Exam 1 Flashcards
Choroid Plexus
-produces CSF
-web of capillaries
-blood filtered 3x
Lateral Ventricles
-above thalamus
-2
-connected to 3rd ventricle by inter-ventricular foramina (Monro)
3rd Ventricle
-surrounded by diencephalon
-connected to 4th ventricle via cerebral aqueduct (sylvius)
4th Ventricle
-behind pons/medulla
-connects to central canal of SC
-drains into subarachnoid space via foramina of Luschka and midline foramen of Magendie
Falx Cerebri
-dense projections in inner layer of dura
-separates 2 hemispheres
Tentorium Cerebelli
-dense projections in inner layer of dura
-separate cerebellum from cerebrum
Homunculus Motor Cortex
-Precentral Gyrus
Medial: Genitals, toes, ankle, knee
Superomedial: trunk, hip, shoulder, elbow, wrist, hand
Superolateral: Hand (fingers pinky-thumb), face
Lateral: Face (top to bottom), jaw (talking), tongue (swallowing)
Homunculus Sensory Cortex
-Postcentral gyrus
Medial: Genitals, toes, ankle, knee
Superomedial: trunk, hip, shoulder, head, arm
Superolateral: Hand (fingers pinky-thumb), elbow, forearm, wrist
Lateral: Face (top to bottom), jaw, tongue, gums, pharynx
Vertebrobasilar A.
-posterior circulation of brain
Posterior Inferior Cerebellar A. (Think of location)
-bottom, posterior cerebellum
Anterior Inferior Cerebellar A.
-front and bottom cerebellum
Superior Cerebellar A.
-top of cerebellum
-under CN III
Posterior Cerebral A.
-posterior cerebrum
-occipital lobe
-Posterior, medial, inferior temporal lobe
-above CN III
Internal Carotid A.
-anterior circulation of brain
Ophthalmic A.
eyes
Posterior Communicating A.
-connects PCerebralA and ICA
-connects 1 side of ant to post
Anterior Cerebral A.
-medial cerebral hemisphere to parietal lobe
-from ICA
Anterior Communicating A.
-between ant. cerebral A.
Middle Cerebral A.
-lateral cerebral hemisphere
EXCECPT:
-superior and front parietal
-inferior temporal
Vertebral A. Stroke
-prone to shear forces from AA joint from abrupt cervical rotation
-gait issues, ataxia, HA
Basilar A. Stroke
-complete blockage causes death
-partial: tetraplegia, numbness, CN damage, locked in syndrome (only movements)
Anterior Cerebral A. Stroke
-hemiparesis loss to contra side
-personality changes
-lower limb issues
Middle Cerebral A. Stroke
-hemiparesis loss to contra side
-face and upper limb issues
L side: aphasia
R side: spacial relationships, nonverbal communication
Posteror Cerebral A. Stroke
-midbrain issues (thalamic syndrome), eye movement issues, cortical blindness (brain cant comprehend vision)
Pontine Arteries
-supplies pons
Torcula
-confluence of sinuses
-drains straight sinus and sup. saggital sinus
-drains to sigmoid
Cavernous SInus
-drains from blood supply of face and brain
-drains to sigmoid
Superior and inferior Petrosal Sinus
-drains from cavernous sinus
-drains to sigmoid
Frontal Lobe
Voluntary Movement, language, higher level function
Parietal Lobe
Sensory perception, sensory integration (5 senses)
Occipital Lobe
-visual perception
Temporal Lobe
-auditory processing, vestibular, memory formation
Post central gyrus
-Primary sensory cortex
-proprioception
-sensory input
Pre central gyrus
-primary motor cortex
-voluntary movement of contralateral side
Central Sulcus
-boundary btwn motor/sensory and parietal/frontal lobes
Lateral Sulcus
-separates temporal from frontal and parietal lobes
Cerebellum
-coordinate movements
Pons
-unconscious processes
-sleep, breathings
Medulla
-vital processing (breathing, BP, HR)
Mammillary Bodies
-recollective memory
Fusiform Gyrus
-high level vision
-face perception, object recognition, reading
Inferior Olive
-learning and timing of movements and comparing them to intended movements
Pyramids and Decussation
-motor fibers that pass from brain to medulla oblongata
-SC nerves cross
Uncus
-olfaction
-emotions
-forming new memories
Parahippocampal Gyrus
-spatial awareness
-memory encoding
Midbrain
-vision, hearing, motor control, arousal, temperature regulation
Middle Cerebellar Peduncle
-connects cerebellum to pons
-largest
- contains afferent fibers
4th Ventricle
-protect brain
-form central canal
Inferior Colliculus
-sound localization
-pitch discrimination
-integration of auditory information
Superior Colliculus
-visual (directing eye movements), auditory processing for orienting toward environment , auditory, and somatosensory spatial information integration
Substania Nigra
-production of dopamine
-body movements
-part of basal ganglia
-on midbrain
Cerebral Peduncles
-refining fine motor movements
conversion of proprioceptive information into balance and posture
Gracile Fasciculus
-main touch pathway
-fine touch, vibrations, conscious proprioception
-lower body to brain stem
Cuneate Fasciculus
-only in cervical
-vibration and conscious perception and fine touch sensations from upper body
Gracile Nucleus
-medulla
-dorsal column nuclei
-fine touch sensation and proprioception of lower body
Cuneate Nucleus
-info from upper body
-medulla
Inferior Olivary Nucleus
-coordinate signals from SC to cerebellum to regulate coordination
Periaqueductal Grey Matter
-modulation and propagation of pain
Cranial Nerve Locations
Midbrain: CN III-IV
Pons: CN V-VIII
Medulla: CN IX-XII
CN I Exit Foramina
Cribriform plate
CN II Exit Foramina
Optic canal
CN III & IV & VI Exit Foramina
Superior orbital fissure
CN V Exit Foramina
V1: superior orbital fissure
