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133 Cards in this Set

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  • Back
Only openings between ventricles and subarachnoid space _
2 foramen of Luschka
1 foramen of Magendie
_ line ventricular system
Ependymal cells
Exchange between CSF and extracellular fluid of brain is possible due to _
Clinical significance?
Cells are loose - no tight junctions
CSF composition can reflect diseases of brain
4 year old presents with glial cell neoplasm in posterior fossa - pathology report indicates tumor involves cells lining ventricles - diagnosis and treatment
Ependymoma - surgical removal and focal irradiation
Found in lateral, 3d and 4th ventricles and starts producing CSF by end of first trimester
CHoroid plexus
Blood- CSF barrier exists where
Choroid epithelial cells joined by tight junctions
How is CSF produced
By selective transport - NaCl is actively transported, water follows, large molecules via pinocytosis/exocytosis
Average volume of CSF in adult is _
120 mL
Production rate of CSF is _ per day
400-500 mL
Compared to blood plasma CSF has increased _ and decreased _
Increased - chlorige, magnesium, sodium
Decreased - potassium, calcium, glucose, proteins
8 year old patient presents with headache, nausea, vomitting, lethargy, hydrocephalus and eye movement deficits due to pressure on CN III, IV, VI. Symptoms are found to be related to increased intracranial pressure and rare intracranial tumor of 4th ventricle, patient also has increased CSF production - what are two possible origins of tumor, tratment for each
Choroid plexus tumor - papilloma or carcinoma
Papilloma - surgical removal
Carcinoma- surgery, chemo or both
LP is done at _ level
L3/L4 (L4/L5)
LP reveals clear CSF with little protein and immunoglobulin and 1-5 leukocytes.mL - this CSF is _
Normal
If LP cannot be done at lumbar cistern where else could it be done
Cisterna magnum - dorsal cerebral medullary system
2 main functions of CSF
Support and shock absorption
2 possible causes of hydrocephalus
Blockage of CSF movement or lack of absorption of CSF into venous system - as a result CSF accumulates in ventricles and subarachnoid space
Patient presents with hydrocephalus due to obstruction of CSF movement - name condition and where shunt must be placed
Obstructive hydrocephalus - shunt must be in ventricular system
Patient presents with hydrocephalus - CSF movement is normal but absorption into venous system of CSF is blocked - name condition and where shunt must be placed
Communicating hydrocephalus - shunt must be in ventricular system or lumbar cistern
Alzheimer patients MRI shows inordinately large ventricles - name condition and what is it due to
Ex vacuo - due to brain atrophy
What are possible causes of communicating hydrocephalus
Elevated venous pressure - heart failure, stenosis of SVC
While performing LP on patient, there is blood in CSF - what are possible causes
Traumatic tap - will gradually disappear on repeated fluid extractions
Subarachnoid bleed - CSF will remain bloody with repeated extractions
3 types of CSF shunts
Ventriculo-peritoneal
Ventriculo-atrial
Lumbo-peritoneal
Dura has 2 layers _
Periosteal and meningeal
This meningeal layers covers brain - doesnt follow contours, space under it contains CSF
Arachnoid
This meningeal layer is tightly adherent to brain and follows contours
Pia mater
Pachymeninx is another name for _
Dura
Arachnoid and pia collectively are called _
Leptomeninges
When popping zits in danger area of the face (nose) you run danger of getting infection into _
Cavernous sinus
Anterior cranial fossa is innervated by _
CN V
Medial cranial fossa is innervated by _
CN V
Posterior cranial fossa is innervated by _
CN X and C1-C3
Patient has space occupying lesion in posterior cranial fossa - he runs risk of _ herniation?
Upward cerebellar
6 month old patient presents with subdural hematoma - possible mechanism ?
Shaken baby syndrome - rupture of bridging cerebral veins
80 year old patient after minor fall experienced headache,weakness, nausea and vomitting which progressed in two weeks to seizures, lethargy, loss of conscioussness and slurred speech - diagnosis and mechanism
Subdural hematoma - rupture of bridging cerebral veins
25 year old patient presents post injury to pterion region of head - presented originally with headache and confusion which progressed over time to lethargy and unresponsiveness - diagnosis and mechanism
Epidural hematoma - rupture of middle meningeal artery
Patient presents with head injury - differential diagnosis includes subdural and epidural hematoma. MRI shows vast lesion occupying whole lateral hemisphere - what is the diagnosis
Subdural - vast lesion
Epidural - smaller lesion - more difficult to pull off periosteal layer
Patient with history of aneurysm in the brain presents with sudden painful headache described as worst headache of life. Patient also complains of neck stiffness, nausea and vomitting, loss of consciousness and photophobia. LP reveals bloody CSF, CT scan shows bleeding - diagnosis and cause
Subarachnoid bleed - ruptured aneurysm - caused by arterial bleeding
