CNS | Evon Chai ME216

Vertebro-basilar A • Occipital lobe: Cortical blindness, homonymous hemianopia

• Vertigo, loss of balance (labyrinthine A)
Anterior cerebral A • Motor deficit: leg, perineum (contralateral)
• Sensory deficit: leg, perineum (contralateral)
• Urinary incontinence
• Apathy, confusion, poor judgement
Middle cerebral A • Motor deficit: lower face, UL, trunk, LL hemiplegia (contralateral)
• Sensory deficit: lower face, UL, trunk, LL hemiplegia (contralateral)
• Frontal eye field, optic radiation: homonymous hemianopia (contralateral)
• Wernicke’s area, Broca’s area (Lt): Global aphasia
• Parietal lobe (Rt): astereognosis, sensory neglect
Post cerebral A • Homonymous hemianopia (contralateral) *with macular sparing
• Cortical blindness
• Hippocampus: transient memory loss
• Subthalamic nuclei: Hemiballismus (involuntary limb jerk)
Lenticulo-striate A Lacunar stroke
• Charcot-Bouchard aneurysm
• Post limb internal capsule: contralateral hemiplegia
• Chronic HTN
Anterior spinal A Medial medullary syndrome
• Corticospinal tract: contralateral hemiplegia
• CN12: ipsilateral tongue palsy (LMN)
• Medial lemniscus: Contralateral loss of position, vibration sense
PICA Lateral medullary syndrome (Wallenburg)
• Lat spinothalamic: contralateral loss of pain & temperature
• CN5: ipsilateral loss of pain & temperature of face (touch normal)
• CN8: vertigo, vomit, nystagmus
• Nucleus ambiguus (CN10, 11): dysphagia, dysarthria, hoarseness, gag reflex
• Cerebellar peduncle: ataxia, DDK
• Carotid plexus: Horner’s syndrome (ipsilateral)
Epidural • Middle meningeal artery (Pterion)
haemorrhage • Talk & die syndrome (Lucid interval +ve)
• LOC
• CT: Lens-shaped
Subdural • Superficial cerebral vein
haemorrhage • CT: crescent-shaped
• Headache, confusion
Subarachnoid • Berry’s aneurysm (HTN)
haemorrhage • Severe headache, vomiting, LOC, fever, seizure
• LP: blood-stained
Frontal eye field (8) • Both eyes look towards side of lesion, then slowly drift to opposite side
Prefrontal cortex 1. Frontal lobe syndrome: Marked personality change: aggressive, major cognitive
(9-12) deficits
2. Loss ability to solve problems, plan and initiate actions
3. Working memory
Post parietal cortex • Agnosia: Astereonogsia
(Somesthetic assoc) • Ideomotor apraxia [Dominant hemisphere]
(5-7)
Inferior parietal lobe Gerstmann’s syndrome [Dominant hemisphere]
Supramarginal gyrus • Finger agnosia
(40); angular gyrus • Acalculia
(39) • Agraphia
• Alexia
• Left-Right confusion
 CNS | Evon Chai ME216

Optic tract • Bitemporal hemianopia

Optic radiation • Homonymous hemianopia
2nd visual area • Prospagnosia
Broca’s aphasia • Non-fluent, telegraphic speech
Wernicke’s aphasia • Fluent, word salad neologisms
(22) • Word deafness
Conduction aphasia • Fluent, paraphasia (wrong syllables) *Arcuate fasciculus
Global aphasia • Both Wernicke’s + Broca’s
• Left hemisphere infarct – ICA, MCA
Angular gyrus (39) • Word blindness, alexia, agraphia (by sight)
Supramarginal (40) • Astereognosis (by touch & proprioception)
Frontal lobe damage • Frontal lobe syndrome
• Motor deficits
• Thinking, planning, working memory
Parietal lobe damage • Impaired sensation
• Gerstmann’s syndrome (dominant)
• Ideomotor apraxia, astereognosis (dominant)
• Neglect syndrome (non-dominant)
• Constructional, geographical, dressing, gait, speech apraxia (non-dominant)
Temporal lobe • Wernicke’s (dominant)
damage • Feelings
• Olfactory hallucinations
Occipital lobe • Cortical blindness
damage • Prosopagnosia + confabulation q
Nucleus accumbens • Pleasure center
• Sexual arousal and drug addiction
• Dopaminergic neurons
Neocerebellum • Dysmetria, DDK
(cerebrocerebellum) • Ataxia
lesion • Nystagmus
• Intentional tremor
*DANISH • Speech scanning (dysarthria)
• Hypotonia
Paleocerebellum • Drunken gait
lesion • Truncal ataxia
Archicerebellum • Dysequilibrium
(vestibulocerebellum) • Nystagmus
lesion • Ataxic gait
• Loss of vestibule-ocular reflex VOR
Syringomyelia • Cyst in central spinal cord that expands (central cord syndrome)
• Dissociated sensory loss (only spinothalamic tract affected, dorsal column not
affected or vice versa)
• Spinothalamic tract (bilateral)
• Ant horn cells (LMN motor) & Corticospinal tract (later)
• Lower cervical, upper thoracic (cape like distribution)
Brown sequard • Corticospinal tract UMN (ipsilateral)
syndrome • Dorsal column (ipsilateral)
• Spinothalamic tract (contralateral)
Fast pain • A fibre
• Neospinothalamic tract
• Laminae I → VPL thalamus → somatic sensory I & II
• glutamate
Slow pain • C fibre
• Paleospinothalamic tract
 CNS | Evon Chai ME216

• Laminae II & III → V → reticular formation → intralaminar nuclei thalamus →

widespread cortex
• Glutamate, substance P (longer pain)
Thalamic syndrome • Damage to post thalamic nuclei (thalamogeniculate A, Post cerebral A)
• Prolonged, severe unpleasant pain
Meniere’s disease • Inner ear disorder (endolymphatic hydrops)
• Vertigo, tinnitus, fluctuating hearing loss → permanent
Argyll Robertson • Neurosyphilitic lesion
pupil • Pretectal nuclei
• Loss of pupillary light reflex
• Accommodation reflex retained (EW nuclei intact)
Nyctalopia • Vitamin A deficiency (rhodopsin regeneration & trans-retinol)
(night blindness) • Bitot spots, keratomalacia, xerolphthalmia, corneal opacity → blindness
Colour blindness • Deuteranope (lack green cones)
• Protanope (lack red cones)

Brain tumour
Diffuse TP53, RB Adults Cerebral cortex 4 grades
astrocytoma IDH1, IDH2
Pilocytic BRAF Children Cerebellum, 3rd Bipolar long hair-like Benign, slow
astrocytoma ventricle, optic N process
Oligodendroma 1p, 19q Adults Frontal, temporal Perinuclear halo, round Benign, good
lobe nuclei granular prognosis
chromatin
Ependymoma Adult Spinal cord Pseudorosette
Children 4th ventricle
Ganglioglioma Children Temporal Low grade astrocytoma Seizures
+ dysplastic neuron
Medulloblastoma Children Cerebellum Small blue round cells MALIGNANT
Meningioma NF2, Adults Arachnoid Psammoma body Encapsulated,
22q11 extend to
ventricle/bone
Primary lymphoma Myc Adults Diffuse large B cell Agressive
oncogene HIV lymphoma
(EBV)
Germinoma Children Midline (pineal, = Testicular seminoma
male suprasellar)
Metastatic Lung, breast, skin, Multiple masses Cerebral oedema,
kidney, GI gliosis