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501 Cards in this Set
- Front
- Back
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CNS neurons origin
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neuroectoderm
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ependymal cells origin
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neuroectoderm
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oligodendrocytes origin
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neuroectoderm
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astrocytes origin
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neuroectoderm
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schwann cells origin
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neural crest
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PNS neurons origin
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neural crest
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microglia origin
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mesoderm
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permanent cells
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neurons
do not divide in adulthood |
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where is nissl substance located and what is it?
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in cell body of nucleus
RER |
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astrocytes function
5 |
physical support
repair K+ metab removal of excess neurotransmitter maintain blood brain barrier |
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reactive gliosis in response to injury is done by what type of cell?
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astrocyte
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what cell type maintains the blood brain barrier?
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astrocyte
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astrocyte marker
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GFAP
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CNS phagocytes- what type of cell?
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microglia
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HIV infected microglia form what in the CNS?
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multinucleated giant cells
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each oligodendrocyte myelinates how many axons?
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up to 30 each
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white matter in the CNS is made of what type of cell
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oligodendrocyte
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what cells are destroyed in MS
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oligodendrocytes
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what CNS cells look like fried eggs on H&E
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oligodendrocytes
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how many axons do schwann cells myelinate?
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1
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what type of cell is destroyed in guillain barre?
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schwann cells
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what cells are responsible for axonal regeneration?
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schwann cells
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what type of tumor is an acoustic neuroma? where is it located?
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schwannoma
located in internal auditory meatus- CN 8 |
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free nerve endings:
what type of fibers location what do they sense |
C, A-delta fibers
skin/epidermis/some viscera pain and temp |
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meissner's corpuscles
location? senses? |
glabrous (hairless) skin near surface
dynamic fine touch, manipulation |
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pacinian corpuscles
location? senses? |
deep skin, ligaments, joints
vibration and pressure (looks like onion) |
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Merkel's disks
location? senses? |
hair follicles
static touch, shape, edges, texture |
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endoneurium
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invests single nerve fiber
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perineurium
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permeability barrier
surrounds fascicle of nerve fibers |
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what peripheral nerve layer must be rejoined in microsurgery for limb reattachment?
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perineureum
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epineureum
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dense connective tissue that surrounds entire nerve (fascicles and blood vessels)
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location of NE
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locus ceruleus
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location of dopamine
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ventral tegmentum
SNc |
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location of seratonin
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raphe nucleus
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location of ACh
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basal nucleus of meynert
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locus ceruleus
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NE
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raphe nucleus
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5HT
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ventral tegmentum
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dopamine
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SNc
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dopamine
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basal nucleus of meynert
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ACh
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NT changes in anxiety
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increased NE
decreased 5HT |
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NT changes in depression
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decreased NE
decreased 5HT |
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NT changes in schizophrenia
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increased dopamine
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NT changes in parkinsons
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decreased dopamine
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NT changes in Alzheimers
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decreased ACh
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NT changes in Huntingtons
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decreased ACh
decreased GABA |
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blood brain barrier is formed by what 3 structures?
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1. tight junctions between nonfenestrated capillary endothelial cells
2. basement membrane 3. astrocyte foot processes |
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what crosses BBB slowly via carrier mediated transport?
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glucose
amino acids |
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what crosses BBB rapidly via diffusion?
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lipids
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region of brain with fenestrated capillaries and no BBB?
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area postrema (vomit after chemo)
OVLT (osmotic sensing) neurohypophysis (neurosecretory products are released into circulation) |
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Name 2 other blood barriers besides the blood brain barrier
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1. blood-testis
2. maternal fetal blood barrier of placenta |
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vasogenic edema can be caused by
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infarction destroying endothelial cell tight junctions (disrupts BBB)
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Hypothalamus functions:
TAN HATS |
Thirst
Adenohypophysis control Neurohypophysis releases its hormones Hunger Autonomic regulation Temperature regulation Sexual urges |
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OVLT
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inputs to hypothalamus
senses changes in osmolarity |
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inputs to hypothalamus
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OVLT- osmolarity changes
area postrema- respond to emetics |
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Name 8 parts of the hypothalamus
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supraoptic nucleus
paraventricular nucleus lateral ventromedial anterior posterior septal nucleus suprachiasmatic nucleus |
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supraoptic nucleus
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part of HT
makes ADH |
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what makes ADH
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supraoptic nucleus of HT
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paraventricular nucleus
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part of HT
makes oxytocin |
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what makes oxytocin
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paraventricular nucleus of HT
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lateral area of HT
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hunger
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what happens if you destroy the lateral area of the HT?
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anorexia
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what inhibits the lateral area of HT?
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leptin
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what part of HT causes hunger?
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lateral area
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ventromedial area of HT
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satiety
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destruction of ventromedial area of HT causes what?
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hyperphagia
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what part of HT causes satiety?
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ventromedial area
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what stimulates the ventromedial area of HT?
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leptin
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what does leptin inhibit? what does leptin stimulate?
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lateral HT
ventromedial HT |
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Anterior hypothalamus
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cooling
parasympathetic |
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posterior hypothalamus
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heating
sympathetic |
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septal nucleus of hypothalamus
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sexual urges
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what part of the brain regulates sexual urges
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septal nucleus of HT
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what part of HT regulates cooling, parasympathetic function?
