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__ Processes unconscious proprioceptive and tactile informtion.

Cerebellum

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List the 4 deep cerebellar nuclei

1) Fastigial Nucleus
2) Globose Nucleus
3) Emboliform
4) Dentate

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(Medial or Lateral) potion of globose nuceus is associated with vestibular system

Medial

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__ nucleus is assocaited with vestibular corrections and functions

Fastigial

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List the tracts in the inferior cerebellar peduncle

1) Dorsal Spinocerebellar Tract (DSCT)
2) Direct Arcuate or Cuneocerebellar Tract
3) Trigeminocerebellar Tract
4) Arcuocerebellar Fibers
5) Reticulocerebellar Fibers
6) Olivocerebellar Fibers

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Lateral Globose, E,boliform, and Dentate n. form cerebellar __ and leave via SCP

efferents

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___ carries unconscious, precise, proprioceptive information from lower 1/2 to the cerebellum.

DSCT

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DSCT originates in the ___

Nucleus Dorsalis (C8-L1)

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___ carries unconscious, percise, proprioceptive information from upper 1/2 of body.

Direct Arcuate Fibers or Cuneocerebellar

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__ carries general proprioceptive and exteroceptive information from the head.

Trigeminocerebellar Tract

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Mneumonic for Tracts in the Inferior Peduncle.

DDT always ruins olives

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____ is demylination of proprioceptive neurons in dorsal roots, posterior columns, medial leminiscus, spinocerebellar, and corticospinal tracts

Friedreichs Ataxia

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What fiber forms all of the middle cerebellar peduncle

Pontocerebellar

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unilateral lesion of cerebellum cause __ deficits

Ipsilateral

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Reticulocerebellar Fibers carry ___ modalities

General Sensory

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Arucocerebellar Fibers recieve information from _ cerebral cortex and project to the __ cerebellar hemisphere.

1) Ipsilateral
2) Contralateral

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___ orginatites from the lateral reticular nuclei and then project __ to cererbellar hemispheres.

Reticulocerebellar Fibers

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___ originate from inferior olivary nucleus and terminate as __ fibers in the ___ cerebellar hemisphere.

1) Olivocerebellar Fibers
2) Climbing
3) Contralateral

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___ recieve infromation from __ which is a critical link between the extrapyramidal system and cerebellum.

Olivocerebellar Fibers

Central Tegmental Fasciculus

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Describe the Cortico-ponto-cerebellar loop

1) Motor Cortex –> Pontine Nucleus
2) Pontine Nucleus sends Ponto-cerebellar fibers that cross the midline to Cerebellar cortex and Dentate Nucleus
3) Cerebellar Cortex talks to the Dentate Nucleus
4) Dentate Nucleus send incormation to Ventral anterior and ventral lateral nuclei of thalamus and Red Nucleus
5) Red nucleus sends information to Thalamus
6) Thalamus sends informtion back to the motor cortex

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Cortico-Ponto-Cerebellar Loop:

1) __ sends information to pontine nucleus
2) ___ cross midline and link up to ___ cortex and ___ nucleus
3) Cerebellar cortex talks to __ and then __ sends fibers to __ and __
4) __ sends information back to the motor cortex

1) Motor Cortex
2) Pontocerebellar fibers
3) Cerebellar
4) Dentate
5) Dentate Nucleus
6) Dentate Nucleus
7) Thalamus (Ventral anterior and ventral lateral nuclei)
8) Red nucleus
9) Thalamus

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List the tracts of superior cerebellar peduncle

1) Ventral Spinocerebellar Tract
2) Trigeminocerebellar Tract
3) Efferents from Deep Cerebellar Nuclei

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All information entering the cerebellar cortex eventually converges upon __ cells

Purkinje

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Molecular layer of cerebellar cortex is comprised of outer __ and __ cells. They are __ upon purkinje cells.

1) Stellate
2) Basket
3) Inhibitory

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Purkinje cell layer is composed of __ Purkinje cell bodies

Inhibitory

What are the only efferent axons of the cerebellar cotex.

