Test2

Question 1

The basal ganglia structure that receives input from premotor and motor cortex

Answer 1

Putamen

Question 2

Superficial cutaneous reflexes: S1-S2

Answer 2

Plantar

Question 3

Adrenergic neurons/receptors- autonomic

Answer 3

NE (norepinephrine)
Released by most sympathetic postganglionic neurons

Adrenal medulla
Release E and NE directly into the blood

Adrenergic receptors
Bind E or NE
2 groups exist, alpha and beta, with subtypes for each

Question 4

Hereditary ataxias

Answer 4

Friedreich’s Ataxia

Spinocerebellar Ataxia

Question 5

Medulla and Pons - control autonomic functions

Answer 5

Medulla:
HR
Respiration
Vasoconstriction/Vasodilation

Pons:
Respiration

Signals relayed to autonomic efferents in spinal cord as well as Vagus to modulate responses

Question 6

L2 dermatome

Answer 6

Medial thigh- mid distance

Question 7

Huntington’s 
Muscle strength?
Muscle bulk? 
Involuntary muscle contraction? 
Muscle tone? 
Movement speed/efficiency?
Postural control?

Answer 7

Muscle strength: normal 
Muscle bulk: normal 
Involuntary muscle contraction: chorea 
Muscle tone:variable 
Movement speed/efficiency: abnormal 
Postural control: abnormal

Question 8

Horner’s syndrome

Answer 8

Lesion affecting sympathetic pathway to head
Sympathetic activity on 1 side of head decreased
Interruption of blood supply, trauma, tumors, cluster headaches or stellate ganglion block

Symptoms: Ipsilateral drooping of upper eye, pupil constriction, skin vasodilation, absence of sweating

Ganglion block

Question 9

UMN lesion

Tone, muscle bulk, reflexes, fasiculations…

Answer 9

Tone: spastic
(May be flaccid early)
Increased tone (hypertonia)

Muscle bulk: minimal atrophy
Only after a long period of disuse

Reflexes: increased (hyperreflexia)
May be clonus, plantar extensor

Fasciculations: absent

Question 10

Focal mononeuropathies (diabetes)

Answer 10

Older patients with Type 2 DM
Acute in onset, associated with pain
Spontaneous recovery 6-8 weeks

CN 2, 6, 7; median, ulnar and peroneal nerves most commonly affected
Caused by microvascular infarction
Also predisposed to common entrapment neuropathies

Question 11

PMA: Progressive Muscular Atrophy

Answer 11

Sporadic degenerative disease selectively affecting Anterior Horn cells WITHOUT UMNs signs

Rare, unknown etiology
Average age of onset 57

Distal limb weakness with muscle atrophy, asymmetric or symmetric

Bulbar symptoms may develop

Median survival rate ~56 months

Question 12

Inferior colliculus

Answer 12

Midbrain nucleus of auditory pathway

Relay auditory info from cochlea -> superior colliculus and medial geniculate body of thalamus

Question 13

Babinski’s

Answer 13

Babinski’s sign (+) = great toe fans or extends upward
Extensor plantar response

Normal = toes downward (flexion)

Question 14

Graphesthesia

Answer 14

Ability to recognize letters, numbers or designs when “written” on skin

Question 15

Spinal cord: 
Begins....
2 enlargements... 
Ends at \_\_\_, ending called \_\_\_\_. 
\_\_\_\_ extends inferiorly ending at \_\_\_.

Answer 15

Begins at foramen magnum just inferior to brainstem

2 enlargements: cervical and lumbosacral
Correspond with brachial and lumbosacral plexus (respectively)

Ends ~L1/L2 in adults
Conus Medullaris- cone shaped end

Cauda equina extends inferiorly
The film terminale anchors the inferior end of the spinal cord to the coccyx

Question 16

Guillain-Barré syndrome

Answer 16

Polyneuropathy that affects motor systems more severely than sensory system
Immune system attacks myelin sheath of peripheral nerves
Rapid onset that results in progressive paralysis
1/3 patients require ventilator
Respiratory failure is major concern due to diaphragm and Phrenic nerve being affected

Question 17

CN IX

Answer 17

Glossopharyngeal nerve
Sensory:
taste to posterior 1/3 tongue, sensory from carotid body and sinus, general sensory external ear, pharynx, middle ear
Parasympathetic:
Parotid gland salivation
Motor: stylopharyngeus to assist swallowing

Brain connection: medulla

Associated disorders: 
Decreased/absent gag reflex and swallowing reflex 
Dry mouth 
Loss of taste 
Dysregulation of HR

Question 18

Common motor manifestations following extrapyramidal system damage

Answer 18

Dystonia 
Rigid hypertonicity (perhaps cogwheel) 
Hyperkinesias (resting tremor) 
Hypokinesias (bradykinesia) 
Impaired motor control (initiation of movement) 
Involuntary movements

Question 19

Paresthesia

Answer 19

Abnormal negatively perceived sensation that may include burning, tickling, tingling or numbness without apparent cause.

Question 20

Charcot-Marie-tooth disease

Answer 20

Most common form of inherited polyneuropathy
Paresis of muscles distal to knee
Results in foot drop, steppage gait, frequent tripping, muscle atrophy
Muscle atrophy and paresis will progress slowly and eventually affect the hands
Foot deformities: high arch and hammertoe (flexion of PIP) common

Typically no numbness
Decreased ability to sense temp and painful stimuli
Typically see adolescent onset, but can vary

Question 21

Erb’s paralysis

Answer 21

C5 and C6

Paralysis as a result of forceful separation of head and shoulder
Thrown from motorcycle or horse

Excessive increase in angle between neck and shoulder

Excessive neck stretch during birth

Erb-duchenne Palsy: adducted shoulder, medially rotated arm, extended elbow

“Waiters tip position”- limb hangs by side in medial rotation

Question 22

Syringomyelia predisposition and treatment

Answer 22

Arnold Chiari malformation
Familial (rare)
Complications of trauma, meningitis, hemorrhage, tumor, or arachnoiditis

Treatment: surgery

Question 23

Spasticity: hypertonia in which 1 or both signs are present…

Answer 23

1) resistance to externally imposed movement increases with increasing speed of stretch and varies with direction of joint movement
2) resistance to externally imposed movement rises rapidly above a threshold speed or joint angle

Question 24

Positive neurological sign

Answer 24

Body system expressions that are not normally present but increase or develop as a result of neuro pathology

Ex: increased DTRs, rigidity, tremor, dystonia

Question 25

Spinal region syndromes

Answer 25

A collection of signs and symptoms that do not indicate a specific cause ``` Transverse cord lesions Hemicord lesions- Brown sequard syndrome Posterior cord syndrome Anterior cord syndrome Central cord syndrome Cauda equina syndrome ```

Question 26

ALS (amyotrophic lateral sclerosis) | Prognosis

Answer 26

Death is usually from respiratory failure 50% survive longer than 30 months 20% live 5 years or more < 10% will survive longer than 10 years

Question 27

2 main events seen clinically with autonomic dysfunction

Answer 27

1. Syncope | 2. Orthostatic hypotension

Question 28

C7 sensation (ASIA)

Answer 28

Dorsal surface of the proximal phalanx of middle finger

Question 29

Dysmetria

Answer 29

Unable to control distance of movements

Question 30

``` SMA IV (spinal muscle atrophy) Symptoms, Onset and Natural history ```

Answer 30

Symptoms: Adult onset Onset: mean onset in mid-30s Normal survival

Question 31

Autonomic nociceptors

Answer 31

Respond to stretch/ischemia | Found in viscera and arterial walls

Question 32

Spinal cord white matter... Columns Tracts

Answer 32

Columns: Dorsal (Posterior) Lateral Ventral (Anterior) Tracts: Ascending- sensory Descending- motor

Question 33

Superficial cutaneous reflexes: Corneal

Answer 33

Trigeminal or Facial | CN V or CN VII

Question 34

``` Parkinson’s: Muscle strength? Muscle bulk? Involuntary muscle contraction? Muscle tone? Movement speed/efficiency? Postural control? ```

Answer 34

Muscle strength: normal Muscle bulk: normal Involuntary muscle contraction: resting tremor Muscle tone: velocity-independent increase (rigidity) Movement speed/efficiency: decreased Postural control: excessive

Question 35

Spina Bifida

Answer 35

Neural tube defect Permanent damage with varying degrees of paralysis May have improperly formed or missing vertebrae 3 types: Myelomeningocele Meningocele Occulta

Question 36

Dysphagia is tested by ____ (mediated by CN ___)

Answer 36

Tested by gag reflex | Mediated by CN 9 and 10

Question 37

The amount of resistance, to passive elongation or stretch of a muscle being tested

Answer 37

Muscle tone

Question 38

L3 joint action

Answer 38

Knee extension | Hip ER

Question 39

Neuropathy classifications

Answer 39

Mononeuropathy Involves single nerve. Considered focal dysfunction. Multiple mononeuropathy Involves several nerves. Considered multifocal. Asymmetrically affects individual nerves. Polyneuropathy Involves many nerves. Presents distally and symmetrically.

Question 40

C4 sensation

Answer 40

Over acromioclavicar joint

Question 41

Short and long circumferential arteries

Answer 41

Penetrating branches that supply lateral and posterior brainstem

Question 42

Multiple mononeuropathy

Answer 42

2 or more nerves in different parts of the body involved Most common causes: Diabetes or vasculitis causes nerve ischemia Vasculitis - restricts blood flow due to vessel weakening/rupture Pattern is random and asymmetric due to the fact that individual nerves are affected

Question 43

Common signs of UMN lesions

Answer 43

Paresis Abnormal timing of muscle activity Babinski’s sign Myoplasticity

Question 44

Which spinal cord syndrome most common?

Answer 44

Central cord syndrome

Question 45

PMA: Progressive Muscular Atrophy | UMN and/or LMN degeneration?

Answer 45

LMN degeneration

Question 46

Seddon- axonotmesis

Answer 46

Injury- axon severed, myelin intact or injured (crush based injury) Recovery- May occur weeks to years Sunderland II-IV

Question 47

Sunderland IV

Answer 47

Only epineurium intact Hypoesthesia, dyesthesia, neuroma formation Recovery: neuroma-in-continuity Corresponds with Seddon axonotmesis

Question 48

Posterior column-Medial Lemniscal pathway conveys

Answer 48

Proprioception Vibration sense Fine/discriminative touch

Question 49

Basal ganglia Executive loop

Answer 49

Role: goal-directed behavior; makes perceptual decisions; plans and decides on actions in context Dorsolateral prefrontal cortex-> head of caudate-> globus pallidus-> ventral anterior thalamic nucleus-> dorsolateral prefrontal cortex

Question 50

Myasthenia gravis exercise considerations

Answer 50

Focus on functional training No set exercise guidelines- endurance exercises hinder and want to minimize inflammatory effects of overworking Fatigue is often more a concern than actual muscle damage

Question 51

Spinothalamic system...

Answer 51

AST: crudely localized touch LST: pain and temp Spinoreticular tract: diffuse pain All going through afferent neurons through thalamus and to specific homonculus regions on post central gyrus

Question 52

CN III testing- convergence

Answer 52

Start ~ 2 feet away and slowly move finger/object toward nose Normal: Both eyes directed towards object/finger Abnormal: unilateral eye movement toward midline and other eye moves outward

Question 53

Hypotonia: Muscle description Reflexes Common conditions

Answer 53

Decreased resistance to elongation Hyporeflexia Some genetic disorders (Downs syndrome, Angels syndrome) Polio (partial) Cerebellar disorders

Question 54

Pharmacology Huntington’s

Answer 54

SSRIs- to address depression and anxiety Tetrabenazine- only FDA approved drug for treatment of chorea in HD patients Promotes early degradation of dopamine

Question 55

Striatum

Answer 55

The caudate nucleus and putamen of the basal ganglia. Name origin: Caudate and putamen joined in some places by cellular bridges which appear as stripes. Caudate nucleus is divided into head, body and tail Putamen is large nucleus forming lateral portion of the basal ganglia

Question 56

Sympathetic nervous system Is a ___ pathway of __ system ___ neuron pathway Targets...

Answer 56

Sympathetic nervous system An efferent pathway of autonomic nervous system 2-neuron pathway Targets are in body walk and cavities

Question 57

Contains sensory axons bringing information into spinal cord; it enters the posterolateral spinal cord via rootlets

Answer 57

Dorsal root

Question 58

Superficial cutaneous reflexes: S3-S4

Answer 58

Bulbocavernous Or Anal (normal = “anal wink” contraction)

Question 59

Combined cortical sensations

Answer 59

1. Stereognosis 2. Tactile localization 3. 2-point discrimination 4. Double simultaneous stimulation 5. Barognosis 6. Graphesthesia 7. Texture recognition

Question 60

Gag reflex: Description Afferent Efferent

Answer 60

Description - touching pharynx elicits contraction of pharyngeal muscles Afferent - glossopharyngeal Efferent - vagus

Question 61

Facial nerve lesions | Distinguish between UMN and LMN

Answer 61

UMN in face area of primary motor cortex regulate LMN In contralateral facial nucleus of pons Forehead receives projections from ipsilateral and contralateral cortices UMN lesions: spare forehead, mild contralateral orbicularis oculi weakness Mainly affects inferior portions of face LMN lesions: Affect entire half of face Forehead is not spared

Question 62

Vegetative state is distinguished from coma by...

Answer 62

Spontaneous eye opening Regular sleep/wake cycles Normal respiratory patterns

Question 63

Deep tendon reflexes: C7-C8

Answer 63

Triceps | C7

Question 64

Anterior spinocerebellar and rostrocerebellar Origin? Function?

Answer 64

Origin: internal feedback tracts originate in dorsal horn Function: info about activity in motor tract pathways and interneurons

Question 65

Deep tendon reflexes: C5-C6

Answer 65

Brachioradialis | C6

Question 66

Lenticular nucleus

Answer 66

Putamen and Globus pallidus of basal ganglia

Question 67

Dysdiadochokinesia Or Adiadochokinesia

Answer 67

Abnormalities or rapid alternating movements, such as tapping one hand with palm and dorsum of the other hand

Question 68

LMN lesion signs

Answer 68

``` Weakness Flaccid paralysis Decreased tone Significant atrophy Fasciculations Hyporeflexia ```

Question 69

Anterior Pons contains

Answer 69

Descending tracts

Question 70

Dysrhythmia

Answer 70

Abnormal timing

Question 71

_____ is abnormal articulation of speech | Can occur due to dysfunction of ...

Answer 71

Motor cortex (related to face area) Cerebellum BG Descending corticobulbar pathways to brainstem

Question 72

Trochlear Palsy causes

Answer 72

Neoplasm, infection, aneurysm Microvascular damage, especially in diabetes Disorders of extraocular muscles MG

Question 73

L4 dermatome

Answer 73

Medial malleolus

Question 74

____ depends on our ability to combine various higher-order forms of sensory, motor, emotional, and mnemonic information from disparate regions of the brain into a unified and efficient summary of mental activity which can potentially be remembered at a later time

Answer 74

Conscious awareness

Question 75

CN ? And muscle? | Eye : depression and intorsion adduction

Answer 75

Trochlear CN 4 | Superior oblique

Question 76

CN XII

Answer 76

Hypoglossal nerve Motor: intrinsic and extrinsic muscles of tongue Brain connection: Medulla Associated disorders: Ipsilateral tongue atrophy Deviation to Ipsilateral side upon protrusion Difficulty with articulations that require tongue (ie “la la la”)

Question 77

S3 sensation (ASIA)

Answer 77

Ischial tuberosity

Question 78

Posterior column pathway

Answer 78

``` DRG -> Ipsilateral white matter of dorsal column -> Medulla-> Synapse/Decussation -> Thalamus-> Primary somatosensory cortex ``` (Proprioception, vibration, fine/discriminative touch)

Question 79

Stupor

Answer 79

Arousable only by strong stimuli, including strong pinching of Achilles’ tendon

Question 80

Orthostatic hypotension

Answer 80

Gravity endured pooling in LE with compromises venous return Decrease in systolic by 20 mmHg Decrease in diastolic by 10 mmHg SCI Autonomic degenerative disorders Peripheral neuropathies

Question 81

The coalescence of ventral rootlets

Answer 81

Ventral root

Question 82

Anterior corticospinal tract Origin Termination Function

Answer 82

Origin: Primary motor cortex and supplementary motor area Terminates: Cervical and upper thoracic cord Function: Control of bilateral axial and girdle muscles

Question 83

NF1

Answer 83

Neurofibromatosis Most common type Symptoms often evident at birth or in infancy Changes in skin appearance (cafe au lait skin), tumors, or bone abnormalities Parent, sibling or child with NF1 (hereditary)

Question 84

PD cardinal characteristics

Answer 84

Resting tremor Bradykinesia Rigidity Postural instability

Question 85

The cell body of the sympathetic postsynaptic neuron is in _____. It travels...

Answer 85

Postsynaptic neuron cell body in paravertebral ganglion Enters another ramus communicans -> ventral or dorsal ramus -> periphery

Question 86

Medications for Myasthenia gravis

Answer 86

Anticholinesterase agents - help to improve NM transmission and increase muscle strength Immunosuppressive- improve strength by suppressing production of abnormal antibodies IV- serum containing abnormal antibodies removed from blood while cells replaced; temporarily modifies immune system by infusing antibodies from donated blood

Question 87

EMG is used to determine which factors are contributing to movement impairment

Answer 87

Contracture Hyperreflexia Co-contraction Inappropriate timing of muscle activity

Question 88

Descending motor tracts

Answer 88

Divided into: Lateral and Medial Lateral: Travel in lateral columns Synapse on more lateral groups of ventral horn motor neurons and interneurons Medial: Travel in anteromedial columns Synapse on medial ventral horn motor neurons and interneurons

Question 89

Syringomyelia diagnosis and prognosis

Answer 89

Diagnosis with MRI Symptoms usually present in early adulthood Some patients stable; some worsen with activity Delayed diagnosis can result in irreversible SC damage Without treatment, can lead to weakness, loss of hand sensation, and chronic severe pain

Question 90

Sympathetic efferent neurons innervate...

