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108 Cards in this Set
- Front
- Back
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Spinal nerve organization
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Nerves C1-C7 exit above vertebra; all other nerves exit below vertebra
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Vertebral disc herniation + common vertebral location
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Nucleus pulposus herniates through anulus fibrosus
L4-L5, L5-S1 |
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Spinal cord extends to which vertebral level?
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Lower border of L1-L2
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Subarachnoid space extends to which vertebral level?
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Lower border of S2
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Lumbar puncture is performed between which level?
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L3-L4, L4-L5
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Anterior vs. lateral spinoathalamic tract
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LateraL sharp pain, temp
Anterior: crude touch, pressure |
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DCML pathway
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1st neuron: sensor nerve endings (body in DRG)
Synapse 1: IPSL cuneate or gracile nucleus 2nd neuron: decussates (internal arcuate fibres), travels in medial lemniscus Synapse 2: VPL of thalamus 3rd neuron: to sensory cortex |
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Spinothalamic tract
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1st neuron: free nerve endings (body in DRG)
Synapse 1: IPSL grey matter dorsal horn 2nd neuron: decussation ventral white commisure, travels in spinothalamic tract Synapse 2: VPL thalamus 3rd neuron: to sensory cortex |
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lateral corticospinal tract
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1st neuron: Betz cells in primary motor cortex
Decussate at pyramidal decussation Descend CL corticospinal tract Synapse 1: cell body of anterior horn 2nd neuron: leaves anterior horn to NMJ |
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Poliomyelitis - location of lesion + symptoms
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Anterior horn, LMN signs + infection (fever, malaise)
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Werdnig-Hoffman disease - location of lesion + symptoms
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Anterior horn congenital degeneration (AR); LMN signs
"Floppy baby" with hypotonia and tongue fasciculations |
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ALS - location of lesion, symptoms
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Lateral corticospinal tract, anterior horn cells
UMN and LMN muscle defects, eventual paralysis |
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Anterior spinal artery occlusion - symptoms
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Dorsal columns, Lissauer's tract sparing - sensory intact
Voluntary movement loss Pain and temperature loss |
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Tabes dorsalis - location of lesion + symptoms
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Dorsal columns - loss of proprioception and sensation
Progressive sensory ataxia Tertiary syphilis |
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Syringomyelia - location of lesion + symptoms
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Central canal cyst compresses ventral white commissure
Bilateral loss of pain/temp, "cape-like" distribution |
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Vitamin B12 deficiency - location of lesion
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Loss of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts
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Vitamin E deficiency - location of lesion
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Loss of dorsal columns, lateral corticospinal tract, spinocerebellar tracts
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Friedreich's ataxia cause + symptoms
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GAA repeats in frataxin gene (AR) - mitoch. malfunction
Seen in boys, staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammar toes, kyphoscoliosis |
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Friedreich's ataxia most common cause of death
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Hypertrophic cardiomyopathy
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Brown-Sequard syndrome (hemisection) symptoms
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IPSL loss motor control below lesion
CL loss of pain/temp below lesion IPSL loss of proprioception below lesion IPSL LMN signs at lesion IPSL loss of sensation |
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Horner's syndrome cause
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Lesion of spinal cord above T1
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Hypothalamus SNS oculosympathetic pathway
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1st neuron: hypothalamus
Synapse 1: Lateral horn of cervical spine 2nd neuron: superior cervical ganglion 3rd neuron: to 1) sweat glands of face + forehead, 2) smooth muscle of eyelid, 3) pupillary dilator |
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C2 landmark
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Back of head
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C3 landmark
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Neck
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C4 landmark
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Clavicles
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T7 landmark
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xiphoid process
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T10 landmark
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Umbilicus
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L1 landmark
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Inguinal ligament
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L4 landmark
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Kneecaps
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S2, S3, S4
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Erection + sensation of perineum
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Paurinaud syndrome
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Superior colliculus lesion - paralysis of conjugate vertical gaze (eg. pineal tumour)
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CN III innervation
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Levator palpabrae superioris
Inferior rectus Superior rectus Medial rectus Inferior oblique |
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CN IV innervation + action
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Superior oblique: depress eyeball in adducted position
Intortion in neutral position |
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CN VI innervation
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Lateral rectus
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Inferior oblique action
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Elevate eyeball in adducted position
Extortion of eye in neutral position |
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Pupillary light reflex pathway
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CN II --> pretectal area --> Edinger-Westphal --> ciliary ganglion --> sphincter pupillae --> constriction
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CN IX innervates which chemo- and baro-receptors?
