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366 Cards in this Set

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What Brodmann area for primary vision?

Brodmann area 17
How much cardiac output does the brain receive?
20% of total CO
What arteries supply the brain?
two internal carotid arteries and two vertebral arteries that join to form the basilar artery
How does the blood supply of the brain drain
venous plexuses and dural sinuses that empty into the internal jugular veins
The internal carotid arteries supply __% and the vertebral basilar arteries supply __%.
80% and 20%
The gray outer layer, the ___, houses the higher mental functions and is responsible for general movement, visceral functions, perception, behavior, and the integration of these functions
cerebral cortex
____ interconnect the counterpart areas in each hemisphere, unifying the cerebrum's higher sensory and motor functions
Commissural fibers (corpus callosum)
The ___ contains the motor cortex associated with voluntary skeletal movement and fine repetitive motor movements, as well as the control of eye movements.
frontal lobe
The ___ tracts extend from the primary motor area into the spinal cord.
corticospinal
The ___ lobe is primarily responsible for processing sensory data as it is received
parietal
Recognition of body parts and awareness of body position (proprioception) are dependent on the ___ lobe
parietal
The ___ lobe contains the primary vision center and provides interpretation of visual data.
occipital
The ___ lobe is responsible for the perception and interpretation of sounds and determination of their source
temporal
reception of speech and interpretation of speech is located in ___ area
Wernicke
The ___ mediates the sense of smell and certain patterns of behavior (primitive behaviors, visceral response to emotional and biologic rhythms) that determine survival, such as mating, aggression, fear, and affection
limbic system
Interference with the physiology of the limbic system results in ___ and ___.
distorted perception and inappropriate behavior
The ___ aids the motor cortex of the cerebrum in the integration of voluntary movement.
cerebellum
Integrated with the vestibular system, the ___ uses the sensory data for reflexive control of muscle tone, equilibrium, and posture to produce steady and precise movements.
cerebellum
The ___ is the pathway between the cerebral cortex and the spinal cord, and it controls many involuntary functions
brainstem
4 structures of the brainstem
medulla oblongata, pons, midbrain, and diencephalon
What cranial nerves are part of the diencephalon?
Cranial Nerve I and II
What cranial nerves are part of the medulla?
Cranial Nerve 9 to 12
What cranial nerves are part of the pons?
Cranial nerves 5 to 8
What cranial nerves are part of the midbrain?
Cranial Nerves 3 and 4
What region of the brain is the pineal body located?
Epithalamus
What sensation is NOT relayed to thalamus for processing?
Olfaction
Can upper motor neurons control movement by themselves?
NO, It has to go through the lower motor neurons
A patient has difficulty saying the phrase "the light" and swallowing, what cranial nerve may be affected.
The hypoglossal nerve: it controls nerve tongue movement for speech sound articulation ( l,t, d, n)
A patient has difficulty saying the phrase "black man" and closing his eyes, what cranial nerve may be affected.
the facial nerve: responsible for labial speech sounds (b, m, w, and rounded sounds)
The ____ contains a network that provides constant muscle stimulation to counteract gravitational forces and regulates cardiovascular functioning and respiration
reticular formation
The reticular formation has fibers that conduct impulses from below the brainstem and up into the cerebral cortex called the ____.
reticular activating system
The ____ is the major integrating center for perception of various sensations such as pain and temperature (along with the cortical processing for interpretation), serving as the relay center between the basal ganglia and cerebellum
thalamus
The ___ transmits information between the brainstem and the cerebellum, relaying motor information from the cerebral cortex to the contralateral cerebellar hemisphere
pons
The ____ is the site where the descending corticospinal tracts decussate (cross to the contralateral side)
medulla oblongata
The ____ function as the extrapyramidal system pathway and processing station between the cerebral motor cortex and the upper brainstem
basal ganglia or cerebral nuclei
They contribute input from visual, labyrinthine, and proprioceptive sources that allow gross intentional movement without conscious thought by exerting a fine tuning effect on motor movements
basal ganglia
Relays impulses between cerebrum, cerebellum, pons, and medulla
Diencephalon
Hormonal control of growth, lactation, vasoconstriction, and metabolism
Pituitary gland
CN? Sensory: smell reception and interpretation
Olfactory (I)
CN? Sensory: visual acuity and visual fields
Optic (II)
CN? Motor: raise eyelids, most extraocular movements
Oculomotor (III)
CN? Parasympathetic: pupillary constriction, change lens shape
Oculomotor (III)
CN? Motor: downward, inward eye movement
Trochlear (IV)
CN? Motor: jaw opening and clenching, chewing and mastication
Trigeminal (V)
CN? Sensory: sensation to cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose, nasal and mouth mucosa, teeth, tongue, ear, facial skin
Trigeminal (V)
CN? Motor: lateral eye movement
Abducens (VI)
CN? Motor: movement of facial expression muscles except jaw, close eyelids, labial speech sounds (b, m, w, and rounded vowels)
Facial (VII)
CN? Sensory: taste-anterior two thirds of tongue, sensation to pharynx
Facial (VII)
CN? Parasympathetic: secretion of saliva and tears
Facial (VII)
CN? Sensory: hearing and equilibrium
Acoustic (VIII)
CN? Motor: voluntary muscles for swallowing and phonation
Glossopharyngeal (IX)
CN? Sensory: sensation of nasopharynx, gag reflex, taste-posterior one third of tongue
Glossopharyngeal (IX)
CN? Parasympathetic: secretion of salivary glands, carotid reflex
Glossopharyngeal (IX)
CN? Motor: voluntary muscles of phonation (guttural speech sounds) and swallowing
Glossopharyngeal (IX)
CN? Sensory: sensation behind ear and part of external ear canal
Vagus (X)
CN? Parasympathetic: secretion of digestive enzymes; peristalsis; carotid reflex; involuntary action of heart, lungs, and digestive tract
Vagus (X)
CN? Motor: turn head, shrug shoulders, some actions for phonation
Spinal accessory (XI)
CN? Motor: tongue movement for speech sound articulation (l, t, d, n) and swallowing
Hypoglossal (XII)
How long is the spinal cord?
