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205 Cards in this Set
- Front
- Back
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ACA lesion will lead to? (typically)
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contralateral leg and foot paralysis/paresis and paresthesia/anesthesia
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MCA lesion will lead to? (typically)
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contralateral hand, arm, and face paralysis/paresis and paresthesia/anesthesia
Language maybe (broca's and Wernicke's area) Vision maybe |
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PCA lesion will lead to? (typically)
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Contralateral visual disturbance
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Basilar artery lesion will lead to? (generally)
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Locked in syndrome
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Vertebral artery and PICA lesion will lead to? (generally)
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lateral medullary syndrome
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ASA lesion will lead to? (generally)
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medial medullary syndrome
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Lenticulostriate artery is a branch of what artery?
What does it supply? Infarct of this artery will lead to? |
MCA
supply portions of the internal capsule Can result in ambulatory spastic hemiparesis with hemihypoesthesia (contralateral) |
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What is a lacunar infarct?
Where does it commonly occur? |
small vessel disease
commonly occurs in the branches of MCA, such as lenticulostriate arteyr |
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How is the internal capsule somatotopically organized (when viewed horizontally)?
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"HAL" (head, arm, leg) in the posterior limb of IC.
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You see hyperintense thalamus and BG on the MRI. What disease do you suspect?
This disease is caused by? |
CJD - Creutzfeldt-Jakob disease
Cuased by prions |
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Name 3 dural septa. Where are they?
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Falx cerebri- fold that lines the longitudinal fissure
Falx cerebelli- runs along the vermis of the cerebellum Tentorium cerebelli- horizontal dural fold extends into the transverse fissure |
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What is VPL?
VPL damage results in what type of deficits? |
Interrupts somatosensory pathway and may lead to loss of conscious sensation of contralateral side of the body
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What type of stroke is more common: ischemic or hemorrhagic?
Name 2 types of ischemic and 2 types of hemorrahgic strokes. |
Ischemic is more common (80%)
Ischemic: thromobotic and embolic Hemorrhagic: intracerebral and subarachnoid |
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A patient has paraysis and sensory impairment of contralateral leg and foot. Which artery is most likely damaged?
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ACA
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Which cerebral hemisphere is usually considered dominant?
What 2 important areas can be found here? |
Left
Broca's and Wernicke's area |
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A patient has the following symptoms:
1. pareisis or paralysis of right face, hand and arm. 2. sensory deficits involving the same region. Which artery is damaged? |
Left MCA
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The Broca's area is damaged. Which artery is damaged? (be specfic)
What is the function of the Broca's area. |
Left MCA (superior division)
expressive aphasia; related to speech production |
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The Wernicke's area is damaged. Which artery is damaged? (be specfic)
What is the function of the Wernicke's area. |
Left MCA (inferior division)
receptive aphasia; related to interpretation of speech |
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Where is the Broca's area? fxn?
Where is the Wernicke's area? fxn? |
Broca's area - lower precentral gyrus area; involved in expressive speech
Wernicke's area - upper, posterior temporal area; involved in receptive speech |
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Define the following terms:
Dysarthria verbal paraphrasia phonemic paraphrasia jargon aphasia |
Dysarthria - difficulty in speech articulation; slurred words; occurs when the Broca's area is affected
The following will occur when the Wernicke's area is affected: Verbal paraphrasia :use allied meaning words: instead of 'use a knife', 'use a fork‘ Phonemic paraphrasia : use of made-up but similar-sounding syllables: instead of 'knife and fork', 'bife and dork‘ jargon aphasia : unintelligible garbling |
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What is the posterior association (parietal portion) of the dominant (left) hemisphere involved in?
What disease occurs when there is lesion here? (name of the syndrome) Explain this syndrome. Which artery supply this region? |
involved in writing, reading, calculating, synthesizing, correlating, and recognizing different fingers.
Gerstmann's syndrome 1. finger agnosia (inability to recognize different fingers) 2. agraphia (inability to write) 3. alexia (inability to read) 4. agnosia (inability to synthesize, correlate or recognize multisensory perceptions) 5. dyscalculia (decreased ability to calculate or use numbers) 6. left-right confusion Left MCA |
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What is anosognosia?
What part of the cerebrum is involved anosognosia? What other symptoms are possible with a lesion in this region? which artery is supplying this region? |
Anosognosia - denial (lack of awareness) that there is antyhing wrong
Posterior association area (parietal portion) of the nondominant hemisphere (right) hemineglect, contralateral neglect, extinction constructional apraxia (disturbances in drawing) disturbances in the awareness of the body image Right MCA |
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What 3 regions, involved in potential visual system, are supplied by the MCA?
Functions of each region? |
Frontal eye field (FEF) in the frontal lobe - conjugate eye movement to the contralateral side (saccades or fast eye movement)
Meyer's loop (optic radiation within the temporal lobes) - lesion can cause superior quadrantanopia Optic radiation within the parietal and temporal lobes - lesion can cause homonymous hemianopia (slide 42) |
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A patient right homonymous hemianopia. What artery is mostly likely damaged? what side?
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Left PCA
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Name the region(s) of the brainstem supplied by the following arteries: Also what CN nuclei or tract is within the region?
ASA PICA or vertebral Basilar PCA |
ASA - medial medulla; CST, DCML, hypoglossal nuclei
PICA or vertebral - lateral medulla; STT, CN IX & X nuclei, sympathetic fibers, CN VIII nuclei Basilar - pons; CN V, VI, VII, and VIII nuclei PCA - midbrain; CST and CN III |
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What CN nuclei are in the medulla?
