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133 Cards in this Set
- Front
- Back
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What nerve branches of the brachial plexus are from the posterior cord?
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STAR
Subscapular Thoracodorsal Axillary Radial |
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A-beta fibers
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medium diameter (6-12 micrometers)
myelinated sensory fibers for proprioception, superficial touch, deep touch, vibration |
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What CN goes through foramen ovale?
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V3
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What CN goes through foramen rotundum?
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V2
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CST descends in what part of the internal capsule?
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posterior
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EMG findings with neuropathy
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dropout and reduction in muscle contraction with prolonged, large motor units
There may be fibrillations and fasiculations |
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EMG findings with myopathy
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full contraction of all muscles but with short, small motor units
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Lambert-Eaton myasthenic syndrome
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resembles MG
+autonomic dysfunction arises from AI attack on pre-synaptic voltage-gated Ca2+ channels |
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What drop = what lesion?
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common peroneal nerve
L5 radiculopathy |
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Corticobulbar tract descends in what part of the internal capsule?
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Genu
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What does the torsional component tell you in a Dix-Hallpike maneuver?
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Which ear is affected
Torsion is ipsilateral to lesion Right tortion = Right ear |
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Horizontal nystagmus on Dix-Hallpike
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canalith is in horizontal canal
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Down beating nystagmus on Dix-Hallpike
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canalith is in anterior canal
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Up beating nystagmus on Dix-Hallpike
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Canalith is in posterior canal
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S1 lesion
-main weakness -reflexes decreased -sensory abnormality -disc involved |
weakness: foot plantar flexion
reflexes: Achilles sensory: lateral foot, small toe, sole disc: L5-S1 |
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Epley maneuver
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canalith repositioning maneuver
Dx maneuver = Dix-Hallpike goal: move canaliths through canal back into saccula maneuver is the same for posterior and anterior canal, but different for horizontal canal |
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Dejerine-Roussy syndrome
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Thalamic lesion --> contralateral pain
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Complete occulomotor palsy that spares pupil
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usually 2/2 DM
not an aneurysm (with rare exceptions) why? parasympathetic fibers located near surface of nerve |
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Fiberse from ventral cochlear nucleus ---> ?
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some fibers cross in trapezoid body --> bilateral input to superior olivary nucleui --> ascend in lateral lemniscus --> MGN
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brachium conjuctivum
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a.k.a. superior cerebellar peduncle
mainly output from cerebellum |
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Musculocutaneous nerve
-motor function -sensory regions |
motor: flexion at elbow, supination at forearm
sensory: lateral cutaneous nerve of the forearm |
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Ulnar nerve
-motor functions -sensory functions |
motor: digits 2-5 adduction and abduction
thumb adduction flexion of digits 4 & 5 wrist flexion/adduction |
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Klumpke's Palsy
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Lower trunk injury
e.g. grabbing branch while falling from a tree hand and finger extension weakness, atrophy of hypothenar muscles, ulnar sensory region loss |
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Erb-Duchenne Palsy
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Upper trunk injury
--> waiter's tip pose arm at side, internally rotated, wrist flexed |
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Deep peroneal nerve
-motor function -sensory region |
motor: foot dorsiflexion, toe extension
sensory: first web space |
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Two most common brainstem vascular syndromes
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lateral medullary syndrome (usually caused by vertebral thrombosis)
