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Neuro 2 Midterm > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Pt presents with….Dx?
1. Deviation of the protruded tongue to the left

2. Dysarthria

3. Loss of proprioception, 2-point tactile discrimination and vibratory sensations on the right side of the body
4. Paralysis of both right limbs

5. Hypertonia and hyperreflexia of both right limbs

6. Right Babinski sign

A

A12H + ML

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2
Q

Pt presents with…Dx?

  • sudden high-pitched ringing in rt ear
  • dizziness
  • rt facial pain
  • collapsed
    1. Nystagmus on right lateral gaze
    2. Partial ptosis of the right eye
    3. Constriction of the right pupil
    4. Right deafness
    5. Intention tremor and dysmetria on the right
    6. Loss of pain/temperature sensations on the right side of face and left side of body
    7. Positive Romberg sign to the right
    8. CT angiography showed significant arteriosclerotic disease

What clinical structures are involved as well?

A

Cerebellopontine angle syndrome (due to vascular origin)

Right sided SL, Descending tract of V, CN 7, 8
cerebellum

(horners due to LRST)

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3
Q

Pt presents with…Dx?

  • sudden paralysis of his right hand
    1. Internal strabismus of the left eye
    2. Right hemiparesis
    3. Hypertonia and hyperreflexia in the right limbs.

Also: What side is the lesion? Where is the lesion level?

A

Alternating abducens hemiplegia (A6H)

Left sided lesion
pontomedullary junction

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4
Q

Pt presents with…dx?

  1. External strabismus, complete ptosis, and fixed and dilated pupil of the right eye
  2. Drooping of the corner of the mouth on the left side
  3. Deviation of the uvula to the right
  4. Left hemiparesis with hypertonia, hyperreflexia and Babinski.

also: what level is the lesion?

A

Alternating oculomotor hemiplegia (Weber’s) on the right

Mesencephalon

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5
Q

Pt presents with…Dx?

  1. Internal strabismus of the right eye
  2. Inability to completely close the right eye
  3. Inability to wrinkle the forehead on the right side
  4. Paralysis of the lower facial muscles on the right side
  5. Irritation of the right eye, which was red and dry
  6. Hemiparesis of the left limbs with Babinski

also: what level is the lesion?

A

Millard-gubler’s syndrome

bells palsy + abducens palsy + spastic hemiplegia=Millard-gublers syndrome

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6
Q

Pt presents with…Dx?

  • severe post-nasal drip for several years
  • Before admission the drainage increased and became yellowish in color. Pt felt chilly
  • On admission, generalized convulsion and became semi-comatose
  • Fever, edema of scalp, distension of scalp veins
  • bilaterally papilledema
  • bilateral weakness and paresthesia below the thighs
  • bilateral Babinski’s
  • responded to commands, cant speak clearly
  • opacification of frontal sinuses
  • dx via angiography
A

Superior sagittal thrombosis with infection
(paracentral lobule bilaterally)

note: couldn’t speak clearly because of the infection not due to neuro issues

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7
Q

Pt presents with…Dx?
Sudden onset of:
1. Complete anesthesia of the left side of the face
2. Deviation of the jaw to the left when protruded
3. Inability to bite down on the left side
4. Right spastic hemiplegia

A

Alternating trigeminal anesthesia (A5H)

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8
Q

Pt presents with…Dx?

  • sudden onset of dysesthesia over left side of body w/ sudden dizziness
  • DM and HTN controlled
  • distraught
  • restless and agitated
  • couldn’t sit because of discomfort in the left leg, which was kept constantly in motion
  • pain diminished on the L side of body (NOT THE FACE)
  • burning pain in the left leg
  • similar pain in the left arm with annoying stimuli such as taking a shower
A

Thalamic syndrome

PCA

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9
Q

Pt presents with…Dx?
CC: double vision and shaking of the left arm and leg during work
-complete ptosis and external strabismus of the rt. eye
-fixed and dilated rt. pupil
-loss of pain and temp sensations on the left side of face
-loss of proprio, 2-pt tactile and vibratory sensations on the left side of the body
-loss of pain and temperature sensations on the left side of the body
-resting tremor of the left limbs

A

Right Benedikts syndrome

lesion of the central midbrain tegmentum
(ML SL TL CN III)

Mesencephalon/Diencephalon and involving red nucleus

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10
Q

In cross sections of the brainstem, the penetrating arteries have a _____-_____ pattern of distribution. A thrombosis or embolus of one of these arteries would therefore result in a ____-_____ region of infarction.

A

wedge-shaped

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11
Q

T/F: The mesencephalon (midbrain) is associated with the cerebral aqueduct, the metencephalon (pons) is associated with the 4th ventricle, and the myelencephalon (pyramids) is associated with the posterior columns

A

True!

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12
Q

What are the 7 major ascending and descending pathways in the brainstem? What does each do?

A
  1. SL: p/t from opposite 1/2 of the body
  2. ML: proprio, vibratory, 2-pt tactile from opp 1/2 of the body
  3. TL: p/t and crude tactile from opp 1/2 of the face
  4. LL: auditory info from opposite ear
  5. Medial longitudinal fasciculus: vestibular influences to the CN III, IV, VI, assoc with horizontal gaze, MS, and internuclear opthalmoplegia
  6. CST: contralateral spastic hemiplegia
  7. CBT: lesion above decussation leads to contralateral paralysis or paresis of the mimetic mm of the lower half of face (supranuclear facial palsy)
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13
Q

The red nucleus is only present at the level of the ______ ______.

A

Superior colliculus

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14
Q

Which pathway in the brainstem is located next to the midline adjacent to the 4th ventricle?

A

Medial longitudinal fasciculus

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15
Q

Lesions of the MLF result in ________ _________, which patient’s have an abnormal response to _________ ____ in the direction opposite the side of the lesion.

A

Internuclear opthalmoplegia

horizontal gaze

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16
Q

Impairment of the MLF results in loss of________ of the ipsilateral eye and a nystagmus of the _________ eye.

A

adduction

abducting

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17
Q

TQ: What are the 3 impt dysfunctions regarding the MLF?

A
  • horizontal gaze
  • internuclear opthalmoplegia
  • Multiple sclerosis
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18
Q

The corticospinal tract is always ______

A

anterior

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19
Q

The corticobulbar fibers decussate in the lower pons between the levels of the trigeminal (V) and abducens (VI) nerves. These are fibers that allow you to__________ swallow, cough, open mouth, frown etc. Therefore, these fibers are/are not relevant if obtunded or inattentive.

A

volitionally

are not relevant if obtunded or inattentive

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20
Q

Unilateral lesions of the corticobulbar fibers ABOVE the level of the decussation leads to contralateral spastic paralysis or paresis of the _____ muscles of the _____ half of the face (___________ _______ ______). This can also affect the abducens, hypoglossal, and nucleus ambiguus nuclei.
Lesions below the decussation result in _______ CN palsies.

A

mimetic muscles of the lower half of the face

(supranuclear facial palsy)

ipsilateral

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21
Q

Uncrossed CBT: lesion at and above ________ n.

Crossed CBT: lesion at and below _______ n.

A

uncrossed: trigeminal
crossed: abducens

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22
Q

The upper quadrant of the face is affected/unaffected by unilateral lesions of the corticobulbar fibers.
Unilateral lesion of the corticobulbar fibers in the facial nucleus result in paralysis of the _________(ipsil/contral) lower quadrant of the face.

A

unaffected

contralateral

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23
Q

The CBF pass through the _____ of the internal capsule. The _________ ______of the internal capsule carries corticospinal fibers

A

genu of the internal capsule

The posterior limb

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24
Q

lesion of the descending nucleus of V results in…

A

Ipsilateral loss of pain and temperature from 1/2 of the face

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25
Q

The level of a brainstem lesion may be determined by identifying the coordinates of the _________ affected cranial n.

A

highest

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26
Q

What two nerves are at the level of the midbrain (mesencephalon)?

A

3, 4

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27
Q

What nerve is at the level of the pons?

A

5

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28
Q

What nerves are at the level of the pontomedullary sulcus (metencephalon) ?

A

6,7,8

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29
Q

What nerves are at the level of the medulla (myelencephalon)?

