Neuroscience Test 4

Front 1

Functions of the Vestibular System

Back 1

1) Detects linear and angular accelerations of head

2) Detects static position of head

3) Coordinates eye and head movements to keep retinal image stationary

4) Adjusts activity in muscles of neck, trunk, and proximal extremities to maintain balance and posture.

Front 2

5 components of vestibular system

Back 2

1) peripheral receptor apparatus

2) central vestibular nuclei

3) vestibulo-ocular network

4) vestibulospinal network

5) vestibulo-thalamo-cortical network

Front 3

Peripheral Receptor Apparatus consists of

Back 3

1) 3 semicircular canals
2) saccule
3) utricle

Front 4

detect angular rotation of head

Back 4

semicircular canals

Front 5

detect linear accelerations of head and orientation of head relative to gravity

Back 5

saccule and utricle

Front 6

Axons from the vestibular nuclei make connections with several other structures:

Back 6

1) Motor Nuclei of Extraocular Muscles

2) Spinal Cord

3) Thalamus/Cortex

Front 7

These axons travel in the medial longitudinal (MLF) and help coordinate eye and head movements

Back 7

Motor Nuclei of Extraocular Muscles

Front 8

Axons from vestibular nuclei terminate in nuclei in the thalamus which in turn project to the ________. This pathway probably conveys our conscious sense of orientation and of movement in space.

Back 8

Vestibular Cortex

Front 9

_________ serve to keep the retina stationary with respect to the outside world when the head is rotated in any of three dimensions so that retinal image is not blurred.

Back 9

Vestibulo-ocular Reflexes (VOR)

Front 10

A very rapid movement of the eyes back to the midline

Back 10

saccade

Front 11

process of slow movement of the eyes in the direction opposite head rotation, followed by fast movement of the eyes in the same direction as head rotation repeats itself and is known as ______

Back 11

nystagmus

Front 12

- Neurons reside primarily in medial vestibular nucleus

- Descends through MLF

- Terminates in cervical spinal cord on neck flexors and extensors

- Facilitation and inhibition of neck flexors and extensors

Back 12

Medial Vestibulospinal Tract

Front 13

- Neurons primarily in lateral and inferior vestibular nuclei

- Descends in ventral funiculus of spinal cord

- Terminates in all levels of spinal cord

- Facilitation of axial and proximal limb extensor muscles

Back 13

Lateral Vestibulospinal Tract

Front 14

Central Disorders of vestibular system

Back 14

- vertigo (mild but persistent)

- brain stem signs

- no auditory symptoms

- nystagmus (mild but persistent)

- nausea & vomiting (mild but persistent)

Front 15

Peripheral Disorders of vestibular system

Back 15

- vertigo more severe

- auditory symptoms common

- no brain stem signs

- nystagmus

- nausea & vomiting (moderate to severe)

- benign paroxysmal positional vertigo (BPPV)

Front 16

Benign Paroxysmal Positional Vertigo (BPPV)

Back 16

- characterized by brief episodes of vertigo triggered by changes in body position

- may be caused by displacement of otolith into posterior semicircular canal

- can be treated by mechanical maneuvers of head

Front 17

Unilateral Disorders of Vestibular System

Back 17

- nystagmus (beating toward side of lesion)

- postural instability (falling toward side of lesion)

- BPPV

Front 18

Unilateral Lesion of Brain Stem causes:

Back 18

1. loss of function of 1 or more cranial nerves on ipsilateral side of body

2. contralateral hemiplegia - because long descending motor pathways innervate contralateral extremities

3. contralateral hemisensory loss - because long ascending sensory pathways carry sensory information from contralateral extremities

Front 19

Structures involved:

- spinal trigeminal tract & nucleus

- ALS pathway

- nucleus ambiguus

- descending sympathetic fibers

- inferior cerebellar peduncle

Back 19

Lateral Medullary Syndrome - Wallenburg's Syndrome

Front 20

Characterized by:

- miosis (constricted pupil)

- partial ptosis of eyelid (drooping)

- enophthalmos (eye appears to be sunken in socket)

- anhidrosis (absence of sweating on affected side of face)

- vasodilation (causes redness of face on affected side)

Back 20

Horner's Syndrome

Front 21

Deficits seen:

