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Flashcards in Neuro2 Deck (211):
1

What is a great vein varix?

Compresses pineal body and posterior commissure

2

Posterior Cerebral artery branches and

THalamogeniculate --> thalamus, choroid plexus, upper midbrain,

Temporal --> inferior temporal complex

Parietooccipital --> visual association

Calcarine --> Primary visual cortex

Posterior pericallosal artery --> anastomose

3

Brancehs of internal carotid?

ophthalmic
anterior chroidal artery
ACA, MCA

4

Ischemia in what structure is death? What vein can cause this ischemia

Deep Cerebellum, from the straight sinus or left transverse sinus

5

MIddle cerebral branches and pathologies

Central - paralysis and paresthesia of head and upper limb

Frontal - broca's

Parietal - body neglect agnosia, apraxia

temporal branch - difficulty localizing sounds

ANgular artery - Wernicke's area.

6

A space occupying brain bleed can lead to what?

Compression on contralateral PCA. Muscle weakness ipsilateral of brain bleed, called kernohan's notch

7

If the centromedian nucleus of dorasl thaalmus is lesioned, what is affected?

THe indirect pathway of pain and temperature.
The slow pain information from the trigeminal to the face.

8

Pt presents with hemianalgesia of the right side of his face, and analgesia of left side of body. Dx?

ALternating anaglesia ( upper medulla lesion of PICA)
Primary descending fibers were destroyed
Spinal lemniscus destroyed

9

Pt presents with facial anesthesia and paralysis on the right side, the left side has spastic hemiplegia. Dx? Where is this located? What artery could have caused it?

Alternating trigeminal hemiplegia, right sided pons lesion AICA

10

Pupillary constriction pathway

light --> CN II --> branchium of superior colliculus

11

A pt presents with involuntary movements of his fingers, absentemindedness and aggresion. What caused this?

= Huntington's.
degeneration of caudate and putamen.
But also a decreased clearing of glutamate.

12

Pt presents with hemiballismus, what caused this?

Lesion of subthalamic nucleus. Contralateral

13

Pt presents with Irregular rapid flowing movements, and a hx of bacterial infection treated with antibiotics.

Sydenham chorea

14

If the substantia nigra was lesioned, what would the symptoms be?

Tremor. bc this nucleus does pars compacta, pars reticulata, and pars lateralis portions. These are dopaminergic.

= Parkinsons!

15

A pt has wide based stance and is unable to walk in tandem. What aprt of the cerebellum sucks?

Nodulus, uvula, fastigial nucleus.

because these things do bilateral stuff

16

Acute onset, sginificant ataxia, intention tremor, no strength weakness. Mx?

Superior cerebellar peduncle contralaterally.
remmeber that this is the efferent fibers place!

17

Which layers of the cerebral cortex have pyramidal cells?

III. External Pyramidal Cells
V. Ganglionic layer, = internal pyramidal cell layer

18

A pt may stand with open eyes but fall with closed eyes. Lesion where?

Dorsal column

19

Histological slides show a loss of Purkinje cells. Dx?

Freidrich ataxia

20

What lies next to the inferior colliculus?
The inferior olivary nucleus is at what brainstem level?

Wha tis next to the superior colliculus?

Superior Cerebellar peduncle, trochlear nerve.

Lateral medulla

Oculomotor nucleus, Red nucleus

21

Bloody csf means

Subarachnoid hemorrhage

22

How many pairs of nerves are there?

31
8 Cervical
12 thoracic
5 Lumbabr
5 sacral
1 coccygeal

23

What is the thin strand of pia mater that anchors the conus medullaris to the coccyx?
What else is terminating from the ocnus medullaris?

Filum terminale

Cauda equina

24

Why does the substantia gelatinosa look so white?

Unmelinated sensory fibers that carry pain and temperature run up these.

25

Where is Clarke's nucleus?
WHat vetebral level? Fxn?

Lamina VII Nucleus sorta close to the central canal on vertebral levels T1 - L2. Fxn: Sensory processing

26

Describe the Laminae of the spinal cord, 10 of them. With their function

I. covers substantia gelatinosa - spinothalamic tract
II. Is substantia gelatinosa - pain and temperature info
III - VI: Posterior horn - sensory
VII: Clarke's nucleus - posterior spinocerebellar tracts; T1 -L3 preganglionic sympathetic; S2-S4 preganglionic parasympathetic to pelvic viscera
VIII: Interneuron zones of anterior horn
IX: Motor Neurons in anterior horn
X: Grey matter surrounding Central Canal

27

Describe special portions of the lamina

T1 - L2 = Clarke's nucleus, Lamina VII, contains posterior spinocerebellar tracts.
T1-L3 = intermediolaeral column; preganglionic sympathetic neurons
S2-S4 = Sacral parasympathetic nucleus; preganglionic parasympathetic neurons to pelvic viscera
Medulla --> C5 = accessory nucleus
C3-C5 = phrenic.

28

Where is the limbic lobe located?Fxn?

It encircles the corpus calloseum
Emotional responses, drive related behavior and memory

29

What do arcuate fibers connect?
Longitudinal fasciculi?
Commissural tracts?
Projection tracts?