Patient presents with neurological symptoms which are found to be due to compression. Benign tumor is found outside the brain tissue - diagnosis and treatment
Meningioma - surgery, radiation if malignant
6 month old baby presents with fever, chills, headache, lowered consciousness. LP reveals elevated CSF pressure, cloudy, with many WBC's, high protein and bacteria
Diagnosis?
Possible causes?
Possible region involved?
Disease was found early and patient received appropriate tretment - what is prognosis?
Bacterial meningitis
Neisseria meningitidis and Strep pneumoniae
Leptomeninges - pia + arachnoid
90% survival rate with appropriate treatment
Cranial nerves associated with medulla are _
Hypoglossal XII
and parts of
Acessory XI
Vagus X
Glossopharyngeal IX
CN's _ are associated with pons-medullary junction
Abducens VI
Facial VII
Vestibulocochlear VIII
2 parts of pons are _
Tegmentum and basilar pons
CN _ emerges from lateral part of pons
V Trigeminal
_ connect cerebellum to medulla oblongata, basilar pons and midbrain
Inferior cerebellar peduncle
Middle cerebellar peduncle
Superior cerebellar peduncle
Myelencephalon is another name for _
Medulla oblongata
Anterior part of metencephalon is another name of _
Pons
Mesencephalon is another name for _
midbrain
CN _ exits anterior aspect of midbrain whereas CN _ exits posterior part of it
CN III Occulomotor
CN IV Trochlear
Posterior (dorsal) aspect of midbrain is characterized by _ and anterior aspect by _
Posterior - superior and inferior colliculi
Anterior - crus cerebri and interpeduncular fossa
Ventricular spaces of brainstem are _
Cerebral aqueduct in midbrain and 4th ventricle in rhombencephalon
Facial colliculus in rhomboid fossa marks location for the underlying _ and _
Abducens motor nucleus
Internal genu of facial nerve
Floor of 4th ventricle is called _
Rhomboid fossa
Patient presents with coma, it is found that portions of his forebrain extruded downward through tentorial notch, he is suffering from _
Central herniation
Patient presented with neurological symptoms and is rapidly declining - he is diagnosed with uncal herniation in which uncus was forced over _ into _
Tentorial edge into midbrain
Patient presents with hydrocephalus and damage to midbrain. His cerebellum has extruded through tentorial notch - he is suffering from _
Upward cerebellar heniation
Patient presented with increased intracranial pressure after MVA, his respiration and cardiac activity have been compromised and he expired - diagnosis and mechanism?
Tonsillar herniation - cerebellar tonsil forced into foramen magnum
Sulcus limitans is an embryologic landmark that persists in adults in pons and medulla and separates _
Structures derived from basal plate from those derived from alar plate
Tumors of pineal gland produce _ because of compression of _ and resulting occlusion of _
Obstructive hydrocephalus
Colliculi of midbrain
Cerebral aqueduct
Area of skin supplied by any one cranial nerve or spinal nerve through its dorsal and ventral rami (GSA)
Dermatome
Dermatomes of consecutive spinal nerves overlap considerably - T/F
T
On section of peripheral nerve which area is greater - tactile loss or pain/thermal sensation - why
Tactile loss - receptive fields are not all same size
Is there any overlap between divisions of CN V dermatomes
NO
Patient has sensory loss in dermatomal distribution - this condition is called _ and it involves _
Radiculopathy - involves roots
Patient has sensory loss in distribution of one spinal nerve - this condition is called _
Mononeuropathy
Patient has stocking and glove distribution of sensory loss - what does he probably have
Diabetic polyneuropathy
CN _ is involved in internal surface of tympanic membrane - involved in otitis media
IX
Part of the external surface of tympanic membrane is innervated by CN _
X
CN _ supplies the skin of the concha of the auricle, a small area behind the ear and external auditory meatus
VII (facial)
Root level for thumb
C6
Root level for middle finger
C7
Root level for little finger
C8
Dermatome of nipple
T4
Dermatome of xiphoid process
T6
Dermatome of umbilicus
T10
Dermatome of pubis
T12
Dermatome of inguinal ligament
L1
Mid-thigh dermatome
L2
Lower and medial thigh dermatone
L3
Patella, medial malleolus and big toe dermatome
L4
Lateral leg, digits 2-4 dermatome
L5
Lateral malleolus and small toe dermatome
S1
Posterior thigh and leg dermatome
S2
Webspace between 1st and 2nd toes is innervated by _
Deep fibular nerve
Perineum is innervated by _ level of spinal cord
Sacral
Patient has lost sensation in upper eyelid, tip of nose and forehead - nerve involved
V1
Patient has lost sensation in lower eyelid, skin around nostril and upper lip - nerve involved
V2
Patient has lost sensation in part of ear, lower lip and chin - nerve involved
V3
Patient doesnt have sensation on the back of head - dermatome?
C2
Patient complains of loss of sensation of the skin of ear lobe - nerve involved
C3
Patient doesnt have sensation over clavicle - dermatome
C4
Patient loss sensation over the lateral part of big toe - dermatome
L5
Skin around anus has lost sensitivity - dermatome involved
S5
Somatosensory system has 3 parts

