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810 Cards in this Set
- Front
- Back
CT - what color is bone/fluid/brain
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"Bone = white / blood = white
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MRI T1 Sequence - what color is bone/fluid/brain
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"Used for high anatomical resolution
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MRI T2 Sequence - what color is bone/fluid/brain
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"Used to identify pathology
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MRI - Diffusion weighted T2
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Used to identify ischemia earlier and more clearly
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Epidural Hematoma
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"Blood b/w dura and skull
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Subdural Hematoma
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"Blood b/w arachnoid and dura
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Lissencephaly
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Smooth brain, no gyri or sulci - mutations in genes involved w/ tubulin dynamics
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Pachygyria
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Large (elephant) gyri + 2 abnormal large clefts, do not extend all the way to ventricle
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Polymicrogyria
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Too many small gyri + mixed patches of pachygyria
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Double Cortex
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Second rim of cortical cells in periventricular area - migration failure
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Schizencephaly
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Large gyral cleft, lined w/ gray matter, extends to connect w/ ventricle
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Beningn Familial Neonatal Convulsion
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Mutation in KCNQ2 or KCNQ3 gene
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Meroanencephaly
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Neural tube closure defect - partial absence of brain
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Anencephaly
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Neural tube closure defect - complete absence of brain
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Exencephaly
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Neural tube closure defect - exposure and possible extrusion of brain
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Otx2 -/- mice
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Anencephaly - defect of anterior nervous tissue differentiation
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Wnt1 -/- mice
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Deletions of specific midbrain and hindbrain regions - expressed at boundary
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Holoprosencephaly
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Defect in forebrain bifurcation - caused by defects in Shh signaling
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ROBO3 human mutation
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Horizontal gaze palsy: unable to look move eyes to either side
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Frog Eye Patterning
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"Nasal retina = Low EphA --> Posterior Tectum = High Ephrin A (repulsive)
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Familial advanced sleep-phase syndrome
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PER2 mutation, PER2 protein builds up quicker, earlier feedback, wake up too early
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Delayed sleep-phase syndrome
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Delayed cycle (4am-noon), may involve PER3
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Ventral Horn Rexed Laminae
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VIII and IX
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Dorsal Horn Rexed Laminae
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I-VI
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I/A-α sensory nerves
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Ia - muscle spindle / Ib - GTO : large, fast, sensitive to anoxia, resistant to anesthesia
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II/A-β sensory nerves
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Innervate cutaneous mechanoreceptors and muscle spindles
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III/A-δ sensory nerves
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Free nerve endings, respond to sharp pain and cold
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IV/C fiber sensory nerves
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Free nerve endings, respond to dull pain and warmth
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Sensory Nerve medial division
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Ia, Ib, IIA. Touch, vibration, pressure, proprioception
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Sensory nerve lateral division
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IIIA, C. Pain and temperature
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Corticospinal Tract
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"Cell bodies in frontal lobe - Primary motor cortex, precentral gyrus, pre-motor area
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Rubrospinal Tract
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"Cell bodies in Red Nucleus - magnocellular division
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Medial / Pontine Reticulospinal Tract (MRST)
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"Cell bodies in pontine reticular formation
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Lateral / Medullary Reticulospinal Tract (LRST)
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"Cell bodies in medullary reticlar formation
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Medial Vestibulospinal Tract
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"Cell Bodies in Medial Vestibular Nucleus
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Lateral Vestibulospinal Tract
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"Cell Bodies in Lateral Vestibular Nucleus
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Tectospinal Tract
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"Cell bodies in Superior Colliculus
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LMN Lesions - Flaccid Paralysis
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Paralysis and suppressed reflexes, fasiculations, atrophy. Ipsilateral and at level of lesion
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UMN Lesion
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Paresis (weakness) and hyperactive refelxes
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Dorsal Column Medial Lemniscus Pathway
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"Proprioception and discriminative touch modalities
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Fasciculus Gracilis
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Medial, lower body - GRacilis / Ground
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Fasciculus Cuneatus
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Lateral, upper body
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Romberg Test
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"Patient sways w/ eyes open = cerebellar vermis lesion - motor ataxia
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Anterolateral Spinothalamic Pathway
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"Pain and temperature
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Dorsal Spinocerebellar Tract
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"Unconscious proprioception - lower limb
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Cuneocerebellar Tract
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"Unconscious proprioception - upper limb
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Horner's Syndrome
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"Compression / Lesion of superior cervical ganglion
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Supraspinal Bladder Disorder - Cortical Lesion
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"Infantile bladder
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Supraspinal Bladder Disorder - Spinal Cord Lesion above Sacral cord
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"Spastic bladder
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Supraspinal Bladder Disorder - Spinal Cord Lesion at Sacral Cord or Cauda Equina
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"Atonic Bladder
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Spinal Muscular Atrophy
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"Progressive loss of motor neurons - others not affected
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Most common level for Radiculopathy
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C5,C6,C7,C8,L4,L5,S1
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PMP22
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"2 copies = normal
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Glutamate Synthesis
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"Glutamine --> Glutamate via Glutaminase
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ACh synthesis
|
"Glucose --> pyruvate --> Acetyl CoA
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4 classical congential myopathies
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Nemaline myopathy, Centronuclear/myotubular myopathy, Central core disease, Multi/minicore myopathy
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Nemaline Myopathy
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Nemaline rods seen on biopsy, red staining inclusions, derived from Z disk components
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Muscular dystrophy histology
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Degeneration, regeneration, and connective and fatty tissue infiltration
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Gowers' Maneuver
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Indicates proximal muscle weakness
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Trendelenberg sign
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"Excessive hip swiging due to proximal muscle weakness
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Dystrophin Gene
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"Out of frame mutations --> truncated protein --> Duchenne Muscular Dystrophy
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Limb-Girdle Muscular Dystrophy
|
"Reduced Sarcoglycan complex - normal dystrophin
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FSHD clinical presentation
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Asymmetric weakness in face, scapula, biceps, and distal leg (foot drop)
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FSHD genetics
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"Deletion of DUX4 repeats from long end of chromosome 4 - only A version
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Acetylcholine synthesis rate limiting step
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Choline uptake
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Nicotinic ACh-R localization
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"Post-synaptic in autonomic ganglia and skeletal muscle
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AChE inhibitors - Alzheimers
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Reversible competitive inhibitor - tertiary amine, hydrophobic, crosses BBB
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Pyridostigmine
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"Carbamylates active site serine on AChE
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Nerve Gase
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"Permanently phosphorylates AChE active site
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ACh - Nicotonic receptor interaction
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π/cation interactions
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ACh - ACh-E interaction
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π/cation interactions
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ACh - Muscarinic Receptor interaction
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Negative charge aspartate binds positive charge quarternary amine
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mAChR downstream effectors
|
"m2, m4 – inhibit adenylate cyclase, reduce cAMP - αi competes w/ αs
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Prolonged ACh exposure - nACh-R
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"Desensitization - conformation change to high affinity but closed channel
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Prolonged ACh exposure - mACh-R
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Desensitization - internalization of receptors
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nACh-R primordial type
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(α7)5
|
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nACh-R Fetal Muscle Type
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(α1γ)(α1δ)β1
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nACh-R Adult Muscle type
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(α1ε)(α1δ)β1
|
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nACh-R Major Brain subtype - high affinity for nicotine
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(α4β2)2β2
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nACh-R Major Autonomic Ganglia Subtype
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(α3β4)2β4
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Lambert-Eaton Myasthenic Syndrome
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"Autoantibodies against v-gated Ca2+ channels - disrupt release of ACh
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nACh-R subtype important in tobacco addiction
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(α4β2)(α6β2)β3
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What level is LP performed at
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L4/L5
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Upper Motor Neuron Lesions - Signs and Symptoms
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"Slowness, stiffness
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Lower Motor Neuron Lesions - Signs and Symptoms
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"Weakness, cramps
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Spinal Cord Arterial Blood Supply
|
"Anterior Spinal Artery --> Ant 2/3 = Corticospinal and ALST
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Complete Cord Transection - Deficits
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"Motor - loss of all motor function below lesion
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Complete Cord Transection - levels and ablities
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"C1-C3: require ventilatory support
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Hemisection of Cord / Brown - Sequard Syndrome deficits
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"Motor - lpsilateral spastic weakness below lesion (CST)
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Central Cord Lesions
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"Motor - Segmental bilateral LMN findings (anterior horn damage)
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Classic Cervical Syrinx
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"Cape-like bilateral thermoanesthesia
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Syringomyelia / Hematomyelia
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Cavity filled w/ CSF or blood
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Tabes Dorsalis / Posterior Column Syndrome
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"Bilateral Destruction of Posterior Columns from untreated Syphillis
|
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Posterolateral Column Syndrome / Subacute Combined Degeneration
|
"B12 deficiency results in myelin degeneration w/o inflammation
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Anterior Horn Cell Disease
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"Segmental LMN findings - flaccid paralysis
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ALS
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"Combined Anterior Horn Cell - Pyramidal Tract Syndrome
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Anterior Spinal Artery Occulsion
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"Acute flaccid weakness - Chronic spastic paraparesis below lesion (UMN)
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Intramedullary Lesion
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"Lesion inside spinal cord - parenchyma involvement
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Intradural Extramedullary Lesion
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"Lesion inside dura / outside spinal cord - extraparenchyma involvement
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Extradural lesion
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"Lesion outside dura - extraparenchyma involvement
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Lumbar Disk Herniation
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"LMN lesion of compressed root - flaccid paralysis
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Cauda Equina Syndrome
|
"Sudden onset - severe pain
|
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Proximal weakness seen commonly in…
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Muscle disorders
|
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Distal weakness / length dependent weakness seen commonly in…
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Peripheral nerve disorders
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Tensilon Test
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"Diagnostic test for myasthenia gravis
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CK test
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"Creatine Phosphokinase
|
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CK extremely high in….
