Important content for final Flashcards
According to my [v. broad] interpretation of what prof jacobus said (309 cards)
1
Q
List the flow of CSF in order (7 steps)
A
Produced by choroid plexus in ventricles
1) Lateral ventricles
2) Foramen of Monro
3) 3rd ventricle
4) Sylvian aqueduct
5) 4th ventricle (joins cerebral aqueduct)
6) Foramen of Luschka and Magendie
7) SA space
[The arachnoid granulations then absorb]
2
Q
What two arteries form the basilar artery? [at circle of willis]
A
Vertebral arteries
3
Q
What connects the anterior cerebral arteries (ACAs) at the Circle of Willis?
A
Anterior communicating artery
4
Q
What two arteries does the posterior communicating artery connect at the Circle of Willis?
A
Internal carotid a. and posterior cerebral a. (PCA)
5
Q
What are the arteries that are always depicted in diagrams as numerous (6), short, and small that come off the basilar a?
[hint: b/t superior cerebellar and anterior inferior cerebellar arteries]
A
Pontine arteries
6
Q
What artery comes off the basilar artery just posterior to the PCA?
A
Superior cerebellar
7
Q
What arteries come off between the vertebral arteries just before they form the basilar artery [at circle of willis]?
A
Anterior spinal artery (medial) and posterior inferior cerebellar arteries (lateral)
8
Q
A
9
Q
Define anosmia
A
Loss of smell
10
Q
What cranial nerve exits at the spinal cord?
A
CN XI (11)
11
Q
What do CN III,IV, VI (oculomotor, trochlear and abducens) do?
A
Control the extraocular muscles
12
Q
1) What does the CNIV (4) (trochlear nerve) do?
2) What is the trochlea?
A
1) Rotates the top of the eye medially and downward
2) Trochlea is a pulley-like structure
13
Q
What does CNVI (6) (abducens) do?
A
Abducts the eye laterally in the horizontal direction
14
Q
What does CN III (oculomotor nerve) do?
A
All other eye movements not done by the trochlear and abducens nerves, including pupillary control
15
Q
1) What does CN V (trigeminal) mainly do? What does this include?
2) What does it also supply?
A
1) Supplies sensory to the face
-Nose, mouth, sinuses
-Anterior 2/3 of tongue
2) Motor to the mandible and the anterior portion of the external ear
16
Q
What are the 3 branches of CNV? Where do they exit the skull?
A
V1-Ophthalmic
V2-Maxillary
V3-Mandibular
The branches each exit the skull in different places
17
Q
1) Define Trigeminal Neuralgia (tic doulouruex) and what nerve branches are involved
2) When does it usually start and what causes episodes of it?
A
1) Recurrent episodes of brief pain, that last seconds to minutes in the distribution of V2/V3.
2) Usually begin after age 35, and are set off by chewing, shaving or touching a specific trigger point on the face.
18
Q
1) What is a potential cause of tic douloureux (since cause is typically unknown)?
2) What two other disorders have this cause?
A
1) Demyelination of the nerve
2) MS and optic neuritis
19
Q
What can cause CV sensory loss?
A
Trauma, tumors, herpes zoster, aneurysms of the internal carotid, schwannomas or meningiomas.
20
Q
Do V2/V3 fibers cross over? What is the implication of that?
A
These fibers do not cross over, so lesions cause ipsilateral deficits
21
Q
1) What does the facial nerve (CNVII) do?
2) What does a small branch of it do?
3) What is its path once it exits the brainstem?
A
1) Controls muscles of facial expression
2) Carries fibers for parasympathetic, visceral and somatosensory functions (tears, salivation, taste)
3) It runs through the auditory canal of the temporal bone, then takes a turn and runs in the facial canal, medial to the middle ear.
22
Q
1) What are the facial nerve’s (CN7) sensory neurons for?
2) What is its path once it exits the skull?
A
1) Sensation of the external ear
2) Passes through the parotid gland and splits into 5 major branches that control the facial expressions.
23
Q
1) What is Bell’s Palsy?
2) What does it cause?
3) Besides its symptoms, what do neuro exam and imaging studies look like with this condition?
A
1) Most common facial nerve disorder; all divisions of the facial nerve are impaired
2) Unilateral facial weakness
3) The remainder of the neuro exam and any imaging studies are typically normal.
24
Q
1) What is Bell’s palsy recovery like?
2) What is its cause?
3) What are its other symptoms?
A
1) Gradual recovery, but ~ 80% of patients fully recover in 3 weeks.
2) Unknown cause - thought to be viral or inflammatory in nature.
3) Ear pain from the somatosensory component, dry eye from decreased lacrimation.
-Can also be associated with loss of taste
25
What is the most common facial nerve (CNVII) disorder?
Bell's palsy
26
1) What can happen after Bell's palsy recovery?
2) Give an example.
1) Sometimes when facial nerves recover, they reach the wrong target.
2) For example, rogue parasympathetic fibers may create “crocodile tears, In which these patients lacrimate instead of salivate when they see food.
27
Recurrent episodes of Bell’s Palsy warrant what?
An extensive work up to rule out tumors, infiltrating diseases, Lyme’s disease sarcoid, and HIV.
28
1) What does Vestibulocochlear Nerve VIII do?
2) Where does it go?
1) Hearing and vestibular sensation
2) Enters internal auditory and then travels with the facial nerve in the auditory canal to the cochlea and the vestibular organs (semicircular canals, utricle and saccule.)
29
What are the two types of hearing loss? Define each.
1) Conductive HL: abnormalities of the external auditory canal or middle ear
2) Sensorineural HL: disorders of the cochlea or CN VIII common
30
What are some common causes of sensorineural HL?
1) Exposure to loud sounds
2) Meningitis
3) Ototoxic drugs (like gentamicin)
4) Head trauma
5) Viral infection
6) Aging
7) Meniere’s disease
8) Acoustic neuroma
31
1) What most common tumor of the inner ear?
2) What is it? What CN is involved?
3) What is the average age of onset?
4) Does it cause unilateral or bilateral hearing loss?
1) Acoustic Neuroma
2) A slow growing tumor that occurs where CN VIII (8) enters the internal auditory meatus
3) 50 years old
4) Almost always unilateral.
32
A) What are the symptoms of acoustic neuroma?
B) What can it affect? What does this cause?
A1) Unilateral hearing loss
2) Tinnitus (ringing in the ear)
3) Unsteadiness (why?)
B) The trigeminal nerve that is nearby; causes facial pain and sensory loss
33
What 5 things does the glossopharyngeal nerve (CNIX) convey?
