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146 Cards in this Set

  • Front
  • Back
CSF does NOT give nutritional support to the s.c. but does do what 4 things?
Provides mechanical support
Buffer venous pressure changes
Assist in Ionic regulation of CNS
Acts as lymphatics for the CNS
Memory + Learning =
Temporal Lobe
Speech + Language =
Frontal Lobe
Visual =
Parietal and Occipital Lobes
What are a few characteristics of a frontal lobe lesion?
Aphasia, Bladder incontinence and mood changes
What lobe involves disorders of the special senses?
Temporal lobe
-Because the primary auditory centers are in the temporal lobe
A dysfunction of the higher cortical region would manifest as?
Language deficits
What sign will present with a cortical disorder?
Agraphesthesia
Higher cortical dysfunction can cause what?
Agraphesthesia
Higher cortical dysfunction results in what 3 things?
-other than agraphesthesia
Complex sensory loss, Language deficit, and Astereognosis
What higher cortical system helps drive memory and learning and is located deep to the temporal lobe?
Limbic system
Where is broca's speech?
Frontal lobe
All of the following are related to an UMNL except?
Increased DTR, Spastic paralysis, Positive Babinski, Atrophy
Atrophy
Disturbances of motor activities such as hemiballismus and choreathatosis indicate a problem where?
Basal ganglia
Rombergs sign is a test for?
Cerebellum
Dysmetria, dysdiadochokinesia and incoordination result from a lesion where?
Cerebellum
If a person cannot stand without swaying, even with their eyes open, the problem is most likely where?

