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204 Cards in this Set
- Front
- Back
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supraoptic nucleus
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hypothalamus, makes ADH
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paraventricular nucleus
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hypothalamus, makes oxytocin
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lateral area of hypothalamus
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hunger, destruction leads to anorexia, inhibited by leptin
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ventromedial area of hypothalamus
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satiety, destruction leads to hyperphagia, stimulated by leptin
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anterior hypothalamus
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cooling, parasymp
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posterior hypothalamus
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heating, symp
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septal nucleus
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hypothalamus, sexual urges
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suprachiasmatic nucelus
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hypothalamus, circadian rhythums
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LGN
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thalamus, visual
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MGN
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thalamus, auditory
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VPL
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thalamus, body sensation (propioception, pressure, pain, touch, vibration; from dorsal columns and spinothalamic tract)
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VPM
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thalamus, facial sensation (CN V)
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VA/VL
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thalamus, motor
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posterior communicating artery
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supplies hypothalamus and ventral thalamus; aneurysm (2nd most common location in COW) causes CN III palsy
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anterior communicating artery
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connects 2 anterior cerebral arteries; most common site of COW aneurysm amd can cause visual field defects
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PCA
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midbrain, thalamus, occipital lobes; terminal branches of basilar artery
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PICA
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branch of the verterbral arteries; part of medulla, inferior cerebellum; obstruction causes Wallenburg
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middle cerebellar peduncle
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receives contralateral cortical imput
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inferior cerebellar peduncle
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recieves ipsilateral propioceptive info
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superior cerebellar peduncle
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output from deep nuclei of cerebellum to contralateral cortex
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# of spinal nerves at each level
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8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal; C1-7 above, the rest come out below the corresponding vertebrae
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structures pierced in lumbar puncture (8)
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occurs at L4-L5; skin/superficial fascia, ligaments, interlaminar space, epidural space, dura mater, subdural space (potential space only), arachnoid, subarachnoid space (CSF)
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white rami
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preganglionic symp fibers, found only in T1-L2
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gray rami
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postganglionic symp fibers, found at all levels of SC
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CN nuclei in the midbrain
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3 and 4
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CN nuclei in the pons
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5,6,7,8
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CN nuclei in the medulla
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9,10,11,12
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nucleus solitarius
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visceral sensory info from 7,9,10 (taste, baroreceptors, gut distention)
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nucelus ambiguus
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motor innervation of pharynx, larynx, upper esophagus (9-11)
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dorsal motor nucleus
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autonomics (PNS) to heart, lungs, upper GI; part of vagal nuclei
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optic canal
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CN II, opthalmic artery, central retinal vein
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superior orbital fissure
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CN 3,4,V1,6, opthalmic vein
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foramen rotundum
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V2
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foramen ovale
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V3
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foramen spinosum
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middle meningeal artery
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internal auditory meatus
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CN 7 and 8
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jugular foramen
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CN 9,10,11, jugular vein
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pathway of miosis
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PNS via CN III, Edinger-Westphal nucleus to the ciliary ganglion to pupillary sphincter muscle
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pathway of mydriasis
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radial muscle, T1 preganglionic symp to superior cervical ganglion to postganglionic symp to long ciliary nerve
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Marcus Gunn pupil (ex: detached retina)
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dilation (or decr constriction) when light is shone in affected eye
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nystagmus in MLF syndrome is in which eye
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the abducting one
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"drop" seizure
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atonic
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Charcot's triad for MS
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SIN: scanning speech, intention tremor, incontinence, internuclear opthalmoplegia, nystagmus
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Charcot-Marie-Tooth disease