- loss of pain and temperature over the ipsilateral face and contralateral body

- hoarseness and difficulty swallowing

- ipsilateral horner's syndrome

- vertigo

- disturbances of equilibrium

Back 21

Lateral Medullary Syndrome - Wallenburg's Syndrome

Front 22

Generally caused by an acoustic neuroma which is a slow growing tumor arising from Schwann cells in sheath of CN VIII

Back 22

Cerebellopontine Angle Syndrome

Front 23

May be caused by occlusion of Posterior Cerebral Arteries

Back 23

Weber's Syndrome

Front 24

Attributed to occlusion of either PICA or Vertebral Artery

Back 24

Lateral Medullary Syndrome - Wallenburg's Syndrome

Front 25

Caused by occlusion of Basilar Artery

Back 25

Locked-In Syndrome

Front 26

Initial symptoms of:

- deafness

- vertigo

- spontaneous horizontal nystagmus

Back 26

Cerebellopontine Angle Syndrome

Front 27

Symptoms include:

- contralateral hemiplegia due to involvement of corticospinal pathways

- external strabismus of ipsilateral eye

- ptosis (ipsi)

- pupillary dilation (ipsi)

- loss of adduction of eye beyond midline (ipsi)

- loss of upward and downward movement of eye (ipsi)

Back 27

Weber's Syndrome

Front 28

Symptoms include:

- patient totally paralyzed

- patient unable to speak

- patient fully awake: may be able to move eyes slightly

Back 28

Locked-In Syndrome

Front 29

External Relay Nuclei

Back 29

- These nuclei relay information from the body and the external world to primary sensory cortical areas

- located in the ventrolateral tier

1) Lateral & Medial Geniculate Nuclei (LGN & MGN)

2) Ventral Posterolateral Nucleus (VPL)

3) Ventral Posteromedial Nucleus (VMP)

Front 30

Internal Relay Nuclei

Back 30

- these nuclei receive information which has already undergone processing by one brain system and relay it to appropriate cortical regions

- located in the anteroventral region

1) Anterior Nucleus (A)

2) Ventral Anterior Nucleus (VA)

3) Ventral Lateral Nucleus (VL)

Front 31

Receives input from the medial lemniscus and ALS and projects to the primary sensory cortex which contains the representation for the body and limbs.

Back 31

Ventral Posterolateral Nucleus(VPL)

Front 32

Receives input from the brachium of the inferior colliculus and projects to the primary auditory cortex.

Back 32

Medial Geniculate Nucleus (MGN)

Front 33

Receives input from the trigeminal lemniscus and projects to the primary sensory cortex which contains the representation for the head.

Back 33

Ventral Posteromedial Nucleus (VPM)

Front 34

Receives input from the optic tracts and projects via the geniculocalcarine tract to the primary visual cortex.

Back 34

Lateral Geniculate Nucleus (LGN)

Front 35

Receives input from the basal ganglia and deep cerebellar nuclei (particulary the dentate nuclei) via the dentatorubrothalmic tract and relays it to the motor cortex areas.

Back 35

Ventral Lateral Nucleus (VL)

Front 36

Receives input from the limbic system via the mammillothalamic tract and fornix, before relaying that information on to the cingulate gyrus (limbic cortex).

Back 36

Anterior Nucleus (A)

Front 37

Receives input from the basal ganglia and cerebellum and relays it to the motor and premotor areas of the cortex.

Back 37

Ventral Anterior Nucleus (VA)

Front 38

Nuclei of this functional group act as relays between cortical areas, between brain (internal) systems, or between other thalamic nucleus and the cortex.

Back 38

Association Nuclei

Front 39

Association Nuclei include:

Back 39

- Dorsomedial Nucleus (DM)

- Lateral Dorsal Nucleus (LD)

- Lateral Posterior Nucleus (LP)

- Pulvinar (P)

Front 40

The thalamus is the _______ point for all sensory impulses.

Back 40

The thalamus is the TERMINATION point for all sensory impulses.

Front 41

The thalamus is integral to the maintenance and regulation of _______, _______, and _______.

Back 41

1) Consciousness

2) Alertness

3) Attention

Front 42

Caused likely from large infarcts in the blood supply to the thalamus.

Back 42

Thalamic Syndrome

Front 43

The large infarcts in thalamic syndrome typically affect what artery?

Back 43

Posterior Cerebral Artery

Front 44

The thalamic area most frequently involved in thalamic syndrome is what?

