Neuro 2 (Brainstem, PNS) Flashcards
(120 cards)
1
Q
C1 dermatome
A
hairline
2
Q
T4 dermatome
A
nipple line (male)
3
Q
T10 dermatome
A
umbilicus
4
Q
L1 dermatome
A
inguinal ligament
5
Q
S1 dermatome
A
sole of foot
6
Q
S4/5 dermatome
A
perianal
7
Q
large cells/axons mediate
A
vibration and joint position sense
8
Q
small cells/axons mediate
A
pain and temperature sensation
9
Q
monomelic amyotrophy
A
Wasting in myotome
Self-limited
Electromyographic exam
May see MRI T2 signal
10
Q
location of C6 root
A
between C5, C6
11
Q
location of C8 root
A
between C7, T1
12
Q
location of L4 root
A
between L4, L5
13
Q
central protrusion in lumbar cord
A
affect descending root
14
Q
lateral protrusion in lumbar cord
A
affects lateral roots
15
Q
how to know it’s a radiculopathy?
A
Sensory and motor symptoms and signs in same dermatome and myotome
16
Q
C5 radiculopathy = weakness in
A
Deltoid (C5, axillary)
Biceps (C5, musculocutaneous)
Infraspinatus (C5, suprascapular)
Rhomboid (C5, dorsal scapular)
17
Q
Erb’s Palsy
A
upper plexus injury
Stretch upper roots (C5, C6)
Waiter’s tip
Musculocutaneous out
18
Q
Klumpke’s Palsy
A
lower plexus traction injury
Pulling arm away from neck
Or nursemaid’s injury
Extensors out
19
Q
How to know it’s a plexus injury
A
® Clinical-sensory, and motor deficits which do not fit a particular dermatoma/myotomal distribution or single nerve distribution
associated pain
usually unilateral
20
Q
Parsonage Turner syndrome
A
□ Hereditary neuralgic amyotrophy
® Males»Females
® SEPT9 gene on chromosome 17w
® Septins are involved in formation of cytoskeleton
® Recurrent
Episide precipitated by physical activity
21
Q
neuropraxia
A
temporary loss of motor and sensory function due to blockage of nerve conduction- focal demyelination
22
Q
axonotmesis
A
disruption of axon w/ little disruption of CT
23
Q
neurotmesis
A
disruption of axon and CT
24
Q
Wallerian degeneration
A
degeneration of axon from distal to proximal. Associated w/ metabolic insufficiency
25
How to know it’s a mononeuropathy?
Sensory and motor symptoms and signs confined to distribution of one nerve
26
most common cause of polyneuropathy in US
diabetes
27
classification of polyneuropathy
```
vascular
infectious
neoplastic
degenerative
inflammatory
congenital
autoimmune
trauma/toxins
endocrine
something else
```
28
how do we know it is a polyneuropathy?
Symptoms and signs in multiple nerves
Early neuropathy may not yet show motor or autonomic sxs
Symptoms and signs are length dependent, distal, symmetrical, dying back over time
29
Guillain-Barre syndrome (AIDP)
Bystander mechanism- antibody made against something else cross-reacts w/ myelin
Autoimmune process
Ascending weakness
Attacking the myelin- inflammatory mediators, damage the axon itself
30
Miller Fisher Variant
5% of GBC
Descending paralysis w/ triad: opthalmoplegia, ataxia (gait/trunk), areflexia
Anti GQ1B Ab in 85-90%
Tx: IVIg, PEx
31
Bickerstaff's Encephalitis
Ataxia, cranial neuropathy, opthalmoplegia, altered mental status, hyperreflexia/Babinski
Anti-GQ1B Ab in 66%
Tx w/ steroids, IVIg, PEx
32
asymmetric polyneuropathy
demyelinating mononeuritis
multifocal motor neuropathy
small fiber neuropathy
33
Slow motor unit
Smaller forces
Maintain composure longer- resistant to fatigue due to subcellular anatomy
Important for posture, maintaining position
34
fast fatigable motor unit
Larger forces
Less myoglobin, fatigue easier
i.e. sympathetic response, standing jump (brief large forces)
35
fast fatigue resistant
Intermediate
| Good for transition movements
36
2 ways to increase force (motor recruitment)
Enlist more friends --> increase number of motor units firing
Tell your friends to work harder --> increased firing frequency
37
