neuropathophys york test 1 Flashcards
(197 cards)
1
Q
Posterior Circulation to Brain
A
Vertebral Artery—- Basilar Artery —— Posterior Cerebellar Artery
2
Q
Vertebral Artery origin
A
Subclavian artery
3
Q
Vertebral Artery supplies
A
Ventrolateral Medulla
4
Q
Vertebral Artery branches
A
Anterior Spinal Artery
Posterior Spinal Artery (2)
Posterior Inferior Cerebellar Artery
5
Q
Posterior Inferior Cerebellar Artery supplies
A
Supplies Lateral Medulla + Cerebellum
6
Q
Posterior Spinal Artery (2) supplies
A
Supplies Posterior Funiculus + Dorsal Horn; Dorsal Medulla
7
Q
Anterior Spinal Artery
A
Supplies Ventral + Lateral Funiculi + Lateral Horn (Symp. T1-L2); Ventral Medulla
8
Q
Basilar Artery formed by
A
Vertebral aa. join at the Pontomedullary Junction
9
Q
Posterior Cerebellar Artery formed by
A
Basilar a. branches in the Midbrain
10
Q
Anterior Circulation to Brain
A
Internal Carotid Artery——> OPAAM
11
Q
OPAAM
A
- Internal Carotid Artery
- Ophthalmic Artery
- Posterior Communicating Artery
- Anterior Cerebral Artery
- Anterior Choroidal Artery
- Middle Cerebral Artery
12
Q
Arteries of the Pons
A
- Anterior Inferior Cerebellar Artery – Supplies Cerebellum + Pons
- Labyrinthine Artery – Supplies ears
- Pontine Arteries (3) - Supplies Pons
- Superior Cerebellar Artery - Supplies Cerebellum & Pons
13
Q
Vertebrobasilar Insufficiency (VBI or VBAI) symptoms
A
- Dizziness
- Diplopia (double vision)
- Drop Attack (spontaneous fall)
- Dysarthria (slurred speech)
- Dysphagia (difficulty swallowing)
- Nausea
- Numbness
- Nystagmus (involuntary rapid eye movement)
- Ataxia (inability to control voluntary muscles)
14
Q
Arterial Circle of Willis
what is it?
A
•Anastomose of anterior and posterior circulation of the brain; specifically Posterior Communicating + OPAMM
15
Q
Most likely place for blood clot in the brain ?
A
Arterial Circle of Willis
16
Q
Circle of Willis
arteries included
A
- Anterior Cerebral Artery
- Posterior Cerebral Artery
- Middle Cerebral Artery
- Anterior Communicating Artery
- Posterior Communicating Artery
17
Q
Terminal Branches of the Internal Carotid Artery
A
Anterior Cerebral Artery
Middle Cerebral Artery
18
Q
Three Main Cerebral Arteries give rise to
A
give rise to numerous branches that travel in the subarachnoid space over the surface of the Brain and into the sulci
- Anterior Cerebral Artery
- Middle Cerebral Artery
- Posterior Cerebral Artery (terminal branch of Basilar part of posterior circulation)
19
Q
Middle Cerebral Artery (MCA):key facts
A
- Supplies 80% of the blood to the brain (forebrain) Telencephalon & Diencephalon
- Telencephalon —–>Limbic System, Corpus Callosum, Corpus Striatum + Olfactory Bulb
- Diencephalon —->Thalamus, Hypothalamus
- Midbrain —->Oculomotor Complex, SC + IC, SN, RN; Hemibolismus + Parkinson’s
20
Q
What artery is most frequently affected by stroke?
A
Middle Cerebral Artery
21
Q
What supplies the entire lateral neocortex?
A
Middle Cerebral Artery
22
Q
T or F
The striate cortex is supplied by the MCA.
A
F
Posterior cerebral artery
23
Q
Middle Cerebral Artery (MCA)
Superior Division Branches
A
- Orbitofrontal Arteries: supplies Orbits & Parietal lobes
- Pre-Rolandic Arteries: supplies Area 6 (pre-motor); anterior to the Central fissure (fissure of Rolando)
- Rolandic Arteries: supplies Area 4 (1° Motor)
- Post Rolandic Arteries: supplies Areas 3,1,2 (1° Somatosensory)
- Posterior Parietal Arteries:
- Angular Arteries
24
Q
Middle Cerebral Artery (MCA)
Inferior Division Branches
A
- Anterior Temporal Arteries:
2. Posterior Temporal Arteries (Anterior Occipital Arteries): – evidence that it branches from MCA or PCA
25
Occlusion of the Middle Cerebral Artery (MCA) mostly affects what?
