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405 Cards in this Set
- Front
- Back
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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
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"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
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"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 Gas
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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
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"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
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"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
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"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
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"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
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"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
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Individual neurons encode actication of specific muscles
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Population code view of motor cortex function
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"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
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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
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"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
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"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
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"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
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"Weak excitatory input from Granule Cells - Simple spikes
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Purkinje Cell Simple Spikes
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"Na+ mediated action potentials
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Purkinje Cell Complex Spikes
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"Ca2+ mediated action potentials - several consecutive, longer lasting spikes
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Effects of inactivating (cooling) deep cerebellar nuceli
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"Delayed, oscillatory movements
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Neural Computation functions of Cerebellum
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"Anticipate and compensate for force
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Cerebellum Cognitive Functions
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Increased activity when subject is mentally active - sensory discrimination
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Posture
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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
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"Motor cortex elicits coordinated limb movement - Lateral Corticospinal Tract
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Compensatory Postural Control - Feedback
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"Stimulated by Proprioceptors - Muscle Spindles and Golgi Tendon Organs
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Lateral Motor System
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"Spinal motor neurons located dorso-laterally in ventral gray of spinal cord
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Medial Motor System
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"Spinal motor neurons located in antero-medial spinal gray matter
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Step Cycle - Muscle contraction patterns
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"Extensors contract during stance phase
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Central Pattern Generator - Locomotion
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"Generates rhythmic repeating motor pattern in response to non-rhythmic input
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Descending Control of Spinal Locomoter Central Pattern Generator
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"Initiated in motor / premotor cortex --> Mesencephalic Locomotor Region (MLR)
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Feedback from Spinal Central Pattern Generator
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"CPG --> Brainstem
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Spinal Central Pattern Generator - circuitry
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"Reciprocally inhibitory populations of functionally antagonistic interneurons
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Strength of Descending Activity - CPG
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"Increasing strength of tonic stimulation of MLR increases speed of locomotion
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Locomotor Central Pattern Generator Location
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"Bilaterally symmetric network in Medial aspect of intermediate gray zone
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Nerve Conduction Velocity
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"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
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Focal demyelinating neuropathy
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Nerve Conduction Study - Decreased Velocity, Normal Amplitude
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Uniform Demyelinating neuropathy
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Genetic Peripheral Demyelinating Disorders - mutant genes
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"Peripheral myelin protein 22
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Repetitive Nerve Stimulation Studies
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"Electrically stimulate nerve 6-10 times at 2/3 Hz
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Repetitive Nerve Stimulation - Decremental Response
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"Neuromuscular transmission disorders
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Neonatal Hypotonia - Localization: Central v Peripheral Lesion
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"Other brain abnormality: C +++ P+/-
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Neonatal Hypotonia - Anterior Horn Cell Lesion - Pattern of Weakness
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"Face +/-
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Neonatal Hypotonia - Muscle Lesion - Pattern of Weakness
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"Face variable
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Neonatal Hypotonia - NMJ Lesion - Pattern of Weakness
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"Face +++
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Neonatal Hypotonia - Peripheral Nerve Lesion - Pattern of Weakness
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"Face -
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Neonatal Hypotonia - Nerve Conduction Study and EMG results - site of involvement
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"Central: NCS - normal EMG - normal
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EMG - Neurogenic Lesion - LMN
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"Insertional activity - increased
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EMG - Neurogenic Lesion - UMN
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"Insertional activity - normal
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EMG - Myogenic Lesion - Myopathy
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"Insertional activity - normal
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EMG - Polymyositis
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"Insertional activity - increased
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Myotubular Myopathy
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"MTM1 gene mutation
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Midline Cerebellar Lesion
