Neurology Falcon Review 1 Flashcards Preview

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Flashcards in Neurology Falcon Review 1 Deck (134):
1

What are the major structures of the brain

From anterior to posterior
1. Telencephalon
2. diencephalon
3. Mesencephalon
4. Metencephalon
5. Myelencephalon

Remember the M's being Alphabetical order.

2

What develops from the telencephalon

Cerebral cortex
basal ganglia

3

What develops from the diencephalon

Thalamus
hypothalamus

4

What develops from the mesencephalon

Midbrain
– cerebral crura
– substantia nigra
– CN's 3 and 4

5

What develops from metencephalon

Cerebellum
Pons
CN's 5, 6, 7, 8

6

What develops from the myelencephalon

Medulla oblongata
CN's 9, 10, 11, 12

7

What are the main lobes of the cerebral cortex

Frontal
parietal
Occipital
temporal

8

What is the function of the frontal lobe

Motor function
problem-solving (executive function)
spontaneity
language
impulse control
social behavior
largest in humans

9

What is the general function of the parietal lobe

1. awareness
2. spatial perception

10

What is neglect syndrome

Results in the neglect of part of the body or space on the contralateral side; can impair many self-care skills such as dressing and washing

11

What is Gerstmann's syndrome

A left-sided lesion to the parietal lobe causing:
– R/L confusion
– Agraphia
– Acalcula
– Aphasia
– visual agnosia

12

What will a lesion to one side of the occipital lobe cause

Homonymous loss of vision with exactly the same "field cut" in both eyes

13

What are the effects of a left temporal lobe lesion

Disturbs recognition of words

imperative memory of verbal material

14

What are the effects of a right temporal lobe lesion

– can cause a loss of inhibition of talking
– inhibition of recall of music and drawing

15

What are the functions of the temporal lobe

Sensory
language
memory
behavior

16

What function does the precentral gyrus have

Motor strip

17

What function does the Post Central gyrus serve

Somatosensory strip

18

The central sulcus separates what 2 areas of the brain

The frontal from the parietal lobe

19

What areas of the brain are separated by the lateral sulcus (sylvian fissures)

Separates frontal and parietal lobe from the temporal lobe

20

What should always be identified from a sagittal view MRI

The central sulcus
cerebellum
Pons
Medulla
corpus callosum
tonsils

21

What may low-lying tonsils cause

Increased intra-cranial pressure

22

Is the genu of corpus callosum anterior posterior

Anterior

the splenium of the corpus callosum is posterior

23

On MRI T1 weighted sequence is CSF black or white

Black

24

On an MRI T2 weighted sequence is CSF black or white

White

25

when is a CT bone window useful

For traumatic brain injury and skull fractures

26

When is a CT brain window useful

Hemorrhage and atrophy

27

What modality is useful for detecting demyelination disease and old infarcts

T2 weighted MRI

28

What 3 things are bright on axial CT brain window

Bone
blood
calcifications

29

What 2 brain regions are derived from the diencephalon

Thalamus
hypothalamus

30

What is the role of the thalamus

Central relay station for all sensory and motor information EXCEPT OLFACTION

31

What is the role the hypothalamus

Sympathetic control
parasympathetic control
temperature control
satiety center

32

What is the Marcus-Gunn pupil

– paradoxical dilation of pupil with the light on the pupil
– caused by delay in conduction of the optic nerve typical of demyelinating disease such as MS

33

What is the only cranial nerve that innervates the contralateral eye

Trochlear nerve
– supplies contralateral superior oblique

34

What will lesion of cranial nerve 7 demonstrate

It will affect the entire face on one side. A stroke will affect only the lower part of the face

35

What direction are afferent fibers traveling

Towards the CNS

36

what direction are efferent fibers traveling

Away from the CNS
– effector nerves are efferent

37

What is cranial nerve 9

Glossopharyngeal nerve

38

What is the function of the glossopharyngeal nerve

Palatal muscles
palatal and pharynx sensation
taste of her posterior one 3rd of the tongue

gag reflex (afferent limb)

39

What is the function of the vagus nerve

Palatal muscles
pharynx and larynx sensation
parasympathetic to viscera (heart, G.I. tract)

gag reflex (efferent limb)

