Anatomy Flashcards
At what days does the neural tube close?
Day 24-25
Describe how the adult brain forms from 3 primary vesicles and then five secondary vesicles
1º Brain Vesicles (x3) Prosencephalon, Mesencephalon, Rhombencephalon
2º Brain Vesicles (x5) Telencephalon (hemispheres), Diencephalon (thalamus, Central), Mesencephalon (midbrain), Metencephalon (pons), Myelencephalon (medulla)
What makes up the CNS?
Brain, spinal cord, retina & CNII
What are the 3 branches of the motor efferent pathway?
Somatic motor
Brachio motor - pharyngeal arch muscles, cranial nerves
Visceral/autonomic motor
What are 3 branches of the sensory afferent pathway?
Somatic sensory
Visceral sensory
Special visceral sensory - taste
What are the 3 meningeal layers in the CNS?
Dura: Periosteal layer - Thick, fibrous and leathery
Dura: Meningeal layer
Arachnoid mater - Thin and web/lace-like
Pia mater - Thin & adherent to cortex
Where do you find CSF in the CNS?
Sub arachnoid space
What is the falx cerebri?
Double-layered inward projecting fold of dura in sagittal plane
Prevents left and right cerebral hemispheres from spinning during axial head rotation
What is the Tentorium cerebelli?
Double-layered inward projecting fold of dura
Prevents occipital lobe compressing the cerebellum especially during flexion & extension
What is the Falx cerebelli?
Double-layered inward projecting fold of dura
Prevents left and right cerebellar hemispheres from rotating
What is the Diaphragm Sellae?
Double layered fold of dura
Forms protective pocket for pituitary
Where does blood from the CNS drain?
Dural venous sinuses located between two layers of dura
Sinuses are valveless & endothelial lined
Name the venous sinuses
Superior sagittal sinus Inferior sagittal sinus Straight sinus Transverse sinus Sigmoid sinus Right cavernous sinus
What can blockage of venous sinus drainage cause?
Cerebral infarction
Which arteries anastamose to form the circle of Willis?
Internal carotid
Vertebral artery
What separates the cerebral hemispheres?
Longitudinal fissure
What separates the frontal and temporal lobes?
Lateral/Sylvian fissure
What structure connects the cerebral hemispheres?
Corpus callosum
Name the cranial nerves
1 olfactory 2 optic 3 occulomotor 4 trochlear 5 trigeminal 6 abducens 7 facial 8 vestibulocochlear 9 glossopharyngeal 10 vagus 11 accessory 12 hypoglossal
Describe where the cranial nerves emerge
CN III & IV: Midbrain CN V: Pons CN VI –VIII: Pontomedullary junction CN IX & X: Lateral medulla CN XI: C1-C5 spinal cord CN XII: Ventral medulla
Where and what are the Cerebral peduncles?
Anterior Midbrain
Axons to and from cerebral hemispheres
Which is the only cranial nerve visible posteriorly?
CN IV - trochlear
What and where are the superior and inferior colliculi?
Posterior midbrain
Superior - linked to visual
Inferior - linked to auditory
Where do Cranial nerves exit the cranium?
Foramen magnum in the skull base
What will result from dysfunction of the cerebellum?
ataxia, wide-based gate, slurred speech, imbalance, nystagmus
What are the main functions of the cerebellum?
Coordination of motor activity
Involved in stabilisation of body (trunk & limbs), memory, cognitive functioning, language processing, logical reasoning
Automates many processes e.g. motor skills, language
Predicts sensory consequence of movements by comparison to previous experience
Frees cerebral cortex for higher level functions
What are the 3 main lobes of the cerebellum?
Anterior
Posterior
Flocculonodular
What are the ventricles?
Cerebrospinal fluid filled chambers within the subcortical regions of the
brain. Associated with many nuclei. And functional regions of the brain.
Produce CSF via choroid plexus
What are nuclei?
Collections of neuronal cell bodies with similar functions and projections. Normally found in subcortical areas at points of synapse
What are Brodmann areas?
Cerebral cortex is arranged into regions with specified functions Brodmann classification is based on cyto-architectural/histological structure of the cortex
Where is the primary auditory cortex?
Temporal lobe
Brodmann area 41
Where is the primary visual cortex?
Occipital lobe
Brodmann area 17
Where is the primary somatosensory cortex?
Parietal cortex, post central gyrus
Brodmann area 1
Where is the primary motor cortex?
