Neuroantomy,

Revisited
Approach to
Localization:
1. Focal Lesion

2. Multi-Focal Lesion

3. Systemic Dysfunction

3. Diffuse Dysfunction
Approach to
Localization:

‘Ceiling to Floor’
 Case 1: Back Pain and a Foot Drop

• A 40-year-old woman with a PMH of breast cancer 2 years ago fell,

developing severe pain in the middle of her back. She has had back pain for
the last several weeks. In the last few days prior to her fall, she had noted
catching the toes of her Left foot
• On examination, she was found to have weakness of the left leg.
• Reflexes were increased in The L Leg, and the L toe was upgoing
• Sensory examination revealed normal light touch bilaterally. PP and Temp
were decreased on the right leg and right trunk below the level of the
eighth thoracic vertebra (T8). Vibration and joint position sense were
reduced in the left leg.
 Case 1: Back Pain and a Foot Drop

At what level of the central

Why is the pinprick and
nervous system does the
temperature loss on one side
finding of decreased pinprick
of the body but vibration and
and temperature below the
joint position sense loss on
level of T8 suggest a lesion
the other side?
may be located?
Case 1: The Brown-Sequard Syndrome
 Case 2: Out of Left Field

• A 32-year-old man is admitted with a history of generalized

convulsions of increasing frequency during the past year and the
recent development of recurrent headaches. He has no visual
complaints.
• Examination reveals normal pupils and papillary reflexes and a
normal fundoscopic exam. Visual acuity is 20/60 without
correction Visual fields: right eye: no perception of motion or
form in the right-half visual field with preservation of central
vision and a narrow wavy band along the vertical meridian; vision
in the left hemi-field is normal. Left eye: same findings as in the
right eye.
Case 2: Out of Left Field

https://frcemsuccess.com/wp-content/uploads/2017/01/Visual-Pathway.png
 Case 3:Feeding the Birds

• T.M. is a 63-year-old right-handed man who is taking medication for

hypertension. One day, while in the park feeding the birds, he noted
that for 5 minutes he had difficulty picking up the birdseed with his
left hand and his left leg collapsed underneath him. 1 week later, his
left leg again collapsed beneath him. He called for help and was
brought to the local emergency room.
 Case 3:Feeding the Birds

• On Examination, his mental status is completely normal and he is able

to recall the entire episode with perfect speech. The left side of his
mouth droops but his forehead is symmetrical. His left arm and left
leg are weak with brisk reflexes. There is an extensor plantar response
to plantar stimulation on the left side.

• CT Scan is Normal