Arcuate connect same gyri
Longtudinal connect same hemisphere, dif lobes
commissural connect hemisphers
Projection connect body to head.

30

Where is the primary auditory complex located?
Wernicke?
Where is the uncus located?
Hippocampus?
AMygdala?

superior temporal gyrus

Posterior superior temporal gyrus

On limbic lobe

folded into temporal lobe

Amgydala: beneath uncus

31

What make up the basal nuclei?

What are the deep cerebellum nuclei?

Caudate nucleus
Lenticular nucleus (putamen and globus pallidus; separated by internal capsule)

DEGF
Dentate
Emboliform
Globus
Fastigial

32

If a lesion occurs between the spinal cord and the medulla on the right side and takes out both medial lemniscus and spinothalamic tracts, what will the symptoms look like?

What if the lesion occured superior to medulla?

Reduction of touch sensations on the right, and pain and temp sensations on the left.

Everything be contralateral.

33

What does the anterior cerebral artery supply?

Caudate nucleus, motor and sensory for legs
Risk for thrombosis due to long course.

34

Pt presents with motor loss, pain and temperature loss, proprioception and fine touch loss on teh left side. What artery hemorrhaged

right lenticulostriate/thalamostriate off the middle cerebral

This supplies: Internal capsule, corpus striatum and thalamus

35

What are the branches of the MCA and their fxn?

Central artery: Primary motor and somatosensory
Lenticulostriate: Internal capsule, corpus striatum, thalamus
Parietal branches: association cortex
Temporal branches: auditory cortex
Angular a: Wernicke

36

A pt presents and can hear and comprehend you, but has diffculty responding. Dx and artery?

Broca's Aphasia, Frontal branches of MCA
Expressive Language disorder

37

Pt presents with body neglect, agnosia (can't interpet senses), apraxia (difficulty motor)

Parietal branches of MCA

38

Pt presents with difficulty localizing sounds?

Temporal brancehs

39

A pt presents and is fluent in speech, but does not make any sense.

Wernicke's, angular artery of dominant hemisphere.

40

A pt presents with facial numbness on the right side, and body numbness on the right side. What artery?

VPL and VPM were hit, so anterior choroidal artery

Other fxns:
Thalamus, choroid plexus of lateral ventricle, upper midbrain

41

Wht artery supplies the primary visual corteX??

Calcarine artery

42

What does the anterior spinal artery supply?

What things do PICA And AICA have in common?

Lateral corticospinal tract
Medial lemniscus
Caudal medulla

Vestibular
Spinothalamic
Spinal Trigeminal
Sympathetic

43

hemorrhage of what artery can result in quadriplegia, where the only action you can do is move your eyes verteical?

basilar "Locked in syndrome"

44

What 3 structures do you need to be able to look left and right? Where are they located?

PPRP Paramedian Pontine
MLF
Abducens

Medial Pontine

45

Medial pontine includes what structures:

Lateral Pontine Includes:

Medial Medullary includes:

Lateral Medullary

Medial pontine: Corticospinal, CN VI & VII (gaze palsy and facial droop)

Lateral pontine: Vestibular nuclei - nystagmus; Spinothalamic, spinal nucleus of V, sympathetic tract. VII facial droop
Cochlear

Medial medullary:
- Lateral Corticospinal, Medial lemniscus, XII
- Lateral corticospinal = contralateral hemiparesis; medial lemniscus = Contralateral proprioception and 2pt touch loss; Hypoglosasl n root = ipsilateral deviation LMN

Lateral Medullary (Wallenburg
- Vestibular, Symapthetic, spinothalamic, V, nuc ambiguus.
- Facial pain and temperature
PICA

46

Contralateral hemianopia with macular sparing is caused by

Posterior Cerebral artery occlusion
or damage to occipiatl lobe

47

What Sx occurs in an uncal herniation

III compression; occlusion of PCA = contralateral hemiparesis, respiratoy compromise

48

What type of hydrocephalus do Alzhemiier's pts get?

Supratentorial atrophy of the cortex

49

What spinal level does the fasciculous gracilis begin?

T6

50

PCML pathway, GO

DRG
Fasciculus cuneatus/gracilis
ipsilateral nucleus cuneatus/gracilis
Decussates internal arcuate fibers
Medial lemniscus
Rotates in pons - upper extremity are medial now, lower are lateral
VPL
PLIC
Somatosensory cortex in postcentral gyrus

51

the subdivisions of the somatosensory cortex include 1, 2, 3a and 3b. Describe

1 - deficit in texture discrimination
2 - size and shape
3a - ?
3b - Initial processing of texture, size and shape

52

What is the secondary somatosensory cortex?

Receives input from ipsilateral SI cortex and VPI thalamus

53

Lateral Spinothalamic pathway, GO!

- Posterolateral fasciculous - Lissaurer's TRACT!!!!
- Ipsilateral substantia gelatinosa and nucleus proprius
- LSTT (lateral spinothalamic tract)
- LSTT and VSTT meet and become spinal lemniscus
- VPL
- PLIC

54

Patient presents with burnt hands, say she put them on the stove and couldn't feel that it was hot. Dx? What other symptoms?

