Neuro Nolte Week 2, Exam 2 (Eye Etc)

Front 1

an excessive dilation of the pupil due to disease, trauma or drugs

Back 1

Mydriasis

Front 2

Argyll-Robertson pupil

Back 2

Pupil is able to constrict during accommodation but is unable to respond (constrict) to light. The exact site of the lesion is presently unknown.

Front 3

Horner's Syndrome
Clinical presentation:
Cause:

Back 3

Clinical presentation: miosis, dry skin, ptosis.

Cause: Damage to the central pathways or peripheral nerves supplying the sympathetic innervation of the head.

Front 4

Strabismus- constant deviation of one of the eyes. Possible cause?

Back 4

Can be caused by lower motor neuron damage.

Front 5

Damage to the Med Longitudinal Fasciculus can mess with circuits in charge of conjugate eye movement resulting in:

Back 5

INO Internuclear Ophthalmoplegia, ie patient is unable to adduct either eye.

Front 6

What is the only DTR of the cranial nerves?

Back 6

Jaw jerk reflex

Front 7

Medial medullary syndrome: Occlusion of a branch of one verterbral artery: Sx include...

Back 7

Contralateral spastic paralysis with tactile and kinesthetic deficits.
Ipsilateral paralysis & atrophy of tongue (ipsilateral deviation) aka, alternating hypoglossal hemiplegia/inferior alternating hemiplegia.

Front 8

Lateral medullary syndrome. Occlusion of branches of vertebral artery or the posterior inferior cerebellar artery. Sx

Back 8

Loss of contra body P&T
Loss of ipsi face P&T
Hoarseness, difficulty in swallowing
Ipsi Horner's syndrome
Possibly also: vertigo, and limb ataxia

Front 9

Damage to cerebral peduncle in rostral midbrain. Occlusion of branches of a posterior cerebral artery. Sx

Back 9

Contra spastic paralysis
Contra loss of mvmt in lower face, forehead can still be wrinkled
Ipsi ptosis and pupillary dilation
Lateral strabismus (ipsilateral)

Front 10

What is the effect of damage to Meyer's Loop?

Back 10

Deficit of contralateral, upper visual quadrant of each eye.

Front 11

Fibers from the medial part of the LGN loop through the parietal cortex (superiorly). Damage to this area would cause:

Back 11

Lower quadrantic deficit on the opposite side

Front 12

What is " an area or island of loss or impairment of visual acuity surrounded by a field of normal or relatively well-preserved vision."

Back 12

Scotoma

Front 13

___________________ believed to be the center of arousal and motivation in mammals (including humans).

Back 13

ARAS Ascending Reticular Activating System

Front 14

___________________ The activity of this system is crucial for maintaining the state of consciousness. It is situated at the core of the brain stem between the myelencephalon (medulla oblongata) and mesencephalon (midbrain).

Back 14

ARAS Ascending Reticular Activating System

Front 15

___________________ systems role is indirect. It is involved with the circadian rhythm. Damage can lead to permanent coma. It is thought to be the area affected by many psychotropic drugs. General anesthetics work through their effect on the reticular formation.

Back 15

ARAS Ascending Reticular Activating System

Front 16

ARAS connection to ADD and ADHD, and the imbalanced neurotransmitter involved.

Back 16

The reticular activating system is believed to cause ADD and ADHD due to the imbalance of norepinephrine in the cells

Front 17

__________ Area anterior to the ventricular space. Contains cranial nerve nuclei, nerve roots, and ascending spinal cord pathways. What pathways are in this area? (3)

Back 17

Tegmentum

Medial lemniscus
ALS
Spinocerebellar Tracts

Front 18

The cranial nerve roots and the ascending tracts in the ARAS form the outer ring of the tegmentum. What is in the inner ring?

Back 18

The Reticular Formation

Front 19

What is the Reticular formation?
Gives rise to ________ projection systems and appears diffuse.
Its general fx is modulatory, and is involved in maintaining ___________.

Back 19

Gives rise to diffuse projection systems and appears diffuse.
Its general fx is modulatory. And is involved in maintaining consciousness.