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heriditary motor and sensory neuropathy, defect in production of proteins involved in peripheral nerves or myelin sheath
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subacute sclerosing panencephalitis
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can follow measles infection, usually occurs before age 18, affects gray and white matter affected; may start with personality changes, memory loss and mental deterioration; later can have motor losses
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location of pain in cluster headache and 3 other associated symptoms
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unilateral periorbital pain; ipsilateral lacrimation, rhinorrhea and Horners
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GFAP
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protein you can stain in astrocytes, +GFAP in glioblastoma multiforme (is an astrocytoma)
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Rosenthal fibers
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eosinophilic corkscrew fibers, found in pilocytic astrocytomas
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brain tumor that can produce EPO
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hemangioblastoma, often found in cerebellum
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prosopagnosia
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inability to recognize faces, bilateral lesion of visual association cortex
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agnosia
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normal perception but perception is devoid of meaning
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ideomotor aproxia
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inability to carry out an action about receiving a command but may do these things spontaneously
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Ganser syndrome
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giving approx answers instead of exact ones
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where in the neuron is Nissl substance found
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body and dendrites only
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which viruses can directly infect oligodendroglia
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JC virus and measles
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unmyelinated axons
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autonomic postganglionic, afferent nerves that conduct heat, afferents that transmit dull, burning or visceral pain
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Meissner's corpuscles
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found in hairless skin areas, repsonsible for dynamic fine touch, adapt quickly
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Merkel's discs
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unencapsulated, found in hair follicles, involved in static touch (adges, shapes, textures), adapt slowly
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endo, peri and epineureum
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endo: around single nerve fiber; peri: around a fascicle of nerve fibers, permeability layer; epineureum: dCT around an entire nerve (fascicles and BVs)
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location of NE synthesis
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locus ceruleus
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location of DA synthesis
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ventral tegmentum and SNc
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location of 5-HT synthesis
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Raphe nucleus
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location of ACh synthesis in the brain
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basal nucleus of Meynert
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GABA vs. glycine vs. glutamate
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GABA and glycine are inhibitory; glutamate is excitatoy (acts at NMDA receptor)
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functions of the hypothalamus
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thirst and water balance, adenohypophysis control, neurhypophysis releases hormones from hypothalamus, hunger, temp regulation, autonomic regulation, sexual urges
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areas in the brain lacking BBB
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area postrema (located in the dorsal medulla, near 4th ventricle): important in vominting response; OVLT: senses changes in osmolarity
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components of the limbic system and its responsibilities
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cingulate gyrus, hippocampus, fornix, mammillary bodies; feeding, fleeing, fighting, feeling, fuckings (5 F's)
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deep nuclei of the cerebeelum
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Dentate, Embolform, Globose, Fastigal (Don't eat greasy foods); lateral to medial
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dysmetria
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over or under shooting, dysfunction in cerebellum
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dysdiadokinesia
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difficulty switching on/off antagonizing muscle groups, test by rapid alternating mvms, dysfunction in cerebellum
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3 DA pathways in the brain and the dz's associated with their dysfunction
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mesolimbic-mesocortex: regulates behavior, abnorm in schizophrenia; nigrostriatal: reg voluntary control, abn in Parkinsons; tuberinfundibulum: controls prolactin levels
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what consists of the striatum
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caudate and putamen
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direct/excitatory pathway of basal ganglia
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D1 excit neurons from the substantia nigra activate striatum; this in turn inhibits GPi which is usually inhibiting the thalamus preventing movement; by inhibiting GPi, you causes thalamic excitation which is relayed to the cortex
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indirect/inhibitory pathway of basal ganglia
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DA from the substantia nigra activates inhibitor neurons in the striatum, thereby inhibiting the inhibitory pathway (incr motion); this occurs through the GPe to the STN to GPi
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findings in Parkinson's
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TRAP: tremor at rest (pillrolling),rigidity (cogwheel), akinesia (unable to initiate mvmt), postural instability; masked like facies
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hemiballismus
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sudden wild flinging of 1 arm, lesion to contralateral subthalamic nucleus, causes loss of thalamic inhibition through the GP (inhibition of the inhibitory pathway)
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neuro deficit in Huntingtons
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atrophy of the caudate leads to loss of GABA neurons, also lose ACh, causes enlarged lateral ventricles; have chorea, depression, progressive dementia
