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159 Cards in this Set
- Front
- Back
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What are the developing brain regions called and what do they give rise to?
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1. Telecephalon --> cerebral hemispheres, lateral ventricles
2. Diencephalon --> thalamus, 3V 3. Mesencephalon --> Midbrain, Aqueduct 4. Metencephalon --> Pons (aqueduct) and cerebellum (4V) 5. Myelencephalon --> Medulla |
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What are the different types of spina bifida?
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1. Spinal bifida occulta: failure of bony spinal canal to close - no structural herniation, dura is intact
2. Meningocele: meninges herniates through SC defect 3. Meningomyelocele: meninges and SC herniate through SC |
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What findings are asc w/ spinal bifida?
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inc a-fetoprotein in amniotic fluid and maternal seruc
low folic acid levels |
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What cells are glial cells and what do they do?
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1. Astrocytes - physical support, repair, K+ metabolism, help maintain bbb
2. Ependymal - inner lining of ventricles, make CSF 3. Oligodendorglia - central myelin production |
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What do microglia do and where are they derived?
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macrophages of brain
Mesoderm |
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What do microglia look like w/ Nissl stains?
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small irregular nuclei w/ relatively little cytoplasm
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What is the difference b/w oligodendroglia and Schwann cells?
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olgi - myelinate multiple CNS axons
Schwann - only 1 |
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What do oligodendroglia look like in Nissl stain and H&E?
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Nissl - small nucleus w/ dark chromatin and little cytoplasm
H&E - fried eggs |
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What are the layers of a peripheral nerve?
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Endoneurium - around single nerve fiber
Perineurium - surrounds fascicle of fibers Epineurium - surrounds entire nerve (fascicles + blood vessels) |
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Which layer in the peripheral nerve is permeable?
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Perineurium
*must be reattached in microsurgery |
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What neurotransmitters is located in the locus ceruleus?
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NE
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What neurotransmitters is located in the ventral tegmentus and SNe?
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Dopamine
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What neurotransmitters is located in the Raphe nucleus?
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5-HT
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What neurotransmitters is located in the Basal nucleus of Meynert?
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ACh
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What forms the blood-brain barrier?
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3 structures:
1. tight junctions b/w nonfenestrated cap endothelial cells 2. basement membrane 3. astrocyte processes |
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What does the hypothalamus function and what regions are involved?
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TAN HATS
1. thirst and water balance (supraoptic nucleus) 2. Adenohypophysis control 3. Neurohypophysis and median eminence (release hormones synthesized in hypothalamic nuclei) 4. Hunger (lateral area) and satiety (ventromedial) 5. Autonomic regulation (anterior regulates parasymp, post regulates sympathetic) and circardian rhythms (suprachiasmatic) 6. Temperature reg (post - heat conservation and production, ant - cooling) 7. Sexual urges and emotiona (septal nucleus) |
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What is released from the neurohypophysis and from which nuclei do they originate?
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oxytocin - paraventricular
ADH - supraoptic |
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What are the nuclei of the thalamus and what does each do?
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1. Lateral geniculate nucleus - visual
2. Medial geniculate nucleus - auditory 3. Ventral post nucleus, lateral part - body sensation 4. Ventral post nucleus, medial part - facial sensation 5. Ventral ant/lateral nuclei - motor |
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What is the blood supply to the thalamus?q
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Post communicating
Post cerebral Ant choroidal art |
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What structures are included in the limbic system and what do they control?
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1. Cingulate gyrus
2. Hippocampus 3. Fornix 4. Mammillary bodies 5F's = Feeding, Fleeing, Fighting, Feeling, sex |
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What are the inputs to the cerebellum?
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Climbing and mossy fibers
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What are the outputs of the cerebellum?
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Purkinje fibers
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What are the basal ganglia important for?
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voluntary movements and making postural adjustments
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What is the direct pathway in the basal ganglia?
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Cortex of D1 from SNc --> Striatum --> inhibit GPi --> disinhibition of thalamus --> cortex
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What is the indirect pathway in the basal ganglia?
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D2 from SNc --> inhibits striatum --> inhibition of GPe --> Disinhibition of STN --> activation of GPi --> inhibition of thalamus --> inhibition of cortex
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What lobe is Broca's area in?
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Frontal
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What lobe is Wernicke's area in?
