BMB 1 - Test Review Flashcards by Jason Worley

How much of the spinal cord is supplied by the anterior spinal artery?

How much is supplied by the posterior spinal arteries?

The anterior 2/3

The posterior 1/3

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The posterior spinal arteries supply which portion(s) of the spinal cord?

Dorsal columns

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The anterior spinal arteries supply which portion(s) of the spinal cord?

Corticospinal tracts, spinothalamics, etc.

(basically everything but the dorsal columns)

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Name the major artery that assists the anterior spinal artery in perfusing the lower half of the spinal cord.

Artery of Adamkiewicz

(arteria radicularis magna)

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The artery of Adamkiewicz (arteria radicularis magna) comes off which artery at which level?

A posterior intercostal artery in the thoracic region

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Which arteries perfuse the internal capsule (carrying fibers between the cortex and brainstem)?

(They arise from which bilateral, major arteries?)

The lenticulostriate arteries

(from the middle cerebral arteries)

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What is the purpose of the internal capsule?

To connect cortical afferents and efferents to the midbrain

(passing between and interacting with the basal ganglia)

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True/False.

Strokes involving the lenticulostriate arteries often result in motor and sensory deficits.

True.

(due to infarction of the internal capsule)

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Describe the somatotropic make-up of the internal capsule (from an axial view).

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Acute inflammatory demyelinating polyradiculopathy typically results in _________ motor neuron symptoms.

Acute inflammatory demyelinating polyradiculopathy typically results in lower motor neuron symptoms.

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Partial myelitis typically results in _________ motor neuron symptoms.

Partial myelitis typically results in upper motor neuron symptoms.

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Which of the following is associated with upper motor neuron symptoms?

Acute inflammatory demyelinating polyradiculopathy

Partial myelitis

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______________ is the most common incomplete spinal cord injury syndrome

Central cord syndrome is the most common incomplete spinal cord injury syndrome

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How does central cord syndrome of the cervical syndrome typically present?

Weakened limbs with upper limbs being weaker than lower limbs

(variable sensory loss)

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True/False

Central cord syndrome has a fairly strong association with syringomyelia (syrinx).

True.

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What are the S/Sy of the spinal cord damage seen in severe, prolonged vitamin B12 deficiency?

Subacute combined degeneration

Diminished vibration, touch, and proprioception;

UMN symptoms;

paresthesias

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Which portions of the spinal cord are damaged in tabes dorsalis (neurosyphilis)?

The dorsal columns and roots

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What is the spinal shock syndrome sometimes seen following a traumatic transection of the spinal cord?

A gradual recovery of reflex (from areflexia or hyporeflexia)

(although motor and sensory function remain lost)

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D____________ (a lack of coordination leading to under- or overshooting in fine motor movements) and D____________ (impairment of alternating movements) are both associated with cerebellar dysfunction.

Dysmetria (a lack of coordination leading to under- or overshooting in fine motor movements) and Dysdiadochokinsia (impairment of alternating movements) are both associated with cerebellar dysfunction.

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All motor cranial nerve nuclei except the lower face and genioglossus receive corticobulbar input from which laterality (i.e. does the cortex send UMN fibers ipsilaterally or contralaterally to synapse in the cranial nuclei)?

Ipsilateral and contralateral

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Which musculature does not receive both ipsilateral and contralateral input from the corticobulbar tracts?

The lower face

the genioglossus

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The lower face and genioglossus receive only _____lateral corticobulbar input.

The lower face and genioglossus receive only contralateral corticobulbar input.

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Lesions of the upper motor neurons (corticobulbar neurons) innervating the motor nuclei of CN VII will lead to what sort of S/Sy?

(Portion(s) of the face and laterality(ies))

Contralateral paralysis of the lower face

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Lesions of the CN VII lower motor neurons will lead to what sort of S/Sy?

(Portion(s) of the face and laterality(ies))

Ipsilateral paralysis of the upper and lower face

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Why can't the eye close in cases of CN VII palsy?

**Orbicularis oculi** paralysis

Bell’s palsy is an older eponym referring to ___________ CN VII palsy, but we now know that most cases are caused by \_\_\_\_\_\_\_\_\_\_\_.

Bell’s palsy is an older eponym referring to **_idiopathic_** CN VII palsy, but we now know that most cases are caused by **_H_****_HSV_**.

Name some causes of isolated CN VI palsy.

DM, stroke, increased ICP, etc.

While damaging CN VI will result in an ipsilateral loss of abduction, what happens when the CN VI nucleus is damaged?