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athetosis
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slow, writhing mvmts, esp of fingers; characteristic of basal ganlia lesions
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broca's
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located in the inferior/posterior frontal lobe of the dominant hemisphere (L); motor speech
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wernicke's
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located in the posterior superior temporal lobe of dominant hemisphere (L), auditory component of speech (comprehension)
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characteristic finding in frontal lobe damage
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lack of social judgement, disinhibition, personality changes
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arcuate fasciculus, damage causes what
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connects brocas and wernickes; damage has good comprehension, fluent speech but poor repitition
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damage to R parietal lobe
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leads to spacial neglect syndrome (agnosia of the contralateral side of the world)
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side of cerebellar lesions
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damage to cerebellum results in ipsilateral defects, fall towards side of lesion
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dysarthria vs. aphasia
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dysphagia: poor articulation, can occur with damage to cerebellar vermis; aphasia: high order inability to speak
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damage to PPRF vs. frontal eye fields
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PPRF: eyes look away from lesion; FEF: eyes look towards lesion
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Wallenberg's syndrome
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due to PICA occlusion, nystagmus, ipsilateral ataxia, N/V, vertigo, ipsilateral Horners, ipsilateral P/T loss of face, contralateral P/T loss of body
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lateral striate arteries
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branches of MCA, supply internal capsule, caudate, putamen, GP; arteries of stroke
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charcot-Bouchard aneurysms
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microaneurysms, associated with chronic HTN, affects small vessels (thalamus, basal ganglia, etc); rupture can lead to lacunar infarcts which often have purely motor or purely sensory deficits
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middle meiningeal artery is branch of what, where does it enter the skull and whats its function
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maxillary artery, enters the foramen spinosum, supplies most of the dura
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pt with subarachnoid has incr risk of what in the days following and what is the preventitive measure
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risk of vasospasm, treat with Ca++ channel blockers
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signs of basilar skull fracture
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damage to occipital or sphenoid bone; get blood behind tympanic membrane, delayed bruising over mastoids (battle sign), racoon eyes, CSF leakage through nose
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dural sinuses
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bridging veins drain into the superior saggital sinus which runs posteriorly to the confulence; the inferior sagital sinus runs posteriorly and the Great Cerebral vein of Galen dumps into this before they reach the straight sinus which dumps into confluence; from the confluence you have the transverse sinuses (2) which turn into sigmoid sinuses (2) which leave through the jugular foramen and become internal jugular
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in what layer do the dural sinuses run
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in the dura, between the meningeal and periosteal layers
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where is common location in dural venous sinuses for thrombi to develop and when
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common in the superior saggital sinus in hypercoagulable states (ex: post partum); cause incr ICP, seizures, infarcts
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what makes CSF
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ependymal cells, part of choryoid plexus (infolding of pia)
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symptoms of hydrocephalus and what part of the brain is affected
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stretching of the descending cortical fibers leads to the triad of dementia, gait problems and urinary incontinence (wacky, wobbly, wet); incr ICP causes progressive damage to white matter
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communicating hydrocephalus
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normal pressure, impaired absorption of CSF by arachnoid granulations (ex: due to arachnoid adhesions)
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obstructive/non-communicating hydrocephalus
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caused by structural blockage of CSF flow (ex: stenosis of aqueduct of Sylvius
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at what levels do the SC and subarachnoid space extend to inferiorly
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SC: L1-2; subarachnoid: S2 (this is why you do LP in L4-5)
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pseudotumor cerebri
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occurs in young obese women, due to incr resistence to CSF outflow at arachnoid, papilledema and incr ICP
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what is located in the epidural space
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cranium: potential space, hosues meningeal arteries and veins; SC: fatty tissue, lymph, venous plexi
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cuneatus vs. gracilus and what do they contain info on
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parts of DC's; cuneatus: carries infor about upper body, located laterally; gracilus: carries info about lower body, is medial; pressure, vibration, touch, propioception
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location of and orientation within the corticospinal tract
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located laterally in the SC, arms are medial, legs are lateral
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pathway of DC's
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sensory goes to 1st neuron cell body in DRG, info enters SC and ascends ipsilaterally; synapses on neuron 2 in the ipsilateral nucleus cuneatus/gracilius located in the caudal medulla; then fibers decusate and ascend contralaterally in the medial lemniscus and synapse in the VPL of thalamus, projects to the sensory cortex via internal capsule
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pathway of spinothalamic
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P/T fibers with cell body in DRG, fibers enter SC and synapse on ipsilateral dorsal horn; decussates immed via anterior white commisure, projects to VPL of thalamus, then to sensory cortex
