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143 Cards in this Set

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  • Back
Show the control of reflex sensory fibers and UMN's on LMN activity.
When do the UMN exert their inhibitory effect on a reflex?
After one reflex contraction, they inhibit the LMN's.
The subcortical spinal tracts control which kinds of muscles?
trunk muscles
Can you show a pic of the corticospinal vs subcorticospinal tracts? (subcortical intitiated from cortical collaterals)
WHat happens if you have a lesion of one side of a corticospinal vs subcortical spinal tract? Why?
corticospinal- contralateral motor deficits
subcorticalspinal- no noticable deficits because they innervate trunk muscles bilaterally so the other side can compensate
Does the rubber mat or ViP only control flexor/extensors?
No they are biased towards f/e, but they can do both.
DO we have to consider the accessory motor pathways extensively? Why?
No because they are poorly understood and also compensate for one another because they have bilateral innervation.
Is the agonist muscle in a tendon stretch reflex the only muscle affected by the reflex arc? What other pathway happens?
No, the antagonist is inhibited via inhibitory interneurons.
Show a picture of the activating and inhibitory pathway in a muscle stretch (myotactic) reflex.
Is there an inhibitory interneuron present in the GTO reflex? WHat is the general rule?
Yes! Anytime you need to relax a muscle reflexively, there is an inhibitory interneuron involved.
What is an alternate name for the GTO reflex?
inverse muscle stretch reflex.
essentially what neurons are we trying to test for when we test a DTR?
all UMN's above it and the LMN at that level feeding that muscle.
Give the chart of what spinal level each DTR tests. (5)
What nerve is being tested in the patellar reflex? Which spinal roots come out to make this giant leg nerve?
The femoral nerve created by L2-L4
What nerve is being tested in the achilles tendon reflex? Which muscles does it innervate?
The posterior tibial nerve innervating the calf muscles (gastrocnemius and solieus)
What is he scale for grading muscle strength? What is 0?
0 is paralysis
Are people with UMN lesions going to have weakness? Why?
Yes because they have lost part of their ability to tell that muscle what to do. (nevermind that it is tense and hyperreflexive on its own)
What is he scale for grading muscle reflex? What is 0?
0 is no reflex
What kind of grade would a person with a LMN lesion vs UMN lesion get on DTR's? Normal?
LMN- 0
UMN- 4+
Normal- 2+
How would you use words to describe a DTR that is 2+?
Normal, moderately brisk
What is clonus?
repeated reflex contractions after a stretch
When does fasiculations vs atrophy come about in a severe LMN lesion?
fasiculations- early manifestation (during anterograde LMN degeneration)
atrophy- late manifestation
What are the clinical terms to define the type of weakness in LMN vs UMN lesions?
LMN- flaccid paralysis
UMN- spastic paresis (weakness) or paralysis (total loss of movement)
What does pathognomonic mean?
A sign that indicates a certain disease beyond a doubt
What is a positive babinski's sign pathognomic for?
an UMN lesion
What is the meaning of phyte?
something that grows on something else
Give a medical and ecological example of the usage of -phyte.
osteophyte- bone grwoth
saprophyte- fungus that grows of dead or decaying matter.
A person is weak. Do they have UMN or LMN lesion?
You don't know. It could be either.
How can you find out if it is LMN or UMN?
do a DTR test
LMN- areflexia
UMN- hyperreflexia/clonus
Is tone and reflexivity always in the same direction?
What happens if you have untreated carpal tunnel syndrome for a long time?
the median nerve will degenerate and then the muscles of the hand will atrophy
What sign happens before degeneration in a LMN lesion?
Do we know how fasiculations happen physiologically? What do they look like?
Like a bunch of muscle twitches. (no one really knows why so Dr. Najeeb was just making a plausible explanation)
Why does a UMN lesion usually just result in paresis rather than paralysis?
Because there are accessory UMN's (extrapyrimidal) to help with conrol of the muscle
Show a picture of decorticate vs decrerebate rigidity/posturing.
What kind of subcortical collateral lesion would result in decorticate or decerebate posturing? WHy?
the one to the red nucleus because this controls wrist muscles for support.
What determines if a pt with a UMN lesions will have paresis or paralysis?
the extent of the damage
What is the main 3 functions of the cerebellum?
1. To promote the smooth execution of muscle movements (fine tuning)
2. To plan muscle movements
3. Motor learning
What does it prevent?
1. Fine tuning function- jerky movements
2. Planning- something else (can't think of it)
How does the cerebellum do these things on a general level?
by comparing the intended movement (corticopontine) with the actual movement (spinocerebellar)
Show the vermis and how deep down the cerebellum it goes.
not just the cortex!
not just the cortex!