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anterior
(A/C think cold!) |
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what part of HT regulates heat, sympathetic function?
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posterior
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suprachiasmatic nucleus
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part of HT
circadian rhythm |
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circadian rhythm location
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suprachiasmatic nucleus of HT
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posterior pituitary function
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receives HT axonal projections from supraoptic (ADH) and paravenricular (oxytocin)
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thalamus function
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major relay for ascending sensory information
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major relay for ascending sensory information?
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thalamus
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lateral geniculate nucleus of thalamus
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vision (light)
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medial geniculate nucleus of thalamus
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sound (m for music)
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ventral posterior nucleus, lateral part
VPL |
part of thalamus
body sensation |
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ventral anterior/lateral nuclei (VA/VL)
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part of thalamus
motor |
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ventral posterior nucleus, medial part VPM
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part of thalamus
facial sensation |
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blood supply to thalamus
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posterior communicating
posterior cerebral anterior choroidal arteries |
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limbic system- 4 parts
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cingulate gyrus
hippocampus fornix mammillary bodies |
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limbic system function
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5 Fs
feed fight flee feel sex |
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middle cerebellar peduncle
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cerebellum
contralateral cortical input |
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inferior cerebellar peduncle
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cerebellum
ipsilateral proprioceptive input |
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cerebellum inputs
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middle cerebellar peduncle- contralat
inferior cerebellar peduncle- ipsilat |
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types of input nerves of cerebellum
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climbing and mossy fibers
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type of output fibers of cerebellum
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Purkinje fibers
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superior cerebellar peduncle
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output to contralateral cortex via purkinje fibers
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deep nuclei of cerebellum
(from lateral to medial) |
Dentate
emboliform globose fastigial (dont eat greasy foods) |
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lateral deep nuclei of cerebellum
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dentate is most lateral
then emboliform movement of extremities |
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medial deep nuclei of cerebellum
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globose
fastigial truncal coordination, balance |
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basal ganglia function
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voluntary movement
postural adjustment |
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basal ganglia input is from
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cortex
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basal ganglia feeds back to
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cortex
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SNc - substantia nigra pars compacta
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dopamine 1 and 2
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D1
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excitatory
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D2
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inhibitory
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striatum is made up of
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caudate
putamen |
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caudate
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part of striatum of basal ganglia
cognitive |
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putamen
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part of striatum of basal ganglia
motor |
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excitatory pathway of basal ganglia
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SNc dopamine binds D1
stimulates motion |
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inhibitory pathway of basal ganglia
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SNc dopamine binds D2
inhibits motion |
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basal ganglia:
stimulatory |
cortex stimulates striatum
thalamus stimulates cortex STN stimulates GPi (which inh thal) |
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basal ganglia:
inhibitory |
striatum inhibits GPi
GPi inhibits thalamus striatum inhibits GPe GPe inhibits STN (which stim GPi which inh thalamus) |
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globus pallidus externus
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inhibits the STN from stimulating GPi to inhibit the thalamus.
Sooo you get motion (thalamus is NOT inhibited) |
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globus pallidus internus
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inhibits the thalamus
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striatum:
direct excitatory pathway indirect inhibitory pathway |
inhibits the GPi = motion
inhibits the GPe (which stimulates STN/GPi) = no motion |
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parkinson's features
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degenerative
Lewy bodies- alpha synuclein depigmentation of substantia nigra |
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parkinson's symptoms
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tremor at rest
cogwheel rigidity postural instability TRAP |
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MPTP
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contaminant of illicit street drugs that has been linked to parkinsons
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lewy bodies
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parkinsons
alpha synuclein |
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alpha synuclein
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lewy bodies
parkinsons |
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substantia nigra
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parkinsons
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hemiballismus
what is it? where is the lesion? |
flail 1 arm
contralateral subthalamic nucleus (STN can no longer stimulate GPi to inhibit the thalamus) |
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Hungtingtons genetics
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AD
trinucleotide repeat CAG chromosome 4 |
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huntingtons mechanism
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atrophy of caudate nucleus
loss of GABA neurons and ACh leads to enlarged lateral ventricles |
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huntingtons symptoms
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chorea
progressive dementia middle aged depression athetosis |
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chorea
what is it where is lesion |
jerky purposeless movement
caudate nucleus of basal ganglia |
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athetosis
what is it where is the lesion |
slow writhing, esp fingers
snakelike caudate of basal ganglia |
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essential or postural tremor
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action tremor
autosomal dominant self medicate with alcohol |
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treat essential/postural/action tremor
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beta blocker
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resting tremor
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parkinsons
(pill rolling) |
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intention tremor
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slow zigzag motion when pointing
cerebellar dysfunction |
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executive functions
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frontal lobe
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medial homunculus
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leg
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lateral homunculus
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arm/face
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motor aphasia
good comprehension |
brocas lesion
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fluent speech
poor comprehension |
wernickes lesion
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conduction aphasia
good comprehension fluent speech poor repetition |
arcuate fasciculus
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hyperorality
hypersexuality disinhibited behavior |
kluver-bucy syndrome
amygdala- bilateral lesion |
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spatial neglect syndrome
agnosia of contralateral world |
right parietal lesion
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reduced levels of arousal and wakefulness
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reticular activating system- midbrain
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confusion
confabulation ophthalmoplegia ataxia |
wernicke korsakoff
mammillary bodies- bilateral |
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rest tremor
chorea athetosis |
basal ganglia lesion
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intention tremor
limb ataxia |
cerebellum
(fall towards side of lesion) |
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truncal ataxia
dysarthria |
cerebellum vermis
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contralateral hemiballismus
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subthalamic nucleus lesion (basal ganglia)
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anterograde amnesia
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hippocampus lesion
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Paramedian pontine reticular formation lesion
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eyes look away from the side of the lesion
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frontal eye field lesion
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eyes look toward the lesion
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aphasia
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higher order inability to speak
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dysarthria
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motor inability to speak
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anterior cerebral artery
|
leg
|
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middle cerebral artery
|
trunk, arm, face
brocas wernickes |
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visual cortex artery
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posterior cerebral artery
|
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most common site of circle of Willis aneurysm
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anterior communicating artery
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location of aneurysm causing CN III palsy
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posterior communicating artery
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infarct of what causes pure motor hemiparesis
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internal capsule
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stroke arteries
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lateral striate- divisions of MCA
(caudate, internal capsule, putamun, globus pallidus) |
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severe hypotension damages what areas?
