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53 Cards in this Set

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What is Horner's syndrome?
ptosis, miosis (pupil constriction) and anhydrosis resulting from lesion of spinal cord above T1; pancoast tumor of lung
Spina bifida occulta
failure of bony canal to close
Think patch of hair!
meninges herniate through spinal canal; dura and arachnoid protrude through the defect; cyst contains CSF
meninges and spinal cord herniate through spinal canal defect in subarachnoid space
Preganglionic sympathetic fibers contain which NT?
What is the adenohypophysis derived from?
Rathke's pouch, an outgrowth of the oral ectoderm
What is hydrocephalus?
Excess volume or pressure of the CSF leading to dilation of ventricles
What are the types of hydrocephalus?
Noncommunicating: obstruction CSF flow inside ventricular system at the foramen of Monro in the cerebral aqueduct or in the fourth ventricle

Communicating: oversecretion of CSF without obstruction in the ventricles or by CSF circulation or absorption problems

Normal pressure: CSF not absorbed by arachnoid villi and the ventricles are enlarged; patients present with confusion, gait apraxia, and urinary incontinence (WET, WOBBLY, WACKY)
Describe the flow of CSF through the ventricular system
Lateral ventricles -> foramen of Monro -> 3rd ventricle -> aqueduct of Sylvius -> 4th ventricle -> foramina of luschka, foramen of Magendie -> subarachnoid space
Composition of CSF in subarachnoid hemorrhage
bloody with RBCs, normal protein, normal glucose (66% of blood)
Composition of CSF in bacterial meningitis
cloudy, >1000 polys, elevated protein and reduced glucose
Composition of CSF in viral meningitis
clear, cloudy, 25-500 polys, slightly elevated protein and normal glucose
At what level is a lumbar puncture performed?
Upper Motor Neuron Lesion
Spastic paralysis, hyperreflexia (normally inhibitory effect on reflex circuit), Babinski sign, increased muscle tone, muscle weakness, decreased speed of voluntary movements
Lower Motor Neuron Lesion
Flaccid paralysis, Areflexia (normally part of reflex circuit), No Babinksi, Fasciculations, decreased muscle tone, atrophy of muscle, loss of voluntary movements, small area of body affected
Describe the Dorsal column-medial lemniscal pathway
(ascending pressure, vibration, touch, and proprioceptive sensation)
DRG -> dorsal horn -> ascends ipsilaterally in dorsal column -> nucleus cuneatus or gracilis -> decussates in the medulla in the pyramid (neuron 2) -> ascends contralaterally in the medial lemniscus -> VPL of thalamus -> sensory cortex
Lesions of the dorsal columns
Loss of joint position sensation, vibratory and pressure sensations, and two-pt discrimination. + Romberg sign
Describe the anterolateral/ spinothalamic system (pain, temp, and crude touch)
DRG and enter spinal cord though A-delta and C-fibers -> ascend though dorsolateral tract of Lissauer -> dorsal horn -> decussates at ventral white commisure -> spinothalamic tract ascends contralaterally -> VPL of thalamus -> cortex
Lesions of the spinothalamic tract in the spinal cord or brain stem
Result in a contralateral loss of pain and temperature. Analgesia begins 1-2 segments below the lesion and includes everything below that level
What is Brown-Sequard Syndrome?
Lesion to three tracts: corticopsinal tract, dorsal columns, spinothalamic tract. Patient presents with two ipsilateral signs and one contralateral sign.

Lesion of the corticospinal tract results in an ipsilateral spastic paresis below the level of the injury.

Ipsilateral loss of all sensation at level of lesion

LMN signs at level of lesion

Lesion to the fasciculus gracilis or cuneatus results in an ipsilateral loss of joint position sense, tactile discrimination, and vibration below the lesion.

Lesion of the spinothalamic tract results in a contralateral loss of pain and temp sensation.
What is Poliomyelitis? Where does the injury occur?
Destruction of anterior horm of the spinal cord; leading to LMN destruction.