V2: foramen rotundum
V3: foramen ovale
CN VII & VIII Exit Foramina
Auditory canal
CN IX & X & XI Exit Foramina
Jugular foramen
CN XII Exit Foramina
Hypoglossal foramen
CN I
Olfactory (sensory)
-smell (olfactory cortex: amygdala, parahippocampal gyrus, uncus, insula)
-only sensory input that reaches cortex before thalamus
1) cover 1 nostril and smell different
CI
Anosmia: loss of smell
-avulsion of olfactory fibers
CN II
Optic (sensory)
-visual acuity (visual cortex: occipital lobe)
Optic Nerve: from eyes
Optic Chiasm: crossing
Optic tract: to visual cortex
1) consensual contralateral light response (midbrain)
2) eye chart
CI
Homonymous Hemianopsia: damage in contralateral visual path results in ipsilateral 1/2 blindness
CN III
Oculomotor (motor)
-eye and eyelid movement
1) eye movements except lateral and down/in
2) consensual ipsi light response
3) cover eye and pupillary constriction of contra
CI
External Strabismus: ipsilateral eye fixed in abd
Ipsilateral ptosis: paralysis of upper eyelid
Diplopia: double vision
Mydriasis: Ipsilateral pupuil fully dilated
CN IV
Trochlear (Motor)
-ipsilaterally eye movement (down and in)
-only CN that exits dorsum of brainstem
1) H test
CI:
Cannot down and in
-double vision
-difficulty reading
-head tilt to opposite side
CN V
Trigeminal (Both)
V1: Opthalamic (sensory)
V2: Maxillary (sensory)
V3: mandibular (both)
Motor: clench jaw and feel masseter and temporalis
Sensory: check in forehead (ophamalic), checks (maxillary), and jaw (mandibular)
CI:
Corneal Blink Reflex
-tactile sensation on cornea
Trigeminal Neuralgia
-sharp pain in face
CN VI
Abducens (motor)
-lateral eye movements
-H test
CI:
-double vision
CN VII
Facial (both)
Motor: facial expression and salivary, stapedius of ear
Sensory: tongue and pharynx
Parasympathetic: salivary gland
Special Sensation: ant 2/3rd of tongue
Testing
-Motor:
1) smile
2) frown
3) move eyebrows
Sensory:
-close eyes and place sweet/salt on anterior 2/3rds of tongue
CI
Bell’s Palsy
CN VIII
Vestibulocochlear (sensory)
-hearing and vestibular
Hearing:
1) rub fingers together
2) whisper word identification
3) Weber Test: tuning fork on head
4) Rhine Test: tuning fork on mastoid
Vestibular:
1) touch nose then pt finger
2) turn head while looking at thumb
CI:
-vertigo, conductive or sensorineural deafness
CN IX
Glossopharyngeal (Both)
-Motor: stylopharyngeus
-Parasympathetic: parotid salivary gland, carotid a.
-Sensory: 1/3 pos tongue, soft palate, ear, gag reflex
Sensory:
1) sour/bitter taste on posterior 1/3 tongue
Motor:
1) swallowing
CI:
decreased gag reflex and salivation
CN X
Vagus (both)
Motor: larynx, pharynx, tongue, gag
Parasympathetic: decrease HR, bronchoconstriction, digesiton
Test
1) saw ah, uvula deviation to strong side
2)Swallowing
CI:
-hoarseness and swallowing difficulties, digestion issues
CN XI
Accessory (motor)
-SCM and trap
-Cell bodies in ventral horn of C1-C4
-travels through foramen magnum and exits jugular foramen
Test
1) shoulder shrug
2) head turning
CN XII
Hypoglossal (motor)
-tongue movements
-swallowing
-speaking
1) stick tongue out, deviates to weak side
CI:
-Dysphagia: difficulty swallowing
-Dysarthria: poor control of speech muscles
-LMN: flaccid tongue, deviates to weak
-UMN: tongue deviates to strong side
Thalamus
-interprets sensation information and perceives it
Name of Pathways
-origin and site of termination for 2nd order neruon
Types of Somatosensory Pathways to Brain
Conscious Relay:
-info about location and stimulus type to conscious awareness
-discriminative sensations
Divergent:
-info to many locations in brainstem and cerebrum
-conscious and non-conscious
Non-Conscious Relay:
-proprioceptive and other movement to cerebellum
Conscious Relay Pathways
-info about location and stimulus type to conscious awareness
-discriminative sensations
Crude Awareness: thalamus
Detailed Awareness: somatosensory cortex
Dorsal Column
Anterolateral Column
Divergent Relay Pathways
-info to many locations in brainstem and cerebrum
-conscious and non-conscious
-medial/slow nociception
-subconscious temperatue
Spinomesencephalic, spinoreticular and spino-emotional tracts
Non-Conscious Relay Pathways
-proprioceptive and other movement to cerebellum
Spinocerebellar Tracts
Descending Motor Fibers (2 types)
Pyramidal Tracts: cerebral cortex
Extrapyramidal Tracts: Brainstem
Flexor-Extensor Rule
-MNs that innervate flexors are located posteriorly to MNs that innervate extensors
Proximal-Distal Rule
-MNs that innervate distal muscles are located laterally to MNs that innervate proximal muscles
Lateral Corticospinal Tracts (function)
-crossed at pyramidal decussation of medulla
-fractionated movements
-primary motor cortex
-most CST fibers
-descends in lat funiculus
Medial Corticospinal Tracts (function)
-uncrossed
-postural movements
-originates from premotor cortex
-descends in venttral funiculus
Nonspecific Motor tracts
-facilitate activity of interneurons and MNs
-activate during intense emotions
Ceruleospinal and Raphespinal Tracts
Corticobrainstem Tracts
-voluntary control of many MM of head and neck
-originate in cortex motor areas and reach CN nuclei in brainstem
Secondary Somatosensory Gyrus
-post to primary
-processes info from primary and thalamus for stereognosis and sensory memory
Crista Gali
-separates olfactory bulbs
Cribiform Plate
Olfactory N.
