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Neurology > General principles > Flashcards

General principles Flashcards

1
Q

What forms the gray matter of the spinal cord?

A
  1. Cell bodies
  2. Unmyelinated axons
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2
Q

What forms the white matter of the spinal cord?

A
  1. Myelinated axons
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3
Q

What runs in the central canal of the spinal cord?

A

CSF - continuous with 4th ventricle

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4
Q

What information does the dorsal column medial lemniscus pathway carry?

A

Fine touch and pressure, vibration and proprioception

enters spinal cord and ascends 1-2 levels before crossing

Cuneatus = upper

Gracilis = lower

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5
Q

What information does the spinothalamic pathway carry?

A

Pain and temperature

Ennters spinal cord, crosses straight away

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6
Q

What is the function of the spinocerebellar tract?

A

Control of posture and coordination of movements

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7
Q

What is the function of the tectospinal tract?

A

Mediate reflex postural movements of the head in response to visual and auditory stimuli

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8
Q

What is the substantia gelatinosa?

A
  • one point (the nucleus proprius being the other) where first order neurons of the spinothalamic tract synapse.
  • Many μ and κ-opioid receptors, presynaptic and postsynaptic, are found on these nerve cells; they can be targeted to manage pain of distal origin
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9
Q

What is the role of the corticospinal tracts?

A

Voluntary muscle control

Upper motor neurons that synpase with lower motor neurons in the spinal cord

90% of fibres cross at the pyramidal decusation (lateral corticospinal tract - distal muscle movement)

10% cross in the spinal cord (anterior corticospinal tract - proximal muscle movement)

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10
Q

Discuss Bell’s Palsy

A

Damage to facial nerve

Weakness or paralysis on one side of the face

Idiopathic - unknown cause

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11
Q

What does vitamin B1 deficiency cause?

A

B1 = thiamine

Low in alcoholics

Wernicke-Korsakoff syndrome

Causes a confused mental state, confabulation (story telling) and hallucinations

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12
Q

Which cranial nerve nuceli are located in the pons?

A

5,6,7,8

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13
Q

Which cranial nerve nuclei are located in the medulla?

A

9,10,11,12

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14
Q

Which cranial nerve nuclei are located in the midbrain?

A

3 and 4

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15
Q

Discuss decorticate and decerebrate rigidity

A

Decorticate: arms adducted, flexed over chect and feet plantar flexed. Due to corticospinal tract damage

Decerebrate: arm adducted, extended down body and feet plantar flexed. Due to upper brain stem damage

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16
Q

Which cranial nerve exits the posterior brainstem?

A

Trochlear (4)

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17
Q

Where does the pituitary sit?

A

Sella turcica

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18
Q

What would a midline optic chiasmic lesion lead to?

A

Bipolar hemianopia

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19
Q

What is the somatic nervous system?

A

Controls conscious and sensation and voluntary movement

Two types of pathway:

  • Afferent pathways carrying sensory input
  • efferent pathways carrying motor output from the brain to the muscles
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20
Q

What is the autonomic nervous system?

A

Division of the afferent motor system that provides automaic/ unconscious control of the viscera and homeostasis

2 divisions:

  1. Sympathetic
  2. Parasympathetic
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21
Q

Temporal lobe functions

A

Language, learning, memory, emotional interpretation, hearing, olfaction, gustation

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22
Q

Parietal lobe functions

A

Sensory function

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23
Q

Discuss grey and white matter

A

Cerebral hemispheres and spinal cord composed of grey and white matter

  • Grey: forms outer layer of cerebrum, composed of cell bodies of cerebral neurones and glia. Neurones are organised into layers
  • White: inner region of the cerebral hemispheres, axonal projections from the neurones which connect the cortex to the rest of the CNS (white colour comes from the myelin sheath that wraps the axons)
24
Q

What is the diencephalon?

A

Thalamus and hypothalamus comprises the diencephalon

25
Q

What comprises the peripheral nervous system?