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path of lateral corticospinal tract
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UMN cell body in motor cortex, descends ipsilaterrly until it decusates in caudal medulla (pyramidal decussation), descends contralaterally to cell body of ant horn in SC, LMN leaves SC and goes to muscle
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CSF and motor findings in polio
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LMN signs (due to destr of ant horn cells), CSF has lymphocytic pleocytosis with slight elevation of protein
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occlusion of anterior spinal artery
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spares dorsal columns and dorsal horns but causes bilateral spastic paresis, loss of P/T below the lesion, LMN damage of innervated muscles, bilateral horners (if above T2)
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Argyll Robertson pupils
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seen in tabes dorsalis, accomodate but don't react
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Brown-Sequard
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hemisection of SC: ipsi UMN below lesion; ipsi loss of tactile, vibration, propioception (DCs) below lesion; contralat loss P/T below lesion; ipsi loss of all sensation at level of lesion; LMN at level of lesion; if above T1, Horners
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IV disc herniation
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most L4-5, L5-S1; prolapse of nucleus pulposis, defective anulus fibrosis; impinges on spinal roots and causes parathesias, pain, sensory loss, hyporeflexia
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Horner's
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pstosis, anhidrosis, misosis; SC lesion abode T1
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dermatomes of C2, C3, C4
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C2: posterior skull cap; C3: high turtleneck; C4: low collar shirt
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dermatomes of T4, T7, T10
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T4: nipple; T7: xiphoid; T10: at umbilicus
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dermatomes of L1 and L4
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L1: inguinal ligament; L4: kneecaps
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dermatomes of S1-4
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S1: lateral foot; S2-4: erection and sensation of penile and anal zones; S1-2: entire backside of legs
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muscle spindle
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in parrallel with muscle fibers, muscle stretch causes intrafusal stretch which stimulates Ia afferent which stimulated alpha motor neuron and cause reflex muscle contraction
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gamma loop of muscle control
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CNS stimulates gamma motor neuron which contracts intrafusal fiber and incr sensitivity of reflex arc
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what monitors tension in muscle
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Golgi tendon organs
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reflex levels for biceps, triceps, patellar and achilles
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biceps: C5; triceps: C6; patella (quad): L4; achilles (gastrocnemeus): S1
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which CN lie medially
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3,6,12
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pinealoma
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compress the vertical gaze center, cause insomnia
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sup and inf colliculi
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superior: conjugate gaze center; inferior: auditory integration area
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what do CN 4 and 6 innervate
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4 (trochlear): SO; 6 (abducens): LR
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which CN closes eye and which muscle; opens?
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close: CN 7, obicularis oculi; open eyelid: CN3, levator palpebrae
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stylopharengeus muscle
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innervated by CN 9, elevates larynx and pharynx
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which structures are in cavernous sinus and which one is most exposed
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internal carotid, CN 3,4,6, V1 and V2; CN6 is more freely floating than the others which are pushed up against the periphery
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what structures does the cavernous sinus receive blood from; where does it drain to
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eye and superficial cortex, drains to internal jugular
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in CN 12, 5, 10 and 11 lesions, which way do the respective organs deviate
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12: tongue deviates towards side of lesion; 5: jaw dev toward side of lesion; 10: uvula deviates away; 11: weakness turning head to contralateral side of lesion, shoulder drop on side of lesion
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Bell's palsy
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complete destruction of the facial nucleus or its efferent fibers; causes ipsilateral facial paraylsis with inability to close that eye
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UMN lesion to facial nerve
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results in contralateral lower face palsy only since upper face receives bilateral UMN innervation
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muscles of mastication (which ones close, which ones open)
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CN V3; close: masseter temproalis (+backward mvmt), medial pterygoid (+elevation); open: lateral pterygoid
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digastric muscle
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depresses the jaw
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buccinator muscle
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innervated by CN 7, holds food against teeth while chewing
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which part of CN V innervates bridge of nose, temples
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bridge of nose: V1; temples: V3
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where are low vs. high freq sounds heard in relation to oval, round windows and helicotrema
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high heard near O/R windows, low near helicotrema
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what chambers do the peri and endolymph fill and what is the composition of each
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peri: scala vestibuli (top) and tympani (bottom); similar to outside cell (think Na+); endo: scala media (which contains cochlear duct), similar to inside cell (think K+)
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utricle and saccule
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detect linear acceleration, located within the vestibule
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cochlear membrane
