
4.OccipitalLobeSyndrome
Involvedinvisualprocessing.
Symptoms:
Homonymoushemianopia(lossofthesamevisualfieldinbotheyes).
Quadrantanopia(upper/lowervisualfielddefects).
Visualagnosia(cannotidentifyobjectsvisually despitenormalacuity).
Metamorphopsia(perceptiondistortion:macropsia,micropsia,porropsia).
Visualhallucinations(simple/complex).
Occipitalataxia(duetoimpairedvisualguidance).
AdditionalNotes:
Manysymptomsoverlapandmayvarywiththeextentor combinationoflesions.
Behavioralandcognitivechangesaremoreprominentwithfrontalandtemporal lesions.
Parietallobelesionsproducemore sensoryandspatialdisorders.
Occipitallobe lesionsmainlycausevisualprocessingdeficits.
40.Formsofdisorders ofconsciousness. Cerebralandextra-cerebralcomas.
FormsofConsciousness Impairment
Consciousnessinvolves wakefulnessandawareness.Itsimpairmentisclassifiedby severity:
1.Stupefaction(Stupor)
Patientisdrowsy,lethargicbutcanmaintainspeechcontactbriefly.
Easilyfatigued,weak.
Abletoanswerquestionssometimesbutquicklyfallsasleep.
2.Sopor
Deeperthanstupor,patientfallsasleepatrest.
Canbe arousedtoopeneyesbystrongstimulibutnospeechcommunication.
Noverbalinteractiondespiteeyeopening.
3.Coma
Nowakefulnessorresponsetousualstimuli.
Dividedintothree stages:
Stage1(LightComa)
Nowaking,butwithdrawalfrompainfulstimuli present.
Tendonandperiostealreflexespreserved.
Vitalfunctionsstable.
Stage2(DeepComa)
Noresponsetopainfulstimuli.
Muscledystoniaorvariable tone indi erentmuscles.
Vitalfunctionsimpaired(irregularheartrate,unstablebloodpressure,breathing di iculties,thermoregulationunstable).
Stemreflexes(corneal,pupillary)remain.
Stage3(TranscendentalComa)
Completemuscleatonyandareflexia.
Pupils dilated,absentreflexes.
Vitalfunctionsseverelycompromised,requiringintensivesupport(ventilator, vasopressors).
Terminalcondition.
41.Brown-Sekarasyndrome,mechanisms,Syndromologyofspinalcordinjurythebrainis attheleveloftheD2segmentonthe right.
Brown-SéquardSyndrome
Mechanism
Causedbyhemisection(partialorcomplete)ofthespinalcordon one side.
Causesincludetrauma,extramedullarytumors,ischemia(especiallyoftheanterior spinalarteryoritsbranch-anteriorstriateartery).
The anteriorspinalarterysuppliesmostofthelateralhalfofthecordexceptthe posteriorcolumns→ischemicBrown-Séquard syndromemayspare epicritic pathways.
Pathophysiology
Lateralcorticospinaltract(motor):ipsilateralspasticparalysisbelowlesion.
Posteriorcolumns (proprioception,finetouch):ipsilaterallossbelowlesion.
Spinothalamic tract(pain,temperature):contralateralloss1-2segmentsbelow lesion(decussateswithinspinalcord).
ClinicalFeaturesofRight D2Brown-SéquardSyndrome
Side |
Deficit Type |
Description |
Ipsilateral |
|
|
(Right) |
Motor |
Spastic paralysis of trunk and right lower limb |
Ipsilateral |
|
Loss of proprioception and touch (partially |
(Right) |
Sensory |
spared in ischemia) |
Ipsilateral |
|
|
(Right) |
Segmental sensory |
Loss of all sensory modalities at D2 dermatome |
Ipsilateral |
|
Horner’s syndrome signs and vegetative |
(Right) |
Autonomic |
changes |
Contralateral |
Sensory (pain and |
Loss of pain and temperature sensation starting |
(Left) |
temperature) |
~T4 level and below |
Summary:
Brown-Séquardsyndromeresultsfromhemisectionorunilateraldamageofspinal cord.
AttheD2levelrightside,motorweaknessandproprioceptiveloss
occuripsilaterally,whilepainandtemperaturelossare contralateralbelowthe lesion.
AssociatedsignsincludeHorner'ssyndromeipsilateraltolesiondue tosympathetic pathwayinvolvement.
Additionalnotes
InvertedBrown-Séquardsyndromemayoccurduetolumbarosteochondrosis causingradicularveincompression.
42.Syndromologyoftransversespinalcordinjuryonvariouslevels.
