B&b 1

Front 1

2 energy sources for the Brain

Back 1

Glucose and Ketone Bodies

(Ketone bodies made from Acetyl Coa in the liver when carbs are scarce so fatty acids are broken down)

Front 2

Pseudounipolar neurons are found as?

Back 2

Sensory ganglia

Front 3

Bipolar cells are found as?

Back 3

Retina and olfactory epithelium

Front 4

Which is the most common type of neuron in the CNS?

Back 4

multiplar neuron

Front 5

What is the septum pellucidum?

Back 5

Thin membrane which separates the anterior horns of the left and right lateral ventricles.

Located midline and between the two cerebral hemispheres

Front 6

What is the interventricular foramina (of Monro)

Back 6

channels that connect the paired lateral ventricles with the third ventricle at the midline of the brain

Front 7

Where is CSF pressure the highest?

Back 7

In the ventricles. Diminishes along the subarachnoid pathways.

Front 8

CSF absorption occurs where?

Back 8

Arachnoid villi. Penetrate the dura and protrude into superior sagittal sinus

Front 9

Hypoventilation does what to do the body's C02 and pH?
Effect on intracranial pressure?

Back 9

Raises pC02 and decreases pH (more acidic). This vasodilates and increases intracranial pressure via increased cerebral bloodflow

Front 10

Hyperventilation effect on body CO2, pH, intracranial pressure

Back 10

reduces c02, increases pH. Vascular resistance increases and decreases CSF pressure.

-Option for management of acutely raised ICP

Front 11

What occurs when Intracranial Pressure raises to mean systemic pressure?

Back 11

Causes widespread reduction in cerebral blood flow and perfusion. Global ischemia will lead to brain death.

Front 12

What are some causes of increased ICP?

Back 12

1) cerebral or extracerebral mass
2) Increase in venous pressure
3) obstruction to flow and absorption of CSF
4) Expansion of CSF volume (meningitis, subarachnoid hemorrhage)

Front 13

Clinical manifestations of ICP?

Back 13

headache, N/V, drowsiness, ocular palsies, papilladema (optic disc swelling)

Front 14

How often is CSF renewed?

Back 14

~5 hours, 5x daily

Front 15

Main sites of CSF formation

Back 15

Choroid plexuses

Front 16

Function of the blood brain barrier

Back 16

Protect brain from substances
Biochemical barrier for selective transport
Regulatory interface for metabolism

Front 17

Disorders which break down BBB

Back 17

Stroke, seizures, infections, autoimmune disorders, multiple sclerosis, tumors

Front 18

CSF composition

Back 18

glucose 50-80 ng/dL
protein 40-45 mg/dL
RBC’s *0
WBC’s *0-4 cells/µL
opening pressure 12 – 20 mmH2O

Front 19

Vasodilation increases blood flow, how does this overall affect CNS BP?

Back 19

Higher blood flow causes higher CNS BP, this increase intracranial pressure.

(Increased CO2 causes vasodilation, an effect of hypoventilation)

Front 20

Venous BP effects on CSF pressure?

Back 20

increasing pressure produces immediate effect on ICP

Front 21

3 ways to perform a spinal tap

Back 21

Lumbar puncture
Cisternal puncture
Ventricular tap

Front 22

Reasons to perform a spinal tap

Back 22

-Diagnose infection
-Subarachnoid hemorrhage
-CSF drainage and pressure reduction
-Infusing medications

Front 23

Proper way to measure CSF pressure?

Back 23

Patient lies in lateral decubitis position.
Draw line between iliac crests (insertion point)
Penetrate through dura, arachnoid mater and draw from subarachnoid space
*Epinephrine helps reduce bleeding

Front 24

Contraindications to a spinal tap

Back 24

Raised intracranial pressure
Coagulopathy (low platelets, elevated prothrombin time)
Area of infection overlying site

Front 25

Cerebral perfusion pressure. What happens when it is too low or too high?

Back 25

Too low: brain tissue becomes ischemic
Too high: elevated ICP

Front 26

Noncommunicating (obstructive)hydrocephalus

Back 26

Tumor/mass/abscess of infection which blocks flow of CSF

Front 27

Blockage of arachnoid granulations is an example of what type of hydrocephalus?

Back 27

Communicating hydrocephalus.
There is still communication of the ventricular tree.

Front 28

Hydrocephalus ex vacuo

Back 28

Occurs due to reduction in brain atrophy (dementias, schizophrenia, post traumatic injuries).
It is not due to increased pressure, but a compensatory enlargement resulting from loss of parenchyma

Front 29

Clinical manifestations of abscess in the brain?

Back 29

Fevers, headaches,

would not see a change in symptoms standing up or lying down

Front 30

Low pressure headaches which get better when standing up can be explained by what condition?

