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ILA formatives > ILA7 - Stroke/weakness > Flashcards

ILA7 - Stroke/weakness Flashcards

1
Q

What are the two types of dysphasia?

A

Receptive and expressive

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2
Q

What is receptive dysphasia?

A

Lesion in Wernicke’s area, difficulty in understanding language

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3
Q

What is expressive dysphasia?

A

Lesion in Broca’s area. Trouble with expressing, say words but dont make sense.

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4
Q

In what percentage of right handed people are Brocas and Wernickes areas on the left side?

A

98%

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5
Q

In what percentage of left handed people are Brocas and Wernickes areas on the right side?

A

60%

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6
Q

Name some of the key areas in the frontal lobe.

A
  • Central sulcus & Sylvian/lateral sulcus
  • Prefrontal cortex (at front, complex cognitive processes)
  • Premotor cortex (ant. to primary motor cortex)
  • Primary motor cortex (pre-central gyrus, movement)
  • Broca’s area (ant. inf. dominant side, speech generation)
  • Sup, middle and inf frontal gyri
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7
Q

Name some key areas in the temporal lobe.

A
  • Sup, midlle and inf temporal gyri
  • Wernicke’s area (post to Broca’s, below lateral sulcus, speech reception and association)
  • Function is to process sensory info to derived meanings for appropriate response, language comprehension and emotional association
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8
Q

Name some key areas in the parietal lobes.

A
  • Bound by central sulcus (ant.) and parieto-occipital sulcus (post), above temporal lobe
  • Function is to integrate sensory info from various parts of the body
  • Primary somatosensory cortex (postcentral gyrus, sensation)
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9
Q

What are the folds of dura mater that divide the cerebellum?

A

Tentorum cerebelli (superior) and the falx cerebelli (divides in two)

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10
Q

Which cranial fossa is the cerebellum located?

A

Posterior

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11
Q

What connects the 2 lobes of the cerebellum?

A

Vermis

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12
Q

What are the 3 LOBES of the cerebellum?

A

anterior, posterior and floccunlonodular

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13
Q

What are the hemispheres and zones of the cerebellum?

A

Vermis, intermediate and lateral hemispheres

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14
Q

What are the functional areas of the cerebellum?

A

Cerebrocerebellum, spinocerebellum and vestibulocerebellum

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15
Q

What is the function of the vermis?

A

DOES NOT ALLOW COMMS BETWEEN 2 HEMISPHERES

  • posture
  • limb movements
  • eye movements
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16
Q

Function and position of the cerebrocerbellum.

A

Lateral parts of the cerebellum. Planning movements and motor learning.

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17
Q

Function and position of the spinocerebellum.

A

Vermis and more medial parts of 2 hemispheres. Regulating body movements, receives proprioceptive info.

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18
Q

Function and position of vestibulocerebellum.

A

Flocculonodular lobe. Control balance and ocular reflexes.

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19
Q

What are the parts of the brain stem (sup to inf)?

A

Midbrain, pons, medulla oblongagta

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20
Q

What are the two areas of the midbrain called and what separates them?

A

Tectum (post) and tegmentum (ant). Cerebral aqueduct.

There is also the cerebral peduncles, seperated by the substantia nigra

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21
Q

What makes up the tectum?

A

Superior and inferior colliculi (sup = visual, inf = auditory)

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22
Q

Why is the substantia nigra black/grey? What does it produce?

A

Neuromelanin. Dopamine

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23
Q

What is the function of the pons?

A

Act as comms between cerebrum and cerebellum

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24
Q

What is the function of the medulla oblongata

A

Houses asc and desc tracts. Control of various functions.

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25
Q

What is Cn 1? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Olfactory. Sensory. Smell from olfactory epithelium. Cribriform plate in ethmoid bone.

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26
Q

What is Cn 2? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Optic. Sensory. Vision. Optic canal.

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27
Q

What is Cn 3? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Occulomotor. Motor. Innervates extraocular muscles (LPS, SR,IR,MR,IO), also supplies the sphincter pupillae and the ciliary muscles of the eye (parasympathetic). Superior orbital fissure.

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28
Q

What is Cn 4? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Trochlear. Motor. Superior oblique (tendon does through the trochlea). Superior orbital fissure.

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29
Q

What is Cn 5? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Trigeminal. I-opthalmic (sensory), scalp to nose, superior orbital fissure
II-maxillary (sensory), nose to top lip, foramen rotundum
III-mandibular (both), sensory is ant 2/3 of tongue, skin and lower teeth, motor is muscles of mastication, foramen ovale

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30
Q

What is Cn 6? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Abducens. Motor. Lateral rectus. Superior orbital fissure

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31
Q

What is Cn 7? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Facial. Both. Sensory= outer ear, taste from ant 2/3 of tongue. Motor= facial expression, mucous membrane. Internal acoustic meatus then stylomastoid foramen.

