Week 1: Lecture/TBL Flashcards
(248 cards)
1
Q
At which week in embryogenesis, does the neural plate begin formation?
A
Week 3
2
Q
Which nutrient is necessary for neural development during pregnancy?
A
B9: Folate
3
Q
From which layer does the neural tube develop (ectoderm, mesoderm, endoderm)?
A
Ectoderm
4
Q
From which layer does the notochord and somites develop (ectoderm, mesoderm, endoderm)?
A
Mesoderm
5
Q
Dandy Walker syndrome affects which level of the nervous system?
A
Cerebellum
6
Q
Which anatomical area of the spinal cord is responsible for maintaining the sympathetic tone for the body?
A
Intermediate horn of the thoracic spinal cord
7
Q
Define spinal dysraphism
A
Spina bifida
8
Q
What tissues/organs are produced from the mesoderm?
A
CV system, muscles, bones
9
Q
What organs are produced from the endoderm?
A
Liver, lungs, GI tract
10
Q
What tissues/organs are produced from the surface ectoderm?
A
Anterior pituitary, lens, cornea
11
Q
What tissues/organs are produced from the neural tube?
A
brain spinal cord, post pituitary, retina
12
Q
What tissues/organs are produced from the neural crest?
A
Autonomic, sensory nerves, skull
13
Q
What are the steps of neural development?
A
- Notochord secretes signaling molecules (Sonic Hedgehog protein)
- Molecules induce overlying ectoderm to become neuroectoderm
- Neuroectoderm becomes neural plate
- Neural plate folds to become the neural tube and neural crest cells
14
Q
What are the 3 primary vesicles of the neural tube?
A
Forebrain (prosencephalon), Midbrain (mesencephalon) and Hindbrain (rhombencephalon)
15
Q
What are the 5 secondary vesicles of the neural tube?
A
Telecephalon, Diencephalon, Mesencephalon, Metencephalon, Myelencephalon
16
Q
When do the three primary brain vesicles form embryonically?
A
3-4 weeks
17
Q
When do the five secondary brain vesicles form embryonically?
A
5 weeks
18
Q
Name 3 types of neural congenital defects
A
- Neural tube defects (Spina bifida, Anencephaly, Encephalocele)
- Cephalic disorders (holoprosencephaly)
- Posterior Fossa Defects (Chiari malformations, Dandy Walker)
19
Q
Define what occurs in spina bifida
A
caudal neuropore fails to close posteriorly; bones do not close around the spinal cord/meninges
20
Q
Define what occurs in Anencephaly
A
rostral neuropore fails to close anteriorly; absence of major portions of brain/skull
21
Q
Neural Tube Defect Risks
A
*decrease in folic acid
*Type 1 diabetes
*Obesity
*Valproic acid/carbamazepine (antiseizure meds)
22
Q
Describe a spina bifida occulta
A
*Bones fail to fuse normally
*Meninges and spinal cord in normal position
*Abnormal tuft of hair or dimple over spinal cord
23
Q
Describe a meningocele
A
*Meninges bulge out
*Spinal cord intact
24
Q
Describe a myelomeningocele
A
*Both meninges and spinal cord bulge out of spine
*Often has Chiari malformation as secondary
25
Describe Anencephaly
*forebrain/brainstem exposed in utero
*Lethal
*Polyhydramnios present
26
What does an ultrasound show in anencephaly?
open calvaria (formation of skull); frog-like appearance of fetus
27
Describe encephalocele
brain or meninges herniate through the skull; usually in occipital area
28
UMN problems occurs where
cortex, internal capsule, corticospinal tract
29
LMN problems occur where
Brainstem, spinal cord (anterior horn)
30
Signs/Symptoms of UMN damage (pyramidal signs)
Spastic paralysis (rigid, stiff muscles)
Hyperreflexia
Muscle overactive
Clasp knife spasticity: passive movement -> initial resistance, sudden release
31
Acute onset back pain and neurologic symptoms in pt.'s with cancer raise suspicion for what?
