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0113 - Neuro 2/3 Flashcards

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1
Q

Purpose of the foramina of Luschka and Magendie?

A

Connect 4th ventricle to the subarachnoid space. Luschka = Lateral. Magendie = Medial.

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2
Q

NPH

A

Expansion fo ventricles distorts fibers of the CORONA RADIATA -> urinary incontinence, ataxia, cognitive dysfunction

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3
Q

Communicating hydrocephalus

A

Decreased CSF absorption by arachnoid graduation lead to inc. ICP, papilledema, herniation

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4
Q

Hydrocephalus ex vacuo

A

Apparent increase of CSF 2/2 atrophy. ICP is normal. (e.g. Alzheimer’s, adv. HIV, Pick)

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5
Q

Noncommunicating hydrocephalus

A

Due to a structural blockage within the CSF system

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6
Q

How many spinal nerves are there?

A

31 spinal nerves. “Have the spine of a man walking outside on January 31st.”

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7
Q

Which nerves exit above their corresponding vertebra?

A

C1-C7.

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8
Q

To what vertebrae does the spinal cord extend to? And where do you do a LP?

A

Lower border of L1-L2. LP usu. between L3-L4 or L4-L5. Subarachnoid space down to S2.

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9
Q

Dorsal column body organization

A

Fasciculus gracilis (lower body and legs) are inside. Fasciculus ceunatus (upper body, and arms)

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10
Q

Anterolateral system body organization

A

Lateral spinothalamic tract. Sacral outside to cervical inside.

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11
Q

Corticospinal tract body organization

A

Sacral lateral. Cervical medial.

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12
Q

Anterolateral system pathway

A

Free nerve endings synapse in ipsilateral gray matter and decussates within 2-3 levels in anterior white commisure, ascending CONTRlaterally, synapsing at VPL -> sensory cortex

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13
Q

Dorsal column pathway

A

Fine touch, vibration, pressure, propioception enter spinal cord and ascend ipsilaterally until it synapses at the nucleus cuneatus (lateral) or gracilis (medial) -> decussates at the MEDULLA and ascends contralaterally up the medial lemniscus -> synapses at VPL -> sensory cortex

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14
Q

Spastic paralysis vs. flaccid paralysis

A

UMN vs. LMN signs

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15
Q

ALS

A

Combined UMN and LMN w/ NO sensory, cognitive, or oucular motor deficits. Some etio = defective superoxide dismutase I. Riluozole tx modest (dec. presynaptic glutamate release).

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16
Q

Tabes dorsalis

A

Tertiary syphilis -> demyelination of dorsal columns and roots -> impaired sensation, propioception, coordination. Charcot joints, Argyll Robertson pupils (small pupils that accommodate but do not react to light). Absent DTRs and POS romberg

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17
Q

Syringomyelia

A

Syrinx damages anterior white commisure -> b/l loss of pain and temperature

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18
Q

Poliomyelitis

A

Poliovirus (oropharynx and SI replication before spreading hematogenously to CNS). Destruction of anterior horn cells -> LMN death. Weakness, hypotonia, flaccid paralysis, fasciculations. CSF shows inc. WBCS and slight increased protein w/ NO CSF glucose change.

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19
Q

Spinal muscular atrophy (Werdnig-Hoffmann disease)

A

Congenital degeneration of anterior horn cells. AR.

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20
Q

Friedreich ataxia

A

AR GAA on Chromosome 9 (frataxin) -> mt dysf(x). Muscle weakness and loss of DTRs. Staggering, frequent falls,nystagmus, pes caves, hypertrophic cardiomyopathy

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21
Q

Brown-Sequard syndrome

A

Hemisection. Ipsilateral UMN signs (corticospinal). Ipsilateral dorsal column. Contralateral anterolateral. (pain and temperature). At the level of lesion, loss of all sensation. Above T1, could have Horner’s syndrome

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22
Q

Horner syndrome and its pathway.

A

Ptosis (superior tarsal m.), Anhidrosis and flushin, Miosis. Hypothalamus to synapse in lateral horn of intermediolateral column of spinal cord (T1) -> superior cervical (sympathetic) ganglion (which is near bifurcate of common carotid) synapse -> sweat glands of face, opthalmic division of trigeminal nerve for pupillary dilator, sweat glands of forehead + smooth muscle of eyelid