Syringomyelia compressing on the anterior white commissure

Shawl or cape like distribution of pain/temperature loss

55

BRown-Sequard syndrome presentation?

- Ipsilateral LMN signs
-Ipsilateral UMN signs
- Ipsilateral Proprioception, vibration, light touch, tactile sensation
- Contralteral loss of pain, temperature, and crude touch.

56

Anterior spinothalamic tract Go

C type enters spinal cord
Lissauer's
Nucleus proprius
Fasciculous proprius ipsilaterally
Centromedian nucleus of dorsal thalamus

--> Reticular formation
--> Hypothalamus, limbic system.

57

UMN pathway,go

- Post Central Gyrus
- PLIC
- Cerebral peduncles
- Anterior pons
- Medullary pyramids
- Decussate at spinomedullary jxn at pyramid
- Lateral corticospinal tract = crossed fibers
- Anterior corticospinal tract = uncrossed
- Hits up that LMN

58

A patient presents quadriplegic. An MRI shows no hemorrhaging. Mx?

ALS, degeneration of the primary motor cortex or the UMN corticospinal tracts

59

4 subtypes to cerebral palsy. What are htey and what region do they involve?

Spastic- cerebral cortex
Dyskinetic - basal ganglia
Ataxis - cerebellum
Mixed - multiple areas

60

What is the mechanism of Polio? Sx?

Polio virus destroys the ventral horn of motor cell bodies
LMN!
Sx: Asymmetric flaccid paralysis, areflexia, Hypotonia, Atrophy of muscles,
normal sensory exam

61

Weird extrapyramidal motor tracts:
Reticulospinal tract
Rubrospinal

Tectospinal tract

Vestibulospinal:

Reticulospinal:
- Antigravity reflexes
- Reflex inhibition: if a reflex intereferes with a voluntary movement, this inhibits it

Rubrospinal:
- Flexor movement;
- Red nucleus

Tectospoinal: coordinates movement of head with eyes (Colliculus)

Vestibulospinal: extensors against gravity for posture

62

Fast pain fibers in face patway

come in on the pons
- Spinal trigeminal nucleus, caudal pars (Mandibular posterior, ophthalmic anterior)
- Contralateral trigemincal lemniscus
- VPM
- PLIC
- Primary somatosensory cortex

63

Slow pain fiber in face pathway

C fibers enter pons
- Spinal nucleus
- Reticular formation
- BILATERALLY to centromedian nucleus and hypohtalamus

64

Precise Tactile info from face?

how is V1-V3 arranged

Afferent fiber
- from oral cavity --> Dorsomedial
- Dorsal trigeminal tract (DCTT)
- VPM on ipsilateral side


- from V1-V3 --> Ventrolateral division
- Trigeminal lemniscus (anerior tract) contralateral side
- VPM

V1 is anterior,
V3 posterior

65

Proprioceptive info from face?

Unconscious proprioceptive afferents
- Mesencephalic nucleus
- Goes to main sensory and does all the stuff over again.

66

What are the trigeminocerebellar tracts?

Proprioception from mastication muscles for chewing.
- Goes to mesencephalic
- spinal nucleus
- inferior cerebellar peduncle
- anterior vermis of cerebellum

Texture of food:
Main sensory
- superior cerebellar peduncle
- Anterior vermis of cerebellum
(Tomato vs onion biting)

67

If there is an upper medulla brainstem lesion,(or PICA stroke) what is the sx and dx?

Sx: Ipsilateral hemianaglesia of face
Contralateral hemianaglesia of body

Wallenburg

68

A pt presnts with right sided trigeminal anesthesia and paralysis; left sided spastic hemiplegia
The right side of the face can feel, but not move.

Alternating trigeminal hemiplegia

69

Path of pupillary constriction?

Light -->
CN II -->
Optic tract -->
Brachium of superior colliculus
--> superior collicululs -->
pretectum-->
EWN of ipsilateral

Posterior commissure --> EWN Contralaterally

70

Areas 18 and 19 along with temporal and parietal lobe parts are considered the

Visual association cortex, in the parieto occipito temporal area

71

If the superior colliculus was taken out, what would the pt sx be?

Retinal reflex = constriction wouldn't be bilateral

Voluntary eye movements left and right

72

What can cause monoocular blindness?

Binasal hemaniopia?

Bitemporal hemanopia

Contralateral homonymous hemianopia

Contralateral superior quadrantopia

Incongruent contralateral hemianopia with macular sparing

Central a effed
optic neuritits
MS

Internal carotid calcification

Pituitary tumor

Vascular lesion of geniculate body

MCA or P. temporal lobe lesion

PCA occlusion

73

How do you control your eye movements voluntarily? What pathway?

Novolitional?

Frontal eye fields --> corticotectal fibers --> superior colliculus --> LMN III, IV, VI,

Nonvolitional: occipital eye fields

74

What cauases visual agnosia?

Cannot name or describe an object, but recognizes its use

Left occipital lobe and posterior corpus callosum infarction

75

What makes up the left half of the visual field?

