NSHN Flashcards
(134 cards)
1
Q
What is the hormone therapy for meningeal bruising? What might cause this to happen?
A
- All hormone replacement
- TBI could sever the infundibulum
- Tumor could compress CN II-VI
2
Q
What is the significance of the Suprachiasmatic nucleus?
A
- Undergoes self-regulating transcription cycle producing ~24 hour rhythms
- Has clock genes that help this
- Can persist without external cues like light and dark but not as strong
3
Q
The Suprachiasmatic nucleus utilizes what tract to receive light input/information?
A
- ipRetinal ganglion cells in Retinohypothalamic tract goes to SCN via optic nerve
- Give information so that SCN can induce a light-dark cycle, melatonin regulation, peripheral clock synchronization
4
Q
What type of ANS stimulates the release of melatonin?
A
- Post ganglionic sympathetic fibers ascend to the pineal gland and control melatonin release
5
Q
What is the sleep stage characterized by sleep spindles and K complexes?
A
- Stage 2 sleep
- Theta wave dominant and eye movment is discontinued
6
Q
Stage ____ sleep is characterized by sleep spindles and K complexes. Classify each feature:
A
- This is Sleep stage 2
- Sleep Spindles: symmetrical bilateral bursts
- K-complex: brief, high-amplitude negative peaks prominent in frontal region
7
Q
What is the significance of sleep spindles and K complexes?
A
In sleep stage 2, these contribute to memory consolidation
8
Q
What are the neurons that suppress LMN activity during sleep but do not suppress oculomotor system?
A
- REMon cells in the pons
- These cells activate the ventromedulla which inhibits LMN resulting in atonia
- However the oculomotor movements are not suppressed
9
Q
Describe Locked in syndrome and the EEG pattern associated with it:
A
- In Locked in Syndrome there is complete paralysis of all voluntary muscles except those controlling eye movements
- EEG pattern is normal b/c patient comprehends what is happening but cannot move
10
Q
In the Limbic System loop, there are cognitive inputs from:
Amygdala
Hippocampus
OFC/vmPFC
Anterior Cingulate Cortex
Describe Amygdala:
A
Amygdala is emotional processing
11
Q
In the Limbic System loop, there are cognitive inputs from:
Amygdala
Hippocampus
OFC/vmPFC
Anterior Cingulate Cortex
Describe Hippocampus:
A
Memory context
12
Q
In the Limbic System loop, there are cognitive inputs from:
Amygdala
Hippocampus
OFC/vmPFC
Anterior Cingulate Cortex
Describe OFC
A
- reward evaluation, decision making
13
Q
In the Limbic System loop, there are cognitive inputs from:
Amygdala
Hippocampus
OFC/vmPFC
Anterior Cingulate Cortex
Describe Anterior Cingulate cortex purpose:
A
Motivation, outcome monitoring
14
Q
What system in the brain can contribute to nightmares and flashbacks?
A
- Limbic system, more specifically the amgydala
- Failure of inhibition of overactive amygadala
15
Q
Define Akinetic mutism:
A
- Absence of spontaneous movement and speech
- Lacking drive to initiate movement, can’t button shirt
- Intact consciousness & sensorimotor function
- Patient is immobile, mute, and unresponsive but not comatose
16
Q
What brain region is associated with Akinetic mutism?
A
- Pt is immobile, mute, and unresponsive but not comatose
- Alert but lack-self awareness may show impaired memory for sequence of past events
- Bilateral lesion of dorsal thalamus & interruption of excitatory inputs to the prefrontal cortex impairing executive function and voluntary behavior initiation
- Can be caused by stroke or severe trauma
17
Q
What is the source of pain when patient experiences headaches?
A
- Pain of the dura mater which is innervated by trigeminal nerve and vagus
18
Q
What is the gyrus associated with weakness of the lower face muscles?
A
- Lateral prefrontal gyrus on the contralateral side
- Lower face has contralateral innervation from one side only, so if one MN for lower face muscles is knocked out, contralateral side is always impaired
19
Q
Contrast circuitry of Upper and Lower Facial muscles in CN VII
A
- Upper Face has dual innervation from contralateral side sending LMN efferents to both sides of upper face
- Lower Face has single innervation from contralateral side sending LMN efferents to only 1 side
20
Q
Where is the auditory cortex?
A
Superior surface of lateral fissure
21
Q
Describe Wernicke’s aphasia other than impaired/absent comprehension of speech
A
- Fluent and high volume of speech that may or may not be coherent
- Will not be able to understand questions asked & may reply with “word salad”
- impaired ability to repeat words
22
Q
Define Broca’s aphasia other than low fluency/volume of speech:
A
- Impaired ability to repeat words on command
- Intact comprehension so can answer with non-verbal answers, like shaking head “yes” or “no”
23
Q
While both Broca’s and Wernicke’s aphasia are different, what is one main characteristic that they share?
