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85 Cards in this Set
- Front
- Back
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Skull Bones
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Ethmoid (eyes/nasal), Frontal (eyes), Temporal, Parietal, Occipital, Sphenoid(eye orbit and floor of cranium)
6 & Only paired are parietal and temporal Base is foramen magnum |
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Spinal column
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Cervical-7 head mvmt and rotation. first atlas, second atlas
Thoracic-12 where ribs are Lumbar-5 hold body weight Sacral-5 usually fused together |
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Meninges
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-Protect underlying brain and spinal cord
-Serve as a supportive framework for arteries, veins and sinuses -Enclose a fluid-filled cavity (subarachnoid space) layers of veins and capillaries -Meninges protects CNS *Pia *Arachnoid *Dura *Skull (in that order) |
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Dura Mater
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Tough Mother
*Parchment like *Epidural space b/w the dura and the skull *Subdural spce b/w the dura and the arachnoid *Falx cerebi b/w the hemispheres of the cerebral cortex *Tentorium cerebelli b/w the hemispheres of cerebellar cortex -Periosteal layer: adheres firmly to skull and anachoid space -Meningeal Dura -Dural venus sinuses form between the layers to drain out venus blood |
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Falx Ceribri
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Goes into longitudinal fissure. structure fixates your skull in midline to keep it from moving around
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Subdural Hematoma SDH
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Cause: trauma
Symptoms: ICP (intercranial pressure) Headaches Lethargy Loss of consiousness Diagnosis Recent trauma, CT/MRI Treatment Wait and see Intracranial pressure Drainage (burr holes, craniotomy, ivc/intraventricular catheter |
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Arachnoid Space
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Spider's web
-Gives appearance of cobweb -Subarachnoid space *SCF circulates through space (one way valve that lets CSF into the system, drain-jugular) *Arachnoid villi |
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Subarachnoid Hemorrhage
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*Bleeding in the subarachnoid space
-cerebral aneurysm -AVM: arterious Venus Malformation *Occurs 1/10,000 *5-10% of strokes (cause death, space is small and heart pumps blood that is not contained, cause swelling and pressure on foramen magnum) generally anurisym not trauma. *Symptoms: worst headache of life, sudden onset, seizures, vision change, nausea (gradual) *Diagnosis: CT, lumbar puncture, cerebral angiogram, eval of pupils *Treat: Craniotomy/drain |
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Pia Mater
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Tender Mother
*Tissue paper like *Fibers anchor the arachnoid to the pia so there is no movement *Conforms to the sulci and gyri and lines ventricles *Only one cell layer thick but is effective barrier to infection (is vascularized) |
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Meningitis
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Infection of fluid surrounding spine and brain
-viral (less severe and resolves on own) -Bacterial (severe and responds to antibiotics Symptoms: fever, headache, stiff neck, nausea, vomit, irritation to lights, confusion, lethargy *Diagnose: spinal tap/reflex test |
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Ventricles
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*Cavity of initial neural tube becomes the ventricles
*Ventricles serve the brain by producing circulating and helping drain CSF from CNS |
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Choroid plexus
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*Specialized cells in all ventricles that manufacture CSF
-Produce lace-like structure ependymal cells (glia) and produce CSF |
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Cerebrospinal Fluid CSF
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*Suspends the brain/flotation and decreases weight
*Bathes neurons and glia *Provides route through which chemical messages can be distributed in nervous system Lymph like fluid Clear/colorless 35-30 ml produced an hour 100-200ml in body at all times (only 25ml (medicine cup full) in ventricles) *Cushions CNS by protecting us from sudden movements *Works w/vascular system to remove waste *Small amt enters spinal cord via central canal, but most flows through ventricular and around CNS |
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Ventricular System
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*4 ventricals total
*There are 2 lateral ventricals connected to third ventricle via foramen monro *Third-near diencephalon *Fourth-near brainstem -3rd and 4th connected by Aqueduct of sylvius Interconnecting chambers in brain |
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Lateral Ventricles
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Anterior, body, posterior horn, inferior horn, atrium (curves around temporal, where everything meets)
Know what hemisphere you are near. |
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4th Ventricle
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foramen of luschka and foramen of Magendie come out of 4th ventricle. Drains into subarachnoid space and goes into the jugular and superior vena cava and finally heart
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Essay: How does the ventricular system work?
