Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
63 Cards in this Set
- Front
- Back
|
What area of the head has sensory innervation by trigeminal?
|
Face and surpratentorial structure except the ear (VII, X, XI)
|
|
|
Which branchial/pharyngeal branch/arch is the trigeminal nerve derived from?
|
1st
2nd - facial 3rd- glossopharyngeal 4th - vagus |
|
|
Where are the cell bodies of trigeminal found?
|
Trigeminal ganglia (semilunar/gasserian) - middle cranial fossa
And mesencephalic nucleus |
|
|
What are the 3 main branches of the trigeminal nerve?
|
Opthalmic
Maxillary Mandibular - contains motor fibres |
|
|
Wich muscles does trigeminal supply?
|
Muscles of mastication - temporalis, masseter, medial and lateral pterygoids
Mylohyoid, anterior digastric, tensor tympany, tensor veli palatini |
|
|
What are the 3 main trigeminal brainstem nuclei and their subdivisions?
|
Mesencephalic (midbrain) - proprioception (special neurons - pseudo-unipolar)
Principal/chief - touch - rostral pons Spinal- pain -pons and medulla -- subnucelus oralis, interpolaris, caudalis |
|
|
Where does information for the spinal trigeminal go? (sensory)
|
VP of the thalamus --> S1 & S2
|
|
|
What reflexes involve the trigeminal nerve?
|
Corneal reflex - sensory to cornea
Sneeze - sensory of nasal mucosa Suckling/rotting - elicited in newborns from SENSORY mechanoreceptors in mouth - + Plus MOTOR output Masseter - sharp tap on jaw causes reflex closure (sensory and motor) |
|
|
Name 2 common false localizing signs.
|
Frontal lobe signs - may be frontal lobe or it's CONNECTIONS
VI -abduents - nerve has a long course - adduction of affected eye |
|
|
Cortical lesions may lead to 3 general classes of symptoms - what are these?
|
Negative - loss of sensation, motor
Positive - epilepsy, migraine Disinhibition - personality changes (frontal lobe) |
|
|
What are the main areas within the frontal lobe?
|
Supplementary motor cortex
Primary motor cortex Fontal eye fields Prefrontal cortex Brocas area |
|
|
Where is the primary motor cortex?
Function? Arrangment? Signs of lesion? |
Precentral gyrus
Contralateral motor control Somatotopic arrangment - homunculus UMN signs - spastic paralysis, hypertonia, hyperreflexia, abnormal babinski's (upward toe) |
|
|
What is the function of the supplementary motor cortex?
Lesion? |
Motor sequencing
Lesion would cause: difficulties performing memories tasks, coordinating bimanual tasks, mutism (dominant hemisphere) |
|
|
What is/are the functions of the frontal eye fields?
|
Eye movements and head turning (focus on a point with head movement)
--- generation, control, voluntary pursuit, contralateral eye deviation and head turning |
|
|
Prefrontal cortex - functions??
|
Thinking and behavior
Cognitive function - planning, working memory, preservation, set shifting, utilization |
|
|
What signs can be associated with PFC lesions?
Prefrontal cortex |
Disinhibition (behaviour)
Abulia ( lack of will or initiative /disorder of diminished motivation) Incontinence + Gait Overriding primitive reflexes -- kissing (Pickering lips), eyes close when tapping on forehead from behind Pt, grabbing hand when told not to (while stroking palm) |
|
|
What is semantic dementia?
|
Loss of meaning of words
|
|
|
What is Non-fluent aphasia ?
|
Inability to speak - know what they want to say but comes out as gibberish
Brocas area Lesion |
|
|
What is Fluent aphasia?
|
Can speak clearly/fluently but words make no sense - no meaning to what they are saying.
Wernikes area lesion |
|
|
What is Surface dyslexia ?
|
Unable to associate written word with meaning
|
|
|
Which areas of the brain are affected in alzhiemers disease?
What is the main deficit? |
Hippocampus, entorhinal cortex, cingulate and parietal cortexes
amestic memory deficits -- cannot make NEW memories --- |
|
|
What is an expressive aphasia?
|
Non-fluent aphasia
They know what they want to say but do not have the mechanics to speak properly Limited to saying yes, swearing, no, BROCA's AREA Important note: they CAN follow intructions because they CAN understand you |
|
|
What is a receptive aphasia?
|
Fluent aphasia -WERNIKES AREA
Unable to understand language, formulate sentences -- speak in gibberish, incomprehensible sentences --- UNABLE TO RESONSE TO QUESTIONS APPROPRIATELY OR FOLLOW COMMANDS |
|
|
What area of the brain is affected in a conductive aphasia?