A
- Neither has the ability to repeat words on command
24
Q
Conduction Aphasia is caused by
A
Conduction Aphasia is caused by damage to arcuate fasciculus
25
Describe conduction aphasia
- Both comprehension and speech production are intact
- But spoken responses are not appropriate to question asked, must test each separately
26
Describe how to test for conduction aphasia.
- Test motor: pointing to a family member, the pt can say their name
- Test comprehension: pt can answer questions but nodding head "yes" or "no"
27
Broca's Aphasia is associated with infarct of:
Broca's Aphasia is associated with an infarct of MCA superior
- B/c Broca's is on lateral surface of cortex and is middle/superior frontal gyrus
28
Wernicke's Aphasia is associated with infarct of:
Inferior division of MCA b/c on lateral surface of temporal lobe
29
What is transcortical aphasia?
- Aphasia proximal to the watershed region of Wenicke's & Broca's
- May be motor or sensory
30
Describe Motor Transcortical Aphasia & stroke associated with it
- MCA-ACA watershed infarct
- Isolates Broca's area from other motor areas
- non-fluent or low fluency matching with Broca's
- **but patient can repeat 2-3 words back**
31
Describe sensory transcortical aphasia and stroke associated with it:
- MCA-PCA
- Isolates an intact Wenicke's area from visual areas
- Fluent aphasia like Wernicke's but **can repeat spoken words** or does so _spontaneously/repetitively_
32
Match Term to Description:
- Patient is not fluent in language
- Patient does not comprehend language
- Patient cannot repeat words
Global aphasia
33
Define anomic aphasia:
Very selective deficit in naming objects or people, otherwise normal
34
Describe Alexia without Agraphia
- Alexia: Cannot read test but comprehension of spoken language is okay
- Agraphia: patient cannot write
35
Where is semantic language processed?
- Semantic language is processed in Dominant Hemisphere
- For majority of population, this will be L dominant b/c most people are R handed
36
The dominant hemisphere processes what type of language?
- Dominant hemisphere processes Semantic language
- This means, for most of the population language is processed by L hemisphere since most people are R handed
37
Where is prosody comprehended?
- Prosody is processed in non-dominant hemisphere
- This means, R hemisphere will be processing in most of the population since most persons are L hand non-dominant
38
Which hemisphere processes prosody of language?
- Non-dominant hemisphere processes prosody of language
- This means, most of the population will process prosody in L hemisphere since most are L hand non-dominant
39
What regions of the brainstem are compressed by a pineal tumor?
- Dorsal Midbrain
- Parinaud syndrome: Upward gaze palsy, pupillary light-near dissociation, eyelid retraction (Collier's sign)
40
How is spina bifida prevented?
- Taking Folate or B9 lowers the incidence of NTD
41
Spina bifida is a disorder of:
Spina bifida is a disorder of neural arches development
- Occulta-lumbosacral region fusion deficit, mild and asymptomatic
42
Which 2 forms of spina bifida are the worst?
- Spina bifida cystica has meningocele: meninges + CSF not enclosed
- Spina bifida meningomyelocele: spinal cord + roots are not envlosed
43
Low levels of this can increase rate of neural tube disorder in pregnancy
Low Vit B12 can increase NTD rate
- Get from liver, fish, red meat, eggs, dairy
44
What are the secondary brain ventricles associated with congenital aqueductal stenosis?
- 3rd & lateral ventricles
- Most common cause of congenital hydrocephalus
45
Describe Arnold-Chiari Type I
Type I: "peg like" cerebellar tonsils extending inferiorly through the foramen magnum
- Gaze deficits are most common, can be asymptomatic
46
What are some causes and sources of ischemic stroke?
Caused by occlusion of an artery
- Deficits are focal and stay focal unlike a hemorrhagic stroke
47
What is the neurotransmitter involved in relay systems?
- Glutamine is the receptor
- Uses AMPA & NMDA receptors
- AMPA depolarize first & then NMDA opens and stays open longer
48
What NT is involved in synaptic plasticity?
Glutamine acting on NDMA receptors
49
What NT is involved in excitoxicity?
- Glutamine
50
What is the role of endocannabinoids?
Travel retrograde to pre synapse to decrease the amount of NT released & thus lowering NT effect on post synapse
- Made on demant
51
What NT is used by the Basal Nucleus of Meynert?