|
watershed areas
between ACA and MCA or PCA and MCA |
|
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wallenberg syndrome artery
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PICA infarct
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nystagmus
ipsilateral ataxia nausea vomiting Horners |
wallenberg syndrome
PICA infarct |
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locked in syndrome artery
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Basilar artery
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general sensory and motor dysfunction
aphasia |
stroke of anterior circle
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vertigo
visual field defects coma ataxia |
stroke of posterior circle
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berry aneurysms location
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bifurcation in circle of willis, Anterior communicating artery
|
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berry aneurysm rupture causes
|
subarachnoid hemorrhage
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berry aneurysms are associated with what 3 diseases
|
adult polycystic kidney disease
ehlers danlos marfans |
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charcot brouchard aneurysms
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microaneurysms
chronic HTN small vessles- basal ganglia, thalamus |
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epidural hemorrhage cause
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middle meningeal artery
secondary to fracture of temporal bone |
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subdural hematoma cause
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rupture of bridging veins
venous bleeding |
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subdural hematoma is seen in these 4 cases
|
elderly
alcoholics blunt trauma shaken baby |
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crescent shaped hemorrhage that crosses suture lines
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subdural hematoma
|
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biconvex hemorrhage that does NOT cross suture lines
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epidural hematoma
|
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subarachnoid hemorrhage cause
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rupture of an aneurysm or AVM
|
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bloody or yellow (xanthochromic) spinal tap
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subarachnoid hemorrhage
|
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type of bleed associated with HTN, amyloid angiopathy, DM, tumor
typical location? |
parenchymal hematoma
basal ganglia, internal capsule |
|
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hemorrhagic stroke
|
intracerebral bleeding
often due to aneurysm rupture may be secondary to ischemic stroke following reperfusion |
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ischemic stroke
|
emboli blocking large vessel
|
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causes of ischemic stroke: 4
|
atrial fib
carotid dissection PFO endocarditis |
|
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lacunar strokes
|
block small vessels,
secondary to HTN |
|
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TIA
|
brief reversible episode
focal ischemia less than 24 hrs |
|
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stroke imaging:
bright on ? in what amount of time dark on ? in what amount of time |
MRI in 3-30 min
CT in 24 hours |
|
|
venous sinuses run where?
|
dura mater, where meningeal and periosteal layers
cerebral veins-> venous sinuses-> IJV |
|
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main location of CSF return via subarachnoid granulations
|
superior sagittal sinus
|
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lateral ventricle to 3rd via what?
|
foramen of monroe
|
|
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3rd ventricle to 4th ventricle via what?
|
aqueduct
|
|
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4th ventricle to subarachnoid granulations via what?
|
foramen of luschka- lateral
foramen of magendie- medial |
|
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hydrocephalus
|
accumulation of excess CSF in ventricular system--> increased intracranial pressure and ventricular dilation
|
|
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dementia
gait problems urinary incontinence |
triad of hydrocephalus
(wet, wobbly, wacky) |
|
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normal pressure communicating hydrocephalus
|
inpaired absorption of CSF by arachnoid granulations
post meningitis arachnoid adhesions |
|
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obstructive noncommunicating hydrocephalus
|
stuctural blockage of CSF in ventricular system
stenosis of aqueduct |
|
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hydrocephalus ex vacuo
|
increased CSF in atrophy
normal intracranial pressure |
|
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how many spinal nerves?
|
31
|
|
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how many cervical nerves
|
8
|
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how many thoracic nerves
|
12
|
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how many lumbar nerves
|
5
|
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how many sacral nerves
|
5
|
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how many coccygeal nerves
|
1
|
|
|
nerves C1-C7 exit via
|
intravertebral foramina above corresponding vertebra
(all others exit below) |
|
|
normal location of vertebral disk herniation
|
between L5 and S1
(nucleus pulposus herniates through annulus fibrosus) |
|
|
adults, spinal cord extends to
|
L1-L2
|
|
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subarachnoid extends to
|
lower border of S2
|
|
|
lumbar puncture is performed where?