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Temporal lobe
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What is the arcuate fasciculus?
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Connection b/w Broca's and Wernicke's area
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Where is the sylvian fissure?
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b/w the frontal and temporal lobe
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What does damage to the frontal lobe cause?
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disinhibition - lack of social judgement
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What is the medial and lateral representation of the motor and sensory cortex?
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Medial - leg
Lateral - face |
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What does the anterior cerebral artery supply?
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medial surface of brain
leg-foot area of motor and sens cortex |
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What does the middle cerebral artery supply?
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lateral aspect of brain
trunk-arm-face area of motor and sens cortex Broca's and Wernicke's speech area |
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What does the posterior cerebral artery supply?
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Occipital lobes
part of temporal lobe |
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What vessels make up the Circle of Willis?
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Vertebral --> Basilar --> Post cerebral --> Post communicating --> Middle cerebral --> Ant communicating
PICA (from ventral) AICA (from basilar) Ant cerebral art (from ant communicating) |
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Where does the venous sinuses run?
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dura mater where meningeal and periosteal layers separate
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What vessels drain the brain?
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Sup sagittal sinus
Sup ophthalmic Cavernous sinus Sphenoparietal sinus Great cerebral vein of Galen Straight sinus Occipital sinus Transverse sinus Sigmonid sinus Int jugular |
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What is the CSF flow in the ventricles?
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Lateral ventricels --> foramen of Mono --> 3V --> cerebral aqueduct --> 4V --> foramina of Luschka and foramina of Magendie --> subarachnoiod space
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How many spinal nerves are there and where do they exit?
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31
C1-C7 - intervertebral foramina C8 and below - below |
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Where does vertebral disk herniation usually occur?
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L5-S1
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Where does the spinal cord end in adults and where is spinal tap done?
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L1-L2
L4 (To keep cord alive, keep the needle b/w L3 and L5) |
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What structures are pierced in a lumbar puncture?
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1. skin/superficial fascia
2. ligaments (supraspinous, interspinous, ligamentum flavum) 3. Epidural space 4. Dura mater 5. Subdural space 6. Arachnoid 7. Subarachnoid *Pia not pierced |
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Trace the dorsal column pathway
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1. Sensory nerve endings --> cell body in dorsal root ganglia --> enters SC, ascends ipsilaterally in dorsal column
2. Synapses in nucleus cuneatus or gracilis (medulla) 3. Decussate in medulla (arcuate fibers) --> ascends contralaterally in medial lemniscus --> 4. Synapse on VPL of thalamus --> 5. Synapse onto sens cortex |
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What info does the dorsal column pathway provide?
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ascending pressure, vibration, touch and proprioceptive
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Trace the spinothalamic pathway
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1. Sensory nerve endings (Ad and C fibers) --> enters spinal cord
2. Synapses ipsilateral gray matter (SC) 3. Decussates at ant white commissure --> ascends contralaterally 4. Synapses at VPL of thalamus 5. Synapses at sensory cortex |
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What info does the spinothalamic pathway provide?
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Ascending pain and temp sensation
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Trace the lateral corticospinal tract
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1. Cell body in 1o motor cortex --> descends ipsillaterally until decussating at caudal medulla (pryamidal decussation) --> descends contralaterally
2. Synapses on lower motor neuron 3. synapses on NMJ |
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Where tract do the legs follow in the dorsal column?
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Fasciculus gracilis
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What is the pudendal block landmark?
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ischial spine
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What is the appendix landmark?
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2/3 way from umbilicus to ant sup iliac spine (McBurney's point)
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What is the lumbar puncture landmark?
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Iliac crest
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C2 dermatome
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post half of skull - "cap"
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C3 dermatome
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high turtleneck shirt
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C4 dermatome
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low-collar shirt
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T4 dermatome
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nipple
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T7 dermatome
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xiphoid process
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T10 dermatome
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umbilicus
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L1 dermatome
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inguinal ligament
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L4 dermatome
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kneenaps
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S2, S3, S4 dermatome
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erection and sensation of penile and anal zones
S2, 3, 4 keep the penis off the floor |
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How do muscle spindles work?
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parallel w/ muscle fiber
muscle stretch --> intrafusal stretch --> stimulates Ia afferents --> stimulates a motor neuron --> reflex muscle (extrafusal) contraction) |
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How does the gamma loop work?