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receives info via oval window (from middle ear), the base is narrow/stiff and responsible for high freq; apex is wide/flexible and responsible for low freq; transmits to CN 8
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organ of Corti
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located within the cochlear duct, contain hair cells which are the sensory elements of the vestibular aparatus and cochlea
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conductive vs. sensorineural hearing loss
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conductive: BC>AC; W lateralizes to affected ear; sensineural: AC>BC, W lat to normal ear
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hearing loss in elderly
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starts with high, then low
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myopia vs. hyperopia
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myopia: nearsighted; hyperopia: farsighted
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aqueous humor flow
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ciliary process produces it, flows into post chamber, then through canal (between lens and iris), to the anterior chamber then to the canal of Schlemm
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muscles in the eye controlling constriction/dilation
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dilator/radial: a1, mydriasis; sphincter/circular/constricter: M3, miosis
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muscle in the eye controlling accomodation
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ciliary muscle, M3 innervation
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open angle glaucoma
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obstructed outflow, usually bilateral, incr in AA, usually silent and chronic
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closed angle glaucoma
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obstruction between iris and cornea causes pressure buildup behind iris, painful, do not give EPI, often unilateral
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what do the SR and IR do
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SR: elevates, adducts; IR: depresses, adducts
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what do the SO and IO do
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SO: depresses and abducts; IO: elevats and abducts
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pathway of pupullary light reflex
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light signal travels back via CN II, nasal fibers corss at optic chiasm, continue back to synapse on pretectal nuclei, projections from each pretectal nuclei then synapses on both Edinger Westfall nucleus, these then send out fibers to synapse on ciliary ganglion; gives you bilateral pupil constriction
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optic tract vs. optic radiations
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tract: from chiasm back to the LGN; radiation: from LGN to cortex, includes both parietal lobe radiations and Meyer's loop
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MLF, damage does what
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involves cohesive mvmt of left LR and right MR and vice versa; right MLF refers to connection from L CN 6 nucleus to the R CN III nucleus; and vice versa; damage leads to uncoordination of the eye and nystagmus in the abducting eye, convergence normal
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severe complication of Alzheimer's
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can cause amyloid angiopathy which can lead to intracranial hemorrhage, usually occurs in temporal lobe
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composition of Pick bodies
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aggregated, intracellular tau protein
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defect in Lewy body dementia
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a-synuclein defect
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CJD
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rapidly progressive dementia with myoclonus, spongiform cortex (grey matter), abnormal EEG
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vascular dementia
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focal neurological deficits, gradual decline
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sequence of events in MS
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lymphocytic infiltration and active myelin digestion, followed by hyperplasia and hypertrophy of astrocytes which leaves gliotic areas
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incr risk of MS
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incr risk the farther away from the equator you are and you assume the risk profile of the location you are at after age 15; mostly white women, 20-30
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findings in MS
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incr protein in CSF (IgG, oligoclonal band), incr lymphs in CSF, periventricular plaques, areas of oligodendrocyte loss, myelin filled macrophages, reactive gliosis; preservation of axons
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G-B syndrome
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ascending loss of mostly motor function, autonomic function can be severely affected; characterized by endoneural inflammatory infiltrate; incr CSF protien which can cause papilledema; post URI or GI infection, type IV HS
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most common location for partial seizure to originate
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temporal lobe
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difference between simple and complex partial
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simple: consciousness intact; complex: loss of consciousness
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peripheral vs. central vertigo
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peripheral:inner ear etiology, horizontal nystagmus; central: brain stem or cerebellar lesion, vert/horiz nystagmus
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Meniere's
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episodic vertigo, SN hearing loss, low pitched tinnitus, due to incr endolymph and loss of cochlear hairs
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oligodendroglioma
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rare, slow growing brain tumor, often in the frontal lobes, chicken wire CAP pattern, often Ca++
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common location for pilocytic astrocytoma and histo
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cerebellum, posterior fossa (one of the few tumors in children that can be supratenteriol); histo: GFAP+, Rosenthal fibers (corkscrew, eosinophilic), often have cystic structure
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tooth like enamel brain tumor and other findings
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craniopharyngioma; is often cystic and filled with cholesterol rich fluid
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cingulate herniation under falx cerebri
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may be due to a supretentorial mass pushing it down and medially, can compress the anterior cerebral artery, often asymptomatic but may cause contralateral leg weakness