Symptoms: Malaise, headache, muscle weakness and atrophy, fasciculations, hyporeflexia
What is Tabes Dorsalis?
Bilateral dorsal column signs below lesions. Associated with tertiary syphilis, + Romberg sign, Argyle Robertson pupils

3Ps: pain, paresthesia, and polyuria
What is ALS?
Amyotrophic Lateral Sclerosis

1. progressive spnial muscular atrophy (ventral horn)
2. primary lateral sclerosis - coricospinal tract

Combined UMN and LMN with no sensory deficit
What does a Complete occlusion of ventral artery artery spare?
Spares dorsal columns and tract of Lissauer
What is syringomyelia?
Crossing of fibers of spinothalamic tract damaged in the anterior white commissure due to enlargement of the central canal of the spinal cord; bilateral loss of pain and temp sensation

Late manifestations involve horner's syndrome
What does Vit-B12 deficiency cause?
Demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts
Where are oligodendrocytes found?
Oligodendrocytes form myelin for all myelinated axons inside the CNS, including tracts in the white matter of the spinal cord
What is the optic nerve's myelin composed of? Why is this important?
The optic nerves are the only nerves that have myelin formed by oligodendrocytes that degenerate in MS
A patient presents with muscle weakness, fasciculations, and suppressed reflexes. Where is the lesion?
Lower Motor Neuron, alpha motor neurons of ventral horn
What would a facial nerve lesion result in?
Bell Palsy - a complete ipsilateral paralysis of muscles of facial expression
What does the Middle cerebral artery supply?
The lateral surface of the frontal, parietal, and upper temporal lobes, the posterior limb and genu of the interal capsule, most of the basal ganglia
What does the ACA supply?
Medial surface of the frontal and parietal lobes, anterior 4/5 of corpus callosum, anterior limb of internal capsule
What does the Posterior Cerebral artery supply?
Occipital lobe, lower temporal lobe, splenium, midbrain
Describe the venous sinuses
Venous sinuses run in the dura mater between the meningeal and periosteal layers.
Arachnoid granulations -> Superior Sagittal sinus -> Confluence of Sinues -> Sigmoid Sinus -> internal jugular vein
How do lesions of the facial nerve in the brain stem or temporal bone result in hyperacusis?
The facial nerve innervates skeletal muscle in the middle ear, the tensor tympani (CN V) and stapedis, which contract to prevent damage to the inner ear when the ear is exposed to loud sounds.
How do middle ear diseases result in a conductive hearing loss?
Because of a reduction in the amplification provided by the ossicles
What do the semicircular canals in the inner ear detect?
Angular Acceleration
What do the Utricle and Saccule do?
They are two large sacs that continue macula which detect linear acceleration.
What is the base of the cochlea tuned for?
It is narrow and stiff and picks up high frequency sounds.
How do compressions by tumors expanding upward from the pituitary gland affect vision? What is this deficit called?
Impinging on the optic chiasm -> Crossing fibers from nasal halfs of the retina (temporal visual field) are lost -> bitemporal heteronymous hemianopsia
Describe the central auditory pathways
Sound -> Organ of Corti in the cochlea -> primary sensory neurons in the spiral ganglion in inner ear -> cerebello-pontine angle -> dorsal and ventral cochlear nuclei -> trapezoid body -> lateral lemniscus -> superior olivary nucleus -> inferior colliculus -> medial geniculate -> Hechl's gyrus in primary auditory complex
What is the blood supply to the primary visual cortex?
The posterior cerebelar artery
What is macular sparing?
preservation of the portion of the center visual field following damage to visual cortex
What does the fusiform gyrus do? (occipitotemporal gyrus)
Face Recognition
Deficit: Prosopagnosia
What may unilateral hearing loss be attributable to?
Vestibular nerve Schwannoma
What does lesion to the upper trunk of the brachial plexus cause?
Erb's palsy - Waiter's tip hand, arm in medial rotation
What is the anterior compartment of the arm innervarted (biceps, brachialis, coracobrachialis) by?
The Musculocutaneous Nerve
What is the Posterior Compartment of the Arm (Triceps, Anconeus) innervated by?
Radial Nerve

Injury results in wrist drop due to loss of wrist extension
What is the Anterior Compartment of the Forearm innervated by
Median nerve
What are the thenar muscles innervated by?
Median nerve
What is the Adductor Pollicis Muscle innervated by?
Ulnar nerve

(Abductor Pollicis longus is innervated by the radial nerve)
What does the long thoracic nerve arise from?
C5-C7 of brachial plexus; damage results in paralysis of serratus anterior muscle leading to winged scapula
Which nerves can be affected by fractures of the humerus?
Axillary,(posterior around surgical neck of humerus), radial (radial groove) and ulnar (medial epicondyle)