A

9, 10, 11, 12

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30
Q

T/F: The size of the lesion may be determined by the number and location (dorsal, ventral, lateral or medial) of the central pathways involved.

A

True!

motor=anterior, pain/temp lateral, proprio=midline, MLF=posterior

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31
Q

The genu of the internal capsule contains….

A

Corticobulbar fibers, supranuclear facial palsy

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32
Q

The posterior limb of the internal capsule contains…

A

CST, contralateral spastic hemiplegia

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33
Q

Lesion of the optic radiations leads to…

A

contralateral homonymous hemianopia

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34
Q

The ________ is the major node between viscerosensory and memory structures and the hypothalamas and septal area.

A

amygdala

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35
Q
  • Corticobulbar fibers pass through the middle 3/5 of the cerebral peduncle, descending in the upper pons (level of the trigeminal n. into the middle cerebellar peduncle)
  • Between the trigeminal n. and the lower pons the corticobulbar tract decussates, and descends to _____ _____ ______ in the brainstem, which leads to various alternating hemiplegias
A

somatic motor nuclei

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36
Q

Which four cranial nerves exit the brainstem adjacent to the corticospinal tract. As a result, a brainstem infarction may yield ipsilateral CN deficits and contralateral motor paralysis or paresis (alternating ______ hemiplegia)

(CN + CST)

A

3, 5, 6, 12

Ex: Alternating oculomotor hemiplegia

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37
Q

Substantia nigra is assoc. with which disease?

A

parkinsons

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38
Q

Pt presents with…Dx?

  • ipsilateral paralysis of the mm. of the tongue, ipsilateral atrophy of tongue mm.
  • contralateral spastic hemiplegia
A

Alternating hypoglossal hemiplegia

Ex: Rt A12H=tongue deviates to the right, L spastic hemiplegia

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39
Q

At what level of the brain is alternating hypoglossal hemiplegia?

A

medulla

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40
Q

Pt presents with…Dx?

  • ipsilateral paralysis of the mm. of the tongue, ipsilateral atrophy of tongue mm.
  • contralateral spastic hemiplegia
  • some ipsilateral spastic paralysis
A

Alternating Hypoglossal Hemiplegia with destruction of the contralateral CST

(Ex: tongue right, spastic hemiplegia on L, with spastic paralysis on R)

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41
Q

Pt presents with…Dx?

  • ipsilateral paralysis of the mm. of the tongue, ipsilateral atrophy of tongue mm.
  • contralateral spastic hemiplegia
  • contralateral loss of proprio, 2-pt tactile discrimination, and vibratory sensations from the body
A

Alternating Hypoglossal Hemiplegia and destruction of the ipsilateral Medial Lemniscus

(Ex: tongue right, spastic hemiplegia and loss of 2 pt tactile on L…pain and temp ok so mm. cramps may occur)

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42
Q

Pt presents with…Dx?

  • ipsilateral paralysis of lateral gaze, and/or internal strabismus
  • contralateral spastic hemiplegia
A

Alternating abducens hemiplegia

Ex: Rt A6H, right CN 6=paralysis of lateral gaze, spastic paralysis on L

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43
Q

At what level of the brainstem is A6H affecting?

A

pontomedullary sulcus on the side of the infarct

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44
Q

Pt presents with…Dx?

  • ipsilateral paralysis of lateral gaze, and/or internal strabismus
  • contralateral spastic hemiplegia
  • ipsilateral facial palsy, loss of taste sensations from the ant. 2/3 of the tongue, decreased lacrimation, hyperacusis
A

Millard-Gubler’s Syndrome (A6H+ CN 7)

(ex: rt millard-gubler syndrome=right CN 6 paralysis of lat gaze aka internal strabismus/eye looks inward, right CN 7=bell’s palsy, L spastic hemiplegia)

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45
Q

Pt presents with…Dx?

  • ipsilateral paralysis of lateral gaze, and/or internal strabismus
  • contralateral spastic hemiplegia
  • contralateral loss of proprio, 2-pt, vibratory sensations from the body
  • internuclear opthalmoplegia (paralysis of horizontal gaze)
  • dysphagia
  • dysarthria
A

Syndrome of foville

-A6H + dorsal extension into the ML, MLF, CN 7, crossed corticobulbar fibers–>Nucleus ambiguus and hypoglossal nucleus

Ex: right syndrome of foville=spastic hemiplegia and loss of proprio on L, internal strabismus on the right, may have bell’s

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46
Q

At what level is the lesion of syndrome of foville?

A

CN 6!

HIGHEST CN =LEVEL
of LESION=6!!!
Not 10, 12

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47
Q

Pt presents with…Dx?

  • loss of all sensation from half the face and scalp
  • paralysis of the ipsilateral mm. of mastication
  • contralateral spastic hemiplegia
A

Alternating trigeminal hemiplegia

Ex: Rt A5H=spastic paralysis on the L, trigeminal palsy on the right

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48
Q

What is the level of the lesion of A5H?

A

Midpons

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49
Q

Pt presents with…Dx?

  • loss of all sensation from half the face and scalp
  • paralysis of the ipsilateral mm. of mastication
  • contralateral spastic hemiplegia
  • contralateral loss of proprio, 2-pt, from body and limbs
  • paralysis of the mimetic mm on the lower 1/2 of the face
  • dysphagia
  • deviation of tongue
A

Alternating Trigeminal Hemiplegia with a Dorsal Extension

A5H, ML, UNcrossed corticobulbar fibers=contralateral CN nuclei including abducens nucleus, facial nucleus (supranuclear facial palsy), hypoglossal nucleus, and nucleus ambiguus

(right A5H + Dorsal extension=L spastic hemiplegia with L loss of proprio, L lower quad palsy, RIGHT trigeminal palsy)

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50
Q

Pt presents with…Dx?

  • ipsilateral external strabismus, pupillary dilation, complete ptosis
  • contralateral spastic hemiplegia
  • contralateral resting tremor
  • supranuclear facial palsy
A

Alternating Oculomotor Hemiplegia (Weber’s syndrome)

CN III, CST, substantia nigra (tremor), UNcrossed corticobulbar tract)

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51
Q

Pt presents with…Dx?

  • dysphagia, dysarthria, hoarseness, paresis of the ipsilateral palatal mm. (deviation of the uvula)
  • contralateral loss of pain and temperature sensations from the body
A

Lesion of the Nucleus Ambiguus and the Spinal Lemniscus

Ex: dysphagia and deviation of uvula to the L= right lesion

(may extend into the: medial lemniscus to result in contralateral proprio, 2-pt hemianesth; solitary nucleus resulting in ipsilateral anesthesia of the palate and pharynx, loss of taste from 1/2 tongue and pharynx (gag reflex))

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52
Q 
Pt presents with...Dx?
-Alternating hemianalgesia: 
contralateral hemianalgesia 
& ipsilateral loss of pain and temperature sensations from the face
-dysphonia
-loss of gag reflex
-asynergia or hypotonia
-nystagmus
A

Lateral Medullary Syndrome (Wallenberg Syndrome, Syndrome of the PICA)

(SL, Descending tract of V, glossopharyngeal and vagus nn., nucleus ambiguus, spinocerebellar tracts, vestibular nuclei)

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53
Q

Pt presents with…Dx?

  • deafness and vestibular disturbances
  • bell’s palsy
  • alternating hemianalgesia (loss of pain and temp on ipsil face and contral body)
  • ataxia, intention tremor, dysmetria, or dysdiadochokinesia
A 
Cerebellopontine Angle (CPA) Syndrome
(acoustic neuroma)

(CN VIII, 7, descending trat of V, SL, cerebellar peduncles)

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54
Q

Pt presents with…Dx?

  • external strabismus, pupillary dilation, complete ptosis
  • contralateral loss of proprio and 2 pt from body
  • contralateral tremor, ataxia, and/or choreiform movements
A

Benedikt’s syndrome
(lesion of midbrain tegmentum)

(CN III, ML, red nucleus/SCP)

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55
Q

Pt presents with…Dx?

  • paralysis of upward gaze
  • paralysis of the consensual light reflex
A

Parinaud’s syndrome

(lesion of the superior colliculus, which controls upward gaze, if destroy post. commissure=loss of consensual light reflex)

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56
Q

Pt presents with…Dx?