Right eyes temporal retinal field
Left eyes nasal retinal field

(left of both eyes)

76

alar plate becomes?

Sensory dorsal

77

Oligodendrocytes, astrocytes, ependymal cells and CNS neurons are derivatives of what in the nural tube?

What about PNS and Schwann cells?

Mammillary bodies?

Neuroepithelium

NCC

Neurobalsts in intermediate zone of diencephalon

78

How is the cerebellum developed?

Cerebral peduncles?

olivary nuclei?

Alar plate --> Cerebellar swellings --> 4th ventricle --> cerebellum

Cerebral cortex fibers = cerebral peduncles

lateral part of basal plates

79

The alar plates become what in these 3 structures?
Midbrain?
Medulla?
Spinal Cord?

Basal plates?

Midbrain = superior/inferior colliculi
Medulla =
Nucleus cuneatus and gracilis
Spinal Cord =
Sensory

Midbrain =
Red nucleus, reticular nuclei, CN III, IV

Medulla = Pyramids
Spinal =
Motor

80

Describe the flexures of the brain and what week they establish brain regions?

5th week
Midbrain flexure: midbrain from forebrain

Pontine: metencephalon and myelencephalon

Cervical Flexure: hindbrain from spinal cord.

81

Describe Cerebral lamina:

I. Dendrites
II & III. Neurons that project to other cortex areas
IV. Thalamus inputs
V. Projects to subcortical structrues
VI. Thalamus outputs

4&5 form first

82

What is the sulcus limitans?

Separates the alar and basal plates

83

Zones of hte spinal cord?

Ventricular = neuroepithlium around spinal cord

Intermediate = grey matter, become neurons

Marginal : white zone = axons

84

How can you tell type I Arnold-Chiari Malformation from Arnold-Chiari Type 2?

TypeI = ectopia of cerebellar tonsils

Type II: Vermis and tonsils both are herniated

85

What is Arnold Chiari TYpe 2 associated with?

Hydrocephalus and lumbosacral meningomyelocele?

86

What causes lissencephaly?

Failure of neuronal migration during week 12

87

what muscle in the oculomotor nucleus decussates?

Superior rectus

88

What nerves are onthe pons medulla junction

Abducens and facial

89

The facial nerve uses what ganglion?

Geniculate

90

What CNs use a corticobulbar tract?

5, 7, 9 10, 11, 12
All the ones with motor fxns that aren't part of the eye

91

Vestibuloarchi cerebellum path GO

From the vestibular/reticular nuclei
- Through the inferior Cerebellar peduncle
- FLocculonodular lobe

Efferents:
- Flocculonodular
- Fastigial nucleus
- vestibular nuclei and RF
Then you got some LMNs going through vestibulospinal and reticulospinal tracts.

All ipsilateral

92

Spinocerebellum path, GO

Spinocerebellar/cuneocerebellar
- Inferior cerebellar peduncle
- cortex of ipsilateral vermis

2 different efferents
- Globose and emboliform nuclei --> superior cerebellar peduncle --> red nucleus and thalamus

- Fastigila nuclei --> Vermis --> vestibualr and reticular nuclei

93

Pontocerebellum pathway go!

Afferent
- Pontocerebellar fibers
- middle peduncle, contralateral to lateral cerebellar hemisphere
Efferent
- Dentate nucleus
- Superior cerebellar peduncle
- COntralateral red nucleus/VLN of thalamus

94

The inferior cerebellar peduncle contains:

Middle?

Superior?

Inferior: Spinal cord and brainstem afferents to cerebellum

Middle: Pontine nuclei to cerebellum

Superior: Only efferents. to diencephalon and brainstem

95

What's the fxn of the juxtarestiform body?

Restiform body?

Juxtarestiform: Bn cerebellum and vestibular structures

Restiform: arise in spinal cord or medulla to cerebellum

96

How do we keep the other muscles that the oculomotor innervates from moving in a roatation situation?
What about the contralateral abducens?

Vestibular nucleus inhibits the other muscles.

IBNs
(EBNs excite the omnipause region/EBN to Stimulate ipsilateral abducens

97

MLF lesion?

Internuclear ophthalmoplegia = loss of vestibulocular reflexes.

Convergence is still normal.

98

Friedreich's ataxia is caused by what?
What are Sx?

Lateral coricospinal tract degeneration = spastic paralysis

Spinocerebellar tract = ataxia

dorsal columns = proprioception

DRG= DTR loss

99

What is the fxn of the caudate?
Globus Pallidus?
Putamen?

Caudate: receives cortical inputs from association areas

Globus Pallidus = lenticualr fasciculus, ansa leticularis (disinhibit thalamus)

Putamen = receives input from somatosensory and motor areas

100

Direct and indirect pathways for the basal ganglia

Just know GPi does all the work and acts on the thalamus.
To turn the thalamus on, you gotta turn the GPi off. Use Gaba from Striatum.


TO turn thalamus off, you gotta turn on the GPi, which means you have to use STN (subthalamic) to stimulate GPi

101

What basal ganglia fibers are serontonergic?
Dopaminergic?
GABAergic?

What are some clinical correlations here?