Hallmarks of ALS Diagnosis
Combination of UMN and LMN signs
Can occur in 4 body regions: bulbar, cervical, thoracic, lumbosacral
Research requires 3/4 areas- may delay diagnosis and treatment
Rule out potentially treatable conditions mimicking this disorder
38
Upper motor neuron signs
Hyperreflexia
□ clonus
Spascicity
Upgoing toes (plantar extensor response)
39
Lower motor neuron signs
Weakness
Muscle atrophy
Fasciculations
Decreased/absent reflexes
40
Important negatives of ALS
Sensory systems in tact
Bowel/bladder dysfunction is spared
Ocular motor problems not effected
41
Poliomyelitis
□ Caused by RNA enterovirus
□ Eventually spreads to alpha motor neurons in spinal cord and brain stem
□ Causes focal atrophy and LMN findings
42
Spinal muscular atrophy
Bucket of autosomal recessive disorders
Survival motor neuron gene- important for alpha motor neuron to live
Looks like a LMN disease
Wernbig-Hoffman disease- huge spectrum of disease
43
muscular dystrophy
disease in muscle membrane or supporting proteins
| ongoing muscle degeneration and regeneration
44
Duchenne/Becker MD
```
x-linked: mytation in dystrophin gene
important for structural integrity of muscles
Duchenne (absent), Beckers (low levels)
eventually lose walking ability
pseudohypertrophy
Gower's sign
```
45
Myotonic dystrophy Type 1
most common in adults
| trinucleotide repeat disease in myotonin protein kinase
46
symptoms of myotonic dystrophy
ptosis, cataracts at early age (slit lamp needed)
Weakness- distal muscles get weak first
hypogonadism (reduced testosterone, testicular atrophy), reduced GH, insulin resistance, frequent loss of pregnancy
Afib, tachyarrhythmia, ectopic beats and cardiomyopathy late
dysphagia, hypokinetic tract w/ pseudo-obstruction, constipation
47
Fascioscapulohumeral MD
face, shoulder, arm
Reduction or deletion of DNA sequence- thought to be activator
70-90% AD inheritance
Highly penetrant- 90% of patients w/ weakness by age 20 w/ sizable deletion
CK values normal (creatine kinase- enzyme in muscles)
48
Fascioscapulohumeral MD Symptoms
Facial weakness early
Horizontal smile, wide palpebral fissures, difficulty burying eyelids and pursing lips
Weakness in arms --> medical attention --> anterior axillary folds
Scapular winging
Triple hump sign- fierce atrophy of deltoid, but trapezius and biceps are in tact
Abdominal laxity
Asymmetry- sometimes.
49
C fibers
nociception
slow conduction velocity
not tested by EMG
50
When to order an EMG
Useful to exclude any peripheral cause of sensory or motor abnormalities on neurological exam when there is a diagnostic uncertainty
51
what is on an NCS report
amplitude
conduction
latency
duration
52
how to diagnose myopathy
EMG
| sensory NCS is normal, as it conduction velocity and distal latency
53
target fibers
seen in chronic denervation
54
dysimmune/inflammatory myopathies
polymyositis
dermatomyositis
inclusion body myositis
55
polymyositis
Cell mediated
Adults 40-70 yo
Proximal, symmetrical weakness and myalgia evolving (several months)
Lymphocytes (CD8+ T cells): w/in fascicules, surround, invade, and destroy myofibers
56
dermatomyositis
```
Children and adults
Microvasculature
Association w/ malignancy
Proximal muscle weakness
Infiltrates B & CD 4+ T lymphocytes in interfascicular distribution
Heliotrope rash
```
57
inclusion body myositis
mostly men
Pathology: inflammation, rimmed vacuoles
Congo red positive inclusions:
No effective treatment
58
mitochondrial myopathies
ragged-red fiber
59
GSE
somites- efferent
60
GVE
sympathetic/parasympathetic
61
SVE
branchial motor- derived from pharyngeal arch muscles
62
GSA
sensation of external environment
63
GVA
sensation of internal environment
| carotid bodies, feedback system.