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Ependymal (glial) cells produce CSF in through the chorid plexus (a lace like structure) in the ventricles. There are 4 ventricles. Two lateral ventricles that extend from the frontal lobe to the temporal lobe (respectively). this drains through the foramen of monroe to the third ventricle located near the diencephalon. This drains into the 4th ventrical via the aquaduct of sylvious which is connected by the aquaduct of sylvius. The 4th ventrical has 2 foramen: Luschka and Magendie at the level of the pons. This drains into the subarachnoid cisterns, to the saggital sinuses, finally the subarachnoid space, which goes into the jugular, vena cava and finally heart.
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Hydrocephalus
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*Enlargement of ventricles due to:
-excess CSF -blockage -failure of CSF to reabsorb Treat by shunt and ICP monitor (shunt drains to paritoneal/stomach cavity) |
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Brain Blood Flow
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Normally 55 ml of blood flowing through every 100g of CNS per minute
-20 ml or less flows, electrical activity stops -10 ml tissue begins to die outer layers less important and will die first (cortex) |
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Blood Brain Barrier
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*Cells are highly selective
*Restricted exchange of molecules from blood into cells of nervous sys *Excludes many drugs from CNS (drug addicts break this down) |
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Brains 2 Ways of Getting Blood
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*Carotid system-(front)subclavian & carotic
*Vertebral system-(back) vertebral artery gets feed back from brain *heart gets message from reticular formation to pump blood to brain *System makes a number of 90 degree turns not to overwhelm the sytem-slows the flow. (slows pressure/bleeding, prob w/clot) |
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Carotid System *pipe cleaners*
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Internal and external carotids
-Opthalmic arteries: to retina, less important -Anterior cerebral arteries (ACA) -Middle cerebral arteries (MCA) -Posterior communicating arteries (Pcomm) |
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Anterior Cerebral Artery-ACA
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Travels up the longitudinal fissure to supply the frontal lobe, olfactory bulbm supplementary motor area, primary somatosensory area, primary motor area
*Lesions result in: -Contralateral hemiparesis and sensory loss (near motor strip) lower extremities. -Aphasia -Apraxia -Cognitive changes |
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Middle Cerebral Artery-MCA
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Travel along lateral sulcus to supply most of the hemisphere including primary motor cortex, premotor cortex, primary somatosensory area and language areas
*Lesions result in: -Contralateral hemiparisis and sensory loss upper extremities and face -Homonymous hemianopsia (visual loss at midline of eye) -Aphasia if dominant hemisphere affected -Attention, memory, visual/ spacial deficits, neglect if non dominant hemisphere |
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Posterior Communicating Arteries PCOMM
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Pair that join the iCA with the PCA in each hemisphere/ connects with posterior circulation. Other small arteries off main are called striate arteries. "locunar/watershed" stroke is when clot is in striate. Makes a hole "like a lake"
*Lesions result in: -Deficits in functions of the optic chiasm, thalmus, hypothalmus -not a common area of infarct |
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Vertebral System
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*Vertebral arteries: fuze together to make the
*basilar artery. Before they do, they feed the spinal chord. *Break off into posterior cerebral arteries (anterior and posterior). Another called the PICA: posterior inferior cerebellar artery, which comes off the posterior cerebral artery. Feeds cerebellum. *Enters the subarachnoid space through foramen magnum: 3 branches which all supply the medulla *Lesion results in: -Decreased consciousness -Nausea and vertigo -Gait ataxia and impaired ballance |
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Anterior Spinal Artery/ASA
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*Supplies the anterior 2/3 of spinal cord
*Lesion results in -Anterior cord syndrome: impaired or absent pain, temperature and motor function |
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Posterior Spinal Artery/PSA
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Supplies the posterior 1/3 of cord
*Lesion results in: -Posterior cord syndrome: absent proprioception, vibration, two point discrimination and asterognisis-knowing what something is by feel/sensation |
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Posterior Inferior Cerebellar Artery/ PICA
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Supplies dorsolateral region of medulla, inferior cerebellum, and choroid plexus of the 4th ventricle
*Lesion results in: -vertigo, vomiting, ataxia -Brainstem dysfunction -Contralateral loss of pain and temperature -Ipsilateral Horners syndrome (contraction of pupil, ptosis, recession of eyelid into orbit -dysphagia/trouble w/swallowing (medulla) |
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Basilar Artery
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*Formed by union of vertebral arteries near pontomedullary junction
*Supplies pons and most of cerebellum *Lesion results in: -Death if complete occlusion (no blood to brain stem) -Partial occlusion: tetraplegia, loss of sensation, coma, cranial nerve deficits -Acute cerebellar infarct: dizzy, nausea, dysarthria, headache |
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Cerebellar Arteries
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*AICA/ Anterior Inferior Cerebellar Artery supplies cortex of inferior surface of cerebellum, upper medulla, pons
*SCA-Superior Cerebellar Artery supplies cortex of the cerebellum, medullary center, pons, and superior cerebellar peduncles -Blood to occipital lobe |
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Posterior Cerebral Artery/PCA
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Formed by division of the basilar artery at the junction of the pons and midbrain.
