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Flashcards in Neuro Deck (286):
0

What is the gap that divides the two hemispheres called? What runs down it?

Longitudinal fissure
Falx cerebri

1

What divides the pre and post central gyrus

The central sulcus

2

What divides the temporal lobe from the frontal and parietal?

Lateral cerebral sulcus

3

What divides the cerebellum from the cerebrum?

The transverse fissure

4

What connects the lateral ventricles to the third ventricle?

Intraventricular foramen

5

What connects the third and fourth ventricle?

Cerebral aqueduct

6

How do the white and grey matter change in the spinal cord in c,t,l and s?

C - big white, small grey
T - smaller white, small grey, lat grey horns
L - big white, big grey
S - small white, big grey

7

What is at the end of the spinal cord
What are they made of?

Conus medularis
Flium terminale - extension of the pia blended with arachnoid and dura)

8

Where do the periosteal and meningeal dura mater separate?

Falx cerebri
Falx cerebelli
Tentorum cerebeli
Diaphragm sellae

9

What covers the pituitary gland?

Diaphragm sellae

10

What are the three ways the brain can herniate with increased icp?

Uncal - the uncus of the temporal lobe is pushed round the tentorum cerebeli
Subfacal - the cingulate gyrus is pushed between the falx cerebri and the corpus callosum
Tonsillar - cerebellar tonsils and brainstem pushed through foramen magnum

11

Which layer of dura persists in around the spinal cord?

Meningeal

12

What is the difference between the epidural and extradural space?

Extradural is around the brain. It is potential as the dura is adhered to the bone
Epidural is around the spine. It is real consisting of fat and connective tissue

13

Why is a basal skull fracture more likely to cause csf leakage?

The dura is not surgically seperable from the bone

14

At what point do the neuropores fuse?

25 and 28 days cranial and caudal respectivly

15

What occurs if the neuropores fail to fuse?

Spina bifida
Anencephaly

16

What might be suggestive of a neuropore deficit whilst the fetus is in utero? What else could cause this?

A raised alpha fetoprotein level
Omphalocele, gastroschisis

17

When should folic acid be taken to reduce chance of neuropore deformity?

3 months before and during 1st trimester

18

What are the cranial regions of the neural tube - how do they divide?

Procencephalon - telencephalon, diencephalon
Mesencephalon - mesencephalon
Rhomboencephalon - metencephalon, mylencephalon

19

Why is the axis of the brain different to the axis of the brainstem?

As the tube grows it runs out of space so folds. This creates a cervical flexure and a cephalic flexure

20

In which regions of the embryonic brain are the ventricles?

Telencephalon (lateral)
Diencephalon (third)
Metencephalon (fourth)

21

What is the derviative of the metencephalon?

Pons and cerebellum

22

What are the types of spina bifida?

Occulta
Meningocele
Mylomeningocele

23

How is the neural tube organised?

Dorsal alar plate (sensory)
Ventral basal plate (motor)

24

How are the alar and basal plates of the neural tube regualted?

Signalling from (dorsal) roof and (ventral) floor plates

25

What do neural crest cells contribute to?

Adrenal glands
Sympathetic ganglion
Enteric ganglion
Schwann cells
Melanocytes

26

What disrupts neural crest cell migration?

Alcohol

27

What are the functions of astrocytes?

Formationof bbb by foot processes (glia limitans)
Structural support
Nutrition (glucose lactate shuttle)
Removal of neurotransmitters
Maintain ionic environment

28

What is the glucose lactate shuttle?

Neurones cant store glycogen so astrocytes break theirs down to lactate, transport it to neurones where it is used to create pyruvate.

29

What would happen if K+ rose around the brains neurones? What stops this?

Decreased k gradient so decreased efflux so cell moves closer to membrane potential so increased excitability of neurones
Astrocytes

30

When does mylination of cns begin? When does it end?

4 months gestation until 1 - though not complete until maturity

31

How can the brain respond to damage?

Plasticity (forming new pathways)
Oligodendrocyte precursors to replace myelin lost in disease

32

How is the bbb formed around penetrating capillaries?

Foot processes of astrocytes inducing tight junctions between endothelial cells using occludins

33

Where is the bbb missing?

Choroid plexuses
Vomiting centre
Pituitary
Pineal gland

34

What does the bbb stop?
What does the bbb slow?
What does the bbb allow?

Stops proteins
Slows creatine, urea, ions
Allows glucose, lipid soluble substances

35

Why is it that csf glucose can be controlled?

They are actively transported

36

Why is the cns immunprivilaged?

Enclosed therefore inflammation would increase icp

37

What is the major excitatory and inhibitory neurotransmitters of the brain and spine?

Brain - ex = glutamate, in = gaba
Spine - ex = glutamate, in = glycine

38

What sorts of glutamate receptors are there?