medial basis pontis infarcts (usually lacunar) |
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Gag reflex circuit
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sensory and motor of CN IX and X
CN IX more important for afferent limb CN X more important for efferent |
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Superficial peroneal nerve
-motor -sensory |
motor: foot eversion
sensory: anterior leg and dorsum of foot EXCEPT first web space |
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Tibial nerve
-motor -sensory |
motor: plantar flexion, inversion, toe flexion
sensory: posterior tibial (sole of foot) |
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Sciatic nerve
-motor -sensory |
motor: leg flexion at knee, also tibial and personeal actions
sensory: foot and lateral leg |
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Nucleus ambiguus
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**named thusly because it does not stain well with conventional histology
CN IV, X SVE |
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cardiorespiratory nucleus
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a.k.a. caudal nucleus solitarius
receives afferents from IX and X for chemo- and bartoreceptors |
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CN of caudal nucleus solitarius
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IX and X
GVA |
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CN of nucleus ambiguus
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CN IX and X
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medial medullary syndrome
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vascular: paramedian of vertebral and ASA
pyramidal tract --> contralateral arm and leg weakness medial lemniscus --> contralateral decrease in position/vibration hypoglossal nucleus/exciting CN XII fasicles --> ipsilateral tongue weakness |
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areflexia and inability to heal walk
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Charcot-Marie-Tooth disease
check for it, see if relatives show same s/sx |
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C7 lesion
-main weakness -reflexes decreased -sensory abnormality -disc involved |
weakness: triceps
reflexes: triceps sensory: 3rd finger disc: C6-C7 **~46% of cervical radiculopathies |
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C6 lesion
-main weakness -reflexes decreased -sensory abnormality -disc involved |
weakness: wrist extensors, biceps
reflexes: biceps and BR sensory: 1st and 2nd fingers, lateral forearm disc: C5-C6 |
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Rigidity in CST lesions?
BG lesions? |
CST: clasp-knife rigidity
BG: plastic, waxy, or lead pipe rigidity |
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Infarct with unilateral ataxia with little or no brainstem signs
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Most commonly SCA
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Fastigal nuclei fibers leave cerebellum via what structure?
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uncinate fasiculus (runs along superior cerebellar peduncle) and juxtarestiform body (runs with inferior peduncle)
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C5 lesion
-main weakness -reflexes decreased -sensory abnormality -disc involved |
weakness: deltoid, infraspinatus, bicepts
reflexes: biceps, pectoralis sensory: shoulder, upper lateral arm disc: C4-C5 |
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L4 lesion
-main weakness -reflexes decreased -sensory abnormality -disc involved |
weakness: iliopsoas, quadriceps
reflex: patellar sensory: knee, medial lower leg disc: L3-L4 |
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L5 lesion
-main weakness -reflexes decreased -sensory abnormality -disc involved |
weakness: foot dorsiflexion, big toe extension, foot eversion and inversion
reflexes: none are decreased sensory: dorsum of foot, big toe disc: L4-L5 **~40-45% of lumbar radiculopathies |
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Femoral nerve
-motor -sensory |
motor: leg flexion at hip, leg extension at knee
sensory: anteromedial thigh, medial leg (saphenous) |
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Most common causes of acute bacterial meningitis in adults
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Streptococcus pneumoniae
Nisseria meningitidis Listera monocytogenes |
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Chronic increased ICP leads to what kind of visual field deficit?
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enlarged blind spots
concentric loss of peripheral visual fields 2/2 damage of the more superficial fibers of CN II |
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Intradural/supraclinoid ICA branches
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OPAAM
Ophthalamic Pcomm Anterior choroidal ACA MCA |
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Hand of Benediction
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median neuropathy
a.k.a. honeymooner's palsy 2/2 lover's head resting on upper arm |
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CN of rostral nucleus solitarius
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CN VII, IX, X (SVA)
a.k.a. gustatory nucleus |
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What CN nucleus lies just ventral (inside) of the facial colliculus?
