Neuromuscular: Anatomy, Physiology, Terminology Flashcards
(147 cards)
0
Q
Cerebrum
A
Joined by corpus callosum which relays info between hemispheres. Surface contains billions of neurons and glia.
Outer = gray matter
Inner = white matter
1
Q
Telencephalon
A
Cerebrum, hippocampus, basal ganglia, amygdala
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Q
Hippocampus
A
Deep in lower temporal lobe. “Memory indexer”. Forms and stores new memories; learning language.
3
Q
Basal Ganglia
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Caudate, putamen, globule pallidus, substantia nigra, subthalamic nuclei. Voluntary and autonomic movement, posture, muscle tone, motor responses. Associated with Parkinson’s, Huntington’s, Tourette’s, ADD, OCD, many addictions.
4
Q
Amygdala
A
Emotional and social processing. Fear and pleasure responses, arousal, memory processing, forming emotional memories.
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Q
Diencephalon
A
Thalamus, hypothalamus, subthalamus, epithalamus. Location of major motor and sensory tracts synapse. Interactive site of CNS and endocrine system, compliments limbic system.
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Q
Thalamus
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Process info to cortex association areas. Info from cerebellum, basal ganglia, and all sensory pathways except olfactory. Lesion can cause thalamic pain syndrome (spontaneous contralateral pain).
7
Q
Hypothalamus
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Integrates info from ANS and regulates hormones; controls hunger, thirst, sexual behavior and sleeping; regulates body temperature, adrenal glands, pituitary gland, other vital activities. Damage associated with obesity, sexual disinterest, poor temperature control, diabetes insipidus.
8
Q
Subthalamus
A
Regulates skeletal muscle movement. Associated with basal ganglia and substantia nigra.
9
Q
Epithalamus
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Pineal gland secretes melatonin; circadian rhythms, internal clock, motor pathways, emotions. Associated with limbic system and basal ganglia.
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Q
Midbrain (Mesencephalon)
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Large relay area for info from cerebrum, cerebellum, and spinal cord. Reflex center for visual, auditory, and tactile responses. Includes tectum and tegmentum.
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Q
Tectum
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Superior and inferior colliculi
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Q
Tegmentum
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Cerebral aqueduct, periaqueductal gray, reticular formation, substantia nigra, red nucleus.
13
Q
Hindbrain (Rhombencephalon)
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Cerebellum, pons, and medulla.
14
Q
Cerebellum
A
Separated from cortex by tentorium. Fine motor control, muscle tone, positioning extremities in space, rapidly alternating movements; ipsilateral impairment of ataxia, nystagmus, tremor, hypermetria, poor coordination, postural reflexes, balance, equilibrium.
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Q
Pons (Metencephalon)
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Respiration rate, orientation of head to visual and auditory stimuli. CN V-VIII
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Q
Medulla Oblongata (Myelencephalon)
A
White exterior, gray interior. ANS activity, RR, HR. Reflex centers for vomiting, coughing, sneezing; relays somatic sensory info from internal organs, arousal, sleep; contralateral impairment. CN IX-XII.
17
Q
Brainstem
A
Midbrain, pons, medulla. Relay between parts of the body and cerebral cortex. Primitive functions like HR and RR. Majority of CNs originate here.
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Q
Reticular Activating System
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Located within midbrain, pons, medulla, and a portion of the thalamus.
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Q
Limbic System
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Corpus callosum, olfactory tract, mammillary bodies, fornix, thalamic nuclei, amygdala, hippocampus, parahippocampal gyrus, cingulate gyrus, hypothalamic nuclei.
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Q
Allodynia
A
Pain sensation in response to normally nonpainful stimuli.
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Analgesia
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Absence of pain while conscious.
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Anesthesia
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Absence of touch.
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Q
Causalgia
A
Constant relentless burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury.
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Dysesthesia
Distortion of any of the senses, especially touch
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Hyperesthesia
Heightened sensation.
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Hyperpathia
Extreme exaggerated response to pain.
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Hypesthesia
A diminished sensation of touch.
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Neuralgia
Severe and multiple shock-like pains that radiate from a specific nerve distribution
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Pallanesthesia
Loss of vibration sensation.
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Paresthesia
Abnormal sensations (tingling, pins, burning).
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Double Crush Syndrome
2 separate lesions along same nerve creating more severe symptoms than one lesion would.
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Mononeuropathy
An isolated nerve lesion; associated conditions are trauma and entrapment.