Metabotrophic - Gaq or Gai
Ionotrophic - Kainate, AMPA and NMDA

39

What is required for NMDA receptor activation?

Binding of glutamate
Degree of depolarisation to move Mg ion

40

What process is involved in the long term potentiation of glutamate receptors?

Activation of AMPA
Depolarisation
Activation of NMDA
Calcium influx
Upregulation of AMPA

41

What is the mechanism for glutamate excitotoxicity?

Ischemia - decreased atp therefore decreased na/k ATPase therefore decreased ecf sodium ions, therefore decreased or reversed na glutamate synporting increasing extracellular glutamate

Trauma or injury resulting in glutamate release

Increased glutamate causes increased intercellular calcium and cell death

42

What are the different sorts of gaba receptors?

GABAa = ionotrophic cl- channels
GABAb = metabotrophic GPCRs decreasing GABA and glutamate release

43

What is the term for one sided weakness?

Hemiparesis

44

What is the term for one sided paralysis?

Hemiplegia

45

What is ataxia?

Uncoordianted movement

46

What is dysarthria?

Slurred speech due to lack of coordination of vocal muscles

47

What is dysphasia?

Difficulty in using language
- expressive
- receptive

48

What is agnosia?

No object perception

49

What is apraxia?

Unable to execute purposeful movement that is already learnt in spite of good power, sensation and coordination

50

Where is ACh released from in the brain? What are its effects?

Nucleus basalis and brainstem
Generally excitatory

51

What are the dopaminergic pathways in the cns? What do they do?

Negrostriatal (control of movement)
Mesocortical (arousal and mood)
Mesolimbic (emotion)
Tuberohypophesal (inhibition of prolactin secretion)
D1 = GalphaS
D2 = GalphaI

52

What are the na pathways of the cns? What do they do?

Pons and medulla right through the cns
Effects arousal and mood

53

Where do 5ht neurones originate, what do they do?

Raphe nucleus in the brainstem
Widely distributed
Effects mood and wakefulness

54

What cell type covers choroid plexuses? What makes them special?

Ependymal - tight junctions with occludins allowing specific filtering

55

What is the rate of csf turnover.

20ml/hour

56

Describe the root of csf circulation

Lateral ventricles
Interventricular foramen
Third ventricle
Cerebral aqueduct
Fourth ventricle
Central canal / medial/lateral apatures
Subarachnoid space

57

Where is csf reabsorbed? How?

arachnoid granulations at the venous sinuses that have arachnoid matter that protrudes through the meningeal dura

58

What are the functions of csf?

Mechanical protection - shock absorber
Maintains icp
Reduces weight of brain preventing crushing of own blood vessels
Chemical protection
Circulation of nutrients


59

What is the pathogen, glucose and cellular composition of csf?

Sterile
Glucose 2/3rds of blood
Low numbers of WBC (no polymorphs)
No erythrocytes

60

What (grossly) can cause hydrocephalus?

Overproduction of csf
Blockage of csf flow
Under reabsorption of csf

61

Differentiate communicating and non communicating hydrocephalus

Communicating - free flowing csf but inadequate reabsorption
Non communicating - blockage to csf flow

62

What is the most common site of csf flow blockage?

Cerebral aqueduct

63

Give 2 examples of communicating hydrocephalus

Congenital absence of arachnoid granulations
Blockage of arachnoid granulations due to RBCs in SAH

64

Give two examples of non communicating hydrocephalus

Tumour compressing cerebral aqueduct
Spina bifida (aquaductal stenosis, open myleomeningoceal)

65

What is the main arterial supply to the meningies?

Middle meningeal artery as a branch of the maxillary artery

66

Where does the middle meningeal artery enter the cranium?
What happens then?

Foramen spinosum
Branches to anterior and posterior

67

Where do the meningies drain?

Through paired middle meningeal veins through the foramen spinosum into the pterygoid venous plexus

68

Where do the vertebral arteries pass?

Up the transverse foramen of the top 6 cervical vertebra then through the foramen magnum

69

What are the branches of the vertebral and basilar artery from posterior to anterior?

Posterior inferior cerebellar arteries
Anterior inferior cerebellar arteries
Pontine arteries
Superior cerebellar arteries
Posterior cerebral arteries

70

What are the branches of the internal carotid artery?

The anterior cerebral, middle cerebral and the posterior communicating

71

Where does the posterior cerebral artery span?

Ica to posterior cerebral

72

Where does the anterior cerebral artery supply?

Medial and anterior surface of the hemisphere

73

Where does the middle cerebral artery supply?

The lateral surface of the hemispheres

74

Where does the posterior cerebral artery supply?

Inferior hemisphere and occipital lobe

75

How does blood drain from the brain?

Small veins pass through arachnoid and meningeal dura into dural venous sinus
Emissary veins into extracranial veins
Through the dural venous sinuses into then ijv

76

What is the order of drainage through the sagittal dural venous sinuses?

