Day-Of Study Notes for neuro test Flashcards by Alexander Lee

Relating to bladder function: The pons inhibits the ________ + __________

The pons controls the __________ which use ______ fibers to activate the bladder wall

pelvic floor muscles and external sphincter

Sacral urination center which uses parasympathetic fibers that activate the bladder wall

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The _________ inhibits the pons when it’s not a good time to peepee

Frontal cortex

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What tract releases seratonin?

What tract released Norepinephrine to help with tonic facilitation?

Raphespinal

Ceruelospinal

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Flexor nerve are usually more _____ to extensor nerves

Distal nerves are usually more ______ to proximal nerves

distal

Lateral

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What tract has to do with anticipatory postural changes?

Reticulospinal

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The anterior spinocerebellar and the rostrospinal are both __________ and ________

Single fiber

Internal feedback

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The rostrospinal is an (ipsi/contralateral) feedback tract from spinal levels ____

Ipsilateral

C1-T1

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Subconcious temperature info is transmitted to the ________

Reticular formation and thalamus

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The slow medial nocieption tract uses what fibers?

C fibers

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What is the destination of the anterior/lateral spinothalamic tract?

Primary and secondary association somatosensory cortex

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The anteriolateral spinothalamic 1st and 2nd order neurons synapse in the….

Substantia gelitanosa

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What spinal levels control reflexive bladder function

T11-L2

S2-S4

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During Hemi-cord syndrome (Brown-Sequard)

You typically see (contralateral/ipsilateral) absence of anteriolateral spinothalamic senses

and (contralateral/ipsilateral) of motor/DCML

Contralateral anteriolateral

Ipsilateral motor/DCML

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_____ cord syndrome typically stretches the anterior c artery

Anterior cord syndrome

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What tract functions are usually unaffected by anterior cord syndrome?

DCML

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Central cord syndrome is usually caused by….

Extension/trauma

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In central cord syndrome (usually cervical)

Small lesions usually cause ____

whereas large lesions _____

Small: nociceptive
& pain impaired at the
level of the lesion

Large: additionally
see upper limb motor
impairments

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True or false: In Cauda Equina syndrome, complete lesion of cauda equina are common

False

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True or false: In Cauda Equina syndrome, you typically see spasticity and hyperreflexia

False, they are abscent

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Stretch injuries of the spinal cord or cauda equina during
child development/growth spurts can cause….

Tethered cord syndrome

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In tethered cord syndrome

Stretching of the spinal cord causes ____

whereas damage to cauda equina causes ____

Upper motor neuron signs

Lower motor neuron signs

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Tethered cord associated with ________

spina bifida
myelomeningocele (L4, L5, S1)

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Damage to the lumbar
and/or sacral spinal roots

Sensory impairments

Flaccid paresis/paralysis of
lower limb muscles,
bladder, & bowels

These describe what?

Cauda equina syndrome

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Spinal shock lasts at least 24 hours and may last ____

2-3 weeks

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The end of spinal shock is marked by return of ____ reflexes

Anal reflexes

With a spinal cord injury, Spinal neurons can become __________ , developing ___________ as neuroplasticity develops new synapses in reflex pathway

Hyperexcitable, hyperreflexia

Somatic reflexes are gone Autonomic reflexes of smooth muscles are impaired or lost Autonomic regulation of blood pressure is impaired Temperature regulation is lost (sweating and goose bumps) These are symptoms of...

Spinal Shock

Injury at S2-S4 or related nerve roots causes **flaccid areflexive bladder** What does this cause and how can it be treated in males?

Overfilling and leaking of bladder Condom catheter

Injury above S2-S4 interrupts descending tracts causing ________ and _______ bladder

**hypertonic, hyperreflexive bladder**

Injury above S2-S4 interrupts descending tracts will require.....

Intermittent catheterization or indwelling catheter required Note: Spasticity of bladder wall can potentially force urine back to kidneys

Lesion between S2 and S4 reflex circuit in males causes....

Impotinence, genitial has no sensation (worst one)

Males with lesion between L2 and S2 will likely have what sexual function?

Normal sexual function due to intact L1-L2 aswell as parasympathetic nerves in S2-S4 being intact. **Genitial sensation is abscent however**

Males with a SCI above T12 will have what sexual function?

