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293 Cards in this Set

  • Front
  • Back
What does the Nervous System originate from?
Neuroectoderm
Neural Crest
Mesoderm
What part of the NS originates from Neuroectoderm?
CNS neurons
Ependymal cells (make CSF)
Oligodendroglia
Astrocytes
What parts of the NS originate from the Neural Crest?
Schwann Cells
PNS neurons
What parts of the NS originate from mesoderm?
Microglia
What is Nissl?
RER in neuron cell bodies and dendrites
Fxns of Astrocytes?
Physical Support
Repair
K metabolism
Removal of excess NT's
Maintenance of BBB
Reactive gliosis in response to injury
Marker for astrocytes?
GFAP
What are Microglia?
CNS Phagocytes
How do Microglia change in response to tissue damage?
small irregular nuclei w/ relatively little cytoplasm
--->
large ameboid phagocytic cells
What happens to microglia in HIV?
HIV-infected microglia fuse to form multinucleated giant cells in the CNS
Fxn of Oligodendrocytes?
Each one myelinates multiple CNS axons (up to 30 each)
Appearance of Oligodendrocytes?
H&E: fried egg
Nissle stain: small nuclei, dark chromatin, little cytoplasm
What can destroy oligodendrocytes?
Multiple Sclerosis
Fxn of Schwann Cells?
Each one myelinates 1 PNS axon
Promote axonal regeneration
What can destroy Schwann Cells?
Guillain-Barre syndrome
Neoplasm associated w/ Schwann cells?
Acoustic Neuroma (schwannoma)
Typical location of Acoustic Neuroma?
Internal Auditory Meatus (CN VIII)
Different Types of Sensory Corpuscles?
Free Nerve Endings
Meissner's Corpuscles
Pacinian Corpuscles
Merkel's Disks
Types of Free Nerve Endings?
C fibers
A-delta fibers
Where are they located and what do they sense:
Free Nerve Endings?
All skin
Epidermis
Some viscera

Pain and Temperature
Where are they located and what do they sense:
Meissner's Corpuscles?
Glabrous (hairles) Skin

Dynamic fine touch (e.g. manipulation)
adapt quickly
Where are they located and what do they sense:
Pacinian Corpuscles?
Deep skin layers
ligaments
joints

Vibration
Pressure
What do Merkel's Disks look like?
Cup-Shaped
Unencapsulated
Where are they located and what do they sense:
Merkel's Disks?
Hair follicles

Static Touch (shapes, edges, textures)
adapt slowly
Peripheral Nerve Layers (inside out)?
Endoneurium
Perineurium
Epineurium
What does Endoneurium surround?
Single Nerve Fiber
Fxn of Perineurium?
Permeability Barrier
Surrounds fascicle of nerve fibers
Must be rejoined in limb reattachment
Fxn of Epineurium?
Dense CT surrounds entire nerve (fascicles and blood vessels)
Types of NT's?
NE
Dopamine
5-HT
ACh
Changes in Disease for NE?
Inc in Anxiety
Dec in Depression
Changes in Disease for Dopamine?
Inc in schizophrenia (inc DA/ACh ratio)
Dec in Parkinson (dec DA/ACh ratio)
Changes in Disease for 5-HT?
Dec in anxiety and depression
Changes in Disease for ACh?
Dec in Alzheimer's and Huntington's
Location of Synthesis for NE?
Locus Ceruleus
Location of Synthesis for DA?
Ventral Tegmentum
Substantia Nigra (pars compacta)
Location of Synthesis for 5-HT?
Raphe nucleus
Location of Synthesis for ACh?
Basal Nucleus of Meynert
What makes up the BBB?
1. Tight Junctions between nonfenestrated capillary endothelial cells
2. BM
3. Astrocyte Processes
What is able to cross the BBB under normal conditions? how?
Glucose and AA's cross slowly by carrier-mediated transport mechanisms

Nonpolar/Lipid soluble substances cross rapidly via diffusion
Exceptions to BBB?
Few specialized areas w/ fenestrated caps and no BBB allow molecules in blood to affect brain fxn or neurosecretory products to enter circulation?
2 Examples of areas where a lack of BBB allows molecules to affect brain fxn?
Area Postrema: chemo--->vomiting

organum vasculosum of the lamina terminalis (OVLT) (aka supraoptic crest): osmotic sensing
Other blood barriers in body?
Blood-Testis barrier
Maternal-Fetal blood barrier of placenta
effect of infarction on BBB?
destroys endothelial tight junctions---> vasogenic edema
Fxns of Hypothalamus? mnemonic?
TAN HATS

