Exam 3 Neuro Anatomy Flashcards by Wendy Pitts

Epidural Hematoma involves what vessel?

Middle meningeal artery

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Subdural Hematoma involves what vessel?

Bridging veins

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Subarachnoid Hemorrhage involves what vessel?

Aneurysm U in Circle of Willis

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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

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Frontal Lobe controls? (4)

1) Executive fxn: Thinking/Planning/Organizing/Problem solving
2) Emotions
3) Behaviors
4) Personality

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Temporal Lobe controls? (3)

1) Memory
2) Understanding
3) Language

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Parietal Lobe controls? (4)

1) Perception
2) Making sense of world
3) Arithmetic
4) Spelling

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Occipital Lobe controls?

Vision

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Motor Cortex controls?

Sensory Cortex controls?

Movement

Sensations

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Midbrain contains what CNs?

II, III, IV

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Pons contains what CNs?

V, VI, VII, VIII

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Medulla contains what CNs?

IX, X, XI, XII

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Crossed Signs is?

Ipsilateral CN deficits and contralat body weakness

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Lateral spinothalamic tract crosses where?

level of spinal cord

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Lateral corticospinal tract crosses where?

level of medulla

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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

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Central cord lesion results in?

Loss of pain, temp

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Anterior cord lesion results in?

Loss of movement, pain, temp

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Posterior column lesion results in?

Loss of vibration, proprioception

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Posterior/Lateral column lesion results in?

Loss of movement, vibration, proprioception

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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

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Conus Medullaris Synd? (7)

EMERGENCY
Symmetric/Bilateral
Less severe pain of low back/legs, perianal
Mod weakness
Saddle anesthesia
Early, SEVERE bowel/bladder problems

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Lesion of Cortex results in? (3)

Aphasia
Hemianopia (blind over part of field)
Hemiparesis/sensory of face/arms

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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