Purkinje Cell Axons

What are the only excitatory neurons in the cortex?

Granule cells

Granule layer has __ which is where cerebellar afferents terminate.

1) Cerebellar Glomerulus

Describe the Climbing Fiber Circuit:

1) Inferior Olivary nucleus sends fibers via olivocerebellar tract to Purkinje Cells and Cerebellar Nuclei 2) Information is sent to Efferents (Purkinje cell axons)

Climbing fibers have a powerful __ effect upon purkinje cells

Excitatory effect

Cerebellar lesion presentation

1) Dysmetria 2) Ataxia 3) Dysdiadochokinesa 4) Intention Tremor

Dysmetria

Missing the mark

Ataxia

Broad based staggering gait

Intention tremor

1) absent while at rest and is progressively worse in motion

Dysdiadochokinesia

Inability to perform rapidly alternating movements such as pronation and supination

Alcohol degeneration of cerebellum can cause ___ which is a memory imparment that affects mammillary bodies.

korsakoff syndrome

In Parkinson's disease __ fibers are destroyed.

Nigro-striatal Fibers

Nigro-striatal Fibers are __ and arise in __ and terminate in caudat and putamen.

1) Dopaminergic 2) PArs Compacta of Substantia Nigra

Parkinsons Disease Presents with what\>

1) Bradkinesia 2) Tremor during rest 3) Rigidity 4) Masked Face (Glabellar Reflex) 5) Postural Embarrassment

\_\_\_ iis caused by destruction of inhibitory GABAnergic Fibers in ___ fibers

1) Huntington's Chorea 2) Striatonigral Fibers

\_\_ is caused by unilateral lesion of subthalamus nucleus

Hemiballism

\_\_\_ presents with __ movement dysfunction characterized by wild, violent, flailing movements

1) Hemiballism 2) Contralateral

\_\_\_ is continuous stream of slow, flowing, writhing, involuntary movements, and is asssoicated with \_\_\_.

1) Athetosis 2) Huntington's Chorea

Composition of Basal Ganglia

1) Striatum (Caudate and Putamen) 2) Lentiform (Puta,em amd Global Pallidus) 3) Substantia Nigra 4) Subthalamic Nucleus

Describe the Direct Pathway of the Basal Ganglia

1) Motor Cortex --\> Stratum --\> GABA released --\> Increased inhibition of Globus Pallidus internus --\> decrease inhibition of thalamus (ventrolateral nucleus) --\> Increased exctment of motor cortex --\> Increased movement

Direct Pathway of Basal Ganglia: The __ stimulates caudate and putamen via __ release. __ activates Putamen --\> release of __ onto Globus Pallidus Internus. Flobus Pallidus internus normall __ thalamus, but with __ inhibiting globus pallidus internus then this allows increased signals to brain.

1) Motor Cortex 2) Glutamate 3) Glutamate 4) GABA 5) Inhibits 6) Putamen

Indirect Pathway of Basal Ganglia: 1) Motor cortex sends information to \_\_. GABA is released which increases ihhibition of Globus Pallidus \_\_\_. Decreases inhibition of __ which causes increased stimulation of globus pallidus \_\_\_. Increased stimulation of globus pallidus __ causes decreased stimulation of ___ leading to decreased excitment of motor cortex.

1) Stiatum 2) Externus 3) Subthalamic Nucleus 4) Internus 5) Internus 6) Thalamus

D1 receptor of Nigrostriatal Pathway is ___ and increases movement.

Excitatory

D2 of the Nigrostriatal Pathway is ___ and decreases movement.

Inhibitory

_CSF volume_ Ventricles: System: Production:

1. Ventricles: 20-25ml 2. System: 140ml 3. Production: 600-700ml/day

Presence of more the __ lymphocytes or erythroctes in CSF is considered abnormal.