40

What is cranial nerve 12

Hypoglossal nerve

41

What are the 4 main arteries that carry blood to the brain

Carotids X2
Vertebrals

42

What does the anterior cerebral artery supply to

Primarily supplies the frontal and medial aspect of the frontal and parietal lobes

43

What does the middle cerebral artery supply

The vast majority of the brain
– the lateral surface
– is a branch of the internal carotid

44

What are the 2 main branches of the middle cerebral artery

Anterior (Brocha's area)
posterior (Vernicke's area)

45

The posterior cerebral artery is a branch of what vessel

Basilar artery

46

Lacuna stroke in the internal capsule will generate what symptoms

Will generally be a pure motor weakness

47

Lacunar stroke in the thalamus will have what signs and symptoms

typically sensory

48

Discuss the anterior spinal artery

It's a fusion of the vertebral arteries, located in the anterior median fissure, supplies the anterior 2/3 of the spinal cord

49

Discuss the posterior spinal arteries

their smaller arteries, derived from the PICA, they form plexus, and supplies the posterior 1/3 of the spinal cord

50

Discuss radicular arteries

They are from the aorta, send collaterals to the spinal cord, and forms the caudal most portion of the anterior spinal artery

51

The deep tendon reflexes the biceps test what nerves

C5, C6

52

The deep tendon reflexes for the brachioradialis test what nerves

C5, C6

53

The deep tendon reflexes for the triceps test what nerves

C7

54

The deep tendon reflexes for the knee test what nerves

L3, L4

55

The deep tendon reflexes for the ankle test what nerves

S1, S2

56

What neurons are in the dorsal horn

Sensory neurons

57

What neurons are in the ventral horn

Motor neurons

58

Discuss the spinothalamic tract

Responsible for pain and temperature
crosses shortly after entering the cord

59

What is the function of the dorsal columns

joint position sense and two-point discrimination
Crosses in the medulla

60

What is the corticospinal tract

Descending motor tract
– extension of internal capsule fibers
– decussate in the lower pyramid
– sends out fibers once it innervates alpha motor neurons

61

What is the dorsal column/medial lemniscus tract

Ascending – touch, position and vibration sensory
– Fasiculous cuneatous = arm
– Fasiculous gracilous = leg

– decussates in brainstem

62

what is the anteriolateral or spinothalamic tract

A sending – pain and temperature sensory
–decussates immediately upon entering spinal cord

63

What is a brown-Sequard lesion

Deficit in pain perception is contralateral to the lesion, the other deficits (weakness, deficit and touch sensation) are ipsilateral

64

what are the symptoms of an upper motor neuron lesion

Weakness
increased reflexes
– Babinski sign
– Hoffman signs
increased tone (spasticity)
muscle hypertrophy

65

What is Babinski sign

Big toe dorsi flexes with stroking a bottom of the foot

66

What is Hoffman sign

Thumb moving inward with flicking of the middle finger of one hand

67

What are the symptoms of a lower motor neuron lesion

Weakness
decreased/absent reflexes
decreased tone (flaccid paralysis)
fasiculations
muscle atrophy

68

What are the four types of peripheral nerve fibers for motor function

Alpha
beta
Gamma
Delta

69

Discuss motor for full nerve fibers

Large size
heavily myelinated, very fast conduction (30 to 110 m/s)