Thirst and water balance
Adenohypophysis control
Neurohypophysis releases hormones
Hunger
Autonomic regulation
Temp regulation
Sexual urges
Inputs to Hypothalamus?
OVLT
Area postrema
Where are the post. pit. hormones produced?
Supraoptic Nucleus: ADH
Paraventricular nucleus: Oxytocin
What is the fxn of the Lateral area of the Hypothalamus?
Hunger

so destruction---> anorexia
What ihibits the lateral hypothalamus?
Leptin
Fxn of Ventromedial Hypothalamus?
Satiety

destruction--->hyperphagia
What stimulates Ventromedial Hypothalamus?
Leptin

so leptin stops your hunger and increases your feeling of being full
Fxn of Anterior Hypothalamus?
Cooling
Parasympathetic
Fxn of Posterior Hypothalamus?
Heating
Sympathetic
Fxn of Septal Nucleus of Hypothalamus?
Sexual urges
Fxn of Suprachiasmatic Nucleus?
Circadian Rhythm
General Fxn of Thalamus?
Major relay for asc. sensory info that ultimately reaches cortex
Important Nuclei of the Thalamus?
Lateral Geniculate (LGN)
Medial Geniculate (MGN)
Ventral Posterior nucleus, lateral part (VPL)
Ventral Posterior n, medial part (VPM)
Ventral Anterior and Lateral Nuclei (VA/VL)
Fxn's of LGN?
Visual
Fxn's of MGN?
Auditory
Fxn's of VPL?
Body Sensation (proprioception, pressure, pain, touch, vibrations)
Fxn's of VPM?
Facial Sensation (via CN V)
Fxns of VA/VL nuclei?
Motor
Blood supply to Thalamus?
Posterior Communicating
Posterior Cerebral
Anterior Choroidal Arteries
Structures of the Limbic System?
Cingulate Gyrus
Hippocampus
Fornix
Mammillary Bodies
Functions of Limbic System? mnemonic?
5 F's
Feeding
Fleeing
Fighting
Feeling
Sex
Where does the Cerebellum's input come from?
Contralateral Cortical Input via Middle cerebellar Peduncle

Ipsilateral proprioceptive info via Inferior Cerebellar peduncle

Input nerves = climbing and mossy fibers
What kind of output does the Cerebellum give out?
Stimulatory feedback to contralateral CTX to modulate movement

Output nerves = Purkinje fibers output to deep nuclei of cerebellum, which in turn output to CTX via Superior Cerebellar Peduncle
Nuclei of Cerebellum?
Deep Nuclei(L-->M) Dentate, Emboliform, Globuse, Fastigial
What are the Fxns of the Lateral and Medial Vermi?
Lateral: Voluntary movements of extremities

Medial: Balance, Truncal coordination
2 pathways of the Basal Ganglia?
Excitatory (direct)
Inhibitory (indirect)
Fxn of DA on the 2 basal ganglia pathways?
DA stimulates the excitatory path (inc motion)
DA inhibits the inhibitory pathway---> inc motion

So in parkinson's, when you have dec DA, you get decreased motion x's 2
Gross morphological changes associated w/ Parkinson's?
Lewy Bodies (of alpha-synuclein)
Depigmentation of substantia nigra pars compacta (loss of dopaminergic neurons)
Rare cause of Parkinson's?
MPTP

contaminant of street drugs
What is Hemiballismus?
sudden, wild flailing of 1 arm
Cause of Hemiballismus?
Lesion of contralateral subthalamic nuclei
Loss of inhibition of thalamus through globus pallidus.

Normally, the inhibitory pathway tells me to not move my arm. Without that pathway (i.e. w/ a lesion of the STN) my arm can do what it wants
Inheritance and Genetics of Huntington's?
Auto Dom trinucleotide repeat disorder.
Chromosome 4
CAG repeats
Gross Morphological Changes seen in Huntington's?
Atrophy of Caudate Nucleus (loss of GABAergic neurons)--->enlarged ventricles on CT
Sx's of Huntington's?
Chorea
Depression
Progressive Dementia
What is chorea?
sudden, jerky, purposeless movements
Typical etiology of chorea?
Basal Ganglia lesions
What is Athetosis?
Slow, writhing movements
esp of fingers
Typical etiology of Athetosis?
Basal Ganglia lesions TOO!
(seen in HD)
3 Types of Tremors?
Essential/Postural
Resting
Intention
What is an essential tremor? etiology?
Action Tremor
Auto Dom disorder
Rx for Essential Tremor?
Alcohol (self-medication)
Beta-Blockers
When do you see resting tremors? most affected part of body?
PD (pill-rolling tremor)
Most noticeable distally
What is an Intention tremor?
slow, zigzag motion when pointing toward a target
General etiology of Intention Tremor?
Cerebellar dysfxn
Where are Broca's and Wernicke's areas? fxns?
Broca's is more anterior area and handles motor speech

Wernicke's is more posterior near root of temporal lobe and handles the Associative auditory cortex