|
L3-L4 or L4-L5 interspaces
at level of cauda equina |
|
|
to keep the cord alive, keep the spinal needle between
|
L3 and L5
|
|
|
landmark for lumbar puncture
|
iliac crest
|
|
|
order of structures pierced in lumbar puncture: 7
|
1. skin/superficial fascia
2. ligaments (supraspinous, inter, ligamentum flavum) 3. epidural space 4. dura mater 5. subdural 6. arachnoid 7. subarachnoid space- CSF |
|
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what is not pierced in lumbar puncture
|
pia
|
|
|
fasiculus cuneatus
|
arms- dorsal column
|
|
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fasiculus gracilis
|
legs- dorsal column
|
|
|
dorsal column artery
|
posterior spinal arteries (2)
|
|
|
lateral corticospinal tract- what is medial and what is lateral
|
medial- arms
lateral- legs |
|
|
what is in the intermediate horn?
|
sympathetics- thoracic cord only
|
|
|
spinothalamic tract- what is lateral?
|
legs
sacral sparing |
|
|
dorsal column 1st order neuron
|
cell body in DRG
ascends ipsilaterally |
|
|
DC synapse 1
|
ipsilateral nucleus cuneatus or gracilis
|
|
|
DC 2nd order neuron
|
decussates in medulla
ascends contralaterally in medial lem |
|
|
DC synapse 2
|
VPL thalamus
|
|
|
DC 3rd order neuron
|
sensory cortex
|
|
|
ST 1st order neuron
|
A-delta and C fibers- cell body of DRG
|
|
|
ST synapse 1
|
ipsilateral gray matter
|
|
|
ST 2nd order neuron
|
decussates at anterior white commissure
ascends contralaterally |
|
|
ST synapse 2
|
VPL thalamus
|
|
|
ST 3rd order neuron
|
sensory cortex
|
|
|
Lateral CST 1st order neuron
|
UMN:
cell body in primary motor cortex descends ipsilaterally thru internal capsule |
|
|
lateral CST decussates
|
caudal medulla (pyramids)
|
|
|
lateral CST synapse 1
|
cell body of anterior horn of spinal cord
|
|
|
lateral CST 2nd order neuron
|
LMN:
leaves spinal cord |
|
|
lateral CST synapse 2
|
neuromuscular junction
|
|
|
atrophy is what type of motor neuron sign
|
LMN
|
|
|
fasciculations are what type of motor neuron sign
|
LMN
|
|
|
anterior horn lesion
|
polio
werdnig hoffmann |
|
|
random white matter lesions
|
MS
|
|
|
anterior horn lesions and lateral CST lesions
|
ALS
|
|
|
ASA occlusion spares what?
|
dorsal columns
|
|
|
dorsal column lesions
|
tabes dorsalis- syphilis
|
|
|
anterior commissure lesion
|
syringomyelia
|
|
|
dorsal column and lateral CST lesions
|
vitamin b12 deficiency
friedreichs ataxia |
|
|
LMN destruction only
|
polio
werdnig hoffman floppy baby |
|
|
CSF with lymphocytic pleocytosis with slight elevation of protein and normal glucose
|
polio
|
|
|
floppy baby
|
werdnig hoffman disease
|
|
|
tongue fasciculations in baby
|
werdnig hoffman disease
|
|
|
infantile spinal muscular atrophy
|
werdnig hoffman disease
|
|
|
genetics of werdnig hoffman disease
|
AR
|
|
|
both LMN and UMN findings
|
ALS
|
|
|
defect in superoxide dismutase 1 (SOD1)
|
ALS
|
|
|
degeneration of dorsal columns and dorsal roots
|
tabes dorsalis
tertiary syphilis |
|
|
impaired proprioception
locomotor ataxia charcots joints shooting pain absence of DTRs |
tabes dorsalis
|
|
|
argyll robertson pupils
|
tabes dorsalis
they accomodate but do not react |
|
|
staggering gait
frequent falling nystagmus dysarthria hypertrophic cardiomyopathy childhood kyphoscoliosis |
Friedreich's ataxia
|
|
|
Friedreich's ataxia genetics
|
AR
trinuc repeat GAA frataxin gene --> imparied mitochondria |
|
|
brown sequard
|
hemisection of spinal cord
1. ips UMN 2. ips DC 3. contralat ST 4. ips sensation at level of lesion 5. LMN at level of lesion |
|
|
lesion above T1
|
horners
|
|
|
horners
|
ptosis
anhidrosis miosis |
|
|
ptosis
|
eyelid drooping
|
|
|
miosis
|
pupil constricts
|
|
|
anhidrosis
|
lack of sweating
|
|
|
lesions causing horners
|
brown sequard
pancoasts tumor late stage syringomyelia |
|
|
horners pathway
|
3 neuron oculosympathetic:
HT-> intermediolat column of spinal cord-> superior cervical ganglion-> pupil, smooth muscle of lid, sweat glands |
|
|
pudendal nerve block (pregnancy) landmark
|
ischial spine
|
|
|
appendix landmark
|
mcburneys
2/3 from umbilicus to anterior superior iliac spine |
|
|
lumbar puncture landmark
|
iliac crest
|
|
|
C2
|
back of skull
|
|
|
C3
|
high turtleneck
|
|
|
C4
|
low collar shirt
|
|
|
T4
|
nipple
|
|
|
T7
|
xiphoid
|
|
|
T10
|
umbilicus
|
|
|
L1
|
inguinal ligament
|
|
|