Frontal lobe, pre Central gyrus
Brodmann area 4
Which side of the cortex looks after speech, writing and language?
Left
Which side of the cortex looks after special perception and facial recognition?
Right
What is synaesthesia?
combination of senses that provides an unusual interpretation
Eg See colour, shapes, textures when hearing sound or words, Experience taste when reading numbers
What is Prosopagnosia?
inability to recognise faces
What are commisural fibres?
White matter structures that connect hemispheres
What are association fibres?
Connect regions within the same hemisphere
What are projection fibres?
Connect each region to other parts of the brain or the spinal cord
What is Brocas area?
Motor planning involved in speech in frontal lobe
What is a Fasciculus?
Bundle of fibres sharing a similar function and route of travel
What is Wernickes area?
Understanding/interpreting heard, spoken and written word
In termporal lobe
What connects Wernickes area and Broca’s area?
Arcuate Fasciculus
What is a Jeffersons fracture?
Fracture of anterior and posterior arches of C1 vertebra
What are advantages and disadvantages of xrays?
Fast, Cheap, Good bone detail, Dynamic images
2-D, Poor soft tissue detail, X-ray dose
What are advantages and disadvantages of ultrasound?
Fast, Cheap, Dynamic images, No radiation
2-D, Poor soft tissue detail, Operator dependent
What role does CT imaging play?
A + E, Trauma - haematomas + fractures, Stroke - haemorrhage, Severe headache - SAH, meningitis, Unconscious patient, Hydrocephalus, CT guided biopsies
Describe CT - intravenous contrast
Iodine based injection to highlight pathology and increase contrast
Hot flush and odd taste
Appears white on CT
Vessels, pituitary + choroid plexus normally enhance
Other enhancement indicates leaky BBB
1/40,000 anaphylaxis: give asthmatics steroid cover
What pathologies can be seen more easily with CT contrast?
Cerebral abscesses
Tumour - glioma
What are advantages and disadvantages of CT?
Excellent bone detail, Good for blood + Ca, Good soft tissue detail, Quiet and spacious, CT guided biopsy, 3-D,
Expensive, Very high X-ray dose
In MRI T1 and T2 assessments, what colour is the CSF?
T1 - black
T2 - White
What is gadolinium?
Contrast medium used in MRI
What are advantages and disadvantages of MRI?
No X-rays, Exquisite anatomy, Excellent soft tissue detail, Multiplanar acquisition
Slow, Expensive, Claustrophobic + noisy, Poor bone detail, Contraindications: Metal implants and foreign bodies, pacemakers
Before being scanned in MRI, patients need to complete a screening questionnaire. Objects to be particularly wary of are…?
Cardiac pacemakers:- some are electrically or magnetically activated (possible death), pacing wires can cause burns
Aneurysm clips:- if ferromagnetic can move causing re-bleed and death
Electronic implants:- magnetic can reset or destroy
Metal in eye:- can move severing optic nerve
What is the role of digital subtraction angiography?
Gold standard for intracranial haemorrhage, aneurysm, arterio-venous malformation / fistula, Assessment of carotid stenosis, Embolisation
What can be a risk of a pituitary tumour?
Compression of optic nerve
Which artery do you find in the Sylvian fissure?
Middle cerebral artery
What is diffusion weighted MRI imaging useful for?
Infarct, Abscess, Cyst, Tumour, Prion disease
Describe a subdural haematoma
Contracoup - occurs on opposite side to area of injury Crescentric and thin Can cross sutures except sagittal Do not cross tentorium Flattens the sulci Mass effect
Describe and extradural haematoma
Coup - at site of injury Concentric Do not cross sutures Can cross tentorium Often underlying fracture Often contralateral subdural Poor prognosis: > 2cm, central lucency, > 1.5cm midline shift
Describe a haemorrhagic contusion
Mild: limited to grey matter
Moderate: involves white matter
Severe: haemorrhages coalesce
Haemorrhage may be delayed
Where can herniation occur?
Uncal/transtentorial
Tonsillar
Subfalcine
What is functional MRI?
Uses different paramagnetic properties of oxygenated and deoxygenated Hb Is a measure of cortical brain activity Can be combined with an EEG Pre surgical planning Research tool
What can a DAT scan be used for?
Parkinson’s disease diagnosis
SPECT images of brain, particularly the striatum
What is MR spectroscopy used for?
