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79 Cards in this Set
- Front
- Back
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What neural cells come from:
Neuroectoderm? Neural crest? Mesoderm |
Neuroectoderm: CNS neurons, ependymal cells, oligodendroglia, astrocytes
Neural creset: Schwann cells, PNS neurons Mesoderm (M's): microglia (like macrophages) |
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what cells destroyed in MS?
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oligodendroglia
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what cells destroyed in Guillain-Barre?
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schwann cells
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acoustic neuroma
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type of schwannoma, located in internal acoustic meatus (CN 8)
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where are these NT synthesized?
NE Dopamine 5-HT ACh GABA |
NE: locus ceruleus
Dopamine: Ventral tegmentum and SNc 5-HT: Raphe nucleus ACh: basal nucleus of meynert GABA: Nucleus accumbens |
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What 3 structures make up the Blood-brain barrier?
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tight junctions (b/w non-fenestrated capillary endothelial cells)
basement membrane astrocyte processes |
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What are the few specialized brain regions w/NO blood-brain barrier
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area postrema (vomiting after chemo)
neurohypophysis (ADH release; also other neurosecretory products to enter circulation) |
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What are the functions of the hypothalamus?
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TAN HATS
T: Thirst and water balance A: Adenohypophysis control N: neurohypophysis (release hormones from hypothalamus) H: Hunger A: Autonomic regulation T: Temp regulation S: sexual urges |
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Where is ADH made
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Supraoptic nucleus
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Where is oxytocin made
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paraventricular nucleus
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what controls hunger
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lateral area
destruction leads to anorexia and failure to thrive in infants inhibited by leptin |
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what controls satiety
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ventromedial area
destruction (cranipharyngioma) -> hyperphagia stimulated by leptin |
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what controls cooling
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anterior hypothalamus (parasympathetic)
(A/C: Anterior Cools) |
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what controls heating
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posterior hypothalamus
(sympathetic) if zap Posterior hypothal, become a Poikilotherm (cold-blooded like a snake) |
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what control sexual urgers
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septal nucleus
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what controls circadian rhythm
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suprachiasmatic nucleus
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where is visual information in the thalamus
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lateral geniculate nucleus
(Lateral for Light) |
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Where is auditory information in thalamus
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Medium geniculate nucleus
(Medial for Music) |
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What information is sent to the Ventral Posterior nucleus, lateral (VPL)?
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body sensation (proprioception, pressure, pain, touch, vibration via dorsal column, spinothalamic tract)
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What information is sent to the Ventral posterior nucleus, medial (VPM)?
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facial sensation via CN 5 (Makeup on face, so vpM)
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What information if sent to Ventral anterior/lateral nuclei (VA/VL)
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motor
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What is the blood supply to the thalamus?
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Pcomm (posterior communicating),
PCA (posterior cerebral), ICA (anterior choroidal arteries) |
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Input to cerebellum?
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contralateral cortical input via MCP
ipsilateral proprioceptive info via ICP input nerves are climbing and mossy fibers |
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Output from cerebellum?
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stimulatory feedback to contralateral cortex to modulate movement
output nerves are Purkinje fibers to deep nuclei of cerebellum, which output to cortex via SCP |
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What are the deep nuclei of the cerebellum, lateral to medial?
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Don't Eat Greasy Foods
Dentate, Emboliform, Globose, Fastigial |
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What does the lateral cerebellum control
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voluntary movement of extremities
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What does the medial cerebellum control?
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truncal coordination, balance, ataxia,
propensity to fall toward injured (ipsi) side |
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What is the excitatory pathway in the basal ganglia?
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SNc dopamine bind to D1 receptors in excitatory pathway -> stimulate excitatory pathway -> increase motion
cortex -> striatum -> GPi/SNr -> thalamus -> cortex |
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What is the inhibitory pathway in the basal ganglia?
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SNc dopamine bind to D2 receptors in inhibitory pathway -> inhibit inhibitory pathway -> increase motion
cortex -> striatum -> GPe -> subthalamic nucleus -> GPi -> thalamus -> cortex |
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How does Parkinson's dz affect the excitatory/inhibitory pathway in the basal ganglia?
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loss of dopamine inhibits the excitatory pathway
and excites inhibitory pathway (disinhibits) both -> decrease in motion |
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Typical characteristics of Parkinson's dz
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TRAP
T: Tremor (at rest, pill-rolling) R: cogwheel Rigidity A: Akinesia P: Postural instability TRAPped in body |
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What is Hemiballismus?