Answer 90

``` Adrenal medulla Vasculature Sweat glands Erectors of hair cells Viscera ```

Question 91

Transverse myelitis | Prognosis

Answer 91

Recovery usually begins within 2-12 weeks If no improvement in 3-6 months, prognosis poor Approximately 1/3 experience good recovery, 1/3 fair and 1/3 no recovery Rapid onset usually = poorer prognosis

Question 92

Motor disorders in Spastic Cerebral Palsy

Answer 92

Problems with coordination Abnormal tonic stretch reflexes both at rest and during movement Reflex irradiation Lack of postural preparation before movement Abnormal co-contraction of muscles Paresis of agonist postural muscles is the primary impairment interfering with balance recovery Lower limb strengthening in children with spastic CP doesn’t improve gait nor have effect on spasticity Spasticity is not a significant contributor to lower limb dysfunction in children with spastic CP

Question 93

T11 sensation

Answer 93

Midclavicular line, midway between level of umbilicus and the inguinal ligament

Question 94

POTS: Postural orthostatic tachycardia syndrome

Answer 94

``` Orthostatic intolerance Symptoms: Lightheadedness or fainting Increased heart beat > 30 > 120 bpm within 10 min of rising ``` Women between 15-50 Can lead to significant deconditioning Etiology unknown ~80% improve but most have residual symptoms

Question 95

Medium myelinated peripheral axons | Innervates/Group

Answer 95

Efferent- Intrafusal muscle fibers A-gamma

Question 96

Consciousness affected when damage occurs in ....

Answer 96

Reticular formation or pathway of ascending reticular activating system

Question 97

L4 sensation (ASIA)

Answer 97

Over medial malleolus

Question 98

Vertebrobasilar branches supply blood to brainstem and cerebellum. The branches are...

Answer 98

PICA : Posterior inferior cerebellar artery AICA : Anterior inferior cerebellar artery SCA : Superior cerebellar Artery PCA : Posterior Cerebral Artery

Question 99

Diabetic neuropathies

Answer 99

One of most common causes of neuropathy Leads to more hospitalizations for patients with diabetes than any other complication ``` Classified as: 1. Symmetric 2. asymmetric or 3. Focal ```

Question 100

Touch Receptors Name/location of spinal pathway Level/name of decussation

Answer 100

Merkel’s disks, FNE (free nerve endings), hair follicle endings, Ruffini endings, Krause’s end-bulb, and possibly Meissner’s corpuscles AST (Anterior Spinothalamic tract) (In contralateral spinal cord) and ML (medial lemniscal) system (In Ipsilateral posterior columns of spinal cord) AST fibers from posterior horn cells cross within 1-2 levels of entry into the spinal cord through the “anterior commissure;” ML fibers cross from nucleus cuneatus and nucleus gracilis in low medulla as the “internal arcuate fibers”

Question 101

Vibration Receptors Name/location of spinal pathway Level/name of decussation

Answer 101

Pacinian corpuscles (subcutaneous and within deep tissues: muscle, tendon, and joint soft tissue) Medial lemniscal system: fasciculus gracilis and fasciculus cuneatus (In Ipsilateral dorsal column of the spinal cord); Becomes the medial lemniscus in the low medulla of the brainstem Fibers cross from nucleus cuneatus and nucleus gracilis in low medulla in low medulla as “internal arcuate fibers”

Question 102

The basal ganglia structure that sends output to motor areas of the cerebral cortex (via motor thalamus), PPN, and midbrain locomotor region

Answer 102

Globus pallidus internus

Question 103

Cervical plexus

Answer 103

Ventral rain C1-C4 Deep to SCM Cutaneous sensory info from posterior scalp -> clavicle Motor supply: Anterior neck muscles Portion contributes to phrenic nerve (C3-C5 diaphragm) Somatic sensory Sympathetics to cutaneous targets

Question 104

T4 dermatome

Answer 104

Nipple line

Question 105

Autonomic neuropathy

Answer 105

Significant cause of morbidity and mortality Involvement of cardiovascular system limits activity tolerance; resting tachycardia and orthostasis; increased risk of sudden death and silent ischemia GI issues: esophageal dysmotility, gastroparesis, constipation or diarrhea, bowel incontinence ED Bladder incontinence Abnormalities in sweating and thermoregulation

Question 106

Cauda equina syndrome

Answer 106

Damage to lumbar/sacral spinal roots Sensory impairment Motor impairment results in flaccid paresis or paralysis of lower limb muscles Bladder and bowel incontinence Depends on which roots are involved

Question 107

Deep tendon reflexes: L5-S3

Answer 107

Hamstrings | S2

Question 108

Lower cranial nerves are occasionally affected by...

Answer 108

Diabetic neuropathy Demyelination Motor neuron disease Traumatic, inflammatory, neoplastic, toxic or infectious conditions

Question 109

C6 dermatome

Answer 109

On dorsal surface of proximal phalanx of thumb

Question 110

CN XI testing

Answer 110

MMT: SCM and trapezius Abnormal- paralysis or paresis

Question 111

Pressure Receptors Name/location of spinal pathway Level/name of decussation

Answer 111

Pacinian corpuscles, FNE (also in muscle), Ruffini endings (esp for maintained pressure), Krause’s end-bulb Medial lemniscal system: fasciculus gracilis and fasciculus cuneatus (In Ipsilateral dorsal column of the spinal cord); Becomes the medial lemniscus in the low medulla of the brainstem Fibers cross from nucleus cuneatus and nucleus gracilis in low medulla in low medulla as “internal arcuate fibers”

Question 112

Brainstem

Answer 112

``` Most ancient part of human brain Consists of midbrain, Pons and medulla Carries almost all info between brain and body Contains nuclei that regulate: Cranial nerves Level of consciousness Cerebellar circuits Muscle tone Posture Cardiac functions Respiratory functions ```

Question 113

ASIA sensory scoring

Answer 113

0 = sensation absent (or cannot differentiate between sharp/dull) 1 = impaired (feels, but “different” from cheek baseline) 2 = normal NT = not testable

Question 114

Lateral corticospinal tract | UMN to LMN Path..

Answer 114

UMN: Motor cortex (precentral gyrus) -> Through posterior limb of internal capsule -> Pyramidal decussation (85% fibers cross)-> Descends Lateral corticospinal tract Synapse with LMN in gray matter of anterior horn

Question 115

Trigeminal neuralgia

Answer 115

Episodes of brief severe pain lasting seconds to minutes Unknown etiology Can occur in MS (demyelination of trigeminal entry zone of brainstem) Most often unilaterally affects maxillary or mandibular nerve More common in women and individuals 35+ years old Exacerbated by stress/cold and relieved by relaxation Anticonvulsants block nerve firing Tricyclic antidepressants to treat pain

Question 116

Tests of autonomic function

Answer 116

1. Supine-> Stand Initial assessment in supine, standing after 2 min Drop of > 30 mmHg systolic or > 15mmHg of diastolic 2. Regulation of the skin Sweat test or hand vasomotor test Vasomotor year- temp changes with hands immersed in cold water 3. Valsalva Blow into closed tube that has a small leak for 30 sec, maintaining 40 mmHg Dangerous after hemorrhagic stroke

Question 117

Potential causes of PD

Answer 117

Viral Environmental factors: exposure to toxins; link between growing up in a rural area (pesticides, insecticides, well water) Genetics Aging

Question 118

Neurofibromatosis NF1 | signs/symptoms

Answer 118

NF1: 6 or more light brown spots on the skin 2 or more neurofibromas or one plexiform neurofibroma Freckling in armpit or groin 2 or more growths on iris Tumor on optic nerve Abnormal development of spine, temporal bone of skull or tibia

Question 119

3 layers of cerebellar cortex

Answer 119

Granular cell layer: numerous small granule cells Purkinje cell layer: cell bodies of Purkinje cells Molecular cell layer: interneurons; unmyelinated granule cell axons; Purkinje cell dendrites

Question 120

Muscle tone

Answer 120

Resistance to passive stretch Some amount of muscle tone is normal Range of muscle tone: Flaccidity - Hypotonia - Normal - Spasticity- Rigidity

Question 121

CN III testing

Answer 121

Patient looks straight ahead Ask to look up without moving head Normal: eyelid position symmetrical Upper eyelid retracts with upward gaze Abnormal: height of space between eyelids asymmetrical; drooping eyelid doesn’t contract OR observe size of pupil in normal room light; should be moderate size, abnormal = dilated OR shine light into eye, normal = constriction abnormal = pupil unchanged OR observe eyes with patient looking straight ahead. Normal = both eyes in same direction Abnormal = diplopia; Ipsilateral eye looks down and out

Question 122

Brainstem lesions: Posterolateral Upper Pons or Midbrain Sensory loss?

Answer 122

Contralateral sensory from face EXCEPT proprioception Contralateral sensory loss from body

Question 123

CN ? and muscle? | Eye depression and extorsion abduction

Answer 123

CN3 oculomotor | Inferior rectus

Question 124

Sacral plexus

Answer 124

Ventral rami L4/5-S4 Supplies gluteal region, pelvic region, perineum, posterior thigh, most LE Somatic sensory and motor fibers Parasympathetic fibers

Question 125

Signs/symptoms of cauda equina

Answer 125

Difficulty with urination and/or defecation Decreased or lost sensation in saddle area LBP Unilateral or bilateral sciatica Lower limb paresis and sensory deficits Decreased or lost lower limb reflexes

Question 126

Substantia nigra

Answer 126

Portion of basal ganglia located in midbrain just dorsal to cerebral peduncles Ventral portion = substantia nigra pars reticulata Dorsal portion = substantia nigra pars compacta The pars compacta is the darkly pigmented dopaminergic neurons Degeneration of pars compacta associated with Parkinson’s

Question 127

C2 sensation (ASIA)

Answer 127

At least 1 cm lateral to occipital protuberance at base of skull. Alternately can be located at least 3cm behind ear

Question 128

SCA: superior cerebellar artery

Answer 128

Supplies superior cerebellum and small portion rostral laterodorsal Pons

Question 129

Peripheral nerves: | Connective tissue sheath that encloses entire nerve trunk

Answer 129

Epineurium

Question 130

Focal

Answer 130

Localized compression Traction Or Trauma

Question 131

Basal ganglia feedback circuit

Answer 131

Cortex -> basal ganglia-> thalamus-> Cortex

Question 132

SMA: Spinal Muscle Atrophy

Answer 132

Genetic disorder Autosomal recessive; deletion of motor neuron-1 gene Motor neurons with cell bodies in spinal cord degenerate Anterior horn cells 1 in 6000 births 4 types

Question 133

PPS (post-polio syndrome) | Presentation

Answer 133

``` New weakness and atrophy Abnormal fatigue Pain Decreased function Slow progression Cold intolerance Cognitive deficits Sleep disturbances Decreased mobility ```

Question 134

Peripheral lesion on left CN 11 causes weakness of head turning in which direction?

Answer 134

Right

Question 135

Proprioceptive information from muscles of mastication transmit ____ by ____ to ....

Answer 135

Proprioceptive information from muscles of mastication transmit Ipsilaterally by CN V axons-> Mesencephalic nucleus in midbrain-> Reticular formation

Question 136

Dorsal column/medial lemniscal

Answer 136

Fast conducting fibers, large diameter, myelinated Mediates: discriminative touch, pressure, vibration, movement, position sense and awareness of joints at rest.

Question 137

2 primary pathways that mediate sensation

Answer 137

1. Anterolateral Spinothalamic | 2. Dorsal Column/Medial Lemniscal

Question 138

If discriminative sensation lost in cerebral region lesion, ____ is still possible

Answer 138

Crude awareness is still possible

Question 139

T9 sensation

Answer 139

Midclavicular line, 3/4 distance between level of xiphisternum and the level of the umbilicus

Question 140

Polio and Werdnig-Hoffmann disease: ___ lesions due to ____

Answer 140

LMN lesions only Due to destruction of anterior horns Flaccid paralysis

Question 141

CN I testing

Answer 141

Test each nostril individually Eyes closed Abnormal response: anosmia

Question 142

Trochlear Palsy

Answer 142

``` Vertical diplopia (hypertropia) In cases with severe weakness, other eye may show hypertropia ``` Vertical diplopia worsens when affected eye looks nasally and with down gaze Improved by looking up (chin tuck) and tilting head away from affected eye Head movement is always in the direction of action normally served by affected muscle

Question 143

Cerebellum is divided into functional regions...

Answer 143

1. Midline vermis and flocculonodular lobe 2. Intermediate part 3. Lateral part

Question 144

Cerebellum ___ movement

Answer 144

Coordinates and refines movement Compares actual motor output with intended movement and adjusts UMN as necessary Involved in movement rhythm, timing and synchronization Regulates Ipsilateral movement

Question 145

Small myelinated peripheral nerves | Innervates/group

Answer 145

Efferent- Presynaptic autonomic B Afferent- Pain, temperature, visceral receptors A-delta

Question 146

T7-12 muscle innervation

Answer 146

Move, stabilize trunk | Abdominals

Question 147

Midline vermis and flocculonodular lobe of cerebellum: function and motor pathways influenced

Answer 147

Function: coordinates proximal and trunk muscles; balance and vestibulocular reflexes ``` Motor pathways influenced: Anterior corticospinal tract, Reticulospinal tract, Vestibulospinal tract, Tectospinal tract ``` Medial longitudinal fasciculus (balance and vestibulocochlear reflexes)

Question 148

Attention depends on

Answer 148

Brainstem and diencephalon arousal circuits and the cortex | With additional processing in frontoparietal association cortex

Question 149

Cerebellar artery infarcts

Answer 149

More common in PICA and SCA Can cause swelling of cerebellum that results in brainstem compression (life-threatening emergency) Often requires surgical decompression of posterior fossa Presentation: vertigo, nausea, vomiting, horizontal nystagmus, limb ataxia, unsteady gait, headache

Question 150

Preganglionic Sympathetic axons to abdominal and pelvic organs pass through...synapse...

Answer 150

Preganglionic Sympathetic axons to abdominal and pelvic organs pass through sympathetic ganglia WITHOUT synapsing They travel in peripheral nerves and synapse in outlying ganglia near the organs

Question 151

L3 dermatome

Answer 151

Medial knee

Question 152

Cerebral spasticity

Answer 152

Enhanced excitability of MONOSYNAPTIC pathways due to lack of inhibition Rapid build-up of reflex activity Bias toward overactivity in the antigravity muscles

Question 153

CVA - Middle Cerebral Artery | Motor system symptoms

Answer 153

Contralateral motor symptoms primarily in face, UE and trunk LE may be involved if infarction of deep subcortical white matter (corona radiata, posterior limb of internal capsule) tales place

Question 154

Because this vascular system supplies structures including brainstem, warning signs of ischemia should warrant immediate medical attention

Answer 154

Vertebrobasilar Artery | Posterior circulation

Question 155

Cerebellar disorder signs and symptoms

Answer 155

Common: nausea/vomiting, vertigo, slurred speech, unsteadiness, uncoordinated limb movements Headache

Question 156

CN ? and muscle? | Eye elevation and extortion adduction

Answer 156

CN3 oculomotor | Inferior oblique

Question 157

Blood supply to brainstem. Supply to posterior fossa structures arise from ____. Vertebral arteries arise from ___. They pass through...

Answer 157

Posterior fossa structures supplied by vertebrobasilar system. Vertebral arteries arise from subclavian Through transverse foramina of cervical vertebrae, pierce dura and enter cranial cavity via foramen magnum

Question 158

Huntington’s presentation- | Sensorimotor deficits, voluntary

Answer 158

Early signs are clumsiness, incoordination, jerkiness Slow and hypometric saccadic eye movements Dysphagia and dysarthria Slow and uncoordinated arm and hand movements Abnormal control of posture, balance and gait Wide BOS Highly correlated with disease severity and functional disability

Question 159

C3 sensation (ASIA)

Answer 159

In supraclavicular fossa, at the midclavicular line

Question 160

Sympathetic trunk ____ rami ____ entrance ____ exit

Answer 160

Ventral rami ``` Entrance = white rami Exit = gray rami ``` (White rami lateral to gray rami)

Question 161

Cerebral region lesions: | Somatosensory Cortex lesions

Answer 161

Contralateral loss of discriminative sensation

Question 162

Babinski’s sign indicates damage in ___ tract.

Answer 162

Corticospinal tract Afferent: medial and lateral plantar nerves (L5 and S1) Efferent: common fibular nerve (L5)

Question 163

The basal ganglia structure that processes information within the basal ganglia circuit

Answer 163

Subthalamic nucleus and Substantia nigra compacta

Question 164

CN II testing- peripheral

Answer 164

Cover 1 eye, patient looks straight ahead Place finger or object near ear and slowly move toward visual center Have patient identify when can see object Abnormal: patient cannot see finger/object

Question 165

Spinothalamic Origin? Function?

Answer 165

Origin: Dorsal horn of SC Function: Discriminative info about pain and temp

Question 166

CN V testing

Answer 166

Patient closes eyes, use light touch with tissue paper or pin prick to assess sensation: forehead, cheek and chin Normal: distinguish between sharp/dull; localization of stimulus Abnormal: anesthesia

Question 167

``` Cerebellar lesions Muscle strength? Muscle bulk? Involuntary muscle contraction? Muscle tone? Movement speed/efficiency? Postural control? ```

Answer 167

``` Muscle strength: normal Muscle bulk: normal Involuntary muscle contraction: none Muscle tone: normal Movement speed/efficiency: ataxic Postural control: depends on location of lesion ```

Question 168

Pathophysiology of spasticity

Answer 168

Decreased inhibitory drive in corticospinal tract UNN lesion disrupts communication between brain and spinal cord - results in a state of net disinhibition of spinal reflexes. Limb is stretched, muscle spindles respond BUT negative feedback system between spindles and alpha-motor neurons is DISRUPTED because UMN lesion Results in abnormal muscle activation

Question 169

Unmyelinated peripheral axons | Innervates/group

Answer 169

Efferent- Postsynaptic autonomic C Afferent- Pain, temp, visceral receptors C

Question 170

S1 muscle innervation

Answer 170

Ankle plantar flexion ``` Triceps Surae (S1-S2) Foot intrinsics (S1-S3) ```

Question 171

PICA: posterior inferior cerebellar artery

Answer 171

Supplies lateral medulla and inferior cerebellum

Question 172

Blockers/agonists- adrenergic (alpha, beta 1 and 2)

Answer 172

Alpha blockers: Block NE binding in blood vessels = vasodilation-> decreased BP Beta1 blockers: Decrease HR/contractility Beta2 agonist: Agonist prevent airway construction in asthma and COPD

Question 173

Stretch reflex

Answer 173

Initial stimulus: muscle stretch 1. Afferent impulses Stretch receptor -> spinal cord (dorsal horn) 2. Efferent impulses to Alpha motor neurons cause contraction of stretched muscle that resists the stretch 3. Efferent impulses to antagonist muscles are damped (reciprocal inhibition)

Question 174

Brain tumors | Motor system symptoms

Answer 174

Contralateral motor symptoms specific to CNS area affected

Question 175

Parinaud’s syndrome causes

Answer 175

Pineal region tumor Hydrocephalus Thalamic hemorrhage

Question 176

Common causes of oculomotor nerve palsy

Answer 176