L4
|
knee
|
|
|
S2,S3,S4
|
penile/anal zones
|
|
|
biceps reflex
|
C5 nerve root
|
|
|
triceps reflex
|
C7 nerve root
|
|
|
patella reflex
|
L4 nerve root
|
|
|
achilles reflex
|
S1 nerve root
|
|
|
muscle spindle
|
muscle stretch->
Ia afferents -> alpha motor neuron -> reflex contraction |
|
|
muscle spindle helps you monitor
|
muscle length
|
|
|
golgi tendon monitors
|
tension (drop heavy suitcase)
|
|
|
gamma loop
|
contracts intrafusal fibers ->
increase sensitivity of muscle spindle reflex arc |
|
|
moro reflex
|
startle baby->
extend limbs |
|
|
rooting reflex
|
stroke baby's mouth or cheek-->
turn head (nipple seeking) |
|
|
sucking reflex
|
touch roof of baby's mouth->
sucking |
|
|
palmar (and plantar) reflex
|
stroke baby's palms ->
curl fingers |
|
|
medial cranial nerves
|
3,6,12
|
|
|
pineal gland
|
melatonin
circadian rhythm |
|
|
superior colliculi
|
conjugate vertical gaze
|
|
|
inferior colliliculi
|
auditory
|
|
|
parinaud syndrome
|
paralysis of conjugate vertical gaze due to lesion of superior colliculi
|
|
|
lesion of superior colliculi
|
parinaud syndrome- paralysis of conjugate vertical gaze
|
|
|
submandibular and sublingual glands
CN ? |
7
|
|
|
parotid gland CN ?
|
9
|
|
|
eyelid closing CN ?
|
7
|
|
|
eyelid opening CN ?
|
3
|
|
|
monitoring carotid body and sinus chemo and baroreceptors
CN ? |
9
|
|
|
CN that elevates pharynx and larynx
|
9 (thru the stylopharyngeus)
(10 does palate elevation) |
|
|
taste from epiglottic region
CN? |
10
|
|
|
CN that elevates palate
|
10
|
|
|
monitoring aortic arch chemo and baroreceptors
CN ? |
10
|
|
|
midbrain cranial nerves
|
3,4
|
|
|
pons cranial nerves
|
5,6,7,8
|
|
|
medulla cranial nerves
|
9,10,11,12
|
|
|
lateral nuclei
sensory or motor |
sensory
|
|
|
medial nuclei
sensory or motor |
motor
|
|
|
corneal reflex
afferent efferent |
V1
7 |
|
|
lacrimation reflex
afferent efferent |
V1
7 |
|
|
jaw jerk reflex
afferent efferent |
V3 sensory
V3 motor |
|
|
pupillary reflex
afferent efferent |
2
3 |
|
|
gag reflex
afferent efferent |
9
9,10 |
|
|
nucleus solitarius
|
visceral sensory
7,9,10 |
|
|
nucleus ambiguous
|
motor- larynx, pharynx, upper esoph
9,10,11 |
|
|
dorsal motor nucleus
|
autonomic (para) to heart/lungs/GI
|
|
|
cribiform plate
|
1
|
|
|
optic canal
|
2
opthalmic artery central retinal vein |
|
|
superior orbital fissure
|
3,4, V1, 6
|
|
|
foramen rotundum
|
V2
|
|
|
foramen ovale
|
V3
|
|
|
foramen spinosum
|
middle meningeal artery
|
|
|
internal auditory meatus
|
7,8
|
|
|
jugular foramen
|
9,10,11
jugular vein |
|
|
hypoglossal canal
|
12
|
|
|
foramen magnum
|
spinal roots of 11
brain stem vertebral arteries |
|
|
cavernous sinus nerves
|
3,4, V1,V2, 6
postganglionic sympathetic fibers internal carotid artery 6 is free floating |
|
|
ophthalmoplegia
ophthamlic and maxillary sensory loss |
cavernous sinus syndrome due to mass effect
|
|
|
sella turcica and diaphragma sella surround the
|
pituitary
|
|
|
hypothalamus is next to what ventricle
|
3rd
|
|
|
what sinus is inferior to the the pituitary
|
sphenoid sinus
|
|
|
what sinus is lateral to the pituitary
|
cavernous
|
|
|
CN 12 lesion- tongue deviates
|
towards lesion
|
|
|
CN V motor lesion- jaw deviates
|
towards lesion
|
|
|
CN 10 lesion- uvula deviates
|
away from lesion
|
|
|
CN 11 lesion- shoulder droop
|
on side of lesion
|
|
|
contralateral paralysis of lower face
|
UMN lesion
|
|
|
ipsilateral paralysis of upper and lower face
|
LMN lesion
|
|
|
peripheral ipsilateral facial paralysis
inability to close ips eye |
bells palsy
|
|
|
bell's palsy
|
destruction of facial nucleus or efferent fibers causing ipsilateral paralysis
|
|
|
bells palsy is seen in:
6 |
AIDS
Lyme Herpes Sarcoid Tumors DM |
|
|
test palate elevation
|
kuh kuh kuh
(10) |
|
|
test tongue
|
la la la
(12) |
|
|
test lips
|
mi mi mi
(7) |
|
|
muscles that close the jaw
|
masseter
temporalis medial pterygoid |
|
|
muscles that open jaw
|
lateral pterygoid
|
|
|
mastication muscles innervated by
|
V3
|
|
|
muscles with glossus
|
CN 12
except palatoglossus (10) |
|
|
muscles with palat
|
CN 10
(except tensor veli palatini- V3) |
|
|
glaucoma
|
impaired aq humor flow->
increased pressure -> optic disk atrophy |
|
|
open angle glaucoma
|
obstructed outflow, canal of schlemm
silent, painless african american, older, myopia |
|
|
closed angle glaucoma