Superior sagittal sinus joins straight sinus (from inferior sagittal sinus and great cerebral vein) at the confluence of sinuses

Confluence of sinuses splits bilaterally into the transverse sinuses into the sigmoid sinus then the ijv

77

What is the drainage into and out of the cavernous sinus?

Superior opthalmic veins and spenoparietal sinus drain in anteriorly

Drains out posteriorly via the superior and inferior petrosal sinus into the transverse and sigmoid sinus respectively

78

How can blood move through the emissary veins?

In both directions - though usually out away from the brain

79

What is sensation?

A conscious or unconscious awareness of an internal or external stimuli

80

What are the neurones of general sensation?

1st order - contain or link to sensory receptor
2nd order - link 1st to thalamus
3rd order - link thalamus to cerebral cortex

81

Where do third order sensory neurones travel?

Through the internal capsule

82

What is the advantage of having multiple neurones in the sensory pathways?

Allow for divergence, convergence and modification from external neurones

83

What are the three general types of sensory receptors? Give an example of what each detects

Free nerve endings - e.g. Cold
Encapsulated nerve endings - e.g. Pressure
Synapse with specialised cell - e.g. Vision

84

Are sensory receptors totally specific for one stimuli type?

No - large input from another modality can cause stimulation e.g. Seeing stars when hit in the eye

85

What is the term for different types of one sensation (e.g. Sweet and sour taste)?

Qualities

86

What sensory receptors are present in muscles? What do they do?

Spindle fibres - detect change in muscle length
Golgi tendon organs - detect change in muscle tension

87

What do we need to know about a sensory stimuli?

What type
Where
How long
How strong

88

How can we determine stimuli strength?

Rate of firing of action potentials (frequency coding)
Activation of neighbouring cells

89

How can neurones encode a time frame for a stimuli?

Phasic response - rapidly adapting, only fire for a short time when stimuli changes - i.e. an on and off signal

Tonic response - slowly adapting, fires for the entire time the stimulus is active

90

What methods does the ns use to localise a sensory stimuli?

Lateral inhibition
Two point discrimination
Convergence and divergence

91

What is the process of lateral inhibition?

Each first order neurone sends inhibitory interneurones to neighbouring second order neurones localising a stimulus.

92

What is two point discrimination?
What does it depend on?

The distance at which you can distinguish two stimuli as distinct

Depends on receptive field of the neurones and the degree of convergence of 1st orders on 2nd orders and 2nd orders on 3rd orders.

93

What does neurone divergence cause in sensory pathways?

Amplification of signal

94

Where in the cns do we convert afferent sensory impulses into the feeling of sensation?

Thalamus - crude localisation and modality
Post central gyrus (somatosensory cortex) - sharp localisation

95

After reaching the somatosensory cortex where are sensory inputs relayed too?

Cortical association areas (combining multiple modalities into a general picture)
Subcortical areas (movement alteration)
Limbic system (emotion)

96

How does then limbic system associate with sensation?

Pain is unpleasant and upsetting
Same touch can be nice from a partner but nasty from a stranger

97

What are the ascending tracts of the spinal cord?
What modalities do they convey?

Posterior column medial leminiscal - fine touch (light touch, vibration, hair movement), conscious proprioception

Anteriolateral system - pain, crude touch, temperature

Spinocerebellar - unconscious proprioception

Cuneocerebellar - unconscious proprioception from upper c-spine

98

Where does the posterior column medial leminiscus tract run?

First order enters spinal cord, passes into gracile or cuneate nucleus, ascends to medulla and synapses in cuneate or gracile nucleus.

Second order decussate and ascend the medial leminiscus pathway to the ventral posterior lateral nucleus of the thalamus

Third order ascend through the internal capsule to the somatosensory cortex

99

What is the route of the anteriolateral system?

1st order enter spinal cord and ascend or descend up to 3 segments in the dorsolateral tract of lissauer. They then synapse in lamina I, II, or V

2nd order neurones decussate immediately crossing in the anterior grey commiseur before ascending in the anteriolateral system to the ventral posteriolateral nucleus of the thalamus

3rd order neurones pass through the internal capsule to the somatosensory cortex

100

What is the route of the spinocerebellar tract?

First order enter the spine. These are the same neurones as the dorsal column medial leminiscal. They branch giving two synapses in the dorsal horn.

Second order neurones ascend in two different ways. The anterior set decussate ascending contralaterally before decussating again syanpsing at the ipsolateral cerebellum. The posterior set ascend ipsolaterally and do not decussate at all

101

Where do lower motor neurones have their cell bodies?

Lamina IX of the ventral horn

102

What is a motor unit?

A combination of a lower motor neurone and the muscle fibres it supplys

103

What are the classifications of nerve fibres based on speed of conduction? What is an example of each?

