Exam 3 Neuro Anatomy Flashcards
Epidural Hematoma involves what vessel?
Middle meningeal artery
Subdural Hematoma involves what vessel?
Bridging veins
Subarachnoid Hemorrhage involves what vessel?
Aneurysm U in Circle of Willis
Review anatomy slides at beginning of lecture
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Contents of Cavernous Sinus? (3)
All EOM: Oculomotor (III), Trochlear (IV), Abducent (VI)
2 branches of CN V: Ophthalmic (V1), Maxillary (V2)
Internal Carotid Artery
Frontal Lobe controls? (4)
1) Executive fxn: Thinking/Planning/Organizing/Problem solving
2) Emotions
3) Behaviors
4) Personality
Temporal Lobe controls? (3)
1) Memory
2) Understanding
3) Language
Parietal Lobe controls? (4)
1) Perception
2) Making sense of world
3) Arithmetic
4) Spelling
Occipital Lobe controls?
Vision
Motor Cortex controls?
Sensory Cortex controls?
Movement
Sensations
Midbrain contains what CNs?
II, III, IV
Pons contains what CNs?
V, VI, VII, VIII
Medulla contains what CNs?
IX, X, XI, XII
Crossed Signs is?
Ipsilateral CN deficits and contralat body weakness
Lateral spinothalamic tract crosses where?
level of spinal cord
Lateral corticospinal tract crosses where?
level of medulla
Brown Sequard Synd is?
Results in?
Partial spinal cord transection
Loss of pain, temp, touch on opposite side
Loss of motor, vibration, position, deep touch on same side
Central cord lesion results in?
Loss of pain, temp
Anterior cord lesion results in?
Loss of movement, pain, temp
Posterior column lesion results in?
Loss of vibration, proprioception
Posterior/Lateral column lesion results in?
Loss of movement, vibration, proprioception
Cauda Equina Synd results in? (6)
EMERGENCY Asymmetric Severe pain/weakness of low back/legs Flaccid paralysis of legs Saddle anesthesia Late, bowel/bladder problems
Conus Medullaris Synd? (7)
EMERGENCY Symmetric/Bilateral Less severe pain of low back/legs, perianal Mod weakness Saddle anesthesia Early, SEVERE bowel/bladder problems
Lesion of Cortex results in? (3)
Aphasia
Hemianopia (blind over part of field)
Hemiparesis/sensory of face/arms
Lesion of Subcortical Structures results in? (2)
(Structures: Internal capsule, Basal gang)
Dense hemiplagia
Abn movements
Lesion of Cerebellum results in?
Ipsilateral truncal or limb Ataxia/Dysmetria (under/over shooting)
Lesion of Brain Stem results in?
CN palsies
Crossed Signs
Lesion of Spinal Cord results in?
Paraparesis
Sensory
Bowel/Bladder
Saddle anesthesia
Lesion of motor neuron results in?
No sensory issue
Fasciculations (spontaneous contractions)
Lesion of Peripheral Nerve results in?
Distal weakness/Sensory
U stocking/glove
No or hyporeflex
Lesion of NMJ results in?
Fatigability
No sensory issue
Normal DTR
Lesion of Muscle results in?
Symmetric, Proximal weakness
No sensory issue
All possible pathologies:
VITAMINCDE
Vascular Inflammatory Trauma Autoimmune Metabolic Infectious Neoplasm Congenital Drugs Epilepsy/seizure
Neuro exam should include? (8)
Mental status Neck/spine Cranial nn Motor Sensory Reflexes Coordination Station/Gait
Mental Status includes?
Level of Arousal: Alert Lethargic Stupor Obtunded Coma
CN II/Optic exam should include? (5)
RAPD is?
Visual acuity Color vision (red desaturation) Visual fields Fundo exam Pupils (direct afferent constriction)
RAPD = relative afferent pupillary defect,
CN II lesion seen when direct light produces no constriction in either eye because the signal never reaches the brain
CN III moves eyes how?
