Neurology Flashcards
(127 cards)
1
Q
Divisions of the Brain
A
Cerebellum
Cerebrum
Brain Stem
2
Q
Cerebrum
A
Divided into left + right hemispheres
Connected by corpus callosum
Interprets sensory impulses, controls voluntary muscles, memory, thought, reasoning
3
Q
Cerebral Cortex
A
Outer layer of grey matter
4
Q
Cerebral Medulla
A
White matter
5
Q
Lobes of cerebrum
A
Frontal, parietal, temporal, occipital
6
Q
Cerebellum
A
Controls posture and fine motor control
7
Q
Meninges
A
Dura mater
Arachnoid mater
Pia mater
Supports structures and vasculature
8
Q
Brainstem
A
Midbrain
Pons
Medulla oblongata
9
Q
Midbrain
A
Just below cerebellum
Connects cerebrum to lower centers
10
Q
Pons
A
Between mid brain and medulla
Conduction network between spinal cord and brain
Respiratory centre
11
Q
Medulla Oblongata
A
Enlargement of cord as it enters cranial nerve through foramen magnum
Cardiac Centre
Vasomotor centre
Respiratory centre
Vomiting
12
Q
Spinal Cord
A
From medulla to L1
Same coverings as brain
13
Q
Reticular Activating System
A
Small portion of brain stem
Collection of neurons responsible for wakefulness and behaviour
14
Q
Blood Supply to Brain
A
16% CO and 20% of total oxygen consumption
Supplied from carotid arteries
10s reserve
Constant supply of glucose
Drainage by jugular veins
15
Q
Somatic Nervous System
A
Conscious control
Spinal + cranial nerves
16
Q
Autonomic
A
Sympathetic
Parasympathetic
17
Q
Spinal nerves #
A
31 pairs
18
Q
Cranial nerves #
A
12
19
Q
Nervous Tissue Function
A
Transmit nerve impulses
Interpretation
Storage (memory)
20
Q
Nervous System Function
A
Receptors
Sensory Input
Integration center
Motor output
Effectors
21
Q
Neurons
A
Relay impulse from body to spinal cord and brain
Messages from brain to all compartments of the body
22
Q
Afferent
A
Sensory
Carry impulses toward brain and spinal cord from tissues and organs
23
Q
Efferent
A
Motor
Carry away from brain and spinal cord
24
Q
Interneurons
A
Connection between neurons
Exclusively in brain + spinal cord
25
3 Parts of Neurons
Dendrite
Cell body
Axon
26
Nervous Tissue Properties
Excitability
Conductivity
27
Cranial Nerve Names
I. Olfactory
II. Optic
III. Occulomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulocochlear/auditory
IX. Glossopharyngeal
X. Vagus
XI. Spinal accessory
XII. Hypoglossal
28
Breakdown of Spinal Nerves
8 Cervical
12 Thoracic
5 Lumbar
5 Sacral
1 Coccygeal
29
Cervical Plexus
C1-C4
Skin and muscles of shoulder and neck
Diaphragm
30
Phrenic Nerve
Innervates diaphragm
C3,4,5
31
Brachial Plexus
C5-C8, T1
Skin and muscles of arm
32
Axillary nerve
Muscles of shoulder
33
Radial nerve
Back of arm, forearm, hand, thumb, 2 fingers (wrist drop)
34
Medial Nerve
Forearm, hand
Carpal tunnel
35
Ulnar Nerve
Wrist and hand muscles (claw hand)
36
Lumbosacral Plexus
T12, L1-5, S1-4
Lower torso + legs
37
Sciatic Nerve
Back of leg, buttocks
38
Femoral Nerve
Lower abdomen, front of thigh, medial leg and foot
39
Peroneal Nerve
Lateral leg, foot
40
Tibial Nerve
Back of leg, foot
41
Autonomic Neurotransmitters
Acetylcholine + Epinephrine
42
Cholinergic
Neurons releasing ACh (PNS)
Parasympathetic pre + post ganglionic neurons
Sympathetic preganglionic
43
Adrenergic
Neurons releasing epi (SNS)
Sympathetic post ganglionic
44
Sympathetic Chain Ganglia
Sympathetic axon collaterals bridge adjacent ganglia
In same side of vertebral column
45
Breakdown of Sympathetic Chain Ganglia
3 Cervical
11 Thoracic
4 Lumbar
4 Sacral
46