Primary blood supply to the midbrain, occipital lobe, part of the inferior and medial temporal lobes, hippocampus, thalmus, choroid plexus *Lesion results in: -Contralateral hemiparisis -Paresis/paralysis of eye movements -Cortical blindness -Memory problems -Thalmic syndrome severe pain, contralateral hemisensory loss, flaccid hemiparisis |
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Circle of Willis!
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*Connecting arteries
*Anastamosis: where something joins together/connects 2 systems front and back *Connect carotid and vertebral systems *AComm *PComm *Safety net for disrupted blood supply if the lesion is below the circle (not above) |
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Transient Ischemic Attack/TIA
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Predictor of CVA
10% of all CVA's start w/TIA -Microemboli/little losses of blood to brain. Small period of time where can't walk or talk. heart still pumps, gives profusion, and moves clot out of the way |
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CVA-Cerebrovasucular attack
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*Ischemic (80-95%) CVA-artery narrow, clot big. not enough blood
*Hemorrhagic (5-15%) too much blood flow-burst |
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Ischemic Stroke
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*Thrombus-narrowed artery/ pinch straw
*Embolus-traveling blood clot *Systemic hypoperfusion-low blood pressure Treatment: Blood thinner:aspirin TPA: tissue plasmogen, IV that thins blood extremely and can reverse stroke within 3 hrs Anticoagulant-anti clot Arotid endarterectom-open artery Cerebral angioplasty:stint |
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Hemorrhagic Stroke
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*Intracerebral hemorrhage (ICH)-not as serious
*Subarachnoid hemorrhage (SAH) need immediate drainage Treatment: -craniotomy -clipping (aneurism) -Coiling- (around aneurism/no blood to it) -Drainage |
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Spinal Cord
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*Begins at foramen magnum of skull-1-2" wide, 42-45" long, 30g
*Travels through vertebral canal of spinal column (bone) *Ends at conus medullaris *Two way conduit to and from brain -receives info from body and brain -conveys info to body and brain *Whole CNS covered by meninges, so CSF in middle and around cord |
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Spinal Cord Damage
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*When damaged, points below are affected. higher injuries worst:
c1/c2 quadrapalegic on ventilator, no nerve to diaphragm C3-C4-quadraparisis/shoulder mvmt C5-C6-move shoulders and bicep C7-shoulder, bicep, wrist flex T1-finger function Thoracic region you have abdomen and trunk control, possible breathing trouble. Lumbar-weak legs (disc slip causes nerve issues and tingling/weakness in extremities |
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Spinal Cord Nourishment
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*Spinal Arteries-75% blood to cord
*Radicular arteries-25% (raduculopothy is prob not getting blood to nerves) |
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Spinal Nerves
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-31 pairs peripheral (12 cranial)
-Each nerve has sensory and motor, sensory=dorsal, enters through dorsal rootlets. Afferent. motor=ventral, exit through ventral rootlets. Efferent. -Each nerve leaves vertebral column via intervertebral foramen -Each nerve branches to innervate muscles -Each nerve innervates skin in specified areas=dermatomes |
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General Somatic Afferent Modality
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Sensory info (pain, touch temperature, proprioception) percieved by body and transmitted to cord
(somatic="of the body", feeling outside body) |
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General Visceral Afferent Modality
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Sensory info from organs, glands, membranes to cord
(visceral is inside body) |
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General Somatic Efferent Modality
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Motor innervation to skeletal muscles
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General Visceral Efferent Modality
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Motor innervation to glands, cardiac muscle, smooth muscle
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Spinal Cord Communication
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*Reflex arc
*Ascending info-periphery to brain *Descending info-brain out to body *Intersegmental info-sharing within spine itself |
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Somatic Reflex Arc
*know picture of what it looks like* |
*3 neurons communicate info
* Immediate reaction from stimulation to sensory spinal cord, motor spinal cord and organ *Sensory stimulus synapses with a cell then synapses with motor neuron. -picture is of sensory/motor vertebrae and source *Sensory info travels from receptors to dorsal root of the cord *Interneuron trasmits info to ventral horn *Motor response goes back to site of sensation reflex *message sent to brain after reflex arc, then there's words and pain. *Does not require cortex, level of spinal cord *Arc contains sensory neuron, interneuron, motor neuron |
