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170 Cards in this Set

  • Front
  • Back
What two cranial nerves only have unilateral innervation?
CN VII (facial nerve) for the lower half of the face and CN XII for the genioglossus muscle.
What are the four parasympathetic nuclei within the cranial nerves?
CN III: Edinger-Westphal
CN VII: superior salvitory
CN IX: inferior salvitory
CN X: dorsal motor nucleus of vagus nerve
What three types of cells does the olfactory nerve (CN I) have?
Miteral cells that synapse with incoming olfactory nerves, tufted cells, and granular cells.
The olfactory tract is a band of ____ matter leaving the olfactory bulb and contains _____ and _____ striae.
White; medial; lateral.
What part of the brain do the lateral stria of the olfactory tract carry axons to?
The olfactory area of the cortex: periamygdaloid and prepiriform areas.
Define bilateral anosmia and its causes.
Inability to smell on both sides; may be caused by disease of the olfactory mucous membrane.
Define unilateral anosmia and its causes.
Inability to smell on the affected side; may be caused by disease affecting the olfactory nerves, bulb, or tract.
Where do most optic tract fibers terminate?
In the lateral geniculate body of the thalamus.
What is the direct light reflex?
Constriction of the pupil on which a light is shone.
What is the consensual light reflex?
Constricting of the opposite pupil even though no light was shone. This occurs because of the bilateral connections of the Edinger-Westphal nucleus.
What is the accommodation reflex?
When eyes are directed from a distant to a near object the eyes rotate medially, the lens thickens, and the pupils constrict.
What is the function of the parasympathetic Edinger-Westphal nucleus?
Contraction of cilliary muscle and constriction of the pupil.
What is the corneal reflex?
Light touch to the cornea or conjunctiva results in blinking of the eyelid.
What is the connection between the opthalamic branch of the trigeminal nerve (CN V, afferent) and a facial nerve (CN VII efferent)?
The medial longitudinal fasciculus (MLF).
What causes bilateral hemianopia?
Tumors of the pituitary gland.
What five muscles does the main motor nucleus of the occulomotor nerve (CN III) innervate?
Medial rectus, superior rectus, inferior rectus, inferior oblique, and levator palpebrae superioris.
Describe complete oculomotor paralysis.
Eye cannot be moved upward, downward, or inward; at rest the eye looks laterally (external strabismus). Patient has diplopia, ptosis, pupil is dilated, and accommodation reflex is absent.
What is the name of incomplete paralysis of the eye caused by damage to the autonomic nerve?
Internal opthalmoplegia.
What is the name of incomplete paralysis of the eye caused by damage to the extraocular muscles?
External opthalmoplegia.
What muscle does the trochlear nerve (CN IV) innervate?
The superior oblique muscle of the eye.
What does injury to the trochlear nerve (CN IV) cause?
Double vision when looking downward due to paralysis of the superior oblique which rotates the eye downward and medially. Difficulty in turning the eye downward and laterally.
What are the four nuclei of the trigeminal nerve (CN V)?
Main sensory in pons, spinal in medulla, mesencephalic, and motor nucleus.
What kind of sensory information does the trigeminal nerve (CN V) convey?
Pain, temperature, touch, and pressure from the skin of the face, mucous membrane, and meninges.
Where is the trigeminal sensory ganglion found?
On the petrous bone.
What are the three branches of the trigeminal nerve (CN V)?
Opthamalic, maxiallary, and mandibular.
What does the opthalamic branch of the trigeminal nerve (CN V) innvervate?
The upper part of the face and supratentorial dura matter.
What does the maxillary branch of the trigemical nerve (CN V) innervate?
The middle parts of the face and meninges.
What does the mandibular branch of the trigeminal nerve (CN V) innervate?
The skin over the lower jaw and around the ear. It also contains the motor fibers to the muscles of mastication.
What would a lesion of the trigeminal nerve (CN V) cause?
Sensory loss in related regions of the face; motor lesions lead to weakness in mastication.
What is trigeminal neuralgia?
Unilateral pain of the face in one or more divisions of the trigeminal nerve.