``` Diabetic neuropathy or other microvascular neuropathy associated with HTN or hyperlipidemia Head trauma (shearing forced damage nerve) Compression of nerve by intracranial aneurysm ```

Question 177

Coma

Answer 177

Unarousable unresponsiveness Patient lies with eyes CLOSED Minimum duration- 1 hour Dysfunction in: bilateral widespread regions of cerebral hemispheres or upper brainstem-diencephalic activating systems

Question 178

Spinal cord blood supply.... | arteries

Answer 178

Anterior spinal artery (1) Posterior spinal artery (2) Spinal arterial plexus connecting anterior and posterior

Question 179

Cholinergic receptors in autonomic system

Answer 179

Muscarinic Initiate G-protein-mediated response; EPSP or IPSP Parasympathetic muscarinic receptors regulate glands, smooth muscle, and HR Nicotinic Located on ALL postsynaptic autonomic neurons in adrenal medulla Causes fast EPSP

Question 180

CN V neurons - light touch

Answer 180

Cell bodies located in trigeminal ganglion | ``` Receptor-> Main sensory nucleus in PONS-> Decussate VPM thalamus-> Somatosensory cortex ```

Question 181

Globus pallidus

Answer 181

“Pale globe” of basal ganglia Many myelinated fibers traverse area. Medial to putamen. Internal and external segments

Question 182

Basal ganglia | Behavioral flexibility and control loop

Answer 182

Role: recognition of social disapproval; self control; discerning relevant vs irrelevant info; maintaining attention; stimulus-response learning Ventrolateral prefrontal and lateral orbital cortex -> head of caudate-> substantia nigra reticularis -> mediodorsal thalamic nucleus-> ventrolateral prefrontal and lateral orbital cortex

Question 183

S2 sensation (ASIA)

Answer 183

Posterior knee

Question 184

Diplopia | CN? Disorders

Answer 184

Double vision CN 3, 4, 6 NMJ disorders like Myasthenia gravis

Question 185

Basal ganglia motor circuit regulates

Answer 185

Muscle contraction and force Multi-joint movements Sequencing of movements Basal ganglia do no have direct output to LMNs, so work through 3 routes

Question 186

Superior colliculi

Answer 186

Midbrain (tectum) Reflexive head and eye movements Turns head and eyes toward stimulus

Question 187

Seeing 3 or more images is NOT

Answer 187

An eye movement abnormality

Question 188

C5 joint actions

Answer 188

Elbow flexion | Shoulder abduction

Question 189

Tetraplegia

Answer 189

Paralysis of trunk, UEs and LEs

Question 190

Infarcts that spare the lateral brainstem and affect cerebellum only are more common with ___ infarcts

Answer 190

SCA

Question 191

Masseter reflex: Description Afferent Efferent

Answer 191

Description - masseter tapped, muscle contracts Afferent - trigeminal Efferent - trigeminal

Question 192

Cerebellopontine angle

Answer 192

Medulla Where CN 7, 8, and 9 exit brainstem

Question 193

AICA

Answer 193

Anterior inferior cerebellar artery Supplies lateral caudal pons and small portion of cerebellum

Question 194

C8 dermatome

Answer 194

5th Metatarsal | 4th and 5th digits

Question 195

CN III- testing inferior oblique

Answer 195

Move finger medial (nasal) and superior Abnormal: unable to adduct and elevate eye

Question 196

Velocity dependent hypertonia AKA

Answer 196

Spasticity

Question 197

Perception of tactile touch input

Answer 197

``` Light touch (lighter) Pressure (stronger) ```

Question 198

Spasticity

Answer 198

NM overactivity, secondary to UMN lesion

Question 199

Huntington’s coordination of care

Answer 199

OT- ADLs and self care SPT- Dysarthria, dysphagia, cognitive training, adaptive equipment. Weight loss Home health- home assessment, equipment needs. Behavioral changes Psychologist/Psychiatrist- depression, anxiety, etc

Question 200

``` UMN lesions: Muscle strength? Muscle bulk? Involuntary muscle contraction? Muscle tone? Movement speed/efficiency? Postural control? ```

Answer 200

Muscle strength: decreased (paresis) Muscle bulk: variable atrophy Involuntary muscle contraction: fibrillations Muscle tone: in SCI and spastic CP velocity-dependent increase Movement speed/efficiency: decreased Postural control: decreased or normal depending on location of lesion

Question 201

Myasthenia gravis prognosis

Answer 201

Stable or slowly progressive With medical treatment >90% survival rate Long lasting complete remission after thymectomy is ~50% Some go into remission (temp or perm) and muscle weakness may disappear so medications can be discontinued Severe weakness may cause respiratory failure - which is a medical emergency

Question 202

Inadequate inhibition basal ganglia...

Answer 202

Hyperkinetic disorders Huntington’s disease Dystonia Tourette’s disorder Dyskinetic cerebral palsy

Question 203

Trophic changes due to denervation

Answer 203

Muscle atrophy Skin becomes shiny Brittle nails Thickening of subcutaneous tissue Common findings: Ulcerations, long wound healing times, infections

Question 204

PSP: Progressive Supranuclear Palsy

Answer 204

``` Bradykinesia Unstable gait with frequent falls Rigidity Vertical gaze palsy More cognitive impairment More rapid progression ```

Question 205

C6 dermatome

Answer 205

Dorsal web space of thumb | 1st and 2nd digits

Question 206

Peripheral nerves fibers

Answer 206

Mixed | Contain sensory, motor and autonomic fibers

Question 207

Adaptive changes within muscle secondary to a MT lesion and/or prolonged positioning. It is produced by ___ and ___.

Answer 207

Myoplasticity Produced by contracture and increased weak actin-myosin bonding

Question 208

Awareness of movement

Answer 208

Kinesthesia

Question 209

Hemiplegia

Answer 209

Paralysis of 1 side of body

Question 210

Transverse myelitis | Predisposition and treatment

Answer 210

``` Specific to no one Peak incidence 10-19 years and 30-39 years Treatment primarily symptom management Corticosteroid therapy PT intervention same as with other SCIs ```

Question 211

Atrophy in proportion to weakness usually indicates

Answer 211

Axonal etiology

Question 212

T1 sensation (ASIA)

Answer 212

On medial (ulnar) side of the antecubital fossa, just proximal to the medial epicondyle of the humerus

Question 213

Muscle stretch hyperreflexia - Tonic

Answer 213

In response to slow stretch; continues as long as stretch maintained Excessive MN response to afferent input from stretch; results in excessive muscle contraction when spindles stretches

Question 214

Damage to these regions can result in abnormal expression of muscle tone

Answer 214

Spasticity: Corticospinal (pyramidal) system in cerebrum Brainstem Motor pathways of spinal cord Rigidity or dystonia: Extrapyramidal elements including basal ganglia ``` Decreased tone: Vestibular centers Cerebellum Anterior horn cells Peripheral nerves NMJ or muscle ```

Question 215

Posterior cord syndrome

Answer 215

Lesions of posterior columns cause loss of vibration and position sense below the level of the lesion Rare, but found in B12 deficiency, trauma, MS, tumors

Question 216

Abducens Palsy

Answer 216

Horizontal diplopia Diplopia better when viewing near objects, worse viewing far objects Worsens when tries to abduct affected eye May turn head toward affected eye to compensate

Question 217

CN XI

Answer 217

Spinal accessory nerve Motor: trapezius and SCM, elevates shoulders, turns head Brain connection: spinal cord and Medulla Associated disorders: Ipsilateral paralysis of SCM and trap

Question 218

Huntington’s pathology

Answer 218

CAG repeat on chromosome More repeats = more severe disease Breakdown of nerve cells in brain in basal ganglia and cerebellum Hyperactivity of BG circuit

Question 219

Afferent autonomic information is processed in...

Answer 219

Solitary nucleus Spinal cord Areas of brainstem, hypothalamus and thalamus

Question 220

Superficial cutaneous reflexes: Palatal

Answer 220

Glossopharyngeal or Vagus | CN IX or CN X

Question 221

CN IV

Answer 221

Trochlear nerve Motor Motor to superior oblique Intorts eyes (medial rotation) and depression In isolation moves eye inferiorlateral but test only depression by looking inferiormedial Brain connection: posterior midbrain Associated disorders: Diplopia Difficulty reading Difficulty descending stairs

Question 222

Central regulation of visceral function

Answer 222

Autonomic system Cranial nerves send visceral info to solitary nucleus (main visceral sensory nucleus) Solitary nucleus sends info to: Pons, medulla, hypothalamus, thalamus and limbic systems Ex: BP monitoring: glossopharyngeal- blood composition and pressure from carotid body, Vagus- sane info from aortic arch

Question 223

Myasthenia Gravis

Answer 223

Autoimmune Damages ACh receptors at NMJ Repeated muscle use leads to increased weakness

Question 224

Tract that controls movement of the extremities

Answer 224

Lateral corticospinal tract

Question 225

Deep sensations

Answer 225

Kinesthesia Proprioception Vibration

Question 226

S3 sensation

Answer 226

Over ischial tuberosity or infragluteal fold

Question 227

Oculomotor nerve palsy

Answer 227

Eye appears down and out Eye may be closed (ptosis) Pupil dilated and unresponsive to light Diplopia worse when looking at near objects- better looking at distant objects (because convergence impaired)

Question 228

PD motor symptoms

Answer 228

``` Tremor Bradykinesia (slow movements) Rigidity and freezing Stooped, shuffling gait Decreased arm swing when walking Difficulty arising from chair Micrographia (small handwriting) Lack of facial expression; mask like Slowed ADLs Postural instability Difficulty turning in bed ```

Question 229

SMA : spinal muscle atrophy | Presentation

Answer 229

Muscle weakness and atrophy | Premature death

Question 230

Abnormal cutaneous reflexes

Answer 230

Babinski’s sign | Muscle spasm

Question 231

Joint position and movement sense (conscious) Receptors Name/location of spinal pathway Level/name of decussation

Answer 231

Muscle spindles, joint receptors, golgi-Type endings in ligaments, In joint capsule: Ruffini endings (direction and velocity), FNE (crude awareness), Paciniform endings (rapid joint movements) Medial lemniscal system: fasciculus gracilis and fasciculus cuneatus (In Ipsilateral dorsal column of the spinal cord); Becomes the medial lemniscus in the low medulla of the brainstem Fibers cross from nucleus cuneatus and nucleus gracilis in low medulla in low medulla as “internal arcuate fibers”

Question 232

S1 joint action

Answer 232

Ankle plantar flexion | Hallux ADD

Question 233

C4 muscle innervation

Answer 233

Shoulder adduction C3-C5: levator scapulae; diaphragm C4-C5: rhomboids

Question 234

Lateral hemisphere of cerebellum: | Function and motor pathways influenced

Answer 234

Function: motor planning for extremities Motor pathways influenced: Lateral corticospinal tract

Question 235

CN VII branches

Answer 235

``` Branches within parotid: Temporal Zygomatic Buccal Mandibular Cervical ``` Posterior auricular

Question 236

Rare disorder that can affect lower cranial nerves. Patients with this often present with impairments of CN IX, X and XI, resulting from compression of these nerves in jugular foramen. The tumor frequently extends to CN XII and can grow upward to affect CN VIII and VII in temporal bone

Answer 236

Glomus tumor/Glomus jugulare

Question 237

Superficial cutaneous reflexes

Answer 237

Normally occurring reflexes in response to noxious stimulus (light scratch) applied to skin

Question 238

CN III

Answer 238

Oculomotor nerve Motor to superior, inferior, medial rectus, inferior oblique, levator palpebrae superioris Turns eye superiorly, inferiorly, medially Raises eyelid Accommodation: changes shape of pupil Parasympathetic to sphincter of pupil and ciliary muscle Brain connection: anterior Midbrain ``` Associated disorders: Ptosis Diplopia Eye appears down and out Loss of pupillary and accommodation reflexes ```

Question 239

Ambulatory movement

Answer 239

Requires coordination of cerebral cortex, basal ganglia, cerebellum, brainstem and sensory input During normal gait, movement of COM must be forward Demonstrated in patients with hemiparesis Demonstrated in patients with PD Dual tasking with gait

Question 240

Tactile localization

Answer 240

To know where being touched

Question 241

Central cord syndrome

Answer 241

Damage to Spinothalamic fibers Typically at cervical levels Loss of pain and temperature sensation at level of lesion Larger lesions may impair UE movement if lateral corticospinal tract is hit Common in elderly and patients with spinal canal stenosis

Question 242

CN IX testing

Answer 242

Touch soft palate with cotton swab to elicit gag reflex Normal: gagging and symmetrical elevation of soft palate Abnormal: lack of gag reflex; asymmetrical elevation of soft palate (Gag reflex: sensory CN IX, motor CN X)

Question 243

Allodynia

Answer 243

Exaggerated or painful response to a stimulus that should not be painful

Question 244

Mononeuropathy due to trauma

Answer 244

Wounds, prolonged compression, repetitive stimuli Classified based on severity of nerve damage Traumatic myelinopathy Traumatic axonopathy Severance

Question 245

``` Sympathetic- heart Neurochemical Receptor Effect Purpose ```

Answer 245

Neurochemical : adrenergic Receptor : beta-1 Effect : dilation Purpose : more blood available to heart

Question 246

Primary Lateral Sclerosis (PLS) | UMN and/or LMN degeneration?

Answer 246

UMN degeneration

Question 247

``` SMA I (spinal muscle atrophy) Symptoms, Onset and Natural history ```

Answer 247

Symptoms: Werdnig Hoffman, Acute infantile Onset: before 6 months Unable to sit independently Poor survival

Question 248

Locked-in syndrome

Answer 248

Infarct of ventral pons Bilateral corticospinal and corticobulbar tracts affected Absent motor function Intact sensation and cognition Often spares vertical eye movement and eye opening

Question 249

L5 sensation (ASIA)

Answer 249

Dorsum of foot at third metatarsal phalangeal joint

Question 250

Brachial plexus

Answer 250

Ventral rami C5-T1 Emerges between anterior and middle scalenes Travels deep to clavicle -> axilla -> UE Major terminal nerves: Axillary, radial, median, ulnar and musculocutaneous Somatic sensory and motor fibers Sympathetics yo cutaneous targets

Question 251

Spinal Spasticity: Primarily Hyperreflexia

Answer 251

Hyperreflexia can contribute to the movement dysfunction in people with chronic SCI May also limit walking speed, interfere with positioning, mobility, hygiene, comfort and sleep Positive aspect to Hyperreflexia is that it can intentionally trigger to elicit involuntary muscle contraction during transfers and help maintain muscle mass and assist venous return

Question 252

Almost all input to basal ganglia arrive via ___. | ___ from ___ = excitation of this structure (___ + ____)

Answer 252

The striatum | Glutamate from cortical motor areas = excitation of striatum (caudate + putamen)

Question 253

Cerebellum feedback circuit

Answer 253

Cortex -> Pons -> Cerebellum-> Thalamus-> Cortex

Question 254

CN X

Answer 254

Vagus nerve Sensory: regulates viscera, swallowing, speech, taste, sensory to mucosa of laryngopharynx Motor: swallowing (pharyngeal constriction), vocal sounds Brain connection: Medulla ``` Associated disorders: Difficulty speaking, swallowing Poor digestion Hoarseness Erratic HR ``` (Motor for gag reflex, sensory is CN IX)

Question 255

Lesions occurring above the pyramidal decussation of the lateral corticospinal tract produce

