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Bateman - Phase 2a COPY > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the anatomical planes and what direction is each?

A
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2
Q

What are the anatomical planes? (advanced)

A
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3
Q

What are the different types of motor nerve fibres?

A

—MOTOR,

  • somatic
  • branchial
  • autonomic
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4
Q

What are the different types of sensory nerve fibres?

A

—SENSORY,

  • somatic
  • autonomic
  • special
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5
Q

What functions do somatic, branchial, autonomic and special have?

A

—Somatic (sensory and motor)

—Branchial (motor only)

—Autonomic (sensory and motor)

—Special (sensory only)

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6
Q

Where does the somatic nervous system arise from?

A

Somas.

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7
Q

Where does the branchial nervous system arise from?

A

Branchial arches.

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8
Q

Where is the autonomic nervous system from?

A

Arise in the most evolutionary primitive parts of the brain

No conscious control;

Smooth and cardiac muscle,

Glands

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9
Q

Where does the special nervous system come from?

A

—Senses which have evolved specialized organs; arise in more evolutionary advanced parts of the brain

Olfaction

—Vision

—Hearing

—Balance

Taste

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10
Q

Where does the peripheral nervous system come from?

—

A

From spinal cord; somatic, autonomic (sensory and motor)

—From brain; somatic, branchial, autonomic, special (sensory and motor)

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11
Q

What is a dermatome?

A

Area of skin supplied by a single spinal nerve

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12
Q

What is a myotome?

A

A volume of muscle supplied by a single spinal nerve

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13
Q

What are some important points for myotomes?

A

T4 nipples

T10 umbilicus

L1 and L2 are pockets

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14
Q

What are the divisions of the autonomic nervous system?

A
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15
Q

What is the function of the spinal cord?

A

—Part of the central nervous system

—

—The pathway for motor control from the brain to the body

—The pathway for sensory information from the body to the brain

—

—Some integration of signals at spinal cord levels

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16
Q

What does grey matter and white matter do?

A

Grey matter has neurons in.

White matter has axons and myelin.

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17
Q

Broadly what does each part of the white matter do?

A

Anterior does motor.

Posterior does sensory.

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18
Q

What happens in the lateral corticospinal tract?

A

Come from cortex, decussate in medulla and influence the contralateral side.

80%

20% in anterior corticospinal tract.

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19
Q

What is in the dorsal column? What do they focus on?

A

Fasciculus gracilis

Fasciculus cuneatus

Proprioception.

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20
Q

Where does motor tracts come from?

A

Precentral gyrus.

Through internal capsule

Crura cerebri

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21
Q

What is the lateral corticospinal tract for? Where does it origin and decussate?

A

Rapid skilled voluntary movement.

Contralateral Motor Cortex

Pyramids

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22
Q

What does the anterior corticospinal tract do? Where does it originate and decussate?

A

Motor cortex.

Thoracic cord.

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23
Q

Where do the descending motor tracts terminate?

A
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24
Q

Where does the dorsal column originate and decussate? What sensation and where does it project to?

A

Leg, Arm.

Upper Medulla

Touch vibration, conscious muscle/joint sense

Sensory cortex (post central)

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25
Q

What does the posterior spinocerrebellar sensate, where does it decussate and where does it project to?

A

non-conscious muscle/joint sense

Ipsilateral

Inf cerrebellar ped

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26
Q

What does the anterior spinocerrebellar sensate, where does it decussate and where does it project to?

A

non-conscious muscle/joint sense

immediate

superior cerebellar ped

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27
Q

Where does the anterior spinothalamic tract project, what does it sense, where does it deccusate?

A

Thalamus

Light touch pressure

Several segments

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28
Q

Where does the lateral spinothalamic tract decussate, what does it sense, where does it project?

A

Two segments

Pain, temperature

Thalamus

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29
Q

What happens in Brown-Sequard syndrome?

A
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30
Q

How can you divide the spinal cord further?

A

Sacral.

Lumbar

Thoracic zones

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31
Q

How is it possible to give somebody an epidural?

A

—The spinal cord finishes at L1

—The corda equina continues through the lumbar vertebra

—The cell bodies for the sensory neurones are in the dorsal root ganglia

—Cell bodies have a higher surface area and take up anaesthetic better than axons

—Epidural anaesthetic gives a greater sensory block than motor block

32
Q

—How do we stay outside the Dura for an Epidural?