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Ascending Sensory Pathway
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*3 neuron pathways: 1st sensory receptors in body, 2nd spinal cord to brain, 3rd thalmus to cortex (front=pain, back=proprioception)
*Lateral anterior column *Dorsal posterior column *Outside of spinal cord is like corpus collosum |
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Ascending First Order Neuron
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-Cell body in periphery/dorsal root ganglion
-Transmits sensory info from periphery to cord |
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Ascending Second Order Neuron
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-Cell body in dorsal horn of spinal cord
-Axon usually decussates (cross) and ascends to brain |
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Ascending Third Order Neuron
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-Cell body located in Thalmus
-Axon ascends ipsilaterally to somatosensory cortex/post central gyrus |
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Lateral Spinophalamic Tract
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*Pain and temperature
-Start: receptors in dermis of skin -To: dorsal horn of grey matter -To: Contralateral ventral gray horn -To:Lateral white column/ funiculus -To: Thalamus -Through:Internal capsule and corona radiata -To: Post central gyrus/sensory cortex |
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Pain
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Neuralgia=nerve pain, any type
Relief? -Analgesia -Gating theory: acupuncture, needles are where pain is -Cordotomy-pain in certain place, doctors damage sensory root to ease pain, but can't feel problem Referred pain: cortex interprets something different-heart attack/ arm pain Phantom: amputees, pain in area that's not there. |
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Ventral/Anterior Spinothalamic Tract
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*Pressure and crude touch
-Start: dermis of skin -To: ipsilateral dorsal white column -To: dorsal gray matter crossing to ventral gray matter -To: ventral white column -To: thalamus -To: sensory cortex/post central gyrus |
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Dorsal Column Tracts
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*Fasiciculus Cuneatus (wedge):
Fine touch, vibration, and proprioception of upper extremeities *Fasiculus Gracilis (slender) -Fine touch, vibration, and proprioception to the lower extremities |
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Dorsal Column Pathologies
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*Proprioception: close eyes someone moves arm. don't know
*Stereognosis: id by touch *2 point discrimination *Vibration-can't feel tuning fork *Romberg sign: stand tall, but person sways *Graphesthesia: draw letter on body and can tell what it is *Kinesthesia: duplicate movement with other limb. |
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Spinocerebellar Tracts
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*Conveys complex info for maintenance of skilled motor activity
*Anterior/ventral spinocerevvellar tract *Posterior/dorsal spinocerebellar tract * Unconscious proprioception- unconscious planning of next movement -Walking -Speaking -Swallowing -Eye movements |
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Descending Motor Pathways
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1st order neuron=upper motor neuron
2nd order neuron=lower motor neuron, or spinal/cranial nerve |
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Pyramidal Tracts
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=direct pathways to muscle
*Responsible for all voluntary movement of skeletal muscles *Corticospinal tract-to trunk and limbs/ periphery *Corticobulbar tract-to muscles of head/facial nerves |
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Corticospinal Tract
Wave Hi! |
*Upper Motor Neurons originate in the precentral gyrus/motor cortex (humunculous) (contralataral damage)
*Axons pass through internal capsule (bunch of white matter in cerebrum) into the brainstem *In the medulla about 80-90% of the axons decussate/cross to the contralateral side of the medulla and then descend into the spinal cord (why kid could run with hemispherectomy) *Then synapse with lower motor neurons at each level of the cord (cause damage lower than neuron same side ipsolaterally) -corticospinal crosses bc when we walk it's opposite |
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Corticobulbar Tract
Wink at me! |
*Two neuron synapse
*Upper motor neurons located in lowest part of the motor cortex *Pass through the internal capsule to then converge in the brainstem (crus cerebri) *Lower motor neuron axons form many of the cranial nerves *Most CN are bilaterally innervated-great so VF vibrate at the same time! *VII and XII differ (tongue and lower face) |
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Extrapyramidal Tracts
Just stand there... |
=indirect activation pathway. Outside of medulla. 4 pathways descending fashion.