Answer 255

Contralateral weakness

Question 256

UMN lesion signs

Answer 256

``` Weakness Spastic paralysis Increased tone No significant muscle atrophy No fasciculations Hyperreflexia Babinski’s reflex may be present ```

Question 257

CN ? and muscle | Lateral eye movement - abduction

Answer 257

Abducens CN 6 | Lateral rectus

Question 258

Sunderland I

Answer 258

Full recovery expected (day - 2 mo) Intrafascicular edema, conduction block, possible segmental demyelination Neuritis, paresthesia Equates to Seddon neuropraxia

Question 259

Medial longitudinal fasciculus

Answer 259

Posterior Pons | Links nerves controlling eye movement CN III, IV and VI with vestibular system

Question 260

SC interruption interrupts.... | Autonomic

Answer 260

All info below level of injury Interrupts both ascending and descending autonomic signals At T6 and above: Autonomic dysteflexia And inability to control body temperature Lumbar spine: Bowel/bladder/genitalia dysfunction

Question 261

Parkinson’s Plus Syndromes

Answer 261

PSP: progressive supranuclear palsy Multiple system atrophy Don’t usually respond to L-dopa More rare than PD; more variable in presentation No significant studies to date regarding rehab

Question 262

Dysautonomia

Answer 262

Dysfunction of autonomic nervous system Failure of sympathetic or parasympathetic components Can be Excessive or overactive; or dampened Symptoms: BP, heart problems, difficulty breathing and swallowing, ED (erectile dysfunction) Can be local or generalized Can be: Acute and reversible or chronic and progressive Other diagnoses: diabetes, alcoholism, guillain-barre, PD

Question 263

Traumatic myelinopathy cause

Answer 263

Focal compression of peripheral nerve due to: Repeated mechanical stimuli Excessive pressure, stretch, vibration, friction

Question 264

With a posterior column spinal lesion, ____ lost and ___.

Answer 264

Conscious proprioception, 2-point discrimination and vibration sense are lost below the level of the lesion. Ataxic movements below level of lesion.

Question 265

Phasic stretch hyperreflexia

Answer 265

Excessive muscle contraction when spindles stretched, caused by excessive firing of MNs (motor neurons) Most common in SCI- but may occur with other MT (motor tract) lesions Loss of inhibitory corticospinal input combined with enhanced excitability of MNs and interneurons.

Question 266

S1 sensation

Answer 266

Lateral aspect of calcaneus

Question 267

Determining: | Sensory vs cerebellar lesions causing ataxia

Answer 267

Rhomberg test Want to look at coordination of movement with eyes open/closed Sensory: movement more coordinated with vision, and not with eyes closed Cerebellar: doesn’t matter if eyes open or closed

Question 268

In unilateral lesions of CN X or nucleus ambiguous cause uvula and soft palate to _____. AKA ____ sign

Answer 268

Uvula and soft palate deviate toward normal side, while abnormal side hangs low “Stage curtain sign”

Question 269

L3 sensation (ASIA)

Answer 269

Medial femoral condyle above the knee

Question 270

Axons are insulated from one another by...

Answer 270

Myelin and endoneurium

Question 271

Cerebral spasticity: Reticulospinal overactivity

Answer 271

Brainstem UMN overactivity is primary cause of stroke spasticity (Ex: involuntary flexion of the paretic upper limb fingers and elbow when person walks) Similar patterns of cerebral spasticity occur with corticospinal brainstem lesions in MS and TBI

Question 272

T4 sensation

Answer 272

At midclavicular line and the 4th intercostal space, located at the level of the nipples

Question 273

Basal ganglia | Walking route

Answer 273

Basal ganglia-> (inhibits) Midbrain locomotor region-> (facilitation) Reticulospinal tracts -> stepping pattern generators -> LMNs-> walking

Question 274

Neurofibromatosis prognosis

Answer 274

Symptoms most often mild, not life threatening or functionally limiting In some cases of NF2, CN8 involvement causes brainstem impairment Some tumors in NF1 can involve SC leading to paraplegia or some degree of paralysis

Question 275

In the spinal cord, the ___ carries the discriminative general senses of the medial lemniscal system. The ____ system of the spinal cord carries light-touch and pain/temp sensations

Answer 275

Posterior funiculus carries discriminative general senses of medial lemniscal system Anterolateral system carries light-touch and pain/temp

Question 276

____ is primarily a segmental sensorimotor reflex with afferent activity, elicited by muscle stretch, being abnormally processed in regular cord segments, ultimately generating excessive drive on segmental alpha motor neurons inner sting the very muscles being stretched.

Answer 276

Spasticity

Question 277

Parkinson’s disease

Answer 277

Neurodegenerative disease Motor and non-motor symptoms Affects ~ 1 million in US Likelihood of developing increases with age Typical onset 50s or 60s Onset before 30 is rare, but 10% of cases have onset by 40 60,000 new cases each year Affects more people than ALS, MD and MS combined Diagnosed in 50% more men than women Some increased risk for people related to someone with PD (2-5%)

Question 278

Carpal tunnel syndrome

Answer 278

Nerve entrapment within anatomical canal often causes traumatic myelinopathy Median nerve gets compressed between carpal bones and flexor retinaculum Paresis and atrophy of thenar muscles

Question 279

We assess spasticity in ____ limbs. No direct causation between spasticity and ___. Hypertonia associated with_____.

Answer 279

Assess spasticity in resting limbs No direct causation between spasticity and function Hypertonia associated with contracture- abnormal movement may be more about stiffness of passive tissues

Question 280

Dyesthesia

Answer 280

Literally “difficult sensation” | Ordinary stimulus results in disagreeable sensation

Question 281

C7 joint actions

Answer 281

Elbow extension

Question 282

Somatic sensory pathway

Answer 282

Ventral/Doral ramus -> Spinal nerve -> DRG -> Dorsal root

Question 283

Traumatic axonopathy

Answer 283

Axons are either cut or crushed typically due to dislocations or closed fractures Part of axon that separates from cell body dies Can affect all axon sizes and result in reduced or absent reflexes, somatosensation, and motor function Results in muscle atrophy Myelin and connective tissue remain intact, so there is a pathway established for axonal regrowth- prognosis good but the regrowth process is slow

Question 284

____ motor neurons regulate how sensitive the stretch reflex is

Answer 284

Gamma motor neurons

Question 285

Principles of manual muscle testing

Answer 285

1. Patient must be able to assume the standard test position (adequate motor control for isolation of the muscle) 2. Consider effects of gravity 3. Direct the resistance (if any) opposite the action of muscle being tested 4. Perform resistance at end of available ROM (muscle shortened) 5. Build manual resistance slowly 6. Allow patient to develop maximal tension 7. Avoid provocation of pain 8. Avoid manual contact over tested muscle or synergistic muscle groups

Question 286

Intermediate hemisphere of cerebellum: function and motor pathways influenced

Answer 286

Function: coordinates distal limbs Motor pathways influenced: Lateral corticospinal tract, Rubrospinal tract

Question 287

Ventral horn processes...

Answer 287

Motor information

Question 288

CN V neurons- fast pain and temperature

Answer 288

Cell bodies located in trigeminal ganglion | ``` Receptor-> Spinal trigeminal nucleus -> Decussate VPM thalamus-> Somatosensory cortex ```

Question 289

Autonomic afferent pathways Information from? Routes?

Answer 289

Information from visceral receptors to CNS 2 routes: Spinal cord via dorsal roots Brainstem via cranial nerves CN 7, 9, 10 Taste from all CN 9 and 10 - visceral information

Question 290

Ataxia and types

Answer 290

Incoordination NOT due to weakness 3 types: Sensory, Cerebellar and Vestibular

Question 291

Cerebral palsy | Motor system symptoms

Answer 291

Motor symptom distribution most often hemiplegia, diplegia, or quadriplegia

Question 292

Syringomyelia ___ damaged ___ loss of ____

Answer 292

Crossing fibers of Spinothalamic tracts damaged | Bilateral loss of pain and temperature sensation

Question 293

Consciousness system

Answer 293

Medial and lateral frontoparietal association cortex with arousal circuits in upper brainstem and diencephalon

Question 294

Pseudobulbar affect

Answer 294

Uncontrollable bouts of laughter and crying without associated feelings CN 7, 9, 10, 12 Lesions to corticobulbar pathways can sometimes produce pseudobulbar affect

Question 295

Dorsal horn processes...

Answer 295

Sensory information

Question 296

ALS: Amyotrophic Lateral Sclerosis

Answer 296

Destruction of UMNs and LMNs bilaterally, although usually present with asymmetric symptoms Degeneration of anterior horn cells and descending corticobulbar and corticospinal tracts Astrocytes fail to clean up excessive glutamate, causing excitotoxicity

Question 297

3 aspects of motor control

Answer 297

MC - Movement MC - Stability MC - Coordination

Question 298

Consensual reflex: Description Afferent Efferent

Answer 298

Description - pupil constricts when light shined in contralateral eye Afferent - optic Efferent - oculomotor

Question 299

Negative neurological sign

Answer 299

Represent a loss or decrease of function Can no longer observe a normal body function that was previously present Ex: weakness, hypotonia, sensory loss, motor loss, vestibular hypofunction

Question 300

MSA: multiple system atrophy

Answer 300

``` Degeneration affecting cortex and cerebellum as well as BG Bradykinesia Rigidity Wide BOS Frontal lobe dysfunction Autonomic dysfunction Shy-Drager syndrome Striatonigral degeneration Olivopontocerebellar atrophy Doesn’t respond to L-dopa ```

Question 301

Autonomic regions

Answer 301

Peripheral Spinal Brainstem Cerebral

Question 302

L2 muscle innervation

Answer 302

Hip flexion and adduction L2-L4: iliopsoas L2-L5: adductors

Question 303

C6 muscle innervation

Answer 303

C6: wrist extension C5-C6: supraspinatus, biceps, brachialis, deltoid C5-C7: pectoralis Major (clavicular head) C5-C8: serratus anterior C6-C7: supinator, pronator teres C6-C8: lats; long extensors of wrists and fingers C6-T1: pectoralis Major (sterns head)

Question 304

CN ? And muscle | Medial eye movements - Adduction

Answer 304

Oculomotor CN 3 | Medial rectus

Question 305

CN XII testing

Answer 305

Ask patient to protrude tongue Abnormal- deviates to side of lesion, Ipsilateral tongue atrophy OR Push tongue toward cheek as you push outside of cheek to resist Abnormal- tongue easily moves against resistance

Question 306

A ___ infarct may result in unilateral hearing loss since it often gives rise to the internal auditory artery

Answer 306

AICA | Anterior inferior cerebellar artery

Question 307

Rubrospinal Origin? Function?

Answer 307

Red nucleus of midbrain Contralateral upper limb extension

Question 308

Modified Ashworth Scale

Answer 308

Subjective scale for grading spasticity 0 = no increase in muscle tone (no spasticity) 1 = slight increase in muscle tone, manifested by a catch and release or by minimal resistance but only at end of ROM when affected part(s) moves into flexion/extension 1+ = slight increase in muscle tone, manifested by a catch, followed by minimal resistance detected throughout the remainder (less that half) ROM 2 = more marked increase in muscle tone detached through most of ROM but affected parts easily moved 3 = considerable increase in muscle tone, passive movement difficult 4 = affected part(s) rigid in flexion and extension

Question 309

Dysmetria

Answer 309

Abnormal undershoot or overshoot during movements toward a target

Question 310

Dysphagia often occurs with ____

Answer 310

Dysarthria

Question 311

CN II testing- pupillary reflex

Answer 311

Dim room lights Shine light into pupil and observe Afferent (sensory) CN II Efferent (motor) CN III Normal response: Both pupils constrict Ipsilateral is direct reflex Contralateral is consensual reflex Abnormal: slow or absent

Question 312

Brain death

Answer 312

Extreme and irreversible coma | Only spinal reflexes exist

Question 313

Amyotrophic Lateral Sclerosis (ALS) | UMN and/or LMN degeneration?

Answer 313

Both | UMN and LMN degeneration

Question 314

Injury to the ____ nerve (branch of CN ____) can occur during surgery of the neck or during cardiac surgery OR can be infiltrated by apical lung tumors. Produces unilateral vocal cord paralysis and hoarseness

Answer 314

Recurrent laryngeal nerve | A branch of CN X

Question 315

Peripheral nerves: | Surrounds axon bundles (fascicles)

Answer 315

Perineurium

Question 316

Exteroceptors

Answer 316

Superficial sensation Receive stimulus from external environment through skin and subcutaneous tissue Pain, temp, light touch, pressure

Question 317

Tectum

Answer 317

Midbrain- Posterior portion Pretectal area: pupillary, consensual, accommodation reflexes of eye Inferior colliculus Superior colliculi

Question 318

Complete occlusion of anterior spinal artery; spares ____

Answer 318

Spares dorsal columns and tract of Lissauer

Question 319

Parinaud’s syndrome

Answer 319

Impairment of vertical gaze, especially upgaze May be due to compression of the dorsal part of the vertical gaze center Large irregular pupils that do not react to light Sometimes may react to near-far accommodation Eyelid abnormalities ranging from bilateral lid retraction (Collier’s sign) or “tucking” to bilateral ptosis. May occur as a result of disruption of optic tract fibers to nuclei via dorsal pathways. Impaired convergence and sometimes convergence-reaction nystagmus, in which the eyes rhythmically converge and retract in the orbits, especially on attempted upgaze

Question 320

Pupil dilated and doesn’t contrast to light- CN?

Answer 320

3

Question 321

CN VII

Answer 321

Facial nerve Sensory: tears, salivation, taste Motor: facial expression, closing eyes Brain connection: between pons and medulla ``` Associated disorders: Bell’s palsy - Ipsilateral facial muscle paralysis Lack of lacrimation Decreased salivation Decreased taste sensation ```

Question 322

CN VII testing

Answer 322

Ask patient to smile, puff cheeks, close eyes, wrinkle forehead Abnormal: Paralysis or paresis Ipsilateral to side of LMN neuron lesion

Question 323

CVA- hemorrhage | Motor system symptoms

Answer 323

Contralateral motor symptoms depending on location of hemorrhage

Question 324

Lesions occurring below the pyramidal decussation of the lateral corticospinal tract produce

Answer 324

Ipsilateral weakness

Question 325

Examining voluntary movement

Answer 325

1. Quality 2. Appropriateness 3. Types of contractions 4. Symmetry 5. Control 6. Abnormal synergies

Question 326

JALS : autosomal recessive juvenile ALS (amyotrophic lateral sclerosis)

Answer 326

Onset during childhood: mean age 6.5 Spasticity of facial muscles, uncontrolled laughter, spastic dysarthria, spastic gait, inconstant moderate muscle atrophy, bladder dysfunction, sensory disturbances

Question 327

PD “other” complications

Answer 327

Depression Speech disturbance: decreased volume; dysarthria ``` Cognitive impairment: frontal lobe function- Inability to shift attention Inability to access “working memory” Visuospatial perception dysfunction Difficulty with procedural learning ``` Dysphagia Narrow BOS

Question 328

R2 - R1 =

Answer 328

Level of dynamic component of spasticity in the muscle A larger difference means large dynamic component A small difference means static contracture in the muscle

Question 329

Normally there is a balance between __and __ (neurotransmitters) In PD...

Answer 329

Balance between dopamine and ACh in basal ganglia In PD- imbalance: more ACh than dopamine

Question 330

The cerebellum regulates ___ movements - unlike the rest of the cerebrum

Answer 330

Ipsilateral

Question 331

Myopathy

Answer 331

Intrinsic to muscle Nervous system unaffected- so sensation and autonomic function remain intact Random muscle fibers degenerate. Now muscle has fewer fibers and produce less force when activated Degeneration progresses and ultimately affects coordination, muscle tone and reflexes-> no muscle activity Example: muscular dystrophy

Question 332

Neurofibromatosis

Answer 332

Causes tumors to grow on nerve tissue Produces skin and bone abnormalities 2 types: NF1 (more common) and NF2

Question 333

PBP: Progressive Bulbar Palsy

Answer 333

Motor neuron disease of bulbar muscles Degeneration of motor neurons in the cerebral cortex, spinal cord, brainstem, and pyramidal tracts Involves Glossopharyngeal, Vagus and Hypoglossal nerves. Slow onset between 50-70 Some develop widespread symptoms common to ALS

Question 334

L5 muscle innervation

Answer 334

Long toe extensors ``` L2-L5: adductors L4-L5: tibialis anterior and posterior L4-S1: glutes med/min; Tfl L5-S2: glut max L5-S1: hamstrings, peroneus ```

Question 335

2-point discrimination Receptors Name/location of spinal pathway Level/name of decussation

Answer 335

Merkel’s disks Medial lemniscal system: fasciculus gracilis and fasciculus cuneatus (In Ipsilateral dorsal column of the spinal cord); Becomes the medial lemniscus in the low medulla of the brainstem Fibers cross from nucleus cuneatus and nucleus gracilis in low medulla in low medulla as “internal arcuate fibers”

Question 336

hearing loss caused by abnormalities of external auditory canal or middle ear (excessive wax, inflammation)

Answer 336

Conduction deafness | CN VIII

Question 337

Syringomyelia

Answer 337

Cyst (syrinx) formation in SC Cyst elongates over time destroying center of cord Obstruction of CSF in central canal, redirecting CSF into SC- results in syrinx formation Fluid moves due to pressure differences; results in growth and SC damage

Question 338

If a peripheral nerve is severed, interruption of sympathetic efferents cause....

Answer 338

Loss of vascular control, temperature regulation and sweating in the region of that nerve. Trophic changes in skin

Question 339

Muscle stretch hyperreflexia

Answer 339

Loss of inhibitory corticospinal input combined with LMN and interneuron development of enhanced excitability results in excessive LMN response to afferent input from stretch receptors Excessive muscle contraction occurs when spindles are stretched as a result of excessive firing of the LMNs

Question 340

Basal ganglia lesions cause

Answer 340

Hypo-/Hyper- kinetic movement disorders

Question 341

Sympathetic preganglionic axons leave spinal cord through.... and synapse...

Answer 341

Leave spinal cord -> ventral root -> spinal nerve -> through ramus communicans-> paravertebral ganglia Either synapse in paravertebral ganglion or travel up/down sympathetic trunk before synapsing in a ganglion

Question 342

Tactile localization Receptors Name/location of spinal pathway Level/name of decussation

Answer 342

Merkel’s disks, Meissner’s corpuscles Medial lemniscal system: fasciculus gracilis and fasciculus cuneatus (In Ipsilateral dorsal column of the spinal cord); Becomes the medial lemniscus in the low medulla of the brainstem Fibers cross from nucleus cuneatus and nucleus gracilis in low medulla in low medulla as “internal arcuate fibers”

Question 343

Where body part is in space

Answer 343

Proprioception

Question 344

Peripheral lesions of ___ cranial nerves are relatively uncommon Most disorders of these cranial nerves are associated with ___ lesions.

Answer 344

Peripheral lesions of lower cranial nerves are relatively uncommon Most disorders of these nerves are associated with central lesions

Question 345

Hypertropia

Answer 345

Vertical deviation (describes eye that is higher)

Question 346

Cerebellar hemorrhage

Answer 346

Can occur with chronic HTN, arteriovenous malformation, hemorrhage conversion of ischemic infarct, metastases Often present with 6th nerve palsy and impaired consciousness Brainstem compression and death are possible May require surgical evacuation and decompression

Question 347

``` LMN lesions: Muscle strength? Muscle bulk? Involuntary muscle contraction? Muscle tone? Movement speed/efficiency? Postural control? ```

Answer 347

``` Muscle strength: absent (paralysis Muscle bulk: severe atrophy Involuntary muscle contraction: fibrillations Muscle tone: decreased Movement speed/efficiency: absent Postural control: normal ```

Question 348

ALS (amyotrophic lateral sclerosis) | Background and etiology

Answer 348

5-7 in 100,000 Onset in mid-50s Men slightly > than women (3:2) 90-95% idiopathic (sporadic ALS) No geographic, ethnic, racial considerations Autosomal dominant (chromosome 21) gene for familial type ALS

Question 349

Myasthenic crisis

Answer 349

Occurs when muscles that control breathing weaken May be triggered by infection (for those already weakened) or another adverse reaction This is a medical emergency

Question 350

Stages of PD

Answer 350

Stage 0- no signs of disease Stage 1- unilateral disease Stage 1.5- unilateral plus axial involvement Stage 2- bilateral disease, w/o balance impairment Stage 2.5- mild bilateral disease; recovery on pull test Stage 3- mild to moderate bilateral disease; some postural instability; capacity for living independent lives Stage 4- severe disability; still able to walk or stand unassisted Stage 5- wheelchair bound or bedridden unless aided

Question 351

Temperature Receptors Name/location of spinal pathway Level/name of decussation

Answer 351

Free nerve endings Lateral Spinothalamic tract (in contralateral anterolateral spinal cord) Fibers from posterior horn cells cross within 1-2 levels of entry into spinal cord through “anterior commissure”

Question 352

LMN lesion | Tone, muscle bulk, reflexes, fasciculations

Answer 352

Tone: flaccid (or low tone) Muscle bulk: decrease in bulk Significant, rapid muscle wasting Reflexes: decreased or absent, plantar flexor Fasciculations: present

Question 353

Ataxia

Answer 353

Irregular uncoordinated movement

Question 354

Huntington’s Outcome measures

Answer 354

BERG balance Increased risk of falls <=40/56 TUG Increased risk of falls >=14 seconds Activities-specific balance confidence scale <50% with recurrent fallers Tinetti Mobility Tests Correlated with UHDRS 1.8 x more likely to fall if <=21/28 UHDRS: unified Huntington’s disease rating scale, Standardized clinical assessment Total motor score: 31 items, 124 possible pts HD-ADL

Question 355

C5 sensation (ASIA)

Answer 355

On lateral (radial) side of the antecubital fossa just proximal to elbow

Question 356

T1 joint action

Answer 356

Finger abduction | Little finger

Question 357

Hypertonia

Answer 357

Abnormally increased resistance to externally imposed movement about a joint May be caused by spasticity, dystonia, rigidity, combo

Question 358

Fundamentals of movement

Answer 358

Postural (brainstem) Ambulatory (brainstem and spinal regions) Reaching and grasping (cerebral cortex)

Question 359

____ (movement) increases cervical nerve root signs and symptoms

Answer 359

Neck extension

Question 360

The basilar artery splits at __ and forms ____. Connects to...

