1st PPT Flashcards
myelinated nerve cells?
white matter
unmyelinated nerve cells?
grey matter
nerve impulses carried by what?
white matter
route sensory or motor stimulus to interneurons of CNS
grey matter
UMN are formed from fibers from where?
corticospinal tracts
UMN synapses with LMN where?
anterior horn of the spinal cord
the motor root leaves the cord _____ to join the sensory root and becomes the spinal nerve
anteriorly
wernicke’s aphasia: INPUT
speech is preserved but language is lost (i called mt mom on the television)
Broca’s aphasia: OUTPUT
comprehension is normal but have trouble saying things out
thalamus:
processing center of the brain, send info where it needs to go (except smell)
hypothalamus:
anterior:
posterior:
body temp endocrine function physical expression of behavior feeding/thrist pleasure
parasympathetic (maintenance
sympathetic (F or F)
medulla:
what cranial nerves:
VIII-XII
respiration
BP/HR
reflex arcs
vomiting
PONS:
what cranial nerves:
V-VII
relays sensory info between cerebellum and cerebrum, contains pneumotaxic centers that help regulate respiration
Cerebellum:
archicerebellum:
paleocerebellum:
neocerebellum:
maintains equilibrium
maintains muscle tone
control coordination
anosmia:
hypersomia:
parosmia:
cacosmia:
colds, rhinits, tumors
hysterics, cocaine
olfactroy hallucinations, seizures, schizophrenia, unicate gyrus lesions
unpleasant odors, decomposition of tissue
injury to CN III causes what?
dilated pupil and ptosis
“fixed and dilated”
CN 3:
superior division supplies what?
inferior division supplies what?
levator palpebrae superiors and superior rectus
medial rectus, inferior rectus,
inferior oblique
CN IV innervates:
superior oblique
CN V:
V1:
V2:
V3:
opthalmic
maxillary
mandible
CN VI:
what muscle?
lateral rectus (abducts)
CN VII:
peripheral:
central:
Bells:
if whole side is paralyzed
if forhead is spared (CVA)
always unilateral (if they can flex forehead its a stroke)
weber: if heard louder in one side then what?
conductive hearing loss in that ear
rhinne: AC>BC normally if not true then what?
conductive hearing loss on that side
CN XII:
tongue deviation
tongue atrophy
tongue fasiculations
peripheral lesions and central lesions where will tongue deviate?
peripheral: towards
central: opposite
persistent disorder of posture and movement, caused by nonprogressive defects or lesions of the immature brain
cerebral palsy
prenata RF of CP:
maternal infx, illness, ETOH/chemical dependence, prenatal anoxia, multiple births, polyhydramnios, bleeding in thrd trimester
perinatal RF of CP:
chorioamnionitis low birth weight hypoxic ischemia encephalaopathy grade IV intraventricular hemorrhage hyperbiliribinemia
postnatal RF of CP:
traumatic brain injury
meningitis/encephalitis, stroke, asphyxia
hemiplegic CP:
MC congenital
hemiplegic CP:
mc the vascular territory of the what?
MC congenital
middle cerebral artery (L>R)
diplegic CP:
premature infant:
term infant:
periventricualr leukomalacia
Grade IV IVH
multifactorial
quadriplegic CP:
multifactorial
structural brain abnormalities
cerebral hypoperfusion and watershed infarcts
dyskinetic CP:
hypoxic brain injury
kernicterus
main PE of CP present with all:
persistence of primitive reflexes
poor trunk/head control with impaired fine motor control
hemiplegic CP PE:
unilateral spasticity arm>leg
relative weakness on one side
eye problems (strab, homo hemianopia )
diplegic CP PE:
spasticity legs>arms
scissoring gait (toe walker, flexed hips)
quadriplegic CP PE:
sig flucation of tone
stimulant induced spasms and strong extensor drive
weak trunk/poor head control
speech/swallowing difficulties
involves a 4 extremities
dyskinetic CP PE:
poor trunk/head control
freq hypotonic
oromotor dysfunction
arms>legs
tests for CP:
cranial US/head CT in early neonatal period
MRI for older infant/child
tx of CP non drugs:
PT, OT, Speech therapy, Special education
tx of CP non drugs:
PT, OT, Speech therapy, Special education, orthopedic intervention
tx of CP drugs:
balcofen
diazepam
botulinum toxin A/B
for CP: dorsal root rhizotomy: consider in who?
diplegic
selectively serves problematic nerve roots in the spinal cord?
rhizotomy
for CP the rhizotomy targets the nerves that dont receive what?