40-50cm
What V lvl does the spinal cord terminate at?
L1/L2
The myelin-coated white matter of the spinal cord contains the ___
ascending and descending tracts
What is the gray matter in the spinal cord?
contains nerve cell bodies
The ___ originate in the brain and convey impulses to various muscle groups by inhibiting or exciting spinal activity
descending spinal tracts (corticospinal, reticulospinal, vestibulospinal)
The ___ tract permits skilled, delicate, and purposeful movements
corticospinal (pyramidal)
The ___ tract causes the extensor muscles of the body to suddenly contract when an individual starts to fall
vestibulospinal
The ___ tract arising from the brainstem innervates the motor functions of the cranial nerves.
corticobulbar
The ___ spinal tracts mediate various sensations
ascending(spinothalamic, spinocerebellar)
The ___ column spinal tract carries the fibers for the discriminatory sensations of touch, deep pressure, vibration, position of the joints, stereognosis, and two-point discrimination.
posterior (dorsal) (fasciculus gracilis and fasciculus cuneatus)
The ___ tracts carry the fibers for the sensations of light and crude touch, pressure, temperature, and pain.
spinothalamic
___ are motor pathways that all originate and terminate within the central nervous system.
Upper motor neurons
Which motor tract primary role is influencing, directing, and modifying spinal reflex arcs and circuits
Upper motor neurons
The___, cranial and spinal motor neurons, originate in the anterior horn of the spinal cord and extend into the peripheral nervous system.
lower motor neurons
Injury to the upper motor neurons results in initial ___ followed by ___ over an extended period
paralysis, partial recovery
Injury to the lower motor neurons often results in _____ .
permanent paralysis
The motor or efferent fibers of the ___ root carry impulses from the spinal cord to the muscles and glands of the body
anterior (ventral)
The sensory or afferent fibers of the ___root carry impulses from sensory receptors of the body to the spinal cord.
posterior (dorsal)
What is the critical time period for initial myelination and brain development.
The first year of life.
The following primitive reflexes are present in the newborn: 6
yawn, sneeze, hiccup, blink at bright light and loud sound, pupillary constriction with light, and withdrawal from painful stimuli.
Brain growth continues until ___ of age
12 to 15 years
Motor maturation proceeds in a ___ direction
cephalocaudal
common physiologic alterations that may occur during pregnancy are
contraction or tension headaches (worsened by postural changes and new situational problems); and acroparesthesia (numbness and tingling of the hands)
Acroparesthesia can be worse in the __ position and severely interrupt or disrupt __
supine, sleep
The number of cerebral neurons is thought to decrease by __% a year beginning at 50 years of age
1%
The velocity of nerve impulse conduction declines __% between 30 and 90 years of age, so responses to various stimuli take longer
10%
When assessing patients with severe, unremitting headaches, the experienced examiner evaluates movement of the eyes for the presence or absence of____ .
lateral (temporal) gaze.
The ___ cranial nerve is commonly one of the first to lose function in the presence of increased intracranial pressure.
sixth
In a patient with an upper motor lesion affecting the face, what is typically spared?
Emotional expressions like laughing and crying
Muscle weakness is evidenced by one side of the ____, ___, ___.
mouth drooping, a flattened nasolabial fold, and lower eyelid sagging
evaluating taste, a sensory function of cranial nerves __ and ___
VII and IX
What cranial nerves carry the sensation of salty and sweet?
Cranial nerve 7
What cranial nervers carry the sensation of bitter and sour?
CN 9
Where is the salty and sweet sensation located on the tongue?
On the anterior 2/3
Where is the bitter and sour sensation located on the tongue?
On the posterior 1/3
Vestibular function is tested by the ___ test
Romberg
Lithium, Methlyxanthines, TCAs toxicity can _____ physiologic tremor.
enhance
What factors can worsen essential tremor?
Stress and fatigue
What body locations can manifest essential tremor ?
head, trunk, voice, and tongue
Describe a resting tremor.
Slow supination -pronation ( pill-rolling) movement
The sensory function of taste over the posterior third of the tongue, which CN
IX
To evaluate nasopharyngeal sensation, tell the patient you will be testing the ___.
gag reflex
Which CN for lingual speech sounds (l, t, d, n)
CN XII
Loss of balance, a positive Romberg sign, indicates __, __, __
cerebellar ataxia, vestibular dysfunction, or sensory loss
The affected leg is stiff and extended with plantar flexion of the foot; movement of the foot results from pelvic tilting upward on the involved side; the foot is dragged, often scraping the toe, or it is circled stiffly outward and forward (circumduction); the affected arm remains flexed and adducted and does not swing
Spastic hemiparesis
The patient uses short steps, dragging the ball of the foot across the floor; the legs are extended, and the thighs tend to cross forward on each other at each step, due to injury to the pyramidal system
Spastic diplegia (scissoring)
The hip and knee are elevated excessively high to lift the plantar flexed foot off the ground; the foot is brought down to the floor with a slap; the patient is unable to walk on the heels
Steppage
The legs are kept apart, and weight is shifted from side to side in a waddling motion due to weak hip abductor muscles; the abdomen often protrudes, and lordosis is common
Dystrophic (waddling)
The legs are positioned far apart, lifted high and forcibly brought down with each step; the heel stamps on the ground.