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32
Q

What is Cn 8? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Vestibulocochlear. Sensory. Hearing, balance. Internal acoustic meatus.

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33
Q

What is Cn 9? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Glossopharyngeal. Both. Sensory= general and special from post 1/3of tongue, ear. Motor= parotid and stylopharyngeus. Jugular foramen.

34
Q

What is Cn 10? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Vagus. Both. Sensory= ear, larynx, pharynx, taste from epiglottic part of tongue. Motor= most muscles of pharynx and larynx. Jugular foramen.

35
Q

What is Cn 11? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Spinal accessory. Motor. Trapezius, sternocleidomastoid and some fibres run with Cn 10 to viscera. Jugular foramen.

36
Q

What is Cn 12? Is it sensory or motor? What is its function? Where does it leave the skull?

A

Hypoglossal. Motor. Tongue muscles except palatoglossus (Cn10). Hypoglossal canal.

37
Q

What is the sulcus that separates the two pyramids?

A

Anterior median sulcus

38
Q

What is the sulcus that separates the pyramids from the olives?

A

Ventero-lateral sulcus

39
Q

What is the sulcus that lies outside the olives?

A

Postero-lateral sulcus

40
Q

Which tracts run through the pyramids (anterior surface of medulla)?

A

Corticospinal and corticobulbar (and so are the pyramidal tracts)

41
Q

Which tracts run through the olives (ant. surface of medulla)?

A

Tectospinal, rubrospinal, vestibulospinal and reticulospinal (extrapyramidal tracts)

42
Q

Where does sensory information come from in the cuneate fasciculi?

A

Cuneate means wedge shaped, and so senory information from upper body

43
Q

Where does sensory information come from in the gracile fasciculi?

A

Lower body, Walking gracefully

44
Q

What are the 2 groups of descending pathways?

A

Pyrimadal and extra pyramidal

45
Q

Where do pyramidal tracts originate?

A

Cerebral cortex

46
Q

Which parts of the body are in the medial aspect of the homunculus?

A

Leg, feet and genitals.

47
Q

What do the pyramidal tracts control.

A

Voluntary control of muscles

48
Q

What are the 2 pyramidal tracts?

A

Corticospinal and bulbospinal

49
Q

What is the general route descending pathways take?

A

Fibres start seperate, go through the corona radiata. They then join and go though the internal capsule. Then on to the brainstem and spinal cord

50
Q

Describe the corticospinal tract.

A
  • Goes to the musculature of the body
  • Input from primary motor, pre motor and somatosensory centres
  • Pass through crus cerebri of midbrain, pons and into medulla within the peduncles (motor only)
  • Divide into lateral corticospinal (90% of fibres, cross over at base of pyramids in medulla) and anterior corticospinal (10% of fibres, desc down the spinal cord then cross )
51
Q

Describe the corticobulbar tract.

A
  • Musculature of the head and neck
  • Same input and origin as corticospinal
  • Terminate on brainstem on motor nuclei of cranial nerves
  • Lower motor neurons carry signals to the head and neck
52
Q

Where do the extrapyramidal tracts originate?

A

Brainstem

53
Q

What do the extrapyramidal tracts control?

A

Voluntary and involuntary control of all musculature such as muscle tone, balance, posture and locomotion

54
Q

Where do the extrapyramidal tracts synapse?

A

No synapses within the descending pathways. All synapse with the lower motor neurons. Cell bodies all in cerebral cortex or brainstem and axons remain in CNS

55
Q

What are the 4 extrapyramidal tract?

A

Tectospinal, rurbrospinal, vestibulospinal, reticulospinal

56
Q

Describe the tectospinal tract.

A
  • Responsible for head turning in response to visual stimuli

- superior colliculus, head and eye movements

57
Q

Describe the rubrospinal tract.

A
  • Assist in motor functions, not really used in humans other animals more so (why cats land on feet when thrown out a window)
  • Less developed corticospinal
  • Red nucleus (rubro, red)
58
Q

Describe the vestibulospinal tract.

A
  • Musle tone and posture

- Vestibular nuclei, balance and posture

59
Q

Describe the reticulospinal tract.

A
  • Spinal reflexes

- Reticular formation (midbrain), posture and locomotion

60
Q

What areas are supplied by the anterior cerebral artery?

A
  • Most of the midline portions of the frontal lobes (medial surface and upper portions) and the superior medial parietal lobes
  • 4/5ths of the corpus callosum
  • Deep structures such as anterior limb of the internal capsule
  • Anteromedial portion of the cerebrum
61
Q

What areas are supplied by the middle cerebral artery?