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23
Q

C2 vs. C3

A

Posterior part of skull cap vs. high turtleneck

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24
Q

Spinal cord lvls that would affect erection

A

S2,3,4

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25
Biceps reflex
C5,6
26
Triceps reflex
C7,8
27
Patellar reflex
L3,4
28
Achilles reflex
S1,2
29
Cremaster reflex
L1,L2
30
Anal wink reflex
S3,S4
31
When are primitive reflexes exhibited?
Before age 1. Or "frontal release" (adult with frontal lobe lesions)
32
Galant reflex
Stroking one side of spine while ventral suspension causes lateral flexion of lower body toward stimulated side
33
Parinaud syndrome
Paralysis of conjugate VERTICAL gaze 2/2 lesion in superior colliculi (e.g. pinealoma)
34
Inferior colliculi
auditory
35
What are the cranial nerves that have both sensory and motor nerves?
CN V, VII, IX, X. "Some say marry money, but my brother says big brains matter most."
36
Midbrain vs. Pons vs. Medulla CN nuclei
Midbrain = CN III, IV. Pons = V, VI, VII, VIII. Medulla = IX, X, XII. Pons 5-8. Generally, lateral nuclei are sensory while medial nuclei are motor.
37
Corneal reflex?
Afferent V1, efferent VII (orbicularis oculi)
38
Lacrimation reflex
Afferent V1, efferent VII.
39
Jaw jerk reflex
Afferent V3 (masster spindle), efferent V3 (masseter)
40
The vagal nuclei
Nucleus solitarius, nucleus ambiguus, dorsal motor nucleus
41
Nucleus solitarius
S for Sensory. Visceral sensory (taste, baro, gut distenstion. CN VII, IX, X.
42
Nucleus ambiguus
M for MOTOR - pharynx, larynx, upper esophagus. IX, X, XI.
43
Dorsal motor nucleus
Parasympathetics of heart, lungs, upper GI. CN X
44
Parotid, submandibular, and sublingual gland innervation?
Parotid = CN IX. Other two are CN VII.
45
Superior orbital fissure
CN III, IV, V1, VI, opthalmic vein, sympathetic fibers
46
Foramen rotundum
CN V2
47
Foramen ovale
V3. CN V = Standing Room Only
48
Foramen spinosum
Middle meningeal artery
49
Internal auditory meatus
CN VII, VIII
50
Jugular foramen
CN IX, X, XI, jugular vein
51
Hypoglossal canal
CN XII
52
What's in the cavernous sinus?
CN III, IV, V1, V2, VI, post-ganglionic sympathetics.
53
Cavernous sinus syndrome
Opathlmoplegia , decreased corneal and maxillary sensation with NORMAL VISUAL acuity. CN VI common.
54
Middle ear ossicles
Malleus, incus, stapes
55
Rinne test
Abnormal in conductive hearing loss (Bone > air) but normal in sensorineural (air > bone).
56
Weber test
Localizes to affected ear in conductive hearing loss. Localizes to unaffected ear in sensorineural hearing loss.
57
Muscles of Mastication
Masseter, Temporalis, Medial pterygoid CLOSE. Only opener is lateral pterygoid. M's munch. Lateral lowers.
58
Uveitis
Inflamation of anterior urea and iris. Sterile pus, conjuctival redness. Associated with sarcoid, RA, JIA, TB, HLA-B27
59
Hyperopia vs. myopia vs. presbyopia?
Myopia = short-sighted b/c eye is too long (football!). Hyperopia = far-sighted b/c eye is too compressed. Presbyopia = decreased focusing ability during accommodation 2/2 sclerosis and decreased elasticity
60
Retinitis
Retinal edema and necrosis that can lead to a scar. Often viral and associated with immunosuppresion.
61
Central retinal artery occlusion
Acute, PAINless, monocular vision loss. Cloud retina and cherry-red spot at the fovea.
62
Retinal vein occlusion
Retinal hemorrhage and edema
63
Diabetic retinopathy
Non-proliferative type is due to leakage of of blood, lipids, and fluid (tx w/ blood sugar control and macular laser). Proliferative type is due to angiogenesis b/c of chronic hypoxia (tx w/ peripheral retinal photocoagulation, anti-VEGF injections)
64
Aqueous humor pathway
Ciliary epithelium produces aqueous humor (Beta stimulation). Aqueous soln moves through posterior chamber in the space between the iris and the lens, then moves into the anterior chamber where it is collected via trabecular meshwork into the Canal of Schlemm.
65
Glaucoma
Optic disc atrophy and progressive PERIPHERAL visual field loss associated w/ increased IOP
66
Open angle glaucoma
Associated with in creased age, AA, family. Painless. Primary - unknown. Secondary - blocked trabecular meshwork b/c of WBC's (uveitis), RBCs (vitreous hemorrhage), retinal elements (retinal detachment)
67
Closed/narrow angle glaucoma
Primary - enlargement or forward movt of lens against the central iris leads to OBSTRUCTION of aqueous flow. Fluid build-up behind iris also pushes peripheral iris against cornea to impede trabecular meshwork flow. Secondary - hypoxia from retinal disease induces a vasoproliferation in the iris that contracts the angle. Acute closure from increased IOP is PAINFUL, frontal headache. No Epi b/c mydriatic.
68
Cataract
Painless often b/l opacification of the lesion. RF include age, smoking EtOH, excessive sunlight, cortico, classic galatosemia, galactokinase deficiency, DM, trauma, infection
69
How does miosis happen?
Edinger-Wetphal nucleus to ciliary ganglion piggy-backing CN III. After synapse, short ciliary nerves to pupillary sphincter
70
How does mydriasis happen?
From hypothalamus to ciliospinal center of Budge (C8-T2!). Exit T1 to superior cervical ganglion. Then move through plexus on internal carotid, through cavernous sinus, through long ciliary nerve to pupillary dilators
71
Pupillary light reflex
From retina to CN II to pretectal nuclei - activates b/l Edinger-Westphal -> miosis.
72
Marcus Gunn pupil
Afferent pupillary defect
73
Cranial nerve III anatomy
Is fed from outside in. Motor components INSIDE are vulnerable to DM. Parasympathetic output (outside) are vulnerable to compression (blown pupil)
74
Internuclear opthalmoplegia
lesion in MLF leads to lack of coordination between eyes.. CN III talking to opposite CN VI. So, when Left eye moves left and right eye does not, the R oculo III isn't syncing with L abducens, so it is the Right MLF that is NOT working. (III is priority) for a Right INO (refers to eye that is paralyzed)

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