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Neuroscience > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

Number of Nerves/segment

A

Cervical: 8
Thoracic: 12
Lumbar: 5
Sacral: 5

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2
Q

Where is conus medularis located?

A

L1-L2

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3
Q

What are the SC enlargements?

A

Cervical: C3-T2
Lumbosacral: L1-S2

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4
Q

What kind of nerve is a somatic peripheral nerve?

A

Mixed nerve

It has sensory, motor, and autonomic components

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5
Q

How are peripheral axons classified?

A

conduction speed and diameter

1a, 1b, II, A-beta, A-delta, C

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6
Q

What rami forms the Brachial plexus?

A

Anterior rami

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7
Q

What do the anterior and posterior rami supply?

A

Anterior: extremities, anterior body, lateral body
Posterior: paravertebral muscles, skin along spine, body

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8
Q

Where are the cell bodies of Sensory axons, LMNs, and autonomic neurons at?

A

Sensory: DRG
LMNs: In SC and Brainstem
Autonomic: Autonomic ganglia and lateral horn of SC

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9
Q

What spinal levels have autonomic cell bodies?

A

Sympathetic: T1-L2
Parasympathetic: S2-S4

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10
Q

What are the components of a neuron?

A

Axons, glial components (Scwann cells), CT (epi/peri/endoneurium)

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11
Q

What is the purpose of neural cutaneous branches?

A

Sensory: skin (touch, pressure, vibration)
Motor: BVs, piloerection, sweatglands

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12
Q

What is the purpose of neural muscular branches?

A

Sensory: Jt receptors (muscle spindle, GTO, Muscle pain receptor)
Motor: Skeletal muscles and BVs to that muscle

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13
Q

What is the function of nerve movement?

A

Maintain nerve health, promote BF in nerve, promote axoplasmic movement

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14
Q

Describe changes in peripheral nerve length

A

Rest: axon wrinkle in endoneurium
Lengthening: CT stretch, axons unwrinkled, fascicles glide
More lengthening: tensile stress, excess leads to damage of CT and axons
Relax: reversed

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15
Q

What are the different nerve plexuses:

A

Cervical: C1-C4
Brachial: C5-T1
Lumbar: L1-L4
Sacral: L4-S4

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16
Q

What is the cervical nerve plexus?

A

C1-C4
Deep to SCM
Cutaneous innervation of posterior scalp to the clavicle
Innervates anterior neck muscles and diaphragm

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17
Q

What is the brachial plexus?

A

C5-T1
Deep to clavicle into axillary region
Between anterior and middle scalenes
Innervate entire upper limb

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18
Q

What is the lumbar plexus?

A

L1-L4
Forms in Psoas major
Innervate skin and muscles of anterior/medial thigh
(obturator and femoral nerves)

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19
Q

What is the sacral plexus?

A

L4-S4
Parasympathetic axons (Sciatic nerve)
Innervate posterior thigh and most of leg and foot

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20
Q

What dermatome supplies the head?

A

Face: Trigeminal n (V)
Remainder: C2

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21
Q

What dermatome supplies the nipple and umbilicus?

A

Nipple: T4
Umbilicus: T10

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22
Q

What dermatome supplies the shoulder?

A

Top of shoulder: C4

Shoulder lateral arm: C5

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23
Q

What dermatomes supply the forearm and digits?

A

Lateral forearm and 1st 2 digits: C6
Middle digit: C7
4th and 5th digit: C8
Medial arm and forearm: T1

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24
Q

What dermatomes supply the thigh?

A

Anterolateral thigh: L2

Anteromedial thigh and knee: L3

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25
Q

What dermatomes supply the shin?

A

Anteromedial shin: L4

Anterolateral shin and top of foot to big toe: L5

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26
Q

What dermatomes supply the small toe, lateral foot, sole, and calf?

A

S1

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27
Q

What dermatomes supply the perineal region?

A

S2, 3, 4

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28
Q

Where are disc herniations most common at?

A

Cervical and lumbosacral level (posterolateral)

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29
Q

Where does the NMJ synapse?

A

Between LMN and skeletal muscle fiber

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30
Q

What is the Neurotransmitter for NMJ?

A

AcH

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31
Q

What are the receptors on the muscle for NMJ?

