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Neuro Test 1 Flashcards

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1
Q

Korbinan Broadmann divides the cortex into ___ areas based on…

A

52 areas

Microscopic appearance and function

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2
Q

Dysfunction of the ____ can cause behavioral changes

A

Limbic system

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3
Q

Anterior circulation of brain supplied by

A

Internal carotid artery

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4
Q

Connects lateral ventricles to 3rd ventricle

A

Foramen of Monro

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5
Q

Limbic basal ganglia

A

VS: ventral striatum
VP: ventral pallidum

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6
Q

Somatic sensory pathway

A 
Ventral/Dorsal ramus->
Spinal nerve -> 
Dorsal root ganglion-> 
Dorsal root ->
Spinal cord
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7
Q

The ___ cortex and ___ cortex maintain, manipulate, and update info in ___ memory

A

Prefrontal cortex and parietotemporal association cortex

Working memory

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8
Q

Perception of body position, equilibrium, and direction of gravitational forces.

A

Graviception

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9
Q

Basilar artery stroke: somatosensory

A

Bilateral sensory loss

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10
Q

Myosin attached to M line

A

Thick filaments

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11
Q

G-protein action

A

Signal amplification
Inflammation

Aspirin and NSAIDs

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12
Q

MCA (middle cerebral artery) arises from ____.
It courses in ____ then fans out over cerebral cortex

Infarct….

A

Arises from internal carotid

Courses in sylvian fissure then fans out over cerebral cortex
Parts of parietal, frontal and temporal lobes

Most common site of stroke/infarct

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13
Q

MCA stroke: emotions/behavior

A

If RIGHT hemisphere (left hemiplegia):
Easily distracted, poor judgement, impulsive

If LEFT hemisphere (right hemiplegia):
Apraxia, compulsiveness, overly cautious

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14
Q

Severe variant of GBS more prevalent in Asia, Central and South America

A

AMSAN: acute motor sensory axonal neuropathy

Rarer than AMAN- potentially same disorder with AMSAN affecting ventral/dorsal roots (AMAN only ventral roots)

Acute onset of distal weakness, loss of deep tendon reflexes, sensory symptoms including paresthesia and pain

Poor prognosis; slow recovery

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15
Q

If eyelids are symmetrical and no ptosis (drooping) then ___ cranial nerve function is likely intact

A

CN III

Oculomotor

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16
Q

Disease that involves dysfunction of ion channels

Cause some cases of epilepsy and migraine headaches

A

Channelopathy

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17
Q

Any pathologic change involving peripheral nerves

A

Peripheral neuropathy

Often involves destruction of myelin surrounding largest, most myelinated sensory and motor fibers

Results in disrupted proprioception and weakness

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18
Q

Axoplasmic transport

A

Mechanism for transporting substances along an axon

Occurs in 2 directions:
Anterograde: soma -> presynaptic terminal
Retrograde: synapse -> soma

Occurs at many speeds
Slows as part of aging and in neurodegenerative diseases

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19
Q

Secondary visual function

A

Analysis of motion, color; control of visual fixation

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20
Q

Non-traumatic subarachnoid hemorrhage

A

Typically result from arterial aneurysm rupture in subarachnoid space

Risk factors:
Atherosclerotic disease
Congenital vessel anomalies 
Polycystic kidney disease 
Connective tissue disorders

“Worst headache of my life”
“Feel like head is going to explode”

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21
Q

PNS neuroglia

A 
Satellite cells
Schwann cells (can regenerate)
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22
Q

Bind to receptors and mimic effects of naturally occurring neurotransmitters

A

Agonists

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23
Q

Neurotransmitters affect the postsynaptic neuron either ____ by ____ or ____ by ____.

A

Directly- by activating ion channels (iontropic)

Indirectly- by activating proteins inside postsynaptic neuron (metabotropic)