70

What type of sensation or motor function are associated with type A fibers

Various size a A fibers
– proprioception, light touch, sharp pain, vibration

71

What type of motor sensation is associated with C fibers

Slow pain fibers
– small size, no myelination, slow conduction

72

What kind of fibers are associated with autonomic's

B size fibers, some on nation, intermediate speed

73

what is an in the endoneurium

The peripheral nerves covering just outside of the neurilemma

74

What is the perineurium

The peripheral nerve covering around the fascicle

75

What is the epineurium

The peripheral nerve covering around the entire nerve

76

What is the function of the musculocutaneous nerve

Motor function
– elbow flexion
– supination

sensory field
– lateral forearm

77

What is the function of the radial nerve

Motor function
– forearm extension
– wrist extension
– finger extension

sensory field
– dorsal hand/thumb

78

What is the function of the median nerve

Motor function
– abductor pollicis brevis
– wrist flexion
– finger flexion

sensory
– ventral fingers/thumb exceptlateral fourth and fifth digit

79

What is the function of the ulnar nerve

Motor function
– Interossei

sensory
– fourth and fifth digits

80

What is the function of the femoral nerve

Motor
– iliopsoas
– quadriceps

sensory
– upper lateral thigh

81

What is the function of a sciatic nerve

Motor
– knee flexion
– plantar flexion

sensory
– back of the thigh
– sole of the foot

82

What is the function of the common peroneal nerve

Motor
– peroneous brevis
– tibialis anterior
– extension hallicus

sensory
– anterior lower leg
– dorsumof foot

83

What cranial nerves are associated with the parasympathetic nervous system

Craniosacral outflow
– III, VII, IX, X
– sacral 2 through 4

84

What enables the diffuse, nonselective generalization of the sympathetic nervous system

Adrenal medulla

85

What is the sympathetic effects on eye physiology

Contracts the radial muscle (alpha-1)
relaxes the ciliary muscle (B-2)

86

What are the parasympathetic effects on eyephysiology

Contracts the sphincter muscle
contracts the ciliary muscle

87

What is the autonomic influence to the ventricles

Sympathetic's
– increase contractility, conduction and automaticity

parasympathetic's
– there is no parasympathetic innervation to the ventricles

88

What is the parasympathetic influence on the bladder

The contracts the detrusor muscle

relaxes the trigone and sphincter

89

What is the third leading cause of death

Stroke

90

What is the difference between a stroke and a transient ischemic attack (TIA)

Stroke: infarction of brain tissue due to lack of blood flow

TIA: temporary neurologic deficit due to relative ischemia that improves with blood supply is restored (symptoms usually lasting less than one hour typically 20 minutes)

91

What is the pathophysiology of a stroke

Ischemic – 85%
hemorrhagic – 15%

92

What are the causes of a focalcerebral ischemia

1. Embolic
2. Thrombotic
3. Cryptogenic

93

What is the cause of global cerebral ischemia

Hypotension

94

What is the number one risk factor for an ischemic stroke

Hypertension

other risk factors include diabetes, tobacco, prior stroke, heart disease, hypercholesterolemia, age

95

What is CADASIL

Cerebral autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy

– notch 3 gene
– associated with a stroke at a younger age

96

Was the major cause of thrombosis

Atherosclerosis

97

What are the risk factors for atherosclerosis

Age
male
hypertension
smoking
diabetes
hypercholesterolemia

98

One of the common sites affected by thrombosis

Carotid bifurcation
origin of middle cerebral artery
Basilar artery

99

What is aphasia

Inability to use or understand language due to a lesion in the brain

100

What isAlexia

Inability to perceive written words

101

What is agraphia

Inability to write words, not related to weakness or sensory deficit

102

What is dysarthria

Slurred or stuttering speech due to motor weakness of incoordination, while language is intact

103

What is apraxia

Inability to carry out a large motor tasks, not due to motor or sensory deficits or inability to understand

104

What is ataxia

Impairment in the performance and coordination of movements, not due to weakness

105

What is dysphagia

Difficulty swallowing due to motor weakness or incoordination

106

Where is the lesion generally associated with a pure motor hemiplegia

Contralateral pons or internal capsule lacune

107

Where is the lesion with a pure sensory stroke

Contralateral thalamus lacune

108

what is the presentation of a middle cerebral artery syndrome

Hemiparesis (face and arm greater than the leg), aphasia (left; neglect syndrome more common on the right) sensory loss, hemianopsia, eye deviation

109

What is the anterior cerebral artery syndrome presentation

Lower extremity weakness and sensory loss, incontinence, limb apraxia

110

What is the posterior cerebral artery syndrome

Homonymous hemianopsia
sensory loss

111

What imaging modality is better for determining cranial bleeds

CT is better

112

What criteria is used for grading of a stroke

NIH stroke scale

113

How soon after stroke will MRI be positive

Within five minutes of a stroke and will stay positive for up to two weeks

114

When should CADASIL testing be done

In a patient less than 40 years old with no risk factors
– skin biopsy
– hypercoagulable workup

115

What is the treatment for an ischemic stroke

1. ABC's
2. Blood pressure control
– SBP less than 180
– DBP less than 140
3. Anti-platelets
– aspirin
4. Anticoagulation
– heparin (use only in afib and dissection)
5. Thrombolytics
– tPA (only use in first three hours)
6. Rehabilitation
– continued for months to years

