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SF2 > E2 > Flashcards

E2 Flashcards

1
Q

The gray matter of the brain/spinal cord consists of ______?

A

cell bodies + nuclei- functional part

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2
Q

The white matter of the brain/spinal cord consists of _____?

A

axons - pathways for informational travel

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3
Q

Association pathways connect what regions of the brain?

A

Different areas within the same hemisphere

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4
Q

Commissural pathways connect what regions of the brain?

A

Both sides of the brain, but the same areas of each side (homotopic)

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5
Q

Projection pathways connect what regions of the brain?

A

Connect specific areas to other areas or nuclei. Can be ascending or descending (sensory or motor)

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6
Q

What is the difference between 1st, 2nd, and 3rd order neurons?

A

A 1st order neuron is the one coming out to the spinal cord where it synapses on neuron 2, which then goes up to the brain and synapses on neuron 3

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7
Q

Afferent neurons carry _____ information

A

Sensory

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8
Q

Efferent neurons carry ____ information

A

Motor (EFFerent, EFFect)

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9
Q

What are the two groups of our conscious sensory information? What do they consist of?

A

Exteroceptive (Somatic (touch, pressure temp, pain) and telereceptors (vision and hearing), and proprioceptive (locomotor and vestibular labyrinth)

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10
Q

What is the non-conscious component of sensory information?

A

Proprioception

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11
Q

The corticospinal tract is the major …..

A

voluntary motor pathway

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12
Q

Where do dorsal rootlets enter?

A

Shallow longitudinal groove (posterolateral sulcus)

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13
Q

Where do ventral rootlets leave

A

Anterolateral sulcus

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14
Q

In terms of spinal cord anatomy, what is unique about the cervical and lumbar regions?

A

Cervial has a region from C5 to T1 called the “Cervical enlargement”, this region supplies the upper extremities. Large because it controls a lot of things Similar for lumbar except it is L2 to S3 and it supplies lower extremities

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15
Q

What is the pyramidal decussation? Where is it located. What is important about it?

A

It is a region at the top of the spinal cord where some nerve tracts cross over.

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16
Q

throughout development, each spinal nerve retains its relationship with this mesoderm derived embryonic structure. What is this structure? What is the exception to this rule?

A

Somite. C1 is the exception because it typically has only a rudimentary dorsal root.

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17
Q

What cord segment innervations the deltoid and supraspinatus? Biceps, brachialis? Triceps?

A

C5 C6 C7

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18
Q

The corticospinal tract is located in what region of the spinal cord?

A

The lateral funiculus

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19
Q

posterior column of medial lemniscus resides in what region of the spinal cord?

A

gracile and cuneate fasciculus

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20
Q

Where is the lateral gray horn present in the spinal cord?

A

Thoracic region and first 2-3 lumbar.

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21
Q

The cuneate fasciculus is present in what region of the spinal cord?

A

Cervical

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22
Q

Why is the anterior horn bigger than the posterior?

A

The anterior horn is motor control, therefore this region has muscles to control and is larger because of that

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23
Q

The anterior horn contains what?

A

Alpha and gamma motor neurons, and where the cells of origin of the fibers of ventral roots

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24
Q

Intermediolateral gray horn is between the dorsal and ventral gray horns, what does it contain?

A

In the thoracic and upper lumbar regions it contains preganglionic cells for the autonomic nervous system. These neurons give rise to sympathetic axons that leave via ventral root and travel to the sympathetic ganglia via white rami. At S2, S3, S4 are sacral parasympathetic neurons, which leave within the sacral ventral roots, and leave to synapse on neurons in pelvic viscera

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25
Q

How can you tell the difference between Cervical, thoracic and lumbar cross sections of spinal cord?

A

Cervical: Dorsal grey column is narrow and ventral is broad Thoracic: Dorsal and ventral columns are narrow and lateral horn present Lumbar: Broad dorsal and ventral columns

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26
Q

Ascending and descending pathways have a defined location in _____

A

White matter

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27
Q

Ascending and descending pathways have a defined location in _____

A

White matter

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28
Q

The posterior column of the spinal cord consists of the… (2 things)

A

Gracile and Cuneate fasciculus

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29
Q

The posterior column of spinal cord is responsible fo transmission of..

A

Fine/discriminative touch, conscious proprioception and vibration

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30
Q

The anterolateral system contains the… (2 tracts)

A

Spinothalamic and spinoreticular tracts

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31
Q

The anterolateral system is responsible for the …

A

Transmission of pain, temperature, non-discriminative touch

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32
Q

What arteries give rise to to the arteries of the spinal cord?

A

Vertebral and radicular

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33
Q

What are the arteries of the spinal cord and where are they anatomically?

A

Anterior spinal artery and two posterior spinal arteries. In the ant/post. They form a spinal arterial plexus around the cord

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34
Q

Explain the knee jerk reflex.

A

It stretches the patellar tendon which stretches the quadriceps muscle. 1a endings are excided and excite alpha motor neurons of quadriceps, they contract. The hamstring muscles are inhibited via reciprocal inhibition

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35
Q

Explain clasped knife reflex

A

If a person has a certain pathologic condition, resistance of muslces is greatly increased. If enough force is applied, the arm/leg will fold tight like a knife

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36
Q

What are two main functions of the nasal cavity?

A

Modifies air and helps smell things.

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37
Q

What are the nasal cartilages?

A

Septal and Alar. Lateral nasal is fuse with Septal.

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38
Q

What is the role of nasal conchae?

A

They increase surface area of the inner nose

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39
Q

What are boundaries of nasal cavity?

A

Palate, Maxillary bone, Palatine bone, Nasal bone, frontal bone, Ethmoid (cribiform plate), sphenoid

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40
Q

If a patient presents with a clear fluid coming from the nose after an injury to the nose, what could have happened and what could occur if not treated?

A

The cribiform plate could be fractured leaking CSF down the nasal cavity. Meningitis could develop.

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41
Q

What are the names of the 3 concha and how can you identify them? During a nose exam, which can you not see?

A

Superior, middle and inferior. Superior is highest and smallest. Cannot see superior

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42
Q

What bones form the superior, middle, and inferior concha?