What muscle does the abducent nerve (CN VI) innervate?
The lateral rectus muscle of the eye.
What does a lesion of the abducent nerve (CN VI) cause?
Medial strabismus (eye is turned medially) due to unopposed action of the medial rectus muscle. Cannot turn eye laterally.
What four cranial nerves pass through the cavernous sinus?
CN III, IV, V, and VI.
What major artery passes through the cavernous sinus?
The internal carotid artery.
What might thrombosis or aneurysm of the major artery of the cavernous sinus cause?
Compression of the nerves that pass through the sinus and opthalmoplegia.
What are the three nuclei of the facial nerve?
Main motor, parasympathetic, and sensory.
What two nerves produce the facial colliculus?
The facial nerve (CN VII) winding around the abducent nerve (CN VI).
What muscles does the facial nerve (CN VII) innervate?
Facial expression muscles, posterior belly of the digastric muscle, and the stapedius muscle. Fibers for the lower part of the face only receives unilateral innervation.
What are the two parasympathetic nuceli of the facial nerve (CN VII)?
Superior salivatory and lacrimal, which are motor to the salivary glands (submandibular and sublingual) and lacrimal glands.
The sensory nucleus of the facial nerve (CN VII) is the upper part of the _____ _____.
Tractus solitarius.
Sensation of taste from the _____ ____ of the tongue are innervated by the facial nerve (CN VII).
Anterior 2/3.
What does a lesion of the facial nerve (CN VII) upper motor neuron cause?
Paralysis of the muscles of the lower part of the face on the opposite side; the angle of the mouth on the opposite side.
What does a lesion of the facial nerve (CN VII) lower motor neuron cause?
Paralysis of all muscles of the face on the affected side, lower eyelid droops, angle of the mouth sags, tears flow on the lower lid, drooling. Inability to close the mouth or eye on the affected side.
What four symptoms does a lesion of the facial nerve (CN VII) cause?
Seceremotor loss, sensory loss (taste for the anterior 2/3 of the tongue), Bell's palsy, and facial nerve paralysis.
What is Bell's palsy?
Temporary dysfunction of the facial nerve due to swelling n the facial canal that results in unilateral lower motor neuron type paralysis.
What does facial nerve paralysis cause?
Loss of function of the stapedius muscle and loss of ability to dampen sound, resulting in hyperacusis (increased sensitivity to sound).
What does secremotor loss from damage to the facial nerve (CN VII) cause?
Secretory activity of the lacrimal gland, submandibular gland, and sublingual gland is lost.
Physiologically, there is no area of the body that is not influenced by the _____.
Hypothalamus.
What are the two ways in which the hypothalamus is connected to the hypophysis cerebri (pituitary gland)?
Nerve fibers from the supraoptic and paraventricular nuceli to the posterior pituitary lobe. Blood vessels connecting sinusoids with the anterior lobe of the hypophysis.
What two hormones are synthesized in the supraoptic and paraventricular nuclei of the pituitary gland?
Vasopressin (ADH) and oxytocin.
What are neurophysins?
Carrier proteins that transport vasopressin and oxytocin to the bloodstream.
What is the function of vasopressin?
Vasoconstriction and increased water absorption in the kidneys.
What stimulates vasopressin production?
The supraoptic nucleus acts as an osmoreceptor and increases ADH production when osmotic pressure is high.
What is the function of oxytocin?
Contraction of the smooth muscle of the uterus and myoepithelial cells around the alveoli of the mammary gland.
What forms the hypophysial portal system?
Internal carotid artery -> superior hypophysial artery -> median eminence capillaries -> hypophysial portal vein -> vascular sinusoids in the anterior lobe.
Releasing hormones of the pituitary gland stimulate the production of what six hormones?
Adrenocorticotropic hormone (ACTH), follicule stimulating hormone (FSH), lutenizing hormone (LH), thyroid stimulating hormone (TSH), and growth hormone (GH).
Release inhibiting hormones of the pituitary gland inhibit the release of what two inhibiting hormones?
