Neuro Block 2

Front 1

4 divisions of the diencephalon

Back 1

- Hypothalamus
- Subthalamus
- Epithalamus
- Dorsal Thalamus THALAMUS

Front 2

Anterior Nucleus

Back 2

PAPEZ CIRCUIT:
Mammillary bodies to Anterior Nucleus to Cingulate Gyrus to Hypocampus to Fornix to Mammillary Bodies

{Learning/Memory: Anterior cingulated gyrus}

Front 3

Dorsomedial nucleii

Back 3

Connected to Frontal Lobe

{Connects Limbic areas: Prefrontal cortex}

Front 4

Ventral Anterior nucleii

Back 4

{Premotor}

Front 5

Ventral Lateral

Back 5

{M1. Primary motor cortex}

Front 6

Ventral Posterior Nucleii

Back 6

1) VPL: from trunk/limbs via Spinothalmic and Medial Lemniscus
2)VPM: from Trigeminal

{Somatosensory input}

Front 7

Medial Geniculate

Back 7

{Auditory input: A1}

Front 8

Lateral Geniculate

Back 8

{Vision: V1}

Front 9

Motor Nucleii
Somatosensory
PTO Cortex

Back 9

Motor Nucleii : VA, VL
Somatosensory: VPL, VPM
PTO Cortex: Pulvinar

Front 10

Subcortical nucleii

Back 10

Have NO CORTICAL PROJECTIONS (project back to other thalmic nucleii)

Front 11

Thalamus irrigated by

Back 11

1) Thalamoperforating a.
2) Thalamogeniculate a.
3) Posterior choroidal aa.

{HTN>Contralateral hemiplegia}

Front 12

Internal capsule irrigated by

Back 12

1) Lenticulostriate a. {HTN>Contralateral hemiplegia}

2) Medial striate a. (from ACA)

3) Anterior choroidal (from MCA)

Front 13

VPL/VPM Lesion

Back 13

Contralateral Somatosensory disturbance

Front 14

LGN lesion

Back 14

Contralateral Visual field defects

Front 15

VA/VL lesion

Back 15

Disturbances in motor control

Front 16

Pulvinar lesion

Back 16

Visual-spatial, perceptual, language disturbances

Front 17

Anterior nuc. lesion

Back 17

Memory loss

Front 18

DM nuc. lesion

Back 18

Executive or frontal lobe deficits

Front 19

Intralaminar nuc. lesion

Back 19

Attention/arousal deficits

Front 20

Multiple nucleii lesion

Back 20

Neglect

Front 21

Ventral posterior nuc. lesion

Back 21

Dejerine-Roussy Syndrome

Sx: Feeling lingering pain after $ removed. Minor $ can cause stron and persistent pain

Front 22

Function of THALAMUS

Back 22

Funnels through all sensory input (except olfactory sense)

SELECTIVE ATTENTION, thalamus prioritizes what is important

Front 23

Four subtypes of cortical architecture

Back 23

"CAMI"

1) Corticoid
2) Allocortex
3) Mesocortex
4) ISOCORTEX

Front 24

Isocortex

Back 24

- 6-layered neocortex
- 2 subtypes
+ Idiotypic/Heterotypic: Layers diff to differentiate
> Granular (sensory cortex)
> Agranular (Motor cortex-pyramids)
+ Homotypic: Easier to differentiate
> Posterior
* Unimodal 2*
* Heteromodal 3*
> Frontal

Front 25

6 Layers of Isocortex

Back 25

1) Molecular: acellular
2) External granular:
3) External pyramidal
4) Internal granular: TERMINATION OF PRIMARY THALAMIC INPUTS
5) Internal pyramidal
6) Multiform (polymorphic)