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sudden, wild flailing of 1 arm +/- leg
contralateral subthalamic nucleus lesion (lacunar stroke in pt w/Hx of HTN) get loss of inhibition of thalamus through globus pallidus |
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Huntington's dz:
What is the mechanism of neuronal death? What are the gross pathology? |
Mechanism: NMDA-receptor binding and glutamate toxicity
Gross: atrophy of caudate nucleus (loss of GABA and Ach), enlarged lateral ventricles, atrophy of putamen and defined sulci |
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what are the main components of the basal ganglia?
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striatum, pallidum (globus pallidus), substantia nigra, and subthalamic nucleus
striatum: caudate nucleus (cognitive) and putamen (motor) |
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What is an essential/postural tremor?
How do you treat it? |
Autosomal dominant,
action tremor (worsens when holding posture), pts often self-medicate w/EtOH, which decreases tremor Trx: B-blockers |
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What is Kluver-Bucy syndrome?
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Amygdala (bilateral) lesion
hyperorality, hypersexuality, disinhibited behavior |
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what happens with a lesion in the reticular activating system (RAS)?
where is the RAS located? |
reduced levels of arousal and wakefulness (e.g., coma)
located in the midbrain |
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Name the characteristics of Wernicke-Korsakoff syndrome.
What lesion is it associated with? |
Wernicke: confusion, ophthalmoplegia, ataxia
Korsakoff: confabulation, memory loss, personality changes assoc w/mammillary bodies lesion (bilateral) |
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What happens with a cerebellar hemisphere lesion?
w/a cerebellar vermis lesion? |
hemispheres are lateral -> affect lateral limbs
vermis is central -> affect central body hemisphere: intention tremor, limb ataxis, IPSIlateral deficits, fall toward side of lesion (cerebellum -> SCP -> contralateral cortex -> corticospinal decussation = ipsilateral) vermis: truncal ataxia, dysarthria |
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What happens w/a lesion in the PPRF (paramedian pontine reticular formation)?
w/a frontal eye fields (FEF) lesion? |
PPRF: eyes look AWAY from side of lesion
FEF: eyes look TOWARD side of lesion |
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Where is Broca's area located?
Wernicke's area? |
Broca's: inferior frontal gyrus
Wernicke's: superior temporal gyrus (associative auditory cortex) both in the dominant hemisphere |
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What is a conduction aphasia?
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Poor repetition but fluent speech and intact comprehension
affects arcuate fasciculus, that connect broca's and wernicke's areas |
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What happens w/a Right parietal lobe lesion?
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spatial neglect syndrome (agnosia of contralateral side of world)
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What is medial medullary syndrome?
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Anterior spinal artery
contralateral hemiparesis (Lower extremities), medial lemniscus (decrease contralateral proprioception), ipsilateral paralysis of hypoglossal nerve |
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Lateral medullary syndrome?
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Wallenberg's syndrome, PICA (post. inf. cerebellar a.),
contralateral loss of pain and temp, ipisilateral dysphagia, hoarseness, decrease gag reflex, vertigo, diplopia, nystagmus, vomiting, ipsi Horner's, ipsi facial pain and temp, trigeminal nucleus (spinal tract and nucleus), ipsi ataxia |
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lateral inferior pontine syndrome?
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AICA,
ipsi facial paralysis, ipsi cochlear nucleus, vestibular (nystagmus), ipsi facial pain and temp, ipsi dystaxia (MCP, ICP) |
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what happens w/a posterior cerebral artery lesion?
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contralateral homonymous hemianopia w/macular sparing,
supplies the occipital cortex |
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what happens w/an MCA lesion?
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contralateral face and arm paralysis and sensory loss, aphasia (dominant sphere), left-sided neglect
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What is the most common site of circle of Willis anuerysms
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Anterior communicating artery
lesion may cause visual field deficit |
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What artery is a common area of aneursyms?
what palsy can it cause? |
Posterior communicating artery,
can cause CN 3 palsy |
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What areas do lateral striate arteries supply?
what is the consequence of an assoc. lesion? |
supply internal capsule, caudate, putamen, globus pallidus,
are "arteries of stroke." infarct of the posterior limb of internal capsule causes pure motor hemiparesis |
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An infarct in which artery causes "locked-in"syndrome?
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Basilar artery (CN 3 is typically intact)
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What happens with a watershed zone infarct?
When do these infarcts clinically happen? |
upper leg/upper arm weakness, defects in higher-order visual processing
happen from damage in severe HYPOtension located b/w ACA/MCA, MCA/PCA |
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What is the risk of subarachnoid hemorrhage 2-3 days after?
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vasospasm due to blood breakdown products which irritate vessels. Trx w/Ca-channel blockers
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what are the most vulnerable parts of the brain to ischemia?
