Anderson Neuro Flashcards
Internal carotid
goes inside head and doesn’t branch until much later
- not blood supply to anything in face or head and neck
arterial vs venus system
arterioles branch
venus goes here and there
branches of external carotid
Some Anatomists like Fucking, Others Prefer S&M
- Sup thyroid
- Asc pharyngeal
- Lingual
- Facial
- Occipital
- Posterior Auricular artery
- Superficial temporal
- Maxillary
terminal branches of external carotid
maxillary artery
superficial temporal artery
Are communicating arteries blood supply?
no
When internal carotid finally branches what does it branch to?
opthalamic
Where is dividing line between circle of willis and vertebral basilar system?
Post cerebral and superior cerebellar
where do vertebral arteries come from?
subclavian
What do vertebral arteries go through?
C6 foramen to C1
out atlantooccipital junction
spinal arteries are branches of what?
everything else branches off what?
vertebral
basilar
berry aneurism: which arteries
sx
anterior communicating
post communicating
middle cerebral
sudden excruciating HA
AVM: which arteries
sx
may occur anywhere
chronic HA
When does Hypertensive encephalopathy occur?
sx
diastolic BP above 120
confusion, drowsiness, ha, nausea
toxic encephalopathy
liver and kidney can’t get rid of toxins
deepest jugular vein that drains everything inside and most outside head
internal jugular
external jugular drains what?
backside of skull
confluens of sinuses
transverse sinus, superior and inferior saggital sinuses come together here
confluens forms what?
inion (bump on back of head)
most of brain blood comes from
sigmoid sinus
cavernous sinus and pterygoid plexus are what and what can they cause?
communicating areas with external face and neck
infections leading to encephalitis
cowdry bodies common in
herpes
negri bodies common in
rabies
intracranial pressure leads to
papilledema
cerebral edema
too much pressure going in
brain hypoxic and acidotic = brain damage
*common after injury, radiation, long term HTN
Hydrocephalus
enlarged ventricles
carbon dioxide buildup =
acidosis which can lead to necrosis
low O2/low pH =
hypoxia/ischemia
encephalomalacia
necrosis
CN1
olfactory
sensory
smells
CN2
optic
sensory
see
CN3
oculomotor
motor
superior oblique muscle
mneumonic for cranial nerves sensory or motor
Some Say Marry Money But My Brother Says Be Brave Marry Me ***B = mixed
what does CN 12 do?
motor to tongue
What does CN 11 do?
motor to trap and SCM
What does CN5 do?
feels the face, chews
What does CN6 do?
L.R. muscle
What does CN 7 do?
moves face, taste, cry, salivate
What does CN9 do?
glossopharyngeal
taste, saliva, swallow, baroreceptors
What does CN10 do?
taste, swallow, talk, lift palate
Nuclei distribution for PONs
CN 5,6,7,8
Nuclei distribution for Midbrain
CN 3,4
Nuclei distribution for Medulla
CN 9,10,11,12
Nuclei distribution for diencephalon
CN 1,2
what order does brainstem go in?
top down: midbrain pons medulla spinal cord
sense of touch inside nose
CN5
anosmia due to
noxious chemicals or tumors or fractures of cribriform plate
sense of smell uses
vision uses
smell = cAMP vision = cGMP
where are cones/ high sensitive area?
fovea of macula
embryonically, eye grows out of
brain
sclera is
outer area, CT/same as dura
all of nerve fibers, receptive tissue
retina (same as brain)
blood vessels of eye are in
choroid (same as arachnoid)
lens is a ___ muscle and it gets ___ when pull it
round
smaller
when ciliary muscle contracts it goes from ____ to ___
relaxed ciliary muscle associated with ______ vision and when it is contracted it is associated with ____ vision.
thin to plump
far
near
aqueos humor is the same as and drains where?
extracellular fluid with no blood, etc.
canal of flegm
afferent vs efferent
afferent: coming in
efferenet: going out
disease with degeneration of pigment cell layer that leads to blindness
macular degeneration
light goes in, but can’t see
lesion at chiasm
bitemporal hemianopsia
optic nerve problem before pathways cross leads to
complete blindness in that eye
lesion behind chiasm
homonomous hemianopsia (seen in brain tumor patients)
where are cones
fovea of macula
central (rods periphery)
make you see color (cones = color)
parasympathetic activity of eye nemonic
(beauty under a bright light) = small pupil, thick lens contracted muscle constricted pupil fatter lens near sight
sympathetic
relaxed ciliary muscle
dilated pupil
far sight
facial nerve does more than facial expression
salivation
tearing
taste (ant2/3)
motor to post digastric and strapedius
What are first and second holes that facial nerve goes through?
