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Old 05-26-2014
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Default Serious neuro help required

Does anyone have some kind of comprehensive chart or table to help memorize different deficits associated with different infarcts/hemorrhage in brain, please share. I always get it wrong on uworld. I mean most of the time. Like hemoparesis or gaze palsy or hemianopia etc and areas involved like putamen, thalamus, basal ganglia, internal capsule etc. I m so confused despite having worked hard on my neuro anatomy in step 1.
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ACA-controlateral lower trunk motor and sensory+urinary incontinence+personality problems
MCA-controlateral lower face palsy+controlateral upper extremity motor and sensory problems, controlateral homonymous hemianopsia+eyes deviate toward the affected side
PCA-controlateral homonymous hemianopsia with macular sparing
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dominant hemisphere (brocas area expressive aphasia, wernickes-receptive aphasia) both can be involved in MCA lesions, if dominant parietal lobe-Gertsmanns syndrome (agraphia acalculia, finger agnosia, R-L disorientation

nondominant parietal lobe-hemispatial neglect
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Thanks! But this is mentioned in mtb (although you made it look easier). I'd like more of the information on basal ganglia, internal capsule, thalamus, putamen alone, and if possible lateral and medial medullary and pontine syndrome as well as mid brain lesion. Too much to ask? Yes I know but if we could see it all written in one place, it'd be a great help. Thanks to anyone who contributes.
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post. limb of internal capsule-pure motor stroke
thalamus-pure sensory with dysesthesia (thalamic pain syndrome later)
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ok no problem
starting from medulla
ASA-medial lesion CN12 (tongue deviates toward lesion)+medial lemniscus and corticospinal tract (controlateral loss of vibration and proprioception+controlateral spastic paralysis)

PICA-lateral medullary syndrome-CN10 (hoarseness, dysphagia, uvula deviates to the unafected side)+vestibular (nystagmus)+inf cerebellar peduncle (ataxia)+trigeminal nucleus (ipsilateral facial sensory loss)+spinothalamic tract (controlateral pain and temp loss in rest of body)
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pons
medial lesion-CN6 (medial strabismus)+medial lemniscus and corticospinal tract (same as in medulla)
lateral lesion-CN7 (ipsilateral facial drop, loss of taste+lacrimation+corneal reflex+hyperacusis etc)+vestibular+cerebellar peduncle+spinothalamic+trigeminal nucleus

if lesion is in upper medial pons (MLF can be involved causing Internuclear opthalmoplegia)
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medial midbrain CN3+corticospinal tract+basal ganglia (controlateral spastic paresis and parkinsonism)
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if subthalamic nucleus is involved contralateral hemibalismus
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ataxic hemiparesis-ant limb of internal capsule
dysarthria clumsy hand syndrome-basis pontis
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i guess this are the mostly tested
let me know if i missed some other highly tested lesions
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yeah by the way if u lesion the CNS above the T1 level u get ipsilateral horners
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easiest way to localize brain stem lesions memorize the cranial nerve patterns
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Can you write about parinaud syndrome and putamen? ANd gaze towards or away from the lesion?
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yep
perinauds-paralysis of upward gaze, mass lesion compressing sup. coliculus (suspect with lesions of pineal gland pinealoma)

when putamen is involved eyes deviate away from lesion wheres when frontal cortex is involved eyes deviate toward the lesion
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It says in thalamus lesions, eyes deviate towards the lesion and cerebral lesions eyes deviate away from lesion? It's mentioned in one of uworld question explanations?
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By the way, thanks a lot for pouring in the information about all the neuro lesions I can think of. God bless you immensely!
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Quote:
Originally Posted by Nixy View Post
It says in thalamus lesions, eyes deviate towards the lesion and cerebral lesions eyes deviate away from lesion? It's mentioned in one of uworld question explanations?
what i know about thalamic strokes they are purely sensory but nothing i have read about eye deviations

cerebral lesion (frontal eye field) eyes deviate toward lesion
http://en.wikipedia.org/wiki/Frontal_eye_fields
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here it is
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Serious neuro help required-img_4880.jpg  
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now i see its deviation towards hemiparesis and not the lesion itself (smack my head), sorry for posting my confusion, lol
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Old 05-27-2014
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Quote:
Originally Posted by Nixy View Post
Does anyone have some kind of comprehensive chart or table to help memorize different deficits associated with different infarcts/hemorrhage in brain, please share. I always get it wrong on uworld. I mean most of the time. Like hemoparesis or gaze palsy or hemianopia etc and areas involved like putamen, thalamus, basal ganglia, internal capsule etc. I m so confused despite having worked hard on my neuro anatomy in step 1.

I made a diagram with the brain stem syndromes.
Hope it helps
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Serious neuro help required-brain_stem_syndromes.pdf  
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So guys just to reinforce cause I see that how eyes deviate in each lesion is high yield:

Basal Ganglia and Thalamus Hemorrhages: eyes deviate TOWARD side of lesion (due to expansion/compression affecting of the optic radiation causing contralateral homonymous hemianopia leading for eyes to deviate towards lesion)
the eye deviation is TOWARD hemiparesis.

Cerebellum: No eye abnormalities, no hemiparesis

Cerebral lobe hemorrhage: eyes deviate TOWARD lesion but AWAY from hemiparesis (lets recall that hemiparesis here is contralateral)

PONS: total paralysis + pinpoint pupils

please someone correct if Im wrong, trying my best in neuro
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Old 08-10-2015
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In uworld in mentions that PCA involvement causes ipsilateral eye involvement while in FA contralateral
thus which is the correct?
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