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"Truncal and Proximal limb dysfunction
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Hemispheric Cerebellar Lesion
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"Limb Ataxia: Arms > Legs
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Rebound - Cerebellar Dysfunction
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Inability to stop an ongoing movement
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Nystagmus
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"Abnormal jerking eye movements
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Ocular Dysmetria
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Inacurate occular fixation on target, overshoot and oscillate
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Ataxic Dysarthria
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"Disruption of metrical structure of speech
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Signs of Cerebellar Dysfunction
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"Gait ataxia, titubation, tremor, dysmetria, dysdiadochokinesis, rebound, nystagmus
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Acute v Chronic Cerebellar Damage - muscle tone
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"Acute hypotonia
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Sensory v Cerebellar Ataxia
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"Sensory Ataxia - loss of input to cerebellum
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Vestibular dysfunction v Cerebellar damage
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Vestibular dysfunction - Vertigo
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Corticospinal Tract Disease v Cerebellar damage
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CST disease - UMN signs present
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Proximal limb weakness v Cerebellar damage
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Proximal Limb Weakness - Weakness, rhythmycity preserved
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Superior Cerebellar Artery
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"Branches off Basilar Artery -
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Anterior Inferior Cerebellar Artery
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"Branches off Basilar Artery
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Posterior Inferior Cerebeller Artery
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"Branches off each vertebral artery
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Superior Cerebellar Artery Syndrome
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"Ipsilateral Cerebellar Ataxia
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Anterior Inferior Cerebellar Artery Syndrome
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"Vertigo
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Posterior Inferior Cerebellar Artery Syndrome
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"Wallenburg Syndrome
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Cerebellar Vascular Disease - Causes
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"Ischemic Stroke
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Cerebellar Mutism
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"Commonly seen after surgery in posterior cranial fossa
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Most common location for brain tumor in children
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Posterior Cranial Fossa
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Cerebellar Malformations - Chiari I
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"Static herniation of medulla and cerebellar tonsils through foramen magnum
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Cerebellar Malformations - Chiari II
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"Neural tube closure defect --> inadequate 4th ventricl formation / small posterior fossa
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Cerebellar Malformations - Chiari III
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"Herniation of medulla, cerebellar tonsils and vermis, and 4th ventricle through foramen magnum
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Dandy Walker Malformation
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"Cerebellar malformation - neonatal presentation
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Joubert Syndrome
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"Cerebellar malformation - neonatal presentation
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Medulloblastoma
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"Midline Cerebellar tumor
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Dysarthria - clumsy hand syndrome
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"Due to infarction in superior cerebellar artery
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Post-infectious cerebellitis
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"Acute cerebellar ataxia - explosive onset of gait ataxia and nystagmus
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Multiple Sclerosis
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"Chronic inflammatory disease of CNS
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Paraneoplastic cerebellar degeneration
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"Tumor associated degeneration - associated w/ specific anti-neuronal antibodies
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Toxic Cerebellar Disease
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"Acute or chronic
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Spinocerebellar Ataxia
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"Group of autosomal dominant disorders
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Basal Ganglia - Input nuclei
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"Striatum - Caudate and Putamen
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Basal Ganglia - Output nuclei
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Substantia nigra Pars Reticularis and Globus Pallidus Interna
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Basal Ganglia - Intrinsic nuceli
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Globus Pallidus Externa, Substantia Nigra Pars Compacta, and Subthalamic Nuclei
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Lenticular Nucleus
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Putamen and Globus Pallidus
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Substantia Nigra
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"Dopmaine oxidizes to form quinones --> polymetize into neuromelanin (black)
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Basal Ganglia - Direct Pathway
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"Initiation of movement - learning positive outcomes associated w/ behaviors
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Basal Ganglia - Indirect Pathway
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"Termination of movement - learning negative outcomes associated w/ behaviors
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Parkinson's Disease - Histology
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"Aggregation of α-synuclein into cytoplasmic Lewy Bodies
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Parkinson's Disease - Signs and Symptoms
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"Bradykinesia - slow initiation of voluntary movement / lack of spontaneous movement
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Parkinson's Disease - Pathology
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"Loss of dopamine input to striatum
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Huntington's Disease - Signs and Symptoms
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"Chorea - brief, jerk-like movements
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Huntington's Disease - Genetics
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"Triplet repeat expansion - CAG
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Huntington's Disease - Pathology
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"Selective loss of medium spiny GABAergic neurons in striatum
