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60 Cards in this Set

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