_ includes discriminative touch, flutter-vibration, proprioception and kinesthesia

_ - for motion coordination

_ includes crude (nondiscriminative touch), thermal sensation and pain
Conscious proprioception

Non conscious proprioception

Protopathic sensibility
Posterior column - medial lemniscus pathway is part of what modality of somatosensory system

a) conscious proprioception
b)non-conscious proprioception
c)protopathic sensibility
Conscious proprioception
2 types of cutaneous mechanoreceptors are _
- Rapidly adapting receptors - responding to application and removal of stimulus but not during maintained stimulation
- Slowly adapting receptors - active as long as stimulus is present
Name rapidly adapting cutaneous mechanoreceptors
Meissners corpuscle - tactile impulse
Hair follicle receptor - tactile impulse
Paccinian corpuscle - vibration
Name slowly adapting receptors
Merkels disk - pressure
Some hair follicle receptors
Ruffinis endings - pressure
2 types of proprioceptors - detect proprioception and kinesthesia
Muscle spindle
Golgi tendon
This pathway carries conscious proprioception from limbs and trunk
Posterior column - medial lemniscus pathway
Posterior column - medial lemniscus pathway :

Receptors detect conscious proprioception from limbs and trunk - primary afferent fibers carry impulses in posterior column tracts - _ and _ , they synapse in _ , after what they cross in _ and go to _ where they synapse again and go to cortex through _