|
obstruction behind iris, lens
painful decreased vision DONT GIVE EPI |
|
|
cataract
|
painless
opacification of lens decreased vision age, smoke, alchohol, DM, infection |
|
|
papilladema
|
increased intracranial pressure
elevated optic disk blind spot |
|
|
test inferior oblique
|
IOU
look up (and in) |
|
|
test superior oblique
|
look down and in
|
|
|
strabismus
|
misalignment of eyes
|
|
|
amblyopia
|
reduction of vision from disuse in critical period
|
|
|
miosis muscles
|
pupillary sphincter muscle
parasympathetic |
|
|
miosis- pupillary sphincter innervation
|
CN 3 from Edinger Westphal to ciliary ganglion
|
|
|
mydriasis muscles
|
radial muscle/pupillary dilator muscle
sympathetic |
|
|
mydriasis- pupillary dilator innervation
|
T1 preganglionic symp->
superior cervical ganglion-> postganglionic sympth-> long ciliary nerve |
|
|
pupillary light reflex pathway
|
light-> CN 2->
pretectal nuclei of midbrain -> EW nuclei -> lateral geniculate nuclei-> ciliary gangion -> pupillary constrictor muscles |
|
|
Marcus Gunn pupil
|
afferent pupillary defect
shine light in affected eye, decreased bilateral pupil constriction |
|
|
CN 3 output to ocular muscles is primarily affected by
|
vascular diseases (DM)
|
|
|
CN 3 parasympathetic output is affected by
|
compression (aneurysm, herniation)
|
|
|
retinal detachment
|
separation of neurosensory layer of retina from epithelium->
degeneration of photoreceptors-> vision loss |
|
|
causes of retinal detachment
|
DM
trauma |
|
|
age-related macular degeneration
|
degeneration of central area of retina
scotoma |
|
|
dry ARMD (age related mac degen)
|
slow, gradual dec in vision
|
|
|
wet ARMD (age related mac deg)
|
rapid
due to neovascularization |
|
|
MS
|
autoimmune demyelination of CNS (brain and SC)
|
|
|
optic neuritis (sudden loss of vision)
internuclear opthalmoplegia nystagmus hemiparesis bladder incontinence |
MS
|
|
|
increased protein/IgG in CSF
|
MS
|
|
|
periventricular plaques
|
MS
(areas of oligodendrocyte loss and reactive gliosis with preservation of axons) |
|
|
oligodendrocyte loss
preservation of axons |
MS
|
|
|
MS epidemiology
|
women in 20s and 30s
|
|
|
treat MS
|
beta interferon
|
|
|
Guillain barre
|
demyelination of peripheral nerves and motor fibers of ventral roots
symmetric ascending muscle weakness (distal lower extrem) |
|
|
facial paralysis in what percentage of guillain barre
|
50%
|
|
|
ascending muscle weakness
cardiac probs HTN or hypotension |
Guillain barre
|
|
|
mechanism of guillain barre
|
autoimmune attack of peripheral myelin due to molecular mimicry
|
|
|
treat guillain barre
|
IV immune globulins
plasmapharesis |
|
|
increased CSF with normal cell count:
what is this called and what disease |
albuminocytologic dissociation
guillain barre |
|
|
albuminocytologic dissociation
|
high protein, normal or low cell count
guillain barre |
|
|
increased protein in CSF
|
papilledema
|
|
|
PML
|
demyelination of CNS due to destruction of oligodendrocytes
JC virus |
|
|
Acute disseminated postinfectious enceophalomyelitis
|
demyelination after infection or vaccine
|
|
|
metochromatic leukodystrophy
|
AR
lysosomal storage disease arylsulfatase A deficiency inc sulfatides-> damage myelin sheath |
|
|
charcot marie tooth
|
motor and sensory
progressive hereditary defective protein production involved with myelin sheath |
|
|
4 demyelinating diseases (not guillain barre or MS)
|
1. PML
2. ADE (acute dissem encephalomyelitis) 3. Metachromatic leukodystrophy 4. charcot marie tooth |
|
|
seizure caused by
|
synchronized, high frequency neuronal firing
|
|
|
partial seizure
|
1 area of brain
usual mesial temporal |
|
|
simple partial seizure
|
consciousness is ok
|
|
|
complex partial seizure
|
impaired consciousness
|
|
|
generalized seizures
|
diffuse:
1 absence 2 myoclonic 3 tonic clonic 4 tonic 5 atonic- fall to floor |
|
|
children causes of seizures
|
genetic
infection trauma congenital metabolic |
|
|
adult causes of seizures
|
tumor
trauma stroke infection |
|
|
elderly causes of seizures
|
stroke
tumor trauma metabolic infection |
|
|
headache
|
pain due to irritation of dura or cranial nerves or extracranial
(not brain parenchyma) |
|
|
migraine
|
unilateral
pulsating nausea light sensitive up to 3 days |
|
|
migraine causes- what nerve and what is released?