What muscles does the vermis vs paravermis/intermediate hemisphere control?
vermis- axial and proximal limb movements
paravermis- distal limb movements
What does the "lateral hemisphere" control? WHy does it's location next to the intermediate hemisphere make sense then>
motor planning
distal limbs need the most amount of motor planning
Show the flocculonodular lobe?
What region of there cerebellum (vermis etc) is it a part of?
It is a little bit of all of them depending on the zone.
Which part of the floccolonodular lobe looked the biggest?
The vermis part
So what can you infer about it's function from that?
it is important for control of trunk muscles
What are trunk muscles mainly used for?
Posture and balance
What is another name for the flocculonodular lopbe?
The archicerebellum
What structure does the flocculonodular lobe get it's input from?
The vestibular nuclei
So What are it's two functions?
1. Help body stand up (ViP) and balance
2. Regulate MLF for eye movement
Which region of the cerebellum will send out fibers to the extrapyrimidal tracts the most?
The vermis/flocculonodular lobe
What is the only type of neuron to exit the cerebellum?
purkinjie cells
What are the most giant cells in the cerebellum?
the purkinjie cells
What NT does the purkinjie cells only use? Implications?
GABA. All output of the cerebellum is inhibitory
What is the only type of input going into the cerebellum?
mossy and climbing fibers which are both excitatory
What do all purkinjie cells end at?
deep cerebellar nuclei, which means they carry out all the effective cerebellar output
What will the deep cerebellar nuclei neurons end on?
always UMN's (main and supporting)
What is the main function of the mossy fibers?
To update the cerbellum about ongoing movements or motor plans
What is the main function of the climbing fibers?
They update the cerebellum about errors in movment
What would you not have if you had damage to your inferior olive or the climbing fibers?
You would not be able to have motor learning
Name whihc fibers fufill the following functions.
Tell cerebellum about...
1. The motor plan
2. The motor outcome
3. Help with motor leanring
1. plan- corticopontine
2. outcome- spinocerebellar
3. learning- inferior olive/climbing fibers
Which spinocerebellar tracts are responsible for arm vs leg movement?
ventral- arm proprioception
dorsal- leg proprioception
(the slide on his lecture was ******* wrong, textbook)
What is the only real thing you need to know about what comes in and out of the cerbellar peduncles?
input comes through mainly the inferior and middle peduncles
output mainly goes through the superior
What are the two fissures of the cerebellujm?
primary and posterolateral
What is anterior and posterior in the cerebellum? (think embryology)
up top is anterior
Show the cerebellum and point out where the two fissures are
Show which region of the cerebellum each deep nuclei is in. Note their size and shape too.
Where do the do the deep cerebellar nuclei mainly send their fibers out? (peduncle) exception?
the superior peduncle except the vermis/flocculonodular lobe goes through the inferior
What is the general rule for what must pass through the thalamus?
Any fiber, sensory or motor, must pass through the thalamus if they want to REACH THE CORTEX
Judging from their functions, the fibers from which deep nuclei go to the red nucleus vs the corrtex?
red nucleus- paravermal- eboloform and globus
cortex- dentate
So which part of the thalamus will relay the denate nuclei fibers?
the ventral anterior and ventral lateral
Do the cerebellar cortical fibers cross? Where?
Yes, in the midbrain
What side of the cortex will the right cerebellum plan and fine tune for? What side of the body is this?
the left of the cortex
the right of the body
Show how the fibers cross back and forth in a frontal view.. Note which level they cross at.
What sx will a person with cerebellar disease have? Will they have weakness?
tremor WITH MOVEMENT (intention tremor)
no weakness
Which side will a pt tend to fall with a cerbellar lesion?
the side ipsilateral to the lesion
What kind of sx will a person will a pt with a vermal lesion have? Why?
an ataxic gait becase they cannot use their thigh muscles well
Dissect a-taxic gait.
a- not
taxic- ordered
disordered gait
How will a person with an ataxic gait walk? Why?
With their feet very far apart because they are probably scared of falling
What kind of ataxia is this when you have a cerebellar lesion?
a MOTOR ataxia
Under what conditions will a person with motor ataxia lose their balance?
under all conditions
do you have tremors with cerebellar lesions at rest?
no, only with movement
When do these intention tremors increase? Why?
As you are nearing the object because that requires the most fine tuning which you don't have.

Since it is motor, looking won't help it much.
What other two intention tremor disorders may people with cerebellar lesions have?
dysmetria and dysdiachokinesis
What is the classic test for dysmetria?
finger to nose
How many times do you need to test finger to nose?
Twice, once on each side.
What are the only two NT's used in the cerebellum?
GABA and glutamate
WHat two sx would someone with a flocculonodular lobe dysfunction have?
scanning speech (scanning dysarthria)
and abnormal conjugate gaze
What is scanning speech like?
you isolate each syllable you say so it sounds really chopped up.
dissect dys-arthria
dys- bad
arthria- articulation
What blood thing will damage purkinjie cells in the short vs long term?
short- alcohol excess
long- thiamine deficiency
What particular part of the cerebellum purkinjie are affected? Mnemonic?
the vermal purkinjie cells because they are involved with balance and officers use the straight line test
What is the main job of the basal ganglia?
