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Patho- Neuro > Neuro Mod 3 > Flashcards

Neuro Mod 3 Flashcards

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1
Q

what does the thalamus relay?

A

sensory input to the cortex

gateway to the cortex

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2
Q

what does the relay center of the thalamus do before projecting to cortex

A

MODIFIES and projects ALL INPUT to the cortex (except CN1)

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3
Q

What is the input to thalamus?

A

ALL sensory must pass through except CN1 (pain input MODIFIED at thalamus)
motor passes through via basal ganglia
limbic system connects to thalamus - thus plays role in emotional behavior

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4
Q

What is the output from thalamus?

A

most fibers project to the cortex - some project to limbic areas and basal ganglia

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5
Q

What is the somatosensory input to the thalamus?

A

enters consciousness

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6
Q

What is the structure of the thalamus?

A

oval shaped cluster of nuclei that comprises 80% of diencephalon

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7
Q

What are the anatomical divisions of the thalamus?

A 
anterior division - anterior nucleus
medial division - dorsomedial nucleus (DM)
Lateral division
intralaminar nuclei
reticular nuclei
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8
Q

What are the 4 parts of the lateral division of the thalamus?

A

dorsal tier - lateral dorsal, lateral posterior, pulvinar
lateral tier - ventral anterior, ventral lateral, ventral posterior, ventral posterolateral, and ventral posteromedial
medial geniculate
lateral geniculate

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9
Q

What are the 3 functional categories/roles of the thalamus?

A
  1. communicate specific sensory input to the appropriate area of the cerebral cortex
  2. Decision maker
  3. functional role for the basal ganglia and limbic system
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10
Q

Give an example of the specific communication role in the thalamus?

A

somatosensory input from the thumb project to the VPL of the thalamus which projects to the thumb in primary somatosensory area (3,1,2)

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11
Q

What is the decision maker role of the thalamus?

A

decides about which form of information should be projected to the cerebral cortex for processing (gate keeper/distribution role between the areas of the cortex)
Has regulatory inputs

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12
Q

Give an example of regulatory inputs in the thalamus?

A

areas of parietal lobe project to the lateral posterior nucleus (an association nucleus) which in turns project back to the parietal lobe of the cortex

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13
Q

What is the functional role for the basal gangle and limbic system in the thalamus?

A

basal ganglia and limbic system project to thalamic nuclei (intralaminar and midline nuclei) which project to both the cortex and back to the basal ganglia or limbic system

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14
Q

Describe the 3 pathology steps of the thalamus?

A
  1. central pain
  2. thalamic pain
  3. thalamic syndrome
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15
Q

What is the internal capsule?

A

bundle of fibers (white matter) located between thalamus/caudate nucleus and the lenticular nucleus

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16
Q

what is the broad expense of white matter spanning up and out to the cortex within the internal capsule?

A

corona radiata

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17
Q

What are the 5 parts of internal capsule?

A 
anterior limb
posterior limb
genu
retrolenticular part
sublenticular part
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18
Q

what does the anterior limb of internal capsule contain?

A

fibers connecting anterior nucleus (thalamic relay nucleus) to cingulate
dorsomedial nucleus (association nucleus) to prefrontal
also projects from frontal lobe to pontine nuclei in brainstem (frontopontine fibers)

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19
Q

What does the posterior limb of internal capsule contain?

A

ascending/descending motor and sensory pathways

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20
Q

what is the genu in the internal capsule?

A

transition area between anterior and posterior limbs

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21
Q

What does the retrolenticular part of the internal capsule contain?

A

fibers connecting thalamus to posterior lobes of cerebral cortex (parietal and occipital)
projections between LP/pulvinar to/from parietal/occipital cortex
optic radiation

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22
Q

What is optic radiation?

A

projection from thalamus to visual cortex (17-occipital lobe)
found in retrolenticular part of internal capsule and sublenticular part

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23
Q

What does sublenticular part of internal capsule contain?

A

optic radiation

fibers of auditory radiation

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24
Q

What is auditory radiation?