1) Parasympathetic (motor) to parotid gland
2) Sensation from ear (external auditory meatus,)
3) Pharynx and posterior 1/3 of tongue
4) Taste from posterior 1/3 of tongue
5) Chemo/baroreceptors of carotid body
34
Which nerve supplies anterior 2/3 of tongue?
CNV Trigeminal
35
1) What are the main functions of the vagus nerve (CNX)?
2) Name two of its branches and what they do
1) Swallowing and gag reflex
2) Recurrent and superior laryngeal nerves; control all laryngeal muscles and the cricothyroid
36
Besides its main functions, what else does the vagus nerve convey? (3 things)
1) Parasympathetics (motor) to heart, lung and GI tract to the splenic flexure
2) Sensation from the pharynx and small region near the external auditory meatus
3) Visceral sensory from chemo/baroreceptors in the aortic arch and GI tract
37
1) Where does the spinal accessory nerve (CN XI) arise from?
2) What is its function?
3) What would a lesion of it cause?
1) The cervical spinal cord
2) Motor innervation to sternocleidomastoid and trapezius muscles
3) Weakness of ipsilateral shoulder shrug and weakness of head turning AWAY from the lesion
38
1) What does the hypoglossal nerve (CNXII) provide?
2) What happens when there's a lesion in it?
1) Motor to tongue
2) Weakness of tongue points towards the side of lesion when protruding
39
1) What is Glossopharyngeal Neuralgia?
2) What does it cause?
1) Similar to Trigeminal Neuralgia except in CN IX (9) distribution.
2) Episodes of severe throat and ear pain
40
1) What can occur during surgeries of the neck?
2) What does this cause?
1) Injury to the recurrent laryngeal nerve
2) Unilateral vocal cord paralysis and hoarseness
41
1) What nerve is responsible for palate elevation?
2) What happens if there's a lesion in it?
1) CNX (vagus)
2) The soft palate and uvula will deviate towards the normal side, while the soft palate on the abnormal side hangs low (stage curtain sign).
42
List the 6 things secreted by the anterior pituitary
1) ACTH
2) PRL (prolactin)
3) GH (growth hormone)
4) TSH
5) LH (luteinizing hormone)
6) FSH
43
What is the endocrine gland that's considered the “master gland” and secretes hormones that regulate many of our bodily functions?
Pituitary gland
44
List the 2 things secreted by the posterior pituitary
1) Oxytocin
2) Vasopressin
45
What part of the hypothalamus is the master clock of circadian rhythms?
Suprachiasmatic nucleus
46
What 2 things link the neural and endocrine systems?
Hypothalamus and pituitary
47
The hypothalamus the central regulator of what? How does it interact?
1) Homeostasis
2) Exerting influence over 4 other body systems:
-1-homeostatic mechanisms (that control hunger, thirst, sexual desire and sleep-wake cycles)
-2-endocrine control via the pituitary (controls release of hormones from the pituitary)
-3-autonomic control
-4-limbic mechanisms
48
List and describe the 4 systems the hypothalamus controls to maintain homeostasis
1) Homeostatic mechanisms: that control hunger, thirst, sexual desire and sleep-wake cycles
2) Endocrine control via the pituitary: controls release of hormones from the pituitary
3) Autonomic control
4) Limbic mechanisms
49
What two places does the hypothalamus receive inputs from?
The amygdala and regions of the limbic cortex
50
The regulator of circadian rhythms receives inputs from where? What do these contain?
Retinal ganglion cells containing photopigment melanopsin that contain information about day and night cycles.
51
1) What core survival function is partially regulated in the hypothalamus?
2) What can lesions in this part of the hypothalamus do?
1) Thirst
2) Decrease water intake
52
The limbic cortex forms what? What two things does it surround?
A ring–like limbic lobe surrounding the corpus collosum and upper brainstem
53
1) Structures of the limbic system regulate what 5 processes?
2) The limbic system contains what?
1) Emotions, olfaction, memory, drives and homeostasis.
2) Cortical and subcortical structures located mainly in the medial and central hemispheres
54
What are the 4 main categories of limbic system functions?
1) Homeostatic functions including autonomic and neuroendocrine control
2) Olfaction
3) Memory
4) Emotions and drives
HOME
55
What is the hippocampus's:
1) Shape?
2) Location?
3) Function?
C-shaped structure buried in the medial temporal lobe important in memory functions
56
1) What is the amygdala?
2) Where is it?
3) What does it function in?
1) Complex of nuclei in the anteromedial temporal lobe
2) Tip of the hippocampus
3) Emotional, autonomic, and neuroendocrine circuits of the limbic system
57
Some fibers of the olfactory tract go where? Why?
Give an example of this function
Amygdala; some odors illicit old memories
**peppermint=> aids in memory and concentration
58
What are the 2 main regions in the brain that are critical for memory formations? What does each contain?
1) Medial temporal lobe memory area: contains the hippocampus
2) Forebrain: contains nuclei of the thalamus and hypothalamus.
-There are numerous pathways that connect the 2.
59
List the jobs of the pituitary hormones
Oxytocin: uterine contractions, milk letdown
PRL: milk production
FSH, LH: gonads
ACTH: adrenal cortex
TSH: thyroid (to make T3 and T4)
ADH (vasopressin): kidney water retention
GH: long bone growth
60
What does the posterior pituitary contain?
Axons whose cell bodies are located in the hypothalamus
61
1) What can the hypothalamus detect?
2) What can lesions there cause because of this?
3) What does the posterior hypothalamus do?
1) Increased body temperature
2) Hyperthermia
3) Conserves heat.
62
1) What is the amygdala? Where is it?
2) What two things does it play a big role in?
1) A group of nuclei in the anteromedial temporal lobe at the tip of the hippocampus
2) In emotions and drives.
63
What is an active participant in all 4 limbic functions?
Amygdala
64
What is the amygdala important in regarding emotions?
Attaching emotions to stimuli perceived by the association cortex.
65
1) What emotional states is the amygdala involved in?
2) What 2 structures have reciprocal interactions with the amygdala?
3) What do all 3 structures do together?
1) Fear, anxiety, aggression, pleasure, and rage
2) Hypothalamus and brainstem
3) Mediate changes in heart rate, peristalsis, gastric secretions, piloerections, and sweating
66
What NTs can be markedly imbalanced in bipolar depression/ mania?
Serotonin, norepinephrine, and dopamine
67
1) What structures being abnormal can cause schizophrenia?
2) What NT is can cause it, and what can improve symptoms?
1) Limbic system, frontal lobes, and thalamus.
2) An abnormality in dopamine, therefore symptoms can improve with antidopaminergic agents
68
What are the 3 primary divisions of the brain?