|
irritation of CN V
release of sub P and CGRP and vasoactive peptides |
|
|
tension headache
|
bilateral
greater than 30 minutes |
|
|
cluster headache
|
repetitive
brief men unilateral periorbital ipsilateral lacrimation, rhinorrhea horners- ispilateral |
|
|
vertigo
|
illusion of movement
|
|
|
peripheral vertigo
|
more common
inner ear cause- debris, infection Menieres disease positional test- delayed horizontal nystagmus |
|
|
delayed horizontal nystagmus with positional testing
|
peripheral vertigo
|
|
|
central vertigo
|
brain stem or cerebellar lesion
postitional test- immediate nystagmus in any direction |
|
|
immediate nystagmus with positional testing
|
central vertigo
|
|
|
sturge weber
|
congenital
port wine stain ipsilateral leptomeningeal angioma glaucoma seizures hemiparesis MR |
|
|
MR
hemiparesis seizures glaucoma port wine stains leptomeningeal angioma |
sturge weber
|
|
|
tuberous sclerosis
|
CNS and skin hamartomas
cardiac rhabdomyoma renal angiomyoliopoma subepend giant cell astrocytoma MR seizures ash leaf spots |
|
|
tuberous sclerosis genetics
|
AD
|
|
|
ash leaf spots
|
tuberous sclerosis
|
|
|
angiomyolipoma
|
tuberous sclerosis
|
|
|
subependymal giant cell astrocytoma
|
tuberous sclerosis
|
|
|
hamartomas of CNS and skin
|
tuberous sclerosis
|
|
|
NF1
|
cafe au lait spots
lisch nodules- iris |
|
|
NF1 genetics
|
AD
|
|
|
cafe au lait spots
|
NF1
|
|
|
lisch nodules
|
NF1
|
|
|
von hippel lindau
|
cavernous hemangiomas
renal cell carcinoma hemangioblastoma in retina/brainstem/cerebellum |
|
|
von hippel lindau genetics
|
AD
|
|
|
cavernous hemangioma
|
von hippel lindau
|
|
|
renal cell carcinoma and neurocutaneous disorder
|
von hippel lindau
|
|
|
retinal hemangioblastoma
|
von hippel lindau
|
|
|
brain stem/cerebellar hemangioblastoma
|
von hippel lindau
|
|
|
4 neurocutaneous disorders
|
sturge weber
tuberous sclerosis NF1 von hippel lindau |
|
|
cingulate/subfalcine herniation
|
under falx cerebri
compress ACA |
|
|
downward transtentorial central herniation
|
down through tentorium cerebelli
|
|
|
uncal herniation
|
stretch CN 3
compress ipsilateral PCA compress kernohans notch duret hemorrhages- paramedian artery rupture |
|
|
signs of uncal herniation
|
ipsilateral ptosis
ipsilateral dilated pupil contralateral homonymous hemianop ipsilateral paresis |
|
|
uncal herniation-
what causes ipsilateral dilation of pupil/ptosis |
CN3 stretches
(levator palpebrae) |
|
|
uncal herniation-
what causes contralateral homonymous hemianopia |
compress PCA
|
|
|
uncal herniation-
what causes ipsilateral paresis |
compression of contralateral crus cerebri (kernohan's notch)
|
|
|
uncal herniation-
what causes duret hemorrhage |
caudal displacement of brain stem-- paramedian artery ruptures
|
|
|
perilymph
|
inner ear, in the bony labyrinth
Na+ rich |
|
|
parts of the inner ear
|
cochlea
vestibule semicircular canals |
|
|
endolymph
|
inner ear, in the membranous labyrinth
K+ rich |
|
|
cochlear parts
|
cochlear duct
|
|
|
vestibule parts and function
|
utricle
saccule detect linear acceleration |
|
|
semicircular canal parts and function
|
ampullae
detect angular acceleration |
|
|
cochlear membrane parts and what frequency sounds do they detect?
|
narrow base- high frequency
wide apex- low frequency |
|
|
conductive hearing loss
|
bone conduction > air conduction on Rinne
Weber localizes to affected ear |
|
|
sensorineural hearing loss
|
air conduction > bone conduction on Rinne
Weber localizes to normal ear |
|
|
hearing loss in elderly
|
high frequency -> low frequency
|
|
|
layers of the eye in the back
|
sclera- white
choroid retina fovea |
|
|
layers of the eye in the front
|
sclera- white
cornea iris lens |
|
|
posterior chamber of the eye
|
behind iris, in front of lens
|
|
|
canal of schlemm
|
collects aqueous humor from trabecular meshwork which absorbs it
|
|
|
anterior chamber of eye
|
aqueous humor
|
|
|
what innervates lateral rectus
|
6
|
|
|
what innervates superior oblique
|
4
|
|
|
what does the superior oblique do?