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CN IX, X, XII, and VIII
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Which artery is occluded in the medial medullary syndrome?
Name all the regions affected and the outcome. |
Anterior spinal artery
Hypoglossal nuclei - paralysis and eventual atrophy of tongue ipsilaterally CST - paralysis of contralateral arm and leg medial lemniscus - loss of tactile sense and proprioception from contralateral arm and legs |
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Which artery is occluded in the lateral medullary syndrome?
What is the another name of LMS? Which regions and structures are affected? (5) |
PICA or vertebral arteries
AKA Wallenburg syndrome Spinal trigeminal tract (CN V) STT Descending sympathetic fibers Nucleus ambiguus (CN IX and X) Vestibular nuclei (CN VIII) |
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What CN nuclei are in the pons? (4)
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CN V, VI, VII, and VIII
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The anterior portion of the pons contain what type of fibers? (3)
What syndrome occurs when the ventral pons is affected? causes? |
Corticospinal
Corticobulbar Abducens Locked-in syndrome caused by bilateral ventral pontine infarcts, hemorrhage, tumor, encephalitis, MS, and central pontine myelinolysis |
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What tracts and fibers are spared in the Locked-in syndrome? why?
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medial lemniscus
spinothalamic spinal trigeminal facial motor Because only the ventral pons is affected |
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What is central pontine myelinolysis?
Which populations are associated with this? What syndrome is associated with this? |
Noninflammatory, demyelinating condition associated with rapid correction of hyponatremia (rapid fluctuations in electrolyte status).
Alcoholics, malnourished persons, and transplant patients Locked-in syndrome |
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What regions are affected with occluded branches of basilar arteries? (6)
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1. facial motor nucleus or nerve
2. abducens nerve 3. medial lemniscus 4. STT 5. main trigeminal nucleus (fine touch and vibration) 6. descending spinal trigeminal tract (pain and temp) |
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There is a tumor at the cerebellopontine angle. What do you suspect?
what regions are affected? |
Vestbiular Schwannoma or acoustic neuroma
CN VII and VIII |
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What CN nuclei are in the midbrain?
How do the nerves exit |
CN III - exit anteriorly, medial to the cerebral peduncle
CN IV - exit posteriorly |
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What is Weber syndrome?
occluded artery? symptoms? |
Occusion of branches of PCA
Lesion sites 1. CST - UMN 2. Oculomotor nerve - paralysis of ipsilateral eye with ptosis, mydriasis, lateral strabismus |
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What are the symptoms of oculomotor nerve lesion?
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Paralysis of ipsilateral eye with ptosis, mydriasis (pupil dilation), lateral strabismus –eye rolls down and out
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A patient has the following symptoms:
1. loss of vertical gaze, eyes deviate downward 2. Nystagmous on eye convergence 3. loss pupillary light response, possibly with accomodaiton intact Where is the affected region? what are possible causes? |
Compression of posterior midbrain.
Caused by pineal tumor or tectal infarct |
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Describe the cardinal features of the following hematoma:
Epidural, subdural, and SAH |
Epidural - lens shaped; tearing of middle meningeal artery
subdural - crescent-shaped; tearing of bridging veins SAH - blood in the CSF; "worst headache of my life"; star-shaped |
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what is the function of the bridging veins?
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drain brain venous blood to the dural venous sinuses
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What is the Monro-Kellie doctrine?
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The contents -blood, brain, and CSF are confined with in the skull:
As the volume of one component increases the volumes of the others compensate to maintain ICP (0-15 mm Hg) and to prevent neurological changes |
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What compensations are made with an increase in intracranial mass? (3)
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1. CSF is displaced into the spinal canal
2. Blood volume is reduced in the brain 3. Displacement of brain tissue = herniation |
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How do you calculate ICP? (i.e. tell me the only equation you need to know in neuro.)
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CPP = MAP - ICP
CPP Cerebral Perfusion Pressure = 80-100 mm Hg MAP (mean arterial Pressure) = 50 – 150 mm Hg; MAP = systolic + (2x Diastolic)/ 3 ICP (intracranial Pressure) = 0-15 mm Hg |
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What does blurred disc margins tell you when looking through the fundoscope?
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Indicates increased ICP, which causes papilledema.
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What is an optic disc? fovea?
Which one is the blind spot? |
Optic disc - where the arteries and veins emerge; the blind spot
Fovea - a region with many cone cells; for acute visoin |
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Do you do lumbar punture when you detect papilledema?
why or why not? |
NO!!!
Papilledema indicates increased ICP. Lumbar puncture will herniate brain. Relieve pressure with burr hole |
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What are two major classes of herniation?
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Supratentorial - above tentorial notch
Infratentorial - below the tentorial notch |
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Describe the circulation of CSF.
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produced by the choroid plexus in all ventricles --> 4th ventricle --> lateral (foramina of Luschka) and medial (foramina of megendie) --> subarachnoid space --> arachnoid villi --> dural sinuses
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What is normal opening pressure when doing lumbar puncture?
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6-13 mmHg
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Where do you do lumbar puncture?
