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6- Neuro Diag > Ex1 / Ch6 Corticospinal Tract and Othe > Flashcards

Ex1 / Ch6 Corticospinal Tract and Othe Flashcards

1
Q

list the Corticospinal pathway

A
  1. Cerebral cortex
  2. Midbrain
  3. Pons
  4. Medulla
  5. Spinal cord
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2
Q

Corticospinal is Influenced by

A

cerebellum and basal ganglia

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3
Q

Corticobulbar Tract begins in

A

primary motor cortex

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4
Q

Corticobulbar Tract projects to

A

brain

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5
Q

how many lower motor neuron does the autonomic system have?

A

2

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6
Q

A 2 lower motor neuron pathway of the autonomic system are influenced by

A
  1. hypothalamus
  2. amygdala
  3. nucleus tractus solitarius
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7
Q

Autonomic Neuron #1 location

A

brain stem or cord

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8
Q

Autonomic Neuron #2 location

A

peripheral ganglion

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9
Q

Parasympathetic division goal

A

Digestion & energy storage

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10
Q

Parasympathetic origin

A

III

VII

IX

X

sacral spinal cord

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11
Q

Parasympathetic has ____ preganglionic, and _____ postganglionic

A

Long preganglionic

Short post ganglionic

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12
Q

Transmitters used in both pre and post ganglionic

(parasympathatic division transmitters)

A

acetylcholine

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13
Q

Parasympathetic effect on eye (vision)

A

adapted to near vision

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14
Q

Parasympathetic effect on Digestion

A

activated by eating

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15
Q

Parasympathetic effect on Heart

A

decrease HR

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16
Q

Parasympathetic effect on lungs

A

Decrease RR

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17
Q

Parasympathetic effect on Peripheral capillaries

A

gets dilated

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18
Q

Parasympathetic effect on Skeletal muscle

A

tone relaxes

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19
Q

Sympathetic division goal

A

releases energy

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20
Q

Sympathetic division origin

A

Intermediolateral cell column (VII lamina) of spinal cord T1-L2

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21
Q

Sympathetic division has ____ preganglionic andd ____ post ganglionic

A

Short preganglionic

Long post ganglionic

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22
Q

Sympathetic Short preganglionic use ____ as a transimitter

A

acetylcholine

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23
Q

Sympathetic Long post ganglionic use ____ as a transimitter

A

norepinephrine

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24
Q

Options for signal distribution

A
  1. sympathetic signal enter the sympathetic chain, synapse at the same lvl, rejoin the same spinal nerve root
  2. sympathetic signal enter the sympathetic chain, go up several segments, synapse and rejoin spinal nerve at a higher lvl
  3. sympathetic signal enter the sympathetic chain, travel down several segments, synapse and rejoin spinal nerve at a lower lvl.
  4. sympathetic signal enter the sympathetic chain, remain unsynapsed, leave the chain as a splanchnic nerve, travel to a prevertebral ganglion (celiac, sup, and inf mesenteric) synapse and travel to the target tissue
  5. sympathetic signal can travel unsynapsed to the adrenal medulla. Releasing epinephrine and norepinephrine (for distribution through the entire body via vascular system)
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25
Q

The preganglionic sympathetic neurons need to be long enough to reach

(3 structures)

A

the chain ganglia

the prevertebral ganglia

or the adrenal medulla

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26
Q

The post ganglionic neuron reaches from the ganglia to

A

target tissue

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27
Q

Sympathetic effect on eyes

A

get wild, pupil dilatate (to get as much light as possible)

vision shift to far away vision

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28
Q

Sympathetic effect on digestion

A

turn off blood going to, and stop secretion

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29
Q

Sympathetic effect on Heart

A

HR goes up

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30
Q

Sympathetic effect on lungs

A

RR goes up

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31
Q

Sympathetic effect on Peripheral capillaries

A

blood gets diverted from peripheral superficial capillary

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32
Q

Sympathetic effect on Skeletal muscle

A

receive more oxygenated blood

(prepare the body to move)

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33
Q

why do peripheral superficial capillar narrow under the sypathetic effect

A

in case of getting a wound so it reduces the bleed

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34
Q

Enteric division reaches which organ

A

intestine

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35
Q

Enteric division contains 2 plexi:

A

Myenteric plexus (of Auerbach)

Submucosal plexus (of Meisner)

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36
Q

Myenteric plexus (of Auerbach) controls

A

muscle contraction

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37
Q

Submucosal plexus (of Meisner) controls

A

blood vessel size and secretory function

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38
Q

Enteric division Regulated by parasympathetic via

A

division X and sacral

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39
Q

Enteric division Regulated by sympathetic via

A

splanchnic

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40
Q

Hirschprung Disease aka

A

Congenital Aganglionic Megacolon

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41
Q

in Hirschprung Disease, what happens to

the migrating cells of the myenteric and submucosal plexuses During development

A

do not continue to the distal colo

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42
Q

with Hirschprung Disease, the disctal colon can’t:

A

can’t relax/contract properly to allow stool to pass

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43
Q

Hirschprung Disease results in

A

Lack of bowel sounds (MC LLQ)

dullness to percussion at LLQ

distention is palpable in that region

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44
Q

how can Hirschprung Disease be managed

A

by eating smaller meals more frequently

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45
Q

Describe the surgial solution for Hirschprung Disease

A

the aganglionic area is removed, and the normal part of the colon is connected to the sigmoid colon and the rectum

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46
Q

Term: Paresis

A

mild weakness

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47
Q

Term: plegia

A

total weakness/0 strength

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48
Q

Term: Paralysis

A

total weakness/0 strength (same as plegia)

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49
Q

Term: Palsy

A

nonspecific term than can mean paralysis or it can mean paresis

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50
Q

Term: Hemi

A

left or right

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51
Q

Term: Para

A

both legs

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52
Q

Term: Mono

A

one extremity

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53
Q

Term: Di

A

2 of the same extremity (usually legs)

54
Q

Term: Quadra or tetra

A

all 4 extremities

55
Q

quadriplegic means

A

can’t move any extremity

56
Q

Motor System Testing order

A

Inspection

Look for abnormal posturing

Involuntary motions

Sings for muscular asymmetry

Preform circumferential mensuration

Measuring around the muscles to confirm asymmetry

Passive ROM (noting spasticity, or rigidity)

Muscle tests for strength

Stress test (holding arm up at shoulder hight for 30 s)

Checking reflexes (for changes in tendon reflexes and presence of uninhibited pathological reflexes)

57
Q

3 Patterns of Weakness

A

Proximal weakness

Cranial Nerve Weakness

Distal Weakness

58
Q

Proximal weakness includes

(body parts)

A

shoulder and hip weakness

59
Q

Proximal weakness signs

A

muscular dystrophy or muscle degeneration

60
Q

Proximal weakness cuased by

(etiology)

A

genetic x-linked (mostly males)

61
Q

Worst form of proximal weakness

62
Q

Duchene Pt life expectancy

(prognosis)

A

fatal by late teens/early 20’s

63
Q

milder form of proximal weakness, and Pt can live longer

A

Diatonic muscular dystrophy

64
Q

Proximal weakness Classical exam finding

A

Gower’s sign

65
Q

explain Gower’s sign

A

pt is weaker at the hips, can’t stand up

66
Q

where can Gower’s sign spread to?

A

distal extremities (hand & feet)

67
Q

Cranial Nerve Weakness Involves

A
  1. facial expression
  2. swallowing, chewing
  3. eye motion
68
Q

Cranial Nerve Weakness Suggest problem at

A

the neuromuscular junction

69
Q

Cranial Nerve Weakness etiology

A

inadequate amount of neuro transmitter production

or

reduced number of muscular receptor

70
Q

Distal Weakness includes

A

hands & feet

71
Q

Distal Weakness origin

A

neurological

72
Q

Upper motor neuron location

A

project from the cerebral cortex to lower motor neurons located in the anterior horn of the spinal cord

73
Q

Lower motor neuron location

A

project via peripheral nerves to skeletal muscle

74
Q

Upper vs Lower Motor Neuron Lesion

A

Sign

UMNL

LMNL

Weakness

Yes

Yes

Atrophy

No

Yes

Fasciculations

No

Yes

Reflexes

Increased

Decreased

Tone

Yes

No

Pathological reflexes

Increased

Decreased

75
Q

Gait Disorders Can be caused by lesion in what part of the nervous system

A

almost anywhere in nervous system

76
Q

Spastic gait caused by

A

lesion of upper motor neurons

(Stroke, MS/Degeneration, Cerebral palsy)

77
Q

Spastic gait signs

A

triple flexion of the arm, elbow, wrist, & fingers.

riple flexion of the leg, hip, knee, and plantar flexion

Stiff legged circumduction

decreased arm swing

unsteadiness

falling

78
Q

Functional gait disorder aka

A

psychologically based gait disorder

79
Q

Functional gait disorder caused by

A

malingering patients or with psychological problem:

  1. conversion disorder
  2. factitious disorder
80
Q

Functional gait disorder main signs

A

has no gait pattern

Pt will not fall

81
Q

Functional gait disorder pt will not fall due to

A

intact postural and gait reflexes

82
Q

If Functional gait disorder pt falls, then it’s _____

A

intentional

83
Q

Define Multiple Sclerosis

A

autoimmune demyelination of the CNS

84
Q

Myelin in CNS is made by

A

oligodendrocytes

85
Q

MS cuases

A

idiopathic

(because of the overlapping etiology)