Both are located on Dominant Hemisphere
Frontal Lobe Fxns?
Planning
Inhibition
Concentration
Orientation
Language
Abstraction
Judgment
Motor Regulation
Mood
how is the homunculus arranged?
medial to lateral
feet
legs
trunk
arms
hands
face

this is mostly the same for motor and sensory
Patient presents w/ ____, where is their lesion?
Motor aphasia w/ good comprehension (nonfluent/expressive)
Broca's area
Patient presents w/ ____, where is their lesion?
Sensory aphasia (fluent/receptive) w/ poor comprehension, neologisms
Wernicke's
Patient presents w/ ____, where is their lesion?
Conduction Aphasia; good comprehension, fluent speech, but poor repetition
Arcuate fasciculus
Patient presents w/ ____, where is their lesion?
Kluver-Bucy Syndrome: hyperorality, hypersexuality, disinhibited behavior
Amygdala (bilateral)
Patient presents w/ ____, where is their lesion?
Personality changes, deficits in concentration, orientation, and judgment
May have reemergence of primitive reflexes?
Frontal Lobe
Patient presents w/ ____, where is their lesion?
Spatial Neglect Syndrome (agnosia of the contralateral side of the world)
Right Parietal Lobe
Patient presents w/ ____, where is their lesion?
Reduced level or arousal and wakefulness (e.g. coma)?
Reticular Activating System (midbrain)
Patient presents w/ ____, where is their lesion?
Wernicke-Korsakoff Syndrome (confusion, confabulation, ophthalmoplegia, ataxis)
Mammillary Bodies (bilateral)
Patient presents w/ ____, where is their lesion?
Tremor at rest, chorea, athetosis?
Basal Ganglia
Patient presents w/ ____, where is their lesion?
Intention Tremor
Limb ataxia
Falls
Cerebellar Hemisphere

damage to cerebellum results in ipsilateral deficits, so the pt will fall towards the side of the deficit
Patient presents w/ ____, where is their lesion?
Truncal ataxia
dysarthria
Cerebellar vermis
What is dysarthria?
motor inability to speak
Patient presents w/ ____, where is their lesion?
Contralateral hemiballismus?
Subthalamic Nuclei
Patient presents w/ ____, where is their lesion?
Anterograde amnesia (can't make new memories)
Hippocampus
Patient presents w/ ____, where is their lesion?
Eyes look away from side of lesion?
Paramedian pontine reticular formation (PPRF)
Patient presents w/ ____, where is their lesion?
Eyes look towards lesion?
Frontal Eye Fields
What is aphasia?
higher-order inability to speak
What are the 4 main types of Aphasia?
broca's
wernicke's
Global
Conduction
Compare Broca's and Wernicke's?
B: Nonfluent aphasia w/ intact comprehension
W: Fluent aphasia w/ impaired comprehension
What is global aphasia/
G: Nonfluent aphasia w/ impaired comprehension

i.e. both broca's and wernicke's areas affected
What is conduction aphasia?
Poor repetition, but fluent speech w/ intact comprehension

damaged arcuate fasciculus which connects broca's and wernicke's areas
areas of brain supplied by posterior, middle, and anterior cerebral arteries?
Anterior: Medial surface of brain, leg-foot area of motor/sensory ctx

Middle: Lateral brain, trunk-arm-face area of motor/sensory ctx, broca's, wernicke's, optic radiations, attention

Posterior: Visual CTX
What is the most common site of circle of willis aneurysms? sx?
Ant. Communicating artery

visual field deficits from impingement on optic chiasm
Aneurysm of Post. Communicating artery--->?
CN III palsy
Where do the Lateral Striate arteries come from? what do they supply?
Come from Middle cerebral
Supply Internal Capsule, caudate, putamen, globus pallidus
What does an infarct of the internal capsule--->?
Pure Motor Hemiparesis
What are the main watershed areas? significance?
between ant and mid cerebral a's
between mid and post cerebral a's

Damaged by severe HTN---> upper leg/upper arm weakness and defects w/ higher-order visual processing
What is Wallenberg's Sydnrome? Sx? Cause?
Infarct of PICA
Sx: nystagmus, ipsilateral ataxia, N&V, horner's syndrome
What causes locked-in syndrome?
Basilar Artery Infarct
In general, what does a stroke of the anterior circle of willis--->?
General sensory and motor dysfxn
Aphasia
In general, what does a stoke of the posterior circle of willis--->?
CN deficits (Vertigo, visual deficits)
Coma
Cerebellar deficits (ataxia)
Location of Berry Aneurysm?
Bifurcation of circle of willis
most common ant. communicating
Most common complication w/ a Berry Aneurysm?
Rupture--->hemorrhagic stroke or subarachnoid hemorrhage
Disease associations w/ Berry Aneurysm?
Adult Polycystic Kidney Disease
Ehlers-Danlos
Marfan's
Other risk factors for Berry's?
Older age
HTN
Smoking
Race (inc w/ blacks)
What are Charcot-Brouchard aneurysms?
Microaneurysms affecting small vessels
What areas are usually affected by Charcot-Brouchard aneurysms?
Basal Ganglia
Thalamus
disease association for Charcot-Brouchard aneurysms?
Chronic HTN
Most common cause Epidural Hematoma?
Ruputre of Middle meningeal artery secondary to fracture of temporal bone
Sx's of Epidural Hematoma?
lucid interval
CT of Epidural Hematoma?
Biconvex Disk not crossing suture lines

