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126 Cards in this Set
- Front
- Back
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to what vertebral level does the spinal cord extend? to where does the subarachnoid space extend?
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lower border of L1, L2
S2 |
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where should spinal tap be performed?
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"to keep cord alive, keep the needle between L3 and L5"
L3-L4 or L4-L5 |
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count out all the spinal nerves.
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31 total (like 31 flavors!)
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal |
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dorsal column is organized like our bodies...how is that?
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legs are medial and arms are outside (ie. nucleus gracilis and nucleus cuneatus)
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spinal cord lesion: lower motor neurons only, flacid paralysis. disease?
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poliomyelitis/Werdig-Hoffmann disease
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spinal cord lesion: mostly white matter of cervical region; random and asymmetric lesions. disease?
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multiple sclerosis
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spinal cord lesion: combined upper and lower motor neuron deficits with no sensory deficit. disease?
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ALS
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spinal cord lesion: only dorsal columns are spared in the cross section. what happened?
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complete occlusion of the ventral artery
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spinal cord lesion: impaired propioception and locomotor ataxia. disease?
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tabes dorsalis from tertiary syphillis; nucleus gracilis is taken out
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spinal cord lesion: vental white commissure and ventral horns are affected. disease?
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syringomyelia
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spinal cord lesion: all dorsal columns are taken out as well as lateral corticospinal and spinocerebellar tracts. disease?
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vitamin B12 deficiency or Friedrich's ataxia
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if hemisection of spinal cord occurs above T1, what is an additional finding?
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Horner's syndrome
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what are 4 findings below the lesion in hemisection of the spinal cord (Brown-Sequard syndrome)?
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1. ipsilateral motor paralysis and spasticity
2. ipsilateral loss of tactile, vibration, proprioception sense 3. contralateral pain and temperature loss 4. ipsilateral loss of all sensation at that level |
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lateral corticospinal tract: function, decussation, origin
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movement of contralateral (to cortex location) limbs
pyramidal (medulla) primary motor cortex |
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dorsal column medial lemniscus: function, decussation, origin
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tactile, vibration, sensation
arcuate fibers at medulla Pacini's, Meissner's tactile disks, muscle spindles and Golgi tendon organs |
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spinothalamic tract: function, decussation, origin
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pain, temperature
ventral white commissure at spinal cord level free nerve endings, pain fibers |
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when a lumbar puncture is performed, what structures are crossed? is the pia pierced?
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1. skin/superficial fascia
2. ligaments (supraspinous, interspinous, ligamentum flavum) 3. epidural space 4. dura mater 5. subdural space 6. arachnoid 7. subarachnoid space - CSF the PIa is NOT PIerced! |
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C2 dermatome
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posterior half of skull
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C3 dermatome
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high turtle neck collar
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C4 dermatome
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low-collar shirt
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T4 dermatome
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nipple (teat pore is T4)
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T7 dermatome
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xiphoid process
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T10 dermatome; why important?
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at the belly butTEN; appendicitis pain referral
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L1 dermatome
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inguinal ligament
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L4 dermatome
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includes the knee caps (down on L4's or "all fours")
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S2, S3, S4 dermatomes
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erection and sensation of penile and anal zones
S2,3,4 keep the penis off the floor |
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via what nerve is gall bladder pain referred to the shoulder?
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the phrenic nerve
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astrocytes
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physical support, repair, K+ metabolism
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microglia
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phagocytosis
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oligodendroglia
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central myelin production
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schwann cells
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peripheral myelin production
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ependymal cells
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inner lining of ventricles
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does dopamine cross the BBB?
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no! that's why L-dopa is used in parkinsonism
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what makes up the BBB?
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it is guarded by the CIA
1. Choroid plexus epithelium 2. Intracerebral capillary endothelium 3. Arachnoid |
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what crosses the BBB readily?
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nonpolar / lipid soluble molecules
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how do glucose and aa's cross the BBB?
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by carrier-mediated transport mxns.
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what are the hypothalamic functions?
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TAN HATS
T: Thirst and water balance (supraoptic nucleus) A: Adenohypophysis control via releasing factors N: Neurohypophysis releases hormones made in hypothalamic nuclei H: Hunger (lateral nucleus) and satiety (ventromedial nucleus) A: Autonomic regulation (anterior hypoth. regulates parasympathetics), circadian rhythms (suprachiasmatic nucleus) T: Temperature regulation (posterior hypoth. regulates heat conservation and production when cold. Anterior hypothalamus coordinates cooling when hot) S: Sexual urges and emotions (Septate nucleus) |
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what part of the hypothalamus regulates cooling when hot?
