1. Neuroanatomy Flashcards

1
Q

How to distinguish ICA and ECA in the neck?

A

ECA has multiple branches in the neck

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2
Q

Major Branches of ECA

A
SALFOPSI
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Superficial temporal
Internal maxillary
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3
Q

Where do common carotid arteries arise?

A

Right: brachiocephalic trunk
Left: aortic arch

Bovine arch vs true cattle arch (which is very rare)
Matters when trying to catheterize left common carotid

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4
Q

What is the carotid siphon?

A

Intracavernous and supraclinoid segment of ICA

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5
Q

Findings in occlusion of anterior choroidal artery?

A

Hemiparesis, hemianesthesia, hemiopsia

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6
Q

Posterior cerebral artery divides into which two arteries?

A

Parietooccipital and Calcarine aa

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7
Q

What artery supplies the choroid plexus of temporal horn?

A

Posterior cerebral artery gives rise to posterior choroidal arteries, anastamose with anterior choroidal arteries

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8
Q

Virchow-Robin spaces

A

Spaces between blood vessels and arachnoid/pia within brain and spinal cord, perivascular spaces

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9
Q

Which large anastomotic vein joins the superior sagittal sinus?

A

Vein of Trolard

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10
Q

Which large anastomotic vein joins veins of sylvian fissure with transverse sinus

A

Vein of Labbe

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11
Q

What is the largest branch of the intracavernous portion of carotid artery?

A

Meningohypophyseal trunk

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12
Q

Three main superficial cerebral veins

A

Vein of Trolard
Vein of Labbe
Superficial middle cerebral vein

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13
Q

Clinical symptom of large unruptured cavernous sinus carotid aneurysm

A

Ipsilateral 6th nerve palsy (most proximal spatial relationship to carotid artery)

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14
Q

Wallenberg syndrome (lateral medullary syndrome) - artery

A

Occlusion of ipsilateral vertebral artery. Infarct supplied by PICA

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15
Q

What artery supply the thalamus?

A

Posterior communicating and perimesencephalic portion of posterior cerebral artery

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16
Q

What artery supply the lateral geniculate nucleus?

A

Anterior choroidal and lateral posterior choroidal (dual supply)

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17
Q

Artery involved in trigeminal neuralgia

A

SCA

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18
Q

Artery involved in hemifacial spasm

A

AICA

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19
Q

Artery involved in glossopharyngeal neuralgia

A

PICA

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20
Q

Artery supply of internal capsule

A

Lateral lenticulostriate branches from MCA
Medial striate from ACA (Huebner)
Direct branch from ICA

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21
Q

Which vessel has highest risk of injury in Chiari decompression surgery?

A

PICA

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22
Q

Vessels supply superior, middle, and inferior cerebellar peduncles?

A

SCA, AICA and PICA respectively

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23
Q

Where is motor strip in relation to the skull?

A

~5 cm behind coronal suture

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24
Q

What external landmark on skull marks the lateral margin of sphenoid ridge and sylvian fissure?

A

Pterion, confluence of frontal, parietal, squamous temporal, and greater wing of the sphenoid bones in the skull

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25
Q

What part of mandible does the temporalis muscle attaches to?

A

Coronoid process of mandible

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26
Q

Which muscle of mastication does the parotid duct cross

A

Masseter muscle

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27
Q

Which cranial fossa is the largest and deepest?

A

Posterior

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28
Q

Suboccipital triangle bounded by which 3 muscles?

A

Rectus capitis posterior major
Superior oblique
Inferior oblique

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29
Q

What sutures make up the asterion?

A

Lambdoid, parietomastoid, occipitaomastoid
It defines lower half of junction of transverse and sigmoid sinuses

Adult, 4cm posterior and 12mm superior to ear canal

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30
Q

Which bones make up the osseous nasal septum?

A

Ethmoid and vomer

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31
Q

Compartments of jugular foramen

A

Pars venosa (posterolateral): sigmoid sinus, jugular bulb, CN X, XI

Pars nervosa (anteromedial): CN IX and Jacobson’s nerve (tympanic branch of IX)

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32
Q

What structure does abducens nerve go through to enter the cavernous sinus?