Back 44

Ventral Posterolateral Nucleus (VPL)

Front 45

Surgical interruption of the reciprocal connections between the Dorsomedial Nucleus (DM) and front lobes.

Back 45

Prefrontal Lobotomy (Leukotomy)

Front 46

Surgical interruption of the connections between the basal ganglia and the cerebral cortex

Back 46

Used to treat Parkinson's Disease

Front 47

characterized by:

1) complete hemianesthesia (contralateral)

2) permanent loss of tactile localization and two point discrimination

3) limited recovery of sensation

4) nonspecific evocation of pain sensations

Back 47

Thalamic Syndrome

Front 48

Typical locations of the thalamic lesions in Parkinson's Disease

Back 48

1) Centromedian Nucleus (CM)

2) Ventrolateral Nucleus (VL)

3) Ventral Anterior Nucleus (VA)

Front 49

Structures of the limbic system are concerned with?

Back 49

1) processes involved with memory

2) visceral and motor responses to emotion

Front 50

Structures involved in the limbic system

Back 50

- cingulate gyrus (limbic lobe)

- parahippocampal gyrus (limbic lobe)

- hippocampus (limbic lobe)

- hypothalamus (including mammilary bodies)

- anterior and medial thalamic nuclei

- uncus (Limbic lobe)

- dentate gyrus (part of hippocampal formation)

- amygdala

- prefrontal & association areas of cerebral cortex

Front 51

Papez Circuit contains what?

Back 51

1) Cingulate gyrus

2) Parahippocampal gyrus

3) Hippocampus

4) Hypothalamus

5) Anterior and Medial Thalamic Nuclei

Front 52

* Hippocampus → fornix → mammillary bodies
* Mammillary bodies → mammillothalamic tract → anterior thalamic nucleus
* Anterior thalamic nucleus → genu of the internal capsule → cingulate gyrus
* Cingulate gyrus → cingulum → parahippocampal gyrus
* Parahippocampal gyrus → entorhinal cortex → perforant pathway → hippocampus

Back 52

Papez Circuit

Front 53

Hippocampal Formation consists of?

Back 53

1) Dentate gyrus

2) hippocampus proper

3) subiculum

Front 54

Involved in memory formation

Back 54

hippocampus

Front 55

Involved in processes of emotion

Back 55

amygdala

Front 56

Fornix Pathway

Back 56

Hippocampal Formation --> Alveus --> Fimbria --> Crus of Fornix --> Body of Fornix --> Columns of Fornix --> Mammilary Bodies

Front 57

Functions in processing EXPLICIT memory for long-term storage

Back 57

Hippocampus

Front 58

Factual knowledge of people, places, and things along with the meaning of those facts; also called declarative memory.

Back 58

Explicit Memory

Front 59

Knowledge of how to perform a motor or perceptual skill; also called nondeclarative or procedural memory.

Back 59

Implicit Memory

Front 60

Process of the hippocampus to convert short-term to long-term memory?

Back 60

Consolidation

Front 61

The hippocampus probably uses ______________ to produce consolidation which will then convert short-term to long-term memory.

Back 61

Long-Term Potentiation

Front 62

Damage to the hippocampus or output circuits results in inability to form new 1)______ memory. 2)______ memory stays intact. Deficits involve 3)_____ memory only.

Back 62

1) Long Term

2) Short Term

3) Explicit

Front 63

Alzheimer's is the first appearance of plaques and tangles in the ______

Back 63

Entorhinal cortex

Front 64

Inability to incorporate new information into memory.

Back 64

Anterograde Amnesia

Front 65

Damage to hippocampus bilaterally causes ___________

Back 65

Korsakoff's psychosis

Front 66

Inability to remember events that occurred prior to onset of illness. Not due to hippocampal damage.

Back 66

Retrograde Amnesia

Front 67

Inability to name objects; damage to posterior parietal cortex

Back 67

Visual Agnosia

Front 68

Inability to recognize familiar faces or learn new faces; damage to inferior temporal cortex.