\_\_\_\_\_ is caused by obstruction of cerebral aqueduct leading to lateral and 3rd ventrical hypertrophy

Supratentorial Internal Hydrocephalus

\_\_ is the enlargement of central canal with a development of a syrinx in the center of the cord

Syringomyelia

Syringomyelia presents with ___ anesthesia of shoulder and upper limbs

Bilateral

Enlargement of lateral ventricles is caused by obstruction of flow of the \_\_\_.

Interventricular foramen of monroe

\_\_\_ could be caused via subarachnoid hemorrhage (SAH) when the arachnoid villi may be temporally clogged via RBCs.

Transient Hydrocephalus

What are some clinical signs of Hydrocephalus

1) Sundown Eyes (Abducens Palsy) 2) Papilledema

What are the two types of external hydrocephalus

1) Supratentorial External Hydrocephalus 2) Infratentorial External Hydrocephalus (Communicating)

\_\_\_ and ___ supply the corticospinal tract.

1) ACA 2) MCA

Corticospinal Blood Supply: __ is responsible for the lower extermity while ___ is responsible for upper extremity.

1) ACA 2) MCA

The origin of the corticospinal pathway is \_\_\_. You'll find large pyramidally-shaped neurons that are also known as __ cells.

1) Primary Motor Cortex 2) Betzs

Corticospinal Tracts decussate at ___ and become the ___ corticospinal tract.

1) Pyramidal Decussation 2) Lateral

Termination of the corticospinal tract is located on the __ side in neuronal pools of ___ Gray matter.

1) Ipsilaterlal 2) Intermediate

Unilateral Lesion of CST causes ___ spastic hemiplegia or spastic hemiparesis.

Contralateral

Unilateral Lesion of ___ causes Ipsilateral paralysis of limb below level of lesion

LCST

\_\_\_\_ general function can be witnessed when someone rolls their eyes, wink, smil, bite down, swallow, sing, and protrude tounge.

Corticobulbar Fibers

\_\_\_, \_\_, ___ supply corticobulbar fibers.

1) MCA 2) ACA 3) Basilar

\_\_\_ is the origin of corticobulbar fibers. You will also see Large pyramidally-shaped neurons called cells of \_\_\_.

1) Primary Motor Cortex 2) Cells of Betz

Corticobulbar fibers can course through the ___ of the internal capsule and travel to the \_\_, __ and ___ motor nuclei. They can also descussate in lower __ between the __ and \_\_\_.

1) Genu 2) Trigeminal, Facial, and Hypoglossal 3) Pons 4) Trigeminal and Abducens

Supranuclear Facial Palsy is caused by a unilateral lesion of __ fibers above the level of __ nucleus. Only the lower portion is affected because the upper portion of the face is __ supplied.

1) Corticobulbar Fibers 2) Facial 3) Dual

Alpha and gama motoneurons are examples of (Upper / Lower) motoneurons

Lower

Damage to the anterior horn causes lesion to \_\_.

Lower Motor Neuron

List the symptoms associated with LMN lesion.

1) Flaccid Paralysis (limp) and no resistance to passive movement 2) Areflexia 3) Atonia 4) Atrophy 5) Fasciculation

How is spasticity charaterized?

1) Hypertonia 2) Hyperreflexia 3) Babinski Sign 4) Clonus 5) Disuse Atrophy

UMN lesion allows for __ influence on the LMN.

Excitatory

\_\_\_ is abnormal passive resistance to movement in all directions.

Rigidity

\_\_\_ is seen in parkinsons disease and is th emost disabling symptom.

Rigidity

Is there sensory deficits in ALS?

In ALS both the ___ and ___ are affected.

1) Upper Motor Neuron 2) Lower Motor Neuron

What LMN neurological structures are affected in ALS.

1) Anterior Horn Cells 2) Hypoglossal Nucleus 3) Nucleus Ambiguous 4) Facial Motor Nucleus

What aare the lower motor neuron clinical expressions in ALS?