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Disorders of skeletal muslce - damage
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CK mildly elevated (<1000) in …
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Muscle damage secondary to peripheral nerve or anterior horn cell denervation
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Fibrillation potentials
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Nonspecific abnormality in both nerve and muscle disease
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EMG - Decreased amplitude and duration of Motor Unit Action Potential
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Myopathic - muscle fibers drop out - size of motor unit is reduced
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EMG - Increased amplitude and duration of Motor Unit Action Potentials
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"Neuropathic - muscle denervation and compensatory sprouting
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EMG - Early full recruitment
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"Myopathic - smaller motor units
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Dermatomyositis
|
"Immune-mediated inflammatory disorder of muscle
|
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Nerve conduction studies - prolonged distal motor and F wave latencies
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Demyelinating polyneropathy - slows conduction velocity
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Albumino-cytologic dissociation
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"Elevated CSF protein w/o cellular reaction
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Upper Motor Neuron Syndrome
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Weakness, Spasticity, Hyperreflexive, Babinski's sign, loss of fine voluntary movement
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Lower Motor Neuron Syndrome
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"Weakness, Flaccid paralysis, hyporeflexive,
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Fasciculation
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"Involuntary but synchronized contraction of all fibers in a motor unit
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Fibrillations
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Spontaneous contraction of single muscle fiber
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Paresis
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Weakness
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Plegia
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Paralysis
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Golgi Stain
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Random selectin of entire cells
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Nissl Stain
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Cell bodies
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Weigert Stain
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Myelinated axons
|
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BA 4
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Primary Motor Cortex
|
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BA 6
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Premotor Cortex
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BA 8
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Supplementary Motor Cortex
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Premotor Cortex
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"Projections to primary motor cortex and spinal cord
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Traditional view of motor cortex function
|
Individual neurons encode actication of specific muscles
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Population code view of motor cortex function
|
"Individual neurons encode a particular direction of movement of specific muscle
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Prolonged stimulation of motor cortex
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"Results in goal-oriented movement
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Cerebellar Lesions - Clinical Syndromes
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"Hypotonia - diminished resistance to passive limb movement
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Dysmetria
|
Errors in range of movement - touching finger to nose, overshoot / undershoot
|
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Dysdiadochokinesia
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Inability to sustain regular rhythm or amount of force
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Ataxia - components
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"Lack of coordination of eye movements during walking
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Cerebrocerebellum
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"Lateral zone / hemispheres
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Spinocerebellum
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"Intermediate zone and medial zone / paravermis and vermis
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Vestibulocerebellum
|
"Flocculus and Nodulus
|
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Deep Cerebellar Nuclei
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"Cerebrocerrebellum --> Dentate Nucleus
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Cerebellar Cortical Layers - Superficial to Deep
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"Molecular - most superficial
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Granular Layer cell types
|
"Granule Cells - excitatory glutamate
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Purkinje Layer cell types
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Purkinje cells - Inhibitory GABA
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Molecular Layer cell types
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"Basket cells - Inhibitory GABA
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Cerebellar Circuitry - Mossy Fibers
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"Inputs from Cerebral Cortex (pontine nuclei), spinal cord, and vestibular system
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Cerebellar Circuitry - Granule Cells
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"Excitatory input from mossy fibers
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Cerebellar Circuitry - Climbing Fibers
|
"Axons from Inferior Olive - enter through contralateral inferior cerebellar peduncle
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Cerebellar Circuitry - Golgi Cells
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"Inhbit Granule Cells
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Cerebellar Circuitry - Basket and Stellate Cells
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"Local inhibitory interneurons
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Cerebellar Circuitry - Purkinje Cells
|
"Weak excitatory input from Granule Cells - Simple spikes
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Purkinje Cell Simple Spikes
|
"Na+ mediated action potentials
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Purkinje Cell Complex Spikes
|
"Ca2+ mediated action potentials - several consecutive, longer lasting spikes
|
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Effects of inactivating (cooling) deep cerebellar nuceli
|
"Delayed, oscillatory movements
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Neural Computation functions of Cerebellum
|
"Anticipate and compensate for force
|
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Cerebellum Cognitive Functions
|
Increased activity when subject is mentally active - sensory discrimination
|
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Posture
|
Muscle tone sufficient to maintain desired body position against pull of gravity
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Balance
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Maintenance of center of body mass above base of support
|
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Anticipatory Postural Control - Feedforward
|
"Motor cortex elicits coordinated limb movement - Lateral Corticospinal Tract
|
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Compensatory Postural Control - Feedback
|
"Stimulated by Proprioceptors - Muscle Spindles and Golgi Tendon Organs
|
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Lateral Motor System
|
"Spinal motor neurons located dorso-laterally in ventral gray of spinal cord
|
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Medial Motor System
|
"Spinal motor neurons located in antero-medial spinal gray matter
|
|
Step Cycle - Muscle contraction patterns
|
"Extensors contract during stance phase
|
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Central Pattern Generator - Locomotion
|
"Generates rhythmic repeating motor pattern in response to non-rhythmic input
|
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Descending Control of Spinal Locomoter Central Pattern Generator
|
"Initiated in motor / premotor cortex --> Mesencephalic Locomotor Region (MLR)
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Feedback from Spinal Central Pattern Generator
|
"CPG --> Brainstem
|
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Spinal Central Pattern Generator - circuitry
|
"Reciprocally inhibitory populations of functionally antagonistic interneurons
|
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Strength of Descending Activity - CPG
|