—How do we get through the Dura for a Lumbar puncture?

A

Correct needles

33
Q

What percentage of strokes are embolic, haemorrhagic and rare?

A

85%

10%

5%.

34
Q

What are the different arteries off the heart?

A
35
Q

What do the internal and external carotid arteries supply?

A

Internal to the brain.

External to head and neck structures.

36
Q

Where is most of the brains anterior circulation from?

A

Carotid artery.

37
Q

What supplies blood to the posterior part of the brain?

A

Vertebral arteries, join to form basilar.

38
Q

What does the internal carotid split into?

A
39
Q

Label each part of the circle of willis?

A
40
Q

What is the blood supply to the brain? Which artery supplies which part?

A
41
Q

What is going to happen when a drop in blood pressure is experienced?

A

Blood supply in the small vessels will suffer the most.

42
Q

Where is an embolus from the heart most likely to affect?

A

Travel up the internal carotid and into the middle cerebral artery to affect the sides of the brain.

43
Q

What are the major functional cortical areas?

A
44
Q

Which part of the brain is represented by each body part? (Humunculus)

A
45
Q

What are the different inter-cranial haemorrhage?

A

Extradural haemorrhage

Subdural haemorrhage

Subarachnoid haemorrhage

Intracerebral haemorrhage

46
Q

What are the different layers of the meninges?

A

—Dura, usually firmly adherent to the inside of the skull

—Arachnoid, more adherent to the brain

——Pia, on the surface of the brain and cannot be separated from the brain

47
Q

Where are the meningeal vessels? What veins cross the subdural space?

A

—Meningeal vessels are in the Extradural space

—Bridging veins cross the subdural space

48
Q

Where does the circle of willis lie?

A

—The circle of Willis lies in the subarachnoid space

49
Q

Are there any blood vessels below the pia?

A

—There are no vessels deep to the Pia, the Pia forms part of the blood brain barrier

50
Q

How is an extradural haemorrhage caused?

A

—Traumatic

—Fractured skull

—Bleeding from Middle meningeal artery

51
Q

What normally happens during a bleed?

A

—Lucid period

—Rapid rise in inter-cranial pressure (ICP)

—Coning and death if not treated

52
Q

What symptoms does an extradural haemorrhage show?

A

Increas- ingly severe headache, vomiting, confusion, and fits follow, ± hemiparesis with brisk reflexes and an upgoing plantar. If bleeding continues, the ipsilateral pupil dilates, coma deepens, bilateral limb weakness develops, and breathing becomes deep and irregular (brainstem compression).

53
Q

What investigations for an extradural haemorrhage can you do?

A

CT (fig 3) shows a haematoma (often biconvex/lens-shaped; the blood forms a more rounded shape compared with the sickle-shaped subdural haematoma as the tough dural attachments to the skull keep it more localized).

Skull X-ray may be normal or show fracture lines crossing the course of the middle meningeal ves- sels. Skull fracture after trauma greatly increases risk of an extradural haemor- rhage, and should lead to prompt CT.

54
Q

How can you treat a extradural haemorrhage?

A

Clot evacuation ± ligation of the bleeding vessel.

Care of the airway in an unconscious patient

55
Q

What is a subdural haemorrhage?

A

—Bleeding from bridging veins

—Commonest where the patient has a small brain (alcoholics, dementia)

Occurs in ‘shaken babies’

56
Q

What happens in a subdural haemorrhage?

A

—Bridging veins bleed, low pressure so soon stops

—Days/weeks later the haematoma starts to autolyse

—Massive increase in oncotic and osmotic pressure sucks water into the haematoma

Gradual rise in ICP over many weeks

57
Q

What are the symtpoms of a subdural haemorrhage?

A

Fluctuating level of consciousness (seen in 35%) ± insidious physical or intellectual slowing, sleepiness, headache, personality change, and unsteadiness.

increased ICP; seizures. Localizing neurological symptoms (eg unequal pupils, hemiparesis) occur late and often long after the injury (mean=63 days).

58
Q

What investigations can you do for a subdural haemorrhage?

A

CT/MRI shows clot ± midline shift (but beware bilateral isodense clots). Look for crescent-shaped collection of blood over 1 hemisphere. The sickle- shape di erentiates subdural blood from extradural haemorrhage.