Tabetic
The patient's feet are wide-based; staggering and lurching from side to side is often accompanied by swaying of the trunk
Cerebellar gait (cerebellar ataxia)
The patient's gait is wide-based; the feet are thrown forward and outward, bringing them down first on heels, then on toes; the patient watches the ground to guide his or her steps; a positive Romberg sign is present
Sensory ataxia
The patient's posture is stooped and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping
Parkinsonian gait
Jerky, dancing movements appear nondirectional.
Dystonia
Uncontrolled falling occurs.
Ataxia
The patient limits the time of weight bearing on the affected leg to limit pain.
Antalgic limp
Deep pressure sensation is tested by squeezing the __, __ and __ muscle
trapezius, calf, or biceps
Loss of sensory modalities may indicate ___
peripheral neuropathy
Symmetric sensory loss indicates a ___
polyneuropathy
Tactile agnosia, an inability to recognize objects by touch, suggests a ___ lobe lesion.
parietal
Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Superficial pain, Temp
Lateral spinothalamic
Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Superficial touch, Deep pressure, Vibration
Anterior spinothalamic
Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Vibration, Deep pressure, Position sense, Stereognosis, Point location, Two-point discrimination
Posterior column
Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Proprioception
Anterior and dorsal spinocerebellar
Which DESCENDING TRACTS-FOR UPPER MOTOR NEURON DISORDER is tested with; Rapid rhythmic alternating movements, Voluntary movement, DTR, Plantar
Lateral and anterior corticospinal
Which DESCENDING TRACTS-FOR UPPER MOTOR NEURON DISORDER is tested with; Posture and Romberg, Gait, Instinctual motor reactions
Medial and lateral reticulospinal
Sensory loss generally less than anatomic distribution of nerve; lost sensation in central portion with a zone of partial loss due to overlap with adjacent nerves; may lose all or selected modalities of sensation.
Single Peripheral Nerve
Sensory loss most severe over legs and feet or over hands (i.e., glove and stocking anesthesia); change from expected to impaired sensation is gradual; usually involves all modalities of sensation.
Multiple Peripheral Nerves (Polyneuropathy)
Usually incomplete loss of sensation in any area of the skin when one nerve root affected; when two or more nerve roots are completely divided, there is a zone of sensory loss surrounded by partial loss; tendon reflexes may also be lost.
Multiple Spinal Nerve Roots
All forms of sensation are lost below the level of the lesion; loss of pain, temperature, and touch sensation occurs one to two dermatomes below the lesion.
Complete Transverse Lesion of the Spinal Cord
Pain and temperature sensation occur one to two dermatomes below the lesion on the opposite side of the body from the lesion; proprioceptive loss and motor paralysis occur on the lesion side of the body.
Partial Spinal Sensory Syndrome (Brown-Séquard Syndrome)
When abdominal reflexes are absent, either an___ or ___disorder should be suspected.
upper or lower motor neuron
Stroke the inner thigh of the male patient (proximal to distal) to elicit the cremasteric reflex.What is a normal response?
The testicle and scrotum should rise on the stroked side
When is Babinski sign normal?
children younger than 2 years of age
What does a positive Babinski sign indicate?
pyramidal tract disease
What is the indicator of a positive abdominal reflex?
Movement of the umbilicus toward each area of stimulation
A left T4 hemisection will result in absent abdominal reflexes on the _____ side of the lesion.
ipsilateral
Absent of DTR indicates ___ or ___
neuropathy or lower motor neuron disorder
Hyperactivity of DTR indicates ___
upper motor neuron disorder
Superficial Reflex:Upper abdominal
T8, T9,T10
Superficial Reflex:Lower abdominal
T10,T11 and T12
Superficial Reflex:Cremasteric
T12, L1, and L2
Superficial Reflex:Plantar
L5, S1, and S2
What are the characteristics of a 4+ deep tendon reflex?
Brisk, hyperactive, with intermittent or transient clonus
DTR: Biceps
C5 and C6
DTR: Brachioradial
C5 and C6
DTR: Triceps
C6, C7, and C8
DTR: Patellar
L2, L3, and L4
DTR: Achilles
S1 and S2
Muscle tone in UMN disorder
Increased tone, muscle spasticity, risk for contractures
Muscle atrophy in UMN disorder
Little or no muscle atrophy, but decreased strength
Sensation in UMN disorder
Sensation loss may affect entire limb
Reflex in UMN disorder
Hyperactive deep tendon and abdominal reflexes; positive Babinski sign
Fasciculation in UMN disorder
No fasciculations
Motor effect in UMN disorder
Paralysis of voluntary movements
Location of insult in UMN disorder
Damage above level of brainstem affects contralateral side of body, damage below the brainstem affects the ipsilateral side of the body
Muscle tone in LMN disorder
Decreased tone, muscle flaccidity
Muscle atrophy in LMN disorder
Loss of muscle strength; muscle atrophy or wasting
Sensation in LMN disorder
Sensory loss following distribution of dermatomes or peripheral nerves
Reflexes in LMN disorder
Weak or absent deep tendon, plantar, and abdominal reflexes, absent Babinski sign, no pathologic reflexes
Fasciculation in LMN disorder
yes Fasciculations
Motor effect in LMN disorder
Paralysis of muscles
Location of insult in LMN disorder
Damage affects muscle on ipsilateral side of body
When the upper motor neurons in face are affected, as in a stroke or brain attack, ___ movements are paralyzed, but ___ movements are spared
voluntary, emotional
In a lower motor neuron face disorder, such as Bell palsy, ____ movements on the affected side are paralyzed.
all facial
Expected result in Bicep reflex
Contraction of the biceps muscle causes visible or palpable flexion of the elbow.
How do you position to obtain a biceps reflex?
flex the patient's arm to 45 degrees at the elbow
How do you position to obtain a brachioradial reflex?
Flex the patient's arm to 45 degrees at the elbow with the hand slightly pronated
How do you position to obtain a triceps reflex?
flex the patient's arm at the elbow up to 90 degrees
Expected result in Brachioradial Reflex
Pronation of the forearm and flexion of the elbow should occur.