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24
Q

4 regions of nervous system

A

Peripheral
Spinal
Brainstem and cerebellum
Cerebrum

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25
____ are ____ cells that remain within the cerebral cortex and service interneurons
Stellate cells | Granular cells
26
The rounded elevations of the cerebral hemispheres are called ___, and the grooves are called ____.
Gyri: rounded elevations Sulci: grooves
27
Developmental deformation of hindbrain... | Types...
Arnold-Chiari malformation Neural tube defect Type1 : often asymptomatic Type 2: progressive hydrocephalus, paralysis of SCM, deafness, bilateral weakness of lateral eye movements, and fascia weakness
28
Hydrocephalus
Blockage of CSF circulation leads to pressure build up Infants: large head size, large anterior fontanel, compression of oculomotor nerve Congenital causes: 4th ventricle doesn’t open Blockage cerebral aqueduct Cysts in 4th ventricle Rarely due to overproduction of CFS or malabsorption Shunts in progressive hydrocephalus
29
Secondary somatosensory lesions cause
Astereognosis
30
Type of neuron for special senses
Bipolar
31
Areas of the cortex not directly involved with sensation or movement
Association cortex
32
Terminal branches of internal carotid artery
(Circle of Willis) Anterior cerebral artery Middle cerebral artery
33
Neuroinflammation good and bad...
Good: activates microglia Bad: death of neurons, oligodendrocytes Inhibits neural regeneration Correlation between abnormal microglial activity is diseases since as Alzheimer’s Parkinson’s MS and stroke
34
``` Emotion = ______ Mood = ____ ```
``` Emotion = short term subjective experience Mood = sustained, subjective, ongoing emotional experience ```
35
Damage to ____ characterized by contralateral paresis and loss of fractionation of movement
Primary motor cortex
36
NTBI
Non-traumatic brain injury No trauma or blow to head Meningitis (bacterial or viral) Encephalitis (infection or autoimmune) Anoxia/Hypoxia (absence/not enough oxygen) Brain tumors Stroke Toxins (exposure or metabolic disturbance)
37
Circle of Willis ____ anastomoses anteriorly via anterior communicating artery ____ and ___ are linked by posterior communicating arteries
Anterior cerebral arteries Anterior and posterior circulations
38
Meningioma
Tumor that arises from meninges Most common type of tumor that forms in head Slow growing but still a space occupying lesion
39
Dyskinetic cerebral palsy
Neuronal damage in basal ganglia Fluctuations in muscle tone: hypertonia (unwanted stiffness) and hypotonia (inadequate contraction) Choreoathetoid is most common form: jerky irregular movements Dystonic form is less common: slow
40
This tract controls movement of extremities. Lesions among this tract often enable precise clinical localizations. Lesions occurring above the ____ produce contralateral weakness Lesions occurring below the ___ produce Ipsilateral weakness
Lateral corticospinal tract Lesions above the pyramidal decussation produce contralateral weakness Lesions below the pyramidal decussation produce ipsilateral weakness
41
Primary somatosensory cortex lies in _____. | Involved in ___.
Lies in postcentral gyrus of parietal lobe. | Involved in sensation for opposite side of body.
42
Muscle length is signaled by ____, reflecting stretch of the ____. Spindle sensitivity to changes in length is adjusted by ____. Velocity change in muscle length is signaled by _____ with information mainly from ___ fibers, who’s sensitivity is adjusted by ____
Length signaled by Type Ia and II afferents Gamma static efferents Velocity of change signaled mainly by type Ia afferents w/ info from nuclear bag fibers who’s sensitivity is adjusted by gamma dynamic efferents
43
Bacteria toxin that prevents ACh release from synaptic bulb
Botulism
44
Patient unable to recognize colors following car crash | Which lobe?
Occipital
45
In medial pain system the c-fiber endings become ___ with repeated stimulation. ____ required for firing after injury.
Sensitized Less stimulation required for firing after injury Tissue injury releases chemicals that sensitize receptors (Example: sunburn)
46
ACA stroke : somatosensory
Loss of sensation in lower limb
47
Virtually all inputs to the basal ganglia arrive via...
The striatum
48
AP refractory period
Defined by ion channels | 2 states: absolute and relative refractory periods
49
MCA stroke: cognition/language/memory
Left MCA: aphasia Right MCA: difficulty understanding spatial relationships, neglect, impairment of nonverbal communication, dressing apraxia, constructional apraxia
50
Formation of nervous system
Occurs during embryonic stage 2 phases: Neural tube formation (days 18-26) Brain formation (begins day 28)
51
Neuromodulators
Function a distance away from synaptic cleft | Effects manifest more slowly and usually last from minutes to days
52
PCA stroke: cognition/language/memory
Difficulty reading
53
Perception
Interpretation of sensation into meaningful forms Occurs in cerebrum Interaction between brain and environment
54
Primary visual lesions cause
Homonymous hemianopia
55
Cranial nerve tested when rub fingers next to ear
CN VIII
56
Modality-gated channels
Sensory neurons | Respond to mechanical forces, changes in temp/chemicals
57
Sensory information
Nerve impulses generated by original stimulus
58
Dorsal horns contain
Interneurons and sensory neuron endings
59
Epidural hematoma is bleeding between ___. Most often ____ torn by fracture of ___. Bleeding is usually ___ compared to a subdural hematoma
Skull and dura Most often middle meningeal artery torn by fracture of temporal or parietal bone. Bleeding usually faster than in a subdural hematoma
60
If you ask patient to push the tongue against resistance, you are testing for...
Lesions in medulla of brainstem | Pushing tongue: Cranial nerve XII
61
Spina bifida with myeloschisis
Most severe Spinal cord malformed and open to body surface Neural folds fail to close
62
The ____ connects 3rd and 4th ventricles
Aqueduct of sylvius
63
Cell types of cerebral cortex
Pyramidal Stellate Granular fusiform
64
Structural unit of muscular system
Muscle fiber
65
Serotonin originates from ____. | Serotonin is the neurotransmitter that regulates _____.
Raphe nuclei | Generalized arousal level
66
Giullain-Barre syndrome
Active inflammation and demyelination of peripheral sensory and motor fibers Patients may have difficulty with chewing, swallowing, speaking, and facial expressions. Pain can be prominent
67
_____ is when inhibitory neuron inhibits an antagonist during agonist contraction.
Reciprocal inhibition Pathway utilized in voluntary motion such as walking
68
Fast pain
Spinothalamic pain | Initial and immediate sharp sensation that indicates location of injury
69
Cranial nerve: tongue movements
XII | Hypoglossal
70
Spinothalamic (anterolateral) | Conscious relay pathway
Discriminative pain, temperature, crude/coarse touch | Crosses midline and ascends contralateral
71
Supplementary motor area lesions cause
Apraxia
72
Primary auditory: lobe and function
Temporal lobe | Conscious discrimination of loudness and pitch
73
Pushing behavior is effort to compensate...
Mismatch between visual and postural vertical Visual vertical based on vestibular AND visual inputs
74
Stages of explicit memory
Encoding Consolidation Retrieval
75
Motor planning areas are anterior to ___. It includes ___.
Anterior to primary motor cortex Supplementary motor area, Premotor area, Broca’s area
76
Agraphia
Inability to write Parietal lobe lesions
77
Subdural specs contains ___ vessels
Bridging veins that drain hemispheres
78
Dorsal column/medial lemniscus | Conscious relay tract
Discriminative light touch, proprioception, vibration | Ascends laterally
79
MS
Multiple sclerosis Immune system produces antibodies that attack oligodendrocytes, producing plaques in white matter of CNS Onset 20-40 years Women 3x more frequently affected
80
MS common comorbidities - secondary conditions
Ankle sprain/fracture (falls due to weakness or sensory loss) Neck pain (weak muscles, fatigue) Hip/knee/ankle pain (loading abnormalities) Osteoporosis (medications, decreased weightbearing)
81
Secondary sensory areas analyze....
Sensory input from both the thalamus and primary sensory cortex.
82
Stimulus intensity sufficient to produce an action potential
Threshold stimulus intensity
83
Alpha beta somatosensory axons
Medium myelinated Touch and pressure Meissner’s, Pacinian, Ruffini, Merkel’s and hair follicles Small myelinated Tissue damage, temp, course touch Free nerve endings
84
Occipital lobe lesions
1. Loss of portion of visual field 2. Achromatopsia (can’t recognize color) 3. Prosopagnosia (facial recognition) 4. Palinopsia (persistence/reappearance of an object previously viewed) 5. Hallucinations 6. Problems with reading and writing
85
In medial pain system the 1st neuron is ____. | ___ sensitive to ____.
Unmyelinated small C- fiber Free nerve endings sensitive to noxious heat, chemical or mechanical stimulation
86
Type 2 somatosensory axon
Medium myelinated Proprioception Muscle spindles Paciniform and Ruffini receptors in joint capsule
87
Acute motor axonal neuropathy (AMAN)
GBS variant Motor only Little or no signs of demyelination or inflammation Acute flaccid parlays day areflexia, sparing sensory fibers. Wallerian degeneration, requiring axon re-growth Common in Japan and northern China- not common in western countries Recovery rapid or slow Overall good prognosis at 1 year
88
Reflexes provide information about ___ circuits. | Reflexes don’t require ____.
Peripheral and spinal circuits | Don’t require the brain
89
4 types of MS
Relapsing/remitting Secondary progressive Primary progressive Progressive relapsing
90
Parietal lobe lesions
Important role in spatial awareness. 1. Distortion of perceived space and neglect of contralateral side 2. Difficulty with math 3. Difficulty with hand/eye coordination 4. Inability to focus on more than one object at a time 5. Anomia (inability to name objects) 6. Agraphia (inability to write) 7. Apraxia (cannot perform purposeful movements)
91
Say “ah” and protrude tongue- which cranial nerve
CN IX, X | CN XII
92
Receptor fields tend to be ___ distally and ___ proximally
Smaller distally | Larger proximally
93
Resting potential - ion channels
Voltage gated sodium and potassium channels closed
94
____ is responsible for planning movements of the mouth during speech and the grammatical aspects of language
Broca’s area
95
A sheath of proteins and fats surrounding an axon | Provides...
Myelination Provides insulation, prevents current flow across axonal membrane Increases speed of AP propagation and the distance s current can passively spread Thicker myelin leads to faster conduction and greater chances for AP propagation
96
Information from all free nerve endings is conveyed by ___
Alpha beta and C afferents
97
Corpus striatum consists of
Caudate Putamen (Basal ganglia)
98
Muscle spindle is ____ (shape) | Contains ___ and ___ fibers
Fusiform (tapered at both ends) | Intrafusal and extrafusal fibers
99
CMT: Charcot-Marie-Tooth
Hereditary motor and sensory neuropathy CMT is most common 1 in 2500 Typically adolescence or young adult Typically does not affect life expectancy Caused by genetic mutations Affects production of protein essential to structure and function of peripheral axons and myelin sheaths
100
Dorsal horns contain
Interneurons and sensory neuron endings
101
Epilepsy is characterized by sudden attacks of _____
Excessive cortical neuronal discharges interfering with brain function
102
Apraxia occurs as a result of damage to ....
Premotor cortex Supplementary motor area or Inferior parietal lobe
103
Sensory contribution to movement control
Feedforward Feedback Visual loss (somatosensation/proprioception must take over) Deafferentiation (afferent connection lost)
104
_____ pathways project to ____. Visual info answers “what?” By analyzing form. Specific regions identify...
Ventral pathways project to occipitotemporal association cortex Specific regions identify colors, faces, letters and other stimuli
105
Procedural memory
Knowing how to perform actions and skills Recall skills and habits Includes perceptual and cognitive skill learning Perceptual skills include object, pattern and face recognition Practice is required to store procedural memories AKA skill, habit, nonconscious , implicit memory
106
Patient reports taste of food changed | Cranial nerve?
CN I | Olfactory
107
Spina bifida occulta
10% population- L5, S1, or both Neural tissue doesn’t protrude through bony defect Neural function usually normally
108
Meissner’s corpuscles
Light touch and vibration Superficial fine touch
109
Spinocerebellar tract vs cerebellar lesions
Look at coordination of movement with eyes open/closed Spinocerebellar: movement more coordinated with vision, and not with eyes closed Cerebellar: doesn’t matter if eyes open or closed
110
Traumatic subarachnoid hemorrhage
Bleeding into CSF from damaged vessels Trauma or cerebral contusions More common than non-traumatic Presents as severe headache due to blood in CSF irritating meninges
111
A developmental disorder, specifically a developmental deformity of the hindbrain; causes tonsilar herniation
Arnold-Chiari
112
Hair follicle receptors
Hair displacement Superficial fine touch
113
MS pathology
2nd leading cause of disability in young adults Immune related response in which antibodies include demyelination by antibody-dependent cell-mediated cytotoxicity Cytokines attack myelin, macrophages help uptake myelin, oligodendrocyte apoptosis leads to an increase in demyelination, increased axonal injury occurs and becomes sclerosed
114
___ regulates and protects the CNS. It is formed primarily in the ventricles and circulates within ___. Supplies ___ and ____.
CSF system Circulates within subarachnoid space Supplies water, certain amino acids, and specific ions Removes waste products
115
Action potential produced by sequence of events ...
Rapid depolarization Decrease in sodium conduction Rapid repolarization
116
Primary visual cortex, info travels from...
Retina to lateral geniculate body of thalamus to primary visual cortex
117
Diplegia
Upper limbs less affected than lower limbs
118
Epidural hematoma -EDH