A alpha - LMN, proprioception
A beta - touch
A delta - sharp pain, temperature
B - preganglionic autonomic
C - dull pain

104

How can lmn be activated?

Input from higher centres
Reflex

105

What is a reflex?

An involuntary, unlearned, automatic repeatable response to a specific stimuli that does not require the brain

106

What must a reflex involve?

A receptor
Afferent neurone
Integration centre
Efferent neurone
Effector

107

Describe the process of a stretch reflex

Tendon hammer stretches tendon
Spindle fibre stretched
Afferent impulse to spinal cord
Afferent impulse up spinocerbellar and DCML (proprioception to brain)
Synapse in cord lamina IX with LMN - excitatory to muscle to contract and inhibits antagonistic muscle causing relaxation

108

What muscles maintain tone during sleep?

Respiratory
Extraoccular
Urinary and anal sphincters

109

What are typical signs of LMN lesion? How are they distributed?

Weakness
Muscle wasting
Loss of tone
Decreased or absent weakness
Initial fasiculations

Tend to be localised to a specific peripheral nerve

110

What two broad groups can UMNs be classified into?

Pyramidal tracts from cortex to effector (CN and spine)
Extrapyramidal tracts from brainstem to effector

111

What are the pyramidal tracts motor tracts? What do they supply?

Corticospial - cortex to spinal lmns
Corticobulbar - cortex to CN lmns

112

Where do the corticospinal and corticobulbar tracts origionate

30% in the precentral gyrus (motor cortex)
30% in the premotor cortex and supplementary motor area
40% in the somatosensory cortex

113

After origination where do the UMNs of the corticospinal tract travel?

Internal capsule
Brainstem
Decussation of pyramids in medulla
85% decussate into the contralateral lateral corticospinal tract
15% remain ipsolateral in the anterior corticospinal tract
All synapse in lamina IX (most via an interneurone)

114

How many of the fibres of the corticospinal tract decussate? Which part of it do they entre?

85%
The lateral section

115

Where do the fibres of the corticobulbar UMN travel?

Through the internal capsule, most decussating and not decussating giving bilateral innervation synapsing with the CN nuclei. The exception to this is the UMN to the facial nerve supplying the muscles of facial expression

116

What is the function of the motor cortex and premotor cortex with supplimentary motor area?

Motor cortex - coordinates action
PMC and SMA - formulating a plan and organising supplementary muscle activation

117

What is the process of altering the state of the other muscles around the body prior to a movement called? What coordinates this?

Body set
PMC and SMA

118

What are the extrapyramidal motor pathways?

Tectospinal
Rubrospinal
Reticulospinal
Vestibulospinal

119

Which extrapyramidal pathways decussate? What do they do?

Tectospinal - decussates, controls head and eye movement to visual and audible stimuli. Stops in upper thoracic spine.

Rubrospinal - decussates, controls upper limb flexor tone. Stops in upper thoracic spine

120

Which extrapyramidal tracts do not decussate? What do they do?

Reticulospinal - posture and rhythmic movements by facilitation and inhibition of LMNs

Vestibulospinal - balance and antigravity msulces

121

What are signs of upper motor neurone lesions? Where are they found?

Hypertonia
Hyperreflexia
Clonus
Babinskis sign
Movement weakness
Clasp knife reflex

Tend to be widespread

122

What are the three regions of the cerebellum? What do they do?

Vestibulocerebellum - coordination of balance via vestibulospinal and reticulospinal tracts. Occular reflex allowing eyes to tract object as head turns
Spinocerebellum - receives proprioceptive info and a copy of the motor plan in order to predict errors in movement and correct them before they occur
Cerebrocerebellum - hand eye coordination, motor learning and memory, predicts sensory consequence of actions

123

Signs of cerebellar dysfunction?

Dysdidochokinesia
Ataxia
Nystagmus
Intenetion tremor
Speech problems
Hypotonia
Past pointing

124

What are the functions of the basal ganglia?

Decision to move
Direction of movement
Amplitude of movement
Motor expression of emotion

125

What makes up the basal ganglia?

The caudate nucleus
The putamen
The globus pallidus
The substantia nigra
The subthalmic nucleus

126

What comprises the striatum?

The caudate nucleus
The putamen

127

What comprises the lenticular nucleus?

The putamen and globus pallidus

128

What are the pathways of the basal ganglia? What do they achieve?

Direct pathway - increase movement
Indirect pathway - decreased movement

129

When the cortex wants to move what is the effect on the direct pathway of the basal ganglia?

Stimulation of the striatum
Inhibits the GPi/SNr
Reduced inhibition of the thalamus
Increased positive feedback to the cerebral cortex affirming the movement

130

When the cortex signals for movement what is the effect on the indirect pathway?

