Quiz 1 Flashcards
Some quiz 1 learning objectives + Cassidy's practice Qs
1
Q
Lesions of thalami, or large lesions in the hemispheres above the brainstem can impair consciousness indirectly due to what?
A
Mass effect (putting pressure on brainstem)
2
Q
What is the area between the midbrain and the pons called?
A
Isthmus
3
Q
Rupture of a berry aneurysm would most likely cause what kind of injury?
A
Subarachnoid hemorrhage
4
Q
A subdural hematoma is typically caused by a rupture of what?
A
Bridging veins
5
Q
A posterior communicating aneurysm can cause what?
A
CN III palsy
6
Q
85% of Berry aneurysms occur in the __________ circulation
A
anterior
7
Q
True or false? All information passed between cerebral hemispheres and the spinal cords pass through the brainstem.
A
True
8
Q
Some of the nuclei in what part of the brain contain neurotransmitters?
A
Brainstem
9
Q
The back of the brain (where the cerebellum sits) is directionally called what (compared to the rest of the brain)?
A
Caudal
10
Q
What is the name of the fold between the frontal and parietal lobes?
A
Central sulcus
11
Q
What is the common excitatory NT in the CNS?
A
Glutamate
12
Q
What is the significance of GABA?
A
Most common inhibitory NT in the CNS
13
Q
True or false: histamine, norepinephrine, dopamine, serotonin are all NTs
A
True
14
Q
True or false: gray matter has local synaptic communications between neurons, white matter is over long distances
A
True
15
Q
The cerebral cortex is made up of _________ matter and wraps around the cerebral hemispheres
A
Gray
16
Q
Why does the spinal cord end at L-1, L-2?
A
Bony canal (vertebra) lengthen faster than spinal cord during development.
17
Q
What condition can be caused by disk herniation, tumors, trauma, epidural abscess below the L1, L2 area?
A
Cauda equina syndrome
18
Q
What separates the temporal lobe from the frontal lobe?
A
The Sylvian (or lateral) fissure (a deep sulcus)
19
Q
What divides the motor and sensory cortex?
A
Central sulcus
20
Q
Where is the primary somatosensory cortex located?
A
Postcentral gyrus
21
Q
The bumps or ridges in between the sulci are called _________
A
gyri
22
Q
What lies in precentral gyrus in the frontal lobe?
A
Primary motor cortex
23
Q
Where is the primary auditory cortex?
A
Transverse gyri of Heschl
(this is 2 fingerlike gyri inside the Sylvian fissure)
24
Q
The right visual cortex innervates which visual field?
A
Left half of each eye
25
Lesions above the pyramidal decussation would mostly cause weakness where?
Contralaterally
26
The ______________________ cortex is less lateralized and input from opposite side is slightly stronger, but not clinically detectable
primary auditory
27
_______________________ is the most important motor pathway
Corticospinal tract/ “pyramidal tract”
28
Pyramidal decussation occurs at junction of __________ and spinal cord
medulla
29
The 2 main spinal cord sensory pathways are called what?
1) Posterior column pathway
2) Anterolateral pathway
30
What project from the cortex down to the spinal cord or brainstem?
Upper motor neurons
31
Ataxia, the loss of balance and coordination, can be caused by lesions where?
Cerebellum
32
What is the somatosensory pathway that conveys proprioception, vibration sense, and fine touch?
Posterior column pathway
33
True or false: your ability to sense things would be completely eliminated if the posterior column pathway was severed. Explain your answer.
False; anterior column pathway would still be working
34
Which somatosensory pathway detects when you have really hot coffee spilled on you? Explain why.
Anterolateral pathway; it conveys pain, temperature, and crude touch
35
Which is the only sensory pathway to not go through the thalamus relay center? Why?
Olfaction; goes directly to olfactory cortex
36
What pathway crosses over immediately?
Anterolateral
37
What is located in the center of the brain and receives information about light and dark and secrets melatonin as needed?
Pineal gland
38
True or false? Wernicke’s area is located in the dominant hemisphere area of the brain (usually left) and processes higher order information.
True
39
What controls autonomic functions and the limbic system, among many other things?
Hypothalamus
40
What causes receptive aphasia?
Damage to Wernicke's area
41
What type of aphasia can damage to Broca's area cause?
Expressive or motor aphasia
42
What may cause a patient to ignore objects, or even their own body parts, to one side? What is this phenomenon called?
Right parietal lesions; hemineglect
43
Lesions to what area may cause a patient to experience problems with personality (like lack of judgement, inappropriate joking, inhibition) and cognition?
Frontal lobe
44
What may cause inability to recognize faces, colors, or persistence or reappearance of an earlier viewed object?
Lesions in the visual cortex (of parieto-occipital lobe)
45
Seizures in what part of the brain may cause visual hallucinations?