Back 68

Prosopagnosia

Front 69

Lies beneath the uncus on the ventral surface of the brain

Back 69

amygdala

Front 70

Afferents to amygdala

Back 70

1) Visceral

2) Olfactory

Front 71

Efferents from amygdala

Back 71

1) To hypothalamus via pathway known as stria terminalis

2) To cortical areas (particularly cingulate gyrus)

3) To brain stem nuclei

Front 72

Stimulation of the amygdala results in:

Back 72

- anxiety/fear reaction along with physical responses:

1) increased HR

2) increased respiration

3) pupillary dilation (sympathetic response)

Front 73

Autonomic responses mediated via connections of amygdala with ________.

Back 73

hypothalamus

Front 74

Conscious feelings mediated via connections of amygdala with _______ and __________.

Back 74

Cingulate gyrus

Prefrontal cortex

Front 75

Bilateral lesions of the amygdala results in:

Back 75

Placidity, flat affect;

do not respond to threatening situations

Front 76

- Degenerative disorder

- Calcium deposition in amygdala

- Unable to discern fear in facial expressions of others

Back 76

Urbach-Wiethe disease

Front 77

- Results from bilateral removal of temporal lobes

- visual agnosia

- hyper orality (tendency to examine objects excessively by mouth)

- hypermetamorphosis (compulsion to intensively explore immediate environment)

- placidity and fearlessness

- hyperphagia (excessive eating)

- hypersexuality

Back 77

Kluver-Bucy Syndrome

Front 78

Thalamic nuclei help ________, __________, and ________ information.

Back 78

Thalamic nuclei help INTEGRATE, CORRELATE, and RELAY information.

Front 79

Types of information the thalamic nuclei help.

Back 79

- sensory

- motor

- consciousness

- limbic system

- visual system

Front 80

The thalamic nuclei located in the diencephalon also function in the mechanisms by which the brain ____1________ (i.e. the thalamus does this essentially by _____2______) and is involved in _____3_______ & interpretation of ___4____

Back 80

1) Focuses Attention

2) Altering cortical receptivity

3) conscious perception

4) pain

Front 81

_____ is the only peripheral sensory stimulus that is interpreted thalamically

Back 81

Pain

Front 82

Leukotomy also eliminates ____1______ & impairs ___2___ & ____3_____.

Back 82

1) most sensations

2)learning

3) memory

Front 83

Thalamotomy is designed to interrupt misinformation flowing through there from the _____1_____ & _____2_____ which produces tremor.

Back 83

1) globus pallidus

2) substantia nigra

Front 84

The amygdala mediates inborn & acquired ____1____, particulary ___2____ & ___3___

Back 84

1) emotional responses

2) fear

3) anxiety

Front 85

The hypothalamus regulates ____________

Back 85

Autonomic reactions

Front 86

The autonomic reactions of the hypothalamus are:

Back 86

- HR

- BP

- Water Metabolism

- General Metabolism

- Sexual behavior

- Temperature

- GI Activity

Front 87

The hypothalamus modulates both ___1___ & ___2____ responses

Back 87

1) sympathetic

2) parasympathetic

Front 88

Part of the hypothalamus that modulates sympathetic responses

Back 88

posterior lateral hypothalamus

Front 89

Part of the hypothalamus that modulates parasympathetic responses

Back 89

anterior medial hypothalamus

Front 90

Anterior boundary of hypothalamus is

Back 90

lamina terminalis

Front 91

superior boundary of hypothalamus is

Back 91

hypothalamic sulcus

Front 92

inferior boundary of hypothalamus

Back 92

optic chiasm & tracts and posterior edge of mammillary bodies

Front 93

The inferior border of the hypothalamus, between the optic chiasm & mammillary bodies is referred to as the ___________

Back 93

Tuber Cinereum

Front 94

Hypothalamus is divided into ___1____, ____2___, & ___3___ regions

Back 94

1) anterior

2) tuberal

3) posterior

Front 95

Anterior region of the hypothalamus is ________.

Back 95

Above optic chiasm

Front 96

Tuberal region of the hypothalamus is _________.

Back 96

above tuber cinereum

Front 97

Posterior region of the hypothalamus is _________.

Back 97

above & including mammillary bodies

Front 98

Each region of the hypothalamus is divided into ________ & _______ areas by the ________.

Back 98

Each region of the hypothalamus is divided into MEDIAL & LATERAL areas by the FORNIX

Front 99

Afferent input to hypothalamus comes from ________ & ___________

Back 99

forebrain

brainstem/spinal cord

Front 100

Forebrain includes afferents from _______, ________, & other areas.