Increased stimulation of the striatum
Increased inhibition of the GPe
Decreased inhibition of the subthalmic nucleus
Increased inhibition of the thalamus
Decreased positive feedback to the cerebral cortex dampening movement

131

What does the nigostriatal pathway do to the direct and indirect pathways? Which receptors are involved?

Direct, D1 receptor - increased stimulation - increases excitation of thalamus
Indirect D2 receptor - decreased stimulation - decreases inhibition of thalamus

132

What are the effects of parkinsons disease?

Resting tremor
Increased tone
Bradykinesia
Mask facies

133

What is the effect of huntingdons disease?

Damage to the striatum removing inhibition on the GPe causing decreased inhbition of the thalamus

134

What is pain?

An unpleasant sensation and emotional experience associated with actual or potential tissue damage

135

What are the two parts to pain?

Nociception (detection of stimuli from actual or potential damage causing ascending unconscious neural traffic)

Conscious perception of pain - the sensation

136

What varies in people who deal with pain differently, what doesn't?

Tollerance varies
Threshold does not!

137

What alters pain tolerance?

Environment (e.g. Better tolerance with adrenaline post accident)
Emotion (worse tolerance if upset, depressed)
Age (better tolerance in elderly)
Distracting injury

138

Where do pain fibres ascend?

Ascend in the lateral part of the anteriolateral system to the ventral posteriolateral nucleus of the thalamus

139

What are the contents of the anteriolateral system?

Spinothalmic - perception of pain
Spinoreticular - arousal to pain
Spinotectal - looking at source
Spinohypothalmic - autonomic response
Spinomesencephalic - descending inhibition and emotion

140

What are the four stages of pain?

Transduction - the activation of the receptor
Transmission - relay
Modulation
Perception

141

What is pain transduction?

Release of k, serotonin, bradykinin, h, prostaglandins from damaged tissue activating nociceptors

142

What fibres convey pain? What activates them?

A delta - mechanical
C - mechanical, thermal, chemical

143

What sort of pain do different nerve fibres produce?

A delta - sharp stabbing localised pain
C - dull throbbing poorly localised pain

144

Which lamina do primary pain fibres terminate?

I, II, V

145

Where does the anteriolateral system arise (lamina)

Lamina I and V

146

How can pain be modulated physiologically?

The gate control theory
Descending inhibition

147

What is the gate control theory of pain?

Stimulation of A beta fibres by rubbing causes stimulation of interneurones in lamina II which cause inhibition of lamina I and V

148

What effects do A delta and C fibres have on lamina II?

Inhibition of interneurones that inhibit lamina I and V thus decreasing own inhibition

149

What substances do A dela and C fibres relase in the 1 st and second lamina? What about the inhibitory synapses?

Substance P and glutamate
Glycine

150

What is the decending inhibition of pain?

Direct - spinothalmic tract to periaquiducal grey matter to raphae nucleus
Indirect - spinomesencephalic to raphae nucleus

Raphae nucleus releases 5HT, enkephalins and noradrenaline into lamina I and V inhibiting the spinothalmic tract

151

Where is pain percieved?

Third order neurones to primary sensory areas but also limbic system and hypothalamus for emotional and stress response

152

Differentiate hyperalgesia from allodynia

Hyperalgesia - increased pain at normal threshold stimulus due to peripheral and central sensitisation
Allodynia - pain from stimuli that are not normally painful or pain in an area not stimulated

153

What is peripheral sensitisation?

Painful stimuli (5HT, K, PGE etc) trigger c fibre. C fibre releases substance P that activates mast cells releasing histamine and other chemicals. These cause vasodilation and also reactivate the original fibre in a vicious cycle.

154

What is central sensitisation?

Glutamate released at first order synaptic bulbs activate AMPA receptors, depolarising second order neurones. Depolarisation allows for opening of NMDA receptors allowing calcium influx. Calcium influx up regulates expression of AMPA. This occurs with long term stimulation.

155

What is the general cut off for a pain to be chronic? What is the usual aetiology of chronic pain?

3 months
Often not known

156

What is the mechanism behind neuropathic pain?

Of neuronal origin, no nociception
Occurs due to increased excitability post injury (ectopic) and activation of neighbouring fibres (ephapatic)

157

What is phantom limb sensation caused by?

Not fully understood but may be cortical remodelling

158

What is complex regional pain syndrome? What are the two types?

No history of trauma - type 1
History of trauma (often minor) - type 2
1) initiation of pain
2) sympathetic and inflammatory response
3) increase pain
4) sympathetic and inflammatory response
And so on

Causes pain, oedema, vasomotor disturbance, movement limitation, muscle waisting, skin thickening

159

What can cause pain in cancer?

The disease
The treatment!

160

Differentiate opiate and opioid

Opiate from a poppy

161

How does the inner ear form?

Otic placode on ectoderm
Sinks and pinches off forming ottic vesicle

162

What forms the middle ear and eustachian tube?