A

Nicotinic

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32
Q

What should happen at the NMJ under normal conditions?

A

100% contraction

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33
Q

What is a MEPP?

A

Small depolarizations in muscle that don’t produce a muscle contraction but release small amount AcH from presynaptic terminal:

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34
Q

What is the function of a MEPP?

A

Promote axon health
LMN: Rapid and severe
UMN: slow atrophy

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35
Q

What are some NMJ disorders?

A

MG: autoimmune dz that damage ACH resulting in weakness of proximal limb muscles, eye muscles, and diaphragm after reps
Botulism: Interfere with AcH from presynaptic terminal resulting in acute, progressive weakness, loss of stretch reflex, little sensory loss, decreased spasticity and dystonia

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36
Q

Describe myopathies:

A

More proximal than distal
Intrinsic to muscles (MD)
No sensory or autonomic dysfunction

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37
Q

Signs of peripheral dysfunction:

A

Sensory: Hyperalgesia, dysesthesia, paresthesia, allodynia
Autonomic: Single (loss of sweating, flushed skin), Many (difficulty regulating BP, HR, sweating, B/B, impotent)
Motor: Paresis/paralysis, No EMG 1wk, rapid atrophy, decreased or lost tone/reflexes, fibrillations
Trophic: shiny skin, brittle nails, SubQ tissue thickening, Ulcers, poor wound healing, increased infection, neurogenic jt dmg

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38
Q

Classification of neuropathies:

A

Mononeuropathy (Neurapraxia, Axonotmesis, Neurotmesis), Multiple mononeuropathy, Polyneuropathy

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39
Q

Describe traumatic myelinopathy (neurapraxia)

A

Loss of myelin to site affecting large-diameter axons, has rapid recovery. Schwann cells come back small
Caused by focal compression or repeated mechanical stimuli

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40
Q

Describe traumatic axonopathy (Axonotmesis)

A

Affects axons and myelin of all size distal to lesion, slow recovery d/t intact myelin and CT; axons and wallerian degeneration
Motor function is decreased or absent

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41
Q

Describe severance (neurotmesis)

A

Excess stretch/laceration interrupting axons and CT

Immediate loss of sensation, paralysis, neuroma

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42
Q

Describe Multiple mononeuropathy:

A

Several nerves and is multifocal
asymmetricall individual
2 or more will be random and assymetrical
Caused by vasculitis

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43
Q

Describe polyneuropathy

A

Many nerves that’s a generalized disorder; has distal and symmetrical presentation
Sensory, motor, autonomic involvement from distal to proximal
Caused by toxic, metabolic, autoimmune

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44
Q

Gross anatomy of the SC

A

Outer: white matter; myelinated axons
Inner: Gray matter; Cell bodies, synapses, connections

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45
Q

Tectospinal tract

A

Origin in Superior Colliculus of Midbrain
Cross and descend in SC only to Cervical region
Controls head, shoulder, upper trunk to orient head/neck movements to visual/auditory input

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46
Q

Rubrospinal tract

A

Origin in Red nucleus of Midbrain
Receives input from CC and Cb
Cross and descend in SC
Controls muscle tone, contralateral UE flexors

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47
Q

Medial vestibulospinal tract

A

Origin in Medial vestibular nucleus
Only to cervical region
Controls head position

48
Q

Lateral vestibulospinal tract

A

Origin in lateral vestibular nucleus
Ipsilateral in anterior funiculus
Excites extensors, inhibits flexor

49
Q

Medial (pontine) reticulospinal

A

Receives direct CC input
Origin in reticular formation in pons
Uncrossed
Enhance postural and extensors

50
Q

Lateral (medullary) reticulospinal

A

Receives direct CC input
Origin in reticular formation in medulla
bilateral
Facilitate flexors, inhibit extensors, regulate voluntary movement, reflex activities, muscle tone

51
Q

Where do the ascending tracts get information from?