Expected result of Triceps Reflex
Contraction of the triceps muscle causes visible or palpable extension of the elbow
Expected result in Patellar Reflex
Contraction of the quadriceps muscle causes extension of the lower leg.
Expect result in Achilles Reflex
Contraction of the gastrocnemius muscle causes plantar flexion of the foot.
How do we evaluate for clonus?
Support the knee in partially flexed position and briskly dorsiflex the foot with the other hand, maintaining the foot in flexion
Sustained clonus is associated with ____disease.
upper motor neuron
What type of patient is the 5.07 monofilament used for?
diabetes mellitus and peripheral neuropathy
A stiff neck or nuchal rigidity is a sign associated with ___ and ___
meningitis and intracranial hemorrhage
Involuntary flexion of the hips and knees when flexing the neck is a positive ___ sign for ___
Brudzinski, meningeal irritation
Pt supine, Pain in the lower back and resistance to straightening the leg at the knee constitute a positive ___ sign, indicating ___
Kernig, meningeal irritation
What are the most reliable indicators of meningitis?
headache, fever, neck stiffness, and altered mental status; 95% of patients had two out of four symptoms
The coordinated suck and swallow of an infant indictes a functioning _______
cerebellum
touch one corner of the infant's mouth; the infant should open its mouth and turn its head in the direction of stimulation; if the infant has been recently fed, minimal or no response is expected
CN V Rooting reflex
place your finger in the infant's mouth, feeling the sucking action; the tongue should push up against your finger with good strength; note the pressure, strength, and pattern of sucking
Sucking reflex CN V
loudly clap your hands about 30 cm from the infant's head; avoid producing an air current; note the blink in response to the sound; no response after 2 to 3 days of age may indicate hearing problems; infant will habituate to repeated testing
Acoustic blink reflex CN VIII
hold the infant under the axilla in an upright position, head held steady, facing you; rotate the infant first in one direction and then in the other; the infant's eyes should turn in the direction of rotation and then the opposite direction when rotation stops; if the eyes do not move in the expected direction, suspect a vestibular problem or eye muscle paralysis.
Doll's eye maneuver CN VIII
Purposeful movement (e.g., reaching and grasping for objects) begins at about ___ of age
2 months
When do we expect the infant to grab an object with one hand?
6 months
When do we expect the infant to transfer an object from one hand to the other?
7 months
When assessing the patellar reflex in a 6 month old, you see about two beats of clonus. Should you be concerned?
no, this is a common finding. Infant with clonus over ten beats should be evaluated further
Hands are usually held in fists for the___ of life, but not constantly
first 3 months
The patellar tendon reflexes are present at ___
birth
Achilles and brachioradial tendon reflexes appear at ___ of age.
6 months
Making sure the infant's head is in midline, touch the palm of the infant's hand from the ulnar side (opposite the thumb); note the strong grasp of your finger; sucking facilitates the grasp; it should be strongest between 1 and 2 months of age and disappear by 3 months
Palmar grasp (birth) Reflex
Touch the plantar surface of the infant's feet at the base of the toes; the toes should curl downward; the reflex should be strong up to 8 months of age
Plantar grasp (birth) Reflex
With the infant supported in semisitting position, allow the head and trunk to drop back to a 30-degree angle; observe symmetric abduction and extension of the arms; fingers fan out and thumb and index finger form a C; the arms then adduct in an embracing motion followed by relaxed flexion; the legs may follow a similar pattern of response; the reflex diminishes in strength by 3 to 4 months and disappears by 6 months
Moro (birth) Reflex
Hold the infant upright under the arms next to a table or chair; touch the dorsal side of the foot to the table or chair edge; observe flexion of the hips and knees and lifting of the foot as if stepping up on the table; age of disappearance varies
Placing (4 days of age) Reflex
Hold the infant upright under the arms and allow the soles of the feet to touch the surface of the table; observe for alternate flexion and extension of the legs, simulating walking; it disappears before voluntary walking
Stepping (between birth and 8 weeks) Reflex
With your index finger, briskly tap the bridge of the infant's nose between the eyes (glabella) when its eyes are open; observe the sudden symmetric blinking of the eyes; the infant will blink for the first four to five taps.
Glabella (birth) Reflex
Suspend the infant in prone position on one of your hands or on a flat surface; stroke one side of the infant's back between the shoulders to the buttocks, about 4 to 5 cm from the spinal cord; observe for the curvature of the trunk toward the side stroked; repeat on the other side.
Galant or trunk incurvature (birth to 4 weeks) Reflex
Suspend the infant in prone position on both of your hands so that the infant's legs and arms are extending over both sides of your hand; observe the infant's ability to lift its head and extend its spine on a horizontal plane; the reflex diminishes by 18 months of age and disappears by 3 years.
Landau (birth to 6 months) Reflex
Hold the infant suspended in prone position and slowly lower it head first toward a surface; observe the infant extend its arms and legs as if to protect itself; this reflex should not disappear.
Parachute (4 to 6 months) Reflex
With the infant supine, turn its head to the side; observe the infant turning its whole body in the direction the head is turned.
Neck righting (3 months, after tonic neck disappears) Reflex
____ is a debilitating, degenerative disorder in which the blood-brain barrier breaks down and permits immune cells to pass into the myelinated white matter of the brain or spinal cord tissue
Multiple sclerosis
What are the typical MRI findings of multiple sclerosis?
Brain lesions that are typically periventricular, ovoid and perpendicular to the ventricles
What are the common EEG findings during a seizure?
Spikes and waves
What is the clonic phase of a seizure?
Contraction alternate with muscle relaxation
What is the tonic phase of a seizure?