can cross falx and tentorium
Causes of Subdural Hematoma?
Rupture of bridging veins
Sx's and onset of Subdural hematoma?
Venous bleeding is under less pressure--->delayed onset of Sx's
Risk factors for Subdural Hematomas?
Elderly
Alcoholics
Blunt Trauma
Shaken Baby
CT of Subdural hematoma?
Crescent-shaped hemorrhage that crosses suture lines

can't cross falx and tentorium
Cause of Subarachnoid hemorrhage?
Rupture of Aneurysm (usually berry) or an AVM
Sx's of Subarachnoid Hemorrhage?
Worst HA of life
Bloody or yellow CSF
Delayed risk for subarachnoid hemmorhage? rx?
2-3 days later there is a risk of vasospasm

rx w/ CCB's
What causes parenchymal hematoma?
HTN
Amyloid angiopathy
DM
Tumor
Typical locations for parenchymal hematoma?
Basal Ganglia
Internal Capsule
3 types of strokes?
Hemorrhagic
Ischemic
Transient
Causes of Hemorrhagic Stroke?
Intracerebral bleeding
aneurysm rupture
Secondary to ischemic stroke following reperfusion (inc vessel fragility)
Causes of Ischemic Strokes?
emboli block large vessels

A-fib
Carotid Dissection
patent Foramen Ovale
Endocarditis
What are small vessel ischemic infarcts called? causes?
Lacunar Strokes
secondary to HTN
Rx for Ischemic strokes?
tPA w/in 3 hours
What is a TIA?
brief, reversible episode of neurologic dysfxn due to focal ischemia

Sx's last < 24 hrs
Strokes on Imaging?
MRI: bright on diffusion-weighted MRI w/in 30 minutes

CT: Dark on CT in a day
Starting from the tippy top of my head, how does blood get out of my head?
Superior Sagittal Sinus
Confluence of Sinuses
Transverse Sinus
Sigmoid Sinus
Internal Jugular V
Staring more interior of head, how does blood get out?
Inferior Sagittal Sinus and Great Vein of Galen come together to become Straight sinus
Straight sinus meets up w/ superior sagittal sinus at confluence
Who drains the inferior, anterior brain?
cavernous sinus
Who makes CSF?
Ependymal cells lining the ventricles
How is CSF reabsorbed?
Arachnoid granulations in venous sinuses (mostly in superior sagittal)
How does CSF get from Lateral ventricles to Spinal cord?
Lateral V's
Foramen of Monro
3rd V
Cerebral Aqueduct
4th V
To subarachnoid space via Foramina of Luschka (lateral) and Foramen of Magendie (medial)
What is Hydrocephalus?
Accumulation of excess CSF in ventricular system---> inc ICP and ventricular dilation
how does hydrocephalus present?
inc ICP and ventricular dilation---> Triad: dementia (wachy), gait problems (wobbly), and urinary incontinence (wet)
3 types of Hydrocephalus?
Normal pressure (communicating)
Obstructive (noncommunicating)
Hydrocephalus ex vacuo
Cause of Normal pressure Hydrocephalus?
Impaired absorption of CSF by arachnoid granulations (e.g. arachnoid adhesions post-meningitis)
Cause of Obstructive Hydrocephalus?
Structural blockage of CSF circulation w/in ventricular system (e.g. stenosis of aqueduct)
Cause of Hydrocephalus ex vacuo?
appearance of inc CSF in atrophy
ICP normal, no Sx's
How many spinal nerves are there? divisions?
31
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
how do spinal nerves exit the vertebral column?
C1-C7 exit above their corresponding vertebrae
The rest exit below
Most common site of vertebral herniation?
between L5 and S1
In adults where does the SC end? how bout subarachnoid space? importance?
SC at level of L1-L2
subarachnoid to lower border of S2

So do a puncture around L3-L4 or L4-L5
What are the 7 structures you have to pierce to get a spinal tap?
Skin
Ligaments (supraspinous, interspinous, ligamentum flavum)
Epidural space
Duramater
Subdural space
Arachnoid
Subarachnoid space (csf!!)
3 Main tracts of SC?
Dorsal Columns
Lateral Corticospinal Tract
Spinothalamic Tract
What does the Spinothalamic tract transmit? organization?
From medial to lateral, it goes cervial to sacral (legs are lateral)

