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X Clin Med III Exam 3 > Clinical Neuroanatomy > Flashcards

Clinical Neuroanatomy Flashcards

1
Q

What does the dura mater consist of?

A

Periosteal layer (stuck to skull) and meningeal layer-they come together and can form sinuses/cavities

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2
Q

Falx cerebri

A

Made of meningeal layer of dura and separates the 2 hemispheres

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3
Q

Tentorium cerebelli

A

Separates the cerebrum from the cerebellum (everything above is anterior fossa)
-Supratentorium is where most brain in adults are

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4
Q

Presentation of epidural hematoma

A

Pt with lucid interval and then rapid deterioration (due to a fast arterial bleed and compression of brainstem)

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5
Q

What vessel is injured in epidural hematoma?

A

Middle meningeal artery

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6
Q

What does epidural hematoma look like on CT?

A

Lenticular (like lens)

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7
Q

Common presentation of subdural hematoma

A

Older pt with insidious onset of HA, confusion, problems with speech and drowsiness
(as brain tissue atrophies and pulls away from periosteum, the veins are more vulnerable to shearing injuries)

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8
Q

What vessel is injured in subdural hematoma?

A

Bridging veins

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9
Q

What does subdural hematoma look like on CT?

A

Crescent shape

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10
Q

Presentation of subarachnoid hemorrhage

A

“Worst HA of my life”-might have had bowel movement of something of that sort (rapid deterioration)

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11
Q

Cause of subarachnoid hemorrhage

A

Aneurysm

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12
Q

How does subarachnoid hemorrhage look on CT

A

Spiderlike

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13
Q

What might be some changes to ventricles seen on CT?

A

Effacement of ventricles due to mass effect (smushed)

Enlarged temporal horns if blood in them etc

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14
Q

What does wet, wacky and wobbly describe?

A

Urinary continence, confusion and magnetic gait (can’t lift foot) seen with normal pressure hydrocephalus (overproduction of CSF)

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15
Q

Blood to brain

A

Right common carotid (off brachiocephalic)
Left common carotid (off aorta)
Vertebral arteries (off subclavian)
Basilar artery (from vertebral arteries joining)

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16
Q

What blood vessel is supplying most of the lateral brain?

A

Middle cerebral artery

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17
Q

What blood vessel is supplying the center of the brain nearest the longitudinal fissure?

A

Anterior cerebral artery

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18
Q

What’s inside the cavernous sinus?

A

All nerves controlling EOMs (CN III, IV, VI)
All divisions of CN 5 (except V3)
Internal carotid artery

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19
Q

What is the presentation of a pt with compression of cavernous sinus (like with cavernous fistula)?

A

Opthalmoplegia (eye pain, double vision, EOM paralysis, chemosis) and decreased facial sensation
-May have weird eye bulge (proptosis) due to increased ICP

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20
Q

Order of CNS

A 
Cortex (UMN)
Subcortical
Brainstem
Cerebellum
Spinal cord
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21
Q

Order of peripheral nervous system

A

Lower motor neuron
Peripheral nerve
NMJ
Muscle

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22
Q

Where is vision located?

A

Occipital lobe

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23
Q

Where is memory, understanding, language located?

A

Temporal lobe

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24
Q

Where do you look with a lesion?

A

“at the lesion” (b/c the opposite side is firing more)

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25
Q

What cranial nerves are from the midbrain?

A

II, III, IV

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26
Q

What cranial nerves are from the pons?

A

V, VI, VII

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27
Q

What cranial nerves are from the medulla

A

IX, X, XI, XII

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28
Q

Where does CN VIII come from?

A

Pons and medulla

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29
Q

What is pyramidal decussation?

A

UMN (corticospinal tract) starts in the cortex and in the lower medulla, it crosses over and goes to the opposite side of the body in the lateral corticospinal tract (why opposite side of the cortex controls contralateral innervation)

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30
Q

What is the internal capsule?

A

Sub cortical area (shaped like X) where the nerves for all of leg, trunk, arm and face all go through– would have to have a huge lesion in the cortex to affect all but only a tiny stroke here to paralyze them all

31
Q

What are crossed signs?

A

Ipsilateral cranial nerve deficits and contralateral body weakness (b/c CNs don’t have contralateral innervation)
-ex: R CN 7 affect the R side of the face but cortex lesion at face of Humunculus on R will affect the L side

32
Q

Where are the vibration and proprioception senses?

A

Posterior column

33
Q

Where is voluntary movement?

A

Lateral corticospinal area

34
Q

Where are pain and temperature senses?

A

Lateral spinothalamic area

35
Q

+ Romberg

A

Proprioception is off so problem in dorsal column (posterior) and think B12 deficiency

36
Q

Where do the sensations of vibration and proprioception cross?