Brief flexion and characteristic cry with contraction of abdominal muscles, followed by generalized extension for 10 to 15 minutes; loss of consciousness for 1 to 2 minutes, eyes deviated upward, and dilated pupils
A___ is characterized by episodic, sudden, involuntary contractions of a group of muscles, resulting from excessive discharge of cerebral neurons
generalized seizure disorder
____ is an acute inflammation of the brain and spinal cord, involving the meninges that is often viral in origin. An arthropod or mosquito may be the vector for the virus, such as in West Nile virus. The onset is often a mild, febrile viral illness with malaise.
Encephalitis
Signs and symptoms include fever, chills, nuchal rigidity, headache, seizures, and vomiting, followed by alterations in level of consciousness
MENINGITIS
What additional signs and symptoms may indicate meningococcal meningitis?
Meningial signs with petechiae and purpura
How is meningitis transmitted?
The bacterial, viral, or fungal organism often colonizes in the upper respiratory tract, invades the bloodstream, and crosses the blood-brain barrier to infect the CSF and meninges
Decreased corneal sensation is associated with what viral infection?
Herpes Simplex
What is the pathway for the corneal reflex?
The cornea sensitivity is mediated by CN 5 and the motor fibers of CN 7 controls the blink response.
Miosis is pupil size less than ____ mm in diameter.
2
Mydriasis is pupil size more than ____ mm in diameter.
6
What pupillary changes can occur with iridocyclitis?
Miosis, Mydriasis, Failure to constrict with increased light stimulus
What is an Argyll Robertson pupil?
Bilateral, miotic, irregularly shaped pupils that fail to constrict with light by retain constriction with convergence.
What are the typical lesions that can cause argyll robertson pupil?
Neurosyphilis; Lesions in the midbrain where afferent pupillary fibers synapse
What is the pupillary effect of pilocarpine?
Miosis
What is the pupillary effect of atropine?
Mydriasis
What is the pupillary effect of acute angle glaucoma?
Mydriasis; slight dilation
Alcohol causes pupillary ____ but morphine causes pupillary ______.
mydriasis; miosis
How can we determine which is the abnormal pupil in anisocoria?
Test whether pupils react equally to light; The abnormal pupil will react more slowly.
What is the pupillary effects of acute uveitis?
Constriction of the pupil with pain and reddened eye
The pupils should constrict when focusing on a ____ object.
near
What is an Adie pupil?
The affected pupil dilated and reacts slowly or fails to react to light but responds to convergence.
What is the difference between Adie pupil and Marcus- Gunn pupil?
Adie pupil is caused by impaired postganglionic parasympathetic innervation to sphincter pupillae muscles- the pupil is dilated and reacts slowly to DIRECT light but responds to convergence. Marcus-Gunn pupil is caused by severe retinal/optic nerve disease- the pupil fails to constrict when direct light is shown in it during the swinging flashlight test
What is are the eye changes with oculomotor damage?
Pupil dilation and fixed position; the eye is deviated laterally and downward; lid ptosis
Can visual acuity be normal in a Marcus-Gunn pupil?
YES
What is a Marcus- Gunn pupil?
An afferent pupil defect; this is detected with the swinging flashlight test- direct light causes the pupil to constrict but when light is directed on the other pupil it dilates
what is the positioning when testing visual fieds?
Sit or stand opposite the patient at eye level at a distance of 1 m
What does the numerator represent in a vision of 20/40?
The numerator indicates the distance at which the patient can read from the chart.
What does the denominator represent in a vision of 20/40?
The denominator indicates the distance at which the average eye can read the line. This means what the average eye can read at 40 ft
What is legal blindness?
vision not correctable to better than 20/200
what is the distance that near vision should be tested with the handheld card?
35cm or 14 inches
What changes does delirium cause to orientation (state of consciousness)?
time and place disorientation only
What changes does depression cause to orientation (state of consciousness)?
time disorientation only
What are some possible causes to person disorientation?
cerebral trauma, seizures, or amnesia
Which migraine has its onset in childhood?
classic migraine
What is the precipitating event for medication rebond headache?
abrupt discontinuation of analgesics
Which headaches are more common in females>
classic migraine and medication rebound
What is the precipitating event for cluster headache?
alcohol consumption
What is likely to be the headache that wakes you from sleep?
A headache caused by a space occupying lesion
Which headaches is worsened by couging or bending forward?
A headache caused by a space occupying lesion
What is the classic pattern of a hypertensive headache?
It starts daily in the morning as a throbbing pain and gets better as the day progresses
What headaches are more common in males?
Cluster headaches
What are some precipitating events for classic migraines?
Menstrual period, missing meals, birth control pills, letdown after stress
What is the peak incidence of brain tumors?
between 65 and 79 years
If vision improves with the pinhole test, this indicates ____
Refractive error is responsible for decreased visual acuity
Young infants do not demonstrate nuchal rigidity until about ___ of age
6 to 9 months
When a lumbar puncture is done for suspected meningitis, the odor of alcohol can indicate a ___ infection
cryptococcal
Lyme disease is a multisystem infection caused by the ___ spirochete, which is carried by ticks.