1st: internal acustic meatus
2nd: styloid mastoid foramen
who goes through styloid mastoid foramen?
motor branch of facial nerve
styloid mastoid foramen is important for which disease?
bells paulsy (all branches involved)
***which cranial nerves are involved with anterior and posterior tongue taste?
ant: 7 taste (5 for touch)
post: 9 is back two thirds taste and touch
**what muscle is innervated by CN9?
stylopharyngeus
what hole does CN9 go through?
medulla through foramen to target areas
what nerve operates parotid gland?
CN9
ability of tongue to touch roof of mouth is what CN?
CN10 (every other motion of tongue is CN12)
salty, sweet, sour, bitter are innervated with which CNs?
7 because they are tasted on anterior tongue
sour and bitter are 9 (post)
optokinetic nystagmus
looking out of a train
- nystagmus improves image
vestibular nystagmus
move head to quickly or put cold water in ear
most common cause of pathologic nystagmus
horizontal nystagmus due to vestibular nerve swelling (hearing and balance issues)
endolymph
perilymph
intracellular (K rich)
extracellular (Na rich)
organ of corti
in basilar membrane
perilymph and endolymph associated
lateral and medial geniculate bodies
auditory is medial (internal)
vision is lateral (external)
gag reflex
CN 9 is sensory
CN 10 motor
speech is which CN?
CN 12 (hypoglossal)
Wernicke’s area
sensory aphasia (word salad) - difficulty understanding written/spoken language
Broca’s area
motor aphasia
- understanding is intact
parasympathetic ganglia come from
brainstem
sympathetic ganglia come from
from thoracic nerve roots
- goes to heart and bronchi
from chest through half of abdomen have
vagal influence: parasympathetic
sexual response cycle uses
both parasympathetic (arousal) and sympathetic (climax) - all come from lower sacral nerve roots
sympathetic bronchial response
dilates
constricts with parasympathetic
saliva secretion is
parasympathetic
how does PNS interact with spinal cord?
sensory input from dorsal horn
motor input from ventral
what horn is involved with Polio?
sensory dorsal horn issues
grey matter and white in spinal cord
grey synaptic in center
white is outer tracts
spinal level reflexes
C-5 bicep C-6 brachioradialis C-7 triceps C-8 finger flex L-4 patellar L-5 foot
fiber types A- alpha B- beta A- gamma A- delta B C
A- alpha: biggest fastest (motor neurons)
B- beta: touch and pressure
A- gamma: slower motorneurons
A- delta: touch, pressure, fast, pain
B: preganglionic autonomic fibers
C: smallest slowest (yes or no) pain and temp
Golgi Tendon Organ
measures tension and inhibits alpha to protect against over stretch
anterolateral system
lower sensitivity: anything shared with dorsal column:
- pain
- thermal
- crude touch
- tickle and itch
- sexual sensation
Upper vs lower motor neurons
UMN defects (hyper): spastic paralysis, hyerreflexia, pos babinski LMN (hypo): atrophy, flaccid paralysis, fibrillations, hyporeflexia, neg babinksi
what are the 3 sensory pathways?
spinothalamic: pain and temp
fasciculus cuneatus, gracilis: concious proprioception
spinothalamic and medial leminiscus: light touch
diancephalon
anything with the word thalamus
hypothalamus, thalamus, epithalmus
fast vs slow pain fibers
slow: end at diencephalon
fast: sensory humunculus (give specific info)
what can cross BBB?
lipid soluble, gases, water
BBB maintains constant env for neurons, prevents escape of neurotransmitters.
CSF
extracellular fluid and plasma
created by choroid plexus
what amino acid does the main membrane transport system use?
glutathione
what hormones enhance cellular AA uptake?
GH and insulin
excitatory neurotransmitters
glutamate and aspartate
inhibitory neurotransmitters
GABA glycine serine alanine cystathione
inactive neurotransmitters
glutamine
lysine
threonine
leucine
brain transmitter uppers
serotonin ACTH norepi epi dopamine glycine (also downer)
downers
GABA nitric oxide histamine neurosteroids glycine (also upper)
primary sulfur containing amino acids and
what does it do?
cysteine
helps make glutathione and taurine
what form of sulfur is toxic?
sulfite (not sulfate)
sulfate used in brain to get rid of junk
What helps get rid of sulfites by turning them into sulfate?
Mo intermediary
Methylation or methyl step involves what?
folic acid and B12
what enzyme creates and enzyme that breaks down acetyl choline
choline acetylase
acetylcholine esterase breaks down
reason muscle don’t go into muscle tetany
acetlycholine esterase
most pesticides are
choline esterase inhibitors
would cause prolonged muscle tetany
tryptophan makes _____ by hydroxylating tryptophan with _____
seratonin
5HTP
** Seratonin can be turned into _____ in the diencephalon
melatonin
- depression = can’t sleep either because no seratonin = no melatonin
tryptophan is ____ dependent
deficiency in ____ can lead to seratonin deficiency
B6
B6
circadian rhythm is driven by?
suprachiasmatic nucleus of hypothalamus which receives input from retina.
primary circadian rhythm hormones
melatonin (sleep)
cortisol (wake)
What leads to cortisol surge?