Optic Canal
-optic N and ophthalmic A.
-loss of vision
Foramen Rotundum
- Maxillary portion of Trigeminal
-loss of function at maxilla
Foramen Ovale
-mandibular portion of trigeminal
-loss of function at mandible
Formamen Spinosum
-middle meningeal artery
-epidural hematoma
Foramen Lacerum
-filled with cartilage
Groove for Meningeal A.
-middle meningeal artery
-epidural hematoma
Grove For Petrosal Sinus
-sup. petrosal sinus
-improper drainage
Internal Auditory Meatus
-Facial N and Vestibularcochlear n
-Hearing loss and facial paralysis
Jugular Foramen
-CN 9,10,11
-int. jugular vein
-Loss of taste, uvula deviation, speech, neck muscles, bleeding out
Sulcus for Transverse Sinus
-transverse sinus
-improper drainage
Hypoglossal Canal
-Hypoglossal nerve
-weak tongue muscles
Foramen Magnum
-SC, vertebral arteries, Accessory N
-Death, paralysis
Sulcus for Superior Saggital Sinus
-sup. saggital sinus
-improper drainage
Superior Orbital Fissure
-Trigeminal N, opthalamic A, abducens N, occulomotor N, Trochlear N
-Loss of vision, pupil reaction, eye movements
Stylomastoid Foramen
-facial N
-Face paralysis and abnormal taste
Homonymous Hemianopsia
damage in contralateral visual path results in ipsilateral 1/2 blindness
External Strabismus
: ipsilateral eye fixed in abd
Ipsilateral ptosis:
paralysis of upper eyelid
Diplopia:
double vision
Mydriasis:
Ipsilateral pupuil fully dilated
Secondary Somatosensory Gyrus
-post to primary
-processes info from primary and thalamus for stereognosis and sensory memory
Dorsal Column Medial Leminiscus
-Ascending tract
-Light touch, proprioception, sterognosis
1st: Dorsal horn ganglion to FG or FC
2nd: Nucleus Gracilis or Cuneatus in Medulla
CROSS with Internal Arcuate Fibers at Medial Leminiscus
3rd: Thalamus to PSSC
Anterolateral System
-ascending tract
-crude touch
Anterior: crude touch
Lateral: Fast nociception and temp
1st: Dorsal root ganglion to DH
CROSS at Anterior Commissure
2nd: Anterior commisure and travels up LST to thalamus
3rd: Thalamus to PSSC
Medial Nociception
-dull/slow pain
-ascending, divergent pathway
1st: C fibers with free ending in DH
CROSS
2nd:
Spinomesencephalic: Sup. colliculi and periaqueductal grey
Spinoreticular: Reticular Formation
Spinoemotional: Cortex
-reaches consciousness
Dorsal Spinocerebellar
-ascending, LE, uncrossed
-Nonconsious postural movements
-coordination and proprioception
1st: DRG to via FG Clark’s Nucleus
2nd: Up DPT through Inferior Cerebellar Peduncle to Cerebellum
Ventral Spinocerebellar
-ascending, LE, crossed, bilateral
-Nonconsious postural movements
-coordination and proprioception
1st: Anterior Hron
CROSS
2nd: Up VPT through Superior Cerebellar Peduncle
CROSS to Cerebellum
Cuneocerebellar
-ascending, UE, uncrossed
-Nonconsious postural movements
-coordination and proprioception
1st: DRG to Nucleus Cuneatus
2nd: Up NC through Inferior Cerebellar Peduncle to Cerebellum
Rostrospinocerebellar
-ascending, UE, uncrossed
-Nonconsious postural movements
-coordination and proprioception
1st: DRG to Superior Cerebellar Peduncles to cerebellum
Medial/Ventral Corticospinal Tract
-automatic trunk movements, uncrossed
-pyramidal
Premotor cortex > internal capsule > Cerebral Peduncle (midbrain)> FG> medial/anterior horn
Lateral Corticospinal Tract
-voluntary limb mmts
-pyramidal
Primary Motor Cortex> internal capsule> Cerebral peduncles (midbrain)>crosses at decussation of medulla>FC>lateral horn
Corticobulbar Tract
-facial movements
-Pyramidal
Primary motor cortex> cerebral peduncles> crosses a lot at CNs> exits cervical ventral horn
Reticulospinal Tract
-extrapyramidal
-postural and gross movements (walking), extensors
Reticular formation in Pons>FG>ventral horn
Vestibulospinal Tract
-extrapyramidal
-postural and vestibular movements
Medial: head and neck motions to maintain position
Lateral: limb and trunk reactions to gravity
Vestibular Nuclei in Pons and medulla>lateral column>ventral horn
Spinal Cord I Zone
-dorsal horn
-marginal zone
Spinal Cord II Zone
-Dorsal horn
-Substantia gelatinosa
Spinal Cord III Zone
-dorsal horn
-Nucleus proprius
Spinal Cord IV Zone
-dorsal horn
-Nucleus proprius
Spinal Cord V Zone
-Dorsal horn
Spinal Cord VI Zone
-dorsal horn
Spinal Cord VII Zone
-intermediate zone
-Clark’s nucleus
Spinal Cord VIII Zone
-ventral horn
-commissural nucleus
Spinal Cord IX Zone
-ventral horn
-motor nuclei
Spinal Cord X Zone
-grey matter
-Grisea centralis
Glia Cells
-non-neuronal cells
-supportive, homeostasis, regulation
Neuron function
Reception, integration, transmission, and transfer of information
Bipolar Neurons
-1 dendrite, cell body and 1 axon
-sensory
Pseudounipolar Neurons
Dendrites, axon and cell body on side
-motor
Multipolar Neurons
Multiple dendrites
-interneurons
-most common
Macroglia
-larger supporting cells
-Astrocytes
-Oligodendrocytes
-Schwann Cells
Microglia
-immune for CNS
-phagocytes
Astrocytes
-macroglia cells in CNS
-support, signal, nutrtients
Oligodendrocytes
