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54 Cards in this Set

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What is true vertigo?
spinning sensation of movement.
What is the cause of true vertigo?
Vestibular disease (lesions anywhere in this path-->labyrinth-->vestibular N-->vestibular nuclei & cerebellum to parietal cortex)
Which type of vertigo is more common? Which type of vertigo may be a neurological emergency?
peripheral; central;
If patient comes in w/ diplopia, other visual changes, somatosensory changes, wkness, dysarthria, incoordination, & impaired consciousness, what should you think?
Pt has Posterior Fossa Disease until proven otherwise.
How much should the systolic BP & pulse change from when going supine to seated?
Systolic BP drops by only 10 mm Hg & pulse inc by 10 bts/ min
What positional testing can be used to distinguish peripheral vs central causes of vertigo?
Barany or Dix-Hallpike positional testing---tilt head to 1 side, endolymph moves to 1 side-->peripheral nystagmus & vertigo fade away w/in 30, no fading in central lesions.
Distinguish b/w peripheral and central vertigo for onset, severity & pattern.
Peripheral: sudden, intense spinning, paroxysmal intermittent.
Central: slow, ill defined, constant pattern.
Distinguish b/w peripheral & central vertigo for mvmt aggravation, assoc NVD, & nystagmus.
Peripheral: yes, frequent NVD, rotatory-vertical, horizontal nystagmus.
Central: N, infrequent NVD, vertical nystagmus.
Distinguish b/w peripheral and central vertigo for fatigue of s &s, hearing loss/tinnitus, CNS S &S.
Peripheral: fatigue, possible hearing loss/tinnitus, no cns s & s.
Central: no fatigue of sx, no hearing loss/tinnitus, usually present S & Sx.
What structure connects the cerebellum to the brainstem and carries info from cerebellum, SC, medulla?
Inferior cerebellar peduncle. (carries proprioceptive & vestibular fibers to cerebellum from medulla)
Which nerves comes off the dorsal side of the brainstem?
Trochlear N.
What is the fxn of the superior colliculus?
Vision
What is the fxn of the inferior colliculus? (on midbrain & below thalamus)
Auditory
Which part of the medulla is considered 'open' & which is considered 'closed'?
Open=rostral pt of medulla w/ pt of IV V

Closed=pt containing central canal.
How do you examine your vibration/position sense?
Peripheral sensory receptors-->peripheral N's to dorsal roots enter SC-->Ascends ipsilateral SC as posterior columns crosses to contralateral side in low medulla-->ascends thru brainstem to reach VPL of thalamus & parietal cortex.
What is the fxn of the corticobulbar tract?
Mediates voluntary control over movements in the head region.
Damage to which tract will you give UMN paralysis?
Pyramidal (Corticospinal Tract)
What are the 5 characteristic features of UMN lesions?
1. Muscle weakness.
2. Increased deep tendon reflexes
3. Depressed abdominal responses
4. Extensor plantar response (Babinski)
5. Spasticity.
In which region will you have a stroke that results in facial & arm weakness?
Internal Capsule
Describe the pathway of the medial lemniscus.
Origin: dorsal column-->go ventrally (called internal arcuate fibers)-->2nd order fibers cross to opp side side of medulla as medial lemniscus-->thru medulla-->pons-->VPL-->somatosensory cortex in postcentral gyrus.
What is the fxn of the medial lemniscus?
Transmits info assoc w/ conscious proprioception & vibratory stimuli to thalamus (VPL)
What is the fxn of trigeminal lemniscus?
Conveys touch sensation for face via ventral posterior medial nucleus thalamus (VPM) to somatosensory cortex.
Which fasciculus is knocked out in MS?
Medial Longitudinal Fasciculus.
What is the fxn of the medial longitudinal fasciculus?
Provides info about position of head in space to CN nuclei that mediate control over position & mvmts of eyes.
Which tract mediates pain & temp sensation from contralateral side of body to thalamus?
Lateral spinothalamic tract
Which tracts mediate unconscious proprioception (from muscle spindles & Golgi tendon organs) to cerebellum?
Spinocerebellar tracts.
Which area is involved in modulating sensory transmission to cortex, regulates motor activity, autonomic regulation, sleep/wake cycle, & modulation of emotional behavior?
Reticular formation
the medulla oblongata (aka myelencephalon) contains autonomic centers that regulate what?
respiration, circulation, and gastrointestinal motility
what cranial nuclei arise from the medulla?