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in the subarachnoid space b/t vertebrae L3 and L4
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Describe the features of a normal spinal tap. (appearance, opening pressure, RBCs, WBCs, proteins, glucose, culture)
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clear CSF
opening pressure - 6-13 mmHg No RBC few lymphocytes but no PMNs <50 mg/dL protein 50-75 mg/dL glucose negative culture |
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Describe the features of a traumatic spinal tap. (appearance, opening pressure, RBCs, WBCs, proteins, glucose, culture)
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bloody appearance
normal pressure WBCs accompanying RBCs increased protein content normal glucose negative culture |
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Describe the features of a spinal tap in a patient with subarachnoid hemorrhage. (appearance, opening pressure, RBCs, WBCs, proteins, glucose, culture)
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bloody; yellowish (xanthochromic) supernatant when spun down due to lysed RBCs
increased pressure normal WBCs increased protein content normal glucose negative culture |
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Describe the features of a spinal tap with bacterial meningitis. (appearance, opening pressure, RBCs, WBCs, proteins, glucose, culture)
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cloudy, purulent appearance
increased pressure no RBCs increased PMNs increased protein decreased glucose positive culture |
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Describe the features of a spinal tap with viral meningitis. (appearance, opening pressure, RBCs, WBCs, proteins, glucose, culture)
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clear
increased pressure normal to increased WBCs normal to increased protein normal glucose negative culture |
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Describe the features of a spinal tap with TB meningitis. (appearance, opening pressure, RBCs, WBCs, proteins, glucose, culture)
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clear to cloudy appearance
increased pressure no RBC normal to increased WBC increased protein decreased glucose positive culture |
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Functions of Schwann cells and satellite cells?
How are these two cells similar |
Satellite cells- support neurons
Schwall cells - secrete neutrophic factors and make myelin Both in PNS |
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What are the function of astrocytes? (4)
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1. support CNS help for Blood brain barrier
2. secrete neutrophic factors 3. take up K+ and NTs 4. Remove EAATs (excitatory amino acids; glutamate) |
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Describe the pathway of the corticospinal tract (lateral).
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Neuron 1 - pyramidal cell in layer V of cortex --> internal capsule --> cerebral peduncle --> anterior pons --> cross at the lower medulla --> lateral funiculus --> synapse at the anterior horn
neuron 2 - anterior horn --> target muscle (nicotinic receptor) |
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What is the function of anterior corticospinal tract? where does it cross?
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fxn - innervates the trunk muscles
crosses at the gray commissure of the appropriate spinal cord level |
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Which cortical layer contains the pyramidal cells of CST?
What does Layer IV contain? |
Layer V - major output layer; pyramidal cells
Layer IV - major input layer |
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What is the function of CN XII?
Where is the nuclei? |
Innervates voluntary muscles of the tongue (except of palatoglossus; stupid DHN)
Medial/posteior region of the medulla (in the medial medullary region) |
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What neuron is damaged when the tongue is deviated contralaterally? ipsilaterally?
The tongue is deviated toward the weak side or strong side? |
Contralateral - Upper MN
Ipsilateral - Lower MN Weak side |
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Where are the cell bodies of lower motor neurons?
What type of axonal fibers do they have? |
Brain stem (Cranial nerve nuclei)
anterior horn of spinal cord Large,fast myelinated axons - type A, subtype alpha |
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What is a motor unit?
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one LMN in the CNS, its axons, and all of the muscles it innervates
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What is fasciculation? what causes it?
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Fasciculation - whole motor unit twitch
Occurs when LMN cell body dies as it might fire spontaneously |
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What does muscle spindle detect?
What does golgi tendon organ detect? |
Muscle spindle detects muscle stretch.
GTO detects muscle tension |
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Describe monosynpatic reflex (DTR).
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Input - muscle spindle via the Ia or II fibers --> synpase on the LMNs in the anterior horn
Output 1 - LMN to extrafusal (skeletal muscle); alpha fibers Output 2 - gamma fibers to intrafusal fibers |
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What is the function of intrafusal fibers?
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Intrafusal fibers are muscle fibers surrounded by sensory muscle spindle fibers.
They modulate the sensitivity of muscle spindle fibers. Intrafusal fibers are innervated by the gamma motor neurons |
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What is inverse myotatic reflex?
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Multisynaptic reflex that detects muscle contraction through golgi tendon organ and counters with muscle relaxation.
This occurs in the antagonistic muscle. e.g. if DTR is occuring in the biceps, triceps are relaxed. |
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Describe one feature that occurs with ACUTE UMN damage.
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flaccid paralysis
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describe 5 CHRONIC findings of UMN damage.
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1. hyperreflexia
2. clonus - rapid alteranating contraction/relaxation of a stretched muscle 3. clasp knife rigidity - describes resistance to passive movement of a joint when spasticity is present 4. spasticity - excessive muscle tone 5. Babinski's sign |
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Describe 5 findings of LMN damage.
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1. decreased muscle strength
2. decreased muscle tone 3. hyporeflexia 4. severe neurogenic atrophy 5. fasciulations and fibrillations |
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What 2 things are common b/t acute UMN lesion and LMN lesion?
How do you differentiate b/t the two? |
Similarities:
1. flaccidity 2. hyporeflexia/areflexia Acute UMN lesion shows Babinski reflex |
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What is the Babinski's sign?
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When the sole of the foot is rubbed, toes fan out.
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What is (are) degenerated in amyotrophic lateral sclerosis (ALS)?
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corticospinal tracts and alpha motor neurons (both UMN and LMN)
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A patient has symmetic gait disturbanace, limb wekaness, reflexes increased or depressed, dysarthria, and dysphagia with respiratory complications. What neuropathy does he have?
Explain the disease. |
ALS (amyotrophic lateral sclerosis)
Degeneration of CST and alpha motor neurons (UMN and LMN) |
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What nerves are affected in polyradiculoneuropathy?
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nerve roots
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What are clinical presentations of AIDP (4)? Cause? Another name?