Between dura and skull Biconvex lens shaped Typical cause: Rupture of middle meningeal artery Fracture of temporal bone
119
Cranial nerve: visual acuity (central vision) and peripheral vision
II | Optic
120
Heat and cold are detected by ____. ___ fibers carry impulses produced by cooling ___ fibers carry information regarding heat
Specialized free nerve endings of small myelinated/unmyelinated neurons A-delta fibers carry cooling impulses C fibers carry information regarding heat
121
Guillian-Barre presentation
Rapid ascending symmetrical motor weakness and sensory deficits (distal -> proximal) Flaccid paralysis A-reflexia or diminished reflexes Numbness and tingling ascending, sticking glove manner progressing through extremities 25-30% require mechanical ventilation Preganglionic fibers ANS myelinated -> tachycardia, BP changes, vasomotor symptoms
122
Formation of a rudimentary brainstem without cerebral and cerebellum hemispheres
Anencephaly Neural tube defect
123
____ acts as the CNS immune system
Microglia Activated during CNS development and following injury, infection or disease Proteins in dying cells attract microglia to site; microglia clean up and remove debris
124
Patient with neurodegenerative disorder unable to recall their birthday, name of parents, or where grew up Which lobe?
Temporal
125
Guillian-Barre prognosis
Poor: Older age, delayed onset of recovery, ventilation necessary, compound motor action potential (CMAP) amplitude of <20% normal, diarrhea with infection Expectations for severe GBS 3-6 weeks IP rehab 3-4 months OP rehab Up to 85% recovery
126
Coarse touch is mediated by ____. Sensations... Examples...
Mediated by free nerve endings through skin Pleasant touch, tickling, itch Nociceptors: relay pain; respond to damage/threat Thermal receptors: warmth/cold
127
Primary vestibular cortices (PVC) receive information from....
Vestibulothalamocortical pathway
128
Cranial nerve: eye position and alignment
IV | Trochlear
129
Spinal bifida with meningocele
Protrusion of meninges through bony defect | May be asymptomatic or have functional impairment
130
Response is ____ in phasic stretch reflex
Brief
131
Right middle cerebral artery (MCA) superior division infarct
Left face/arm weakness
132
CVA primary impairments
Contralateral motor control impairment (limitation in producing isolated movement) Contralateral spasticity Contralateral sensory deficits Cognitive or attention deficits
133
Lesions affecting ___ interfere with nonverbal communication
Inferior frontal gyrus
134
Relative refractory period
Membrane potential is returning to resting level and may be hyperpolarized
135
Fast pain pathway...(neurons)
1st order neuron: Info -> dorsal horn Small myelinated A-delta fiber 2nd order neuron: Crosses midline immediately and ascends from spinal cord -> VPL of thalamus within spinothalamic tract 3rd order neurons: Thalamus-> primary and secondary sensory cortex
136
Spinoreticular tract ascending neurons synapse in ____. Where axons project to ____.
Reticular formation-> Midline and intralaminar nuclei of thalamus Reticular formation modulates arousal, attention, circadian
137
Peripheral sensory neurons have 2 axons. Distal- conducts.... Proximal- conducts...
Distal: conducts receptor -> cell body Proximal: Cell body -> spinal cord/brainstem
138
Hand, foot and lower face are controlled exclusively by
The contralateral primary motor cortex
139
Released by a presynaptic neuron and acts directly on postsynaptic ion channels or activates proteins inside postsynaptic neuron
Neurotransmitter
140
Brainstem lesions
1. Insomnia (circadian rhythm disrupted) 2. Difficulty breathing 3. Difficulty regulating HR and BP 4. Nausea/dizziness 5. Dysphagia (difficulty swallowing) 6. Cranial nerve disorders
141
MCA stroke common symptoms
Contralateral hemiplegia and hemisensory loss Upper limb and face may be more affected (than lower limb) Left side: language impairment Right side: nonverbal communication and spatial relationships impairment If deep branches affected: upper and lower limb and face equally affected
142
Achromatopsia
Cannot recognize colors Occipital lobe lesion
143
Receives inputs mainly from other thalamic nuclei and the cortex and then projects back to the thalamus
Reticular formation
144
The interpretation of sensation into meaningful forms
Perception
145
Most common excitatory and inhibitory CNS neurotransmitters
Excitatory: Glutamate Inhibitory: GABA
146
Respond to temperature changes
Thermoreceptors
147
Main PNS sympathetic neurotransmitter
Norepinephrine
148
Receptors that respond as long as stimulus maintained
Tonic receptors
149
Disease in which antibodies destroy voltage-gated calcium ion channels in presynaptic terminal
Lambert-Eaton syndrome
150
Ruffini’s corpuscles
Skin stretching Subcutaneous fine touch
151
The primary motor cortex...
Descending control of motor output
152
Multipolar neurons
Multiple dendrites arising from many regions of the cell body and a single axon Most common cells in vertebrate nervous system
153
Area of the brain? | Vision
Occipital lobe
154
3 pathways that relay sensory information to brain
Conscious relay Divergent pathway Unconscious relay pathway Difference is fidelity of information transmission High fidelity- accurate details about stimulus location.
155
The ___ secrete most of CSF. | The CSF flow...
Choroid plexus secrete most CSF ``` Lateral ventricles 3rd ventricle 4th ventricle Subarachnoid space Arachnoid villi Venous system ```
156
Common disorders of CSF system
Hydrocephalus Meningitis (bacterial or viral) Epidural and subdural hematomas (usually from trauma)
157
Primary motor cortex function
Voluntarily controlled movements
158
Dorsal column/medial lemniscus system | Axons from 3rd order neurons
``` Connect thalamus (VPL) -> Sensory cortex ```
159
Premotor cortex lesions impair
Speed and automaticity of reaching and grasping Sequential movements Gait and posture
160
Ataxic dysarthria
Slurred speech Cerebellum lesions
161
Distortion of subjective postural vertical
Pusher syndrome
162
Prosopagnosia (no facial recognition) is usually associated with ___ damage to ___.
Bilateral damage to inferior secondary visual areas.
163
Premotor area lesions cause
Apraxia
164
Cranial nerve: voice quality, vocal cord strength; Gag reflex
IX | Glossopharyngeal
165
Some axons may be specialized for faster AP progression because...
Increased diameter of axon | Myelination
166
Collection of structures that regulates emotions, appetite, autonomic and neuroendocrine control
Limbic system
167
Cutaneous innervation receptive field distribution
Smaller distally Larger proximal Distal regions contain greater density of receptors than proximal
168
3 developmental stages in utero
Pre-embryonic: conception to day 14 Embryonic: day 15 - end of week 8 Fetal: week 8 to birth
169
Gamma motor neurons axon size? project to?
Medium sized myelinated axons Project to intrafusal fibers in muscle spindle
170
Dural ectasia
Widening of dural sac around spinal cord Usually occurs in lumbosacral region LBP, headaches, bowel and bladder dysfunction, pain in leg, numbness Common in Marfan syndrome; also occurs in EDS: Ehlers-Danlos Syndrome, neurofibromatosis Type 1, ankylosis get spondylosis or as a result of trauma
171
Secondary auditory lesions cause
Auditory agnosia
172
Inferior frontal gyrus lesions cause
Difficulty in processing nonverbal communication | Usually lesion in right hemisphere
173
Local synaptic potentials generated in ____ when stimulated by input from other neurons
Motor neurons and interneurons
174
The premotor cortex, supplementary motor area, and Broca’s area receive information from ____.
Secondary sensory areas
175
Slow pain
Spinolimbic pain | Dull, throbbing ache following fast pain that is not well localized
176
Bipolar neurons
2 primary structures: dendritic root and axon Mainly sensory cells ``` Subclass of bipolar cells: pseudopolar No true dendrites ```
177
PCA: posterior cerebral artery supplies
Occipital lobe Inferior temporal lobe Deep structures: thalamus, posterior limb internal capsule
178
Absolute refractory period
Membrane unresponsive to stimuli
179
1b somatosensory axon
Large myelinated Proprioception Golgi tendon organs and ligament receptors Stimulated by tendon and ligament tension (respectively)
180
Lesions of the primary sensory areas impair the ability to...
Discriminate intensity and quality of stimuli, severely interfering with the capacity to use the sensations
181
Spinomesencephalic and spinoreticular ascending projection transmit ___
Arousal, motivation and reflexive functions
182
CNS is most susceptible to major malformations between ____
Day 14 and week 20 Growth and remodeling continue, but later insults can cause functional disturbances and/or minor malformations
183
Association areas of cerebral cortex
Dorsolateral prefrontal association Parietotemporal association Ventral and medial dorsal prefrontal association
184
RAS
Reticular activating system | Functions: sleep/wake cycle, filters information to focus on details you need
185
Cuneocerebellar pathway
High fidelity pathway (Unconscious relay) Information from arm and upper half of body to cerebellum via ipsilateral inferior cerebellar peduncle
186
Astereognosis
Inability to identify objects by touch and manipulation despite intact discriminative somatosensation.
187
____ disrupts positioning of limbs
Deafferentiation | Loss of afferent connection
188
Tract that is direct connection between cerebral cortex and spinal cord. Synapse -> LMNs neck, shoulder, trunk
Medial corticospinal tract
189
IPSP
Inhibitory postsynaptic potentials Decreases chance of AP Chloride enters Potassium exits Postsynaptic membrane becomes hyperpolarized Summation EPSP + IPSP (depends on which is more)
190
Presentation CMT (Charcot Marie tooth)
Paresis of muscles distal to knee Foot drop, muscle atrophy, frequent tripping, a step page gait Paresis of muscles distal to elbow- muscle atrophy Sensory involvement: numbness NOT common; altered sensitivity to heat, cold, painful stimuli; neuropathic pain common May see: foot deformities; vascular-like presentation in distal extremities
191
Damage to the ___ can result in contraversive pushing. Misperception of.... Problems integrating....
Posterolateral thalamus Misperception of body orientation in relation to gravity Problems integrating visual and vestibular info. Somatosensation is NOT associated with pusher syndrome
192
This herniation occurs when a space-occupying lesion in cerebrum e eyes pressure on the diencephalon- moving the diencephalon, midbrain and pons inferiorly. This moves stretches the branches of the basilar artery: causing brainstem ischemia and edema. Bilateral paralysis ensues and consciousness and oculomotor control are impaired
Central herniation
193
Ischemic stroke risk factors
``` Hypertension Diabetes Hypercholesterolemia Smoking Family history Atrial fib Mechanical valves Patent foramen ovals ```
194
Circle of Willis
Site where anterior and posterior circulations communicate
195
Primary somatosensory function
Discriminates shapes, texture or size of objects
196
Threshold potential- ions
Voltage-gated sodium channels open. | Sodium ions enter axon, beginning to depolarize axon
197
MCA stroke: special senses/autonomic
Homonymous hemianopia
198
___ are more likely to sustain a TBI. | ___ have highest rates or TBI related hospitalization and death
Children under 4 are most likely to sustain | Adults over 75 have highest rates
199
Ischemic stroke
Blockage
200
A lesion of vestibular cortex leads to ___ but not ___
Tilt of perceived visual vertical | NOT to contraversive pushing
201
Calcification of a foramen will likely cause..
Backup of CSF | Hydrocephalus
202
Ruffini’s endings- joint
Extremes of joint range Respond more to passive movement Type 2
203
Cranial nerve: shoulder elevation
XI | Accessory
204
Primary auditory cortices (PAC) receive info from...
Both Cochlea
205
MS EDSS scores
Severity 0-3.5 normal to mild disability 4-5.5 self sufficient to disability with ADLs 6-7.5 AD with gait to needs assist with transfers 8-9.5 dependent with self care, restricted, to unable to communicate (10 death)
206
ACA stroke: other
Urinary incontinence
207
Lesions of the limbic system impair...
Immediate recall -> | Long-term memory
208
Primary brain damage
``` Complete at time of impact Skull fracture Contusions, bruises, hematomas Hemorrhages Lacerations DAI: diffuse axonal injury ```
209
____ UMN Descend from locus coeruleus and raphe nuclei Enhance activity of interneurons and LMN
Nonspecific UMN
210
Major causes of TBI
``` MVA Firearms Falls Sports injury Struck by or against Blasts (military) ```
211
Primary auditory function
Conscious discrimination of loudness and pitch of sounds
212
The ___ cortex stabilizes the shoulders during upper limb tasks and the hips during walking
Premotor cortex
213
Schwann cells originate from neural __. | Oligodenrocytes originate from neural ___.
Schwann... neural crest cells | Oligodendrocytes...neural tube
214
Fast pain information from face
Travels from trigeminal nerve Fibers enter pons and travel down to trigeminal nerve nucleus in medulla/upper cervical region Synapse with 2nd neuron and cross midline and ascend back up to VPM nucleus of thalamus 3rd order neuron projects to cerebral cortex
215
Most common variant of GBS
AIDP: acute inflammatory demyelinating polyneuropathy ``` Peaks at 4 weeks Slow gradual recovery Autonomic dysfunction Progressive a-reflexive weakness and sensory changes (sensory precedes motor; but motor deficits greater) Distal paresthesia and loss of DTRs 20% develop respiratory failure ```
216
Dopamine originates in ____. | It regulates ___.
Substantia nigra and ventral tegmental area | Regulates motivation, motor activity and cognition
217
Guillian-Barre pathogenesis
Inflammatory process affects Schwann cells Macrophages attack Schwann cells causing demyelination with intact axon Lymphocytic infiltration can destro axons (Walkerian degeneration) Axonal regrowth and remyelation occur- but slow ~1mm day; some reports 3-5 mm/day for PNS
218
Ligand-gated channels
Open in response to specific neurotransmitter
219
Clinical features of meningitis
Headache Stiff neck Fever
220
Comprehension of spoken language occurs in ___
Wernicke’s area
221