Controls lid how?
Control pupil how?
IV?
VI?
review slide 70, 73 - 76
When looking at pt
III = Up, Down, 11:00, 1:00 (both eyes) Nose (9:00 L, 3:00 R) Cheeks (5:00 L, 7:00 R) Opens lid Accommodation, consen constr, efferent direct const
IV = Lips (7:00 L, 5:00 R)
VI = Ears (3:00 L, 9:00 R)
CN V/Trigeminal exam should include? (3)
Sensation
MM of mastication
Sensory corneal reflex (cotton whips)
CN VII/Facial exam should include?
Facial expression
Motor corneal reflex
Closes eyelid
Central facial palsy affects which mm?
Contralat lower facial expression
Upper face preserved
Peripheral facial palsy affects which mm?
Ipsilat up/low facial expression
Pupillary Reflex: In on what CN?
Out on what CN?
CN II
CN III
Corneal Reflex: In on what CN?
Out on what CN?
CN V1
CN VII
Gag Reflex: In on what CN?
Out on what CN?
CN IX
CN X
Vestibulo-ocular Reflex is what?
Eyes move opposite way of head to be able to keep looking at target
e.g. head rotates right, eyes rotate left
Vestibulo-ocular Reflex: In on what CN?
Out on what CN?
CN VIII
CN III and VI
Vestibulo-ocular Reflex: Cerebral damage affects this how?
Nystagmus
Vestibulo-ocular Reflex: Brainstem damage affects this how?
Eye reflex is absent
Eyes stay fixed in head, they follow head
CN XI/Spinal Accessory controls what mm?
Sternocleidomastoids -> turn head
Trapezius -> shrug shoulders
CN XII/Hypoglossal lesion presents how?
Paralysis of the ipsolateral side of tongue
Sticking tongue out -> looks like contralateral side of tongue “licks the lesion” side
Motor Exam should include? (4)
Tone: spasticity, rigidity, flaccidity
Bulk: atrophy, hypertrophy, fasciculations
Abnormal movement
Strength : proximal to distal
Spasticity is from lesion located where?
Is dependent or independent on velocity?
UMN
Dependent
The faster the stretch, the more the resistance. Resists start of movement, then let’s go.
Rigidity is from lesion located where?
Is dependent or independent on velocity?
Basal ganglia
Independent
Causes cogwheel rigidity - rigid thru entire ROM)
Sensory Exam should include? (5)
Distal to Proximal:
Pin Thermal Touch Joint position Vibration
DTR Spinal Nerve Roots:
Biceps?
Brachioradialis?
Triceps?
Patellar?
Achilles?
Biceps = C5, C6
Brachioradialis = C6
Triceps = C7
Patellar = L4
Achilles = S1
Coordination Exam should include? (4)
Finger-to-nose
Heel-Knee
Thumb tapping/Toe tapping
Rapid alternating mvmts
Station and Gait Exam should include? (6)
Posture Romberg Gait/Arm swing Heel walk Toe walk Tandem gait
Upper Motor Neuron weakness presentation? (3)
Spastic
Hyper-reflex
Babinski
Lower Motor Neuron weakness presentation? (4)
Flaccid
Hypo-reflex
Atrophy
Fasciculations
Cortical neural lesions presentation? (6)
Face/Arm more affected than Legs if Middle Cerebral Artery
Legs > Face/Arms if Anterior Cerebral Artery
Hemi-sensory/motor
Aphasia
Apraxia
Agnosia
Subcortical neural lesions presentation? (3)
Dense unilat motor or sensory
Face/Arm/Leg equally affected
Movement disorders
Frontal Eye Fields turn eyes in which direction?
Lesions here present how?
Towards the opposite direction (right field turns eyes left)
“Look at your lesion”
e.g. right frontal lesion causes right gaze preference
Hemianopia is opposite visual fields
e.g. left hemispheres are blind