"Increasing strength of tonic stimulation of MLR increases speed of locomotion
|
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Locomotor Central Pattern Generator Location
|
"Bilaterally symmetric network in Medial aspect of intermediate gray zone
|
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Nerve Conduction Velocity
|
"Stimulate neuron distally, record latency to muscle response
|
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Nerve Conduction Study - Normal Velocity, Decreased CMAP
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Axonal Neuropathy
|
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Nerve Conduction Study - Conduction block
|
Focal demyelinating neuropathy
|
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Nerve Conduction Study - Decreased Velocity, Normal Amplitude
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Uniform Demyelinating neuropathy
|
|
Genetic Peripheral Demyelinating Disorders - mutant genes
|
"Peripheral myelin protein 22
|
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Repetitive Nerve Stimulation Studies
|
"Electrically stimulate nerve 6-10 times at 2/3 Hz
|
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Repetitive Nerve Stimulation - Decremental Response
|
"Neuromuscular transmission disorders
|
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Neonatal Hypotonia - Localization: Central v Peripheral Lesion
|
"Other brain abnormality: C +++ P+/-
|
|
Neonatal Hypotonia - Anterior Horn Cell Lesion - Pattern of Weakness
|
"Face +/-
|
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Neonatal Hypotonia - Muscle Lesion - Pattern of Weakness
|
"Face variable
|
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Neonatal Hypotonia - NMJ Lesion - Pattern of Weakness
|
"Face +++
|
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Neonatal Hypotonia - Peripheral Nerve Lesion - Pattern of Weakness
|
"Face -
|
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Neonatal Hypotonia - Nerve Conduction Study and EMG results - site of involvement
|
"Central: NCS - normal EMG - normal
|
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EMG - Neurogenic Lesion - LMN
|
"Insertional activity - increased
|
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EMG - Neurogenic Lesion - UMN
|
"Insertional activity - normal
|
|
EMG - Myogenic Lesion - Myopathy
|
"Insertional activity - normal
|
|
EMG - Polymyositis
|
"Insertional activity - increased
|
|
Myotubular Myopathy
|
"MTM1 gene mutation
|
|
Midline Cerebellar Lesion
|
"Truncal and Proximal limb dysfunction
|
|
Hemispheric Cerebellar Lesion
|
"Limb Ataxia: Arms > Legs
|
|
Rebound - Cerebellar Dysfunction
|
Inability to stop an ongoing movement
|
|
Nystagmus
|
"Abnormal jerking eye movements
|
|
Ocular Dysmetria
|
Inacurate occular fixation on target, overshoot and oscillate
|
|
Ataxic Dysarthria
|
"Disruption of metrical structure of speech
|
|
Signs of Cerebellar Dysfunction
|
"Gait ataxia, titubation, tremor, dysmetria, dysdiadochokinesis, rebound, nystagmus
|
|
Acute v Chronic Cerebellar Damage - muscle tone
|
"Acute hypotonia
|
|
Sensory v Cerebellar Ataxia
|
"Sensory Ataxia - loss of input to cerebellum
|
|
Vestibular dysfunction v Cerebellar damage
|
Vestibular dysfunction - Vertigo
|
|
Corticospinal Tract Disease v Cerebellar damage
|
CST disease - UMN signs present
|
|
Proximal limb weakness v Cerebellar damage
|
Proximal Limb Weakness - Weakness, rhythmycity preserved
|
|
Superior Cerebellar Artery
|
"Branches off Basilar Artery -
|
|
Anterior Inferior Cerebellar Artery
|
"Branches off Basilar Artery
|
|
Posterior Inferior Cerebeller Artery
|
"Branches off each vertebral artery
|
|
Superior Cerebellar Artery Syndrome
|
"Ipsilateral Cerebellar Ataxia
|
|
Anterior Inferior Cerebellar Artery Syndrome
|
"Vertigo
|
|
Posterior Inferior Cerebellar Artery Syndrome
|
"Wallenburg Syndrome
|
|
Cerebellar Vascular Disease - Causes
|
"Ischemic Stroke
|
|
Cerebellar Mutism
|
"Commonly seen after surgery in posterior cranial fossa
|
|
Most common location for brain tumor in children
|
Posterior Cranial Fossa
|
|
Cerebellar Malformations - Chiari I
|
"Static herniation of medulla and cerebellar tonsils through foramen magnum
|
|
Cerebellar Malformations - Chiari II
|
"Neural tube closure defect --> inadequate 4th ventricl formation / small posterior fossa
|
|
Cerebellar Malformations - Chiari III
|
"Herniation of medulla, cerebellar tonsils and vermis, and 4th ventricle through foramen magnum
|
|
Dandy Walker Malformation
|
"Cerebellar malformation - neonatal presentation
|
|
Joubert Syndrome
|
"Cerebellar malformation - neonatal presentation
|
|
Medulloblastoma
|
"Midline Cerebellar tumor
|
|
Dysarthria - clumsy hand syndrome
|
"Due to infarction in superior cerebellar artery
|
|
Post-infectious cerebellitis
|
"Acute cerebellar ataxia - explosive onset of gait ataxia and nystagmus
|
|
Multiple Sclerosis
|
"Chronic inflammatory disease of CNS
|
|
Paraneoplastic cerebellar degeneration
|
"Tumor associated degeneration - associated w/ specific anti-neuronal antibodies
|
|
Toxic Cerebellar Disease
|
"Acute or chronic
|
|
Spinocerebellar Ataxia
|
"Group of autosomal dominant disorders
|
|
Basal Ganglia - Input nuclei
|
"Striatum - Caudate and Putamen
|
|
Basal Ganglia - Output nuclei
|
Substantia nigra Pars Reticularis and Globus Pallidus Interna
|
|
Basal Ganglia - Intrinsic nuceli
|
Globus Pallidus Externa, Substantia Nigra Pars Compacta, and Subthalamic Nuclei
|
|
Lenticular Nucleus
|
Putamen and Globus Pallidus
|
|
Substantia Nigra
|
"Dopmaine oxidizes to form quinones --> polymetize into neuromelanin (black)
|
|
Basal Ganglia - Direct Pathway
|
"Initiation of movement - learning positive outcomes associated w/ behaviors
|
|
Basal Ganglia - Indirect Pathway
|
"Termination of movement - learning negative outcomes associated w/ behaviors
|
|
Parkinson's Disease - Histology
|
"Aggregation of α-synuclein into cytoplasmic Lewy Bodies
|
|
Parkinson's Disease - Signs and Symptoms
|
"Bradykinesia - slow initiation of voluntary movement / lack of spontaneous movement
|
|
Parkinson's Disease - Pathology
|
"Loss of dopamine input to striatum
|
|
Huntington's Disease - Signs and Symptoms
|
"Chorea - brief, jerk-like movements
|
|
Huntington's Disease - Genetics
|
"Triplet repeat expansion - CAG
|
|
Huntington's Disease - Pathology
|
"Selective loss of medium spiny GABAergic neurons in striatum
|
|
Motor defects - Cerebellar / Pyramidal / Basal Ganglia
|
"Brainstem / Cerebellar injury --> Ataxia
|
|
Striatum Interneurons
|
"95% medium spiny - GABA - Inhibitory
|
|
Dopamine Biosynthesis
|
"Tyrosine --> L-DOPA --> Dopamine
|
|
Parkinson's Pharmacology - Levodopa
|
"Levodopa replacemtn of dopamine - crosses BBB
|
|
Parkinson's Pharmacology - DA receptor agonists
|
Longer lasting effects than L-DOPA, more selective receptor stimulation
|
|
Parkinson's Pharmacology - inhibit DA breakdown
|
Inhibitors of monoamine oxidase (MAO-B) and catechol-O-methyltransferase (COMT)
|
|
Parkinson's Pharmacology - ACh muscarinic antagonists
|
Block ACh-M receptor activity in striatal interneurons - relieve inhibition on thalamus
|
|
Parkinson's Therapy - Deep brain stimulation
|
Inactivate GPi or STN
|
|
Huntington's Disease Pharmacology
|
"Nothing available to halt disease progression
|
|
Tremor
|
Rhythmical and sinusoidal movement
|
|
Parkinson's Disease v Essential Tremor
|
"PD: Asymmetrical, Rest > postural/action
|
|
Chin Tremor and Facial Masking
|
Parkinson's Disease
|
|
Head tremor
|
Essential Tremor
|
|
Chorea
|
"Irregular, random, abrupt, flowing movement
|
|
Athetosis
|
Low amplitude chorea - affects distal muscles
|
|
Ballismus
|
High amplitude chorea - affects proxmial muscles
|
|
Hemiballismus
|
"Unilateral High amplitude chorea - affects proximal muscles
|
|
Myoclonus
|
"Irregular shock-like movements
|
|
Tic
|
"Abrupt, brief, stereotyped movement
|
|
Dystonia
|
"Sustained muscle contractions w/ twisitng posutres
|
|
Writer's Dystonia
|
Task-specific
|
|
Parkinsonism
|
"Core common features - Rigidity, Akinesia / Bradykinesia, Basal Ganglia Pathology
|
|
Multiple Systems Atrophy
|
"Parkinsonism + Autonomic Failure
|
|
Progressive Supranuclear Palsy
|
"Parkinsonism + opthalmoparesis (weakness in eye movement muscles)
|
|
Corticobasal Degeneration
|
"Parkinsonism + Apraxia and Dystonia
|
|
Wilson's Disease
|
"Parkinsonism + Dystonia (young onset)
|
|
Diencephalon subdivisions
|
"Dorsal Thalamus - Thalamus
|
|
Thalamus boundaries
|
"Anteriorly - interventricular foramen
|
|
Thalamus anatomy - myelinated fibers
|
"Internal Medullar Lamina
|
|
Thalamus anatomy - Lateral Division - nuclei / function
|
"Dorsal Tier:
|
|
Thalamic relay nuclei
|
"VPL/VPM - sensory relay for body / head
|
|
Thalamic association nuclei
|
"Dorsomedial Nucleus:
|
|
Thalamic neurons - types
|
"Thalamocortical - glutaminergic excitatroy projection neurons
|
|
Thalamo-cortico-thalamic circuit
|
"Thalamocortical (TC) projection neurons (Glu) to cortex - no TC-TC connections
|
|
Thalamocortical neuron electrophysiology
|
"Tonic: Vm = -55mv --> depolarization causes sustained discharge
|
|
Thalamocortical Tonic-Burst Transition
|
"Tonic firing = relay mode --> faithfully relays prethalamic input to cortex
|
|
CNS Acetylcholine source
|
Nucleus Basalis of Meynert, brainstem reticular formation
|
|
CNS Noradrenaline source
|
Locos coeruleus
|
|
CNS serotonin source
|
Periacqueductal Gray, Dorsal Raphe Nucleus
|
|
CNS dopamine source
|
Substantia Nigra Pars Compacta
|
|
Human Paleocortex
|
Base of telencephalon - involved w/ olfaction
|
|
Human Archicortex
|
Hippocampus
|
|
Agranular Cortex
|
"Apparent lack of stellate (granule) cells
|
|
Granular Cortex
|
"Many small cells (pyramidal and non-pyramidal)
|
|