Metastatic disease
32
If pt presents with neurologic symptoms in the lower extremities but none in the UE, where is the lesion
Below T1 level (or below brachial plexus)
33
Symptoms of a herniated disc
Worse with Valsalva maneuvers such as sneezing and coughing
34
Signs a lesion is localized to the spinal cord
--Bilateral leg weakness with spasticity
--hyperreflexia
--Babinski sign
--Sensory level at T8
35
Define hypotonia
Flaccid weakness
36
Functions of frontal lobe
--Motor control
--Executive function
--Speech production
--Personality, emotions, behavior
--Eye movements (frontal eye fields)
37
Functions of the parietal lobe
--Somatic sensation
--Spatial orientation
--Language comprehension
--Attention
38
Functions of temporal lobe
--Auditory processing
--Memory (hippocampus)
--Language comprehension
--Emotional regulation
39
Functions of the occipital lobe
--Visual processing
40
How is the precentral gyrus organized
Somatotopically (motor homunculus)
41
What is the function of the post-central gyrus?
Process sensory information: touch, vibration, proprioception, pain, temperature
42
Broca's area controls:
speech production; movement of lips, tongue, larynx
43
Wernicke's area controls:
Language comprehension (spoken and written)
44
Gerstmann area function:
Complex language functions (reading and writing), calculation, right-left orientation, finger recognition
45
Lesion in Gerstmann area
Agraphia (cannot write), acalculia, finger agnosia, left-right disorientation
46
Main function of the corticospinal tract
Voluntary control of skeletal muscles (fine movements)
47
Type of pathway of the corticospinal tract
Descending, efferent, pyramidal motor pathway
48
Describe the anatomical organization of the corticospinal tract
Origin: primary motor cortex --> fibers descend through the white matter (corona radiata) --> posterior limb of internal capsule --> cerebral peduncles of midbrain --> form the pyramids of the medulla (DECUSSATION) --> Lateral corticospinal tract decussate, and anterior corticospinal tract remains uncrossed
--Lateral CST: controls distal limb muscles (fine motor control)
--Anterior CST: controls axial/proximal muscles (posture, trunk)
--Synapse at LMN
49
For corticospinal tract, lesion above decussation ie cortex
Contralateral weakness or paralysis
50
For corticospinal tract, lesion below decussation
Ipsilateral weakness or paralysis
51
UMN lesion signs in the corticospinal tract
Weakness, spasticity, hyperreflexia, Babinski sign
52
LMN lesion signs in corticopsinal tract
Flaccid paralysis, atrophy, fasciculations, hyporeflexia
53
UMN signs
Spasticity, hyperreflexia, Babinski (positive sign is abnormal)
54
Where to neurons in the corticospinal tract synapse?
Anterior horn
55
LMN lesion signs
flaccid paralysis, hyporeflexia or areflexia, atrophy, fasciculations, no sensory loss, babinski is negative
56
Lesion location in a lacunar stroke
Internal capsule
57
Key features of a lacunar stroke
pure motor hemiparesis (contralateral face, arm, leg)
58
Function of the spinothalamic tract (anterolateral system or ALS)
transmits pain, temperature, and crude touch (gross, non-discriminative touch)
59
Organization of the spinothalamic tract
1. First order neuron (sensory receptor to DRG)
2. Entry into spinal cord (dorsal horn)
3. Synapse in the dorsal horn
4. Immediately cross in anterior white commissure
5. Second-order neuron now
6. Travel up in the spinothalamic tract (anterolateral funiculus)
6. Goes through medulla, pons, midbrain
7. Synapse in the Ventral posterolateral (VPL) nucleus of thalamus
8. Third order neuron projects to primary somatosensory cortex
60
Divisions of the spinothalamic tract
Lateral spinothalamic tract = pain & temperature
Anterior (ventral) spinothalamic tract = crude touch & pressure
61
Function of spinothalamic tract
Pain and temperature
62
Function of dorsal column tract
Pressure, vibration, fine touch, proprioception
63
Function of the corticospinal tract
Voluntary movement
64
Spinothalamic tract order (1st order, 2nd order, 3rd order)
1st order: Sensory nerve ending of pseudounipolar neuron in dorsal root ganglion --> enters spinal cord
1st synapse: posterior horn (spinal cord)
