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129 Cards in this Set
- Front
- Back
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What is the frontal lobe responsible for? (5)
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-motor
-higher intellectual processes -concentration -planning -complex pro |
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Functions of the Parietal Lobes (3)
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-sensory- temp, touch, pressure, pain
-speech -express thoughts and feelings |
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Functions of the Temporal Lobes (3)
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-sensory- hearing
-interp. experiences -memory visual scenes, music, complex patterns |
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Functions of the Occiptal Lobes (2)
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-sensory- vision
-combining visual images with sensory experiences |
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What are the primary functions of the NS?
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control and communicaiton
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What are the 2 major parts of the CNS?
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1. enclosed in bone- brain, spinal cord
2. peripheral NS- vert. column- includes cranial/spinal nerves, autonomic NS |
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What is included in the autonomic nervous system and what does it mean? (4)
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"self-regulating"
includes- contractions of wall stomach -secretion of salivary glands -rate of heart beat -secretion of- sweat, gallbladder |
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What are tissues of the NS formed by?
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the ectoderm layer (brain cells) of the primary germ layer
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Describe the brain. (3)
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-largest most complex part of the nervous system
-in cranial cavity -composed of 100 billions neurons/nerve fibers |
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How is the brain divided?
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into 3 parts
-cerebrum -cerebellum -brain stem |
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Describe cerebrum. (5)
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-largest part of brain
-sensory/motor functions -higher mental functions -memory/reasonin -2 hemispheres |
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What connects the 2 hemispheres of the cerebrum? What separates it?
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connects- corpus callosum
separates- longitudinal fissure |
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What are the lobes of the cerebrum named after?
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the skull bones that cover them
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Where is the gray matter of the cerebrum?
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the cerebral cortex- outer layer
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Where does white matter of the cerebrum lie?
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inside the cortex
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What is the white matter of the cerebrum?
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consists of nerve fibers that form tracts or bundles that connect the cerebrum w/ NS
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Describe the cerebellum. (4)
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-large mass tissue below occipital lobes of cerebrum and post brain stem
-separated by fold- tentorium cerebella -2 lateral hemispheres sep by dura mater called falx cerebella -connected midline by vermis |
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What is the cerebellum composed of? its functions?
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-composed of white and gray matter and cerebellar cortex
functions- reflex center, coord. skeletal muscle movements, muscle tone |
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Describe brain stem.
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-bundle of nerves
-extends from base cerebrum to foramen magnum |
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What are the parts of the brain stem? (4)
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-diencephalon
-midbrain -pons -medulla oblongata |
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Describe diencephalon. (4)
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-located between cerebral hemispheres above midbrain
-surrounds 3rd ventricle -control of emotional responses -includes thalamus, hypothalamus, pituitary, pineal gland |
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Describe thalamus. (2)
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-acts as central relay station for sensory impulses
-receives all sensory (except smell) and channels to regions of cerebral cortex for interpertation |
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Describe hypothalamus (3)
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-maintains homeostasis
-regulates visceral activities -link between nervous and endocrine system |
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What are main functions of hypothalamus? (5)
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1. regulate heart rate and arterial BP
2. regulate body temp 3. regulate water/electrolyte balance 4. control hunger and regulate body weight 5. regulate sleep and wakefulness |
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Describe mesencephalon or midbrain. (4)
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-short section of brain stem between diencephalon and pons
-joins lower brain stem with upper brain -gray matter- serve as reflex center -cerebral aqueduct connects 3rd and 4th ventricles |
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Describe pons. (4)
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-rounded bulge under the brain stem
-separates midbrain from medulla oblongata. -relays sensory impulses from peripheral nerves to higher brain centers -pons/medulla oblongata regulate rate and depth of breathing |
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Describe medulla oblongata. (8)
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-enlarged continuation of spinal cord
-foramen magnum to pons -most inferior portion of brain -all ascending and descending nerve fibers pass -control center for vital activities: cardiac rate, -vasomotor effects (raises/lowers BP), -respiratory function -injuries here are FATAL |
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Describe spinal column. (2)
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slender nerve column w/ oval cross section that passes from brain to vertebral canal
-begins where nerve tissue leaves the cranial cavity at foramen magnum |
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What are the 4 basic divisions of the spinal cord?