Homotypical / Heterotypical Cortex
|
"Homotypical - 6 distinct neocortical layers
|
|
Cortical Columnar Orientation
|
"Cells arranged in column perpendicular to cortical surface
|
|
Cortical Pyramidal Cells
|
"Excitatory, glutaminergic projection neurons
|
|
Cortical Spiny Stellate (granule) cells
|
"Excitatory, glutaminergic interneurons
|
|
Cortical Basket Cells
|
"Inhibitory GABAergic interneurons
|
|
Regular Spiking (RS) Cortical Cells
|
"Generate sustained firing proportional to depolarizing input
|
|
Fast Spiking (FS) Cortical Cells
|
"Thin action potentials, brief spike afterhyperpolarizaton (HAP)
|
|
Bursting Cells
|
"All-or-none bursr of high frequency spikes
|
|
Properties of local cortical circuits
|
"Recurrent excitatory input b/w neighboring excitatory cells - synapse on spines
|
|
Route of information flow through cortex
|
Thalamus --> L4 --> L2/3 <--> L5 --> L6 --> Thalamus
|
|
Somatosensory nerve endings
|
Generate graded potentials - behave like dendrites
|
|
Somatosensory free nerve endings
|
"Tuned for pain, temperature, and crude touch
|
|
Slow adapting somatosensory receptors
|
"Signal sustained presence of stimulus
|
|
Fast adapting somatosensory receptors
|
"Signal onset and offset of stimulus
|
|
Lateral / Surround Inhibition
|
"Stimulation of receptor excites cell - axon collateral to recurrent inhibitory interneurons
|
|
Cortical Representation - Receptive Fields
|
"Increased cortical representation --> increased receptor density, 2 point discrimintation
|
|
Primary SS cortex - body representation - stimulus type
|
"3a - muscle afferents
|
|
Cranial Nerves Exiting at Ponto-Medullary Junction
|
VI, VII, and VIII
|
|
Laterally exiting cranial nerves
|
V, VII, IX, and X - all mixed sensory / motor
|
|
Medially exiting cranial nerves
|
III, IV, VI, and XII - all motor
|
|
Medial Lemniscus Position in Brainstem
|
"Moves from medial to lateral position while ascending
|
|
Anterolateral System Position in Brainstem
|
Courses in lateral aspect - does not change location
|
|
Descending Hypothalamic Fiber Position in Brainstem
|
Courses in lateral aspect w/ ALST - does not change position
|
|
Brainstem Anatomy - 4th ventricle in…
|
Pons and Rostral Medulla
|
|
Brainstem Anatomy - Cerebral aqueduct in…
|
Midbrain
|
|
Brainstem Anatomy - Central canal in…
|
Caudal Medulla
|
|
Brainstem Anatomy - Cerebellar Peduncles in…
|
"Medulla - ICP
|
|
Brainstem Anatomy - Olives in…
|
Rostal Medulla
|
|
Brainstem Anatomy - Pyramidal Decussation in…
|
Caudal Medulla - Medullary-cervical junction
|
|
Brainstem Anatomy - Caudal Medulla Structures
|
"Pyramidal Decussation
|
|
Brainstem Anatomy - Rostral Medulla Structures
|
"Inferior Olivary Nuclei - Dentate Cerebellar Nuclei looks similar but on dorsal aspect
|
|
Brainstem Anatomy - Caudal Pons Structures
|
"Transverse Pontine Fibers - Pontocerebellear fibers
|
|
Brainstem Anatomy - Rostral Pons Structures
|
"4th Ventricle
|
|
Brainstem Anatomy - Caudal Midbrain Structures
|
"Inferior Colliculi
|
|
Brainstem Anatomy - Rostral Midbrain Structures
|
"Superior Colliculi
|
|
Brainstem Anatomy - Arrangement of CN VI and CN VII
|
"CN VI nuclei located dorso-medial to CN VII nuclei
|
|
Facial Weakness - UMN v LMN
|
"Most cranial nerve LMN receive bilateral UMN input - except some LMN in facial nerve (VII)
|
|
Brainstem Nerve Fiber Classification
|
"G / S: General - whole body / Special - Head or Neck only
|
|
Neural Tube - Brainstem Patterning
|
"Neural Tube - Dorsal = Sensory / Ventral = Motor
|
|
Brainstem Cranial Nerve Nuclei Organization
|
"Discontinous columns of functionally similar motor nuclei
|
|
Brainstem Cranial Nerve Nuclei - GSE
|
"Column 1 next to midline - Innervated Skeletal Muscle
|
|
Brainstem Cranial Nerve Nuclei - GVE
|
"2nd column from midline - Pre-ganglionic Parasympathetics
|
|
Brainstem Cranial Nerve Nuclei - SVE
|
"3rd column from midline - Pharyngeal arch derived muscles
|
|
Brainstem Cranial Nerve Nuclei - SVA / GVA
|
"1st column from Sulcus Limitans - visceral sensory
|
|
Brainstem Cranial Nerve Nuclei - SSA
|
"2nd column from Sulcus Limitans - Vestibulocochlear sensory
|
|
Brainstem Cranial Nerve Nuclei - GSA
|
"3rd column from Sulcus Limitans - Continuous column of Trigeminal Nuclei (V)
|
|
Trigeminal Nerve - Sensory - Touch
|
"Large diameter afferents - cell bodies in Trigeminal Ganglion or Mesencephalic Nucleus
|
|
Trigeminal Nerve - Sensory - Pain and Temp
|
"Small diameter afferents - cell bodies in trigeminal ganglion
|
|
Nucleus Caudalis - Topography
|
"Spinal Trigeminal Nucleus - Facial Pain and Temperature - Onion Skin Pattern
|
|
Babinski Sign
|
"Stroke planta surface of foot
|
|
Unilateral Babinksi Sign
|
"Lesion of contralateral corticospinal tract
|
|
Bilateral Babinksi Sign
|
"Lesion of both corticospinal tracts
|
|
Spasticity
|
"Increased tone
|
|
Rigidity
|
"Increased tone
|
|
EMG - Spontaneous Activity
|
"Normal Muscle - Silent
|
|
Primary Olfactory Sensory Neurons
|
"Located in nasal neuroepithelium
|
|
Olfactory Bulb projections
|
"Lateral Olfactory Tract - Ipsilateral Targets
|
|
Olfactory Neuroepithelium Cells
|
"Olfactory Sensory Neurons - ciliated bipolar receptor cells
|
|
Olfactory Signal Transduction
|
"Odorant binding to GPCR in cilia of sensory neuron
|
|
Sensory Neuron Receptor Expression
|
"Single nuerons expresses single receptor type
|
|
Odor quality and intensity coding
|
"Combinatorial coding from multuple receptors
|
|
Olfactory Coding in Bulb
|
"Axons of sensory neurons expressing same receptor converge onto same glomerulus
|
|
Olfactory Bulb - Cell types
|
"Mitral/Tufted cells - excitatory glutaminergic projection neuron - excitatory input from OSN
|
|
Olfactory Bulb Lateral Inhibition
|
"M/T cell firing - secondary dendrites release glutamate --> excited granule cells
|
|
Cortical Olfactory Coding
|
"M/T cells project to olfactory cortex - Piriform (Paleocortex - 3 layers)
|
|
Anosmia
|
Absence of smell sensation - general or specific
|
|
Hyposmia / Hyperosmia
|
Decreased smell sensation / abnormally acute smell sensation
|
|
Dysosmia
|
Distortion of smell sensation
|
|
Phantosmia
|
Olfactory hallucination - dysosmia in absence of stimulus
|
|
Olfactory agnosia
|
Inability to recognize odor sensation - common in stroke patients
|
|
Odorant Qualities
|
"Volatile organic molecules
|
|
Taste Bud Location
|
"Clustered in circumvallate, foliate, and fungiform papillae on tonge
|
|
Taste Bud Innervation
|
"Anterior 2/3 of tongue - Facial Nerve VII - Chorda Tempani - Geniculate Ganglion
|
|
Taste Information to Cortex
|
"Sensory fibers in Geniculate and Petrosal Ganglion
|
|
Primary Gustatory Cortex
|
"Anterior Insular Cortex and Frontal Operculum
|
|
Gustatory Transduction - Salt
|
"Na+ stimulus
|
|
Gustatory Transduction - Sour
|
"H+ stimulus
|
|
Gustatory Transduction - Sweet, Umami, Bitter
|
"GPCR
|
|
Taste Cells - Receptors and Released products
|
"Each cell has single type of receptor (Salt, Sour, Sweet, Bitter, Umami)
|
|
Gustatory Receptors - Sweet, Umamia, Bitter
|
"Sweet = T1R2 + T1R3
|
|
Ageusia
|
Absence of taste sensation
|
|
Hypoguesia
|
Decreased sensation to tastants
|
|
Dysgeusia
|
Distortion of taste sensation
|
|
Gustatory agnosia
|
Inability to recognize taste sensation
|
|
Chemosensation Overview
|
"Integration of Olfactory, Gustatory, and Somatosensory input
|
|
Umami
|
"MSG - monosodium glutamate
|
|
Sweet
|
"Sucrose, Lactose, Fructose
|
|
Medulla Cranial Nerves
|
IX, X, XI, XII
|
|
Pons Cranial Nerves
|
V, VI, VII, VIII
|
|
Midbrain Cranial Nerves
|
III, IV
|
|
Characteristic Finidng of Brain Stem Disorder
|
"Crossed hemiparesis
|
|
Medially Located Brainstem Cranial Nerves and Tracts
|
"CN III, IV, VI, XII
|
|
Laterally Located Brainstem Cranial Nerves and Tracts
|
"V, VII, VIII, and X
|
|
Crossed Hemiparesis - Lesion of CN…
|
III, VI, VII, XII
|
|
Involvement of multiple cranial nerves on same side of body
|
"Suggests lesion outside brainstem - extraaxial
|
|
Pupillary Light Reflex
|
"Tests integrity of Midbrain
|
|
Corneal Reflex / Blink Reflex
|
"Tests integrity of Pons
|
|
Vestibulo-Occular Reflex
|
"Tests integrity of brainstem from medulla to midbrain
|
|
Internuclear Ophthalmoplegia
|
"Disorder of Conjugate Lateral Gaze
|
|
Brainstem Vasculature
|
"Midline vessels branch of Basilar or Vertebral Arteries
|
|
Isolated CN III palsy
|
"Dilated pupil - Down and Out
|
|
CN III palsy + Head Trauma
|
"Temporal Lober herniation into midbrain
|
|
Wernickes - Korsakoff's Disease
|
"Triad of Double Vision, Confusion, and Ataxia
|
|
CN V palsy
|
"Jaw deviates TOWARDS weak side
|
|
Wallenberg Syndrome
|
"Lesion to Dorsal-Lateral Medulla
|
|
CN IX or X palsy
|
"Palate hemiparalysis
|
|
CN XII palsy
|
Ipsilateral tongue atrophy
|
|
Brain major vascular supply
|
"Receives 20% of cardiac output
|
|
Brain Vascular Anatomy - Internal Carotid Artery
|
"Enter skull through Foramen Lacerum
|
|
Brain Vascular Anatomy - Vertebral Artery
|
"Enter skull through Foramen Magnum
|
|
Brain Vascular Anatomy - Circle of Willis
|
"Posterior - Vertebral Arteries join to form Basilar Artery
|
|
Brain Vascular Anatomy - Middle Cerebral Artery territory
|
"Lateral Frontal Lobe, Parietal Lobe, Temproal Lobe, Insular Cortex, Putamen, and Internal Capsule
|
|
Middle Cerebral Artery occlusion
|
"Contralateral hemiparesis - face and arms affected more than legs (central in homonculous)
|
|
Ophthalamic artery occlusion
|
Ipsilateral monocular blindness
|
|
Brain Vascular Anatomy - Anterior Cerebral Artery territory
|
Medial Frontal Lobe, Cingulate, Corpus Callosum, Caudate
|
|
Anterior Cerebral Artery occlusion
|
"Contralateral lower extremity weakness - medial homonculous
|
|
Brain Vascular Anatomy - Posterior Cerebral Artery territory
|
Medial Temporal lobe, Occipital Lobe, Anteromedial Thalamus
