Flashcards in Week 2 Final Exam Deck (106):
1
Transection of the spinal cord between levels of C5-C6 results in bilateral paralysis of the ___ extremities aka ___plegia
Transection of the spinal cord between levels of T1-L2 results in bilateral paralysis of the ___ extremities aka ___plegia
Upper and Lower, quadriplegia
Lower, Paraplegia
2
1) The reticulospinal fibers can descend to the intermediolateral cell column, which is the main player in the preganglionic ___ system and since the ILCC exists only at the levels of ___-____, if you transect the spinal cord above ____ you lose this aspect and ___ syndrome results
^**** Symptoms include slight ptosis, miosis (pupil constriction), Enophthalmos, and Anhydrosis
2) Lesions to the cord above ___ can result in reflex bladder
3) Lesions in the region of __-___ can result in flaccid anal sphincter tone with bowel incontinence
1) Sympathetic, T1-L2, T1, Horners
2) S2
3) S3-S5
3
Spastic paralysis results from an ___ motor neuron lesion
^** UMN lesions have hyperactive reflexes and LMN lesions have absent reflexes
Spastic paralysis results in a ___nated foot aka pigeon toed
Also, the ___ sign, Clonus, and ____ (aka paralysis of the upper and lower extremities on the same side of the body) occur with UMN lesions
Upper
Supinated
Babinski sign, hemiplegia
4
********** WILL BE ON THE TEST*******
A unilateral transverse lesion or hemisection of the spinal cord is called Brown-Sequard syndrome a results from a lesion to 3 things, which include destruction of the ___, ___, and ___
So proprioception (Posterior column) and motor paralysis (LCST) occurs on the ___ side and the loss of pain and temperature on the ___ side
*************************
*********** WILL BE TESTED ON SO KNOW THIS*********
Transection of the spinal cord above S2 disrupts the ____ tract to the ___ nucleus, and the patient is therefore unable to voluntarily void their bladder (urinary retention occurs)
^** After ____, the bladder reflex man return without voluntary control and the patient will have automatic reflex voiding or a ___ bladder
If a lesion to the dorsal roots of S2-S4 or dorsal funiculi of S2-S4 occurs, ___ results and this causes a ___ bladder and increased bladder capacity; but voluntary voiding is still possible, but incomplete
LRST, SAN
Spinal Shock, reflex
Atonic Bladder, flaccid
********** WILL BE ON THE TEST*******
A unilateral transverse lesion or hemisection of the spinal cord is called Brown-Sequard syndrome a results from a lesion to 3 things, which include destruction of the ___, ___, and ___
So proprioception (Posterior column) and motor paralysis (LCST) occurs on the ___ side and the loss of pain and temperature on the ___ side
*************************Posterior columns, LCST, and LSTT
Ipsilateral, contralateral
5
Name the sensory nuclei
1) Fast Pain and temp info at all levels of spinal cord
2) Slow Pain and temp Info and tactile info at all levels of spinal cord
3) GVA information involved in autonomic responses and located only at T1-L2 and S2-S4
4) Unconscious proprioceptive info
Name the motor nuclei
1) Preganglionic sympathetic neurons at thoracolumbar segments
2) Preganglionic parasympathetic neurons at S2-S4
3) Sensorimotor integration
4) Movements of distal limb musculature
5) Movements of axial limb musculature
1) Substantia Gelatinos
2) Nucleus Proprius
3) Visceral Afferent Nucleus
4) Nucleus Dorsalis
1) Intermediolateral cell column
2) Sacral Autonomic Nucleus
3) Intermediate gray
4) Lateral Motor Cell Column
5) Medial Motor Cell Column
6
Glove and stocking anesthesia occurs in ____ and ____ and often occurs due to a ___ deficiency
^** Also posterior columns and LCSTs can be destroyed
Subacute combined degeneration and pernicious anemia, Vitamin B12
7
The central processes of the Trigeminal nerve enters the brainstem at the middle cerebellar peduncle and ascends and descends
Some of the fibers that ascend do so in the ___ tract of V and terminate in the ____ nucleus of V to convey ____ information from the face
*******************The other fibers descend in the ___ tract of V and send collaterals along the entire length of the descending nucleus and finally terminate in the ___ of the descending nucleus of V. This tract conveys ___ info******************
^Fast info via Alpha-delta fibers and slow goes to the RFs via C type fibers******
Some fibers also course through the mesencephalic tract of V, which conveys ____ info to the main sensory nucleus
There are also connections from the descending nucleus of V into the ___ for slow pain and temp
^** Called the trigeminoreticulothalamic pathway (aka slow pain pathway)
** Note that crude tactile sends info to both main sensory nucleus of V and descending nucleus of V, so it is VERY hard to lose crude tactile sensation
Ascending tract of V, Main sensory nucleus of V, Touch (precise discriminative tactile info)
Descending, Subnucleus Caudalis, Pain and temp
Proprioception
Reticular formation
8
Once the Trigeminal primary axons synapse on secondary axons, the secondary axons are conveyed via the ____ to the ____ and then to the ____ cortex
