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Clinical Application


Case History • 57 year-old right-handed man presents with neck pain and the sudden onset of neurologic deficits. • Key findings – 1. Inability to speak but understands – 2. Weakness of the right face, arm and leg – 3. Numbness of the right face, arm, and leg – 4. Inability to see the right side of the world – 5. Deviation of the eyes to the left


1. Inability to speak but understands • Aphasia – Loss of ability to produce or understand language • An asymmetric function of the brain

Medina LS, Radiology 2007


Neuroanatomy of Aphasia 1. Broca’s area: Inability to speak 2. Wernicke’s area: Inabilty to comprehend


MRI Brain


MRI Brain 1. Broca’s aphasia:


2 . We a k n e s s o f t h e r i g h t f a c e , a r m a n d l e g

• Weakness can result from injury to the… – Brain – Spinal Cord – Peripheral Nerves or their cell bodies – Neuromuscular Junctions – Muscles


Upper and Lower Motor Neurons


Central Sulcus


The Homunculus


From the London Natural History Museum


The Corticospinal Tract


MRI Brain 1. Broca’s aphasia: 2. Weakness


3. Numbness of the right face, arm, and leg

• Two parallel systems mediating sensation from the body


Posterior/Dorsal Column Pathway


Spinothalamic Pathway


The Homunculus


Spinothalamic Pathway


MRI Brain 1. Broca’s aphasia: 2. Weakness 3. Numbness


4. Inability to see the right side of the world

http://en.wikipedia.org/wiki/Visual_field


Major Functions of the Cortex


The Visual Pathways Right

Left


MRI Brain 1. Broca’s aphasia: 2. Weakness 3. Numbness 4. Visual loss


5. Deviation of the eyes to the left • Each hemisphere is involved in moving the eyes in the direction away from that hemisphere


Left Gaze Deviation


5. Deviation of the eyes to the left


MRI Brain 1. Broca’s aphasia: 2. Weakness 3. Numbness 4. Visual loss 5. Gaze Deviation


MRI Brain 1. Broca’s aphasia: 2. Weakness 3. Numbness 4. Visual loss 5. Gaze Deviation


MRI Brain


MRI Brain


Vascular Supply to the Brain


Circle of Willis


Territory of Major Vessels


CT Angiography Brain


Where Do Cerebral Emboli Come From?


CT Angiography Neck


CT Angiography Neck


Neurologia clinica