Front 20

The pontine enlargement, corticospinal fibers, pyramids of the medulla, crus cerebri and substantia nigra are all located in the ________ portion of the brainstem.

Back 20

Basal

Front 21

The tectum is that area posterior to the ventricular space. It is found only in the midbrain and consists of the superior and inferior __________.

Back 21

colliculi

Front 22

________ _______are a part of the pons which store the memory of intention during motor activity. Corticopontine fibres carry information from the primary motor cortex to the ipsilateral pontine nucleus in the ventral pons, and the pontocerebellar projection then carries that information to the contralateral cerebellum via the middle cerebellar peduncle.
They therefore allow modification of actions in the light of their outcome, or error correction, and are hence important in learning motor programs.

Back 22

Pontine Nuclei

Front 23

Pontocerebellar Fibers

Back 23

fibers that run within the middle cerebellar peduncles, from the pons to the cerebellum.

Front 24

What level of the brainstem contains the decussation of the superior cerebellar peduncles?

Back 24

Midbrain

Front 25

In the midbrain, the tectum refers to the inferior colliculi forming the roof over a ventricular space. Which one?

Back 25

Cerebral Aqueduct

Front 26

True or False
Axons arising from isodendritic neurons in the reticular formation may bifurcate and ascend and descend for long distances and influence many cells in many areas.

Back 26

True
Bc of this there is a lot of divergence ariging from the reticular formation, ie maintain the potential to respond to many diff kinds of stimuli

Front 27

On LATERAL GAZE,
Which muscles are tested in the adducted eye?
Which muscles are tested in the abducted eye?

Back 27

Inf and Sup Oblique muscles

Inf and Sup Rectus muscles

Front 28

LR?
SO?
Rest are III

Back 28

LR6
SO4

Front 29

Constant deviation of one eye is called a :

Back 29

Strabismus

Front 30

What is the main muscle involved in adduction?
Abduction?

Back 30

Medial Rectus
Lateral Rectus

Front 31

Abducens internuclear neurons have cells bodies in the Abducens nucleus (posterior part of pons) and send axons across the MIDLINE thru the MLF to the contralateral ___________ nucleus.

Back 31

oculomotor

Front 32

Damage to the MLF will disrupt the local circuts responsible for ____________ eye movement.

Back 32

Conjugate



Patient is unable to adduct the eye.

Front 33

Internuclear Ophthalmoplegia
Damage to the nerve or nerve nucleus?

Back 33

Damage to the nerve root.
This condition is known as INO and is often associated with MS, patient cannot adduct the eye.

Front 34

If there is damage to the Abducens nerve nucleus the patient will have INO and will not be able to _________ the eye.

Back 34

Abduct (CN VI)

Front 35

Internuclear lesion located in between left abducens nucleus and left occulomotor nucleus. What deficit will it cause? Will convergence be affected?

Back 35

Left eye will be unable to adduct on lateral gaze, but convergence will be unaffected.

Front 36

Which of the following is a disconjugate movement?
Sccadic, mooth pursuit, vestibulo-ocular, optokinetic, and vergence.

Back 36

Vergence - eyes move in opposite directions and sometimes by different amounts.

Front 37

Vestibulo-ocular vs Optokinetic
a reflex eye movement that stabilizes images on the retina during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field. For example, when the head moves to the right, the eyes move to the left, and vice versa.

Back 37

Vestibulo-ocular

Front 38

Vestibulo-ocular vs Optokinetic
allows the eye to follow objects in motion when the head remains stationary (e.g. observing individual telephone poles on the side of the road as one travels by them in a car).

Back 38

Optokinetic

Front 39

If the eyes move in the opposite direction than the head during the dolls head procedure, the ____ is probably intact.

Back 39

VOR (brainstem)
If this occurs as expected but pt cannot move eyes to the left voluntarily, the lesion is more than likely in the supratentorial compartment.

Front 40

Warm and cold water irrigation can cause an induced nystagmus, explain.