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CNS stimulates gamma motor neuron --> contracts intrafusal fiber --> inc sensitivity of reflex arc
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What do muscle spinals monitor?
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length
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What do Golgi Tendon organs monitor?
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Tension
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What level is the biceps reflex?
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C5
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What level is the tricepts reflex?
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C7
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What level is the patella reflex?
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L4
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What level is the Achilles reflex?
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S1
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What is the Moro reflex?
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extension of limbs when startled
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What is the Rooting reflex?
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Nipple seeking
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What is the palmar reflex?
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grasps objects in palm
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How does a facial nerve lesion manifest?
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complete ipsilateral paralysis of muscles
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How does a corticobulbar lesion present?
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drooping of corner of mouth on contralateral side only
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Where is the pineal gland and what does it do?
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Dorsal midbrain - melatonin secretion, circadian rhythms
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Where is the superior colliculi and what does it do?
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Dorsal midbrain - conjugate vert gaze center
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Where is the inferior colliculi and what does it do?
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Dorsal midbrain - auditory
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What is the Parinaud syndrome and what is most common cause?
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Paralysis of conjugate vert gaze due to lesion in superior colliculi
(pinealoma) |
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What does CN VII do?
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facial movement
taste from ant 2/3 of tongue lacrimation salivation eyelid closing stapedius muscle |
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What does CN V do?
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mastication, facial sensation
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What does CN IX do?
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Taste from post 1/3 of tongue
swallowing salivation (parotid) monitoring carotid body and sinus chemo and baroreceptors Stylopharyngeus |
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What does CN X do?
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Taste from epiglottic region
Swallowing Palate elevation Talking Coughing Thoracoabdominal viscera Monitoring Ao arch chemo and baroreceptors |
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What does CN XII do?
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tongue movement
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What CN originate in the midbrain?
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III, IV
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What CN originate in the pons?
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V, VI, VII, VIII
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What CN originate in the medulla?
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IX, X, XI, XII
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Where are sensory nuclei in relation to motor nuclei in the brain stem?
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Lateral
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What are the afferent and efferent nerves in the corneal reflex?
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A = V1
E = VII |
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What are the afferent and efferent nerves in the lacrimation reflex?
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A = V1
E = VII |
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What are the afferent and efferent nerves in the jaw jerk reflex?
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A = V3 (sens)
E = V3 (motor) |
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What are the afferent and efferent nerves in the pupillary reflex?
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A = II
E = III |
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What are the afferent and efferent nerves in the gag reflex?
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A = IX
E = IX, X |
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What are the vagal nuclei and what does each do?
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1. Nucleus Solitarius - visceral sensory infomration (taste, baroreceptor, gut distention) - VII, IX, X
2. Nucleus ambiguus - motor innervation of pharynx, larynx and upper esophagus (swallowing, palate elevation) - IX, X, XI 3. Dorsal motor nucleus - send autonomic (para) fibers to heart, lungs and upper GI |
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What bone is the middle cranial fossa in and what CN go through it?
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Sphenoid bone - CN II-VI
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What structures cross through the middle cranial fossa and through what section do they do so?
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1. Optic canal = CN II, opthalmic art, central retinal vein
2. Sup orbital fissure = CN III, IV, V1, VI, ophthalmic vein 3. Foramen Rotundum = V2 4. Foramen Ovale = V3 5. Foramen spinosum = middle meningeal art |
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What bone is the posterior cranial foosa in and what CN go through it?
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temporal and occipital bone - CN VII-XII
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What structures cross through the middle cranial fossa and through what section do they do so?
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1. Internal auditory meatus = CN VII, VIII
2. Jugular foramen - IX, X, XI, jugular vein 3. Hypoglossal canal - XII 4. Foramen magnus - spinal roots of XI, brain stem and vert arteries |
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What structures pass through the cavernous sinus?
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CN III, IV, V1, V2 and VI
postganglionic symp fibers cavernous portion of int carotid art |
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What eye nerve doesn't pass through the cavernous sinus?
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VI
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What is cavernous sinus syndrome and how does it present?
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mass effect --> ophthalmoplegia, opthalmic and max sensory loss
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What does saying "kuh-kuh-kuh" test and what nerve is involved?
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palate elevation - X
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What does saying "la-la-la" test and what nerve is involved?