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ADIP (acute inflammatory demyelinating polyradiculoneuropathy; or Landry-Guillain-Barre syndrome)
Causes - 40% viral prodrome; days to weeks after URI or GI infection Clinical presentations (acute): 1. Symmetrical glove/stocking paresthesia followed by leg weakness (several days)- and spreads up- ascending paralysis 2. Pain –bilateral sciatica, or aching pain in thigh muscles and back (“Charley horse”) Difficulty walking bilateral foot drop & unsteady waddling, 3. DTRs absent or reduced 4. Severe cases – respiratory distress |
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A patient presents with symmetrical glove/stocking paresthesia followed by leg weakenss and spreads up (ascending paralysis). He has difficulty walking and DTRs are absent or reduced. What neuropathy does he have?
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AIDP or Guillain-Barre syndrome
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A patient presents with following symptoms:
1. high plantar arches with hammer toes 2. atrophy of foot muscles 3. Weakness/wasting in lower leg and foot (inverted wine leg) What neuropathy does she have? |
Charcot-Marie-Tooth disease (hereditary)
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What leads to diabetic neuropathy?
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Microvascular damage
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What is a warm up phenomenon? What disorder has it?
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Larger response with repeated stimulation
Presynaptic disorders; e.g. LEMS (Lambert-Eaton Myasthenic Syndrome) |
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What disorder is charcterized by fatigueability?
What is fatigueability in terms of neuropathy? |
Smaller response with repeated stimulation
Postsynaptic disorders; e.g. Myasthenia Gravis |
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What is the cause of LEMS? MG?
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LEMS - autoimmune disorder; antibodies against VCCC
MG - autoimmune disorder; Antibodies against nicotinic Ach receptors |
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How do you test for MG in a clinical setting?
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Ask Patient to look up
Rapid fatiguing of muscles seen in drooping of eyelids (ptosis) |
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What CN nuclei are associated with the midbrain? pons? medulla?
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Midbrain - CN III and IV
Pons - CN V, VI, VII, VIII Medulla - CN VIII, IX, X, XII |
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CN nuclei associated with motor tend to medial or lateral aspect of the brainstem?
How about sensory? |
Medial to lateral: somatic motor-branchial motor-autonomic-visceral senses-special senses
Slide 111 |
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Which CN(s) are the following nuclei associated? fxn?
1. Superior salivatory 2. inferior salivatory 3. Nucleus ambiguus 4. Nucleus of solitary tract 5. Edinger-Westphal |
1. Superior salivatory - CN VII; sublingual, submandibular and lacrimal glands
2. inferior salivatory - CN IX; parotid gland 3. Nucleus ambiguus - CN IX and X; muscles of speech and swallowing 4. Nucleus of solitary tract - CN VII, IX, and X; taste 5. Edinger-Westphal - CN III; parasympathetic CN III |
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Name 4 nuclei associated with CN V in the brainstem. What are their fxns?
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1. Mesecephalic - proprioception
2. Principal (main, pontine) trigeminal - fine touch, pressure, and vibration 3. Spinal trigeminal - pain and temperature 4. motor or masticator - muscles of mastication |
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Which CNs are involved in the following reflex tests? which one is sensory? motor?
1. Corneal reflex test or blink 2. Gag reflex 3. Light reflex 4. Oculovestibular |
1. Corneal reflex test or blink:
CN V - sensory; CN VII - motor 2. Gag reflex CN IX - sensory; CN X - motor 3. Light reflex CN II - sensory; CN III (parasym) - motor 4. Oculovestibular CN VIII - sensory; CN III and VI |
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Which extraocular muscles are innervated by CN IV? CN III? CN VI?
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CN III - Superior, inferior, and medial recti muscles and levator palpebrae superioris
CN IV - superior oblique CN VI - lateral rectus |
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What are the consequences of CN III lesion?
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Eye position: down and out; strabismus and diplopia
Ptosis - droopy eye lid Mydriasis - pupil dilation |
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What are the consequences of CN VI lesion?
Why is it susceptible to damage, especially due to increased ICP |
Eye rolls in
Cannot look laterally beyond midline Has a very long run and is not very thick |
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How are the signs from oculomotor nerve compression (due to temporal lobe herniation) different from vascular lesion to the nerve?
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Compression - a dilated and unresponsive pupil
Vascular lesion - frequently affect eye movement with pupil sparing |
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What is MLF involved in? What 2 CN nuclei are involved in it?
What happens if right MLF is damaged? |
MLF is involved in conjugate eye movements.
CN III and VI Cannot adduct the right eye when attempting a lateral gaze to the left. I.e. Selective weakness of the ipsilateral medial rectus. |
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What is PPRF? fxn? where is it?
What happens if there is a lesion in PPRF? |
PPRF - paramedian pontine reticular formation; timing saccades
Located lateral to the abducens nucleus in the pons Damage to PPRF causes selective loss of rapid eye movements to ipsilateral side. |
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What happens during conjugate eye movement when the abducens nucleus is damaged?
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Loss of LR ABduction ipsilaterally and loss of contralateral eye ADduction
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What is INO?
What neuropathy is associated with it? |
INO = internuclear opthamoplegia; an injury to MLF
MS |
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What is physiological nystagmus?
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smooth pursuit in one direction and saccadic movement in other direction.
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What are clinical symptoms of trochlear nerve lesion?
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difficult to look down and in
likely vertical diplopia (double vision) tilt head to good side (eye) to 'fix' diplopia |
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Describe the circuitry for voluntary saccades to LEFT.