|
|
Posterior Cerebral Artery occlusion
|
"Contralateral visual field loss (hemianopsia) - occipital
|
|
Weber / Medial Midbrain Syndrome
|
"Ipsilateral CN III palsy w/ contralateral hemiparesis
|
|
Locked In / Pontine Syndrome
|
"Occlusion of proximal or midbasilar artery - infarct in pons - Bilateral damage
|
|
Wallenberg / Lateral Medullary Syndrome
|
"Occlusion of PICA
|
|
Signs common to Cerebellar Infarction
|
"Sudden onset ataxia, vertigo, nausea and vomiting
|
|
Major Clinical Finidings - Lacunar (small vessel) occlusion
|
"Contralateral motor OR sensory deficit
|
|
Penumbra
|
"Viable brain tissue
|
|
Brain Vascular Anatomy - Venous Drainage
|
"Sup and Inf Sagital Sinus in midline
|
|
Brain Vascular Anatomy - Cavernous Sinus
|
"Located on each side of sella turcica
|
|
Venous Sinus Thrombosis
|
"Swelling --> hemorrhage
|
|
Inferior Cerebellar Peduncle
|
"Connects Medulla to Cerebellum - Afferent
|
|
Middle Cerebellar Peduncle
|
"Connects Cortex to Cerebellum (via Pons) - Afferent
|
|
Superior Cerebellar Peduncle
|
"Connects Cerebellum to Red Nucleus and VA/VL thalamus - Efferent
|
|
CT - what color is bone/fluid/brain
|
"Bone = white / blood = white
|
|
MRI T1 Sequence - what color is bone/fluid/brain
|
"Used for high anatomical resolution
|
|
MRI T2 Sequence - what color is bone/fluid/brain
|
"Used to identify pathology
|
|
MRI - Diffusion weighted T2
|
Used to identify ischemia earlier and more clearly
|
|
Epidural Hematoma
|
"Blood b/w dura and skull
|
|
Subdural Hematoma
|
"Blood b/w arachnoid and dura
|
|
Lissencephaly
|
Smooth brain, no gyri or sulci - mutations in genes involved w/ tubulin dynamics
|
|
Pachygyria
|
Large (elephant) gyri + 2 abnormal large clefts, do not extend all the way to ventricle
|
|
Polymicrogyria
|
Too many small gyri + mixed patches of pachygyria
|
|
Double Cortex
|
Second rim of cortical cells in periventricular area - migration failure
|
|
Schizencephaly
|
Large gyral cleft, lined w/ gray matter, extends to connect w/ ventricle
|
|
Beningn Familial Neonatal Convulsion
|
Mutation in KCNQ2 or KCNQ3 gene
|
|
Meroanencephaly
|
Neural tube closure defect - partial absence of brain
|
|
Anencephaly
|
Neural tube closure defect - complete absence of brain
|
|
Exencephaly
|
Neural tube closure defect - exposure and possible extrusion of brain
|
|
Otx2 -/- mice
|
Anencephaly - defect of anterior nervous tissue differentiation
|
|
Wnt1 -/- mice
|
Deletions of specific midbrain and hindbrain regions - expressed at boundary
|
|
Holoprosencephaly
|
Defect in forebrain bifurcation - caused by defects in Shh signaling
|
|
ROBO3 human mutation
|
Horizontal gaze palsy: unable to look move eyes to either side
|
|
Frog Eye Patterning
|
"Nasal retina = Low EphA --> Posterior Tectum = High Ephrin A (repulsive)
|
|
Familial advanced sleep-phase syndrome
|
PER2 mutation, PER2 protein builds up quicker, earlier feedback, wake up too early
|
|
Delayed sleep-phase syndrome
|
Delayed cycle (4am-noon), may involve PER3
|
|
Ventral Horn Rexed Laminae
|
VIII and IX
|
|
Dorsal Horn Rexed Laminae
|
I-VI
|
|
I/A-α sensory nerves
|
Ia - muscle spindle / Ib - GTO : large, fast, sensitive to anoxia, resistant to anesthesia
|
|
II/A-β sensory nerves
|
Innervate cutaneous mechanoreceptors and muscle spindles
|
|
III/A-δ sensory nerves
|
Free nerve endings, respond to sharp pain and cold
|
|
IV/C fiber sensory nerves
|
Free nerve endings, respond to dull pain and warmth
|
|
Sensory Nerve medial division
|
Ia, Ib, IIA. Touch, vibration, pressure, proprioception
|
|
Sensory nerve lateral division
|
IIIA, C. Pain and temperature
|
|
Corticospinal Tract
|
"Cell bodies in frontal lobe - Primary motor cortex, precentral gyrus, pre-motor area
|
|
Rubrospinal Tract
|
"Cell bodies in Red Nucleus - magnocellular division
|
|
Medial / Pontine Reticulospinal Tract (MRST)
|
"Cell bodies in pontine reticular formation
|
|
Lateral / Medullary Reticulospinal Tract (LRST)
|
"Cell bodies in medullary reticlar formation
|
|
Medial Vestibulospinal Tract
|
"Cell Bodies in Medial Vestibular Nucleus
|
|
Lateral Vestibulospinal Tract
|
"Cell Bodies in Lateral Vestibular Nucleus
|
|
Tectospinal Tract
|
"Cell bodies in Superior Colliculus
|
|
LMN Lesions - Flaccid Paralysis
|
Paralysis and suppressed reflexes, fasiculations, atrophy. Ipsilateral and at level of lesion
|
|
UMN Lesion
|
Paresis (weakness) and hyperactive refelxes
|
|
Dorsal Column Medial Lemniscus Pathway
|
"Proprioception and discriminative touch modalities
|
|
Fasciculus Gracilis
|
Medial, lower body - GRacilis / Ground
|
|
Fasciculus Cuneatus
|
Lateral, upper body
|
|
Romberg Test
|
"Patient sways w/ eyes open = cerebellar vermis lesion - motor ataxia
|
|
Anterolateral Spinothalamic Pathway
|
"Pain and temperature
|
|
Dorsal Spinocerebellar Tract
|
"Unconscious proprioception - lower limb
|
|
Cuneocerebellar Tract
|
"Unconscious proprioception - upper limb
|
|
Horner's Syndrome
|
"Compression / Lesion of superior cervical ganglion
|
|
Supraspinal Bladder Disorder - Cortical Lesion
|
"Infantile bladder
|
|
Supraspinal Bladder Disorder - Spinal Cord Lesion above Sacral cord
|
"Spastic bladder
|
|
Supraspinal Bladder Disorder - Spinal Cord Lesion at Sacral Cord or Cauda Equina
|
"Atonic Bladder
|
|
Spinal Muscular Atrophy
|
"Progressive loss of motor neurons - others not affected
|
|
Most common level for Radiculopathy
|
C5,C6,C7,C8,L4,L5,S1
|
|
PMP22
|
"2 copies = normal
|
|
Glutamate Synthesis
|
"Glutamine --> Glutamate via Glutaminase
|
|
ACh synthesis
|
"Glucose --> pyruvate --> Acetyl CoA
|
|
4 classical congential myopathies
|
Nemaline myopathy, Centronuclear/myotubular myopathy, Central core disease, Multi/minicore myopathy
|
|
Nemaline Myopathy
|
Nemaline rods seen on biopsy, red staining inclusions, derived from Z disk components
|
|
Muscular dystrophy histology
|
Degeneration, regeneration, and connective and fatty tissue infiltration
|
|
Gowers' Maneuver
|
Indicates proximal muscle weakness
|
|
Trendelenberg sign
|
"Excessive hip swiging due to proximal muscle weakness
|
|
Dystrophin Gene
|
"Out of frame mutations --> truncated protein --> Duchenne Muscular Dystrophy
|
|
Limb-Girdle Muscular Dystrophy
|
"Reduced Sarcoglycan complex - normal dystrophin
|
|
FSHD clinical presentation
|
Asymmetric weakness in face, scapula, biceps, and distal leg (foot drop)
|
|
FSHD genetics
|
"Deletion of DUX4 repeats from long end of chromosome 4 - only A version
|
|
Acetylcholine synthesis rate limiting step
|
Choline uptake
|
|
Nicotinic ACh-R localization
|
"Post-synaptic in autonomic ganglia and skeletal muscle
|
|
AChE inhibitors - Alzheimers
|
Reversible competitive inhibitor - tertiary amine, hydrophobic, crosses BBB
|
|
Pyridostigmine
|
"Carbamylates active site serine on AChE
|
|
Nerve Gase
|
"Permanently phosphorylates AChE active site
|
|
ACh - Nicotonic receptor interaction
|
π/cation interactions
|
|
ACh - ACh-E interaction
|
π/cation interactions
|
|
ACh - Muscarinic Receptor interaction
|
Negative charge aspartate binds positive charge quarternary amine
|
|
mAChR downstream effectors
|
"m2, m4 – inhibit adenylate cyclase, reduce cAMP - αi competes w/ αs
|
|
Prolonged ACh exposure - nACh-R
|
"Desensitization - conformation change to high affinity but closed channel
|
|
Prolonged ACh exposure - mACh-R
|
Desensitization - internalization of receptors
|
|
nACh-R primordial type
|
(α7)5
|
|
nACh-R Fetal Muscle Type
|
(α1γ)(α1δ)β1
|
|
nACh-R Adult Muscle type
|
(α1ε)(α1δ)β1
|
|
nACh-R Major Brain subtype - high affinity for nicotine
|
(α4β2)2β2
|
|
nACh-R Major Autonomic Ganglia Subtype
|
(α3β4)2β4
|
|
Lambert-Eaton Myasthenic Syndrome
|
"Autoantibodies against v-gated Ca2+ channels - disrupt release of ACh
|
|
nACh-R subtype important in tobacco addiction
|
(α4β2)(α6β2)β3
|
|
What level is LP performed at
|
L4/L5
|
|
Upper Motor Neuron Lesions - Signs and Symptoms
|
"Slowness, stiffness
|
|
Lower Motor Neuron Lesions - Signs and Symptoms
|
"Weakness, cramps
|
|
Spinal Cord Arterial Blood Supply
|
"Anterior Spinal Artery --> Ant 2/3 = Corticospinal and ALST
|
|
Complete Cord Transection - Deficits
|
"Motor - loss of all motor function below lesion
|
|
Complete Cord Transection - levels and ablities
|
"C1-C3: require ventilatory support
|
|
Hemisection of Cord / Brown - Sequard Syndrome deficits
|
"Motor - lpsilateral spastic weakness below lesion (CST)
|
|
Central Cord Lesions
|
"Motor - Segmental bilateral LMN findings (anterior horn damage)
|
|
Classic Cervical Syrinx
|
"Cape-like bilateral thermoanesthesia
|
|
Syringomyelia / Hematomyelia
|
Cavity filled w/ CSF or blood
|
|
Tabes Dorsalis / Posterior Column Syndrome
|
"Bilateral Destruction of Posterior Columns from untreated Syphillis
|
|
Posterolateral Column Syndrome / Subacute Combined Degeneration
|
"B12 deficiency results in myelin degeneration w/o inflammation
|
|
Anterior Horn Cell Disease
|
"Segmental LMN findings - flaccid paralysis
|
|
ALS
|
"Combined Anterior Horn Cell - Pyramidal Tract Syndrome
|
|
Anterior Spinal Artery Occulsion
|
"Acute flaccid weakness - Chronic spastic paraparesis below lesion (UMN)
|
|
Intramedullary Lesion
|
"Lesion inside spinal cord - parenchyma involvement
|
|
Intradural Extramedullary Lesion
|
"Lesion inside dura / outside spinal cord - extraparenchyma involvement
|
|
Extradural lesion
|
"Lesion outside dura - extraparenchyma involvement
|
|
Lumbar Disk Herniation
|
"LMN lesion of compressed root - flaccid paralysis
|
|
Cauda Equina Syndrome
|
"Sudden onset - severe pain
|
|
Proximal weakness seen commonly in…
|
Muscle disorders
|
|
Distal weakness / length dependent weakness seen commonly in…
|
Peripheral nerve disorders
|
|
Tensilon Test
|
"Diagnostic test for myasthenia gravis
|
|
CK test
|
"Creatine Phosphokinase
|
|
CK extremely high in….
