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Nervous System Structures Flashcards

1
Q

The frontal eye field is located in what Brodman area?
What is its function?
Symptom of a lesion in this area?

A

area 8
conjugate eye movement to the opposite side (tracking objects, reading)
lesion: both eyes will deviate to the side of the lesion

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2
Q

People with Broca’s aphasia frequently also have damage to what structures?

A

muscles of the face and the arms

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3
Q

Where is Broca’s area located?
Wernicke’s area?

A

Broca: left frontal
Wernicke: left temporal

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4
Q

What defect occurs with damage to the right parietal lobe?

A

spatial neglect

  • contralateral (left) agnosia
  • can’t perceive object in part of space despite normal vision & somatic sensation

right sided spatial neglect is rare

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5
Q

Visual defects caused by parietal lesions?

A

optic radiations

quadrantic anopia (pie in the floor)

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6
Q

What type of hearing deficit is caused by a lesion to the primary auditory cortex?

Where is the primary auditory cortex?

A

“cortical” deafness

temporal lobe

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7
Q

What are the major structures located in the temporal lobe?

A
  • primary auditory cortex
  • Wernicke’s area
  • Olfactory bulb
  • Meyer’s loop
  • Hippocampus
  • Amygdala
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8
Q

What is psychomotor epilepsy?

Frequently associated with epilepsy occuring where?

A

sights, sounds & smells that aren’t there

temporal lobe epilepsy - can result from irritation of the olfactory bulb

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9
Q

What type of visual field defect is caused by a lesion in Meyer’s loop of the temporal lobe?

This could result from a stroke of what artery?

A

“pie in the sky”

quadrantic anopia

MCA stroke

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10
Q

What is the cause & symptoms of Kluver-Blucy syndrome?

Rare complication of what infectious disease?

A

damage to bilateral amygdala (rare complication HSV1 encephalitis)

hyperhpagia

hyperorality

inappropriate sexual behavior

visual agnosia

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11
Q

What is the major deficit from lesions of the occipital lobe?

Cause by a strok of what artery?

A

cortical blindness

PCA stroke

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12
Q

What type of visual defect is cause by a left or right PCA stroke?

A

homonymous hemianopsia

will often spacre the macula d/t the dual blood supply of the macula (MCA & PCA)

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13
Q

What vertebral level does the spinal cord end?

What is the name of this area?

A

L1/L2

conus medullaris -> leading to cauda equina

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14
Q

What type of cell bodies are found in the posterior horn?

A

Sensory neurons - receivin info from spinothalamic tract

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15
Q

What type of cell bodies are found in the anterior horn?

A

motor neurons

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16
Q

What infomation is being carried in the lateral corticospinal tract?

A

motor information

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17
Q

What infomation is being carried in the posterior/dorsal columns?

A

proprioception & vibraion

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18
Q

What infomation is being carried in the spinothalamic tract?

A

pain, temperature & touch

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19
Q

Describe the neuronal pathway of the spinothalamic tract:

A
  • 1st neuron: spinal root to cord
  • 2nd neuron: dorsal horn to thalamus
  • 3rd neuron: VPL thalamus to cortex

crosses the spinal cord where the sensory information enters

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20
Q

Describe the neuronal pathway of the dorsal column - medial lemniscus tract:

A
  • 1st neuron: spinal root (Meissner’s & Pacinian corpuscles) to cord
  • 2nd neuron: gracilis (lower); cuneatus (upper)
  • 3rd neuron: VPL to cortex

decussates in lower medulla

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21
Q

Describe the neuronal pathway of the corticobulbar tract:

A
  • 1st neuron: cortex to anterior horn
  • 2nd neuron: anterior horn to muscle

decussates in lower medulla

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22
Q

Polio destroys what cell types?

Symptoms?

A

anterior horn (lower motor neurons)

febrile illness & 4-5 days later w/ neuro symptoms

flaccid muscle tone (legs> arms)

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23
Q

What disease is very similar to polio but is genetic rather than infectious?

Presentation? Prognosis?

A

Werdnig-Hoffman Disease

“floppy baby syndrome” & tongue fasiculations

death in few months

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24
Q

MS affects what cell types?