Area of skin innervated by a single afferent neuron
Receptive field
222
What neurotransmitter mediates motivation, motor activity and cognition?
Dopamine
223
Synaptic cleft
Space between terminals
224
Basilar artery stroke: other
Coma
225
The ____ pathway transmits information about slow aching pain. This information is used at the ___ levels.
Divergent pathway | Info used at conscious and unconscious levels
226
Membrane is polarized when potential becomes ___ than the resting potential
Less negative
227
Causes of ICP (intracranial pressure)
Cerebral edema Hydrocephalus Tumors Other lesions
228
2 sets of veins that drain cerebrum
Superficial veins and Deep veins Ultimately drain into internal jugular vein
229
Communicating vs noncommunicating hydroencephalus
Noncommunicating: ventricle system block, usually aqueduct Communicating: blockage beyond 4th ventricle
230
Cranial nerve : sense of smell
I | Olfactory
231
Fast pain | The ___ registers sharp pain in a specific location
Somatosensory Cortex
232
Waking and sleeping, paying attention, and the initiation of action are the ___ system
Consciousness system
233
Cranial nerve: pupillary reaction to light
III | Oculomotor
234
Spinocerebellar tract: Information is ___. Utilized for ___. It compares....
Information not consciously perceived Utilized for unconscious adjustments of movement and posture Compares intended motor output with actual movement and then refined movement
235
Primary somatosensory function
Discriminates shape, texture, or size of objects
236
Muscle spindle responds to ___. Type 1a afferents.... Type 2 afferents...
Stretch Type 1a: register quick tonic stretch of spindle Type 2: monitor tonic stretch
237
Localization of touch and vibration and the ability to discriminate between two closely spaced points touching the skin
Discriminative touch
238
Respond to substances released by cells
Chemoreceptors
239
Relay tension in tendons
Golgi tendon organs
240
Pain is comprised of both ____
Sensational and emotional response to the sensation
241
Most common neuron type
Multipolar
242
Tonic stretch reflex: Response? Receptor location? UMN lesion?
Response remains as long as stimulus present Receptors are primary and secondary ending in muscle spindle Only present following UMN lesions
243
Secondary auditory function
Classification of sounds
244
Most ischemic strokes occlude the ___. | Stereotypic standing posture...
``` Middle cerebral artery Standing posture on hemiparetic dude: Shoulder adduction Elbow flexion Lower limb extension ```
245
Communication at cell body
Axosomatic synapse
246
The ___ separates the cerebral hemispheres
Longitudinal fissure
247
Long processes that carry most outputs of neurons
Axons
248
Fasciculus gracilis makes up the medial portion of the dorsal column which relays axons from....
Lower limbs
249
Causes of meningitis
Viral- most common; favorable prognosis Bacterial- can lead to septicemia and organ failure; grave prognosis Aseptic- no infective agent identified; caused by inflammatory or malignant disease, drugs or chemical irritants introduced into CSF
250
Myelination begins ___ and most sheaths completed ___.
4th fetal month | End of 3rd year of life
251
Spinocerebellar tracts relay information from ____ to ____.
Relay info from proprioceptors and spinal interneurons about activity to adjust movement -> Cerebellum Unconscious relay pathway
252
Psychologic and somatic interactions
Thoughts and emotions influence organ function Individual’s reactions to experiences can disrupt homeostasis (stress response) Neurotransmitters and hormones modulate immune system cells and the cytokines that regulate the neuroendocrine system
253
Flow of cortical information from primary sensory cortex to motor output
``` Primary sensory cortex-> Secondary sensory cortex-> Association cortex-> Motor planning areas -> Primary motor cortex ```
254
ACA stroke: emotions and behavior
``` Flat affect Impulsiveness Perseveration Confusion Motor inactivity ```
255
Gradual longer-lasting changes in membrane potential are called
Modulation | Involves small changes in electrical potential of membrane that alter the flow of ions across a cell membrane.
256
Elastic filament that anchors M line to Z line | Keeps sarcomere intact
Titin
257
The ___ regulated homeostasis; eating, reproductive, and defensive behaviors; daily rhythms; and endocrine system
Hypothalamus
258
Declarative memory
Facts, events, concepts, locations Easily verbalized AKA conscious or explicit memory
259
Motor task - motor system flow
Anterior frontal lobe- make a decision Motor planning areas activate specific control circuits (cerebellum and basal ganglia) UMN -> spinal interneurons and LMN -> skeletal muscle
260
Lenticulostriate artery
Deeper branch of MCA Supplies basal ganglia Supplies axons of internal capsule Contralateral hemiplegia Prone to narrowing - Hypertension
261
Tonsilar herniations
Cerebellar tonsils pushed through foramen magnum | Compress brainstem
262
Primary motor cortex lesions cause
Paresis, loss of fine motor control, spastic dysarthria
263
MS common comorbidities- co-existing conditions
``` Osteoarthritis Hypertension Depression Cardiovascular disease Musculoskeletal injuries/trauma ```
264
A pathology when pathology causes cerebral tonsils to push into foramen magnum
Tonsillar herniation
265
Which ion channel most abundant at Nodes of Ranvier?
Sodium
266
Primary visual : lobe and function
Occipital lobe | Distinguishes intensity of light, shape, size, and location of objects
267
White matter is mainly ____. Transmit signals...
Myelinated axons | Transmit signals over greater distances
268
In people post stroke, of the lesion includes the premotor cortex....
Mobility and independence outcomes are worse than if the lesion spares the premotor cortex Because premotor cortex lesions interfere with axial motor control, causes persistent proximal muscle weakness in contralateral limbs, and interferes with motor planning
269
Peripheral receptors have ___ channels
Modality-gated
270
A person who can hear a doorbell, but not distinguish it from the sound of footsteps has ___. This is usually due to...
Auditory agnosia | Destruction of the RIGHT secondary auditory complex
271
In pure dysarthria, only ___ is impaired; ____ are unaffected.
Production of speech impaired Language generation and comprehension is unaffected. The difficulty involves mechanics of producing sounds accurately, NOT grammar or finding words.
272
The cerebral cortex is...
Unique mantle of gray matter that covers the cerebral hemispheres
273
Spinomesencephalic tract carries ___ information to the ____ Turning eyes and head toward ___ Activating...
Nociceptive information to the superior Collicus and periaqueductal gray Toward the source of noxious input Activating descending tracts that control pain
274
Consists of an almost pure population of GABAergic neurons
Reticular formation | Inhibitory therefore regulates thalamic activity
275
Information is transmitted longer distances in action potential than ___.
Receptor or synaptic potentials
276
Anterior spinocerebellar tract transmits information from ___ The info enters cerebellum via ___.
From thoracolumbar spinal cord | Info enters cerebellum via superior cerebral peduncle
277
Premotor area function
Control of trunk and girdle muscles, anticipatory postural adjustments
278
Contraversive pushing is s dysfunction of...
Perceptual system- specifically graviception
279
Subarachnoid hemorrhage
In CSF space between arachnoid and pia mater Blood along contours of pia mater 2 forms: traumatic and non-traumatic
280
Primary visual cortex lies ___.
In occipital lobe along calcarine fissure.
281
2 main types of generalized epileptic seizures
1. Absence seizures Brief loss of consciousness without motor manifestations 2. Tonic-clonus seizures Tonic contractions of skeletal muscles, followed by alternating contraction and relaxation of muscles Typically tonic and clonic phases last ~1 min each
282
Activation of individual muscles independently
Fractionation
283
Worst effects of primary motor cortex lesions is to
Lower face and distal limbs.
284
Most common source of epileptic seizures
Limbic system
285
Where is the lesion located in contraversive pushing?
Posterolateral thalamus
286
The primary motor cortex receives somatosensory information relayed by ____from ___ . And motor instructions from ____.
Relayed by the thalamus from the primary somatosensory cortex Motor instructions from the motor planning area
287
The ____ approach to stroke recovery emphasizes using the paretic limb with an adapted approach or using the nonparetic limb to perform the task
Compensation approach
288
Secondary somatosensory function
Stereo genesis and memory of the tactile and spatial environment
289
Info transmitted from Golgi tendons into spinal cord by ___
Type Ib afferents
290
Somatosensory 1st order neurons Cell bodies located in? Type of neuron? Axon conduction?
Cell bodies located in DRG Pseudounipolar Distal axon: receptor-> cell body Proximal axon: cell body-> spinal cord
291
Utilize touch and proprioceptive information to identify an object
Stereognosis
292
The ___ optimizes blood flow to the organs, regulates body temp and metabolic rate, and regulates activity of viscera
Sympathetic nervous system
293
CNS response to infections, diseases and injuries
Neuroinflammation
294
___ UMN Responsible for fractionation Distal limb movements
Lateral UMN
295
Spinal cord injury primary impairments
Paralysis of muscle groups below lesion level Spasticity below lesion level Bowel, bladder, and sexual function impairments
296
Disorders of vascular supply
Episodes classified according to both pattern of progression and cause Transient ischemic attack- brief, focal loss Completed stroke- greater than 1 day and stable Progressive stroke- deficits increase over time
297
Presynaptic facilitation
More neurotransmitter released
298
Secondary visual lesions cause
Visual agnosia or optic ataxia
299
Posterolateral thalamus functions
Vision: info about movement and cues for judging upright posture Vestibular: informs about head position relative to gravity and about head movement Somatosensation: info about weight bearing and relative position of body parts
300
Therapist asks patient post stroke to name each object she holds up. She holds up a cup and patient can’t name this, despite knowing how to use object. What lobe?
Parietal lobe
301
The basal ganglia have ___ functions
Motor Cognitive Behavioral Emotional
302
Medial pain system pathway and neurotransmitter
``` Free nerve endings-> DRG -> Central axons enter spinal cord and synapse at dorsal horn -> Interneurons-> Ascending projection neurons ``` Substance P is neurotransmitter
303
Skeletal muscle structure and function. ____ is on the surface membrane of the muscle cell. Next to it is ___ is the storage site of calcium. ___ and calcium releases. Resulting in ___.
T-tubules SR (sarcoplasmic reticulum) ACh binds, depolarization occurs and calcium released Resulting in muscle contraction
304
Flow of info during conversation
``` Primary auditory cortex-> Secondary auditory cortex-> Wernicke’s area -> Subcortical connections -> Broca’s area-> Oral and throat region of sensorimotor cortex ```
305
Disease in which antibodies attack and destroy nicotinic receptors on muscle cells
Myasthenia gravis
306
____ are small, graded amplitude; either depolarizing or hyperpolarizing; passively propagated.
Local potential
307
Secondary sensory areas process info from...
Thalamus and primary sensory cortex
308
Chemicals that convey info among neurons
Neurotransmitter | Neuromodulators
309
Sensory organ in muscle composed of muscle fibers, sensory endings, and motor endings
Muscle spindle
310
Wrist extension myotome
C6
311
Working memory
Temporary storage Maintains goal-relevant info for short time Essential for language, problem-solving, mental navigation and reasoning Complex mental multitasking requires working memory and is central to cognition
312
Deep veins
Basal ganglia Diencephalon Adjacent white matter Straight sinus
313
Subcortical structures are involved in the ...
Nonconscious regulation of sensory, autonomic, and motor functions
314
Ventral and medial dorsal prefrontal association function
Emotion, motivation, personality Impulse control Ventral: mood and affect Medial-dorsal: perceives others emotions
315
Cranial nerve: hearing acuity
VIII | Vestibulocochlear
316
Synaptic receptors produce either direct or indirect actions..
Directly: when receptor and ion channel make up a single functional unit Indirectly: uses cascade of intracellular molecules to activate ion channels or cause other changes within postsynaptic neuron
317
The cerebral cortex processes...
Sensory, motor and memory info | Reasoning, language, non-verbal communication, intelligence and personality
318
Basal ganglia outputs leave via...
The internal segment of the globus pallidus and the substantia nigra pars reticulata
319
As neural tube closed, the adjacent mesoderm divides into somites. Anteromedial part of somite... Posteromedial oart of somite... Lateral part of somite...
Antetomedial (sclerotome) becomes vertebrae and skull Posteromedial (myotome) becomes skeletal muscle Lateral (dermatome) becomes dermis
320
Subset of mechanoreceptors, chemoreceptors, thermoreceptors | Preferentially sensitive to stimuli that damage/threaten tissue
Nociceptors | Stimulation results in pain
321
Neuroglia that maintain blood brain barrier
Astrocytes
322
Meaning of a signal determined by
Neural pathway
323
Primary visual function
Distinguishes intensity of light, shape, size, and location of objects
324
Axoaxonic activity produces...
Presynaptic effects (as well as local postsynaptic potential)
325
Which type of neuron is responsible for carrying olfaction sense to CNS?
Bipolar
326
GBS varieties
AIDP: acute inflammatory demyelination polyneuropathy AMAN: acute motor axonal neuropathy AMSAN: acute motor sensory axonal neuropathy Miller-Fisher Syndrome CIDP: chronic inflammatory demyelinating polyneuropathy
327
Cerebral palsy classifications
``` Spastic Dyskinetic Ataxic Hypotonic Mixed ```
328
Ventral horns contain...
Motor neuron cell bodies and interneurons
329
The parasympathetic nervous system uses a ___ pathways from ___ to effectors