What about if the eyes are closed?
Cerebellum

Dorsal Column
Cerebellar disorders include all the following except: intention tremor, disdiadochokinesia, walking smoothly, dysmetria
Walking smoothly
Conjugate gaze is accomplished through multiple cranial nerves. What two portions of the brainstem are involved in integrating these activities?
Mesencephalon (midbrain) and Pons
If a patient presents with hyperreflexia, spastic paresis, and deviation of the tongue on protrusion, to the side opposite the hyper-reflexia, the lesion is likely located where?
Medulla
Which cranial nerve does not have its nucleus in the pons?
4, 5, 6, 7, 8
4
The trigeminal nerve nucleus responsible for motor activity is located where in the neuraxis?
Pons
The nuclei responsible for cardioregulatory functions are located where in the neuraxis?
Medulla
The nucleus of which CN is located outside of the CNS?
1 and 2
The nucleus of which CN is located in the midbrain and is motor only?
1, 2, 3, 4
4
CN V has nuclei located in?
Pons, medulla, cervical cord
Which CN is not located in the medulla?
7, 9, 10, 11
7
Which CN nucleus is located in the midbrain?
4, 5, 6, 7
4
A lesion that involves loss of pain and temp on the R of the body and dilation of the pupil with the L eye down and turned outward. There is also ptosis of the eyelid. Where is the lesion located?
L midbrain
What is the only CN nucleus that is in all three parts of the brain stem?
Trigeminal CN V
Expansion of the central canal of the s.c. will likely first disrupt with s.c. pathway?
Lateral spinothalamic
In traumatic lesions to the s.c., the area that suffers greatest injury is?
The central gray
At what point in the cord does UMN stop and become LMN?
Anterior Horn cells
Temp is mediated by?
Lateral spinothalamic tract
MM contraction is mediated by?
corticospinal tract
(pyramidal < decussate in medulla)
Dermatomal sensory loss, flaccid weakness and depressed reflexes indicate a lesion where?
Nerve root
Fasciculations are seen with lesions in which two?
Nerve root and peripheral nerve
All of these terms go with a nerve root lesion except?
Radiculopathy, Dermatome, Myotome, Myelopathy
Myelopathy
MS =
demyelinating of the PNS
Your pt complains of increasing weakness of muscles, especially of the jaws during a meal. The lesion is likely where?
Neuromuscular junction
What mm are most rapidly impacted by NMJ ds?
Intrinsic mm of the hands, mm of face, eyes and jaw, the erector spinae, suboccipital mm
MM of face, eyes, and jaw
NMJ lesions are characterized by which of the following?
-Proximal symmetric weakness that is better with exercise
-Distal symmetric weakness that is better w/ exercise
-Proximal symmetric weakness that is worse with exercise
-Distal symmetric weakness that is worse with exercise
Proximal symmetric weakness that is worse with exercise
Having a pt sustain an upward gaze is a good test for a lesion where?
NMJ
Which ds is assoc w/ a NMJ lesion?
MG
Which of of the following indicates a NMJ lesion?
-Gets worse w/ ex
-Decreased contractility of mm w/ prolonged active use
-No sensory changes
-All of the above
All of above
Which receptors show a marked reduction on the postsynaptic membrane?
ACH receptors
A marked reduction in the number of ACH receptors on the NMJ results in a dx of which NMJ ds?
MG
Which of the following are possible cause(s) of NMJ ds?
-Autoimmune
-Sensory loss
-Inherited
Autoimmune and inherited
Which of the following is NOT a possible cause of NMJ ds?
-Virus
-Sensory loss
-Genetic
-Autoimmune
Sensory loss
NM ds is caused by all of the following except:
-familial
-dairy
-chromosomal
-genetic
dairy
A pt walks into your office and complains to you about his quick fatigue after performing daily activities. In fact he feels like he has to take a nap right after he completes any activity. What possible ds might the pt be displaing?
NMJ ds
Your pt is complaining of his weight-lifting routine getting shorter and shorter. This "plate-head" figures he's just getting stronger and doesn't need to work-out long and hard. He tell's you he is also feeling very weak after his gym routine but after he rests, he feels like he can do it again. What is wrong with the "plate-head"?
Suffers from a NMJ ds
MG is?
Ds of unknown cause
A pt with MG would present w/ the following symptoms?
Weakness during continued activity, but strength returns after a period of rest
Which of the following includes a hereditary disorder that has an affinity for proximal mm w/o sensory changes?
Myopathy
What is a characteristic of a myopathic lesion?
Weaker mm
Which is a myopathic lesion?
-MS
-Alzheimer's
-Duchenne's
-Gordie Howe
Duchenne's
What is an important factor in myopathic lesions?
Family hx
Which is NOT a characteristic of myopathic lesion?
-Sensory changes
-Proximal symmetric weakness
-Normal to decreased tone
-Normal to decreased reflexes
Sensory changes
Which is not assoc w/ myopathic lesions?
-Asymmetric mm weakness
-Loss of sensation
-Intact cutaneous reflexes
Loss of sensation
Which is a myopathic lesion?
-MS
-MD
-Polio
-Parkinsons
MD (muscular dystrophy)
What relieves its blood supply from the anterior cerebral artery?
Corpus collosum
The anterior limb of the internal capsule receives its blood supply from which artery?
Anterior cerebral
The sensory homunculus for the fascial region receives its blood supply from what major artery?
MCA
Strokes frequently occur in the posterior limb of the internal capsule. What artery perfuses this region?
MCA
The CN nuclei responsible for lateral gaze for the R eye and R sided facial mm control receive their bloos supply from which major artery?
Basilar A
The aterior spinal artery is generated from branches off which of the following?
Vertebrobasilar artery
Which of the following are located in the posterior limb of the internal capsule?
Thalamic formation for somatosensory information, corticospinal tract, corticobulbar tract
Five steps in making a Dx
SHAFE
Syndrome
Hx and physical exam
Anatomic dx (localize lesion)
Functional dx
Etiological dx (whats occuring at perticular anatomy)
Location of CN I, II
Brain
CN located in Midbrain
Midbrain
CN III, IV, V
CN located in Pons
Pons
CN V, VI, VII, VIII
CN located in Medulla
Medulla
CN VIII, IV, X, XI, XII
CN located in C/S
CN V, VI
Cortex:
Sensory
Motor
Special
Sensory = complex loss, astereognosia, agraphesthesia, visual spatial disorder

Motor = Variable

Special = decreased language, decreased intellectual function
Cerebellum:
Blood supply
Sensory
Motor
Special
BS = VBA
Sen = incoordination and clumsiness
Mot = Intention tremor, dysmetria, dysdiodochokinesia
Spe = possible brain stem involvement
UMNL
-Hyperreflexia
-Spastic paralysis
-mm weakness
-Babinski
-Hypertonia
-Clasp knife response
LMNL
-CNS or PNS
-Hyporeflexia
-Atrophy
Nerve root/radicular lesion:
-Dermatomal sensory loss
-Usually asymmetric
-Myotomic hyporeflexia
-Atrophy
-Fasciculations/flaccid weakness
-Pain
NMJ:
-Autoimmune is inherited
-Sensory, no change
-Motor = proximal symmetric weakness (worsens w/ exercis, late in the day, normal tone and reflexes
Spe = effects mm of eyes, jaw, and face
Myopathic lesion
Sensory
Motor
Special
Sen: none
Mot: proximal symmetric weakness, no atrophy, no fasciculations, decreased tone and reflexes
Spe: family Hx
Lateral corticospinal (pyramidal):
-Info = motor signals from pre-central gyrus
-Decussation = caudal to medulla (columns to medial meniscus)
-Test = myotome strength
Dorsal columns
-info = 2 pt discrimination, light touch, vibration, proprioception
-decussation = medulla, dorsal column nuclei
Lat spinothalamic
-info = pain, temp, crude touch
-dec = ventral white commissure, 2 levels above
Cervical spondylosis occurs mostly at?
C4, C5, C6
If the pt has vascular compromise of the postero lateral spinal column (dorsal horn and dorsal columns) which modality is lost?
All sensory modalities
Posterolateral spinal arteries come from
VBA
The vermis of the cerebellum is essential for balance mechanisms and maintaining the upright posture. This structure receives its arterial blood supply from what vessel?
VBA
Carotid arteries deliver arterial blood to all aspects of the cerebral hemisphere except
???? Posterior 1/3 ?????
Not positive but I think
The cause of the weakness is best deteremined?
After the disorder has been localized
Damage to the anterior spinal artery will result in deficits in all but which of the following?
Vibration below level of lesion
Gain disorders with imbalance of station and no mm?
Cerebellum
W/ damage to the dorsal horn at C6 which sensation will likely be spared in that dermatome?
None
Organophosphate toxicity will cause which of the following?
Acute of subacute motor weakness
Three tests checking cerebellar fx
Heel to shin, finger to now, rombergs, gait
The pt presents complaining of some difficulty maintaining his balance. In addition u notice on this intake paperwork, the writing seems course ad unsteady. When he extends his hand to shake yours, you notice shaking that worsens as he reaches out towards you. What is the likely location of lesion?
What is this movement called
Which side will the pt fall to?
cerebellum