Provides information on biochemical and metabolic composition of tissues
Good for tumour - Glioma vs other mass lesion, Tuberculoma, Leukodystrophies
What is the lateral geniculate body of the thalamus?
Relay for optic tract fibers
What is the medial geniculate body of the thalamus?
Relay for auditory pathway fibres
What is the ventral posterior nucleus of the thalamus?
Ventral Posterior Lateral nucleus - Body
Ventral Posterior Medial nucleus - Face – CN V
Sensory relay nucleus of multiple modalities from body & face (touch, pain, temperature, taste). Input from spinothalamic tract, medial lemniscus & trigeminothalamic tracts
What symptoms can damage to the thalamus cause?
Contralateral motor & sensory functions
Contralateral part of visual field of each eye
Effects on memory, emotion & mood
Certain lesions can cause pain (thalamic syndrome)
Which cranial nerve emerges from the dorsal midbrain and decussates?
Trochlear - IV
Which cranial nerves could be compressed by a 4th ventricle tumour?
CN VI nucleus and VII wound around
Where does most nociception from CN VII, IX, X pass?
Via CN V sensory nucleus
Describe cortical connections to brainstem motor nuclei and the exceptions to the normal pattern
Bilateral supply from the motor cortex
Innervation from corticobulbar/corticonuclear neurons
The majority of UMN innervation comes from contralateral cortex
Cerebral cortex infarction causes an initial contralateral weakness/paralysis that can recover with time due to ipsilateral supply
Exception - Unilateral supply to CN VII nucleus for lower face
And CN III, IV & VI – have a different innervation pattern
Describe the process of forehead sparing in some facial nerve lesions
CN VII Nucleus receives bilateral & unilateral innervation from the cortex
Forehead part of the nucleus receives bilateral UMN innervation
Lower face part receives only contralateral UMN innervation
UMN lesion results in paralysis of the contralateral lower face with forehead sparing due to ipsilateral supply
What is a bulbar palsy?
Lower motor neurone lesion affecting CN VII - XII
Paralysis of pharynx, soft palate, larynx, tongue (sometimes face & mastication)
Dysarthria, dysphonia, drooling, poor swallowing, aspiration
Flaccid paralysis, wasting, fasciculations
Causes = Polio, radiotherapy, CVE
What is pseudo bulbar palsy?
Bilateral corticobulbar tract disorder (upper motor neurone lesion)
Presents initially as LMN lesion
Bilateral damage is clinically significant
Similar symptoms to bulbar palsy but can develop spastic paralysis of
pharynx & larynx = airway occlusion emergency
Causes = Head injury, CVE, high brainstem tumour
Describe the vertebrobasilar arterial system
Vertebral arteries combine to form basilar artery along with anterior spinal artery
Basilar gives off pontine branches and superior cerebellar
Then posterior cerebral artery and posterior communicating
Aneurysm of which artery could compress cranial nerves 3 and 4?
Superior cerebellar artery
Which cranial nerves are supplied by the PICA?
Lateral aspects of the medulla
CN V, VIII
Which parts of the brainstem are supplied by the anterior spinal artery?
Anterior midline medulla
Corticospinal tracts
What are branchio motor structures?
Derived from pharyngeal arches
Muscles of facial expression, mastication, stylopharyngeus (IX), nucleus ambiguus (X - muscles of pharynx, palate, larynx),
CN V, VII, IX, X
What does CN III motor nucleus damage cause?
Leads to eye positioned down & out at rest and a full ptosis
What is the Edinger Westphal nucleus? And what symptoms would result from damage?
Parasympathetic nucleus involved in pupillary light reflex
Damage leads to ipsilateral loss of accommodation & pupil light reflex
What is the red nucleus?
Linked to cerebellum & rubrospinal tract
Controls flexor muscle tone; If damaged possible tremor/ataxia of contralateral body
What is the medial lemniscus?
Tract carrying contralateral dorsal column fibres
Which cranial nerves emerge from the midbrain?
CN III, IV
What does damage to CN IV nucleus lead to?
Contralateral loss of superior oblique function
Diplopia when reading & descending stairs; head tilted toward side of damaged nucleus
At what level do the dorsal columns decussate?
Medial lemniscus in the medulla. Cross to anterior part of brainstem
What are the 3 parts of the trigeminal nucleus?
Midbrain - proprioception - mesencephalic nucleus
Pons - touch - chief nucleus
Medulla - pain and temp - spinal nucleus
Describe the path from the trigeminal nucleus to the sensory cortex
Trigeminothalamic tract decussates
Travels as trigeminal lemniscus
Travels via ventral posteriomedial nucleus of the thalamus to the sensory cortex
Which brainstem nuclei are involved in sleep and wakefulness?