A

projection from thalamus to auditory cortex (41-temporal lobe)

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25
What is the pathology of the internal capsule?
stroke | contains perforating arteries
26
What are perforating arteries?
numerous small branches that originate from the circle of Willis and the ACA, MCA, PCA and basilar arteries
27
What do the perforating arteries supply within the internal capsule?
sub cortical regions 1. diencephalon (thalamus, hypothalamus, subthalamus) 2. internal capsule -pathway of myelinated axons leaving and entering the cerebral cortex (located between thalamus and basal ganglia) 3. limbic structures 4. pons 5. cerebellum
28
What is infarction (occlusion) in the perforating arteries in the internal capsule called?
lacunar stroke/small vessel stroke
29
What blood supply is affected in the lacunar stroke?
supply to the internal capsule (and thalamus) lenticulostriate arteries of MCA perforating arteries of ACA and anterior communicating artery
30
3 RF of the lacunar stroke?
HTN smoking and DM
31
depending on location of lacunar stroke may present how?
pure motor, ataxic, mixed motor/sensory and pure sensory
32
Pathology of lacunar stroke?
micro-deposits of CT of fatty tissue blocks artery obstruction results in small necrotic tissue necrotic tissue is removed by macrophages leave hole -cystic lesion small penetrating arteries are not usually directly affected by athrerosclerosis
33
4 common patterns of lacunar stroke?
pure motor stroke (MC form) ataxic hemiparesis (2nd MC form) Mixed motor and sensory involvement Pure sensory stroke
34
What is a pure motor stroke?
contralateral hemiparesis/hemiplegia | face/arms/hands/legs
35
what is ataxic hemiparesis stroke?
combination of cerebellar/motor symptoms site of lesion involves cerebellar tracts as well as motor pathways homolateral ataxia and crural paresis
36
What is mixed motor and sensory involvement?
contralateral hemiparesis and hemiparaesthesia | face/arm/trunk/leg
37
What is a pure sensory stroke?
contralateral hemiparaesthesia along face/arm/leg/trunk | usually affects limbs more than face/trunk
38
What is the function of a basal ganglia?
modify motor control - initiation & execution of motor activity
39
What is the structure of a basal ganglia?
group of nuclei located bilaterally deep in the telencephalon, diencephalon, and midbrain
40
What are the 5 major nuclei of the basal ganglia?
``` putamen caudate nucleus nucleus accumbens globus pallidus other - substania nigra (midbrain), subthalamus (diencephalon) ```
41
What are lentiform nuclei?
putamen and globus pallidus
42
What is striatum?
putamen, caudate nucleus and nucleus accumbens
43
What is corpus striatum?
all three- putamen, globus pallidus and caudate nucleus
44
what do the basal ganglia stimulate the thalamus to do?
either increase or decrease thalamic drive to the motor cortex thalamic drive to cortex
45
What does increased thalamic drive result in?
increasing the motor output from motor cortex | if too much drive excessive unwanted movement (hyperkinetic)
46
What does decreased thalamic drive result in?
decreasing the motor output from motor cortex | if too little drive - not enough movement (hypokinetic)
47
Basal ganglia are always sending input to the thalamus that does what?
increase inhibition or decrease inhibition | the balance between the 2 determines whether the thalamus is inhibited or stimulated
48
if thalamus is stimulated/inhibited then thalamic drive is what
``` inhibited= decreased stimulated= increased ```
49
What is the direct pathway of the basal ganglia to the thalamus cortex-striatum?
GP/SNr-thalamus -cortex
50
What is the function of the direct pathway of basal ganglia?
stimulates thalamic drive to motor cortex decreases inhibition which results in increased thalamic drive facilitates movements
51
What is the indirect pathway of the basal ganglia to the thalamus?
this pathway involves the subthalamic nucleus and its influence on the GP cortex-striatum -GP-STh-GP-thalamus-cortex
52
What is the function of the indirect pathway of the basal ganglia?
inhibits thalamic drive to motor cortex increases inhibition on the thalamus which decreases thalamic drive inhibits unwanted movements
53
Disorders of the basal ganglia are commonly classified as what 2 types?
hyperkinetic | hypokinetic
54
What happens with hypokinetic movement disorders?
an absence or difficulty with intended movements | ex: bradykinesia & rigidity
55
What happens with hyperkinetic movement disorders?
extraneous unwanted movements | ex: chorea, athetosis, ballismus
56