A

mostly cervical white matter

relapsing & remitting pattern

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25
What cell types are affected in ALS? Symptoms?
combo upper & lower motor neurons (lose anterior horn & corticobulbar tracts) NO sensory symptoms will have UMN symptoms: spasticity & exaggerated reflexes as well as LMN symptoms: wasting & fasciculations
26
Classic presentation & prognosis ALS? Treatment?
40-60 dysphagia usually fata 3-5 years (aspiration pneumonia) Treatment: riluzole (decrease glutamate release neurons)
27
Familial cases of ALS are due to mutations in what enzyme?
Zinc copper superoxide dismutase deficiency leads to increased free radical damage
28
What are the only sensory infomation that stay in tact in an ASA stroke?
vibration & proptioception
29
Presentation of ASA stroke?
spinal shock - flaccid bilateral paralysis below lesion later: LMN damage at point of lesion, UMN damage below lesion (hyperreflexia & spasticity)
30
What is Tabes Dorsalis?
manifestation tertiary syphilis demyelination posterior columns & loss of dorsal roots lose proprioceptive ability & lose reflexes (d/t loss of DR) pt. will also have Argyl Robertson pupils
31
What are Argyl Robertson pupils? They are seen in what conditions?
very small pupils that do not react to light, but do react to accomodation Tabes Dorsalis (tertiary syphilis)
32
What is Syringomelia? Where does it usually occur?
fluid-filled space in spinal column damages spinothalamic fibers as they are crossin midline - bilateral loss of pain & temp usulaly C8-T1 (arms/hands) - ONLY affect level of the lesion (b/c doesnt affect tracts) Can expand to affect anterior horn (muscle weakness) & lateral horn (loss of sympathetic innervation - Horner syndrome)
33
What conditions are commonly associated with syringmyelia?
kyphoscoliosis can be trauma induced (can occur years later) or congenital (Chiari malformation)
34
What is the cause & symptoms of subacute combined degeneration?
vitamin B12 deficiency leads to demyelination of the posterior columns (vibration/proprioception) & loss of lateral motor columns slowly progressive - weakness, ataxia (may not have macrocytosis)
35
Describe Brown-Sequard syndrome;
loss of half of the spinal cord (trauma/tumor) lose pain & temp on contralateral side lose motor, position & vibrational sense on ipsilateral side
36
How are the symptoms at the level of the lesion different in Brown-Sequard syndrome?
level of lesion - complete sensory loss & LMN loss
37
What additional symptoms is seen in Brown-Sequard syndrome if the lesion is above T1?
Horner syndrome (constricted pupil, eyelid droop)
38
Causes & symptoms of cauda equina syndrome:
compression cauda equina (massive disk rupture, trauma, tumor) severe low back pain & saddle anesthesia loss of anocutaneous reflex w/ bladder and bowel dysfunction normal babinski
39
What symptoms are more commonly seen in conus medularis syndrome as opposed to cauda equina syndrome?
perianal anesthesia (bilateral) impotence
40
What information is being carried in the medial lemniscus?
proprioception & vibration | (connected to the posterior columns)
41
The red nucleus is important for what functions? What if there is a lesion? Where is it located?
fine tuning movements tremor & ataxia midbrain
42
What cranial nerve is located in the midbrain?
oculomotor nerve
43
What tracts are located in the cerebral peduncle? Results of a lesion? Where is it located?
corticospinal & corticobulbar UMN paralysis of the face & lower extremities midbrain
44
Wahat is the importantce of the medial longitudinal fasiculus? Result of a lesion?
conjugate gaze problems with lateral gaze
45
At what level of the spinal cord does a stroke that causes Benedikt syndrome occur? What structures are damaged? Symptoms?
midbrain CN3, meidal lemniscus, red nucleus contralateral loss of proprioception/vibration & involuntary movements (ataxia/tremor), ipsilateral eye will be down, out & dilated
46
At what level of the spinal cord does a stroke that causes Weber syndrome occur? What structures are damaged? Symptoms?
midbrain CN3, corticospinal tract, corticobulbar tract contralateral hemiparesis, looking down, out & with a dilated pupil, along with pseudobulbar palsy (UMN CN motor weakness, exaggeraged gag reflex, tongue spastic, spastic dysarthria)
47
At what level of the spinal cord does a stroke that causes Parinaud syndrome occur? What structures are damaged? Symptoms?
posterior midbrain superior colliculus & pretectal area vertical gaze palsy & pseudo Argyl-Robertson pupils
48
What are the major causes of Parinaud syndrome? What complications should you look out for?
pinealoma/germinoma of pineal region cerebral aqueduct obstruction (non-communicating hydrocephalus, compression from pineal tumor)
49
The nuclei of what cranial nerves are located in the pons?
CNVIII, CNVII, CNVI, CNV
50
What are the 3 structures in the pons required for lateral gaze?
nucleus CNVI, MLF, PPRF
51
What are the general features of meidal pontine syndromes?
lose: corticospinal tract, CNVI, CNVII contralateral hemeparesis, can't look to the affected side, facial weakness/droop on affected side
52
What are the general features of lateral pontine syndromes?
lose: vestibular nuclei, spinothalamic tract, spinal CNV nucleus, CNVII nucleus, sympathetic tract, cochlear nuclei nystabmus/vertico, loss of contralateral pain/temp, ipsilateral face pain/temp, ipsilateral facial droop & loss of corneal reflex, Horner syndrome, deafness
53
Lateral pontine syndreom is classically caused by a stroke in what artery?
AICA
