DIAG 2740 Exam 3 Review Material

DIAG 2740 Exam 3 Review Material - Neurological Diagnosis...

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Neurological Diagnosis 3: Final Exam material Chapter 14: Brainstem III: internal structures and vascular supply Main Components o Cranial nerve nuclei o Long tracts: have to pass through brain stem, can lead to global problems if lesion here Corticospinal Corticobulbar: corticospinal for cranial nerves Other motor: tectospinal, reticulospinal, vestibulospinal Autonomic pathways Dorsal columns Anterolateral pathways: STT o Cerebellar circuitry: cerebellar peduncles Pontine nuclei Red nucleus Central tegmental tract Inferior olive Lesions cause uncoordination (ataxia) Superior peduncle: output to red nucleus which goes to primary motor area Middle cerebellar peduncle to cerebellar hemispheres Inferior cerebellar peduncle: SC to cerebellum o Recticular formation: pain modulation mechanisms Arousal Posture and locomotion centers Red nucleus: tied with pain mechanisms Substantia nigra: part of basal ganglia system Autonomic nuclei: apneustic nucleus, cardiovascular and respiratory centers Rostral (superior) = consciousness: projects to thalamus, lesions can cause coma Caudal = Reflex, autonomic, motor function (case study with hiccups) o Wipe out brain stem lose motor function and coordination o Locked - in syndrome Usual cause is ventral pons infarction (basilar artery) Patient is unable to move anything but the eyes Sensory pathways are intact Patient is aware and able to feel o Vascular supply Comes from vertebrobasilar artery Important branches on handout Infarct causes: thrombus, embolus, lacunar (little tiny arteries that get blown out with hypertension) infarct Warning signs Symptom Region of ischemia Dizziness/nausea VIII cerebellum Diplopia eye movement paths Blurry vision eye movement paths Incoordination cerebellum Unsteady gait cerebellum/CST Dysarthria/dysphagia cranial nerves corticobulbar Numbness/tingling long sensory tracts
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Hemi/quadra paresis corticospnal tract Somnolence reticular formation Headache meninges Midbrain lesions : III-IV palsy, papillary dilation, flexor posturing Pons : bilateral Babinski general weakness, perioral numbness, facial tingling, upper or lower visual loss (PCA), extensor posture Medulla signs: vertigo, ataxia, nystagmus, nausea, vomiting, respiratory arrest, autonomic instability, hiccups Damage to posterior circulation May be due to atherosclerosis of vertebral or basilar arteries o Results in waxing waning deficit with change in blood pressure or vascular tone May be due to dissection resulting from neck injury loosening an embolus o Aneurysm or clot Medial medullary syndrome Pyramidal tract: contralateral weakness Medial lemniscus: contralateral decrease of joint position and vibration Hypoglossal nucleus: ipsilateral tongue weakness Lateral medullary syndrome (Wallenberg’s) More often thrombic in nature
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DIAG 2740 Exam 3 Review Material - Neurological Diagnosis...

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