  • constant spontaneous pain without appropriate stimulus
  • extreme mood swings
  • feels like ants crawling on half of the body
  • may show contralateral hemiparesis, homonymous hemianopia, or auditory deficits as well
A

Thalamic syndrome (Dejerine-Roussy syndrome) due to thrombosis of the PCA

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57
Q

As the _______develops from Hensen’s node, it induces the overlying ectoderm to form a neural plate

A

notocord

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58
Q

TQ: Day 15 is important because….

A

it is the beginning of gastrulation (formation of notocord + 3 layers)

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59
Q

The ____ _____ gives rise to the future brain and spinal cord.

A

neural plate

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60
Q

When does the neural plate form the neural tube?

A

Day 18-26

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61
Q

By day 20, a midline sulcus appears, called the ______ _____, which is created in part by the development of the adjacent neural folds.

A

neural groove

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62
Q

By day 22, the neural folds have elevated and bridged over the neural groove to fuse. Somites assist in the formation of the neural tube. By day 26, the _____ and ______ _________ close to form the future brain and spinal cord.

A

rostral and caudal neuropores

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63
Q

________ is a vertebral column defect with exposure of primitive spinal cord and/or nerves

A

Rachischisis

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64
Q

______ ______ ______ is a vertebral column defect with herniation of meninges or neural tissue. Usually presents as cystic, midline, hairy mass in lumbar region. Failure of the roof plate of the neural tube to induce the development of the spinal processes

A

Spinal bifida occulta

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65
Q

________: vertebral column defect with herniation of meninges

A

Meningocele

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66
Q

_____________: vertebral column defect with herniation of meninges, spinal cord, and/or nerves

A

Meningomyelocele

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67
Q 
What is the timeline after fertilization?
Day 1:
Day 3:
Day 6:
Day 9:
Day 15*:
Day 21:
Day 23:
A 
Day 1: Zygote
Day 3: Morula (ball of embryonic cells)
Day 6: Implantation of embryoblast 
Day 9: Blastocyst
Day 15*: Gastrulation
Day 21: Neurolation
Day 23: Folding/closing of neural tube
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68
Q

As the primitive streak regresses, the ______ forms.

A

notocord

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69
Q

TQ: The prechordal area&raquo_space; _______ ________&raquo_space; ______

A

prechordal plate

BRAIN

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70
Q

What does the epiblast form? (3)

A

notocord
mesoderm
endoderm

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71
Q

Notocord induces the formation of the neural plate&raquo_space; neural plate&raquo_space; _____ ____

A

neural tube

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72
Q

The notocord induces cells in the overlying neural tube to form the ____ ___ and ____ ______ and has a significant role in the development of ventral and dorsal roots.

A

floor plate

motor neurons

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73
Q

______ ________:

  • Primary induction by the notocord
  • secondary induction by neural tissues
A

Ventral induction

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74
Q

_____ ________:

-Epidermal ectoderm influences neural tube to form roof and alar plates, and affect neural crest before they migrate

A

Dorsal induction

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75
Q

The anterior and posterior neuropores close at day __

A

26

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76
Q

_____ ____:future white matter of the spinal cord

A

marginal zone

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77
Q

___________ ____: future grey matter of the spinal cord

A

intermediate (mantle) zone

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78
Q

The mantle layer is divided into ____ and _____ plates by sulcus limitans

A

alar and basal plates

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79
Q

The alar plate will form the ____ (sensory/afferent) horn of the spinal cord

A

dorsal

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80
Q

The basal plate will form the ____(motor/efferent) horn of the spinal cord

A

ventral

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81
Q

_____ ____ cells form:

  • schwann and satellite cells (neurinomas, neuromas, schwannomas)
  • craniospinal ganglia
  • autonomic ganglia
  • adrenal medulal
A

neural crest cells

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82
Q

______ form:

  • neurons
  • bipolar
  • pseudounipolar
  • multipolar
  • medulloblastomas (33%)
A

neuroblast

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83
Q

_____ form:

  • astrocytes
  • oligodendrocytes
  • microglia
  • glioblastomas (50%)
  • Astrocytomas (20-30%)
A

glioblasts

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84
Q
  • At 3 months, the fetal spinal cord extends throughout the entire length of the vertebral column.
  • At 5 months, the fetus conus medullaris is at the level of the ____ _____ _____.
  • As a neonate, the conus medullaris is at the level of the _____ _____ _____.
A

1st sacral vertebra

3rd lumbar vertebra

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85
Q

Where is the conus medullaris as an adult?

A

At the level of the L1-2 interspace

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86
Q

At week 4, flexures divide the neural tube into _______ ____ _____.

A

primary brain vesicles

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87
Q

What are the three primary brain vesicles?

A

proencephalon (forebrain)
mesencephalon(midbrain)
rhombencephalon (hindbrain)

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88
Q

After 5 weeks, the brain is divided into secondary brain vesicles:

  • Proencephalon divides into the __________ and the __________
  • The mesencephalon remains unchanged
  • The rhombencephalon is subdivided into the __________ and ___________ by the development of the pontine flexure
A

telencephalon, diencephalon

metencephalon, myelencephalon

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89
Q

The lateral ventricle lies in the ___________

A

telencephalon

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90
Q

The third ventricle lies in the ____________

A

diencephalon

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91
Q

The cerebral aqueduct lies in the _________

A

mesencephalon

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92
Q

The fourth ventricle lies in the __________

A

metencephalon

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93
Q

The central canal lies in the ____________

A

myelencephalon

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94
Q

___________ may be due to congenital stenosis of a portion of the ventricular system, fetal infections (CMV, toxo), or Hurler’s

A

Hydrocephalus

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95
Q

Pt presents with….dx?

  • meningomyelocele
  • elongated vermis herniates through foramen magnum
  • aqueductal stenosis, hydrocephalus, syringobulbia/myelia, or polio
A

Arnold-Chiari malformation

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96
Q

Pt presents with..dx?

  • internal hydrocephalus secondary to obstruction of medial and lateral apertures
  • absence of vermis
  • post. cranial fossa continuous with 4th ventricle
A

Dandy-Walker malformation

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97
Q

________ involves varying degrees of cranial or cervical rachischisis….meroanencephaly

Absence of the brain=day 26

A

Anencephaly

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98
Q

Pt presents with…dx?

  • herniation of the meninges and brain tissue
  • usually with arnold chiari
  • may have hydrocephalus
A

Meningoencephalocele

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99
Q

Herniation of meninges, brain, and ventricle

A

meningohydroencephalocele

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100
Q

Pt presents with…dx?

-absence of forebrain with defect of frontal and parietal bones from failure of neural tube to close

A

cranial rachischisis

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101
Q

General neural function development:

  • 5 wks: none
  • 6-8 wks: tactile sensitivity
  • By wk 12: all skin sensitive except head
  • Basic reflexes develop in a _________ direction
A

craniocaudal

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102
Q

What are the 4 stages of neuronal circuitry?

A
  • presynaptic stage (motor, sensory, interneurons develop axons)
  • closure of the primary reflex circuit
  • connections with longitudinal and lateral inputs
  • completion of circuits and myelination
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103
Q
  • PNS myelination starts in the motor roots and followed by dorsal roots
  • spinal cord myelination starts in the ___th week and continues in a craniocaudal direction.
A

11th

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104
Q

What trimester does myelination of the brain start? initially involves sensory tracts (visual)..

A

3rd

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105
Q

By 40 wks, the ________ tracts are myelinated to the level of the medulla

A

pyramidal

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106
Q 
9 yo pt presents with...Dx?
CC: severe headache, double vision, trouble walking, N/V
-Bilateral papilledema
-Bilateral paresis of lateral gaze
-tilting of head to the left
-Romberg test pos to the left
-Wide-based ataxia of the trunk
CT/MRI scans confirmed the diagnosis
A

medulloblastoma of the 4th ventricle

increased ICP, cerebellum issues

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107
Q

4 yo pt presents with…dx?

  • vomiting
  • unsteady in walking
  • irritable
  • loses balance and falls frequently
  • truncal ataxia and nystagmus
  • wide-based gait with staggering
A

Medulloblastoma

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108
Q

16 yo pt presents with…dx?