Reticular formation
Sleep - Midbrain raphe nuclei (seretonin)
Awake - Cholinergic neurons adjacent to cerulean excite the cortex
via the thalamus
Which CNs leave the skull via foramen in the posterior cranial fossa?
CN IX - XII
Jugular foramen IJV & CN IX-XI
Hypoglossal canal CN XII
What is the nucleus ambiguus?
Motor supply nucleus to branchiomotor muscles
CN IX (stylopharyngeus)
CN X (pharynx & larynx, upper 1/3 of oesophagus)
Cranial CN XI (larynx)
What is the nucleus solitarius?
Special sensory information via visceral afferents
Taste, Visceral sensation (RS & GI), Baroreceptors & chemoreceptors (Carotid body & sinus), pneumotaxic centre etc
What does the spinal part of CN XI supply?
Sternocleidomastoid and trapezius muscles
What are the 4 medial structures which begin with M in the brainstem?
Motor pathways (Corticospinal) - Contralateral weakness of UL/LL Medial lemniscus (dorsal column) - Contralateral loss of vibration & proprioception Medial longitudinal fasciculus - No ipsilateral eye adduction on lateral gaze Motor nuclei of CNIII, IV, VI & XII - Ocular palsies
What are the 4 lateral structures which begin with S in the brainstem?
Spinocerebellar tract - Ipsilateral limb ataxia
Spinothalamic tract - Contralateral loss of limb pain and temp
Sensory nucleus of CNV - Ipsilateral facial pain and temp sensation loss
Sympathetic fibres - Ipsilateral Horner’s syndrome
Which structures leave the skull via the foramen rotundum?
CN Vb
Which structures leave the skull via the foramen spinosum?
Middle meningeal artery Meningeal nerve (CNVc)
Which foramen in the skull do the CN Vc, lesser petrosal nerve and accessory meningeal artery?
Foramen ovale
Which structures leave the skull via the superior orbital fissure?
CN III, IV, Va, VI
Which foramen do the ophthalmic artery and CN II leave the skull by?
Optic canal
Which structures leave the skull via the jugular foramen?
Internal jugular vein & CN IX-XI
Which foramen does the hypoglossal nerve leave the skull by?
Hypoglossal canal
Which structures leave the skull via the internal acoustic meatus?
CN VII, VIII
What is the cavernous sinus?
Large dural venous sinus located to the left and right lateral sides of the pituitary fossa of the sphenoid bone containing internal jugular vein, CN III, IV, VI, Va, Vb
Where does the cavernous sinus drain?
Pterygoid venous plexus
Aneurysm of the internal carotid can compress nearby structures such as?
Lateral sides of optic chiasm - loss of nasal visual fields
CN VI - cross eyed
Sympathetic nerves to the face - Horners signs
What are the ventricles of the brain?
Hollow regions, site of CSF production (500ml/day) via choroid plexus which forms the blood-CSF-barrier
What does CSF do?
Support
Cushioning
Transport
Where does CSF leave the ventricles?
2 Lateral Apertures (Luschka) Median Aperture (Magendie)
What connects the lateral ventricles to the 3rd ventricle?
Interventricular foramen (Monro)
What connects the 3rd ventricle to the 4th ventricle?
Cerebral aqueduct
What does blockage of the ventricular system lead to?
Hydrocephalus
In child - head increase in size due to unfused sutures of skull
In adult - raised ICP
Which cells produce CSF?
choroidal ependymal cells
What forms the selectivity of the BBB?
Blood CSF barrier - Tight junctions and microvilli between choroidal ependymal cells
Blood ECF barrier - between capillary beds and neural tissue. Endothelial cells bound by tight junctions
How much CSF is present at any one time?
150ml
What are cisterns and where are they?
Widened areas of the subarachnoid space Quadrigeminal - above cerebellum Prepontine Cisterna magna - below cerebellum Lumbar
What pathway does the CSF follow once it has left the ventricles?
Flows through subarachnoid space
Some CSF travels to lumbar cistern
Travels to arachnoid granulations for absorption into venous sinus blood
Granulations also sit around spinal nerves
What are arachnoid granulations?
Project into the superior sagittal sinus
permit a one-way flow of CSF
How can meningitis lead to increased ICP?