|
Disorders of skeletal muslce - damage
|
|
CK mildly elevated (<1000) in …
|
Muscle damage secondary to peripheral nerve or anterior horn cell denervation
|
|
Fibrillation potentials
|
Nonspecific abnormality in both nerve and muscle disease
|
|
EMG - Decreased amplitude and duration of Motor Unit Action Potential
|
Myopathic - muscle fibers drop out - size of motor unit is reduced
|
|
EMG - Increased amplitude and duration of Motor Unit Action Potentials
|
"Neuropathic - muscle denervation and compensatory sprouting
|
|
EMG - Early full recruitment
|
"Myopathic - smaller motor units
|
|
Dermatomyositis
|
"Immune-mediated inflammatory disorder of muscle
|
|
Nerve conduction studies - prolonged distal motor and F wave latencies
|
Demyelinating polyneropathy - slows conduction velocity
|
|
Albumino-cytologic dissociation
|
"Elevated CSF protein w/o cellular reaction
|
|
Upper Motor Neuron Syndrome
|
Weakness, Spasticity, Hyperreflexive, Babinski's sign, loss of fine voluntary movement
|
|
Lower Motor Neuron Syndrome
|
"Weakness, Flaccid paralysis, hyporeflexive,
|
|
Fasciculation
|
"Involuntary but synchronized contraction of all fibers in a motor unit
|
|
Fibrillations
|
Spontaneous contraction of single muscle fiber
|
|
Paresis
|
Weakness
|
|
Plegia
|
Paralysis
|
|
Golgi Stain
|
Random selectin of entire cells
|
|
Nissl Stain
|
Cell bodies
|
|
Weigert Stain
|
Myelinated axons
|
|
BA 4
|
Primary Motor Cortex
|
|
BA 6
|
Premotor Cortex
|
|
BA 8
|
Supplementary Motor Cortex
|
|
Premotor Cortex
|
"Projections to primary motor cortex and spinal cord
|
|
Traditional view of motor cortex function
|
Individual neurons encode actication of specific muscles
|
|
Population code view of motor cortex function
|
"Individual neurons encode a particular direction of movement of specific muscle
|
|
Prolonged stimulation of motor cortex
|
"Results in goal-oriented movement
|
|
Cerebellar Lesions - Clinical Syndromes
|
"Hypotonia - diminished resistance to passive limb movement
|
|
Dysmetria
|
Errors in range of movement - touching finger to nose, overshoot / undershoot
|
|
Dysdiadochokinesia
|
Inability to sustain regular rhythm or amount of force
|
|
Ataxia - components
|
"Lack of coordination of eye movements during walking
|
|
Cerebrocerebellum
|
"Lateral zone / hemispheres
|
|
Spinocerebellum
|
"Intermediate zone and medial zone / paravermis and vermis
|
|
Vestibulocerebellum
|
"Flocculus and Nodulus
|
|
Deep Cerebellar Nuclei
|
"Cerebrocerrebellum --> Dentate Nucleus
|
|
Cerebellar Cortical Layers - Superficial to Deep
|
"Molecular - most superficial
|
|
Granular Layer cell types
|
"Granule Cells - excitatory glutamate
|
|
Purkinje Layer cell types
|
Purkinje cells - Inhibitory GABA
|
|
Molecular Layer cell types
|
"Basket cells - Inhibitory GABA
|
|
Cerebellar Circuitry - Mossy Fibers
|
"Inputs from Cerebral Cortex (pontine nuclei), spinal cord, and vestibular system
|
|
Cerebellar Circuitry - Granule Cells
|
"Excitatory input from mossy fibers
|
|
Cerebellar Circuitry - Climbing Fibers
|
"Axons from Inferior Olive - enter through contralateral inferior cerebellar peduncle
|
|
Cerebellar Circuitry - Golgi Cells
|
"Inhbit Granule Cells
|
|
Cerebellar Circuitry - Basket and Stellate Cells
|
"Local inhibitory interneurons
|
|
Cerebellar Circuitry - Purkinje Cells
|
"Weak excitatory input from Granule Cells - Simple spikes
|
|
Purkinje Cell Simple Spikes
|
"Na+ mediated action potentials
|
|
Purkinje Cell Complex Spikes
|
"Ca2+ mediated action potentials - several consecutive, longer lasting spikes
|
|
Effects of inactivating (cooling) deep cerebellar nuceli
|
"Delayed, oscillatory movements
|
|
Neural Computation functions of Cerebellum
|
"Anticipate and compensate for force
|
|
Cerebellum Cognitive Functions
|
Increased activity when subject is mentally active - sensory discrimination
|
|
Posture
|
Muscle tone sufficient to maintain desired body position against pull of gravity
|
|
Balance
|
Maintenance of center of body mass above base of support
|
|
Anticipatory Postural Control - Feedforward
|
"Motor cortex elicits coordinated limb movement - Lateral Corticospinal Tract
|
|
Compensatory Postural Control - Feedback
|
"Stimulated by Proprioceptors - Muscle Spindles and Golgi Tendon Organs
|
|
Lateral Motor System
|
"Spinal motor neurons located dorso-laterally in ventral gray of spinal cord
|
|
Medial Motor System
|
"Spinal motor neurons located in antero-medial spinal gray matter
|
|
Step Cycle - Muscle contraction patterns
|
"Extensors contract during stance phase
|
|
Central Pattern Generator - Locomotion
|
"Generates rhythmic repeating motor pattern in response to non-rhythmic input
|
|
Descending Control of Spinal Locomoter Central Pattern Generator
|
"Initiated in motor / premotor cortex --> Mesencephalic Locomotor Region (MLR)
|
|
Feedback from Spinal Central Pattern Generator
|
"CPG --> Brainstem
|
|
Spinal Central Pattern Generator - circuitry
|
"Reciprocally inhibitory populations of functionally antagonistic interneurons
|
|
Strength of Descending Activity - CPG
|
"Increasing strength of tonic stimulation of MLR increases speed of locomotion
|
|
Locomotor Central Pattern Generator Location
|
"Bilaterally symmetric network in Medial aspect of intermediate gray zone
|
|
Nerve Conduction Velocity
|
"Stimulate neuron distally, record latency to muscle response
|
|
Nerve Conduction Study - Normal Velocity, Decreased CMAP
|
Axonal Neuropathy
|
|
Nerve Conduction Study - Conduction block
|
Focal demyelinating neuropathy
|
|
Nerve Conduction Study - Decreased Velocity, Normal Amplitude
|
Uniform Demyelinating neuropathy
|
|
Genetic Peripheral Demyelinating Disorders - mutant genes
|
"Peripheral myelin protein 22
|
|
Repetitive Nerve Stimulation Studies
|
"Electrically stimulate nerve 6-10 times at 2/3 Hz
|
|
Repetitive Nerve Stimulation - Decremental Response
|
"Neuromuscular transmission disorders
|
|
Neonatal Hypotonia - Localization: Central v Peripheral Lesion
|
"Other brain abnormality: C +++ P+/-
|
|
Neonatal Hypotonia - Anterior Horn Cell Lesion - Pattern of Weakness
|
"Face +/-
|
|
Neonatal Hypotonia - Muscle Lesion - Pattern of Weakness
|
"Face variable
|
|
Neonatal Hypotonia - NMJ Lesion - Pattern of Weakness
|
"Face +++
|
|
Neonatal Hypotonia - Peripheral Nerve Lesion - Pattern of Weakness
|
"Face -
|
|
Neonatal Hypotonia - Nerve Conduction Study and EMG results - site of involvement
|
"Central: NCS - normal EMG - normal
|
|
EMG - Neurogenic Lesion - LMN
|
"Insertional activity - increased
|
|
EMG - Neurogenic Lesion - UMN
|
"Insertional activity - normal
|
|
EMG - Myogenic Lesion - Myopathy
|
"Insertional activity - normal
|
|
EMG - Polymyositis
|
"Insertional activity - increased
|
|
Myotubular Myopathy
|
"MTM1 gene mutation
|
|
Midline Cerebellar Lesion
|
"Truncal and Proximal limb dysfunction
|
|
Hemispheric Cerebellar Lesion
|
"Limb Ataxia: Arms > Legs
|
|
Rebound - Cerebellar Dysfunction
|
Inability to stop an ongoing movement
|
|
Nystagmus
|
"Abnormal jerking eye movements
|
|
Ocular Dysmetria
|
Inacurate occular fixation on target, overshoot and oscillate
|
|
Ataxic Dysarthria
|
"Disruption of metrical structure of speech
|
|
Signs of Cerebellar Dysfunction
|
"Gait ataxia, titubation, tremor, dysmetria, dysdiadochokinesis, rebound, nystagmus
|
|
Acute v Chronic Cerebellar Damage - muscle tone
|
"Acute hypotonia
|
|
Sensory v Cerebellar Ataxia
|
"Sensory Ataxia - loss of input to cerebellum
|
|
Vestibular dysfunction v Cerebellar damage
|
Vestibular dysfunction - Vertigo
|
|
Corticospinal Tract Disease v Cerebellar damage
|
CST disease - UMN signs present
|
|
Proximal limb weakness v Cerebellar damage
|
Proximal Limb Weakness - Weakness, rhythmycity preserved
|
|
Superior Cerebellar Artery
|
"Branches off Basilar Artery -
|
|
Anterior Inferior Cerebellar Artery
|
"Branches off Basilar Artery
|
|
Posterior Inferior Cerebeller Artery
|
"Branches off each vertebral artery
|
|
Superior Cerebellar Artery Syndrome
|
"Ipsilateral Cerebellar Ataxia
|
|
Anterior Inferior Cerebellar Artery Syndrome
|
"Vertigo
|
|
Posterior Inferior Cerebellar Artery Syndrome
|
"Wallenburg Syndrome
|
|
Cerebellar Vascular Disease - Causes
|
"Ischemic Stroke
|
|
Cerebellar Mutism
|
"Commonly seen after surgery in posterior cranial fossa
|
|
Most common location for brain tumor in children
|
Posterior Cranial Fossa
|
|
Cerebellar Malformations - Chiari I
|
"Static herniation of medulla and cerebellar tonsils through foramen magnum
|
|
Cerebellar Malformations - Chiari II
|
"Neural tube closure defect --> inadequate 4th ventricl formation / small posterior fossa
|
|
Cerebellar Malformations - Chiari III
|
"Herniation of medulla, cerebellar tonsils and vermis, and 4th ventricle through foramen magnum
|
|
Dandy Walker Malformation
|
"Cerebellar malformation - neonatal presentation
|
|
Joubert Syndrome
|
"Cerebellar malformation - neonatal presentation
|
|
Medulloblastoma
|
"Midline Cerebellar tumor
|
|
Dysarthria - clumsy hand syndrome
|
"Due to infarction in superior cerebellar artery
|
|
Post-infectious cerebellitis
|
"Acute cerebellar ataxia - explosive onset of gait ataxia and nystagmus
|
|
Multiple Sclerosis
|
"Chronic inflammatory disease of CNS
|
|
Paraneoplastic cerebellar degeneration
|
"Tumor associated degeneration - associated w/ specific anti-neuronal antibodies
|
|
Toxic Cerebellar Disease
|
"Acute or chronic
|
|
Spinocerebellar Ataxia
|
"Group of autosomal dominant disorders
|
|
Basal Ganglia - Input nuclei
|
"Striatum - Caudate and Putamen
|
|
Basal Ganglia - Output nuclei
|
Substantia nigra Pars Reticularis and Globus Pallidus Interna
|
|
Basal Ganglia - Intrinsic nuceli
|
Globus Pallidus Externa, Substantia Nigra Pars Compacta, and Subthalamic Nuclei
|
|
Lenticular Nucleus
|
Putamen and Globus Pallidus
|
|
Substantia Nigra
|
"Dopmaine oxidizes to form quinones --> polymetize into neuromelanin (black)
|
|