-macroglia cells in CNS
-create myelin
Schwann Cell
-PNS macroglia
-support PNS and make myelin
-does all the job
Local Potential
-small, graded
-occurs in receptor or synapse
-spreads passively
Action potential
Large “all or none”
-depolarizing
Resting Membrane Potential
-70mV
Ion Cell Distribution at Rest
More Na+ outside, more K+ inside
-Extracellular positive charge outside
-Intracellular negative charge inside
-more permeable to K+M
Movement of K+ during AP
-diffuses down concentration gradient and towards negative charges
-chemical gradient force out, electrical gradient force in
2K+/3Na+
4 Membrane Ion channels
Leak (non-gated): small amount leak, K+
Modality-gated: Sensory neurons only; mechanical, temp or chemicals
Ligand-gated: opens when stimulated by neurotransmitters
Voltage-gated: opens when reaction; Ca+
Movement of Na+ during AP
-moves through leaky channels and then voltage gated negative charges
2K+/3Na+
Spatial Summation
I…..I……I……I
Temporal Summation
AP combine to form a large AP.
-Build up of multiple excitatory waves merging
Depolarization
-voltage gated channels release Na+ into cell
- polarity becomes positive
Repolarization
-Na+ channels close, K+ voltage channels open and release to the outside of the cell
Hyperpolarization
K+ gates remain open and cause hypo
-90mV
Absolute Refractory Period
completely unresponsive to stimuli
-Na+ has not reset yet
Relative Refractory Period
May respond to higher stimuli
-Most Na+ resets
Factors Influencing AP
-diameter of axon, larger=faster
-myelin, more=faster
-temperature, warm=faster
Nodes of Ranvier
-site of saltatory conduction
-location of AP generation and depolarization
-high density of voltage gated ion channels
Conduction Speeds of fibers
large myelinated: PNS sensory and motor
Thin unmeylinated:
-short axons in grey matter in CNS
-visceral ANS axons
-pain fibers
Muscle Cell AP vs neuron
-90mV RMP
-AP 1-5msec
-18x slower than neuron
Presynaptic Terminal
-neuron conducting impulse toward synapse
-feet
-release neurotransmitters/neuromodulators
Postsynaptic terminal
-dendrite or cell body receiving neurotransmitter
Axosomatic Synapse
-synapse that binds to cell body of another nerve
-local membrane potential
Axoaxonic Synapse
-synapse that binds to axon of another nerve
-1st neuron activates second
-presynaptic effects
Axodendritic
-synapse that binds to dendrite of another nerve
-local membrane potential
Steps of Synaptic Transmission
- AP comes to presynaptic terminal
- Presynaptic membrane depolarizes and releases Ca+
- Ca+ causes vessicles to exocytose neurotransmitters
- Neurotransmitter binds to postsynaptic receptor
- Postsynaptic receptor opens ion channel or triggers intracellular messengers
Excitatory Postsynaptic potential (EPSP)
-local depolarization with Na+ or Ca+ into neuron
-facilitates AP generation
-common throughout CNS and PNS
Inhibitory Postsynaptic Potential (IPSP)
-local hyperpolarization with K+ out of neuron
Presynaptic Facilitation
-1st presynaptic neuron (Axoaxonic) releases neurotransmitters that attaches to 2nd neurotransmitter (axosomatic) and slightly depolarizes it to releases Ca+
Presynaptic Inhibition
-1st presynaptic neuron (axoaxonic) causes slight hyperpolarization to decreased Ca+ released from 2nd neuron (axosomatic)
Neurotransmitters
-fast
-released from synapse
-EPSP and IPSP
-ms to mins
Neuromodulators
-extracellular space
-alter gene expression, open iono channels, change metabolism, affects many neurons
-mins to days
Ligand-Gated Ion Channels
-fast response
-aka ionotropic receptor
-some excitatory and inhibitory
-inactivate due to lack of neurotransmitter and resorption
Guanine Nucleotide Binding Protein Activation of Ion Channels
-alters electrical excitability or neurons
-Neurotransmitter being to G protein and alter the shape
-Internal subunit breaks away and binds to membrane ion channel to change shape and open
-slower than ligand
-Mood disorders, Parkinson’s, Alzheimer’s
Agonist
-drugs the bind to receptors and copy actions of neurotransmitter
Antagonists
-drugs that block postsynaptic neurotransmitter
-drugs that inhibit release of neurotransmitter in presynaptic neurons
Acetylcholine (Ach)
-Neurotransmitter produced in basal forebrain above eyes and midbrain (at top of brainstem)
-Skeletal Muscles: Ach for neuromuscular junctions for muscle contraction. Blocking: causes weakness, fatigue, paralysis
-Autonomic NS: slows HR, constricts pupils
-Brain: Arousal, pleasure, cognitive function, movement and attention. Pleasure seeking behaviors and alzheimers
Glutamate
-amino acid principal fast neurotransmitter of CNS
-Neural changes w/ learning and development (neuroplasticity)
Excessive:
-excitotoxiciity and neuron death
-seizures
Associated with
-chronic pain, Parkinson’s, schizophrenia, neuron death, stroke
GABA
-Glycine and y-aminobutyric acid
-animo acid primary inhibitory neurotransmitter that prevent excessive neural activities in CNS (downers)
