ion of lesion

8/3/2019 ion of Lesion

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Dr. Ragess

Post Graduate Resident


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Where is the lesion?

What is the lesion?

What can be done?


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1) Cognitive impairment

2) Motor weakness3) Sensory impairment4) Postural instability and

Imbalance5) Autonomic disturbances6) Abnormal movements


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Knowledge of Basic functional anatomy and

different pathways


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Cortical Brain

Subcortical Brain

Brainstem

Cerebellum Spinal Cord

Root

Peripheral Nerve

Neuromuscular Junction Muscle


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Corticospinal tract extend from UMN in motor

cortex through internal capsule, brainstem and

into spinal cord which ends at the level between

D12 and L1

Lesion involving the UMN or corticospinal tract

produce spasticity or upper motor neuron

type of findings (UMN i.e spasticity))

Lesion below the level of spinal cord produces

lower motor neuron type of findings

( LMN ie flaccidity)

All the cranial nerve nuclei in brainstem

have bicortical supranuclear control except

lower half of 7th nerve nucleus and

12 th N nucleus


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Upper motor neuron

Lesion

Lower motor neuron

lesion

Weakness Weakness

Increased tone

(Spasticity)

Decreased tone

( Flaccidity)

Brisk deep tendon reflexes Absent or diminished deep

tendon reflexes

Plantars up going Plantars down going


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Cortical Area Function

Prefrontal Cortex Problem Solving, Emotion, ComplexThought

Motor Association Cortex Coordination of complex movement

Primary Motor Cortex Initiation of voluntary movement

Primary Somatosensory Cortex Receives tactile information from the

body

Sensory Association Area Processing of multisensory information

Visual Association Area Complex processing of visual

informationVisual Cortex Detection of simple visual stimuli

Speech Center(Broca's Area)

Speech production and articulation

Wernicke's Area Language comprehension
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Hemiplegia with facial weakness of upper

motor neuron (UMN) type on the same side

Hemisensory disturbance including face on same sideAstereognosis, sensory inattention, etc.

Speech defect ( dominant hemisphere)

Visual field defect ( homonymous hemianopia)

Disorientation in time , Place , person

Memory impairment, behavior disturbance

Seizures etc.


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Either

Intellectual impairment, personality change

Urinary incontinence

Mono or Hemiparesis

Released primitive reflexes

Left Brocas aphasia


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RightParietal LeftParietal

Left sided sensory loss or neglect Right sided sensory loss or neglect

Agraphesthesia AgraphesthesiaLeft inferior quadrantinopia Right inferior quadrantinopia

Dressing apraxia Limb apraxia

Facial Agnosia

RightTemporal LeftTemporoparietal

Confusional state Agraphia

Facial agnosia Acalculia

Left superior quadrantinopia Finger agnosia

Left Right disorientation

Wernickes Aphasia

Alexia

Right superior quadrantinopia


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Visual field defects


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Hemiplegia with facial weakness of uppermotor neuron(UPN) type on the same side

Hemisensory disturbance including face on sameside

No Speech defect

Visual field defect ( homonymous hemianopia)

Extrapyramidal features including tremor, rigidity,bradykinesia or chorea


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A small stroke

there

(or there)will result in a major

deficit as the fibres are

packed close together


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Right arm weakness

Right facial weakness Dysphasia

Mild k f i h d l


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Mild weakness of right arm and leg


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, Dysphasia

Loss of right visual field


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Vertigo, Vomiting, Diplopia, Dysarthria, Dysphagia,Ataxia

Crossed hemiplegia - with cranial nerve on one side andhemiplegia on opposite side

Midbrain - Ipsilateral 3rd nerve with contralateral hemiplegiaIpsilateral cerebellar signs

Pons - Ipsilateral 6th + 7th nerve( lower motor neuron) withcontralateral hemiplegia

Ipsilateral cerebellar signIpsilateral hornors

Medulla - Ipsilateral 10th or 12th NIpsilateral cerebellar signs

Ipsilateral hornor's syndromeContralateral hemiplegia or hemianesthesia


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CervicalQuadriplegia (Spastic)Sensory loss with level in the neck or upper limbsSphincter disturbance(retention)

DorsalParaplegia (Spastic)Sensory loss (sensory level on abdomen or chestSphincter disturbance (retention)

Lumbosacral

Paraplegia (Flaccid)Sensory loss in lower limbs especially saddle area

Loss of anal sphincter tone and reflexSphincter incontinence


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Pain is the hallmark and provocativemaneuvers exacerbate the pain Sensory loss in a dermatome motor deficit confined to a particular myotome

(LMN type)

Usually No sphincter involvement

Level Function


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Level Function C1-C6 Neck flexors C1-T1 Neck extensors C3, C4, C5 Supply diaphragm (mostly C4)

C5, C6 Shoulder movement, raise arm (deltoid); flexion of elbow(biceps); C6 externally rotates the arm (supinates) C6, C7 Extends elbow and wrist (triceps and wrist extensors);

pronates wrist C7, T1 Flexes wrist C7, T1 Supply small muscles of the hand T1 -T6 Intercostals and trunk above the waist T7-L1 Abdominal muscles L1, L2, L3, L4 Thigh flexion L2, L3, L4 Thigh adduction

L4, L5, S1 Thigh abduction L5, S1, S2 Extension of leg at the hip (gluteus maximus) L2, L3, L4 Extension of leg at the knee (quadriceps femoris) L4, L5, S1, S2 Flexion of leg at the knee (hamstrings) L4, L5, S1 Dorsiflexion of foot (tibialis anterior)

L4, L5, S1 Extension of toes L5 S1 S2 Plantar flexion of foot


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Biceps

Brachioradialis

Triceps

Finger jerk

Knee jerk

Ankle jerk

C5-6

C5-6

C7-8

C8-T1

L3-4

S1


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Distal weakness (LMN type)

Distal sensory loss

No sphincter involvement


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Proximal weakness

Preserved tendon reflexes

No sensory loss No sphincter involvement


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Pure motor weakness which may involve any

skeletal muscle group Intermittent or variation in degree of

weakness during the day

Fatiguability


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Neck stiffness

Kerning's sign

Brudzinski sign

Contralateral sign

Head jolting


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ion of lesion

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