|
Acute fasciculus
Connects broca's and wernike's areas Nrmal comprehension , unable to REPEAT words (ask them to repeat a sentence), fluent but meaningless speech |
|
|
What is a global aphasia ?
|
Broca's and wernikes areas affected
Unable to follow command, non-fluent speech |
|
|
Wich is usually the dominant hemisphere?
|
Left - 99% of right handed people
Left handed people (5-10% population) - 50-60% LEFT |
|
|
What are the visual field deficits associated with a temporal or parietal lesion?
|
Parietal - inferior homonymous quadrantanopia (both eyes, bottom corner of contralateral eye)
Temporal - superior homonymous quadrantanopia (both eyes, bottom corner of contralateral eye) |
|
|
What are the main areas within the parietal lobe?
|
Primary somatosensory cortex
Association cortex Visual pathways (inferior fields) |
|
|
What is dysgraphaesthesia ?
|
Inability to recognise letters or numbers written on hand
(when not looking) |
|
|
What is Astereognosisa?
|
Unable to identify an object by touch only
SENSORY AGNOSIA Place an object in a persons hand with eyes closed (coins, keys, bottle top) |
|
|
What problems are associated with a dominant parietal lobe lesion?
|
Left -right disorientation
Dyscalculia Dysgraphia - inability to write Finger agosia - inability to distinguish fingers on hand Apraxia - inability to do something - command, create plan for action -- brush ur teeth, pick up a pen and write ur name |
|
|
Neglect of limb (contralateral) is usually associated with which hemisphere?
|
Nn-dominant parietal lobe
(usually right) Get them to draw a clock, house |
|
|
What is a contructional apraxia?
|
Inability to draw or construct simple configurations
Intersecting pentagons Associated with non-dominant parietal+ dressing apraxia |
|
|
What is the main use of T1, T2 MRIs?
|
T1 - anatomical - (fat is white)
T2 - pathological - usually bright on T2 (wet lesion) |
|
|
What is the basis for T1 Vs T2 images?
MRI |
MRI - big magnet that aligns the protons in a Pt - then a radio frequency is applied and and the protons spin- depending on location, actions etc --- pluse is turned off ---- protons emit energy --- RECORD
T1 - RECOVERY - 1 sec- SLOW (how quickly the protons realign in the magnetic field) T2 - DECAY -<0.5 sec - FAST ( how quickly the protons give off energy as they recover to equilibrium) T1 & T2 refer to timing that the image was taken |
|
|
What is a function MRI - ?
|
fMRI - uses blood flow as a proxy for neuronal activity --- using T2
BOLD contrast - blood oxygen level dependent contrast Differences in Oxyhaem (BRIGHT) Vs Deoxyhaem (DARK/low blood flow/low neuronal activity) --- effects image Increased neuronal activity = increased blood flow = increased Oxyhaem = increased MR signal = BRIGHT |
|
|
Regard malignancies in the brain - why is it less important whether they are metastatic or benign?
|
Because the main problem is usually that is is a space occupying lesion rather than the cancerous nature of the tumour ---
Raised ICP may lead to death |
|
|
What are some signs seen on CT of an expanding intracranial lesion ?
|
Narrowed sulci, flattened gyri
Compression of ventricles Herniations - subfalcine, transtentorial, tonsillar |
|
|
How do tumors cause raised ICP?
|
Tumor - space occupying lesion
Cerebral oedema - vasogenic Tumor blocks CSF pathways - hydrocephalus |
|
|
What are the S&S of raised ICP?
|
Diffuse HA - worse in morning, with straining/coughing (may also be unilateral or throbbing)
N&V CN VI palsy Papillodema Coma, death |
|
|
What are common presenting symptoms with Brain tumors?
|
Symptoms of Raised ICP
Progressive neurological deficits - reflect site of tumor SEIZURES - often 1st symptoms - 15-90% |
|
|
Hw is Dx of brain tumors made?
|
CT - can miss some
MRI - with contrast - (if negative - rules out tumor) PET - to distinguish low and high grade tumors Dx - HISTOLOGICALLY |
|
|
What are the 5 major classes of brain tumours?
|
Gliomas - astrocytoma (including glioblastoma), Oligodendroma, ependymoma
Neuronal tumors Poorly differentiated Meningiomas Metastases + other parenchyma tumors - CNS lymphoma, germ cell, pineal parenchyma |
|
|
What are brain tumors graded on?
|
Abnormal nuclei - pleomorphism
Mitoses Neovascularisation Necrosis |
|
|
What are the major prognositic factors with glial tumors?
|
Tumor grade
Age Clinical status Tis innfluence outcome more than treatment These tumours often infiltrate throughout the brain - hard to resect |
|
|
What is the micro pathology associated with glioblastoma multiform?