  • difficulty walking and balancing over 12 mo
  • loss of hand/eye coordination
  • rheumatic fever during childhood with some severe nerve deafness
  • loss of proprio, 2pt in all limbs
  • paresis of lower limbs with slight hypotonia and hyporeflexia
  • bilateral babinski
  • horizontal nystagmus
  • slow lurching ataxic gait
  • bilateral intention tremor, dysmetria, dysdiadochokinesia
  • bursts of laughter
  • CT and CSF normal
A

Friedreich’s ataxia

deafness not related but bursts of laughter are related to the dz

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109
Q

Pt presents with…dx?

  • clumsiness and difficulty walking worsening over last few years
  • poorly nourishes
  • confused and disoriented to time
  • broad, ataxic gait
  • dysmetria on finger to nose, dysdiadochokinesia
  • uncoordinated movements on heel to shin test
  • no muscle weakness
A

alcohol degeneration

(Chronic indigestion of ethanol may cause a cortical atrophy of the anterior lobe of the cerebellum, and, in some advanced cases, the neocerebellum and dentate nucleus. In the later stages of the disease, the patient presents with severe ataxia of the lower extremities and trunk, and a relatively minor involvement of the upper limbs. The disease may be seen in conjunction with other conditions such as Korsakoff’s syndrome)

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110
Q

Pt presents with…Dx?

  • trembling hands and limb stiffness
  • masked facial expression and stare
  • shuffling gate
  • difficulty initiating movements
  • pill-rolling tremors of both hands
  • bilateral rigidity of the limbs
A

Parkinsons disease

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111
Q

_______ _______is a subcortical degeneration disorder involving the substantia nigra, globus pallidus, upper brainstem nuclei (mainly RF), and occasionally the postganglionic sympathetic neurons.

A

Parkinson’s disease

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112
Q

Parkinson’s disease or symptoms may be brought on by a number of different causes; three of the major ones are what?

A

postencephalitic, arteriosclerotic, and drug-induced.

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113
Q

Pt presents with…dx?

  • bradykinesia
  • tremor during rest
  • rigidity
  • postural embarrassment
  • masked face with reptilian gaze and glabellar reflex
  • autonomic effects
  • cognitive changes
A

Parkinson’s disease

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114
Q

AR disease of adolescence and early adulthood leading to neuronal necrosis and deterioration of the cerebellum and posterior column

A

Friedreich’s ataxia

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115
Q

Pt presents with…Dx?

  • severe depression during the previous year
  • balance unsteady
  • jerky movements with the hands -facial grimacing and rapid tongue movements
  • general hypotonia and hyporeflexia
A

Huntington’s chorea

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116
Q
  • Autosomal dominant motor disorder
  • patient begins to develop early symptoms, the most common of which is depression.
  • Common features include dementia, chorea and behavioral disturbances.
  • The disease steadily deteriorates until the patient dies 10-15 years after onset.
  • The principal areas of degeneration are the corpus striatum and the cerebral cortex.
A

Huntington’s chorea

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117
Q

_______due to degeneration of the striatum. It is characterized by slow, involuntary, writhing, worm-like movements of the limbs and face.
(may be a result of brain damage at birth, Rh incompatibility, or vascular insufficiency)

A

Athetosis

Post-infarction Hemiplegic Athetosis


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118
Q

Pt presents with…dx?

  • involuntary movements in right arm
  • violent flinging movements of right upper limb originating at the shoulder and the elbow
  • upper limb muscles appear flaccid and hypotonic between movements
A

unilateral hemiballismus and parkinson’s symptoms

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119
Q
  • due to unilateral lesions of the subthalamus
  • results in contralateral movement dysfunction characterized by wild, violent, flailing (-ballism=throwing) movements of the proximal musculature of bother the upper and lower ext.
  • may be due to a reduction or loss of inhibition (via glycine) upon the globus pallidus by the subthalamus
  • It is an example of a release phenomenon.
A

Hemiballism

120
Q

Lesions in the superior parietal lobe of the dominant hemisphere disturb the sensory- spatial hologram and results in_______, which is the inability to perform certain complex learned motor acts in the absence of any paralysis, ataxia, sensory changes, or deficiencies of understanding (confusion).

A

apraxia

121
Q
  • may result in a specific disorder of articulation in which basic language, grammar and word choice, are intact
  • In severe form there are distorted, unintelligible speech sounds that cannot be accurately transcribed by the listener.
A

dysarthria

moderate to severe forms

122
Q

The vestibular system is a special proprioceptive system that primarily influences ______ and ______ limb muscle tone and the ________ system

A

postural (axial) and proximal limb muscle tone

oculomotor system

123
Q

Where are vestibular receptors (neuroepithelial cells) located?

A

cristae ampullaris of the semicircular ducts

124
Q

What are the vestibular receptors innervated by?

A

bipolar neurons of the vestibular nerve

125
Q

_____ _____ consists of bipolar neurons whose long axons form the vestibular nerve.

A

Scarpa’s ganglion (vestibular ganglion)

126
Q

The vestibular nerve enters the brainstem at the pontomedullary sulcus, courses under the ICP and terminates in one of the four vestibular nuclei or in the ________________. Some primary fibers enter the cerebellum via the ____________ ____ (medial portion of the ICP)

A

vestibulocerebellum

juxtarestiform body

127
Q

After entering the brainstem, the central process of the primary vestibular neuron bifurcates into ascending and descending branches and terminates in the:
________ _____
________ _____
______-______ _____

A

vestibular nuclei
fastigial nuclei
flocculo-nodular lobe

128
Q

After the fibers from the vestibular nuclei decussate and bifurcate, the ascending component forms the ______ ________ ______ and the descending component forms the _______ _____________ ____

A

medial longitudinal fasciculus (MLF)

medial vestibulospinal tract (MVST)….primarily uncrossed fibers

129
Q

The ascending MLF terminates in the oculomotor, trochlear, and abducens nuclei (vestibulo-ocular pathway). Therefore, the MLF is the critical link in the oculomotor system and has a role in __________ ____

A

horizontal gaze

130
Q

The descending MVST terminates in the cervical level of the spinal cord and is a key link in coordinating the positioning of the ____ relative to the eye movements

A

head

131
Q

The MLF conveys reciprocal connections between the abducens nucleus and the __________ ________ nucleus

A

contralateral oculomotor

132
Q

The ______ _________ _____ originates from the lateral vestibular (Deiter’s) nucleus, descends in the lateral funiculus of the spinal cord, and terminates in the ipsilateral IG of ALL spinal levels

A

lateral vestibulospinal tract (LVST)

133
Q

Secondary fibers (vestibulocerebellar fibers) from the vestibular nuclei project through the juxtarestiform body, and terminate bilaterally in the _______ nuclei and the _______-______ lobe.

A

fastigial nucleus

flocculo-nodular lobe

134
Q

Vestibular efferents: ________ axons from the vestibular nuclei terminate on the neuroepithelial cells and decrease the firing of the receptors and attenuate incoming vestibular info

A

inhibitory axons

135
Q

Some vestibular nuclei project into the _________ ___________, which affect the somatic motor system (posture), and provide a mechanism for visceral autonomic effects assoc w/ vestibular stimulation.

A

Reticular formation

136
Q

The vestibulocerebellum is made up of what? (2) It is the oldest part of the cerebellum and present in vertebrates that only have axial mm. (fishes)

A

flocculo-nodular lobe

fastigii nucleus

137
Q

T/F: The fastigial nucleus (a deep cerebellar nucleus) is considered a displaced vestibular nucleus

A

TRUE

138
Q

These fibers originate in the fastigial nucleus and terminate in the ipsilateral vestibular nuclei

A

Direct Fastigiobulbar Tract

139
Q

What originates in the fastigial nucleus, decussates in the cerebellar commissure and bifurcates into ascend. and descend. limbs.

A

Indirect fastigiobulbar tract (uncinate fasciculus)

140
Q

What exits the cerebellum via the juxtarestiform body of the ICP and terminates in the vestibular nuclei and RF?

A

Descending limb of the uncinate fasciculus

141
Q

In lesions involving the flocculus or acoustic neuroma you get ________ impairment

A

postural

142
Q

TQ In doll’s eyes maneuver, side to side movement of the head results in what?

A

horizontal movement of the eyes in the opposite direction so that the pt is looking foward

143
Q

T/F: Doll’s eyes maneuver is contraindicated in a pt with cervical injury,

A

True!