2nd order Neuron: Decussates in spinal cord as the anterior white commissure --> ascents contralaterally
2nd synapse: VPL (thalamus)
3rd order neuron: projects to primary somatosensory cortex
65
Function of dorsal column
Pressure, vibration, fine touch, proprioception
66
Dorsal column tract anatomy
1st order: sensory nerve ending of pseudounipolar neuron in dorsal root ganglion --> enters spinal cord --> ascends ipsilaterally in dorsal columns
1st synapse: nucleus gracilis, nucleus cuneatus (ipsilateral medualla)
2nd order: Decussates in medulla --> ascends contralaterally as the medial lemniscus
2nd synapse: VPL (thalamus)
3rd order: projects to primary somatosensory cortex
67
Anatomy of corticospinal tract
UMN: primary motor cortex --> descends ipsilaterally (through the posterior limb of internal capsule and cerebral peduncle), decussates at caudal medulla (pyramidal decussation) --> descends contralaterally
1st synapse: anterior horn
LMN: leaves spinal cord going to muscle
68
Visual pathway organization
1. Retina
2. Optic nerve
3. Optic chiasm
4. Optic tract
5. Lateral geniculate nucleus (LGN) of thalamus
6. Optic radiations (white matter tracts transmitting LGN output to visual cortex)
7. Primary visual cortex
69
Anterior Cerebral Artery (ACA) supplies which structures
Medial surface of the frontal and parietal lobes
Superior front gyrus
Paracentral lobule
Corpus callosum
Cingulate gyrus
70
Deficits of ACA stroke
-- Contralateral leg > arm weakness and sensory loss
--Behavior changes (frontal lobe involvement)
--Urinary incontinence
71
Middle Cerebral Artery (MCA) supplies
--lateral surface of the frontal, parietal, and temporal lobes
--primary motor and sensory cortex (face and upper limbs > leg)
--Broca's area
--Wernicke's area
--Internal capsule
--Basal ganglia
72
Classic deficits of Middle cerebral artery (MCA) stroke
--contralateral face and arm > leg weakness and sensory loss
--aphasia
--hemineglect
--visual field defect (contralateral homonymous hemianopia)
--gaze preference
73
PCA/Posterior cerebral artery supplies what
Occipital lobe, inferior temporal lobe, thalamus, midbrain
74
Deficits of PCA stroke
--Contralateral homonymous hemianopia
--Visual hallucination or cortical blindness
--Thalamic syndrome
--Memory impairment
75
Broca Area
Language production
76
Functions of CN II
Pupillary light reflex and visual fields
77
Functions of CN III
Eye movement
Dysconjugate vertical gaze
Pupil constriction
Pupillary light reflex
Lens accomodation
78
Functions of CN V
Facial sensation
Muscles of mastication
Jaw jerk reflex
79
Functions of CN VII
Muscles of facial expression
Facial weakness
Lacrimation
Salivation (submandibular and sublingual glands)
Taste (ant. 2/3 of tongue)
80
Dysfunction of CN XII
Dysarthria (difficulty with words)
Dysphagia (trouble swallowing)
81
What 2 arteries supply the brain?
Internal carotid artery (ICA)
Vertebrobasilar artery
82
ID
83
ID
84
Cauda equina
Nerve roots at the end of the spinal cord
85
Define spinal nerve trunk
Union of ventral and dorsal roots
86
Anatomy of spinal nerves
Roots (either sensory or motor) --> together become spinal nerve trunk --> split into ventral and dorsal rami
87
Function of the pre-central gyrus
initiation and voluntary control of movement by sending motor commands to skeletal muscles via corticospinal tract
88
Function of Broca's area
Location: left dominant inferior frontal lobe
--language speech production and motor planning for speech
--Damage: non-fluent expressive aphasia
89
Function of frontal eye fields
Control voluntary, conjugate gaze to the contralateral side
--Eyes look toward a destructive frontal eye field lesion (stroke) and away from an irritative cortical lesion (seizure)
90
Function of Gerstmann area
Writing, math, body awareness, and spatial orientation
--Damage: agraphia, acalculia, finger agnosia, left-right disorientation
91
Function of Wernicke area
language comprehension
--Damage: flue aphasia, no meaning nor understanding
92
Location and function of primary visual cortex
Location: calcarine fissure
Function: receives and processes visual input from the retina via optic radiations
93
Pathway of the corticospinal tract (descending pathway)