Front 26

Brodmann's Areas

Back 26

S1 - 3, 1, 2
S2 - 5, 7

M1 - 4
M2 - 6

A1 - 41, 42
A2 - 22

V1 - 17
V2 - 18, 19

Front 27

3 types of cortical pathways

Back 27

"ACP"
1) Association
2) Commissural
3) Projection

Front 28

Association pathways

Back 28

>Within same hemisphere
>(1) Arcuate fasciculus: frontal cortex to superior temporal cortex {ant & post speech}
>(2) Cingulum: septal frontal lobe to cingulated/parahippocampal gyrus {limbic}

Front 29

Commissural pathway

Back 29

>Left hemisphere to right
> {Spatial info}
> Ex: Corpus collosum

Front 30

Projection pathways

Back 30

>Up and down cortex to non-cortex
>(1) Internal capsule: Corticobulbar/spinal/pontine
>(2) Optic radiations: Geniculocortical fibers

Front 31

Watershed/Border zone

Back 31

Anastomosis between ACA and MCA in medial frontal and parietal lobes

LESION: Nebulous cortical probs like diff calculating and reading (no motor deficits)

Front 32

ACA irrigates

Back 32

Medial frontal and parietal lobes

Front 33

MCA irrigates

Back 33

Runs in lateral sulcus; supplies lateral frontal, parietal, and temporal lobes

Front 34

PCA irrigates

Back 34

Occipital lobe, part of inferior temporal lobe

Front 35

Triune Brain

Back 35

1) Posterior cortex: Info gathering, processing, integration

2) Frontal lobe: Executive, decision making

3) Hypothalamus/limbic: Emotion/motivation

Front 36

Lesion to primary posterior cortex

Back 36

No sensory deficits

Front 37

Cannot recognize objects.

Can open door when given key but doesn't know what it is

Back 37

Lesion to secondary posterior cortex

Hint 37

Apperceptive agnosia

Front 38

Lost ability to associate things with multiple concepts.

Knowing what a hat looks AND feels like.

Back 38

Lesion to tertiary posterior cortex

Hint 38

Associate agnosia

Front 39

Left frontal cortex

Back 39

Speech, motor skills

Front 40

Right frontal cortex

Back 40

Emotion, expression, perception, social skills

Front 41

Inability to recognize own fingers

Back 41

Lesion of left angular gyrus

Hint 41

Gerstmann's Syndrome

Front 42

Pt. unaware of own disease/deficit

Back 42

Ansognosia

Front 43

Pt. cannot name colors, cannot read, can see in ipsilateral visual field and can write

Back 43

Lesion to left or right PCA>damaging ipsilateral occipital lobe and ipsilateral corpus callosum

Hint 43

Alexia (without agraphia)

Front 44

Inability to carry our a discrete previously learned movement

"How do you use a hammer?"

Back 44

Lesion to supramarginal gyrus, arcuate fasciculus, left premotor area > bilateral deficit

Also from injury to corpus collosum or right premotor area > left side deficit only

Hint 44

Ideomotor apraxia

Front 45

Pt can speak but cannot repeat things. Difficulty naming objects, reading aloud, writing, and occasionally will substitute sounds for words

Back 45

Disconnection between Broca's (speaking) & Wernicke's areas (comprehension)

Hint 45

Conduction aphasia

Front 46

MRI of swiss cheese brain

Back 46

Arteriovenous malformation, no Sx. other than headaches and seizures

Front 47

MRI with giant fucking cyst

Back 47

Subarachnoid cyst

Front 48

Three types of headaches

Back 48

1) Tension
2) Cluster
3) Migraine
>With/Without Aura

Front 49

Tension Headaches

Back 49

> Most common
> Head in vise
> 30 min to 7 days
> Chronic if >15days over one month

Hint 49

Tx: Stress relief

Chronic
>NSAIDS,
>ASA-Caffeine-Bulbital (barbituate!)
>Phenacetin

also
>Anti-depressants
>Muscle relaxant

Front 50

Cluster Headaches

Back 50

>Severe unilateral pain in and around orbit
>Icepick into face
>15 min to 2 hours