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tongue (XII)
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What does saying "mi-mi-mi" test and what nerve is involved?
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lips (VII)
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What are the muscles that close and open jaw and what are they innervated by?
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Close = masseter, temporalis, med pterygoid
Open = lat pterygoid V3 |
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What are all muscles with the word glossus in their name innervated by and what is the exception?
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hypoglossal nerve
Except - palatoglossus = X |
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What are all muscles with the word palat in their name innervated by and what is the exception?
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Vagus
Except - tensor veli palantini = V |
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What are the different types of sensory receptors, where is each found and what does it do?
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1. Free nerve endings (C, Ad) - skin - pain and temp
2. Meissner's corpuscle - hairless skin (fingertips) - dynamic find touch 3. Pacinian - deep skin layer, ligaments and joints - vibration 4. Merkel's disk - hair follicles - static touch (shapes, edges, texture) |
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What is the consistency of perilymph and what tubes are filled with it?
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Na+ rich
Cochlea, vestibule and semicircular canals |
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What is the composition of endolymph and which tubes are filled with it?
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K+ rich
Membranous labyrinth = cochlear duct (w/i cochlear), utricle and saccule (w/i vestibule) and semicircular canals |
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Where are hair cells located?
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Organ of Corti
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Where is teh maculae contained and what does it detect?
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utricle and saccule - linear acceleration
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What detects angular acceleration?
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Ampullae w/i semicircular canals
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What part of the cochlear membrane transmits high and low frequencies?
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Scuba flipper
High = base (narrow/stiff) Low = apex (wide, flexible) |
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What are the Rinne and Weber results for conductive hearing loss?
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Rinne - (bone>air)
Weber - localizes to affected ear |
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What are the Rinne and Weber results for sensorineural hearing loss?
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Rinne + (air> bone)
Weber - localize to normal ear |
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What are the eye muscles innervated by and what action to they do?
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CN VI = LR (abduct)
CN IV = SO (adduct + down) III = rest |
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What results with damage to CN III, IV and VI?
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III = eye looks down and out
IV - diplopia and downward gaze VI = medially directed eye |
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Trace the pupillary light reflex
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Light --> either retina --> CN III --> pretectal nucleus of both --> Edinger-Westphal nucleus of both --> bilateral pupil contraction
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What is the Marcus Gunn phenomonon and what is it due to?
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Afferent pupillary defect
optic nerve damage, retinal detachment |
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What would a lesion in the R optic nerve cause?
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R. anopia (no vision from R, all from L)
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What would a lesion at the optic chiasm cause?
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Bitemporal hemianopia (both temporal fields lost)
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What would a lesion at the R optic tract cause?
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L. homonymous hemianopia (L temp and R nasal)
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What would a lesion in the R. Meyer's loop (temp lobe) cause?
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L. upper quadrantic anopia (L upper temp, R upper nasal)
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What would a lesion in the dorsal optic radiation (parietal lobe) cause?
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L. lower quadrantic anopia (L. lower temp, R. lower nasal)
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What would a lesion in the calcarine fissue cause?
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L. hemianopia w/ macular sparing (L . temp w/ central intact, R. nasal w/ central intact)
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What would a lesion in the macula cause?
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Central scotoma (central vision gone)
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How does the MLF pathway work?
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1. Turning head to side activates VIII -->
2. Ipsilat vestibular nucleus --> synapses --> 3. contralat CN VI nucleus --> synapses --> 4. ipsilat LR and contralat CN III --> synapse 5. Ipsilat MR Eyes turn opposite direction head has turned |
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What is internuclear ophthalmoplegia?
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lesion in MLF --> medial rectus palsy on attempted lateral gaze and nystagmus in the abducting eye
convergence is normal |
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Where is MLF syndrome common seen?
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MS
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What is anencephaly and how does it present?
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malformation of ant end of neural tube -->
no brain/calvarium, inc AFP and polyhydramnios |
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What is holoprosencephaly, how does it present and what is it asc w/?
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dec separation of hemispheres across midline -->
cyclopia Asc w/ Patau's syndrome and severe fetal alcohol syndrome |
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What are signs of upper motor neuron damage?
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+:
Weakness Babinski Spastic paralysis Inc: Reflexes Tone No: atrophy or fasciculations |
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What are signs of lower motor neuron damage?
