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6- Neuro Diag > Ex1 / Ch6 Corticospinal Tract and Othe > Flashcards

Ex1 / Ch6 Corticospinal Tract and Othe Flashcards

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1
Q

list the Corticospinal pathway

A
  1. Cerebral cortex
  2. Midbrain
  3. Pons
  4. Medulla
  5. Spinal cord
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2
Q

Corticospinal is Influenced by

A

cerebellum and basal ganglia

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3
Q

Corticobulbar Tract begins in

A

primary motor cortex

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4
Q

Corticobulbar Tract projects to

A

brain

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5
Q

how many lower motor neuron does the autonomic system have?

A

2

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6
Q

A 2 lower motor neuron pathway of the autonomic system are influenced by

A
  1. hypothalamus
  2. amygdala
  3. nucleus tractus solitarius
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7
Q

Autonomic Neuron #1 location

A

brain stem or cord

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8
Q

Autonomic Neuron #2 location

A

peripheral ganglion

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9
Q

Parasympathetic division goal

A

Digestion & energy storage

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10
Q

Parasympathetic origin

A

III

VII

IX

X

sacral spinal cord

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11
Q

Parasympathetic has ____ preganglionic, and _____ postganglionic

A

Long preganglionic

Short post ganglionic

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12
Q

Transmitters used in both pre and post ganglionic

(parasympathatic division transmitters)

A

acetylcholine

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13
Q

Parasympathetic effect on eye (vision)

