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Neuro Block 6 Clinical
KYCOM Block 6
51
Anatomy
Graduate
02/23/2013

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Term
trigeminal lesion (symptoms)
Definition
loss of sensation to face and mucous membranes, loss of corneal reflex (V1), flaccid paralysis of muscles of mastication, deviation of jaw to weak side due to unopposed lateral pterygoid, paralysis of tensor tympani leading to hypacusis (partial deafness to low pitch)
Term
trigeminal neuraligia / tic dolourex (symptoms, cause, demographic, treatment)
Definition
Paroxysms: sudden outbursts of sharp pain on side of face in a trigeminal division usually maxillary. Can turned only light touch, there can be remission than pain again
usually in women over 50 yrs
loop of superior cerebellar (small aberrant a according to Soltesz lecture) impinges on trigeminal root causing demyelination of axons
treat with surgery or crabamaspine / tegretol (if idipoathic), lesioning of trigeminal ganglion or sensory root of trigeminal nerve
Term
herpes zoster opthalamius (cause, symptoms)
Definition
viral infection in sensory ganglion (usually V1)
burning pain, itching, skin erruptions, corneal ulceration
may involve CN III, IV, VI
Term
paratrigeminal (reader) syndrome (cause, symptoms)
Definition
lesion of trigeminal ganglion of sympathetic fibers usually in parasellar region
mitosis, ptosis, facial pain, trigeminal palsy
may involve CN III, IV, Vi
Term
cavernous sinus syndrome (cause, possible effected fibers)
Definition
aneurysm of cavernous sinus
may involve: oculomotor nerves (if CN III it is complete internal opthalmoplegia), trigeminal V1 and V2, postganglionic sympathetic fibers to the orbit (horner syndrome)
Term
autistic neuroma / schwannoma (possible affected areas and their symptoms, cause)
Definition
extramedullary tumor of CN VIII in cerebellopontine angle or internal acustic meatus, associated with neurofibromatosis II bilateral
Cn VIII lesion: tinnitus and heading loss
CN VII lesion: facial weakness, loss of efferent limb of corneal reflex
if it expands it affects spinal trigeminal tract: loss of pain and temp and corneal reflex afferent limb
Term
onion skin distribution / dejerine (areas affected, cause, symptoms per area)
Definition
lesion on spinal trigeminal tract and nucleus possibly after surgical sectioning of spinal trigeminal nucleus
lower levels of the nucleus: peripherial areas of face, scalp, ears, chin
higher levels of the nucleus: more central areas, nose, cheeks, lips
highest levels of the nucleus: mouth, teeth, pharyngeal cavity
higher areas may be spared preserving pain and temperature in nose, upper lip, and mouth and removing them in the forehead, cheeks, and chin (analegesia distribution, non-physologic does not follow dermatome)
Term
thalamic pain syndrome (cause, symptoms)
Definition
lesion in somatosensory path, especially VPL or VPM
exaggerated disagreement to cutaneous stimulation
emotional instability, spontanious pain
Term
subacute combined degneration (cause, symptoms)
Definition
bilateral demyelination and loss of nerve fibers in dorsal and dorsolateral funiculi
vitamin B12 deficiency leads to pernicious anemia causing loss of senses of discrimitive touch and vibration and ataxic gait
Term
asterognosis (cause, symptoms)
Definition
cant identify object with eyes closed (tactile anginosa), lesion to somatosensory association cortex
Term
neglect syndrome (cause, symptoms)
Definition
patient cant recognize other side of their body and objects and surroundings on that side, often lesion in paracentral lobule, lesion of somatosensory association cortex
Term
lesion in primary sensory cortex
Definition
impairs fine somatic sensation (exact location and judging), positional movement, tactile sensation is fine