144
Q

TQ For doll’s eyes maneuver, when the head turns right, the right eye should ________ and the left should ________. If the left eye remains neutral, then we have a left CN ___ palsy.

A

adduct
abduct
CN 6 palsy

(you can figure out the other situations using common sense)

145
Q

What is doll’s eye testing?

A

vestibular reactions

146
Q

How can we test for the vestibuloocular response?

A

oculocaloric testing

147
Q

In an unconscious pt, injection of cold water into the external auditory meatus results in_________ gaze _______ the side of the stimulus

A

horizontal gaze towards the side of the stimulus

148
Q

Stimulus: caloric testing of the right ear, right eye has no response, left eye adducts. What does this indicate?

A

Right CN 6 palsy

149
Q

The vestibular system has a very strong influence on _____ mm.

A

axial

150
Q

Pts with INO have an abnormal response to horizontal gaze in the direction ________ the side of the lesion

A

opposite

151
Q

TQ A unilateral lesion of the MLF superior to abducens nucleus results in a ___________ disturbance of horiz gaze ( loss of ________ (MR) of the ipsilateral eye and a nystagmus of the _________eye)

A

contralateral
adduction
abducting

152
Q

Lesion of crossed fibers from the abducens area to the oculomotor nucleus results in loss of ________ of the ipsilateral MR

A

adduction

153
Q

Destruction of descending fibers from the oculomotor nucleus to the abducens area results in the nystagmus of the ________ (contralateral) eye

A

abducting

154
Q

INO is named for what?

A

side of oculomotor impairment

155
Q

TQ If horizontal eye movement to the right is normal and you cant look left (right eye doesn’t adduct and left eye shows nystagmus) then it is a _______ INO due to a lesion of the _______ MLF

A

right INO

right MLF

156
Q

If horizontal eye movement to the left is normal and you cant look right (left eye doesn’t adduct and right eye shows nystagmus) then it is a _______ INO due to a lesion of the _______ MLF

A

left INO

left MLF

157
Q

PPRF stands for what?

A

Paramedian pontine reticular formation

158
Q

The PPRF includes a ______ ____ _____

A

lateral gaze center

159
Q

Pt presents with paresis or paralysis of horizontal gaze toward the same side of the lesion, and a gaze preference away from the side of the lesion

A

unilateral lesion of the PPRF

160
Q

Pt unable to move both eyes in a conjugate horizontal gaze to the right with a gaze preference to the left

A

Right PPRF lesion

161
Q

T/F: In a PPRF lesion, there is a destruction of the ipsilateral abducens nucleus and contralateral oculomotor nucleus (cant look towards lesions)

A

TRUE

162
Q

What comprises the central core of white matter in the cerebellum?

A

Corpus medullares

163
Q

The corpus medullares has 4 pairs of deep cerebellar nuclei, which are?

A

fastigial nucleus
globose nucleus
emboliform nucleus
**dentate nucleus

164
Q

TQ Which deep cerebellar nucleus is a large, convoluted cup-shaped nucleus that gives rise to the vast majority of the efferents from the neocerebellum?

A

dentate nucleus

165
Q

What is the source of output from the cerebellum to brainstem?

A

the deep cerebellar nuclei

NOT THE CORTEX!

166
Q

TQ What is the chief efferent from the cerebellum via the SCP?

A

dentate nucleus

167
Q

What afferents to the cerebellum course through the ICP? (6)

DDT Always Ruins Olives

A
  • Dorsal spinocerebellar tract (DSCT)
  • Direct arcuate fibers (cuneocerebellar tract)
  • Trigeminocerebellar tract
  • Arcuocerebellar fibers
  • Reticulocerebellar fibers
  • Olivocerebellar fibers
168
Q

TQ Which tract conveys unconscious, precise proprio info from the lower 1/2 of the body/extrem via ICP to the cerebellum?

A

DSCT

169
Q

TQ Which tract conveys unconscious, precise proprio info from the upper 1/2 of the body/extrem via ICP to cerebellum?

A

Direct Arcuate Fibers (cuneocerebellar tract)

170
Q

Which tract conveys general proprio from the head via ICP to the cerebellum? (and may include some fibers form the subnuclei rostralis and interpolaris of descend. V )

A

Trigeminocerebllar tract

171
Q

Which tract conveys general sensory modalities via the ICP to the cerebellum. Where does it originate?

A

Reticulocerebllar fibers

lateral reticular nuclei

172
Q

Which tract represents a large bundle of afferent fibers that originate in the ION and terminates via ICP as climbing fibers in the contralateral cerebellar hemispheres?

A

Olivocerebellar fibers

173
Q

The olivocerebellar fibers go to the purkinje cells and climb the proximal portion of the dendritic tree and excite the inhibitory neuron to decrease the inhibitory effect of the purkinje cell. Therefore output from the cerebellar cortex via the purkinje cell nuclei is _______ to the deep cerebellar nuclei

A

inhibitory

174
Q

TQ: Finger to nose test is an example of how the output from the cerebellar cortex _______ the deep cerebellar nuclei by way of the purkinje cells

A

inhibits

175
Q

The ION receives direct input from the _______ _____ ______, which consists of ascending and descending fibers of the reticular nuclei

A

central tegmental fasciculus (CTF)

176
Q

The central tegmental fasciculus originates in the red nucleus, periaqueductal gray, and midbrain tegmentum. This tract is a critical link between the _____________ system and the ________.

A

Extrapyramidal system

cerebellum

177
Q

What pathway is the following?

PAG, RN, midbrain tegmentum=central
tegmental fasciculus»descend to ION»ION olivocerebellar
fibers»DCN & cerebellar cortex»cerebellar
cortex back to DCN to turn down motor activity» SCP with red nucleus»dorsal thalamus»cerebellar cortex

A

Rubroolivocerebellar pathway

motor sys->cerebellum

178
Q

What forms the middle cerebellar peduncle?

A

pontocerebellar fibers

179
Q

The corticopontine fibers terminate in the _______ (ips/contra) pontine nuclei, which project to the cortex of the _________(ips/contra) cerebellar hemispheres. These pontocerebellar fibers form part of an important feedback loop between the motor cortex and cerebellum

A

ipsilateral

contralateral

180
Q

What is the corticopontocerebellar circuit starting with the motor cortex?

A

Motor cortex>corticopontine fibers>pontine nucleus>pontocerebellar fibers>cerebellar cortex (purkinje cells=dendritic tree inhib)>dentate nucleus>red nucleus>thalamus>motor cortex

181
Q

The _____ ____ _____ forms the middle layer of the cerebellar cortex. They are large inhibitory neurons that have elaborate dendritic trees.

A

purkinje cell layer

182
Q

TQ All information entering the cerebellar cortex eventually converges upon _____ ____, which are the ONLY efferent from the cerebellar cortex and terminate in the deep cerebellar nuclei

A

purkinje cells

183
Q

What is the function of the cerebellar cortex?

A

adjust or modify the output of the motor systems to a level appropriate to the incoming proprio and tactile info.

184
Q

T/F: The cerebellum initiates motor activity

A

FALSE is does NOT initiate motor activity

185
Q

T/F: ALL efferent fibers form the cerebellar cortex are purkinje axons

A

TRUE

186
Q

What are the most direct afferents to the cerebellar cortex?

A

climbing fibers (terminals of olivocerebellar fibers from the ION)…excite the purkinje fibers!

187
Q

What forms the motor movement pattern?

A

subcortical loop structures: putamen, caudate, SN, subthalamic nucleus

188
Q

What is the general motor system loops?

A

cortex>subcortical structures>dorsal thalamus>cortex

189
Q

What system is responsible for recalling movement patterns?

A

limbic system

190
Q

The _____ ____ is what gives personality movement, such as the way you walk

A

frontal lobe

191
Q

The motor system exemplifies the evolutionary process of ______________, whereby ever more systems depend upon the cerebral cortex to perform their sophisticated functions

A

encephalization

192
Q

T/F: In broca’s aphasia the pt gets more agitated as you ask questions and in Wernicke’s they continue talking

A

True

193
Q

Although these fibers do not affect the LMN’s as strongly as the direct corticobulbar fibers, they may play a role in the recovery from infarction involving the direct corticobulbar fibers

A

Indirect corticobulbar fibers (corticoreticulobulbar fibers: terminate in reticular formation)

194
Q

Why do you have recovery of dysphagia after stroke rehab?