UMN: precentral gyrus, descend through the internal capsule and brainstem, decussate at the cervicomedullary junction, continue contralaterally through the spinal cord white matter to synapse in the ventral horn gray matter
LMN: synapse with skeletal muscles
94
Pathway of spinothalamic tract (ascending pathway)
pain and temperature sensations enter each spinal segment immediately decussating, then ascending contralaterally antero-lateral white matter to the thalamus through the internal capsule to the postcentral gyrus
95
Pathway of dorsal column-medial lemniscus (DCML)
vibration and proprioception enter at each spinal segment and ascend ipsilaterally in dorsal-column white matter, decussating at the cervocmedually junction, and continue contralaterally through the medial lemniscus to the thalamus via internal capsule to the postcentral gyrus
96
CN III functions
eye movements, pupil constriction, and light reflex
97
Function of the reticular formation
regulates arousal, consciousness, attention
(reason to produce a coma)
98
Function of the substantia nigra
modulates activity of the basal ganglia to initiate and regulate smooth, purposeful movement
Injury: Parkinsons
99
Function of CN V
Facial sensation and chewing
100
Function of CN VII
facial expression and taste
101
What produces locked in syndrome
Pontine lesions due to basilar artery thrombosis
102
Where do the cardio-respiratory centers
Medulla
103
What causes lateral medullary syndrome?
Vertebral artery dissection
Symptoms: vertigo, dysphagia, hoarseness, ipsilateral facial numbness, contralateral body pain/temperature loss and cerebellar ataxia
104
What sensory input does not pass through the thalamus?
Smell
105
Function of cerebellum
Coordinates voluntary movement, balance and posture; ensures smooth and accurate motor activity
106
List regions of cerebellum and function
Lateral hemispheres: motor coordination
Vermis: Gait and trunk control
Flocculonodular lobe: eye movements and balance
----Injury cases ipsilateral deficits (ataxia, intention tremor, dysmetria)
107
Components of the basal ganglia:
Striatum: caudate nucleus and putamne
Globus pallidus: indirect motor pathway and major output to thalamus
Substantia nigra: produced dopamine, modulates striatal activity
Subthalamic nucleus: modulates activity of globus pallidus and involved in indirect pathway
108
Huntington's disease causes damage to....
Striatum (caudate nucleus and putamen)
Symptoms: chorea (involuntary, dance-like movement), dystonia, bradykinesia (slowed movements), speech difficulties, impaired coordination
109
What does the Internal carotid artery supply (what sections of the brain)
frontal, parietal, lateral, temporal lobes
110
what sections of the brain does the vertebral-basiliar system supply
brainstem, cerebellum, occipital lobe, medial temporal lobes
111
AICA supplies what region of the brain
Cerebellum
112
Ventral horns of spinal cord contain what
LMN and send motor output to skeletal muscles
113
Lateral horns in spinal cord have what type of output
sympathetic
114
Define aphasia
a disorder of language comprehension or expression due to damage in the dominant hemisphere (Broca's or Wernicke's area)
115
Define apraxia
the inability to carry out learned purposeful movements despite desire and physical ability (disorder of motor planning)
116
Agnosia
inability to recognize objects, persons, sounds, shapes, or smells
--normal sensory function
--brain can not associate input with meaning
117
Astereognosis
Inability to recognize objects by touch w/o visual input, despite intact primary sensation (usually parietal lobe dysfunction); intact dorsal column pathway required for tactile input
118
Ataxia
Lack of voluntary coordination of muscle movements, include gait abnormality, speech changes, and eye movements
(cerebellum dysfunction)
119
Dysarthria
motor speech disorder caused by impaired control of the muscles used for speech, resulting in slurred, slow, or difficult-to-understand articulation, while language comprehension and word selection remain intact
120
Dysmetria
Form of cerebellar ataxia characterized by the inability to accurately control the range or distance of movements, leading to overshooting or undershooting
121
Intention tremor