Melanocyte-stimulating hormone (MSH) and lutenotopic hormone (LTH) or prolactin.
What hormone inhibits the release of growth hormone (GH)?
Somatostatin.
What is the function of the supraoptic nucelus?
To synthesize vasopressin (ADH).
What is the function of the paraventricular nucleus?
To synthesize oxytocin.
What is the function of the preoptic and anterior nuclei?
To control the parasympathetic system.
What are the functions of the posterior and lateral nuclei?
To control the sympathetic system.
What are the functions of the anterior hypothalamic nuclei?
To regulate temperature in response to heat.
What are the functions of the posterior hypothalamic nuceli?
To regulate temperature in response to cold.
What are the functions of the lateral hypothalamic nuceli?
To initiate eating, increase food intake, and increase water intake (the hunger and thirst center).
What are the functions of the medial hypothalamic nuceli?
To inhibit eating and reduce food intake (satiety center).
What is the function of the suprachiasmatic nucleus?
To control circadian rhythms.
What are the six main functions of the hypothalamus?
To control emotional states, assist in the regulation of fat, carbohydrate & water metabolism. To influence body temperature, genital functions, and sleep & food intake.
What are the six symptoms of a lesion of the hypothalamus?
Genital hypoplasia (atrophy), diabetes insipidus, obesity, distrubances in sleep, irregular plexia (fever), and emaciation.
What type of scan is used to measure regional blood flow?
Positron emission tomography (PET).
What two main arteries supply blood to the brain?
Two internal carotid arteries (anterior) and two vertebral arteries (posterior).
In what percentage of people is the circle of Willis complete?
25%.
Cerebral blood flow is regulated by the concentration of what three molecules?
Carbon dioxide, oxygen, and hydrogen.
How soon after cerebral blood cessation does a person become unconscious?
Ten seconds.
What are the five branches of the cerebral portion of the internal carotid artery?
Ophthalmic, posterior communicating, chorodial, anterior cerebral, and middle cerebral.
What five parts of the brain does the anterior cerebral artery supply?
The medial surface of cerebral hemispheres, leg motor areas, lentiform nucleus, caudate nucleus, and internal capsule.
What seven parts of the brain does the middle cerebral artery supply?
The lateral surface of the cerebral hemispheres, occipital pole, infereolateral cortex, all major motor areas (except the leg area), lentiform nucleus, caudate nucleus, and internal capsule.
What are the five branches of the cranial portion of the vertebral artery?
Meningeal, posterior spinal, anterior spinal, posterior inferior cerebellar, and medullary.
What are the five branches of the basilar artery?
Pontine, labyrinth, anterior inferior cerebellar, superior cerebellar, and posterior cerebral.
What parts of the brain are supplied by the basilar artery?
Inferolateral and medial surfaces of the temporal and occipital lobes, thalamus, lentiform nucleus, midbrain, pineal gland, medial geniculate bodies, and choriod plexus.
Cerebral arteries are innervated by _____ _____ nerve fibers.
Postganglionic sympathetic.
What causes vasoconstriction in cerebral arteries?
Hypertension.
What causes vasodilation in cerebral arteries?
Increased carbon dioxide and hydrogen concentration, decreased oxygen concentration, and products of metabolism.
What is the most common cause of interruption of cerebral blood flow?
Cardiac arrest due to obstruction of a major coronary artery.
What does complete arrest of cerebral blood flow cause?
Irreversible brain damage with death of nervous tissue. Neuronal function ceases after about 1 minute, and permanent damage starts to occur after 4 minutes.
Which artery is the most common site of infarcts and ischemic events?
Middle cerebral artery.
What would an infarct of the left side middle cerebral artery superior division cause?
Right face and arm weakness of the upper motor neuron type, Broca's aphasia. Right face and arm cortical sensory loss.
What would infarct of the left side middle cerebral artery inferior division cause?
Wernike's aphasia, right field visual field deficit, right face and arm cortical sensory loss, mild right side weakness.
What would infarct of the left side middle cerebral artery deep territory cause?
Right motor hemiparesis and aphasia.