A

43 pairs of nerves

  • 31 spinal nerves
  • 12 pairs cranial nerves
26
Q

What are UMN lesions?

A

Occur in the brain or spinal cord - a lesion in the neuronal pathway above the anterior horn cells

Causes:

  • TBI
  • Cerebral palsy
  • Stroke
27
Q

Frontal lobe functions

A

Motor functioning and higher cognition

  • Problem solving
  • Behavioural control
28
Q

What is the corticospinal tract?

A

AKA the pyramidal tract because it passes through the medullary pyramids

a) lateral corticospinal tract: voluntary movement of contralateral limbs
b) anterior corticospinal tract: voluntary movement of the trunk, neck and shoulders (axial muscles)

29
Q

Discuss the descending tracts of the nervous system

A

Pyramidal tracts: originate in the cortex and carry motor fibres to the spinal cord and brain stem. Responsible for voluntary control of the musculature of the body and face

Extrapyramidal tracts: originate in the brain stem and carry motor fibres to the spinal cord, responsible for the involuntary and autonomic control of al musculature e.g. muscle tone, balance, posture and locomotion

30
Q

Discuss the extrapyramidal tracts

A

Descending tracts, automatic control of musculature e.g. tone, balance, posture

  1. Vestibulospinal
  2. Tectospinal
31
Q

What are the pyramidal tracts?

A

Originate in the cerebral cortex, carry motor fibres to the spinal cord and brain stem - responsible for the voluntary control of the muscles of the body and face

32
Q

What are the extrapyramidal tracts?

A

Originate in the brain stem, carry motor fibres to the spinal cord - responsible for the involuntary control of all musculature e.g. tone, balance, posture, locomotion

33
Q

What are the corticobulbar tracts?

A

UMNs that synapse with LMNs n the cranial nerve nuclei and control muscles of the face and neck

34
Q

Signs if there was a UMN lesion

A

This is anything affecting the cerebral cortex down to the anterior horn cells of the spinal cord

Signs equate to spasticity: contralateral, unilateral hemiparesis

  • Flexed upper limb (weak extensors)
  • Extended lower limb (weak flexors)
  • Increased tone
  • Brisk reflexes (nothing to fine tune it)

Spastic gait (scissor legs if bilateral, hemiplegic gait if unilateral)

35
Q

What are the common brain causes of spastic hemiparesis?

A

Anything that causes a unilateral UMN lesion

  • Stroke (hyperacute)

Space occupying lesion (more degenerative and chronic)

  • Haemorrhage (can be acute or chronic)
  • Abscess (acute/ chronic)
  • Inflammation
36
Q

Why are the corticospinal tracts prone to damage?

A

They span the full length of the CNS and pass through the internal capsule which is a common site of cerebrovascular events

37
Q

Discuss UMN lesions in the spinal cord

A

Likely to cause bilateral UMN signs below the level of the lesion bevaise it is unlikely only one side of cord affected

Thoracic spinal cord: spastic paraparesis

Cervical spinal cord: spastic quadriparesis

38
Q

What are the categories of spinal cord lesion?

A

Extrinsic

  • Trauma: fracture, disc prolapse, haematoma
  • Infection: osetomyelitis, discitis, abscess

Neoplastic: breast/ prostate mets, myeloma

Intrinsic

Inflammatory: MS, infections

Other: B12 deficiency, spinal ischaemia (stroke), intrinsic neoplasm, hereditary spastic paraparesis

39
Q

You have a patient who cannot feel their legs when you touch them - how do we find the sensory level?

A

Go up the thorax trying to find where sensation is present

T4 = nipple

T10 = umbilicus

40
Q

Differentiating from a spinal UMN lesion and a brain UMN lesion?

A

Spinal = bilateral (usually)

Brain = unilateral (usually)

41
Q

What are lower motor neurons?