Answer 360

Basilar artery splits at pontomesencephalic junction and forms 2 posterior cerebral arteries. Connect to anterior circulation provided by internal carotid artery via posterior communicating arteries.

Question 361

Parasympathetic nervous system functions

Answer 361

1. Primary = energy conservation and storage 2. Pupillary constriction - CN3 3. Brochoconstriction - CN X 4. Decrease HR - CN X 5. Stimulate digestion 6. Salivation - CN 7 and 9 7. Lacrimation - CN 7 8. Intestinal vasodilation 9. Sacral efferents (bowel/bladder emptying; penile/clitoral erection)

Question 362

Spinocerebellar Ataxia

Answer 362

Main autosomal dominant ataxia Manifestations vary Spinocerebellar Ataxia “Type 3” Formerly known as Machado-Joseph disease May be most common dominantly inherited Spinocerebellar Ataxia worldwide Symptoms: Ataxia, parkinsonism, and possibly dystonia, facial twitching, ophthalmologist, and peculiar bulging eyes

Question 363

Organization of typical spinal nerve

Answer 363

``` Ventral root (motor) Dorsal root (sensory) DRG (sensory) Spinal nerve (motor and sensory) Ventral ramus (motor and sensory) Dorsal ramus (motor and sensory) ```

Question 364

Cerebellum synaptic inputs

Answer 364

1. Mossy Fibers Excite granule cells that excite inhibitory Purkinje cells Purkinje cells form inhibitory synapses on deep cerebellar nuclei and vestibular nuclei 2. Climbing Fibers Directly excite Purkinje cells Originate in spinal cord and brainstem

Question 365

Sunderland II

Answer 365

Full recovery expected (2-4 mo) Paresthesia, episodic dyesthesia Axon severed, endoneurium intact Corresponds to Seddon Axonotmesis

Question 366

Clonus

Answer 366

Involuntary, repeating, and rhythmic muscle contractions Unsustained clonus fades after a few beats, even with maintained muscle stretch Sustained clonus is always pathologic in origin and is produced when a lack of UMN control allows the activation of oscillating neural networks in the spinal cord

Question 367

Peripheral nerves: | Connective tissue sheath that separates individual axons

Answer 367

Endoneurium

Question 368

CN VI

Answer 368

Abducent nerve Motor Motor to lateral rectus muscle Turns eye laterally Brain connection: between pons and medulla Associated disorders: Eye will look medially Diplopia Lateral rectus paralysis

Question 369

Gag reflex | CN?

Answer 369

Afferent: CN9 glossopharyngeal Efferent: CN10 vagus

Question 370

“Wrong-way-eyes”

Answer 370

Eyes look toward side of weakness. (Usually it’s opposite) Seizure activity in cortex, large lesions such as thalamic hemorrhage, lesions of pontine basis and tegmentum

Question 371

CN II

Answer 371

Optic nerve Sensory Sense of vision Brain connection: diencephalon Associated disorders: Ipsilateral blindness Visual field cuts Abnormal pupillary light reflex

Question 372

Midline lesions of vermis or flocculonodular lobes primarily result in...

Answer 372

``` Unsteady gait (truncal ataxia) Eye movement dysfunctions ```

Question 373

Seddon system

Answer 373

Focal nerve injury classification Neuropraxia Axonotmesis Neurotmesis

Question 374

____ is impaired swallowing | Dysfunction of muscles of ____; by lesions of CN ___, or ...

Answer 374

Dysphagia is impaired swallowing Dysfunction of: tongue, palate, pharynx, epiglottis, larynx or esophagus Lesions of CN 9, 10, 12 of their nuclei Or by dysfunction at NMJ or in descending corticobulbar pathways

Question 375

2-point discrimination

Answer 375

Ability to perceive 2 points of touch on skin at same time

Question 376

Generalized =

Answer 376

Systemic processes

Question 377

Corneal reflex: Description Afferent Efferent

Answer 377

Description - blink; eyelids close when cornea touched Afferent - trigeminal Efferent - facial

Question 378

3 divisions of sensory receptors

Answer 378

1. Superficial sensation: exteroceptors 2. Deep sensation: proprioceptors 3. Combined cortical sensations: exteroceptors and proprioceptors

Question 379

Transverse cord lesions

Answer 379

ALL sensory and motor pathways are either partially or completely interrupted Pattern of weakness and reflex loss can help determine lesion spinal cord level

Question 380

Sympathetic nervous system functions

Answer 380

1. Primary role= maintain optimal blood supply to organs 2. Fight or flight response induced by fear 3. Pupil dilation 4. Bronchodilation 5. Cardiac acceleration 6. Digestion inhibited 7. Piloerection 8. Glucose release stimulated 9. Systemic vasoconstriction

Question 381

Dysmetria

Answer 381

Abnormal trajectories through space

Question 382

Dorsal column/medial lemniscus Origin? Function?

Answer 382

Origin: Peripheral receptors; 1st order neuron synapses in Medulla Function: Light touch, conscious Proprioception

Question 383

Visceral afferents synapse with ___. Ex: Carotid sinus massage

Answer 383

Visceral afferents synapse with visceral efferents Carotid sinus massage: Mechanical stimulation activates CN 9 (glossopharyngeal) Info sent to solitary nucleus Visceral afferents synapse with visceral efferents CN 9-> brainstem-> CN 10 (vagus) output = decreased HR

Question 384

Clasp-knife response

Answer 384

Occurs when a paretic muscle is slowly and passively stretched and resistance drops at a specific point in the ROM Change in resistance is similar to the opening of a pocketknife. The initial string resistance to opening the knife blade gives way to easier movement Type II afferents elicit the clasp-knife response

Question 385

Dysrhythmia

Answer 385

Abnormal rhythm and timing of movements Best known tests for ataxia are finger-nose-finger test and heel-shin test

Question 386

Flaccid: Muscle description Reflexes Common conditions

Answer 386

muscle description: Complete absence of resistance to elongation Reflexes = absent ``` Common conditions: Acute CVA Spinal shock in SCI Polio (complete) Some spinal atrophy Peripheral nerve injury Guillain-Barre ```

Question 387

Barognosis

Answer 387

Ability to feel different weights

Question 388

Rigidity can be differentiated from spasticity as

Answer 388

Rigidity is not velocity dependent and is likely to be present even during PROM at slow speeds

Question 389

Key symptom of central cord syndrome

Answer 389

More effect on UE than LE

Question 390

Stretch reflex and motor tract damage

Answer 390

Loss of presynaptic inhibition Contraction of muscle spindle can elicit continued contraction Normally gamma motor neuron would inhibit- but ability to inhibit lost.

Question 391

PD prognosis

Answer 391

Progressive disease for which there is no cure Shift from unilateral to bilateral involvement Increasing rigidity and flexion of posture Increasingly limited mobility and increasing need for assistance Eventually w/c and/or bed bound Cause of death is usually pneumonia

Question 392

Excessive inhibition of basal ganglia....

Answer 392

Hypokinetic disorders | Parkinson’s

Question 393

Brainstem autonomic control

Answer 393

Modulated by hypothalamus, thalamus and limbic system Visceral info -> Hypothalamus Regulation of homeostasis and internal equilibrium Affects heart and respiratory rate, metabolism, water balance, digestion, body temperature Visceral info -> thalamus Projected to limbic system Emotions, moods, activation Limbic system activation Induce autonomic responses Ex: anxiety increasing HR

Question 394

I am not drunk I have _____ Literally means..

Answer 394

Ataxia “Lack of order”

Question 395

Accommodation reflex: Description Afferent Efferent

Answer 395

Description - lens adjusts to focus light on retina, pupil constrict, pupils move medially when viewing close object Afferent - optic Efferent - oculomotor

Question 396

Clasp-knife response

Answer 396

Slow passive stretch of paretic muscle results in resistance at specific point in ROM

Question 397

Neurofibromatosis predisposition and treatment

Answer 397

Often inherited 30-50% of new cases through spontaneous mutation First degree relative with NF1 First degree relative and unilateral vestibular schwannoma before age 30 Treatment consists of surgical removal of tumors affecting nerve function

Question 398

CN V3 testing

Answer 398

Tap downward on chin with reflex hammer Normal: masseter contracts, chin elevates Abnormal: absent or decreased reflex

Question 399

Cerebellum synaptic output

Answer 399

Purkinje cells: All cerebellum outputs to deep cerebellar nuclei or vestibular nuclei Outputs of the deep cerebellar nuclei are excitatory

Question 400

3 most common abnormal reflexes in those with chronic SCI

Answer 400

Muscle stretch hyperreflexia Clonus Clasp-knife response

Question 401

Autonomic thermoreceptors

Answer 401

Hypothalamus- blood temp | Cutaneous- external temp changes

Question 402

Autonomic neurons that secrete ACh

Answer 402

ALL autonomic PREganglionic neurons PARAsympathetic POSTganglionic neurons

Question 403

Lumbar plexus

Answer 403

Ventral rami L1-L4 Subcostal nerve also contributes L4/L5 contributes to lumbosacral trunk Sensory and motor innervation to groin, inguinal region, anterior and medial thigh Saphenous nerve from femoral relays sensory info from medial leg and foot Somatic sensory and motor fibers Sympathetics to cutaneous targets

Question 404

Stereognosis

Answer 404

Ability to recognize by tactile manipulation | Form, characteristics of an object: shape, size, weight, consistency, texture

Question 405

Spinal spasticity

Answer 405

Removal of inhibition on segmental POLYSYNAPTIC pathways Slow, progressive rise of excitatory state through cumulative excitation Afferent activity from 1 segment may lead to muscle response many segments away Flexors and extensors may be overexcited

Question 406

PCA

Answer 406

Posterior cerebral artery Supplies midbrain, thalamus, medial occipital lobes, inferior-Medial temporal lobe

Question 407

Parasympathetic preganglionic cell bodies in _____.

Answer 407

Preganglionic cell bodies: craniosacral Postganglionic bodies and fibers: head or target organ wall

Question 408

Basal ganglia oculomotor loop

Answer 408

Decisions about eye movements and spatial attention Determines if fast eye movements occur Body of caudate Runs parallel to motor loop Links cortical frontal and supplementary motor eye fields to basal ganglia

Question 409

Primitive spinal reflexes

Answer 409

Present developmentally in normal infants and some patients with brain injury Flexor withdrawal Crossed extension reflex Traction Grasp

Question 410

L1 dermatome

Answer 410

Inguinal region | Upper middle thigh

Question 411

Hemiparesis

Answer 411

Weakness 1 side of body

Question 412

Tegmentum

Answer 412

Midbrain Vertical sensory tracts CN III and IV nuclei Superior cerebellar peduncle Connects midbrain-> cerebellum Carries efferents from cerebellum Red nucleus: Info from cerebellum and cerebral cortex and projects to cerebellum, spinal cord, and reticular formation Pedunculopontine nucleus: Part of BG circuit Regulates muscle tone

Question 413

Pseudobulbar palsy | UMN and/or LMN degeneration?

Answer 413

UMN- bulbar region

Question 414

Corneal (blink) reflex | CN?

Answer 414

Ophthalmic branch - CN V Info relayed to spinal trigeminal nucleus CN 7 activates muscles of both eyes

Question 415

Transverse myelitis symptoms

Answer 415

Acute (hours to days) or subacute (1-2 weeks) Localized LBP, sudden paresthesia in legs, sensory loss, partial paralysis of legs Bowel and bladder dysfunction Spasms

Question 416

Velocity-dependent hypertonia during passive stretch, caused by myoplasticity, hyperreflexia and/or Reticulospinal tract overactivity

Answer 416

Spasticity

Question 417

R1 and R2 far apart

Answer 417

Large dynamic component | Suggesting spasticity

Question 418

NPH: Normal Pressure Hydrocephalus

Answer 418

Hydrocephalus that occurs typically in older adults Slow developing Slow enlargement of ventricles Gait disturbance, urinary incontinence, dementia/cognitive decline Often reversible with treatment Typically > 60 years old

Question 419

T5 sensation (ASIA)

Answer 419

Midclavicular line and 5th intercostal space, located midway between level of nipples and level of xiphisternum

Question 420

Autonomic preganglionic nerves Location? Receptor/Neurotransmitter?

Answer 420

Between CNS and ganglion Cholinergic (ACh) May be myelinated

Question 421

Huntington’s presentation- Sensorimotor deficits, involuntary

Answer 421

Chorea - most obvious feature but not most disabling Dystonia (up to 95%)- most prevalent posturing: shoulder IR, fist clenching, excessive knee flexion, foot inversion. Increases with disease severity and associated with decline in functional capacity

Question 422

Minimally conscious state

Answer 422

Minimal or variable degree of responsiveness There is arousal and awareness

Question 423

S1 dermatome

Answer 423

Lateral heel (base of 5th digit, fibula head, lateral malleolus, little toe)

Question 424

CN III testing- | Superior, inferior and medial rectus

Answer 424

Patient follows finger/object Up/down/medial Normal: eyes follow finger symmetrically and smoothly Abnormal: deficits in adduction, depression or elevation

Question 425

JPLS: Juvenile Primary Lateral Sclerosis

Answer 425

ALS2 (amyotrophic lateral sclerosis) Onset and loss of ability to walk during 2nd year of life. Progressive signs of UMN disease Wheelchair dependent by adolescence Later loss of motor speech production

Question 426

Acquired Ataxia

Answer 426

``` MSA (multiple system atrophy) MS Strokes Repeated TBI Toxic exposure ``` Systemic disorders: alcoholism, celiac disease, heatstroke, hypothyroidism, vit E deficiency Rarely... paraneoplasmic syndrome with breas cancer, ovarian cancer, small cell carcinoma of lung, or other solid tumors Cerebellar degeneration may precede the discovery of cancer by weeks to years In children, primary brain tumors may be the cause- midline cerebellum most common site of such tumors

Question 427

T7 sensation (ASIA)

Answer 427

Midclavicular line, one quarter of the distance between level of xiphisternum and level of umbilicus

Question 428

Sunderland V

Answer 428

Loss of continuity Anaesthetic, intractable pain, neuroma formation No recovery Corresponds with Seddon Neurotmesis

Question 429

R1

Answer 429

Angle of catch after a fast velocity stretch We function at R1

Question 430

Pathology =

Answer 430

Generalized process, focal injury or combo

Question 431

5D And 3N | Cervical ischemia signs

Answer 431

``` Dizziness or lightheaded related to neck movements Drop attacks (spontaneous falls) Dysphagia (difficultly swallowing) Dysarthria (muscles- hard to talk) Diplopia (double vision) Ataxia (mimic being drunk) Nausea Numbness Nystagmus (repetitive eye movements) ```

Question 432

4 cardinal signs of brainstem dysfunction

Answer 432

Diplopia Dysphagia Dysarthria Dysmetria

Question 433

Muscle disuse atrophy

Answer 433

Some damaged motor tracts decrease neuromuscular signals; decreases motor cortex representation of disused body part, leading to further paresis (Myoplasticity)

Question 434

L2 joint action

Answer 434

Hip flexion | Hip ADD

Question 435

Muscle stretch hyperreflexia- Phasic

Answer 435

Excessive MN response to afferent input from | stretch; results in excessive muscle contraction when spindles stretches

Question 436

CN VIII testing

Answer 436

Rub fingers together near patients ear Alternate sides and together Abnormal: different acuity of sound in either ear

Question 437

C4 dermatome

Answer 437

Medial acromion and below clavicle

Question 438

Brainstem nuclei involved with laughing and crying

Answer 438

CN 7, 9, 10, 12

Question 439

Autonomic Postganglionic nerves Location? Receptor/Neurotransmitter?

Answer 439

Between ganglion and organ Parasympathetic: Cholinergic- ACh Sympathetic: Mostly adrenergic - E/NE

Question 440

AICA: anterior inferior cerebellar artery

Answer 440

Supplies lateral caudal pons and small portion of cerebellum

Question 441

Measuring tone

Answer 441

EMG or MAS (modified ashworth scale)

Question 442

Postural movement

Answer 442

Provides orientation and balance Central commands to LMN Adjusts by sensory output Sensory uses feedback and feedforward Sensory input uses 3 senses: Somatosensation Vision Vestibular Posture is maintained through constant adjustments to these systems k

Question 443

Cerebellar lesions

Answer 443

Ataxia presents IPSILATERAL to side of lesion Lateral lesions: Appendicular ataxia Midline lesions (vermis or flocculonodular lobes): Unsteady gait “drunken” (note: alcoyskso impairs cerebellar function), Truncal ataxia, Impaired VOR resulting in vertigo, nausea, vomiting, Dysarthria (both rate and volume of speech or slurred “drunken” speech)

Question 444

Signs of motor tract lesions

Answer 444

1. Paresis or paralysis 2. Abnormal reflexes 3. Myoplasticity 4. Abnormal muscle tone 5. Loss of fractionated movements 6. Abnormal contraction 7. Abnormal muscle synergies

Question 445

Parasympathetic nervous system Is a ___ pathway of __ system ___ neuron pathway Targets...