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Anterior nucleus (A/C)
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Lateral geniculate nucleus (LGN)
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visual
Lateral to Look |
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Medial geniculate nucleus (MGN)
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auditory
Medial for Music |
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Ventral posterior nucleus, lateral part (VPL)
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body senses (proprioception, pressure, pain, touch vibration)
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Ventral posterior nucleus, medial part (VPM)
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facial sensation, including pain
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Ventral anterior/lateral nuclei (VA and VL)
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motor
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what are the functions of the limbic system?
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5 F's
Feeding Fighting Feeling Flight ******* |
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chorea
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sudden jerky, purposless movements
basal ganglia lesion (eg. Huntington's) |
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athetosis
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slow, writhing movements, especially fingers
basal ganglia lesion |
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hemiballismus
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sudden, wild flailing of 1 arm ("half ballistic" - throwing a ball)
contralateral subthalamic nucleus lesion; loss of inhibition of thalamus through globus pallidus |
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lesion: Broca's area
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motor (expressive) aphasia with good comprehension
BROca's is BROken speech |
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lesion: Wernicke's area
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sensory (fluent/receptive) aphasia with poor comprehension
Wernicke is Wordy but makes no sense |
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lesion: arcuate fasciculus
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conduction aphasia; poor repetition with good comprehension, fluent speech
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lesion: amygdala (bilateral)
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Kluver Bucy syndrome (hyperorality, hypersexuality, disinhibted behavior)
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lesion: frontal lobe
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frontal release signs (eg. personality changes and deficits in concentration, orientation, judgement)
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lesion: right parietal lobe
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spatial neglect syndrome (agnosia of the contralateral side of the world)
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lesion: reticular activating system
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coma
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lesion: mammilary bodies (bilateral)
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Wernicke-Korsakoff's encephalopathy (confabulations, anterograde amnesia)
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lesion: basal ganglia
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tremor at rest
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lesion: cerebellar hemisphere
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intention tremor, limb ataxia
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lesion: cerebellar vermis
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truncal ataxia and dysarthria
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anterior cerebral artery
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supplies medial surface of brain, leg-foot area of motor and sensory cortices
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middle cerebral artery
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supplies lateral aspect of brain, trunk-arm-face area of motor and sensory cortices, Broca's and Wernicke's speech areas
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what artery supplies Broca's and Wernicke's speech areas?
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middle cerebral artery
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where is the most common circle of Willis aneurysm? what problems can such an aneurysm cause?
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anterior communicating artery
visual field defects |
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what blood vessel is likely involved in a CN III palsy?
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posterior communicating artery
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what arteries supply the interal capsule, caudate, putamen and globus pallidus?
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lateral striate
"arteries of stroke" |
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in general, strokes in the anterior circle cause...
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general sensory and motor dysfunction, aphasia
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in general, strokes in the posterior circle cause...
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cranial nerve deficits (vertigo, visual defects), coma, cerebellar deficits (ataxia)
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what brain herniation can compress anterior cerebral artery?
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cingulate herniation under the falx cerebri
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name the 4 herniation syndromes.
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1. cingulate herniation under falx cerebri
2. downward transtentorial (central) herniation 3. uncal herniation 4. cerebellar tonsillar herniation into the foramen magnum |
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uncal herniation: ipsilateral dilated pupil/ptosis. cause?
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CN III is stretched
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uncal herniation: contralateral homonymous hemianopsia. cause?
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compression of ipsilateral posterior cerebral artery
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uncal herniation: ipsilateral paresis. cause?
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compression of contralateral crus cerebri (Kernohan's notch)
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uncal herniation: Duret hemorrhages - paramedian artery rupture. cause?
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caudal displacment of brainstem
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what are the 3 vagal nuclei?
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nucleus Solitarius: visceral Sensory information (eg. taste, gut distention; VII, IX, X)
nucleus aMbiguous: Motor innervation of pharynx, larynx, upper esophagus (IX, X, XI) dorsal motor nucleus: sends autonomic (parasympathetic) fibers to heart, lungs, upper GI |
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CN XII lesion (LMN). deviation?
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tongue deviates TOWARD side of lesion
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CN V motor lesion. deviation?
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jaw deviates TOWARD side of lesion
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unilateral lesion of cerebellum. deviation?
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patient falls TOWARD side of lesion
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CN X lesion. uvula deviation?
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AWAY from side of lesion
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how does a CN XI lesion present?
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weakness turning head to contralateral side of lesion; shoulder droop ON the side of the lesion
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achilles reflex?