Trigeminal lemniscus, VPM (Ventral posterior medial nucleus of the thalamus), Primary somesthetic
9
The ____ nucleus is the only nucleus in the CNS comprised of a pseudounipolar neuron
It receives conscious and unconscious ____ and pressure information from the muscles of the head and oral region
The central processes terminate in the __ nucleus that connects conscious awareness of facial and oral proprioception via the trigeminal lemniscus and DCTT
Other central processes terminate in the ___ nucleus and this is the monosynaptic circuit for the ____-reflex since SVE fibers leave from here
Mesencephalic
Proprioception
Main sensory nucleus
Trigeminal motor nucleus, jaw-jerk
10
There is a trigeminocerebellar tract that conveys unconscious crude tactile (light touch) info from the trigeminal nerve -> ____ (name both) and then send trigeminocerebellar fibers to the ____ of the cerebellum via the ____
There is another trigeminocerebellar tract that conveys unconscious precise tactile and proprioception info from the Trigeminal nerve to the ____ nucleus and then trigeminocerebellar fibers are sent to the ___ of the cerebellum via the ___
Subnuclei rostralis and interpolaris, anterior vermis, inferior cerebellar peduncle
Main sensory nucleus, anterior vermis, superior cerebellar peduncle
11
The descending nucleus of V lines up with the ___ for the rest of the bodies pain and temp
The descending tract lines up with the ___ for the rest of the body
Substantia gelatinosa
Dorsolateral fasciculus of Lissaur
12
********************* If a patient has ipsilateral hemianalgesia (loss of pain) of the face and contralateral hemianalgesia (loss of pain) of the body, ___ has occured
^** This is because you destroy the primary fibers in the descending tract of V and the secondary fibers in the ___ since it runs right next to it
Alternating analgesia
Spinal lemniscus
13
Ipsilateral trigeminal anesthesia (loss of sensation) and paralysis in the face, along with contralateral spastic hemiplegia (paralysis on one side of the body) in the body, it is called ____
This is due to a unilateral destruction of the trigeminal nerve and ___ tract in the pons
Alternating Trigeminal Hemiplegia
Corticospinal tract (since it must be an UMN lesion due to the spastic paralysis)
14
Name the section of the descending spinal nucleus of V
1) Receives tactile info from the central region of the face
2) Receives info from the peripheral region of the face
3) Receives pain and temp info from the anterior one-half of the head
1) Subnucleus Rostrlis
2) Subnucleus Interpolaris
3) Subnucleus Caudalis
15
The primary neurons for hearing is located in the ___ ganglion, which is embedded in the modiolus
The cohclear division of the VIII nerve is formed via the central processes of the neurons that leave the ganglion and the central process terminate on the ____ nuclei and ___ nuclei
Fibers from the dorsal cochlear nucleus decussate in the upper medulla as the ___ striae and ascend in the contralateral ____ where they terminate in the ___
^** Note the dorsal stria when visible are called the stria medullaris acoustica
Fibers from the ventral cochlear nucleus can decussate as the ____ in the upper medulla where they also ascend in the contralateral Lateral Lemniscus and terminate at the inferior colliculus
Finally, fibers from the ventral cochlear nucleus can also cross the ___ lemniscus and form the ____ where they terminate in the ___ and then fibers get projected from the ___ SON to the inferior colliculus (Primarily via an ipsilateral lateral lemniscus, although some contralateral fibers pass as well)
^** So the Trapezoid body is located at the junction of the medial lemniscus and the ventral acoustic stria
Then the fibers from the IC project to the ____ via the ____ of the inferior colliculus and then fibers from the MGB project to the ____ cortex via auditory radiations (located in the transverse and superior temporal gyrus)
Spiral ganglion
Dorsal and ventral cochlear nuclei
Dorsal Acoustic Striae, Lateral Lemniscus, Inferior Colliculus
Intermediate Acoustic striae
Medial, Trapezoid body, SON (Superior Olivary Nucleus), medial
Medial Geniculate body (MGB), brachium, primary auditory cortex
16
The SON has a medial and lateral portion.. The ___ portion localizes sound and the ___ portion gives rise to olivocochlear efferents which inhibit the organ of corti (aka inhibit receptor sensitivity)
Medial, lateral
17
***********1) Ipsilateral complete deafness occurs from a unilateral lesion of the ___
2) ********A unilateral lesion to the central auditory pathway results in _____ diminution of hearing, BUT it is more prominent in the ____ ear ************* (This can occur via the LL, IC, Brachium of IC, or MGB)
1) Cochlear nerve
2) Bilateral, contralateral
18
*********** The auditory association cortex, which is needed to process and integrate sounds is located in the ____ association cortex and ___ area
*******Therefore, a lesion in the POT can result in ___, which is characterized by the inability to ___ auditory information (spoken and written language remain intact)
If Wernicke's area is damaged in the dominant hemisphere, the patient has an inability to ___ the spoken or written language, but they can speak fluently although they have weird speech patterns) and this is called _____ *******************