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-cervical
-thoracic -lumbar -sacral |
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Where does the cord taper to a cone shape structure? what is it called?
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ends about L2 and is called conus terminalis
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What starts at level L2?
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cauda equine
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What is the inner part of the cord composed of?
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gray matter and composed of nerve cell bodies
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How is gray and white matter arranged in the spinal cord?
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exactly opposite than brain
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What is the CNS surrounded by?
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bones
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Where are the meninges of the CNS?
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between bone and soft tissue of the nervous system
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What are tumors of the meninges called?
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meningiomas
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How many layers do the meninges have? What are they called?
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3 layers
-dura mater, arachnoid mater, pia mater |
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Describe dura mater. (2)
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-outer most layer
-composed of white fibrous connective tissue |
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Describe arachnoid mater. (3)
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-middle layer
-overlies pia mater -DOES NOT dip into grooves between it and pia mater |
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Describe pia mater. (2)
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-delicate inner membrane
-closely applied to outer surface of brain and cord. |
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Where is the subarachnoid space?
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space between arachnoid and pia mater
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Where does CSF circulate?
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in the space around brain and spinal cord
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Describe nerve tissue of brain and spinal cord.
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-consits of masses of nerve cells or neurons
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Describe neurons. (3)
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-structural and functional units of the NS
-specialized to react to physical and chemical changes -conduct nerve impulses to other neurons and cells outside the NS |
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What are 2 kinds of nerve fibers that extend from the cell bodies of most neurons?
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dendrites and axons
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Although a neuron has many _____, it normally has a ___ ____.
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Although a neuron has many DENDRITES, it normally has a SINGLE AXON.
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What are dendrites function?
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to carry impulses toward the neuron cell body
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What are axons functions?
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to carry impulses away from the neuron cell body.
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What may axons be enclosed by?
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sheaths composed of Schwann cells
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Where are neuroglial cells and what is its function? (4)
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-between neurons and function like the connective tissue in other systems
-they fill spaces and give support to surrounding structures -capable of reproduction -sometimes responsible for dev. of tumors in brain or spinal cord |
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What is the percentage of CNS cancer deaths? and who does it effect?
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2% of cancer deaths
effects children and young adults |
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In children brain tumors are _____ second to leukemia as cause of death.
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2nd
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What % of CNS tumors involve the brain. What % effects spinal chord?
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CNS- 80%
Spinal chord-20% |
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What % of CNS tumors are mets? Where do CNS tumors met from? (5)
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40% met
met from- *lung*, breast, kidney, ovary melanoma and GI tract |
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Why are CNS tumors unique?
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-locally invasive
-rarely spread beyond the CNS *due to lack of lymphatics to that area |
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What % is distant mets from primary CNS tumors?
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1%
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In most brain tumors what is the initial presenting symptom? What is second?
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1st- headaches- due to increased intracranial pressure
2nd- seizure: grand mal or focal Jacksonian seizure |
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Why does the first seizure often ignored by patient?
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because it is a momentary loss of alertness or concentration
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What is a strong indicator of of brain tumors of persons under 20?
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onset seizures
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What are neurologic symptoms of CNS? (6)
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-weakness
-sensory loss -deficits -blurred vision -intercranial pressure -N/V |
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What symptoms occurs as intercranial pressure increases? (4) What happens when these symptoms are present?
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-lethargy*-unfavorable prognosis
-drowsiness -irritability -diff ambulation A real urgency to getting medical aid and relieving pressure |
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What are symptoms with spinal cord tumors? (4) What are these symptoms produced by ?
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-pain
-weakness -loss of sensation -diff bowel and bladder control They are generally produced by cord compression by the growing tumor. |
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What happens when the bladder is affected with spinal cord tumors?
