Transcript
- Slide 1
- Localising the lesion Ed Hutchison and Paul Swift
- Slide 2
- Aims Approach UMN vs. LMN Spinal tracts Cerebellum Cerebrum Visual lesions Cases
- Slide 3
- Approach to localising the lesion
- Slide 4
- Muscle e.g. diabetic myopathy NMJ e.g. myasthenia gravis Peripheral nerve e.g. GBS Spinal cord e.g. cord compression Cerebrum e.g. Stroke
- Slide 5
- Timeline Immediate Intermediate Long-term
- Slide 6
- UMN vs. LMN ???
- Slide 7
- UMN vs. LMN UMNLMN HyperreflexiaHyporeflexia HypertoniaHypotonia ClonusMuscle wasting No muscle wasting/fasciculationFasciculation Plantars upgoing (lower limbs)Plantars downgoing (lower limbs)
- Slide 8
- Pyramidal vs. Extrapyramidal PyramidalExtrapyramidal WeaknessTremor SpasticityChorea Pronator driftHemiballismus Loss of skilled movementAthestosis HyperreflexiaDystonia Change in tone/tendon reflexes Plantars upgoing Loss of abdominal/cremasteric reflex
- Slide 9
- Clonus http://www.youtube.com/watch?feature=player_detailp age&v=8GC8F2UMYbQ#t=42
- Slide 10
- Facial nerve palsies Bulbar vs. pseudobulbar Pseudobulbar = UMN of CN IX-XII Spastic tongue Sparing of forehead Bulbar = LMN of CN IX-XII Tongue wasting/fasciculation Affects all facial muscles
- Slide 11
- Slide 12
- The tracts Dorsal column Corticospinal Spinothalamic ? ? ?
- Slide 13
- Lateral Spinothalamic Pain and temperature Decussates at the level of the spinal cord
- Slide 14
- Anterior Spinothalamic Crude touch and pressure Decussates at the level of the spinal cord
- Slide 15
- Dorsal columns Discrimination, proprioception, vibration. Crosses at the medulla. Subacute combined degeneration of the cord, Tabes dorsalis, Spinal trauma.
- Slide 16
- Corticospinal Tracts Descending motor tracts. Cross at the medulla.
- Slide 17
- Brown-Sequard
- Slide 18
- Brainstem Symptoms/signs: Dysarthria Dysphagia/drooling Tongue weakness Absent palatial movement CN IX-XII
- Slide 19
- Cerebellum Cerebellospinal tracts Ipsilateral DO NOT CROSS
- Slide 20
- Blood Supply
- Slide 21
- Cerebellar Signs dysdiadochokinesia ataxia (truncal and limb) nystagmus intention tremor slurred speech hypotonia DANISHDANISH
- Slide 22
- Causes Alcohol Thiamine deficiency CVA Friedreichs ataxia Etc etc
- Slide 23
- The Homunculus
- Slide 24
- Cerebral Artery Territories
- Slide 25
- Slide 26
- Circle of Willis Anterior cerebral artery Middle cerebral artery Posterior cerebral artery Basilar artery A = ? B = ? ? Anterior spinal artery Vertebral artery
- Slide 27
- Speech Centres
- Slide 28
- Tono man http://www.youtube.com/watch?v=6CJWo5TDHLE
- Slide 29
- Brocas dysphasia http://www.youtube.com/watch?v=1aplTvEQ6ew
- Slide 30
- Stroke Syndromes TACS all 3PACS 2 of 3LACSPOCS Hemiplegia/hemi sensory loss See leftNo visual field defect Bilateral motor or sensory Visual field disturbance Pure motorConjugate eye movement disturbance Disturbance in higher function e.g. dyphasia/dysphag ia Pure sensoryCerebellar dysfunction Sensory-motorHemiplegia or cortical blindness Ataxia
- Slide 31
- Visual Defects Ipsilateral blindess Bilateral hemianopia Left homonymous hemianopia Left superior quadrantanopia Left homonymous hemianopia with macular sparing
- Slide 32
- Cases
- Slide 33
- Case 1 57 year old man complaining of weakness and altered sensation in upper limbs and lower limbs Loss of sensation from shoulders and down, urinary incontinence On Examination: CN intact Upper limbs weakness, hypotonia, reduced reflexes Lower limbs spasticity, hyper-reflexia and Babinski +ve, reduced sensation from shoulders down
- Slide 34
- Case 2 85 year old man with long standing (20yr) history of balance problems worse in the dark. Gait is high stepping On Examination: CN intact Motor intact Loss of proprioception with +ve Rombergs test
- Slide 35
- Case 3 23, female presents to her GP with a 2 week history of bilateral leg weakness having started with pins and needles and numbness in her hands and feet. She has had a few days of urinary incontinence which has resolved. 2 years ago she had an episode of blurred vision and pain in the right eye which lasted a month and fully resolved
- Slide 36
- Case 4 56 male 6 month history of progressive weakness of his right hand. Also had problems with swallowing and has choked whilst eating on several occasions o/e he has wasting of his upper and lower limbs and some fasciculation's were noted his right plantar was up going and his reflexes were generally brisk
- Slide 37
- Things weve not had time to cover Peripheral neuropathies Motor neurone Parkinsons Huntingtons GBS Myasthenia gravis
- Slide 38
- Peripheral Neuropathies A alcohol B B12 deficiency C CKD D drugs/diabetes E every vasculitis