A

The indirect corticobulbar fibers taking over the direct corticobulbar fibers

195
Q

T/F: Indirect CBT fibers ameliorate s/s of CBT lesions

A

true!

196
Q

These special fibers originate in the frontal and occipital eye fields and terminate in the superior colliculus and PPRF as part of the oculomotor system.

A

Aberrant corticobulbar (corticomesencephalic) fibers

197
Q

T/F: Due to the aberrant corticobulbar fibers, you can have lesions of the CBT that don’t effect the eys

A

true!

198
Q

Lesions in the parieto-occipito-temporal (POT) cortex in the superior parietal lobe of the dominant hemis disturb what? result in?

A

sensory-spatial hologram

apraxia

199
Q

What are the two types of apraxia?

A

Ideomotor apraxia

Ideational apraxia

200
Q

What is ideomotor apraxia?

A

inability to perform a given act correctly although old, habitual motor acts are still intact (such as piano skills)

201
Q

What is ideational apraxia?

A

loss of the ability to formulate the ideational concepts necessary to perform a motor activity. The pt can perform the isolated tasks but not a series of them

202
Q

A pt is unable to perform the following in the correct order or at all:
folding a letter, putting it in envelope, sealing, and stamping it

Dx?

A

Ideational apraxia

203
Q

The extrapyramidal system (EPS) is involved in what?

A

crude, stereotyped, movements of axial/proximal limb mm such as swinging the arms while walking

204
Q

How does the EPS initiate movement patterns?

A

subcortical loops

205
Q

What provides the framework for all focal motor activity?

A

EPS

206
Q

What is the principal subcortical loop?

A 
All areas of the cortex>>
striatum>>
GP SN>>
Ventral lateral, Vental Anterior>>
All areas of the cortex
207
Q

A small accumulation of gray matter b/t the putamen and caudate below the ant. limb of the internal capsule

A

Nucleus accumbens

208
Q

What nucleus plays a role in the motivational and emotional aspects of movement?

A

nucleus accumbens

209
Q

Corticorubrospinal pathway

A 
premotor cortex>>
dentate nucleus>>
red nucleus>>
VA nucleus>>
premotor cortex

(some descending red nucleus fibers form part of the CST and also output to the RF…staging tone of the mm)

210
Q

The dorsal and ventral division of the ansa lenticularis have very similar connections to the _____ ______

A

globus pallidus

211
Q

All cortical areas go to the ______

A

striatum

212
Q

Dorsal and ventral divisions of the ansa lenticularis projects to the VA and VL thalamic nulcei. The VA projects to the _________ _____ while the VL projects to the ________ _____ ____.

A

premotor cortex

primary motor cortex

213
Q

The development of the internal capsule subdivided the efferents from the GP into divisions, including the_____ and______ ansa lenticularis

A

dorsal and ventral

214
Q

TQ: _____-_____ ____ are non-dopaminergic fibers that originate from the pars reticularis of the SN and project to the VA & VL thalamic nuclei.

A

nigro-thalamic fibers

215
Q

TQ____-_____ ____ are dopaminergic fibers that originate in the pars compacta of the SN and terminate in the caudate and putamen (striatum).

A

nigro-striatal fibers

216
Q

TQ What fibers are destroyed in parkinson’s dz?

A

nigro-striatal fibers

217
Q

TQ Destruction of the inhibitory GABAnergic fibers in the striatonigral fibers are involved in __________ _____

A

huntington’s chorea

218
Q

TQ
Strianigral fibers:
____nergic fibers assoc with _________ ______

A

Strianigral fibers:
GABAnergic
huntington’s chorea

219
Q

TQ
Nigrostriatal fibers:
____nergic fibers assoc with
_______ ______

A

Nigrostriatal fibers:
Dopaminergic fibers
Parkinson’s dz

220
Q

The SN»striatum via nigrostriatal fibers from the ___ _______

A

pars compacta

221
Q

Unilateral lesions of the subthalamus or its connections result in ________ hemiballism (loss of glu inhib on GP), characterized by violent, involuntary, flinging movements of the limbs.

A

contralateral

222
Q

The pallidothalamic and nigrothalamic fibers are primarily _________ upon these specific motor thalamic nuclei.

A

inhibitory

223
Q

Connections of the EPS with limbic sys:
hippocampus, amygdala, entorhinal cortex, temporal lobe»________ _________»putamen»GP SN»VAN»ant cingluate gyrus»orbitofrontal area»putamen etc

A

nucleus accumbens

224
Q

T/F As the CNS evolved, the RF developed as well. The RF retains its primitive role in reflex activities such as intersegmental conditioned reflexes, but now it processes, integrates, modifies, and initiates a variety of sensory, motor, behavioral, and cognitive functions.

A

True!

225
Q

The _____ _______ contains the principal discharge pathways for the olfactory/limbic systems and the hypothalamus. Therefore, it plays an important role as mediator of somatic and visceral motor components of autonomic, emotional, and behavioral responses

A

reticular formation

226
Q

Somatic motor response (postural changes) and visceral responses (HR pupils, etc) are both __________ mediated. This is why you stand up straighter and heart races when someone says something to you that gets you going.

A

hypothalamically

227
Q

The limbic system sets the ______ ____ for individuals.

A

emotional tone

228
Q

_________ (prefrontal lobe) determines the emotional tone appropriateness (should you start a fight? Is he bigger than you?)…if damaged can impair our judgement–>fight

A

neocortex

229
Q

T/F: 1:1 relationship b/t olfactory input and the limbic system so therefore smell can lead to behaviors/reactions and why there is favorable vs. unfavorable smell

A

True

230
Q

The _______ ______ is the mediator of limbic responses

A

reticular formation

231
Q

If no RF in place, then no EEGs! aka you are ____ _____

A

brain dead

232
Q

What connects the septal area of limbic lobe with the hypothalamus?

A

medial forebrain bundle

233
Q

The tuberal region of the hypothalamus contains what 2 centers?

A

satiety center/punishing center

feeding center/pleasure center

234
Q

Lesions of the mammillary body result in what?

A

memory impairment called Korsakoff’s syndrome

235
Q

What are two important links in the papez circuit creating memory?

A

mammillary body and the dorsomedial thalamic nucleus

236
Q

What is the papez circuit from the neocortex?

A 
neocortex>>
entorhinal cortex>>
hippocampus>>
mammillary bodies>>
ant. nucleus of the thalamus>>
cingulate gyrus>>
parahippocampus>>
neocortex
237
Q

S/S assoc. with what?

  • Obesity/anorexia
  • Personality changes
  • Diabetes insipidus
  • Temperature maintenance problems
  • Hormonal problems
A

lesion of the hypothalamus

238
Q

The “50 first dates” is due to what syndrome?

A

korsakoff’s syndrome (impairment of recent memory and confabulations)

239
Q

T/F: Eventually, the development of the limbic system and neocortical areas preempted the need for a stimulus to trigger an affective feeling. Breaking this link allowed humans to have affective feelings that are quite separate and independent of a particular sensation from the sensory environment.

A

True!

240
Q

Primary olfactory cortex=______ ___=uncus and parahippocampus

A

entorhinal cortex

241
Q

_______ ______ ____=re-enforces smell and goes to the orbitofrontal cortex

A

Medial olfactory stria (MOS)

242
Q

________ ________ ____->temporal cortex, hippocampus, amygdala aka strong input into
LIMBIC (amygdala, hippocampus) and neocortical area (temporal cortex)

A

Lateral olfactory stria (LOS)

seizure activity out of this area…temporal lobe and amygdala may be removed

243
Q

What terminates in the primary olfactory cortex (lateral olfactory gyrus, periamygdala and rostral parahippocampus), and connects directly to the amygdala. This is the principal pathway for the awareness of olfactory stimuli.

A

Lateral olfactory stria (LOS)

244
Q

What is the chief input into the hippocampus, and apparently acts as a critical integrator and mediator of information to the hippocampus?