Answer 445

Parasympathetic Efferent pathway of autonomic nervous system 2-neuron pathway Targets structures in body cavities, head and external genitalia

Question 446

Esotropia

Answer 446

Abnormal medial deviation of 1 eye

Question 447

____ tract damage interferes with fine movement (loss of fractionated movement)

Answer 447

Corticospinal tract

Question 448

T1 muscle innervation

Answer 448

Finger abduction Hand intrinsics C6-T1: pectoralis Major (sterna head) C7-T1: triceps C8-T1: long flexors wrist and fingers

Question 449

Chaddock sign

Answer 449

Inframalleolar noxious stimulus (+) = great toe extension with or without splaying toes (Like babinski’s but dorsolateral aspect of foot inferior to malleolus)

Question 450

Reticular formation

Answer 450

Posterior Pons Sleep-wake cycle Modulates pain information

Question 451

Spinal spaces

Answer 451

Subarachnoid space: Between arachnoid and pia maters , and Arachnoid trabeculae run between Contains CSF Epidural space: Between arachnoid and dura maters Contains fat and Batson’s plexus (venous drains)

Question 452

T1 sensation (ASIA)

Answer 452

Medial elbow

Question 453

Common contralateral motor manifestations of pyramidal system damage

Answer 453

Paresis Impaired motor control (lack of isolated movement and impaired timing) Possible hypotonia (initially) Spastic hypertonia and hyperreflexia (typically develops later)

Question 454

Surgical consideration for Myasthenia gravis

Answer 454

Thymectomy Recommended for individuals with thymoma But reduces symptoms in some individuals without thymoma and may cure some people- possibly re-balancing immune system

Question 455

Pressure in spinal region or restriction of blood flow as a result of compression can cause...

Answer 455

``` Pain (usually constant) Sensory changes Weakness Paralysis Hypertonia Ataxia Impaired bladder/bowel function ```

Question 456

Basal ganglia | Postural and girdle muscle route

Answer 456

Basal ganglia-> (inhibits) Pedunclopontine nucleus VL -> (inhibits) Reticulospinal tracts -> (facilitation) LMNs -> postural and girdle muscles

Question 457

Cholinergic receptors - autonomic

Answer 457

1. Muscarinic When ACh binds, initiates G-protein mediated responses Excitatory or inhibitory Regulates glands, smooth muscle, HR 2. Nicotinic ACh binding= fast induction of EPSP Nicotine binding = increased task performance and attention (Non-smoking women-> calming -> smoking to reduce stress Non-smoking men-> enhanced aggression)

Question 458

Cerebellum attaches to brainstem via...

Answer 458

3 peduncles 1. Superior- mainly cerebellar output 2. Middle- input of cerebral cortex via Pons 3. Inferior- input from brainstem and spinal cord; output to vestibular nuclei and reticular nuclei

Question 459

Double vision- possible CN?

Answer 459

3 4 6

Question 460

T6 or T7 dermatome

Answer 460

Xiphoid process

Question 461

C5 dermatome

Answer 461

Deltoid | Lateral elbow and lateral acromion

Question 462

Chronic sensorimotor distal polyneuropathy (diabetes)

Answer 462

Most common type of diabetic neuropathy Symmetric First in feet, progresses proximal Involves both small and large fibers Motor and sensory, with vague sensory symptoms early Dull, cramping ache Vibratory and position sense lost early; loss of Achilles reflex; wasting with progression

Question 463

PD pathology

Answer 463

overall decrease in excitatory input Cells within the substantia nigra produce and release dopamine Dopamine is involved in the control of movement and balance; also aids in regulation of other neurons Target for this dopamine is putamen and caudate In PD, degeneration occurs in the substantia nigra (Lewy bodies where pigmentation should be); no longer produces dopamine

Question 464

Basal ganglia

Answer 464

Collection of gray matter nuclei located deep within white matter of cerebral hemispheres Predicts the effects of action, them makes and executed an action plan Vital for normal motor function, sequencing of movements and cognitive functions Main components: caudate nucleus, putamen, Globus pallidus, subthalamic nucleus, substantia nigra

Question 465

ALS2- Juvenile amyotrophic lateral sclerosis | Types...

Answer 465

1. IAHSP: infantile-onset ascending hereditary spastic paralysis 2. JPLS: juvenile primary lateral sclerosis 3. JALS: autosomal recessive juvenile ALS

Question 466

____ motor neurons run to muscle fiber. | ____ motor neurons run to spindle (intrafusal)

Answer 466

Alpha motor neurons- fibers | Gamma motor neurons- spindle (intrafusal)

Question 467

Location of lesions causing sensory ataxia

Answer 467

Peripheral sensory nerves Dorsal roots Dorsal column Medial lemnisci

Question 468

Paresis or paralysis is __of MNs. | Loss of ____ function

Answer 468

Inadequate facilitation of MNs Loss of all somatosensory and voluntary motor function

Question 469

Role of thymus: Myasthenia gravis

Answer 469

Thymus is part of immune system. Some individuals with MG develop thymomas. Thymus gland gives incorrect instructions to developing immune cells - production of ACh receptor antibodies

Question 470

Friedreich’s Ataxia

Answer 470

Gene mutation; autosomal recessive Decreased frataxin levels lead to mitochondrial iron overload and impaired mitochondrial function Gait unsteadiness followed by UE Ataxia, dysarthria and paresis, particularly of the LE Mental function often declines Talipes equinovarus (clubfoot), scoliosis, and progressive cardiomyopathy are common Death, often due to arrhythmia or heart failure, usually occurs by middle age Onset 5-15; usually wheelchair bound by 20

Question 471

The stretch reflex

Answer 471

Muscle contraction in response to stretching within the muscle. As muscle lengthens, spindle is stretched and nerve activity increases Results in increased alpha motor neuron activity. This causes muscle fibers to contract and resist stretching. Secondary set of neurons also cause opposing muscles to relax (reciprocal inhibition) All of this happens to maintain muscle at constant length. Regulated by gamma motor neurons Relaxes or tightens fibers within spindle

Question 472

Huntington’s presentation - psychiatric

Answer 472

Depression, irritability, anxiety, apathy May present as aggressive outbursts, impulsivity, social withdrawal, suicidal ideation Depressive symptoms were associated with a more rapid decline in functional abilities

Question 473

Abducens Palsy causes

Answer 473

Susceptible to injury from downward traction caused by increased ICP Head trauma, infection, neoplasm, inflammation, aneurysm, cavernous sinus thrombosis

Question 474

“Other” findings ataxia

Answer 474

Eye movement abnormalities Speech abnormalities Decreased muscle tone Higher order cognitive function

Question 475

Lateral corticospinal Origin? Function?

Answer 475

Origin: supplementary motor, premotor and primary motor cerebral cortex Function: contralateral fractionation of movement, particularly hand movement

Question 476

T12 dermatome

Answer 476

Anterior iliac crest/pubic symphysis

Question 477

PPS (post-polio) Prognosis

Answer 477

Not life threatening Progressive weakness- average ~1% loss per year Learning compensatory strategies

Question 478

NF2

Answer 478

Neurofibromatosis Less common form Bilateral tumors of CN 8 Similar signs in parents, sibling or child (hereditary) Hearing loss as early as teen

Question 479

Generalized peripheral neuropathies | Location along 3 major axes...

Answer 479

1. Axon or myelin or both 2. Motor or sensory fibers 3. Peripheral nerves in symmetric (diffuse fashion) or asymmetric or multifocal pattern

Question 480

Diabetic polyneuropathy

Answer 480

Axons and myelin damaged Sticking/glove sensory loss All sizes sensory axons can be affected resulting in decreased sensation and pain. First sign is often impaired vibration sense. Ankle reflexes decreased Autonomic loss results in increased bone reabsorption Motor neuropathy results in abnormal stress on joints Sensory neuropathy leads to damaged foot joints and foot ulcers

Question 481

Medial corticospinal Origin? Function?

Answer 481

Supplementary motor, premotor and primary motor cerebral cortex Control of neck, shoulder and trunk muscles

Question 482

Where in brain can a lesion cause coma?

Answer 482

Upper brainstem reticular formation and related structures OR Dysfunction of extensive bilateral regions of cerebral cortex; bilateral lesions of thalamus

Question 483

C8 joint action

Answer 483

Finger flexion | Distal phalanx middle finger

Question 484

Spasm (consortium)

Answer 484

Disordered sensorimotor control, presenting as involuntary muscle activation following an UMN lesion.

Question 485

Myasthenia gravis presentation

Answer 485

Can affect any voluntary muscle, but those that control eye and eyelid movement, facial expression, and swallowing are most affected. Generally first signs: eyes, speech, swallowing Severity varies greatly from Ocular Myasthenia (limited eye movements) to Generalized Form Also noted: ptosis (drooping eyelid), diplopia (dbl vision), unstable/waddling gait, SOB, weakness in arms, hands, fingers, legs and back.

Question 486

Autonomic efferent neurotransmitters

Answer 486

Autonomic neurons secrete ACh (cholinergic) NE and E (adrenergic)

Question 487

Hyperesthesia

Answer 487

Hypersensitivity | Excessive or increased sensitivity to sensory stimuli

Question 488

PPS (post-polio syndrome) | Pathology

Answer 488

1. Motor unit dysfunction due to overuse 2. MSK overuse and disuse 3. Loss of motor units with normal aging 4. Predisposition to motor neuron degeneration 5. Virus reactivation 6. An immune mediated syndrome 7. Effect of growth hormone 8. Combined effects

Question 489

Sunderland classification

Answer 489

Focal nerve injury classification I-V1 (6)

Question 490

PICA

Answer 490

Posterior inferior cerebellar artery Supplies lateral medulla and inferior cerebellum

Question 491

Spasticity- spinal origin

Answer 491

Flexors and extensors overexcited

Question 492

Anterolateral pathways convey

Answer 492

Pain Temperature sense crude touch AKA Spinothalamic

Question 493

Vasculitic and connective tissue disease neuropathies

Answer 493

LE nerves more commonly affected RA, Lupus (SLE), and Sjogren’s - diffuse symmetric peripheral neuropathies Distal neuropathy in RA and SLE tend to be mild and late presentation RA can progress to rheumatoid vasculitis, causing multi mononeuropathies Compression neuropathies common in SLE and RA Sjogren’s can present as pure sensory neuropathy

Question 494

Reticulospinal Origin? Function?

Answer 494

Reticular formation in Medulla and pons Postural muscles and gross limb movement

Question 495

Medulla connects with CN ____. Contains CN nuclei __. Located between ___ and _____ Anterior surface contains ____. Functions in regulation of..,,

Answer 495

Connects with CN IX-XII Contains CN nuclei VII-X and XII Between pons and spinal cord Anterior surface contains pyramids and olives Functions in regulation of cardiovascular and respiratory control, head moving and swallowing

Question 496

Paramedian branches

Answer 496

Midline of brainstem Supply left/right paramedian regions Extend variable distance from ventral brainstem

Question 497

C2 dermatome

Answer 497

Posterior half of skull

Question 498

Solitary nucleus

Answer 498

In medulla | Main visceral sensory nucleus

Question 499

Rootlets

Answer 499

Small groups of axons sending information to the periphery

Question 500

Reaching and grasping

Answer 500

Requires vision and somatosensation (Vision, Proprioception) First phase of reaching - fast/mainly feedforward Second phase of reaching- slower/fine adjustment to grab it Grasping is a coordinated activity Demonstrated feedforward and feedback control In infants In adults with parietal lobe damage

Question 501

If diplopia goes away when patient closes or corners 1 eye- this suggests

Answer 501

Eye movement abnormality

Question 502

CN V1 testing

Answer 502

Touch outer cornea with cotton wisp Normal- blink Abnormal- eye remains open

Question 503

CN III testing- pupillary near/far

Answer 503

Ask patient to look at examiner’s finger, then nose Observe pupillary response Normal: near object = constriction, far object = dilation Abnormal = pupil unchanged

Question 504

Parasympathetic fibers have cell bodies in...

Answer 504

Lateral horn S2-S4

Question 505

____ (movement) produces anterior movement of the cauda equina, stretching the lumbosacral roots

Answer 505

Hip flexion

Question 506

Rinne test

Answer 506

CN VIII testing using tuning fork Conductive vs sensorineural hearing loss Tuning fork held on mastoid process, when patient no longer hears move fork into air ~1 inch from ear canal Normal: patient hears fork in air after bone sound diminishes Abnormal: patient hears through air but not bone Conductive: bone conduction > air Sensorineural: air conduction > bone in both ears; hearing decreased in affected ear

Question 507

``` Sympathetic- skeletal muscle Neurochemical Receptor Effect Purpose ```

Answer 507

Neurochemical : adrenergic Receptor : alpha Effect : vasoconstriction venules/veins Purpose : increase BP, increase peripheral vascular resistance

Question 508

There are __ cranial nerves and __ spinal nerves

Answer 508

12 cranial nerves | 31 spinal nerves

Question 509

Cerebellum lesions cause

Answer 509

Ataxia

Question 510

Adrenergic receptors distribution

Answer 510

Most abundant in peripheral smooth muscle Also in heart and bronchial smooth muscle Heart: mainly beta1 adrenergic receptors; increased HR and contractility Bronchial smooth muscle: mainly beta2 adrenergic receptors; bronchial tree dilation Skeletal muscle arteriole walls: mainly alpha adrenergic receptors; NE binding = vasoconstriction

Question 511

Spinal cord venous drainage

Answer 511

Drainage via Batson’s plexus Located in epidural space Batson’s plexus doesn’t contain valves

Question 512

4 classic features of Transverse myelitis

Answer 512

1. Weakness of legs and arms 2. Pain Primary presenting symptom in 1/3-1/2 LBP or radiating down limbs or torso 3. Sensory alterations Paresthesia, hypersensitivity 4. Bowel and bladder dysfunction

Question 513

Neurofibromatosis NF2 | Signs/symptoms

Answer 513

Hearing loss and tinnitus Poor balance Headache, facial pain or facial numbness Increased risk of developing other nervous system tumors such as spinal schwannomas and meningiomas

Question 514

C3 muscle innervation

Answer 514

Breathing; elevate scapula C2-C3: SCM and trap C3-C5: levator scapulae; diaphragm

Question 515

Traumatic myelinopathy

Answer 515

Loss of myelin limited to site of injury Peripheral myelinopathies: Interfere with function of large diameter axons. Resulting deficits: motor, discriminative touch, Proprioception, phasic stretch reflex Autonomics typically remain intact and no axonal damage unless injury is really severe Recovery is typically complete due to quick remyelination

Question 516

Basal ganglia: Limbic loop

Answer 516

Role: determines value of stimulus; reward based behaviors; monitors predictive errors; pleasure seeking Ventral striatum links limbic, cognitive, and motor systems (involved in reward circuit and addiction) Medial orbital and medial prefrontal cortex-> ventral striatum-> ventral pallidum-> mediodorsal thalamic nucleus-> medial orbital and medial prefrontal cortex

Question 517

Pupillary reflex: Description Afferent Efferent

Answer 517

Description - pupil constricts in response to light Afferent - optic Efferent - oculomotor

Question 518

T6 sensation (ASIA)

Answer 518

Midclavicular line, located at level of xiphisternum

Question 519

``` Sympathetic- skin Neurochemical Receptor Effect Purpose ```

Answer 519

Neurochemical : adrenergic Receptor : alpha Effect : vasoconstriction arterioles Purpose : decrease heat loss

Question 520

``` SMA II (spinal muscle atrophy) Symptoms, Onset and Natural history ```

Answer 520

Symptoms: Werdnig Hoffman, Acute infantile Onset: before 18 months Sits independently No independent ambulation >50% survive to mid-20s

Question 521

Sunderland III

Answer 521

Endoneurial tube torn Paresthesia, dyesthesia Recovery: slow, incomplete (12 mo) Corresponds with Seddon axonotmesis

Question 522

Obtunded

Answer 522

Sleeping more than awake | Drowsy and confused when awake

Question 523

Midbrain and cortical reactions

Answer 523

Present developmentally in normal infants and some patients with brain injury ATNR: asymmetrical tonic neck STNR: symmetrical tonic neck Positive supportive Associated reactions

Question 524

Developmental Spasticity

Answer 524

Normal development: Weaker synapses are eliminated By age of 4, a corticospinal axon that previously synapses with LMN to agonists and syngerists will only synapse with LMN to the agonist. Damage to corticospinal tracts

Question 525

Common motor manifestations of cerebellar damage

Answer 525

Muscle incoordination (Ataxia) Hypotonia Asthenia (general decrease strength or energy) Diminished postural equilibrium Nystagmus (involuntarily rhythmic eye movement) Speech disturbance (ataxic)

Question 526

Swallowing reflex: Description Afferent Efferent

Answer 526

Description - food in pharynx elicits movement of pharynx and contraction of pharyngeal muscles Afferent - glossopharyngeal Efferent - vagus