A

Superior and middle are part of ethmoid, while inferior is a separate bone

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43
Q

What is the space above the superior concha called?What is present there?

A

Spheno-ethmoidal recess. Olfactory foramina and spehnoid air sinus

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44
Q

What is the sensation type of the nose and where does it derive? What are the nerve branches named?

A

Somatic Sensory. V1 and V2. V1- anterior ethmoidal nerve. V2- Nasal branches, Nasopalatine N.

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45
Q

The mucous glands of the nose are what type of innervation via what nerve?

A

Visceral motor, parasympathetic. Via Facial nerve by pterygopalatine ganglion

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46
Q

Irritation of the ptergopalatine ganglia can cause an increase in…

A

Mucous and tears

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47
Q

What arteries supply the nasal cavity?

A

Sphenopalatine A from Maxillary. Ant and Post ethmoidal A from Opthalmic. Facial A branches.

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48
Q

What veins drain the nasal cavity?

A

Ethmoidal V drain to opthalmic, other to pterygoid venous plexus, facial vein.

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49
Q

Why can a nosebleed produce significant amounts of blood? How do you know if it is arterial or venous?

A

Anastomoses. Would spurt if it was arterial.

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50
Q

What are the names of the paranasal sinuses? Which one, if blocked via infection can spread to the orbit?

A

Frontal, ethmoid, sphenoid. Ethmoid.

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51
Q

Do babies have sinuses?

A

Nope

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52
Q

What is the largest sinus? What is the clinical association with it?

A

Maxillary sinus. Roots of maxillary teeth are in floor of sinus and this can be damaged by a tooth extraction.

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53
Q

What nerve supplies the Max sinus and teeth?

A

V2. A sinus infection can feel like a tooth ache.

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54
Q

Describe development of primary and secondary palate

A

Primary palate is anterior to incisive foramen and formed by union of Medial Nasal Processes. The secondary palate is posterior to incisive foramen and is formed by fusion of the maxillary processes

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55
Q

Explain how a posterior cleft palate forms, and an anterior cleft palate (cleft lip).

A

PCP forms from the maxillary processes on both sides not fusing. ACP forms from medial nasal process AND maxillary processes not fusing

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56
Q

What is the function of the soft palate?

A

Flap valve that closes off the nasopharynx during swallowing

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57
Q

What are the muscles of the soft palate?

A

Tensor palati, Levator Palati, musculus uvuli, palatoglossus.

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58
Q

When you contract these muscles of the soft palate, it opens the auditory tube and equilibrates pressure. What are these muscles

A

Tensor and Levator Palati

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59
Q

What supplies blood to the palate?

A

Descending palatine A (from maxillary A) this dovodes tp hard palate GREATER PAL A. and soft palate LESSER PAL A Sphenopalatine artery passes through the incisive foramen Ascending palatine A. (from Facial)

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60
Q

What innervation is the palate? What nerves do this.

A

ALL V2 (somatic sensory) Greater palatine N, nasopalatine N (both to hard), lesser palatine N (soft)

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61
Q

Where does lymphatic drainage of palate go?

A

Retropharyngeal nodes

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62
Q

The palatoglossal arch is the site of the… What is the innervation of these regions?

A

Oropharyngeal membrane, boundary between the Oral cavity and pharynx. The oral cavity is somatic sensory. Pharynx is visceral sensory

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63
Q

Muscles of the palate are under what type of control?

A

Branchiomotor, voluntary control.

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64
Q

What muscles push the bolus back when contracting?

A

Mylohyoid and Styloglossus. Note: this is voluntary

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65
Q

What is the mistake to do when eating food? Why?

A

Talk. Palate goes down, and nasopharynx is no longer sealed off. This can put food into your nasal cavity.

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66
Q

What nerve/artery can be damaged in a tonsillectomy?

A

Glossopharyngeal nerve, tonsillar branch of facial A.

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67
Q

Where does the lymphatic drainage of the palatine tonsils go?

A

Deep cervical nodes.

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68
Q

What are the veins of palatine tonsils?

A

Pharyngeal plexus to facial lingual or inferior jugular.

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69
Q

What muscles form the tonsillar bed?

A

Superior constrictor of Pharynx and styloglossus

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70
Q

What are the names of the branches of the Facial A that supply palate and tonsils?

A

Ascending palatine artery and tonsillar branch

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71
Q

If looking at a sagittal view of the submadibular region, what is the order of muscles from top to bottom?

A

Genioglossus, geniohyoid, mylohyoid, digastric

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72
Q

What is ludwig’s angina?

A

Infection of submandibular space (floor of mouth), often due to an abscessed mandibular tooth

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73
Q

What is the sulcus terminalis and where is it located? What does it divide?

A

It is the “V” shape groove that divides tongue into Ant 2/3 of tongue, and post 1/3. Ant is somatic sensory, post is visceral sensory.

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74
Q

What is the foramen cecum and what is its significance?

A

It is the pit in the middle of the sulcus terminalis, which is the site of invagination of the thyroid gland

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75
Q

What innervates the muscles of the tongue?

A

CN XII

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76
Q

What is the clinical sign of a patient with a damaged hypoglossal nerve (Lower motor neuron)?

A

The tongue protrudes and deviates TOWARD the lesion due to unopposed action of the genioglossus muscle

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77
Q

What way will the tongue deviate in an upper motor neuron lesion?

A

Away from side of cotrical lesion

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78
Q

What is the lymphatic drainage of the tongue? (3 regions)

A

Tip of tongue - submental nodes Rest of Ant 2/3 - submandibular nodes and deep cervical nodes Post 1/3 of tongue - deep cervical lymph nodes

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79
Q

What is the clinical sig. about lymph vessels?

A

They cross the midline of the tongue, so the lesion may spread to the opposite side

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80
Q

What is sensory innervation of the tongue?

A

Ant 2/3 - V3 (touch) and CN7 (taste) (Lingual N. and Chorda Tympani) - the Lingual hitchhikes with the Chorda Tympani Post 1/3- CN 9 Ant to epiglottis - Vagus

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81
Q

The facial nerve has three branches in the Facial Canal, what are they? What do they do and what type of innervation are they?