intention tremor

The side of lesion
Your pt presents w/ his spuse at your office. she tells u that for the last few days, the pt doesn't seem to understand what she says to him and his responses make no sense. She also tells you his speech seems to be slurred. The pt has a hx of coronary artery ds, vascular ds in the lower extremity and the L/S xrays u took 3 yrs ago demonstrate atherosclerotic chnages in the abdominal aorta. Assuming the pt has had a vascular event what artery is involved that will explain the problems the pt is experiencing?
MCA
Bony components of the spinal canal?
2 pedicles, 2 lamina, vb
bony components of the IVF
2 bodies, 2 pedicles, set of z joints
Symptoms of the VB insufficiency are referred to as the Ds and Ns. List 5 symptoms
Dizziness, Dysphasiz, Disarthria, Diploplia, Nausea, Nystagmus, Numbness, Ataxia
The pt has developed hoarseness in addition to weakness and hyperreflexia in the R upper and lower extremities. Also identified on exam is failure of palatal elevation on the L. Where is the likely level of lesion?
CN lesion plus long tract sign = brainstem; probably in the medulla
An extramedullary anterior cord lesion will that impacts the R lateral spinothalamic pathway will effect fibers from which extremity first?
L Lower extremity
5 peripheral nerves
-Median
-Radial
-Ulnar
-Femoral
-Peroneal
3 different demyelinating ds
MS
ALS
Guillan-barre syndrom
With increased intracranial pressure, what CN will be first affected?
As the pressure increases it begins to press down on the tentorium, which begins to press down on CN II
Which sensory exam diff with LMNL, peripheral neuron ds?
LMN = dermatomal/myotomal pattern
Peripheral = territorial, usually distal
Causes of myopathic disorders?
Typically hereditary
Causes of NMJ disorders?
destruction of Ach receptors on post synaptic membrane, auto-immune Dx, anti-cholinergic drugs
-exasterbated through prolonged activity or exercise
3 functions of CSF?
1) shock absorption/mechanical support
2) electrolyte buffer/ venous pressure buffer
3) CNS lymph system/ ionic regulation of CNS
Anterior cerebral artery supplies?
cortically the anterior 3/4 of the frontal lobe including the medial orbital fissure, frontal lobe, 4/5 of the corpus callosum and the aterior limbe of the internal capsule
MCA supplies?
Cortical branches = cortex and white matter of lat/inf frontal lobe, cortex and white matter of parietal lobe, superior temporal lob es and insula, face and upper extremity
Deep penetrating branches = putamen, part of head and body of caudate nucleus, posterior limb of the internal capsule, corona radiata
PCA supplies?
Interpeduncular branches = cortex and white matter of the lat/inf frontal lobe, cortex and white matter of the parietal lobe, superior temporal lobes and insula. Face and upper extremity
Cerebral emboli
80% released from carotid bifurcation
20% are from the heart
Battle Sign
Basilar fracture of the skull extending posteriorly damaging the sigmoid sinus, tissue behind the ear and over the mastoid process becomes boggy and discolored
Clinical effects of concussion
Immediate LOC
Suppression of reflexes
Transient arrest of respiration
Brief bradycardia
Fall in BP
4 complaints with post concussion syndrome
1) headaches = central symptom, general or localized
2) dizziness = not true vertigo, dizzy or light headed
3) intolerance = to noise, crowds, emotional excitement
4) restlessness = inability to concentrate, very tense
Lhermite's sign = ?
Reports electric shock/like sensations down the spine upon neck flexion caused by cervical spndylogenic ds, intermedullary lesions
PAG 3 in cerebrovascular accident
1) thrombus
2) embolus
3) hemorrhagic
2 processes cause arenchymal change with stroke
1) ischemia
2) hemorrhage
Risk factors for stroke?
-HTN
-Smoking
-Increased age
-HRT ds
-Diet
-Obesity
-Sedentary life style
-Anemia
-Dehydration
-Diabetic
3 types of generalized seizures
Convulsing = tonic, clonic, or tonic-clonic (grand mal)
Non-Convulsive = Absense (petit-mal)
Juvenile = Myoclonic and epilepsy, infantile spasm, atonic
Characteristics of tonic-clonic
-Pt often senses the approach
-Half of cases have some type of MVT before LOC w/ no memory of it
-Half ar out of the blue
-Initial flexion of trunk, opening mouth and eyelids, upward deviation of the eyes, arms elevated/abducted, hands pronated
Characteristics of absence seizures
-Brief/sudden interruption of consciousness
-90% have a burst of fine clonic MVT of facial mm, eyelids, or fingers at rate of 3/5
-Pt do not fall
-Briefly stop talking and fail to respond
-High frequency in adolescent females
Partial seizures
1. simple (w/o LOC or psychic change)
2. complex (w/ impared consciousness)
-benign as simple partial progressing to LOC
-impairment of consciousness upon onset
Common partial seizure pattern
Seizure is a product of demonstrable facial lesion or EEG abnormality in cerebral cortex or diencephalons
-Simple = partial sensory-motor cortex, simple partial-frontal lobe
Pain sensitive cranial structures
1) skin, subcutaneous tissue, mm, skull periosteum
2) eye, ear, nasal cavity, paranasal sinus
3) intracranial venus sinus, paricavernous structures
4) dura at base of brain, arteries w/in dura, pia, and arachnoid, anterior and mca and internal carotid
Early signs and symptoms of MS
-Unilateral
-Weakness
-Incoordination
-Paresthesia
-Positive LHermitte's sign
-B/L babinski
-Cerebellar ataxia
-Optic neuritis
Areas of CNS primarily affected by MS
-Optic nerve, brain
-Brain: scattered patches below surface
-Optic nere and chiasm (rarely optic tract)
-S.C. where pia veins are next to or w/in white matter
ALS vs. MS
ALS = mm wasting, fasciculation, sensory involvement, males over 50