A

The entorhinal cortex

245
Q

Olfactory nerves/epith»MOS»_____ ____»>medial forebrain bundle»________» reticular formation

A

septal area

hypothalamus

246
Q

The LOS goes directly into the _________ ____ and the ________, which outputs to septal areas via stria terminalis and the hypothalamus via VAF fibers

A

entorhinal cortex and the amygdala

247
Q

The amygdala projects to the hypothalamus and septal areas via the ____ ______ ____ and ______ ______

A

ventral amygdalofugal fibers and stria terminalis

248
Q

The _____ _____ projects from the amygdala to the septal area

A

stria terminalis

249
Q

The primary olfactory cortex projects to the ________ cortex, which is the chief input to the hippocampus and an important link in the Papez memory circuit

A

entorhinal

250
Q

TQ pt cant create new memories, may be due to herpes encephalitis

A

Hippocampal amnesia due to bilateral lesions of the hippocampi

251
Q

Pyramidal cells of the _____ _____ of the hippocampus (Sommer’s sector) are vulnerable to hypoxic or ischemic injury. This can lead to ________ ____

A

CA1 region

hippocampal amnesia

252
Q
  • imaginary odor, such as burning rubber, rotten egg, sulfar like smell
  • mildly pleasant or curious
  • disturb the individual
A

olfactory hallucinations due to lesion of the uncus or amygdala

253
Q

______ refers to the loss of the sense of olfactoin

A

Anosmia

254
Q

Pt presents with…dx?

  • cant recognize objects
  • strong oral tendencies
  • hypersexual activity
A

Kluver-Bucy syndrome due to bilateral lesion of the amygdala, uncus, and temporal pole of the hippocampus

255
Q

TQ
____ ________ may lead to any of the following….
-Compression of the oculomotor nerve= Pupillary dilation, external strabismus and complete ptosis
-Compression of the abducens nerve=Gaze is down and in
-Compression of the cerebral peduncle=The herniation pushes the contralateral cerebral peduncle against the sharp edge of the tentorium cerebelli (Kernohan’s notch). Spastic hemiplegia on the same side of original lesion.
-Compression of the posterior cerebral artery=Contralateral incongruent homonymous hemianopia with macular sparing
-Compression of the ARAS=Decreasing levels of consciousness
-Stretching of the brainstem blood vessels=Post-traumatic thrombosis of the brainstem may cause Weber’s or Benedikt’s syndromes.
-Communicating hydrocephalus
=CSF blockage from infratentorial to supratentorial regions

A

Uncal herniation

256
Q

Sensory and motor systems have become dependent on the development of _____ ____, which can discriminate, analyze, interpret, and respond to stimuli. This upward shifting of functions is called ___________

A

cortical areas

encephalization

257
Q

What is one of the most important neocortical derivatives? What does this correspond with?

A

language

development of the larynx and vocalization

258
Q

The development of the corpus callosum allowed the __________ of a specific function to reside in one hemisphere yet still share its information with the other side.

A

lateralization

259
Q

What are the two major processes in the evolution of the neocortex?

A

Encephalization and lateralization

260
Q

What layers of the cortex receive most of the afferents into the cortex? However, only 1% of these afferents are thalamocortical fibers; the remaining afferents are corticocortical fibers.

A

Layers 3-4

261
Q

TQ -critical link for
the language association areas.
-lesions in this area result in conduction aphasia

A

Superior longitudinal fasciculus (SLF)

262
Q

-fluent with only minor word finding pauses and paraphasias
-ability to repeat
words or sentences is severely impaired.

A

Conduction aphasia

263
Q

What interconnects the septal area, cingulate and parahippocampal gyri to the entorhinal cortex?

A

cingulum

264
Q

TQ What interconnects the base of the association areas of the frontal lobe to the inferior temporal lobe. The latter is connected to the entorhinal cortex.

A

The uncinate fasciculus (impt b/c connects temporal lobe and entorhinal cortex)

265
Q

What interconnects neocortical areas of the two cerebral hemispheres?

A

commissural fibers

266
Q

As the fibers of the corpus callosum radiate into the hemispheres they form the ______ ______ in the frontal lobe and the_____ _____ in the occipital lobe.

A 
minor forceps
major forceps (connects visual with motor)
267
Q

-Patients with this rare, acquired condition are unable to visually recognize objects or pictures.

A

Visual agnosia

May be due to bilat damage to visual assoc cortex by anoxia

268
Q
  • may result from infarction of the left occipital lobe and posterior corpus callosum secondary to occlusion of the posterior cerebral artery
  • The lesion disconnects the language area from the visual association cortex
  • Although the patient cannot name or describe an object in the visual field, he can recognize and demonstrate its use.
  • Visual perception is intact. Most of these patients are also alexic, and agraphic.
A

Associative visual agnosia

269
Q

What syndrome is characterized by apathy, occasional euphoria, abrupt irritability and socially inappropriate behavior?

A

Frontal lobe syndrome

270
Q

The primary auditory cortex lesions result in what?

A

difficulty localizing sounds

271
Q
  • Large lesions of this area may result in failure to recognize
    the body scheme (denial of body scheme) on the opposite side.
A

Superior parietal lobule of the somesthetic assoc. cortex

272
Q

What syndrome is due to a lesion of the dominant parietal lobe and is characterized by finger agnosia, right-left disorientation, dysgraphia and dyscalculia.

A

Gerstmann syndrome

cant tell R from L, cant write, cant calculate

273
Q
  • A lesion of the __________ ____ in the dominant hemisphere results in agnosia
  • The patient may be unable to recognize, identify or discriminate somato-sensory (tactile), visual, auditory, smell, or taste information
A

supramarginal area

274
Q

Pt cannot recognize own body as self is called neglect….lesion of what?

A

paretio-occipital area

275
Q

Eighty percent of the population is right handed and left dominant. Although the development of handedness is not functionally related to the development of dominance, it is, however, a fair clinical indicator. Wernicke’s area is located in the dominant hemisphere in 98% of the cases.

A

Certain higher cognitive functions such as perception and memory are processed in both hemispheres. Language, speech, writing, analytic functions and the learning of skilled movements are located in the dominant hemisphere. Higher cognitive functions such as non-verbal expressions, creativity, abstraction and spatial discrimination are associated with the non-dominant hemisphere

276
Q

Pt presents with…dx?

  • nuchal rigidity
  • bruit over left orbit
  • complete left oculomotor n. palsy
  • hypalgesia of the left opthalmic dermatome
  • paresis of the right masseter m.
  • left supranuclear facial n. palsy
  • deviation of tongue to right
  • loss of p/t on L body
  • paresis of L arm
  • lumbar puncture bloody
A

carotid-cavernous fistula

277
Q

Pt presents with..Dx? TQ
1. Inability to adduct either eye when testing for horizontal gaze
2. Both eyes could adduct during convergence
3. There was a horizontal nystagmus only in the abducting eye when attempting to look to
either the right or left.

A

bilateral internuclear opthalmoplegia

may see in MS

278
Q

Pt presents with…dx?
CC: weakness in legs.
-legs felt tired when he stood up too long.
-increased patellar reflexes, but normal Achilles reflexes in both lower limbs.
-Two months later, limbs had continued to weaken until he was unable to walk. Examination at this time revealed spastic paralysis and increased patellar and Achilles reflexes in both lower limbs.
-Babinski signs were elicited bilaterally.

A

Parasagittal Meningioma of the falx cerebri (compressing the anterior paracentral lobule)

279
Q

Pt presents with…dx?
-CC: intermittent headaches associated with “the stresses of my job.”
-history of intermittent psychotic episodes during which he has bowel and bladder incontinence. Each episode usually lasted 1-2 weeks.
-Two months prior to the clinic visit, noted difficulty in walking especially climbing stairs. This condition had become progressively worse.
-At the clinic he collapsed on the floor and had a generalized seizure.
Neurological examination revealed bilateral weakness, spasticity, hyperreflexia, Babinski signs, and a spastic gait.
-disorganization of thought and made many silly wisecracks during the examination

A

Parasagittal meningioma

280
Q

TQ What connects the entorhinal cortex to the temporal cortex/hippocampus?