POT (Parieto-Occipito-Temporal association cortex), Wernicke's
Auditory Agnosia, Comprehend
Comprehend, Fluent Paragrammatical Aphasia
19
The Visual fields are projected to the retinal fields and the image is inverted and reversed and then the retinogeniculocalcarine pathway is the primary pathway for the visual system
The axons of the ganglion cells leave the retina -> Optic nerve -> Optic Chiasma -> Optic tract -> and then terminate in the ____ (while some terminate in the superior colliculus as part of the tectal and visual pathways)
Info from the lower hemiretina projects to the ___ part of the LGB, along with the ___ and ___ gyrus
LGB (Lateral geniculate body)
Lateral, Loop of Meyer, Lingual gyrus
20
Once synapsed in the LGB, optic radiations project to the ____ cortex
***********The optic radiations are retinotopically organized, and the most important section of the optic radiations is the ____, which is located in the posterior aspect of the ___ lobe and contains fibers _____ and _____ fibers **********
Primary visual cortex
Loop of Meyer, temporal, contralateral lower nasal (LN) and Ipsilateral lower temporal (LT)
21
Blindness in one half of the visual field is called ___
Hemianopia
22
1) A Unilateral lesion of the optic nerve results in ____ monocular blindness
2) If you lesion the lateral aspect of the optic chiasma bilaterally, ____nymous blindness in the ___ fields of each eye occur... If it is a unilateral lesion, lets say on the right side of the optic chiasma, then ____, ___ hemianopia of the ___ eye occurs
**********3) If a midline lesion to the medial portion of the optic chiasma occurs, you get ___ hemianopia and lose sight in both left and right ____ visual fields ***********
^*** Can occur via a pituitary adenoma
4) Unilateral lesions of the lateral geniculate body, or complete optic radiations, it results in a ____, ____nymous hemianopsia... So if you take out the right LGB, you lose vision in your left temporal and left nasal fields and therefore this is called a ___ hemianopia
**********5) Unilateral lesion of the loop of meyer results in a homonymous deficit called a ____ so lets say you cut the right loop of meyer, it is a ____ (since you lose vision in your upper left temporal and nasal visual fields ************
1) Ipsilateral
2) Heteronymous, nasal, left nasal, right
3) Bitemporal, Temporal
4) Contralateral, homonymous, left homonymous
5) Contralateral superior quadrantanopia, left superior quadrantanopia
23
If you take out your primary visual cortex, it results in a ___
So for example, if you take out your right primary visual cortex you get a ____ with ___
^** So anytime you see a incongruent hemianopia or macular sparing, think cortical lesion of the visual cortex************
Incongruent contralateral homonymous hemianopia with macular sparing
Left homonymous hemianopia with macular sparing
24
Pupillary constriction is a parasympathetic light reflex that is centrally processed through the ___, however this is NOT used in the accommodation pathway
For the consensual light reflex, the fibers cross over to the contralateral eye at the ___
Pretectum
Posterior commissure
25
Interruption of the pupillary dilation response results in ___ syndrome characterized by ___, ___, and ____
Horners, Slight ptosis/miosis/anhydrosis
26
Due to ___, this can lead to the disease called ____ pupil and the pupils are unreactive to ___, but constrict during ___ and this can be due to destruction of the ____ (which is important in the light reflex, but not in accommodation)
DO NOT CONFUSE THIS WITH a similar condition called ____ pupil... Here, the pupil is once again unreactive to ___, however for accommodation, the pupil will at first appear to be non-reactive to convergence, however if it is held for a few seconds, then the pupil will slowly constrict
^Due to _______
Syphilis infection, Argyll-Robertson, light, accommodation, Pretectum
Holmes-Adie (also called tonic pupil), light, lesion of ciliary ganglion
27
Accommodation is a ____ mediated visual response, originating in the ___ eye field of the ___ lobe and results in convergence of vision, pupil constriction, and thickening of the lens
So the ___ eye field is for volitional (voluntary) eye movements, however there is also a ___ eye field involved in nonvolitional eye movements
Cortically, frontal, frontal
Frontal, Occipital
28
**************Know MRI images and what level of the brainstem we would be at************
**** WILL BE TESTED ON
29
******************The ___ connects the occulomotor nucleus with the Abducens nucleus and is important for ____*************
^** So a MLF lesion would disturb horizontal gaze and is called ______ and patients have an abnormal response to horizontal gaze in the ___ direction of the lesioned side
A unilateral lesion of the MLF results in the loss of adduction of the ___ eye and a nystagmus of the ____lateral aka abducting eye
MLF (Medial Longitudinal Fasciculus), horizontal gaze
Internuclear Ophthalmoplegia, opposite
Ipsilateral, contralateral