Visual cortex (of parieto-occipital lobe)
46
What arteries directly supply the brain?
Internal carotid and vertebral arteries
47
What forms the basilar artery?
The vertebral arteries joining
48
What supplies the posterior of the brain?
Basilar artery
49
What supplies the anterior of the brain?
Internal carotid arteries
50
The _________________ vein returns the brain's blood
internal jugular
51
Where does the middle meningeal artery run?
Epidural space
52
List the flow of CSF in order (7 steps)
1) Lateral ventricles
2) Foramen of Monro
3) Third ventricle
4) Sylvian aqueduct
5) Fourth ventricle
6) Foramen of Luschka and Magendie
7) Subarachnoid space
[Arachnoid granulations then absorb]
53
Bridging veins are found where?
Subdural space
54
What ventricle is in the diencephalon?
3rd ventricle
55
What ventricle is surrounded by the pons, medulla and cerebellum?
Fourth
56
Normal volume of CSF in an adult is _____cc, the choroid plexi produce about _______ cc/d
150cc; 500 cc/d
57
What houses the cauda equina?
Lumbar cistern
58
What tract controls voluntary movement of distal muscles (hands and limbs) and is involved in fine motor skills?
The lateral motor system, aka lateral corticospinal tract
59
If there's a lesion in the lateral corticospinal tract of the brain, what would happen?
Contralateral hemiparesis, particularly affecting fine motor control
60
What two tracts originate in the primary motor cortex?
Lateral corticospinal tract and anterior corticospinal tract
61
What are the two divisions of the motor system's tract?
Lateral (lateral corticospinal tract) and medial (anterior corticospinal tract)
62
Damage of what part of the motor system leads to issues of the trunk like gait disturbances, difficulty maintaining upright posture, or gross motor movement difficulties in Parkinson's?
Medial motor system
63
What tract controls bending, twisting, and movements of the trunk?
Anterior corticospinal tract
64
What 3 things control the sympathetic and parasympathetic nervous systems?
Hypothalamus, brainstem, and amygdala
65
What can dysfunctions in the ANS lead to?
Autonomic neuropathies (nerve disorders) in the axon, myelin sheath, or both.
66
Neuropathy affecting spinal nerve roots is called _____________
radiculopathy
67
1) Burning, tingling pain, that often radiates down a limb or dermatome is called what?
2) What causes this?
3) What is that cause often secondary to?
1) Radiculopathy
2) ANS neuropathy affecting spinal nerve roots
3) Diabetes (most common), Lyme disease, HIV, or varicella-zoster (shingles)
68
Gray matter in the spinal cord is surrounded by what?
Ascending and descending white matter columns
69
Where do the nerve plexuses of the arms and legs originate?
Cervical and lumbosacral enlargements of the spinal cord
70
Vertebral arteries form what besides the basilar artery?
Both the anterior and posterior spinal arteries
71
What supplies most of the spinal cord with blood? What part does it *not* supply?
Anterior spinal artery; doesn't supply dorsal surface
72
Venous return for the spinal cord occurs where?
Epidural space
73
Where is the corticospinal tract of the brain?
In the posterior limb of the internal capsule
74
A lesion/stroke of the ________________ can cause weakness of the entire contralateral side of the body from face to lower extremity
internal capsule
75
What are the 3 long tracts of the spinal cord?
1) Posterior column-medial leminiscal system
2) Anterolateral systems (2, includes spinothalamic tract)
3) Corticospinal tract
76
What are the two main somatosensory pathways?
1) Posterior column-medial leminiscal system
2) Anterolateral systems (2, includes spinothalamic tract)
77
A lesion of what tract will cause a loss of pain and temp sensation in the contralateral side below the level of the lesion? Why?
Spinothalamic tract; mediates pain and temp sense
78
What decussates at anterior commissure of spinal cord?
Anterolateral systems (includes spinothalamic tract)
79
What does the spinothalamic tract relay info through and to?
Through the thalamus to the primary somatosensory cortex
80
What tract conveys proprioception, vibration sense, and fine touch?
Posterior column-medial leminiscal system
81
What long tract decussates in the lower medulla?
Posterior column-medial leminiscal system
82
What is the most common cause of spinal cord lesions?
External compression from degenerative spinal disease, trauma, and metastatic cancer.
83
Vitamin B12 deficient can affect what part of the CNS?
Posterior cord
84
Lesions (trauma, compression, multiple sclerosis) of the ___________________ of the spinal cord causes loss of vibration sense, and proprioception below the level of the lesion. This is called _________________________
posterior columns; posterior cord syndrome
85
Anterior spinal artery infarcts can cause what condition that leads to loss of pain and temp sensation below the level of lesion?