Hint 50

Tx:
>Pure oxygen
>5-HT agonists (serotonin agonists)
>Intranasal lidocaine

also
>Ca++ channel blockers
>Bellergal
>Lithium
>Steroids
>Antihistamines

Front 51

Migraine Headaches

Back 51

>Unilateral
>Pulsation rather than icepick stab
>Females experience more
>Peak between 30s and 50s
>Can present with anorezia, nausea, vomiting (and photo- and phono-phobia)

Hint 51

Tx
ACUTE
>Analgesic, triptans (serotonin agonists)

PROPHYLACTIC
>Antiepileptics
>Beta-blocker
>Antidepressant

BEHAVIORAL
>Limiting caffeine/stress
>Inc exercise
>Sleep

Front 52

Migraine stages

Back 52

Prodrome
Aura
Headache
Postdrome

Front 53

Three theories of migraine causes

Back 53

1) Spreading wave: Brainstem to cortex like epileptic seizure

2) Trigeminal: Efferent vasospasms (why serotonin agonists work)

3) Allodynia theory: Hypersensitivity

Front 54

Memorize syndrome chart:
BROCA
WERNICKE
CONDUCTION
ANOMIA
GLOBAL
TRANSCORTICAL (Motor&Sensory)

Back 54

Front 55

Irrigation to language part of brain

Back 55

MCA

Front 56

Left M1 loss yields...

Back 56

Loss of entire left side of brain
>Contralateral hemiplegia and sensory loss
> Homonymous hemianopia
>Eye deviation toward affected side
>Global aphasia (if left)
>
>Neglect and Anosognosia (if right)

Front 57

M2 loss yields...

Back 57

>Eye deviation
>Contalateral motor loss
>Broca's aphasia

Front 58

ACA problems

Back 58

Echolalia: Pt repeats back what you said to them

Front 59

Parts of Frontal lobe

Back 59

1) Superolateral cortex
2) Orbitofrontal area

Front 60

Superolateral cortex

Back 60

>Executive center
>Working memory/Scratchpad
>Processes things
>Only area to produce actions without external $

-X- Pathological inertia
>Can't move from one task to another without a $
>Easily distracted

Front 61

Orbitofrontal cortex

Back 61

>Prone to injury from falls
>Center of social self
>Inhibits impulses that are socially unacceptable

"Oh Fuck" - OF

Front 62

Types of Memory

Back 62

1) Immediate
2) Short term
3) Recent
4) Remote

Front 63

Memory pathway

Back 63

>Sensory memory
+Attn or +Forget
>Working memory
+Encode or +Forget
>Longterm memory
+Declarative (facts_
*Semantic (knowledge,meaning)
*Episodic (events,times,places)
+Procedural (skills)

Front 64

Constructional ability

Back 64

Ability to reproduce drawings (right brain)

Front 65

Abstract reasoning

Back 65

Math, proverbs, similarities/differences

Front 66

Apraxia

Back 66

Manifestation of dysfxn in multiple areas. Inability to do somethin on command

Front 67

Neglect

Back 67

Usually right brain problem (and neglect left side)

Front 68

Types of neglect

Back 68

>Hemibody
>Motor
>Sensory
>Visual
>Auditory

Front 69

Lesion to dominant angular gyrus

Back 69

>Gerstmann's Syndrome
>MCA dz.

Front 70

Acalculia

Back 70

Can't calculate

Front 71

Agraphia

Back 71

Can't write sentence

Front 72

Finger agnosia

Back 72

Don't know which finger is ring finger

Front 73

R/L Confusion

Back 73

Can't determine which is R or L

Front 74

R frontal eye field drives eye to _____

Back 74

Left

Eye looks to side of destruction

Front 75

PCA dz.