A

Dorello’s canal

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33
Q

What structures go through internal acoustic meatus

A

CNVII (facial), CNVIII (vestibulocochlear) and labyrinthine artery (internal auditory)

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34
Q

Major parts of temporal bone

A

Squamous and petrous parts

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35
Q

cribriform plate is part of what bone?

A

Ethmoid bone

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36
Q

What goes through the jugular foramen?

A

Nerves: CNIX (glossopharyngeal), CNX (vagus), CN XI (accessory)
Artery: posterior meningeal artery
Vein: internal jugular vein
Sinus: inferior petrosal sinus

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37
Q

What are the bones that form the orbit?

A
Frontal
Sphenoid
Zygomatic
Ethmoid
Lacrimal
Maxilla
Palatine
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38
Q

What structures pass through the annulus of zinn?

A

Tendinous ring of 4 rectus muscle
CNII (Optic), CNIII (Oculomotor), CNVI (Abducens), nasociliary nerve (branch of opthalmic V1 nerve)

Opthalmic artery

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39
Q

What pass through pterygopalatine fossa?

A

Maxillary artery
Maxillary nerve
Pterygopalatine ganglion

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40
Q

What bones make up the clivus

A
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41
Q

What pass through the inferior orbital fissure?

A
Infraorbital nerve (maxillary) - innervate lower eyelid/upper lip
Zygomatic nerve (maxillary) - skin over zygomatic/temporal bone (sensory)
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42
Q

What bones are approximated at pterion?

A

Frontal, parietal, temporal, sphenoid

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43
Q

What structure separates optic canal from superior orbital fissure?

A

Optic strut

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44
Q

5 parts of lateral ventricle?

A
Frontal horn
Temporal horn
Occipital horn
Body
Atrium
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45
Q

Choroid plexus and flocculus protrude from which foramen?

A

Foramen of Luschka

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46
Q

Which cranial nerve nuclei positioned in lateral recess near foramen of luschka?

A

Dorsal/ventral cochlear nuclei of CNVIII

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47
Q

Where is BBB absent?

A
Pineal gland
Subforniceal organ
Organum vasculosum of lamina terminalis
Median eminence of hypothalamus
Neurohypophysis (posterior pituitary)
Area postrema
Subcommissural organ
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48
Q

What forms lateral walls of frontal horns of lateral ventricle? Medial wall? Roof?

A

Caudate nucleus, septum pellucidum, corpus callosum

Caudate injury causes abulia and psychic akinesia, neglect, frontal

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49
Q

Outlet of 4th ventricle

A

2 lateral foramina of luschka
1 medial foramen of magendie

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50
Q

What separates chiasmatic cistern from interpeduncular cistern?

A

Liliequist membrane

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51
Q

Where do sympathetic fibers of head originate from?

A

Hypothalamus, Through brainstem and cervical spinal cord to T1-L2

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52
Q

Where in brain are cholinergic neurons found?

A

Basal nucleus of Meynert

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53
Q

Norepinephrine-containing neurons

A

Locus cereuleus

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54
Q

Sympathetic innervation to head and neck?

A

Stellate ganglion

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55
Q

What ganglions form the stellate ganglion

A

Inferior cervical ganglion fuse with first thoracic ganglion to form cervical thoracic (stellate) ganglion

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56
Q

Type of nerve fiber of vidian nerve

A

Parasympathetic fibers from greater superficial petrosal nerve (lacrimal nasal palatine glands)
Sympathetic fibers from deep petrosal nerve around ICA (sympathetic innervation to lacrimal, and blood vessels)

Nerve passes in the pterygoid canal with vidian artery

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57
Q

Type of nerve fiber of intermediate nerve (nervus intermedius)

A

Sensory and parasympathetic division of facial nerve
Preganglionic parasympathetic fiber from superior salivary nucleus that synapse in pterygopalatine and submandibular ganglia
Taste from anterior 2/3 of tongue

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58
Q

What provides the parasympathetics of parotid glands?

A

Glossopharyngeal nerve - originate from inferior salivatory nucleus and travels through CN IX -> synapse at otic ganglion -> parotid gland

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59
Q

What are leptomeninges?

A

Arachnoid and pia mater

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60
Q

Embryologic origin of meninges

A

Pia: ectoderm
Arachnoid: ectoderm
Dura: mesoderm

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61
Q

How much CSF is produced each day

A

450mL

~150mL in average body at a time.