Glycine: inhibits postsynaptic in brainstem and SC
Low Levels:
-seizure, involuntary muscle contractions, anxiety
Huntington’s Disease
-causes loss of neurons that use GABA
-causes jerky, involuntary movements and cognitive decline
Dopamine
-amine neurotransmitter produced in substantia nigra of the brain
-affects motor function, cognition, and behavior, reward seeking behaviors (good for eating, bad for addiction)
-2nd messenger systems
Abnormalities seen in:
-Parkinson’s: not enough dopamine; bradykinesia, treat with precursor
-Schizophrenia: signalling pathways, treat with drugs that prevent binding
Excessive:
-drug abuse by preventing reuptake of presynaptic terminals
Norepinephrine
-amine neurotransmitter produced in brainstem, hypothalamus, and thalamus
-released by neurons of ANS and adrenal glands
-fight or flight
Excessive:
-fear, panic, PTSD
-beta blockers to treat
Low:
-sleeping
-depression
Serotonin
-amine neurotransmitter involved with mood, pain, arousal, and motor acitivities
High
-alert and during REM
Low
-depression
Opioid Peptides
-endogenous: endorphins, enkephalins, dynorphins
-produced in NS and bind to receptors for opium
-receptors in SC, hypothalamus, brainstem to inhibit pain
Substance P
-peptide that stimulates nerves at injury site
Neurotransmitter: acts on CNS to cary info to brain
Neuromodulator:
-pain syndromes
-hypothalamus and cerebral cortex during long duration excitation
-modulate immune activity during stress
Ways to Restrict of # Receptors
-internalize receptor
-inactivate receptor
Increase of # receptors
-infrequent activate
-low levels of neurotransmitters
Lamber-Eaton Syndrome
-antibodies damage Ca channels in presynaptic membrane
-no Ach release
-muscle weakness
Myasthenia Gravis
-antibodies damage receptors on muscle cells
-Ach released but cannot bind
-muscle fatigue
-life threatening
Pre-Embryonic Stage
0-14 days
-Inner cell mass of cells becomes embryonic disc
-endoderm and ectoderm
Embryonic Stage
15dy- 8wks
-3 layers
Ectoderm
-NS
-epidermis
Mesoderm
-CS
-Excretory sys
-dermis
-muscles
-skeleton
Endoderm
-Respiratory sys
-organs
Fetal Stage
8wks - Birth
-myelination starts
Neural Tube Development
18-26 days
-Neural groove done at 21d
-closes at cervical 1st
-Superior neuropore closes at 27d
Inner layer
-grey matter
-dorsal horn: sensory
-ventral horn: motor
Outer layer
-white matter
Somites
-appear in occiput first, the caudally
Anteromedial: vertebrae and skull
Posteromedial: muscles of myotome
Later: dermis/dermatome
Conus Medullaris
-end of SC
-l1-l2
Cauda Equina
-individual nerves extending at end of SC
-starts at L1-L2
Filum Terminale
-connection of meninges at end of SC
SC Growth
-stops at 4-5
-vertebral column stops at 16-18y
Grey and White Matter
SC:
Grey: outside, unmyelinated
White: inside, myelinated
Brain:
Grey: inside, unmeylinated, cell bodies
White: outside, myelinated
Brain Development
Hindbrain: brainstem (w/o midbrain), 4th ventricle
Midbrain: cerebral aquaduct
Forebrain
Posterior: Diencephalon
Anterior: telencephalon (cortex, white matter, lateral ventricles
Abnormal Neck and reflexes
-Asymmetric tonic reflex
-Symmetric tonic reflex
-Tonic labyrinth reflex
Neural Tube Defects
-Anencephaly: head does not develop
-Chiari Malformation: foramen magnum contains part of brainstem
-Spina Bifida
-Tethered cord syndrome: filum terminale is stretched
Geriatric Cognition
-decreases everywhere
-long term memory and procedural are stable
-retention of new info stable but needs more cues
-visual recognition of objects are stable
-decrease in vocabulary
Atypical Cognition Aging
-mood changes
-visual-spacial changes
-memory changes
-difficulty communicating
Mild cognitive impairment
-do not interfere with ADLS (unlike dementia and Alzheimer’s)
-90% develop alzheimer’s
-gradual, opposite of learning
Causes of Aging Changes
-25% of motor neurons die
-myelin fragmented
-less dendrite density, less neurotransmitters, less synapses
-shrinkage
3 Neuron Pathways
1st: sensory receptor to SC or BS
2nd: SC or BS to thalamus
3rd: Thalamus to cerebral cortex
Stimulus
-when applied to a receptor, triggers graded membrane potential
-determines type of receptors activated
Receptor
-converts stimulus into AP
-specialized and responds only to specific stimulus type and intensity
Conduction
AP travels to CNS
Translation
CNS receives, integrates info, prepares response
Receptor Morphology
-different shapes/functions of receptors
Simple Receptors: unmyelinated, free nerve endings
Complex Neural receptors: myelinated, nerve endings enclosed in connective tissue
Special Senses Receptors: Myelinated, release neurotransmitters onto sensory neurons
Special Senses Receptors
-somatic: tactile, thermal, pain, proprioceptive
-Visceral: internal organs
Exteroceptors
-near body surface
-external stimuli
Interoceptors
-deep
- comes from body
-BP, blood pH, proprioception
Nociceptors
-occur in all receptors that are sensitive to stimuli that either damage or have damage potential