A

Peripheral nerves starting at the anterior horn cell in the spinal cord

  • Nerve roots
  • Cauda equina

Brachial and sacral plexus

  • Cranial nerves 3-12 are peripheral nerves
42
Q

Clinical signs of a LMN lesion

A

Think Lower think Loss

  • Loss of tone
  • Muscle wasting (severe and quick)
  • Loss of power
  • Loss of reflexes
  • Gait is often high stepping or slapping due to foot drop
43
Q

Signs of cerebellar disease

A

V: Vertigo

A: Ataxia

N: Nystagmus

I: Intention tremor

S: Slurred speech

H: Hypotonia

E: Exaggerated broad-based gait

D: Dysdiadochokinesia

44
Q

If there is a lesion in the left of the cerebellum, where will the signs be present?

A

On the left - this is because the fibres of the cerebellum do not cross

Both afferent and efferent fibres remain ipsilateral

45
Q

What can commonly cause bilateral cerebellar signs?

A

Paraneoplastic syndrome

Alcohol

46
Q

What would a lesion in the vermis of the cerebellum cause?

A

Truncal ataxia - inability to sit upright or stand without support

Can be caused by haematomas that only affect the vermis - although this is rare

47
Q

What are the basal ganglia?

A

Think about a gang sitting under the cortex

Subcortical nuclei strongly connected withc erebral cortex

Functions:

- Control/ selection/ initiation of voluntary movement (sub. nigra is a basal ganglia structure) - best known role

  • Procedural learning
  • Habits
  • Eye movements
  • Congition
  • Emotion
48
Q

What are the main input nuceli of the basal ganglia?

A

Striatum = caudate and putamen

  • Information comes into the striatum from the cortex for fine tuning
49
Q

What are the main output nuclei of the basal ganglia?

A

Globus pallidus + sub. nigra

They send most of their outputs to the thalamus and some to brainstem nuclei

50
Q

Reminder of the direct and indirect pathways

A

Theory suggests that the thalamus wants to allow movement all the time but the basal ganglia is there to keep it in check

Direct pathway: signal comes from the motor cortex to move, signal goes through basal ganglia and thalamus, movement is fine tuned and we move - controlled by D1 receptors

Indirect pathway: normal function is to stop movement by inhbiting the feedback from the thalamus to the motor cortex - controlled by D2 receptors

Think of it like dopamine and the basal ganglia have the final say about movement

51
Q

How might a sensory problem present?

A
  • Numbness
  • Tingling
  • Pain
  • Pins and needles
52
Q

What is important to look for when doing a sensory examination?

A
  • Dermatomal/ glove and stocking sensory loss
  • Pressure ulcers, muscle wasting
  • Gait: Romberg’s test/ sensory ataxia, swaying occurs when eyes closed because lack of feedback from peripheral nerves
53
Q

Rigidity vs spasticity on examination

A

Rigidity: resistance feels the same in all movements and does not depend on velocity

Spasticity: resistance is felt in one direction and is velocity dependent - the faster you go the worse the spasticity gets

54
Q

What causes spasticity?

A

UMN lesion

Lesion in the pyramidal tract

  • Stroke
  • Spinal cord compression
  • MND
55
Q

Types of rigidity

A
  • Cogwheel: due to a tremor + hypertonia
  • Lead pipe
56
Q

Neurotransmitters in the CNS and PNS

A

CNS

Glutamate = main excitatory NT

Gaba = main inhibitory NT

PNS

  • Ach for somatic & autonomic transmission

NA main NT for sympathetic branch of autonomic NS

57
Q

Cerebral dominance

A
  • Each hemisphere has separate & combined functions.
    • Motor/sensory control is bi-lateral.
    • Certain functions however are uni-lateral.
  • Dominant hemisphere is responsible for;
    • Language.
    • Mathematical processing.
    • Writing.
    • In Right handed & 70% of left handed pt. this is in the left hemisphere.
  • Non-dominant is responsible for;
    • Spatial recognition.
    • Musical interpretation.
    • Interpretation of emotional salience & tone of speech.

Neurology (23 decks)

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