CN9-12 (5 and 8 extend caudally into the medulla)
where is the pyramidal (motor) decussation located?
caudal medulla
define vertigo and the differences in the two types.
vertigo is a spinning sensation of movement; 2 types: central and peripheral: CENTRAL: more serious and is a lesion of the brainstem or cerebellum (pattern: constant, hearing loss and tinnitus doesn't occur); PERIPHERAL: intermittent (will fade, central won't), moving the head makes it worse; no other CNS signs and symptoms; N/V, may get tinnitus and hearing loss.
if a patient has central vertigo, what are some possible origins?
brainstem stroke, posterior fossa hemorrhage, brainstem tumors
A patient with posterior fossa disease (with central vertigo), may present with what?
diplopia, visual changes, somatosensory changes, weakness, dysarthria, incoordination, impaired consciousness
when diagnosing vertigo, make sure to do what physical exam?
otoscopic - very likely to be peripheral if ear is involved
what test can help determine peripheral vs. central?
Barany or Dix-Hallpike positional testing
how do you clinically test the posterior columns?
test position of up or down fingers; also can use tuning fork - vibratory sense
what is the only CN that comes off the posterior brainstem? what part of the brainstem?
trochlear comes off the posterior side of the midbrain
there are two main cuts that are important in the midbrain, superior and inferior colliculus. what will you grossly see that will help you identify them and what do each control?
will see substantia nigra pigmented cells; superior colliculus-vision; inferior-auditory
what do the corticobulbar tracts mediate?
voluntary control over movements in the head; innervate CN motor nuclei; so motor tracts are either corticospinal (motor of body) or corticobulbar (motor of head)
location: caudal medulla (in the area of the pyramidal decussation); the decussated axons(90%) will descend into the spinal cord and become _____________; the remaining uncrossed component of the corticospinal tract will pass ipsilaterally into the ventral white matter and be called _____________ (they eventually cross in the anterior commissure).
lateral corticospinal tract; ventral corticospinal tract
if someone has central cord syndrome what is more affected, arms or legs and why?
arms are effected because the more medial part of the lateral corticospinal cord control the arms; the lateral part of the lateral corticospinal tract controls legs
where would a lesion be if the following features existed?
muscle weakness, increased tendon reflexes, spasticity, depressed abdominal responses, babinski response?
describe the pathway of sensory information (from touch of arm to the somatosensory cortex in the postcentral gyrus).
arm gets touched -> dorsal root ganglia into the dorsal horn -> up the fasciculus cuneatus (dorsal column) -> enters the mid-medulla -> crosses or decussates to the opposite side of the mid-medulla (area is called the internal arcuate) -> after decussation it travels up as the medial lemnisucus and goes through the pons and midbrain up into the thalamus (VPL) -> projects through the internal capsule to the primary somatosensory cortex in the postcentral gyrus
what afferent sensory pathways does the face use to get to the postcentral sensory gyrus.
touching the face is similar to the body (medial lemniscus --> VPL) except it uses the trigeminal lemniscus via the ventral posterior medial nucleus thalamus (VPM) to somatosenory cortex
what sensory pathway can be destroyed by itself with multiple sclerosis?
medial longitudinal fasciculus (MLF) - controls coordination of eye movements
where is the sensory nucleus of trigeminal nerve located?
pons (also,trigeminal uses the VPM thalamus)
what does the lateral spinothalamic tract regulate and what would be the deficit?
contralateral pain and temperature since it as soon as it enters the spinal cord it decussates
what CN send sensory information to the vestibular nuclei?
CN III, IV, VI
how will Horner's Syndrome present and why does it present?
HS results from damage to the sympathetic fibers in the brainstem or spinal cord; ptsosis, anhydrosis, miosis, and injected conjunctiva
if someone presents with loss of pain and temperature on his right side of face and loss of P&T on left side of body with difficulty swallowing and a hoarse voice, what do you think of? why does this happen?
Lateral Medullary Syndrome aka Wallenberg's Syndrome occurs usually b/c of an infarction of the PICA or Verterbral artery - but always b/c the lateral medulla has been damaged
what is the most important ? you ask a headache patient?
How did it start? if it started because of lifting something (ie sudden onset) think SAH
If someone under 40 has a stroke, what should you think of as the cause?
DRUGs, esp cocaine, amphetamines
Name this syndrome. loss of motor, position sense, deviation of the tongue?
medial medullary syndrome due to anterior spinal artery occlusion.
clinically, how would one display a dorsal medullary syndrome and what is the cause?
due to vascular lesion of the medial branch of PICA and affects the inferior cerebellar peduncle; symptoms: nystagmus, vomiting, vertigo, and ataxia