-can take a scenic route instead of going to the brain
Proprioceptors
-muscles, tendons, ligaments, tendons
-position and kinesthetic sense
Photoreceptors
-vision
Tonic Receptors
-respond continuously if stimulus remains
-slow adapting
-detect object pressure (static)
Book laying on hand
Phasic Receptors
-adapt to continuous stimulus and then stop responding even with stimulus
-fast adapting
-motion, vibration, rate of change
Wearing glasses, clothing on body
Afferent Axon diameter decreasing diameter
Ia, Ib, II, III, IV
AB, ADelta, C
Sensory neuron receptive field
-area of skin innervated by 1 afferent nerve
-smaller fields with greater densiy distally, more sensitivity
-larger fields proximally, less sensitivity
Cutaneous Receptors
Superficial, subcutaneous, mechanoreceptors (AB), Free nerve endings (Adelta & C)
-all go to the same peripheral nerve bundle
Superficial Cutaneous Receptors
-small receptive field, epidermis and dermal palpalae
-Meisner’s Corpuscles: light touch, vibration (superficial)
-Merkel’s Discs: pressure (deeper)
Subcutaneous Cutaneous Receptors
-large receptive field, dermis
-Pacinian Corpuscle: touch, vibration (deeper)
-Ruffini’s ending: stretch (more superficial)
Mechanoreceptors
-light touch, vibration, stretch, pressure
- AB fibers
Free nerve endings
-ADelta & C fibers
-course touch, pain, temperature
Conduction
-3rd step of sensory system
Determinants:
-Modality: specialized stimulation
-Location
-Intensity: # and frequency of activated receptors
-Duration
Signal Integration Levels
3 Levels
-Receptor Level: normal receptor/stimulus interaction; more stimulus more reaction
-Circuit level
-Perceptual Level
Circuit Level of Integration
-Divergence: synapses spread AP to several areas of CNS
-Convergence: synapses can focus action potentials from several sensory neurons on narrowed area
Perceptual Level of Integration
-sensory tract caries impulse to respective region of the brain
-testing comes in to determine what level of integration is faulty
Nerve Conduction Velocity Tresting
Electrical stimulation to peripheral nerves (NCV)
Looks at
-Distal latency: time from stimulation to distal recording sight (testing myelination)
-Amplitude: # of axons conducting
-Conduction Velocity: indication of myelin
Somatosensory evoked potentials (SSEP)
-tests peripheral and central pathways
stimulation at distal sight recording proximally
Clinical Implications : Peripheral Nerve Lesions
-neuropathy
-Nerve compression: large first then small
Order of sensory loss
-proprioception and light tough
-cold
-fast pain
-heat
-slow pain
Clinical Implications : Sensory Ataxia
-injury to dorsal column, roots, or nerves
-EC vs EO testing
Cerebellar: cannot adapt, same with EC/EO, intact proprioception
Sensory: can adapt with EO/EC, impaired proprioception
Clinical Implications : Varicella Roster
-Shingles
-painful rash in dermatome pattern
-chicken pox remains dormant in sensory ganglia then travel to nerve endings
Nociceptive Pain
-acute or chronic tissue injury stimulates nociceptors to become perception of pain
Non-Nociceptive pain
-malfunction of neural pain without the presence of injury
-neuropathic pain, central sensitivity, pain syndromes
Pain Control
Central Processing:
-cingulate and insula during perception of pain
Endogenous Opioids:
-endorphins bind to opiate receptors
Spinal Cord:
-inhibitory neurons
-enkephalin and dynorphin
Segmental Level of Control:
-Gate control theory
-non nociceptive fibers closes a gate for nociceptive fibers
Pain inhibition (at each level)
Periphery: decreases prostaglandins,
-Gate control theory: non nociceptive fibers closes a gate for nociceptive fibers
Dorsal Horn: release enkephalin or dynorphin
Brainstem: descending system
Hormonal System: pituitary gland and periaqueductal grey
Cortical Level: prefrontal, insular, and cingulate lobes
-spinolimbic, spinomesencephslic, and spinoreticular tracts
Referred Pain
-visceral tissues to skin
-convergence of nociceptive and somatic info
Chronic Pain
Disease (Primary pain):
-no biological function or tissue damage
Ex: fibromyalgia, migraines
Symptom (secondary pain):
-symptom of another condition
-continuous stimulation of nociceptors from tissue injury
-even after healing
-damage to somatosensory system
Central Sensitization
-CNS responds excessively to continuing nociceptive input
-cause changes to cells reactiveness
-pain top-down regulation disturbed
Paresthesia
-abnormal sensation
-dysfunction of neurons
Neuropathic Pain
-pain from direct lesion or disease
-Dysesthesias
Dysesthesias
- abnormal sensation that can occur on it’s own or from stimulation
Allodynia, hyperalgesia, spontaneous pain, temporal summation
Allodynia
pain caused by something that normally doesn’t cause pain
Hyperalgesia
-Primary: excessive sensitivity to normal pain
-Secondary: pain spreads to uninjured areas
Spontaneous Pain
pain unrelated to external stimulus
Temporal Summation