Alpha 1 receptors
Blood vessel vasoconstriction
47
Alpha 2 Receptors
Presynaptic neuron, eliminates release of NE
48
Beta 1
Heart, increases contractility and heart rate
49
Beta 2
Lungs, skeletal muscle, dilation
50
Norepinephrine
2 main receptors (alpha + beta)
51
NE Deactivation
2 enzymes MAO and COMT
Slower than ACh deactivation
52
Parasympathetic Neurons
Cell bodies in ganglion near effector organ
Synapse with one postganglionic neuron
53
Parasympathetic Effect
Restores vegetative function
Slows body function
Speeds up body functions (GI motility)
54
ACh deactivation
Acetylcholinesterase in synaptic cleft
55
2 Components of Consciousness
Content
Arousal
56
Anisocoria
Unequal pupils
57
Doll's Eye Test
Move head side to side or up and down slow then quick
Should focus on fixed point
Abnormal is eyes fixed and move with head
Indicates brainstem dysfunction
58
Nystagmus
Involuntary but rhythmic oscillation of eyes
59
Hoover's Sign
Flex contralateral leg against resistance
Involuntary extension of opposite leg won't occur in cases of paresis with psychiatric etiology
60
Chair Test
Pts with gait disturbances
Propel self forward while seated, then walk same distance
Functional gait disturbance can ambulate chair but not standing
61
Scalp acronym
Skin
SubCutaneous tissue
Adipose
Ligament
Pericranium
62
Syncope
Transient complete LOC due to cerebral ischemia followed by recovery to mental status
Rapid onset
Short duration
Spontaneous complete recovery
63
Neually mediated syncope
Vasovagal
Carotid sinus sickness
Situational
64
Cardiac Syncope
Dysrhythmias
Structural disease
65
Cerebrovascular/neurologic syncope
Migraine
Subclavian steal
TIA
Carotid artery disease
66
Orthostatic Syncope
Autonomic failure
Drug-induced
Volume depletion
67
Patho Neurally Mediated Syncope
Autonomic reflex
Vasodilation + bradycardia
Systemic hypotension + cerebral hypo perfusion
LOC
68
Carotid Sinus Sickness
Over-activity or over-stimulation of carotid sinus
Quick head movement
Tight collar
Shaving over sinus area
Tumor or other growth
Emotional stress
69
Orthostatic Syncope Patho
Upright position causes hypotension and cerebral hypoperfusion without bradycardia
Standing up with exertion or with prolonged standing in crowds
Hypovolemia/faulty ANS
70
Medications affecting Orthostatic Syncope
Diuretics
B-adrenergic blockers
Anti-hypertensives
NTG
71
Common Dysrhythmias causing syncope
Transient VT
AV block
Sinus bradycardia
SVT, VF
Sick sinus syndrome
Pacemaker malfunction
Long QT
72
Structural Cardiac Syncope
Cardiac Ischemia
Outflow obstruction
Restrictive cardiomyopathy
Pericardial tamponade
PE
Aortic dissection
Congenital
73
Subclavian Steal
Occlusion/stenosis of subclavian artery or innominate artery
Causes retrograde flow in ipsilateral vertebral artery
Collateral pathway takes blood from contralateral vertebral artery and basilar artery to supply blood to arm
74
Pre-syncopal S/Sx
Weakness, headache, blurred vision, diaphoresis, n/v
75
Post Syncope S/Sx
Persistent drowsiness, headache, dizziness, nausea
76
S/Sx Cardiac Syncope
Chest pain
SOB
Palpitations
Supine syncope
Exercise syncope
77
S/Sx Reflex mediated syncope
Abdo pain
Nausea
Light-headedness
78
Seizures
Sudden change in behaviour due to excessive electrical activity in brain
79
Causes of Seizures
Electrolyte imbalances
Idiopathic
Epilepsy
Injury/head trauma
Infection
Brain tumor
Stork
Hypoglycemia
Drug use
Alcohol withdrawal
High fever
Eclampsia
80
Causes of Epilepsy