upper body
26
Superior Division Occluded MCA
| symptoms
• Contralateral Paralysis or muscle weakness
• Motor loss in the upper body (Area 4- 1° Motor)
• Sensory loss possible- Contralateral face & arm
• Dysarthria (difficulty speaking)
• Broca’s Aphasia/ Expressive or Non-Fluent Aphasia (inability to form words)
- Left Area 44
- Articulation of speech, Motor Speech and Language
27
Lower Division Occluded:symptoms
• Confusion
• Agitation
• Wernicke’s Aphasia/ Semantic/ Receptive or Fluent Aphasia (inability to comprehend speech)
- Left Area 22 (Caudal), Areas 40 + 39
- Semantic Speech (the meaning, recognition + comprehension of speech)
28
Stem of Middle Cerebral Artery Occluded: symptoms
• Symptoms of both upper & lower division
29
Deep Territory Occluded:symptoms
• Combination of Superior, Lower + Stem
30
Anterior Cerebral Artery supplies
most of the MEDIAL SURFACE (cortex) of the Brain
31
Branches of the Anterior Cerebral Artery
1. Orbital Artery: supplies orbits & frontal lobe
2. Frontopolar Artery: supplies frontal lobe
3. Pericallosal Artery:
4. Callosomarginal Artery:
32
Occlusion of the Anterior Cerebral Artery
| Orbital Artery or Frontopolar Artery
1. Apathy (lack of motivation)
2. Some memory loss
3. Behavior abnormalities
33
Occlusion of the Anterior Cerebral Artery
| Callosomarginal Artery
• May affect cingulate gyrus, area 3,1,2 (1°Somatic Sensory)
• Contralateral Paralysis and muscle weakness of the lower body
• May lead to urinary incontinence and abnormalities in pain perception (allodynia)
o Urinary Incontinence Possibly Cauda Equina Syndrome due to “Saddle Anesthesia”
34
Cauda Equina Syndrome
| signs
1. weakness of the muscles of the lower extremities innervated by the compressed lumbar roots (often paraplegia)
2. detrusor weaknesses causing urinary retention and post-void residual incontinence
3. there may be decreased anal tone and consequent fecal incontinence; sexual dysfunction; saddle anesthesia; bilateral (or unilateral) sciatic leg pain and weakness; and absence of ankle reflex
35
acute Cauda equina syndrome
| Red Flag Symptoms
sciatic leg pain and/or severe back pain, with altered sensation over saddle area (genitals, uretha, anus, inner thighs), urine retention or incontinence.
36
Posterior Cerebellar Artery
| major branches
1. Posterior Temporal Arteries
2. Internal Occipital Arteries
3. Posterior Choroidal Arteries
4. Posterolateral Arteries (Thalamogeniculate Arteries)
5. Posteromedial Arteries
37
Posterior Temporal Arteries supply
Striate Cortex/ Area 17 (1° Visual area)
38
Internal Occipital Arteries supplies
Striate Cortex/ Area 17 (1° Visual area)
39
Posterior Choroidal Arteries supplies
Inferior & Superior Colliculus
40
Posterolateral Arteries (Thalamogeniculate Arteries) supplies
posterior + part of middle thalamus
41
Posteromedial Arteries supplies
1. Hypothalamus, Hypophysis (pituitary stalk)
2. Anterior & Middle Thalamus (part of middle not supplied by Posterolateral)- done by Thalamoperforating Artery
3. Mammillary Bodies, Subthalamic Nucleus, Red Nucleus, Substantia Nigra, Crus Cerebri
42
Occlusion of the Posterior Cerebral Artery
| symptoms
* Hemianopia (decreased vision or blindness takes place in half the visual field of one or both eyes)
* Aphasia (inability to form words)
* Sensory loss (contralateral)
* Hemiparesis (contralateral)
43
Thalamoperforating Arteries occlusion symptoms
• Reaches Anterior and Subthalamus
• Damage to Subthalamic Nucleus Hemiballismus (post stroke)
o Basal Gangia: Subthalamic Nucleus, Substantia Nigra, Striatum (Putamen + Caudate Nucleus), Globus Pallidus + Nucleus Accumbens
44
Thalamogeniculate Arteries occlusion symptoms
* Contralateral numbness
* Damage to VPL (area 3,1,2), VPM, MG, LG
* May get a “Thalamic P! Syndrome” – everything is painful (area 43- pain) including normal movement & touch
45
Wallenberg Syndrome (Lateral Medullary Syndrome)
• Neurological condition caused by stroke in Vertebral Artery or Posterior Inferior Cerebellar Artery (PICA)
46
Wallenberg Syndrome (Lateral Medullary Syndrome) symptoms
- Dysphagia (difficulty swallowing)
- Hoarseness
- Dizziness
- Nausea & vomiting
- Nystagmus (involuntary rapid eye movement)
- Problems with balance & gait (ataxia)
47
Wallenberg Syndrome (Lateral Medullary Syndrome) possible symptoms
- Lack of pain & temperature sensation on ½ of the face
- Pattern of symptoms on opposite side of body
o Numbness + Paralysis on right side of face with Numbness + Weakness of left limbs
- Uncontrollable hiccups
- Loss of sensation to ½ of tongue
- Horner’s Syndrome (occurs due to damage of the Medulla)
o Ptosis – drooping eyelid
o Anhydrosis- lack of sweat (sympathetic)
o Miosis- pinpoint pupils (parasympathetic)
48
Wallenberg Syndrome (Lateral Medullary Syndrome) treatment
Try to fix the symptoms; G-Tube, Epileptic drugs, Speech + Physical Therapy
49
Wallenberg Syndrome (Lateral Medullary Syndrome) ataxia occurs where in the brain and causes what problem?