Back 100

Limbic system

retina

Front 101

Posterior portion of pituitary gland is ________

Back 101

neurohypophysis

Front 102

Anterior portion of pituitary gland is ________

Back 102

adenohypophysis

Front 103

Hypothalamus connected to neurohypophysis via __________

Back 103

neural pathways

Front 104

Hypothalamus connected to adenohypophysis via __________

Back 104

hypophyseal portal vessels

Front 105

Nuclei from what release neuroendocrine products directly into the general circulation

Back 105

neurohypophysis

Front 106

Nuclie connected w/ neurohypophysis?

Back 106

1) Supraoptic Nucleus (SON)

2) Paraventricular Nucleus (PVN)

Front 107

Supraoptic nucleus (SON) & Paraventricular nucleus (PVN) both release ______ & ________

Back 107

Oxytocin

Vasopressin

Front 108

Also known as ADH (anti-diuretic)

Back 108

Vasopressin

Front 109

PVN also releases

Back 109

corticotropin-releasing hormone

Front 110

Causes uterine contraction during labor & initiates milk secretion from mammary glands?

Back 110

Oxytocin

Front 111

Alters membrane permeability of collecting ducts & convoluted tubules of kidneys so that their membranes become more permeable to water. Also causes decreased urine volume, increased body water, and increased blood pressure.

Back 111

Vasopressin

Front 112

Nuclei connecting with adenohypophysis?

Back 112

- Arcuate nucleus

- Periventricular nucleus

- Suprachiasmatic nucleus

- Ventromedial nucleus

- Lateral nucleus

Front 113

Arcuate nucleus releases _________ & __________

Back 113

Growth-Hormone Releasing Hormone

Gonadotropin-Releasing Hormone

Front 114

Periventricular nucleus releases _________ & _______

Back 114

Thyrotropin releasing hormone

somatostatin

Front 115

Gonadotropin releasing hormone stimulates release of __________ and _________

Back 115

1)Luteinizing Hormone (LH) - induces ovulation in females; in males production of testosterone

2) Follicle Stimulating Hormone (FSH) - promotes growth of ovarian follicles

Front 116

Somatostatin _____________

Back 116

inhibits release of growth hormone

Front 117

Thyrotropin-releasing hormone stimulates release of ______________ by adenohypophysis

Back 117

Thyroid Stimulating Hormone (TSH)

Front 118

Has direct connections with the retina; controls circadian rhythm

Back 118

Suprachiasmatic nucleus

Front 119

Involved with regulation of food intake

Back 119

Ventromedial & Lateral Nuclei

Front 120

Stimulation of VMN

Back 120

decreases appetite

Lesion produces opposite effect

Front 121

Stimulation of lateral nucleus

Back 121

increase appetite

Lesion produces opposite effect

Front 122

Maintenance of set-point for body temperature

Back 122

Posterior Hypothalamus

Front 123

Symptoms - polydipsia & polyuria

- Due to decreased or absent production of vasopressin

- Lesions of supraoptic/paraventricular nuclei

Back 123

Diabetes Insipidus

Front 124

- Hypersecretion of pituitary growth hormone after maturity

- Characterized by enlargement of extremities of skeleton, particularly fingers, toes, jaw, and nose

- Damage of arcuate nucleus

Back 124

Acromegaly

Front 125

- Caused by excess ACTH production

- Rapid development of adiposity in face, neck, and trunk

- Symptoms: kyphosis, amenorrhea, increased hair production, impotence, HTN

Back 125

Cushing's Disease

Front 126

The nuclei comprimising the basal ganglia include the ____________, _______, and _________.

Back 126

Caudate Nucleus

Putamen

Globus Pallidus (Internal & External)

Front 127

Associated with the basal ganglia, but not classified as basal ganglia nuclei, are the ___________, _________, and __________

Back 127

Subthalamic nucleus

Substantia nigra

Pedunculopontine nucleus

Front 128

The _____ and ______ are functionally identical, are actually fused anteriorly in the brain, but are separated by the embryological growth of the anterior limb of the internal capsule.

Back 128

Caudate Nucleus

Putamen

Front 129

The caudate nucleus & putamen are referred to as the ________

Back 129

Striatum

Front 130

The putamen and globus pallidus (both external & internal) are collectively referred to as the ____________

Back 130

Lentiform Nucleus

Front 131

The subthalamic nucleus is part of the ________, while both the substantia nigra and the pedunculopontine nucleus are ____________.