2 neuron pathway | From brainstem and sacral spinal cord to the effectors
330
Involves memory of experiences, motivation, expectations, selection of sensory info, and active search for pertinent sensory info
Perception
331
CIDP prognosis
Chronic inflammatory demyelinating polyneuropathy Faster diagnosis leads to less disability Gradual onset -> delayed diagnosis -> more nerve damage Average time between symptom onset “Stable in remission with (or without) disability” Active or progressive Poorer outcomes correlated with decreased functional mobility and increased pain
332
Area of brain? | Movement, speech, reasoning, emotions, planning, problem solving
Frontal lobe
333
This connective tissue layer adheres to the brain and spinal cord. What lateral extensions does it form?
Denticulate ligaments
334
Area of brain? | Primitive functions: respiratory rate, BP, HR, connection to body
Brainstem
335
Distinct areas of the ____ are devoted to analyzing sensation, planning and controlling movements, communicating, controlling behavior, and performing activities
Cerebral cortex
336
Somatotropic arrangement of information
Primary sensory cortex: size, texture and shape of objects Somatotropic arrangement maintained in 2nd and 3rd order neurons Homunculus. Larger cortical representation = high density of receptors in regions associated with areas of fine motor control
337
Ataxic cerebral palsy
Damage in cerebellum | Weakness and loss of coordination during voluntary movement
338
Dorsal column- medial lemniscal pathway Touch and conscious proprioception Primary, secondary and tertiary neurons
Primary: receptors to medulla Secondary: medulla to thalamus Tertiary: thalamus to cerebral cortex
339
Receptors typically names for ...
The transmitter/modulator to which they bind
340
Change from local results in depolarization
Action potential
341
Ataxia
Disorders in balance and coordination Cerebellum lesions
342
Chronic inflammatory demyelinating polyneuropathy (CIDP)
1 in 500,000 Clinical presentation and diagnosis similar to GBS Progressive form: extending over several years Recurrent form: multiple episodes that may be separated by months or a year Monophasic form: single episode that extends over 1-3 years without recurrence
343
MCA stroke: somatosensory
Hemianesthesia - face and upper limb more than lower limb
344
Substance P
One of most common neuropeptides Stimulates nerve endings at the site of injury and then in the CNS Acts as neurotransmitter carrying info from spinal cord to brain Neuromodulator in pathophysiologic response to pain syndromes
345
Actin attached to Z line
Thin filaments
346
Reflex path
``` Receptors-> Primary afferents-> Synapses -> LMN-> Muscles ```
347
Broca’s area lesion cause
Broca’s aphasia- difficultly producing nonverbal communication (usually lesion in left hemisphere)
348
Shortened muscles are very resistant to stretch due to
Decreased amount of Titin
349
Guillian-Barre time presentation
50% of cases, progression stops by 2 weeks 80-99% stops by 4 weeks Static phase 2-4 weeks Recovery in proximal to distal manner Often takes months/years to recover 65-85% fully recover 15-20% persistent disability Recurrence in 10% Long term depression and anxiety
350
Two types of dysarthria (and cause)
Spastic - caused by damage to motor tracts Characterized by harsh awkward speech Flaccid - caused by damage to motor neurons in CN 9, 10 and/or 12 Breathy, soft imprecise speech
351
The 3rd ventricle is in
Diencephalon
352
Arachnoid granulations
Involved in CSF -> venous system
353
Myotatic, muscle stretch, deep tendon reflex
Phasic stretch reflex
354
Area of the brain? | Sensation and spatial reasoning
Parietal lobe
355
Primary auditory lesions cause
Loss of localization of sounds
356
Cranial nerve: elevation of palate (say “Ah”)
X | Vagus
357
Hypotonic cerebral palsy
Low muscle tone “floppy” Little/no ability to move Unknown damage site
358
Hindbrain- rhombencephalon- divides into..
Metencephalon: pons and cerebellum Myelencephalon: medulla
359
ACA stroke: motor
Apraxia Hemiplegia (lower limb more than upper limb and face) Impaired gait
360
Actin sites exposed and myosin heads activated by .... | The myosin head binds to actin and ....
By converting ATP to ADP Phosphate released (ATP binds to myosin, breaking myosin-actin bond.)
361
Primary somatosensory cortex receives information from ___ via a ____ neuron pathway.
Receives info from tactile and proprioceptive receptors 3 neuron pathway: Peripheral afferent/dorsal column neuron Medial lemniscus neuron Thalamocortical neuron
362
Activation of the spinolimbic or spinoreticular tract results in
Arousal, with drawl, and autonomic responses to pain
363
CVA secondary impairments
ROM deficits from lack of full-range movement Muscle atrophy in affected muscles from decreased muscle activation Impaired cardiovascular/pulmonary endurance (deconditioning)
364
4 main components of typical neuron
Soma (cell body) Dendrites (main input sites) Axon (output unit) Presynaptic terminals
365
____ can be considered motor agnosia; ____ is lost
Apraxia The knowledge of how to perform skilled movement is lost (Ex: brushing teeth with a dry toothbrush, and then putting toothpaste on it. Or putting socks on over shoes)
366
CNS neuroglia
Ependymal cells Oligodendrocytes Astrocytes Microglia
367
Main cerebral artery territories
Anterior cerebral artery Middle cerebral artery Posterior cerebral artery
368
Optic ataxia occurs with damage to...
Damage to dorsal visual stream in parietal lobe
369
Secondary sensory cortex...
More complex analysis of sensation
370
Awareness of the movements and relative position of body parts
Conscious proprioception
371
The ____ regulates circadian rhythms
Epithalamus
372
Patient presents with signs and symptoms of dysfunction in several cranial nerves Which lobe?
Brainstem
373
Reflex testing activates ___.
Reciprocal inhibition
374
Guillian-Barre etiology
Unknown Autoimmune response Inflammatory response to infection, surgery or vaccination. Up to 90% report illness in prior 30 days. 2/3 report GI or Upper respiratory tract within 1-3 weeks prior. H1N1 flu vaccine in 1976-77 27% report no preceding illness Peaks ~4 weeks from onset 30% rapidly progress to ventilation dependent in days Autonomic response in 70%
375
PCA stroke: special senses/autonomic
Homonymous hemianopia Cortical blindness Hallucinations, lack of depth perception, impaired eye movements- except lateral and inferomedial, visual agnosia Limbs may show vasomotor and/or trophic abnormalities
376
Golgi tendon organs, ___ afferents woven into ___. | Sensitive to...
1b afferents woven into collagen (tendon) | Sensitive to small changes- both active contraction and passive stretch
377
Both fast and slow pain travel in ___ pathway and then separate in the brain
Anterolateral pathway
378
Depolarization- ions
More voltage-gated sodium ion channels open Sodium ions rush in depolarizing membrane Sodium channels close ~1 msec after opening
379
CMT3
Rare form Charcot Marie tooth | Dejerine-Sottas disease by mutation in PMP-22 gene
380
Neuroglia that line ventricles of brain and move CSF
Ependymal cells
381
Initial change in membrane potential
Local potential
382
Sensory loss proceeds in order of descending axon diameter (return in reverse order)
1. Light touch and conscious proprioception 2. Cold 3. Fast nociception (“sharp pain”) 4. Heat 5. Slow nociception (“aching pain”)
383
PCA (posterior cerebral artery) infarcts
Contralateral homonymous hemianopia Infarcts in penetrating vessels affect the thalamus, diencephalon, and hippocampus Contralateral sensory loss Contralateral hemiparesis Thalamic syndrome
384
Aspects of consciousness
Generalized arousal level Attention Selection of object of attention, based on goals Motivation and initiation for motor activity and cognition
385
Sustained stretch path
1a and 2 afferents-> Spinal cord -> Multiple interneurons-> LMN
386
Cortical motor planning areas
SMA: supplementary motor area PMC: premotor cortex Broca’s area (usually L hemisphere) Inferior frontal gyrus (area corresponding to Broca’s area in opposite hemisphere- usually R)
387
Thalamic nucleus for limbic
MD: mediodorsal
388
Peripheral axons (_____) are classified based on ...
Afferents | Classified based on axon diameter
389
Glia category by size/function
Large: macroglia Small: microglia
390
Extensors Stance phase: GTO signals ____ Extensors ____ Swing phase: GTO ____ ____ extensors
Stance: GTO signals activate LMN Extensor contraction Swing: GTO tension less LMN inhibit extensors
391
TIA
Transient ischemic attack Mini-stroke Typical duration ~10 min (Greater than 20 min = permanent cell death) Warning sign for potentially larger ischemic brain injury 15% have stroke within 3 months 50% of these occur within 48 hours post TIA
392
Dopamine receptors suppress activity of ___. | Dopamine receptors act in....
Calcium ion channels | Motor activity, motivation, cognition
393
This herniation is from pressure that forces the cerebellar tonsils through the foramen magnum. The brainstem is compressed, interfering with vital signs, consciousness, and CSF flow
Tonsillar herniation
394
Golgi tendon organs register tension within tendons. Information is transmitted to ___ by __. Signal to ___ determines if LMN is ___.
Transmitted to spinal cord by 1b afferents Signal to interneuron determines if LMN is excited or inhibited
395
Used when there is known or suspect neuro pathology. Detailed exam to determine what is intact and what is impaired
Investigative
396
The ____ recognize sensations
Secondary sensory areas
397
Merkel’s disks
Pressure Superficial fine touch
398
Membrane is hyperpolarized when the potential becomes ____ than the resting potential
More negative
399
Leading causes of TBI
``` Falls 35% Unknown/other 21% Motor vehicle 17% Assault 17% Struck by/against 10% ```
400
7 key areas of Neuro screen
1. Mental status 2. Cranial nerves 3. Motor 4. Reflexes 5. Sensation 6. Coordination 7. Stance and gait
401
Lower motor neuron cell bodies are located in ___. Orientation corresponds to anatomical position. Medial neurons : ____ muscles Lateral neurons: ____ muscles Anterior neurons : ___ muscles Posterior neurons: ____ muscles
``` Ventral horn of spinal cord Medial: axial and proximal muscles Lateral: distal muscles Anterior: extensors Posterior: flexors ```
402
Basilar artery stroke: cognition/language/memory
Reduced consciousness
403
PCA stroke: somatosensory
Hemianesthesia | Slow nociception
404
Leak channels
Small number of ions leak at a slow continuous rate
405
CMTX
X-linked Charcot Marie tooth | Point mutation on connexin-32 protein on X chromosome
406
Depolarization typically sufficient to trigger an action potential
15-mV | Change from -70 mV to -55 mV
407
Cells which form a critical support network for neurons
Glial cells | Also transmit information
408
Areas in ___ control vital function. The ___ modulate brainstem control
Areas is medulla and pons control vital function | Hypothalamus, thalamus and emotion/motivational areas modulate brainstem control.
409
Awareness of stimuli from senses
Sensation
410
Hypothalamus functions
Maintain homeostasis Emotional expression Circadian rhythms Endocrine regulation
411
Most of the pyramidal cells are ___ for the cerebral cortex
Output cells
412
Posterior circulation of brain supplied by
Vertebral artery from subclavian artery
413
___ pathways project to ____. Visual info that answers “where?” By analyzing motion and spatial relationships between objects
Dorsal pathways project to parieto-occipital association cortex
414
Common sites of intracranial aneurysm
Saccular (Berry) Aneurysm Typical near branch points in circle of Willis 85% occur in anterior circulation: (30% anterior communicating, 25% posterior communicating, 20% middle cerebral) 15% in vertebrobasilar system
415
A person can hear, but is unable to understand speech. | This is called ____, and is due to ____.
Auditory agnosia | Destruction of LEFT secondary auditory cortex
416
``` ___ tract Bilateral LMNs postural and gross limb movement Active during walking Neck reflexes Reaching movements Anticipatory postural adjustments ```
Reticulospinal tract
417
Respond to deformation of joint capsule and ligaments... | 4 types...
Joint receptors Ruffini’s endings, Paciniform corpuscles, ligament receptors, free nerve endings
418
Area of brain? | Coordination and balance
Cerebellum
419
Common areas affected by cerebral infarcts
``` Primary motor cortex Primary somatosensory cortex Wernicke’s area Broca’s area Primary visual cortex ```
420
Exposure to alcohol in utero
Fetal alcohol syndrome (more severe) or alcohol-related birth defects Abnormally small head, indistinct philtrum, thin upper lip, short vertical space between open eyelids Cognitive, movement, and behavioral problems; impaired intelligence, memory, language, attention, reaction time, visuospatial abilities, decision-making skills, goal-oriented behavior, find and gross motor skills, social and adaptive functioning
421
Lesions in pain pathway result in ___
Analgesia | Absence of pain when stimuli present
422
4th ventricle has 2 lateral ______. | Midline opening _____
Openings of Luschka | Foramen of Magendie
423
3 types of memory
Working Declarative Procedural
424
Limbic cerebral cortex
Medial orbital and medial prefrontal cortex
425
Stretch reflex path
1a afferents-> Spinal cord-> Synapse-> Alpha motor neuron
426
_____ tract Information about head movement and position Project -> LMNs that control neck and upper back muscles
Medial Vestibulospinal tract
427
Post stroke patient had tremor in right hand when trying to use hand Which lobe?
Cerebellum
428
Apraxia
Cannot perform purposeful movements Parietal lobe lesions
429
___ are spindle shaped cells that mainly output (cerebral cortex) to the thalamus
Fusiform cells
430
Secondary auditory function
Classification of sounds
431
Reflex elicited due to cutaneous stimulation
Withdrawal reflex | Ex: step in something sharp - withdrawal reflex draws foot away
432
Slow-acting neuromodulators and neurotransmitters
Amines: Dopamine, norepinephrine, serotonin, histamine Peptides: Hormones, neuromodulators, neurotransmitters Nitric oxide (diffusible transmitter)
433
G-protein second-messenger system