Serotonin: Raphe nucleus

DOPA: Nigrostriatal fibers = Parkinson's destroys these neurons in the substantia nigra

GABA: Striatonigral
Huntinton's disease destroys these.

102

What is the Mx of Parkinson? and Sx?

Huntington's?

Mx: Loss of Nigrostriatal fibers which are dopaminergic in the substantia nigra pars compacta

Sx: TRAPS
Tremor, Rigidity, Akinesia, Posture, Shuffling

Huntington's:
loss of caudate and putamen; low levels of Gaba (striatonigral gone), increase in dopamine. Glutamate cytotoxicity
Sx: Aggression, depression, athetosis, depression, dementia

103

Syndeham's chorea?

What is chorea?
- dancing, purposeless movements

What is hemiballism?

athetosis?

Happens from previous rheumatic fever, creates abs against basal ganglia

one flailing limb from contralteral subthalamic nucleus

Athetosis: Sake like movements from basal ganglia

104

What is the ventral lateral nucleus used for?

MOtor only

105

Pt presents with hyperorality, hypersexuality, disinhibited behavior
apathetic

Kluver Bucy syndrome, destruction of amygdalas

106

What organ regulates the autonmic nervous system?

Hypothalamus

107

Pt presents with trouble remembering day to day activities, but still retains all of his old memories. What's effed up?

Hippocampus puts Short term mems into long term mems.

Hippocampal amnesia

108

Name the fibers that make up the pathways.

Amygdala --> hypothalamus?

Amygdala --> septal area?

Hippocamus --> septal area?

Cingulate gyrus --> entorhinal fibers?

anterior nucleus of thalamus --> cingulate gyrus

Septal area to hypothalamus?

Stria terminalis

Ventral amygdalofugal fibers

fornix

Medial mammillary nuclei

Mammillothalamic tract

MFB = dopaminergic

109

What may cause olfactor hallucinations?

lesion of temporal lobe, hippocampus, amygdala, medial dorsla thalamic nuclei?

110

A pt presents with a chief complaint of difficulty learning new tasks, understanding written material, and confabulation. Dx? Mx? Cause?

Dx: Korsakoff's syndrome
- mammillary bodies degenerate
can't convert short term to long term
cause: thiamine deficiency commonly seen in alcoholics

111

What is the fxn of ependymal cells?

move CSF

112

Which substance has a higher pH, CSF or Blood?

Blood!!!

113

What are the components of a Blood Brain Barrier?

Endothelial cell layer, Basement membrane, Pericytes, Foot processes of astrocytes and oligodendrocytes

114

What is the fxn of OVLT? Area postrema?
Subfornical organ? (median eminence of hypothalamus)
P. Pituitary?

circumventriular organs

OVLT = osmotic sensing
Area postrema - vomiting reflex for toxins
Subfornical: sensory

Endorine stuff for PP.

115

Glut 3 transports what?
Glut 5 transports what?

Glut 3: neurons

GLUT 5: microglia

116

Where is NKCC located? What helpers does it have?

Apical side, brings in K, Na, Cl. back across her.
Endothelin 1 and 3

117

What are the rate limiting enzymes for the production of Epinephrine and serotonin?

Tyrosine hydroxylase (tyrosine to dopa)
PNMT NE-->Epi

Tryptophan hydroxylase (tryptophan to serotonin)

118

For Epi/NE what are the receptors and terminators?

Histamine?

Serotonin?

Receptors: alpha beta; terminators: COMT: inactivates epi; MAO - degades NE/serotonin

Receptor: H1, H2
terminator: diamine oxidase

Serotonin:
G proteins
5HT2a - smooth muscle
5HT2c - body weight
5HT3 - vomiting
5HT6 - drug targets

119

Fxns of dopamine?

Tons of functions:
Substantia nigra: Motor - Parkinsons
Mesolimbic: VTA --> nucleus accumbens - plays role in reward, pleasure addiction
Mesocrtical: VTA --> frontal cortex
Tuberoinfundibular: hypothalamus --> A pit, suppreses prolactin

120

Acetylcholine
- Location of synthesis
- Temrination
- Receptor types
Fxn?

Location:
- pons midbrain
-septal nuclei, nucleus basalis
-pontomesncephalotegmental complex
Uses VAchT

Termination: acetylcholinesterase

Receptor type:
- Nicotinic = opens Na channels, NMJ
Muscarininc = M1, M3, M5 = IP3
M2 Cadiac
M4 Gi

Fxn: wakefulness for learning and memory

121

What are the inhibitory proteins?
What are their:
Location of synthesis?
Enzymes?
Termination?
Receptor tyeps?
Fxns?