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62
Q

Brodmann’s area for Broca

A

Area 44

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63
Q

Brodman’s area for Wernicke

A

Area 22

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64
Q

Brodman’s area for primary auditory cortex

A

Area 41

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65
Q

Which area of hippocampus is most vulnerable to hypoxia?

A

CA1 (Sommer’s ector)

CA3 is resistant

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66
Q

What is the indusium griseum?

A

Remnant of hippocampus that courses over the dorsal surface of corpus callosum (supracallosal gyrus) - medial and lateral longitudinal striae

67
Q

What makes up the neostriatum?

A

Caudate and putamen

68
Q

What white matter projects from Wernicke to Broca?

A

Arcuate fasciculus

69
Q

Gustatory area receives input from which nucleus?

A

Ipsilateral nucleus solitarius

70
Q

What is ischemic penumbra?

A

Decreased blood flow where neurons survive but not function. Gray matter require more blood supply than white matter

71
Q

Lesion to right Meyer’s loop

A

Left upper quadrantanopia

72
Q

Lesion of posterior part of middle frontal gyrus

A

Cortical lateral conjugate gaze center - causes conjugate eye deviation toward ipsilateral side

73
Q

Hypothalamus receives fibers from amygdala through which bundle?

A

Stria terminalis

74
Q

Classic syndrome from dominant parietal lobe lesion

A

Gertsmann - agraphia without alexia, L/R confusion, finger agnosia, acalculia

75
Q

Where is lesion for patient with hemineglect

A

Posterior parietal association cortex

76
Q

Where in internal capsule do corticobulbar fibers run

A

Genu

77
Q

Where in internal capsule are corticospinal tract located

A

Posterior limb

78
Q

Main neurotransmitter of corticothalamic tract

A

Glutamate

79
Q

Satiety center

A
Medial hypothalamus (stimulation causes decreased food intake)
Hunger in lateral
80
Q

Where is ADH made?

A

Supraoptic and paraventricular nuclei of hypothalamus

81
Q

Which part of hypothalamus lowers body temperature

A

Anterior (stimulation causes dilation of blood vessels/sweating)

82
Q

Where does corticospinal tract originates?

A

Layer 5 of cerebral cortex -> corona radiata -> posterior limb of internal capsule -> cerebral peduncles and pyramids of medulla -> lamina 7 in spinal cord

83
Q

What makes up inferior parietal lobule

A

Angular and supramarginal gyri

Parietal lobe is divided into superior and inferior lobules by the interparietal sulcus.

84
Q

Prosopagnosia - which part is damaged?

A

Temporal association cortex - impairment in visual processing - recognize voice (auditory) but not recognize familiar faces

85
Q

Papez circuit of the brain

A

hippocampus -> fornix -> mamillary bodies -> mammillothalamic tract -> anterior thalamic nucleus -> cingulate gyrus -> parahippocampal gyrus -> entorhinal gyrus -> hippocampus

86
Q

Afferent fibers of pupillary light reflex cross the contralateral edinger-westfall nucleus through which structure?

A

Posterior commissure

87
Q

Sensation from face - which thalamic nucleus

A

VPM (VPL for body)

88
Q

Which layer of cerebral cortex receives thalamocortical afferents?

A

Layer IV (internal granular)

89
Q

Which layer of cerebral cortex has the main efferent neurons

A

V (internal pyramidal layer) - send axons through white matter to internal capsule

90
Q

Layers of cerebral neocortex

A

I (molecular): most superficial, synaptic area
II (external granular): densely packed neurons
III (external pyramidal)
IV (internal granular): primary receiving station of cerebral cortex
V (internal pyramidal): send axon to internal capsule
VI (fusiform): primary origin of corticothalamic fibers

91
Q

Primary reason for macular sparing in occipital cortex lesion

A

Macula has dual supply from MCA and PCA to occipital poles

92
Q

Occipital (striate) cortex has dominance columns, except which 2 areas?

A
  1. where blind spot is located

2. monocular temporal crescent of both eyes

93
Q

of cortical layers of cerebellum

A

3

  1. molecular
  2. purkinje
  3. granular
94
Q

Only output cells of cerebellar cortex

A

Purkinje cells (inhibitory)

95
Q

Cerebellar glomeruli consist of?