30
The vestibular system (which has the function of signaling changes in position of the head with respect to gravity and motion) has bipolar neurons in the vestibular ganglion send info to the ___ nuclei, and then from that nuclei the ___ leaves to control horizontal gaze, the ____ goes to the cervical levels for head gaze orientation, and the ___ goes to all spinal cord levels to affect posture via the axial musculature
There are also afferents that go to the ____ from the vestibular ganglion
Vestibular nuclei, MLF, MVST (medial vestibulospinal tract), LVST (lateral vestibulospinal tract)
Vestibulocerebellum
31
The fibers that innervate the somatic motor nuclei of the face come from the ___ fibers
These fibers make up the corticobulbar tract (CBT), which inneravte the brainstem cranial nerve motor nuclei
******The fibers decussate in the lower pons and are uncrossed CBT at and above the level of the ___ nerve, and are crossed at or below the level of the ___ nerve*******
A lesion of the CBT above the decussation results in ____ cranial nerve palsies (such as supranuclear facial palsy) and a lesion of the CBT below the decussation can result in ___ cranial nerve palsies
Corticobulbar fibers
Trigeminal nerve, abducens nerve
Contralateral, Ipsilateral
32
*********Unilateral lesion of the corticobulbar fibers to the facial nucleus results in paralysis of the ____, ___ quadrant of the face**********
This is called _____
^**** WILL BE TESTED ON
Contralateral lower
Supranuclear Facial Palsy
33
*************80% of strokes occur near the ___ and ____ ****************
Genu and posterior limb of the internal capsule
34
Name the nerves associated with each brainstem level
1) Diencephalon
2) Midbrain (Mes)
3) Pons (Met)
4) Pontomedullary sulcus
5) Medullar Oblongata (Mye)
1) 2
2) 3, 4
3) 5
4) 6, 7, 8
5) 9, 10, 11, 12
35
Yolk like anesthesia is due to a lesion of the ____ and also syringomyelia and bilateral loss of pain and temp occurs along with loss of crude tactile
Anterior white commissure
36
1) Unilateral hemianalgesia (loss of pain to one side) and thermal hemianesthesia (loss of temp to one side) of the face results from ____
2) Spinal lemniscus lesion results in ____ of the body
1) Descending nucleus and tract of V
2) Contralateral hemianalgesia (loss of pain sensation)
37
The fastigial, globose, emboliform, and dentate nucleus are best seen in an ____ view
Upper medulla/lower pons
38
****************When the ___ is damaged the unvula will deviate ___ from the affected side
When the ___ nucleus is damaged the tongue will deviate ___ the affected nucleus ******************
Nucleus Ambiguss, away
Hypoglossal Nucleus, towards
39
In the anterior region of the brainstem, the ___ tract is located there (remember it goes through the pyramids)
Spinothalamic tract
40
Which cranial nerves exit the brainstem close to the spinal lemniscus and therefore a lesion to the cranial nerve can cause ___ deficits along with ___ loss of pain and temp sensation to the body
ipsilateral, Contralateral
5, 7, 9, 10, 11
41
When cranial nerves exit near the corticospinal tract and therefore can result in ___ cranial nerve deficits and ____ motor paralysis and paresis (hemiplegia)
ipsilateral, contralateral
42
****When the Abducens nerve is lesioned, it's called an _____ (aka the eye deviates medially and loss of lateral gaze occurs) *****
Internal strabismus
43
____ syndrome is an alternating abducens hemiplegia plus a lesion of the ___ nerve and nucleus (and this results in bells palsy)
A6H + 7
Millard-Gubler's, 7th
44
An alternating abducens hemiplegia + dorsal extension of the lesion (aka and A6H + ML) is called ____
There is also destruction of ___ corticobulbar fibers and this results in denervation of the ___ (contralateral or ipsilateral?) ___ and ____
^***** Therefore we can see some dysarthria (aka difficulty speaking) since the tongue is fucked up
BUT DO NOT FUCKING CONFUSE THIS for a lesion in the Hypoglossal nerve because remember, you name the lesion at the highest nerve and since you have internal strabisumus, it must be at the 6th CN
Syndrome of Foville
Crossed, ipsilateral, Nucleus ambiguss and hypoglossal nucleus
45
The _____ tract contains UMN of the cranial nerves and controls the muscles of the face head and neck so if you take out the
The corticobulbar fibers are __ above the level of the 5th CN, and then they cross below the level of the ___ nerve
Corticobulbar
Uncrossed, abducens
46
In an alternating trigeminal hemiplegia with a dorsal expansion, you get the normal V palsy and contralteral hemiplegia associated with it
However, since it has a dorsal expansion, you also take out some of the ____ CBT fibers that results in ____ deneration of the nucleus ambiguus, hypoglossal nucleus, abducens nucleus, ****AND the facial motor nucleus that can result in ______ can result****
*****ONCE AGAIN, realize the highest cranial nerve tells you side and lesion so if you see trigeminal nerve palsy, it's the highest
Uncrossed, contralateral, Supranuclear facial palsy
47
An alternating oculomotor Hemiplegia is called ___ syndrome and results in ____ strabismus (aka eye turned down and out), pupillary dilation (mydriasis), and complete ptosis