A

Greater Petrosal N. (Visceral motor to parasymp of lacrimal and mucous glands. Visceral sensory to nasopharynx) Stapedial N. - Branchiomotor to stapedius Chorda Tympani - Taste to ant 2/3 of tongue, visceral motor parasymp to submandibular, sublingual, and salivary glands

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82
Q

What is the name of the fissure that chorda tympani travels in? What else travels here?

A

Petro- tympanic fissure , Ant. Tympanic A.

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83
Q

Severing the lingual nerve in the floor of the mouth can by an impacted tooth or a fall can cause what?

A

Severing the lingual nerve + hitchhiking fibers of CN 7 Will lose general sensation to Ant tongue and taste to Ant 2/3

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84
Q

Where does CN 7 exit the skull? Where does it leave in the skull internally?

A

Stylomastoid foramen - internal auditory meatus

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85
Q

The parasympathetics of CN7 go to what ganglia? Then to where?

A

Pterygopalatine to lacrimal gland, mucous, nose palate. Some also go to submandibular ganglia

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86
Q

A tumor at the internal auditory meatus (an acoustic neuroma) produces what effects by blocking what nerve(s)?

A

Blocks CN 8 and 7. 8 will cause auditory/vestibular deficits 7 will have all symptoms present - facial paralysis, hyperacousia, loss of taste to ant 2/3, decrease secretion of lacrimal

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87
Q

What is the clinical presentation of damage to CN 7 at the stylomastoid foramen or parotid gland?

A

ONLY Facial paralysis NO loss of taste, hyperacousia, decrease in secretion note: CN 8 not effected here

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88
Q

What two vessel / nerve run in the temporal fossa?

A

Superficial temporal artery and Auriculotemporal N (V3)

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89
Q

What A. supplies blood to the nasal cavity, calvarium, oral cavity, middle ear?

A

Maxillary A.

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90
Q

The maxillary A. cannot be ligated, so to stop a bleed branches must be ______

A

Cauterized

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91
Q

What are the branches of the Maxillary A.?

A

1st part Deep Auricular A, Ant Tympanic A, Middle Meningeal A, Accessory Meningeal A, Inferior Alveolar A 2nd part: Deep Temporal A, Pterygoid A., Masseteric A, Buccal A, 3rd part: Post Sup Alveolar A, Descending Palatie A, Artery of Pteryoid canal, Sphenopalatine A, Infraorbital A

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92
Q

Damage to the middle meningeal artery can cause…

A

Epidural Hematoma, Uncal herniation, Tonsillar herniation

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93
Q

Why can infections spread from the teeth, nasal cavity, palate, to brain?

A

Because the pterygoid plexus has anastomoses with veins that drain to the cavernous sinus

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94
Q

What are the three ligaments of the Temporo-madibular joint?

A

Temporo-mandibular ligament, sphenomandibular ligament, stylomandibular ligament

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95
Q

The muscles of mastication are all what innervation?

A

Branchiomotor by V3

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96
Q

Which direction does the lateral pterygoid pull the disc when opening mouth?

A

Antieriorly

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97
Q

When the jaw is stuck from injury, what is it stuck on?

A

Articular tubercle

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98
Q

Trigeminal nerve damage how does the jaw deviate?

A

Goes TOWARD paralyzed side when patient opens mouth due to unopposed action of lateral pterygoid muscle

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99
Q

What nerve is involved in the jaw jerk reflex?

A

Senory and motor V3

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100
Q

What germ layer does the parotid gland bud from?

A

Ectoderm

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101
Q

What are accessory parotid glands?

A

Incomplete joined parotid glands - shows no clinical significance

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102
Q

A viral infection of the parotid can lead to pain in what region due to compression of what nerve?

A

Pain in ear from Auriculotemporal nerve compression (V3)

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103
Q

What is the innervation of Parotid?

A

Visceral motor parasymp of CN 9

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104
Q

Where is conscious sensation perceived? What are the two types of sensation?

A

At the cerebral cortex. Exteroceptive (somatic receptors include touch, pressure, heat, cold, pain) and proprioceptive

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105
Q

Where is non-conscious sensation perceived? What are the two types of sensation?

A

It is not perceived, it is routed to the cerebellum. The two types are proprioception and interoception (involves unconscious afferent signals)

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106
Q

In general, what is the purpose of an ascending pathway?

A

To take sensory information up to the brain.

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107
Q

What are the two major pathways for somatic sensory perception?

A

Posterior (Dorsal) Column - Medial lemniscal pathway Spinothalamic (anterolateral) pathway

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108
Q

Where does the Posterior dorsal column pathway decussate?

A

At the medulla (cunea nucleus, cuneate gracilis)

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109
Q

Neurons are post-mitotic cells, meaning….

A

If they die they cannot be replaced

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110
Q

Name the three meninges surrounding the brain and spinal cord

A

Dura, subarachnoid space, and pia

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111
Q

Is the dura of the brain continuous with the dura of the spinal cord?

A

NO

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112
Q

What is the role of the dural septa in the brain?

A

It divides the brain and provides support and protection.. Protects the brain against sudden and violent head movements

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113
Q

What does the falx cerebri separate?

A

The two cerebral hemispheres

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114
Q

What does the tentorium cerebelli separate?

A

The cerebellum from the cerebrum

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115
Q

The midbrain fits through a notch formed by the tentorium cerebelli, what is it called?

A

Tentorial incisure

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116
Q

Infratentorial lesions are more common in children or adults?

A

children

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117
Q

Supratentorial lesions are more common in children or adults?

A

Adults

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118
Q

What is the big purpose of the dural venous sinuses?

A

A way to circulate and return CSF to general circulation

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119
Q

Describe the arachnoid matter.

A

A delicate membrane between pia and dura mater where all major blood vessels lie in this region (in the subarachnoid space). Making this space common for hematomas

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120
Q

Name the 4 major cisterns. What fluid is in the cistern?

A

Cerebellomedullary cistern, pontine cistern, interpenduncular cistern, lumbar cistern. CSF

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121
Q

What is the role of arachnoid villi? What can happen to these and what is the clinical condition?