1. Cerebellum
| 2. Sensory loss on face
50
Strokes
| general info
* Third Leading cause of death in the US
* 750,000 new cases every year (150,000 die)
* 2/3 of strokes occur over age 65
* Higher incidence in males and African
51
PCA stroke affects
midbrain
52
MCA stroke affects
lateral brain
53
Risk Factors for stroke
* Use of Oral Contraceptives
* Previous Stroke and/or family history
* Systemic or diastolic (bottom number) hypertension (120/80 = normal)
* Smoking
* Hypercholesterolemia
* Heavy alcohol consumption
* Diabetes
* Type A Personality (possibly)
54
Two Types of Stokes
1. Transient Ischemic Attack (TIA)
| 2. Cerebrovascular Accident (CVA)
55
Characteristics of Transient Ischemic Attack (TIA)
* Blood flow to area of brain is cut off for a few seconds
* No permanent tissue damage
* Patient will feel weak for a couple minutes to a ½ hr
* At 24 hrs no markings of stroke on CT or MRI
* Usually put patients on blood thinners*
* Predictor of CVA
* Also known as “Mini- Stroke”
56
Characteristics of Cerebrovascular Accident (CVA)
* Blood Supply cut off to artery long enough to destroy tissue
* Death of some brain tissue
* At 24 hrs damage will be visible on a CT or MRI
* Full Blown Stroke
* Can recover- must build new pathways to destroyed area of brain
57
Differences btw TIA + CVA:
* Length of time without blood
* Tissue Damage
* Signs + Symptoms
58
Polio general info
* Fecal/Oral Transmission (water supply 3rd world countries)
| * Somatic Alpha Neuron in Lamina IX is destroyed by Retrosynapse- can no longer contract skeletal muscle
59
Lower Motor Neuron Lesion (LMN)
| Muscle Tone
Decreased muscle tone (hypotonic)
60
Lower Motor Neuron Lesion (LMN)
| Paralysis (Flaccid or Spastic)
Flaccid Paralysis
61
Lower Motor Neuron Lesion (LMN)
| Deep Tendon Reflex (DTR)
Hyporeflexia or Absent
62
Lower Motor Neuron Lesion (LMN)
| Superficial Reflex
Absent (only in area affected)
63
Lower Motor Neuron Lesion (LMN)
| Muscle Atrophy
Present
64
Lower Motor Neuron Lesion (LMN)
| Clonus
Absent
65
Upper Motor Neuron Lesion (UMN)
| Muscle Tone
Increased muscle tone (hypertonic)
66
Upper Motor Neuron Lesion (UMN)
| Paralysis (Flaccid or Spastic)
spastic Paralysis
67
Upper Motor Neuron Lesion (UMN)
| Deep Tendon Reflex (DTR)
Hypereflexia
68
Upper Motor Neuron Lesion (UMN)
| Superficial Reflex
Absent (only in area affected)
69
Upper Motor Neuron Lesion (UMN)
| Muscle Atrophy
Absent
70
Upper Motor Neuron Lesion (UMN)
| Clonus
Present
71
Lower Motor Neuron Lesion (LMN)
| Fasciculations or Fibrillations
Both Present
72
```
Lower Motor Neuron Lesion (LMN)
Pathological Reflex (Babinski)
```
absent
73
Upper Motor Neuron Lesion (UMN)
| Fasciculations or Fibrillations
Both Absent
74
```
Upper Motor Neuron Lesion (UMN)
Pathological Reflex (Babinski)
```
Present
75
Clonus:
Very rapid movement from contraction to relaxation; Tonic would be sustained relaxation
76
Fasciculations:
Can be seen, unlike Fibrillations; Occur when only a few fibers of a muscle are contracting
77
Babinski:
Reflex of foot/toe; Stroke the foot and watch for movement of the toes- Abnormal if big toe and little toes move in opposite direction
78
LMNL: info/example
All occur in the PNS; Myasthenia Gravis, Bell’s Palsy, Polio
79
UMNL: info/example
Encephalitis, Meningitis, MS, Brain Tumor, Stroke
80
Segmental Arteries info
* Anastomose with Anterior & Posterior Spinal Arteries
* Effectiveness varies person to person
* Minority of supply
* Supply all areas of the cord
81