Borrelia burgdorferi
characteristic skin circular red rash that continues to grow with central clearing, giving the appearance of a bulls-eye
Lyme disease
signs associated with the third stage of the infection Lyme disease
Arthritis and acrodermatitis
Peak ages of incidence in SPACE-OCCUPYING LESIONS (INTRA-CRANIAL TUMORS)
3 to 12 years and 50 to 70 years
Supplies the cerebral hemispheres and diencephalon by the ophthalmic and ipsilateral hemisphere arteries
INTERNAL CAROTID ARTERY
Supplies frontal lobe, parietal lobe, cortical surfaces of temporal lobe (affecting structures of higher cerebral processes of communication; language interpretation; perception and interpretation of space, sensation, form, and voluntary movement)
MIDDLE CEREBRAL ARTERY
Supplies superior surfaces of frontal and parietal lobes and medial surface of cerebral hemispheres (includes motor and somesthetic cortex serving the legs), basal ganglia, corpus callosum
ANTERIOR CEREBRAL ARTERY
Supplies medial and inferior temporal lobes, medial occipital lobe, thalamus, posterior hypothalamus, and visual receptive area
POSTERIOR CEREBRAL ARTERY
Supply the brainstem and cerebellum
VERTEBRAL OR BASILAR ARTERIES
Supplies the lateral and posterior portion of the medulla
POSTERIOR INFERIOR CEREBELLAR ARTERY
Supply the cerebellum
ANTERIOR INFERIOR AND SUPERIOR CEREBELLAR ARTERIES
Supplies the anterior spinal cord
ANTERIOR SPINAL ARTERY
Supplies the posterior spinal cord
POSTERIOR SPINAL ARTERY
___ is a chronic autoimmune neuromuscular disease involving the lower motor neurons and muscle fibers. The disorder is characterized by an insidious, muscle fatigue and progressive weakness of the voluntary muscles with repetitive activity.
Myasthenia gravis
What is the cause of myathenia gravis?
The acetylcholine sites stop transmitting nerve impulses across the NMJ to direct muscle contraction
How can we reproduce ptosis in myasthenia gravis?
ptosis develops within 2 minutes of upward gaze
What is the pattern of weakness in Guillain-Barre
Progressive weakness, more in the legs than in the arms, increased difficulty walking; Bilateral and symmetric and diminished reflexes in ascending pattern
What is the facial weakness pattern in myasthenia gravis vs. guillain-barre syndrome?
In myasthenia gravis, the facial weakness occurs when puffing out the cheeks. In Guillain-Barre, facial nerve weakness results in bell's palsy
What are the lumbar puncture findings in Guillain-Barre?
Increased protein in the CSF
What type of paralysis is associated with Guillain-Barre?
Flaccid paralysis
What is the pattern of sensory and coordination deficits in myasthenia gravis?
There are none. The weakness of skeletal muscles are without reflex, sensory and coordination abnormalities
_____ is an acute polyradiculoneuropathy that commonly follows a nonspecific infection that occurred 10 to 14 days earlier
Guillain-Barré syndrome (acute idiopathic polyneuritis)
Widespread inflammation or demyelination of the ascending or descending peripheral nerves leads to impaired conduction of nerve impulses between the nodes of Ranvier. It is characterized by ascending symmetric weakness (with sensation preserved) that increases in severity over days or weeks
GUILLAIN-BARRÉ SYNDROME
____ is a recurrent paroxysmal sharp pain that radiates into one or more of the branches of cranial nerve V
Trigeminal neuralgia
Triggers of pain may include chewing, swallowing, talking, washing the face, brushing the teeth, exposure to cold, and even a breeze across the face. The usual age of onset is 40 to 60 years, and women are more commonly affected than men.
TRIGEMINAL NEURALGIA (TIC DOULOUREUX)
____ is a disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves, most commonly in the hands and feet.
Peripheral neuropathy
What are the changes to the facial appearance with Bell's palsy?
Facial creases and nasolabial fold disappear on affected side; Eyelid will not close on affected side and lower lid sags;
Common causes of Peripheral neuropathy
diabetes mellitus, but it may also be caused by toxins, such as kerosene, or vitamin B12 deficiency
Cerebral palsy occurs in an estimated ___ per 1000 births.
2 to 3
____ is a group of brain damage syndromes in which a static and nonprogressive cerebral lesion causes significant motor delay and abnormal neuromuscular findings.
Cerebral palsy
What is the most common cause of cerebral palsy?
Injury to the immature periventricular white matter in fetuses and premature infants
What is the clinical presentation of spastic CP
Hypertonicity, tremors, scissor gait, toe walking. There are persistent primitive reflexes, exaggerated DTRs
What is the clinical presentation of dyskinetic CP
Involuntary slow writhing movements of the extremities; tremors may be present. Exaggerated posturing, inconsistent muscle tone that varies during the day.
What is the clinical presentation of ataxic CP
Abnormalities of movement involving balance and position of trunk and extremities. There are intention tremors; also instability and wide based gait
What maternal health conditions are associated with myelomeningocele?
Diabete mellitus, folic acid deficiency, and maternal obesity
What are the contents of a myelomeningocele?
The exposed meningeal sac is filled with fluid and nerves
What are the sensory deficits associated with myelomeningocele?
May have loss of bladder or bowel control; sensory deficit and paralysis (or weakness) that is dependent on the level of weakness
Characteristic signs include retinal hemorrhages, altered consciousness with axonal injury, as well as subdural or subarachnoid hemorrhage.
Shaken baby syndrome
In kids, It is associated with impaired brain growth due to cerebral atrophy, progressive motor dysfunction, regression or a plateau in developmental milestones, and generalized weakness with upper motor neuron signs. Less common findings include dysphagia, gait ataxia, and seizures.
HIV ENCEPHALOPATHY
____ is a progressive encephalopathy of unknown cause that develops in girls between 6 and 18 months of age after normal neurologic and mental development. Head growth decelerates between 5 and 48 months of age.
Rett syndrome
in kids, Characteristic signs include loss of voluntary hand movement, loss of previously acquired hand skills, hand wringing movements, gradual development of ataxia and rigidity of the legs, growth retardation, seizures, loss of facial expression, and autistic behavior
RETT SYNDROME
What nerves are involved in intrapartum maternal lumbosacral plexopathy?
Lumbosacral trunk; superior gluteal and obturator nerves
___ results from compression of the lumbosacral plexus and peripheral nerves in the pelvic wall by the fetal head or forceps
Femoral neuropathy
____ may result from compression of nerves in the lumbosacral trunk when the fetal brow presses against the mother's sacral ala.