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Polyneuropathy
Diffuse nerve dysfunction symmetrical and from pathology and not trauma. Guillain-Barré syndrome, peripheral neuropathy, neurotoxic drugs, HIV.
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Wallerian Degeneration
Distal degeneration specific to myelin sheath and axon.
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Neurapraxia
No nerve fiber damage. Conduction block. Pain, min atrophy, numbness or greater motor/sensory loss, proprioception. Recover 4-6 days. Pressure injuries.
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Axonotmesis
Axon damage preserving endo/epineurium, Schwann, supporting structures. Wallerian degeneration. Regenerate 1mm/day. Recover spontaneous, possible surgery. Traction, compression, and crush injuries.
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Neurotmesis
Axon, myelin, CT all damaged. Irreversible. Paralysis, wasting, sensation loss. All motor/sensory distal to lesion impaired. Surgery with 1mm/day recovery.
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Akinetic Mutism
Inability to spontaneously move or speak
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Brudzinski's Sign
Neck flexion facilitates hip and knee flexion
| Suggests meningeal irritation
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Kernig's Sign
Pain with hip flexion combined with knee extension
Due to hamstring spasm
If B, suggests meningeal irritation
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Sun Setting Sign
Downward deviation of the eyes
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Anterior Cerebral Artery (ACA) Location
Anterior frontal lobe
| Medial frontal and parietal lobes
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Anterior Cerebral Artery (ACA) Impairments
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CL LE motor and sensory involvement
B&B
Behavioral inhibition
Significant mental changes
Neglect
Aphasia
Apraxia
Agraphia
Preservation
Akinetic mutism with significant B involvement
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Middle Cerebral Artery (MCA) Location
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Most of outer cerebrum
Basal ganglia
Posterior and anterior internal capsule
Putamen
Pallidum
Lentiform nucleus
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Middle Cerebral Artery (MCA) Impairments
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Most common CVA
Wernicke's aphasia in dominant hemisphere
Homonymous hemianopsia
Apraxia
Flat affect in R hemisphere
CL weakness and sensory in face, UE and less in LE
Spatial relations
Anosognosia in non-dominant hemisphere
Body schema
```
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Posterior Cerebral Artery (PCA) Location
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Portion of midbrain
Subthalamic nucleus
Basal nucleus
Thalamus
Inferior temporal lobe
Occipital and occipitoparietal cortices
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Posterior Cerebral Artery (PCA) Impairments
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CL pain and temperature
CL hemiplegia (central area), mild hemiparesis
Ataxia, athetosis or choreiform movement
Movement quality
Thalamic pain syndrome
Anomia
Prosopagnosia with occipital infarct
Hemiballismus
Visual agnosia
Homonymous hemianopsia
Memory
Alexia, dyslexia
Cortical blindness in B involvement
```
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Vertebral-Basilar Artery Location
Lateral pons and midbrain with superior cerebellum
Cerebellum - BA branches (PICA, AICA, SCA)
Medulla - PICA, VA smaller branches
Pons - BA branches
Midbrain and Thalamus - PCA
Occipital Cortex - PCA, BA
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Vertebral-Basilar Artery Impairments
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Loss of consciousness
Hemiplegia or tetraplegia
Comatose or vegetative state
Inability to speak
Locked-in syndrome
Vertigo
Nystagmus
Dysphasia
Dysarthria
Syncope
Ataxia
```
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ACA Bilateral Impairments
Paraplegia, incontinence, abulic aphasia, frontal lobe symptoms (personality changes), akinetic mutism.
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MCA Bilateral Impairments
CL hemiplegia and sensory loss
Dominant hemisphere - global, Wernicke's, or Broca's aphasia
Other impairments are lobe dependent
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PCA Bilateral Impairments
Thalamic Pain - abnormal pain, temp, touch, and proprioception.
Cortical Blindness - Eye is normal but full or partial visual loss. Pupil constricts/dilates in response to light (not brain-induced)
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V-BA Bilateral Impairments
Severe - Locked-in syndrome, coma, or vegetative state
| Wallenberg Syndrome - Lateral medullary infarct with IL face pain, IL ataxia, vertigo, CL pain, thermal impairment.
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Meninges
CT covering brain and SC. Protects from contusion and infection. Contains blood vessels and CSF.
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Dura Mater
Outer. Protects from contusion and infection. Subdural space separates from arachnoid.
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Arachnoid
Middle. Lines skull periosteum. Protects brain. Subdual space separates from pia mater.
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Pia Mater
Inner. Covers brain contours. Forms choroid plexus in ventricular system.