86
Q

some of the suggestions about cause of MS includes:

A

Vit D deficiency

genetic predisposition

diet

87
Q

MS Pathological process

A

Lymphocytes attack CNS myelin only

88
Q

MS Progression

A

Exacerbation

remission

89
Q

MS Classic first suspicion is

A

two or more deficits separated anatomically and temporally

90
Q

Definitive diagnosis is based upon

91
Q

how does MS look on MRI

A

multiple bright scars (oligoclonal banding), decreased nerve conduction, and oligoclonal bands (immunoglobulin) in CSF

92
Q

oligoclonal banding is due

A

myelin destruction

93
Q

Demyelination effect on conduction velocity and action potentials

A

slows conduction velocity

allows action potentials to disperse

94
Q

Demyelination effects occurs more at what kind of temprature

A

at Higher temperatures

(while taking hot bath/showers)

95
Q

MS Female : male ratio

A

Female: male 2:1

96
Q

the age range of MS onsit

97
Q

Can MS pt have a normal life span

A

yes, with very strict management strategy

98
Q

Multiple nerve demyelination leads to

A

signal dispersal

99
Q

Hallmark neuro symptom

A

optic neuritis

100
Q

deffine optic neuritis

A

bright white optic disc – inflammation of the optic disc

101
Q

MS Motor symptoms

A

Weakness

Spasticity

UMNL sign

102
Q

Def: Weakness in the conjugate movements of the eyes

A

Internuclear Ophthalmoplegia

103
Q

Internuclear Ophthalmoplegia is due to

A

demyelination of the tract connecting the eyes

104
Q

MS Sensory signs

(Spinothalamic, Dorsal columns)

A

Impairment of vibratory/position sense
Impairment of pain, temperature, or touch sense
Pain (moderate to severe)
L’hermitte’s sign

105
Q

MS Cerebellar signs

A

Lack of coordination (ataxia)

106
Q

Other location signs:

A
  1. Cranial nerve signs
  2. Autonomic
  3. Psychaiatric
107
Q

Define L’Hermitte Sign

A

electric shock like sensation with neck flexion

108
Q

L’Hermitte Sign is due to

A

inflammation of the spinal cord

109
Q

the definitive diagnosis of MS is based on

A

complete neurological diagnosis

MRI

CSF analysis

110
Q

MS management is mainly based on

A
  • Inflammation management
111
Q

MS inflammation management includes

A

prednisone

anti-inflammatory diet

increase venous drainage via chiropractic

112
Q

Define prednisone

A

steroidal anti-inflammatory

113
Q

long term use of prednisone can lead to

A

kidney damage

114
Q

anti-inflammatory diet includes avoiding

(type of food)

A

wheat & dairy

115
Q

increase venous drainage can reduce

A

metabolic waste

116
Q

Motor Neuron Disease:

Amyotrophic lateral sclerosis (ALS) aka

A

Lou Gehrig disease

117
Q

ALS is a degeneration of

A

both upper and lower motor neuron cell bodies

118
Q

ALS prognosis

A

Prognosis respiratory failure and death usually in 3-5 years

119
Q

respiratory failure happens due to a damage of which nerve

A

phrenic nerve

120
Q

in ALS Upper motor neuron lesion signs in _____ extremeties

(upper/lower)

A

Lower extremity

121
Q

Upper motor neuron lesion signs in the Lower extremity are

A
  • weakness
  • spasticity
  • increased tendon reflexes
122
Q

Lower motor neuron lesion signs in the _____ extremity

(Upper/Lower)

A

Upper extremity

123
Q

Lower motor neuron lesion signs in the Upper extremity are

A
  • weakness
  • flaccidity
  • decreased tendon reflexes
124
Q

First symptom of ALS is usually

A

focal weakness

125
Q

focal weakness in ALS spreads to other muscle groups including

A

intrinsic muscles of the hand & feet

126
Q

ALS may start with what type of sings

A

bulbar signs

127
Q

bulbar signs includes

A

Dysarthria

Dysphagia

128
Q

Dysarthria means

A

weakness of the larynx

129
Q

Dysphagia means

A

difficulty swallowing

130
Q

Other possible diagnosis based on ALS symptoms

A

Lead poisoning

Dysproteinemia

Thyroid dysfunction

Vitamin B12 deficiency

Vasculitis

Neoplasms

Cervical spine compression

131
Q

Normal MRI vs ALS MRI

6- Neuro Diag (10 decks)

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