A

Mossy fibers stimulate granule cells

Golgi type 2 cells inhibit them

96
Q

Where do climbing fibers originate from

A

Contralateral inferior olive - cross to inferior cerebellar peduncle and ascend olecular layer -> stimulate dendrites of purkinje cells

97
Q

Which cerebellar peduncle contains only afferent fibers

A

Middle

98
Q

Another name for superior, middle and inferior peduncles

A

Brachium conjunctiva, brachium pontis, restiform body

99
Q

Only afferent tract that runs through superior cerebellar peduncle

A

Ventral spinocerebellar tract (proprioceptive info to cerebellum from lower extremities/trunk)

100
Q

2nd order neuron of olfactory

A

Mitral cells -> lateral olfactory area -> lateral/intermediate/medial olfactory areas

101
Q

Pineal region tumor - syndrome

A

Parinaud syndrome: upper gaze palsy, dissociated light near response, retraction nystagmus, absence of convergence

102
Q

Weber syndrome

A

CN3 palsy and contralateral hemiparesis. Infarct of medial midbrain.

103
Q

Millard-Gubler syndrome lesion

A

At base of pons - 6/7 nerve palsy and contralateral hemiplegia

104
Q

Function of red nucleus

A

Maintains flexor muscle tone

105
Q

What are at level of midbrain

A
Red nucleus
pyramidal tract (corticonuclear/spinal fibers), oculomotor nerve
106
Q

Input of red nucleus

A

Deep cerebellar nuclei and cerebral cortex

107
Q

What are internal arcuate fibers

A
Crossing fibers of dorsal column fibers
Dorsal column (gracile fasciculus/cuneate) -> medulla synapse at nuclei -> migrate ventrally around central gray matter of medulla and cross midline -> ascend as medial lemniscus to reach VPL of thalamus.
108
Q

Where is vertical gaze center

A

Rostral interstitial nucleus on medial longitudinal fasciculus

109
Q

Crossed nasal retinal visual fibers go to which layers of LGN

A

Layer 1,4,6

Ipsilateral to 2,3,5

110
Q

Which trigeminal nucleus receives pain/temp of face

A

Spinal trigeminal nucleus. Extends from ponds to C2 and merges caudally with substantia gelatinosa.

111
Q

Which trigeminal nucleus receives prorioception from face

A

Mesencephalic nucleus

112
Q

Lateral lemniscus carry?

A

2nd order neuron of auditory pathway -> ascends to inferior colliculus

113
Q

Sensation from external auditory canal carried by vagus nerve arrives at which nucleus

A

Travel through Arnold’s nerve to superior (jugular) ganglion of CN10 -> spinal trigeminal tract -> spinal trigeminal nucleus

114
Q

General visceral sensation of vagus nerve arrives at which nucleus

A

Travel to inferior ganglion of 10 -> solitary tract to solitary nucleus in medulla.

115
Q

Which CN most susceptible during carotid endarterectomy

A

CN11 (hypoglossal)

116
Q

Hypoglossal nerve palsy in skull base tumor

A

Tumor infiltration into anterior portion of ipsilateral occipital condyle

117
Q

Optic chiasm nml anatomic location?

A

Above diaphragma sellae

May be prefixed and lie over tuberculum sellae or post fixed over dorsum sellae

118
Q

Which CN carry general visceral efferent?

A

3, 7, 9, 10

119
Q

Where does trochlear nerve decussate

A

Within superior medullary velum

120
Q

What triggers a glossopharyngeal neuralgia attack?

A

Swallowing, talking, chewing

121
Q

Hering’s nerve

A

Branch of CN9 (sensory limb of carotid body)

Detects changes in blood O2 and CO2 concentration

122
Q

Digastric muscle innervation

A

Anterior - CN5

Posterior - CN7

123
Q

Which CNs pass through foramen magnum

A

Accessory

124
Q

Unilateral vagal injury - symptoms

A

Hoarseness, dyspnea, dysphagia, ipsilateral decreased cough reflex, uvular deviation

125
Q

Hypoglossal nerve innervates?

A

All intrinsic/extrinsic muscles of tongue except palatoglossus (CN10)

126
Q

CN most often involved with tumors of upper cervical canal

A

Spinal accessory (torticollis/weakness of trapezius and SCM muscles)

127
Q

Largest avascular organ in body

A

Intervertebral disk

128
Q

Most common dermatome syndrome with craniocervical dx

A

C2

129
Q

Where does pyramidal decussation begin and complete decussation?