Loss of psychogenic erection, no sensation, reflexive erection/ ejaculation possible

Sexual function: Males after a SCI will have ____ Females after a SCI will have ____

Males: Low spermcount/fertility Females: Fertility returns to normal after SCI However, pregnancy can be high risk due to lack of sensation, muscle contractions and **may require Ceasarian section**

Urination/defecation problems Reduced or lost sensation in “saddle” area LBP Unilateral/B sciatica LE weakness and sensory deficits Reduced LE reflexes These are symptoms of _______

cauda equina lesions

What are 2 mechanisms for UMN overactivity?

Absence of corticospinal/ DORSAL reticulospinal inhibition OR Brain stem UMN overactivity

What is clasp-knife phenomenon

Catch is build up of resistance to stretch initially Basically initial rigidity followed by relaxation during PROM

Spasticity arises when pyramid tract is interrupted at: ____ ____ ____

Cortex, Corona Radiata, Internal Capsule

Lesions must include the _______ to produce spasticity

Pre-motor cortex

What tract is found in the genus of the internal capsule?

Corticobulbar

Where does the cortico-reticular tract arise?

Premotor and supplementary motor areas

Where does the cortico-reticular tract go?

Medial and lateral/dorsal reticulospinal

What is the ventromedial reticular formation?

Inhibitory area in medulla, dorsal to pyramids Controlled by pre-motor cortex INHIBITS SPINAL STRETCH REFLEX via dorsal/lateral reticulospinal tract

The excitatory system of the extrapyramidal tracts facilitates ______ and inhibits ____

Facilitates: Spinal stretch reflex, extensor tone Inhibits: flexors (Note: under less cortical control than inhibitory system)

True or false: Lesions of ventromedial reticular formation or the dorsal/lateral reticulospinal tract will produce spasticity

True

What are the different kinds of spinal segmental inhibition?

1a presynaptic inhibition 1a reciprocal inhibiton 1b autogenic inhibiton Renshaw cell inhibition

1a presynaptic inhibition is mediated by the release of ________

GABA-ergic neurotransmitters that decrease efficacy of 1a afferent transmitters release

Renshaw cells inhibit homonymous muscles and _____

Synergistic muscles Note: they also inhbiit both gamma MN and 1a neurons

Recurrent neurons excite renshaw cells using what neurotransmitter?

AcH

What is the most common measurement of spasticity?

Modified Ashworth scale Patient in relaxed position (generally supine) Passively move joint rapidly through available PROM Graded 0-4

Describe the pathway of the consensual blink response

1st order neuron – trigeminal ganglion 2nd order neuron – spinal trigeminal nucleus To interneuron in reticular formation To B CN VII facial n to B orbicularis oculi to blink both eyes

What nerve innervates the "Stapedius of ear"

Facial N

Vestibular system considered central and peripheral . what is the Peripheral part?

Peripheral part = peripheral vestibular n and vestibular apparatus

True or false: Damage to 1 spinal segment or root cannot completely paralyze any limb muscle

True, due to the plexus

Traumatic axonopathy: If Schwann cells and connective tissues intact, can regrow at rate of __________ Occurs after crush injury or closed fracture

1mm/day

Carpal tunnel syndrome is example of...

Traumatic myelinopathy

Repeated mechanical pressures impair blood flow and cause changes to connective tissue of nerve Myelin becomes damaged and with sensitization of nociceptors the n becomes excessively sensitive to mechanical or chemical stimuli Can have full recovery

How does polyneuropathy progress?

Distal to proximal (stocking glove)

The first symptoms of polyneuropathy tend to be....

First symptoms tend to be sensory loss/dysfunction Small fiber symptoms: pain, temperature, numbness, dysthesias Large fiber symptoms: sensory ataxia, proprioception and vibration sense

Guillain-Barré Syndrome

Inflammatory demyelinating syndrome that typically occurs after viral infection causing more motor than sensory problems, distal to proximal progression Urgent need to seek medical help due to risk of respiratory failure Sig # require ventilator support Prognosis good for recovery for classical form; some rarer variants cause axonal injury

CNS injuries vs PNS injuries on a NCV test

CNS injuries have normal nerve conduction velocity whereas PNS injuries have decreases velocity and amplitude

What has faster muscle atrophy? A CNS injury or a PNS injury?

PNS