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Motor defects - Cerebellar / Pyramidal / Basal Ganglia
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"Brainstem / Cerebellar injury --> Ataxia
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Striatum Interneurons
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"95% medium spiny - GABA - Inhibitory
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Dopamine Biosynthesis
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"Tyrosine --> L-DOPA --> Dopamine
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Parkinson's Pharmacology - Levodopa
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"Levodopa replacemtn of dopamine - crosses BBB
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Parkinson's Pharmacology - DA receptor agonists
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Longer lasting effects than L-DOPA, more selective receptor stimulation
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Parkinson's Pharmacology - inhibit DA breakdown
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Inhibitors of monoamine oxidase (MAO-B) and catechol-O-methyltransferase (COMT)
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Parkinson's Pharmacology - ACh muscarinic antagonists
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Block ACh-M receptor activity in striatal interneurons - relieve inhibition on thalamus
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Parkinson's Therapy - Deep brain stimulation
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Inactivate GPi or STN
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Huntington's Disease Pharmacology
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"Nothing available to halt disease progression
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Tremor
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Rhythmical and sinusoidal movement
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Parkinson's Disease v Essential Tremor
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"PD: Asymmetrical, Rest > postural/action
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Chin Tremor and Facial Masking
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Parkinson's Disease
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Head tremor
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Essential Tremor
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Chorea
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"Irregular, random, abrupt, flowing movement
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Athetosis
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Low amplitude chorea - affects distal muscles
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Ballismus
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High amplitude chorea - affects proxmial muscles
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Hemiballismus
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"Unilateral High amplitude chorea - affects proximal muscles
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Myoclonus
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"Irregular shock-like movements
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Tic
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"Abrupt, brief, stereotyped movement
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Dystonia
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"Sustained muscle contractions w/ twisitng posutres
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Writer's Dystonia
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Task-specific
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Parkinsonism
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"Core common features - Rigidity, Akinesia / Bradykinesia, Basal Ganglia Pathology
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Multiple Systems Atrophy
|
"Parkinsonism + Autonomic Failure
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Progressive Supranuclear Palsy
|
"Parkinsonism + opthalmoparesis (weakness in eye movement muscles)
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Corticobasal Degeneration
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"Parkinsonism + Apraxia and Dystonia
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Wilson's Disease
|
"Parkinsonism + Dystonia (young onset)
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Diencephalon subdivisions
|
"Dorsal Thalamus - Thalamus
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Thalamus boundaries
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"Anteriorly - interventricular foramen
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Thalamus anatomy - myelinated fibers
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"Internal Medullar Lamina
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Thalamus anatomy - Lateral Division - nuclei / function
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"Dorsal Tier:
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Thalamic relay nuclei
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"VPL/VPM - sensory relay for body / head
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Thalamic association nuclei
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"Dorsomedial Nucleus:
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Thalamic neurons - types
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"Thalamocortical - glutaminergic excitatroy projection neurons
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Thalamo-cortico-thalamic circuit
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"Thalamocortical (TC) projection neurons (Glu) to cortex - no TC-TC connections
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Thalamocortical neuron electrophysiology
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"Tonic: Vm = -55mv --> depolarization causes sustained discharge
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Thalamocortical Tonic-Burst Transition
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"Tonic firing = relay mode --> faithfully relays prethalamic input to cortex
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CNS Acetylcholine source
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Nucleus Basalis of Meynert, brainstem reticular formation
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CNS Noradrenaline source
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Locos coeruleus
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CNS serotonin source
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Periacqueductal Gray, Dorsal Raphe Nucleus
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CNS dopamine source
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Substantia Nigra Pars Compacta
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Human Paleocortex
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Base of telencephalon - involved w/ olfaction
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Human Archicortex
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Hippocampus
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Agranular Cortex
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"Apparent lack of stellate (granule) cells
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Granular Cortex
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"Many small cells (pyramidal and non-pyramidal)
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Homotypical / Heterotypical Cortex
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"Homotypical - 6 distinct neocortical layers
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Cortical Columnar Orientation
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"Cells arranged in column perpendicular to cortical surface
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Cortical Pyramidal Cells
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"Excitatory, glutaminergic projection neurons
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Cortical Spiny Stellate (granule) cells
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"Excitatory, glutaminergic interneurons
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Cortical Basket Cells