GABA
carpal tunnel:
RF:
tx:
compression of MEDIAN nerve
repititive motion, pregnancy, wrist fx
splinting, NSAIDS, cortisone, surgery
special tests for carpal tunnel:
tinel’s sign
phalen’s test
cubital tunnel syndrome:
clinical:
tx:
compression of ulnar nerve at elbow
weakness/numbness over ulnar nerve, intrinisic handwashing
ulnar nerve transposition
saturday night palsy:
clinical:
radial nerve injury usually due to trauma (falling asleep or hit with stick)
wrist drop
peroneal nerve palsy:
clinical:
trauma to knee, fibular fx, high boots
paresthesia, foot drop, extremeity weakness
tarsal tunnel syndrome:
clinical:
tx:
compression of post tibialis nerve at elbow
pain/burning over sole of foot worse with movement
wide shoes, arch supports, nsaids, cortisone, surgery
meralgia paresthetica:
rf:
clinical:
tx:
lateral femoral cutaneous nerve
obesity, tight clothing, wallets, cheerleaaders, cross county
dysesthesia of lateral hip
avoid trigger, nsaids, injection
inflammatory process of meninges and CSF withing subarachnoid space?
rf:
meningitis
immunocompromised, ETOH, post surgery
meningitis:
<3 months pathogen and tx:
3months to 18 years pathogen and tx:
18-50 year old pathogen and tx:
> 50 years old pathogen and tx:
GBS, ampicillin + vancomycin
n meningitidis ceftriaxone + vancomycin
S penumo Ceftriaxone + vancomycin
L monoytogens ampicillin and ceftriaxone
(CV over 3 months and AC over 50)
bacterial meningitis:
meningeal symptoms:
HA, nuchal ridigity, seizures, PRURITIC RASH FROM DIC
these signs would be positive in meningitis:
Kernigs and Brudzinski (neck flexion and involuntary flexing of hip/knee)
dx of bacterial meningitis:
what is shown on CSF:
high PMN, decreased glucose <45
increased protein, increased CSF pressure
must do head CT first in High RIsk pts
viral meningitis:
peaks when?
summer
enteroviruses, arthropod borne viruses, mumps in winter/spring
viral meningitis dx:
CSF:
high PMN, NORMAL GLUCOSE, mildly increased protein, increased CSF pressure, neg gram stain, lymphocytic pleocytosis
fungal meningitis:
neoformans:
c immitis:
h capsulatum:
pigeon droppings
yeasts (fatal)
yeasts
just know it can also be from candida and s schenckii (soil)
what will not be on labs for fungal meningitis?
NEUTROPHILS!!!
will have low glucose, india ink, cryptococcal antigen
what steroid can we give in meningitis?
dexamethasone
what bacteria is most fatal in meningitis?
s pneumo
viral infection of the brain parenchymas?
encephalitis (meningioencephalitis if meningies also affected) (will see focal deficit like weakness, double vision, aphasia we wont see this shit in meningitis)
mc virus in encephalitis?
HSV-1
clinical of encephalitis:
fever, HA, profound AMS (confusion, behavioral, lethargy, coma), aphaisa, ataxia, UMN, LMN, CN deficits, seizures!!!
CSF in encephalitis:
same as viral meningitis, lymphocytosis C is normal, lymphocytic plepcytosis (10-300)
what will happen to the parenchymal in MRI of encephalitis?
light the fuck up (frontal/temporal involvement is HSV-1)
management of encephalitis:
symptomatic tx is mainstay
acyclovir/valacyclovir if HSV
full recovery seen in most pts