Which hemisphere control the saccade to the left? |
Projection from the Right frontal eye field (FEF) --> synapse at Right superior colliculus AND LEFT PPRF --> from Left PPRF to left abducens nuclei
Right FEF controls the saccade to the left. See side 125 |
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Is the control for pursuit (smooth) movements ipsilateral or contralateral?
Which cortices are involved? (3) |
Ipsilateral
Frontal eye field, visual association cortex (parietal lobe), and cerebellum (flocculus) |
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The damage to right FEF will result in which sided gaze preference?
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Possible right gaze preference due to unopposed left frontal fields activity
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What 2 reflexes are involved in gaze stabilization? Explain them.
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Optokinetic reflexes - keep the fovea on target during slow, sustained movements of head or target; use visual feedback
Vestibulo-ocular reflexes - keep the fovea on target during rapid and jerky head movments; NO time for visual feedback; uses vestibular inputs |
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What are the functions of each movement? Which region of the cerebrum and/or brainstem are associated with each?
1. saccadic rapid eye movments 2. smooth pursuit movements 3. vestibulo-ocular movements 4. vergence movements |
1. saccadic rapid eye movments - to bring new objects onto fovea
associated with FEF and PPRF 2. smooth pursuit movements - to keep a moving image centered on the fovea associated with parietal-occipital gaze center via cerebellar and vestibular pathways 3. vestibulo-ocular movements - keeps image steady on fovea during head movement associated with vestibular system; NO FEEDBACK! 4. vergence movements - to keep image in focus when moving near associated with oculomotor |
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Explain the blink reflex circuitry
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Sensory via V1 (nasociliary branch)
Motor via VII to orbicularis oculi; both eyes should blink with the stimulus |
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What are clinical symptoms of V lesion?
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1. hypo- or anesthesia one side of the face
2. disappearance of the corneal reflex 3. impaired mastication (mouth becomes oval) |
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What is Bell's Palsy? (which CN is affected?)
Cause? |
A facial nerve paralysis
Caused by herpes simplex I virus |
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What is the difference b/t UMN lesion and LMN lesion of the facial nerve?
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UMNL - contralateral effect on LOWER QUANDRANT only; this is b/c upper quadrant receives input from both hemispheres, where as lower quadrant receives only contralateral input
LMNL - ipsilateral effects on both upper and lower quadrants of the face |
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What 2 nerves are involved in the gag reflex? which one is motor? sensory?
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CN IX - sensory
CN X - motor |
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Describe the pathway of the first sensory neuron in DCML tract.
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Nucleus in the DRG (dorsal root ganglion)
Axons ascend in posterior funinculus Leg - fasciculus gracilis hand - fasciulus cuneatus |
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Describe the pathway of the second neuron in DCML tract.
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Cell bodies in
Leg - nucleus gracilis of caudal medulla arm - nucleus cuneatus lateral of caudal medulla axons cross midline as internal arcuate (lower medulla) Synpase the VPL of thalamus |
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Describe the pathway of the third neuron in DCML tract.
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Cell bodies in the VPL of thalamus
Axons join internal capsule to project to primary (and secondary) somatosensory cortex. |
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What type of sensations are detected by DCML tract?
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Vibration, proprioception, and fine touch.
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How do we test proprioception?
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Move big toe up and down (both on sides of toe)
The Romberg test |
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What causes a positive Romberg test? (2)
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problem with DCML or a problem with afferent sensory information
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Describe the STT. (be specific.... very very specific)
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1˚ afferents (ascend or descend for 2-3 segments ) synapse on second order neurons (PTN)
Cross the midline in anterior white commissure of spinal cord PTN axons ascend in the anterior portion of the lateral funiculus as the anterolateral system STT transmits information from the spinal cord to the VPL of the thalamus to Somatosensory cortex |
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What functions would be lost when MS strikes the brainstem causing demyelination of posteiror columns.
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Impaired tactile sense
Loss of proprioception Multiple lesions in space and time INO |
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What 2 disease can cause posterior column damage? (one is autoimmune and the other one is infection)
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MS
Syphilis (Tabes dorsalis) |
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Right half of the C5 spinal cord is damaged. How would this affect the eye?
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Damage to the cervical spinal cord causes loss of control of ipsilateral sympathetic preganglionics
Resulting in a partial Horner syndrome- Miosis and ptosis affecting the right eye |
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What is Horner syndrome? Ipsilateral or contralateral?
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Ipsilateral to lesion
Symptoms: 1. loss of sweating 2. Pupil constriction (miosis) 3. lid droop (ptosis) |
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What 5 things can cause damage to the sympathetic out-flow to face?
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1. Hypothalamus
2. Brainstem (Lat Med Syn) 3. Cervical spinal cord- interrupts descending control or affects sympathetic preganglionic cell bodies 4. Ascending Symp. Trunk (apical lung tumor) 5. Postganglionic symp. Fiber damage (Carotid artery aneurysm) |
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What is syringomyelia? what tract is most likely to be damaged?
Symptoms?? |
Syringomyelia - a central cavity in the spinal cord.
STT - anterior white commissure hit symptoms (cape-like) 1. analgesia and thermanesthesia in both hands (segmented and bilateral) 2. fasciculations in both arms (LMN) |
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What deep nuclei are part of the lentiform nucleus? corpus striatum?
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Lentiform nucleus: Putamen and Globus pallidus
Corpus Striatum: Caudate nucleus and Lentiform nucleus |
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What nuclei are included in the basal ganglia? fxn?