Issues in both eyes (due to the MLF connection); now **neither eye will point towards the side of the lesion**

Which nucleus contributes parasympathetics to CN III?

Edinger-Westphal

Does ALS affect UMNs or LMNs?

Both

Identify which (or both or neither) of the following _do_ decussate: ## Footnote **CN VI** **The medial longitudinal fasciculus** **CN III**

The medial longitudinal fasciculus

What effect does a lesion of the right medial longitudinal fasciculus have on eye movement?

**Failure** **of** **left eye adduction** in conjugate gaze with right eye abduction

Upon asking a patient to look to their left, their left eye abducts but their right eye remains pointing forward. Where is the lesion likely to be?

The left medial longitudinal fasciculus

Neurons from what location innervate the abducens nuclei and subnuclei (the subnuclei control the MLF)?

The paramedian pontine reticular formation

What is the effect of a lesion in the PPRF (paramedian pontine reticular formation)?

Failure to abduct ipsilateral eye

A lesion of both the PPRF (paramedian pontine reticular formation) and also the ipsilateral medial longitudinal fasciculus will result in what?

**Cannot abduct OR adduct ipsilateral eye** or **adduct contralateral eye** ('one-and-a-half syndrome')

A patient presents with an eye that points down and out. Further investigation reveals a stroke in the posterior cerebral artery. What is the diagnosis?

**Medial midbrain syndrome** | (Weber syndrome)

Identify the mechanism by which the frontal eye fields (Brodmann 8) move the eyes towards an object coming from the leftside of your body.

Right half of retinas see object --\> optic nerves rearrange in optic chiasm --\> right tract sends info. to the right frontal eye --\> the right frontal eye field project to the PPRF --\> the PPRF projects to the abducens nucleus and subnucleus --\> the eyes are turned leftwards to see the object

A patient presents with weakness of her upper and lower face plus an inability to abduct the ipsilateral eye. What is the likely pathology?

LMN CN VII palsy + CN VI palsy

A patient presents with weakness of her upper and lower face plus an inability to abduct the ipsilateral eye and an inability to adduct the contralateral eye. What is the likely pathology?

LMN CN VII palsy + CN VI nucleus palsy

You are likely to note ________________ dissociation in a lumbar puncture of a patient with Guillain-Barré syndrome.

You are likely to note **_cyto-alubumino_** dissociation in a lumbar puncture of a patient with Guillain-Barré syndrome.

**True/False**. Lacunar strokes are a common form of embolic ischemic stroke that often occurs due to occlusion of the lateral striate feeding the posterior capsule.

True.

**True/False**. Lacunar strokes are often characterized entirely by motor deficits.

True.

What is the presentation for a medial medulla lesion?

Ipsilateral tongue deviation and contralateral weakness

What tracts are affected in a lesion of the medial medulla?

Corticospinal tracts + medial lemniscus tracts + hypoglossal nuclei

What tracts are affected in a lesion of the lateral medulla?

Spinothalamic tracts + trigeminothalamic tracts + nucleus ambiguus + vestibular nucleus + inferior cerebellar peduncle

Damage to the **right** cerebral peduncle will produce what S/Sy?

**Tongue** deviation to the **left** and **left**-sided **weakness**.

Via what mechanism do patients treated for subarachnoid hemorrhage sometimes develop communicating hydrocephalus following treatment?

High [**protein**] from the subarachnoid hemorrhage is **clogging the arachnoid granulations**

The posterior thalamus is mainly supplied by which bilateral arteries?

The **posterior cerebral** arteries

Polymyositis is mainly ______ cell mediated. Dermatomyositis is mainly ______ cell mediated.

Polymyositis is mainly **_CD8+_** cell mediated. Dermatomyositis is mainly **_CD4+_** cell mediated.

Both polymyositis and dermatomyositis show a(n) ___________ CK and a(n) ___________ ESR.

Both polymyositis and dermatomyositis show an **_elevated_** CK and a **_normal_** ESR.

A patient presents with dysphagia, a normal serum CK, weakness that spares the deltoids, and inclusion bodies on myocte biopsy. What is the diagnosis?

Inclusion body myositis

A patient with stiffness, elevated ESR, and giant cell arteritis likely has what condition?

Polymyalgia rheumatica

Myasthenia gravis gets __________ with stimulation.

Myasthenia gravis gets **_worse_** with stimulation.

Lambert-Eaton syndrome gets __________ with stimulation.