59
Q

What is the treatment for a subdural haemorrhage?

A

Irrigation/evacuation,

eg via burr twist drill and burr hole craniostomy, can be considered 1st-line; craniotomy is 2nd-line, if the clot has organized. Address causes of the trauma (eg falls due cataract or arrhythmia; abuse).

60
Q

What is a subarachnoid haemorrhage?

A

—Rupture of the arteries forming the circle of Willis

—Often because of ‘Berry aneurysms’

61
Q

What are the symptoms of a subarchanoid haemorrhage?

A

—Sudden onset severe headache photophobia and reduced consciousness

—‘Thunderclap headache’

—Rapidly fatal, the commonest source of organs for transplant since seat belts were made compulsory.

Vomiting, collapse, seizures and coma often follow. Coma/drowsiness may last for days

62
Q

What are the differential diagnosis of subarchanoid haemorrhage?

A

Meningitis, migraine, intracerebral bleeds, or cortical vein thrombosis

63
Q

What are the investigations for a subarchanoid haemorrhage?

A

CT detects >90% of SAH within the 1st 48h.

CSF in SAH is uniformly bloody early on, and becomes xanthochromic (yellow) after several hours due to breakdown products of Hb (bilirubin).

64
Q

What is the treatment for subarchanoid haemorrhage?

A

Refer all proven SAH to neurosurgery immediately.

Re-examine CNS often; chart BP, pupils and GCS (p802). Repeat CT if deteriorating. • Maintain cerebral perfusion by keeping well hydrated, and aim for SBP 160mmHg.

Treat BP only if very severe.
Nimodipine (60mg/4h PO for 3wks, or 1mg/h IVI) is a Ca2+ antagonist that reduces

vasospasm and consequent morbidity from cerebral ischaemia.

65
Q

What are the properties of an embolic stroke?

A

Death of cell bodies in the cortex

‘Small’ well defined territory of

loss of motor and sensory function

No recovery

66
Q

What are the properties of a haemorrahagic stroke?

A

Compression of the internal capsule

With no death of cells

Large territory of loss of motor and

sensory function

Possibility of complete recovery

67
Q

Name the parts of the limbic system?

A
68
Q

What happens if you cut the optic tracts at different points?

A
69
Q

What comes off the aortic arch?

A

1) Brachiocephalic trunk divides into (R) common carotid and (R) subclavian arteries
2) (L) common carotid artery
3) (L) subclavian artery
4) (L) vertebral artery (<1%)

70
Q

Where do the common carotids arise and where do they bifurcate?

A

(R) CCA arises from the brachiocephalic A.

(L) CCA arises from the aortic arch

They have no branches

The CCAs bifurcate at approx. C3-C4

71
Q

What are the different parts of the internal carotid?

A

Cervical

Petrous

Cavernous

Supraclinoid (intradural)

72
Q

What are the qualities of the cervical ICA?

A
  • No narrowings/dilatations/branches
  • Anterior and medial to internal jugular vein
  • Lies posterior and lateral to ECA at origin
  • Ascends behind and then medial to ECA
  • (Rare carotid-basilar anastomoses)
73
Q

What are the qualities of the petrous ICA?

A
  • Penetrates temporal bone and runs horizontally (anteromedially) in the carotid canal
  • Small branch to middle/inner ear (caroticotympanic artery)
  • (small potential connection with ECA- vidian artery)
74
Q

What are the qualities of the cavernous carotid?

A
  • Turns superiorly at foramen lacerum.
  • Enters cavernous sinus (siphon)
  • Pierces dura at level of anterior clinoid process
  • Small branches supply dura, cranial nerves 3-6 and posterior pituitary (meningo-hypophyseal artery, inferolateral trunk [ILT])
  • Potential small connections with ECA via ILT
75
Q

What are the qualities of the supraclinoid ICA?

A
  • (I) Ophthalmic artery is usually intradural and passes into optic canal
  • (II) Superior hypophyseal arteries/trunk supply pituitary gland,stalk, hypothalamus and optic chiasm
  • (III) Posterior communicating artery runs backwards above CN3 to connect with the PCA
  • (IV) Anterior choroidal artery supplies choroid plexus, optic tract , cerebral peduncle, internal capsule and medial temporal lobe

Bateman - Phase 2a COPY (15 decks)

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