Location:
- Gaba = cortex/cerebellum, with glutamtae decarboxylase
-Glycine = spinal cord, strychnines

Termination: Gaba transaminase

Receptors:
GABAa - ionotropic; uses cholrine to inhibit. Also benzodiazepine receptor enhanves inhibition

GABAb - metabotropic, K conductance
Glycine: GlyR? poisoin

Fxn:
GABA & Glycine - inhibit

122

What are the excitatory proteins?
What are their:
Location of synthesis?
Enzymes?
Termination?
Receptor tyeps?
Fxns?

location: presynaptic neuron

alpha ketoglutamate --> glutamate via glutaminase

Termination: GLIA

Receptor types:
- AMPA: Fast, voltage dependent; premotor for UMN
- NMDA: slow, but strong EPSP. Must have Glycine and glutamate to kick off Mg, plus PCP blocks this as well!! Long term synaptic changes, learning/memory
NMDAs - excitotoxicity

123

What are the excitatory proteins?
What are their:
Location of synthesis?
Enzymes?
Termination?
Receptor tyeps?
Fxns?

ENDORPHINS
- derived from: POMC

ENKEPHALINS
- derived from: Proenkephalins

DYNORPHINS
- derived from: prodynorphins

Receptors of all of them:
Mu: analgesia, respiratory depression. Increases K+ = Hyperpolarizes

Kappa: analgesia, diruesis, sedation, dysphoria. Decrease Ca

Delta: analgesia, decrease Ca

Nociphetin: tolerance to opioids, increases pain.

Fxn: Turn bad feelings into good feelings.

124

What are the excitatory proteins?
What are their:
Location of synthesis?
Enzymes?
Termination?
Receptor tyeps?
Fxns?

Location: ?

Enzymes: made in post synaptic cleft and retrograde actions

Receptor type:
CBI --> most abundant GPCR in brain
- decrease adenylyl cyclase activity

fxn:
CB1 = decrease NT release to protect against excitotoxicity. modulates nociception, protect against cytotoxicity

CB2: Binds 2 AG
Brain- alzheimers
Immune - antifinflamatory
viscera - IBD

125

How does excitoxicity work?

ATP = 0 --> NaK shuts off --> cell depolarizes,--> AP releases EAAs, -->Na gets all used up, --> tons of glutamate in cleft--> increased calcium

Increased Ca activates
1. phospholipase A2
2. Calciuneurin
3. Mu calpain
4. Apoptosis

126

The increased Ca activates what 4 systems, and how do they work?

1. phospholipase A2
- Arachidonate damages membrane by acting as a ryanodine receptor on ER - unfolded protein response
2. Calciuneurin
activates Nitric Oxide
3. Mu calpain
Proteolysis via Spectrin and eIF4G
4. Apoptosis of cells
Bcl2 is inhibited

127

In an ischemic patient, what happens when you give them O2?

Neuron is altered, and when you give them O2 it becomes free radicals.

O2 = ATP = kinases = phosphrylate IF2a = caspace 3

128

A pt can open their eyes and track things, but they do not responsd to auditory stimuli, pain or hunger. What is this called and what caused it?

Vegetative.
Arousal but no awareness
From hyperpolarization

129

Describe the states of awareness in regards to Arousal and Awareness
Normal consciousness
COma
Vegetative
Miniimally conscious
Locked in

Normal: arousal and awareness high

COma: Arousal and awareness low

Vegetative state: Arousal high, Awareness some.

Minimally conscious: high arousal, low awareness, EEG monitored.

Locked in: eerything's there you just can't move.

130

What are the 5 arousal systems?

1. Excitatory amino acid via RAS and parabrachial nuclei
2. cholinergic (PPT)
3. noradrenergic (Locus Coeruleus
4. Serotonergic (raphe nuclei
5. Dopaminergic (VTA

131

Cholinergic
Origin/
Pathways?
Fx?

Origin: Pedunculopntine tegmental

Dorsal and ventral pathway

uses acetylcholine arousal. Baseline

132

Noradrenergic origin pathway fx

Locus coeruleus
ascending, descending
fxn: awareness

133

Serotongeric

Raphe nuclei

Dorsal and ventral pthas

Same as everything, but this also has quiet awareness and mood

134

What neurotransmitters are vasoconstrictors?

NPPY Neuropeptide Y
NE/Epi

135

If a pt presents with low respiration, what opioid receptor is being stimulated?
What if teh pt expereinces analgesia and dysphoria? Just analgesia?

Mu

Analgesia and dysphoria = Kappa

Analgesia only = delta

136

What is the action of 2-AG?

Reduces Excitatory AA, which reduces effects of excitotoxicity

137

What neuotransmitter increases edema?

NO

138

What is the main inhibitor of the lower central nervous system

glycine

139

What NTs are found in the following:
- Parabrachial nuclei?
- Pediculopontine tegemental nucleus?
- Locus Ceruleus
- Raphe nuclei
- Tubulomammary
- Tubuloinfundibular
- Ventral Tegmental area
- Pontomesencephalic
-Laterodorsal nuclei?

Parabrachial & RAS = Excitatory amino acids

Pediculopontine tegemental nucleus: Acetylcholine

Locus ceruleus : Norepinephrine

Raphe nuclei: Serotonin

Tuberomammillary: histamine

Tubuloinfundibular: anterior pituitary

VTA: Dopamine

Pontomesencephalic: Ach

Laterodorsal nuclei: ACh

140

Ischemia is caused by what ion? What receptor is associated with this ion?

Calcium.
NMDA

141

What is the effect of Hydrocephalus on Cerebral blood flow? how?