1) Paresis and atrophy of intrinsic muscles of hands, arms, and shoulders 2) Dysarthria, Dysphagia, and paresis of tongue

Define Dysarthria

1) Trouble Speaking b/c of muscles are weakened

Dysphagia

Difficulty swallowing

Neurological Structures involved in UMN lesions in ALS

Chronic progressive degeneration of corticospinal tracts

Clinical expression of UMN lesions in ALS

1) Spastic Paralysis 2) Hyperreflexia and Babinski Sign

Somatic Motor nerves innervate skeletal muscle including the extraocular and tongue muscles. Innervation is accomplished via the \_\_\_, \_\_\_, \_\_\_, \_\_\_.

1) Oculomotor 2) Trochlear 3) Abducens 4) Hypoglossal Nerves

Which CN nuclei are located in the midbrain.

1) Mesencephalic 2) Red Nucleus 3) Trochlear 4) Oculomotor 5) Accessory Nucleus

Which Nuclei are located in the Pons.

1) Cochlear Nuclei 2) Vestibular 3) Salivary 4) Abducens 5) Trigeminal Motor 6) Facial 7) Main Trigeminal Nucleus

Which Cranial Nerve Nuclei are in the Medulla

1) Hypoglossal Nucleus 2) Dorsal Motor Nucleus of Vagus 3) Nucleus AMbiguus (IX, X, XI) 4) Solitary Nucleus 5) Spinal Trigeminal Nucleus 6) Inferior Olivary Nucleus

Supranuclear Facial Paralysis is a __ lesion. It only affects the __ quadrant.

1) UMN 2) Lower

Bell's Palsy is a __ lesion.

LMN

Where are lenticulostriate arteries commonly occluded.

1) Basal Ganglia - Putamen - Internal Capsule

Symptoms of Lenticulostriate occlusion

1) Pure motor or sensory motor stroke on CONTRALATERAL side - Pure motor hemiparesis of face, arm, and leg (Posterior limb of internal capsule) - Sensorimotor stroke on contralaeral side - Pure sensory lacunar infarct due to occlusion of central thalamus

D1 and D5 are ___ coupled and increase \_\_.

1) Gs 2) cAMP

D2 is __ coupled and decrease \_\_. This increases \_\_.

1) Gi 2) cAMP 3) gK

D3 and D4 are __ like and decrease \_\_\_.

1) D2 2) cAMP

5HT3 is associated with \_\_\_. This is the vomiting control center.

1) Area Postrema

List all the Opioids

1) Endorphins 2) Enkephalins 3) Dynorphins 4) Nociceptin

All of the Opoid receptors ( Mu, Kappa, and Delta) are ___ coupled.

Location of Histamine

Tuberomammillary nucleus of hypothalamus

Parkinsons Disease have distincive inclusions that are seen in remaining neurons called \_\_\_.

Lewey bodies are rounded, pink-stanting inclusions w/ __ halo. Composed of aggregates of the protein ___ and other proteins.

1) Halo 2) Alpha-synuclein

\_\_\_ paraluysis is characterized by flaccid paralysis, areflexia, atonia, atrophy and fisciculations

LMN

A patient presents with Anosmia. what CN is defected.

CN I

Patient presents with bell's palsy: inability to raise eyebrow, close eye, smile, purse lips. What CN is lesioned

Mucles of facial expression

Patient comes in with Dysphonia and Dysphagia. What cranial nerve is defected

CN X

Patient comes in with internal strabismus. What CN is defected

CN VI

\_\_\_ conveys pain and temperature information from the opposite 1/2 of the body. These fibers are lateral to the medial lemniscus.

Spinal Lemniscus

\_\_\_ conveys propriocepetive vibratory, and two-point tactile discriminative information from the opposite 1/2 of the body.

Medial Leminscus

\_\_\_ conveys pain, temperature, and crude tactile sensations from the opposite 1/2 of the face. These fibers are located between the medial lemniscus and spinal leminscus.

Trigeminal Lemniscus

Trigeminal Lemniscus Lesion causes ___ loss of pain/temperature of Face.

Contralateral

Lesions to the ___ result in internuclear ophthalmoplegia.

MLF

A unilateral lesion of the corticospinal tract is classically describe as a contralateral \_\_\_\_.

Spastic Hemiplegia

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