Block arachnoid granulations
Describe the difference between a communicating and non communicating hydrocephalus
Communicating - blockage of arachnoid granulations
Non communicating - blockage of cerebral aqueduct, CSF can’t get out of ventricles
What does damage to the superior temporal gyrus result in?
Injury leads to inability to recognise sounds e.g. Speech vs. a door opening
What is the Posterior parietal cortex (superior lobule)? And what would damage here result in?
Integrates sensory inputs and controls perception of the contralateral environment/body
Damage can result in hemi-spatial neglect, Most often seen following right-sided damage, Patients ignore the contralateral half of their world, Walk into objects in affected visual field
What is Achromatopsia?
Inability to recognise colours
What is Prosopagnosia?
Inability to recognise faces
Where are Facial, shape and colour recognition cortices located?
medial occpital lobe
Right side dominant
What is Associative agnosia?
perceives object but does not recognise
Damage to visual association cortices
What can damage to the Frontal eye field?
Eye deviation toward damaged side
What is Dysphasia/Aphasia?
Defect of power of expression by speech or of comprehending spoken and written language
What is a Broca’s dysphasia?
Motor speech - Content correct, but slow or missing words
What is Wernickes dysphasia?
Receptive aphasia (auditory & reading) Content incorrect, but speech fluent
What would a Angular gyrus lesion dysphasia present like?
Alexia / agraphia (inability to read or write)
What would a lesion to 1° Auditory cortex present like?
Reduction of hearing sensitivity in both ears (mostly contralateral) & loss of stereo perception of sound origin
Which side of the brain usually controls speech and language?
Left
What would damage to the arcuate fasciculus result in?
Conductive aphasia
Fluent dysphasic speech
Understands spoken and written word
What would damage to the corpus callosum result in?
Inability to name objects held in left hand
Inability to read via left half of visual fields
What 4 ways can the arterial supply to the CNS be compromised?
Vessel occlusion – embolus or thrombus
Haemorrhage – burst aneurysm, degeneration of vessel wall
Aneurysm – often at sites of branching
Blocked venous drainage
Where does the internal carotid branch off the common carotid?
C3-4
Where do the vertebral arteries arise from?
Branches of subclavian artery
Pass up foramen transversarium & enter skull via foramen magnum
Supply the brainstem, cerebellum proximal spinal cord and posterior and inferior parts of the cerebral hemispheres
Which territories are supplied by the carotid circulation?
ACA and MCA - anterior circulation
What is the blood supply to the internal capsule?
medial & lateral striate arteries & anterior choroidal artery
What is the limbic system involved with?
Sensations of emotion
Visceral responses to emotion
Memories
Where is the limbic system ?
Made up from a rim of cortex: includes hippocampus & insula
Subcortical nuclei: amygdala, accumbens, septal, hypothalamic
Receives multiple inputs & provides multiple outputs
What is Papez circuit?
hippocampal formation → fornix → mammillary bodies → mammillothalamic tract → anterior thalamic nucleus → cingulum → entorhinal cortex → hippocampal formation
Where is the hippocampus?
Inferiomedial temporal lobe
Associated with inferior horn of lateral ventricle
What does damage to the hippocampus produce?
Anterograde amnesia
No new memory formation
Patients are often be able to recall long term memories
Hippocampus also involved in memories involving spatial/ visuo-spatial tasks
What is Korsakoff’s Psychosis?
Metabolic damage / alcohol abuse
Mamillary and anterior thalamic damage, thiamine (B1) deficiency
Anterograde amnesia & often retrograde amnesia
Patients insert fabricated ‘memories’ of long term events into current
conversation (confabulation)
Werickne-Korsakoff syndrome – Above + Ataxia, opthalmoplegia &
dementia
What is the cingulate gyrus?
Cortical part of Papez circuit (limbic function)
Autonomic area: cardiorespiratoty & digestion, visceral response to emotions
Functions in emotional modulation of pain
Bladder control; Visual searching (for object)
Vocal area controlling appropriate sentence construction
What emotional response is the Amygdala responsible for?
Fear Anger Behavioural emotions Impulsivity Sexual behaviour & emotions
What can stimulation of the Amygdala cause?
Increase HR & BP Reduce saliva Increase GI motility Cause irritability Startle easily Increase muscle tension Cause pupil dilation
What area is involved in recognising emotional content of facial expression?
Amygdala
What is Kluver-Bucy Syndrome?