Back 131

diencephalon

mesencephalic structures

Front 132

The basal ganglia participate in the preparation for ________ and in the ______________________

Back 132

movement

ordering of sequences of movement

Front 133

Corticostriatal fibers from all areas of cortex end in the ______-

Back 133

striatum

Front 134

Corticostriatal afferents are topographically organized such that frontal areas project to the ___________

Back 134

head of the caudate

Front 135

_______, ________, and _______ areas project to the body and tail of the caudate.

Back 135

Parietal

Temporal

Occipital

Front 136

Corticostriatal projections use __________ as an excitatory neurotransmitter, thus activating striatal neurons.

Back 136

Glutamate

Front 137

Centromedian nucleus of the thalamus sends projections to the ________.

Back 137

striatum

Front 138

Substantia nigra fibers arise in _________

Back 138

dopaminergic neurons

Front 139

Inputs to the Striatum are?

Back 139

1) Corticostriatal fibers

2) Centromedian nucleus of the thalamus

3) Substantia nigra

Front 140

The direct pathway ________ a flow of information through the thalamus.

Back 140

facilitates

Front 141

The indirect pathway _______ information flow through the thalamus.

Back 141

inhibits

Front 142

The result of activation of the direct pathway is ______ output from the thalamus with a resultant ________ in activation of the ___________

Back 142

Increase

Increase

Cerebral Cortex

Front 143

When the indirect basal ganglia pathway is activated, the result is ______ activity of the thalamus and, as a result, ______ activity of the _______.

Back 143

Decreased

Decreased

Cerebral Cortex

Front 144

Patients with pathology of the basal ganglia typically exhibit:

Back 144

1) didsturbances of muscle tone (rigidity)

2) hypokinetic disturbances (bradykinesia/akinesia)

3) hyperkinetic disturbances (dyskinesia - abnormal involuntary movments which may include ballismus, choreiform movments, or athletoid movements)

Front 145

Parkinsonism is characterized by

Back 145

1) akinesia (inability to initiate movements, lack of spontaneous movement)

2) bradykinesia (abnormal slowness of movement)

3) rigidity (due to coactivation of agonists and antagonists)

4) tremor-at-rest (pill rolling) (disappears when making a voluntary movement)

Front 146

Violent, flinging movement occurring in proximal musculature

Back 146

ballismus

Front 147

Disorder where there is a loss of dopaminergic neurons of the substantia nigra that project to the striatum

Back 147

Parkinsonism

Front 148

Treatments for Parkinsonism

Back 148

1) Levodopa (L-Dopa) Therapy

2) Implants of dopamine-secreting cells into the human striatum

3) Thalamotomy

4) Pallidotomy (surgical procedure where lesion is made in iGP)

5) Deep Brain Stimulation (putting an electrode in the iGP)

Front 149

Movement disorder may be seen as a result of damage to the subthalamic nucleus

Back 149

Ballismus

Front 150

Disease that is characterized by:
- Hereditary
- Autosomal dominant inheritance (mutation to short arm of Chromosome 4)
- progressive psychomotor disorder
- adult onset

Back 150

Huntington's Chorea

Front 151

Organic changes of Huntington's are?

Back 151

- Atrophy of cerebral cortex and caudate nucleus (loss of neurons in both structures)

Front 152

Underlying neural mechanism of Huntington's?

Back 152

-Loss of cells in striatum that give rise to indirect pathway.

- Result is increased motor output from cerebral cortex with accompanying hyperkinetic disturbance (choreiform movements). As disease progresses, cells of direct pathway also are lost so that, toward the end of the disease, there is inhibition of motor output.

Front 153

Disease of pro boxers

Chronic traumatic encephalopathy

Back 153

Dementia Pugilistica

Front 154

Characteristics of dementia pugilistica

Back 154

- parkinsonism

- tremor

- ataxia

- cerebellar signs

- in some cases: dementia (may show rage reactions)

Front 155

Drug induced syndrome of persistent, abnormal involuntary movements.

Back 155

Tardive Dyskinesia

Front 156

In tardive dyskinesia, movements are _____ and _____

Back 156

rapid

stereotypic (hyperkinetic disorder)