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cerbellar tonsillar herniation
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into the foramen magnum, can cause damage to medulla and decr respiration
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uncal herniation
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medial portion of temporal lobe pushed under tenteorium cerebelli; can cause ipsilateral dilated pupil and pstosis (compression of CN 3), eye down and out, contralateral homonymous hemianopsia (compression of PCA), ipsilateral paresis (compression of contralateral crus cerebri), Duret hemorrhages (midbrain)
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why do you hyperventilate a pt with head trauma
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to cause resp alkylosis which constricts cerebral vessels, decr risk of cerebral edema (vs. acidodid and hypoxemia which incr vascular permeability)
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colloid cyst
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derived from embrylogically misplaced endodermal epithelium, mucin producing ciliated cells (~resp epi), can present with symptoms of incr ICP, usually near 3rd ventricle
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cell type destroyed in MS and GB respectively
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MS: oligodendrocytes; GB: schwann cells
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pacinian corpuscles
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found in deep layers of skin, ligaments and joints; vibration and pressure
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input and output nerves of the cerebellum
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input: climbing and mossy fibers; output: Purkinje cells
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order of the internal capsule, GP and putamen
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from near the ventricle outward: IC, GP, putamen
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location of RAS
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midbrain
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basilar artery
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formed from the 2 vertebral arteries; gives off the AICA and superior cerebellar
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vertebral arteries
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branches of the subclavians, give rise to anterior spinal cord artery and PICA
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location of substantia nigra
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midbrain, just posterior to the crus cererbri which carry corticospinal tracts
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what is destroyed in Vit B12 def
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demyelination of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts; ataxic gait, hyperreflexia, impaired position and vibration sense
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path of polio infection and findings
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transmitted by oral-fecal route; replicated in oropharynx and SI before spreading through blood stream to CNS where it causes destruction of anterior horn cells; malaise, fever, abdominal pain, sore throat, LMN signs; CSF with incr lymphs and slight elevation of protein
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moro reflex
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extension of limbs when startled
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subclavian steal syndrome
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occlusion of subclavian artery proximal to the origin of the vertebral artery, involves reverse blood flow in the vertebral artery
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olfactory tract and location of cortex
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travels back to the primary olfactory cortex near the uncus, does not go to the thalamus first
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uveitis
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refers to the ciliary body, the iris and the choroid; think autoimmune (IBD, RA, ank spond), leads to changes in vision
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amblyopia
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reduction in vision from disuse in critical period
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CN III damage
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interior of CN3 is the output to occular muscles, this is primarily affected by vascular dz (ex: DM); exterior of CN3 is PNS and is affected by compression (ex: PCA berry aneurysm, uncal herniation), "blown pupil"
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gene associated with familial alzheimers (2)
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APOE4, p-App
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neuro desinigration with myoclonus
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CJD
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PML
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demyelination of CNS due to destruction of oligoden. by JC virus, forms abnormal giant cell oligodendroglia with eosinophilic inclusions (virus); aphasia, hemiparesis, ataxia, rapidly progressive and often fatal
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what cells are affected first in global systemic ischemia
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pyramidal cells of hippocampus, purkinje cells of cerebellum
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BPPD
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most common cause of vertigo, short lastin, position related; due to otoconium (Ca-carb stones) which can dislodge
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schwannoma histo
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biphasic: areas with lots of cells and areas with few cells, splindle cells, S100+
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medullablastoma
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highly malignant, primitive neuroectoderm tumor, occurs in cerebellum and can compress the 4th ventricle; may form rosettes
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ependymoma
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most commonly found in the 4th ventricle and can cause hydrocephalus, rod shaped perivascular pseudorosettes
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micro of hemangioblastoma
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foamy cells with high vascularity
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vasogenic vs. cytotoxic edema
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vasogenic: due to disruption of BB (ex: astrocytoma); cytotoxic: occurs when cell injury impairs Na/K pump and causes swelling, common in ischemic result
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3 findings in axonal reaction
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occurs with loss of axon: enlarged cell body, eccentric nucleus, displaced nissl
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most potent cerebral dilator
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incr PCO2
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pontine hemorrhage
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can occur secondary to long term HTN; cause pinpoint pupils, loss horizontal gaze, quadriparesis, decrebrate
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