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Abducens
The facial nerve wraps around CN VI |
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Foster-Kennedy syndrome
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large lesions (e.g. meningioma) to olfactory sulcus region
anosmia optic atrophy (ipsilateral tumor compression) of one eye and papilledema of the other (increased ICP) |
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Tetrad of narcolepsy
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1) excessive daytime sleepiness
2) cataplexy 3) sleep paralysis 4) hypnogognic hallucinations |
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side effects of Sinemet
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**carbidopa-levodopa
dyskinesias after 5-7 years of treatment N/V, anorexia, HTN, hallucinations "on-off" phenomenon |
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Shy-Drager
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Parkinsonian symptoms + autonomic insufficiency
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Complications of hemorrhagic stroke
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Increased ICP
seizures rebleeding vasospasm hydrocephalus SIADH |
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causes of hemorrhagic stroke
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MCC (50-60%) = HTN
amyloid angiopathy (10%) anticoagulation/thrombolytic use (10%) brain tumors (5%) AVMs (5%) |
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heparin or warfarin for acute stroke?
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no efficacy in acute setting
unless stroke is embolic from cardiac origin Then the Tx is anticoagulation |
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Don't give tPA if...
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time unknown
>3 hours uncontrolled HTN, bleeding d/o, pt is anticoagulated, or h/o recent trauma/surgery why? increased risk of hemorrhagic transformation |
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When does cerebral edema occur with stroke?
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within 1-2 days and can --> mass effect for up to 10 days
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C fibers
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small (0.2-1.5 micrometer) unmyelinated fibers
pain/temp (warm) |
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Lhermitte's sign
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neck flexion --> electricity-like sensation running down back and into extremities
seen in cervical lesions (including MS) |
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"man in a barrel" syndrome
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ACA-MCA watershed stroke
effects proximal/trunk muscles |
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sensory deficit with medial medullary lesion
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contralateral body pain/temp deficit
**lateral medullary catches spinal trigeminal and ---> ipsilateral face |
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Fibers from the dorsal cochlear nucleus ---> ?
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pass dorsal to inferior cerebellar peduncle, decussate in pontine tegmentum, then ascend to contralateral lateral lemniscus ---> MGN
**decussates in trapezoid body |
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Partial oculomotor palsy that spares pupil
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Could be partial compression by aneurysm --> get angio!
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Pontine pupils
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bilateral small pupils reactive to light
MoA: disruption of descending sympathetic information |
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BA 41
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primary auditory cortex
lies on Heschel's gyrus |
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angular acceleration detected by what?
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semicircular canals
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"Rightward gaze" components
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R CN VI
R abducens nucleus R PPRF L MLF |
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midbrain lesions --> what type of respirations?
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hyperventilation
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Linear acceleration detected by what?
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maculae within utricle and saccule
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Thalamic nucleus for cranial nerve somatosensory pathway
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VPM
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Head position with CN IV palsy
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head tilted away from affected eye; compensates for extorsion
chin-tucked; look up, compensates for hypertropia |
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Thalamic nucleus for spinothalamic tract
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VPL
**projections also to intralaminar thalamic nuclei (central lateral nucleus) and medial thalamic nuclei (mediodorsal nuclei) |
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Eye "down and out"
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complete CN III palsy
diplopia looking up and medial and near objects (2/2 impaired convergence) |
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sensory level for rectum, bladder, urethra, and genitalia
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S2-S4
ascends in both PC-ML and anterolateral systems |
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frontal-type incontinence
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Lesions to bilateral medial frontal micturition centers --> reflex activation of pontine and spinal micturition centers when bladder full
removes voluntary control |
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painful oculomotor palsy that involves the pupil
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Pcomm aneurysm until proven otherwise!
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Lesions below pontine micturition center but above S2-S4 effects on bladder?
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initially: flacid, atonic bladder
-continued reflexive contraction of urethral sphincter --> retention, distention, overflow incontinence weeks/months later: spastic bladder --> frequency, urge incontinence 2/2 detrusor-sphincter dyssynergia |
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Peripheral lesions at level of S2-S4 effects on bladder
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flaccid areflexic
--> overflow incontinence, stress incontinence |
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Kernohan's phenomenon
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When the contralateral CST is compressed in uncal herniation --> ipsilateral hemiplegia
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Common s/sx of increased ICP
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HA
N/V diplopia change in mental status Cushing's triad: HTN, bradycardia, irregular respirations Papilledema (in chronic increased ICP) |
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What are the four vestibular nuclei?