Rhythmic, involuntary shaking that occurs during voluntary movement, worsens as target is approached
(cerebellar dysfunction)
122
Sensory dissociation
pattern of sensory loss which involves preservation of fine touch and proprioception with selective loss of pain/temperature (or vice versa)
123
C5 Dermatome
Lateral shoulder/lateral elbow
124
C6 Dermatome
thumb
125
C7 Dermatome
middle finger
126
C8 Dermatome
pinky
127
T1 Dermatome
medial elbow
128
T4 Dermatome
teet-pore
129
T7 Dermatome
Xiphoid
130
T10 Dermatome
Belly-button
131
L1 Dermatome
Inguinal Ligament
132
L4 Dermatome
Medial malleolus
133
L5 Dermatome
Top of foot
134
S1 Dermatome
Lateral heel
135
C3-C5 Myotomes
Diaphragm (breathing)
136
C5 Myotomes
Shoulder abduction (deltoid)
137
C6 Myotomes
Elbow flexion (biceps; brachiorad)
138
C7 Myotomes
Elbow extension (triceps)
139
C8 Myotomes
Wrist/finger flexion (FDS)
140
T1 Myotomes
Finger abduction (DABs)
141
L2 Myotomes
hip flexion
142
L3 Myotomes
Hip adduction
143
L4 Myotomes
Knee extension
144
L5 Myotomes
Dorsiflexion (tibialis anterior)
145
S1 Myotomes
Plantar flexion (gastrocnemius)
146
C5 reflex
Bicipital tendon reflex
147
C6 Reflex
Brachioradialis reflex
148
C7 Reflex
Triceps reflex
149
L4 Reflex
Patellar tendon reflex
150
S1 Reflex
Achilles tendon reflex
151
152
153
Medulla has which cranial nerves
CN IX-XII
154
Midbrain has which cranial nerves
CN III, IV
155
Pons has which cranial nerves
CN V-VIII
156
157
Sensory information asecends the spinal cord through which tracts
White tracts
--Ipsilateral is the DCML
--Contralateral is the spinothalamic (or ALS)
158
Dorsal Column or Medial Lemniscus contains what type of information
Vibration, Proprioception, Fine (discriminative) touch
--Ascends ipsilateral spinal cord white matter
159
Anterolateral system or Spinothalamic tract contains what type of information
Pain, temperature, crude (non-discriminative) touch
--Ascends in contralateral spinal cord white matter
160
Symptoms of injury to a LMN (or somatic motor neuron)
-Flaccid paralysis (muscle weakness)
-Hypotonia (loss of muscle tone)
-Muscle atrophy
-Fasciculation
-Hypo-reflexia (reduced or absent reflexes)
161
Injury to an UMN symptoms
-Spasticity (increased muscle tone)
-Clonus (rhythmic muscle contractions with sudden stretching)
-Hyperreflexia (exaggerated DTR)
-Muscle weakness
-Minimal muscle atrophy
-Babinski sign (Extension of the great toe when sole is stroked)
162
C
163
Location and Fuction of Broca's area
Location: left (dominant) inferior frontal lobe
Function: Language production and motor planning for speech
Damage: non-fluent expressive aphasia
164
Location and Function of Wernicke area
Location: Left (dominant) superior temporal gyrus
Function: Language comprehension
Damage: fluent (receptive) aphasia
165
Location and function of Gerstmann area
Location: Left (dominant) hemisphere, inferior parietal lobe
Function: Writing, math, body awareness, spatial orientation
Damage: agraphia, acalculia, finger agnosia, L-R disorientation
166
What provides posterior circulation of the brain
Vertebrobasilar artery
167
Distribution of the anterior cerebral artery
Medial aspect of cerebral hemisphere back to parietal lobe
168
Distribution of the MCA
Lateral aspect of cerebral hemispheres
169
Distribution of posterior cerebral artery
Occipital lobe and temporal lobe
170
Describe circle of Willis
ring-like arterial structure at the base of the brain that provides collateral blood flow b/w anterior and posterior cerebral circulations
171
Define stroke
sudden onset of focal neurologic dysfunction due to disrupted arterial flow to a portion of cerebral parenchyma
172
2 types of strokes
1. Hemorrhagic stroke
2. Ischemic stoke
173
Define ischemic stroke
blood clot occludes cerebral arteries within brain tissue resulting in down stream regions of the brain not getting O2 and nutrients
174
Define hemorrhagic stroke
blood vessel within the brain ruptures and blood hemorrhages into the parenchyma resulting in brain damage as a result of blood pooling and downstream regions of the brain not getting O2/nutrients
175
C - Midbrain
176
177
178
179
If you knockout a spot on the spinal cord white columns (Corticospinal tract) then what happens below...
