Select Brain Lesions

Snapshot

  • A 35-year-old woman presents to the emergency department with lower extremity weakness and double vision. Past medical history is significant for multiple sclerosis which is treated with Rituximab. Physical examination is significant for 2/5 strength in the bilateral lower extremity as well as right-sided internuclear ophthalmoplegia. MRI of the brain and spine shows new hyperintense lesions. (Lesion affecting the medial longitudinal fasciculus)

Introduction

Select Central Nervous System Lesions
LesionClinical Features
Frontal lobeFrontal lobe lesions can result in disinhibition and an impairment injudgmentorientationconcentrationfrontal release signsmagnetic gaitFrontal eye field (FEF) lesions can result ineye deviation towards the side of the lesionan example is a stroke affecting the FEF
Parietal lobeLesions affecting thedominant parietal (usually the left) cortex results in Gerstmann’s syndromeagraphiaacalculiafinger agnosiaright-left confusionnon-dominant (usually the right) parietal cortex results incontralateral hemineglectdistortion of perceived spaceextinction
Temporal lobeLesions affecting the superior temporal lobe (Wernicke area) can result Wernicke aphasia and a right superior quadrant visual defect Lesions affecting limbic structures can result in deficits inconsolidation and behavioral changesSeizures in the medial temporal lobe limbic structures results inemotions such asfeardeja vuolfactory hallucinationsBilacteral lesions in the amygdala results inKluver-Bucy syndrome 
BrainstemLesions affecting thesuperior colliculusParinaud syndromereticular activating systemdecreased consciousness and comabasal gangliaresting tremorchoreaathetosismedial longitudinal fasciculusinternuclear ophthalmoplegiaparamedian pontine reticular formationeyes look aways from the side of the lesion