What would infarct of the left side middle cerebral artery stem cause?
Right hemiplegia, right hemianesthia, right homonymous hemianopia, global aphasia, and left gaze preference.
What would infarct of the right side middle cerebral artery superior division cause?
Left face and arm weakness, left hemineglect, left face and arm cortical sensory loss.
What would infarct of the right side middle cerebral artery inferior division cause?
Profound left hemineglect, left visual field and somatosensory deficits, left motor neglect, right sided weakness, and right gaze preference.
What would infarct of the right side middle cerebral artery deep territory cause?
Left motor hemianopia and cortical defects like left hemineglect.
What would infarct of the right side middle cerebral artery stem cause?
Left hemianesthesia, left homonymous hemianopia, profound left hemineglect, and right gaze preference.
What would infarct of the left side anterior communicating artery cause?
Right leg weakness, right leg cortical sensory loss, grasp reflex, frontal lobe behavioral abnormalities, transcortical aphasia, and right hemiplegia.
What would infarct of the right side anterior communicating artery cause?
Left leg weakness, left leg cortical sensory loss, grasp reflex, frontal lobe behavioral abnormalities, left hemineglect, and left hemiplegia.
What would infarct of the left side posterior communicating artery cause?
Right homonymous hemianopia, alexia, aphasia, right hemisensory loss, and right hemiparesis.
What would infarct of the right side posterior communicating artery cause?
Left homonymous hemianopia, left hemisensory loss, and left hemiparesis.
What are the symptoms of a middle cerebral artery stroke?
Left side: aphasia
Right side: hemineglect
Hemianopia and face-arm or face-arm-leg sensorimotor deficits.
What are the symptoms of an anterior cerebral artery stroke?
Contralateral leg weakness, contralateral sensory loss, and frontal lobe dysfunction (behavioral changes, incontinence, semiautonomic movements of the contalateral arm).
What are the symptoms of a posterior cerebral artery stroke?
Contralateral homonymous hemianopia and contralateral sensory loss and contralateral weakness.
When decreased blood flow in adjacent cerebral arteries occurs, what region is affected most?
The watershed zones, or the border zones.
What would a watershed infarct between the middle cerebral artery and anterior communicating artery cause?
Proximal arm and leg weakness and aphasia syndromes if the dominant sphere is affected.
What would a watershed infarct between the middle cerebral artery and posterior communicating artery cause?
High order visual deficits.
What is transient ischemic attack (TIA)?
A neurological deficit caused by temporary brain ischemia that lasts less than 24 hours; typical duration is 10 minutes.
Transient ischemic attacks (TIAs) are important indicators of _____ problems that could lead to major _____ in the future.
Cerbrovascular; stroke.
What are two events that can mimic transient ischemic attack (TIA)?
Hypoglycemia and focal seizures.
What are the three mechanisms of transient ischemic attack (TIA)?
Embolus temporarily blocks a vessel then dissolves; in situ embolus formation on vessel wall; or vasospasm leading to temporary narrowing of vessel lumen.
What is an ischemic stroke?
Inadequate blood supply to a region of the brain for long enough to cause death of brain tissue. Can be caused by hemorrhage or ischemic infarct.
What is an embolic infarct?
A piece of material, usually a blood clot, forms in one place then becomes lodged in a downstream vessel.
What is a thrombotic infarct?
A clot forms locally on the vessel wall, usually at the site of an atherosclerotic plaque, causing occlusion.
What are the five stroke risk factors?
Hypertension, diabetes, hypercholesteremia, cigarette smoking, and family history.
What are the five main veins of the brain?
External cerebral, superficial middle, deep middle cerebral, basal, and internal cerebral.
Superficial veins of the brain drain into the _____ _____ sinus and _____ sinus.
Superior sagittal; cavernous.
Where do deep veins of the brain drain?
Into the great vein of Galen.
Where does the superior sagittal sinus drain?
Into two transverse sinuses which lead to the sigmoid sinus that connects to the jugular vein.
What are the three types of arteries of the spinal cord?
