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Neuroscience > Exam 3 Part 2 - Clinical Scenarios and Notes > Flashcards

Exam 3 Part 2 - Clinical Scenarios and Notes Flashcards

1
Q

Divisions of the Brainstem (3)

A

Mesencephalon: tectum, cerebral aqueduct, crura cerebri
Metencephalon: cerebellum, 4th ventricle , pons
Myencephalon: PCs, central canal, pyramids

all of these contain the tegmentum

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2
Q

In cross sections of the brainstem, how do the penetrating arteries appear?

A

Wedge-shaped pattern of distribution - a thrombosis here is a reason we get lesion patterns

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3
Q

Seven major ascending and descending pathways:

A

Spinal Lem, Medial Lem, Lateral Lem, Trigeminal Lem, Descending Tract of V, MLF, CST, and CBT

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4
Q

Spinal Leminiscus is responsible for:

A

Contralateral pain and temperature of the BODY

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5
Q

Medial Lemniscus is responsible for:

A

Contralateral propioception of the BODY

At the level of upper pons/midbrain: conveys taste from ipsilateral tongue

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6
Q

Trigeminal Lemniscus is responsible for:

A

Contralateral pain, temperature, and crude tactile of the FACE

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7
Q

Lateral Lemniscus is responsible for:

A

Bilateral auditory information but primarily the opposite ear

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8
Q

Medial Longitudinal Fasciculus conveys:

A

Vestibular influences to the CN 3, 4, 6

involved in multiple sclerosis

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9
Q

General Lesions of the MLF results in:

A

Internuclear Ophthalmoplegia = abnormal response to horizontal gaze in the direction OPPOSITE to the lesion

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10
Q

Unilateral Lesion of the MLF results in:

A

Impairment/loss of adduction (medial rectus) of the ipsilateral eye, and nystagmus of the abducting eye

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11
Q

Corticospinal Tract is responsible for:

A

Conveys descending motor information from the motor cortex

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12
Q

Parts of the Corticospinal Tract

A

Midbrain: middle 3/5 of the cerebral peduncle
Pons: fascicles by the pontine nuclei
Medulla: forms the pyramids and fibers will decussate in the lower medulla

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13
Q

Unilateral lesion of the corticospinal tract is called:

A

Contralateral Spastic Hemiplegia

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14
Q

Brainstem cranial nerve motor nuclei are innervated by what types of fibers?

A

Corticobulbar Tract Fibers

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15
Q

Unilateral Lesion of the CBT

A

Denervation of the motor nuclei below the level of the lesion (some motor nuclei like the facial one receive input from both hemispheres so they won’t be affected)

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16
Q

Unilateral lesions of the CBT above the level of the decussation?

A

Results in contralateral paralysis or paresis of the mimetic muscles (supranuclear facial palsy) as well as other palsies from CN 6, 12, 10

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17
Q

Unilateral lesions of the CBT below the decussation?

A

Ipsilateral cranial nerve palsies

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18
Q

80% of strokes appear where?

A

In the internal capsule or the basal ganglia

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19
Q

Cranial Nerves of the Diencephalon

A

CN 2 - leads to visual field blindness

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20
Q

Cranial Nerves of the Midbrain

A

CN 3 and 4

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21
Q

Cranial Nerves of the Pons

A

CN 5 - ipsilateral loss of sensations from face

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22
Q

Cranial Nerves of the Pontomedullary Sulcus

A

CN 6, 7, and 8

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23
Q

Cranial Nerves of the Medulla Oblongata

A

CN 9-12

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24
Q

Lesion of the Nucleus Ambiguus

A

Deviation of the uvula away from the affected nucleus

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25
Q

Lesion of the Hypoglossal Nucleus

A

Protruded tongue towards the side of the affected nucleus

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26
Q

How do you determine how large the lesion is?

A

By the number and location of the central pathways involved.

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27
Q

How do you determine the level and side of the lesion?