A

They reabsorb CSF from subarachnoid space to superior sagittal sinus. They can become calcified, often in the elderly, and this can lead to herniations and hydrocephaly

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122
Q

Describe pia mater. What is unique about arteries that dive into the inner brain from the pia?

A

Thin, highly vascularized layer that covers closely to the surface of the brain and spinal cord. The pia covers the arteries when they dive to the inner brain (Virchow-Robin Space)

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123
Q

Describe the flow of CSF with regards to the portion that extends to the eye. What is the clinical condition that can result from increase CSF pressure?

A

The CSF flows down but does not necessarily have a way back. An increase in pressure can squeeze the venous return and lead to papilladema

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124
Q

What is the largest ventricle?

A

Lateral ventricle

125
Q

What is the name of the 4 parts of the lateral ventricle?

A

Frontal (ant.) horn, body, temporal (inf.) horn, occipital (post.) horn

126
Q

What separates the lateral ventricles?

A

Septum pellucidum

127
Q

What are the walls of the third ventricle formbed by?

A

Thalamus and hypothalamus

128
Q

What are the outpockets of the 3rd ventricle?

A

Infundibular, optic, pineal, suprapineal recesses

129
Q

What connects the 3rd and 4th ventricles? Why is this important?

A

Connects to the 4th via the cerebral aqueduct of sylvius, which is very prone to blockage. (pineal tumor)

130
Q

What forms the 4th ventricle?

A

Cerebellum and pons and medulla

131
Q

What is a big role of the circumventricular organs?

A

to tell the brain what is in the blood so the brain can respond appropiately

132
Q

What is the role of pineal body?

A

Secretion of melatonin, regulation of circadian rythyms

133
Q

What is the role of the organum vasculosum of the lamina terminalis?

A

Sensory area that supplies input to other brain regions, contains osmoreceptors sensitive to Na+ and osmotic pressure in blood

134
Q

What is the role of the median eminence?

A

Secretion of hormones

135
Q

What is the role of subcommissural organ?

A

Produces transthyretin

136
Q

What is the role of the pituitary gland (neurohypophysis)

A

Secrete oxytocin and vasopressin

137
Q

What is the area postrema and the role in the body?

A

Detect toxins in blood, vomit center. Responsible for sea and travel sickness

138
Q

What secretes CSF? Where does this occur?

A

Choroid plexus. Lateral and 4th ventricles

139
Q

Where is CSF found?

A

Ventricles, subarachnoid space, cisterns (these are all continuous with each other

140
Q

What is typically the state of CSF in the body?

A

Clear, sterile

141
Q

What does pink/red CSF suggest?

A

Blood in the CSF (could be a bad tap)

142
Q

What does yellow color and spontaneous clotting?

A

Could mean increased bilirubin from RBC lysis, increased protein, MS

143
Q

What does cloudy or white CSF suggest?

A

Could suggest infection, bacterial meningitis, which would lead to increased protein and decreased glucose

144
Q

What does clear to cloudy CSF suggest?

A

Aseptic meningitis, would have normal values for protein and glucose so less likely to be bacterial

145
Q

Explain the circulation of CSF.

A

CSF is formed in the lateral ventricles by choroid plexus and passes through the interventricular foramina into the third ventricle. Then thru the cerebral aqueduct into the 4th ventricles where more CSF is added. Then thru the foramen of magendie and foramina of luschka apertures into the cisterna magna and pontine cistern. From these basal cisterns, the fluid slowly moves thru the tentorial notch, up and over the cerebral hemisphers thru the arachnoid villi and into the superior sagittal sinus. Some CSF moves from the cisterns around the 4th ventricle to the subarachnoid space, then to the spinal cord

146
Q

How does CSF move through the CNS?

A

Through arterial pulsations, respiratory movements - they cause a constant ebb and flow

147
Q

What is the equation for cerebral perfusion pressure?

A

CPP= mean arterial BP minus intracranial pressure

148
Q

If pressure increases in the skull, what compensatory mechanism will occur?

A

CPP will decrease by decreasing blood flow pressure

149
Q

What is a subfalcine herniation?

A

A herniation of brain matter between the lower part of the falx cerebri and the corpus callosum

150
Q

What is an uncal herniation?

A

Herniation of the uncal region of the temporal lobe thru the tentorial notch

151
Q

What symptoms can arise from an uncal herniation?

A

Contralateral motor weakness if compression of the ipsilateral crus cerebi. If compressed against tentorium cerebelli at the contralateral crus, then it will be ipsilateral motor weakness Decreased consciousness, pupillary dilation on side of herniation due to compression of CN3 parasymp.

152
Q

What symptoms can arise from tonsillar herniation? What is a tonsillar herniation?

A

The tonsil region going through the foramen magnum, squeezing medulla oblongata. Significant decrease in level of consciousness, change in vital signs. Can cause death from cardiac/respiratory failure

153
Q

A subarachnoid hemorrhage can be spontaneous, how does this occur?

A

Rupture of berry aneurysm at Circle of Willis.

154
Q

What are the cardinal symptoms of a subarachnoid hemorrhage?

A

Sudden onset of severe headache, stiff neck, altered consciousness

155
Q

What region of the skull is the worst to fracture?

A

The base of the skull

156
Q

What is the shape of an epidural hematoma on a CT/MRI. What common A. ruptures in this situation?

A

Lens - Middle Meningeal A

157
Q

What is the shape of an subdural hematoma on a CT/MRI. What common vessel ruptures in this situation?

A

Crescent shaped - Bridging veins

158
Q

TBI is a risk factor for what diseases?

A

Alzheimers, Parksinsons, ALS

159
Q

What is chronic traumatic encephalopathy (CTE)? Symptoms?

A

Repeated TBIs over a period of time. Memory loss, paranoia, depression, ataxia

160
Q

What are the two types of hydrocephalus?

A

Non-communicating and communicating AKA obstructive vs non-obstructive

161
Q

What is the difference between non-communicating and communicating hydrocephalus?

A

Non-communicating means CSF flow out of one or more ventricles from 4th to subarachnoid is blocked. Communicating means too much CSF is made ornot enough is absorbed

162
Q

Anatomically speaking, what is the common culprit in non-communicating hydrocephalus? What condition can cause this?