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lateral
medial inferior superior form lateral floor of fourth ventricle |
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gustatory nucleus
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a.k.a. rostral nucleus solitarius
CN VII, IX, and X SSA |
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CN X functions
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branchial motor: pharyngeal and laryngeal muscles (swollowing and speaking)
parasympathetic: heart, lungs, digestive tract down to splenic flexure GSA: sensation from pharynx, meninges, region near EAM SSA: taste from epiglottis and pharynx VSA: chemo- and baroreceptors from aortic arch |
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CN IX functions
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branchiomotor: stylopharyngeus muscle
parasympathetic: parotid gland GSA: sensation from middle ear, region near EAM, pharynx, posterior 1/3 of tongue |
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input to inferior vestibular ganglion
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posterior saccule
posterior semicircular canal |
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Localization of apneustic respirations
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**brief 2-3 second pauses at full inspiration
lesions of rostral pons -medial parabranchial Koelliker-Fuse area located just dorsal to motor nucleus of CN X |
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input to superior vestibular ganglion is from ?
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utricle
anterior saccule anterior and lateral semicircular canal |
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localization of ataxic breathing
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medullary lesions that don't instantly --> arrest
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Cheyne-Stokes respiration localization
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**breathing progressively deeper then shallower with each breath at the point of apnea
bilateral lesions at or above the pons (including cortex) also seen in mountain climbers and in cardiac failure. not harmful, per se. |
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Duret-Bernard hemorrhage
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2/2 severe compression of the midbrain and other brainstem areas during transtentorial herniation
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Thalamic nucleus for PC-ML
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VPL
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CNs of jugular foramen
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CN IX, X, XI
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stylomastoid foramen
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CN VIII
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A-alpha fibers
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large diameter (13-20 micrometers) myelinated sensory fibers
receptors are muscle spindle and Golgi tendon organs for proprioception |
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Nerves of superior orbital fissure
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III
IV VI V1 +V2 = nerves of cavernous sinus |
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superior olivary nuclear complex function
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function to localize sounds horizontally in space
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jaw jerk reflex circuit
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monosynaptic
primary sensory neurons in the mesencephalic trigeminal nucleus ---> motor trigeminal nucleus in pons |
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Which vestibular nuclei ---> MLF
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medial and superior vestibular nuclei
mediates vestibuloocular reflex this is the "ascending MLF" "descending MLF" = medial VST |
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A-delta fibers
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small (1-5 micrometers) myelinated
bare nerve ending pain, temp (cool) |
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sensory deficit with lateral pontine/medullary lesion?
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contralateral body pain/temp
ipsilateral face pain/temp |
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Inferior salivatory nucleus
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CN IX
GVE primary neuons to otic ganglion, then --> parotid gland |
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superior salivatory nucleus
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CN VIII
GVE primary neurons go to either sphenopalantine ganglion then --> lacrimal glands or to submandibular ganglion and then --> submandibular and sublingual glands |
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? --> medial vestibulospinal tract
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medial vestibular nucleus with contributions from inferior vestibular nucleus
also a descending motor system, but only extends through C-spine important for head/neck position |
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CSF in Guillain-Barre
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increased protein
normal cell counts |
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Lateral vestibular nucleus --> what tract?