MS = Pyramidal weakness, optic neuritis, sensory loss, brainstem dysfunction
Common parkinson
-1 million pt in america
-1% of pop over 65
-familial tendency 5%
-asians 1/2 - 1/3
-blacks 1/4
Clinical features of parkinsons
-tremor (resting)
-rigidity
-akinesia
-postural reflexes
-66% gone before signs and symptoms appear
-expressionless face
-stooped posture
Pathological changes in partkinsons
-loss of pigmented cells in substantia nigra
-decreases melanin in cells
-increased eosinophilic granules - lewy bodies
-neuronal loss in mesencephalic formation
-slight neuronal loss, lewy bodies in sympathetic ganglia
S and S of Guillan-Barre
-mild respiratory of GI infection preceeding s and s
-paresthesia and slight numbness in fingers and toes
-symmetrical weakness
-proximal and distal extremities involved (usually lower extremities first)
Diff dx problems w/ GBS-
-distinguish GBS from acute spinal cord ds marked by sensorimotor paralysis
-acute lesion of cord where DTR in intially lost
-early transient urinary retention
-cervical myelopathy
Duschenne muscular dystrophy features: progressive mm weakness and
-affects only boys, skeletal mm are destroyed by dystrophin protein
-age 3-6
-can later affect hrt and lungs
-Belker type MD features: inherited mm wasting Ds
-begins in 2nd or 3rd decade of life
-males
-mm of hips and shoulders are weakened
Posterior limb of the Internal Capsule
-Thalamic radiation
-Corticospinal tract
-Corticobulbar tract
Basal ganglia has what
-Corpus striatum: caudate and putamen
-substantia niagra
-globus pallidus
Consensual reflex is performed by what and where?
Performed by Edinger Westphal nucleus
In the midbrain
Anterior limb of the Internal Capsule
Genu: corticobulbar pathway
Posterior limb: corticospinal pathway
Caudate
Extrapyramidal activity
Movement of involuntary nature:
Basal ganglia
Putamen and globus pallidus form what?
the lentiform nucleus
Lateral ventricles produes?
CSF
CSF flow is based on respiratory rate. What happens when u breath in it ?
Decreases the pressure
Obstruction of CSF flow b/w cranial vault and cord = ?
Hydrocephalus
What is the communication b/w the 2 hemispheres?
Corpus Callosum