64
SSA
vision
hearing
vestibular function
65
SVA
chemical transmission:
| olfaction, taste
66
lesion on XII in cortex
contralateral tongue deviation
67
lesion on XII nucleus, fascicles, or nerve
ipslateral tongue deviation
68
lesion on XI in R cortex
L trapezius, R SCM weakness
| head deviates toward the R
69
lesion on R XI nerve itself
R trapezius, R SCM weakness
| if anything, deviation toward R
70
vagus nerve nuclei
Dorsal motor nucleus
Nucleus ambiguus
Solitary tract/nucleus
Spinal trigeminal nucleus
71
Dorsal motor nucleus
parasympathetic
72
Nucleus ambiguus
branchial motor supply (arch 4-6)
73
Solitary nucleus
visceral sensation, taste
74
Uvular deviation
deviates towards the good side (away from the lesion)
Dysphagia: cortical lesion
Focal swallowing dysfunction/hoarseness: nerve lesion
75
rostral part of nucleus solitarius
gustatory nucleus- taste
76
caudal part of nucleus solitarius
cardiorespiratory nucleus- chemo and baroreceptors
from aortic arch, cardiorespiratory system, digestive tract
77
big difference between IX and X
parasympathetics:
IX: from inferior salivatory nucleus to parotid gland. Sympathetics synapse in otic ganglion
78
area postrema
open BBB
| center for vomiting, closely related to CN X
79
CN VIII- type of fibers
all SSA
80
pathway of sound
```
cochlear nuclei
decussation in trapezoid body
superior olivary nucleus
lateral lemniscus
inferior colliculus
medial geniculate body of thalamus
auditory cortex- frontal lobe
```
81
nuclei of facial nerve
spinal trigeminal
solitary nucleus
superior salivatory nucleus
82
VII: branchial motor
facial motor nucleus and nerve fascicle
| to muscles of facial expression, posterior belly of digastric, stylohyoid, stapedius
83
upper face innervation
ipslateral and contralateral contribution
84
lower face innervation
only contralateral side
85
VII lesion in UMN
contralateral weakness of lower face only
86
VII lesion in LMN
all fibers to one side of face (upper and lower face)
87
VII parasympathetics
from superior salivatory nucleus
via greater petrosal nerve
synapse in sphenopalatine ganglion
all salivary glands except for parotid
88
IX parasympathetics
inferior salivatory nucleus
89
VII taste
nucleus solitarius (rostral)--> geniculate ganglion--> central tegmental tract --> thalamus --> insularr cortex -->...
90
VII GSA
cell bodies in geniculate ganglion
91
exit of CN VI
superior orbital fissure
92
does V have parasympathetics?
no, just motor and sensory
93
location of VI, 2, 3 cell bodies
trigeminal ganglion
94
V1 exit
superior orbital fissure
95
V2 exit
foramen rotundum
96
V3 exit
foramen ovale
does NOT pass through cavernous sinus
97
what is alone in the cavernous sinus?
VI
98
SVE of VII
to muscles of mastication, a nterior belly of digastric, tensor tympani, tensor velli palatini
99
lesion in V3
jaw deviation toward the weak side (due to pterygoids)
100
V for proprioception
GVA for fine touch- mesencephalic nucleus and tract
101
where is the cell body for V proprioceptive neurons?
mesencephalic nucleus
102
corneal reflex
in on V --> blinking VII
103
types of fibers in IV
GSE
104
parasympathetic nucleus for III
edinger-westphall
105
DRG history
Pain and numbness in dermatomal distribution
Decreased sensation in dermatomal distribution
Trouble with balance/coordination
No weakness- no motor
106
APD
○ Damage to the optic nerve or bad retinal disease
○ Not seen with cataracts, vitreous or corneal disease, refractive error
○ Not seen in functional (non-organic disease)
107
cocaine test
blocks reuptake of NE. Dilation is normal.
with Horner's syndrome, nothing happens.
108
apraclonidine
alpha adrenergic agonist
reversal of Horner's syndrome
denervation supersensitivity
109
Adie's Pupil
Occurs in young woman, benign, probably viral
Unlike pharm blockage, you constrict to near
Also reacts to dilute pilocarpine (1/8%) unlike the normal pupil
no response to light, but response to near
absent reflexes
110
binocular vision
sign of issue on efferent side, likely ocular misalignment
111
worse diplopia at a distance
VI
112
worse diplopia near
III, medial rectus
113
vertical diplopia
III, IV
myasthenia gravis
thyroid eye disease
114
benign positional vertigo
last less than a minute- positional
115
Meniere's disease
lasts hours usually with tinnitus (ringing noise) and hearing loss
116
Vestibular neuritis
inflammation of the inner ear- last days to weeks
117
Acoustic neuroma
evolves over weeks to months
118
pathologic nystagmus characteristics
amplitude greater than 4 degrees
asymmetry
commonly caused by drugs and anti-seizure meds
doesn't fatigue with prolonged gaze
119
peripheral nystagmus
beats in one direction regardless of gaze
120
central nystagmus
vertical component, direction changing