A

uncinate fasciculus

281
Q

Pt complained of not being able to see objects off to either side. -noted a significant weight gain during that period

  • problem with recalling recent events.
  • Examination revealed blindness in the temporal fields of both eyes.
  • Blood tests and CT scan confirmed the diagnosis.
A

Korsakoff’s syndrome

bilat destruction of mammillary bodies or pituitary tumors

282
Q

Pt presents with…dx?

  • insidious onset of forgetfulness and impaired judgment, with occasional acute episodes of disorientation in time and place. -required frequent assistance with the basic activities of daily living and urinary incontinence. –She could not bathe or groom herself because she could not remember how to do these simple tasks. If she left the house, she would immediately forget where she lived or where she had been.
  • marked disorientation in time and space, mixed aphasia, apraxia, pathologic mouth-opening responses, a grasp reflex on the right, and hyperreflexia of all extremities. -CT scan showed marked dilation of the ventricles and subarachnoid space, and indicated the final diagnosis.
A

Alzheimer’s disease

283
Q

Pt presents with..Dx?
CC: pt collapsed in parking lot, hx of HTN
1. Sensory Deficits
• Hemianalgesia and thermal hemianesthesia on the left side of the body and face
• Proprioception/2 pt tactile sensations were absent from the left side of body and
slightly diminished on the left side of the face
• Slow pain sensations were vaguely perceived on the left side of the body and face
2. Left spastic hemiplegia with hyperreflexia and Babinski
3. Inability to smile on the left side
4. Left homonymous hemianopsia

A

Infarct of the internal capsule

284
Q

Pt presents with…dx?

  • one-year history of decreasing interest in caring for her house and personal needs
  • uncharacteristic changes in behavior marked by a lack of interest in conversation, unkempt appearance, a lack of concern about family affairs, and total neglect of personal and household cleanliness.
  • discontinued attending church, did very little shopping, and no longer made social visits.
  • Upon examination at the hospital, pt awake and markedly apathetic. Offered no spontaneous conversation and answered all questions with single word responses.
  • slow shuffling gait and had several episodes of incontinence.
  • Cranial or spinal nerves were normal.
  • The findings of the neurodiagnostic evaluation (MRI scan) were significant.
A

Frontal lobe syndrome

285
Q

Pt presents with…Dx?

  • Wife never wanted to do anything, wouldn’t perform her daily chores, and didn’t eat properly.
  • Pt was easily distracted.
  • When asked why her eating habits had changed she explained that food seemed tasteless to her.
  • The neurological examination indicated that pt was unable to smell in either nostril.
  • During the examination, pt urinated on the floor yet seemed undisturbed or embarrassed by the incident.
A

Frontal lobe syndrome

286
Q

Pt presents with…dx?

  • following acute head trauma, brought to hospital.
  • The patient underwent a personality change of the past 12 years, deteriorating more during the last three years.
  • He developed progressive memory loss, especially short-term memory.
  • Spontaneous movements and speech were markedly reduced and the patient had a loss of bowel and bladder function.
  • pt alert, but disoriented especially with respect to time and place.
  • examination revealed, slow responses to questions and simple commands with occasional incorrect responses. Naming, spelling, and repetition were intact.
  • very little spontaneous behavior, no change in affect, and disinhibition of behavior.
  • Pupillary responses and extraocular movements were normal and there was no nystagmus.
  • Optic discs were flat and fundi were pale. Other cranial nerves were normal. Pathological reflexes were not present.
  • unable to stand without help and could not walk.
  • tenderness of the skull over the right temporal region, right periorbital hematoma, and no nuchal rigidity.
  • Plain skull films revealed a right temporal fracture. ACAs were depressed and displaced. Post-mortem findings included a giant aneurysm of the ACoA.
A

Frontal lobe syndrome

287
Q

Pt presents with..dx?

  • Pt found wandering aimlessly around the tracks picking his nose with no recollection of the incident.
  • When walking to work when he smelled something burning, then he remembered seeing gigantic trains running up and down the highway.
  • hallucinating and suffered amnesia and nightmares more frequently.
  • A neurological examination revealed a left superior homonymous quadrantanopia.
A

Temporal lobe tumor

288
Q

Pt presents with…dx?
CC: complaint hearing difficulties.
-difficulty understanding what people said to her even when they talked loud enough for her to hear.
-understood perfectly everything that she read.
-spoke fairly easily,difficulty understanding spoken questions or instructions, and often used the wrong words and phrases in her descriptions.
- six months earlier complained of a buzzing noise in her ears.

A

Auditory aphasia

289
Q

Pt presents with…dx?

  • pt no longer able to read or write.
  • no defect in the visual fields or eye movements.
  • could recognize and identify objects in both visual fields, but he couldn’t read.
  • He seemed to understand everything that was said to him, and he responded to questions quite fluently although occasionally he seemed to misuse a word or two.
  • When pt given a pencil, paper and a drawing of a sailboat, he became confused and could not determine which fingers to use or decide which hand was right or left.
  • Doc said not to worry and pt simply picked up the pencil and drew an accurate copy of the boat.
  • When asked to write the word “boat” below the drawing, he was unable to do so.
  • Later, tests determined that pt had considerable difficulty working arithmetic problems despite his determination and prior ability to solve them.
A

Gerstman’s syndrome

290
Q

Pt presents with..dx?

  • significant history of multiple strokes including some in the parieto-temporal cortex (aphasic zone) of the dominant hemisphere.
  • automatic speech patterns (“yes…,” “well…”) are intact, and her intellectual abilities are appropriate for her condition.
  • difficulty in understanding speech or pictures; words are used in the wrong order or are omitted; word finding difficulties; neologisms or new word creations; and some perseveration.
A

Wernicke’s aphasia

291
Q

Pt presents with…dx?

  • didn’t seem to know what to do with himself anymore.” He would wander around the house and often had difficulty finding the front door, although he seemed to be able to “see all right.”
  • started to go to bed with his left shoe and sock on. He would also leave the left half of his shirt and trousers on. His left arm and leg were always seen to be hanging off the side of the bed.
  • One night wife undressed his left side after he went to sleep only to discover that he neglected to dress his left side when he got up the next morning.
  • The man’s only complaint was that, although he was an artist, he no longer seemed able to draw anything properly.
A

Neglect of body scheme secondary to a parietal tumor

292
Q

Pt presents with…dx?
-4-week history of gait disturbance.
-nonspecific dizziness 3 weeks prior to admission and diplopia on lateral gaze one week before examination.
-nauseated and vomiting. Examination revealed:
1. Patient was well developed and well nourished with no acute distress.
2. Dysmetria on right finger-to-nose and heel-to-shin testing.
3. Difficulty with rapidly alternating movements on the right.
4. Wide-based gait.
5. Nystagmus on bilateral lateral gaze.
6. Bilateral papilledema
CT scan confirmed a mass in the right cerebellar hemisphere. Her vomiting and diplopia were relieved after operation. Four months later she had only minimal residual ataxia.

A

cerebellar medulloblastoma

293
Q

Pt presents with…dx?

  • seizure with staring spell and speech interruption followed by convulsions
  • normal neuro exam and lab
  • soft-tissue density in right nasal cavity and sphenoid, ethmoid, and maxillary sinus
A

frontal encephalocele with seizure

-encephalocele can present in adulthood as epilepsy

294
Q

Pt presents with…dx?

  • right upper extremity weakness after violent coughing spell
  • large fluid filled calvarial defect containing herniated brain near the level of the motor cortex
A

symptomatic left intradiploic encephalocele

295
Q

Pt presents with…dx?

  • suddenly developed hemiparesis
  • hypotonia and babinksi
  • slight dysarthria
  • facial weakness of right
  • hypesthesia and impaired vibration and position on same side
A

Ipsilateral hemiparesis after putaminal hemorrhage due to uncrossed pyramidal tract

296
Q 
Pt presents with...dx?
-chronic severe headache, neck pain, N/V
-bloody CSF
post-op...
-left homonymous hemianopsia
-right homonymous impairment
-distortion of visual fields
-hallicinations
A

right parietal AV anomaly
(subarachnoid hem)

post op
-scar in right parieto-occipito-temporal region

297
Q

Pt presents with…dx?

  • altitude sickness followed by…
  • personality changes
  • apathetic, uncommunicative, expressionless
A

Acute mountain sickness followed by globus pallidus syndrome

prone to hypoxia in high altitude

Neuro 2 Midterm (5 decks)

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