Stroke
Brain tumor
Brain infection
Past head injury
Metabolic problems
Neurological conditions
Genetic factors
81
Status Epilepticus
Prolonged seizures/numerous seizures without complete recovery between them (>5 min)
One constant seizure lasting longer than 5 min
82
Febrile Seizures
Fever >38
Child younger than 6
No CNS infection
NO metabolic abnormality
No history of previous seizures
Generalized vs focal
Short
Single rather than multiple
83
Benzodiazepine Actions
Enhance binding of GABA to GABA receptors in CNS
Opening of Cl channels
Hyperpolarization of cell membrane, decreasing ability to reach action potential
84
Midazolam
Short acting water soluble
Rapid administration causes hypotension + respiratory depresison
85
Phenytoin
Dilantin
Alters neuronal membrane permeability to sodium
Stabilizes membranes and suppresses firing
Does not act as CNS depressant
Effective in partial seizures + tonic-clonic and status
Worsens petit man
Crosses placental barrier
86
Carbamazepine
Tegretol
Blocks neuronal sodium channels
Inhibits repetitive action potentials
Drug for partial seizures
CNS depressant and eventually hepatotoxic
Metabolism inhibited by several drugs
87
Phenobarbital
Unknown mechanism but generally CNS depressant
Effective in treatment of recurrent seizures
Acute presentations of tonic-clonic and in adults that don't respond to diazepam
Risk of rebound seizures
88
Valproic Acid
Enhances neuronal inhibitory synapses
Myoclonic seizures
89
Primidone
Similar to phenobarbital
90
Benzodiazepine Antidote
Flumazenil
91
Adverse effects Midazolam
CNS depression
Resp depression
Hypotension
N/v
Paradoxical CNS stimulation
Profound risk in elderly, debilitated, chronic illness
92
IV Pharmacokinetics Midazolam
Sedation in 3-5 min
Anterograde amnesia in 1-5 min, persists for 20-40 min
Elimination in 1.8-6.4
93
IM Pharmacokinetics Midazolam
Peak concentration in 30 min
Peak sedation 30-60 min
Duration ~1hour
94
Midaz Routes Preferred
Adults: IM -> IV
Ped: Buccal -> IN -> IM
95
Ketamine MOA
Blocks NMDA of GABA receptors
Antidepressive effects due to blockage of HCN1 receptors
Affect on cholinergic, aminergic and opioid systems
96
Side Effects Ketamine
Tachycardia
HTn
Increased ICP
Laryngospasm
Hypersalivation
N/v
Confusion, hallucination, paranoia
Impaired motor coordination
97
Anterior Circulation Stroke
Most common
Like typical stroke
MCA, ACA, and anterior choroidal artery
98
Posterior Circulation Stroke
Difficult to detect with vague, non-specific symptoms
99
Episodic Vestibular Syndrome
Symptoms resolved
Vasovagal/panic attack
100
Triggered Vestibular Syndrom
Pt sits up and dizzy, resolves when back down
Trigger causes symptom, removal of trigger resolves symptoms
101
Acute Vestibular Syndrome
Persistent Symptoms
Trigger, but no improvement with removal of trigger
Possible posterior circulation stroke
102
Pontine Stroke S/Sx
Pinpoint pupils
Bilateral paralysis/weakness
Vertigo
double vision
Locked in syndrome
103
CVA Mimickers
Hypoglycemia
Encephalopathy
Metabolic
Infections
Systemic
Mass lesions
Migraines
transient global amnesia
104
Todd's Paralysis
Post-ictal hemiparesis
Focal weakness to one side post seizure lasting 20 min - 48 hours
105
Corticospinal Tract
Damage causes ipsilateral weakness, spasticity, increased deep tendon reflexes, babinski's sign
106
Spinothalamic tract
Damage causes loss of pain + temperature sensation
107
Dorsal Column
Injury causes ipsilateral loss of vibration and proprioception sensation
