Central sensory loss involving thalamus or sensory cortex- affect CONTRA face, arm, leg Patterns sensory loss per localization Site of Lesion Sensory Findings Other neuro abn Examples Root Variable loss of all sensory modalities in dermatomal dist Weakness in myotomal dist atrophy, segmental hyporeflexia Peripheral nerve Loss LT, T, PP, an proprio eetion affected area a/ weakness in ms Plexus Sensory loss in dist of 2 or + peripheral nerves Weakness cannot localize to single nerve or root Brachial plexopathy d/t trauma, inflamm Spinal cord Sensory lcl: b/l loss all sensory modalities Sensory dissociation CONTRA hypoesthesia and OPSO loss proprioception (brown-sequard syndrome) Paraplegia, tetraplegia initially areflexia then hyperreflexia below lesion, Babinski sign Myelopathy, central cord syndromes, br degeneration
Proprioceptive loss and CST involvement Brainstem IPSI facial numbness and CONTRA body numb Alternating hemiplegia, CN findings, INO, ataxia Posterior circulation stroke; tumor Thalamus Hemibody anesthesia May have motor findings Lacunar stroke, hemorrhage Posterior limb internal capsule Hemibody anesthesia Hemiplegia Lacunar stroke, hemorrhage, tumor Cortex All modalities affected on the CONTRA side Sensory neglect agraphesthesia Parietal stroke, hemorrheage, AVM Psychogenic Hyperesthesia for one modality in one area with anesthesia for another modality in the same area changing sensory findings and non- physiologic sensory lvl changes Any Conversion d/p or malignering Chapter 7: Dizziness, Vertigo, Syncope Vertigo - illusion of hallucination of movement usually rotary but may be linear Light headedness - feeling faint, presyncopal Disequilibrium : a sensation of imbalance or unsteadiness that is usually referable to the legs rather than to a feeling inside the head (ataxia) Vertigo : acute asymmetric or imbalance of neural activity between the left and right vestibular systems, central (diplopia, dysarthria, dysphagia, brain stem dysfunction central process, impaired ability to walk or maintain posture) vs. peripheral (tinnitus, hearing loss suggests peripheral, n/v) central process : Vertical and direction changing gaze evoked nystagmus either central or peripheral process: Unidirectional nystagmus Vestibular Neuronitis: acute unilateral complete or incomplete peripheral vestibulopathy, sudden spontaneous onset of vertigo, nausea, and vomiting, minutes to hours, peak at 24 h and then improvement gradually over several days or weeks, nystagmus is unilateral Labyrinthine concussion : result from head injury, vertigo +/- hearing loss/tinnitus
Infarction of the labyrinth, brainstem, cerebellum blood supply to central and peripheral vestibular apparatus and the cerebellum via vertebrobasilar system Vertebrobasilar system : supplied by posterior and anterior inferior cerebellar arteries and superior cerebellar artery Inner ear blood supply via internal auditory artery a branch of anterior inferior cerebellar artery (infarction: sudden onset deafness, vertigo, or both)
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- Winter '14
- Vertigo, peripheral nerve, Anterior inferior cerebellar artery, nerve- sensory loss, Patterns sensory loss