A

This depends on the symptoms from the HIGHEST cranial nerve and which side it correlates to

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28
Q

Lesion to the Descending Tract of V

A

Loss of pain/temp sensations from the same side of the FACE

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29
Q

Alternating Hypoglossal Hemiplegia

A

Shorthand: A12H
Symptoms: tongue protrudes to ipsilateral side (hypoglossal nucleus) and contralateral spastic hemiplegia

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30
Q

Important Similarities b/t the Alternating Hemiplegias

A

Each of them exit the brainstem adjacent to the CST so when they are cut, the IPSILATERAL CST is too = contralateral spastic hemiplegia

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31
Q

Alternating Hypoglossal Hemiplegia + Destruction of Contralateral CST

A

Shorthand: A12H + CST
Symptoms: tongue protrustion, contralateral spastic hemiplegia, and the second CST will result in the ipsilateral spastic paralysis

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32
Q

Alternating Hypoglossal Hemiplegia + Ipsilateral ML

A

Shorthand: A12H + ML
Symptoms: tongue protrustion, contralateral spastic hemiplegia, and contralateral loss of propioception

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33
Q

Alternating Abducent Hemiplegia

A

Shorthand: A6H
Symptoms: ipsilateral paralysis of lateral gaze, internal strabismus and contralateral spastic hemiplegia

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34
Q

Millard-Gubler’s Syndrome

A

Shorthand: A6H + 7
Symptoms: ipsilateral paralysis of lateral gaze, internal strabismus and contralateral spastic hemiplegia AND ipsilateral facial palsy, loss of taste, decreased lacrimation, hyperacusis

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35
Q

Syndrome of Foville

A

Shorthand: A6H + ML + MLF
Symptoms: ipsilateral paralysis of lateral gaze, internal strabismus and contralateral spastic hemiplegia AND contralateral loss of propioception, AND internuclear ophthalmoplegia

destruction of the CROSSEDCBT –> nucleus ambiguus, hypoglossal nerves

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36
Q

Alternating Trigeminal Hemiplegia

A

Shorthand: A5H
Symptoms: ipsilateral loss of face sensations, paralysis of muscles of mastication, and contralateral spastic paralysis

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37
Q

Alternating Trigeminal Hemiplegia with Dorsal Expansion

A

Shorthand: A5H + ML
Symptoms: ipsilateral loss of face sensations, paralysis of muscles of mastication, and contralateral spastic paralysis AND contralateral loss of propioception from body

destruction of UNCROSSED CBT –> abducens, facial, hypoglossal, and nucleus ambiguus

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38
Q

Alternating Oculomotor Hemiplegia (Weber’s Syndrome)

A

Shorthand: A3H
Symptoms: external strabismus, pupillary dilation, and complete ptosis; contralateral spastic hemiplegia

destruction of the substantia nigra may cause contralateral resting tumor, UNCROSSED CBT may cause supranuclear facial palsy

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39
Q

Where do the CBT fibers decussate?

A

In the lower pons between the levels of the trigeminal and abducens nerve.

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40
Q

What specific characteristic can you look for to know the disease includes uncrossed CBT fibers?

A

Look for supranuclear facial palsy!

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41
Q

Lesion of the Nucleus Ambiguus and Spinal Lemniscus

A

NA Symptoms: dysphagia, dysarthria, hoarseness
SL Symptoms: contralateral loss of pain and temperature from the body

may also include the ML and solitary nucleus

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42
Q

Lateral Medullary Syndrome (Wallenberg’s or Syndrome of PICA)

A

Shorthand: SL + Desc Tract of V + CN 9,10
Destruction of the SL (contra loss of pain/temp from body) and descending tract of V (ipsilateral loss of pain/temp from face)

key symptoms: Alternating Hemianalgesia + Dysphagia

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43
Q

Cerebellopontine Angle (CPA) Syndrome

A

Shorthand: SL + Desc Tract V + CN8
Destruction of CN8 results in deafness and vestibular disturbances

Key symptoms: Alternating Hemianalgesia + Deafness

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44
Q

Benedikt’s Syndrome (Lesion in Midbrain Tegmentum)

A

Shorthand: CN3 + ML
Destruction of CN 3 (external strabismus, pupil dilation, ptosis) and ML (contralateral loss of propioception from body)

Lesion of the red nucleus: may have tremor, ataxia

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45
Q

Parinaud’s Syndrome

A

Due to a lesion of the superior colliculus which controls upward gaze (they won’t be able to look straight up)

May be due to a pineal tumor, lesions may destroy the posterior commissure (no consensual light reflexes)

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46
Q

Unilateral Lesions of VPM and VPL

A

Contralateral Hemianesthesia:

  • loss of pain/temp on contralateral face and body
  • loss of propioception from contralateral body and ipsilateral head
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47
Q

Thalamic Syndrome (Dejerine-Roussy Syndrome)

A

Due to thrombosis of the branches of PCA

Symptoms: spontaneous pain, extreme mood swings, may also involve contralateral hemihypalgesia (crawling ants feeling)

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48
Q

Relationships of the Vestibular Nerve

A

Enters brainstem at pontomedullary sulcus

Travels beneath the restiform body

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49
Q

Primary neuron of the vestibular nerves bifurcate and terminate in these locations: (3)

A

Vestibular nuclei
Fastigial nuclei
Flocculo-nodular lobe

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50
Q

MLF in the Vestibular Nuclei

A

Terminates in the CN3, 4, and 6 nuclei, responsible for synchronized eye movements

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51
Q

Vestibulo-ocular responses can be tested clinically by:

A

Doll’s Head Maneuver or Oculocaloric (ice water) testing

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52
Q

Paramedics Pontine Reticular Formation (PPRF)

A

Critical center for horizontal gaze - affects the abducens nerve/lateral rectus muscle so that the ipsilateral affected eye CANNOT look outwards (right eye cannot abduct)

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53
Q

Medial Vestibulospinal Trac

A

responsible for movements of the head

Influences the muscles of the neck, upper neck, and proximal upper limbs - moves the head relative to eye movements

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54
Q

Lateral Vestibulospinal Tract

A

moves the rest of the body

Facilitates the extensor tone and reflexes of the antigravity axial and appendicular musculature

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55
Q

Vestibulospinal-cerebellum refers to these structures:

A

The flocculo-nodular lobe, underlying deep cerebellar nuclei, and the fastigii

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56
Q

Normal Results for the Doll’s Eye Maneuver

A

Normally (without cervical injury) we would expect the eyes to move in the opposite direction of the head

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57
Q

Oculocaloric Testing for Vestibulo-ocular Response

A

In an UNCONSCIOUS patient, injection of cold water into the external auditory meatus results in horizontal gaze toward the side of the stimulus

Example: If water is poured into right ear

  • Right eye abducts, left eye adducts = normal finding
  • Right eye abducts = left III nerve palsy
  • Left eye adducts = Right VI palsy
  • No responses = Right VIII palsy, midbrain damage
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58
Q

Unilateral Lesions of the Vestibular Systems

A

Postural impairment
Eyes, head, body turn towards affected side
Patients tends to fall towards that side
Nystagmus and vertigo

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59
Q

Internuclear Ophthalmoplegia (INO)

A

Named according to the side of the oculomotor impairment:

  • is horizontal gaze to the right is normal, and dis conjugate to the left (right eye doesn’t adduct) = RIGHT INO
  • if left eye doesn’t adduct and right eye has nystagmus = LEFT INO
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60
Q

80% of the INO cases are either young adults with _____ or older patients with _____

A

Young: bilateral INO with MS
Old: unilateral INO with vascular disease

61
Q

Central core of the white matter of the cerebellum is called _____ and includes _____

A

Corpus Medullares

Includes: fastigial nucleus, globuse nucleus, emboliform nucleus, and the dentate nucleus

62
Q

Fastigial Nucleus

A

Medial-most nucleus of the four nuclei, has vestibular connections and function

63
Q

Dentate Nucleus

A

Cup-shaped nucleus that gives rise to most of the efferents in the superior cerebellar peduncle (called the dentato-rural tract)

64
Q

Vestibular efferents will come from what part of the cerebellum?

A

Inferior cerebellar peduncle

65
Q

Cerebellar afferents that course through the inferior cerebellar peduncle: (mnemonic)

A

DDT Always Ruins Olives

  1. DSCT
  2. Direct Arcuate Fibers/Cuneocerebellar Tract
  3. Trigeminocerebellar Tract
  4. Arcuocerebellar Fibers
  5. Reticulocerebellar Fibers
  6. Olivocerebellar Fibers
66
Q

Dorsal Spinocerebellar Tract is responsible for:

A

Unconscious, precise information from the lower 1/2 of the body

Spinal nerves terminate in the nucleus dorsalis (C8-L3)

67
Q

Cuneocerebellar Tract is responsible for:

A

Unconscious, precise information from the upper 1/2 of the body

These fibers terminate in the vermis

68
Q

Trigeminocerebellar Tract is responsible for:

A

Unconscious sensory tracts from the face (general propioception)

Moderate number of fibers from subnuclei Rostralis and Interpolaris to the anterior vermis

69
Q

Olivocerebellar Fibers

A

Heavily influence the purkinje cells of the cerebellar cortex

These fibers originate in the ION and terminate as climbing fibers in the contralateral cerebellar hemisphere

70
Q

The ION receives direct input from:

A

Central tegmental fasciculus and the spinoolivary tract

71
Q

Central Tegmental Fasciculus (CTF)

A
  • originates in the red nucleus

- this tract is a critical link between the extra pyramidal system and cerebellum

72
Q

What fibers make up the middle cerebellar peduncle?

A

Pontocerebellar fibers

73
Q

Ventral Spinocerebellar Tract is responsible for:

A

Unconscious, general propioception from the lumbosacral levels to the cerebellum

74
Q

All information entering the cerebellar cortex eventually converges upon _____

A

The purkinje cells - these are the only efferents from the cerebellar cortex (and they are inhibitory)

75
Q

Signs and Symptoms of Cerebellar Dysfunction

A

Results in ipsilateral deficits

Symptoms: dysmetria, ataxia, dysdiadochokinesia, intention tremor

76
Q

Friedreich’s Ataxia

A

Just know this is a good cerebellar disorder with the typically expected symptoms

77
Q

Where are the CBT fibers located as compared to the the CST fibers?

A

CBT: genu of the internal capsule
CST: posterior limb of the internal capsule

78
Q

Motor regions of the brainstem are usually located in what part?

A

Anterior (red areas shaded on photo in lecture)

79
Q

Bell’s Cruciate Paralysis

A

Characterized by midline involvement of the upper portion of the pyramidal decussation resulting in paralysis of the upper extremity (without lower extremity involvement)

this can happen with damage to the odontoid process because it’s adjacent to the pyramids

80
Q

What is the extrapyramidal system (EPS) responsible for?

A

Crude, associative movements of the axial and proximal limb musculature

EPS initiates movements through the subcortical loops

81
Q

Parts of the Basal Ganglia

A

Globus pallidus (GP), caudate nucleus, putamen, substantia nigra, red nucleus

82
Q

Motor nucleus of the thalamus refers to:

A

The ventral anterior and ventral lateral nuclei

83
Q

Connections of the Globus Pallidus

A

Dorsal division of the ansa lenticularis = lenticular fasciculus
Ventral division of the ansa lenticularis

84
Q

Connections of the Substantia Nigra

A

Nigro-thalamic fibers = pars reticularis –> terminate in the VA and VL thalamic nuclei
Nigro-striatal fibers = pars compacta –> terminates in the caudate and putamen (striatum)

85
Q

Destruction of inhibitory GABAnergic fibers in the striatonigral fibers results in:

A

Huntington’s Chorea

86
Q

Fibers in the GP and SN don’t terminate in the same place - this is important for what procedure?

A

Stereotaxic surgery for Parkinson’s disease

87
Q

Destruction of Nigrostriatal Fibers results in:

A

Parkinson’s Disease

Dopaminergic

88
Q

Symptoms and Cause of Parkinson’s Disease

A

Symptoms: Bradykinesia, tremors during rest, rigidity, reptilian gaze, glabellar reflex, postural embrassment, autonomic effects, cognitive changes

Caused by: degeneration of SN, GP, brainstem RF, and postganglionic sympathetic neurons

89
Q

Symptoms and Cause of Huntington’s Chorea

A

Symptoms: 30-40yrs onset, choreiform movements, severe dementia, choreoathetosis (involuntary movements), behavioral disturbances

Caused by: autosomal dominant (chromosome 4), degeneration of corpus striatum and cerebral cortex (destruction of the GABAnergic fibers)

90
Q

Symptoms and Cause of Hemichorea

A

Symptoms: unilateral choreiform (repetitive, rapid) movements

Caused by: vascular lesion in the basal ganglia

91
Q

Symptoms and Cause of Athetosis

A

Symptoms: slow, involuntary, writhing movements of the limbs and face

Caused by: degeneration of the striatum

92
Q

Symptoms and Cause of Hemiballism

A

Symptoms: contralateral, violent flailing movements of proximal musculature (both upper/lower extremities)