A

adapted to near vision

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14
Q

Parasympathetic effect on Digestion

A

activated by eating

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15
Q

Parasympathetic effect on Heart

A

decrease HR

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16
Q

Parasympathetic effect on lungs

A

Decrease RR

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17
Q

Parasympathetic effect on Peripheral capillaries

A

gets dilated

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18
Q

Parasympathetic effect on Skeletal muscle

A

tone relaxes

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19
Q

Sympathetic division goal

A

releases energy

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20
Q

Sympathetic division origin

A

Intermediolateral cell column (VII lamina) of spinal cord T1-L2

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21
Q

Sympathetic division has ____ preganglionic andd ____ post ganglionic

A

Short preganglionic

Long post ganglionic

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22
Q

Sympathetic Short preganglionic use ____ as a transimitter

A

acetylcholine

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23
Q

Sympathetic Long post ganglionic use ____ as a transimitter

A

norepinephrine

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24
Q

Options for signal distribution

A
  1. sympathetic signal enter the sympathetic chain, synapse at the same lvl, rejoin the same spinal nerve root
  2. sympathetic signal enter the sympathetic chain, go up several segments, synapse and rejoin spinal nerve at a higher lvl
  3. sympathetic signal enter the sympathetic chain, travel down several segments, synapse and rejoin spinal nerve at a lower lvl.
  4. sympathetic signal enter the sympathetic chain, remain unsynapsed, leave the chain as a splanchnic nerve, travel to a prevertebral ganglion (celiac, sup, and inf mesenteric) synapse and travel to the target tissue
  5. sympathetic signal can travel unsynapsed to the adrenal medulla. Releasing epinephrine and norepinephrine (for distribution through the entire body via vascular system)
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25
The preganglionic sympathetic neurons need to be long enough to reach (3 structures)
the chain ganglia the prevertebral ganglia or the adrenal medulla
26
The post ganglionic neuron reaches from the ganglia to
target tissue
27
Sympathetic effect on eyes
get wild, pupil dilatate (to get as much light as possible) vision shift to far away vision
28
Sympathetic effect on digestion
turn off blood going to, and stop secretion
29
Sympathetic effect on Heart
HR goes up
30
Sympathetic effect on lungs
RR goes up
31
Sympathetic effect on Peripheral capillaries
blood gets diverted from peripheral superficial capillary
32
Sympathetic effect on Skeletal muscle
receive more oxygenated blood | (prepare the body to move)
33
why do peripheral superficial capillar narrow under the sypathetic effect
in case of getting a wound so it reduces the bleed
34
Enteric division reaches which organ
intestine
35
Enteric division contains 2 plexi:
Myenteric plexus (of Auerbach) Submucosal plexus (of Meisner)
36
Myenteric plexus (of Auerbach) controls
muscle contraction
37
Submucosal plexus (of Meisner) controls
blood vessel size and secretory function
38
Enteric division Regulated by parasympathetic via
division X and sacral
39
Enteric division Regulated by sympathetic via
splanchnic
40
Hirschprung Disease aka
Congenital Aganglionic Megacolon
41
in Hirschprung Disease, what happens to the migrating cells of the myenteric and submucosal plexuses During development
do not continue to the distal colo
42
with Hirschprung Disease, the disctal colon can't:
can’t relax/contract properly to allow stool to pass
43
Hirschprung Disease results in
Lack of bowel sounds (MC LLQ) dullness to percussion at LLQ distention is palpable in that region
44
how can Hirschprung Disease be managed
by eating smaller meals more frequently
45
Describe the surgial solution for Hirschprung Disease
the aganglionic area is removed, and the normal part of the colon is connected to the sigmoid colon and the rectum
46
Term: Paresis
mild weakness
47
Term: plegia
total weakness/0 strength
48
Term: Paralysis
total weakness/0 strength (same as plegia)
49
Term: Palsy
nonspecific term than can mean paralysis or it can mean paresis
50
Term: Hemi
left or right
51
Term: Para
both legs
52
Term: Mono
one extremity
53
Term: Di
2 of the same extremity (usually legs)
54
Term: Quadra or tetra
all 4 extremities
55
quadriplegic means
can’t move any extremity
56
Motor System Testing order
Inspection Look for abnormal posturing Involuntary motions Sings for muscular asymmetry Preform circumferential mensuration Measuring around the muscles to confirm asymmetry Passive ROM (noting spasticity, or rigidity) Muscle tests for strength Stress test (holding arm up at shoulder hight for 30 s) Checking reflexes (for changes in tendon reflexes and presence of uninhibited pathological reflexes)
57
3 Patterns of Weakness
Proximal weakness Cranial Nerve Weakness Distal Weakness
58
Proximal weakness includes | (body parts)
shoulder and hip weakness
59
Proximal weakness signs
muscular dystrophy or muscle degeneration
60
Proximal weakness cuased by | (etiology)
genetic x-linked (mostly males)
61
Worst form of proximal weakness
Duchene
62
Duchene Pt life expectancy | (prognosis)
fatal by late teens/early 20’s
63
milder form of proximal weakness, and Pt can live longer
Diatonic muscular dystrophy
64
Proximal weakness Classical exam finding