Transmits pain and temperature
What do the Lateral Corticospinal tracts transmit? organization/
Voluntary Motor

Legs are Lateral
arms are medial
What do the Dorsal Columns transmit?
Pressure
Vibration
Touch
Proprioception
How are the Dorsal Columns divided up? significance?
Fasciculus Cuneatus (lateral)
Fasciculus Gracilis (medial)

Cuneatus: upper body, extremities

Gracilis: lower body, extremities

so not legs are not lateral
Where are the Sympathetics transmitted in the SC?
Intermediate horns (only in thoracic cord)
Which tracts are ascending? descending?
Dorsal columns and Spinothalamic are ascending

Corticospinal is descending
Take the Dorsal column from the 1st order neuron all the way up?
Sensory Nerve Endings---> cell body in DRG---> enters SC and ascends ipsilaterally in dorsal column

Synapses at ipsilateral nucleus cuneatus or gracilis in Medulla

Crosses over in medulla and ascends contralaterally in medial lemniscus

Synapses at VPL of thalamus

Relayed to Sensory CTX
Take the Spinothalamic tract from the 1st order neuron all the way to the top?
Sensory Nerve Endings (a-delta and C)---> cell body in DRG---> SC

Ascends ipsilaterally in gray matter

Crosses at Anterior White Commissure and ascends contralaterally

Synapses at VPL and is relayed to Sensory CTX
Take the Lateral Corticospinal tract from the top down?
UMN's cell body in Primary Motor CTX--->descends ipsilaterally through internal capsule and crosses at caudal medulla (pyramidal decussations--->desc contralaterally

Synpases at cell body in anterior horn of SC (LMN)

Leaves SC--->NMJ
What does a UMN lesion do to:
Weakness
Atrophy
Fasciculations
Reflexes
Tone
Babinski
Spastic Paralysis
UMN
Inc weakness
no atrophy
no fasciculation
Inc reflexes
inc Tone
Positive babinski
Does exhibit spastic paralysis
What does a LMN lesion do to:
Weakness
Atrophy
Fasciculations
Reflexes
Tone
Babinski
Spastic Paralysis
Inc weakness
Inc atrophy
Inc Fasciculations
dec reflexes
dec tone
negative babinski
No spastic paralysis
Which tracts are ascending? descending?
Dorsal columns and Spinothalamic are ascending

Corticospinal is descending
How do you get Poliomyelitis?
Poliovirus via F-O route
Course of Poliomyelitis?
Virus replicates in oropharynx and SI before heading via the blood to the CNS where it destroys cells in anterior horn of SC--->LMN destruction
Take the Dorsal column from the 1st order neuron all the way up?
Sensory Nerve Endings---> cell body in DRG---> enters SC and ascends ipsilaterally in dorsal column

Synapses at ipsilateral nucleus cuneatus or gracilis in Medulla

Crosses over in medulla and ascends contralaterally in medial lemniscus

Synapses at VPL of thalamus

Relayed to Sensory CTX
Sx's of Poliomyelitis?
LMN sx's:
weakness and atrophy
fasciculations
fibrillation
hyporeflexia

Malaise
HA
fever
Nausea
Abd pain
sore throat
Take the Spinothalamic tract from the 1st order neuron all the way to the top?
Sensory Nerve Endings (a-delta and C)---> cell body in DRG---> SC

Ascends ipsilaterally in gray matter

Crosses at Anterior White Commissure and ascends contralaterally

Synapses at VPL and is relayed to Sensory CTX
Clinical findings w/ Poliomyelitis?
CSF w/ lymphocytic pleocytosis and slight elevation of protein (no change in glucose)

Virus recovered from stool or throat (hopefully not stool in throat)
Take the Lateral Corticospinal tract from the top down?
UMN's cell body in Primary Motor CTX--->descends ipsilaterally through internal capsule and crosses at caudal medulla (pyramidal decussations--->desc contralaterally

Synpases at cell body in anterior horn of SC (LMN)

Leaves SC--->NMJ
What does a UMN lesion do to:
Weakness
Atrophy
Fasciculations
Reflexes
Tone
Babinski
Spastic Paralysis
UMN
Inc weakness
no atrophy
no fasciculation
Inc reflexes
inc Tone
Positive babinski
Does exhibit spastic paralysis
What does a LMN lesion do to:
Weakness
Atrophy
Fasciculations
Reflexes
Tone
Babinski
Spastic Paralysis
Inc weakness
Inc atrophy
Inc Fasciculations
dec reflexes
dec tone
negative babinski
No spastic paralysis
How do you get Poliomyelitis?
Poliovirus via F-O route
Course of Poliomyelitis?
Virus replicates in oropharynx and SI before heading via the blood to the CNS where it destroys cells in anterior horn of SC--->LMN destruction
Sx's of Poliomyelitis?
LMN sx's:
weakness and atrophy
fasciculations
fibrillation
hyporeflexia