1) Forebrain (prosencephalon)
2) Midbrain (mesencephalon)
3) Hindbrain (rhombencephalon)
69
1) What is the largest part of the nervous system in humans?
2) What is it subdivided into? (2 things)
3) Where is it located?
1) The forebrain
2) Telencephalon and diencephalon.
3) Sits on top of midbrain.
70
Name the 2 parts of the forebrain and what they consist of
1) Telencephalon: cerebral hemispheres, cerebral cortex, white matter, basal ganglia
2) Diencephalon: thalamus, hypothalamus
71
1) Is the midbrain long or short? What does it connect?
2) What 3 things does the hindbrain consist of?
3) What 3 things does the brainstem consist of? What does it connect?
1) Midbrain: short, connects the fore and hind brains
2) Hindbrain: pons, cerebellum and medulla
3) Brainstem: midbrain, pons, medulla; connects brain to spinal cord
72
What does the brainstem do? Give examples
Controls most of the basic bodily functions needed for survival.
Ex: **respirations, BP, HR
73
1) What two parts of the brain are important in the regulation of consciousness level?
2) What 3 things are also involved in consciousness?
3) What happens if there are lesions in these two areas?
4) What is the clinical correlation?
1) Upper pons and midbrain
2) Cortical, thalamic and forebrain networks
3) Therefore, lesions in these areas cause lethargy and coma
4) Lesions of thalami, or large lesion/s in the hemispheres/areas above brainstem) can impair consciousness indirectly through mass effect -putting pressure on the brainstem and thereby distorting or compressing its systems
74
1) What's the primary function of the cerebellum?
2) What two things does the pons do?
3) What two things does the medulla do?
4) What do these 3 parts have in common?
1) Integrates sensory and other inputs from brain and spinal cord; coordinates movements from those inputs
2) Connects brain and spinal cord, and regulates level of consciousness
3) Passes information between brain and spinal cord, and regulates cardiovascular and respiratory systems
4) They're all part of hindbrain
75
What are the 3 primary divisions of the brain?
1) Forebrain (prosencephalon)
2) Midbrain (mesencephalon)
3) Hindbrain (rhombencephalon)
76
1) What 3 things make up the brainstem?
2) What 3 things is the brainstem connected to?
3) What arises from here? 4) What is the brainstem packed with? What do some of these things contain?
1) Midbrain, pons and medulla
2) Connected to the diencephalon, cerebellum and spinal cord.
3) Most of the cranial nerves arise from here
4) Also packed with other nuclei and white matter tracts; some nuclei contain neurotransmitters
77
1) What does the brainstem do? Give examples
2) What passes through the brainstem?
1) In charge of all vital functions needed to stay alive, ex/HR, BP, respirations; some of its nuclei contain neurotransmitters
2) ALL information passed between cerebral hemispheres and the spinal cord
78
List the 12 cranial nerves in order
1) Olfactory
2) Optic
3) Oculomotor
4) Trochlear
5) Trigeminal
6) Abducens
7) Facia
8) Vestibulocochlear
9) Glossopharyngeal
10) Vagus
11) Accessory
12) Hypoglossal
79
1) What is the most common excitatory NT in the CNS?
2) What is the most common inhibitory NT in the CNS?
3) What neurotransmitter is responsible for skeletal, smooth and cardiac muscle contractions
1) Glutamate
2) GABA (gamma-aminobutyric acid)
3) Acetylcholine
80
1) Describe the location of the frontal lobe
2) Describe the location of the temporal lobes in relation to the frontal lobe
3) What separates the frontal lobe and temporal lobes?
1) In the front, extends back to the central sulcus
2) Inferior and lateral to frontal lobe
3) A deep fissure called Sylvian (or lateral) fissure (a deep sulcus)
81
1) Where is the parietal lobe in relation to the central sulcus and Sylvian fissure?
2) Where is the occipital lobe in relation to the parietal lobe? What separates it from the parietal lobe when viewed medially?
1) Parietal lobe: posterior to the central sulcus and superior-posterior to the Sylvian fissure
2) Posterior to parietal; separated by parieto-occipital sulcus when viewed medially
82
What are the primary sensory and motor areas (4)?
1) Primary somatosensory cortex
2) Primary motor cortex
3) Primary visual cortex
4) Primary auditory cortex
83
1) Where is the primary motor cortex? What is it immediately anterior to?
2) What does the primary motor cortex control?
3) Where is the primary somatosensory cortex? What does it control?
1) Lies in precentral gyrus in frontal lobe, immediately anterior to central sulcus.
2) Controls movement to opposite side of body.
3) Lies in postcentral gyrus in the parietal lobe; involved in sensation for the opposite side of the body
84
1) Motor areas lie ________ to somatosensory areas
2) What lobe is the primary visual cortex in?
1) anterior
2) In occipital lobe
85
1) Describe the location of the primary auditory cortex
2) How are sensory and motor pathways usually organized?
1) Primary auditory cortex- transverse gyri of Heschl —2 fingerlike gyri inside the Sylvian fissure on superior surface of each temporal lobe
2) Usually topographically organized (adjacent receptors on motor surfaces are mapped to adjacent fibers in white matter pathways and to cortex ex/ motor and somatosensory regions controlling the hand are next to the arm, etc)
86
Is the primary auditory cortex lateralized?
It's less lateralized and input from opposite ear is slightly stronger, but not clinically detectable
87
What is the acronym to remember whether the cranial nerves are sensory, motor, or both?
Some Say Money Matters, But My Brother Says Big Brains Matter More
88
1) What is the most important motor pathway?
2) Where does this pathway begin?
1) Corticospinal tract/ “pyramidal tract”
2) Begins in primary motor cortex where neurons project axons through cerebral white matter and brainstem to the spinal cord
89
1) What percent of fibers in the corticospinal tract cross over to control movement on the opposite side?
2) What is this crossing over called and where does it occur?
3) What happens if there's a lesion above this? What about below?
1) About 85%
2) Pyramidal decussation; at junction of medulla and spinal cord
3) Lesions above will cause contralateral weakness; below will cause ipsilateral weakness
90
1) Lesions in the cerebellum cause what?
2) What do lesions in the basal ganglia cause?
3) Give 2 examples of the effects of basal ganglia lesions
1) Movement disorders (especially balance and coordination= ataxia)
2) Hypokinetic movement disorders
3) Slow and rigid as in Parkinsonism or hyperkinetic as in Huntington’s disease “dancelike” involuntary movements
91
What are the two pathways in the spinal cord for sensation? What 3 things do they each convey?
1) Posterior column pathway: conveys proprioception, vibration sense, and fine touch
2) Anterolateral pathway: conveys pain, temperature sense, and crude touch
92
What is conveyed by both somatosensory pathways? Why?
Touch sensation; so a lesion in one pathway does not completely eliminate touch sensation
93
1) Define posterior column pathway. What 3 things does it carry information about?
2) Where does it enter?
3) Where does it ascend?
4) Where does it end up?
1) Sensory motor neurons carrying information about proprioception, vibratory sense and fine touch. A somatosensory pathway.
2) Enters the spinal cord via the dorsal roots
3) Ascends ipsilateral white matter dorsal/posterior column [all the way up to]
4) The dorsal column nuclei in the medulla.
here they synapse to secondary sensory neurons whose axons cross over to the other side of the medulla
94
Where does the posterior column pathway continue onto after synapsing to secondary sensory neurons?
Continues up on the contralateral side to the thalamus into the primary somatosensory cortex.
95
1) Define anterolateral pathway. What 3 things does it carry information about?
2) Where does it enter the spinal cord?
3) Where do these axons initially synapse?
1) Primary sensory neurons carry information about pain, temperature sense and crude touch. A somatosensory pathway.
2) The dorsal root
3) Synapse in the gray matter.
96
1) What do the primary motor and somatosensory cortexes represent?
2) Why?
3) Why is this important?
4) What does the visual cortex represent?
1) The opposite side of the body to where they are located.
2) The somatosensory and motor pathways cross over in the nervous system
3) Knowing this information helps guide clinicians to area of abnormality
4) Visual input from opposite visual field; the left half of visual field for each eye is mapped to right visual cortex
97
The two pathways in the spinal cord for sensation are called what?
Somatosensory pathways (posterior and anterior)
98
1) What anterolateral pathway axons cross over to the other side of the spinal cord?
2) Where does this pathway synapse?
3) Where does this pathway terminate?
1) Axons from the secondary sensory neurons
2) The thalamus
3) The primary somatosensory cortex
99
1) What is the most important motor pathway?
2) Where does this pathway begin?
1) Corticospinal tract/ “pyramidal tract”
2) Begins in primary motor cortex where neurons project axons through cerebral white matter and brainstem to the spinal cord
100
1) What percent of fibers in the corticospinal tract cross over to control movement on the opposite side?
2) What is this crossing over called and where does it occur?
3) What happens if there's a lesion above this? What about below?
1) About 85%
2) Pyramidal decussation; at junction of medulla and spinal cord
3) Lesions above will cause contralateral weakness; below will cause ipsilateral weakness
101
1) Define posterior column pathway. What 3 things does it carry information about?
2) Where does it enter?
3) Where does it ascend?
4) Where does it end up?
1) Sensory motor neurons carrying information about proprioception, vibratory sense and fine touch. A somatosensory pathway.
2) Enters the spinal cord via the dorsal roots
3) Ascends ipsilateral white matter dorsal/posterior column [all the way up to]
4) The dorsal column nuclei in the medulla.
here they synapse to secondary sensory neurons whose axons cross over to the other side of the medulla
102
Where does the posterior column pathway continue onto after synapsing to secondary sensory neurons?
Continues up on the contralateral side to the thalamus into the primary somatosensory cortex.
103
1) What sense is not relayed through the thalamus?
2) Where does it go instead?
3) What does the thalamus encompass?
1) Olfaction
2) Directly to the olfactory cortex.
3) The pineal gland
104
Where is the pineal gland? What does it do?
1) In the center of the brain
2) Receives information about light and dark and secretes melatonin as needed
105
1) Where is the association cortex?
2) What does it do?
1) Contained within the cerebral cortex
2) Processes higher order information
106
1) Motor planning is distributed among many areas of the association cortex. What does this mean in regards to lesions?
2) What type of lesions cause hemineglect (patients ignore objects or even their own body parts to one side)
1) That lesions in the cortex can cause apraxia (uncoordinated or disassociated movements.)
2) Right parietal lesions
107
1) What is the largest lobe? What does this mean?
2) What would lesions in the frontal lobe cause?
1) The frontal lobe; it contains the largest amount of the association cortex.
2) Many different problems with personality (lack of judgement, inappropriate joking, inhibition) and cognition
108
1) Where is the primary visual cortex?
2) What do lesions in this cortex cause?
3) What about seizures in this area?
1) In the parieto-occipital lobe
2) Inability to recognize faces, or colors or persistence or reappearance of an earlier viewed object.
3) Seizures cause visual hallucinations.
109
Name 6 arteries that compose the circle of Willis. Know their locations
1) Internal carotid arteries
2) Anterior cerebral arteries (ACAs)
3) Posterior cerebral arteries (PCAs)
4) Posterior communicating arteries (PCOMs)
5) Vertebral arteries
6) Middle cerebral arteries (MCAs)
110
1) What do the primary motor and somatosensory cortexes represent?
2) Why?
3) Why is this important?
4) What does the visual cortex represent?
1) The opposite side of the body to where they are located.
2) The somatosensory and motor pathways cross over in the nervous system
3) Knowing this information helps guide clinicians to area of abnormality
4) Visual input from opposite visual field; the left half of visual field for each eye is mapped to right visual cortex
111
The two pathways in the spinal cord for sensation are called what?
Somatosensory pathways (posterior and anterior)
112
1) What anterolateral pathway axons cross over to the other side of the spinal cord?
2) Where does this pathway synapse?
3) Where does this pathway terminate?
1) Axons from the secondary sensory neurons
2) The thalamus
3) The primary somatosensory cortex
113
Name 4 elements of the association cortex
1) Wernicke's area
2) Broca's area
3) Frontal lobe
4) Primary visual cortex
114
What is CN1?
Olfactory
115
What is CNVII?
Facial
116
What pathway conveys proprioception, fine touch, and vibration?
Posterior
117
What structure secretes melatonin?
Pineal gland
118
What structure is responsible for expressive language?
Broca's
119
What structure is responsible for receptive language?
Wernicke's
120
Damage to what structure causes hypo or hyperkinetic movement?
Basal ganglia
121
What drains blood from the brain?
Internal jugular
122
What supplies blood to the anterior portion of the brain?
Internal carotid arteries
123
What pathway conveys pain, temperature, and crude touch?
Anterolateral
124
True or false: Adjacent parts of the body are mapped to adjacent parts of the cerebral cortex
True
125
Where is the primary motor cortex?
Precentral gyrus
126
What lobe has the primary visual cortex?
Occipital
127
Arteries of the brain:
1) ACA and MCA come from what artery?
2) What artery does the PCA come from?
1) Internal carotid
2) Basilar
128
Bridging veins are found where?
Subdural space
129
What ventricle is in the diencephalon?
3rd ventricle
130
What ventricle is surrounded by the pons, medulla and cerebellum?
Fourth
131
What tract controls voluntary movement of distal muscles (hands and limbs) and is involved in fine motor skills?
The lateral motor system, aka lateral corticospinal tract
132
If there's a lesion in the lateral corticospinal tract of the brain, what would happen?
Contralateral hemiparesis, particularly affecting fine motor control
133
What two tracts originate in the primary motor cortex?
Lateral corticospinal tract and anterior corticospinal tract
134
What are the two divisions of the motor system's tract?
Lateral (lateral corticospinal tract) and medial (anterior corticospinal tract)
135
What tract controls bending, twisting, and movements of the trunk?
Anterior corticospinal tract
136
Bridging veins are found where?
Subdural space
137
What ventricle is in the diencephalon?
3rd ventricle
138
What ventricle is surrounded by the pons, medulla and cerebellum?
Fourth
139
What tract controls voluntary movement of distal muscles (hands and limbs) and is involved in fine motor skills?
The lateral motor system, aka lateral corticospinal tract
140
If there's a lesion in the lateral corticospinal tract of the brain, what would happen?
Contralateral hemiparesis, particularly affecting fine motor control
141
What two tracts originate in the primary motor cortex?
Lateral corticospinal tract and anterior corticospinal tract
142
What are the two divisions of the motor system's tract?
Lateral (lateral corticospinal tract) and medial (anterior corticospinal tract)
143
What tract controls bending, twisting, and movements of the trunk?
Anterior corticospinal tract
144
Where is the corticospinal tract of the brain?
In the posterior limb of the internal capsule
145
A lesion/stroke of the ________________ can cause weakness of the entire contralateral side of the body from face to lower extremity
internal capsule
146
What are the 3 long tracts of the spinal cord?
1) Posterior column-medial leminiscal system
2) Anterolateral systems (2, includes spinothalamic tract)
3) Corticospinal tract
147
What are the two main somatosensory pathways?
1) Posterior column-medial leminiscal system
2) Anterolateral systems (2, includes spinothalamic tract)
148
A lesion of what tract will cause a loss of pain and temp sensation in the contralateral side below the level of the lesion? Why?
Spinothalamic tract; mediates pain and temp sense
149
What decussates at anterior commissure of spinal cord?
Anterolateral systems (includes spinothalamic tract)
150
What tract conveys proprioception, vibration sense, and fine touch?
Posterior column-medial leminiscal system
151
What long tract decussates in the lower medulla?
Posterior column-medial leminiscal system
152
Lesions (trauma, compression, multiple sclerosis) of the ___________________ of the spinal cord causes loss of vibration sense, and proprioception below the level of the lesion. This is called _________________________
posterior columns; posterior cord syndrome
153
Sensory loss in what region is called saddle anesthesia?
S2-S5
154
Impairment of _________ (perianal) can cause bladder dysfunction, constipation, fecal incontinence, and loss of erections and needs immediate treatment
S2-S4
155
What is the processing center of the brain?
Thalamus
156
Define dermatome
A peripheral region innervated by sensory fibers from a single nerve root level
157
________________ are organized in a way that allows clinicians to map sensory information to the corresponding spinal nerve, which can be useful in diagnosing certain neurological conditions.
Dermatomes
158
What is the T4 dermatome?
Nipple line
159
What is the T10 dermatome line?
Umbilicus
160
What is the C4 dermatome line?
Thumb
161
What is the S5 dermatome?
Perianal
162
What supplies the anterior hemispheres of the brain?
Internal carotid arteries
163
____________________ supply posterior hemispheres and join forming the basilar artery
Vertebral arteries
164
The anterior and posterior blood supplies form the ___________________ from which all major cerebral vessels arise
Circle of Willis
165
About __[fraction]_____of general population has a full/complete ring/ circle of willis
1/3
166
_______________________ come off the aorta and split into the internal and external carotid arteries
Common carotid arteries
167
The main arteries that supply the cerebral hemisphere are what?
The anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA)
168
The anterior and middle cerebral arteries are the termination of what?
Internal carotids
169
The ___________ join anteriorly by the anterior communicating artery
ACA (anterior cerebral arteries)
170
The anterior and posterior circulations are linked by the ________________________ arteries
posterior communicating
171
What two arteries are linked to join anterior and posterior circulation of the brain?
Internal carotid and the posterior cerebral arteries
172
What does the anterior cerebral artery (ACA) supply?
-Cortex on the anterior medial surface of the brain, from frontal to parietal lobe.
-Medial sensorimotor cortex.
173
The _____________ artery's branches supply the cortex above and below the Sylvian fissure including the lateral temporal lobe and parts of the parietal lobe. Also includes large parts of the basal ganglia and internal capsule, and the thalamus
Middle cerebral artery (MCA)
174
What does the posterior cerebral artery (PCA) supply blood to?
1) Inferior and medial temporal lobes
2) Medial occipital cortex
175
Branches of the ____________ supply large regions of the basal ganglia and the internal capsule.
MCA
176
In the setting of HTN, what small vessels are prone to narrowing, which can lead to blockages causing lacunar infarctions?
MCA branches that supply large regions of the basal ganglia and the internal capsule
177
Lacunar infarction in what area causes contralateral hemiparesis?
Posterior limb of the internal capsule (which houses motor pathways of the corticospinal tract) and thalamus
178
What characterizes lacunar infarct syndrome (stroke) (clinical manifestation of lacunar infarct)?
Pure motor hemiparesis; contra/unilateral face, arm, and leg weakness. Due to lacunar infarct of posterior limb of internal capsule.
179
What is the most common type of stroke?
Lacunar infarct syndrome
180
What strokes are more common, ACA, MCA, or PCA?
MCA
181
What type of stroke is characterized by aphasia, hemineglect, hemianopia, face/arm or face/arm/leg sensorimotor loss, and a gaze toward the side of the lesion?
MCA stroke
182
Where is Broca's area?
Just superior to Sylvian fissure in frontal lobe of left hemisphere
183
What is inferior to the lateral fissure in the temporal lobe?
Wernicke’s area
184
____________________ supply posterior hemispheres and join forming the basilar artery
Vertebral arteries
185
The anterior and posterior blood supplies form the ___________________ from which all major cerebral vessels arise
Circle of Willis
186
About __[fraction]_____of general population has a full/complete ring/ circle of willis
1/3
187
_______________________ come off the aorta and split into the internal and external carotid arteries
Common carotid arteries
188
The main arteries that supply the cerebral hemisphere are what?
The anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA)
189
The anterior and middle cerebral arteries are the termination of what?
Internal carotids
190
The ___________ join anteriorly by the anterior communicating artery
ACA (anterior cerebral arteries)
191
The anterior and posterior circulations are linked by the ________________________ arteries
posterior communicating
192
What two arteries are linked to join anterior and posterior circulation of the brain?
Internal carotid and the posterior cerebral arteries
193
What does the anterior cerebral artery (ACA) supply?
-Cortex on the anterior medial surface of the brain, from frontal to parietal lobe.
-Medial sensorimotor cortex.
194
The _____________ artery's branches supply the cortex above and below the Sylvian fissure including the lateral temporal lobe and parts of the parietal lobe. Also includes large parts of the basal ganglia and internal capsule, and the thalamus
Middle cerebral artery (MCA)
195
What does the posterior cerebral artery (PCA) supply blood to?
1) Inferior and medial temporal lobes
2) Medial occipital cortex
196
Branches of the ____________ supply large regions of the basal ganglia and the internal capsule.
MCA
197
In the setting of HTN, what small vessels are prone to narrowing, which can lead to blockages causing lacunar infarctions?
MCA branches that supply large regions of the basal ganglia and the internal capsule
198
Lacunar infarction in what area causes contralateral hemiparesis?
Posterior limb of the internal capsule (which houses motor pathways of the corticospinal tract) and thalamus
199
What characterizes lacunar infarct syndrome (stroke) (clinical manifestation of lacunar infarct)?
Pure motor hemiparesis; contra/unilateral face, arm, and leg weakness. Due to lacunar infarct of posterior limb of internal capsule.
200
What is the most common type of stroke?
Lacunar infarct syndrome
201
What strokes are more common, ACA, MCA, or PCA?
MCA
202
What type of stroke is characterized by aphasia, hemineglect, hemianopia, face/arm or face/arm/leg sensorimotor loss, and a gaze toward the side of the lesion?
MCA stroke
203
Where is Broca's area?
Just superior to Sylvian fissure in frontal lobe of left hemisphere
204
What is inferior to the lateral fissure in the temporal lobe?
Wernicke’s area
205
Carotid dissection can cause TIA or infarct in the __________ circulation
anterior
206
Vertebral dissection can cause TIA or infarct in the __________ circulation
posterior
207
Where are the spinothalamic tracts of the spinal cord in relation to the anterior gray matter horn?
Anterior
208
Where are the corticospinal tracts of the spinal cord in relation to the dorsal horn of the gray matter?
Lateral
209
What function does the lateral corticospinal tract control?
Movement of extremities
210
True or false? The lateral corticospinal tract starts in the precentral gyrus and travels down through the spinal cord but crosses at the pyramidal decussation.
True
211
What percent of the corticospinal tract continues ipsilaterally after the pyramidal decussation?
15%
212
The 85% of the corticospinal tract that crosses over becomes the _____________ corticospinal tract; the 15% that doesn't becomes the ___________ corticospinal tract.
85% becomes lateral corticospinal tracts; 15% becomes anterior corticospinal tract
213
Where does the anterolateral pathway cross the spinal cord?
Anterior commissure
214
What tract crosses over in the lower medulla?
Posterior column-medial leminiscal pathway
215
List the 3 processes that control the levels of consciousness and what's involved with each
1) Alertness: normal functioning of the brainstem and arousal circuits
2) Attention: same circuits as above plus the frontoparietal association cortex
3) Awareness: a combination of multiple higher order systems from different regions of the brain into a summary of mental activity that can be remembered at a later time
216
1) What is the major excitatory neurotransmitter in the CNS?
2) What does too much of this cause?
1) Glutamate
2) Huntington’s chorea
217
What is referred to as "nature's valium"? Why?
GABA; it's inhibitory
218
1) Meds that increase GABA are used to treat what 3 things?
2) What 4 arousal systems does it inhibit to promote deep sleep?
1) Anxiety, seizures, muscle spasms
2) Serotonergic, noradrenergic, histaminergic, and cholinergic arousal systems.
219
What are the 3 primary functions of acetylcholine (Ach)?
1) Autonomic function
2) Stimulates receptors at NMJ to cause muscle contraction.
3) In CNS it helps with memory
220
What is Myasthenia gravis and what does it lead to?
An autoimmune Ab block Ach receptors on skeletal muscle, leading to weakness
221
1) What can dopamine cause?
2) What does it work on?
3) What can too much lead to?
4) What can too little lead to?
1) Feelings or pleasure, satisfaction and motivation.
2) Reward center.
3) Schizophrenia, increased energy/arousal, hallucinations
4) Parkinson’s Disease
222
1) What are the two main functions of norepinephrine?
2) What does increased amounts cause?
3) What does too little cause?
1) Used in sympathetic response and functions in attention, cognition and BP.
2) Aggression
3) Depression, inattention/ADD
223
1) What is also known as the "feel good” chemical?
2) Is it excitatory, inhibitory, or both?
1) Serotonin
2) Can have excitatory and inhibitory effects
224
1) What does serotonin function in?
2) When is it markedly decreased?
1) Psychiatric symptoms like depression, anxiety, OCD, aggressive behavior and eating disorders.
2) During sleep
225
1) What does increased amounts of serotonin do?
2) What can increase it?
1) Lift and brighten mood
2) Exercise and bright light
226
What is histamine used to regulate?
Alertness and wakefulness
227
1) Most histamine is found where?
2) In what?
3) What does it do here?
1) Outside of the CNS
2) Mast cells
3) Plays a role in immune responses and allergic reactions
228
List the 3 processes that control the levels of consciousness and what's involved with each
1) Alertness: normal functioning of the brainstem and arousal circuits
2) Attention: same circuits as above plus the frontoparietal association cortex
3) Awareness: a combination of multiple higher order systems from different regions of the brain into a summary of mental activity that can be remembered at a later time
229
1) What is the major excitatory neurotransmitter in the CNS?
2) What does too much of this cause?
1) Glutamate
2) Huntington’s chorea
230
What is referred to as "nature's valium"? Why?
GABA; it's inhibitory
231
1) Meds that increase GABA are used to treat what 3 things?
2) What 4 arousal systems does it inhibit to promote deep sleep?
1) Anxiety, seizures, muscle spasms
2) Serotonergic, noradrenergic, histaminergic, and cholinergic arousal systems.
232
What are the 3 primary functions of acetylcholine (Ach)?
1) Autonomic function
2) Stimulates receptors at NMJ to cause muscle contraction.
3) In CNS it helps with memory
233
What is Myasthenia gravis and what does it lead to?
An autoimmune Ab block Ach receptors on skeletal muscle, leading to weakness
234
1) What can dopamine cause?
2) What does it work on?
3) What can too much lead to?
4) What can too little lead to?
1) Feelings or pleasure, satisfaction and motivation.
2) Reward center.
3) Schizophrenia, increased energy/arousal, hallucinations
4) Parkinson’s Disease
235
1) What are the two main functions of norepinephrine?
2) What does increased amounts cause?
3) What does too little cause?
1) Used in sympathetic response and functions in attention, cognition and BP.
2) Aggression
3) Depression, inattention/ADD
236
1) What is also known as the "feel good” chemical?
2) Is it excitatory, inhibitory, or both?
1) Serotonin
2) Can have excitatory and inhibitory effects
237
1) What does serotonin function in?
2) When is it markedly decreased?
1) Psychiatric symptoms like depression, anxiety, OCD, aggressive behavior and eating disorders.
2) During sleep
238
1) What does increased amounts of serotonin do?
2) What can increase it?
1) Lift and brighten mood
2) Exercise and bright light
239
What is histamine used to regulate?
Alertness and wakefulness
240
1) Most histamine is found where?
2) In what?
3) What does it do here?
1) Outside of the CNS
2) Mast cells
3) Plays a role in immune responses and allergic reactions
241
What produces melatonin and in what pattern?
Pineal gland in a circadian pattern
242
1) Define coma
2) What is it a dysfunction of?
1) Unarousable, unconsciousness with closed eyes > 1 hour
2) Upper brainstem reticular formation
243
1) What can occur during coma?
2) What can cause comas?
3) What reflexes are still present?
1) Can still have vestibulo-ocular eye movements, but no purposeful movements.
2) Typically caused by catastrophic brain injury such as trauma or anoxia.
3) Brainstem reflexes (gag, corneal, v-o)
244
When is consciousness typically spared?
If the reticular formation is spared
245
1) What 3 things should you do when a patient is in a coma? (step 1)
2) What is the second step?
3) What is the third step?
4) What exam should then be done?
1) Always secure airway, ensure patient is breathing, and has normal circulatory function.
2) Establish IV access and give IV thiamine, glucose and naloxone.
3) Treat to reverse cause of coma, if known and able.
4) ** Pupils**, labs, head CT
246
1) Define Akinetic Mutism, Catatonia
2) Is the patient awake? Can they respond?
3) What may cause it to improve?
1) Impaired frontal lobe and dopamine function, profound deficits in response to initiation
2) Patient appears fully awake and can track with eyes, but can not typically respond to commands, though sometimes may after a long delay.
3) Dopamine agonist
247
Define dissociative state. What neurologically is wrong?
Non-responsiveness (but not unconscious) from severe emotional trauma, neuro exam is normal
248
Define brain death
Based on clinical exam: no evidence of forebrain or brainstem function; no sleep-wake cycles
249
What does CNIII do? Through what pathways?
Pupillary control; parasympathetic and sympathetic pathways
250
List the 3 processes that control the levels of consciousness and what's involved with each
1) Alertness: normal functioning of the brainstem and arousal circuits
2) Attention: same circuits as above plus the frontoparietal association cortex
3) Awareness: a combination of multiple higher order systems from different regions of the brain into a summary of mental activity that can be remembered at a later time
251
1) What is the major excitatory neurotransmitter in the CNS?
2) What does too much of this cause?
1) Glutamate
2) Huntington’s chorea
252
What is referred to as "nature's valium"? Why?
GABA; it's inhibitory
253
1) Meds that increase GABA are used to treat what 3 things?
2) What 4 arousal systems does it inhibit to promote deep sleep?
1) Anxiety, seizures, muscle spasms
2) Serotonergic, noradrenergic, histaminergic, and cholinergic arousal systems.
254
What are the 3 primary functions of acetylcholine (Ach)?
1) Autonomic function
2) Stimulates receptors at NMJ to cause muscle contraction.
3) In CNS it helps with memory
255
What is Myasthenia gravis and what does it lead to?
An autoimmune Ab block Ach receptors on skeletal muscle, leading to weakness
256
1) What can dopamine cause?
2) What does it work on?
3) What can too much lead to?
4) What can too little lead to?
1) Feelings or pleasure, satisfaction and motivation.
2) Reward center.
3) Schizophrenia, increased energy/arousal, hallucinations
4) Parkinson’s Disease
257
1) What are the two main functions of norepinephrine?
2) What does increased amounts cause?
3) What does too little cause?
1) Used in sympathetic response and functions in attention, cognition and BP.
2) Aggression
3) Depression, inattention/ADD
258
1) What is also known as the "feel good” chemical?
2) Is it excitatory, inhibitory, or both?
1) Serotonin
2) Can have excitatory and inhibitory effects
259
1) What does serotonin function in?
2) When is it markedly decreased?
1) Psychiatric symptoms like depression, anxiety, OCD, aggressive behavior and eating disorders.
2) During sleep
260
1) What does increased amounts of serotonin do?
2) What can increase it?
1) Lift and brighten mood
2) Exercise and bright light
261
What is histamine used to regulate?
Alertness and wakefulness
262
1) Most histamine is found where?
2) In what?
3) What does it do here?
1) Outside of the CNS
2) Mast cells
3) Plays a role in immune responses and allergic reactions
263
What produces melatonin and in what pattern?
Pineal gland in a circadian pattern
264
1) Define coma
2) What is it a dysfunction of?
1) Unarousable, unconsciousness with closed eyes > 1 hour
2) Upper brainstem reticular formation
265
1) What can occur during coma?
2) What can cause comas?
3) What reflexes are still present?
1) Can still have vestibulo-ocular eye movements, but no purposeful movements.
2) Typically caused by catastrophic brain injury such as trauma or anoxia.
3) Brainstem reflexes (gag, corneal, v-o)
266
When is consciousness typically spared?
If the reticular formation is spared
267
1) What 3 things should you do when a patient is in a coma? (step 1)
2) What is the second step?
3) What is the third step?
4) What exam should then be done?
1) Always secure airway, ensure patient is breathing, and has normal circulatory function.
2) Establish IV access and give IV thiamine, glucose and naloxone.
3) Treat to reverse cause of coma, if known and able.
4) ** Pupils**, labs, head CT
268
1) Define Akinetic Mutism, Catatonia
2) Is the patient awake? Can they respond?
3) What may cause it to improve?
1) Impaired frontal lobe and dopamine function, profound deficits in response to initiation
2) Patient appears fully awake and can track with eyes, but can not typically respond to commands, though sometimes may after a long delay.
3) Dopamine agonist
269
Define dissociative state. What neurologically is wrong?
Non-responsiveness (but not unconscious) from severe emotional trauma, neuro exam is normal
270
Define brain death
Based on clinical exam: no evidence of forebrain or brainstem function; no sleep-wake cycles
271
What does CNIII do? Through what pathways?