Also it can mess up the ___ corticobulbar fibers and result in contralateral brainstem motor nuclear palsies and supranuclear facial palsy
Weber's syndrome, external
Uncrossed
48
A lesion of the ____ results in dysphagia, dysarthria, hoarseness, and paresis of the ____ palatal muscles (since it is involved in innervating the soft palate, pharynx, and larynx
And the spinal lemniscus causes contralateral loss of pain and temp
Nucleus Ambiguus, ipsilateral
49
Lateral Medullary syndrome aka ___ syndrome or Syndrome of the ___ results in ___ loss of pain and temp to the face due to destruction of the ___ and loss of pain and temp to ___ side of body since the SL is lost
*************************************This is a type of alternating ____ since you loose sensation to the ipsilateral face and sensation to the contralateral body
***** THIS INCLUDES ____, so if you have an alternating hemianalgesia with dysphagia, it is Wallenberg syndrome
^********** KNOW THIS IT WILL BE ON THE TEST
Wallenberg, PICA, Ipsilateral, Descending tract of V, contralateral
Hemianalgesia, Dysphagia (difficulty swallowing),
50
*************************Like Wallenberg syndrome, the other syndrome with an alternating hemianalgesia is ____ syndrome, but the way you can tell them apart is due to the fact that you lose ____ due to the fact that the vestibulocochlear nerve is also damaged
************** KNOW THIS ALSO**********
Cerebellopontine Angle Syndrome, hearing
51
When someone can not look straight up (paralysis of upward gaze) and the posterior commissure destroyed causing the loss of consensual light reflex, ___ syndrome is most likely the cause
Parinauds
52
Remember, in Weber's syndrome you take out the Oculomotor nerve AND the CST
However if you take out the Oculomotor N (complete ptosis, mydriasis, and eye down and out) AND the Medial Lemniscus (loss of proprio/2pt to contralateral side) AND Spinal Lemniscus (loss of pain and temp to contralateral side) it is called ____ syndrome
Benedikt's syndrome
53
*******If the posterior cerebral arteries are destroyed, ____ syndrome occurs and signs of a "crawling ant" sensation ********
Thalamic syndrome
54
******The red nucleus and substantia Nigra has a resting tremor, but note there are also fibers from the superior cerebellar peduncle to the red nucleus and lesions of those fibers result in an ___******
Intention tremor
55
For the parasympathetic NS, pre ganglionic fibers release ___ onto ___ receptors and then post ganglionic release _____ onto ___ receptors
For the sympathetic NS, pre ganglionic fibers release ___ onto ___ receptors and then post ganglionic release _____ onto ___ receptors
For skeletal muscle, ___ is released and binds to ____
Ach, nAchR, Ach, mAChR
Ach, nAchR, Epi/NE, Alpha or Beta adrenergic
Ach, nAchR
56
********* Alpha 1 receptors cause ___ of all smooth muscle (so vasoconstriction for vascular smooth muscle and secretion for glandular smooth muscle)
Beta 2 receptors cause ____ of all smooth muscle (vasodilation)
Muscarinic receptors cause ____ of smooth muscle except in some special cases *********
Contraction
Relaxation
Contraction
57
Name if the response is parasympathetic or sympathetic
1) Salivation/lacrimation
2) Increase in HR
3) Urination/defecation
4) Decreased secretion and motility
5) Pupil dilation
6) Pupil constriction
7) Decreased in HR
8) Cutaneous vasodilation
9) increased secretion and motility
10) Reduction/elimination of the desire to urination
11) Smooth muscle contraction
12) Smooth muscle relaxation
13) Sweating
1) Para
2) Symp
3) Para
4) Symp
5) Symp
6) Para
7) Para
8) Symp
9) Para
10) Symp
11) Para
12) Symp
13) Symp
58
Constipation and dry mouth (from decreased secretion and motility) is due to either increasing ___pathetics or decreasing ___pathetics
Sympathetics, parasympathetics
59
Remember, mAchRs cause smooth muscle contraction, but M3 is able to contraction of the urinary bladder (the detrusor muscle) and RELAXATION of the trigone and sphincter (so that you can let the stuff out) is due to the fact that it activated ___ in the smooth muscle cells of the sphincter muscles
^** So realize M3 can cause relaxation in certain cell types
NO
60
Headache, Perspiration, and Palpitations is indicative of a ___ and there will be metanephrines present in the urine
^** AKA over activity of the sympathetic NS
Pheochromocytoma
61
Name the receptor
1) Vasoconstrictor on smooth muscle
2) Vasodilator for smooth muscle (like in lungs etc)
3) Increases heart rate via being on cardiac muscle
4) Decrease heart rate via being on cardiac muscle
5) Plays a role in voiding
6) Found in the Gi system and presynaptic in the sympathetic NS
7) Smooth muscle constrictor
1) Alpha 1
2) Beta 2
3) B1
4) M2
5) M3
6) Alpha 2
7) mAchR
62
So if you activate Alpha 2 receptors, since they are located presynaptically, it would cause a ____ in Epi and NE release and therefore a decrease in sympathetics since it has a negative feedback on the system
One can use Clonidine to treat pheochromocytomas
Decrease
63
KNOW ANTIHISTAMINE STUFF