Back 40

If cold water is irrigated into the left ear, the eyes will go toward the left and then snap back to center.
If warm water is irrigated into the left ear, the eyes will go toward the right and then snap back to center.
Eyes only snap back to center if cortical influence is intact.

Front 41

Right parieto-occipital lesions result in difficulty in horizontal pursuit movements toward which side?

Back 41

Right

Front 42

WHen eyes are converging, what happens to the lens and pupils?

Back 42

Lens rounds and pupils constrict.

Front 43

If the eyes move in the opposite direction than the head during the dolls head procedure, the ____ is probably intact.

Back 43

VOR (brainstem)
If this occurs as expected but pt cannot move eyes to the left voluntarily, the lesion is more than likely in the supratentorial compartment.

Front 44

Warm and cold water irrigation can cause an induced nystagmus, explain.

Back 44

If cold water is irrigated into the left ear, the eyes will go toward the left and then snap back to center.
If warm water is irrigated into the left ear, the eyes will go toward the right and then snap back to center.
Eyes only snap back to center if cortical influence is intact.

Front 45

Right parieto-occipital lesions result in difficulty in horizontal pursuit movements toward which side?

Back 45

Right

Front 46

WHen eyes are converging, what happens to the lens and pupils?

Back 46

Lens rounds and pupils constrict.

Front 47

What type of lesion is this (peripheral, brainstem or cortical)?
Strabismus
Ophthalmoplegia
Diplopia

Back 47

Peripheral

Front 48

What type of lesion is this (peripheral, brainstem or cortical)?
Eyes parallel at rest
INO
Diplopia on movement

Back 48

Brainstem

Front 49

What type of lesion is this (peripheral, brainstem or cortical)?
Eyes remain conjugate but deviated
Loss of voluntary gaze

Back 49

Cortical Lesion

Front 50

What is expected in cold and warm water irrigation in the right ear, for a normal patient, one with branstem damage, and gone with supratentorial damage?

Back 50

Normal: Cold Opposite, Warm Same (COWS)
Brainstem damage: nothing
Supratentorial: no fast component, just cows and stays there.

If MLF damage: only abduction, NO adduction. INO

Pg 34-24,25

Front 51

Hypertropia is when the eye is deviated in which direction?

Back 51

downward

Front 52

Pupillary Sphincter constricts for two reasons, what are they?
What type of innervation?

Back 52

Accomodation and due to bright light

Parasympathetic

Front 53

What directions do the superior oblique allow the eye to move (2)?

Back 53

Intorsion (adduction)
Infraduction

Front 54

In the iris, what muscle is parasympathetically innervated and what is sympathetically innervated?

Back 54

Pupillary Sphincter muscle - para

Dialator pupillae - symp

Front 55

Cilliary body allows for accomodation and facilitates the outflow of aqueous humor thru the trabecular meshwork. How is this muscular contraction mediated?

Back 55

parasympathetic

Front 56

Ciliary epithelium produces the aqueous humor. How is stimulation of the epithelium innervated?

Back 56

sympathetic

Front 57

Superior tarsal muscle also known as th Muller's muscle. It elevates the upper eyelid. Innervation?

Back 57

Sympathetic

Front 58

Two possible treatments of glaucoma?

Back 58

Decrease aq humor production
Increase aq humor drainage

Front 59

Pilocarpine is a cholinergic; stimulates parasympathetic innervation ie

Back 59

constrict pupil allowing for more drainage

Front 60

Atropine, an anticholinergic, blocks parasympathetic innervation dilating the pupil and causing....

Back 60

increased pressure due to less drainage.

Front 61

Epinephrine and Phenylephrine dilate the pupil and activate the superior tarsal muscle. Therefore, you can guess correctly that they are

Back 61

Sympathomimetics

Front 62

An antisympathomimetics, timolol, is a beta blocker, blocks sympathetic innervation of the ciliary epi therefore

Back 62

decreasing aq humor production and lowering eye pressure.

Front 63

Clinical Signs of __________ Syndrome
1. Miosis
2. Ptosis
3. Decreased eye pressure.

