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60 Cards in this Set
- Front
- Back
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what are the components of the Ascending Reticular Activating System?
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Rostral Pontomesencephalic reticular formation
Rostral intralaminar and thalamic nuclei Pulvinar Reticular nucleus of thalamus Hypothalamus Basal forebrain |
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where are the afferents coming from that input into the pontomesencephalic reticular formation?
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association cortex
limbic cortex thalamus spinoreticular pathways |
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what is the function of the rostral intralaminar thalamic nuclei?
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help maintain a conscious alert state
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where do the primary inputs for the rostral intralaminar thalamic nuclei come from?
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pontomesencephalic reticular formation
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what is the major input to the Pulvinar?
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midbrain reticular formation
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what is the Pulvinar involved in?
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arousal and attention
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what is the function of the reticular nucleus of thalamus?
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regulate the excitability of other thalamic nuclei
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what type of neurons are found in the reticular nucleus of thalamus?
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GABAnergic
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where are the outputs from reticular nucleus of thalamus going to?
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mainly within the thalamus
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what type of neurons are found in the hypothalamus?
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TMN: histaminergic
Orexin/hypocretin VLPO: GABAnergic |
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what are the nuclei of the basal forebrain?
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medial septal nuclei
diagonal band nucleus nucleus basalis |
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What do the basal forebrain nuclei make up?
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part of the cholinergic modulatory system
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what are the components of the Cholinergic diffuse modulatory system?
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Pontomesencephalic (PPT & LDT nuclei)
Basal forebrain nuclei (nucleus basalis, medial septal nuclei, nucleus of diagonal band) |
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Does the PPT nuclie have any projections to the cortex?
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NO
only projections to basal ganglia, tectum, cerebellar nuclei, pons, medulla, and spinal cord |
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what nucleus is know as the mesencephalic locomotor region?
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PPT nucleus
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what do the cholinergic projections from PPT and LDT nuclei regulate?
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projections to the intralaminar thalamic nuclei regulate excitablity of sensory relay nuclei in thalamus
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where do the medial septal nuclei and nucleus of diaganol band project?
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to hippocampus
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what is the function of the cholinergic projection from basal forebrain?
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attention, memory, learning
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degeneration of basal forebrain is an early sign of ___________
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Alzheimers disease
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where do the rostral raphe nuclei project to? what NT do they release?
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cortex, thalamus, and basal ganglia
Serotonin |
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what are the rostral raphe nuclei part of controlling?
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control sleep wake cycles and mood by projection of serotonin
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where do the caudal raphe nuclei project to?
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cerebellum, medulla, and spinal cord
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what are the caudal raphe nuclei involved in controlling?
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modulation of pain and other functions
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what are the main two Noradrenergic nucleus of the nervous system?
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Locus coeruleus
Lateral tegmental area of medulla |
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what does locus coerulus release of NE play a role in?
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innervates cerebellum, thalamus, hypothalamus, OB, cerebellum, and spinal cord
role in regulation of attention and arousal making the cerebrum & cerebellum more responsive to salient stimuli, sleep wake cycles, and mood |
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what is the lateral tegmental tract involved in controlling?
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lateral tegmental area of medulla involved in sympathetic control
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what are Dopaminergic projections important for?
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DA projections are important for motor control (basal ganglia) and reward driven behaviors
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where are histaminergic projections found?
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TMN of hypothalamus
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what is the function of histamine release?
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projection to forebrain maintains alertness
projection to thalamus & brainstem reticular formation regulate sleep and arousal regulated by other hypothalamic nuclei |
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what nuclei regulates histamine release?
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VLPO releases GABA
Orexin neurons are excitatory |
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what can produce a coma?
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lesions to
Pontomesencephalic reticular formation bilateral cerebral cortex bilateral medial and intralaminar regions of thalamus |
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what would the EEG appears as with a patient who is in a coma?
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EEB abnormal, NO sleep wake cycles
invariant over time but NOT FLAT |
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what is the cerebral metabolism of a patient in a coma?
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decreased 50% or more
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will a patient in a coma have any reflexes? what reflexes would you test for?
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may have intact reflexes
VOR Corneal GAG Exhibit spontaneous movement |
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if a patient is in a coma will the patient be able to be aroused by painful stimuli?
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NO
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Can a patient in a coma have meaningful responses mediated by the cortex to such things as pain?
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NO-lack of purposeful responses mediated by the cortex such as withdrawal from painful stimuli
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what type of metabolic imbalances can cause coma?
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Imbalance of sodium, glucose, hypoxia, hepatic encephalopathy, thiamene deficiency
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True or False
the appearance of the pupils can be informative of determining cause of coma |
TRUE
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Cause of Coma?
Pupils are normal |
toxic or metabolic
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Cause of Coma?
Pupils are fixed and dilated |
midbrain lesion or transtentorial herniation
-pupils are fixed and dilated because of loss of sympathetics |
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Cause of Coma?
Pontine Pupils |
bilateral lesion of pons, associated with wrong way eyes
-small but respond to light -loss of sympathetics |
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Cause of Coma?
Bilateral pinpoint pupils |
Opiate overdose
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Intact eye movements. what does this indicate of a patient in a coma?
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brainstem is intact
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In sleep what is the metabolic activity of the brain?
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HIGH
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what does the EEG appear as in sleep?
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variant
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When are person is sleeping are they aware of time and dreaming?
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YES
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When a person is sleeping can they be aroused by sensory stimuli?
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YES
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No evidence of brain function is indicative of what?
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BRAIN DEATH
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what will the EEG appear like in brain death?
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FLAT
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if your patient is brain dead can they be any brainstem reflexes initiated?
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NO
no VOR, pupillary response |
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The cerebral metabolism of your patient is zero. what is your diagnosis?
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brain death
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what is the difference between a coma and a persistent vegetative state?
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coma: no sleep wake cycles
PVS: sleep wake cycles may return |
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If a patient is in a PVS are they able to be aroused?
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YES
patient may open eyes and arouse, orient using brainstem pathways |
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Your patient has no evidence of cortical responses, is unable to track visual stimuli, but opens eyes and can be aroused. What is your diagnosis?
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Persistent Vegetative State
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If your patient is in a PVS is their cerebral metabolism normal?
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NO
cerebral metabolism is depressed slightly more than coma |
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If your patient is aware of examiner and can be aroused by strong stimuli, but doesn't respond to simple commands, what type of altered state of consciousness are they in?
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STUPOR
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Describe what your observations would be if your patient had suffered frontal lobe damage?
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Akinetic Mutism & Catatonia
-patient is awake but no spontaneous movements or speech NON-responsive to commands |
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Your patient has suffered bilateral damage to the cerebral peduncles. The patient is conscious, has perception of sensation, has vertical eye movement, and can blink. What will happen to this patient?
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This patient will have Locked in syndrome
completely paralyzed: only vertical eye movement and blinking perserved patient has a poor prognosis because complications from paralysis usually arise as respiratory infections |
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bilateral damage to what structures can cause locked in syndrome?
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descending motor pathways in ventral pons, cerebral peduncles, or internal capsule
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If the medulla is involved in bilateral damage to the cerebral peduncles or ventral pons what will be required for a patient suffering from locked in syndrome?
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require ventilation
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