What is Chorea?
involuntary, constant, rapid, complex body movements that flow from one body part to another
57
What is choreiform
resembling chorea | involuntary dance like movement of the limbs
58
What is athetosis?
slow, writhing movements of the fingers and hands and sometimes the toes
59
What is ballismus?
violent, flailing movements | damage to subthalamic nuclei of basal ganglia results in hemiballismus
60
What is dystonia?
a persistent spasm/posture of a body part which can result in grotesque movements and distorted positions of the body
61
What is a resting tremor?
occurs when a body part is at complete rest against gravity | tremor amplitude decreases with voluntary activity
62
What is a postural tremor?
occurs during maintenance of a position against gravity and increases with action
63
What is essential tremor?
MC form of tremor | occurs in a person who is moving or trying to move and no cause can be identified
64
What is an intentional tremor?
manifests as a marked increase in tremor amplitude during a terminal portion of targeted movement example include cerebellar tremor/pathology
65
What is bradykinesia?
slowing of voluntary movement
66
What is cogwheel rigidity?
periodic resistance at different points throughout the range of movement
67
What is spasticity?
is speed-dependent | move slow and can move limb through ROM
68
What is one of the MC (hypo kinetic) neurological disorders in individuals >60 yo
Parkinson's Disease
69
What are the manifestations of PD
bradykinesia difficulty initiating movement (use center of gravity to compensate) increased muscle tone -lead-pipe rigidity and cogwheel rigidity resting tremor - pill rolling, diminishes/abolishes with movement decreased voluntary movements other s/s - dementia and depression secondary to lesions in brainstem
70
what do the decreased voluntary movements in PD lead to?
decreased facial expression masked expression quiet monotone speech micrographia (small writing)
71
What is the pathology of PD?
destruction of the substantia nigra (reduced dopamine production) net result decreased thalamic drive to motor cortex
72
What is the pathway of reduced thalamic drive in PD?
PD inhibits the direct pathway= decreased thalamic drive | PD allows the indirect pathway to dominate=decreased thalamic drive
73
2 causes of Parkinson's disease
Genetic - 1st degree relative: 2-3x's risk of developing PD | Environmental - pesticide exposure, narcotic agent MPTP, trauma
74
Huntington's Disease
(hyperkinetic) a degenerative neurological disease that manifests in choreiform movement, dementia and behavioral changes
75
Where does the choreiform movements begin in Huntington?
in the face/arms and progress to whole body
76
What is dementia?
short term memory deficits, poor ability to plan, organize and sequence, slow thinking (bradyphrenia)
77
What are the behavioral changes seen in Huntington?
apathy, disinhibition, irritability also depression/euporia changes
78
when is the usual onset of Huntingtons?
middle age and often progresses to death in 10-15 years
79
What is the pathology of Huntingtons?
severe degeneration of striatum (caudate and putamen nucleus) and frontal cortex impairs the direct and indirect pathways
80
What does Huntingtons do to the direct pathway?
facilitates AND inhibits direct pathway at some level | the direct pathway normally decreases inhibition on the thalamus increasing thalamic drive
81
Huntington's does what in the indirect pathway?
inhibits | increases inhibition results in decreased thalamic drive
82
What does tardive mean?
delayed or belated onset of symptoms
83
What is tardive dyskinesia?
characterized by involuntary uncontrollable movements esp of mouth, tongue, trunk and limbs ex: tics and other involuntary, uncontrollable writhing movement patterns
84
How does tardive dyskinesia occur?
as a SE of prolonged use of antipsych drugs or dopamine antagonists pt may be put on a drug holiday to prevent or treat (3-6months)
85
What is a tic?
rapid and repeated and stereotyped involuntary movements | can range from simple benign tic to more severe syndrome such as Tourettes syndrome
86
What is tourettes syndrome characterized as?
motor and vocal tics
87
How is diagnosis of tourettes made?
presence of both motor and vocal tics occurrence of multiple tics nearly every day through period of 1 yr - without remission of tics for a period of greater than 3 consecutive months symptoms cause distress or impairment of in functioning
88
What is the age of onset of tourettes?
<18

Patho- Neuro (5 decks)

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