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NeuroRehab > Brainstem/ Cerebellar > Flashcards

Brainstem/ Cerebellar Flashcards

1
Q

3 parts of brain stem

A

Midbrain
Pons
Medulla oblongata

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2
Q

Midbrain contains

A

Cerebellar peduncles (motor tracts to SC)
Super and inferior colliculi
Red nucleus

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3
Q

Midbrain nerves

A

III and IV
Inc ICP = dysfunction of nerve III -
Abnormal pupil size, poor reactivity to light

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4
Q

Pons has

A

Two resp. Centers in dorsal pons. Work w/ principle resp center in medulla

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5
Q

Reticular formation controls

A

Consciousness and attention
(Asleep, awake, alert, attending)
Also relays in an ascending pathway to thalamus, limbic, cerebral cortex

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6
Q

Medulla oblongata regulates

A

Cardiac
Vascular
Resp function

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7
Q

Medulla coordinates

A

Swallowing
Vomiting
Coughing
Sneezing

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8
Q

Medulla is decussation for

A

Dorsal column and CST

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9
Q

CN in medulla

A 
Part of VIII
IX
X
XI
XII
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10
Q

______ of the 12 CN pairs originate from nuclie in _______

A

10 of the 12 CN pairs originate from nuclie in brainstem

“If you have CN involvement, you know you are in the BS”

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11
Q

Initial BS dysfunction

A 
Gait distubrance
Diplopia
Focal weakness
HA
Vomit
Facial numb/weak
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12
Q

Dorsal midbrain involvement

A

Parinaud syndrome

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13
Q

Parinaud syndrome characterized by

A

Loss of upward gaze
Pupillary areflexia to light
Loss of convergence

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14
Q

Reticular formation involvement

A

Apnea
Hypoventilation or hyper
Orthostatic hypotension
Syncope

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15
Q

BS involvement management

A 
Equipment/orthotic evaluation 
– Functional training
• Bed mobility, transfers, wheelchair
– Gait training 
– Balance and coordination training 
– Family training
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16
Q

Cerebellum connects to rest of brain by

A

Superior, middle, inferior cerebellar peduncles

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17
Q

Inferior cerebellar peduncle

A

Carries afferent fibers coming mainly from SC

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18
Q

Middle cerebellar peduncles

A

Contains afferent fibers from the contralateral pontine nuclei

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19
Q

Superior cerebellar peduncle

A

Carries efferent fibers leaving cerebellum. Crossed afferent fibers from ventral spinocerebellar tract

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20
Q

There are a large number of axons projecting to cerebellum carying _____

A

Vestibular and proprioceptive info

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21
Q

Cerebellar nuclei

A

Dentate nucleus
Interposed nuclei
Fastigial nuclei

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22
Q

Biggest part of cerebellum formed by

A

Lateral hemisphere

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23
Q

Info from cerebullum goes to cortex. Used to

A

Plan and program voluntary movement, especially skilled, learned movement

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24
Q

Cerebellum:

SOS DEFTT

A

Smooth
Orderly
Sequencing

Direction
Extent
Force
Timing
Tone
25
Q

Vestibulospinal and reticulospinal tracts

A

Influence spinal motor pathways and influence posture and stereotyped movements which are regulated by BG

26
Q

Flocculonodular lobe receives info from

A

Vestibulocerebellum

vestibular nuclei

27
Q

Flocculonodular lobe primary role

A

Regulate balance, influencing eye movement needed for visual tracking

28
Q

BG PASS

A

Basal Ganglia

Postural
Adaptation
Semivoluntary
Semiautomatic

29
Q

Cerebellum and feedback control

A

Comparator and error detection mechanism

Controls onset, level, rate of force production of muscles

30
Q

Peripheral feedback during motor repsonse given by

A 
Muscle spindle
GTO
Joint
Cutaneous receptors
Vestibular apparatus 
External info through eyes and ears
31
Q

Closed loop

A

Feedback used as references for correctness, compilation of error and subsequent correction in order to maintain desired state

32
Q

Feed forward

A

Predictive compensatory modifications

  • cerebellum programs voluntary movement skill based on memory of previous sensory input and motor output
  • vital to anticipatory muscle activity
33
Q

Stereotyped movements and rapid short duration movements

A

Controlled by open loop

34
Q

Open loop system

A

Control system w/ preprogrammed instructions to effector that does not use feedback info and error detection processes
-control from motor program memory/preprogrammed pattern of info for controlled movement

