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? Cerebral CV VII PALSY Паралич седьмого, лицевого нерва

Взято со страницы http://www2.kumc.edu/coa/Education/AMED900/Neurology.htm

4. LOCALIZATION


Source: Image adapted from an image at coachhouserehab.com/images/brain.jpg

Frontal lobe

  • Contralateral weakness due to involvement in the motor strip (precentral gyrus)
  • Urinary incontinence when bilateral lesions are present because the micturition center is located in the frontal lobes
  • Expressive aphasia (Broca’s aphasia) involves a lesion in the dominant posterior inferior frontal region (Brodmann’s area 44 and 45)
  • Executive dysfunction and personality changes when the prefrontal cortex is affected

Parietal lobe

  • Contralateral sensory loss due to involvement in the post-central gyrus
  • Inferior quadrantanopia – caused by a lesion along the fibers from the superior retina (supplying the lower visual field)


Localization in Clinical Neurology 4th ed. Brazis et al.

  • Apraxia (dressing, construction, ideomotor) – disorder of skilled movement, not caused by weakness or sensory loss, occur with a lesion in the dominant inferior parietal lobe
  • Extinction or simultanagnosia on double simultaneous stimulation occurs with lesions in the left parietal lobe.  The individual can sense light touch in both arms, for example, individually, however when both arms are touched simultaneously, only 1 side is felt. Occurs with lesions in the left parietal lobe.
  • Neglect - inability to report, respond, or orient to stimuli, generally in the contralesional space. Occurs with a lesions in the right parietal lobe
  • Anosagnosia (denial of deficits).  The patient clearly has weakness on one side but the patient denies having this deficit occurs with a lesions in the right parietal lobe.
  • Gerstmann’s syndrome occurs with a lesion in the left parietal lobe.
    • Finger agnosia - difficulty naming and differentiating among the fingers of either hand as well as the hands of others
    • Agraphia (inability to draw)
    • Acalculia (inability to calculate)
    • Right-left disorientation
  • Balint’s syndrome occurs with bilateral parietal lobe lesions
    • Inability to voluntarily control the gaze (ocular apraxia)
    • Inability to integrate components of a visual scene (simultanagnosia)
    • Inability to accurately reach for an object with visual guidance (optic ataxia)
       
Temporal lobe
  • Receptive aphasia (Wernicke’s aphasia) - Brodmann's area 22 occurs with a lesion in the dominant laterosuperior temporal lobe
  • Sensory amusia (inability to interpret or appreciate musical sounds) occurs with a lesion in the nondominant laterosuperior temporal lobe
  • Sensory aprosodia (imparied ability to comprehend the emotion conveyed in spoken language and impairment of identification of emotional gesturing) occurs with a lesion in the nondominant laterosuperior temporal lobe
  • Superior quadrantanopia or “pie-in-the-sky defect” is caused by a lesion along the fibers from the inferior retina (supplying the upper visual field) as they travel through Meyer’s loop


    Localization in Clinical Neurology 4th ed. Brazis et al.

    (Click here for picture)
  • Kluver-Bucy syndrome occurs with lesions affecting the tips of the bitemporal lobes
    • hyperorality, hypersexuality, flattened emotions, memory loss, inability to recognize faces and objects
  • Amnesia can occur when the inferomedial aspect of the temporal lobes are involved, affecting the amygdala and hippocampus (the “memory centers” of the brain)
  • Impaired recognition of facial emotional expression occurs with lesions in the nondominant lateroinferior temporal lobe
     

Occipital lobe

  • Homonymous hemianopsia (loss of entire half of visual field).


    Localization in Clinical Neurology 4th ed. Brazis et al.

     
  • Macular sparing is present because this is a watershed area, supplied by terminal branches of the Posterior Cerebral Artery (PCA) and Middle Cerebral Artery (MCA).  Since occipital lobe strokes are due to PCA occlusion, the macula is spared because of supply by the MCA.
     

Brainstem

  • Wallenberg syndrome-lesion of lateral medulla
    • Loss of pain and temperature on ipsilateral face and contralateral limbs and trunk
    • Loss of vibrations, proprioception, ataxia in ipsilateral limbs
    • Ipsilateral Homer's syndrome, vertigo, nystagmus, hoarseness, and dysphagia are often present

Cerebral Artery Territories

  • middle cerebral artery (pink)
  • posterior cerebral artery (green)
  • anterior cerebral artery (blue)

http://www.cnsforum.com/content/pictures/imagebank/hirespng/brain_struc_stroke.png

Deficits can be due to tumors, etc as well as from strokes.  If a deficit is due to a stroke, here is a table summarizing the localization and relevant arterial distribution.  For more detail on the deficits, please refer to the text below.

Anterior Cerebral Artery

Middle Cerebral Artery

Posterior Cerebral Artery

  • Rare (0.6-3%)
  • Contralateral weakness affecting leg > arm
  • May have lack of initiation or abulia (lack of will or motivation)
  • May have sensory loss to contralateral leg
  • May have gait and postural disorders
  • Most common site of ischemic stroke
  • Contralateral weakness affecting face/arm > leg
  • May have deviation of the eyes to the side of the lesion
  • Dominant hemisphere: Broca’s, Wernicke’s, conduction, or global aphasia
  • May have Gerstmann syndrome (see below)
  • Nondominant hemisphere: inattention, neglect, denial, apraxia
  • Contralateral homonymous hemianopsia with macular sparing (see below)

 

CASE

The following deficits are found on physical examination of a stroke patient.  Based on your knowledge of the neurologic examination and physiology, a lesion in what area of the brain is the most likely to cause these deficits?

  1. Loss of pain, temperature on ipsilateral face and contralateral body, loss of vibration, proprioception ipsilateral limbs
    1. Frontal lobe
    2. Parietal lobe
    3. Temporal lobe
    4. Occipital lobe
    5. Brainstem (lateral medullary syndrome)

       
  2. Contralateral sensory loss, inferior quadrantanopia (loss of vision in the right lower quadrant, for example), apraxia
    1. Frontal lobe
    2. Parietal lobe
    3. Temporal lobe
    4. Occipital lobe
    5. Brainstem (lateral medullary syndrome)

       
  3. Homonymous hemianopsia (loss of right half of the visual field of both eyes, for example)
    1. Frontal lobe
    2. Parietal lobe
    3. Temporal lobe
    4. Occipital lobe
    5. Brainstem (lateral medullary syndrome)

       
  4. Receptive aphasia, superior quadrantanopia (pie-in-the-sky defect)
    1. Frontal lobe
    2. Parietal lobe
    3. Temporal lobe
    4. Occipital lobe
    5. Brainstem (lateral medullary syndrome)

       
  5. Contralateral weakness, expressive aphasia
    1. Frontal lobe
    2. Parietal lobe
    3. Temporal lobe
    4. Occipital lobe
    5. Brainstem (lateral medullary syndrome)
       

Tags: Галактоземия
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