Anterior spinal, posterior spinal, and segmental.
Segmental arteries of the spinal cord branch into _____ arteries.
Radicular.
What is the biggest segmental artery?
Adamkiewicz anterior artery.
Where is the anterior spinal artery narrowest?
T8.
Where do veins of the spinal cord drain?
Into the internal vertebral venous plexus.
What is Meriere's disease?
Loss of balance and ringing in the ear, caused by edema of the labyrinth or inflammation of the vestibular nerve.
Describe Weber's test.
Hold the base of a tuning fork against the top of the head. In conductive deafness sound is louder in the affected ear. In nerve deafness sound is louder in the normal ear.
Describe Rinne's test.
Hold the base of a tuning fork against the mastoid bone then near the external meatus. In conductive deafness bone conduction is better than air conduction. In nerve deafness both bone and air conduction are impaired.
Describe the caloric test (vestibulo-ocular reflex).
Cold or warm water is injected into the external auditory meatus; nystagmus usually develops after a 20 second delay and lasts for more than a minute.
What are the three nuclei of the glossopharyngeal never (CN IX)
Main motor nucelus, inferior salivatory nucleus (parasympathetic), and sensory nucleus.
What is the function of the main motor nucleus of the glossopharyngeal nerve (CN IX)?
It innervates the stylopharyngeal muscle and is part of the ambiguus muscle.
What is the function of the inferior savivatory (parasympathetic) nucleus of the glossopharyngeal nerve (CN IX)?
It innervates the parotid gland.
What is the function of the sensory nucleus of the glossopharyngeal nerve (CN IX)?
Takes the taste and general sensation of the posterior 1/3 of the tongue to the tractus solitarius as well as general sensation of the pharynx and part of the ear.
What is the function of the main motor nucleus of the vagus nerve (CN X)?
Innervates the pharyngeal and intrinsic laryngeal muscles.
What is the function of the sensory nucleus of the vagus nerve (CN X)?
Carries the taste sensation from the pharynx to the tractus solitarius.
What is the function of the parasympathetic nucleus of the vagus nerve (CN X)?
Forms the dorsal nucleus of the vagus nerve, which innervates the muscles of the bronchi, heart, esophagus, stomach, and intestine. It is also involved in the carotid sinus reflex.
What would a lesion of the glossopharyngeal nerve (CN IX) and the vagus nerve (CN X) cause?
Uvula deviation towards the intact side.
What is the function of the cranial root of the accessory nerve (CN XI)?
Joins the vagus nerve to innervate the pharyngeal and laryngeal muscles.
What is the function of the spinal root of the accessory nerve (CN XI)?
It innervates the trapezius muscle and sternocleidomastoid muscle.
What is congenital torticollis?
Fibromatosis (fibrous tissure tumor) of the sternocleidomastoid muscle; head turns to the side and faces away from the affected side. Stiffness of the neck due to fibrosis and shortening of the sternocleidomastoid muscle.
What is spasmodic torticollis?
Cranial dystonia (abnormal tonicity) of unknown cause that involves the bilateral neck muscles especially the sternocleidomastoid muscle. Unilateral deviation of the head.
What is the function of the hypoglossal nerve (CN XII)?
Innervates all intrinsic muscles of the tongue. It receives bilateral innervation except for unilateral innervation of the genioglossus muscle.
What would a lesion of the hypoglossal nerve (CN XII) cause?
Deviation of the tongue towards the affected side and muscle atrophy on the affected side.
What does stimulation of the sympathetic system lead to? (8)
Fight or flight response. Increased heart rate, constriction of arterioles of the skin and intestine, dilation of arterioles of skeletal muscle, raised blood pressure, dilation of pupils, sphincters close, hair stands, and sweating occurs.
What does stimulation of the parasympathetic system lead to? (6)
Conservation and storage of energy. Decreased heart rate, pupil constriction, increased peristalsis, increased glandular activity, sphincters open, and bladder wall is contracted.
At what levels of the spinal cord does the thoraco-lumbar (sympathetic) system originate?
T1-L2/L3.