You knockout everything below as the fibers run north to south, so nothing occurs below it.
180
If you knockout a ventral root what happens?
Only that myotome is affected. Nothing affected at other levels.
181
If you knockout the dorsal root ganglion at a spinal level what happens?
Only that dermatome is affected. Nothing below or above it.
182
If you knockout a tract in the DCML posterior white column, what happens?
All the dermatomes below it on the same side are knocked out on lower spinal levels as the tract ascends ipsilaterally.
183
What happens if you knockout a section of the spinothalamic tract?
All the dermatomes from below on the OPPOSITE SIDE are knocked out as the tract desscuates immediate after entering spinal cord. And it ascends up.
184
185
186
187
188
189
Symptoms of a vertebral artery stroke
--Vertigo, dizziness (brainstem/cerebellar involvement)
--Nausea, vomiting (brainstem)
--Ataxia (cerebellum)
--Nystagmus
--Dysphagia, dysarthria (lateral medulla)
--hoarseness (vagus nerve)
--Horner's syndrome
--Ipsilatearal facial numbness
--Contralateral body numbness
190
Two syndromes associated with vertebral artery stroke
1. Lateral medullary syndrome
2. Medial medullary syndrome
191
Symptoms of medial medullary syndrome
--Contralateral hemiparesis
--Contralateral proprioception/vibration loss
--Ipsilateral tongue weakness
192
Lateral medullary syndrome is associated with which vessel
PICA
193
Symptoms of a PICA stroke
Vertigo, nausea, vomiting, nystagmus, Ipsilateral limb ataxia, Ipsilateral facial pain and temperature loss, Contralateral pain. Dysphagia, Dysarthria, hoaseness, Ipsilateral Horner's syndrome, Hiccups
NO MOTOR WEAKNESS
194
Basiliar artery supplies what brain structures
Pons, Midbrain, Medulla, Cerebellum, Occipital lobe
195
Symptoms of basilar artery stroke
--Quadriplegia
--Dysarthria, dysphagia, facial weakness
--Coma
--gaze palsies
--Bilateral sensory loss
--Ataxia
--Repiratory abnormalities
"everything but the eyes"
196
Syndromes with basilar artery stroke
Locked-in syndrome due to pons
--Anarthria (unable to speak), quadriplegia
--CAN DO vertical gaze and blinking
197
Symptoms of posterior cerebral artery stroke
--Contralateral homonymous hemianopia (ie cannot see from left field in either eye)
--Visual agnosia (cannot recognize objects)
--Burning pain
--CN III palsy (ptosis
--Memory impairment
--Vertical gaze palsy
198
Symptoms of Anterior Spinal Artery (ASA) Stroke
--NO DCML symptoms b/c supplied by posterior spinal artery
--Bilateral weakness below lesion (corticospinal tract)
--Flaccid paralysis (LMN)
--Bilateral loss of pain and temperature below the lesion (Spinothalamic tract)
--Urinary retention, bowel dysfunction, sexual dysfunction (autonomic fibers)
199
Classic presentation of Anterior Cord syndrome of Anterior spinal artery stroke
--Sudden onset bilateral weakness
--Loss of pain & temperature
--Preserved vibration and proprioception
--Autonomic dysfunction (bowel, bladder, sex)
--MAINTAINS vibration and position
200
MCA stroke symptoms
--Contralateral face and arm > leg (precentral gyrus)
--Contralateral face & arm sensory loss (Sensory cortex)
--Broca's aphasia
--Wernicke's aphaisa
--Hemineglect (parietal lobe) inability to respond to unilateral stimuli
--Contralateral homonymous hemianopia
201
Unique MCA stroke dominant side symptom
Aphasia broca's or Wenicke's
202
Unique non-dominant stroke symptom
Left-sided neglect, constructional apraxia (inability to draw objects with many parts)
203
Symptoms of Anterior Cerebral Artery
--Contralateral leg > arm weakness (motor and sensory)