Decreases it

Increase ICP cuts off venous flow, which decreases the cerebral blood flow

142

What is the path of Dopamine projection in the brain?

Substantia nigra --> VTA --> Nucleus accumbens in the limbic system; and the cortex.

143

What NT is crucial for making up and awareness? Where is this synthesized?

What about wakefulness?

NE. Locus coeruleus

Histamine - tuberomammilary

144

What NT is crucial for learning and memory? PLace it's made?

What about consciuosness and awwareness?

Ach - substantia nigra and VTA

Conscious awareness
GABA, COrtex/Cerebellum

145

What is derived from POMC?

All opiods

146

Where arethe CBI receptors located and what do they recept? Fxn?

Where are CB2 receptors located?

Axons and presynaptic terminals in CNS and PNS. Recept Opiods - 2AG and anadaminde. Abundant GPCR
Decrease NT release by inhibiting adenylyl cyclase

CB2:
- found on microglia. Big in anti-inflammation and bladder stuff.

147

What is the NMDA for?

What activates them?

What blocks the channel, what opens it?

For excitatory NTs
NMDA: CA INFLUX

Glutamate and aspartate activate them to activate Ca influx

Blocks: PCP and Mg
Opens: Glycine + glutamate/aspartate

148

What is the AMPA for?

What activates them?

Na/K; SODIUM INFLUX

These activate NMDA channels

149

What excitatory receptors are primary afferents and premotor?

Long- term changes in synaptic strength and learning, memory

Learning memory and motor?

AMPA/non NMDA

NMDARs

Metabotropic

150

What role does Nitric oxide play in excitation?

NMDA --> Calcium influx --> activates calcineurin --> activates Nitric Oxide synthase to make more NO from arginine

NO can then relax smooth muscle, increase edema, produce free radicals, and control cardiovascular and respiration.

151

What information runs through RAS?
What NT?
Pathways?

all ascending sensory information is relayed through RAS,
uses glutamate to stimulate...
Ventral Pathway: the cortex and
Dorsal pathway: thalamus

152

Parabrachial nuclei complex's function is to?
Pathways?

Generate respiration patterns while awake... sometimes hyperventilation.
Uses Glutamate.

Vental only straight to cortex

153

What represents baseline cortical activity?

Excitatory amino acids, and also ACh

154

What is the PPT (pedunculopontine tegemental) and LDT (Laterodorsal nuclei)?
Pathway?

The arousal system that uses acetylcholine.

Dorsal and ventral

155

What pathway is the primary cause of wakefulness and REM sleep? What helps with REM and wakefulnes?

Arousal II, PPT/LDT with ACh
Monoamines help.

156

WHat is special about the Arousal III system - locus coeruleus?

Has ascending (dorsal and ventral pathways to cortex and thalamus from the RAS) but also descneding: sensory modulation called the dorsal noradrenergic bundle!

157

What pathway is crucial in startle and altering rsponses? What NT?

Locus Coerulus, Norepinephrine

158

What Arousal pathway is inc harge of quiet awareness, mood and affect, modulation of pain?

Arousal IV, Raphe nuclei = serotonin!

159

What arousal pathway is in charge of cognitive functions, motor activity, and emotion?

Ventral tegemental nuclei = DOPAMINE!

160

What does it mean to be in a persistent vegetative state?

Hyperpolarized all the tiiime.

161

What NT allows us to be aware?

NE and Serotonin

162

What NT allows us to be alert and have many cognitive functions?

Dopamine!

163

A patient has lost sensation in his right lower
extremity. If there is a lesion in the pons, which of
the following is most likely to be true?

Lateral most portion of the left medial lemniscus

Remember that the arms and legs switch after the decussation; the lateral cuneatus becomes the medial in the medulla!

164

What lesion i associated with relfex bladder?

Spinal shock

165

A pt presents with flaccid legs, patella and achilles DTRs of 0/4 and incontinence. Where is the lesion?

ABOVE S2 for bladder. L1

166

What lobe of the brain does higher order processing of visual information and learning and memory?

Temporal

167

Pt presentswith down and out eye, what herniation may have occured?

Uncus goes under the tectorial notch

168

A pt presents with respiratory arrest upon a blow to the head. What is herniated and where?

Tonsillar herniation in the foramen magnum

169

A pt presents with a head injury, there are no lesions on MRI and the neuro exam is WNL. A few days later he is brought back into the ER. What hemorrhage?

Subdural

170

What causes macular sparing?

Lesion in the visual cortex. So this is behind everything, all the way in the occipital lobe.

171

Trapezoid body originates from what structure?

Anterior portion of anterior cochlear nucleus

172

If lateral lemniscus gets cut, what results?

Bilateral hearing loss, worse in the left ear.

173

What ist he fxn of hte OCB?

Dampen sound from loud noises = olivocochlear bundle

174

The cerebral cortex layers are arranged oldest to youngest. Is I or VI older?

older - VI

175

The posterior pituitary comes from what, embryologically?

diencephalon, downgrowth of diencephalon!

Anterior from stomoedum, comes up from mouth

176

Pt presents with difficulty swallowing, talking, muscle weakness, + babinski. They are hyperrefelxive and spastic. They also have weakness, atrophy, and fasciculations

Their sensory is okay.