Back 75

Can write but not read

Front 76

Three things to look for in a neurological exam

Back 76

1) Localize the lesion
2) Determine the tempo (onset/duration)
3) Get demographics (exposure, hazards to help Dx)

Front 77

Two pathological processes that can impair consciousness

Back 77

1) Bilateral cerebral hemisphere dysfxn

2) Rostral brainstem-thalmic dysfxn in
>Diencephalon
>Midbrain
>Rostral pons
>Disruption os ARAS (ascending reticular activating system)

{Consciousness, sleep/wake cycles}

Front 78

Delirium

Back 78

>Acute onset, fluctuating course
>Impaired attn and arousal
>Agitated/altered sleep cycle

Dementia is more global

Front 79

Delirium risk factors

Back 79

SHE DIES
I WATCH DEATH

[Seizure, hemodynamic, endocrine, drugs, infection, electrolytes, stroke]

[Infections, Withdrawal, acid/base disturbance, trauma, CNS pathology, hypoxia, deficiency in vitamins, endocrinopathies, acute vascular, toxins/drug, heavy metals]

Front 80

Pupillary response in CN exam (Symp vs Parasymp)

Back 80

Pupillodilator - Symp damage causes constricted pupil and ptosis (like horner)

Pupilloconstrictor PS damage causes unreactive dilated pupil
>Uncal herniation

Front 81

Sluggish light reactivity retained until all other brain stem reflexes lost

Back 81

Diffuse cellular cerebral dysfxn (toxic-metabolic encephalopathy)

Front 82

Unilateral papillary dilation, pupil unreactive to light

Back 82

3rd CN compression (like transtentorial herniation) usually due to ipsilateral lesion

Front 83

Pupils fixed in midposition

Back 83

Midbrain dysfxn due to structural damage (infarction, hemorrhage)
Central herniation
Prolonged metabolic depression by drugs or toxins

Front 84

Pupils tiny (1mm wide)

Back 84

Massive pontine hemorrhage
Toxicity due to opoids or certain insecticides (organophosphates, carbamates)

Front 85

General CN by test
Ocular mvmt
Facial grimacing
Corneal reflex
Gag reflex

Back 85

General CN by test
Ocular mvmt [3, 4, 6] LR6SO4R3
Facial grimacing [5, 7]
Corneal reflex [5, 7]
Gag reflex [9, 10]

Front 86

Doll's eyes

Back 86

Oculocephalic reflex

If absent eyes stay static

Front 87

Calorics

Back 87

Oculovestibular reflex

Cold water turns eyes away
Warm water attracts

Front 88

Arms flexed and legs extended

Back 88

Decorticate rigidity, problem above midbrain

Front 89

Arms and legs extended

Back 89

DEcErEbratE rigidity, prob at or below midbrain

E - all limbs ExtEntEd

Front 90

Compartments of cranial vault, must be balanced to maintain intercranial pressure

Back 90

Monroe-Kellie Doctrine

1) Parenchyma (80%)
2) CSF (10%)
3) Blood (10%)

Front 91

**Cerebral perfusion pressure eqn (CPP)

Back 91

CPP = Mean art press - Intercranial press

CPP = MAP - ICP

Front 92

**Uncal herniation

Back 92

From high to low pressure

Uncus and/or hippocampus shifts from Middle cranial fossa to posterior fossa.
Compression of ipsilateral CN3, contra CN2, and mesencephalon

Front 93

Uncal herniation stages

Back 93

1)Early: drowsy/sluggish
2)Herniation of midbrain/poins: coma, babinski
3)Later herniation of medulla (IRREVERSIBLE)

Front 94

Persistent vegetative state

Back 94

No awareness, communication, response to $, voluntary mvmt, control

Front 95

Locked in syndrome

Back 95

Due to basilar artery thrombosis

Awake and alert but tetraplegic, can only blink

RAS and oculomotor nerve fine but other motor (cortico____ not)

Front 96

Mental status chart:
COMA
PVS
MinCS
LIS

Back 96

Front 97

Brain death

Back 97

Loss of fxn of entire cerebrum and brain stem, resulting in coma, no spontaneous respiration, loss of ALL BRAINSTEM REFLEXES (some spinal reflexes such as deep tendon, plantar flexion, and withdrawal remain)

No recovery.