35
Q

If cerebellum is damaged

A

Learned motor program cannot be used
-movement guided by feedback systems
-movement is slow and uncoordinated
Inability to adapt to minor changes

36
Q

Cerebellum - disturbed balance

A

Difficulty maintaining upright posture

Visual compensation not effective

37
Q

Cerebellum hypotonicity

A

DTR normal

-decreased excitation from deep cerebellar nuclei to regions of brain that excite alpha and gamma motor neuron

38
Q

Dysmetria

A

Deficit in reaching target
Inability to judge distance or ROM

Over or under shooting (hyper/hypo metric)

39
Q

Disdiadochokinesia

A

Inability to perform rapidly alternating movements

-movements are irregular w/ rapid loss of range and rhythm esp as speed is increased

40
Q

Movement decomposition (dyssynergia)

A

Movement performed in its component parts instead of one coordinated movement

41
Q

Asynergia

A

Inability to associate muscle groups together for complex movements

42
Q

Ataxia most often associated w/

A

UE/LE/trunk/head/mouth/trunk

*Gait disturbances
Wide BOS, steps irregular in direction and distance

43
Q

Ataxia initation of LE movement

A

May start slow then extremity may unexpectedly be rapidly flung to hit floor

  • arms held out to improve balance
  • gait is generally instead, irregular, staggering
44
Q

Asthenia

A

Generalized muscle weakness associated w/ cerebellar lesion

Muscle strength on involved side can be reduced by 50%

45
Q

Intention tremor

A

Occur during voluntarily movement and ted to increase as extremity reaches its intended goal

46
Q

Speech disturbances (dysarthria)

A

Rhythm of speech is changed. Syllables are slow, accents misplaced.

Grammar and word selection not involved

47
Q

Cerebellar involvement: control of eye movement and gaze

A

Deviate toward contralateral side, inability to move accurately to target in periphery

  • saccades either too large or too small
  • nystagmus is rhythmic, quick oscillatory movement of eyes
48
Q

BS stroke AICA

A

Pontomedullary syndrome

49
Q

Pontomedullary syndrome

A 
Severe vertigo
Dysarthria
Altered precaution of vertical
Ataxia
*Loss of pain/temp ipsi face, contra body
Oculomotor abnorm
*Unilateral hearing loss
50
Q

BS stroke PICA

A

Lateral medullary syndrome

51
Q

Lateral medullary syndrome

A 
Severe vertigo
Dysarthria
Altered perception of vertical
Ataxia 
Loss of paintemp ipsi face, contra body
Oculomotor abnormal
*horners syndrome
52
Q

Friedreich’s ataxia

Eti

A

Genemutation —> mitochondrial function

Autosomal recessive

53
Q

Friedreich’s ataxia characteristics

A

Gait unsteadiness: 5-15yo

  • UE ataxia, dysrarthirai, paresis (esp LE)
  • mental function decline
  • reflexes, vibration, position sense lost
  • clubfoot, scoliosis, progressive cardiomyopathy
54
Q

Friedreich’s ataxia prognosis

A
  • by late 20s, pt may be confined to W/C

- death , arrhythmia or heart failure, usually by middle age

55
Q

Spinocerebellar ataxias (SCA)

A

Autosomal dominant
Most common affect multiple areas in CNS and ONS: neuropathy, pyramidal signs, restless leg syndrome, ataxia

Some SCA only cause cerebellar ataxia

56
Q

SCA type 3/ machado-Jospeh disease

A

Most common inherited SCA worldwide

Ataxia, Parkinsonism, possibly dystopia, facial twitching, ophthalmoplegia, bulging eyes

57
Q

AOA 1

A

Ataxia oculomotor apraxia
Autosomal recessive
Aprataxin
Onset folder-adolescent

58
Q

AOA 1 S/s

A

Horizontal and vertical oculomotor apraxia
DTR disappear early
Axonal neuropathy —> distal muscle wasting
Dysarthria develops, choreoathetosis frequnent
Possible pyramidal signs

59
Q

AOA2

A

Autosomal recessive
Senataxin
Onset pre and early teens
Progressive cerebellar ataxia followed by oculomotor apraxia and sensorimotor neuropathy

NeuroRehab (33 decks)

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