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Lesions part II
Can you name the anatomic structure affected in the following clinical presentations?
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Where is the lesion?
Alcoholic pt shows truncal instability and lack of coordination of the legs. Anterograde amnesia, patient makes up stories
Caused by thiamine deficiency (alcoholism)
Pt has a broad-based gait, intention tremor and dysdiadochokinesis, with nystagmus
Phenytoin can affect this area
Resting tremor, bradykinesia and has difficulty initiating voluntary movements. Tone is abnormal
Violent, flinging movements of the arms and legs (hemiballismus)
Horner's syndrome, loss of pain and temperature sense on one side of the body and the opposite side of face, deviation of the uvula
Often due to occlusion of the posterior inferior cerebellar artery
Contralateral loss of pain of temperature with ipsilateral weakness and loss of position sense
Loss of pain and temperature sense on one side of the body and the opposite side of face. Ipsilateral facial nerve palsy of the entire face.
Loss of conjugate gaze
MS can cause this
Patient has preserved long-term memory but is unable to remember new information
Pt lacks the ability to gaze to the left with either eye
Pt shows increased placidity and decreased aggressive behavior. Patient does react normally to fearful stimuli and has problems recognizing facial expressions
Right sided hemiparesis and sensory loss that is worse in the arms and face than legs. Non-fluent aphasia
Patient cannot comprehend language and has a fluent aphasia. Patient has upper right 'pie in the sky' quandrantanopia. Difficulty with tests of spatial intelligence
Patient has a left-sided homonymous hemianopia with multimodal sensory deficits
Where is the lesion?
'Man in the barrel' syndrome
Due to compression of the optic chiasm
Patient has an incongruous visual field deficit in the right visual field
Fibers from right and left eye are not yet in close proximity
Patient has a visual field deficit in the right visual field that is identical in each eye
May be caused by a PCA stroke
Contralateral hemiparesis with contralateral loss of pain and position sense. Deviation of the tongue to the ipsilateral side.
Right-sided hemiparesis with loss of vibratory and position sense on the right. When patient attempts to look left, the left eye does not cross the midline
Left-sided hemiparesis with a third nerve palsy and loss of the pupillary light reflex on the left
Head trauma can cause this
Inability to produce fluent speech with intact comprehension. Patient has difficulty especially with short interconnecting words
Damage to the left inferior motor cortex
Inability to comprehend commands. Speech production is fluent but nonsensical. Patient is not aware of the defecit
Damage to the left posterior superior temporal gyrus
Intact speech production and comprehension, but inability to repeat speech
On the left
Patient cannot write, preform simple arithmetic, and cannot distinguish right from left. Finger agnosia
Patient has left-world hemineglect. You observe extinction of tactile, visual and auditory stimuli on the left. Patient is not aware of the deficit
Patient cannot understand speech, but has normal auditory acuity.
Patient has suspended pain and temperature loss across a cervical dermatome. There are LMN signs in the arms and UMN signs in the legs.
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