ALS Amyotrophic lateral sclerosis

Mix of UMN and LMN bc the degeneration of ventral horn and UMN tract

177

In what artery occulsions do you lose motor function?

anterior spinal --> gets lateral corticospinal tract
Lenticulospinal arteries --> Gets PLIC
MCA = gets somatosensory cortex
ACA = gets somatosensory cortex
Basilar = Quadriplegia, gets corticospinal and corticobulbar

178

A pt presents to the ER following a head injury. Upon examination he is A&Ox3. a few minutes later, there is a rapid mental decline. Dx?

Epidural hematoma = classic lucid interval followed by rapid mental decline.

179

What arteries are space occupying and therefore shift midline? What is the bleed like?

subdural only
Bridging VEINS so takes a while to leak out. Caused from trauma

180

An epidural hematoma looks like what?

biconvex, does not cros suture lines.

181

what hemorrhage can happen in cases otehr than trauma?

Subdural hematoma, can happen from alcohol or old age. It's slow.

182

What is resopnsible for emotion of memory?

Amygdala

183

What nerve does sensory to throat, tongue, ear?

Glosspharyngeal

184

What cranial nerves do sensory to ear?

Facial = external
Vagus = external ear
Glossopharyngeal = inner ear

185

What is neuropil?

Fibrous intercellular network of cellular processes emerging from neurons anglial cells

186

What is nissl substance?

Bunch of stuff found in body of a neuron

187

Pt has throat and inner pain, what nerve?

Glossopharyngeal

188

However, upon palpation of the RUQ, when the patient takes a
deep breath it, there is sudden pain. what pain fibers?

C fibers, bc they do visceral

189

A pt presents with sensory loss and paralysis in the lower right limb. Dx?

Anterior cerebral artery. ANTERIOR DOES LEGS

POSTERIOR DOES ARMS

190

What pathway activates antigravity reflexes?

Pontine reticular pathway

191

A blockage of the median and lateral aperatures can cause what disease?

Arnold Chiari Malformation or Dandy Walker Cyst

192

A pt presents witha combination of infratentorial external hydrocephalus and internal hydrocephalus. What was this caused by, and do the ventricles hypertrophy?

Yes, ventricles hypertrophy.
Caused by meningitis.

193

What's the drainage of the spinal cord?

Internal venous plexus of Batson,

194

Biggest sensory density?

Lips and fingertips

195

The core of anuclei body receives what inputs? What about the outer shells?

Outer: Muscle spindles, joints, pacinian

Core; adapting afferents?

196

Arcuate lamina separates what?

VPL and VPM

197

Local circuit interneurons are excitatory or inhibitory?

inhibitory

198

which fibers innervate extrafulsa fibers?
Intrafusal?

alpha

Gamma

199

Difference between rigidity and spastic paralysis

Rigidity: Non velocity dependant increase in resistance to passive motion in all directions

200

Spinal shock does what 2 things:

Gives you LMN Signs and Symptoms for a few weeks.
Also inhibits reflexes

201

In the occipital pole, what part of the retina is represented the most posteriorly and the largest?

Macula

202

What is the function of corticotectal fibrs?
Pretectal?

Control LMN of CN III, IV, VI

Receive afferent from optic tract and LGN
Pretectal = intensity of light chagnes

203

Argyll Robertson pupil is what?

Pupil does not constrict under light reflex, bu it does under the accommodation reflex

204

What are the zones of the hypothalamus?

Preoptic area

Medial preoptic = Neurons that make GnRH

Periventricular zone: Adjacent to 3rd ventricle, makes hormones for A pit

Medial Zone: Has tons of nuclei

Lateral Zone: Feeding center and medial forebrain bundle.

Mammilary has the mamillary bodies I think

205

What does the fornix arise from?

Subiculum (precommissural) and hippocampus (postcommissural)

206

Do the auditory tract

Spiral ganglia
- AVCN --> VENTRAL ACOUSTIC STRIA/TRAPEZOID BODY --> Superior olivary nucleus, contralateral and ipsilaterally, and Inferior colliculus

- VPCN --> INTERMEDIATE ACOUSTIC STRIA --> Nucleus Lateral lemniscus and inferior colliculus

- DCN --> DORSAL ACOUSTIC STRIA --> Nucleus Lateral lemniscus and inferior colliculus


--> all this to medial geniculate body

207

What's the nucleus accumbens?

Addiction and chronic pain
in from amygdala and hippocalmpus, efferent to hypothalmus, and brainstem

208

draw the circuit of Papez

CIngulate gyrus --> entorhinal hippocampus --> mammillary body --> Anterior nucleus

Medial mamillary nuclei connects cingulate to entorhinal.

209

What is the subiculum?

What are teh afferents into the hypothalamus?

Efferents from hippocampus to form fornix

Afferents: Perforant pathway
CA3 --> CA1 --> Subiculum

210

What is the formation of hippocampus?

External layer is molecular
MIddle layer = granule and pyramidal
Inner layer = polymorphic

211

Interposed nucleis is another word for

emboliform and globose