Expansion of the 1st pharangeal pouch

163

What forms the ossicles of the ear?

Merckels and reicherts cartilage

164

What forms the external aucoustic meatus?

1st pharangeal cleft

165

What forms the auricle?

Proliferation of the first and second arches

166

Where does the ear form?

The embryonic neck

167

Which part of the ear is most susceptible to teratogenesis?

Inner ear from the otic vesicle

168

What is the first stage of eye formation?

Formation of the optic placode and outpouching of the proencephalon towards it

169

How does the lens of the eye form?

Invagination of placode forming vesical

170

How is the embyonic lens of the eye supplies with blood?

The hyaloid artery that runs up the optic stalk (from the proencephalon)

171

How does the hyaloid artery fit in the optic stalk? What does persistance of this feature cause?

The stalk contains a fissure, the choroid fissure. Persistence causes a coloboma

172

How does the central artery of the retina form?

Degeneration of distal hyaloid artery (proximal remnants becoming the central artery)

173

How does the proencephalon outpouching go on to form the optic nerve and retina

Stalk becomes optic nerve
End envelopes the lens forming a double layered cup
Outer layer becomes the pigment layer and inner layer becomes the sensory layer of the retina

174

How does the retina detach in pathology?

Opening of the intraretinal space between the pigment layer and the neural layer of the retina

175

How does the iris of the eye form?

Lining of the optic cup buckles forming the ciliary body and iris.

176

Hw doe the extraoccular muscles form?

From preotic myotomes

177

Where do the eyes develop?

Side of the embryonic head

178

What is the structure of the retina from back to front?

Pigment cells - absorb scattering light
Photoreceptive cells - rods and cones
Bipolar neurones
Ganglion cells

179

What is special about the fova?

Concentrated cone cells
Overlying neurones displaced

180

Difference between rods and cones inc. neural wireing

Rods - high sensitivity, many rods into one bipolar neurone, low acuity
Cones - low sensitivity, high acuity, one rod to one bipolar neurone , colour

181

Where is the fova?

Lateral to the optic disk

182

Which regions of the retina (and vision) form the left optic tract?

Left temporal retina (left nasal vision) and right nasal retina (right temporal vision)

183

Where do fibres of the optic tract go?

90% to lgn
10 % superior colliculus - edinger westphal - CNIII

184

What are the optic radiations?

inferior half of each retina - meyers loop
superior half of each retina - baums loop

185

Which optic radiation is direct?

Baums loop - superior retina (inferior visual field)

186

Where do fibres of the lgn go?

Primary visual cortex

187

In the primary visual cortex what patterns are maintained from the retina?

Spacial
Magnocellular vs parvocellular

188

How do fibres leave the primary visual cortex?

Ventral stream - to temporal - object recognition
Dorsal stream - to parietal - object location and motion

189

What are the four types of strabismus?

Esotropia - defective eye looks in
Exotropia - defective eye looks out
Hypertropia - defective eye looks up
Hypotropia - defective eye looks down

190

Why dont kids with strabismus have double vision?

Plasticity in nerves allows supression of vision

191

Why do occipital lesions spare the macular?

Dual blood supply to the regions that detect macular vision

192

Pupil reflex pathway

Light - retina - optic nerve - optic tract - pretectal nuculus - superior colliculus - edinger westphal nucleus - cniii, cillary ganglion, constrictor pupillae

193

Why is the pupil reflex pathway bilateral?

Optic tract contains fibres from both retina
Neurones from superior colliculus innervate both edinger westphal nuclei

194

What two parameters of sound are detectable?

Frequency and volume

195

What is the decibel scale?

A measure of volume
dB = log10 (P2/P1)

196

How do louder sounds get detected as being louder?

More intense vibrations of sensory hairs and activation of neighbouring fibres

197

What are the three chambers of the cochlea?

Scala vestibuli
Scala media
Scala tympani

198

Where are the cells that detect sound located in the cochlea?

In the scala media

199

What is the membrane that sits above the hair cells in the ear?

Tectoral membrane

200

What are the membranes between the cavities of the cochlea?

Scala vestibuli
VESTIBULAR MEMBRANE
Scala media
BASALAR MEMBRANE
Scala tympani

201

What fluid is found in the cavities of the cochlea?

Scala vestibuli and scala tympani = perilymph
Scala media = endolymph

202

What windows border the cavities of the cochlea?

Scala vestibuli - oval window
Scala tympani - round window

203

What are the distribution of the hair cells in the cochlea? Which is more sensitive? What is the function of the others?

1x inner hair cell = most sensitive
3x outer hair cells = vibrate with the sound alternating the tension on the tectoral membrane

204

How is movement of the oval window translated into movement of the hair cells of the cochlea?

Pressure wave in perilymph, deformation of vestibular membrane, pressure wave in endolymph, deformation of basilar membrane, hair cells move against tectoral membrane

205

What happens to the hair cells on movement?