Gower's sign
65
explain Gower's sign
pt is weaker at the hips, can’t stand up
66
where can Gower's sign spread to?
distal extremities (hand & feet)
67
Cranial Nerve Weakness Involves
1. facial expression 2. swallowing, chewing 3. eye motion
68
Cranial Nerve Weakness Suggest problem at
the neuromuscular junction
69
Cranial Nerve Weakness etiology
inadequate amount of neuro transmitter production or reduced number of muscular receptor
70
Distal Weakness includes
hands & feet
71
Distal Weakness origin
neurological
72
Upper motor neuron location
project from the cerebral cortex to lower motor neurons located in the anterior horn of the spinal cord
73
Lower motor neuron location
project via peripheral nerves to skeletal muscle
74
Upper vs Lower Motor Neuron Lesion
Sign UMNL LMNL Weakness Yes Yes Atrophy No Yes Fasciculations No Yes Reflexes Increased Decreased Tone Yes No Pathological reflexes Increased Decreased
75
Gait Disorders Can be caused by lesion in what part of the nervous system
almost anywhere in nervous system ![]()
76
Spastic gait caused by
lesion of upper motor neurons (Stroke, MS/Degeneration, Cerebral palsy)
77
Spastic gait signs
triple flexion of the arm, elbow, wrist, & fingers. riple flexion of the leg, hip, knee, and plantar flexion Stiff legged circumduction decreased arm swing unsteadiness falling
78
Functional gait disorder aka
psychologically based gait disorder
79
Functional gait disorder caused by
malingering patients or with psychological problem: 1. conversion disorder 2. factitious disorder
80
Functional gait disorder main signs
has no gait pattern Pt will not fall
81
Functional gait disorder pt will not fall due to
intact postural and gait reflexes
82
If Functional gait disorder pt falls, then it's \_\_\_\_\_
intentional
83
Define Multiple Sclerosis
autoimmune demyelination of the CNS
84
Myelin in CNS is made by
oligodendrocytes
85
MS cuases
idiopathic ## Footnote *(because of the overlapping etiology)*
86
some of the suggestions about cause of MS includes:
Vit D deficiency genetic predisposition diet
87
MS Pathological process
Lymphocytes attack CNS myelin only
88
MS Progression
Exacerbation remission
89
MS Classic first suspicion is
two or more deficits separated anatomically and temporally
90
Definitive diagnosis is based upon
MRI study
91
how does MS look on MRI
multiple bright scars (*oligoclonal banding*), decreased nerve conduction, and oligoclonal bands (*immunoglobulin*) in CSF
92
oligoclonal banding is due
myelin destruction
93
Demyelination effect on conduction velocity and action potentials
slows conduction velocity allows action potentials to disperse
94
Demyelination effects occurs more at what kind of temprature
at Higher temperatures | (while taking hot bath/showers)
95
MS Female : male ratio
Female: male 2:1
96
the age range of MS onsit
20-40
97
Can MS pt have a normal life span
yes, with very strict management strategy
98
Multiple nerve demyelination leads to
signal dispersal
99
Hallmark neuro symptom
optic neuritis
100
deffine optic neuritis
bright white optic disc – inflammation of the optic disc
101
MS Motor symptoms
Weakness Spasticity UMNL sign
102
Def: Weakness in the conjugate movements of the eyes
Internuclear Ophthalmoplegia
103
Internuclear Ophthalmoplegia is due to
demyelination of the tract connecting the eyes
104
MS Sensory signs | (Spinothalamic, Dorsal columns)
Impairment of vibratory/position sense Impairment of pain, temperature, or touch sense Pain (moderate to severe) L'hermitte’s sign
105
MS Cerebellar signs
Lack of coordination (ataxia)
106
Other location signs:
1. Cranial nerve signs 2. Autonomic 3. Psychaiatric
107
Define L’Hermitte Sign
electric shock like sensation with neck flexion
108
L’Hermitte Sign is due to
inflammation of the spinal cord
109
the definitive diagnosis of MS is based on
complete neurological diagnosis MRI CSF analysis
110
MS management is mainly based on
* Inflammation management
111
MS inflammation management includes
prednisone anti-inflammatory diet increase venous drainage via chiropractic
112
Define prednisone
steroidal anti-inflammatory
113
long term use of prednisone can lead to
kidney damage
114
anti-inflammatory diet includes avoiding (type of food)
wheat & dairy
115
increase venous drainage can reduce
metabolic waste
116
Motor Neuron Disease: Amyotrophic lateral sclerosis (ALS) aka
Lou Gehrig disease
117
ALS is a degeneration of
both upper and lower motor neuron cell bodies
118
ALS prognosis
Prognosis respiratory failure and death usually in 3-5 years
119
respiratory failure happens due to a damage of which nerve
phrenic nerve
120
in ALS Upper motor neuron lesion signs in _____ extremeties (upper/lower)
Lower extremity
121
Upper motor neuron lesion signs in the Lower extremity are
* weakness * spasticity * increased tendon reflexes
122
Lower motor neuron lesion signs in the _____ extremity (Upper/Lower)
Upper extremity
123
Lower motor neuron lesion signs in the Upper extremity are
* weakness * flaccidity * decreased tendon reflexes
124
First symptom of ALS is usually
focal weakness
125
focal weakness in ALS spreads to other muscle groups including
intrinsic muscles of the hand & feet
126
ALS may start with what type of sings
bulbar signs
127
bulbar signs includes
Dysarthria Dysphagia
128
Dysarthria means
weakness of the larynx
129
Dysphagia means
difficulty swallowing
130
Other possible diagnosis based on ALS symptoms
Lead poisoning Dysproteinemia Thyroid dysfunction Vitamin B12 deficiency Vasculitis Neoplasms Cervical spine compression
131
Normal MRI vs ALS MRI

6- Neuro Diag (10 decks)

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