A

Cb and thalamus (Thalamus–>CC)

52
Q

DCML

A 
Large myelinated (1a, 1b, II, A-beta)
Information from mechanical receptors
Lesions result in impaired tactile and kinesthetic senses (can feel touch, can't localize)
53
Q

Spinothalamic

A 
P/T, crude touch (light touch, itch, tickle, B/B pressure, sex sensation)
Lateral fibers are for caudal body parts
Primary fibers for P/T
Everything but itch is bilateral 
Unilateral damage will be minor
54
Q

Spinocerebellar pathway

A

Bilateral unconscious sensory information (muscle, jt and cutaneous proprioception, body position in space and position of body segments)
Injury should result in ataxia however rarely detectable

55
Q

Organization of long and short tracts

A

Long: away from gray matter
Short: 1 level SC to the next level (periospinal, outside gray matter)

56
Q

Where do descending axons terminate?

A

Alpha and gamma motor neurons

Spinal interneurons

57
Q

What does the gray matter of the SC contain?

A

Cell bodies, dendrites, myelinated and unmyelinated axons, glial cells

58
Q

What is the intermediate horn region of the gray matter?

A

Autonomic, sympathetic

thoracic and upper lumbar (T1-L2)

59
Q

What Laminae levels does the dorsal horn represent?

A

I-VI

60
Q

What laminae levels does the intermediate horn represent?

A

VII

61
Q

what laminae levels does the ventral horn represent?

A

VII-XI

62
Q

what laminae level does the central canal represent?

A

X

63
Q

What is the organization of motor neurons for proximal muscles?

A

Trunk, shoulder/hip girdles

Medial motor pathways

64
Q

What is the organization of motor neurons for flexor muscles?

A

Dorsal part of the ventral horn

Lateral motor pathways

65
Q

Segmental vs vertical tract injury

A

Segmental: at level (dorsal/ventral roots/horns)

Vertical tracts: at and caudal (UMN pathway or ascending tracts)

66
Q

Describe damage to white matter

A

Lesioned structures include ascending/descending axons, damage UMN axons
S/S seen below level of injury

67
Q

Describe damage to gray matter

A

Lesioned structures include sensory interneurons in dorsal horn, 2nd neuron for ALS, ventral horn LMNs
S/S seen at level of injury

68
Q

Tract somatotopy at most caudal level

A

DC: medial
ALS: lateral
Lateral corticospinal: lateral

69
Q

Crossing of DC, ALS, Lateral corticospinal

A

DC: Caudal medulla
ALS: ventral horn SC
Lateral corticospinal: Caudal medulla

70
Q

What are the 3 types of pain?

A

Local (dmg to bone/ligament surrounding SC)
Radicular (dmg to sensory nerve root)
Diffuse ache/burn (dysfunction in SC pain pathway)

71
Q

Local pain

A

Rapid (trauma, infarction, herniation), slow (tumor, transverse myelitis, syrringomyelia)
More severe at level but can go lower

72
Q

Radicular pain

A

Excruciating, possible local pain in a dermatomal pattern

73
Q

Diffuse ache/burn pain

A

Pts after traumatic SCI that may not be until months after the injury
Not localized

74
Q

Sensory abnormalities

A

DC: Numb/dead arm
ALS: analgesia

75
Q

Muscle weakness

A

UMN: hyperreflexia, spasticity, abnormal reflex responses
LMN: atrophy, hypotonia, hyporeflexia or areflexia, fasciculations

76
Q

Effect of the Sympathetic nervous system on pelvic organ function:

A

Inhibit contraction to stimulate filling

Internal sphincter contraction

77
Q

What spinal level of Sympathetic nervous system for pelvic organ function?

A

(T11-L2)

78
Q

Effect of the Parasympathetic nervous system on pelvic organ function:

A

Bladder emptying
Contraction of bladder wall
Open internal sphincter

79
Q

What spinal level of Parasympathetic nervous system for pelvic organ function?

A

(S2-S4)

80
Q

Effect of somatic fibers on pelvic organ function:

A

Open external sphincter

81
Q

What spinal level of somatic fibers for pelvic organ function?

A

S2-S4

82
Q

Describe infant bladder control

A

Involuntary control

Reflexive (doesn’t involve conscious control)

83
Q

What is reflexive bladder control?

A

Doesn’t involve conscious control

Requires sensory afferents, T11-L2, Somatic/Sympathetic/Parasympathetic efferents

84
Q

What is voluntary bladder control?

A

Sensory information from reflex center in SC to the brain

Decision for micturition

85
Q

What effect do the corticospinals have on micturition?

A

Inhibit external sphincter muscles

86
Q

What effect does the brainstem pathways have on micturition?