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Cartoid body and sinus
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CN V innervates which chemo- and baro-receptors?
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Aortic arch body and sinus
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Cranial nerve nuclei in midbrain
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CN II, IV
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Cranial nerve nuclei in pons
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CN V, VI, VII, VIII
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Cranial nerve nuclei in medulla
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CN IX, X, XII
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Cranial nerve nuclei in spinal cord
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CN XI
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Corneal reflex afferent & efferent
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AFF: V1 ophthalmic
EFF: VII (to obicularis oculi) |
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Lacrimation reflex aff & eff nerves
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AFF: V1
EFF: VII |
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Jaw jerk reflex aff & eff nerves
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AFF: V3 (muscle spindles in masserter)
EFF: V3 (masster) |
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Pupillary reflex aff & eff nerves
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AFF: II
EFF: III |
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Gag reflex aff & eff nerves
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AFF: IX
EFF: X |
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Nucleus solitarius innervated by + function
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CN VII, IX, X (receives visceral sensory information)
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Nucleus ambiguus innervated by + function
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CN IX, X - motor innervation of pharynx, larynx, upper esophagus
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Dorsal motor nucleus innervated by
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CN X - sends autonomic fibres to heart, lungs, GI
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Stuctures passing through superior orbital fissues
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CN III, IV, V1, VI
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Structure passing through foramen rotundum
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CN V2
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Structure passing through foramen ovale
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CN V3
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Structure passing through foramen spinosum
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Middle meningeal artery
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Structure passing through internal auditory meatus
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CN VII< VIII
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Structure passing through jugular foramen
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CN IX, X, XI, jugular vein
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Structure passing through foramen magnum
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spinal roots of CN XI, brain stem, vertebral arteries
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Cavernous sinus contents
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Venous sinuses on either side of pituitary
Nerves: III, IV, V1, V2, VI Internal carotid artery Sympathetic fibres to orbit |
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Cavernous sinus syndrome symptoms
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Ophthalmoplegia, decreased corneal, maxillary sensation
Vision intact and normal |
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CN V motor lesion effect
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Jaw deviation TOWARDS lesion side
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CN X lesion effect
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Uvula deviates AWAY from lesion side
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CN XI lesion effect
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Weakness turning head to contralateral side
Shoulder droop on IPSL side |
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CN XII lesion effect
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Tongue deviates TOWARDS side of lesion
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Conductive hearing loss: Weber & Rinne test
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Weber test: sound louder in affected ear
Rinne test: Abnormal - Bone > Air |
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Sensorineural hearing loss: Weber & Rinne test
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Weber test: sound louder in normal ear
Rinne test: Normal - air > bone |
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Noise-induced hearing loss
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Loss of high-frequency hearing 1st
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UMN CN VII lesion symptoms
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IPSL facial droop, forehead-sparing
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LMN CN VII lesion symptoms
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IPSL full facial droop (forehead included)
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Facial nerve palsy
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CN VII nucleus lesion - like LMN facial lesion - full facial droop
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Facial nerve palsy associations
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AIDS, Lyme disease, HSV, herpes zoster, sarcoidosis, tumours, diabetes
Bell's palsy = idiopathic |
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Mastication muscles that open & close jaw
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OPEN: lateral pterygoid
CLOSE: masseter, temporalis, medial pterygoid |
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Light focusses where in hyperopia and myopia?