Hereisaconcisesummarytableofthesyndromologyoftransverse spinalcordinjuryat variouslevels, includingthespecificfeaturesrelatedtotheD2segmentlesionontheright:
Level |
ClinicalFeatures |
Sensory |
MotorLoss |
Other |
|
|
Loss |
|
Features |
|
|
|
Diaphragm |
|
|
|
Lossofall |
paralysis |
|
Upper |
Tetraplegia/spastic |
sensitivities |
(hiccups, |
Central |
Cervical |
paralysisofallfour |
atleveland |
breathing |
pelvicorgan |
(C1-C4) |
limbs |
below |
di iculty) |
dysfunction |
|
|
|
Flaccid |
|
|
|
|
paralysisof |
|
|
Peripheral |
|
diaphragm |
Possible |
|
paralysisofupper |
|
(phrenicnerve |
Bernard- |
|
limbs;central |
Segmental |
involvement); |
Horner |
MidCervical |
paresisoflower |
sensitivity |
spasticlower |
syndrome |
(C5-T1) |
limbs |
loss |
limbs |
ipsilaterally |
Upper
Thoracic
(T1-T6)
Mid-
Thoracic (D2)
Spasticparalysis |
Lossofall |
Centralpelvic |
Ipsilateral |
oflowerlimbs |
sensations |
organ |
Horner’s |
(centralparesis) |
belowlevel |
dysfunction |
syndrome |
|
Ipsilateral |
|
|
|
deep |
|
|
(Rightside |
sensation |
Ipsilateral |
Possible |
hemisection→ |
loss; |
spastic |
Horner’s |
Level |
ClinicalFeatures |
Sensory |
MotorLoss |
Other |
|
|
Loss |
|
Features |
|
Brown-Séquard |
contralateral |
paralysis |
syndrome |
|
syndrome) |
pain/temp |
(hemiplegia) |
ipsilaterally |
|
|
loss |
|
|
|
|
(dissociated) |
|
|
|
|
|
Lossof |
|
|
|
|
cremasteric, |
Contralateral |
Lower |
|
Ipsilateral |
plantar, |
lossof |
Thoracic |
Spasticparalysis |
deep |
abdominal |
pain/temp |
(T7-T12) |
oflowerlimbs |
sensoryloss |
reflex |
sensation |
|
|
|
Flaccid |
|
Lumbar |
Peripheral |
|
paralysisin |
Central |
Enlargement |
paralysisoflower |
Segmental |
corresponding |
pelvicorgan |
(L1-S2) |
limbs |
sensoryloss |
myotomes |
dysfunction |
|
|
|
Peripheral- |
Reflex |
|
|
|
typebladder |
voiding |
Conus |
Lossofallsensory |
|
andbowel |
preservedby |
Medullaris |
modalitiesin |
Perineal |
dysfunction |
sacral |
(S3-S5) |
perinealregion |
sensoryloss |
(incontinence) |
segments |
Mechanism:
DamagetospinalcordhemisectionatD2 right a ectsthecorticospinaltract (motor)andposteriorcolumns(proprioception)ipsilaterally.
Crossedspinothalamictractinjuryproduces contralateralpainandtemperature sensationlossbelowlesion.
InjurytolateralhornsympatheticneuronsresultsinipsilateralHorner’ssyndrome.
43.Syndromesofdamagetotheradial,ulnar,mediannerves.
RadialNerveSyndrome
Motordeficits:
Weaknessofforearmextension(elbowextensiona ectedifhighlesion)
Wristandfingerextensionweakness→"wristdrop"or"hanginghand"
Weakabductionofthumbandfirstfinger
Hypotrophyofdorsalmusclesofshoulderandforearm
Reflexchanges:
Weakorabsenttricepsreflex
Sensorydeficits:
Hypoesthesiaon theback(dorsalsurface)oftheshoulder,forearm
Sensorylossontheouterhalfofthedorsalhand,thumb(Ifinger), index(II), andradialhalfofmiddle finger(III)
Commoncauses:midshafthumeralfracture,compressionataxilla("Saturdaynight palsy"),entrapmentatradialgroove, proximalarmtrauma
Clinicalsign:inabilitytoextendwristandfingers,sensory lossinradialnerve distribution
UlnarNerveSyndrome
Motordeficits:
Di icultywithpalmarflexionofhand
Weakfingerabduction/adduction
"Clawhand"deformity: extensioncontractureatmetacarpophalangeal joints,flexioncontractureatinterphalangealjoints,especiallyfingersIVand V
Atrophyofinterossei,hypothenar,andthenarmuscles(hypothenarmainly ulnar)
Partialatrophyofforearmmuscles
Sensorydeficits:
Hypoesthesiaonpalmarsurfaceoflittle(V)finger
Dorsalsurface ofV and IVfingers
Ulnarside ofmiddlefinger(III)
Commonsitesofentrapment:cubitaltunnelatelbow,Guyon’scanal atwrist
Signs: clawing,sensorylossinulnardistribution,musclewasting
MedianNerveSyndrome
Motordeficits:
Impairedwristflexionandpronation
WeaknessinflexionofI,II,IIIfingers
Di icultywiththumbopposition(thenarmusclesa ected)
Atrophyofforearmflexorsand thenareminence
“Apehand”or“monkeyhand”deformity:flattenedthenareminence,inability toopposethumb,weaknessinfingerflexion
Sensorydeficits:
HypoesthesiaonpalmarsurfaceofI,II,IIIfingersandradialhalf ofIV finger
Associatedsigns:
Causalgia(burningpain)innervedistribution
Vegetativeand trophic changesina ectedskinareas
Commoncauses:carpaltunnelsyndrome,pronator syndrome, traumaatmidforearm
44.Syndromesofdamagetothetibialandfibularnerves.
TibialNerveSyndrome
Function:
Motor:flexionoffootandtoes,inversion(footturninginward).
Sensory:posteriorlowerleg,sole,plantarsurfaceoftoes,dorsalsurfaceof distalphalangesandlateralfoot.
Clinicalmanifestations:
Paralysisoffootandtoeflexors;di icultystandingontoes.
"Heelfoot"deformity:footextendedposition,calfatrophy.
LossofAchillesreflex.
Sensorylossonposteriorlower legandsole.
Pain(causalgia)andtrophic/vegetative changesinsevereneuropathy.
Diagnosis: