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Flashcards in Nervous System Deck (31):
1

Three primary brain vesicles: ______

Forebrain/prosencephalon
Midbrain/mesencephalon
Hindbrain/rhombencephalon

2

At the ______ week of development, the prosencephalon divides into _________ and _________; and the rhombencephalon divides into the _________ and _________.

5th
telencephalon, diencephalon
metencephalon, myelencephalon

3

Derivatives of the brain vesicles:
Telencephalon -
Diencephalon -
Mesencephalon -
Metencephalon -
Myelencephalon -

Neural tube -
____________ - PNS; ANS; cranial, spinal, and autonomic ganglia

Cerebrum
Thalamus
Midbrain
Pons, cerebellum
Medulla oblongata

CNS
Neural crest

4

Neural crest derivatives:
- ___________ ganglia of cranial and spinal nerves
- neurolemmal sheath of ____________ nerve
- meninges
- __________ cells of the retina
- cells of adrenal __________

Neural crest derivatives:
- sensory ganglia of cranial and spinal nerves
- neurolemmal sheath of peripheral nerve
- meninges
- pigment cells of the retina
- cells of adrenal medulla

5

ANATOMICAL LEVELS OF NERVOUS SYSTEM

_______________
- above the tentorium cerebelli
- cerebrum, basal ganglia, thalamus, hypothalamus, CNs _______

_______________
- below the tentorium cerebelli
- cerebellum, brainstem, CNs _______

_______________
- below foramen magnum but contained within the vertebral column
- spinal cord, spinal nerves within the vertebral column

_______________
- located outside the skull and vertebral column
- neuromuscular structures located outside skull and vertebral column including cranial nerves and spinal nerves and their peripheral branches

Supratentorial Level
I, II

Infratentorial / posterior fossa level
III-XII

Spinal

Peripheral

6

DURA MATER OF THE BRAIN
Endosteal layer
Meningeal layer
- sends inward four septa: (4)


Falx cerebri
Tentorium cerebelli
Falx cerebelli
Diaphragma sella

7

______________
Sickle-shaped fold of dura mater that lies in the midline between two cerebral hemispheres. Its narrow anterior end is attached to the ___________ and ___________

______________
Crescent-shaped fold of dura mater that roofs over the posterior cranial fossa; covers the upper surface of the cerebellum and supports the occipital lobes of the cerebral hemispheres

______________
Small sickle-shaped fold of dura mater attached to the internal occipital crest and projects forward between the two cerebelli rings hemispheres

______________
Small circular fold of dura mater that forms the roof for the sella turcica (part of the sphenoid bone)

Falx cerebri
frontal crest, crista galli
Tentorium cerebelli
Diaphragma sella

8

The arachnoid mater is separated from the pia mater by the _________________, which is filled with _______________.

subarachnoid space
CSF

9

SENSORY AND MOTOR AREAS OF THE CEREBRAL CORTEX
Primary motor area = ___________ gyrus = BA ____
Primary somesthetic area = ___________ gyrus = BA _____
Primary visual area = BA ____
Primary auditory area = BA _____
Broca's area = ___________ gyrus = BA ______
Wernicke's area = ____________ gyrus = BA 22

SENSORY AND MOTOR AREAS OF THE CEREBRAL CORTEX
Primary motor area = pre-central gyrus = BA 4
Primary somesthetic area = post-central gyrus = BA 3, 1, 2
Primary visual area = BA 17
Primary auditory area = BA 41, 42
Broca's area = inferior frontal gyrus = BA 44, 45
Wernicke's area superior temporal gyrus = BA 22

10

Wernicke's / __________ aphasia - patient hears but does not understand
Broca's / __________ aphasia - patient knows what he wants to say but speech is slow, deleting many words

sensory
motor

11

All areas are supplies by the MCA (middle cerebral artery) except the leg area (supplied by the _________)

ACA (anterior cerebral artery)

12

Location of the decussation of the corticospinal tract: __________

Lesions _________ the level of decussation manifest contralaterally.
Lesions _________ the level of decussation manifest ipsilaterally.

Lower medulla
above
below

13

UMN Lesion or LMN Lesion
1) spastic paralysis
2) muscle atrophy
3) fasciculations
4) clonus
5) pathologic reflexes
6) increased muscle tone

1) UMN
2) LMN
3) LMN
4-6) UMN

14

CEREBELLUM

Anterior lobe / ________________ / Spinocerebellum
- connected to limbs via spinal connections
- Function: Maintains coordination of _________ movements while the movements are being executed; regulation of muscle tone
- marked gait instability, heel-to-shin test

Posterior lobe / ______________ / Cerebrocerebellum
- connected to the cerebral cortex
- Function: ______________ of voluntary movements
- ataxia, dysmetria, dysdiadochokinesia, intention tremor

Flocculonodular lobe / ________________ / Vestibulocerebellum
- connected to the vestibular apparatus
- Function: Responsible for coordination of the paraxial muscles associated with ______________
- truncal ataxia

CEREBELLUM

Anterior lobe / Paleocerebellum / Spinocerebellum
- connected to limbs via spinal connections
- Function: Maintains coordination of limb movements while the movements are being executed; regulation of muscle tone

Posterior lobe / Neocerebellum / Cerebrocerebellum
- connected to the cerebral cortex
- Function: Coordination of voluntary movements

Floculonodular lobe / Archicerebellum / Vestibulocerebellum
- connected to the vestibular apparatus
- Function: Responsible for coordination of the paraxial muscles associated with equilibrium

15

Intention/voluntary/essential tremors are due to lesion in the ____________.
Resting/involuntary tremors are due to a lesion in the _____________.

posterior lobe of the cerebellum
basal ganglia

16

VENTRICULAR SYSTEM
Lateral ventricle - in each cerebral hemisphere
3rd ventricle - in the ______________
4th ventricle - in the ______________

diencephalon (thalamus)
hindbrain (between the cerebellum and pons/medulla)

17

CSF Flow
lateral ventricle -> Foramen of __________ or interventricular foramen -> 3rd ventricle -> aqueduct of ________ or Iter -> 4th ventricle -> Foramen of ____________ and Foramina of Luschka -> subarachnoid space -> arachnoid villi -> superior sagittal sinus -> ___________ sinus -> __________ sinus -> _______________ vein

lateral ventricle -> Foramen of Monroe or interventricular foramen -> 3rd ventricle -> aqueduct of Sylvius or Iter -> 4th ventricle -> Foramen of Magendie and Foramina of Luschka -> subarachnoid space -> arachnoid villi -> superior sagittal sinus -> transverse sinus -> sigmoid sinus -> internal jugular vein

18

CSF
- produced mainly by the _________________ of the lateral, third, and fourth ventricles; some originate from the _____________ cells lining the ventricles
- rate of production: ____ mL/min
- pressure: ________ mmH2O
- total volume: _______mL
- protein: _______ mg/ 100 mL
- glucose: _______ mg/ 100 mL
- chloride: _______ mg/ 100 mL
- number of cells: _____ lymphocytes/mm^3

- produced mainly by the choroid plexuses of the lateral, third, and fourth ventricles; some originate from the ependymal cells lining the ventricles
- rate of production: 0.5 mL/min
- pressure: 60-150 mmH2O
- total volume: 130-150mL
- protein: 15-45 mg/ 100 mL
- glucose: 50-85 mg/ 100 mL
- chloride: 720-750 mg/ 100 mL
- number of cells: 0-3 lymphocytes/mm^3

19

LUMBAR PUNCTURE
- usually done at level ________

LUMBAR PUNCTURE
- usually done at level L3-L4 or L4-L5

20

CSF Patterns in Meningitis
Bacterial or Viral?
1) WBC count 500-1000
2) WBC count less than 500 (mostly lymphocytes)
3) high protein
4) normal to high protein
5) low glucose
6) normal glucose

CSF Patterns in Meningitis
Bacterial or Viral?
1) bacterial
2) viral
3) bacterial
4) viral
5) bacterial
6) viral

21

Organization of the BASAL NUCLEI
Corpus striatum
1. Caudate nucleus
2. Lentiform nuclei
---- putamen
---- globus pallidus
3. Subthalamic nucleus
4. Substantia nigra

Organization of the BASAL NUCLEI
Corpus striatum
1. Caudate nucleus
2. Lentiform nuclei
---- putamen
---- globus pallidus
3. Subthalamic nucleus
4. Substantia nigra

22

______________
- refers to the interconnected nuclear masses deep within the cerebral hemispheres (corpus striatum), diencephalon (__________________), and midbrain (________________)
- for initiation of voluntary movements
- for control of postural adjustments associated with voluntary movements
- abnormalities will result to movement disorders

Basal Ganglia
- refers to the interconnected nuclear masses deep within the cerebral hemispheres (corpus striatum), diencephalon (subthalamic nucleus), and midbrain (substantia nigra)
- for initiation of voluntary movements
- for control of postural adjustments associated with voluntary movements
- abnormalities will result to movement disorders

23

BASAL GANGLIA
Involuntary movements = dyskinesia
- Irregular repetitive jerking movements: ____________
- Irregular repetitive writhing (worm-like) movements: ____________
- Slow sustained abnormal movement: ____________
- Explosive violent movement: ____________

- Irregular repetitive jerking movements: Chorea
- Irregular repetitive writhing (worm-like) movements: Athetosis
- Slow sustained abnormal movement: Dystonia
- Explosive violent movement: Ballismus

24

Parkinson's disease (a.k.a. paralysis agitans)
- due to degeneration of __________ which secretes dopamine

substantia nigra

25

Chorea
- autosomal ___________ disorder
- due to degeneration of __________ neurons

Hemiballismus
- due to damage to the contralateral _____________ nucleus
- usually results from strokes of the _______
- often resolves after a few weeks

Chorea
- autosomal dominant disorder
- due to degeneration of striatal neurons

Hemiballismus
- due to damage to the contralateral subthalamic nucleus
- usually results from strokes of the PCA
- often resolves after a few weeks

26

UMN lesion vs. Basal ganglia lesion
Weakness -- No weakness
Spastic paralysis -- No paralysis; slow / involuntary
Spasticity -- _____________
Clasp knife phenomenon -- ______________
Hypertonia -- Normal muscle tone
Hyperreflexia -- Normal reflexes

UMN lesion vs. Basal ganglia lesion
Weakness -- No weakness
Spastic paralysis -- No paralysis; slow / involuntary
Spasticity -- Rigidity
Clasp knife phenomenon -- Lead pipe rigidity
Hypertonia -- Normal muscle tone
Hyperreflexia -- Normal reflexes

27

Location of Cranial Nerve Nuclei (?)
I-II: _______
III-IV: _______
V-VIII: _______
IX-XII: _______

I-II: Supratentorial
III-IV: Midbrain
V-VIII: Pons
IX-XII: Medulla

28

Cranial Nerves with Parasympathetic Component: (4)

III - constrictor of the pupil
VII - lacrimal and sublingual glands, etc
IX - parotid gland
X
(MNEMONIC: 1973)

29

CRANIAL FOSSAE and the structures passing through them

Anterior CF - Foramina in cribriform plate of ethmoid:
Middle CF
- optic canal:
- superior orbital fissure:
- foramen rotundum:
- foramen ovale:
Posterior CF
- internal acoustic meatus:
- jugular foramen:
- hypoglossal canal:
- foramen magnum: medulla and meninges, vertebral arteries, CN XI spinal roots

Anterior CF - Foramina in cribriform plate of ethmoid: CN I
Middle CF
- optic canal: CN II, ophthalmic artery
- superior orbital fissure: CN III, IV, V1, VI, ophthalmic vein
- foramen rotundum: CN V2
- foramen ovale p: CN V3

Posterior CF
- internal acoustic meatus: CN VII, VIII
- jugular foramen: CN IX, X, XI
- hypoglossal canal: CN XII
- foramen magnum: medulla and meninges, vertebral arteries, CN XI spinal roots

30

Cranial nerve affected?
Diplopia (eye turned down and out):
Diplopia (extortion of the eye, weakness of downward gaze):
Diplopia (medial deviation, abductor paralysis):
Ptosis, and dilated and fixed pupil:
Facial hemianesthesia:
Paralysis of muscles of mastication:
Deviation of jaw to weak side:
Loss of general sensation of anterior 2/3 of tongue:
Loss of corneal/blink reflex:

Diplopia (eye turned down and out): III
Diplopia (extortion of the eye, weakness of downward gaze): IV
Diplopia (medial deviation, abductor paralysis): VI
Ptosis, and dilated and fixed pupil: III
Facial hemianesthesia: V
Paralysis of muscles of mastication: V
Deviation of jaw to weak side: V
Loss of general sensation of anterior 2/3 of tongue: V
Loss of corneal/blink reflex: V(afferent) or VII(efferent)

31

Cranial nerve affected?
Hyperacusis:
Dry mouth, loss of Lacrimation:
Loss of taste sensation of anterior 2/3 of tongue:
Dysphagia:
Loss of taste and common sensation of posterior 1/3 of tongue:
Loss of gag reflex:
Dysphonia:
Dyspnea:
Sagging of palatal arch:
Deviation of uvula:
Hemianesthesia of pharynx and larynx:
Weakness in head-turning and shrugging:
Hemiparalysis of the tongue:
Tongue deviation:

Hyperacusis: VII (stapedius muscle paralyzed)
Dry mouth, loss of Lacrimation: VII
Loss of taste sensation of anterior 2/3 of tongue: VII
Dysphagia: IX or X
Loss of taste and common sensation of posterior 1/3 of tongue: IX
Loss of gag reflex: IX or X
Dysphonia: X
Dyspnea: X
Sagging of palatal arch: X
Deviation of uvula: X
Hemianesthesia of pharynx and larynx: X
Weakness in head-turning and shrugging: XI
Hemiparalysis of the tongue: XII
Tongue deviation: XII