--Personality changes, apathy, abulia (loss of initiative)
--Urinary incontinence
--Alien hand syndrome
204
Symptoms of Ophthalmic artery stroke
--Sudden, painless monocular blindness
--Amaurosis fugax (vision loss)
--Afferent pupillary defect (Marcus Gunn pupil)
205
Name the assoociated CN and their functions within the brainstem
Midbrain
-- CN 3& 4: Dysconjugate vertical gaze
Pons
--CN 5: facial sensation, jaw jerk
--CN 6: dysconjugate horizational gaze
--CN 7: facial weakness, blink reflex
--CN 8: vertigo, nausea, emesis
Medulla
--CN 9: reduced gag reflex
--CN 10: reduced gag reflex and hoarseness
--CN 11: weak head turn and shoulder shurg
--CN 12: dysarthria and dysphagia
206
Define the neuroaxis
Schematic organization of the nervous system, particulaty in relation to the CNS
207
Direct lesion to the cortex produces what symptoms
Motor weakness (UMN)
Sensory changes
Eye deviation (frontal eye fields)
Cortical blindness
Aphasia
--Broca (frontal)
--Wernicke (temporal)
Gerstmann (parietal)
208
Direct Lesion to the Subcortex produces what symptoms (cerebellum and basal ganglia)
--Motor weakness F= A = L (UMN)
--Sensory changes F=A=L
--Visual hemi- or quadrant defects
--Cerebellum: hypotonia, ataxia, nystagmus, dysdiadochokinesia, stance & gait, tremor
--Basal ganglia: hypertonia (rigidity), postural instability, bradykinesia, tremor (at rest)
209
Direct lesion to the Brainstem: Midbrain
-CN3, 4, RAS, Motor weakness (UMN F=A=L), sensory changes
210
Direct lesion to the brainstem: Pons
CN 5, 6, 7, 8
211
Direct lesion to the brainstem: medulla
CN 9, 10, 11, 12
Cardio-respiratory centers
212
Discrete lesion at the roots
Monomeric dermatome and myotome (LMN); reflexes attenuated in one limb
213
Discrete lesion at the plexus
Extreme pain, sensory change monomelic non-dermatome; motor weakness (monomelic non-myotoma (LMN)
--Reflexes: attenuated in one limb
214
Discrete lesion at the peripheral nerve level
Sensory change: diffuse stocking-glove
Motor weakness: distal (LMN)
Reflexes: attenuated distally
215
Discrete lesion at the muscle level
Sensory: Normal
Motor: Non-fatigueable weakness (diffuse & proximal)
Reflexes: Reduced to normal
216
Signs of UMN to determine if CNS (Cortex - spinal cord)
Hypertonia, Hyperreflexia, Clonus, Babinski
217
Signs of LMN to determine if PNS (starts at the level of root - muscle)
Hypotonia, Hyporeflexia, Atrophy, Fasciculations
218
Ddx for cortex lesions
Meningitis
Encephalitis
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Abscess
Meningioma
Dementias: Alzheimer
Cortical vein thrombosis
Depressed skull fracture
Migraine
Epilepsy
219
Ddx for lesions in the subcortex
MS
Brain tumor
Diffuse axonal injury
Encephalitis: infectious v. autoimmune
Intraparenchymal hemorrhage
Abscess
Cerebritis
Encephalitis
220
Ddx of lesion to the brainstem
Parkinson disease
Pineal tumor
Sarcoidosis
Diffuse axonal injury
221
Ddx of lesion to the pons
Basilar artery thrombosis: locked in syndrome
Central pontine myelinolysis
Encephalitis
Schwannoma
Charcot-Bouchard aneurysms
222
Ddx of lesion to the medulla
Lateral medullary syndrome
Chiari malformation
Vertebral artery dissection
CNS infection: listeria, rabies
223
Ddx of lesion spinal cord
B12: subacute combined degeneration
Brown Sequard syndrome
Anterior spinal artery syndrome
Transverse myelitis (ie MS)
Syrinx
Infections: TB, Syphilis
Amyotrophic lateral sclerosis
Spondylosis/Spondylitis (herniating disc)
224
Ddx for a lesion on the root level
Traumatic root avulsion
Disc impingement
Acute inflammatory demyelinationf (Guillain Barre syndrome)
Chronic inflammatory demyel.