A

Pathways to autonomic efferents

87
Q

Describe neural control of Sexual function:

A

Erection: Parasympathetic (S2-S4)
Ejactulation: Sympathetic (T11-L2), pudendal n (S2-S4), somatic efferents

88
Q

What controls visceral function:

A

Lateral corticospinal tracts: volitional breathing

Lateral columns: volitional micturition, automatic control of micturition, breathing, sweating, BP)

89
Q

What effect does spinal shock have on urinary bladder dysfunction?

A

Areflexic bladder (urinary retention)

90
Q

What effect does a cauda equina lesion of S2-S4 cause:

A

Areflexic bladder

91
Q

Effect of SCI injury above S2 on urinary bladder dysfunction

A 
Hyperreflexive/spastic bladder
Loss of conscious awareness of bladder
Decreased bladder capacity
Increased BP
Incomplete emptying
urine retention
92
Q

What are you at an increased risk for with urinary bladder dysfunction?

A

UTI, urinary stones, upper urinary tract degeneration

93
Q

What are some SCI causes that produce urinary dysfunction?

A

SCI, MS, tumors, Tabes dorsalis d/t syphilis

94
Q

What is in the genital system?

A

Spinal LMN (bilateral), sensory afferents (from tissues), ascending/descending pathways (ALS)

95
Q

What happens with SC lesions of lower lumbar and sacral?

A

Disrupt erection and ejaculation

96
Q

What happens with lesions above T12?

A

Loss of psychogenic erections, reflexive erections if LMN is intact, Ejaculation in some pops

97
Q

What are the main muscles for breathing?

A

Diaphragm (C3-C5), Intercostales (T1-T12), Abs (T6-T12)

98
Q

What do the intercostales do?

A

Normal inspiration, high volume respiration

99
Q

What are the functions of the abs?

A

expiration

100
Q

What are the accessory muscles for breathing?

A

SCM (C1-C3), Scalenes (C4-C8), Traps (C1-C4, CN XI)

101
Q

What are the effects of a lesion to C5 or higher on breathing?

A

Affect diaphragm

102
Q

What are the effects of a lesion to C3 or higher on breathing?

A

Artificial respirator needed

103
Q

What are the effects of a lesion to lumbar region on breathing?

A

Little effect

104
Q

What are the effects of a lesion to the thoracic region on breathing?

A

Impaired cough, little effect on normal breathing

105
Q

What are the effects of a lesion to the lower cervical region on breathing?

A

More effects on breathing

106
Q

Which tracts are responsible for voluntary breathing?

A

Corticospinal tracts

107
Q

What is all affected after a complete lesion?

A

Sensory: Radicular pain, local vertebral pain, segmental paresthesias
Motor: Spinal shock symptoms
Autonomic: Spastic bladder, constipation, anhidrosis, trophic skin changes (Q thin, SubQ thick), impaired temp, vasomotor instability

108
Q

What is all affected after an incomplete injury to SC?

A

Some fibers go below injury

Check sensation in low SC (perianal area S2-S3)

109
Q

What is lost after an anterior cord syndrome?

A

Anterior horn (LMN)
Corticospinal tracts
Spinothalamic tracts

110
Q

What is the etiology of anterior cord syndrome?

A

Ischemia (anterior spinal artery)
Infarction
Trauma (flex type, acute traumatic herniation)

111
Q

S/S anterior cord syndrome:

A

Losses below level
Motor control (UMN injury bilateral)
Pain and temp (bilateral)
DT, Vibration, Proprioception intact

112
Q

What is the etiology of Posterolateral cord syndrome?

A

Subacute combined degenerated of SC (B12, Aids, Pernicious anemia)
Chronic syphilis DC syndrome

113
Q

S/S Posterolateral cord syndrome

A

Lose fine touch, proprioception, vibration
Sensory ataxia
Parasthesias in feet
Impaired vibration and proprioception in legs
Motor dysfunction (spastic weakness, hyper, Babinski)
P/T intact

114
Q

Etiology of Central cord syndrome:

A 
Whiplash
tumor
postradiation myelopathy
infarction
syringomyelia
115
Q

S/S central cord syndrome

A

Bilateral loss P/T at level (cape pattern)
Normal tactile senses
UE

Neuroscience (6 decks)

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