A

Aqueduct of sylvius. A tumor.

163
Q

Idiopathic intracranial hypertension is what?

A

Increased ICP with no apparent cause on imaging.

164
Q

In a patient with ICP (idiopathic intracranial hypertension) what is a common symptom. What provides relief almost immediately?

A

Daily pulsatile headaches, possible visual disturbances. A lumbar puncture will provide instant relief.

165
Q

What is the common patient characteristics of a person with ICP?

A

Female, obese, XS Vit A, estrogen BC, tetracycline antibiotics

166
Q

What is normal hydrocephalus? What group is this prevalent in?

A

In elderly adults, it can be due to an imbalance between production/reabsorption of CSF, but can occur without na increase in ICP

167
Q

What are the symptoms of normal hydrocephalus?

A

Gait difficulty, cognitive disturbance, urinary incontinence

168
Q

Where does the spinothalamic pathway decussate?

A

At the level it enters

169
Q

What information does the cuneate fasiculus carry, and what vertebral level?

A

Starts at T6, carries anything T6 up like the arm, upper trunk, neck, occiput

170
Q

The medial portion of the gracile fasiculus carries information from what region?

A

Legs and lower trunk

171
Q

Where do 1st order afferents of the posterior column medial lemniscal pathway terminate?

A

Gracilis and cuneatus in medulla oblongota

172
Q

Where do 2nd order afferents of the posterior column-medials lemniscal pathway terminate?

A

Thalamus

173
Q

Where do 3rd order afferents of the posterior column-medials lemniscal pathway terminate?

A

Somatosensory cortex

174
Q

What is the function of the medial lemniscal pathway?

A

Conscious proprioception and discriminative touch

175
Q

Disturbance of the posterior column pathway is common in what diseases? What are symptoms?

A

Demyleninating diseases like MS. Classic symptom is sensory ataxia and positive Romberg sign

176
Q

Describe the somatotopic organization of the anterolateral tract.

A

Like an onion layer, the inner most is Neck, then arm, trunk, leg (outermost layer).

177
Q

What are the three tracts in the anterolateral pathway?

A

Spinothalamic, spinoreticular, spinomesenphalic

178
Q

What type of information does the spinothalmic tract carry?

A

Pain and temperature

179
Q

Why do some axons of spinothalamic ascend/descend in Lissauer’s tract before entering the central gray?

A

It provides a more coordinated response

180
Q

Where do the 1st order neurons of the spinothalamic tract synapse onto the 2nd order?

A

In the dorsal horn (lamina 1 and lamina 5)

181
Q

Are primary afferents of nerves that make up spinothalamic tract myelinated?

A

No

182
Q

What level of afferent decussates in the spinothalamic tract. Where does it do this?

A

The secondary afferent decussates at the level it enters the spinal cord

183
Q

Where do they anterior spinal thalamic tract and the lateral spinal thalamic tract merge? What does each one contribute to in terms of sensation. What else hitchhikes with these fibers in the head region?

A

They merge in the brain stem and form the spinal lemniscus. The ASTT contributes touch. LSTT is temperature and pain (mediating noxious and thermal sensation separetly) Trigeminal nerve

184
Q

All input from the spinothalamic tract end up where?

A

Somatosensory cortex

185
Q

In the homunculi, what is the relationship between size and sensory function?

A

The things with more important sensory need (hands, face) occupy a larger area of the somatosensory cortex

186
Q

Describe the spatial relationship of the somatosensory cortex and the motor cortex

A

The somatosensory cortex is behind the gyrus (in the back) and then motor cortex is in front of gyrus

187
Q

What incident often leads to Syringomyelia? What is it and what clinical presentation occurs.

A

Often occurs in car crashes. Characterized by a cyst in or beside central canal in cervical region, spinothalic fibers are obliterated. Pts present with dissociated sensory loss in a arms and across upper chest - “cloak and arms”

188
Q

What lamina does the spinoreticular tract arise from?

A

6-7

189
Q

Where does the spinoreticular tract terminate -

A

Medullary-pontine reticular formation

190
Q

What is the role of the spinoreticular tract?

A

Arouses the cerebral cortex, inducing a wake state. It reports to the limbic cortex about the nature of a stimulus (pleasurable or aversive)

191
Q

Where does the spinomesencephalic tract arise from?

A

Lamina 1 and 5

192
Q

Where, in the brain, does the spinomesencephalic prokect to?

A

Periaqueductal gray and the superior colliculus

193
Q

What is the role of the spinomesencephalic tract?

A

the regulation of pain

194
Q

You step on a nail with your foot, explain the general way the anterolateral tract will handle this.

A

Spinothalamic - Something sharp on foot Spinoreticular + Spinothalamic intralaminar projections- this sharp thing hurts - OW Spinomesencephalic - It will be okay, it will feel better

195
Q

There are also three pathways that run to the cerebellum, what are these called?

A

Spinocerebellar pathways: Posterior and anterior spinocerebellar tracts, cuneocerebellar tact

196
Q

Yea just know this table, I guess

A

Do et

197
Q

Where does the posterior spinocerebllar tract begin to exist?

A

At the Clarkes nucleus (medial part of lamina 7), which begins at about L2

198
Q

The posterior spinocerebellar tract is principally concerned with the ______ leg

A

Ipsilateral

199
Q

The posterior spinocerebellar tract project ipsilaterally to medial zones of the cerebellum through the ______

A

inferior cerebellar peduncle

200
Q

The cuneocerebellar tract is principally concerned with ________

A

Ipsilateral upper thorax and arm

201
Q

Where do fibers of the cuneocerebellar tract terminate

A

A nucleus in the medulla called the lateral cuneate nucleus

202
Q

Axons of the cuneocerebellar tract projects to the cerebellum through the _____

A

Inferior cerebellar peduncle

203
Q

The anterior spinocerebellar tract is different from the posterior spinocerebellar tract in 3 major ways, what are they?

A

Its sensory information is more compolex due to it receiving input from more than just golgi tendon organs, like cutaneuous receptors and spinal interneurons.