54
What is the function of the nucleus soltarius & dorsal motor nucleus CNX? Where are they located?
where autonomic info comes in from places like the aortic arch & carotid body medulla
55
What is the function of the nucleus ambiguous? Where is it located?
shared motor nucleus of CVIX, CNX, CNXI medullla
56
What CN nuclei are located in the medulla?
nucleus soltarius, dorsal motor nucleus CN X, nucleus ambiguous, CNXII, spinal nucleus & tract CNV, CNVIII
57
What structures are damaged in medial medullary syndrome? symptoms?
corticospinal tract, medial leniscus, CNXII contralateral hemiparesis, contralateral loss of proprioception/vibration, flaccid paralysis of tongue (deviation to side of lesion)
58
A stroke of what arters is most commonly the cause of medially medullary syndrome?
anterior spinal artery
59
What structures are damaged in lateral medullary syndrome? What is the other name for lateral medullary syndrome? symptoms?
vestibular nuclei, sympathetic tract, spinothalamic tract, spinal CNV nucleus, nucleus ambiguous Wallenberg Syndrome nystagmus/vertigo, horner's syndrome, loss of contralateral pain/temp, hoarseness/dysphagia
60
Stroke of what arter is most commonly associated with lateral medullary syndrome?
PICA
61
What information does a loss of pain & temp to the face tell you about localizing a lesion?
CNV localize to ipsilateral lateral (big nucleus- not necessarily pons)
62
What sign indicating damage to CNVIII nucleus help you localize to the pons?
hearing loss do NOT use vestibular signs to localize to the pons
63
What is the only sense in the body that does not go through the thalamus?
smell
64
What is the pathway to the brain of the olfactory nerve? Originates from what embryonic structure?
cribiform plate of the ethmoid bone diencephalon
65
What is the pathway to the brain for the optic nerve?
optic canal of sphenoid bone
66
In addition to moving the eye, the oculomotor nerve also has what functions?
innervates levator palpebrae (elevates eyelid) carries parasympathetic fibers that innervates sphincter pupillae (constricts pupil)
67
How do patients with a trochlear nerve palsy compensate for the resulting double vision?
head will be tilting away from the affected side (b/c trochlear nerve internally rotates eyeball)
68
How does the jaw deviate in a trigeminal nerve palsy?
toward affected side
69
Afferent & Efferent nerves in corneal reflex?
afferent: trigeminal V1 (sensation) efferent: VII (blink)
70
Symptoms of a VII palsy?
loss of corneal reflex (motor part) loss of taste to anterior 2/3 tongue hyperacusis (stapedius paralysis)
71
What test do you perform on unconsious patients to determine if CNVIII is working? Describe the test
_Dolls eye test_ head rotates from side-to-side with eyelids held open "positive" - eyes stay fixed & do not turn with head (both CNVIII are working) "negative" - eyes move with head - indicates lesion _Inject cold water_ b/c cold water disrupts CNVIII function if working- eye will turn slowly toward ear with cold water & then quickly away if CNVIII not working - no slow toward if cortex is not workign - slow toward but no fast away
72
Symptoms of a CNIX palsy?
loss of gag reflex loss of taste on posterior 1/3 tongue loss of sensation upper pharynx/tonsils b/c innervates carotid bodies - tricks body into thinking low BP, so you will see increased HR, vasoconstriction & increased BP
73
Symptoms of a vagus nerve palsy?
hoarseness, dysphagia, dysarthria loss of gag reflex loss of sensation pharynx & larynx weak side of palate collapses (uvula deviates away from affected side) d/t unopposed sympathetic stimulation of heart - increased HR
74
What cranial nerves are being tested with the following sounds? This is due to what associated function? "kuh kuh kuh" "mi mi mi" "la la la"
"kuh kuh kuh": CN X, raise palate "mi mi mi": CN VII, move lips "la la la": CNXII, move tongue
75
The recurrent laryngeal nerve ascends toward larynx through what structures? The L & R branches loop around what structures respectively? These nerves are classically compressed in what conditions?
btw trachea & esophagus (tracheoesophageal groove) L: aortic arch R: right subclavian dilated left atrium (mitral stenosis) aortic dissection
76
If you cut V1, can you still produce tears?
yes - you can produce emotional tears (b/c CNVII is still in tact) but you cannot produce reflexive tears
77
afferent & efferent nerves in gag reflex?
afferent: CN IX efferent: CN X
78
What is the "jaw jerk" reflex & which nerves are involved?
place finger on patient chin & tap finger - jaw will jerk upward V3 sense & V3 jerk
79
afferent & efferent nerves involved in pupillary light reflex?
afferent: CNII efferent: CNIII
80
What is the only tongue muscle not innervated by CNXII? It is innervated by what muscle?
palatoglossus CNX
81
What nerves provide sensation & taste to the tongue?
* sensation * ant 2/3: V3 (mandubular) * post 1/3: CNIX (glossopharyngeal) * tongue root: CNX (vagus) * taste * ant 2/3: CNVII (facial) * post 1/3: CNIX (glossophayngeal) * tongue root, larynx & upper esophagus: CNX
82
What cranial nerves exit via the middle cranial fossa? Provide their specific exit points as well.
* CNII: optic canal * CNIII, IV, V1, VI: superior orbital fossa * V2: foramen rotundum * V3: foramen ovale
83
What cranial nerves exit via the posterior cranial fossa? Provide their specific exit points as well.
* CNVII, VIII: internal auditory meatus * IX, X, XI: jugular foramen * XI & brainstem: foramen magnum * XII: hypoglossal canal

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