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Basal ganglia include:
1. caudate 2. putamen 3. globus pallidus 4. substantia nigra 5. thalamus fxn: selection and initiation of willed movements, and suppression of unwanted movements |
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Differentiate b/t the direct and indirect pathways of basal ganglia control movement.
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The Direct Path releases thalamic activity
This results in increased thalamic activity and increased motor output (Because caudate & putamen inhibit SNr/Gpi) The Indirect Path inhibits thalamic activity This results in decreased thalamic activity, and decreased motor output (Because of increased BG output (SNr/GPi) |
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What is the cause of Parkinson's disease?
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Loss of Dopaminergic neruons in substantia Nigra
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What are the symptoms of Parkinson's?
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"TRAP D"
Tremor (resting) Rigidity Akinesia (hypokinesia, bradykinesia) Posteral instability (flexed posture- Festinating gate) Dementia Cogwheel rigidity (Charles Barkely's golf swing!!!) |
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Symptoms of Huntingtons disease?
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dementia - caused by primarily by the degenration of neurons in the cerebral cortex
chorea - caused by degenration in the basal ganglia |
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What causes hemiballismus? Symptoms?
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Caused by subthalamic nucleus hit
contralateral unintentional, forceful flinging movements of the right arm and leg (or rotatory in nature) |
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What is dystonia? examples?
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persistence of postural abnormality, a sustained posture or position of any part of the body.
e.g. cervical dystonia and Blepharospasm |
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What is Wilson's disease?
What is the hallmark? Does it affect movment? if so, how? |
Disorder of copper metabolism affecting brain and liver
Hallmark - Kayser-Fleischer ring (copper-colored ring around cornea) yes: dystonia, tremor, chorea, rigidity, and other BG-related signs It's treatable!! |
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What is the function of cerebellum?
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coordination of movement:
1. proper execution of planned motor arc 2. establishes, direction, timing, force of planned motor acts 3. compares intended movements with ongoing movment 4. involved in motor learning |
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What are some symptoms of cerebellar dysfunction? (5)
Ipsilateral or contralateral? |
1. Intention Tremor -during planned motor activity
2. Hypotonia- loss resistance 3. Disequilibrium- loss balance, gate and trunk (dystaxia) 4. Dyssynergia- loss coordination, dysmetria, 5. ataxia - uncoordinated voluntary movement |
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Alcoholic cerebellar degeneration affects what part of the cerebellum?
symptoms? |
Superior vermis
gait ataxia without limb ataxia probably a problem relating to malnutrition |
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What neurotransmitter is used in the following pathways? Is it involved in Sleep-inducing or arousal?
1. Serotonergic pathway 2. Norepinephrine pathway 3. Dopaminer pathway |
1. Serotonergic pathway: raphe nuclei; promote sleep
2. Norepinephrine pathway: Locus cerulues and lateral tegmental area; arousal 3. Dopaminer pathway: substantia nigra pars compacta (SNc) and the ventral tegmental area (VTA); arousal |
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What does EEG measure?
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Electroencephalogram (EEG)
Measures cortical electrical activity, EPSPs and IPSPs summed from cortex |
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Rank the following EEG rhythm based on their amplitude:
Alpha, beta, theta and delta. Which one is involved in REM sleep? awake state? stage 1-4 sleep (non-REM)? What is the frequency of each sleep stage? |
alpha < beta < theta < delta
REM and awake state: alpha and beta; 15-40 Hz Stage 1: theta 3-7 Hz Stage 2: sleep spindles 12-14 Hz Stages 3 and 4: delta 2-3 Hz |
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What stage describes drowsy sleep? light sleep?
which stage is characterized by hypnic myoclonia? |
Stage 1: drowsy sleep; hypnic myoclonia (BIG muscle contractions)
stage 2: light sleep |
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Which stage describe deep slow wave sleep?
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Stages 3 and 4
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Which sleep stage is characterized by Parasympathetic control? Sympathetic?
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Parasympathetic - stages 3 and 4 (deep slow wave sleep)
Sympathetic - REM |
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Which sleep stage does Valium (benzodiazepines) suppress?
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stages 3 and 4
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What sleep stage is charcterized with night terrors and sleepwalking?
Another word for sleepwalking? |
Stages 3 and 4
Somnambulism |
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Which sleep stage is characterized with atonia?
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REM
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which sleep stage is characterized by spontaneous waking and vivid dreaming?
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REM
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What pharmacological agents can suppress REM sleep? deep slow wave sleep?
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REM - suppressed by EtOH, barbiturates, and TCAs
Deep slow wave sleep (stages 3 and 4) - valium (benzodiazepines) |
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What is insomina?
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SUBJECTIVE sense of insufficient sleep. Inability to achieve sufficient sleep or difficulty in falling asleep ( > 30 min)
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What are the causes of insomia? (4)
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anxiety, depression, stress, pain
side effect of meds, alcohol, and poor sleep habits disruption of circadian rhythms. increasing age |
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What are the effects of insomnia? (4)
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1. Problems with memory & concentration
2. Potential link with cardiovascular disease 3. 4-fold increase in likelihood of depression 4. Impaired performance (at home, on the job, driving) |
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what is obstructive sleep apnea?
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brief periods of interrupted breathing during sleep due to obstruction in the airway.
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What is Narcolepy? What protein is associated with it?
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Entering REM sleep directly from the waking state
a lack of orexin (hypocretin- a hypothalamic protein) |
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What is cataplexy? when does it occur?
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Cataplexy -sudden loss of muscle tone in awake state
Occurs during a narcolpetic state. |
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The rostral portion of the reticular system is involved in what fxns? caudal?