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By the time bladder is affected, cord is usually severely and irreversibly compressed.
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What is needed to dx CNS tumors? what is also useful? (4)
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a complete and often vigorous neurologic exam
also useful: CT, MRI, pneumoencephalograms, cerebral angiograms |
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What are the 2 broad categories of CNS tumors?
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intrinsic tumors- arising in brain and/or spinal cord itself
tumors arising from the supporting structures of NS |
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Name CNS intrinsic tumors. (5)
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-gliomas
-astrocytomas -oligodendroglioma -ependymomas -medulloblastomas |
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What % is gliomas? Where do they arise?
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50%
they arise from neuroglial cell also called astrocytes |
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How common are gliomas? Where do they occur?
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Gliomas are the most common primary brain tumors in adults.
They occur in the cerebrum mainly between ages 40-60 |
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What kind of gliomas occur in children?
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gliomas of the brainstem and cerebellum
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What % of spinal chord tumors are gliomas?
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23%
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What kind of glial cells? (3) which are most common?
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*astrocytes- most common
oligodendroglia ependymal cells |
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How are astrocytomas graded? Describe.
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I-IV
I-well differentiated IV-pleomorphic and very invasive |
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What name is given for highly malignant astrocytomas? What grade?
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glioblastoma multiforme
grade III and IV |
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Describe oligodendrogliomas? (5)
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-well defined glioma that arises from oligodendroglial cells.
-have astrocytic mixtures -encapsules dendrites* -slow growing -usually fairly solid and discrete from surrounding brain |
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Describe ependymomas? (3) Where are they?
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-situated deep w/in CNS
-common in children -major group of spinal chord tumors |
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What do ependymomas found in the brain tend to do?
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seed into the subarachnoid space and may filter down the spinal chord
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Who are medulloblastomas exclusively found in?
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the cerebellum of children
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Describe medulloblastomas. (4)
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-rapidly growing
-undifferentiated -infiltrative neoplasms -tendency to spread throughout the subarachnoid space (seed down spinal column) |
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Why are medulloblastomas unlike other CNS tumors?
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widespread distant mets seen
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What are the tumors of supporting structures of the CNS? (5)
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-meningioma
-acoustic tumors or Schwannomas -pituitary tumors -craniopharyngiomas -chordomas |
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Describe meningiomas. (4)
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-arise from pia or arachnoid layers (cover the CNS)
-most benign -most common after gliomas -50 yrs |
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Describe acoustic tumors or schwannomas. (2)
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-benign
-originate from schwann cells of the nerve sheath of the eighth cranial nerve at the internal auditory canal |
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What do acoustic tumors affect? (4)
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affects facial, trigeminal nerves, brain stem, and cerebellum
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What are symptoms of schwannomas?
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-unilateral hearin loss
-tinnitus -unsteadiness |
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Describe pituitary tumors. (4)
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-benign
-slow growing -local to optic nerves, hypothalamus, third ventricle -increase intercranial pressure |
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Where does the pituitary lie and where is it located?
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pituitary lies in sella turcica which is 3/4 ant and 3/4 sup to EAM
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Describe craniopharyngiomas. Where does it occur? Common symptom? (6)
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-resemble pitiutary adenomas
-benign tumors -in children and young adults before 20 -occurs in suprasellar region -involve pituitary gland, hyperthalamus, and visual system. -common symptom- decreased vision or field cut |
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Describe chordomas. (5)
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-found at caudal or cranial ends of spinal chord
-benign -do no met -locally invasive -poor prognosis- due to difficulty eradicate and regrow after surgery (w/ or w/o RT) |
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Most common area to which met to the brain is
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lung ca, particularly small cell ca
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Approx what % of pts dying from ca have intercranial mets
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30%`
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What is the initial tx for all intercranial tumors?
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surgical incision
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What is the goal of intracranial tumors (4)
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1. bx for dx
2. total excision 3. subtotal removal 4. unblocking of CSF (shunt) |
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When is RT used on intracranial tumors?