Basal Ganglia - Direct Pathway
|
"Initiation of movement - learning positive outcomes associated w/ behaviors
|
|
Basal Ganglia - Indirect Pathway
|
"Termination of movement - learning negative outcomes associated w/ behaviors
|
|
Parkinson's Disease - Histology
|
"Aggregation of α-synuclein into cytoplasmic Lewy Bodies
|
|
Parkinson's Disease - Signs and Symptoms
|
"Bradykinesia - slow initiation of voluntary movement / lack of spontaneous movement
|
|
Parkinson's Disease - Pathology
|
"Loss of dopamine input to striatum
|
|
Huntington's Disease - Signs and Symptoms
|
"Chorea - brief, jerk-like movements
|
|
Huntington's Disease - Genetics
|
"Triplet repeat expansion - CAG
|
|
Huntington's Disease - Pathology
|
"Selective loss of medium spiny GABAergic neurons in striatum
|
|
Motor defects - Cerebellar / Pyramidal / Basal Ganglia
|
"Brainstem / Cerebellar injury --> Ataxia
|
|
Striatum Interneurons
|
"95% medium spiny - GABA - Inhibitory
|
|
Dopamine Biosynthesis
|
"Tyrosine --> L-DOPA --> Dopamine
|
|
Parkinson's Pharmacology - Levodopa
|
"Levodopa replacemtn of dopamine - crosses BBB
|
|
Parkinson's Pharmacology - DA receptor agonists
|
Longer lasting effects than L-DOPA, more selective receptor stimulation
|
|
Parkinson's Pharmacology - inhibit DA breakdown
|
Inhibitors of monoamine oxidase (MAO-B) and catechol-O-methyltransferase (COMT)
|
|
Parkinson's Pharmacology - ACh muscarinic antagonists
|
Block ACh-M receptor activity in striatal interneurons - relieve inhibition on thalamus
|
|
Parkinson's Therapy - Deep brain stimulation
|
Inactivate GPi or STN
|
|
Huntington's Disease Pharmacology
|
"Nothing available to halt disease progression
|
|
Tremor
|
Rhythmical and sinusoidal movement
|
|
Parkinson's Disease v Essential Tremor
|
"PD: Asymmetrical, Rest > postural/action
|
|
Chin Tremor and Facial Masking
|
Parkinson's Disease
|
|
Head tremor
|
Essential Tremor
|
|
Chorea
|
"Irregular, random, abrupt, flowing movement
|
|
Athetosis
|
Low amplitude chorea - affects distal muscles
|
|
Ballismus
|
High amplitude chorea - affects proxmial muscles
|
|
Hemiballismus
|
"Unilateral High amplitude chorea - affects proximal muscles
|
|
Myoclonus
|
"Irregular shock-like movements
|
|
Tic
|
"Abrupt, brief, stereotyped movement
|
|
Dystonia
|
"Sustained muscle contractions w/ twisitng posutres
|
|
Writer's Dystonia
|
Task-specific
|
|
Parkinsonism
|
"Core common features - Rigidity, Akinesia / Bradykinesia, Basal Ganglia Pathology
|
|
Multiple Systems Atrophy
|
"Parkinsonism + Autonomic Failure
|
|
Progressive Supranuclear Palsy
|
"Parkinsonism + opthalmoparesis (weakness in eye movement muscles)
|
|
Corticobasal Degeneration
|
"Parkinsonism + Apraxia and Dystonia
|
|
Wilson's Disease
|
"Parkinsonism + Dystonia (young onset)
|
|
Diencephalon subdivisions
|
"Dorsal Thalamus - Thalamus
|
|
Thalamus boundaries
|
"Anteriorly - interventricular foramen
|
|
Thalamus anatomy - myelinated fibers
|
"Internal Medullar Lamina
|
|
Thalamus anatomy - Lateral Division - nuclei / function
|
"Dorsal Tier:
|
|
Thalamic relay nuclei
|
"VPL/VPM - sensory relay for body / head
|
|
Thalamic association nuclei
|
"Dorsomedial Nucleus:
|
|
Thalamic neurons - types
|
"Thalamocortical - glutaminergic excitatroy projection neurons
|
|
Thalamo-cortico-thalamic circuit
|
"Thalamocortical (TC) projection neurons (Glu) to cortex - no TC-TC connections
|
|
Thalamocortical neuron electrophysiology
|
"Tonic: Vm = -55mv --> depolarization causes sustained discharge
|
|
Thalamocortical Tonic-Burst Transition
|
"Tonic firing = relay mode --> faithfully relays prethalamic input to cortex
|
|
CNS Acetylcholine source
|
Nucleus Basalis of Meynert, brainstem reticular formation
|
|
CNS Noradrenaline source
|
Locos coeruleus
|
|
CNS serotonin source
|
Periacqueductal Gray, Dorsal Raphe Nucleus
|
|
CNS dopamine source
|
Substantia Nigra Pars Compacta
|
|
Human Paleocortex
|
Base of telencephalon - involved w/ olfaction
|
|
Human Archicortex
|
Hippocampus
|
|
Agranular Cortex
|
"Apparent lack of stellate (granule) cells
|
|
Granular Cortex
|
"Many small cells (pyramidal and non-pyramidal)
|
|
Homotypical / Heterotypical Cortex
|
"Homotypical - 6 distinct neocortical layers
|
|
Cortical Columnar Orientation
|
"Cells arranged in column perpendicular to cortical surface
|
|
Cortical Pyramidal Cells
|
"Excitatory, glutaminergic projection neurons
|
|
Cortical Spiny Stellate (granule) cells
|
"Excitatory, glutaminergic interneurons
|
|
Cortical Basket Cells
|
"Inhibitory GABAergic interneurons
|
|
Regular Spiking (RS) Cortical Cells
|
"Generate sustained firing proportional to depolarizing input
|
|
Fast Spiking (FS) Cortical Cells
|
"Thin action potentials, brief spike afterhyperpolarizaton (HAP)
|
|
Bursting Cells
|
"All-or-none bursr of high frequency spikes
|
|
Properties of local cortical circuits
|
"Recurrent excitatory input b/w neighboring excitatory cells - synapse on spines
|
|
Route of information flow through cortex
|
Thalamus --> L4 --> L2/3 <--> L5 --> L6 --> Thalamus
|
|
Somatosensory nerve endings
|
Generate graded potentials - behave like dendrites
|
|
Somatosensory free nerve endings
|
"Tuned for pain, temperature, and crude touch
|
|
Slow adapting somatosensory receptors
|
"Signal sustained presence of stimulus
|
|
Fast adapting somatosensory receptors
|
"Signal onset and offset of stimulus
|
|
Lateral / Surround Inhibition
|
"Stimulation of receptor excites cell - axon collateral to recurrent inhibitory interneurons
|
|
Cortical Representation - Receptive Fields
|
"Increased cortical representation --> increased receptor density, 2 point discrimintation
|
|
Primary SS cortex - body representation - stimulus type
|
"3a - muscle afferents
|
|
Cranial Nerves Exiting at Ponto-Medullary Junction
|
VI, VII, and VIII
|
|
Laterally exiting cranial nerves
|
V, VII, IX, and X - all mixed sensory / motor
|
|
Medially exiting cranial nerves
|
III, IV, VI, and XII - all motor
|
|
Medial Lemniscus Position in Brainstem
|
"Moves from medial to lateral position while ascending
|
|
Anterolateral System Position in Brainstem
|
Courses in lateral aspect - does not change location
|
|
Descending Hypothalamic Fiber Position in Brainstem
|
Courses in lateral aspect w/ ALST - does not change position
|
|
Brainstem Anatomy - 4th ventricle in…
|
Pons and Rostral Medulla
|
|
Brainstem Anatomy - Cerebral aqueduct in…
|
Midbrain
|
|
Brainstem Anatomy - Central canal in…
|
Caudal Medulla
|
|
Brainstem Anatomy - Cerebellar Peduncles in…
|
"Medulla - ICP
|
|
Brainstem Anatomy - Olives in…
|
Rostal Medulla
|
|
Brainstem Anatomy - Pyramidal Decussation in…
|
Caudal Medulla - Medullary-cervical junction
|
|
Brainstem Anatomy - Caudal Medulla Structures
|
"Pyramidal Decussation
|
|
Brainstem Anatomy - Rostral Medulla Structures
|
"Inferior Olivary Nuclei - Dentate Cerebellar Nuclei looks similar but on dorsal aspect
|
|
Brainstem Anatomy - Caudal Pons Structures
|
"Transverse Pontine Fibers - Pontocerebellear fibers
|
|
Brainstem Anatomy - Rostral Pons Structures
|
"4th Ventricle
|
|
Brainstem Anatomy - Caudal Midbrain Structures
|
"Inferior Colliculi
|
|
Brainstem Anatomy - Rostral Midbrain Structures
|
"Superior Colliculi
|
|
Brainstem Anatomy - Arrangement of CN VI and CN VII
|
"CN VI nuclei located dorso-medial to CN VII nuclei
|
|
Facial Weakness - UMN v LMN
|
"Most cranial nerve LMN receive bilateral UMN input - except some LMN in facial nerve (VII)
|
|
Brainstem Nerve Fiber Classification
|
"G / S: General - whole body / Special - Head or Neck only
|
|
Neural Tube - Brainstem Patterning
|
"Neural Tube - Dorsal = Sensory / Ventral = Motor
|
|
Brainstem Cranial Nerve Nuclei Organization
|
"Discontinous columns of functionally similar motor nuclei
|
|
Brainstem Cranial Nerve Nuclei - GSE
|
"Column 1 next to midline - Innervated Skeletal Muscle
|
|
Brainstem Cranial Nerve Nuclei - GVE
|
"2nd column from midline - Pre-ganglionic Parasympathetics
|
|
Brainstem Cranial Nerve Nuclei - SVE
|
"3rd column from midline - Pharyngeal arch derived muscles
|
|
Brainstem Cranial Nerve Nuclei - SVA / GVA
|
"1st column from Sulcus Limitans - visceral sensory
|
|
Brainstem Cranial Nerve Nuclei - SSA
|
"2nd column from Sulcus Limitans - Vestibulocochlear sensory
|
|
Brainstem Cranial Nerve Nuclei - GSA
|
"3rd column from Sulcus Limitans - Continuous column of Trigeminal Nuclei (V)
|
|
Trigeminal Nerve - Sensory - Touch
|
"Large diameter afferents - cell bodies in Trigeminal Ganglion or Mesencephalic Nucleus
|
|
Trigeminal Nerve - Sensory - Pain and Temp
|
"Small diameter afferents - cell bodies in trigeminal ganglion
|
|
Nucleus Caudalis - Topography
|
"Spinal Trigeminal Nucleus - Facial Pain and Temperature - Onion Skin Pattern
|
|
Babinski Sign
|
"Stroke planta surface of foot
|
|
Unilateral Babinksi Sign
|
"Lesion of contralateral corticospinal tract
|
|
Bilateral Babinksi Sign
|
"Lesion of both corticospinal tracts
|
|
Spasticity
|
"Increased tone
|
|
Rigidity
|
"Increased tone
|
|
EMG - Spontaneous Activity
|
"Normal Muscle - Silent
|
|
Primary Olfactory Sensory Neurons
|
"Located in nasal neuroepithelium
|
|
Olfactory Bulb projections
|
"Lateral Olfactory Tract - Ipsilateral Targets
|
|
Olfactory Neuroepithelium Cells
|
"Olfactory Sensory Neurons - ciliated bipolar receptor cells
|
|
Olfactory Signal Transduction
|
"Odorant binding to GPCR in cilia of sensory neuron
|
|
Sensory Neuron Receptor Expression
|
"Single nuerons expresses single receptor type
|
|
Odor quality and intensity coding
|
"Combinatorial coding from multuple receptors
|
|
Olfactory Coding in Bulb
|
"Axons of sensory neurons expressing same receptor converge onto same glomerulus
|
|
Olfactory Bulb - Cell types
|
"Mitral/Tufted cells - excitatory glutaminergic projection neuron - excitatory input from OSN
|
|
Olfactory Bulb Lateral Inhibition
|
"M/T cell firing - secondary dendrites release glutamate --> excited granule cells