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Rostral reticular formation (upper pons and midbrain) - attention, arousal, and consciousness
Caudal reticular formation (medulla and lower pons) - motor reflex and autonomic functions |
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What modulates the pain (intrinsic analgesic system)?
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reticular formation
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What is the causes of persistent vegetative state?
What functions are intact? lost? |
Causes - severe, diffuse cerebral cortical damage with brainstem function intact (“cerebral death”)
Intact - Respiratory system, circulatory system functioning Possible preservation of sleep-wake cycle on EEG Spontaneous eye movements Lost NO evidence of awareness / responsiveness / interaction with environment NO meaningful responses |
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What defines a coma?
What is implied? |
Definition - >6 hours; diffuse axonal injury
Implies unconsciousness |
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Where is the lesion in the following posturing reflexes seen in coma? which tract is unopposed?
1. decorticate posture 2. decerebrate posture |
1. decorticate posture - above the red nucleus; unopposed rubrospinal tract
2. decerebrate posture - at or below the red nucleus; unopposed vestibulospinal tract |
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What is the main function of each UMN pathway?
1. tectospinal 2. rubrospinal 3. reticulospinal 4. vestibulospinal |
1. tectospinal - reflex head turning
2. rubrospinal - arm flexor bias; lesion above this results in decorticate posture 3. reticulospinal - feedforward adjustments; extensor bias 4. vestibulospinal - feedback adjustments; arm and leg extension bias |
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What does Glasgow _____ scale measure?
What score indicates coma? moderate head injury? mild head injury? |
measure mental response; analysis of coma
15-13 = mild head injury, 9-12 = moderate head injury, 3-8 = severe head injury, coma |
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What part of the brainstem needs to be damaged to have respiratory arrest? why?
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Mid-medulla - location of the respiratory center
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Describe the respiratory patterns in the following levels of lesion?
1. Deep forebrain 2. midbrain 3. rostral pons 4. midpons 5. caudal pons or rostral medulla 6. respiratory centers in mid-medulla |
1. Deep forebrain - cheyne-stokes
2. midbrain - neurogenic hyperventilation 3. rostral pons - apneustic 4. midpons - cluster breathing 5. caudal pons or rostral medulla - ataxic breathing 6. respiratory centers in mid-medulla - respiratory arrest |
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What 5 brain-stem reflexes are tests to assess brain death? indicate the CNs involved in each reflex.
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1. grimacing or eye opening –apply deep pressure on the temporomandibular condyles (afferent V & efferent VII)
2. corneal reflex - touching the edge of the cornea (V and VII) 3. light reflex (II and III) 4. oculovestibular response (VIII and III and VI) 5. gag reflex – push suction catheter deep in the trachea (IX and X) |
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Describe the appearance of pupils with the following causes of coma.
1. toxic or metabolic 2. midbrain lesion or transtentorial herniation 3. pontine lesion 4. opiate overdose or pontine damage |
1. toxic or metabolic - normal sized and reactive
2. midbrain lesion or transtentorial herniation - unilateral or bilateral blown pupil 3. pontine lesion - small, responsive to light bilaterally 4. opiate overdose or pontine damage - bilateral pinpoint pupils |
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What CNs are involved in the oculocephalic reflex?
Describe the eye movements in the oculocephalic reflex. |
CN III,VI, VIII (sensory)
Positive reflex if the eyes move in the opposite direction of the head movements (doll's eyes) |
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What are doll's eyes?
Absence of them suggest what? |
Oculocephalic reflex - Positive reflex if the eyes move in the opposite direction of the head movements (doll's eyes)
Absence suggests brainstem dysfunction in coma |
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What reflex is tested in the calorics testing? what CNs are involved?
What happens to the firing rate of ipsilateral inner ear when cold water is injected? what does this suggest? Warm water? |
Vestibuloocular reflex (CN III, VI, and VIII)
Ipsilateral vestibular system is inhibited; suggests that the head is turning contralateral to the "cold" ear side. Warm water - increases the firing rate of the vestibular system |
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What would be result of the calorics test when there is a lesion of MLF?
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the contralateral eye will not adduct but the ipsilateral eye will abduct.
Ipsilateral = the side cold water is injected Indicates INO |
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What would cause a complete negative response to calorics testing?
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CN VIII lesion.
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How will a comatose patient with intact brainstem react to the cold water calorics test?
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Normal tonic conjugate deviation to side of cold stimulus BUT not nystagmus (fast) component
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what is the difference between partial and generalized seizure?
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Partial - involves a limited portion of the brain; starts on one side
generalized - involves the entire brain (both hemispheres) |
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what is the difference b/t simple and complex partial seizures?
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simple - no impair consciousness
complex - altered consciousness |
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What are 4 types of generalized seizure?
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1. Absence (petit mal) Occur in children, last seconds, loss of activity and not responsive
2. Myoclonic large jerky movements 3. Tonic clonic- LOC-alternating intense contraction and relaxation, hoarse cry out, post ictal may sleep, confused, sore 4. Atonic (drop attacks) |
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What would you expect to see in generalized seizure on EEG?
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synchronized and larger amplitudes
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Where are the sympathetic preganglionic neurons (soma) located?
Parasympathetic preganglionic neurons? |
Sympathetic - T1-L2 (intermediate horn)
parasympathetic - brainstem (CN III, VII, IX, and X) and S2-S4 ( intermediate horn) |
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Do autonomic neurons cross?