*Vestibulospinal pathway *Rubrospinal pathway-helps posture (maintain normal), large muscle groups *Tectospinal pathway-eye mvmt *Reticulospinal pathway-muscle tone -Just know there's other places where info gets processed, so we maintain homeostasis. |
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Cerebellar Tracts
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*Corticopontocerebellar (motor)
-Starts in: Cerebral cortex -Through: Internal capsule -To: Pons (synapses with LMN) -Cross midline to: cerebellum, then ipsilaterally *Spinocerebellar (sensory)-refer to Ascending pathway slide. |
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Key Concepts: Decussation
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Pyramidal decussation-crossover
Damage above decussation-will cause problems on opposite/ contralateral side Damage below decussation-cause problems same/ipsilateral side -contralateral motor mvmt -bilateral speech motor control |
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UMN-Upper Motor Neuron Damage
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Spasticity
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LMN-Lower Motor Neuron Damage
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Flaccidity
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The Motor Circut
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Major circuit for anything you do
*Cerebral cortex: initiates and directs voluntary movement, transforms sensory into plans for voluntary movement "time to leave for class" *BG: Basal ganglia movement learning, motivation, intitiation "make sure we get up and go" *Cerebellum: Motor learning, timing, and control -walk to door *Thalmus: "If you want to speak at the cortex, you have to go through the thalmus"-feedback when walk to door |
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Cranial Nerves
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*12 pairs (3-12 enter and exit brainstem, so stem houses 10)
*Exit from left and right sides of brainstem *Innervate muscles of oropharynx, face, larynx, neck, other organs *Part of peripheral nervous system *Arranged hierarchichally in the brain by number *May have sensory, motor, or both functions |
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Where are the Nuclei for the Cranial Nerves?
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I. cerebrum
II. Diencephalon III. & IV Midbrain V-VIII: Pons IX-XII: Medulla |
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Brainstem's Function:
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Sensory goes to stem=proccess
*Conduit for ascending tracts to reach thalamus and cerebellum and descending tracts to reach spinal cord *Cranial nerve nuclei:III-XII *Integrative functions (respiration, cardiovascular function, consiousness) via the reticular formation. Without it your dead. imput from all over body including cortex |
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Reticular Formation
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RAS: Reticular activating system: Path of neurons to cortex
*Helps control movemnet through connections with both the spinal cord and the cerebellum *Modulates the transmission of information in pain pathways *Contains autonomic reflex circuitry *Control of arousal and consciousness |
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Remember the facial nerves /sensory & motor
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Sensory/Motor:
Some Say Marry Money, But My Brother Says Big Brains Matter More. On -Olfactory Old -Optic Olympus-Oculomotor Towering-Trochlear Tops-Trigeminal A-Abducens Fin-Facial And-Auditory/vestibulocochlear German-Glossopharyngeal Viewed-Vagus Some -Spinal accessory Hops-Hypoglossal |
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I Olfactory
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*Sensory/Motor/Both: Sensory
*Origin: Cerebrum, Frontal love to hypothalmus and amygdala *Exit: Brainstem nuclei/reticular formation involved in visceral response *Function: Smell, the only sense that doesn't go through thalmus *Symptoms:Loss of smell/taste *Test: Present odors to each nostril (coffee, lemon) and have patient identify *Damage: could be in any part of system, nostril can't get chemoreceptor, or brain lesion. any one of 3 pathways. |
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II Optic
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*Sensory/Motor/Both: Sensory
*Origin: 1st order neuron is in rods and cones (cells) form optic nerves to leave the eye. Immediately synapses to 2nd order neuron: leaves back of eye, crosses, stops by thalmus, finally 3rd order: lateral geniculate nucleous in thalmus. *Exit: Occipital lobe *Function: Info from left visual field goes to right occipital love and vice versa *Symptoms:blindness, decreased visual field *Test: Snellen/ABC chart, visual field testing *Damage: actual eye damaged=no vision, optic nerve damaged=no vision occipital lobe damgd=weird vis |
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III. Oculomotor