Caused by: unilateral lesions of the subthalamus result in a reduction of glutamate inhibition on the globus pallidus

93
Q

Spinal Cord Growth in a 3 Month Fetus

A

Spinal cord extends throughout the entire length of the vertebral column

94
Q

Spinal Cord Growth in a 5 Month Fetus

A

Vertebral column is longer than the spinal cord; conus medullaris is at the level of SV1

95
Q

Spinal Cord Growth in a Neonate

A

Conus medullaris is at the level of LV3

96
Q

Spinal Cord Growth in an Adult

A

Conus medullaris is at the level of LV1-2 interspace

97
Q

Rachischisis

A

Vertebral column defect, with exposure of primitive cord - NOT SURVIVABLE

98
Q

Spina Bifida Occulta

A

Herniation of meninges or neural tissue - usually presents as a midline, hairy mass in lumbar region

May be caused due to failure of the roof plate of neural tube - may be asymptomatic for years

99
Q

Meningocele

A

Vertebral column defect with herniation of meninges

100
Q

Meningomyelocele

A

Vertebral column defect with herniation of meninges, spinal cord, or nerves

101
Q

Anencephaly

A

Literally means “absence of the brain” but these babies still have a brainstem and vital functions

102
Q

Meningoencephalocele

A

Cranial defect with herniation of meninges and brain tissue

Also all of these babies also have a chiari malformation and they may develop hydrocephalus

103
Q

Meningohydroencephocele

A

Cranial defect with herniation of meninges, brain, and ventricles

104
Q

Cranial Rachischisis

A

Congenital absence of the forebrain usually with cranial defect of frontal and parietal bones

fatal anomaly

105
Q

Hydrocephalus

A

Congenital stenosis of a portion of the ventricular system or certain fetal infections

106
Q

Arnold-Chiari Malformation

A

Common cerebellar anomaly that is almost always present with meningomyelocele, sometimes with syringomyelia

Involve elongation of the cerebellar vermis, which herniates through the foramen magnum

107
Q

Three important structures of emotional expression:

A

Limbic lobe, neocortex, and hypothalamus that goes to the reticular formation

108
Q

Scheme of the Reticular Formation

A

Ascending from the RF –> ARAS, centromedian nucleus hypothalamus, and special systems

Descending from the RF –> sensory and motor input

109
Q

Importance of the Septal Areas

A

Near the corpus callosum, does addiction, pleasure/reward system, drugs

Receives input from olfactory system

110
Q

Major feature of frontal lobe syndrome:

A

APATHY

111
Q

Korsakoff’s Syndrome

A

Bilateral destruction of the mammillary bodies and the dorsal medial nucleus of the thalamus

See an impairment in recent memory

Usually due to long-term chronic alcoholism, pituitary tumors

112
Q

Papez Circuit

A

Responsible for flash/recent memory and shows the relationship between the cortex, amygdala, and septal areas

113
Q

Papez Circuit in the Cortex

A

Mammillary body –> anterior tubercle –> cingulate gyrus –> entorhinal cortex –> hippocampus (receives all sensory)

Important tracts: fornix (sends info both ways), mammillothalamic between the MB and AT

114
Q

Importance of Olfactory Input in Papez Circuit

A

Provides olfactory information to the hippocampus, amygdala, and the septal area

115
Q

Communication between the Amygdala and Septal Areas

A

Amygdala –> Septal Area via the stria terminalis

Amygdala –> Hippocampus via the ventral amygdalofugal fibers

116
Q

Hypothalamus communicates with the septal areas and the midbrain tegmentum via:

A

Medial forebrain bundle

117
Q

Primary Olfactory Cortex is made up of:

A

Entorhinal Cortex (which includes the uncus and rostral parahippocampus), lateral olfactory gyrus, amygdaloid nucleus

118
Q

The amygdala is an important processing center for:

A

Olfactory, somatosensory, viscerosensory, and emotional expressions

119
Q

Hippocampus is responsible for:

A

Memory storage and retrieval

120
Q

Hippocampal Amnesia

A

Due to bilateral lesions of the hippocampi, sometimes happens after surgical resections for intractable epilepsy

Axons of neurons in this pathway send fibers to the entorhinal cortex (CA1 pyramidal cells)

121
Q

Uncal Herniation Signs and Symptoms

A

Uncus usually herniates through the ipsilateral tentorial notch (can be due to a tumor or hematoma)

Compresses the follow: CN3 (external strabismus, ptosis), CN6 (gaze is down and in), Cerebral Peduncle (spastic hemiplegia ipsilateral), PCA (homonymous hemianopsia), ARAS, blood vessels, and hydrocephalus

122
Q

In order to have language, what part of the brain is needed?