Bilateral damage to the amygdala
Docile, lack fear or anger
Increased appetite & hypersexual
Excess exploratory behaviour with mouth and hands
Visual agnosia
Memory disorders: lack of facial/object recognition
What are septal nuclei involved in?
Pleasure - sexual
What is the nucleus accumbens involved in?
Dopamine-activated reward centre
Intense sense of well being
Amphetamine & cocaine activate
What is the carotid sheath? Which structures lie inside it?
Membrane formed from the condensation of the cervical fascia, contains the internal carotid, internal jugular and vagus nerve
Which arteries supply the spinal cord?
Anterior spinal artery and posterior spinal arteries
The middle meningeal artery (which supplies the meninges) is a branch of which main artery? Where does it enter the skull?
The middle meningeal is a branch of External Carotid and enters the skull through the Foramen Spinosum
One of the first symptoms of intracranial haemorrhage is a ‘worst-ever’ headache. What nerves carry the sensory input from the meninges?
The cranial nerves carrying sensory info from the meninges are CNV (trigeminal), CNX (vagus) and a bit of CNIX (glossopharyngeal) and also cervical nerves 2 & 3 (C1 rarely has a sensory component)
What is the average blood flow in the brain (ml/100g/min)? How can you measure this?
60 ml/100g/min which can be measure by Doppler Ultrasound or Angiography
Name the deep veins that drain the corpus striatum, choroid plexuses and thalamus. Which main sinus do these drain into?
Thalamostriate, choroidal and internal cerebral veins, which drain into the great cerebral vein and into the straight sinus
Which main artery supplies the basal ganglia and internal capsule? What are the branches in this region known as?
The middle cerebral supplies the BG and IC and the branches are known as the Lenticulostriate arteries
The plexus of veins known as the cavernous sinus surrounds sections of which artery and cranial nerves? This sinus drains via two routes, what are they?
cavernous sinus surrounds the internal carotid and CNIII (oculomotor), CNIV (trochlear), CNV (trigeminal) and CNVI (abducens). It drains via the superior petrosal sinus into the transverse sinus or the inferior petrosal sinus into the internal jugular vein
Areas between the regions supplied by two adjacent cerebral arteries are most susceptible to ischaemia and infarction. What are these areas known as?
Watershed areas and infarcts are known as ‘Watershed infarcts’
What are the consequences of a blockage of a cerebral artery by an embolus?
Stroke – ischemic death of regions supplied by the artery, effects depend on area damaged
Define (a) ischaemic and (b) haemorrhagic stroke
a) Caused by blockage of a cerebral artery
b) Damage caused by leaking of blood within or around the brain
What type of blood (arterial, venous, mixed) characterises Epidural (Extradural) haemorrhage?
Arterial
What type of blood (arterial, venous, mixed) characterises a subdural haemorrhage?
Venous
What type of blood (arterial, venous, mixed) characterises a subarachnoid haemorrhage?
Mixed - arterial and venous
Which imaging procedure would be most useful in diagnosing an aneurysm in a cerebral artery?
CT scan
What type of intracranial haemorrhage is most likely to result from a blow on the chin?
A blow to the chin generally Contrecoup injury when the brain rebounds from the blow, usually resulting in subdural haemorrhage
Can a cerebral infarct raise intracranial pressure sufficient to produce coning?
Yes, if it reaches >15mm Hg, e.g. swelling and coning of temporal lobe
What is diffusion weight imaging (DWI)? Following a stroke what is this technique useful for showing?
DWI is an MRI technique that maps the diffusion of water molecules in tissue. Useful for revealing ischemic damage and can reveal this far quicker that other MRI techniques following stroke
Which spinal nerves innervate the hand?
C6-8
Give 4 of the main signs used to distinguish upper and lower motor lesions
Pattern of weakness, pattern of wasting, plantar response, tendon reflexes, fasciculation (present/absent), tone of muscles, pain, sensory disturbance
What is the window for thrombolysis?
You have 4.5 hours post stroke to administer thrombolytics
What is the current recommended first line thrombolytics for ischaemic stroke?
Alteplase
Why would you expect an older person to respond more slowly to a haemorrhaging stroke than younger patients?
Cerebral atrophy is a natural part of the ageing process and as a result elderly patients have more available space to accommodate increases in volume from the bleed and would show a slower increase in intra-cranial pressure
What is a positive Romberg sign?
Instability when standing with eyes closed
What folds to form the neural tube?
Neural ectoderm