The tract crosses at the level of spinal cord it enters

The route to cerebellum is different, it enters the cerebellum via the superior cerebellar peduncle

204
Q

Two-point discrimination and vibration is detected by what pathway?

A

Posterior column - medial lemniscal pathway

205
Q

The three sensory systems that provide cerebellum input to maintain truncal stability are:

What clinical test tests for this functionality

A

Vision, proprioception, vestibular sense.

Romberg

206
Q

Name where this lesion could be:

Sensory deficit to one half of body (right side of body)

A

Somatosensory cortex: deficit contralateral to lesion. discriminative touch and join position sense affected, contralateral neglect is a CORTICAL SIGN because awareness of our bodies as being part of ourselves is integrated and processed in the cortex

Thalamic region: Deficit contralateral to lesion

207
Q

Name where this lesion could be:

Sensory loss to right side of body except face. Sensory loss to face on left side of body

A

Lateral Pons / Lateral medulla

  • contralateral anterolateral and IPSILATERAL trigeminal pathway

Loss of pain and temperature in body opposite of lesion

Loss of pain and temperature in the face on side of lesion

208
Q

Name where this lesion could be:

Sensory loss to right side of body except face

A

Medial medulla

Lesion involves the medial lemniscus, causes contralateral loss of vibration and joint position sense

209
Q

Name where this lesion could be:

Sensory loss on lower arm, hands or leg

A

In a peripheral nerve.

Can be distal symmetric polyneuropathy causeing a glove and stocking distribution

Or it can be an isolated nerve injury

210
Q

What is Tabes Dorsalis caused by? What is it?Symptoms?

A

Tertiary syphillis

It is inflammation of dorsal roots resulting in degeneration of dorsal columns of spinal cord

PT will present with bilateral loss of fine touch, vibration, and conscious proprioception. PT may present with Romber or Lermittes sign

211
Q

What is Lermitte’s sign

A

Electric like shock that occurs when there is damage to the dorsal columns in the cervical areas of the spinal cord

212
Q

A deficiency in Vit B12 intake or metabolism can cause …

Who may have this type of disorder?

A

Subacute combined degeneration:

Spinal cord degeneration via demyelination and loss of axons.

Vegans

213
Q

MS can involve demyelination of ____ pathway

A

CNS

214
Q

A lesion of the postcentral gyrus can induce what in patients?

A

Sensation loss, paresthesias may be present,

Pt will lose two-point discrimination, difficutly localizing painful stimulation precisely, astereognosis (loss of size/shape/texture discrimination), agraphesthesia

215
Q

The parasympathetic nervous system originates where?

A

Brain stem (CN3,7,9,10) and sacral region of spinal cord

216
Q

Preganglionic neurons of the parasympathetic nervous system have ____ axons

A

Long

217
Q

Preganglionic neurons of the sympathetic nervous system have ____ axons

A

short

218
Q

The sympathetic nervous system orginates where?

A

Thoracic and lumnar cord (T1 - L3)

219
Q

Fibers of the autonomic nervous system travel down what tract/pathway?

A

Central Autonomic Pathway

220
Q

What is referred pain? Where would one experience referred heart pain?

A

Poorly localized pain. T1-T4 dermatomes mainly left side

221
Q

What is the great voluntary motor pathway? Where do 40% of its fibers take origin from?

A

Corticospinal tract.

Precentral gyrus

222
Q

What is the path of the corticospinal tract?

A

Descends through the corona radiata and posterior limb of the internal capsule to reach the brainstem.

Continues through the crus of the midbrain and the basilar pons to reach the medulla oblongata

Forms the pyramid

223
Q

The 3 major descending motor systems we focused on are the..

A

Lateral and anterior corticospinal tracts and the rubrospinal

224
Q

What is the difference between an upper motor neuron and a lower motor neuron?

A

An UMN is a neuron projecting from the brain or spinal cord. They form synapses on LMN in the anterior horns of grat matter in the spinal cord or brain stem.

LMN project from the CNS to various places/muscles

225
Q

Where does the corticospinal tract start?

A

Primary motor cortext (Brodmann 4)

226
Q

Explain the decussation of the corticospinal tract.

A

85% of fibers dessucate at the pyrimidal decussation (end of medulla), and forms the fibers of the lateral corticospinal tract. The remaining fibers form the anterior corticospinal tract, which decussate when they come out of the spinal cord

227
Q

Where does the rubrospinal tract start? What does this suggest about its function?

A

It begins in the red nucleus of the brain stem. This means it does not contribute to higher level brain activity

228
Q

Where does the rubrospinal tract decussate?

A

At the ventral tegmentum

229
Q

What does the rubrospinal tract do?

A

Integrates motor information and influences muscle tone, inhibits some voluntary movement of body

230
Q

Need to learn this: anatomy of the anterior gray horn

A
231
Q

What is the unique property of lateral cortico spinal tract neurons when they synapse upon the alpha and gamma motor neurons of limb muscles?

A

Fractionation. They can selectively activate small groups of neurons for fine control

232
Q

Differentiate alpha and gamma motor neurons

A

Alpha motor neurons supply the extrafusal fibers, and are the main force generators, while gamma motor neurons supply the intrafusal fibers of neuromuscular spindles which contribute to fine motor regulation

233
Q

What is the purpose of renshaw cells?

A

They provide a signal that a muscle has been used enough and pulls back. Limits the activity of contraction of alpha motor neurons

234
Q

What are the first neurons to be activated by the LCST during voluntary movements?

A

1A inhibitory internuncials

235
Q

Compare and contrast clinical presentations of UMN lesion vs LMN lesion

A
236
Q

What is the BIG difference between a UMN lesion vs LMN lesion

A

LMN lesion = FLACCID PARALYSIS

UMN lesion = SPASTIC PARALYSIS

237
Q

Hyperreflexia is characteristic of a ____ lesion

A

UMN

238
Q

Here is a chart to memorize if you have the time

A
239
Q

A pt presents with unilateral face, arm, and leg weakness on the right side of the body. No somatosensory symptoms were noted. Where could the lesion be?

A

Corticospinal fibers between cortex and medulla (internal capsule, pons, cerebral peduncle).