- Nucleus is a structure of the Limbic system
- Uses AcH
52
Dysfunction of Basal Nucleus of Meynert due to low AcH is associated with:
Huntington's disease
53
What is the neural pathway involved when using Caloric testing?
Vestibulo-occular reflex
- That will indicate if BS is intact
- COWS for fast movment
54
Trace the pathway from vestibular ganglion to CN III in Caloric testing:
Ipsilateral Vestibular nuclei → Ipsilateral Vestibular ganglion → Contralateral PPRF → CN VI/Abducens → Contralateral MLF & CN III
55
What is the part of the brain stem associated with the otoacoustic emission test?
- Pontomedullary junction where cochlear nuclei is
- If signals are being relayed to Midbrain via auditory pathway
56
What is the significance of the otoacoustic emission test?
- Tests hearing using noninvasive procedure
- Tests outer hair cells which are important to amplification & tuning
- If outer hair cells can shorted or elongate using Prestin-motor protein then they are able to amplify or tune sound
57
What is the brain nucleus associated with difficulty tracking moving objects?
- Optokinetic Reflex Circuit
- Eyes see large, high contrast moving object detected by **accessory optic nuclei** → goes to dorsal "where pathway" → slow eye phase movement in same direction as moving scene & fast phase reset in opposite direction = nystagmus
58
What does Trochlear N. innervate?
What CN is it & where in brain stem is the nucleus?
- Trochlear CN IV is the only CN to exit the midbrain dorsally proximal to the _inferior colliculus_
- Innervates Superior Oblique **contralateral** to its nucleus b/c decussates prior to exiting midbrain
59
What is the action of Superior Oblique muscle?
Intorsion
60
What is the eye movement in Left Trochlear N palsy?
- Pt will have head tilt **away** from affected eye
- Either contralateral nucleus is lesioned or ipsilateral nerve lesioned
- Eye will be extorted
-
61
Describe the intermediate input pathway to Deep Cerebellar Nuclei?
4 Afferent Nuclei to Cerebellum: Spinal cord, Vestibular Nuclei, Pons ascend using Mossy Fibers & Olivary Nucleus ascends using Olivary Nucleus → both terminate into Granular cells that communicate with Parallel fibers → end of afferent tract → Efferent Pukinje fibers release GABA to Deep Cerebellar Nuclei
62
Damage to what portion of Cerebellum would cause Ataxia?
- Flocconodular lobe & Vermis = Ataxia
- Can be truncal or appendicular
63
What is a common cause of Flocconodular lobe & Vermis impairment in children?
What are the s/s?
- Ataxia would occur, either truncal or appendicular
- In kids originates in vermis caused my medulloblastoma
64
What is a common cause of Flocconodular lobe & Vermis impairment in adults?
What are the s/s?
- Ataxia either truncal or appendicular
- Adults originates in cerebellar hemisphere
- Think of a waddling gate of a whild learning to walk
65
Define ataxia
Disorder of contraction of agonist & antagonist muscle
66
Lesion of the flocconodulus would cause what eye deficit?
- Cerebellum maintains stable eye movement when looking peripherally
- Would cause nystagmus
67
Cerebellar hemisphere lesion would cause:
Cerebellar hemisphere lesion would cause ipsilateral motor coordination deficits
68
What does the Superior Longitudinal Fasciculus connect?
Ipsilateral Parietal and Frontal Lobe
69
What does the Inferior Longitudinal Fasciculus connect?
Ipsilateral Occipital and Temporal lobe on medial surface
70
Which Fasciculus connects ipsilateral Frontal and Occipital lobes?
Inferior Fronto-ocipital Fasciculus
71
What does the Uncinate Fasciculus connect?
Anterior Temporal + Medial Prefrontal cortex
72
What does the Cingulum connect?
Medial Frontal to Parietal
- Think cingulate gyrus
73
What are U fibers?
- Tracts of white matter that connect proximal gyri
74
What does the Anterior Commissure connect?
Anterior Temporal Areas
75
What are Forceps?
Connect L & R regions of corresponding lobes
- I.e. Frontal Forceps or Occipital Forceps connecting L & R
76
What connects the L & R hippocampus?
Hippocampal Commissure
77
What fasciculus connects the inferior parietal lobule with frontal operculum?
This is talking about Wernicke's & Broca's area
Arcuate Fasciculus
78
What is the consequence of medial longitudinal fasiculus damage?
What about abducens (CN ___)
- Abducens is CN VI innervating ipsilateral LR
- PPRF → CN VI → Decussation at MLF → Contralateral CN III
- MLF Lesion: contralateral MR cannot look medially
- If damage L MLF, when looking **RIGHT** cannot utilize L MR
79
Horizontal Gaze is largely directed by what nucleus?