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Epidural Space
Area between skull and dura mater and in SC between dura mater and vertebrae periosteum
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Subdural Space
Area between dura and arachnoid meninges
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Subarachnoid Space
Area between arachnoid and pia mater. Contains CSF and circulatory system for cerebral cortex.
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Meningitis
```
Bacterial - Potentially fatal within hours of onset
Acute - Medical emergency
Symptoms:
Fever, HA, vomiting
Stiff, painful neck, nuchal rigidity
Lumbar, posterior thigh pain
Brudzinsky's sign
Kernig's sign
Light sensitivity
```
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Brain Ventricular System
Protects and nourishes brain. Four fluid-filled ventricles and multiple foramina. Choroid plexus in ventricles makes CSF.
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Cerebrospinal Fluid (CSF)
Clear fluid. Provides cushion, mechanical buoyancy, support, nutrition, and removal of metabolites for brain and SC. Constantly absorbed and replenished in brain and SC. 500-700 ml/day.
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Blood-Brain Barrier
Meninges, protective glial cells, brain capillary beds. Exchange nutrients between CNS and vascular system. Restricts some molecules from passing while others pass freely.
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Hydrocephalus
Result of CSF poor resorption, flow obstruction, or excessive production.
Congenital, acquired, or idiopathic.
Communicating or non-communicating.
Spina bifida, choroid plexus neoplasm, CP, tumor, meningitis, encephalocele.
Shunt or endoscopic third ventriculostomy (ETV), often multiple procedures with unpredictable long term health.
Enlarged head, bulging fontanelles in infants
HA
Vision changes
Large scalp veins
Behavioral changes
Seizures
Appetite, vomiting
"Sun setting" sign
Incontinence
Immediate medical intervention or possible coma or death.
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SC
White and gray matter. Largest amount of gray matter in L-spine. VA forms anterior spinal artery and two posterior spinal arteries. Foramen magnum to conus medullaris (L1-2).
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Ascending Tracts
Sensory. White matter. Arise from cells of spinal ganglia or intrinsic neurons in gray matter receiving primary sensory input. Relay sensory info to cerebrum and cerebellum.
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Ascending Tracts By Name
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Fasciculus Cuneatus (Posterior or Dorsal Column)
Fasciculus Gracilis (Posterior or Dorsal Column)
Spinocerebellar Tract (Dorsal)
Spinocerebellar Tract (Ventral)
Spino-olivary Tract
Spinoreticular Tract
Spinotectal Tract
Spinothalamic Tract (Anterior)
Spinothalamic Tract (Lateral)
```
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Descending Tracts
Voluntary motor function, muscle tone, reflexes, equilibrium, visceral innervation, modulation of ascending sensory signals. Largest (corticospinal tract) originates in cortex. Smaller tracts originate in midbrain, pons, and medulla nuclei.
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Descending Tracts By Name
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Corticospinal Tract (Anterior)
Corticospinal Tract (Lateral)
Reticulospinal Tract
Rubrospinal Tract
Tectospinal Tract
Vestibulospinal Tract
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Fasciculus Cuneatus (Posterior or Dorsal Column)
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Sensory Tract:
Trunk, neck, UE
Proprioception
Vibration
Two-point discrimination
Graphesthesia
```
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Fasciculus Gracilis (Posterior or Dorsal Column)
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Sensory Tract:
Trunk, LE
Proprioception
Vibration
Two-point discrimination
Graphesthesia
```
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Spinocerebellar Tract (Dorsal)
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Sensory tract:
IL subconscious proprioception
Tension in muscles
Joint sense
Trunk and LE posture
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Spinocerebellar Tract (Ventral)
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Sensory tract:
Crossing then recrossing in the pons
IL subconscious proprioception
Tension in muscles
Joint sense
Trunk, UE, and LE posture
```
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Spino-olivary Tact
Sensory Tract:
| Info from cutaneous and proprioceptive organs
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Spinoreticular Tract
Sensory Tract:
| Pathway for reticular formation that influences levels of consciousness, deep and chronic pain
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Spinotectal Tract
Sensory Tract:
Spinovisual reflexes
Assists with eye and head movement towards a stimulus
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Spinothalamic Tract (Anterior)
Sensory Tract:
Light touch
Pressure
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Spinothalamic Tract (Lateral)
Sensory Tract:
Pain
Temperature
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Corticospinal Tract (Anterior)
Pyramidal Motor Tract:
| IL voluntary, discrete, and skilled movements
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Corticospinal Tract (Lateral)
Pyramidal Motor Tract:
CL voluntary fine movements
(+) Babinski, no superficial abdominal or cremaster reflexes, loss of fine motor/skilled voluntary movement
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Reticulospinal Tract
Extrapyramidal Motor Tract:
(+) or (-) of voluntary and reflex activity
Accomplished with influence on alpha and gamma motor neurons
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Rubrospinal Tract
Extrapyramidal Motor Tract:
Gross postural tone
(+) flexor muscles
(-) extensor muscles
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Tectospinal Tract
Extrapyramidal Motor Tract:
| CL postural muscle tone associated with auditory/visual stimuli
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Vestibulospinal Tract