Postpartum footdrop
Compression of the ____ between the leg holders and the fibula during delivery can also cause unilateral footdrop.
common peroneal nerve
___ is a slowly progressive, degenerative neurologic disorder of the brain's dopamine neuronal systems
Parkinson disease
Symptoms (often unilateral initially) begin with tremors at rest and with fatigue, disappearing with intended movement and sleep, respectively. The disorder progresses with tremor of the head, slowing of voluntary and automatic movements (bradykinesia), and bilateral pillrolling of the fingers. Motor impairment causes delays in execution of movement, masked facial expression, and poor blink reflex
Parkinson disease
Describe the Parkinsonian gait.
Freezing gait with short, rapid, shuffling steps with reduced arm swinging
Describe the gait of normal pressure hydrocephalus.
Gait impairment with wide-based stance, short,small steps and reduced floor clearance. Difficultly turning
___ is a syndrome caused by noncommunicating hydrocephalus (i.e., dilated ventricles, but intracranial pressure is within expected ranges) that simulates degenerative diseases.
Normal pressure hydrocephalus
What impairments are expected with normal pressure hydrocephalus?
Cognitive, gait and executive function impairement, Eventual urinary incontinence
Patients have a triad of signs including a gait disorder, psychomotor slowing, and incontinence. Patients may have progressive dementia with memory loss, mild bilateral upper motor neuron signs, and fecal and urinary incontinence.
Normal pressure hydrocephalus
What is the cause of postpolio syndrome?
During recovery, damaged neurons sent out axonal links to activate muscle fibers that hd neurons killed by the poliovirus; The remaining motor neurons activated many more muscle fibers than they were expected to handle ; over time the overloaded damaged neurons died, causing polio symptoms to recur.
What is the triad of symptoms associated with post-polio syndrome?
weakness, dysphagia, and sleep apnea
Relay center for major ascending and descending spinal tracts that decussate at the pyramid
Reflexes of pupillary action and eye movement
Regulates respiration; houses a portion of the respiratory center
Reflexes of swallowing, coughing, vomiting, sneezing, and hiccupping
Medulla oblongata CN IX-XII
Controls voluntary muscle action with corticospinal tract pathway
Reflex center for eye and head movement
Auditory relay pathway
Pons CN V-VIII
Corticospinal tract pathway
Integrates impulses between motor cortex and cerebrum, influencing voluntary movements and motor response
Midbrain CN III-IV
Controls state of consciousness, conscious perceptions of sensations, and abstract feelings
Thalamus
Sexual development and behavior
Houses the pineal body
Epithalamus
Maintains temperature control, water metabolism, body fluid osmolarity, feeding behavior, and neuroendocrine activity
Major processing center of internal stimuli for autonomic nervous system
Hypothalamus
Test extraocular eye movements.
Inspect eyelids for drooping.
Inspect pupils' size for equality and their direct and consensual response to light and accommodation.
Test visual fields by confrontation and extinction of vision.
CN III (oculomotor), IV (trochlear), and VI (abducens)
Test corneal reflex.
Palpate jaw muscles for tone and strength when patient clenches teeth.
Test superficial pain and touch sensation in each branch (test temperature sensation if there are unexpected findings to pain or touch).
Inspect face for muscle atrophy and tremors.
CN V (trigeminal)
Test ability to identify sweet and salty tastes on each side of tongue.
Inspect symmetry of facial features with various expressions (e.g., smile, frown, puffed cheeks, wrinkled forehead).
CN VII (facial)
Test for lateralization of sound.
Compare bone and air conduction of sound.
Test sense of hearing with whisper screening tests or by audiometry.
CN VIII (acoustic)
Test gag reflex and ability to swallow.
Test ability to identify sour and bitter tastes.
Inspect palate and uvula for symmetry with speech sounds and gag reflex.
Observe for swallowing difficulty.
CN IX (glossopharyngeal)
Evaluate quality of guttural speech sounds (presence of nasal or hoarse quality to voice).
CN X (vagus)
Test sternocleidomastoid muscle strength (turn head to each side against resistance).
Test trapezius muscle strength (shrug shoulders against resistance).
CN XI (spinal accessory)
Evaluate quality of lingual speech sounds (l, t, d, n).
Inspect tongue in mouth and while protruded for symmetry, tremors, and atrophy.
Test tongue strength with index finger when tongue is pressed against cheek.
Inspect tongue movement toward nose and chin.
CN XII (hypoglossal)
Artery Affected?
Profound aphasia
Severe contralateral hemiplegia and hemianesthesia
Unilateral blindness
INTERNAL CAROTID ARTERY
What artery affected?
Alterations in communication, cognition, mobility, and sensation
Contralateral homonymous hemianopia
Contralateral hemiplegia or hemiparesis, motor and sensory loss, greater in face and arm than the leg
MIDDLE CEREBRAL ARTERY
What artery affected?
Emotional lability
Confusion, amnesia, personality changes
Urinary incontinence
Contralateral hemiplegia or hemiparesis, greater in lower than upper extremities
ANTERIOR CEREBRAL ARTERY
ANTERIOR CEREBRAL ARTERY
What artery affected?
Emotional lability
Confusion, amnesia, personality changes
Urinary incontinence
Contralateral hemiplegia or hemiparesis, greater in lower than upper extremities
What artery Affected? Hemianesthesia
Contralateral hemiplegia, greater in face and upper extremities than in lower extremities, cerebellar ataxia, tremor
Visual loss-homonymous hemianopia, cortical blindness
Receptive aphasia
Memory deficits
POSTERIOR CEREBRAL ARTERY
POSTERIOR CEREBRAL ARTERY
What artery Affected? Hemianesthesia
Contralateral hemiplegia, greater in face and upper extremities than in lower extremities, cerebellar ataxia, tremor
Visual loss-homonymous hemianopia, cortical blindness
Receptive aphasia
Memory deficits
What artery affected?