Lambert-Eaton syndrome gets **_better_** with stimulation.

Myasthenia gravis is associated with ____________ (tumor). Lambert-Eaton syndrome is associated with ____________ (tumor).

Myasthenia gravis is associated with **_thymomas_**. Lambert-Eaton syndrome is associated with **_small cell lung carcinomas_**.

What term refers to inflammation of the spinal cord?

Myelitis

What are the S/Sy of myelitis?

**UMN** signs **T2 hyperintensities** of brain and C-spine **Unsteady** **gate** and **decreased** **vibration** sense

An occlusion of the superior branch of the MCA can lead to ________ aphasia.

An occlusion of the superior branch of the MCA can lead to _**production (*Broca's*)**_ aphasia.

An occlusion of the inferior branch of the MCA can lead to ________ aphasia.

An occlusion of the inferior branch of the MCA can lead to _**receptive (*Wernicke's*)**_ aphasia.

What is "Todd's paralysis"?

Focal paralysis following a seizure

Which artery supplies the **basal** **ganglia**? Which artery supplies the anterior limb of the **internal** **capsule**? Which artery supplies the motor and sensory cortex which innervates the **lower extremities**? Which artery supplies the **corpus** **callosum**?

Anterior cerebral Anterior cerebral Anterior cerebral Anterior cerebral

Which artery supplies the temporal lobe? Which artery supplies the hippocampus? Which artery supplies Broca's area? Which artery supplies the posterior limb of the internal capsule? Which artery supplies the putamen and globus pallidus? Which artery supplies the cortical structures which innervate the motor and sensory supply to the face and upper extremities?

Middle cerebral Middle cerebral Middle cerebral Middle cerebral Middle cerebral Middle cerebral

What visual S/Sy does occlusion of the anterior cerebral artery typically cause?

None

What visual S/Sy does occlusion of the middle cerebral artery typically cause?

Contralateral homonymous hemianopia without macular sparing; gaze deviation towards the side of infarction

What visual S/Sy does occlusion of the anterior cerebral artery typically cause? What visual S/Sy does occlusion of the middle cerebral artery typically cause?

None Contralateral homonymous hemianopia without macular sparing; gaze deviation towards the side of infarction

Tongue fasciculations are pathognomonic for what disease?

ALS

Cerebellar strokes cause \_\_\_\_lateral S/Sy.

Cerebellar strokes cause **_ipsi_**lateral S/Sy. (**due to double-crossing**)

For a lesion in the corticobulbar tract of the hypoglossal nucleus: UMN lesion will cause deviation _________ the lesion. LMN lesion will cause deviation _________ the lesion.

For a lesion in the corticobulbar tract of the hypoglossal nucleus: UMN lesion will cause deviation **_away_** **_from_** the lesion. LMN lesion will cause deviation **_towards_** the lesion.

Golgi tendon organs respond to \_\_\_\_\_\_\_\_\_\_\_. Muscle spindles respond to \_\_\_\_\_\_\_\_\_\_\_.

Golgi tendon organs respond to **_tension_**. Muscle spindles respond to **_stretch_**.

Reflex testing (e.g. the patellar reflex) mainly involves ______________ (golgi tendon organs / muscle spindles).

Reflex testing (e.g. the patellar reflex) mainly involves **_muscle spindles_**.

In muscle spindles, excessive ________ motor firing leads to increased ________ motor firing.

In muscle spindles, excessive **_gamma_** motor firing (***to*** ***intrafusal fibers***) leads to increased **_alpha_** motor firing (***to extrafusal fibers***).

Muscle spindles are __________ to muscle fibers. Golgi tendon organs are __________ with muscle fibers.

Muscle spindles are **_parallel_** to muscle fibers. Golgi tendon organs are **_in line_** with muscle fibers.

\_\_\_\_\_\_\_\_\_\_\_\_ positioning - following injury to a supratentorial location, the **lower** **extremities** are **extended** but **upper** **extremities** are **flexed**.

**_Decorticate_** positioning - following injury to a supratentorial location, the **lower** **extremities** are **extended** but **upper** **extremities** are **flexed**.

\_\_\_\_\_\_\_\_\_\_\_\_ positioning - following injury to a supratentorial location *and midbrain*, the **lower** **extremities** are **extended** and **upper** **extremities** are **extended**.

**_Decerebrate_** positioning - following injury to a supratentorial location *and midbrain*, the **lower** **extremities** are **extended** and **upper** **extremities** are **extended**.