-increased pain due to repeated stimulus
Fibromyalgia
-tenderness and stiffness of muscles and tissues
-widespread pain
-increased pain without stimuli
Complex Regional Pain Syndrome
-not related to nerve or nerve root distribution
-affects distal limb
-abnormal response to trauma
-central sensitization with functional changes in brain
Sx: red or pale skin, edema, stiff joints, muscle atrophy, tremors
Nonspecific Low Back Pain
-no specific injury
-muscle guarding and abnormal movements
Ectopic Foci
-cause pain
-outside of nociceptors and become unmyelinated, increasing sensitivity to stimuli
Ephaptic Transmission
-Cross Talk
-lack of insulation due to demyelination that allows 1 action potential to affect more than 1 neuron
-cause for allodynia
Structural Reorganization
-long term central sensitization causes CNS rewiring
-new synapses carry more nociceptive information
Small Fiber Neuropathy
Partial central sensitization cause by :
-post-herpetic neuralgia: shingles
-diabetes
-gulliain barre syndrome (polyneuropathies)
Phantom Limb Sensations
-sensations related to posture, length, and movement of missing limb
Residual Limb Pain:
-easier to treat then Phantom limb pain
Phantom Limb Pain:
-absence of sensory inputs causing nociceptors to be overactive
PT Clinical Implication (chronic pain)
-considered psychosocial aspects of chronic pain
-Consider: distress, disuse, and disability
Muscle Spindle Components
-on skeletal muscles to sense stretch
Intrafusal Muscle in non-contractile regions
-Dynamic nuclear bag (1a, dynamic y)
-Static Nuclear Bag (1a, II, static y)
-Nuclear Chain (1a, II, static y)
Large Diameter myelinated sensory receptors
-central regions of fibers
Small Diameter myelinated motor endings
-innervate polar contractile regions
Extrafusal Muscle Fibers
Outer skeletal muscle that generate movement by attaching to tendon
Intrafusal Muscle Fibers
Inner skeletal muscles that form spindle
-non-contractile
-proprioceptors (length and velocity)
Nuclear Bag Fibers
Type of Intrafusal Fibers
-centrally located
-large
Static
Dynamic
Nuclear Chain Fibers
Type of intrafusal fiber
-smaller
-length dependent
-activate alpha motor neurons
Ia Fibers
-primary sensory endings on muscle spindle
-phasic and tonic discharges
-changes to length
IIa
-secondary sensory endings
-tonic discharges
-responds to steady state length
Gamma Motor Neuron
-regulate sensitivity of muscle spindle fibers
-innervate polar regions and stretch
-motor supply to intrafusal fibers
Dynamic: innervate dynamic NB, increase sensitivity of Ia
Static: innervate NB and NC, increase tonic activity both, decrease dynamic sensitivity Ia
Alpha-Gamma Co-activation
Gamma: innervate polar regions and initiate stretch causing; mechanical gated channels to depolarize on intrafusal fibers
Alpha: …. contract the muscle to maintain length-tension relationship
Reciprocal Inhibition
-1 muscle contracts and opposing muscle is inhibited
- Intrafusal fiber senses stretch
- Info travels to dorsal horn
- Interneuron
4.Travels to ventral horn - Opposite muscle
Golgi Tendon Organ
-proprioceptive structures at junction between muscle fibers and tendon
-sensitive to stretch in tendon/contraction of muscle
-innervated by Ib fibers that send AP to
GTO Motor Control
-afferent signal from GTO relaxes muscles OR activates muscles depending on receptors and feedback
Motor Neuron Pools
-clusters MNs in SC
-innervate a single muscle
Medal MN: innervate axial and proximal limb muscles, laterally, distal
Ventrally MN: innervate extensors and dorsal flexors
Small MNs
-innervate slow twitch fibers
-less force
-long periods of time
Large MNs
-fast twitch fibers
-large forces
-fatigue quickly
Rate Coding
-MN signals amount of force exerted by muscle
Size Principle of MNs
-smaller MNs are recruited and fire before larger
Ohm’s Law: V=IR (voltage= current x resistance)
Transverse Tube
(T-tube)
-surrounds sarcoplasmic reticulum and propagates
Sarcoplasmic Reticulum
-released acetylcholine
-stores Ca+
Z Line
-fibrous disc at end of each sarcomere
M line
-holds together fibers at sarcomere center
Titin
-maintains actin/myosin positions to prevent them from being pulled apart
Troponin
-calcium binding causes tropomyosin to move and uncover sites on actin
Muscle Tone
Resistance to stretch of a muscle
Muscles immobilized in shortened position
-lose sarcomeres
Muscles immobilized in lengthened position
Gain sarcomeres
Phasic Stretch Reflex
-DTR
-muscle contraction in response to quick stretch
-monosynaptic
Cutaneous Withdrawl Reflex
-monosynaptic
-response to pain, withdrawal/flexion before consciously aware of pain
Muscle Cramps
-painful contractions due to overstimulation of nerve tracts
Fasciculations
-fast twitches of all motor fibers in a MU
-eyelash twitching
Myoclonus
-brief contractions of a group of muscles
Tremors
-involuntary rhythmic movements
-with movement or at rest
Polio and post-polio syndrome (types)
- normal MU
- death of selected MUs