Malaise
HA
fever
Nausea
Abd pain
sore throat
Clinical findings w/ Poliomyelitis?
CSF w/ lymphocytic pleocytosis and slight elevation of protein (no change in glucose)

Virus recovered from stool or throat (hopefully not stool in throat)
What is Werdnig-Hoffman disease? inheritance?
Infantile Spinal Muscular Atrophy
Auto Rec disorder associated w/ degeneration of ant. horns w/ LMN involvement only
Sx's of Werdnig-Hoffman?
Floppy Baby
Tongue Fasciculations
Life expectancy w/ Werdnig-Hoffman?
Median age of death = 7 months
What is ALS?
Amyotrophic Lateral Sclerosis (lou gehrig's)
Sx's of ALS?
UMN and LMN signs!!!
No Sensory, Cognitive, or Oculomotor deficits
Possible etiology of ALS?
Defect in Superoxide Dismutase 1 (SOD1)
Betel Nut Ingestion
What is Tabes Dorsalis?
Degeneration of the Dorsal Columns and Dorsal roots due to Tertiary Syphilis
Sx's of Tabes Dorsalis?
Impaired Proprioception
Locomotor Ataxia
Charcot's joints
Shooting (lightning pain)
Argyll Robertson pupils
Absent DTR's
What are Charcot's Joints
Chronic, progressive degeneration of one or more joints

swellin, instability, heat, hemorrhage, etc
What are Argyll Robertson pupils?
Prostitute pupils!

accomodate, but don't react (to light)
What is Friedreich's Ataxia? genetics?
Auto Rec Trinucleotide repeat disorder (GAA)---> impaired mitochondrial functioning
Sx's of Friedreich's Ataxia?
Staggering Gait
Frequent Falling
Nystagmus
Dysarthria
Hypertrophic cardiomyopathy
How does Friedrich's Ataxia present?
in childhood w/ kyphoscoliosis
What is Brown-Sequard Syndrome?
Hemisection of SC
Sx's and Findings for Brown-Sequard?
1. Ipsilateral UMN lesion sx's below lesion (corticospinal)
2. Ipsilateral loss of tactile, vibration, proprioception below lesion (dorsal column)
3. Contralateral pain and temp loss below lesion (spinothalamic)
4. Ipsilateral loss of all sensation at level of lesion
5. LMN signs (e.g. paralysis) at level of lesion
What if the Brown-Sequard lesion is above T1?
You also get Horner's Syndrome
What is Horner's Syndrome?
Sympathectomy of the Face
Sx's of Horner's?
Ptosis
Anhidrosis (absent sweating) and flushing
Miosis (pupil constriction)
What is Horner's usually associated w/?
Lesion of SC above T1
Landmarks for Pudendal nerve block? lumbar puncture?
PNB: ischial spine

LP: Iliac crest
Landmark Dermatomes:
C2
C3
C4
C2 posterior half of skull
C3 high turtleneck
C4 low collar shirt
Landmark Dermatomes:
T4
T7
T10
T4: nipple
T7: xiphoid process
T10: umbilicus
Landmark Dermatomes:
L1
L4
wiener
L1: inguinal ligament
L4: knee caps
S2, 3, 4 keep the wiener off the floor (erection and sensation of penile and anal zones)
How does Muscle Spindle work?
Spindle in parallel w/ muscle fibers
Muscle stretch--->intrafusal stretch---> stimulates Ia afferent---> corresponding alpha motor neuron--->reflex extrafusal contraction
What is up w/ the Gamma Loop of spindle?
CNS stimulates gamma motor neuron--->contracts intrafusal fiber---> inc sensitivity of reflex arc
Clinical Reflexes and who they're testing?
Biceps: C5, 6
Triceps: C7, 8
Patella: L3, 4
Achilles: S1, 2
Babinski: sign of UMN lesion after 1 year of age
5 Primitive Reflexes?
Moro: extension of limbs w/ scare
Rooting: nipple seeking
Sucking: roof of mouth
Palmar and Plantar: curling of fingers/toes if palm stroked
Babinski: fan up
Which CN's lie medially at BS?
3, 6, 12
Location and Fxn of Pineal Gland
Dorsal view of BS. Superior and medial

Secretes melatonin and thus controls circadian rhythms
What lies below Pineal Gland in same view?
Superior and Inferior Colliculi (in pairs)
Fxns of Colliculi? Pathology?
Superior: Conjugate vertical gaze center. Lesion here--->paralysis of conjugate vertical gaze = Parinaud Syndrome