The lesion would be above the pyriamidal decussation so the symptoms would be contralateral to the lesion

240
Q

A pt presents with unilateral face, arm, and leg weakness on the right side of the body. Somatosensory symptoms were noted. Where could the lesion be?

A

Primary cortex damaged possibly dude to stroke or tumor, trauma

241
Q

A pt presents with unilateral arm and leg weakness on the right side of the body. Where could the lesion be?

A

Arm and leg region of the motor cortex, and the cortical spinal cord below medulla and above C5. If the spinal cord was damaged below C5, then there would be some arm sparing.

Spinal cord may also have brown-sequard

242
Q

A pt presents with unilateral face, arm weakness on the right side of the body. Where could the lesion be?

A

Face and arm areas of the motor cortex. The lesion is contralateral. Could have brocas aphasia if occured in dominant hemisphere.

Commonly caused by middle cerebral artery infarct

243
Q

Unilateral arm weakness / paralysis

A

Could be peripheral nerve supplying arm or damage to the motor cortex region for the arm.

Could differentiate based on differences between UMN lesion and LMN lesion

244
Q

Unilateral leg weakness or paralysis

A

Leg area of motor cortex / lateral corticospinal tract below T1 / peripheral nerves supplying leg

245
Q

Unilateral face weakness

A

Could be Bells palsy CN 7 (ipsilateral)

If forehead spared, could be lesion in genu of internal capsule or lesion in motor cortex (contra)

246
Q

Bilateral arm weakness or paralysis

A

Medial fibers of both lateral corticospinal tracts, could be an anterior artery infarct

247
Q

Bilateral leg weakness or paralysis. Where is the lesion?

A

Bilateral leg areas of motor cortex, lateral corticospinal tracts below T1. Cauda equina syndrome

248
Q

Bilateral arm and leg weakness. Where is the lesion

A

Bilateral arm and leg areas of primary motor cortex, bilateral lesions of corticospinal tracts between medulla and C5, peripheral nerve and muscle disorders that affect all four limbs

249
Q

Where does spinal muscular atrophy occur? What is the name of this?

A

Congenital degeneration of cells anterior horns of spinal cord. Pts presents with diffuse proximal weakness and decreased deep tendom reflex

Werdnig Hoffman Disease

250
Q

Amyotrophic lateral sclerosis (ALS) results in …

A

Progressive loss of anterior horn cells and corticospinal tract. Patients will present with both LMN and UMN symptoms.

251
Q

What can result from occlusion of anterior spinal artery?

A

UMN deficit below lesion due to corticospinal tract

LMN deficit at level of lesion (anterior horn)

Loss of temp and pain sensation below lesion (spinothalamic tract)

252
Q

What is cauda equina syndrome?

A

Compression of spinal roots at L2 and below often due to disc herniation. Gives the effect of saddle anesthesia

253
Q

Describe poliomyelitis

A

Due to polio virus infection, causes destruction of cells in anterior horn. Present with LMN signs, asymmetric weakness, hypotonia, flaccid paralysis

254
Q

What is brown-sequard?

A

Caused by damage to one half of the spinal cord. Presents with Ipsilateral loss of all sensation at level of lesion, ipsilateral LMN signs at level of lesion. Ipsilateral UMN signs below level of lesion (corticospinal tract damage). Ipsilateral loss of proprioception, vibration, light touch sense below level of lesion, contralateral loss of pain, temp, non-discriminative touch 1 -2 levels below the lesion due to spinothalamic damage

255
Q

Compare and contrast AMP/KA and NMDA channels

A

Compare - Both have glutamate binding sites, permeable to Na and K

Contrast- NMDA is also Ca perm., NMDA also has a binding site for glycine and both sites (gly and glu) must be bound and open for functioning, NMDA has a binding site for Mg in the pore thay must be removed for functioning

256
Q

What direction is the normal driving force for Mg

A

Inward

257
Q

explain the cascade of an NMDA channel being activated

A

binding of glu and gly opens the NMDA channel, where Mg binds to the pore.

The cell membrane is depolarized via temporal summation of EPSPs, reducing driving force for Mg and allowing current flow. Mg leaves pore.

258
Q

Explain the cascade of how cytotoxic edema occurs

A

Some anoxia, aglycemic event, leads to low oxygen and glucose, so no ATP production.

Primary active transport fails and ion gradients begin to break down.

Potassium gradients in particular are messed up, and the neurons depolarize to threshold and being firing APs at high rate. This releases a lot of Glu.

Depolarization and Glu present activated NMDA channels

Additionally in low ATP levels, Ca regulation is messed up. Lipases and proteases are abnormally activated and free radicals form.

Cytotoxic edema from massive ion influc and impared volume regulation

259
Q

What is vasogenic edema?

A

When protein gets in the brain and brings H2O with it increasing ICP

260
Q

Nociceptors are…

A

Free nerve endings

261
Q

What type of transduction mechanisms do somatosensory receptors use?

A

Stretch gated ion channels, temp sensitive channels (TRP), can also be stimulated by chemical signals

262
Q

What is the difference between Alpha gamma and C nociceptors?

A

Alpha gamma is small diameter and myelinated. They responds to Pain and temp.

C is unmyelinated and small diamter. They respond to pain, temp, and itch

263
Q

If a cell is lysed by injury, what ion leaks to activate nociceptors?

A

Potassium

264
Q

What chemicals sensitize nociceptors?

A

Arachidonic acid, prostaglandins, leukotrienes, substance P

265
Q

What is divergence?

A

Axon from single neuron branches many times froming synaptic contacts with multiple target cells. Allows for large recruitment of signals

266
Q

What is convergence?

A

Multiple presynaptic neurons merging on a single neruon. This allows for integration among many sources of information (retina)

267
Q

Are most neurons in the CNS spontaneously active?

A

Yes

268
Q

What is presynaptic inhibition?

A

Regulation of a signal before the synapse

269
Q

What is disinhibition?

A

Removing the inhibition of something inhibitory. If X is inhibiting Y, well Z can inhibit X. So the inhibition is lifted. Net excitatory

270
Q

What is lateral inhibition?