Bending of steriocillia opens K+ channels, K+ diffuses into the cell due to high conc. in endolymph, cell depolarises, calcium flows. Through vgCa channels, neurotransmitter released

206

What are the ganglia of the cochlear nerve termed?

Spiral ganglia

207

How do the ears detect changes in frequency?

Activation of hair cells at specific points down scala media

208

Where in the scala media are high frequencies detected

Near the oval and round windows?

209

Where in the scala media are the low frequencies detected?

Near the heicotrema

210

What is the range of frequencies in normal human hearing?

20-20000 Hz

211

What is the nervous propergation of sound from the hair cells to the brain?

Hair cell
Spiral ganglion cell
CNVIII
Cochlear nucleus (medulla)
Superior olivary complex
Inferior colliculus
Medial geniculate nucleus
Auditory cortex

212

What can cause hearing impairment?

Loud noise
Congenital defect
Infection
Ototoxic compounds
Trauma
Age

213

What are the three types of hearing impairment?

Conductive (blockage, rupture of membrane)
Sensory (hair cell destruction, hair cell death)
Neural (spiral ganglion damage, tinnitus)

214

What test can be used to quantify a degree of hearing loss? How does it work?

Audiogram
Sensitivity vs frequency

215

How can the function of the outer hair cells be measured?

Otoacoustic emissions

216

Treatments for hearing loss

Hearing aids
Cochlear implant

217

What are primary and secondary haemorrhagic strokes?

Primary - no structural lesion
Secondary - following a lesion (tumour, aneurysm, malformations, thrombotic disease). These abnormalities may themselves be secondary to diseases such as htn or dm

218

What could be effected by a frontal stroke?

Expressive dysphasia - brocca's area
Motor disturbance - motor cortex and premotor areas
Disinhibition - cortical association areas
Incontinence - micturition inhibition centre

219

What could be caused by a temporal stroke?

Receptive aphasia - wernicke's area
Memory problems - hippocampus
Superior quadrantanopia - meyers loop

220

What could a parietal stroke cause?

Inferior quadrantanopia or hemianopia - baums loop
Somatosensory deficits - somatosensory cortex
Nominal aphasia - angular gyrus

221

What could an occipital stroke cause?

Visual disturbance

222

What are the different grades of stroke?

Total anterior circulation (TACS)
Partial anterior circulation (PACS)
Lacunar (LACS)
Posterior circulation (POCS)

223

What is a lacunar stroke?

A stroke effecting a single perforating artery
Usually asymptomatic - if symptomatic single system signs

224

Differentials of stroke

Hypoglycemia
Seizure
Migrain
Space occupying lesion
Demylination

225

Blood tests in a stroke

Bm, fbc, inr, u+e

226

Scanning in a stroke

Ct, mri, carotid us, cxr, echo, holter, ecg

227

What is the blood supply to the spine?

Single anterior artery, duel posterior arteries

228

What sort of arterial occlusion is most serious in the spine? How does it present?

Anterior as no anastamosis
Acute painful with sensory loss and progression to upper motor neurone signs.

229

First signs of raised icp

Behaviour changes
Decreased gcs
Localising signs
Pupil reactions
Cushings triad

230

What is the shape of a epidural haematoma on imaging

Lentiform

231

What is the shape of a subdural haemotoma on imaging

Follows skull contours

232

What does cat stand for?

Computer axial tomography

233

How does bone appear on CT.

White

234

What is seen in a T1 MRI?

Fatty tissues (cortex)

235

What is seen in a T2 MRI.

Watery tissues (oedema, lesions)

236

Indications for ct head?

Gcs 1 vomiting post trauma
>65 with LOC or amnesia
Dangerous MOI

237

Complications of a skull fracture

Neuronal damage
Blood vessel damage
Infection risk

238

Signs of a SAH on CT

Blood in ventricles

239

What are the components of a TACS

Hemiparesis / hemianaesthesia
Hemianopia
High cerebral dysfunction (dysphasia, dyspraxia, cortical signs)

240

What are the componenets of a PACS?

2 of TACS

241

Which sort of stroke is most likely fatal?
Which sort of stroke has a high reoccurance rate ?

TACS
PACS

242

Where does a TACS effect

ICA or proximal MCA

243

Where does a PACS effect

Distal MCA or branch of MCA

244

Why do we need sleep?

Cns resetting
Toxin clearance
Long term memory

245

What are the two types of sleep? Differentiate appearance / dreaming / obs

REM - active brain (dreaming), body still (inhibition of motor neurones), difficult to disturb, erection, irregular pulse and rr

NonREM - low brain activity, body mobile (rolling over, sleep walking), decreased bp, spo2, rr,

246

Differentiate rem/nonrem sleep in terms of bmr

Increase bmr in rem
Decrease bmr in non rem

247

Differentiate rem / nonrem in terms of eeg

Rem - eeg as awake (beta)
Non rem - eeg alpha to theta to delta

248

How does the pattern of sleep change through the night?