Back 30

hydrocephalus (accumulation of CSF fluid)

Front 31

Why is hydrocephalus a possible complication from meningitis?

Back 31

Arachnoid granules become thickened. This is communicating hydrocephalus as there is no blockage of the ventricular system.

Front 32

Patient has a small tumor in brain. Headaches which only present when sleeping lying down can be explained due to?

Back 32

Hypoventilation which occurs naturally as we sleep.

Side note: Sleep apnea is a common cause of daily headaches

Front 33

Why do you not perform a spinal tap to relieve pressure on a person with cerebral edema?

Back 33

The pressure will drop and the brain will push down on the foramen magnum.
(Should increase ventilator rate on patient to reduce blood flow to the brain. This decreases CO2 in blood)

Front 34

Cranial nerve lesions produce findings on which side of the body?

Back 34

Ipsilateral (Same)

Front 35

Tract which is a sensory pathway for pain and temperature?

Where does it decusate?

Back 35

Spinothalamic
Originates in the spinal cord.
Decusates at the spinal level it enters and goes straight to the brain

Front 36

Tract which conveys vibration and proprioception? Decusates?

Back 36

Dorsal column / medial lemniscus

(Decusates at the cervicomedullary junction - where cord becomes medulla)

Front 37

Tract that conveys motor impulses? Location of decusation?

Back 37

Corticospinal (pyramidal tract)

Decusates at pyramids, where brainstem becomes cords

Front 38

Diplopia

Back 38

Suspect CN 3,4,6

CN 2 is not part of brainstem and lesions to this causes loss in clarity/vision

Front 39

Droopy face. What CN affected? Brain location?

Back 39

CN 7 - facial expression
In the Pons (CN 5,6,7,8 lies here)
(CN 5 is possible but mainly is chewing muscles)

Front 40

Tongue weakness is a problem of what cranial nerve?

Back 40

CN 12 - Hypoglossal
which emerges out of medulla

Front 41

Facial numbness is a problem of what CN?

Back 41

CN 5 - in the pons

Front 42

Alar plate becomes?

Back 42

The dorsal horn or sensory cell columns in spinal cord development

Front 43

Basal plate becomes?

Back 43

Ventral horn or motor cell columns

(Sulcus limitans separates alar and basal)

Front 44

Define Dermatome

Back 44

Region of skin innervated by axons of cells located in ONE dorsal root ganglion. Dermis associated with a developing somite.

Front 45

Characteristics of a reflex

Back 45

Prewired connection
Automatic, involuntary
Predictable and uniform
Can test a single cord segment or pair of cranial nerve

Front 46

Deep Tendon Reflexes (name some and their associated level)

Back 46

Arm C5, 6 biceps
Forearm C5, 6 brachioradialis
Elbow Extension C7 triceps
Knee Jerk L4 quadriceps femoris
Ankle Jerk S1 Gasrocnemius/ soleus

Front 47

What are muscle spindles?

Back 47

Special sense organs innervated by Ia fibers, the largest and fastest axons

Front 48

Synonyms for efferent limb (motor neuron)

Back 48

Alpha motor neuron
motoneuron
anterior horn cells
ventral horn cell
final common pathway
lower motor neuron = LMN to muscle fiber

Front 49

What is a flexor reflex?

Back 49

protective reflex, has an interneuron, occurs on ipsilateral side

Front 50

Cross extensor reflex?

Back 50

Ipsilateral withdrawal and contralateral extension
Involves commissural interneurons which cross midline.

Front 51

Preganglionic parasympathetic neurons in brain steam have axons traveling in CN's____ and preganglionic axons in ____spinal cord

Back 51

CN 3,7,9,10

S2-S4 spinal cord

Front 52

SLUDD parasympathetic responses + 3 "decreases"

Back 52

Salivation, lacrimation, urination, digestion and defecation

Decreased HR, diameter of airways and diameter of pupil

Front 53

Describe parasympathetic pathway for the cranium

Back 53

1) cellbody located in brain stem (nucleus)
2) nucleus joins with axons entering/leaving that cranial nerve
3) synapse on postganglionic neuron such as otic, ciliary, submandibular, pterygopalantine

Front 54

CN involved in the baroreceptor reflex

Back 54

CN 9
Medulla is the control center
Parasympathetic can decrease/increase vagal activity
Sympathetic can increase heart rate, cardiac filling, contractility and also constrict arterioles

Front 55

Thalamus function

Back 55

Its function includes relaying sensation, spatial sense, and motor signals to the cerebral cortex, along with the regulation of consciousness, sleep, and alertness.

Front 56

Hypothalamus function

Back 56

autonomic and endocrine functions (hormones)

Front 57

What is the corpus callosum?