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S1, S2
(S1 nerve root) |
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patellar reflex?
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L3, L4
(L4 nerve root) |
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biceps reflex?
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C5, C6
(C5 nerve root) |
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triceps reflex?
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C7, C8
(C7 nerve root) |
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Babinski sign?
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big toe dorsiflexes and other toes fan
sign of UMN lesion except in first year of life |
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"kuh" test?
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CN X palate elevation
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"la" test?
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CN XII (hypoglossal)
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"mi" test?
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CN VII (facial)
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CSF from lateral to 3rd ventricle
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foramen of Monro
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CSF from 3rd to 4th ventricle
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aqueduct of Sylvius
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CSF from 4th to subarachnoid space?
lateral? medial? |
Lateral: Foramen of Luschka
Medial: Foramen of Magendie |
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when you want both eyes looking to the left, how does it work neurologically?
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nucleus of CN VI fires on the left (lateral rectus) and stimulates the contralateral CN III nucleus to fire via the MLF (medial longitudinal fasciculus)
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how does the light reflex work?
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signal sent to pretectal nucleus in midbrain -> Edinger Westphal nucleus is stimulated -> bilateral pupillary constriction (consensual reflex)
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is convergence affected in MLF syndrome?
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NO!
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what disease often presents with MLF syndrome?
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multiple sclerosis
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CN through cribriform plate?
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CN I
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CN through optic canal?
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CN II
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CN through superior orbital fissure?
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CN III, IV, V1, VI
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CN through foramen rotundum?
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V2
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CN through foramen ovale?
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V3
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CN through internal auditory meatus?
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VII, VIII
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CN through jugular foramen?
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IX, X, XI
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CN through hypoglossal canal?
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XII
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signs of LMN?
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weakness
atrophy fasciculation decreased reflexes decreased tone no Babinski sign |
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where is the principal visual cortex?
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in the back of the occipital lobe
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where are the association areas of the brain?
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temporal lobe
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where is the primary auditory cortex?
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temporal lobe by the lateral fissure
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where is Wernicke's area (associative auditory cortex)?
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temporal lobe by the lateral fissure
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where is Broca's area (motor speech)?
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lower frontal lobe
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loss of dorsiflexion (foot drop). nerve and roots?
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common peroneal (L4-S2)
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loss of plantar flexion. nerve and roots?
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tibial
(L4-S3) |
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loss of knee jerk. nerve and roots?
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femoral
(L2-L4) |
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loss of hip ADDuction. nerve and roots?
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obturator
(L2-L4) |
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what are the functions of the common peroneal nerve? the tibial?
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PED: Peroneal Everts and Dorsiflexes
TIP: Tibial Inverts and Plantarflexes; if Tibial is injured, can't stand on TIPtoes |
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what nerve innervates the intrinsic muscles of the hand? what happens when the nerve is damaged?
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ulnar nerve
claw hand |
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brachial plexus: organization and nerve root #'s?
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Randy Travis Drinks Cold Beer
Roots Trunks Divisions Cords Branches C5 C6 C7 C8 T1 |
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damage to upper trunk (C5, C6)?
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Waiter's tip (Erb's palsy)
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what muscle does the axillary nerve innervate?
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deltoid
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what nerve is damaged in "wrist drop"?
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radial nerve
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what structures does the radial nerve innervate?
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it innervates the BEST!
Brachioradialis Extensors of the wrist & fingers Supinator Triceps |
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what are the 3 muscles of the thumb? hypothenar?
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OAF: Opponens pollicis, Abductor pollicis, Flexor pollicis brevis
OAF: Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi |
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what landmark is important in a pudendal nerve block?
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ischial spine
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what is the thoracic outlet syndrome (aka. Klumpke's palsy)?
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embryologic defect (anamolous cervical rib) which can compress the subclavian artery and inferior trunk of brachial plexus
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what are the clinical presentations of thoracic outlet syndrome?
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1. atrophy of thenar and hypothenar eminences
2. atroph of the interosseous muscles 3. sensory deficits on medial side of forearm and hand 4. disappearance of radial pulse when moving head to opposite side |
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what landmark do you look for in a lumbar puncture?
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iliac crest
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what 3 muscles close the jaw? which 1 muscle opens the jaw?
innervation? |
close:
Masseter teMporalis Medial pterygoid open: Lateral pterygoid nerve: V3 |
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all muscles with the root "glossus" in the name (except palatoglossus, CN X) are innervated by what CN?
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hypoglossal, CN XII
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all muscles with the root "palat" in the name (ex. tensor veli palatani, CN V) are innervated by what CN?
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CN X
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