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"Inhibitory GABAergic interneurons
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Regular Spiking (RS) Cortical Cells
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"Generate sustained firing proportional to depolarizing input
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Fast Spiking (FS) Cortical Cells
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"Thin action potentials, brief spike afterhyperpolarizaton (HAP)
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Bursting Cells
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"All-or-none bursr of high frequency spikes
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Properties of local cortical circuits
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"Recurrent excitatory input b/w neighboring excitatory cells - synapse on spines
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Route of information flow through cortex
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Thalamus --> L4 --> L2/3 <--> L5 --> L6 --> Thalamus
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Somatosensory nerve endings
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Generate graded potentials - behave like dendrites
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Somatosensory free nerve endings
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"Tuned for pain, temperature, and crude touch
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Slow adapting somatosensory receptors
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"Signal sustained presence of stimulus
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Fast adapting somatosensory receptors
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"Signal onset and offset of stimulus
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Lateral / Surround Inhibition
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"Stimulation of receptor excites cell - axon collateral to recurrent inhibitory interneurons
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Cortical Representation - Receptive Fields
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"Increased cortical representation --> increased receptor density, 2 point discrimintation
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Primary SS cortex - body representation - stimulus type
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"3a - muscle afferents
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Cranial Nerves Exiting at Ponto-Medullary Junction
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VI, VII, and VIII
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Laterally exiting cranial nerves
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V, VII, IX, and X - all mixed sensory / motor
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Medially exiting cranial nerves
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III, IV, VI, and XII - all motor
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Medial Lemniscus Position in Brainstem
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"Moves from medial to lateral position while ascending
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Anterolateral System Position in Brainstem
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Courses in lateral aspect - does not change location
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Descending Hypothalamic Fiber Position in Brainstem
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Courses in lateral aspect w/ ALST - does not change position
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Brainstem Anatomy - 4th ventricle in…
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Pons and Rostral Medulla
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Brainstem Anatomy - Cerebral aqueduct in…
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Midbrain
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Brainstem Anatomy - Central canal in…
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Caudal Medulla
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Brainstem Anatomy - Cerebellar Peduncles in…
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"Medulla - ICP
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Brainstem Anatomy - Olives in…
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Rostal Medulla
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Brainstem Anatomy - Pyramidal Decussation in…
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Caudal Medulla - Medullary-cervical junction
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Brainstem Anatomy - Caudal Medulla Structures
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"Pyramidal Decussation
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Brainstem Anatomy - Rostral Medulla Structures
|
"Inferior Olivary Nuclei - Dentate Cerebellar Nuclei looks similar but on dorsal aspect
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Brainstem Anatomy - Caudal Pons Structures
|
"Transverse Pontine Fibers - Pontocerebellear fibers
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Brainstem Anatomy - Rostral Pons Structures
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"4th Ventricle
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Brainstem Anatomy - Caudal Midbrain Structures
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"Inferior Colliculi
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Brainstem Anatomy - Rostral Midbrain Structures
|
"Superior Colliculi
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Brainstem Anatomy - Arrangement of CN VI and CN VII
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"CN VI nuclei located dorso-medial to CN VII nuclei
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Facial Weakness - UMN v LMN
|
"Most cranial nerve LMN receive bilateral UMN input - except some LMN in facial nerve (VII)
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Brainstem Nerve Fiber Classification
|
"G / S: General - whole body / Special - Head or Neck only
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Neural Tube - Brainstem Patterning
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"Neural Tube - Dorsal = Sensory / Ventral = Motor
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Brainstem Cranial Nerve Nuclei Organization
|
"Discontinous columns of functionally similar motor nuclei
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Brainstem Cranial Nerve Nuclei - GSE
|
"Column 1 next to midline - Innervated Skeletal Muscle
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Brainstem Cranial Nerve Nuclei - GVE
|
"2nd column from midline - Pre-ganglionic Parasympathetics
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Brainstem Cranial Nerve Nuclei - SVE
|
"3rd column from midline - Pharyngeal arch derived muscles
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Brainstem Cranial Nerve Nuclei - SVA / GVA
|
"1st column from Sulcus Limitans - visceral sensory
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Brainstem Cranial Nerve Nuclei - SSA
|
"2nd column from Sulcus Limitans - Vestibulocochlear sensory
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Brainstem Cranial Nerve Nuclei - GSA
|
"3rd column from Sulcus Limitans - Continuous column of Trigeminal Nuclei (V)
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Trigeminal Nerve - Sensory - Touch
|
"Large diameter afferents - cell bodies in Trigeminal Ganglion or Mesencephalic Nucleus
|
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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
|
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|
Unilateral Babinksi Sign
|
"Lesion of contralateral corticospinal tract
|
|
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Bilateral Babinksi Sign
|
"Lesion of both corticospinal tracts
|
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Spasticity
|
"Increased tone
|
|
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Rigidity
|
"Increased tone
|
|
|
EMG - Spontaneous Activity
|
"Normal Muscle - Silent
|
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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
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|
|
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
|