Back 57

Connects left and right hemispheres, facilitates interhemispheric communication. Largest white matter structure (containing 200-250 controlateral axon projections)

Front 58

Lateral and medial geniculate

Back 58

Structures of the thalamus
Lateral - Light (visual cortex)
Medial - music (auditory cortex)

Front 59

What is the ventral posterior nucleus made up of? what part of brain? function?

Back 59

VPL (body) +VPM (head)
Ventral posterolateral nucleus and ventral posteral medial

Somatosensory (body and head) relay nucleus in the thalamus of brain

Front 60

What are upper motor neurons?

Back 60

are cortical neurons that innervate lower motor neurons (either directly or via local interneurons). The axons of upper motor neurons are contained within the pyramidal system, which is composed of the corticospinal (pyramidal) and corticobulbar tracts.

Front 61

What are lower motor neurons?

Back 61

neurons that directly innervate skeletal muscle. The cell bodies of these neurons are located within the ventral horns of the spinal cord and within brainstem motor nuclei.

Front 62

a lesion involving all of the corticospinal and corticobulbar fibers from the left cerebral cortex produces

Back 62

1) Right hemiparesis (weakness of the right upper and lower limbs).
2) Weakness of the right face below the forehead.
3)Deviation of the tongue to the right upon protrusion (transient).

Front 63

Spinothalmic tract decusates where?

Back 63

At the level it enters the spinal cord (pain/ temp)

Front 64

Which lobe picks up sensory?

Back 64

Parietal lobe

Front 65

Lesion in the precentral region would cause what?

Back 65

Affects motor since it is where the corticospinal tract originates

Front 66

Which lobe controls motor function?

Back 66

Parietal lobe (precentral region)

Front 67

What circulation feeds the brainstem?

Back 67

Posterior circulation (vertebral arteries (which merge to form the basilar artery at the pons))

Front 68

CN 9 functions

Back 68

somatic motor stylopharyngeus (elevate pharynx)
visceral motor parotid gland
somatic sensory external ear
special sensation taste to the tongue (posterior 1/3)
visceral sensation baro- and chemoreceptor reflexes
reflex gag (afferent limb only)

Front 69

What CN does sensation and taste to the posterior 1/3 of tongue?

Back 69

CN 9

-
Anterior 1/3: CN 7 is taste and CN 5 is touch

Front 70

What are features of a CN 9 neuropathy?

Back 70

Hoase voice
Dysphagia (difficulty swallowing)
Gag reflex absent (afferent limb)
Abnormal taste

Front 71

Dysphagia
vs
Dysphasia

Back 71

Difficulty swallowing (Brainstem problem)
-
Dysphasia = abnormal language (cortex problem)

Front 72

Vagus nerve functions

Back 72

somatic motor muscles of the larynx/pharynx
(speech and swallow)
visceral motor thoracic and abdominal viscera
somatic sensory external ear
special sensation taste (posterior 1/3)
visceral sensation pharynx, larynx, aortic arch/body
thoracic and abdominal viscera
special sensation tongue (posterior 1/3)

Front 73

What does a CN 10 neuropathy look like?

Back 73

uvula deviated away from the lesion
hoarse voice (more so than CN 9)
dysphagia
tachycardia

Front 74

Describe the gag reflex

Back 74

CN 9 is afferent limb
CN 10 is efferent limb

Uvula deviates away from the cranial nerve lesion

Front 75

Person with a downsloping shoulder would be suspected of having?

Back 75

CN 11 lesion (Weakness of trapezius muscle)

Front 76

CN 11 innervates what muscles?

Back 76

Trapezius and Sternocleidomastoid

Front 77

CN 12 Hypoglossal innervates what muscles?

Back 77

Intrinsic and Extrinsic muscles of tongue

Front 78

What does hypoglossal neuropathy look like?

Back 78

Dysarthria (motor speech problem -abnormal articulation)
Dysphagia
tongue biting
Tongue deviation "lick your wounds"

Front 79

Dysphagia
Dysphasia
Dysarthria

Back 79

Difficulty swallowing
Abnormal language
Abnormal Articulation (motor)

Front 80

What does a complete, right medullar lesion look like?

Back 80

pain and temperature contra
vibration and proprio contra
hemiparesis contra
gag absent
Tongue deviation Toward lesion
voice hoarse
swallowing dysphagia
uvula deviation opposite les.

Front 81

Diplopia can be due to what involvement of structures?

Back 81

CN III, IV, VI nuclei, nerves, NMJ’s or extraocular muscles

Front 82

Difficulty swallowing (dysphagia) and hoarseness can be due to involvement of motor neurons whose cell bodies are located in a structure called the _______________ and whose axons contribute to cranial nerve(s) _______.

Back 82

nucleus ambiguous
CN’s IX and X

Front 83

UMN and LMN

Describe: Tone, atrophy, fasciulations, reflex, Babinski sign, weakness

Back 83

Front 84

How can a muscle atrophy if some sort of lesion is the problem?