It has anti-cholinergic effects (aka it blocks Ach at mAchRs) and those cause the parasympathetics to be blocked and this causes sympathetic tone to take over and increase
It also blocks a patients ability to sweat, because sweat glands have ____ receptors on them even though they are a sympathetic problem (realize even though mAchR are associated with parasympathetic responses, sweat glands are an exception)
Realize it increases sympathetics
MAchR
64
Diaphoresis is excess ___
Sweating
65
Remember, there are NO adrenergic receptors in skeletal muscle, only cholinergic receptors that are called ___ and bind to Ach
********So if you see muscle fasciculations and overactivity of parasympathetics, think excess of ____ such as an AChE inhibitor***********
^ Can be treated with a mAchR antagonist but DO NOT block nAchR in order to treat the muscle fasciculations because then you'll block everything
NAchRs
Ach
66
***********Fibers from the vestibular nuclei via the ___ go to the ___ and ___ nucleus to control the turning of the eyes *************
The ___ is needed to turn the head and goes only to the ___ spinal cord levels
The ____ turns the body and goes to all spinal levels
MLF, Oculomotor and abducens
Medial vestibulospinal tract (MVST), cervical, LVST
67
******The afferents from the vestibular ganglion travel to the cerebellum and do so through the juxtarestiform body (aka restiform body aka inferior cerebellar peducnel) and terminate in the cortex called the ___ lobe, and then get sent to the deep cerebellar nuclei called the ___ (which together are referred to as the vestibulocerebellum)
Info is sent back from the fastigial nucleus to the vestibular nuclei (and therefore also important for coordinating the oculomotor system of gaze) via the direct and indirect ___ tract AND the fastigial nucleus sends info to the ___ nucleus via the ___ tract
The ventral lateral nucleus sends info to the primary motor cortex which then effects the ___ tract and therefore effects axial musculature (just like the vestibulospinal tracts) *remember thats the descending tract from the corticospinal tract*
***********
Flocculo-nodular, Fastigial
Fastigiobulbar, ventral lateral nucleus, indirect fastigiobulbar
ACST (Anterior corticospinal tract)
68
************** When one moves someones head to one side and their eyes move to the other side, it is called the ___ maneuver (this is an oculocephalic reflex)
When you inject cold water into someones external auditory meatus and it results in horizontal gaze towards the side of the stimulus, it is called an ____ test for a __ response
Doll's eyes
Oculocaloric testing for a vestibuloocular response
69
********Patients with an ____ have an abnormal response to horizontal gaze in the direction ___ the lesion and is due to the MLF being lesioned *********
BUT YOU NAME IT FOR THE SIDE THAT HAS THE OCULOMOTOR IMPAIRMENT aka the eye that DOES NOT adduct is the lesioned named side
*********************
WILL BE TESTED ON***********
So if you have a lesion of the right MLF, your horizontal gaze to the left is fucked up in the right eye and the left eye will go into nystagmus
^*** In other words, name it for the eye that doesnt adduct
******** Similarly, a lesion to the PPRF (Paramedian Pontine RF) results in paralysis of horizontal gaze towards the ___ side of the lesion
So if you have a lesion of the right PPRF, you cant move either eye to the right
INO (Internuclear Ophthalmoplegia), opposite
Same
70
****Remember the cerebellum has the fastigial nucleus for one of its deep cerebellar nuclei, and 3 others with the most important being the ___ nucleus that sends cerebellar efferents out through the ____******
Dentate nucleus, Superior Cerebellar Peduncle
71
********** Remember, unconscious precise proprioception of lower extremity muscles comes from the ___ tract**********
DSCT (Dorsal spinocerebellar tract)
72
Olivocerebellar fibers (climbing fibers) are afferent fibers that come from the ___ nucleus and travel through the restiform body (ICP) where they terminate as ___ fibers in the contralateral cerebellar hemisphere (cerebellar cortex)
^* They have a VERY powerful influence in the cerebellar cortex
Fibers from the cerebellar cortex get relayed to the dorsal thalamus and red nucleus
From the red nucleus and thalamus, the ____ fasciculus sends motor info back to the ION and therefore this tract is CRITICAL in linking the extrapyramidal system and the cerebellum *****
^** So the motor system needs to be connected to the cerebellum because it readjusts motor activty to the appropriate level for the motor responses
There is also the corticopontine fibers that come from the motor cortex, to the pontine nuclei, and then to the cerebellum (in the middle cerebellar peduncle) and therefore form all of the ____ peduncle ****
^******* Direct relationship between the size of the motor cortex and the pons and cerebellar hemispheres and this is needed to allow for upright posture and fine movements
ION (Inferior Olivary Nucleus)
CTF (Central tegmental fasciculus)
Middle
73
So just to recap, which 2 important tracts course through the inferior cerebellar peduncle?
Which 2 important tracts course through the superior cerebellar peduncle?