Strong and lasting changes in nervous system Can regulate... Mood, pain perception, movement, motivation, cognition
434
Association cortex...
Control behavior, interpret sensation, process emotions and memories
435
Tentorium cerebelli
Tent-like sheet of dura | Covers upper surface of cerebellum
436
Functional groups of neurons based on direction of information flow...
Afferent Body -> CNS Efferent CNS -> smooth/striated muscles and glands Interneurons Throughout nervous system
437
The ___ perform simple analysis of sensation
Primary sensory cortices
438
3 mechanisms postsynaptic receptors use to transduce signals
Directly- fast transmission Indirectly- slow transmission Activates a cascade of intracellular events- slow transmission
439
Structures of diencephalon
Thalamus Hypothalamus Epithalamus Subthalamus
440
Repolarization - ions
Many voltage-gated potassium channels open. | Potassium ions exit, taking positive charge out of axon
441
Review of select function to determine that system is intact
Screening
442
MS patients should avoid ___ and ensure ____
Avoid: high temperatures and excessive exertion Ensure: adequate vitamin D3, stress management, regular exercise and proper medical management to try to slow disease progression
443
Hypertension associated with ___ hemorrhage
Subarachnoid
444
Neurotransmitter types
Fast-acting: Act directly Transmission less than1/1000 second Slow-acting: Act indirectly Transmission requires 1/10 second to minutes
445
Non-specific thalamic nuclei (multi roles)
Pulvinar | Mediodorsal
446
TBI
``` Traumatic brain injury Acquired brain injury Sudden trauma damages brain Males 2x more likely than females Incidence: 0-4, 15-20s, 65+ Alcohol associated ```
447
Signs/symptoms of meningitis
Nuchal rigidity, headache, fever, confusion, vomiting, photophobia Pain intensifies with movement and upright posture
448
____ plan and initiate movements, including movements of speech and nonverbal communication
Motor planning areas
449
Intracranial hemorrhage
Traumatic or atraumatic Various locations of cranial vault Classified according to location
450
Parasympathetic ganglia are located...
Near or in target organs | Unlike sympathetic which are interconnected in sympathetic trunk
451
Forebrain (prosencephalon) is largest part of nervous system in humans. Divided into..
Telencephalon “end brain” - cerebral hemispheres, cerebral cortex, subcortical white matter, basal ganglia Diencephalon - thalamus, hypothalamus, epithalamus, subthalamus
452
This tract deals with fractionate movements of the distal limbs
Lateral corticospinal tract | Lateral UMN
453
Decision making depends on...
Stimulus coding system Action selection system Expected reward system Lambic loop is active when outcome uncertain
454
In the ___ pathway, 2 high fidelity pathways relay somatotopic information from muscle receptors, tendon and joints. 2 other pathways relay internal feedback about activity in spinal interneurons and descending motor tracts
Unconscious relay pathway | Spinocerebellar tracts
455
Basilar artery stroke: motor
``` Tetraplegia Abducens nerve palsy Locked in syndrome Oculomotor nerve palsy Decorticate or decerebrate rigidity Paresis or paralysis of muscles of tongue, lips, palate, pharynx and larynx ```
456
Spinal cord injury secondary impairments
ROM deficits from lack of full-range movement Muscle wasting from lack of muscle activation Impaired cardiovascular/pulmonary endurance (deconditioning)
457
Medial pain system
Slow pain Uses several pathways with variable numbers of projection neurons (NOT 3 neuron like fast pain) Elicits affective, motivational, withdrawal, arousal and autonomic responses Info is NOT somatotopically organized
458
Internal feedback tracts of unconscious relay pathway
Monitor and control activity via spinal interneurons and descending motor signals from cerebral cortex, brainstem and spinal reflex circuits
459
4 categories of concussion
1. Thinking/Remembering: problems concentrating, can’t think clearly, can’t remember new info 2. Physical: headache, nausea/vomiting, dizziness/balance, light/sound sensitivity 3. Emotions/Mood: nervous/anxious, emotional, easily angered/upset 4. Sleep: more or less than usual, hard time getting to sleep
460
2 high fidelity pathways | Unconscious relay
Posterior spinocerebellar | Cuneocerebellar
461
2 internal feedback tracts | Unconscious relay pathway
Anterior spinocerebellar tract | Rostrospinocerebellar tract
462
Thalamic nucleus for behavioral flexibility and control loop
MD: mediodorsal
463
Paciniform corpuscles- joint
Movement | Type 2
464
Anatomy associated with pusher syndrome.... | Lesions of __ found to be affected in those with CP
Left or right Posteriolateral thalamus (Fundamentally involved in control of upright body posture) Lesions of thalamic nuclei
465
Herniation ICP
Compressible brain tissue forced around edges of falx or tentorium
466
Local potential strength can be increased and potentials integrated via ____.
Temporal and spatial summation. | Local potentials generally travel 1-2 mm; amplitude decreases with distance
467
Spinal cord injury functional limitations
Requiring assistance or special equipment for UE reach and manipulation tasks Requiring assistance, or assistive equipment, with functional transfers and bed mobility Limited functional locomotion (including dependence on bracing and equipment or mandatory wheelchair)
468
Layers of cerebral cortex
1: molecular layer 2: external granular layer 3. external pyramidal layer 4: internal granular layer 5: internal pyramidal layer 6: multiform layer
469
Primary sensory areas receive sensory information directly from _____.
Ventral tier of thalamic nuclei
470
Post-traumatic hydrocephalus
Fairly common following TBI, can be life threatening Causes: overproduction of CSF, blockage of normal CSF flow, insufficient absorption Communicating (non-obstructive): normal flow, may be impaired absorption; occlusion of arachnoid villi. Seen in severe skull fractures, hemorrhage and meningitis Non-communicating (obstructive): CSF blockage causes accumulation in ventricles; ventricles enlarge, hemisphere expands
471
In pushing syndrome, ___ and ___ are not necessarily disturbed. Problems integrating ___, and ___ not associated.
Visual and vestibular processing not necessarily disturbed. Normal perception of vision vertical. Problems integrating visual and vestibular information. Somatosensation is not associated.
472
ACA stroke: cognition/language/memory
Difficulty with divergent thinking
473
The interpretation of sensation into meaningful forms
Perception
474
Secondary visual function
Analysis of motion, color Recognition of visual objects Understanding visual spatial relationships Control of visual fixation
475
Subarachnoid space contains ___ vessels
CSF and major arteries/veins of brain
476
Norepinephrine originates in ____. | It is the neurotransmitter that regulates ____.
``` Locus coeruleus and medial reticular zone Regulates attention (direction of consciousness) ```
477
Cellular mechanism that transports substances along axon
Axoplasmic transport
478
The ___ tract extends the wrist and fingers
Rubrospinal tract | Lateral UMN
479
Main PNS transmitter at neuromuscular junctions
ACh: acetylcholine
480
The ___ selectively filters information from cerebral cortex, thus regulating cortical activity
Thalamus
481
Cerebral palsy
Movement and postural disorder Permanent and nonprogressive brain damage Several different effects New problems may emerge with normal aging Classified according to type of motor dysfunction
482
MS common complaints
Decreased sensation, Fatigue, Tremor, Bowel/Bladder sx, vision changes, balance loss, vertigo, coordination, pain, spasticity, weakness, heat sensitivity, cognitive changes, depression, sexual dysfunction, speech/swallowing difficulty
483
Anomia
Inability to name objects Parietal lobe lesions
484
ACA (anterior cerebral artery) infarcts
Upper motor neuron type weakness and cortical type sensory loss Contralateral hemiplegia/hemisensory loss Affects contralateral leg more than arm or face May include frontal lobe dysfunction: impaired judgment, flat affect, incontinence... Deep branches cause motor dysfunction Internal capsule
485
Left MCA (middle cerebral artery) superior division infarcts
Right face/arm weakness | Broca’s aphasia
486
Falx cerebri
Flat sheet of dura suspended from roof of cranium
487
Anticipatory use of sensory information
Feedforward
488
White and gray matter distribution in cerebral hemispheres.
Gray matter outside cortex. | White matter inside cortex.
489
Flow of cortical info from primary sensory cortex to motor output
``` Primary sensory cortex-> Secondary sensory cortex-> Association cortex-> Motor planning areas-> Primary motor cortex ```
490
Ischemic stroke proposed mechanism
Embolic infarct Clot travels-> sticks in vessel-> occlusion Sudden occurance Maximal deficits at onset Thrombotic infarct Local formation of clot
491
Arachnoid trabeculae connect
Arachnoid and pia layers
492
Large depolarizing signal actively propagated by repeated generation of a signal
Action potential
493
The subthalamus is part of the
Motor basal ganglia
494
Myelinating neuroglial cells
CNS : oligodendrocytes | PNS: Schwann cells
495
Patient had a stroke that affected left cerebral hemisphere. Which side of body affected? What does patient look like while sitting on mat if contraversive pushing?
Right side | Lean towards right (pushing from left side)
496
Spinolimbic tract relays ___ information to _____. Then projects to ____ areas involved with...
Relays slow pain information to medial and interalaminar nuclei of thalamus Then projects to cerebral cortex and basal ganglia areas involved with: Emotions, sensory integration, personality and movement
497
Supplementary motor area function
Initiation of movement, Orientation planning, Bimanual ad sequential movements
498
Brainstem
Midbrain, pons, medulla Most ancient part of human brain Controls body functions necessary for survival (respiration, BP, HR)
499
Somatosensation
Sensory information from skin and musculoskeletal system Information sent to brain via ascending white matter tracts Axon diameter and myelination determines transmission rate
500
The 4th ventricle drains into subarachnoid space via
2 lateral foramina: foramen of Luschka | Midline opening: foramen of Magendie
501
All fine touch receptors transmit information on ____
Alpha beta afferents
502
5 categories localized function of cerebral cortex
1. Primary sensory cortex 2. Primary motor cortex 3. Secondary sensory cortex 4. Motor planning areas 5. Association cortex
503
Patient post TBI makes inappropriate, sexually oriented comments What lobe?
Frontal
504
Hemorrhagic stroke
Word deficits within hours of onset | Improvement as edema decreases
505
Secondary impairments
Abnormal changes in the structure or function of a given system that may occur as a consequence of initial pathology and related impairments and/or result over time of some other type/influence (ex: aging or lifestyle)
506
Gray matter is mainly ___. | Where most ___ occurs.
Cell bodies | Where most local communication between neurons in the CNS occurs
507
Cranial nerve: facial expression
VII | Facial
508
Lenticular nucleus consists of
Putamen Globus pallidus (Basal Ganglia)
509
Spina bifida with meningomyelocele
Meninges protrude outside body | LE dysfunction
510
Left middle cerebral artery (MCA) inferior division infarct
Wernicke’s aphasia | Right visual field defect
511
Primary auditory cortex is composed of ___ on the ___.
Composed of transverse gyro of Heschi | On superior surface of each temporal lobe
512
Frontal lobe lesions
1. Personality disorders 2. Difficulty performing a sequence of actions 3. Difficulty problem solving 4. Cannot focus on task 5. Inability to express language 6. Impaired judgment 7. Inappropriate joking 8. Stare passively and delayed response 9. Magnetic gait (feet shuffle) 10. Urinary incontinence
513
Broca’s area function
Motor programming of speech (usually in left hemisphere only)
514
Intrafusal and extrafusal muscle spindle fibers
Intrafusal- Inside spindle Extrafusal- skeletal muscle fibers outside spindle Ends of intrafusal connect to extrafusal Stretching muscle = stretching intrafusal fibers
515
Contractile unit of striated muscle
Sarcomere
516
Primary somatosensory lesions cause
Loss of tactile localization and conscious proprioception
517
Cavernous sinus pressure can compress __ CN
CN 3,4,6 | Eye problems
518
Secondary somatosensory function
Stereognosis and memory of the tactile and spatial environment
519
Subdural hematoma types
Chronic- Often seen in elderly Oozes slowly and venous blood collects over weeks/months Vague symptoms- headache, cognitive impairment, unsteady gait Acute- High velocity impact Usually associated with other serious injuries Prognosis worse than with chronic
520
Crude awareness takes place in ___
Thalamus | Information must reach thalamus to make us aware of sensory information
521
Cerebral cortex disorders
Aphasia Apraxia Agnosia Astereognosis
522
Acute neurologic deficits that affect more than 25% of people surviving brain infarctions
``` Hemiparesis, Hemianopia, Ataxia, Aphasia Visual-perceptual deficits, Sensory deficits, Memory deficits Dysarthria Problems with bladder control ```
523
EPSP
Excitatory postsynaptic potentials CNS and PNS NMJ release neurotransmitter...which binds and opens ion channel...sodium or calcium enters...postsynaptic membrane becomes depolarized Summation of EPSPs
524
Posterior cerebral artery arise from (Circle of Willis)
Top of basilar
525
Forebrain malformation
Prosencephalon does not divide into 2 cerebral hemispheres, resulting in a single cerebral hemisphere (holoprosencephaly) Associated with facial abnormalities: single eye (or no eye), deformed nose, cleft lip and palate
526
G-proteins are ___ activation of ion channels
Indirect activation
527
Crude touch
Pleasurable touch Tickle Itch
528
______ is 3rd leading cause of death in US m, and a major cause of permanent disability
Ischemic stroke Occurs when oxygen-rich blood flow to brain is restricted by a blood clot or other blockage
529
Presynaptic inhibition
Less neurotransmitter released
530
Anterior cerebral artery stroke
Personality changes (frontal lobe) Contralateral hemiplegia Hemisensory loss More sever in lower limbs (than upper) bc medial sensorimotor cortex