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Hyperopia: behind retina
Myopia: in front of retina |
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Presbyopia
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Sclerosis and decreased elasticity of lens - decreased focussing ability
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Uveitis + associated conditions
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Inflammation of iris, ciliary body, choroid
Sarcoid, RA, JIA, TB, HLA-B27 (seronegative arthritis) |
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Retinitis + association
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Retinal edema and necrosis - scar
CMV, HSV, HZV, immunosuppression |
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Central retinal artery occlusion
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Monocular vision loss, acute, painless
Retina whitening with cherry-red spot |
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Muscle used for pupillary constriction + receptor type + innervation
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Sphincter pupillae, M3 receptor, Edinger-Westphal
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Muscle used for pupillary dilation + receptor type
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Dilator pupillae, a1 receptor
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Muscle used for accommodation
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Ciliary muscle
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Aqueous humour production + receptor type
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Ciliary processes, B2-receptor
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Open/wide angle glaucoma cause + symptoms
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Decrease outflow at Canal of Schlemm, peripheral --> central painless vision loss, increased IOP
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Open/wide angle glaucoma causes
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Uveitis, trauma, corticosteroids, vasoproliferative retinopathy; idiopathic
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Closed/narrow angle (chronic) + symptoms
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Lens blocking flow through canal of Schlemm
Chronic: asymptomatic --> peripheral vision loss |
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Acute closed/narrow angle glaucoma + symptoms
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Abrupt closure of canal of Schlemm
PAIN, sudden vision loss, halos around lights, rock-hard eye |
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Cataracts
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Bilateral, painless opacification of lens --> decrease in vision
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Cataracts risk factors
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Age, smoking, EtOH, sunlight, corticosteroids
Classic galactosemia, galactokinase deficiency, diabetes |
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Papilledema + appearance on fundoscopy
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Optic disc swelling (bilateral) due to increased ICP
Enlarged blind spot, elevated optic disc with blurred margins |
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CN III lesion
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Eyes look down and out, ptosis, pupillary dilation, loss of accommodation
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CN IV lesion
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Eyes look upwards when adducted; problems with reading, going down stairs
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CN VI lesion
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Medially directed eye that can't abduct
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Vertical eye movement when abducted - which muscles?
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Upward gaze: superior rectus (CN III)
Downward gaze: inferior rectus (CN III) |
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Vertical eye movement when adducted - which muscles?
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Upward gaze: inferior oblique (CN III)
Downward gaze: superior oblique (CN IV) |
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Mydraisis pathway
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1st neuron: hypothalamus to C8-TI (centre of Budge)
2nd neuron: T1 to superior cervical ganglion 3rd neuron: pass through cavernous sinus --> enters orbit as long ciliary nerve Destination: dilator pupillae |
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Marcus Gunn pupil + test
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Decreased bilateral pupillary constriction when light shown in affected eye
"Swinging flashlight test" |
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Hypoxia vs. compression on CN III function
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Hypoxia: affects inner motor component - palsies
Compression: affects outer PNS component - "blown pupil" |
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Retinal detachment
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Detachment of retina from outermost pigmented epithelium --> photoreceptor degeneration --> vision loss
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High myopia, flashes and floaters, monocular vision loss - which condition?
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Retinal detachment; emergency
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Dry macular degeneration
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Yellowish deposition beneath retinal pigment epithelium --> gradual decrease in vision
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Wet macular degeneration + treatment
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Bleeding due to choroidal neovascularization --> rapid vision loss; treatment with anti-VEGF
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Right anopia - where is the lesion?
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R. optic nerve
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Bitermporal hemianopsia - where is the lesion?
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Optic chiasm (eg. pituitary adenoma)
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Left homonymous hemianopsia - where is the lesion?
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R. optic tract
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Left upper quadrantic anopsia - where is the lesion?
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R. Meyer's loop of temporal lobe
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Left lower quadrantic anopsia - where is the lesion?
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R. parietal lobe
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Left hemianopsia with macular sparing - where is lesion?
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PCA
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Central scotoma - where is the lesion?
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Macular degeneration
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Conjugate gaze pathway
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CN VI nucleus --> IPSL lateral rectus + CN III subnucleus (via MLF)
CN III subnucleus --> medial rectus |
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Internuclear ophthalmoplegia
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MLF syndrome; lateral gaze in normal eye, impaired adduction in affected eye; nystagmus, convergence normal
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