Start Contralateral FEF → PPRF → CN 6 (LR) Nucleus of Pons → Ipsilateral LR & Contralateral CN 3 for MR
80
What is the consequence of Abducens nuclei damage?
Ipsilateral Gaze palsy → if trying to look right, R lateral Rectus cannot engage & L medial rectus unable to look R
81
Lesion to oculmotor N causes the eye to:
Eye remains down and out
82
What is the blood supply to the anterior limb of the Internal Capsule?
Anterior Choroidal A. which came from MCA
83
What is the blood supply of the posterior Internal Capsule?
- Posterior has the Motor & Sensory Tracts
- Supplied by Lenticulostriate A. which came from MCA & ACA
- Some anterior choroidal
84
What is the brain region associated with Left Homonymous superior quadrantanopia?
- L nasal Retinal and R temporal Retina problem
- R hemisphere
- Using Meyers loop (inferior portion of brain) going back to Lingual gyrus of R occipital lobe
- Could be R optic Tract or Hypothalamic or Thalamic tumor
85
What are the signs and symptoms of a lesion in the premotor cortex?
Premotor cortex is preparation for movement
- Lesion would calls apraxia with the inability to say button a shirt
- But reflexes are intact
86
Frontal Eye lesion causes:
Frontal eye lesion causes contralateral gaze deficits-meaning if L FEF is not working, cannot induce R gaze and eyes will slowly gaze L
- Can use doll's head maneuver to get eyes to move, but voluntary movement of eye does not occur
- Eyes will tend to
87
Damage to the DLPFC can disturb behavior inhibition, meaning:
Unable to inhibit unwanted/inappropriate behavior
88
Frontal Eye Field controls:
Frontal Eye field controls contralateral eye movements
89
DLPRC integrates:
DLPFC information across time
- known information to guide future behavior
90
DLPFC is involved in attention control and cognitive flexibility:
Can filter distractions and change the frame of thinking when needed, like switching between tasks
91
DLPFC manages top-down control of emotional response meaning:
Modulates emotional reactivity to stay focused on a task or goal
92
How does DLPFC manage goal directed behavior?
Drives task engagement & persistence toward long-term objects
93
Describe Stroops Test:
Cognitive conflict with incongruent trial
- The word green is written with red ink
- The word blue is written with yellow ink
- In future tests, see if brain can adjust goal relevant features while ignoring distractions and inhibit behavior to read only the word
94
What does Wisconsin Card Sorting task do?
- Tests DLPFC to see if brain can change to meet a new goal once one has already been established
- Sort cards, then directed how to sort cards, when given new information of how to sort cards can the brain adjust
- Cognitive flexibility and attention control
95
What does Stroop's Test actually test?
DLPFC to test selective attention, processing speed and inhibitory control
96
What executive test of DLPFC tests planning and sequencing?
Tower of London Test, to see the fewest moves of ball on peg to get a certain order
- Can the brain use STM, behavioral inhibition, and error detection to continuously check progress and adjust strategy?
97
Where is Primary Olfactory Cortex?
Parahippocampal gyrus & uncus
98
The following structures are part of:
piriform cortex, anterior cortical amygdaloid nucleus, periamygdaloid cortex, lateral entorhinal cortex, Anterior olfactory nucleus, olfactory tubercle,
Olfaction Tract
99
What does the orbital area have to do with olfaction?
Discrimination of smell & ID odors
100
What does Lateral hypothalamus have to do with olfaction?
Integrates smell with feeding
101
Wat does Hippocampus have to do with olfaction?
Memory, learning, behavior related to smell
Receives inputs from entorhinal
102
What are the symptoms assocaited with hippocampal damage
difficulty learning new thing, as information is not retained
Most susceptible area is CA1
103
Damage to Hippocampus will cause problems with what type of amnesia?
Anterograde amnesia due to Hippocampus forms _new_ memories
104
Procedural memory is related to what brain structure?
Basal nuclei
105
When there is Amygdala damage, how might fear response change?
Person will understand everything that happen, but not have fear associated with it
106
What lobe has primary auditory cortex?