At what levels of the spinal cord does the cranio-sacral (parasympathetic) system originate?
Oculomotor nerve (CN III), facial nerve (VII), vagus nerve (CN X), S2, S3, and S4 (pelvic splanchnic nerve).
What neurotransmitter is used for preganglionic fibers?
Acetylcholine (Ach).
What neuotransmitter is used for postganglionic sympathetic fibers?
Norepinephrine (NA).
What neurotransmitter is used for postganglionic parasympathetic fibers?
Acetylcholine (Ach).
What are the three types of sympathetic adrenergic receptors?
Alpha (α-1 and α-2), beta (β-1 and β-2), and dopamine (D1 and D5).
What are the two types of parasympathetic cholinergic receptors?
Nicotinic and muscarinic.
What is the function of postsynaptic sympathetic α-1 receptors?
Contraction of vascular smooth muscle, papillary smooth muscle, pilomotor smooth muscle (erects hair).
What is the function of presynatpic sympathetic α-2 receptors?
Inhibits neurotransmitter release on adrenergic and cholineric nerve terminals, inhibits lipolysis in fat cells, stimulates aggregation of platelets, and contraction of smooth muscle.
What is the function of sympathetic β-1 receptors?
Stimulates heart rate and force.
What is the function of sympatheic β-2 receptors?
Relaxes vascular, bronchial, and gastrointestinal smooth muscle, stimulates glyconeogenesis in the liver, and stimulates insulin release by the pancreatic B cells.
What is the function of parasymathetic nicotinic receptors?
To produce excitation (opening of sodium-potassium channels).
What is the function of parasympathetic muscarinic receptors?
+ve effect in glands, -ve effect in the heart, +ve effect in smooth muscle (except vascular).
What organ releases epinephrine (adrenaline)?
The adrenal medulla.
What are the two plexuses of the digestive system?
Submucosal plexus of Meissner and myenteric plexus of Auerobach.
What is the baroreceptor reflex?
An increase in arterial pressure stimulates the baroreceptor (CN IX and CN X afferents) which stimulates the medulla and activates the vagus efferent to decrease blood pressure and inhibit the sympathetic effect on the heart.
What is the atrial (Bainbridge) reflex?
An increase in venous pressure stimulates the vagus nerve (CN X) and the tractus solitarius, which inhibits the parasympathetic outflow and stimulates the sympathetic system.
What is Horner's syndrome?
Damage (interruption) of the sympathetic nerve supply to the head and neck.
What are the five major symptoms of Horner's syndrome?
Miosis (pupil constriction), ptosis, enopthalmos (unequal eye size), anhydrosis, and vasodilation of skin arterioles (flushing).
What are the additional symptoms associated with central Horner's syndrome?
Contalateral hyperesthesia (abnormal sensitivity) and less of sweating on half the body.
What are the additional symptoms associated with preganglionic Horner's syndrome?
Loss of sweating is limited to the face and neck, as well as flushing of the face and neck.
What are the additional symptoms associated with postganglionic Horner's syndrome?
Facial pain or ear, nose, throat problems.
What is Argyll Robertson pupil?
Small pupil with an irregular shape which does not react to light but does react to accommodation.
What are the five symptoms of Shy-Drager syndrome?
Orthostatic hypotension, anhydrosis, impotence, and bladder atonicity.
What is Raynaud's syndrome?
A painful disorder of the terminal arteries of the extremities where cold and emotion cause contraction of the arterioles and arteries.
What are the four symptoms of familial dysautonomia (Riley-Day syndrome)?
Abnormal sweating, blood pressure instability, difficulty in feeding, and progressive sensory loss.
What is Hirschsprung's disease (congenital megacolon)?
Absence of the myenteric plexus which causes dilation and hypertrophy of the colon and fecal retention.
What is botulism?
Paralysis of all striated muscles due to clostridium botulinium toxic which blocks the release of acetylcholine. Additional symptoms include dry eyes and mouth and bowel obstruction.
What is peptic ulcer disease?
Excessive production of hydrochloric acid due to increased parasympathetic stimulation.