Question 527

Reflex scoring scale

Answer 527

``` 0 = absent 1+ = tone change; no visible movement of extremities 2+ = visible movement of extremities 3+ = exaggerated, full movement of extremities 4+ = obligatory and sustained movement, lasting > 30 sec ```

Question 528

Deep tendon reflexes: CN V

Answer 528

Trigeminal nerve Jaw reflex

Question 529

Wallenberg syndrome

Answer 529

AKA posterior inferior cerebellar artery syndrome Lateral medulla lesion Ipsilateral: Limb ataxia, dysarthria, dysphagia, vertigo, pathological nystagmus Horner’s syndrome Loss of nociception and temp in face Contralateral: Loss of nociception and temp in body

Question 530

Sunderland VI

Answer 530

Severe injury Not likely to recover Corresponds with Seddon neurotmesis

Question 531

Deep tendon reflexes: C5-C6

Answer 531

Biceps | C5

Question 532

Diagnosing myasthenia gravis

Answer 532

Motor dysfunction WITHOUT sensation, cognitive, or autonomic symptoms Often missed or delayed in people who experience mild weakness Blood test can detect ACh receptor antibodies (Anti-MuSK in 30-40%; but often negative for those with primarily Ocular MG) IV of Endrophonium Chloride (blocks ACh breakdown) Single fiber EMG (fatigue the nerves)

Question 533

Anterior cord syndrome

Answer 533

Damage to anterolateral pathways and descending motor tracts Causes loss of pain and temperature sensation and motor dysfunction below level of lesion Anterior horn cell damage produces LMN weakness

Question 534

Polyneuropathy

Answer 534

Key features: symmetric involvement of sensory, motor, and autonomic fibers within peripheral nerves Symptoms begin distally, feet then hands. This is where the longest axons are- susceptible to damage Not associated with trauma or ischemia Causes: toxic, metabolic, immune Diabetes is common cause (stocking/glove distribution of sensory loss) Nutritional deficiencies due to alcoholism Autoimmune disease

Question 535

Discriminative touch (stereognosis, texture) Receptors Name/location of spinal pathway Level/name of decussation

Answer 535

Meissner’s corpuscles Medial lemniscal system: fasciculus gracilis and fasciculus cuneatus (In Ipsilateral dorsal column of the spinal cord); Becomes the medial lemniscus in the low medulla of the brainstem Fibers cross from nucleus cuneatus and nucleus gracilis in low medulla in low medulla as “internal arcuate fibers”

Question 536

Posterior spinocerebellar and cuneocerebellar Origin? Function?

Answer 536

Origin: High- fidelity paths originate in peripheral receptors; 1st order neurons synapse in nucleus dorsalis or Medulla Function: Unconscious Proprioceptive info

Question 537

Congenital malformations

Answer 537

Almost always sporadic Often occur as part of complex malformation syndromes that affect other parts of CNS Chiari malformations Dandy-walker malformation Manifest early in life Typically nonprogressive Ataxia is usually present

Question 538

Reticulospinal tracts Origin Function

Answer 538

Pontine and medullary reticular formation Automatic posture and gait-related movements

Question 539

L5 joint action

Answer 539

Long toe extensors | Great toe extension

Question 540

Alertness depends on normal function of

Answer 540

Brainstem and diencephalic arousal circuits and the cortex

Question 541

____ is examined passively and is not an indicator of ability to move actively

Answer 541

Muscle tone

Question 542

CN ? and muscle? Eye elevation and intorsion abduction Superior rectus

Answer 542

Oculomotor CN 3

Question 543

Most clinically important descending motor pathway

Answer 543

Lateral corticospinal tract

Question 544

Autonomic nervous system overview

Answer 544

Motor to smooth muscle, cardiac muscle, and glands Regulates homeostasis Afferent pathways: info from visceral receptors Efferent pathways: sympathetic and parasympathetic

Question 545

Brainstem lesions- Upper Midbrain | Sensory loss?

Answer 545

Contralateral

Question 546

Basal ganglia motor loop

Answer 546

Role: movement selection and action Motor and premotor cortex-> putamen-> globus pallidus-> ventral lateral thalamic nucleus-> motor and premotor cortex

Question 547

Anterolateral pathway

Answer 547

AKA Spinothalamic ``` DRG -> Immediate synapse in gray matter/ Cross Over -> Anterolateral white matter path -> Thalamus synapse -> Primary somatosensory cortex ``` (Pain, temp, crude touch)

Question 548

Clonus

Answer 548

Involuntary, repeating, rhythmic, reflexive contractions of a single muscle group

Question 549

R2

Answer 549

Passive joint ROM following a slow velocity stretch

Question 550

MMT grades

Answer 550

5 = normal; full ROM against gravity and “maximal resistance” 4 = good; full ROM against gravity, strong resistance with slight difference noted between affected and unaffected limb 3 = fair; full ROM against gravity, but unable to sustain resistance 2 = poor; gravity eliminated able to produce full AROM 1 = trace; gravity eliminated unable to produce full AROM, however muscle tension is palpable 0 = gravity eliminated; unable to initiate AAROM and muscle tension is NOT palpable

Question 551

Dural sac ends at level

Answer 551

S1-2

Question 552

Post ganglionic efferent fibers from ____ innervate arteries of the face, dilate pupils of eyes, and assist with elevating upper eyelid

Answer 552

Superior and stellate ganglia | Sympathetic

Question 553

The image ___ from midline and ____ haze is always the one seen by the abnormal eye

Answer 553

Image further from midline and towards the direction of attempted gaze is always the one seen by the abnormal eye Ex: object at right, if 1 eye does not move to right, it forms a second image and that second image appears displaced to right (Diplopia)

Question 554

``` SMA III (spinal muscle atrophy) Symptoms, Onset and Natural history ```

Answer 554

Symptoms: Kugelberg-Welander chronic juvenile Onset: After 18 months Ambulates independently Normal survival

Question 555

Hemicord lesions: | Brown-Sequard Syndrome

Answer 555

Ipsilateral UMN weakness and loss of joint position and vibration Contralateral loss of pain and temperature Damaged Ipsilateral corticospinal tract and posterior columns, and contralateral anterolateral system

Question 556

CN V

Answer 556

Trigeminal nerve Motor and sensory Sensory: face and TMJ Motor: mastication (V3) Brain connection: lateral pons. Branches: V1 - ophthalamic V2 - maxillary V3 - mandibular Associated disorders: Ophthalamic: absent blink reflex (sensation from cornea) Mandibular: jaw deviated toward damaged side during opening, absent masseter reflex, and weakened mastication muscles Trigeminal neuralgia

Question 557

T10 sensation (ASIA)

Answer 557

Midclavicular line, located at level of umbilicus

Question 558

Decorticate rigidity/posturing

Answer 558

Upper limbs flexed Lower limbs extended Feet plantarflexed (UE- flexed LE - extension)

Question 559

C2 muscle innervation

Answer 559

Head and neck movement C2-C3: SCM and trap

Question 560

After a complete spinal cord transaction, ___ sensation ___ level of lesion is lost

Answer 560

All sensation at 1-2 levels below the level of lesion is lost. (And all voluntary motor control)

Question 561

Examining involuntary movement

Answer 561

``` Assessing movement Involvement Frequency, amplitude, pattern Triggering stimuli Methods for assessment ```

Question 562

Rigid Hypertonia: Muscle description Reflexes Common conditions

Answer 562

Increased resistance to elongation that does not increase with faster stretch (present at low speeds) Often present in muscles on both sides of joint and present throughout the range (though may show cog wheel pattern) Reflexes: may be increased but often dampened by activity of opposing muscle group Parkinson’s, basal ganglia trauma or stroke

Question 563

Anterolateral Spinothalamic Pathway

Answer 563

Self-protective reactions Reactions to stimuli that are potentially harmful Slow conducting, small unmyelinated fibers Thermal and nociceptive info Mediated pain, temp, crudely localized touch, tickle, itch and sexual sensations

Question 564

Stellate ganglion

Answer 564

Cervical paravertebral sympathetic ganglia formed by fusion of inferior cervical ganglion and first thoracic ganglion AKA cervicothoracic ganglion

Question 565

C3 sensation (ASIA)

Answer 565

Medial end of clavicle

Question 566

4 basal ganglia- thalamic routes All loops contribute to full-functioning of basal ganglia...

Answer 566

Oculomotor Executive Behavioral flexibility and control Limbic ``` All loops contribute... Predicting future events Controlling desired/undesired behaviors Motor learning Shifting attention Spatial working memory ```

Question 567

MS is characterized by .... Sensory complaints... Frequently produces...

Answer 567

Random multifocal demyelination limited to CNS Numbness, paresthesia, Lhermitte’s sign Asymmetric weakness and ataxia of lower limbs

Question 568

Brainstem lesions- Posterolateral Medulla | Sensory loss?

Answer 568

Ipsilateral pain and temp loss from face Contralateral pain and temp loss from body

Question 569

Presentation cerebellar infarcts

Answer 569

``` Vertigo, nausea/Vomiting Horizontal nystagmus Limb ataxia Unsteady gait Headache ``` Signs/symptoms of cerebellar infarct can result from infarct of lateral medulla or pons. More common in PICA and SCA

Question 570

Autonomic mechanoreceptors

Answer 570

Pressure: Baroreceptors (aorta and carotid sinus) and lungs Stretch: Veins, bladder, intestines

Question 571

Anchors spinal cord laterally

Answer 571

Denticulate ligaments | Run from pia mater through arachnoid and anchor to dura mater

Question 572

Age-related sensory changes

Answer 572

Neurons slow to be replaced Decreased conduction velocity Reduced Meissner’s and Pacinian Corpuscles Degeneration of myelinated fibers Reduction of spinal nerve and cranial nerve fibers Changes in sensory integrity Medications affecting sensory input

Question 573

CVA- Anterior Cerebral Artery | motor system symptoms

Answer 573

Contralateral motor symptoms primarily in LE

Question 574

CN I

Answer 574

Olfactory Sensory Sense of smell Brain connection: inferior frontal lobe Associated disorders: Anosmia- loss of sense of smell

Question 575

Muscle tone

Answer 575

The resistance to stretch in the resting muscle

Question 576

Fundamentals of movement

Answer 576

1. Postural (primarily brainstem) 2. Ambulatory (primarily brainstem and spinal regions) 3. Reaching and grasping (primarily cerebral cortex)

Question 577

Sympathetic preganglionic cell body is located in ____, and postganglionic cell body located in ___.

Answer 577

Sympathetic Preganglionic cell body- Lateral horn Thoracolumbar (T1- L2/L3) Postganglionic cell body- sympathetic trunk

Question 578

Body temperature regulation

Answer 578

E released by adrenal medulla increasing metabolic rate By-product is heat Sympathetics control the diameter of blood vessels, sweat gland secretion, and piloerection

Question 579

2 main feedback systems utilized to refine motor output

Answer 579

Basal ganglia | Cerebellum

Question 580

S2 sensation (ASIA)

Answer 580

At midpoint of popliteal fossa

Question 581

Somatic motor pathway

Answer 581

Motor cell body (ventral horn) -> Ventral root -> Spinal nerve -> Ventral/Dorsal Ramus

Question 582

Spasticity

Answer 582

``` Type of hypertonia Motor disorder Velocity dependent increase in tonic stretch reflexes Exaggerated DTRs (deep tendon reflexes) Component of upper motor neuron syndrome ```

Question 583

Consequences of hypertonicity and spasticity

Answer 583

``` Pain Deformity/tightness Fatigue Interference with function: Gait, functional mobility, ADL/hygiene, posture/balance, stability, overall activity ```

Question 584

Mononeuropathies

Answer 584

Usually due to local trauma and compression of a specific nerve (Ex- carpal tunnel etc) Many folks with SCI or other neuro disorders develop mononeuropathies from wheelchair use, chronic assistive device use

Question 585

Muscles of larynx innervated by

Answer 585

Brachial motor portion of CN X

Question 586

Proximal motor neuropathy (diabetes)

Answer 586

``` Diabetic amyotrophy Older patients with Type 2 Severe pain, unilateral or bilateral Marked atrophy of thigh mm Sensory abnormalities in femoral distribution and sometimes saphenous ``` Differential diagnosis: spinal stenosis CIDP

Question 587

White matter is thickest at ___ area of spinal cord. | More gray matter in ____ area of spinal cord

Answer 587

White thickest in Cervical area due up both ascending and descending fibers present Sacral cord is mostly gray matter

Question 588

ALS (amyotrophic lateral sclerosis) | Presentation

Answer 588

MUST present with BOTH UMN and LMN Characterized by absence of sensory symptoms (only 20% have sensory changes) Cognition, extraocular eye movements, autonomic, bowel/bladder, sexual functions, sight, smell, hearing- USUALLY remain INTACT Pseudobulbar symptoms/signs: Dysarthria Dysphagia Emotional changes Autonomic dysfunction ~1/3 Pain and depression common Respiratory impairments Muscle weakness starts in limbs moves into body over time.

Question 589

Myoplasticity

Answer 589

Adaptive changes within a muscle in response to changes in NM activity level and prolonged positioning

Question 590

Paraplegia

Answer 590

Paralysis of all or part of trunk and both LEs

Question 591

Causes of dysarthria

Answer 591

``` Infarcts, MS or other lesions of corticobulbar pathways, brainstem lesions, lesions of cerebellar pathways or BG; toxins (alcohol), diffuse encephalopathy, Myasthenia gravis ```

Question 592

Scratch reflex

Answer 592

Spinal circuits that generate a rhythmic locomotor pattern

Question 593

ALS (amyotrophic lateral sclerosis) | Upper and lower motor signs

Answer 593

``` Upper: Hyperreflexia Weakness (2ndary effect) Pathologic reflexes Babinski sign Pseudobulbar affect Spasticity ``` ``` Lower: Hyporeflexia Hypotonia Fasciculations Fibrillations Atrophy and weakness ```

Question 594

T3 sensation (ASIA)

Answer 594

At midclavicular line and the 3rd intercostal space. | Found by palpating the anterior chest to locate the 3rd rib and the corresponding 3rd intercostal space below it.

Question 595

SCA

Answer 595

Superior cerebellar artery Supplies superior cerebellum and small portion rostral laterodorsal Pons

Question 596

CN X testing

Answer 596

Open mouth and say “aaahh” Examine soft palate Normal- elevation of soft palate Abnormal- asymmetrical elevation of soft palate; hoarseness

Question 597

PD non-motor symptoms

Answer 597

``` Diminished sense of smell Low voice volume Painful foot cramps Sleep disturbance Sleep disturbance Depression Constipation Drooling Increased sweating Urinalysis frequency/urgency Male erectile dysfunction ```

Question 598

Pseudobulbar Palsy

Answer 598

Bilateral dysfunction of corticobulbar innervation of brainstem nuclei Produces similar symptoms as bulbar palsy May present with inappropriate emotional outbursts

Question 599

Paravertebral ganglia

Answer 599

Sympathetic efferents to the limbs, face, body wall, heart and lungs synapse Paravertebral ganglia are interconnected, forming the sympathetic trunks

Question 600

Disorders of UMN

Answer 600

Myoplasticity Spasticity: Developmental spasticity Cerebral spasticity Spinal spasticity Spastic Cerebral Palsy

Question 601

Exotropia

Answer 601

Abnormal lateral deviation of one eye

Question 602

Decerebrate rigidity/posturing

Answer 602

Limbs and trunk extended Upper limbs internally rotated Feet plantarflexed (UE in extension)

Question 603

In the ___ only the ___ ( basal ganglia) participate in motor control.

Answer 603

In the striatum only the putamen and body of caudate participate in motor control

Question 604

PLS: Primary Lateral Sclerosis

Answer 604

Rare sporadic disorder with progressive spasticity, mostly spinal and bulbar onset. Degeneration of UMN only LMNs remain INTACT Spasticity is most common presenting symptom Typically engines in LE Slower progression than ALS ~45% will develop LMN symptoms and progress to ALS

Question 605

T2 sensation (ASIA)

Answer 605

Apex of axilla

Question 606

Pons

Answer 606

Connects with CN V-VIII Between midbrain and medulla Relays and processes motor information from cerebral cortex and sends to cerebellum via middle and inferior cerebellar peduncles

Question 607

Klumpke’s paralysis

Answer 607

Result of avulsion of motor roots of C8 and T1 Less common Upper limb suddenly pulled superiorly - breaking fall or baby limb pulled excessively Short muscles of hand affected- results in claw hand

Question 608

Large PICA or SCA infarcts can cause swelling of cerebellum....

Answer 608

Can compress 4th ventricle causing hydrocephalus Compression within posterior fossa can be life threatening Can develop over time May require surgical decompression

Question 609

Abnormal muscle tone

Answer 609

Resistance to stretch in resting muscle

Question 610

Somatic efferent pathways have ___ neuron(s) in peripheral nervous system. Autonomic efferent pathways usually have ___ neuron(s) outside the CNS

Answer 610

Somatic efferent pathways have 1 neuron in the peripheral nervous system Autonomic efferent pathways usually comprise of 2 neurons that synapse outside the CNS.

Question 611

L5 dermatome

Answer 611

Base of great toe | And lateral aspect of leg/plantar aspect to heel)

Question 612

Proposed Pathology of ALS...

Answer 612

1. Excitotoxicity and Glutamate transport Loss of transporter interferes with glutamate clearance, induces Ca influx, triggers apoptotic pathways and motor death 2. Oxidative stress Mutation of enzyme in 20% of familial ALS patients leading to oxidative stress 3. Mitochondrial dysfunction Damage to organelles, leading to impaired Ca handling- promotes activation of cell-death pathways 4. Protein aggregation During increased physiological or environmental stress, cells which normally keep mutant proteins in check, become overloaded and impaired

Question 613

Hypotonia

Answer 613

Abnormally low resistance to passive stretch

Question 614

_____ activity constructs arterioles supplying skeletal muscle, skin and the digestive system

Answer 614

Sympathetic

Question 615

Superficial cutaneous reflexes: T7-T12

Answer 615

Abdominal

Question 616

_______ is abnormal articulation of speech. | From lesions involving.... (muscles and CN)

Answer 616

Dysarthria Lesions involving muscle of articulation (jaws, lips, palate, pharynx, tongue), NMJ, or peripheral or central portions of CN 5, 7, 9, 10, 12

Question 617

C6 joint actions

Answer 617

Wrist extension

Question 618

Huntington’s presentation- cognitive

Answer 618

Slowed thinking, impaired ability to manipulate information, poor attention, impaired memory Difficulty switching from one task to another Can lead to difficulty with IADLs Dementia Personality changes Impaired judgement

Question 619

Brainstem lesions- Medial Medulla | Sensory loss?

Answer 619

Contralateral: Loss of pain sensation in face

Question 620

L4 muscle innervation

Answer 620

Ankle dorsiflexion ``` L2-L4: iliopsoas L2-L5: adductors L3-L4: quads L4-L5: tibialis anterior and posterior L4-S1: glutes med/min; Tfl ```

Question 621

Syncope

Answer 621

Brief loss of consciousness due to inadequate blood flow to the brain Can be from emotional cause can be from stimulus Vasovagal attack: both sympathetic and parasympathetic systems

Question 622

Proprioceptors

Answer 622

Deep sensation Receive stimulus from muscles, joints, ligaments, tendons and fascia Position sense and awareness of joints, vibration

Question 623

Refers to muscle spindle input leading to overactivity in disinhibited MNs resulting in muscle contraction

Answer 623

Hyperreflexia

Question 624

Dementia | Motor system symptoms

Answer 624

Decreased movement and activity level

Question 625

Dermatomes associated with median nerve

Answer 625

C6 and C7

Question 626

S4/5 sensation (ASIA)

Answer 626

In perianal area, less than 1 cm lateral to mucocutaneous junction

Question 627

T8 sensation (ASIA)

Answer 627

Midclavicular line, one half distance between level of xiphisternum and level of umbilicus

Question 628

Syringomyelia signs and symptoms

Answer 628

Typically slow in progress Pain, weakness, sensory impairment, stiffness of back, shoulders, arms, legs Symptoms vary according to size of cyst Headaches, loss of ability to feel extreme hot/cold Sexual, bowel and bladder dysfunction

Question 629

Midbrain connects ___ to ___ Contains the ___ nuclei Contains the ____ which connects the ___ and ___ ventricles Is divided into ___ regions...