108
Neurogenic Shock
Loss of vasomotor tone and sympathetic nervous system tone
Hypotension + bradycardia + poikilothermia
Occurs within 30 min of cord injury T5 or above, lasts up to 6 weeks
109
Spinal Shock
Acute spinal cord injury
Absence of all voluntary and reflex neurologic activity below site of injury
Lasts days to months
110
Neurogenic Pulmonary Edema
Form of ARDS, increase in pulmonary interstitial and alveolar fluid
Caused by seizures, cerebral hemorrhage, head injury
111
S/Sx of Neurogenic Pulmonary Edema
Sudden dyspnea, mild hemoptysis
Tachypnea
Tachycardia
Bibasilar crackles
Respiratory distress
Pulmonary edema with normal JV pressure and absence of cardiac gallop
Fever
112
Autonomic Dysreflexia
Body's resolution of effects of spinal shock
Injuries at or above T6
Sudden HTN, bradycardia, headache, blurred vision, sweating + flushing skin
113
Myasthenia Gravis
Auto immune neuromuscular disorder
Signs of muscle weakness of voluntary muscles
Reduction in ACh receptors at synaptic cleft
114
S/Sx Myasthenia Gravis
Drooping eyelids
Double vision
Slurred speech
Nasal quality to speak
Drooling
Nasal regurgitation
Weak cough
problems chewing + swallowing
Trouble sitting up/holding head erect
Trouble walking
Feeling SOB
115
Complications of Myasthenia Gravis
Myasthenia crisis
Cholinergic crisis
Pneumonia
Sepsis
Complications related to immobility
Respiratory distress
Choking
116
Bells Palsy
Rapid onset
15-60 yo
7th cranial nerve affected
Unilateral/bilateral facial weakness
Majority have full recovery
117
Causes of Bells Palsy
Infection
Hemorrhage
Tumor
Meningitis
Local trauma
118
S/Sx Bells Palsy
Unilateral facial weakness
Aching pain around angle of jaw/behind ear
Headache
tearing
Unilateral mouth drooling + drooping
Inability to control facial expression in smiling, squinting, blinking/closing eyelid
Loss of sensation of taste
119
Complications Bell's Palsy
Corneal ulceration + blindness
Impaired nutrition
Long-term psycho social problems
120
Guillan Barre Syndrome
Widespread inflammation or demyelination of ascending/descending nerves in peripheral nervous system
Weakness/paralysis
Muscles unable to respond to commands from brain due to decreased conduction
121
Cause of Guillian Barre Syndrom
Unknown
>50% non specific infection 10-14 days prior
122
S/Sx Guillian Barre
Lower extremity weakness leading to upper extremity and facial weakness
Sensory and motor loss
Complete paralysis with respiratory failure within 48 hours
Paralysis progressing in 2-3 weeks
HTN
Hypotension
Dysrhythmias
Circulatory collapse
123
Complications Guillian Barre
Cardiac failure
Respiratory failure
Infection + sepsis
Venous thrombosis
Pulmonary embolus
124
Cause of Parkinson's
Lack of cells producing dopamine
Inability to relay information from cell to cell
125
S/Sx of Parkinsons
Muscle rigidity and akinesia
Jerky tremor
Difficulty walking
High pitched monotone voice
Mask like facial expression
Loss of posture control
Difficulty speaking/swallowing
Decreases with purposeful movement and sleep
126
ALS
Progressive degeneration of nerve cells in spinal cord and brain
Unknown cause, suspected excess glutamate
127
S/Sx ALS
Twitching + cramping muscles
Loss of motor control in hands + arms
Increased weakness in diaphragm and chest muscles
tripping and falling
Fatigue
Slurred/thick speech
Difficulty breathing + swallowing
Paralysis
Cardiac arrhythmia
Pneumonia
Respiratory arrest