|
abducts
intorts depresses |
|
|
eye looks down and out
ptosis pupillary dilation loss of accommodation |
CN 3 damage
|
|
|
diplopia with downward gaze
|
CN 4 damage
|
|
|
medially directed eye
|
CN 6 damage
|
|
|
right optic nerve lesion
|
right anopia
|
|
|
optic chiasm lesion
|
bitemporal hemianopia
|
|
|
right optic tract lesion
|
left homonymous hemianopia
|
|
|
right Meyer's loop lesion (temporal lobe)
|
left upper quadrantic anopia
|
|
|
right dorsal optic radiation lesion (right parietal lobe)
|
left lower quadrantic anopia
|
|
|
lesion at the right calcarine fissure (end of the optic radiations)
|
left hemianopia with macular sparing
|
|
|
macular lesion (central retina)
|
central scotoma (macular degeneration)
|
|
|
internuclear opthalmoplegia
|
MLF syndrome
lesion in the medial longitudinal fasciculus -> medial rectus palsy on attempted lateral gaze |
|
|
nystagmus in which eye with MLF syndrome/internuclear opthalmoplegia
|
abducting eye
|
|
|
MLF syndrome is commonly seen in what disease
|
MS
|
|
|
Look left with a normal MLF- what are the steps?
|
look left
left nucleus of CN 6 fires contracts left lateral rectus stimulates contralateral (right) MLF stimulates right nucleus of CN 3 contracts right medial rectus |
|
|
Look left with a damaged right MLF- what happens?
|
right beating nystagmus in left eye
medial rectus palsy in right eye |
|
|
majority of adult primary brain tumors are located where?
|
supratentorial
|
|
|
majority of childhood primary brain tumors are located where?
|
infratentorial
|
|
|
most common primary adult brain tumor
|
glioblastoma multiforme
|
|
|
glioblastoma multiforme is what type of tumor
|
grade 4 astrocytoma
Bad prognosis |
|
|
butterfly glioma
|
glioblastoma multiforme crossing corpus callosum
|
|
|
stain for glioblastoma multiforme astrocytes
|
GFAP
|
|
|
pseudopalisading cells
(pleomorphic near areas of necrosis and hemorrhage) |
glioblastoma multiforme
|
|
|
2nd most common adult brain tumor
|
meningioma
|
|
|
meningiomas arise from
|
arachnoid cells
|
|
|
spindle cells arranged in whorled pattern
|
meningioma
|
|
|
psammoma bodies- laminated calcifications
|
meningioma
|
|
|
prognosis of meningioma
|
good?, resectable
|
|
|
3rd most common adult brain tumor
|
schwannoma
(acoustic) |
|
|
bilateral schwannomas found in ?
|
NF2
|
|
|
prognosis for schwannoma
|
good
|
|
|
rare, slow growing, less common adult brain tumor
|
oligodendroglioma
|
|
|
oligodendrogliomas are often found where?
|
frontal lobe
|
|
|
chicken-wire capillary pattern
|
oligodendroglioma
|
|
|
fried egg cells of CNS
|
oligodendrocytes
|
|
|
Most common type of pituitary adenoma
|
prolactinoma
|
|
|
bitemporal hemianopia-causing tumor
|
pituitary adenoma
|
|
|
5 adult brain tumors:
|
1. GM
2. meningioma 3. schwannoma 4. oligodendroglioma 5. pituitary adenoma |
|
|
5 childhood brain tumors:
|
1. pilocytic astrocytoma
2. medulloblastoma 3. ependymoma 4. hemangioblastoma 5. craniopharyngioma |
|
|
well circumscribed low grade childhood tumor
|
pilocytic astrocytoma
posterior fossa |
|
|
Rosenthal fibers- eosinophilic corkscrew fibers
|
pilocytic astrocytoma
|
|
|
highly malignant childhood tumor
|
medulloblastoma
|
|
|
form of PNET- primitive neuroectodermal tumor
|
medulloblastoma
|
|
|
childhood tumor that often compresses the 4th ventricle and causes hydrocephalus
|
ependymoma
(medullo can do this too) |
|
|
rosettes
|
medulloblastoma
|
|
|
childhood tumor that is radiation sensitive
|
medulloblastoma
|
|
|
childhood tumor most commonly found in 4th ventricle
|
ependymoma
poor prognosis |
|
|
2 childhood tumors with poor prognosis
|
ependymoma
medulloblastoma |
|
|
pseudorosettes
|
ependymoma
|
|
|
rod shaped blepharoplasts- basal ciliary bodies
|
ependymoma
|
|
|
location of hemangioblastoma
|
retina/brain stem/cerebellar
seen in von hippel lindau |
|
|
childhood tumor associated with von hippel lindau and retinal angiomas
|
hemangioblastoma
|
|
|
tumor that produces EPO and can cause secondary polycythemia
|
hemangioblastoma
|
|
|
foamy cells
|
hemangioblastoma
|
|
|
benign childhood tumor confused with pituitary adenoma
|
craniopharyngioma
|
|
|
most common childhood supratentorial tumor
|
craniopharyngioma
|
|
|
tumor derived from rathke's pouch remnants, commonly calcified
|
craniopharyngioma
|