A

THE CORTEX

123
Q

Layers 3-4 of the Cortex

A

Most of the afferents into the cortex

124
Q

Layers 5-6 of the Cortex

A

Source of efferents from the cortex

125
Q

Superior Longitudinal Fasciculus (SLF) or Arcuate Nucleus

A

Type of association fiber that is a critical link for language association areas

Lesions here: conduction aphasia (spontaneous speech, good comprehension, may have some right-sided paralysis)

126
Q

Uncinate Fasciculus

A

Connects the association areas of the frontal lobe to the interior temporal lobe (this is connected to the entorhinal cortex)

127
Q

Fibers of the Genu of IC

A

Corticobulbar (lesion = supranuclear facial palsy)

128
Q

Fibers of the PLIC

A

Corticorubral
Corticospinal = contralateral spastic hemiplegia
Thalamocortical = contralateral hemianesthesia

129
Q

Fibers of the Retrolenticular Portion of IC

A

Optic Radiations = contralateral homonymous hemianopsia

130
Q

Nuclei of the Basal Ganglia

A

Substantia Nigra (pars compacta and reticularis)
Striatum (caudate and putamen)
Globus Pallidus
Subthalamic Nucleus

131
Q

Nigrostriatal Dopaminergic System

A

SNPC –> nuclei of striatum

Effects: Dopamine will either stimulate or inhibit

132
Q

Intrastriatal Cholinergic System

A

Travels between nuclei of striatum

Effects: excitatory (ACh)

133
Q

Striatonigral GABAnergic System

A

“Direct Pathway”
Striatum –> SNPR and GPi –> thalamus
Effects: releases GABA, leads to initiation of movement

134
Q

When the SNPC is abolished, what disease/effects does it have?

A

Parkinson’s Disease

Direct pathway can’t activate so the indirect pathway becomes overactive

Can’t initiate motion

135
Q

When the direct pathway is active…

A

ALLOWS MOTION

Needs Dopamine at D1, then GABA at VA/VL nuclei

136
Q

When the indirect pathway is active…

A

INHIBITS MOTION

Needs lots of GABA to inhibit the thalamus

137
Q

Voluntary motion comes from the association cortex and involves:

A

Planning of complex motor actions and carrying out the “thought” process

138
Q

If the brain activates or inhibits an alpha motor neuron…

A

It will also activate or inhibit a gamma motor neuron

139
Q

Reaching requires:

A

Dorsal pathway of the primary visual cortex
VIP cortex
F4

140
Q

Grasping requires:

A

Inferior parietal cortex (anterior intraparietal area and PFG)
F5

141
Q

Premotor Cortex receives input from…

A

F4 and F5, determines whether it is okay to move

142
Q

Supplementary Motor Area (SMA)

A

Postural controls

143
Q

Pre-SMA

A

Plans the motor program required to make the action occur

also changes tactics if necessary

144
Q

Primary Motor Cortex

A

Codes motions to reach the goal
Arranged in columns that produce specific movements

Layer 4: sensory input
Layer 5: output for the CST

145
Q

Role of the Cerebellum

A

Sequence complex actions
Correct forces/directions
Balance and eye movements

146
Q

Spinocerebellum (vermis portion)

A

Postural controls
Inputs: vestibular, hearing, and auditory
Outputs: interpositus nucleus, fastigial nucleus (RST)

147
Q

Spinocerebellum (lateral portion)

A

Feedback control of motion, ballistic motion
Inputs: efferent copy, afferents from muscle
Outputs: interpositus nucleus

148
Q

Cerebrocerebellum

A

Planning complex motions, sequence rapid movement, learning
Inputs: cerebral cortex
Outputs: dentate nucleus

149
Q

Vestibulocerebellum

A

Future balance and eye movements
Inputs: vestibular apparatus
Outputs: fastigial nucleus

Neuroscience (4 decks)

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