A

At the level of the brainstem

37
Q

Where do the sensations of pain and temperature cross?

A

At the level of the spinal cord (and then goes to the parietal cortex)

38
Q

What is Brown Sequard syndrome?

A

Loss of pain, temp and light tough on opposite side of lesion
Loss of motor function and vibration, position and deep touch sensation on same side as cord damage

39
Q

Central cord syndrome presentation

A

Bilateral loss of pain and temperature (b/c corssing in the spinal cord)

40
Q

Anterior cord syndrome presentation

A

Paralysis and loss of pain and temp (lateral)

41
Q

Posterior cord syndrome presentation

A

Loss of vibration and proprioception (B12)

42
Q

Posterior and lateral column cord syndrome presentation

A

Paralysis (lose voluntary movement) and loss of vibration and proprioception

43
Q

Presentation of cauda equina syndrome

A 
More severe pain and weakness
Asymmetric 
Severe radicular pain
Flaccid LE paralysis
Saddle anesthesia
Late and less severe bowel and bladder problems
44
Q

Presentation of conus medullaris syndrome

A 
Less severe pain and weakness
Symmetric
Bilateral and perianal pain
Mild to mod LE weakness
Saddle anesthesia
Early, severe bowel and bladder problems
45
Q

What must be remembered about cauda equina and conus medullaris syndrome?

A

They are both emergencies and require immediate neuroimaging and decompression

46
Q

What is the nerve root?

A

Comes off the spinal cord and has sensation and motor in it

47
Q

LMN vs peripheral nerve lesion

A

LMN is weakness

Peripheral nerve is weakness and numbness

48
Q

The first 3 questions with a neuro problem

A

Is it neurologic?
Where is the lesion?
What is the pathological process?

49
Q

Presentation of lesion in the cortex

A

Aphasia, neglect, hemianopia
(UMN hemiparesis, hemisensory involving face and arm vs legs)
*face and arm not affected same as leg so NOT equal

50
Q

Presentation of lesion in the subcortical structures (internal capsule and basal ganglia)

A 
Dense hemiplegia (face, arm, leg etc)
Abnormal movements (chorea, ballism, tremor, cogwheeling)
51
Q

Presentation of lesion in the cerebellum

A

Truncal vs limb ataxia and dysmetria

52
Q

Presentation of lesion in the brainstem

A

CN palsies and crossed signs

53
Q

Presentation of lesion in the spinal cord

A

Paraparesis, sensory level different below lesion, Bowel/Bladder involvement (rectal tone), saddle anesthesia
*bilateral LE weakness and paralysis!!

54
Q

Presentation of lesion in the LMN

A

No sensory involvement, fasciculations (muscles contract on own and see little worms under skin)

55
Q

Presentation of lesion in the peripheral nerve

A

Distal weakness and sensory involvement, usually stocking glove, areflexia or hypoflexia

56
Q

Presentation of lesion in the NMJ

A

Fatigability, no sensory involvement, normal DTRs

57
Q

Presentation of lesion in the muscle

A

Proximal weakness, symmetric, no sensory involvement

58
Q

How to determine the underlying pathology

A 
Vascular
Inflammatory
Trauma
Autoimmune
Metabolic
Infectious
Neoplastic
Congenital
Drugs
Epilepsy/seizures
59
Q

Optic nerve

A

Visual acuity, color vision (red desaturation-optic neuritis with MS), visual fields
Do fundoscopic exam and check pupils

60
Q

What is involved in normal response to light when shine in left eye?

A

L CNII intact and R and L CN III intact

61
Q

Cranial nerve 5

A

Sensation of face, muscles of mastication, sensory limb of corneal reflex

62
Q

Cranial nerve 7

A

Muscles of facial expression

Motor limb of corneal reflex

63
Q

CN 3 lesion

A

Lack of eyelid opening or ptosis

64
Q

CN 7 lesion

A

Lack of eyelid closure

65
Q

Gag reflex

A

CN9 to 10

66
Q

Vestibulo-ocular reflex

A

CN 8 to 6 and 3 (abnormal is if head rotated to right and eyes move and follow-brainstem damage)

67
Q

CN 12 lesion

A

In brainstem then lick your lesion when stick out tongue

68
Q

Reasons for spasticity

A

Velocity dependent

UMN lesion

69
Q

Reasons for rigidity

A

Velocity independent
Cogwheel rigidity
Basal ganglia lesion

70
Q

Clues to UMN

A

Spastic weakness
Hyperreflexia
Babinski

71
Q

Clues to LMN

A

Flaccid weakness
Hyporeflexia
Atrophy
Fasciculations

72
Q

If face and arm is > leg?

A

MCA

73
Q

If leg is greater than arm/face?

A

ACA

X Clin Med III Exam 3 (7 decks)

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