To get movements started
How do the basal ganlia and cerebellum work together?
CB helps plan the movement
the BG gets the movement started
and the Cb makes sure it is run smoothly
What regions of the basal ganglia are subtelecephalic (4), diencephalon (1), and brainstem (1)?
subtelencephalic- CN, putamen, GPI, GPE
diencephalic- subthalamus
brainstem- SN
Is subtelencephalic part of the telencephalon?
WHat is the destination of the BG?
UMN in the cortex
WHat 4 NT's are used by the BG?
GABA, Glutamate,
ACh, dopamine
Show a netters diagram of what the internal capsule looks like.
What passes through the internal capsule?
highlight where the straitum is in the last pic.
Show a coronal view of what the internal capsule (blue) and striatum (red) look like.
What NT's will enhance the direct vs indirect pathways?
direct- DOPA
Indirect- ACh
WHat is it called to have two inhibitory neurons next to each other?
disinhibition (the following neuron is activated)
What things do the direct and indirect pathway have in common?
They both start and end with an excitatory neuron
They both contain one set of disinhibitory neurons
Which thalamic nuclei does the BG feed fibers through?
same as the cerebellum
VA and VL
What is the same about the begining couple of neurons in the direct and indirect pathways? What is different later?
They are both
The indirect has an extra alternamting inhibit-excite afterwards
How does the indirect pathways complement the direct?
It inhibits all other muscle movements so you can focus on the tast at hand
WHat is the net effect of dopamine on movement?
promotes more movement by aiding the direct and inhibiting the indirect
What is the MAIN effect of ACh?
To suppress unwanted movement and help the indirect pathway. (although it has a small aiding effect on the direct as well)
What kind of of tremors will parkinson's people have?
tremors at rest (problems in suppressing movement)
Basically sum up the main function of dopamine and ACh in the BG.
Dopamine- help direct pathway intitate movements
ACh- help indirect pathway suppress movements
Which side of the body will be afected by a lesion of the BG on one side?
the opposie side because the BG affects the ipsilateral cortex which innervates the contralateral body.
What pathway is affected in Parkinson's?
the direct pathway, which is underactive
WHy do pt's with Parkinsons get resting tremors then?
We're not really sure
What is an example of a parkinson's resting tremor? WHat does it look like?
A pill rolling tremor which looks like the pt is trying to roll a pill between their fingers
Show a pic of the guy with pill rolling tremors
Can parkinson's affect young people?
YES! Juvenille onset parkinson's
What can you see often in the dopaminergi neurons that are degenerating?
Lewy bodies which are eosinophilic inclusions containing alpha synuclein
What degenerates and where in Huntington's disease? Mnemonic?
The GABA neurons contained in the head of the caudate nucleus.
(why the caudate nucleus shrinks)
What happens to the activity of the cortex in Huntington's vs Parkinson's?
H- overactive
P- underactive
dissect the word chorea
dance (choreography) like
What is athetosis?
writing limb movements
Why don't we just give dopamine for parkinson's pts?
because it can't cross to BBB
Does L-DOPA fix all sx?
No, the resting tremors are still there and we don't know where they are coming from
WHat other drug could help people with parkinson's? WHy?
a muscarinic blocker so block the ACh's promoting of the indirect pathway... allowing more movement
What surgery has been shown to help with tremors?
taking out a part of the BG
Is L-DOPA a sustainable treatment option for Parkinson's?
No, it wears off over time
Wilson's disease is also known as _____ degeneration.
hepatolenticular degeneration
What is pathognomonic for Wilson's disease?
a Kayser-Flischner ring (can be VERY SUBTLE)
a Kayser-Flischner ring (can be VERY SUBTLE)
Will people with WIlson's have sx more like parkinson's or huntington's?
Either one depending on which pathway gets degeneration (direct or indirect)
what characteristic tremor will pts with wilson's get?
wing beating tremor
Show the boy with the wing beating tremor. Describe it?
arms contracted slightly and beating. No movement in legs.
arms contracted slightly and beating. No movement in legs.
What types of drugs are used to treat Wilson's?
a copper chelator or another mineral to block absorption
Which is the copper chelator?
which is the mineral to block absorption?
zinc acetate
What type of stroke causes a hemiballism? (think logically)
It would havew to be an intracranial stroke to reach the subthalamus.
Specifically, a lacunar hemorrhagic stroke.
Whaty disease is this? What side of the body is affected?
Whaty disease is this? What side of the body is affected?
Parkinson's disease for the left side of the body
Why is the substantia niagra black?
It releases melanin as a byproduct of dopamine synthesis.