function? |
lateral vestibulospinal tract
part of MEDIAL descending motor system extends length of spinal cord, maintains balance and extensor tone **remember, medial vest. tract only goes through C-spine |
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Median nerve
-motor functions -sensory regions |
motor: thumb flexion, opposition, flexion of digits 2 and 3, wrist flexion/abduction, forearm pronation
sensory: "fast ball grip" (distal digits 1-3) |
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Radial nerve
-motor functions -sensory regions |
motor: extends arms/wrists/fingers (joints below shoulder), forearm supination, thumb abduction in plane of palm
sensory: posterior cutaneous n. of the arm and forearm, dorsal digital nerves (back of hand proximal to digits 2-3) |
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Muscles innervated by musculocutaenous nerve
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BBC
Biceps Brachialis Coricobrachialis |
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Thalamic nucleus of cerebellar output
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VL
**VL pars oralis receives basal ganglia VL pars caudalis receives cerebellar input **both BG and cerebellum also --> VA and intralaminar nucleus |
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Intrinsic hand muscles innervated by nerves other than ulnar
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LOAF
Lumbricals I and II Oponens pollicis Abductor pollicis brevis Flexor pollicis brevis- superficial head |
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Magnocellular Red Nucleus
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input from interposed nuclei
output decussates in ventral tegmental decussation and descends in rubrospinal tract **double-crossed because input decussates in superior cerebellar peduncle |
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Parvocellular Red Nucleus
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input from dentate nucleus
output to inferior olivary nucleus which --> cerebellum |
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Climbing fibers
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arise exclusively from neurons in the contralateral inferior olivary nucleus
strong modulatory effect on the response of Purkinje cells --> sustained decrease in their response to parallel fiber inputs |
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Cerebellar nuclei
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lateral to medial
Don't Eat Greasy Foods Dentate Emboliform Globose Fastigial **Emboliform and Globose = interposed nuclei |
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Restiform body
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a.k.a. inferior cerebellar peduncle
means "ropelike" body |
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nerves acting on thumb
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RUM
Radial: Abductor pollicis longus (abduction in plane of palm) Ulnar: Adductor pollicis (adduction) Median: Opponens pollicis (opposition); Flexor pollicis longus and superior head of flexor pollicis brevis (flexion) |
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brachium pontis
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a.k.a. middle cerebellar peduncle
named because of massive connections with pons mainly input to cerebellum |
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Von Hippel-Lindau
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AD inheritance
cavernous hemangiomas of brain or brainstem, renal angiomas, cysts in multiple organs associated with renal cell carcinoma |
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Sturge-Weber
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acquired disease
capillary angiomatoses in pia mater classically, facial vascular nevi (port wine stain) epilepsy and mental retardation usually present Treatment of the epilepsy is often mainstay of treatment |
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Tuberous sclerosis
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AD inheritance
Presents with cognitive impairment, epilepsy, skin lesions (facial angiofibromas, adenoma subaceum) |
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Muscle involvement in DMD
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progressive, symmetric, and starts in childhood
proximal muscles primarily affected (e.g. pelvic girdle) Eventually involves respiratory muscles |
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DMD: death by ____ decade
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third
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Rx that exacerbates Sx of myasthenia gravis
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ABx: aminoglycosides and tetracyclines
Beta-blockers Antiarrhythmics- quinidine, procainamide, and lidocaine |
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DDx of ring-enhancing brain lesion
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metastatic ca
brain abscess GBM lymphoma Toxo |
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Dx of GBS
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CSF: increased protein, nl. cell counts
NCS: decreased motor velocity |
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Tx of GBS
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monitor pulmonary function, may require mechanical ventillation
IVIG if significant weakness, if progression continues plasmaphoresis may decrease severity DO NOT GIVE STEROIDS |
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Guillain-Barre syndrome
-general characteristics |
acute inflammatory demyelinating polyneuropathy
primarily motor. distal --> proximal, usually symmetric usually preceded by viral or mycoplasmal infection of UR or GI tract (Campylobacter, CMV, hepatitis, HIV) May occur in Hodgkin's disease, lupus, post-surgery, or after HIV seroconversion |
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What chromosone is the gene for Huntington's disease on?
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4
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Loading dose of lorazepam (Ativan) in status epilepticus
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0.1 mg/kg
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Myopathy with asymmetric distal arm and proximal leg weakness
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virtually pathognomonic for inclusion body myositis
falls caused by "knees giving out" and difficulty walking down stairs |