|
|
Cortical Olfactory Coding
|
"M/T cells project to olfactory cortex - Piriform (Paleocortex - 3 layers)
|
|
Anosmia
|
Absence of smell sensation - general or specific
|
|
Hyposmia / Hyperosmia
|
Decreased smell sensation / abnormally acute smell sensation
|
|
Dysosmia
|
Distortion of smell sensation
|
|
Phantosmia
|
Olfactory hallucination - dysosmia in absence of stimulus
|
|
Olfactory agnosia
|
Inability to recognize odor sensation - common in stroke patients
|
|
Odorant Qualities
|
"Volatile organic molecules
|
|
Taste Bud Location
|
"Clustered in circumvallate, foliate, and fungiform papillae on tonge
|
|
Taste Bud Innervation
|
"Anterior 2/3 of tongue - Facial Nerve VII - Chorda Tempani - Geniculate Ganglion
|
|
Taste Information to Cortex
|
"Sensory fibers in Geniculate and Petrosal Ganglion
|
|
Primary Gustatory Cortex
|
"Anterior Insular Cortex and Frontal Operculum
|
|
Gustatory Transduction - Salt
|
"Na+ stimulus
|
|
Gustatory Transduction - Sour
|
"H+ stimulus
|
|
Gustatory Transduction - Sweet, Umami, Bitter
|
"GPCR
|
|
Taste Cells - Receptors and Released products
|
"Each cell has single type of receptor (Salt, Sour, Sweet, Bitter, Umami)
|
|
Gustatory Receptors - Sweet, Umamia, Bitter
|
"Sweet = T1R2 + T1R3
|
|
Ageusia
|
Absence of taste sensation
|
|
Hypoguesia
|
Decreased sensation to tastants
|
|
Dysgeusia
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Distortion of taste sensation
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Gustatory agnosia
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Inability to recognize taste sensation
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Chemosensation Overview
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"Integration of Olfactory, Gustatory, and Somatosensory input
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Umami
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"MSG - monosodium glutamate
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Sweet
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"Sucrose, Lactose, Fructose
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Medulla Cranial Nerves
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IX, X, XI, XII
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Pons Cranial Nerves
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V, VI, VII, VIII
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Midbrain Cranial Nerves
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III, IV
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Characteristic Finidng of Brain Stem Disorder
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"Crossed hemiparesis
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Medially Located Brainstem Cranial Nerves and Tracts
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"CN III, IV, VI, XII
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Laterally Located Brainstem Cranial Nerves and Tracts
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"V, VII, VIII, and X
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Crossed Hemiparesis - Lesion of CN…
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III, VI, VII, XII
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Involvement of multiple cranial nerves on same side of body
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"Suggests lesion outside brainstem - extraaxial
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Pupillary Light Reflex
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"Tests integrity of Midbrain
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Corneal Reflex / Blink Reflex
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"Tests integrity of Pons
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Vestibulo-Occular Reflex
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"Tests integrity of brainstem from medulla to midbrain
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Internuclear Ophthalmoplegia
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"Disorder of Conjugate Lateral Gaze
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Brainstem Vasculature
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"Midline vessels branch of Basilar or Vertebral Arteries
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Isolated CN III palsy
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"Dilated pupil - Down and Out
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CN III palsy + Head Trauma
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"Temporal Lober herniation into midbrain
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Wernickes - Korsakoff's Disease
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"Triad of Double Vision, Confusion, and Ataxia
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CN V palsy
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"Jaw deviates TOWARDS weak side
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Wallenberg Syndrome
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"Lesion to Dorsal-Lateral Medulla
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CN IX or X palsy
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"Palate hemiparalysis
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CN XII palsy
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Ipsilateral tongue atrophy
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Brain major vascular supply
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"Receives 20% of cardiac output
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Brain Vascular Anatomy - Internal Carotid Artery
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"Enter skull through Foramen Lacerum
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Brain Vascular Anatomy - Vertebral Artery
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"Enter skull through Foramen Magnum
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Brain Vascular Anatomy - Circle of Willis
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"Posterior - Vertebral Arteries join to form Basilar Artery
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Brain Vascular Anatomy - Middle Cerebral Artery territory
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"Lateral Frontal Lobe, Parietal Lobe, Temproal Lobe, Insular Cortex, Putamen, and Internal Capsule
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Middle Cerebral Artery occlusion
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"Contralateral hemiparesis - face and arms affected more than legs (central in homonculous)
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Ophthalamic artery occlusion
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Ipsilateral monocular blindness
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Brain Vascular Anatomy - Anterior Cerebral Artery territory
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Medial Frontal Lobe, Cingulate, Corpus Callosum, Caudate
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Anterior Cerebral Artery occlusion
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"Contralateral lower extremity weakness - medial homonculous
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Brain Vascular Anatomy - Posterior Cerebral Artery territory
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Medial Temporal lobe, Occipital Lobe, Anteromedial Thalamus
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Posterior Cerebral Artery occlusion
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"Contralateral visual field loss (hemianopsia) - occipital
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Weber / Medial Midbrain Syndrome
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"Ipsilateral CN III palsy w/ contralateral hemiparesis
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Locked In / Pontine Syndrome
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"Occlusion of proximal or midbasilar artery - infarct in pons - Bilateral damage
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Wallenberg / Lateral Medullary Syndrome
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"Occlusion of PICA
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Signs common to Cerebellar Infarction
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"Sudden onset ataxia, vertigo, nausea and vomiting
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Major Clinical Finidings - Lacunar (small vessel) occlusion
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"Contralateral motor OR sensory deficit
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Penumbra
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"Viable brain tissue
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Brain Vascular Anatomy - Venous Drainage
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"Sup and Inf Sagital Sinus in midline
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Brain Vascular Anatomy - Cavernous Sinus
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"Located on each side of sella turcica
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Venous Sinus Thrombosis
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"Swelling --> hemorrhage
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Inferior Cerebellar Peduncle
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"Connects Medulla to Cerebellum - Afferent
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Middle Cerebellar Peduncle
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"Connects Cortex to Cerebellum (via Pons) - Afferent
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Superior Cerebellar Peduncle
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"Connects Cerebellum to Red Nucleus and VA/VL thalamus - Efferent
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