Back 63

Horner's Syndrome (disruption of sympathetic innervation to only ONE of the eyes)

Front 64

Hyper/hypocapnia

Back 64

too much to too little CO2

Front 65

Types of Skull Fracture, explain:
Depressed:
Compound:
Compound-comminuted:
Basilar:
Artifactual:

Back 65

Depressed: Bone fragment pushed down.
Compound: Open to exterior
Compound-comminuted: open & in multiple pieces.
Basilar: base of skull, can cause vascular strx damage --> fatal
Artifactual: from fire

Front 66

Major preventable cause of mortality in CNS trauma is failure or delay in diagnosis of:

Back 66

Intracranial hematoma

Front 67

Which of the following is usually arterial?
Epidural, Subdural, Subarachnoid

Back 67

Subdural

Front 68

Which of the following is usually venous?
Epidural, Subdural, Subarachnoid

Back 68

Epidural

Front 69

Which of the following is often due to atrophy from age, chronic alcholism or coagulative disorders?
Epidural, Subdural, Subarachnoid

Back 69

Subdural

Front 70

Which of the following is usually associated with a loss of consciousness, gain, and then repeated loss (lucid interval)?
Epidural, Subdural, Subarachnoid

Back 70

Epidural

Front 71

Which of the following is usually pancake-like in shape?
Epidural, Subdural, Subarachnoid

Back 71

Epidural (middle meningeal artery, extradural hematoma)

Front 72

What are some signs of "organization" after a subdural bleed?

Back 72

New capillaries, fibroblasts, scar tissue, hemosiderin macrophages, colagen.

Front 73

What are two causes of enlargement of a hematoma?

Back 73

Hemosiderin is there and causes water to follow.
Re-bleed

Front 74

Does concussion alway present with a loss of consciousness?

Back 74

No, only 9% of the time.

Front 75

DAI

Back 75

Diffuse Axonal Injury
Traumatic tears of the nerve fiber tracts

Causes:
Fatal concussion, shaken-baby-syndrome.
* May be of particularly rapid onset, severe, and fatal in kids.

Front 76

Brain with petechiae....think....

Back 76

fat emboli (38-34)

Front 77

Is the use of corticosteroids to treat edema in TBI and spinal cord injuries unanimously accepted?

Back 77

No, Lancet trial called it into serious question

Front 78

Types of Injuries to spine and spinal cord.

Back 78

Falls
Crush
Birth
Local infection
Grisel's syndrome
Hematoma of vertebral-basilar arteries

Front 79

Hemorrhage of the spinal cord may be secondary to two things:

Back 79

Anticoagulant or lumbar puncture

Front 80

Dementia Pugilistica

Back 80

a post-traumatic encephalopathy often associated with boxers.

Front 81

Levator Palpebrae is innnervated by?

Back 81

CN 3

Front 82

Superior Tarsal Muscle

Back 82

Innervated by sympathetics

Front 83

Occulocephalic Reflex
Dolls head maneuver

Back 83

Move head to the right. If eyes go to the left past the midline, then brainstem is ok
Baby doll brainstem ok

Front 84

Median - Raphe Nucleus
Neurotransmitter?

Back 84

Serotonin secreting

Front 85

Medial zone of reticular formation, what neurotransmitter

Back 85

Norepi

Front 86

Lateral zone of reticular formation. No neurotransmitter, involve in ____________ fx?

Back 86

visceral
& cn reflexes

Front 87

Rostral pons up --->

Caudal pons down --->

Back 87

Modulates brain fx of frontal cortex

modulates brain fx of brainstem and sp cord

Front 88

ARAS pathway

Back 88

brainstem reticular formation -> thalamic intralaminar nuclei -> cortex

Front 89

Midbrain and rostral pons is the location of the cell bodies of the

Back 89

reticular formation

Front 90

Ability to maintain consciousness, think

Back 90

ARAS

* ARAS projects up to cortex and down to spinal cord, modulating diffuse projections pathways (NE, epi, ACH, Serotonin, Dopamine)