DSCT and Olivocerebellar fibers (CTF)
VSCT and Trigeminocerebellar tract
74
Dysdiadochokinesia, and dysmetria are indicative of a ___ dysfunction
Cerebellum
75
All information entering the cerebellar cortex converges upon the ___ cells, which are the ONLY efferent cells from the cerebellar cortex and have ___ responses
Purkinje, inhibitory
76
The corticobulbar fibers are located at the ____ of the internal capsule and the Corticospinal tract is located at the _____ of the internal capsule
^**** KNOW THIS IT WILL BE TESTED ON
Genu, Posterior limb
77
*******************If a lesion to the upper portion of the pyramidal decussation occurs, paralysis of the ___ extremities and NO lower extremity involvement occurs, this is ____ paralysis and this can occur if the odontoid process gets protruded into the medial decussating arm fibers (since the medial arm of the LCST goes to the upper extremity vs the lateral arm of the LCST which goes to the lower extremity)
*************************************
^** So upper extremity motor fibers in the medulla decussate more superior and medial and lower extremity decussate more inferior and lateral ****
Upper, Bell's Cruciate paralysis
78
************A lower quadrant paralyzed face is called ____ ************* FUCKING KNOW THIS IT WILL BE ON THE TEST
The most common sites are if one takes out the facial region of the motor cortex or the ____ of the internal capsule ***************
Supranuclear facial palsy
Genu ******
79
For the extrapyramidal system involved in crude, stereotyped, associative movements of the axial and proximal limb musculature ******(like swinging arms when walking, facial grimaces while talking)*****, the cortex sends info to the ___, which sends info the the ___ and ___, which send info back to the cortex via the Ventral lateral and Ventral anterior nucleus of the thalamus
Sensorimotor goes into the ___ of the striatum and memory and motivation goes into the ___ of the striatum
Striatum (includes the caudate and putamen), globus pallidus and substantia nigra
Putamen, Caudate
80
*****___ fibers are dopaminergic fibers that originate in the ___ and terminate in the ____*****
These neurons are destroyed in ___ disease *********
____ fibers go from the striatum to the substantia nigra pars reticularis and are GABAnergic fibers involved in ___ disease
___ fibers are NON-dopaminergic that originate in the pars reticularis of the N and terminate in the VA and VL thalamic nuclei but fibrs from the GP and SN DO NOT terminate in the same areas of the VL and VA which is important for surgery in parkinsons disease *****************
Nigrostriatal, pars compacta of the substantia nigra (SNPC), striatum (caudate and putamen)
Parkinsons
Striatonigtral, huntingtons
Nigrothalamic
81
****Hemiballism (violent involuntary flinging movements of the limb) is due to a lesion of the ____******
Subthalamic Fasciculus
82
The ____ pathway leaves the visual cortex (occipital cortex) and goes to the pariental/frontal cortex in order to allow us to complete motor acts based on visual input
Dorsal
83
For reaching motions
****The information from the visual cortex gets moved to the ___ that allows us to create a rough map of the space around us**** And this info from VIP gets moved to ___ to create the DETAILED space around us ******
The ____ cortex is part of developing a map that says where YOU are in space and this input gets moved to ____ where it constructs the map of where you arm is in relation to your body and the things around you
VIP (Ventral intraparietal area), F4
superior parietal, F2
84
For grasping
The ___ and ___ part of the ____ parietal cortex receive the visual input and send the info to ___ in order to aid in grasping an object
^** Note the F5 motor neurons fire with the goal in mind, not the motor act
Anterior intraparietal area and PFG, inferior, F5
85
The ___ cortex receives the sensory info required to move (F4 and F5) and the dorsal premotor cortex applies that rules that determine if it is ok to move
^** AKA the part that makes the decision aka ***identifying a goal and a map to allow us to reach that goal***
The supplementary cortex has two divisions to it; the ___ for postural control and the ___ for planning the motor program required to make the action occur
^ ******AKA how are you going to make your motor actions work (planning) aka identifies the specific motor sequence required and any changes necessary
Premotor
SMA (Supplementary motor area), Pre-SMA
86
The ___ is the final integration center before the info is relayed down to the alpha motor neurons
The stimulation of a given column produces a specific motion and the ___th layer receives the sensory input and layer ___ becomes the output for the CST pathway
^** There are two types of columns, one for on/off of an agonist muscle and one for an antagonist muscle
** So in other words, the primary motor cortex codes individual motions required to reach the goal
Primary motor cortex
4th, 5
87
There are various parts of the cerebellum including the ____ with two regions for postural control (central) and force and direction (either side of vermis), the ____ for complex motions, and the ____ for balance eye movements **Realize this is planned motion not the reflex motion
Spinocerebellum, Cerebrocerebellum, Vestibulocerebellum
88
**********Postural control relayed to the central (vermis) spinocerebellum, gets processed and sent out right to the spinal cord via the ___ nucleus, ___ nucleus, and ___ tract
^** has vestibular, hearing, and auditory input
Force and direction and ballistic (fast/flinging) motions related to the outer portions of the spinocerebellum get processed and sent out via the ___ nucleus and ___ tract