Nerve sheath tumors
Infections/Radiculitis (HSV, CMV, VZV, WNV)
225
Ddx for lesions on the plexus
Traumatic/mechanical injury
Erb paralysis
Klumpke paralysis
Pancoast tumor
226
Ddx of peripheral nerve
D: Diabetes
A: Amyloid
N: Nutritional (B1, B12)
G: Guillaume Barre syndrome
T: Traumatic
H: Hereditary (Charcot Marie Toothe disease)
E: Endocrine
R: Rheumatologic (vasculitic)
A: Alcohol
P: Porphyria
I: Ischaemic, infectious (rabies, herpes)
S: Sarcoid
T: Toxic
227
Ddx for Neuromuscular junction
Myasthenia gravis
Lambert Eaton Myasthenic Syndrome
Botulism
Snake bite envenomation
Weapons of mass destruction
Paraneoplastic
228
Ddx for Muscle Level
Acquired Inflammatory myopathies: Dermatomyositis, Polymyositis, Inclusion boy myositis
Muscular dystrophies: Duchenne, Becker muscular dystrophy, Fascio-Scapulo-Humeral muscular dystrophy, Myotonic dystrophy
McArdle disease
229
Risk factors for vascular disease
Obesity, prediabetes, sleep apnea, tobacco, pro-thrombotic conditions, Amyloid angiopathy, vasculitis, mixed connective tissue disorder, sickle cell, shunts, pregnancy, PAD
230
The subcortex contains which pathways
1. Ascending sensory pathways which spread out/diverge as they project to the parietal cortex
2. Descending motor pathways which converge as they approach the brainstem
3. Anterior-to-posterior visual radiating fibers
4. Trans-hemispheric fibers
231
3 characteristics of locked in syndrome
1. Preserved sensation
2. Vertical eye movements
3. Cognition in a paralyzed body
232
Where are the cardio-respiratory centers located?
Medulla
233
Cranial nerve lesions produce ______abnormalities
Ipsilateral
234
Right pontine lesion effects
CN 5-9
Right facial numbness, binocular diplopia, right facial weakness, right ear hyper-acusis, right tongue dysgeusia (abnormal taste) and vertigo.
235
Right medullary lesion effects
CN 9-12
Right throat discomfort, swallowing difficulties, downsloping shoulder on right, head is slightly rotated to the left, tongue deviates to the right
236
Imaging results for a left MCA
--sulcal effacement
--loss of grey-white junction
237
Characteristics of a left MCA (dominant)
238
Signs of MCA right (nondominant) stroke
-breathless
-leg weakness
-NO confusion, or altered
-atrial fibrillation
-Upper extremity weakness
-gaze preference to the right
239
Characteristics of ACA
-Incontinence of urine
-Sudden leg weakness
240
ICA left characteristics
-right hemiparesis
-inability to speak
-left carotidynia
-only look to the left
-left monocular blindness prior
-weakness in all extremities
-gaze deviate to the left
241
Vertebral artery-right stroke characteristics
Vertigo, jumping eyes, cervicalgia
coughing on salvia
hiccups
anisocoria OS>OD, ptosis, dysarthria, nystagmus
dull sensory
242
Characteristics of basilar artery stroke
-locked in syndrome
-"in a coma"
-no spontaneous movements
-bilateral Babinski sign
243
Characteristics of posterior cerebral artery (PCA-left)
-homonymous hemianopsia (ie cannot read the right side of a menu)
-contralateral hemi-pain syndrome
-neck pain, dull headache
244
Symptoms of a PICA stroke
-hiccups, vertigo, ataxia, dysphagia, sensory changes
-hoarseness
-ptosis OD, meiosis OD, RUE ataxia, RUE dysmetria
-Right lateral medullary syndrome
245
Symptoms of right lateral medullary syndrome
246
Characteristics of SCA (superior cerebellar artery) right side
-ataxia, dysmetria, intention tremors, vertigo, N/V, dizziness, imbalance
-vocal ataxia, hypotonia
247
Symptoms of an Anterior Spinal Artery (ASA)
-UMN weakness below level of lesion (paraparesis)
-Pain and temp abnormal (below lesion)
-Vibration and proprioception NORMAL
-priapism
bilateral weakness
248
ID