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+: weakness, atrophy, fasciculations
dec: reflexes, tone No: babinski or spastic paralysis |
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Where is the lesion in Poliomyelitis and Werdnig-Hoffmann dz and how does it present?
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Ant horns only - lower motor neuron dz
Flaccid paralysis |
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Where is the lesion in MS and how does it present?
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Mostly white matter of cervical region - random and asymmetric lesion
scanning speech, intention tremor, nystagmus |
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What is the lesion with complete occulsion of anterion spinal art and how does it present?
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Everything but dorsal column and tract of Lissauer
intact sensation (not pain/temp) only |
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What is the lesion in Tabes dorsalis and how does it present?
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Degeneration of dorsal roots and dorsal column -->
impaired proprioception and locomotor ataxia, Charcot's joint, shooting pain, absence of DTR |
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What is the lesion in syringomyelia and how does it present?
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Crossing fibers of spinothalamic tract damaged -->
bilateral loss of pain and temp sensation |
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What is the lesion in B12 neuropathy and Friedreich's ataxia and how does it present?
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Demyelination of dorsal column, lateral corticospinal and spinocerebellar tracts -->
ataxic gait, hyperreflexia, impaired position and vibration sense |
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What is syringomyelia, where does it commonly present, and what is it often asc w/?
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Enlargement of central canal of spinal cord
C8-T1 Often present in pts w/ Arnold-Chiari malfomration |
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What is Brown-Sequard syndrome and how does it present?
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Hemisection of SC -->
1. Ipsilateral UMN signs below lesion (corticospinal) 2. Ipsilateral loss of tactile, vibration, proprio below lesion (dorsal column) 3. Contralat pain and temp loss below lesion (spinothalamic) 4. Ipsilateral loss of all sensation at level of lesion 5. LMN sings (flaccid paralysis) at level of lesion *If above T1 --> Horner's syndrome |
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What is Horner's syndrome, what is it asc w/ and how does it present?
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Sympathectomy of face
Lesions of SC above T1 (Pancoast tumor, Brown-Sequard, late-stage syringomyelia) PAM is Horny 1. Ptosis 2. Anhidrosis (no sweat) and flushing on affected side 3. Miosis (pupil constriction) |
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What is the pathway interrupted in Horner's syndrome?
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Hypothalamus --> intermediolateral column of SC --> Sup cervical (symp) ganglion --> pupil, smooth muscle of eyelids and sweat glands of forehead and face
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What is the consequence of a lesion to Broca's area?
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motor aphasia (nonfluent/expressive) w/ good comprehension
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What is the consequence of a lesion to Wernicke's area?
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Sensory aphasia (fluent/receptice) w/ poor comprehension
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What is the consequence of a lesion to arcuate fasciculs?
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Conduction aphasia - poor repetition w/ good comprehension, fluent speech
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What is the consequence of a lesion to amygdala (bilateral)
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Kluver-Bucy syndrome - hyperorality, hypersexulaity, disinhibited behavior)
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What is the consequence of a lesion to frontal lobe?
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personality change and deficits in concentration, orientation and judgement...may have reemergence of primitive reflexes
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What is the consequence of a lesion to R parietal lobe?
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spatial neglect syndrome
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What is the consequence of a lesion to reticular activating system?
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Red levels of arousal and wakefulness (coma)
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What is the consequence of a lesion to mammillary bodies (bilat)?
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Wernicke-Korsakoff syndrome
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What is the consequence of a lesion to basal ganglia?
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tremor at rest, chorea or athetosis
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What is the consequence of a lesion to cerebellar hemisphere?
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Intention tremor, limb ataxia
*ipsilateral deficits |
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What is the consequence of a lesion to cerebellar vermis?
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truncal ataxia
dysarthria |
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What is the consequence of a lesion to subthalamic nucleus?
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contralateral hemiballismus
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What is the consequence of a lesion to hippocampus?
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anterograde amnesia - can't make new memories
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What is the consequence of a lesion to parapontine reticular formation?
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eyes look toward side of lesion
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What is the consequence of a lesion to frontal eye fields?
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eyes look away from lesion
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What is normal pressure hydrocephalus and how does it present?
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enlarged ventricles w/ normal opening pressure on lumbar puncture (impaired absorption)
dementia, gait problems and urinary incontinence |
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What is noncommunicating hydrocephalus?
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Structural blockage of CSF
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