Inferior: auditory
What does CN III control?
SR, IR, MR, IO muscles
Pupillary Constriction
Accomodation
Eyelid Opening (levator palpebrae)
Who are CN V, VII, IX, XII?
V: Trigeminal
VII: facial
IX: Glossopharyngeal
XII: Hypoglossal
Fxn of CN V?
Trigeminal

Muscles of Mastication
Facial Sensation
Fxns of CN VII?
Facial Movements
Taste for ant 2/3 of tongue
lacrimation
Salivation (submand, subling)
Eyelid closing (orbicularis orculi)
Stapedius muscle (ear)
Fxns of CN IX?
Taste for post. 1/3 tongue
Swallowing
Salivation (parotid)
Monitors Carotid body and sinus
Stylopharyngeus (elevates pharynx, larynx)
Fxns for CN X?
Taste from epiglottic region
Swallowing
Palate elevation
Talking
Coughing
Thoracoabdominal viscera
Monitor Aortic arch chemo and baro-receptors
Fxns of CN-XII?
Tongue movements
Where are the nuclei for the CN's located?
Tegmentum of BS

Midbrain: III, IV
Pons: V, VI, VII, VIII
Medulla: IX, X, XI, XII
How does nuclei location affect fxn?
Lateral: sensory
Medial: motor
CN Reflexes? aff? eff?
Corneal: aff-V1, eff-VII
Lacrimation: aff-V1, eff-VII
Jaw Jerk: aff-V3 (sensory), eff-V3 (motor)
Pupillary: aff-II, eff-III
Gag: aff-IX, eff-IX, X
Vagal Nuclei?
Nucleus Solitarius
Nucleus Ambigus
Dorsal Motor Nucleus
Fxn of Nucleus Solitarius?
Visceral Sensory Info (taste, baroreceptors, gut distention)

VII, IX, X
Fxn of Nucleus Ambigus?
Motor innervation of pharynx, larynx, and upper esophagus (swallowing, palate elevation)

IX, X, XI
Fxn of Dorsal Motor Nuclei?
Sens autonomic (Para) fibers to heart, lungs, and upper GI
How do CN I-->VI exit the skull?
CN I: cribiform plate
CN II-->VI go through Middle Cranial Fossa through the sphenoid bone

CN II: Optic canal (w/ ophthalmic artery and retinal vein)
CN III: Sup. Orbital Fissure
CN IV: SOF
CN V1: SOF
CN V2: Foramen Rotundum
CN V3: Foramen Ovale
CN VI: SOF
Who else exits via middle crania fossa in the sphenoid bone? where exactly?
Middle Meningeal Artery via Foramen Spinosum
How do the rest of the CN's get out of the head?
Posterior Cranial Fossa through the temporal or occipital bone

CN VII: Internal Auditory Meatus
CN VIII: IAM
CN IX, X, XI: Jugular foramen
CN XII: Hypoglossal canal
What goes through foramen magnum?
Spinal roots of CN XI
BS
Vertebral arteries
Where is the Cavernous Sinus?
On both sides of pituitary
What does the Cavernous sinus drain?
Eye
Superficial CTX
What passes through the Cavernous Sinus?
CN III
CN IV
CN V1 &2
CN VI

so EOM nerves and V1&2
What is Cavernous Sinus Syndrome? cause?
due to mass effect

Ophthalmoplegia
Ophthalmic and maxillary sensory loss
My tongue deviates to the right side?
CN XII lesion on the RIGHT
Jaw deviates to the right?
CN V motor lesion on RIGHT side
My uvula deviates to the right?
CN X lesion on the LEFT side
Its hard for me to turn my head to the left and my right shoulder is drooped?
CN XI lesion on RIGHT
motor innervation kicker for face?
Upper face receives BILATERAL UMN innervation
Lower face receives Contralateral UMN innervation
So a Right side UMN lesion will do what to face?
Contralateral (left) paralysis of lower face only. upper face is fine
So a LMN lesion of facial nerve--->
Ipsilateral paralysis of upper and lower face
general cause of Bell's Palsy?
Complete destruction of Facial Nucleus or all of its efferent fibers
Sx's of Bell's Palsy?
Peripheral ipsilateral facial paralysis w/ inability to close eye on involved side
Specific disease associations w/ Bell's Palsy?
Idiopathically (gradual recovery usually)
AIDS
Lyme disease
Herpes zoster
Sarcoidosis
Tumors
Diabetes
What are the KLM Sound tests? what do they test?
Kuh Kuh Kuh tests palate elevation (CN X)
La La La tests tongue (CN XII)
Mi Mi Mi tests lips (CN VII)
Who are the Muscles of Mastication? innervation?
3 close jaw:
Masseter
Temporalis
Medial Pterygoid