531
Muscles immobilized in a shortened position for prolonged periods.... Results in optimal contractile force at ___. Muscles immobilized in lengthened position will...
Tend to lose sarcomeres Loss results in optimal contractile force at new resting length Add sarcomeres
532
Cranial nerves with parasympathetic fibers
3, 7, 9 and 10
533
Glutamate receptors
AMPA, Kainate, NMDA
534
Postsynaptic terminal
Membrane of cell receiving signal | Contains receptors
535
The corpus callosum is ____ that connects ____.
White matter that connects homologous/heterologus hemispheres
536
3 systems create stress response
Somatic nervous system Autonomic nervous system Neuroendocrine system
537
Prevent release of neurotransmitters or bind to receptor and impede effects of a naturally occurring transmitter
Antagonists
538
Dysphagia
Difficulty swallowing Brainstem lesions
539
The ___ has an external periosteal layer and internal meningeal layer
Dura mater
540
Intrafusal fibers are contractile at ___. | There are 2 types....
Ends, the central region doesn’t contract. 2 types: nuclear bag fibers (clumps of nuclei) and nuclear chain fibers (single file nuclei)
541
____% all injury deaths in US associated with TBI ____ people sustain TBI in US each year ____ die daily in US from TBI related issues
30% die 1.7 million annually 138 people daily
542
Cerebral palsy traditionally believed to result from...
Difficulties during birthing process Epidemiological studies indicate that 80% of cases result from events (genetic, metabolic, maternal infection, endocrine and metabolic disorders etc) occurring before onset of labor Hypoxia during birth is rarely a cause
543
You stub your toe Eyes move to injury site Foot moves away from what you hit Emotional response to pain activated This is an example of...
The divergent pain pathway
544
Limits of attention
Amount of attention is limited; information that is not attended to is not processed. As tasks become more automatic, less attention is required Attention is limited by amount of time available Limits exist on ability to switch attention from one task to another
545
Voltage-gated channels
Change in electrical potential
546
The lateral ventricles connect to the third ventricle by the ____
Foramen of Monro (interventricular foramen)
547
Sustained stretch in undamaged nervous system vs spinal cord injury
Undamaged: Sustained stretch does not elicit reflexive contraction due to presynaptic inhibition SCI: Sustained firing of spindle endings due to loss of presynaptic inhibition (= muscle contraction)
548
Nervous system forms from ___derm
Ectoderm
549
Primary vestibular function and location
Discriminates among head positions and head movements, contributes to perception of vertical Right hemisphere
550
Changes in glutamate transmission...
``` Chronic pain Depression Parkinson’s Schizophrenia Injury associated with acute stroke ```
551
2 tracts of the lateral UMN
Rubrospinal tract | Lateral corticospinal tract
552
4 types of membrane channels allow ions to flow across the membrane
Leak channels Modality-gated channels Ligand-gated channels Voltage-gated channels
553
Temporal lobe lesions
1. Problems with long-term memory 2. Problems with facial recognition 3. Cannot understand spoken words 4. Impaired hearing 5. Increased aggression 6. Altered sexual desire
554
White and gray matter distribution in spinal cord
White matter outside | Gray matter inside
555
Secondary sensory areas of the cerebral cortex
Secondary somatosensory Secondary visual Secondary auditory
556
The ___ approach of stroke recovery attempts to decrease the severity of the neurologic deficits
Remediation approach
557
2 tracts of nonspecific UMN
Ceruleospinal | Raphespinal
558
Primary impairments
The symptoms/signs that are the direct result of disease/pathology
559
Perception is an active process requiring...
Interaction among brain, body and environment
560
Crossed analgesia
Ipsilateral analgesia in face and contralateral in the body
561
There are separate primary sensory areas for....
Somatosensory, auditory, visual and vestibular information.
562
Miller-Fisher Syndrome
Only 5% GBS cases Characterized you paralysis or weakness of extraocular muscles, ataxia and areflexia Cranial nerve involvement- diplopia, slurred speech, difficulty swallowing Limb or gait ataxia, decrease proprioception, LE and UE weakness, respiratory complications Good recovery (begins at 2 weeks, ataxia by 3 months, total resolution by 6 months)
563
Posterior spinocerebellar pathway
High fidelity pathway (Unconscious relay) Info transmitted from legs and lower half of body to cerebellum via Ipsilateral inferior cerebellar peduncle
564
Cranial nerve- Protrude lower jaw
CN V
565
Superficial veins
Cortex Adjacent white matter Superior sagittal/other sinus
566
The substantia nigra sends its neurons to..
The striatum where they release dopamine
567
Use of sensory information during/after movement to make corrections
Feedback
568
Astrocytes
Macroglial cells Star shaped Throughout CNS Link neurons and capillaries
569
____pathway Sensory information relayed about location and type of stimulation. High fidelity transmission
Conscious relay pathway
570
Types of MS
Clinically isolated syndrome Relapsing remitting Primary progressive Secondary progressive
571
CSF is in the ___ space
Subarachnoid space | Has
572
Basic functions of neurons
Reception Integration Transmission Transfer of information
573
Transition point between internal carotid and middle cerebral
(Circle of Willis) | Opthalamic
574
Events at the synapse
1. AP reaches presynaptic terminal 2. Calcium enters presynaptic terminal 3. Vesicles move toward release site 4. Presynaptic terminal release neurotransmitter 5. Neurotransmitter binds to postsynaptic membrane receptor 6. Membrane channel changes shape and ions enter postsynaptic cell
575
Effects of serotonin
Impulsivity Moral decision making Obsessive-compulsive Serotonin and dopamine imbalance: aggression, harm avoidance Serotonin and norepinephrine imbalance: anxiety, irritability
576
Discriminative touch information from the face
Supplied by 3 divisions of trigeminal nerve 1st order: cell bodies in trigeminal ganglion and proximal axons end at trigeminal main sensory nucleus 2nd order: cell bodies located in trigeminal main sensory nucleus-> Cross midline in pons, travel in trigeminal lemniscus and end in VPM (ventral posteromedial) nucleus of thalamus 3rd order: thalamus-> somatosensory cortex
577
At the __, changes in membrane potential are either excitatory or inhibitory to the neuron
Postsynaptic membrane
578
Concussion
TBI Temporary or permanent loss of consciousness Disrupts the RAS (reticular activating system)
579
Involuntary uncontrollable movement of upper limb. The limb may elevate, unintentionally grasp objects, and may interfere with movements of unaffected hand.
Alien hand syndrome
580
Subdural hematoma -SDH
Between dura and arachnoid mater Typical cause: rupture of bridging veins
581
Vertebrobasilar artery infarct
Affect posterior cerebral territory and brainstem Locked-in syndrome: Tetraplegia, bulbar paralysis CN V-XII, unable to speak, can have vertical eye movement and blinking (no lateral/horizontal eye movement), initially in coma
582
Behavioral flexibility and control loop cerebral cortex
Ventrolateral prefrontal and lateral orbital cortex
583
C afferent somatosensory axons
Small unmyelinated Free nerve endings Tissue damage, temperature, itch, tickle
584
PCA stroke: motor
If lesion near origin of artery: Vertical gaze palsy, oculomotor nerve palsy, loss of medial deviation of eyes with preserved convergence, vertical skew deviation of eyes Rarely: hemiparesis
585
The primary motor cortex and motor planning areas receive information from
Basal ganglia and cerebellum, relayed by the thalamus
586
Acetylcholine originates in ____. | It is the neurotransmitter regulating ____.
Pedunculopontine nucleus | Regulates selection of object of attention, based upon goals
587
Cranial nerve: eye position
VI | Abducens
588
Broca’s area, located in ___ lobe, provides instruction for __
Left frontal lobe Language output Instructions consist of planning the movements to produce speech and providing grammatical function words, such as the articles a, an and the.
589
Autosomal dominant CMT
CMT1: gene duplication Chr17 Controls production of myelin sheath Most common form CNT2: defect in mitofusin 2 gene Leads to defect in peripheral nerve cell axon
590
Limbic Loop...seeking ___
Pleasure | Involved in addiction
591
5 categories of the cerebral cortex
1. Primary sensory cortex 2. Secondary sensory cortex 3. Motor planning areas 4. Primary motor cortex 5. Association cortex
592
Fasciculus cuneatus makes up the lateral portion of the dorsal column which relays axons from...
Upper limb
593
Myelin sheath is formed by...
Oligodendrocytes in CNS | Schwann cells in PNS
594
Optic ataxia is _____.
Inability to use visual information to direct movements, despite intact ability to visually identify and describe objects.
595
___ utilized to process discriminative information
Cortex
596
Basilar artery stroke: special senses/autonomic
Vertigo, diplopia, vomiting, nausea, hearing loss, pupil constriction
597
White and gray matter distribution in brainstem
Mixed distribution
598
Effects of norepinephrine
``` Fat oxidation Sympathetic stimulation (fight/flight) ``` Norepinephrine and serotonin imbalance: anxiety, irritability Norepinephrine and dopamine imbalance: motivation, schizophrenia
599
Muscle fiber type is dependent on ....
Neuron fibers
600
ACA (anterior cerebral artery) infarcts are...
Rarer due to the anterior communicating artery
601
Spinolimbic ascending projection transmit ___ information
Pain
602
Short processes that receive inputs to neuron
Dendrites
603
Cutaneous receptors contribute to proprioception. Respond to ...
Stretching and increasing pressure on skin
604
MCA stroke: motor
Face and upper limb more impaired than lower limb | If striated arteries involved: lower limb paresis or paralysis in addition to face and upper limb impairment
605
Fast-acting neurotransmitters and neuromodulators
``` ACh (usually excitatory) Amino acids: glutamate (excitatory) glycine (inhibitory) GABA (inhibitory) ```
606
Rostrospinocerebellar tract transmits info from ___ to ___ via ___
Cervical spinal cord -> Ipsilateral cerebellum Via inferior cerebellar peduncles
607
Risk factors for aneurysm rupture
Hypertension Smoking Drinking Stressful situations thy modulate BP
608
Auditory agnosia results from damage to secondary auditory area. The right cortex interprets ____. The left cortex interprets ___.
Right: interpretation of environmental sounds Left: understanding speech
609
Afferent autonomic information is processed in...
Solitary nucleus Spinal cord Areas of brainstem, hypothalamus and thalamus
610
Ascending projection neurons transmit to ...
Midbrain Reticular formation Limbic area Via 3 tracts in anterolateral spinal cord
611
Difficulty in expressing oneself using language of symbols
Broca’s aphasia | Person with Broca’s aphasia is impaired in both speaking and writing
612
Guillian-Barre incidence
1-2 per 100,000 No geographic clustering 2-3% mortality rate, generally in acute phase More common in men than women More common in caucasians vs African Americans
613
Cranial nerve- facial expression
CN VII
614
Electrochemical gradient in neurons and membrane resting potential are maintained by...
Negativity charged molecules (anions) trapped inside neuron that are too large to pass through channels Passive diffusion of ions through leak channels in cell membrane Sodium/potassium pump
615
1a somatosensory axon
Large myelinated Proprioception Muscle spindles Stimulated by muscle stretch
616
____ link Wernicke’s and Broca’s areas
Subcortical connections
617
Palinopsia
Persistence/reappearance of an object previously viewed Occipital lobe lesions
618
Primary motor complex is located in ___ lobe. It is the source of most neurons in the ____. It controls___.
Frontal lobe Source of most neurons in the corticospinal tract. Controls contralateral voluntary movements.
619
Spinal muscular atrophy
Autosomal recessive disorder Motor neurons with cell bodies in the spinal cord that innervated skeletal muscles degenerate Most common genetic deficit is the deletion of the survival motor neuron 1 gene Usually premature death
620
4 tracts regulate posture/gross movement
Reticulospinal Medial vestibulospinal Lateral vestibulospinal Medial corticospinal
621
Brain formation begins day 28, three main divisions....
Forebrain- prosencephalon Midbrain- mesencephalon Hindbrain- rhombencephelon
622
Exposure to cocaine in utero
Effects depend on stage of development Disturbance of neuronal proliferation is the most frequent consequence; interference with other neurodevelopment processes Symptoms include difficulties with attention and impulse control
623
Prosopagnosia
Problems with facial recognition | Occipito-temporal lobe problems (lesions)
624
Presynaptic terminal
End of axon | Release of chemicals
625
The foramen Monroe connects
The paired lateral ventricles with the third ventricle
626
Hyperpolarization -ions
Voltage-gated potassium channels remain open. | Potassium ions continue to leave axon, restoring polarized membrane potential
627
The ___ controls contralateral voluntary movements, especially hands and face
Primary motor cortex
628
ICP: intracranial pressure values
normal: 7-17 mm Hg in supine ICP above 25-30 mm Hg Can result in substantial reduction in blood flow to brain and/or herniation- can also impact CSF flow
629
Motor perseveration is..
Uncontrollable repetition of a movement Is more associated with amount of damage than with damage to a specific site. Ex: a person may continue to lock and unlock the brakes of a wheelchair despite intending to lock the braked
630
2 point discrimination on fingertip is due to ___ receptive field and ___ density receptors
Small receptive field | High density receptors
631
Spastic cerebral palsy
Axons adjacent to lateral ventricles damaged Spasticity Toe walking Scissor gait
632
Central herniations
Pressure on diencephalon Stretches basilar artery Bilateral paralysis
633
Behavioral flexibility and control loop basal ganglia
