General issues of lesions
- - site of lesion
- - size/ extent of lesion
- - pathological process
- - potentialfor treatment/ recovery
- - age/ neuroplasticity
- - stage of rehabilitation: primary problems vs secondary changes
How do you know if a lesion is an upper motor neuron syndrome?
- -weakness or paralysis of movement
- - no profound wasting- global
- - spasticity and hyperreflexia
- - primitive reflexes
How do you know if a lesion is an lower motor neuron syndrome?
- - weakness or paralysis of individual muscles
- - wasting- specific mm wasting
- - fasciculation- spontaneous firing of nerves
- - hypotonnia and hyporelexia/areflexia
What symptoms would a patient have if they have a cerebellar lesion?
- - incoordination
- - poor postural control
- - ataxia
- - vertigo
- - nystagmus (voluntary or involuntary eye movement)
- - intention tremour- tremour when you move
- - dysmetria- inaccuracy with reach
- - rebound phenomenon (oppose elbow flex when you remove force and the pt will continue to contract)
- - dysdiadokineasia- cant rapidly alt movements
- - dysynergia- inability turn mm off/on
How can you tell if a pt has a basal ganglia lesion?
- - motor control (bradykineasia)
- - mm tone (eg rigidity)
- - involuntary movements (eg resting tremour, chorea (big movement), athetosis (small), hemiballisums (violent/ abrubt)
- - NO weakness or sensory loss
How can you tell if a pt has a thalamic lesion?
- - pain direct consequence- only this type
- - loss of sensation in the contralateral face and limbs
- - thalamic pain/ causalgia (burning pain)
- - emotional disturbance- hypothalamus
- - sleep/ wake cycle problems
- Rich connections: can mimic cortical defects
What are some mid brain syndromes that may occur as a result of brainstem lesion?
- - weber's
- - benedikt's
- - medial pons syndrome
- - wallenberg syndrome- most common- lesion in pons
- - locked syndrome- upper pons/ medualla- paraplegia and face movements
- - unilateral lesion: ipsilesional CN findings, contralateral motor and sensory signs
- - bilateral lesions = coma and death
what are the types of lesions?
- - vascular (occlusive, haemorrhagic)
- - traumatic (focal, diffuse) - car accident
- - trauma (benign, malignant)
- - infective (bacterial, viral)
- - degenerative
- - congenital/ developmental
- - other eg demyelinating disease
Where does the ACA feed?
- anterior circulation feeds the optic nerves, frontal, parietal and temporal lobes
where does the posterior circulation feed?
- cerebellum, brainstem, thalamus, occipital lobe and the medial part of the temporal bone
intracranical haemorrhage types?
- - extradural haematoma- trauma- blood outside between dura and skull- #s and skull fracture
- - subdural haematoma- can be acute or chronic- blood under dura, caused by rupture of veins in subdural space
- Above 2 not stroke- out side of brain
- Below- stroke
- - intracerebral haematoma- trauma, AVM, tumour, HT
- - subarachnoid haemorrhage- trauma, aneurysm- blood below the arachnoid in the subarachnoid space, due bleeding of vessles on surface of the brain mixes with CSF
What are the different types of traumatic lesions?
- - penertrating force: foreign object, skull #, gun shot
- - acceleration/ deceleration: contusions and bleeds
- - rotational: sheering/tearing of axons and blood vessels- grey and white matter moves at different speeds
- - secondary injury: hypoxia, metabolic effets, infection, system failure