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NO
Always stay ipsilateral |
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In the ANS:
What type of neuron utilizes muscarinic ach receptor? nicotinic ach receptors? |
mAChR - parasympathetic postganglionic
nAcR - parasympathetic preganglionic and sympathetic preganglionic AND somatic LMN |
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What part of the brainstem controls micturition? name?
How does sympathetic NS innervate micturition? parasympathetic? somatic? Spinal cord level for each? |
Pontine micturition center?
Sympathetic (T10-L2) to Stop Parasympathetic (S2-S4) to Pee Somatic motor (S2-S4) to Stop voluntarily |
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How does UMN lesion affect micturition? LMN lesion?
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LMN lesion - bladder fills to max capacity, then dribbles; overflow incontinence
UMN lesion - hyperactivity; empties reflexively; must catherize this individual |
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What are anterior hypothalamic nuclei involved in? lesion leads to?
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head dissipation center (AC) - triggers sweating, cutaneous vasodilation
Lesion - hyperthermia; inability ot dissipate heat |
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What are posterior hypothalamic nuclei involved in? lesion leads to?
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heat conservation center - triggers cutaneous vasoconstriction and heat production center
Bilateral lesion - inability to raise core temperature; may result in complete loss of ability to thermoregulate (poikilothermia) |
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Which visual field(s) is affected when there is a lesion in the optic chiasm? what do you call this?
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Bitemporal hemianopia - visual defect in temporal fields of each eye.
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What is Left homonymous hemianopia?
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left visual field of each eye.
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What visual defect is obseved when the left Meyer's loop is cut?
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Left superior qundrantanopia
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Lower bank of calcarine sulcus is involved in which visual field? upper bank?
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Lower bank - superior
Upper bank - inferior |
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What 2 nerves are involved in pupillary reflex?
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CN II and III
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If there is no pupillary reflex in both eyes when the light is shone, what CN is damaged?
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CN II
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If the light is shone in the left eye and only the left pupil constricts, where is the lesion?
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Right oculomotor nerve
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Acoustic neuroma occurs where? what CNs are damaged?
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Cerebellopontine juction
CN VII and VIII |
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What is the function of the following organs?
1. semicirucular canal 2. utricle 3. saccule |
1. semicirucular canal - angular acceleration
2. utricle - horizontal acceleration 3. saccule - vertical acceleration |
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Lesions in the vestibular potion of CN VIII causes?
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disequilibrium
Vertigo Nystagmus |
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What is the difference b/t conductive hearing loss and sensorineural hearing loss?
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Conductive hearing loss - those that impair the ability of airborne vibrations to reach the organ of corti (e.g middle ear infection)
Sensorineural hearing loss - impair the ability of hair cells or the cochelar nerve |
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Give 3 examples of conductive hearing loss, sensorineural hearing loss, and central hearing loss.
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Conductive Hearing Loss
1. External ear obstructions (wax?, peas?) 2. Middle ear obstructions: Otitis 3. Otosclerosis - commonly causes progressive hearing loss Sensorineural Hearing Loss 1. Degeneration of hair cells 2. Presbycusis (high freqs go first: 20,000 down to 8,000 or 4,000 Hz) 3. Lesion of cochlear nerve Central Hearing Loss 1. Lesion of primary auditory cortex (Brodmann's areas 41 and 42) 2. Lesion of Wernicke's area (Brodmann's area 22) 3. Seizure activity in the auditory cortex (e.g. temporal lobe epilepsy) Tinnitus = the paresthesia of the auditory system |
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Where do you place the tuning fork in the Weber test?
When the sound is louder in the bad ear during the Weber test, what kind of hearing loss do you have? |
top of the head
Conductive loss b/c the vibration by passes the conduction part |
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Where do you place the tuning fork in the Rinne test? (2 places)
Is this test more sensitive for conductive hearing loss or sensorineural hearing loss? |
Mastoid process (bone) for bone conduction
Near the external acoutic opening for air conduction More sensitive for conductive hearing loss |
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What is Meniere's disease?
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hearing loss and vertigo due to alteration in endolymph pressure
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Differetiate dementia from delirium.
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Dementia is characterized by a slow insidious onset and a progressive course, but no problem with attention until dementia is quite advanced
Delirium is characterized by an acute onset, a fluctuating consciousness and impaired attention |
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What causes dementia?
3 Ws? (symptoms) |
due to normal pressure hydrocephalus
3Ws - wet, wobbly, and wacky |
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What are the cardinal features of AD?
What are definitive diagnosis of AD? |
progressive memory impairment
disordered cognitive function altered behavior, including paranoia and delusions progressive decline in language function plaques - extracellular tangles - intracellular |
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What are 3 genes associated with AD?
What gene is protective from AD? |
3 genes associated with AD - APP, PS1, and PS2
APOE E2 - protective (holy shiiiiiiiit!!!) |
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How do you keep an old brain young?
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Language, culture, symbolic systems and the utilization of tools both create external supports and generate developmental environments that protect and enhance cognitive abilities early and late in life
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What is the function of hippocampus?
Amygdala? |
Hippocampus-involved in memory, and damage results in amnesia
Amygdala is involved with fear and anger and the emotional interpretation of events and VISUAL STIMULI |
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the anterior cingulate cortex is involved in?
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pain processing
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what part of the spinal cord is involved in pain modulation?
Which neurotransmitters are used? |
serotonin (5HT), NE, endogenous opiates
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How is the visceral pain transmitted to CNS?
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Visceral pain transmitted to spinal cord primarily bundled in sympathetic afferents (T1-L2)
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