Amyotrophic Lateral Sclerosis (ALS) Lou Gehrig's Disease info
* All features of Lower Motor Neuron Lesion (LMN) except has increased deep tendon reflex
* Considered both LMN & UPN
82
activities of daily living
the things we normally do in daily living including, self-care, work, homemaking, and leisure
83
abasia
inability to walk due to impaired muscle coordination
84
afebrile
a condition where no associated fever exists with an illness
85
agnosia
the inability to view or percieve things
86
alimentation
giving or receiving of nourishment
87
allodynia
a condition in which pain arises from a stimulus that would normally be experienced as painful
88
analgesic
a drug used to relieve pain
89
anesthesia
total loss of sensation
90
aneurysm
an abnormal swelling in a blood vessel
91
anhidrosis
abscence of sweating
92
anisocoria
pupils of different sizes
93
ankylosis
partial or complete stiffness of a joint
94
anosmia
abscence of the scence of smell
95
antalgic posture
a posture or gait assumed to avoid or lessen pain
96
anoxia
abscence of oxygen supply to an organ or a tissue
97
anuria
a condition which is characterized by complete abscence of urine flow
98
aphagia
a reflexive action which makes it partially or totally impossible to swallow
99
aphasia
a cortico-motor disorder resulting in a complete inaility to form words; loss of language expression or comprehension
100
aphonia
the partial or total inability to speak in a coherent fashion
101
appendicular
of or pertaining to an appendage or limb.
102
aponeurosis
a whitish, fibrous membrane that connects a muscle to a bone or fascia.
103
apraxia
loss of previous ability to perform a skilled act without loss of motor or sensory
104
arteriosclerosis
degenerative changes in the arteries, characterized by thickening of the vessel walls and accumulation of calcium with consequent loss of elasticity and lessened blood flow.
105
Arthalgia
pain in a joint
106
Ascites
an accumulation of fluid in the abdomen
107
astasia
a lack of motor coordination marked by an inability to stand or sit without assistance
108
ataxia
loss of coordination of the muscles, especially of the extremities.
109
atherosclerosis
a common form of arteriosclerosis in which fatty substances form a deposit of plaque on the inner lining of arterial walls.
110
athetosis
condition, chiefly in children, of slow, involuntary, wormlike movements of the fingers, toes, hands, and feet, usually resulting from a brain lesion.
111
autonomic nervous system
the system of nerves and ganglia that innervates the blood vessels, heart, smooth muscles, viscera, and glands and controls their involuntary functions, consisting of sympathetic and parasympathetic portions.
112
aura
a sensation, as of lights or a current of warm or cold air, preceding an attack of migraine or epilepsy.
113
axial
skull, thorax, vertebral column
114
bradykinesia
extremely slow or abnormal deliberate movement
115
bursa
small sacs that cushion joints between tendons and bones
116
caudal
tail, or base
117
causalgia
a neuralgia distinguished by a burning pain along certain nerves, usually of the upper extremities.
118
cephalic
head
119
chorea
quick, jerky, purposeless involuntary movements
120
claudication
limping, lameness
121
clonus
alternate involuntary muscular contraction and relaxation in rapid succession
122
cogwheel rigidity
Rigidity in which the muscles respond with cogwheel-like jerks to the use of force in bending the limb, as occurs in Parkinson's disease.
