Where’s the Lesion.ppt

Where’s the Lesion? Neuroscience Core Lecture Series 23 October 2002 David Roman Renner, MD Department of Neurology Scott’s CC: “My balance is off.” Multiple ER visits for fall-related trauma “I’m losing the fine control of my fingers.” Loss of manual dexterity “I’ve had pneumonia three times.” Dysphagia to liquidssolids All of Scott’s Complaints Sounded Neurologic in Origin His lesion should lie somewhere in the neuraxis. Divisions of the Neuraxis Cortical Brain Subcortical Brain Brainstem Cerebellum Spinal Cord Root Peripheral Nerve Off the Top of my Head . . . Imbalance = Cerebellum Pneumonia = Brainstem (related dysphagia) Loss of Dexterity = Peripheral Nerve Neurologic Examination Higher Cortical Function Cranial Nerves Cerebellar Function Motor Sensory Deep Tendon Reflexes Pathologic Reflexes The Neuro Exam Should Evaluate the Entire Neuraxis Higher Cortical Function: cortex Cranial Nerves: subcortex, brainstem Cerebellar Function: cerebellum Motor: motor homonculous, subcortical pyramidal tracts, BS, cord, radicle, PN, muscle Sensory: ascending tracts, thalamus, subcortical tracts, sensory hononculous Deep Tendon Reflexes: afferent PN, radicle, cord, efferent PN, muscle Pathologic Reflexes: Scott’s Exam Showed: Higher Cortical Function: normal Cranial Nerves: oropharyngeal dysarthria Cerebellar Function: hypotonia, assynergy, dysmetria, staccato dysarthria, intention tremor, appendicular ataxia Motor: hypotonia, normal strength Sensory: decreased vibration and temperature Deep Tendon Reflexes: areflexia Pathologic Reflexes: plantar flexing So Where’s the Lesion? Divisions of the Neuraxis Cortical Brain Subcortical Brain Brainstem Cerebellum Spinal Cord Root Peripheral Nerve Cortical Brain Depends upon hemispheric dominance Non-neurologists generalize: right: visual/spatial, perception and memory left: language and language dependent memory Look for aphasias, apraxias, and agnosias Neurologic Examination when Cortical Brain is Lesioned Highe