Unilateral and bilateral weakness of extremities; upper motor neuron weakness involving face, tongue, and throat; loss of vibratory sense, two-point discrimination, and position sense
Diplopia, homonymous hemianopia
Nausea, vertigo, tinnitus, and syncope
Dysphagia
VERTEBRAL OR BASILAR ARTERIES
VERTEBRAL OR BASILAR ARTERIES
What artery affected?
Unilateral and bilateral weakness of extremities; upper motor neuron weakness involving face, tongue, and throat; loss of vibratory sense, two-point discrimination, and position sense
Diplopia, homonymous hemianopia
Nausea, vertigo, tinnitus, and syncope
Dysphagia
What artery affect?
Wallenberg syndrome
Dysphagia, dysphonia
Ipsilateral anesthesia of face and cornea for pain and temperature (touch preserved)
Ipsilateral Horner syndrome
Contralateral loss of pain and temperature sensation in trunk and extremities
Ipsilateral decompensation of movement
POSTERIOR INFERIOR CEREBELLAR ARTERY
POSTERIOR INFERIOR CEREBELLAR ARTERY
What artery affect?
Wallenberg syndrome
Dysphagia, dysphonia
Ipsilateral anesthesia of face and cornea for pain and temperature (touch preserved)
Ipsilateral Horner syndrome
Contralateral loss of pain and temperature sensation in trunk and extremities
Ipsilateral decompensation of movement
What artery affected?
Difficulty in articulation, swallowing, gross movements of limbs; nystagmus
ANTERIOR INFERIOR AND SUPERIOR CEREBELLAR ARTERIES
ANTERIOR INFERIOR AND SUPERIOR CEREBELLAR ARTERIES
What artery affected?
Difficulty in articulation, swallowing, gross movements of limbs; nystagmus
What artery affected?
Flaccid paralysis, below level of lesion
Loss of pain, touch, temperature sensation (proprioception preserved)
ANTERIOR SPINAL ARTERY
ANTERIOR SPINAL ARTERY
What artery affected?
Flaccid paralysis, below level of lesion
Loss of pain, touch, temperature sensation (proprioception preserved)
What artery affected?
Sensory loss, particularly proprioception, vibration, touch, and pressure (movement preserved)
POSTERIOR SPINAL ARTERY
POSTERIOR SPINAL ARTERY
What artery affected?
Sensory loss, particularly proprioception, vibration, touch, and pressure (movement preserved)
What are the early signs of peripheral neuropathy?
Unusual sensations of walking on cotton, floors feeling strange, or inability to distinguish between coins by feel
Causes of Peripheral Neuropathy: I'M DISTAL
Idiopathic, Inherited
Metabolic, Mechanical
Drugs
Infections
Sarcoidosis
Tumors
Autoimmune, Allergy
Lack of vitamins Mnemonics
behavior used to limit pain, as limping reduces the time of weight bearing on an affected leg
Antalgic
inability to coordinate muscle activity during voluntary movement
Ataxia
pathway and processing station between the cerebral motor cortex and the upper brainstem
Basal ganglia
acts as the pathway between the cerebral cortex and spinal cord
Brainstem
sign characterized by involuntary flexion of the hips and knees when the neck is flexed
Brudzinski
works with the motor cortex of the cerebrum; involved in voluntary movement; processes information from eyes, ear, and touch
Cerebellum
contains the motor cortex; associated with voluntary skeletal movement
Frontal lobe
tactual ability to recognize writing on the skin
Graphesthesia
maintains temperature control, water metabolism, and neuroendocrine activity
Hypothalamus
attempt to straighten a leg of a supine patient with leg flexion at the knee and hip
Kernig sign
mediates primitive behaviors that determine survival
Limbic system
absence of deep tendon reflexes may be an indication of this type of neuron disorder or of peripheral neuropathy
Lower motor
acts as as the respiratory center and relay center for major ascending and descending spinal tracts
Medulla oblongata
stiff neck; associated with meningitis
Nuchal rigidity
contains the primary visual center and interpretation of visual data
Occipital lobe
patient standing with eyes closed is unable to maintain balance when pushed slightly
Romberg
unexpected gait pattern manifested by an excessive lift of the hip and knee and an inability to walk on the heels
Steppage
ability to identify an object by touch
Stereognosis
responsible for perception and interpretation of sounds, taste, smell, and balance
Temporal lobe
conveys sensory impulses to and from the cerebrum and integrates the impulses between the motor cortex and the cerebrum
Thalamus
Fatigue, bowel and bladder dysfunction, sexual dysfunction, sensory changes, muscle weakness
Multiple sclerosis
Disturbances in consciousness, behavior, sensation and autonomic functioning
Generalized seizure disorder
Fever, chills, headache, nuchal rigidity
Meningitis
Headache, polyneuritis, unilateral or bilateral facial paralysis, ataxia
Lyme disease
Sudden weakness and numbness, confusion, difficulty speaking, loss of balance, paralysis of face, arm, or leg
Cerebral vascular accident
Chronic autoimmune neuromuscular disease
Myasthenia gravis
Acute polyradiculoneuropathy
Guillain-Barre syndrome
Recurrent paroxysmal sharp pain that radiates onto CN V
Trigeminal neuralgia
Static and nonprogressive cerebral lesions cause significant motor delay in a child
Cerebral palsy
Progressive, degenerative neurologic disorder in older adults
Parkinson disease
What artery affected?
Alterations in communication, cognition, mobility, and sensation
Contralateral homonymous hemianopia
Contralateral hemiplegia or hemiparesis, motor and sensory loss, greater in face and arm than the leg
Middle Cerebral artery