Extrapyramidal Motor Tract:
IL gross postural adjustments subsequent to head movements
(+) extensor muscles
(-) flexor muscles
Paralysis, hypertonicity, exaggerated DTRs, clasp-knife reaction
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Peripheral Nervous System (PNS)
Motor, sensory, and autonomic neurons
Innervate sensory receptor, muscle, and gland end-organs
Most nerves contain sensory and motor fibers
Sensory originates in DRG
Motor originates in anterior horn
Sympathetic = lateral horn, thoracic SC
Parasympathetic = lateral gray matter, sacral SC and brain
Classified by diameter and conduction speed
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Endoneurium
Inner
| Surrounds individual axon
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Perineurium
Middle
Envelops fascicles or groups of axons
Maintains blood-nerve barrier
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Epineurium
Outer
Surrounds entire nerve
Provides buffer for nerve
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Myelin
Proteins and lipids
Sheath around nerve
Increases conductivity
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Saltatory Conduction
Action potential jumping to each node
Decreases use of sodium-potassium pumps
Increases conduction speed
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Schwann Cell
Cover nerve fibers
| Form myelin sheath
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A Fibers
```
Large
Myelinated
High conduction
Alpha, beta, gamma, delta subsets
Sensory components - muscle spindle (primary and secondary afferent endings), golgi tendon organs
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Alpha
Alpha motor neurons
Muscle spindle primary endings
Golgi tendon organs
Touch
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Beta
Touch
Kinesthesia
Muscle spindle secondary endings
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Delta
Pain
Touch
Pressure
Temperature
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Muscle Spindle Primary Afferent Endings
For low threshold stretch
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Muscle Spindle Secondary Afferent Endings
Receptors that respond to length changes
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Golgi Tendon Organ
Responds to tendon tension/stretch
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B Fibers
Medium
Myelinated
Reasonably fast conduction
Pre-ganglionic autonomic fibers
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C Fibers
```
Small
Poorly or unmyelinated
Slow conduction
Post-ganglionic sympathetic fibers
Exteroreceptors for pain, temperature, and touch
```
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Peripheral Nerve Lesion
Mechanical, crush and percussion, lacerating/penetrating trauma, stretch, high velocity trauma, or cold.
With nerve degeneration, voluntary muscles have altered response to Ach, wasting of sarcoplasm, and loss of fibrils.
Total muscle loss over time and replacement by fibrous tissues.
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Agnosia
Inability to recognize familiar objects (Parietal lobe, dominant hemisphere)
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Alexia
Inability to read (Parietal lobe, dominant hemisphere)
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Agraphia
Inability to write (Parietal lobe, dominant hemisphere)
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Anosognosia
Unaware or in denial of one's disability (Parietal lobe, nondominant hemisphere)
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Aphasia
Neurological impairment of processing for receptive and/or expressive language.
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Abulic Aphasia
Inability to make decisions or act independently
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Paraphasia
The production of unintended syllables, words, or phrases during the effort to speak
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Neologism
Substitution within a word that is so severe the word is unrecognizable
(The creation of a new word)
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Dysarthria
Motor disorder of speech
UMN lesion weakening muscles of speech
"Slurred" speech, may affect respiratory or phonatory systems
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Prosody
Melody and rhythm of speech
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Fluent Aphasia
```
Wernicke's and Conduction Aphasia
Temporal, Wernicke's, or parietal
Word output and speech production functional
Empty speech/jargon
Speech lacks substance, paraphasias
Neologisms
```
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Wernicke's Aphasia
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Posterior superior temporal
Receptive
Comprehension impaired
Good articulation, uses paraphasias
Writing impaired
Naming ability poor
No motor impairment
```
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Conduction Aphasia
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Supramarginal, arcuate fasciculus
Repetition severely impaired
Fluency, comprehension intact
Word finding difficult
Writing impaired, reading intact
```
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Non-Fluent Aphasia
Broca's and global aphasias, verbal apraxia, dysarthria
Frontal lobe, dominant hemisphere
Poor word output, dysprosody
Poor articulation, increased effort
Content present, impaired syntactical words
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Broca's Aphasia
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Frontal lobe, dominant hemisphere
Expressive
Most common
Intact comprehension
Repetition and naming impaired
Frustration with speech errors
Paraphasias
Motor impairment common (proximity)
```
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Global Aphasia
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Frontal, temporal, parietal
Comprehension severely impaired
Naming, writing, repetition impaired
Involuntarily verbalized out of context possible
Use nonverbal skills
```
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Apraxia
Inability to carry out specified movements despite physical ability to do so.