What leads to melatonin release?
- ACTH
- low light leads to increased activity of retina-hypothalamic pathway which leads to pineal gland melatonin release
high doses of corticosteroids leads to
sleeplessness (brain thinks it is awake constantly)
***phenylalanine converts to? what enzyme is used?
tyrosine phenylalanine hydroxylase (deficeint in children with phenylketonuria (PKU))
number one cause of mental retardation?
caused by what?
PKU
deficiency of phenylalanine hydroxylase
tyrosine is used for:
base for thyroid hormone syntheses
used in TCA cycle for energy
makes melanin
hydroxylated to L-DOPA and then to Dopamine
difference between PNS and CNS catecholamine producing neurotransmitters
N-Methyl-Transferase (final step for formation of EPI)
L-Dopa to Dopamine is dependent on what?
B6 and B1
Dopamine to NE inhibited by and stimulated by?
inhibited by: gluatathione, cysteine, B-5
stimulated by: copper and vit c
If you don’t get rid of catecholamines what happens
What disease has this?
go into hyper metabolic state
(increased HR, manic/psychotic rage, PNS breaks down)
- pheochromocytoma
Two enzyme reactions critical for getting rid of catecholamines
MAO
COMT
VMA (most important intermediate) tested in urine to see if overproducing catecholamines.
what is tested in urine to see if overproducing catecholamines?
VMA
what is donor of NO and what enzyme
arginine
NO synthase
NO associated with
what does it do?
GMP (vision)
vascular smooth muscle dilation (control HTN, erectile tissues, etc) dependent on GMP
histadine is bioconverted to ____ using ____
histamine
B1 and histadine decarboxylase
purposes of histamine
peripherally: part of cytokine system to trigger immune response (good)
first step to get histamine out of the body
next step
final step
1) methylate
2) MAO (monoamine oxydase: also used to get rid of catecholamines, seratonin, etc.)
3) removed through liver
what converts glutamine to GABA?
why is this important
GABA decarboxylase (B1 dependent) important because GABA (primary inhibitory neurotransmitter) is formed by same thing that makes glutamate (primary excitatory neurotransmitter)
basal nuclei do what?
filter info to and from motor cortex
talk to cerebellum
= purposeful normal movement
vestibulocerebellum
pontocerebellum
spinocerebellum
- balance and eye movement coordination
- planning and initiation of movement
- synergy, which controls rate, force, range of movement
diseases from basal nuclei
parkinsons and hutingtons
choreaform/hutington’s chorea
jerky uncontrolled movements
younger
progress to death
Parkinson’s is damage to
sx
cause
substantia nigra (dopaminergic system) festinating gait, cog-wheel rigidity, pill-rolling, resting tremor autoimmune or drug-induced
ALS/Lou Gerhig’s
loss of UMN or LMN muscle atrophy weakness hyper-reflexia death due to resp complication
most common organisms for 0-4 weeks infxn
Group B strep, E. coli, Listeria
most common organism 4 weeks->50
S pneumoniae
difference between encephalitis and meningitis
presence of neurologic deficit in encephalitis due to inflammation of brain
clinical signs of brain tumors
drowsiness, lethargy, personality changes, psychosis, seizures, HA, N/V, papilledema (same for most issues with brain)
** new seizures could be due to tumor
neuroglial tumors
all called astrocytomas up to grade 3. glioblastoma multiforme (grade 4 astrocytoma): most common brain tumors of adults
peripheral nerve tumors
schwannoma = benign
acoustic neuroma = CN8
neurofibroma = benign if solitary
neurofibromatosis = autosomal dominant (Von Recklinghausens)
Demyelinating disorders
MS is biggest: glove and stalking parasthesias (CNS)
Guillain-Barre Syndrome (PNS): first flu-like illness, then ascending paralysis
Dysmyelination disorders (CNS)
leukodystrophy
abnormal myelin
B1 deficiency due to alcoholism
Wernicke-Korsakoff syndrome
dementia, dermatitis, diarrhea, death (4D’s)
Pellegra/niacin def (B3)
*used to be mental hospitals filled with people who just had B3 deficiency
macrocytic anemia, degeneration of spinal cord, not cured by folate
vit B12 def
folate does not cure what in B12 def
neurologic component
diffuse cortical atrophy, neurofibrillary tangles, senile plaques in cortex, abnormal tau proteins, microglia, astrocytes
alzeimer’s
lysosomal storage disease progressive neurodegenerative disorder paralysis, dementiamia, seizures follow dev retardation def of hexosaminidase A death by age 4
Tay-Sachs
- def of what enzyme in Tay-Sachs
hexosaminidase A
alpha-glucosidase deficiency
Pomp’s
lack of what enzyme in PKU
phenylalanine hydroxylase
toxic levels of copper storage
liver, brain, eye (Kaiser-Fleisher rings)
Wilson’s Disease