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*Sensory/Motor/Both: Motor
*Origin: Midbrain *Exit: Exraocular muscles *Function: Eye movement and pupil dilation. 4 muscles, 4 movements: up, down, away from nose, rotates to nose *Symptoms: Ptosis, diplopia/double vision *Test: Follow finger, pupis dilate in bright and dim lights |
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IV: Trochlear
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*Sensory/Motor/Both: Motor
*Origin: Midbrain *Exit: Superior extraocular muscles *Function: Eye movement, moves eye inward *Symptoms: Diplopia/double vision. can't walk down steps *Test: track finger w/eye |
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V Trigeminal
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*Sensory/Motor/Both: Both-bilat
*Origin: Pons *Exit: -Opthalmic branch: forhead, between eye/nose=V1 -Maxillary branch: cheek and upper lip=V2 -Mandibular branch: jaw=v3 *Function: Somatosensory infor from face/head and motor for mastication *Symptoms: facial numbness, facial weakness, jaw weakness/ chewing *Test: close/open jaw-feel masseter, light touch to V1,V2,V3 from midline *Damage: -UMN: minimum unless bilateral, then it has spasticity/tightness -LMN: wasting, weakness, jaw deviation, flaccid. rare to have flaccid on both sides -Trigeminal neuralgia |
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VI Abducens
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*Sensory/Motor/Both: Motor
*Origin: Pons *Exit: Lateral rectus muscle *Function: Lateral eye movement, move eye away from nose, tracking/fixating *Symptoms: diplopia *Test: follow finger, can person keep head streight *Damage: w/speech it can be a corticobulbar system |
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VII Facial
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*Sensory/Motor/Both: Both
*Origin: Pons *Exit: 5 Branches (Temporal, Zygomatic, Buccal, Mandibular, Cervical) *Function: Contralateral innervation to lower face, bilateral ennervation to upper face, gives facial expressions and sensory is taste anterior 2/3 of tongue. 1st order taste bud, 2nd thalmus, 3rd gyniculate. *Symptoms: facial weakness, decreased taste to anterior 2/3 tongue *Test: smile, pucker lips/whistle, raise eyebrows/ wrinke Ennervation: contralateral innervation to lower face bilateral to upper face *Damage: LMN-droopy lip on affected side-CVA, lips not held tight, can keep food in mouth LMN-Bells palsy, facial asymmetry, eye droop, smoothing of head and nasolabial folds, can't close eye or seal mouth |
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VIII Auditory
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*Sensory/Motor/Both: Sensory-bilateral
*Origin: Pons *Exit: Acoustic, vestibular-converts energy to neural signal. cilia are 1st order, 2nd crosses over and goes to inferior colliculi of midbrain and thamus, 3rd medial geniculate nuclei:opposite auditory cortex. *Function: Hearing and balance *Symptoms:dizziness, vertigo, nystagmus *Test: ticking watch, speak behind person to check hearing *Damage: |
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IX Glossopharyngeal
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*Sensory/Motor/Both: Both-bilat
*Origin: Medulla *Exit: Pharynx, larynx, parotid gland, tongue *Function: Swallowing, elevate pharynx, can still eat if damaged, posterior 1/3 of tongue taste, saliva *Symptoms: dysphagia, increased secretions, taste in posterior 1/3 tongue, pressure to Eustachian tubes *Test: swallowing exam. *Damage: brainstem damage on one side you may not see elevation of pharynx on one side. |
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X Vagus
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*Sensory/Motor/Both: Both-bilat
*Origin: Medulla *Exit: Pharyngeal branch, laryngeal branch *Function: Swallowing, visceral functions, move phayrnx and larynx *Symptoms: velar weakness, dysphagia, hypernasality, dysphonia *Test: palate, swallow, voice. palate deviates to stronger side |
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XI Accessory or Spinal Accessory
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*Sensory/Motor/Both: Motor-bilateral innervation
*Origin: Medulla *Exit: trapezius, sternocleidomastoid *Function: head movement / shoulders *Symptoms:shoulder weakness, poor control of head movement *Test: shoulder shrug, head side to side |
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XII Hypoglossal
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*Sensory/Motor/Both: Motor-contralateral
*Origin: Medulla *Exit: Extrinsic muscles of tongue *Function: tongue *Symptoms: dysarthria, tongue weakness *Test: protrude tongue, deviation *Damage: harder to determine where stroke-hemisphere or LMN |
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Clusters of Neurons in the Brainstem
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Cranial Nerve Nuclei: either receive sensory messages or transmit motor messages
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