123
concentric contraction
a muscle shortens in length and develops tension
124
coronal
vertebral body plane, divides body into front and back
125
coprolalia
involuntary swearing or the involuntary utterance of obscene words
126
decubitus
lying down
127
dermatome
an area of skin that is mainly supplied by a single spinal nerve root
128
diaphoresis
excessive sweating
129
DDX
a diagnosis made by comparing symptoms of two or more diseases
130
diplopia
double vision
131
distal
farthest from center
132
diuresis
frequent urination
133
drop attack
sudden spontaneous falls while standing or walking
134
dysesthesia
impaired or abnormal interpretation of mornal stimuli
135
dysarthia
a disturbance of speech function due to emotional stress
136
dyskinesia
impairment of voluntary movement; inability to make physical motion
137
dysphagia
difficulty swallowing
138
dysphasia
partial or incomplete impairment of the ability to communicate resulting from brain injury
139
dystonia
a movement disorder that causes muscles to contract and spasm involuntarily usually producing a twisting and repetitive movements
140
eccentric contraction
the development of tension whilst the muscle is being lengthened
141
echolalia
the uncontrollable and immediate repetition of words spoken by another person
142
embolism
the lodging of an embolus that obstructs circulation
143
embolus
a small clot or foreign substance detached from inside a blood vessel
144
emesis
vomiting
145
enuresis
bed wetting
146
epistaxis
nose bleeds
147
fascia
a band or sheath of connective tissue investing, supporting, or binding together internal organs or parts of the body.
148
fasciculation
a small visible muscle contractio and relaxation
149
febrile
pertaining to fever
150
fibrillation
uncontrolled twitching or quivering of muscular fibrils
151
flaccid paralysis
weakness or loss of muscle tone resulting from injury or disease of the nerves innervating the muscles
152
formication
a tactile hallucination involving the belief that something is crawling on the body or under the skin.
153
gait
manner of walking
154
graphesthesia
the ability to recognize writing on the skin purely by the sensation of touch
155
hemoptysis
coughing up blood
156
hypoxia
insufficient levels of oxygen in blood or tissue
157
iatrogenic
induced py a patient by a physician's activity, manner, or therapy
158
idiopathic
of unknown cause
159
incontinence
involuntary leakage of urine or the inability to control one's bowels
160
intermitten claudication
pain, tension, and weakness in the legs on walking, which intensifies to produce lameness
161
ischemia
insufficent blood flow to part of the body
162
isometric contraction
the muscle contracts but does not shorten giving no more
163
isotonic contraction
the muscle contracts and shortens given movement
164
intussesception
a problem with the intestine iin which one portion of the bowel slides into the next, much like the pieces of a telescope
165
incontinence
involuntary leakage of urine or the inability to control ones bowels
166
intermittent claudication
pain, tension, and weakness in the legs on walking, which intensifies to produce lameness and is relieved by rest it is seen in occlusive arterial disease
167
ischemia
local deficiency of blood supply produced by vasoconstriction or local obstacles to the arterial flow.
168
isometric contraction
the muscle contracts but does not shorten giving no move
169
isotonic contraction
the muscle contacts and shortens, giving movement
170
myelopathy
disease of the spinal cord
171
myelitits
inflammation of the spinal cord
172
myoclonus
abrupt. suppen irregular mm contraction (MS)
173
neuralgia
pain along the course of a nerve
174
neuritis`
inflammation of a nerve
175
nystagmus
involuntary jerking eye movements
176
palliative
relieving pain
177
paralysis
a complete loss of motor function
178
paresis
a partial loss of motor function
179
paresthesia
sensation of tingling, pricking, numbness
180
paroxysm
a sudden attack or recurrence of symptoms
181
proprioception
detection of the body's orientation in space
182
ptosis
drooping of the eyelid
183
ridiculopathy
disease of the nerve root
184
radiculitis
inflammation o the nerve root
185
space occupying lesion
any abnormal tissue
186
spastic paralysis
a chronic pathological condition in which muscles are affected by persistant spasms
187
stenosis
narrowing
188
stereognosis
the ability to perceive and recognize the form of an object when the eyes are closed
189
strabismus
cross-eyed
190
syncope
fainting
191
syrinx
cavity or tube
192
thrombus
formation of a clot inside a blood vessel
193
tics
compulsive, repetitive, inappropriate stereotyped movements, ususally affecting the face and shoulders
194
tonic
sustained contraction
195
tremors
involuntary movements involving alternate contraction and antagonistic mm
196
vertigo
a type of dizziness, where there is a feeling of motion when one is stationary
197
varus
denoting a deformity where an anatomical part is turned inward toward the midline of the body