Anterior cord syndrome
86
The cauda equina consists of nerve roots from ______ to ______ in the coccygeal tail bone end
L2 to Co1
87
What is responsible for the motor and sensory innervation to pelvic organs (e.g bladders and bowel), lower limbs, and perineum?
The cauda equina
88
What controls voluntary sphincter control and sensory functions in the saddle region?
Cauda equina
89
Sensory loss in what region is called saddle anesthesia?
S2-S5
90
Impairment of _________ (perianal) can cause bladder dysfunction, constipation, fecal incontinence, and loss of erections and needs immediate treatment
S2-S4
91
Is the thalamus made of gray or white matter? What is it shaped like?
Gray; like eggs
92
What is the processing center of the brain?
Thalamus
93
Define dermatome
A peripheral region innervated by sensory fibers from a single nerve root level
94
________________ are organized in a way that allows clinicians to map sensory information to the corresponding spinal nerve, which can be useful in diagnosing certain neurological conditions.
Dermatomes
95
What is the T4 dermatome?
Nipple line
96
What is the T10 dermatome line?
Umbilicus
97
What is the C4 dermatome line?
Thumb
98
What is the S5 dermatome?
Perianal
99
What supplies the anterior hemispheres of the brain?
Internal carotid arteries
100
____________________ supply posterior hemispheres and join forming the basilar artery
Vertebral arteries
101
The anterior and posterior blood supplies form the ___________________ from which all major cerebral vessels arise
Circle of Willis
102
About __[fraction]_____of general population has a full/complete ring/ circle of willis
1/3
103
_______________________ come off the aorta and split into the internal and external carotid arteries
Common carotid arteries
104
The main arteries that supply the cerebral hemisphere are what?
The anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA)
105
The anterior and middle cerebral arteries are the termination of what?
Internal carotids
106
The ___________ join anteriorly by the anterior communicating artery
ACA (anterior cerebral arteries)
107
The anterior and posterior circulations are linked by the ________________________ arteries
posterior communicating
108
What two arteries are linked to join anterior and posterior circulation of the brain?
Internal carotid and the posterior cerebral arteries
109
What does the anterior cerebral artery (ACA) supply?
-Cortex on the anterior medial surface of the brain, from frontal to parietal lobe.
-Medial sensorimotor cortex.
110
The _____________ artery's branches supply the cortex above and below the Sylvian fissure including the lateral temporal lobe and parts of the parietal lobe. Also includes large parts of the basal ganglia and internal capsule, and the thalamus
Middle cerebral artery (MCA)
111
What does the posterior cerebral artery (PCA) supply blood to?
1) Inferior and medial temporal lobes
2) Medial occipital cortex
112
Branches of the ____________ supply large regions of the basal ganglia and the internal capsule.
MCA
113
In the setting of HTN, what small vessels are prone to narrowing, which can lead to blockages causing lacunar infarctions?
MCA branches that supply large regions of the basal ganglia and the internal capsule
114
Define lacunar infarct
A blockage of one of the small branches (esp of the MCA) can cause an area to infarct, leaving a hole or depression in that area of the brain known as a lacunar infarct/stroke
115
Lacunar infarction in what area causes contralateral hemiparesis?
Posterior limb of the internal capsule (which houses motor pathways of the corticospinal tract) and thalamus
116
What characterizes lacunar infarct syndrome (stroke) (clinical manifestation of lacunar infarct)?
Pure motor hemiparesis; contra/unilateral face, arm, and leg weakness. Due to lacunar infarct of posterior limb of internal capsule.
117
What is the most common type of stroke?
Lacunar infarct syndrome
118
What strokes are more common, ACA, MCA, or PCA?
MCA
119
What type of stroke is characterized by aphasia, hemineglect, hemianopia, face/arm or face/arm/leg sensorimotor loss, and a gaze toward the side of the lesion?
MCA stroke
120
Define watershed infarcts
The area when the blood supply of 2 adjacent cerebral arteries is compromised, the region between the 2 vessels is at high risk for ischemia or infarction
121
What are two causes of watershed infarcts?
Sudden occlusion of the internal carotid or a drop in BP setting of carotid stenosis
122
Where is Broca's area?
Just superior to Sylvian fissure in frontal lobe of left hemisphere
123
What is inferior to the lateral fissure in the temporal lobe?
Wernicke’s area
124
1) Define Transient Ischemic Attacks (TIAs)
2) What are their symptoms?
3) What are their causes?
1) A neurological deficit caused by cerebral ischemia that lasts <24 hours (usually closer to 10 mins)
2) Motor, sensory, visual, auditory, emotional or cognitive
3) Migraines, seizures, arrhythmias and hypoglycemia
125
_______% of patients with TIAs will have a stroke within ___ months and most of those within the next ______ hours
10%; 3 months; 48 hours
126
What is the 5th leading cause of death in the US?