A

A inhibitory receptive field made by interneurons. It is to enhance detection of CONTRAST by creating larger detectable differences

Slide 10 of Neuronal Integration

271
Q

What is feedback inhibition?

A

Requires a recurrent pathway where a product of the pathway inhibits an earlier step along the pathway

272
Q

What is feedforward inhibition?

A

It requires a divergent pathway. It is useful for controlling antagonistic pathways. A good example is reflex pathways controlling antagonistic muscles

273
Q

What is the reverberating circuit?

A

They allow for persistent activity in a system after the stimulus is gone. Can allow for information to be stored (short term memory). It is excitatory connections

274
Q

Disruption of reverberating circuits can cause what?

A

Seizures. Normally feedback inhibition pathways regulate this

275
Q

What are central pattern generators?

A

Rhythmically alternating activity can be created by several types of neural circuits. Example is during walking. Only one part will be active at once

(slide 15 neuronal integration)

276
Q

What are the same 4 elements of every neuronal cell?

A

Input, integration zone, conduction zone, output zone

277
Q

How do graded potentials encode signal strength?

A

Amplitude.

278
Q

What occurs at the integration zone of a neuron?

A

Graded potentials are converted to all-or-none potentials (APs)

Other ion channels can impact signal response here

279
Q

How do ion channels in the integration zone impact APs?

A

Certain calcium channels are open at certain times which can modulate the signals.

280
Q

Contrast HVA and LVA (t-type) calcium channels.

A

HVA channels require strong depolarization (AP) for their activation

LVA open between resting potential and AP, and rapodly inactivate. Inactivation is removed at an IPSP

281
Q

If an integration zone only had VGNa and K channels, what would the frequency look like?

A
282
Q

If the integration zone contains HVA calcium channels and calcium activated potassium channels, what would frequency look like

A

Firing rate gradually slows causing slow adaptation

283
Q

What can occur if an integration zone contains LVA VGCa? How?

A

Burst firing. T channels activate at membrane potentials below threshold. They open transiently and inactivate rapidly.

284
Q

This is a good pic to understand

A
285
Q

How do central pattern generators and T channels work together?

A

Once triggered active, they can remain active without active input because the T channels can modulate the APs while the pattern generator regulates the alternating APs

286
Q

Abnormal T-type channels can cause ____, which can be treated with _____.

A

abscence seizures - ethosuximide

287
Q

What are the 5 major subdivisions of adult human brain: what are the regions come from them?

A

Forebrain: Telencephalon, Diencephalon, Midbrain: Mesencephalon, Hindbrain: Metencephalon, Myelencephalon

T: Cerebral Hemispheres - cerebral cortex, subcortical white matter, basal ganglia, basal forebrain nuclei

D: Thalamus and hypothalamus

M: Cerebral peduncles, midbrain tectum, midbrain tegmentum

M: Pons cerebellum

M: Medulla

288
Q

What is the one sense not processed in the thalamus?

A

Smell

289
Q

What is the main role of the hypothalamus?

A

CNS center for regulation of autonomic and endocrine activity

290
Q

What is the role of the superior and inferior colliculi?

A

Visual and auditory reflexes

291
Q

A tumor of the pineal gland can lead to what?

A

Compression of the aqueduct of Sylvius, causing non-communicating hydrocephalus

292
Q

What lobe of the cerebellum manages the input from vestibular system?

A

Flocculondular

293
Q

What bridges the brain to the cerebellum?

A

The Pons

294
Q

Pontine nuclei project (Ipsilaterally or contralaterally) to the cerebellum

A

Contralaterally

295
Q

What does the medulla do?

A

Controls vital respiratory and cardiovascular centers

296
Q

Long term alcoholism can damage this part of the hypothalamus, what is it?

A

Mamillary bodies

297
Q

Where is the precentral gyrus anatomically? What is it? What is the brodmann number?

A

It is in front of the central sulcus and is the motor cortex. It is Brodman number 4

298
Q

What is Brodmann area 8. Stimulation to this region causes what?

A lesion to area 8 produces what effect?

A

Frontal eye fields. Stimulation of 8 causes paired eye movements to the contralateral side.

An area 8 lesion on one side causes both eyes to deviate to the side of the lesion, and loss of ability to turn eyes to the opposite side

299
Q

Brodmann areas 44 and 45 is what? Damage to this region would cause..?

A

Brocas area. Damage would cause the inability for motor production of speech.

Note: Brochas aphasia is an acquired disorder of LANGUAGE and is not the same as dysarthria (difficulty with articulation)

300
Q

What Brodmann area controls the ability to make decisions, prioritize, plan / weigh the consequences of actions, problem solving, jusdgement, etc.

A

Areas 6 and 8 in the pre-fontal cortex

301
Q

What region of the brain controls personailty and social behavior? Lesion in this region causes what?

A

Orbitofrontal cortex (Areas 10,11,12,24,25,32)

Personaluty changes, irritability

302
Q

The temporal portion of the limbic system, if lesioned, can exhibit what symptoms?

A

Impaired decision making, distractibility, impusliveness, hyperphagia, deficient emphathy, etc

303
Q

What brodmann areas is the postcentral gyrus. What does the postcentral gyrus do?

A

Areas 1,2,3. It is the somatosensory cortex.

304
Q

If a patient tells you they can feel a painful stimulus, but cannot precisely localize it, what could this suggest about the somatosensory cortex?

A

That it has a lesion. The somatosensory cortex is only involved in higher aspects of painful stimuli

305
Q

What is the brodmann region of the higher order visual area? What region is the primary visual cortex?

What is unique about Area 17 in terms of organization?

A

7 // 17

The retina is represented in the brain

306
Q

Alexia and agraphia are symptoms of a person with a lesion in what brodmann area / name of region?

A

Area 39,40. The inferior parietal lobule

307
Q

Brodmann area 41 is the..

A

Primary auditory cortex

308
Q

Wernickes area is brodmann area___. A lesion in the region will result in what?

A
  1. Gibberish speech and cannot understand language
309
Q

In a T1 weighted MRI, what color is CSF? T2?

A

Black, White

SF2 (2 decks)

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