|
Necroses with Palisading cells, vascular proliferation
Irregular ring- like contrast enhancement on imaging Median survival - 1 yr |
|
|
The outcome of gliobltoma multiform is dependent on what?
|
Age
Extent of resection Performance status MMSE Methylation status of MGMT promoter |
|
|
Fom which cells do meningiomas develop?
|
Arachnoid cells
|
|
|
What is the most common site for a schwannoma?
|
Angle between pons and cerebellum
Signs: Tinnitus, hearing difficulties, abnormal facial sensation Arise from peripheral nerve schwann cells |
|
|
What are the most common cancers to metastasise to the brain?
|
Beast
Melanoma Lung Unknown Cannon ball appearance |
|
|
Headaches with a throbbing pain indicate what about the cause?
|
Probably Vascular sensitivity
|
|
|
When taking Hx of headache which is a better indication of severity?
a) pain scale out of 10 b) impact on daily activities |
B
Things such as cannot work, awakens from sleep are better indicators than a subjective number |
|
|
What cranial structures are sensitive to pain?
|
skin, subcutaneous tissue, muscles, extracranial arteries and periosteum
ear, eye, nasal cavities, sinuses, intracranial venous sinuses dura CN - II, III, V, IX, X, C1-3 |
|
|
does pain referral occur with cranial structures, like it does with the rest of the body?
|
yes
Supratentorial structures -- Ant. 2/3rd head Infratentorial structures -- vertex and back of head/neck ... |
|
|
What is the onset, severity, character, duration, trigger, cause and S&S of a CLASSIC MIGRAINE?
|
CLASSICA MIGRAINE
ONSET - early morning SEVERITY - peak in 1/22 hour, very mild --> severe (increasing in pain) CHARACTER - unilateral dull Throbbing TRIGGERS - stress, food, menstruation, meds S&S - abrupt - vision disturbance (unilateral flashes of white, multicoloured, zigzag....), Nausea, photophobia, tender temporal vessels CAUSE: genetic + distention and excessive pulsitation of branches of the external carotid |
|
|
What medications are used to treat migraine?
|
ergot alkaloids (alhpa adrenergic agonist with 5HT affinity --> vasocontrictor activity)
antiemetics caffeine sumatriptan (selective 5HT agonist) - expensive |
|
|
What can be used in the prevention of migraines?
|
anti-hypertensives (beta blockers, calcium channel blockers, alpha2 adrenergic agonist)
antidepressants - MAOI Anticonvulsants - phenytoin, valproic acid ergot alkaloids NSAIDs, steroids |
|
|
What are the characteristics of a TENSION HA?
duration, onset, trigger, severity, S&S, cause, .. |
Duration - weeks to months
TRIGGER - stress, anxiety, depression ONSET - gradually - temples and back of head S&S - band like pressure around head - NO photophobia, NO N&V, NO exaccerbation on exercise CAUSE: unknown More common than migraine |
|
|
What are the characteristics of a CLUSTER HA?
Onset, location, severity, S&S |
ONSET - after falling asleep, or the same time during the day (predictable)
LOCATION: unilateral orbital-temporal pain SEVERITY: severe but Brief S&S - nasal stuffiness, eye watering on same side as HA Uncommon Rx ---> oxygen, migraine drugs, steroids, NSAIDS, calcium channel blockers |
|
|
What are some the indications for Calcium channel blockers?
|
HT
Angina Cardiac Arrhythmias Cluster HA Migraine prevention |
|
|
What is temporal vasculitis?
Problems associated with it? other S&S? What does ESR have to do with it? |
vasculitis of the medial extra and intracranial vessels --> Temporal artery prominence and tenderness
Severe pain > 55YO Important to pick up as they can lead to stroke and blindess Associated Symptoms -- polymyalgia rhematica (tenderness in proximal MM), visual symptoms (loss, black spots), retina (infarcts, haemorrhage) SCREEN --> very high ESR Rx -- steroids!!! |
|
|
What are the S&S of an intracranial Haemorrhage?
|
severe HA, N&V, photophobia neck pain, stiffness, focal neurological sings, low grade fever
Do a CT (lesion) and LP (rule out meningitis) |
|
|
What are some RED FLAGS associated with a Hx of HA?
|
• New or different • New HA after 40Y (migraine is usually 2nd after this age) • Fever with neck stiffness •
Abrupt onset of HA – “do u remember what you were doing at the time? – yes or no” • Altered consciousness – drowsy, groggy, confused, coma • Persistent focal neurological S&S - numbness, weakness, aphasia, visual loss • Migraine as a complication of vascular lesions • Significant Head trauma • Anticoagulant use • Immune suppression – HIV, serious cancers, iatrogenic (steroids, chemo) • Seizures |
