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45 Cards in this Set

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  • Back
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Anterior spinal artery arises from?
Vertebral arteries
Posterior spinal arteries arise from?
vertebral or posterior inferior cerebellar arteries
Great radicular artery of Adamkiewicz usually arises where? Supplies what?
Usually T9-T12 and provides blood supply to lumbar and sacral cord
Most susceptible to infarction with decreased aortic pressure?
T4-T8
Venous return from the spinal cord?
Epidural veins called Batson's plexus. Has no valves
Lesions of association cortex can lead to?
Apraxia (deficit in higher-order motor planning and execution despite normal strength)
Site of decussation of lateral corticospinal tract?
Pyramidal decussation at the cervicomedullary junction
Levels of termination and function of anterior corticospinal tract? medial or lateral?
Terminates in cervical and upper thoracic cord; controls bilateral axial and girdle muscles. Medial
site of origin, level of termination and function of reticulospinal tracts? Medial or lateral?
Site or origin is pontine and medullary reticular formation, terminates throughout entire cord and does automatic posture and gait related movements. Medial
2 lateral motor tracts?
4 medial motor tracts?
Lateral motor tracts: lateral corticospinal & rubrospinal
Medial motor tracts: Anterior corticospinal, vestibulospinal, reticulospinal, tectospinal
Unilateral lesions of the medial motor system produces?
No obvious deficits
Signs of lower motor neuron lesions
muscle weakness, atrophy, fasciculations, decreased tone, hypOreflexia
Signs of upper motor neuron lesion
Muscle weakness, increased tone, hyperreflexia (spasticity), Babinski's sign
Oligoclonal Bands
In CSF of MS patients. Result from synthesis of large amounts of relatively homogeneous immunoglobin by individual plasma cell clones in the CSF
The arms are medial to the legs with what 2 exceptions?
Primary sensorimotor cortices and posterior columns
The corticospinal tract lies in the ___________ of the internal capsule?
Posterior limb
Lesion of the internal capsule often produce?
Weakness of the entire contalateral body
The cervicomedullary junction is at what level and what occurs there?
Is at the foramen magnum, and 85% of the pyramidal tract fibers cross over in the pyramidal decussation
Autonomic system consists only of _______ pathways
efferent
Preganglionic neurons of the sympathetic division are located in what cell column in what lamina?
Intermediolateral cell column in lamina VII
Preganglionic neurons in both sympathetic and parasympathetic ganglia release _______ activating ____________________
sympathetic and parasympathetic ganglia release ACETYLCHOLINE activating NICOTINIC CHOLINERGIC RECEPTORS
Hemiplegia with no associated sensory defects
Corticospinal and corticobulbar tracts between the medulla and cortex: corona radiata, posterior limb of internal capsule, basis potin, or middle third of the cerebral peduncle. All contralateral to weakness.
Hemiplegia with associated somatosensory, ocuolomotor, visual, or higher cortical deficits
Entire primary motor cortex, corticospinal and corticobulbar tracts above the medulla. Can be more localized with more info
Hemiplegia sparing the face
Arm and leg area of motor cortex; corticospinal tract from lower medulla to C5
Unilateral face and arm weakness
Face and arm area of the primary motor cortex over the lateral frontal convexity. Cause?
Middle cerebral artrey superior division infarct
Unilateral arm weakness or paralysis
Arm area of primary motor cortex or peripheral nerve supplying the arm.
Cause?
Motorcortex: infarct of small cortical branch of middle cerebral artery
Peripheral: Compression injury, diabetic neuropathy
Unilateral leg weakness or paralysis
Leg area of primary motor cortex along medial surface of frontal lobe
Lateral coritcospinal tract below T1 or peripheral nerves suppling the leg
Cause?
Motor cortex: Infarct in the anterior cerebral artery territory
Spinal cord: Unilateral cord trauma, compression
Peripheral: Compression, diabetic neuropathy
Unilateral facial weakness
CN VII
Cause?
Bell's palsy, trauma, surgery
Bilateral arm weakness of paralysis
Medial fibers of both lateral corticospinal tracts; bilateral ventral horn cells
Causes?
Central cord syndrome: syringomyelia, intrinsic spinal cord tumor, myelitis
Anterior cord syndrome: anterior artery infarct, trauma, myelitis
Bilateral leg weakness or paralysis
Bilateral leg areas of the primary motor cortex; lateral corticospinal tracts below T1; cauda equina syndrome
Causes?
Bilateral medial frontal lesions: parasagittal meningioma, cerebral palsy
Quadriparesis or quadriplegia
Bilateral arm and leg areas of motor cortex; bilateral lesion of corticospinal tracs between medulla and C5
Cause?
Bilateral motor cortex: Watershed infarcts, affect proximal more than distal musccles
Corticospinal damage generally spares _______ relative to ________
corticospinal damage generally spares flexors relative to extensors
Spastic gait
Stiff-legged, circumduction, decreased arm swing, fall toward side of greater spasticity
Location? Cause?
Corticospinal tract(s)
Brain infarct affecting upper motor neuron pathways, cerebral palsy, ms
Ataxic gait
Wide based, unsteady, staggering side to side
Location? Cause?
Cerebellar vermis or other midline cerebellar structures.
Alcohol or infarct or ischemia of cerebellar pathways
Frontal gait
Slow, shuffling, "magnetic", unsteady
Location? Cause?
Frontal lobes or frontal subcortical white matter.
Hydrocephalus; frontal tumors, bilateral anterior cerebral artery infarcts
Tabetic gait
High stepping, foot flapping gait, difficulties walking in dark or on uneven surfaces
Location? Cause?
Posterior columns or sensory nerve fibers.
Posterior cord syndrome
Cause of multiple sclerosis?
T lymphocytes are triggered by a combo of genetic and environmental factors to react against oligodendroglial (CNS) myelin.
Worse symptoms when warm
Sudden onset of right hand weakness
- Afib
Left precentral gyrus, primary motor cortex, hand area
cause?
Embolic infarct, small cortical branch of the left middle cerebral artery, superior division
Sudden onset of left foot weakness and right frontal headache
-Diabetes/hypertension
Right precentral gyrus, primary motor cortex, leg area
Embolic infarct of a cortical branch of the right anterior cerebral artery
Sudden onset of right face weakness, trace curling of right fingertips
-Diabetes
Lesion in the left motor cortex face area
Embolic infarct of a cortical branch of the left middle cerebral artery
Pure Motor Hemiparesis
- woman in 30s with no vascular risk
-Gets worse when warm
Right corticobulbar and corticospinal tracts in the posterior limb of the internal capsule or ventral pons
Motor hemiparesis is usually caused by lacunar infarct of contralateral internal capsule or pons.
Given her lack of vascular risk and it getting worse when warm, probably ms
Pure right sided motor hemiparesis
- decreased right palate movement, rightward tongue deviation
Left corticobulbar and corticospinal tracts in the posterior limb of the internal capsule or ventral pons
Lacunar infarction of contralateral internal capsule or pons
Progressive weakness, muscle fasciculations and cramps
-atrophy
-Babinsky's sign
Amyotrophic lateral sclerosis
Treat with?
Riluzole
Lateral corticospinal tract
Precentral gyrus -- posterior limb of the internal capsule -- cerebral peduncle in midbrain -- ventral pons --- crosses at pyramidal decussation -- lateral spinal cord -- anterior horn
Lateral motor systems control what? Medial motor systems control what?
Lateral motor systems are involved in limb control
Medial motor systems control proximal trunk muscles