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hippocampus, neocortex, cerebellum, watershed areas
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what are the etiologies of ischemic stroke>
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AFib, carotid dissection, PFO, endocarditis
trx: is tPA w/in 3 hours |
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describe flow of ventricular system?
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Lateral ventricle -> 3rd ventricle (via foramen of monro) -> 4th ventricle (via cerebral aqueduct) -> subarachnoid space (via foramina of Luschka and Magendie)
Luschka is Lateral; Magendie is Medial |
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What are the characteristics of Normal pressure hydrocephalus?
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Wet, Wobbly, Wacky
Ventricle expansion distorts fibers of corona radiata -> urinary incontinence, ataxia, and dementia (reversible cause of dementia in elderly) NO increase in subarachnoid space volume |
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List order of structures pierced in a lumbar puncture
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1. Skin/superficial fascia
2. Ligaments (supraspinous, interspinous, ligamentum flavum) 3. Epidural space 4. Dura mater 5. Subdural space 6. Arachnoid 7. subarachnoid space - CSF Pia is NOT pierced |
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Poliomyelitis
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anterior horn cell destruction -> LMN destruction
fecal-oral transmission and virus replicates in oropharynx and small instestine before spreading through blood to CNS CSF has lymphocytic pleocytosis w/slight elevation of protein (NO glucose change) virus recovered from stool and throat |
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Werdnig-Hoffman dz
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infantile spinal muscular atrophy (SMA)
auto-recessive; presents at birth as "floppy baby," tongue fasciculations, median age of death 7 months anterior horn degeneration. only LMN involvement |
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Tabes dorsalis: characteristics
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Charcot's joints, shooting (lightning) pain, Argyll-Robertson pupils, NOT DTRs, positive Rhomberg, sensory ataxia at night
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Friedreich's ataxia: characteristics
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staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, hypertrophic cardiomyopathy (cause of death). presents in childhood w/kyphoscoliosis
is the FRatastic (frataxin gene GAA repeat) frat brother, always falling, staggering |
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What disease presents w/kyphoscoliosis in childhood
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Friedreich's ataxia
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What are the findings in Brown-Sequard syndrome?
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Ipsilateral: UMN signs below lesion (corticospinal), loss of tactile/vibration/proprioception sense below lesion (dorsal columns), loss of all sensation AT level of column
Contralateral: pain and temp loss below lesion (spinothalamic) LMN signs AT level of lesion |
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What if a Brown-Sequard syndrome lesion occurs above T1?
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pt will present with Horners's syndrome
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Causes of Horner's syndrome?
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Pancoast tumor, Brown-Sequard, late-stage syringomyelia
assoc w/lesions of cord above T1 |
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What are the landmarks?
T4 T7 L1 L4 |
T4: nipple
T7: xiphoid process L1: inguinal ligament L4: kneecaps |
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Moro reflex
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"hang on for life": abduct/extend limbs when startled, and then draw together
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What cranial nerves lie medially in the brain stem
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CN 3, 6, 12
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What is parinaud syndrome?
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paralysis of conjugate vertical gaze due to lesion in superior colliculi (e.g., pinealoma)
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Where are the cranial nerve nuclei located in the brainstem
What nuclei are in the midbrain? in the pons? in the medulla? |
Tegmentum portion (b/w dorsal and ventral portions)
midbrain: CN 3, 4 pons: CN 5-8 medulla: CN 9-12 |
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What cranial nerve nuclei and information is sent by the Nucleus Solitarius?
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Visceral Sensory info (taste, baroreceptor, gut distention)
CN 7, 9, 10 |
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What cranial nerve nuclei and information is sent by the Nucleus Ambiguus?
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Motor Innervation of pharynx, larynx, and upper esophagus (swallowing, palate elevation)
CN, 9-11 |
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What info does the dorsal motor nucleus send?
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sends autonomic (PARAsympathetic) fibers to heart, lungs and upper GI
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What is cavernous sinus syndrome?
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(from mass effect): ophthalmoplegia, ophthalmic and maxillary sensory loss
nerves that control extraocular mm (plus V1 and V2) also pass through cavernous sinus |
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What happens w/a LMN lesion of CN 7
What happens w/an UMN lesion of CN 7? |
ipsilateral paralysis of upper and lower face
contralateral paralysis of lower face ONLY |
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What are some causes of Bell's palsy
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AIDS, Lyme dz, Herpes zoster, Sarcoidosis, Tumors, Diabetes
(ALexander graHam Bell w/STD) |
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What innervates palatoglossus?
What innervates tensor veli palatini? |
palato: CN 10
(every other "glossus" m innervated by CN 12) tensor veli: CN V (V3, mandibular br.) (every other "palat" muscle innvervated by CN 10) |