Start into non rem
Duration and frequency of rem increases during the night
Tend to awake naturally from rem

249

What is the change in neurotransmitters during rem/nonrem sleep?

In rem ach increases and 5ht/na decrease
In non-rem all of ach, 5ht and na decrease

250

What are the different eeg wave types in order of decresing frequency?
When are they seen?

Beta - awake eyes open
Alpha - awake eyes shut
Theta - children, mediating adults
Delta - deep sleep, coma

251

Where in the brain would closing eyes cause a decrease in eeg wave frequency from beta to alpha with an increase in amplitude?

Occiput as its sending 'im not seeing anything signals

252

Two types of parasomnia

Sleep paralysis
Acting out dreams

253

Two types of hypersomnia

Narcolepsy
Obstructive sleep apneoa

254

What activates RAS

Sensation - auditory, visual, nociception, viceral

255

What inhibits ras?

Alcohol,
Sedatives
Sleep centre

256

Where is the reticular formation? Why?

In the white matter of the pons where it can sense ascending tracts

257

Functions of the reticular formation?

Sleep regulation
Motor control
Motivation and reward
Cvs and rs control and autonomics

258

Functions of reticular activating system?

Raises conciousness (depresses hypothalmic sleep centre)
Filters incoming signals (removing response to background stimulation)

259

What generates eeg loops ?

Thalmocoritcal loops - stimulation from thalamus to cortex is reinforced by positive feedback from cortex to thalamus - staying awake!

260

What happens in the different layers of the cortex?

1/2/3 - signals too and from other areas of cortex
4 - input from body
5/6 - output too body

261

What are the functional classifications of the areas of the cortex (generally)?

Primary sensory / primary motor areas
Secondary sensory / supplementary motor areas
Tertiary areas
Association cortex

262

Which areas of the brain deals with more than one modality of sense?

Association areas

263

What are the functions of the
Frontal
Parietal
Temporal
Occipital
Association areas?

Frontal - interlect, personality, mood
Parietal - language, calculation, visiospacial
Temporal - memory, language
Occipital - vision

264

Lesions of the association areas of the parietal cause...

Attention deficites
Contralateral neglect

265

Lesions of the association areas of the temporal lobe cause

Agnosia

266

In a left handed person which hemisphere is more likely to be dominant?

Left!

267

What processes in the brain are effected by lateralisation?

Dominant - language, maths, logic, motor skill
Non dominant - visiospacial, music, art, emotion, body awareness

268

What connects the hemispheres?

Corpus callosum
Anterior and posterior commissure

269

What is the function of broccas area?
Dysfunction?

Formulation of language components
Expressive dysphasia - poorly constructed disjointed speech

270

What does wernicks area do?
Dysfunction?

Interpretation of written and spoken word
Receptive dysphasia - lack of comprehension and with fluid but nonsensical speech

271

Define the two categories of memories. What major brain areas are associated with each?

Declarative - things you can state - hippocampus
Procedural - motor memories - cerebellum, premotor cortex, basal ganglia

272

What is needed to transfer memories from short to long term memory?

Rehersal
Emotion
Association
Automatic (trivia!)

273

Where are memories 'stored'?

Each modality in its appropriate cortical area - then combined by the hippocampus

274

What brain functions are vital in memory formation?

Neuronal plasticity
Long term potentiation

275

Why dont we remember everything

Long term depression

276

What pathology causes anterograde amnesia?

Hippocampal damage

277

What disease may cause reterograde amnesia"

Alzheimers

278

What is dementia?

Aquired loss of cognitive ability sufficiently severe to interfere with daily function and quality of life
Can be direct (neuronal damage) or indirect (vascular)

279

What is the cut off age for presenile demetia?

65

280

Causes of dementia and differentiating factors

Cjd - young
Picks disease - personality change
Vascular - stepwise progression
Alzheimers - senile onset
Lewis body - parkinsonism

281

What are the effects of sub cortical damage in dementia?

Slowness and forgetfulness

282

What are the effects of anterior cortical damage in dementia?

Decreased inhibition
Antisocial behaviour
Irresponsibility

283

Effects of posterior cortical damage in dementia?

Loss of memory
Disturbed language

284

What structural changes occur in dementia?
What happens to csf pressure?

Cortical atrophy with ventriculomegaly
Csf pressure normal (normal pressure hydrocephalus)

285

What are the types of the following nerve fibres:
Light touch
Proprioception
Pain
Temperature
Muscle fibre motor
Muscle spindle motor

Light touch - A alpha
Proprioception - A alpha
Pain - C
Temperature - A delta
Muscle fibre motor - A alpha
Muscle spindle motor - A beta