In some cases there are 3 synapses -
Fasciculus gracilis and fasciculus cuneatus

Gracile and cuneate nuclei

Medial lemniscus

VPL of thalamus

Thalamo-cortical pathways

Synapses - lamina III, IV, gracile and cuneate nuclei and VPL of thalamus
Conscious proprioception from head is carried by _ pathways
Anterior and posterior trigeminothalamic
Muscle spindle, Golgi tendon organ and joint receptors all target Brodman areas _
3a and 2
Cutaneous receptors target Brodman areas _
3b and 1
Patient who suffered stroke has lost texture discrimination - location of his lesion is most likely area _
1
Patient who suffered from stroke is suffering from astereognosis - cannot discriminate size and shape - his lesion is most likely located in area _
2
Patien who suffered from stroke presents with both diminished texture discrimination and astereognosis - his lesion is in area _
3b
Somatotopic representation of body surface on primary sensory cortex is called _
Homunculus
Secondary somatosensory cortex is supplied by _ artery
Middle cerebral artery
_ receives input from ipsilateral primary sensory cortex and ventral posterio-inferior thalamic nucleus
Secondary somatosensory cortex
Patient presents with agnosia (contralateral part is lost from personal body map) The lesion is in _
Area 5 and lateral portion of area 7
Posterior column is supplied by _ artery
Posterior spinal artery
Medial lemniscus is supplied by _ artery
Anterior spinal
VPL and VPM are supplied by _
Thalamogeniculate branches of posterior cerebral artery
Primary sensory cortex is supplied by _ arteries
Anterior and middle cerebral
Principal sensory and mesencephalic trigeminal nuclei are supplied by _
Basilar and superior cerebellar arteries
Which two pathways are pathways of nonconscious proprioception
Spinocerebellar and trigeminocerebellar
Patient presents with lack of coordination during walking and other movements (no sensory feedback to cerebellum necessary to regulate movements) - diagnosis and which pathway is disrupted
Friedrich ataxia - degeneration of major spinocerebellar tracts
Which pathways are reperesentative of protopathic sensibility
Anterolateral system - spinothalamic tract and spinoreticular tract
_ receptors respond to intense stimuli that have potentialto damage tissue
Nociceptors
_ nociceptors have thinly myelinated fibers
A delta mechanical
_ nociceptors ahve nonmyelinated fibers
C-polymodal nociceptors
_ receptors sense tactile impulse
Meisners corpuscle
Hair follicle receptor
_ sense pressure
Merkels disk
Ruffinis endings
_ sense vibration
Paccinian corpuscle
Patient presents with contralateral loss of pain, temperature and crude touch, sensibility over the body (hemianalgesia) and ipsilateral loss over face - which blood vessel is damaged, diagnosis - which pathway involved
Posterior inferior cerebellar artery - PICA
Wallenberg syndrome
Medullary anterolateral system and spinal trigeminal nucleus (anterior trigeminothalamic tract)
Patient presents with ipsilateral loss of discriminative, positional and vibratory tactile sensations at and below segmental level of injury, contralateral loss of nociceptive, crude touch and temperature below segmental level of injury and ipsilateral paralysis of limbs/trunk muscles - diagnosis
Brown - Sequard syndrome
Patient presents with bilateral loss of nociceptive, nondiscriminative (crude)touch and thermal sensations beginning several segments below the segmental level of injury - MRI showed cystic cavitation of central regions of spinal gray matter and destruction of decussating ALS fibers in anterior commissure - diagnosis
Syringomyelia
Is sensory cortex necessary for pain perception
NO - electrical stimulation of somatosensory cortex doesnt result in pain, painful stimuli can be recognized without presence of sensory cortex
Pain is perceived at _ levels
Subcortical
_ pathway and cortex seems to be necessary to localize pain
Spinothalamic
_ component is necessary for suffering component of pain experience ( some drugs like benzodiazepine can disrupt this component)
Spinoreticular
Patient suffers with phantom limb (deafferentation) pain. Thalamic lesioning is choosen as treatment of choice - you can do lateral or medial thalamic lesioning - which one would you choose and why
MEDIAL - long lasting pain relief, minimal side effects (transient confusion, somnolenc but no apparent sensory loss)
Lateral - transient release of pain, side effects - loss of cutaneous and position senses in affected limb
Deep brain electrical stimulation for treatment of phantom limb pain requires placement of electrodes in _
Medial thalamus or paraventricular or periaqueductal grey