1 opens jaw:
Lateral Pterygoid

Innervated by CN V3
Generalizations for Muscles containing "glossus"? exception?
All of them are innervated by CN XII

exception: palatoglossus by CN X
Generalizations for muscles containing "palat"?
All of them are innervated by CN X

exception: tensor veli palatini who is innervated by CN V3
Fluids of the inner ear? location, contents?
Perilymph: in the bony labyrinth, Na rich, similar to ECF

Endolymph: in membranous labyrinth, K rich, Similar to ICF
2 main types of Hearing Loss?
Conductive
Sensorineural
What happens with auditory test w/ a pt w/ Conductive hearing loss?
Bone conduction > air conduction on Rinne
Weber localizes to affected ear
Auditory test results for a pt w/ sensorineural hearing loss?
Air conduction > bone conduction on Rinne
Weber localizes to normal ear
What elements of the Inner Ear detect acceleration?
Linear acc: Maculae detects it (located in utricle and saccule)

Angular Acc: Ampullae in the semicircular canals
What's the Cochlear membrane like? significance?
A scuba flipper
Narrow and stiff at base (for high frequency sounds)
Wide and Flexible at apex (for low frequency sounds)
What is the progression of hearing loss in elderly?
High frequency---> low frequency
Where are the anterior and posterior chambers of the eye?
Ant: between cornea and iris
Post: behind iris, in front of lens
What is the Aqueous Humor Pathway?
Produced by Ciliary Process
Does its thing
Trabecular Meshwork absorbs humor
Canal of Schlemm collects humor from meshwork
What is Glaucoma?
Impaired flow of aqueous humor--->inc IOP--->optic disk atrophy w/ cupping
Difference between Open and Closed Angle Glaucoma?
Open: obstructed outflow (e.g. schlemm), painless, more common

Closed: obstruction of flow between iris and lens--->pressure buildup behind iris. Painful, dec vision
Risk factors for Open Angle Glaucoma?
Myopia
Inc Age
Black
Contraindicated meds for Closed Angle?
Epinephrine
What is a Cataract?
Painless, bilateral opacification of lens---> dec vision
Risk factors for Cataracts?
age
smoking
EtOH
Sunlight
Diabetes
Trauma
Infection
What is Papilledema?
Inc ICP---> elevated optic disk w/ blurred margins, bigger blind spot
If I damage CN III, what happens?
Eye looks down and out
Ptosis
Pupillary Dilation
Loss of accomodation
If I damage CN IV what happens?
Diplopia w/ downward gaze
If I damage CN VI, what happens?
Medially directed eye
Fxns of the Superior Oblique muscle?
Abducts
Intorts
Depresses
What is Strabismus?
misalignment of eyes

multiple etiologies
What is Amblyopia?
Reduced vision from disuse/dysfxn of eye during a critical period of development (childhood)
What can amblyopia be secondary to?
strabismus
deprivation
unequal refractive errors
What controls Miosis?
Miosis = Constriction

Pupillary Sphincter Muscles innervated by the PANS via CN III via the Edinger-Westphal Nucleus---> ciliary ganglion
What controls mydriasis?
myDriasis = Dilation

Radial Muscle (aka pupillary dilator) via SANS. Innervated by T1 preganglionic symapathetics--->superior cervical ganglion--->postganglionic sympathetic--->Long Ciliary Nerve
How does the Pupillary Light Reflex work?
Light sends a signal via CN II to Pretectal nuclei in midbrain--->activates bilateral Edinger-Westphal nuclei---> pupils contract bilaterally (consensual reflex)
What is a Marcus Gunn pupil?
Afferent pupillary defect (e.g. optic nerve damage)---> dec bilateral pupillary constriction when light is shone in the AFFECTED eye
In a cross section of CN III, what does what?
Outside is for PANS output

Inside is for output to ocular muscles
how are the different areas of CN III cross-section affected differently?
Outside is susceptible to compression via PCA berry, uncal herniation, etc---->screwed up pupillary light reflex

Inside is more susceptible to vascular disease (diabetes)
What is Retinal Detachment?
separation of the neurosensory layer of retina from pigment epithelium---> degeneration of photoreceptors---> vision loss
What can cause Retinal Detachment?
Trauma
Diabetes
What is ARMD? types?
Are-Related Macular Degeneration

Degeneration of Macula (centreal area of retina)

Types: Dry and Wet
Sx's of ARMD? general and by type
General:
Loss of central vision (Scotomas)

Dry ARMD:
slow, gradual loss of vision

Wet ARMD:
rapid vision loss due to neovascularization
What is MLF Syndrome?
Internuclear Ophthalmoplegia

Lesion in medial longitudinal fasciculus
Sx's of MLF syndrome?
Medial rectus palsy on attempted lateral gaze (i.e. look left. the left eye will go lateral and the right eye won't go medial.

Nystagmus in abducting eye
Convergence is normal
Disease association for MLF syndrome?
Seen with many MS pts