Pupillary control; parasympathetic and sympathetic pathways
272
1) What can CNIII palsy lead to?
2) What commonly causes CNIII palsy?
1) Dilated pupils.
2) Aneurysm of p comm artery
273
List 4 causes of coma and what the pupils look like with each
1) Toxic and metabolic disorders: Normally (usually)
2) Midbrain lesion or herniation: Unilateral or bilateral “blown” pupil
3) Pontine lesion: Small, responsive to light bilaterally
4) Opiate overdose: Pinpoint pupils bilaterally
274
1) What controls breathing?
2) What do these have numerous inputs to?
1) Circuits in medulla
2) To respiratory circuit, including peripheral chemoreceptors for blood O2 level and pH and stretch receptors in the lungs
275
1) Where is the nucleus solitarius?
2) What is it? Where does it get input from?
1) In the medulla
2) Cardiorespiratory nucleus (controls heart rate and BP); receives inputs from baroreceptors in carotid body and aortic arch via CNs 9 and 10
276
The _________________ system gives rise to many branches that supply the brainstem and cerebellum
vertebrobasilar
277
1) Deficits in coordination occur in what direction compared to cerebellar lesions?
2) What cerebellar lesions cause ataxia of the limbs?
3) What lesions bilaterally affect the trunk muscles?
1) Ipsilateral
2) Lesions lateral to the vermis
3) Medial lesions
278
1) What are the functions of the intermediate hemispheres of the cerebellum?
2) What motor pathways do they influence?
1) Distal limb coordination
2) Lateral corticospinal tract and rubrospinal tract
279
1) What are the functions of the vermis and flocculonodular lobe of the cerebellum?
2) What motor pathways do they influence?
1) Proximal limb and trunk coordination AND balance and vestibulo-ocular reflexes
2) Proximal limb and trunk: Anterior corticospinal tract, reticulospinal tract, vestibulospinal tract, tectospinal tract
-Balance and reflexes: Medial longitudinal fasciculus
280
What is the vestibular system? What does it do?
Sensory system that senses balance and spatial orientation coordinating movement with balance
281
What are the two parts of the labyrinth of the inner ear?
1) Bony labyrinth
2) Membranous labyrinth.
282
The bony labyrinth is filled with ________ called ______
fluid; perilymph
283
1) What makes up the membranous labyrinth?
2) Where is it?
3) What is the membranous labyrinth filled with?
1) The cochlear duct, utricle, saccule and semicircular canals
2) Suspended in the perilymph.
3) Filled with endolymph.
284
The maculae consist of ___________ called ________ sitting in a gelatinous layer where mechanoreceptor hair cells are embedded
calcified crystals; otoliths
285
Primary vestibular neurons in the vestibular ganglia convey information about what?
Angular and linear acceleration
286
1) The lateral vestibular nucleus gives rise to what?
2) What two things is this important in?
1) The lateral vestibulospinal tract
2) Maintaining balance and extensor tone.
287
1) Where is the MVT (medial vestibulospinal tract) found?
2) What is it important in?
1) Extends only to the cervical spine
2) Important in controlling head and neck position
288
What is an important job of the medial longitudinal fasciculus (MLF)?
Conjugates the gaze
289
Define vertigo
Spinning sensation
290
1) Most vertigo cases are caused by what?
2) What is a less common cause of vertigo?
1) Peripheral disorders involving the inner ear (usually benign.)
2) Central disorders of the brainstem or cerebellum are less common (usually urgent.)
291
Dix-Hallpike testing can help differentiate between what?
Central or peripheral causes of vertigo
292
1) What does the Dix-Hallpike test look like if the patient has peripheral lesions of the inner ear?
2) What does the nystagmus look like?
1) 2-5 second delay [in vertigo and nystagmus]
2) The nystagmus is horizontal or rotary and does not change directions
293
1) What does the Dix-Hallpike test look like if the patient has central lesions of the inner ear?
2) What does the nystagmus look like?
3) Is there adaptation if it's repeated?
1) Nystagmus and vertigo may begin immediately in supine position
2) Vertical nystagmus, nystagmus that changes directions while the patient is in the same position or prominent nystagmus in the absence of vertigo are only seen with central lesions.
3) No adaptation
294
1) What is the most common cause of vertigo?
2) How long does it last?
3) When does it happen?
1) Benign paroxysmal positional vertigo (BPPV)
2) Brief episodes of vertigo lasting for a few seconds
3) Occur with change of position
295
1) With Benign paroxysmal positional vertigo (BPPV), what helps the dizziness?
2) What is usually the cause?
1) If the patient remains still, the dizziness usually abates.
2) Otolithic debris in the semicircular canals
296
1) What characterizes Meniere's disease?
2) What is the etiology?
1) Recurrent episodes of vertigo with progressive hearing loss and tinnitus
2) Excess fluid (and pressure in endolymphatic system)
297
1) Besides Meniere's, what can cause cause hearing loss and tinnitus with associated dizziness?
2) How is it different? (3 things)
1) Acoustic neuroma
2) Causes unsteadiness, it's not true vertigo, and does not have discrete episodes.
298
Name two common causes of central vertigo
1) Vertebrobasilar ischemia or infarct
2) Small hemorrhage in cerebellum or brainstem
299
What can gentamicin cause?
Bilateral vestibular dysfunction (and dizziness)
300
1) What is the second most common cause of vertigo?
2) What is its suspected origin?
3) Who does it affect?
4) Is hearing impaired?
1) Vestibular neuritis
2) Viral origin
3) 30 to 50 years of age; men and women are affected equally
4) Not impaired
301
What are the 3 angular axes that semicircular canals use to detect angular acceleration?
1) Anterior
2) Posterior
3) Horizontal (lateral)
302
Name 3 essential roles of the vestibular nuclei
1) Adjustment of posture
2) Muscle tone
3) Eye position in response to movements of the head in space.
303
Where are vestibular nuclei found?
Brainstem
304
Semicircular canals convey information about ______ acceleration, while otolith organs convey information about ________ acceleration.
angular; linear
305
What tract is important in maintaining balance and extensor tone, and extends the entire length of the spinal cord?
Lateral vestibulospinal tract
306
List 2 nuclei that contribute to the medial vestibulospinal tract (important in controlling head + neck position; extends only to the cervical spine).
Medial vestibulospinal nucleus and Inferior vestibulospinal nucleus
307
What part of the vestibular system conjugates the gaze?
Medial longitudinal fasciculus (MLF)
308
Name a positive sign that could mean that a patient possibly has a problem outside of their vestibular system
Orthostatic hypotension
309
Name 2 common causes of central vertigo
1) Vertebrobasilar ischemia or infarct
2) Small hemorrhage in cerebellum or brainstem