Head of caudate (hC) | Substantia nigra reticularis
634
Norepinephrine receptors
2 major subtypes: alpha and beta Brain, gut, heart G-protein mediated
635
_____ structures are involved in consciousness, emotions and memory
Cortical and subcortical
636
_____ area comprehends spatial relationships providing schemas of ....
Wernicke’s area | Body, body in relation to it’s surroundings, external world
637
Pacinian corpuscles
Touch and vibration Subcutaneous fine touch
638
Contraversive pushing or pusher syndrome occurs in persons with ___. Causes them to ...
Stroke Actively push away from the nonhemiparetic side- resulting in falling toward paralyzed side. Decreased awareness of midline Resists attempts to correct posture
639
Deficit that impairs ability to draw and arrange objects correctly in space. Interference with ability to comprehend the relationship of parts to the whole.
Constructional apraxia
640
FOGS “spelling”
Ask patient to spell “world” forward and backward If can not spell - ask patient to count backwards from 100 by 3s, or to repeat a 7-digit number. (To assess ability to perform mental manipulations of information)
641
Mental status screen
``` “FOGS” Family story of memory loss Orientation of the patient General information Spelling ``` To begin determine if patient foggy: assess basic level of arousal and ability to attend to a task. If patient is semicoma or comatose- terminate screen- a detailed Neuro exam is needed. If not, proceed with FOGS
642
Autosomal recessive CMT
CMT4 - caused by severe gene mutations
643
The ____ approach of stroke recovery emphasizes task specificity- practicing the desired task in a specific context
Motor control approach
644
Elbow flexion myotome
C5
645
Secondary brain damage
``` Evolves after trauma Increase ICP Infection Fever Edema Gas composition (oxygen/carbon dioxide) Anemia Metabolic changes ```
646
Most neurons have a single axon that arises from a specialized region of the cell called...
Axon hillock | Which has a high density of sodium ion channels
647
Midbrain- mesencephalon- is the short and narrow region that...
Connects forebrain to hindbrain Cerebral peduncles Midbrain tectum Midbrain tegmentum
648
Cranial nerve- visual fields
CN II
649
The pia mater flows along the ___ | The ____ anchors the spinal cord to the pia mater.
Gyri and sulci | Denticulate ligaments
650
IPSP
Local hyperpolarization- inhibitory postsynaptic potential
651
Local potentials are categorized as either
Receptor potentials- peripheral sensory neuron receptor Synaptic potentials- postsynaptic membrane
652
Neuron organelles
Golgi body Mitochondria Lysosome Endoplasmic reticulum
653
Carotid stenosis
May result in TIA or stroke Internal carotid stenosis just beyond bifurcation Symptoms mimic MCA blockage Patient may be asymptomatic - Circle of Willis collateral flow Severity evaluated by ultrasound
654
Parietotemporal association function
Sensory integration, problem solving, understanding language and spatial relationships Cognitive intelligence
655
Dorsolateral prefrontal association function
Goal-oriented behavior, Self-awareness Executive functions
656
Motor areas of cerebral cortex
``` Primary motor cortex Premotor area Supplementary motor area Broca’s area Inferior frontal gyrus (usu R hemisphere) ```
657
Lower motor neuron types
Alpha motor neurons | Gamma motor neurons
658
Spina bifida
Neural tube defect- doesn’t close Spina bifida occulta Spina bifida with meningocele Spina bifida with meningimyelocele Spina bifida with myeloschisis
659
Ligament receptors - joint
Signal tension | Type 1b
660
Cranial nerve- eye movements
CN III, IV, VI
661
___ respond to quick and prolonged stretches of muscle. ___ signal the force generated by muscle contraction or passive stretch of tendon. ___ respond to mechanical deformation of joint capsule and ligaments.
Muscle spindles Tendon organs Joint receptors
662
Lateral horns contain
Autonomic cell bodies
663
MCA (middle cerebral artery) infarcts
Infarcts common Large territory- 3 divisions Deficits: aphasia, hemineglect, hemianopia, face-arm or face-arm-leg sensorimotor loss
664
An inflammatory autoimmune disorder of peripheral nerves leading to rapidly developing motor deficits (symmetrical ascending paralysis), autonomic dysfunction, sensory deficits and respiratory failure
Guillain-Barré syndrome
665
Monosynaptic reflex caused by electrical stimulation. To quantify level of alpha motor neuron facilitation or inhibition
H-reflexes
666
CVA functional limitations
Asymmetrical functional limitations in any functional skill, including UE reach and manipulation tasks. Gait deviations and slow gait velocity related to underlying impairments Unable to stand from sitting, or asymmetrical sit-to-stand Limited, asymmetrical ability to perform transfers, step on curbs/ramps, or walk steps
667
MS prognosis
Good: few attacks, good recovery from attacks, relapsing-remitting, early medical management and adherence Poor: multiple attacks, poor recovery from attacks, primary progressive, pyramidal, brainstem, or cerebellar signs
668
Sensory Endings in muscle spindle intrafusal fibers
``` Primary endings (annulospiral) Type 1a neurons around central region Phasic and tonic discharge ``` Secondary endings (flower-spray) Type 2 afferents End on nuclear chain only respond tonically
669
The most clinically important descending motor pathway
Lateral corticospinal tract
670
Agnosia
Inability to recognize objects when using a specific sense, even though discriminative ability within that sense is intact.
671
Discriminative pain, temperature, coarse/crude touch | Pathway/tract
Anterolateral pathway Spinothalamic tract Less localized information Transmitted by unmyelinated C fiber axons Projected to left insula (Insula is associated with positive emotional feelings)
672
MS demographics
Women vs men 2-3:1 Peaks around age 30 Almost never before puberty ~ 3 million worldwide General population 1/750, relatives 1/40 Genetic component (2-5% family, 30% twin) Higher socioeconomic status No increases risk from vaccination No definitive research on viral response More common in caucasians (nonexistent in Inuit) 40-60 northern hemisphere
673
Free nerve endings- joint
Stimulated by inflammation
674
Alpha motor neurons | Cell body, axon size, where project to?
Large cell bodies Large myelinated axons Axons of alpha neurons projects to extrafusal skeletal muscle Released enough ACh that all muscle fibers it innervated contract
675
This type of herniation occurs when a mass in one hemisphere displaced the cingulate cortex under the falx cerebri. May be asymptomatic; if ACA compressed, motor deficits affecting contralateral lower limb
Cingulate herniation
676
____ constricts arterioles supplying skeletal muscle, skin and digestive system
Sympathetic activity
677
Uncal herniation
Uncus displaced medially Compression of midbrain Affects oculomotor nerve function and consciousness
678
Primary sensory areas of cerebral cortex
Primary somatosensory Primary auditory Primary visual Primary vestibular
679
____ can modify the reflexive response
Arousal levels Anxious- exaggerated response Relaxed- minor delay
680
Effects of dopamine
Pleasure seeking Motor control (movement) Hunger Norepinephrine and dopamine imbalance: motivation, schizophrenia Dopamine and serotonin imbalance: aggression, harm avoidance
681
Conduction of information originates with local potentials at receiving sites of the neuron. Sensory neurons : _____ Motor and interneurons : ____
Sensory: at sensory receptor | Motor and interneurons: at postsynaptic membrane
682
Local receptor potentials generates when ____ are stretched, compressed, deformed, or exposed to thermal or chemical agents
Peripheral receptors of a sensory neuron
683
Receptors that adapt to constant stimulus and then stop responding
Phasic receptors
684
Tethered spinal cord
Cord adheres to a lower vertebra Causes dermatomal and myotomal deficits in lower limbs If traction mild, signs may only occur when mechanical stress increases
685
Ligand-gated ion channels
Direct activation of ion channels Channels consist of proteins that function as receptors for the neurotransmitter and as ionotropic receptors Gates open to specific chemical ligand binding to receptor surface; gates are closed in resting state Ion receptors act like lock and key
686
EPSP
Local depolarization- excitatory postsynaptic potential
687
A speech disorder resulting from spasticity or paresis of the muscles used for speaking
Dysarthria
688
Most primary CNS tumors are derived from ___ and are therefore called ___.
Glia | Gliomas
689
Inability to visually recognize objects despite having intact vision
Visual agnosia
690
Area of the brain? | Memory, understanding speech, hearing
Temporal lobe
691
Major deformities occur before
Week 20 After week 20 damages cause minor malformations/damage
692
Receptive field
Area of skin innervated by a single afferent neuron
693
``` ____ tract Information about gravity Project-> LMNs that activate extensors and inhibit flexors Center of gravity Response to destabilization ```
Lateral Vestibulospinal tract
694
Primary vestibular function
Discriminates among head positions and head movements
695
Respond to mechanical deformation due to touch, pressure, stretch, vibration
Mechanoreceptors
696
Cranial nerve: sensation of face and jaw motor function
V | Trigeminal
697
Conscious relay pathway | Tracts...
Dorsal column/medial lemniscus | Spinothalamic (anterolateral)
698
Medial UMN controls
Postural and girdle control
699
A specific type of visual agnosia; unable to visually identify faces despite being able to correctly interpret emotional facial expressions and being able to recognize other items in the environment
Prosopagnosia
700
Area analogous to Broca’s in opposite hemisphere
Planning nonverbal communication: emotional gestures, tone of voice. Usually in right hemisphere
701
Epidural space contains ___ vessels
Middle meningeal artery (blood to dura)
702
Released into ECF and adjust activity of many neurons
Neuromodulators
703
Primary vestibular lesions cause
Change in awareness of head position and movement and perception of vertical
704
Only nucleus of thalamus that does not project to cortex
Reticular formation
705
Dorsal column/medial lemniscus system | Axons from 2nd order neurons
Cross midline and ascend to thalamus as medial lemniscus End in VPL (ventral posterolateral) nucleus
706
Cerebellum lesions
1. Ataxia (coordination and balance) 2. Difficulty walking 3. Coordinating fine movements 4. Nystagmus 5. Ataxic dysarthria (Drunken/slurred speech) 6. Unilateral or bilateral intention tremor 7. Truncal ataxia
707
The primary sensory cortex...
Discriminates among different intensities and qualities of sensory info
708
Lateral UMN control
Face and neck | Fractionated movement
709
TIA proposed mechanism
Embolus- occlusion that then dissolves In situ thrombus- thrombus forms randomly on vessel wall Vasoplasm- temporary narrowing of vessel lumen
710
____ UMN activity can occur before a person is consciously aware of a stimulus
Medial
711
Neural stem cells
Immature and undifferentiated cells, precursors to both neurons and glial cells Able to self-renew, differentiate into most types of neurons and glial cells, populate developing and degenerating regions of CNS
712
(Muscle contraction) Depolarization of muscle membrane spreads to ____ Calcium is released from SR and bind to ___. Allowing __ to move and expose ___. ___ are formed between ____.
T-tubules Calcium binds to troponin Tropomyosin moves and exposes actin binding sites Cross bridges are formed between myosin and actin
713
Current research indicates that ___ produces significantly better motor function compared to the ___ approach
Intensive, task-specific therapy (motor control approach) better compared to the remediation approach
714
This herniation occurs when a space-occupying lesion in the temporal lob displaced the uncus medially- forcing the uncus into the OpenOffice the tentorium cerebelli. This compressed the midbrain, interfering with function of oculomotor nerve and consciousness
Uncal herniation
715
Cell bodies of sympathetic preganglionic neurons are located ____ and innervate _____
Sympathetic efferent (preganglionic) cell bodies are located in lateral horn T1-L2 Innervate adrenal medulla, vasculature, sweat glands, erectors of hair cells, and viscera
716
Tracts of the divergent pathway
Spinomesencephic tract Spinoreticular tract Spinolimbic tract
717
Superficial fine touch receptors have ___ receptive fields. | Examples are...
Small receptive fields | Meissner’s corpuscles, Merkel’s disks, and hair follicle receptors
718
ACA: anterior cerebral artery supplies
Frontal cortex Pre-frontal cortex Supplementary motor cortex Parts of the primary somatosensory/motors cortices
719
ICP (intracranial pressure) symptoms
Vomiting, nausea, headache, drowsiness, frontal lobe gait ataxia, visual problems
720
``` Lateral corticospinal tract Ascending or descending? Origin? Decussation? Cord location? Terminates? Function? ```
``` Descending Primary motor cortex Below medulla Lateral column Contralateral anterior horn Control of contralateral muscles ```
721
``` Anterior/Ventral corticospinal tract Ascending or descending? Origin? Decussation? Cord location? Terminates? Function? ```
Descending Primary motor cortex Level of synapse Anterior column Contralateral Cervical and upper thoracic anterior horn Control of contralateral axial and girdle muscles
722
``` Dorsal Column- Gracile fasciculus Ascending or descending? Origin? Decussation? Cord location? Terminates? Function? ```
``` Ascending DRG Medulla Medial dorsal column VPL thalamic nucleus Fine touch, vibration; lower body proprioception ```
723
``` Dorsal Column- Cuneate fasciculus Ascending or descending? Origin? Decussation? Cord location? Terminates? Function? ```
``` Ascending DRG Medulla Lateral dorsal column VPL Fine touch, vibration; upper body proprioception ```
724
``` Anterolateral: Spinothalamic tract Ascending or descending? Origin? Decussation? Cord location? Terminates? Function? ```
``` Ascending Dorsal horn Crosses at spinal level Lateral anterior columns VPL Crude touch, pain, temp ```

Neuroscience (4 decks)

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