Temporal
107
Describe how the Direct pathway of Basal Ganglia directs movement:
- Overall upregulates movement/starts movement
- Cortex releases Glu → Striatum releases GABA → Globus pallidus Internis releases less GABA → Thalamus has less GABA reaching it and can release more Glu
- Disinhibition
108
Describe how Substantia Nigra acts on Direct Pathway in Basal nuclei:
Substantia nigra releases Dopamine to **D1** Receptors on Striatum
- D1 receptors are Gs which will cause increased release of GABA from striatum to increase disinhibition
109
Describe how Indirect pathway of Basal ganglia directs movements:
Has double inhibition pathway
- Cortex releases Glu → Striatum releases GABA to Globus Pallidus Externis → Globus Pallidus Externis releases GABA to subthalamus → Subthalamus will then be allowed to release Glu to Globus Pallidus internis → b/c globus pallidus releases GABA, receiving more GLU will induce Globus Pallidus to release **more** GABA to thalamus and **decrease movement**
110
Damage/decreased of Dopamine from Substania nigra acts on which pathway that leads to Parkinsons:
Damage to substantia nigra releasing dopamine to direct pathway has implications to Parkinson's and decrease movement
111
Reward and addiction are thought to be part of what brain system?
Mesolimibic system & basal nuclei by dopamine interaction
112
How does Dopamine from substania nigra cause changes to indirect pathway
- When dopamine goes to striatum in indirect pathway, D2 receptors are activated which are Gi
- The entire pathway is disinhibited such that the thalamus will be allowed to be more active
- Cortex releases Glu → Striatum releases GABA to Globus Pallidus Externis → Globus Pallidus Externis releases GABA to subthalamus → Subthalamus will then be allowed to release Glu to Globus Pallidus internis → b/c globus pallidus releases GABA, receiving more GLU will induce Globus Pallidus to release **more** GABA to thalamus and **decrease movement**
113
How do pyrogens act on hypothalamus to allow fever?
- In the Preoptic Area of Hypothalamus, the Preoptic area releases GABA to inhibit the Raphe pallidus
- Pyrogens will inhibit the release of GABA so that the Nucleus Raphe pallidus can begin to fire
114
Signs and symptoms of a growing tumor in the parietal lobe
- “pie on the floor” lower contralateral field deficit –lesion of Baum’s Loop
Contralateral hemineglect
- Consider Werknicke's aphasia if in dominant Hemisphere
- Finger agnosia
- L-R disorientation
115
Gelastic seizure is associated with:
Hypothalamic dysfunction, i.e. a tumor, can cause Gelastic seizure where there is uncontrollable laughter or crying
116
What NT is involved in Huntington's disease?
- Decreased release AcH in Basal Nucleus of Meynert
117
Pituitary tumor can cause changes to what circuitry?
Pituitary tumor can compress optic chiasm and changes to Light reflex circuitry
118
Tumors of Pineal gland can cause changes to light reflex, how?
- Pineal tumor can compress pretectal area of light reflex tract
- May cause Parinaud syndrome: impaired vertical gaze, light-near dissociation, pupillary abnormalities, eyelid retraction
119
Where is caudate nuclei?
Lateral wall of lateral ventricles
120
Caudate nuclei is part of what system?
Forms striatum of Basal nuclei
- Part of Direct and Indirect pathway
121
What is the most common type of Arnold Chiari malformation?
Type II: Cerebellar and brainstem herniation, often with myelomeningocele
122
What is sy
123
What is the feeling associated with insula?
Disgust
124
What is the feeling associated with anterior cingulate?
Distress
125
What feeling is associated with Nucleus accumbens?
Reward
126
What is Weber’s syndrome?
- Blockage of proximal branches of PCA, CN3 & Cerebral Peduncle
- Damage to midbrain
127
What is Medial Pons syndrome?
- Medial Pons Infarct: Paramedian pontine Vertebral branches
CN 6
Corticospinal Tract and Medial Leminiscus
128
What is Wallenberg syndrome?
- Lateral Medulla Infarct: PICA, CN9/10, Anterolateral tract deficits
129
What is Syringomyelia?
- Neurological condition with fluid filled cyst forming in spinal cord
- Assoc. with Chiari Type I
- Syrinx expands the spinal cord and stretches the overlying tissue
- Causes permanent nerve damage and paralysis, neuropathic pain, loss of sensation, muscle weakness and bladder/bowel problems
130
What is Chiari type III?
- Most serious form
- Rare
- Protrusion or herniation of cerebellum and brain stem
131
Describe Chiari Type IV
- Incomplete/undeveloped cerebellum, exceedingly rare
- Associated with exposed parts of the skull and spinal cord
132
What is Dandy Walker Syndrome
Blockage of foramina of 4th ventricle
133
Describe Chiari Type II
- Associated with Spina bifida
- Progressive hydrocephalus and myelomeningocele
- Cerebellum and brainstem extend into foramen magnum
134
What is the most common cause of congenital hydrocephalus?
Aqueductal stenosis with ventricular enlargement