Strokes
127
What are the two types of strokes? Define each
1) Hemorrhagic: blood vessel ruptures
2) Ischemic: lack of adequate blood supply to the brain for long enough to cause cell death.
128
What are the two main causes of ischemic strokes? Which one happens more suddenly?
1) Thrombus and embolus
2) Embolus is more sudden
129
What type of ischemic stroke do emboli cause?
Large vessel strokes
130
What are small vessel strokes also called?
Lacunar infarcts
131
For ________ strokes, you need to find the source to prevent additional strokes. Why?
embolic; emobli are most often blood clots and commonly come from the heart
132
What can cause emboli to come from the heart?
Afib or areas of damaged cardiac tissue from previous MI, where slow moving or dead areas of cardiac muscle have stagnant blood flow and create emboli
133
What can form on valve leaflets or artificial valves?
Valvular disease thrombi
134
What type of emboli can come from stenotic area of another vessel?
Artery to artery emboli
135
_____________ of carotids or vertebral arteries often form thrombi/clot which can embolize to the brain
Dissection (tear of the inner wall of an artery)
136
Carotid dissection can cause TIA or infarct in the __________ circulation
anterior
137
Vertebral dissection can cause TIA or infarct in the __________ circulation
posterior
138
Cortical signs come from _________ strokes
lobar
139
What are the cortical signs?
Aphasia, neglect, homonymous visual field defects, apraxia, hemiparesis, and sensory loss
140
Headaches occur in about ____ of ischemic stroke patients from the innervation of the blood vessels and meninges.
¼
141
Headaches are more commonly seen in ________ strokes and can include _______ pain if carotid or vertebral arteries are involved
hemorrhagic; neck
142
Strokes in younger patients are usually from?
Dissection/trauma
143
Stroke risk factors include?
HTN, DM, hypercholesterolemia, cigarette smoking, (+) family history, prior h/o stroke or vascular disease, Afib
144
Deep and superficial veins drain the brain and dump into __________ sinuses. They ultimately exit via the internal ____________ veins
dural sinuses; jugular veins
145
_____________ sinuses lay near the dura and collect deoxygenated blood
Cerebral venous sinuses
146
If a pt experiences neck stiffness or nuchal rigidity, along with a sudden horrible headache, what may be occurring?
A subarachnoid hemorrhage
147
What are potential symptoms of a subarachnoid hemorrhage other than a headache and nuchal rigidity?
Altered mental status, nausea, vomiting, or focal neurological deficit
148
What is the most common cause of subarachnoid hemorrhages?
Rupture of an intracranial aneurysm
149
Explain why subarachnoid hemorrhages are associated with thunderclap headaches
When there's an aneurysm rupture at the Circle of Willis, blood fills the subarachnoid space, causing irritation to the meninges, leading to severe headache
150
What are the diagnostic tools for subarachnoid hemorrhages?
1) CT scan is the initial diagnostic tool (as shown in the case image)
2) If CT is negative but suspicion is high, lumbar puncture may be performed
151
How are subarachnoid hemorrhages treated?
Emergent neurosurgical evaluation; aneurysm may be clipped neurosurgically to prevent recurrent hemorrhage
152
True or false: you can't recover from a subarachnoid hemorrhage. Explain your answer
False; varies depending on the severity of the bleed and promptness of treatment, but full recovery is possible
153
Give 4 differential diagnoses for subarachnoid hemorrhages/ severe headaches
1) Cervical artery dissection
2) Cerebral venous sinus thrombosis
3) Pituitary apoplexy
4) Hypertensive emergency
154
True or false: The complaint of "worst headache of my life" should always prompt immediate medical evaluation to rule out life-threatening conditions, particularly subarachnoid hemorrhage. Explain your answer
True; if its a subarachnoid hemorrhage their chance of recovery depends on promptness of treatment
155
Where are the spinothalamic tracts of the spinal cord in relation to the anterior gray matter horn?
Anterior
156
Where are the corticospinal tracts of the spinal cord in relation to the dorsal horn of the gray matter?
Lateral
157
What function does the lateral corticospinal tract control?
Movement of extremities
158
Where is the spinal cord the thickest?
Cervical area
159
True or false? The lateral corticospinal tract starts in the precentral gyrus and travels down through the spinal cord but crosses at the pyramidal decussation.
True
160
What percent of the corticospinal tract continues ipsilaterally after the pyramidal decussation?
15%
161
The 85% of the corticospinal tract that crosses over becomes the _____________ corticospinal tract; the 15% that doesn't becomes the ___________ corticospinal tract.
85% becomes lateral corticospinal tracts; 15% becomes anterior corticospinal tract
162
Where does the anterolateral pathway cross the spinal cord?
Anterior commissure
163
What tract crosses over in the lower medulla?
Posterior column-medial leminiscal pathway