- Neuroplasticity cause giant motor units
- Muscle fatigue and pain
CN of PNS
I and II
Order of Nerve Naming (CNS to PNS)
Rootlets
Root
Spinal Nerve
Rami
Peripheral Nerve
Axoplasm
-transports nutrients and chemicals
-allows nerves to glide
-becomes viscous when stationary
A-Alpha Nerve Fibers
-fastest and thickest
-Muscle spindles and golgi, touch, MNs
Ia Nerve Fibers
-fastest and thickest
-muscle spindle
A-Beta Nerve Fibers
-2nd thickness and speed
-touch, muscle spindle
A-Gamma Nerve Fibers
-3rd thickest
-touch, pressure, gamma MNs
Ib Nerve Fibers
2nd-thickness
-golgi tendon organs
II Nerve Fibers
3rd thickest
-touch, muscle spindle
III
-pain, crude touch, pressure, temp
-touch, muscle spindle
A-delta Nerve Fibers
-pain, crude touch, pressure, temp
B Nerve Fibers
-preganglionic autonomic
C Nerve Fibers
-slowest, thinnest
-pain, crude touch, pressure, temp
-postganglionic autonomic
IV Nerve Fibers
-Slowest, thinnest
-pain, crude touch, pressure, temp
Cervical Plexus
-C1-C4
Lumbar Plexus
-L1-L4
Sacral Plexus
-L5-S4
Peripheral Neuropathy
-any disease of peripheral nerves
Mononeuropathy
-single nerve involvement
Traumatic Myelinopathy:
-repeated mechanical pressure and myelin gets damaged
-carpal tunnel
Traumatic Axonopathy:
-crush injury or fracture
-can regrow if schwann and myelin remain (1mm/day)
Severance:
-poor prognosis
-wallerian degeneration within 3-5dy
Polyneuropathy
-symmetric involvement
-distal to proximal distribution
Small fibers:
-pain, temp, numb loss
Large fibers:
-ataxia, proprioception loss
Guillain-Barre Syndrome
-acute inflammatory demyelinating polyradiculoneuropathy
-occurs after viral infection
-motor issues
-can recover
Spinal Levels Traveling Caudally
-L2-S5
Medial Dorsal Rootlets
-Ia and AB for fine touch and proprioception
Lateral Dorsal Rootlets
-AGamma and c fibers for pain and temp
Propriospinal Tract
-only in SC
-surround grey matter
Tract Cells
Long axon cells
Clark’s Nucleus
- T1-L3
-proprioceptive info to cerebellum
Substantia Gelatinosa
-glial and small nerve cells
-spinothalamic
Lateral Horn
-T1-L2
-cell bodies of pregangilonic SNS neurons
Preganglionic PNS Cell Bodies
-S2-S4
Epidural Space
-L3-L4
Order of Spinal Arteries
-Anterior Spinal Artery
-Segmental A.
-Segmental Marginal A
-Radicular A.
Mmt of SC
-stretches 10% with flexion
-none for Cauda
Jendrassik’s Maneuver
-changes descending input to alter motor function
Central Pattern Generators
-Rhythmic activity patters generated by central circuits without external cues
-locomotion, swimming, breathing, swallowing, urinating
Stepping Pattern Generators
-type of GPG for walking without cortical output
-flexor-extensor activation using proprioceptive information
-has to be activated
Withdrawal Reflex
-remove noxious input by activating remaining LE to prevent falling
-crossed extension reflex
Reciprocal Inhibition
-inhibits activated of antagonist while turning on agonist
Recurrent Inhibition
-inhibit agonist and synergist muscles to turn on antagonist
-Renshaw cells
SC Control of Bladder and Bowel
-afferent into needed
-T11-L2 and S2-S4
Frontal Cortex: tells pons to empty OR corticospinal tract to contract PF muscles
Pons: Sends signals to sacral cord center to contract bladder
Sacral Cord: signals parasympathetic neurons to contract bladder and relax sphincters
SC Control of Sexual Function
Psychogenic processes: L1-L2
Reflexogenic Processes: S2-S4
Pudenal: L1-L2 and S2:S4 for orgasm
Injuries
-Above T12: loss of erection and genital sensation, reflexive erections
-L2-S2 intact circuits: normal function, no sensation
-S2-S4 circuit lesion: nothing
Segmental SC Injuries
-dermatomal or myotomal patters
Vertical Tract Impairments
-ipsi/contra deficits below lesion
Anterior Cord Syndrome
-A. Spinal Artery issue
-Paralysis, analgesia, loss of discriminative sensation, loss of temp below lesion
-Keep proprioception and light touch (DCML)
Central Cord Syndrome
-trauma induced
Small Lesion: pain and nociception impaired at level of lesion
Large Lesion: pain and nociception impaired at level of lesion AND UE motor issues
Brown-Sequard (Hemicord) Syndrome
Ipsilateral segment:
-paralysis and analgesia of everything
Ipsilateral Below:
-Paralysis and loss of proprioception and light touch
Contralateral Below:
-nociceptive and temp impaired
Cauda Equina Syndrome
-sensation impaired, pain, LE paralysis, bowel/bladder
-no hyperreflexia
Tethered Cord Syndrome
- stretch injury, scar tissue
-LE, bowel/bladder, spine issues
Ant. Cauda equina: LMN
Excessive stretch: UMN
Spinal Shock
-24h-3wks
-all reflexes, function and autonomic regulation lost
-end with return of anal reflexes
Post-Traumatic SC Injury
-hyperexcitability and hyperreflexia
-more sensation
-poor thermoregulation
-orthostatic hypotension
-dysreflexia
SC Bowel/Bladder Dysfunction
S2-S4: flaccid a-reflexive bladder
Above S2-S4: hyperreflexive bladder
-reflex emptying or spasms that cause urine to backflow into kidneys
SC Injury and Sexual