A

-Majority of the lateral surface of the hemisphere (except the superior inch of the frontal and parietal lobe (ACA) and the deep structures of the anterior hemisphere

62
Q

What areas are supplied by the posterior cerebral artery?

A
  • Supplies the occipital lobe and the posterior temporal lobe
  • Supplies the medial surfaces of the thalamus and walls of the IIIrd ventricle via the thalamoperforating branches
  • Supplies the thalamus via the peduncular perforating branches
  • Supplies the choroid plexus
63
Q

Which arteries supply the cerbellum?

A

Superior cerebellar, anterior inferior cerebellar and posterior inferior cerebellar

64
Q

What is the difference between upper and lower motor neuron?

A

Upper runs from motor cortex then synapses (glutamate)onto lower in the anterior horn of the grey matter in spinal cord or in the brain stem. Whereas a lower mn goes from the synapse to the muscle, where it synapses (ACh).

65
Q

Describe upper motor neurons.

A
  • cell bodies in cerebral cortex
  • Axons in CNS
  • Controls movement, tone, spinal reflexes, autonomic functions, sensory info to higher centres
66
Q

Describe lower motor neurons.

A

a) Motor neurons of the cord and brain stem
- Those from brainstem carry motor signals to the muscles of the face and neck (Corticobulbar tracts)
- In spinal cord: Synapse with upper motor neurons at the ventral horn and then go on to supply the muscles of the bdoy
b) Motor neurons located in either:
- The anterior grey column
- Anterior nerve roots
- Cranial nerve nuclei of the brainstem and cranial nerves with motor function
c) Function
- Control of all voluntary movement (innervate the skeletal muscle fibres)
- Act as a link between upper motor neurons and muscles
- Directly innervate the muscles to produce movement

67
Q

Describe the pattern of weakness in an upper motor neuron lesion.

A
  • Board weakness
  • Increased muscle tone (specificity) as uncontrolled LMN activation (most UMN are inhibitory)
  • High then low resistance to movement (clasp knife)
  • Increased deep tendon reflexes
  • Decreased superficial tendon reflexes
  • Flexors weaker than extensors in legs
  • Extensors stronger than fkexors in arms
  • Babinski sign, big toe raised (usually curled) when bottom of foot is stimulated
  • Minimal atrophy
68
Q

Describe the pattern of weakness in a lower motor neurone.

A
  • Decreased tone
  • Paralysis
  • Weakening and wastage (atrophy)
  • Absence of relevant reflexes (arreflexia)
  • Muscle fasciculations
69
Q

What is the difference between weakness and fatigue?

A

Weakness is constant loss of strength, whereas fatigue is the gradual onset and build up a lack of strength

70
Q

What are the key parts of a neurological history for a patient with weakness?

A

a) Pattern of weakness
- Proximal or distal (prox=polyneuropathy, dis=myopathic)
- Location and symmetry of weakness (single limb= spinal nerve root compression,general= CNS damage or pathology attacking neurons, limb and face same side= above brainstem)
b) Associated symptoms
- twitching or atrophy
- vertigo, vision disturbance = wider spread
- myelopathy
c) Temporal characteristics
- Chronic or episodic
- Tempo of onset and progression
d) Family hist of hereditary neuropathies
e) Pain

71
Q

Describe the weakness in MND.

A

-Fluctuating strength

72
Q

Describe the weakness in myopathies.

A
  • Proximal and symmetrical

- Usually minimal atrophy until later except myotonic dystrophy

73
Q

Name some causes of upper motor neuron weakness.

A

Stoke, lesion, tumour, SC compression, acute transverse myelitis, spinal cord infarct, spinal epidural or subdural haemorrhage, intervertebral disc herniation and MS

74
Q

Name some causes of LMN weakness.

A

Guillian-Barre, heavy metal poisioning, Bell’s Palsy, alcohol/drug induced, diabetic and plexopathies (brachial, lumbar)

75
Q

Name some neuromuscular causes of weakness.

A

Myasthenia gravis (autoimmune), tick paralysis, Lambert-Eaton myasthenic syndrome and organophosphate poisoning

76
Q

Name some muscular causes of weakness.

A

Inflammatory, alcohol/drug induced, muscular dystophy, endocrine related

77
Q

Is motor facial nerve innervation to forehead bilateral or unilateral?

A

Bilateral

78
Q

Is motor facial nerve innervation to lower face bilateral or unilateral?

A

Unilateral, contralateral

79
Q

Where would a lesion occur in the facial nerve to cause forehead sparing weakness?

A

Central (brain), eg stroke

80
Q

Where would a lesion occur in the facial nerve to cause whole facial weakness?

A

In the facial nerve (peripheral)

ILA formatives (10 decks)

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