^* Uses feedback control of motion via muscle afferent info
Complex motions like sequencing of rapid movement gets relayed to the cerebrocerebellum and then sent out to the ____ and then back to the ___
Balance via eye movement go to the vestibulocerebellum and is important for the future*********
Interpositus, Fastigial, Rubrospinal (FIR)
Interpositus, Rubrospinal (IR)
Dentate, Cortex
89
*****___ fibers are dopaminergic fibers that originate in the SNPC and terminate in the striatum*****
^The dopamine can bind to either D___ which is stimulator for motion (direct) or D___ which is inhibitory for motion (indirect)
The ___ system sends ___ between the nuclei of the striatum and are excitatory
____ fibers go from the striatum to the substantia nigra ___ (and ____'s internal segment branch) and are ___ fibers
^* This is a direct pathway
Nigrostriatal D1, D2
Intrastriatal cholinergic, Ach
Striatonigral, SNPR (pars reticularis), Globus pallidus (GPi), GABAnergic
90
The SNPR and GPi project to the ___ where they release ____ (which is inhibitory towards the thalamus)
Thalamus, GABA
91
The striatum gets its input from the cortex via the ___ tract which has ___ released
Corticostriate tract, EAA
92
*** So the direct pathway comes from the SNPC releasing DOPA binding to ___ receptors in the striatum, which then allow the striatonigral fibers to relay their info to the GPi and SNPR and therefore more GABA to SN and less to thalamus
The indirect pathway has DOPA from the SNPC binding to ___ receptors in the striatum and this causes the indirect pathway to be inhibited
D1
D2
93
So in other words, DOPA allows for motion to occur via binding to D1 (activating the direct pathway) and binding to D2 (inhibiting the indirect pathway)
BUT if we want to inhibit motion aka turn ON the indirect pathway, it is done so by turning on the EAAs and and Ach releasing pathways, which releases more GABA
****KNOW THIS
94
The ____ cortex is involved in planning of complex motor actions and carrying out the thought processes and it interacts with the PTO and motor cortex levels
**** To make motion occur the brain activates the ___ motorneurons and also the ____ motorneurons for spindles in the contracting (agonist) muscle (alpha-gamma coactivtion)
If the brain inhibits the alpha motor neurons, it ___ the gamma motorneurons for spindles in the stretching (antagonist) muscle
Association cortex
Alpha, Gamma
Inhibits
95
____ lobe syndrome causes patients to be apathetic
Frontal
96
When one performs the glasgow coma scale, level of consciousness or drugs they are determining if the ___ system can activate other functions
Brainstem ARAS
97
The brainstem ARAS can activate the ___ nuclei that has a role in energizing the cortex and therefore we see EEGs
It also sends fibers to the ___ cortex aka the frontal lobe, and if damaged this syndrome causes patients to be apathetic
The olfactory input goes to the ___ areas and is involved in drugs (like smelling salts), alcohol, etc.
Intralaminar reticular nuclei (IRN)
Prefrontal cortex
Septal
98
*********Chronic alcoholism can lead to bilateral destruction of the mammillary bodies called ___ syndrome ************** and this results in impairment of recent memory
^* Ten second tom from 50 first dates
Korsakoffs
99
*********** In the papez circuit, the cortex starts by sending info to the ____ cortex -> ___ -> through the ___ to the ___ -> ___ nucleus via the ___ tract -> ____ via the cingulum -> ___ via the cingulum and then it starts back at the entorhinal cortex
The Hippocampus can send info to the ___
The olfactory input can go to the hippocampus, amygdala, or septal area
***************
Entorhinal cortex, hippocampus, fornix, mammillary bodies, anterior nucleus, mammillothalamic tract, cingualte gyrus, parahippocampus
Septal area
100
**********************
The amygdala is connected to the ___ via ___ and the ___ via ___
The septal area, hypothalamus, and ___ make up the ____ bundle
************
Septal area via stria terminalis, Hypothalamus via Ventral Amygdalofugal fibers
Midbrain tegmentum (aka RF), Medial Forebrain bundle
101
******Once again, the ______ cortex is made up from the uncus and rostral parahuppocampus and is the main player in taking all the info from the cortex and olfactory system and turning it into memory, amygdala, etc.
^** Aka omnisensory information ***********
Entorhinal
102
*****Layers 3 and 4 of the cerebral cortex receive info and 99% of those are ___ fibers and only 1% are thalamocortical fibers*****
Corticocortical fibers
103
A lesion to the ___ results in conduction aphasia (difficulty speaking) and can't repeat words or sentences
The ___ fasciculus connects the association areas of the frontal lobe to the inferior temporal lobe and the inferior temporal lobe remember is associated with the ___ cortex
SLF (Superior Longitudinal Fasciculus)
Uncinate fasciculus, entorhinal
104
Remember, the ___ gyrus is the primary motor function and if lesioned a ___ spastic paralysis will occur
The ___ gyrus if where the sensory is so the somesthetic cortex function and results in ___ anesthesia or paraesthesia
Precentral, contralateral
Postcentral, contralateral
105
The ___ artery supplies Brocas and Wernicke's area, the ____ supplies the primary visual cortex and the ____ supplies the paracentral lobule
***********If the ___ is lesioned sensory or motor deficits in the contralateral upper limbs and head can occur***********************
If the ___ is lesioned contralateral homonymous hemianopia can occur
MCA, PCA, ACA
MCA
PCA
106