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Verbal Apraxia
Verbal expression impaired by motor planning deficits
Unable to articulate despite understanding
Left frontal adjacent to Broca's area
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Constructional Apraxia
Inability to reproduce geometric figures and designs
| Often unable to visually analyze how to perform a task
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Decerebrate Rigidity
Brainstem corticospinal lesion
| Extension of trunk and extremities
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Decorticate Rigidity
Diencephalon corticospinal lesion
| Extension of trunk and LEs, flexion of UEs
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Perservation
Repeatedly performing same task segment or repeatedly saying same word/phrase without purpose
125
Emotional Lability
Right hemisphere infarct
| Inability to control emotions; outbursts laughing/crying inconsistent with situation
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Ideational Apraxia
Inability to formulate initial motor plan and sequence tasks where proprioceptive input needed is impaired
127
Hemiparesis
Weakness on one side of the body
128
Hemiplegia
Paralysis on one side of the body
129
Ideomotor Apraxia
Plans movement/task but cannot volitionally perform it
| Automatic movement may occur but cannot impose additional movement on command
130
Cortical Blindness
Loss of vision due to cortex lesion (Occipital lobe, bilateral involvement)
131
Homonymous Hemianopsia
Loss of half of the visual field on the same side of both eyes (Occipital lobe)
132
Anterior Cord Syndrome
Compression and damage to anterior SC or anterior spinal artery
Cervical flexion injury
Motor function and pain/temp below lesion
Corticospinal and spinothalamic tracts damaged
133
Brown-Sequard's Syndrome
Incomplete lesion, hemisection of SC
IL paralysis and loss of vibration and joint position sense
Corticospinal tract and dorsal column damage
CL pain/temp
Lateral spinothalamic tract
134
Cauda Equina Injuries
Injury below L1 where long nerve roots transcend
Often incomplete
Considered peripheral nerve injury
Flaccidity, areflexia, B/B
Full recovery atypical - distance for axonal regeneration
135
Central Cord Syndrome
Incomplete lesion from compression and damage to center of SC
Cervical hyperextension
Spinothalamic tract, corticospinal tract, dorsal columns damaged
UE > LE
Motor > Sensory
136
Posterior Cord Syndrome
Compression of posterior spinal artery
Pain, proprioception, two-point discrimination, and stereognosis loss
Motor function preserved
137
Myelotomy
Severs certain SC tracts to decrease spasticity and improve function
138
Neurectomy
Removal of nerve segment to decrease spasticity and improve function
139
Neurogenic Bladder
Bladder empties reflexively
Injury above S2
Sacral reflex arc remains intact
140
Nonreflexive Bladder
Flaccid bladder
Cauda equina or conus medullaris lesion
Sacral reflex arc is damaged
141
Paradoxical Breathing
Common in tetraplegia
Inspiration: Abdomen rises, chest pulls inward
Expiration: Abdomen falls, chest expands
142
Rhizotomy
Resection of sensory component of spinal nerve
| Decrease spasticity and improve function
143
Sacral Sparing
Incomplete lesion, some innermost tracts remain innervated
Sensation of saddle area
Movement of tow flexors
Rectal sphincter contraction
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Spinal Shock
Physiologic response 30 to 60 minutes after SCI
Lasts up to several weeks
Total flaccid paralysis, loss of reflexes below level of injury
145
Zone Of Preservation
Poor or trace motor or sensory function up to 3 levels below neurological level of injury
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Autonomic Dysreflexia
Lesions at or above T6
Triggered by noxious stimulus
Sudden BP elevation
Symptoms: HTN, severe HA, blurry vision, stuffy nose, diaphoresis, goosebumps below, vasodilation (flushing) above
Treatment: Move to sitting, remove stimulus or medical attn