Term
lesion in vestibular part of CN VIII (symptoms)
Definition
vertigo, disequlibrium, nystagmus
Term
lesion in chcolear part of CN VIII (symptoms)
Definition
destructive: hearing loss (sensorineural deafness)
irritative: tinnitus
auditory processing disorders
Term
transection of CN II symptoms
Definition
ipsilateral bindness, loss of direct pupillary light reflex, will not regenerate
Term
increase in intracrainial pressure symptoms
Definition
papilledema (swollen optic disc), hemmorhages, exudates, optic atrophy (white disc, a late finding. cup preserved)
Term
oculomotor paralysis symptoms
Definition
transtentorial herniation: subduaral or epidural
diploa: double vision when looking in direction of paretic muscle
denervation of levator palpareae causes pitosis (drooping of upper lid)
denervation in extraocular muscles causes looking down and out to lateral rectus and superior oblique
interrupted parasympathetic dilates popul and stops accommodation (cycloplegia)
Term
transtentorial herniation cause and symptoms
Definition
increased supratentorial pressure forces hippocampal uncus through tentorial notch and compresses oculomotor nerve
pupilloconstrictor fibers affected first dilating and fixing pupil
somatic efferent fibers next causing external strabismus (extraopia)
Term
aneurysm of carotid or posterior communicating artery symptoms
Definition
compresses oculomotor nerve in cavernous sinus of interpenducular cistern
affects peripherial pupilloconstrictor fibers first via uncal herniation
Term
diabetes mellitus effects on CN
Definition
diabetic oculomotor palsa, damages central fibers of CN III, spares pupilloconstrictior fibers
Term
trochlear nerve paralysis symptoms
Definition
extorsion of the eye, weak down gaze, vertical diplopia increases when looking down, head tilting to compensate for extorsion
Term
abducent nerve paralysis
Definition
convergent strabismus (eostropia): inability to abduct eye due to unopposed action of medial rectus
horizontal diplopia: max seperation of double images when looking to paraetic lateral rectus
Term
ansomia (cause, symptoms)
Definition
loss of smell ipsilatera, involves fracture to floor of anterior crainial fossa, cracks cribiform plate damaging olfactory nerve
Term
cerebral fluid rhinorrhea (cause, symptoms)
Definition
leaking CSF from subarachnoid into nasal cavity
fracture and tear of meninges
provide route for bacteria entry
Term
determination (cause)
Definition
occurs with age
degenerative diseases like parkinsons and alzheimers
neuronal loss of corticomedial nuclei in the amygdala
Term
what can cause taste disorders
Definition
head trauma, virus, lesion in root of VII (loss of taste in ant 2/3 tounge vestibular schwanoma), psyc issues
Term
bells palsy (cause, symptoms, treatment)
Definition
edema of VII via virus, idiopathic unilateral facial nerve paralysis usually self limiting caused by trauma to facial canal, tumors like acoustic neuroma, Gillian barre, diphtheria, Lyme disease,ear infections, sarcoidosis, herpes simplex
Loss of taste in ant 2/3 of tongue, paralysis of muscles of facial expression, pain around ear,sensitivity to sound, can't close eye, wrinkling of forehead, pulling up corners of mouth
Rapid onset of partial or complete paralysis often overnight, rarely bilateral
Manage with corticosteroids
Term
ageusia (cause, symptoms)
Definition
complete loss of taste, rare, lots of CN involved
Term
dysgeusia (cause, symptoms)
Definition
distortion of taste. (cause may be medication)
Term
hypoageusia symptoms
Definition
decreased taste
Term
coacoagusia (cause, symptoms)
Definition
unplesant taste triggered by seizure of central taste processing area. aura for people with seizures
Term
What is an issue that can happen to the glomus chordieum?