116

What is the criteria to use tPA

– Clinical diagnosis of the stroke
– age greater than 18
– time to TP administration less than three hours from onset of symptoms
– head CT without evidence of hemorrhage or large stroke

117

What are the contraindications for the use of tPA

any indication for the potential of increased bleeding

118

What are some approaches to secondary prevention of a stroke

1. Antiplatelet agents
– Aspirin
– clopidogrel
– dipyridamol
2. Anticoagulation for atrial fibrillation or clot
3. Carotid endartectomy In appropriate patients
4. Correcting high-risk causes

119

What are the causes for intracerebral hemorrhage

Hypertension
mass lesions
vascular malformations
amyloid angiopathy
cocaine/amphetamine use

120

Were the causes for a subarachnoid hemorrhage (SAH)

Aneurysms
trauma

121

What is the most common site for hypertensive hemorrhage

Basal ganglia (50-60%)
thalamus
pons
cerebellum
lobar (cortex)
associated with atherosclerosis and diastolic blood pressure greater than 110

122

What is the treatment for hemorrhagic stroke

1. Reverse coagulopathy
– FFP for elevated PT/PTT
– platelets for thrombocytopenia
2. Control blood pressure
– labetalol is the drug of choice
3. Identify underlying structural abnormalities
– tumors (MRI with contrast)
– AVM's (cerebral angiography)

123

What are the clinical features of the subarachnoid hemorrhage

thunderclap headache
meningismus
altered mental status

124

What are the common sites for cerebral aneurysms

Anterior communicating
posterior communicating at the ICA
MCA (distal greater than proximal)
ICA at ophthalmic
Basilar apex

125

What are the clinical features of a berry aneurysm

Most frequently complication during the fifth decade
– large aneurysms can present as mass lesion with symptoms related to compression of neurologic structures
– third nerve palsy (involving the pupil) the eye will be down and out

– if the pupil'sis spared, then likely infarction of the nerve, seen in diabetics

126

What imaging should be done for a patient suspected of a subarachnoid hemorrhage

1. Noncontrast CT of the head
2. If CT scan is negative, lumbar puncture is indicated
– examined tubes one and four for red blood cell count
3. Patients with positive CT scan or lumbar puncture should have cerebral angiogram

127

What is the Hunt and Hess scale

Measure of clinical status for hemorrhagic patients

I: asymptomatic or mild headache
II: moderate to severe headache, nuchal rigidity, cranial neuropathies
III. Confusion, lethargic, mild focal deficits
IV: stupor or hemiparesis
V: comatose or posturing

128

What is the treatment for an SAH/aneurysm

– Clip or coil identified aneurysm
– treatment vasospasm
– treatment hydrocephalus

129

What is hydrocephalus

Dilation of ventricular system with increase cerebrospinal fluid volume
– communicating or not communicating

130

What is the difference between nine communicating and non-communicating hydrocephalus

Communicating: third ventricle is open, the fourth ventricle is proportionally dilated
– blockage of CSF exit, either at arachnoid granulation's or foramen's of Magendi or Luska

non-communicating: 4th ventricle not involved
– compression of third or lateral ventricles by mass or mass effect from edema

both can results in herniation is not treated

131

What is the Monroe doctrine with regards to increased intracranial pressure

"Brain in a box"
– skull contains brain, CSF, blood
– there's no room for expansion and an increase in pressure displaces something

132

what are the herniations associated with an increased cranial pressure

1. Subfalcine
– cingulate gyrus displaced underneath the falx to opposite side
2. Transtentorial (Uncal)
– medial aspect of temporal lobe is compressed against the tentorium cerebelli
3. Tonsillar herniation (most serious)
– displacement of cerebellar tonsils through the foramen magnum. Compression of medullary respiratory centers leading tocommaand death

133

What is the treatment for increased intracranial pressure

1. Raise head of bed 45Β°
2. Hyperventilation (PCO2 25-30 mm Hg) normal is 40
3. Mannitol (2 g/kg)
4. Hypertonic saline
5. IV steroids if due to a tumor
6. Intraventricular drain.

134

What a factor will hyperventilation have on intracranial pressure

Hyperventilation will reduce ICP