A

Just below obex -> below exit of first cervical nerve root

130
Q

Foramen magnum tumor with hand weakness - which spinal tract?

A

Cortical spinal tract

131
Q

Enalrged intervertebral foramen on radiography

A

Nerve root tumor

132
Q

What ligament important to divide for proper visualization of ventral spinal tumor after dural opening in posterior appraoch

A

Dentate ligament

133
Q

Perioral tingling/numbness in syringobulbia is compression of which tract

A

Spinal trigeminal tract

134
Q

Which ligament is primary restraint against atlantoaxial anteroposterior translation

A

Transverse ligament

135
Q

What supplies sympathetic innervation to arm

A

T2 and T3 ganglia

136
Q

Dorsal ramus of the C1 nerve root

A

Suboccipital nerve

137
Q

What innervates cervical disk

A

Plexus formed by sinuvertebral nerve dorsally and plexus by cervical symp trunk ventrally

138
Q

Level of aortic bifurcation

A

midbody of L3

139
Q

What level spinal cord ends in adults

A

L1-L2

140
Q

Loss of sensation over webspace of 1-2 toes

A

Injury to deep fibular nerve

141
Q

Nerve root - loss of achilles reflex

A

S1

142
Q

Nerve roots with biceps reflex

A

C5-C6

143
Q

L5 nerve root - which reflex

A

None

144
Q

Pain and temp first order neurons synapse?

A

-> DRG -> dorsolateral tract and synapse at substantia gelatinosa

145
Q

XR of acute transverse myelitis

A

Usually normal; may have increased T2 weighted MR

146
Q

Pott dx

A

Tuberculous vertebral osteomyelitis - affects body rather than disks

147
Q

XR of infx vs tumor in spine

A

Destruction of disk space (infxn)

Destruction of body and not cross disk space (tumor)

148
Q

2 most common herniated disks

A

L4-L5

L5-S1

149
Q

Immunologically priviledged site of intervertebral disk

A

Nucleus pulposus - isolated from vascular/immune

150
Q

Spurling/s sign

A

radicular pain when exert downward pressure on vertex while tilting head to symptomatic side - narrowing of intervertebral foramen

151
Q

How do sympathetic fibers exit spinal cord

A

Ventral roots by white rami communicantes

152
Q

Sensory loss in axillary nerve injury

A

Lateral aspect of shoulder

153
Q

Posterior interosseous neuropathy - symptoms

A

Finger extension weakness including thumb with no wrist drop/sensory loss.
May be entrapped at arcade of Frohse (into supinator muscle)

154
Q

Meralgia paresthetica

A

Bernhardt-Roth syndrome
Entrapment of lateral femoral cutaneous nerve of thigh - purely sensory nerve and compression causing burning dysesthesia in lateral upper thigh

155
Q

Which muscle of thumb has dual innervation

A

Flexor pollicis brevis

- median and ulner nerves

156
Q

Site of entrapment of suprascapular nerve

A

Suprascapular notch beneath transverse scapular ligament

157
Q

True neurogenic thoracic outlet syndrome - which nerve roots

A

C8 and T1

Commonly due to cervical rib or elongated C7 transverse process

158
Q

Symptoms of anterior interosseous syndrome

A

Weakness of flexion of distal phalanges of thumb, index, middle fingers - “pinch sign”
No sensory loss (pure motor branch of median nerve)

159
Q

Wrist drop - what must be ruled out

A

Lead poisoning

160
Q

Nociceptive vs neuropathic pain

A

Nociceptors: well localized pain, constant, aching or throbbing; time-limited usually, respond well to opioids

Neuropathic - longstanding, triggered by injury, infiltrative/tumor compression/scar strangulation/inflammation by infxn - burning, lancinating, electric shock qualities

161
Q

Why is extensor carpi radialis muscle unique?

A

Innervated solely by C6 nerve root

162
Q

Ligament of Struthers?

A

Present in small % of people
Crossing cubital fossa above medial intermuscular septum - can compress median nerve and mimic carpal tunnel.

Thenar numbness more pronounced

163
Q

Arcade of Struthers

A

At elbow near medial head of triceps - may compress ulnar nerve