Definition
Calcification in the elderly seen on CT or X-ray
Term
Non communicating hydroencephalus ( cause )
Definition
Obstruction in cerebral aquduct or interventricular foramen or ventricle to subarachnoid
Ventricles enlarge
Term
Communicating hydroencephalus ( cause)
Definition
Impaired csf reabsorption into granulations causes excess csf production
Term
Normal pressure hydroencephalus ( demographic, cause, symptoms, differential diagnosis, treatment)
Definition
In elderly
Chronically dialated ventricles, thought to be a form of communicating
Fair disturbance, urinalysis incontinence, mental decline, csf pressure normal
Differential diagnosis is Alzheimer's or Parkinson's
Treatment reduce csf volume
Term
Glossopharyngeal lesion symptoms
Definition
Loss of gag reflex via interruption of afferent limb
Loss of carotid sinus reflex via interruption of sinus nerve
Loss of taste sensation in post 1/3 of tongue
Glossopharyngeal neuralgia
Term
Vagus lesion symptoms and causes
Definition
Tardive dyskinesia: laryngeal muscles ipsilateral paralysis of soft palate, pharynx, larynx, hoarseness, dyspnea, dysphasia, loss of gag reflex (efferent), anesthesia of pharynx and larynx leads to loss of cough reflex
Could be compressed by aortic aneurism, neck or thorax tumor,vasectomy for weight loss
Term
Accessory lesion symptoms
Definition
Paralysis of scm: difficult to turn head contralateral
Paralysis of trapezius: shoulder droop, can't shrug ipsilateral shoulder
Paralysis of larynx
Term
Hypoglosseal lesion symptoms and upper vs lower neuron lesion
Definition
Hemi paralysis of tongue, points to week side due to unopposed contralateral genioglossus
Upper motor neuron lesion: tongue deviates to opposite side and muscles don't atrophy
Lower motor neuron lesion: tongue deviates to same side muscles atrophy on affected side
Term
Facial nerve lesion symptoms
Definition
Flaccid paralysis to muscles of facial expression
Loss of corneal or blink reflex efferent limb which may lead to ulceration (keratitis paralytica)
Hyperacusis: increased acuity to sound nerve paralysis, usually self limiting
Term
Central facial palsy / supra nuclear palsy (cause and symptoms)
Definition
Transaction of corticobulbar fibers in internal capsule
Contralateral facial weakness below orbit
Upper motor neuron lesion affecting lower face muscles
Term
Crocodile tears syndrome (cause and symptoms)
Definition
Lacrimation during eating
Facial lesion proximal to geniculate ganglion
Regenerating preganglionic salivating fibs misdirected to pterygopalatine ganglion which projects to lacrimal gland
Term
Moebius syndrome symptoms
Definition
Congenital oculofacial paralysis
Facial diplegia (CN VII)
Convergent strabismus (CN VI)
Term
Syringomyelia (cause, symptoms, location)
Definition
Cavitation or softening of central spinal cord
Disrupts pain and temp propagating in anterior white comissure: yolk like loss of pain and temp
Most evident in cervical enlargement
Classic symptoms: burn that isn't painful
Term
Irritation of peripheral nerve (symptoms, cause )
Definition
External pressure or local inflammation stimulates pain and temp, burning in affected roots
Example: herniated disc
Term
Local anesthetics (moa, effects, example)
Definition
Block conduction along C fibers
Low does reduces pain perception with out much loss of tactile sensation
Example: lidocaine
Term
Ischemia of nerve (cause, symptoms)
Definition
Cause is tourniquet that blocks conduction of a fibers
Causes burning pain before complete failure of conduction
Term
Tactotomy of chordotomy
Definition
Surgical section of spinothalamic and spinoreticular pathways to relieve intractable pain
Considered for militant diseases of pelvic origin
Unilateral of bilateral
Pain may return several weeks after due to alternate ascending pathways
Term
Comissural myelotomy
Definition
Analgesic procedure
Decussating spinothalamic and spinoreticular axons are cut by medial inclusion at a few sections above level of source of pain
Term
Botulinum toxin (used to treat, moa)
Definition
Treats acute or chronic spasticity
Blocks release of ach from presynaptic terminal causing flaccid paralysis of muscle
Inhibits peripheral and central sensations, reducing pain
Treats non-neurological muscle conditions like neck and low back pain, myocardial pain syndrome, fibromyalgia, tmj pain, headache
Term
Cone snail ( moa, functional molecules)
Definition
Complex venom with neuropeptides that immobilize prey by targeting voltage channels. Blocks Ca entry into neurons, blocking neurotransmitter release from nociceptive afferents
Delivered into subarachnoid space via intrathecal administration
Zconotide (prialt) was isolated for clinical use. No tolerance or addiction,may cause suicidal thoughts,
Omega contoxin is being tested for post surgical pain
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