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Lesion to posterior inferior cerebellar artery (PICA)
Medial medullary syndrome
- Damage to:
- 1. Medullary pyramids - contralateral spastic paralysis (body)
- 2. Medial Lemniscus - contralateral loss of proprioception, vibration (body)
- 3. Hypoglossal nerve - ipsilateral paralysis of hypoglossal nerve (tongue deviates to side of lesion)
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Lesion to posterior inferior cerebellar artery (PICA)
Lateral medullary syndrome (Wallenberg)
Damage to: - 1. Lateral spinothalamic tract - contralateral loss of pain and temperature (body)
- 2. Spinal trigeminal nucleus - ipsilateral loss of pain and temperature (face)
- 3. Descending sympathetic fibers - Horner's syndrome (ipsilateral ptosis, miosis, anhydrosis)
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Lesion to anterior inferior cerebellar artery (AICA)
Lateral pontine syndrome
Damage to: - 1. Lateral spinothalamic tract - contralateral loss of pain and temp (body)
- 2. Facial nucleus & facial nerve (CN VII) - ipsilateral paralysis of face (LMN), ipsilateral loss of lacrimation and salivation, ipsilateral loss of taste from anterior 2/3 of tongue, loss of corneal reflex
- 3. Lesion of middle and inferior cerebellar peduncle - ipsilateral gait and limb ataxia
- 4. Descending sympathetic trunk - Horner's syndrome (ipsilateral ptosis, miosis, anhydrosis)
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Lesion to posterior cerebral artery (PCA)
Contralateral heminopia with macular sparing
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Lesion to middle cerebral artery (MCA)
- Contralateral face and arm paralysis and sensory loss
- Aphasia (dominant hemisphere)
- Spatial hemi-neglect syndrome (non-dominant hemisphere)
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Lesion to anterior cerebral artery (ACA)
Contralateral leg and foot paralysis and sensory loss
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Lesion to anterior communicating artery
- Most common site of berry aneurysmsMay compress optic chiasm (bitemporal heminopia)
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Posterior communicating artery
- 2nd most common site of berry aneurysms
- causes CN III palsy (eyes look down and out)
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Lesion to basilar artery
- Causes "locked-in" syndromeCN III typically intact.
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Biconvex lens shaped collection of blood
Epidural hematoma
- Rupture of middle meningeal artery (branch of maxillary artery)
- Usually secondary to fracture of temporal bone
- Loss of consciousness -> lucid interval -> coma -> death
- Can cause transtentorial herniation and CN III palsy.
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Crescent shaped collection of blood
Subdural hematoma
- Rupture of bridging veins
- Slow bleeding -> delayed onset of symptoms
- Associated with elderly, alcoholics, blunt trauma, shaken baby, whiplash
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Central bleeding
- Rupture of aneurysm (usually berry aneurysm) or Arterio-venous malformation (AVM)Increased risk of berry aneurysm in Marfan's, Ehlers-Danlos, ADPKD
- "worst headache of my life"blood or yellow (xanthochromic) spinal tap
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Lesion to Broca's area (inferior frontal gyrus)
Broca's aphasia
- Non-fluent aphasia with intact comprehension
- Ex: "want....food.....eat"
Broca's broken boca
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Lesion to Wernicke's area (superior temporal gyrus)
Wernicke's apahasia
- Fluent aphasia with impaired comprehension
- Ex: "Work gun sky fly red?"
- Wernicke's word salad
- Wernicke = what?
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Lesion to both Wernicke's and Broca's area
Global aphasia
non-fluent aphasia with impaired comprehension
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Lesion to arcuate fasciculus
Conduction aphasia
Poor repetition but fluent speech with intact comprehension - Arcuate fasciculus connects Broca's and Wernicke's areas.
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Supraoptic nucleus
Makes ADH
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Paraventricular nucleus
Makes oxytocin
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Lateral nucleus of hypothalamus
- Stimulates hunger
- Lesion: anorexia
- Inhibited by leptin
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Ventromedial nucleus of hypothalamus
- Stimulates satiety
- Lesion: hyperphagia (craniopharyngioma can lesion)
- Stimulated by leptin
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Anterior nucleus of hypothalamus
- Cools you down, parasympathetic
- Lesion: hyperthermia
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Posterior nucleus of hypothalamus
- Heats you up, sympathetic
- Lesion: poikilothermia - (cold blooded)
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Suprachiasmatic nucleus of hypothalamus
Circadian rhythm
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Leptin
- Stimulates ventromedial nucleus (satiety)
- Inhibits lateral nucleus (hunger)
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