Answer 629

Midbrain connects diencephalon to Pons Contains CN III and IV nuclei Contains cerebral aqueduct which connects the 3rd and 4th ventricles Divided into 3 regions (ant-> post) Basis pedunculi Tegmentum Tectum

Question 630

ASIA sensory grading

Answer 630

``` 0 = absent 1 = altered (decreased, impaired, hyposensitivity) 2 = normal NT = not testable ```

Question 631

Myasthenia gravis demographics

Answer 631

3 per 100,000 All ethnic groups Women (<40 years old) more than men (>60 years old) Normal life expectancy Not directly inherited but may occur in more than 1 family member Up to 82% complain of fatigue

Question 632

C7 dermatome

Answer 632

3rd digit

Question 633

Sensory loss order | Peripheral nerve compression

Answer 633

``` Conscious proprioception and discriminative touch Cold Fast pain Heat Slow pain ``` Opposite order for return when compression relieved

Question 634

Myasthenia gravis

Answer 634

“Grave muscle weakness” Characterized by varying degrees of weakness, which increases with activity and improves with rest Repetitive muscles affected first, especially high contracting muscles (eyelids, facial expression, respiration) Chronic autoimmune NM disease Produce antibodies against ACh receptors (nicotinic) Affects peripheral nervous system

Question 635

C5 muscle innervation

Answer 635

Elbow flexion C3-C5: levator scapulae; diaphragm C4-C5: rhomboids C5-C6: supraspinatus, biceps, brachialis, deltoid C5-C7: pectoralis Major (clavicular head) C5-C8: serratus anterior

Question 636

``` ____ disorders, ___ dysfunction: Tics Chorea Althetosis Tremor Myoclonus ```

Answer 636

Extrapyramidal disorders | Basal ganglia dysfunction

Question 637

Velocity-dependent hypertonia

Answer 637

Limits joint ROM, interferes with function, and may cause deformity (Ex: significant bilateral plantarflexor hypertonia May only allow toe-walking because lack of ankle dorsiflexion prevents heels from touching ground.) UMN hypertonia is caused by muscular changes (myoplasticity) and/or spasticity

Question 638

Autonomic Adrenergic neurons

Answer 638

Most Sympathetic POSTganglionic neurons release NE Adrenal medulla (sympathetic) specialized to release E and NE directly into bloodstream

Question 639

Signs of motor tract lesions

Answer 639

Loss of fractionated movements Abnormal co-contraction Abnormal muscle synergies

Question 640

PBP: progressive bulbar palsy | UMN and/or LMN degeneration?

Answer 640

LMN- bulbar region

Question 641

Weakness without significant atrophy typically indicates

Answer 641

Demyelinating etiology

Question 642

Sharp/dull discrimination

Answer 642

Pain | Acts as protective sensation

Question 643

Lateral horn processes...

Answer 643

Autonomic information

Question 644

CN 2-4-3 rule

Answer 644

(2) : CN 3 and 4 connect to Midbrain (4) : CN 5-8 connect to Pons (3) : CN 9, 10 and 12 connect to Medulla (CN 11 connects to cervical spinal cord)

Question 645

CN V testing- jaw

Answer 645

MMT of jaw movement Normal: jaw opens strong/symmetrically Clench and relax teeth and palpate masseter Abnormal: jaw deviates toward damaged side in unilateral damage

Question 646

Brainstem vascular supply Ventral aspect of medulla The ___ join at ___ to form ___.

Answer 646

The vertebral arteries join at pontomedullary junction to form the basilar artery

Question 647

Superficial cutaneous reflexes: L1-L2

Answer 647

Cremaster Stroke proximal medial thigh Normal = elevation of Ipsilateral testicle Absent in SCI or corticospinal lesions

Question 648

Glossopharyngeal neuralgia

Answer 648

Similar to trigeminal neuralgia but involves the sensory distribution of CN IX, causing episodes of severe throat and ear pain

Question 649

Control of the level of consciousness involves at least 3 processes

Answer 649

Alertness Attention Awareness

Question 650

Regulation of body temperature

Answer 650

Sympathetic E released by adrenal medulla: increases metabolic rate Blood flow in skin controlled by alpha-adrenergic receptors in smooth muscles of arterioles To decrease heat loss: NE binding to alpha-adrenergic receptors stimulates precapillary sphincters to contract, bypassing capillaries

Question 651

L4 joint action

Answer 651

Ankle DF | Ankle inversion/eversion

Question 652

CN IV testing

Answer 652

Testing superior oblique Ask patient to follow finger medially and then inferiorly Only testing depression aspect of superior oblique Rule out depression by inferior oblique by looking medially Abnormal- eye doesn’t follow finger; diplopia

Question 653

CN VI testing

Answer 653

Observe neutral position of eyes looking forward Normal: both eyes look ahead in same direction Abnormal: one eye looks medially Diplopia OR Ask patient to follow finger/object laterally Abnormal- no abduction of affected eye/muscle

Question 654

ALS: ____ neuron deficits with ___ deficit

Answer 654

Combined UMN and LMN deficits | With NO sensory deficits

Question 655

C8 sensation (ASIA)

Answer 655

Dorsal surface of proximal phalanx of little finger

Question 656

Corneal reflex CN?

Answer 656

7

Question 657

CN II testing - visual fields

Answer 657

Testing visual fields Patient looks directly at you while you wiggle fingers in each of 4 quadrants and ask to identify which fingers moving Have them point to fingers moving Can move 2 fingers at same time to rule out visual extinction Abnormal: patient can’t identify which fingers are moving in each quadrant

Question 658

Basal ganglia inhibits....

Answer 658

Motor thalamus PPN (pedunculopontine nucleus VL) MLR (midbrain locomotor region)

Question 659

2 main pathways in spinal cord for somatic sensation

Answer 659

Posterior column- medial Lemniscal pathway Anterolateral pathways (Spinothalamic)

Question 660

Basis pedunculi

Answer 660

Midbrain- anterior portion Contains cerebral peduncles and substantia nigra

Question 661

L2 sensation (ASIA)

Answer 661

Anterior-Medial thigh, at midpoint drawn on imaginary line from midpoint of inguinal ligament connecting to medial femoral condyle

Question 662

Sharp/dull pain Receptors Name/location of spinal pathway Level/name of decussation

Answer 662

Free nerve endings, Thermoreceptors Lateral Spinothalamic Tract (In contralateral anterolateral spinal cord) Fibers from posterior horn cells cross within 1-2 levels of entry into the spinal cord through the “anterior commisure”

Question 663

Discriminative senses are carried by the ____ system

Answer 663

Lemniscal system

Question 664

Abnormal resistance to passive movement

Answer 664

Hypertonia

Question 665

T12 sensation (ASIA)

Answer 665

Midclavicular line, over midpoint of inguinal ligament

Question 666

Deep tendon reflexes: L2-L4

Answer 666

Patellar tendon | L2

Question 667

Tension of muscle Receptors Name/location of spinal pathway Level/name of decussation

Answer 667

Golgi tendon organs Medial lemniscal system: fasciculus gracilis and fasciculus cuneatus (In Ipsilateral dorsal column of the spinal cord); Becomes the medial lemniscus in the low medulla of the brainstem Fibers cross from nucleus cuneatus and nucleus gracilis in low medulla in low medulla as “internal arcuate fibers”

Question 668

IAHSP: Infantile-onset ascending hereditary spastic paralysis

Answer 668

ALS2 (amyotrophic lateral sclerosis) Onset: spasticity with increased reflexes and sustained clonus of the lower limbs within the first 2 years of life. Progressive spasticity of upper limbs by age 7-8 Wheelchair dependence in 2nd decade with progression toward severe spastic tetraparesis and pseudobulbar syndrome

Question 669

Cerebellum vascular supply

Answer 669

3 branches of the vertebrobasilar system PICA: Posterior inferior cerebellar artery AICA: anterior inferior cerebellar artery SCA: superior cerebellar artery

Question 670

Most common cause of spinal cord lesions

Answer 670

Extrinsic compression: Degenerative disease of spine Trauma Metastatic cancer

Question 671

CN VIII

Answer 671

Vestibulocochlear nerve Sensory: head position relative to gravity, head movement, hearing Brain connection: between pons and medulla ``` Associated disorders: Unilateral deafness Tinnitus Disequilibrium Nystagmus ```

Question 672

PPS: Post-Polio syndrome

Answer 672

New slowly progressive muscle weakness occurring in individuals with a confirmed history of acute poliomyelitis following a stable period of functioning. Unknown etiology (~1352 cases in 2010 worldwide) No accurate demographics 22-68% polio survivors develop Women greater than men Peaks 30-34 years after acute polio LMN- anterior horn cells

Question 673

Transverse myelitis

Answer 673

Inflammation across both sides of one segment of SC Damages or destroys myelin; causes scarring which disrupts neural impulse transmission Symptoms: Loss of SC function, several hours to several weeks Sudden onset of LBP, muscle weakness, or abnormal sensation Progresses to more severe symptoms

Question 674

Spastic hypertonia: Muscle description Reflexes Common conditions

Answer 674

Increased resistance to elongation that increases with faster stretch (velocity-dependent) Usually more predominant in muscle in on 1 side of affected joints in stroke/TBI Or in both agonists and antagonists in affected areas following SCI More obvious toward end of range when muscle is on maximal stretch Hyperreflexia Stroke (CVA), TBI, SCI, MS

Question 675

C7 muscle innervation

Answer 675

Elbow extension C5-C7: pectoralis Major (clavicular head) C5-C8: serratus anterior C6-C7: supinator, pronator teres C6-C8: lats; long extensors of wrists and fingers C6-T1: pectoralis Major (sterns head) C7-T1: triceps

Question 676

L1 sensation (ASIA)

Answer 676

Midway between the key sensory points for T12 (inguinal ligament) and L2

Question 677

Severence

Answer 677

Excessive stretch or laceration physically separates nerves. Axons and connective tissue are affected and nerve degeneration starts 3-5 days post injury No guidance during regrowth so nerve sprouts may reach inappropriate targets -> poor recovery Scar tissue in wound may cause nerve sprouts to get entangled and form a traumatic neuroma Patient may never regain stimulation distal to injury

Question 678

T10 sensation (ASIA)

Answer 678

Umbilicus

Question 679

Pyramids

Answer 679

Descending axons of corticospinal tract Anterior surface of medulla Pyramidal decussation ~85% corticospinal axons cross over

Question 680

Seddon- neuropraxia

Answer 680

Injury- mild Nerve intact, conduction disrupted Recovery- full (day to weeks) Impairments: neuritis, paresthesia Equivalent to Sunderland I

Question 681

Myoplasticity

Answer 681

Adaptive changes in a muscle, in response to changes in neuromuscular activity level and prolonged positioning. (Muscle disuse atrophy)

Question 682

L3 muscle innervation

Answer 682

Knee extension L2-L4: iliopsoas L2-L5: adductors L3-L4: quads

Question 683

Infectious neuropathies

Answer 683

Most common cause of neuropathy in the world Leprosy most common HIV and agents to treat HIV Lyme disease

Question 684

(Neuropathy) | Side to side symmetry and/or proximal sensory/motor greater than distal

Answer 684

Suggests multifocal (rather than diffuse)

Question 685

Hearing loss caused by disorders of cochlea or cochlear nerve/receptor cells

Answer 685

Sensoneural deafness Less common Can be caused by drugs and acoustic neuromas (CN VIII)

Question 686

Basal ganglia | Voluntary muscles route

Answer 686

Basal ganglia-> (inhibit) motor thalamus | Motor thalamus-> (facilitation) motor cortex -> corticospinal tracts-> LMNs -> voluntary muscles

Question 687

Autonomic efferent system- | Sympathetic

Answer 687

Preganglionic Lateral horn -> sympathetic trunk (Via ventral root, spinal nerve, ventral ramus) Postganglionic Sympathetic trunk -> target organ

Question 688

Abnormal muscle synergies are typically seen with ____. | Muscle activity can return, but in a ___ pattern. Flexion- ____. Extension-___.

Answer 688

Abnormal muscle synergies typically seen in stroke Muscle activity can return, but in a synergistic pattern UEs- flexion LEs- extension

Question 689

Denotes contracture, atrophy and weak actin-myosin binding

Answer 689

Myoplasticity

Question 690

Seddon- neurotmesis

Answer 690

Severe injury Loss of continuity Recovery not likely Sunderland V and VI

Question 691

Complications from neuropathy

Answer 691

Foot complications (ulceration; Charcot changes) Pain Large fiber: dull, deep, toothache like, cramping Small fiber: superficial, burning, hypersensitive Functional impairment Increased fall risk; limited physical activity/deconditioning

Question 692

Lesions lateral to cerebellar vermis mainly cause...

Answer 692

Ataxia of limbs (appendicular ataxia)

Question 693

Abnormal posturing- _____ or ____ rigidity- can signal that...

Answer 693

Decorticate rigidity Decerebrate rigidity Can signal brain herniation is occurring- can be red flag for medical emergency

Question 694

Deep tendon reflexes: S1-S2

Answer 694

Achilles | S1

Question 695

Huntington’s disease | Background and demographics

Answer 695

``` Generally 30-50 (Ranges 4-80, mean average is 40) Lifespan from initial onset is 15-25 years In US: 30k HD patients, 150k at risk Men = Women Caucasians have greater risk Very rare in Asians ``` Autosomal dominant: children have 50% chance to get it from parents 85-90% had HD parent If have gene, 100% have HD

Question 696

Sympathetic trunk: postganglionic cell bodies

Answer 696

Paravertebral: Cervical, Thoracic, Lumbar, and Sacral ganglia Prevertebral: Celiac ganglion Superior and Inferior mesenteric ganglions Ganglion impar (Prevertebral structures below diaphragm)

Question 697

Double simultaneous stimulation

Answer 697

Ability to feel 2 points at same time in different parts of body

Question 698

Large myelinated peripheral axons Innervates (efferent/ afferent) Group

Answer 698

Efferent- extrafusal muscle fibers A-alpha Afferent- Spindles, GTO, touch and pressure receptors Ia, Ib, II

Question 699

Posterior pons contains

Answer 699

``` Sensory tracts Reticular formation Autonomic pathways Medial longitudinal fasciculus CN V-VII nuclei ```

Question 700

Autonomic chemoreceptors

Answer 700

Sensitive to chemical concentrations in blood ``` Carotid and aortic bodies (oxygen) Medulla (H+ and CO2) Hypothalamus (blood glucose; electrolytes) Taste buds Olfactory glands ```

Question 701

Tectospinal tract Origin Decussation Termination

Answer 701

Origin: Superior colliculus Decussation: dorsal tegmental decussation, in midbrain Termination: cervical cord

Question 702

Vegetative state

Answer 702

Regain sleep/wake cycles and other primitive responses and reflexes ; remain unconscious > 3 months

Question 703

Botulism toxin

Answer 703

Interferes with release of ACh from motor axon Results in acute, progressive weakness Loss of stretch reflexes Sensation remains intact Botox used to weaken overactive muscles Spasticity and dystonia

Question 704

T2 dermatome

Answer 704

Anterior axilla

Question 705

Testing for truncal ataxia

Answer 705

Tandem gait | Romberg test

Question 706

Dysconjugate gaze

Answer 706

Cause of diplopia when extraocular muscle is not working correctly

Question 707

Outputs exit the basal ganglia via ___. ____ sends neurons to ___ where they release ___. This adjusts signals to the output nuclei. Allows them to .... The ___ inhibits ___.

Answer 707

Exit via internal segment of Globus pallidus and substantia nigra pars compacta Substantia nigra sends neurons to striatum where they release dopamine. This adjusts the signals to the output nuclei. Allows them to provide the appropriate level of inhibition to their target nuclei. Globus pallidus internus inhibits motor thalamus, PPN, and midbrain locomotor region

Question 708

Additional roles (non-motor control) of the basal ganglia

Answer 708

Executive, Social, Behavioral, Emotional

Question 709

C8 muscle innervation

Answer 709

Finger flexion ``` C5-C8: serratus anterior C6-C8: lats; long extensors of wrist and fingers C6-T1: pectoralis Major (sterna head) C7-T1: triceps C8-T1: long flexors wrist and fingers ```

Question 710

Pain on left side of face | CN?

Answer 710

5

Question 711

Hypertonia

Answer 711

Abnormally high resistance to passive stretch 2 types: 1. Velocity-dependent: amount of resistance to passive movement depends on velocity of movement 2. Velocity-independent: Resistance constant regardless of speed of force

Question 712

3 types of double vision

Answer 712

Exotropia Esotropia Hypertropia

Question 713

Ischemia in brainstem

Answer 713

Rapid onset of symptoms: dizziness, visual disturbances, weakness, problems with coordination, and somatosensory disturbances Vertebrobasilar Artery insufficiency Transient brainstem symptoms Especially when neck extended and rotated.

Question 714

Vestibulospinal tracts (VSTs) Origin Termination Function

Answer 714

Origin: Medial VST- Medial and inferior vestibular nuclei Lateral VST- Lateral vestibular nucleus Terminates: Medial VST- Cervical and upper thoracic cord Lateral VST- entire cord Function: Medial VST- positioning of head and neck Lateral VST- balance

Question 715

Spastic cerebral palsy

Answer 715

Abnormal supraspinal influences, failure of normal neuronal selection, and consequent aberrant muscle development lead to movement dysfunction

Question 716

Peripheral nerves: | Sheath that surrounds epineurium

Answer 716

Mesoneurium

Question 717

Lesions of cerebral hemisphere impair eye movement in ___ direction. Eyes look ___

Answer 717

Contralateral direction Eyes look away from side of weakness

Question 718

Superficial sensations

Answer 718

AKA tactile sensation Pain Temperature Light touch Pressure

Question 719

4 medial motor systems

Answer 719

Anterior Corticospinal tract Vestibulospinal tract Reticulospinal tract Tectospinal tract These pathways control the proximal and girdle muscles (postural tone, balance, orienting movements of head and neck, and autonomic gait-related movements)

Question 720

Cerebral region lesions: | VPL and VPM

Answer 720

Decreased or loss of sensation Contralateral body and face May exhibit severe pain on contralateral side