Back 84

Peripheral nerve lesion - connection to a muscle completely lost causing it to atrophy

Front 85

What happens to a muscle in acute denervation?

Back 85

Fasiculations occur, involuntary muscle twiches due to spontaneous discharge of an injured/severed axon - loss of resting tone and becomes hypotonic

Front 86

Why is weakness seen with upper motor neuron lesions?

Back 86

The signal from UMN to LMN is then interrupted and weakness will be seen. The LMN is still alive

Front 87

A patient who complains of tremors or "Worms under their skin" would lead you to think what?

Back 87

Lower motor neuron lesion

Front 88

Difference in muscle loss with UMN and LMN

Back 88

UMN- longer period of time till muscle GROUP loses tone

LMN- occurs acutely from denervation and is more focal

Front 89

A patient complains of jumpy legs or difficulty relaxing legs. What is the problem?

Back 89

UMN lesion

Front 90

Which is more severe: lesion in corona radiata, or in the internal capsule?

Back 90

Corona radiata contains less fibers

Front 91

What is a myotome?

Back 91

THe muscles innervated by a single nerve root

Tears of roots give a pattern of weakness in a myotome

Front 92

Spasticity is seen in what type of lesion?

Back 92

UMN lesion.
This leads to increased tone

Front 93

A CNS lesion does not always show UMN lesion findings. Why?

Back 93

THe lesion must occur in the corticospinal tract in order to produce UMN findings

Front 94

Legs which give out while standing is a common symptom of what lesion?

Back 94

UMN

Also, patient's inability to relax legs or having shaky legs

Front 95

Motor strength grading is on what scale?

What grade describes ability to only move joint with gravity removed?

Back 95

5 scale

2/5 : can only move w/out gravity
3/5: Full ROM but against no resistance

Front 96

Describe the scores of reflex grading

Back 96

4/4 sustained clonus
3/4 Spread to other segments
2/4 NORMAL
1/4 requires reinforcing maneuvers
0/4 absence with reinforcing maneuvers

Front 97

CT images are acquired in the ____plane and occasionally in ____plane

Back 97

Axial plane
Sometimes in coronal

Front 98

Calcifications appear at what light intensity?

Back 98

Bright
(grey and white matter appear grey)
Nonhemorrhagic lesions are slightly dark

Front 99

What is the risk of using contrast medium in patients?

Back 99

They are potentially nephrotoxic and of high concern is diabetics / renal failure

Front 100

What type of scan is this? What is the arrow pointing to?

Back 100

CT scan (all white calvarium)
Pointing to non hemorrhagic lesion

Front 101

In CT scans:

What appears bright?
What appears slightly dark?

Back 101

Bright: calcifications, acute blood, contrast
SLightly dark: Most nonhemorrhagic lesions

Front 102

How does contrast help make diagnoses?

Back 102

Contrast helps us visualize if blood is seeping into areas that usually don't have contrast-
Ex: variety of lesions, absces, subacute infarct, tumors

Only regions that lack a BBB will normally show brightness

Front 103

MRI images are collected in what plane?

Back 103

Cross-sectional

Front 104

Advantages of MRI over CT

Back 104

More cost -effective overall
Diagnostically answers questions better
No ionizing radiation

Front 105

Disadvantages of MRI

Back 105

SLower than CT (CT better for ER)
Must sedate younger children since scans are slow

Front 106

In T1 MRI: how does gray matter, csf, and white matter appear

Back 106

Gray matter=gray
White matter= white
CSF is dark

Front 107

In T2 MRI: what is appearance of gray matter, white matter, CSF

Back 107

CSF is white**
Gray matter is relatively white
White matter is relatively gray

Front 108

MRI FLAIR: how does gray, white matter appear? CSF?

Back 108

CSF is black*
Gray matter is relatively white
white matter is relatively gray

Front 109

What distinguishes CT from MRI?

Back 109

An All white calvaria

Front 110

What is the most sensitive MRI for nonhemorrhagic lesions?
(shows brightest)

Back 110

FLAIR

Front 111

T2* GRE is most sensitive route for detecting what?

Back 111

Hemorrhagic lesions
(Have black appearances)

Front 112

DWI and DTI are most sensitive routine sequences for what?

Back 112

Acute infarctions

(areas of restriction diffusion of tissue water appear bright)

Front 113

Which neurotoxin affects presynaptic cholinergic transmission in the PNS

Back 113

Botulism (most potent known toxin)

Front 114

Which CN tests visual acuity AND visual fields

Back 114

CN II

Front 115

3 most common areas of aneurysms

Back 115

Anterior communication artery (30%)
Middle Cerebral artery (20%)
Posterior communicating (25%)