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when tumor is surgically inaccessible or too great of danger, or complete removal of tumor unlikely
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Which tumors of the brain stem are rarely operated on because of grave risk of surgical mortality. (4)
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-midbrain
-pons -medulla -diencephalon |
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When is surgery used for met cancer of the brain?
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never
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What doses and of what make surgical decompression or removal unnecessary?
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XRT 3000-5000 cGy
corticosteroids (Decadron) |
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Mets from the spinal chord arise from
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primary tumors of lung and breast
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What is the means of treatment for malignant brain tumors?
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Surgery with XRT following
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When is XRT indicated?
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1. inaccessible surgically (midbrain, 3rd ventricle, brain stem)
2. metastatic 3. uncomplicated pituatary adenoma 4. medulloblastoma |
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Postop RT is advocated for most CNS tumors if?
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tumor removal is incomplete
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In general, adults CNS tumors are relatively?
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radiosensitive
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Doses for CNS tumors.
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5,000-7,000 cGy in 6-8 wks.
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How are treatment fields determined for CNS tumors?
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by anatomic extent of the tumor and potential areas of spread.
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What tx fields are advocated for medulloblastomas, high grade ependymomas, and malignant gliomas of the posterior fossa
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spinal iraddiation
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What has proven useful to pts w/ brain mets tumors to help swelling and intercranial pressure from XRT?
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corticosteriods
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What is the treatment of choice for low grade astrocytomas?
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surgical removal
-RT added it not completely removed |
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What is the prognosis for Grade I cerebellar astrocytomas? for Cerebrum astrocytomas?
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Grade I cerebelar astrocytomas-90%/5yr
Cerebrum astrocytomas- 46%/5yr |
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What is tx for high grade Astrocytomas (glioblastomas)?
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rarely totally resected w/ XRT if pt can tolerate, however hard to control even with 8,000 cGy
TX: RT, chemo, steroids |
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What is the prognosis for glioblastoma multiforme?
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dismal w/ more than 50% w/ grade IV will die w/in 6 mo and virtually all in 2 yrs.
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What are common tumors of the cerebellum?
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medulloblastoma
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Who are the only CNS tumors to have DISTANT mets? where do they go?
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medulloblastoma
they have a strong tendency to seed down the spinal chord |
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Tx for medulloblastomas.
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rarely surgery alone
Postop cranial spine RT- to brain and spinal chord Adj chemo |
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What is the prognosis for medulloblastomas?
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40-50%/5yr
30%/10yr |
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What 3 tumors are treated with craniospinal irradiation?
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medulloblastoma and ependymomas and posterior cranial fossa
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How do ependymomas spread? where?
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seed down the spinal chord
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What is the prognosis for ependymomas?
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50%/5yr
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Tx for ependymomas?
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surgery and craniospinal RT
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What are the doses and fields for ependymomas?
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postop doses 5000 cGy/6wks
generous 2-3 cm margins with ependymomas of spinal chord |
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Tx for Oligodendrogliomas.
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surgery and RT
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Prognosis for oligodendrogliomas.
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80%/5yr
30%/10yr |
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Describe pituatary adenomas.
Tx choices. |
benign
surgery and adj RT 45-50 Gy |
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Prognosis of pituatary adenomas.
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80-90%/5yr
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What is sometimes a side effect of XRT of pituitary adenomas? What does it cause?
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empty sella syndrome
causes headaches and visual defects |
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Tx for Craniopharyngiomas.
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surgery and postop RT 50 Gy
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Describe meningiomas. Tx choice.
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benign, slow growing
surgery, sometimes adj RT |
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Where is CSF fluid?
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in the subarachnoid space which surrounds the brain and spinal chord
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What lobe controls vision?
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occipital lobe
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What lobe controls memory?
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temporal lobe
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What does the brain stem regulate?
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sensory, homeostasis, breathing, heart rate, vasomotor, and respiratory
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