Core temp will be more than 32C

Front 98

How to confirm brain death

Back 98

Must confirm absence of brain stem reflexes

>Pupils don't respond to brigh light
>No oculocephalic reflex
>No oculovestibular reflex
>No corneal reflex
>No grimacing due to pain
> No jaw jerk
>No cough response to bronchial suctioning

Front 99

Only fibers from the _____ project directly into the thalamus

Back 99

Spinothalmic (duh, look at the name)

Front 100

What are the three somatosensory systems

Back 100

1) DCMLS (M>L as ^) foot is medial {VPL}
2) Trigeminal
3) ALS (L>M as ^) foot is lateral {VPL}

Front 101

Loss of discrimination in

>3B
>1
>2

Back 101

>3B: severe deficit in texture and shape discrimination

>1: Deficit in texture disc

>2: Deficit in Finger coordination, shape, and size discrimination

Front 102

Receptive field and what determines amount of discrimination

Back 102

A single neuron area

Size and density as well as contrast (affected by lateral inhibition)

Front 103

The fastest most dense sensory pathway to the cortex is _______

Back 103

ML

Front 104

The four fundamental properties for a $

Back 104

"MIDL"

1)Modality: Class of $ (Touch,temp,pain)
2)Intensity
3)Duration
4)Location

All affect RECRUITMENT

Front 105

Modalities and type of receptor

MR. PM

Front 106

Modalities and Receptor types

Back 106

MR.PM

Front 107

Dynamic/fast adapting receptors

Back 107

Pacinian corpuscles and Meissner

LOW freq, discontinuous APs

Front 108

Slowly adapting receptors

Back 108

Merkel cells and Ruffini ends

HIGH freq, continuous APs

Front 109

Thermoreceptors

Back 109

"Combo"

Adapt quickly then fire steady state APs for entire duration of temperature stimulus

Front 110

Nociceptors

>Types of fibers

Back 110

A-delta: myelinated, fast pain, localized, sharp {mechanosensitive, mechanothermal}

C fibers: nonmyelin, slowpain, diffusem aggravating

Front 111

Encapuslation effects

Back 111

WITH: receptor potention only when skin undergoes change (rapidly adapting)

WITHOUT: slowly adapting receptor

Front 112

Basal Ganglia functions

Back 112

1) Preparation
2) Smooth transitioning
3) Inhibiting
4) Monitoring
5) Initial learning
6) Adapting

Front 113

Basal ganglia derived from ______

Back 113

Telencephalon

Front 114

Basal ganglia comprised of

Back 114

Caudate
Globus pallidus
Putamen
(all together considered Corpus striatum)

Last two are lentiform/lenticular nucleus

Front 115

Excitatory NT
Inhibitatory NT

Back 115

+Glutamate
-GABA

Front 116

Receiving Nucleii

Back 116

Caudate and putamen

Front 117

Processing nucleii

Back 117

GPe and subthalmic nucleus

Front 118

Output nucleii

Back 118

GPi and SNr

(SNc - mixed fxn nucleus)

Front 119

MOTOR LOOP

Back 119

Front 120

LIMBIC LOOP

Back 120

Front 121

COGNITIVE LOOP

Back 121

Front 122

OCULOMOTOR LOOP

Back 122

Front 123

Blood supply to basal ganglia

Back 123

>Lenticulostriate (from M2 of MCA)
>Medial striate aa.
>Ant. choroidal aa.

Front 124

Motor basal ganglia disorders

Back 124

Hypokinetic: Parkinsons, prob direct system


Hyperkinetic: Huntington's prob of indirect inhib system

Front 125

Parkinson's disease

Back 125

> degen of SNc
> less dopamine (which inhib inhib paths, if less would inhib)

Front 126

Huntington's disease

Back 126

>Striatum diminished cap to inhib GPe, less inhibition of thalamus, increasing unwated cortical activatio

Front 127

Hemiballism

Back 127

Lesion of subthalamus (stim inhib GPi in thalamus)

Yields excessive cortical activation