Introduction Class Flashcards
22-year-old patient. Male. Since two months ago, with a sudden onset, he feels numbness in half of his head, including the face and the back of the head. He says he feels no sensation in that area. About the same time, he began to have double vision.
The neurologic exam shows a complete right hemicraneal anesthesia (face and back of the head), including all kinds of stmuli (tactile, thermo-algesic and vibratory). The sensation in the neck, body and all limbs is normal.
He has diplopia exclusively with his right eye, present in every direction of the gaze. The diplopia does not dissapear when the left eye is closed
Rest of the exam is normal.
DOES HE HAVE A PROBLEM IN THE NERVOUS SYSTEM?
He does not have a problem in the nervous system, the problem might be in the eye or could be psychiatric.
Sensation of the face (mainly trigeminal) is perceived by a different innervation from the posterior part of the head (greater occipital nerve-C2). Moreover, double vision might be because of bad alignment of the eyes.
A woman has had a movement present day and night for five years in the tongue, which makes a sound like a “click”. Is it a problem in the nervous system?
Yes , it is a PALATAL TREMOR.
What questions do we have to make ourselves to know if there is a problem in the nervous system?
Does he have a lesion? What systems are lesioned? Where is the lesion?
In the peripheral nervous system we find…
Roots, plexus and nerves
Contents of central nervous system
Brain and spinal cord
Parts of the spinal cord
Cervical, thoracic/dorsal, lumbar, sacral (conus medullaris-roots that go down).
Spinal cord ends at…
L1-L2 (CONUS MEDULLARIS)
One thing is the spinal level (where they originate), another thing is the vertebral level (where they exit). Lumbar and sacral roots originate much higher than their place of exit.
What is grey matter?
Mostly cells bodies, also glia and vessels
What is white matter?
Mainly axons (in nerve fibers) and oligodendrocytes (mielin), also glia and vessels
What do ventricles contain? How many do we have?
Cerebrospinal fluid. We have 4.
In some images, which are not fresh and are stained, white matter appears as…
Black
In brain, the gray matter is in the…
Cerebral cortex
All the information that has to go to the cortex, passes before by the…
Thalamus
The information getting out of the cortex also has to pass through the thalamus, as when it enters (T/F)
False
Gray matter in the spinal cord is … while white matter is…
In the middle, in the outside.
In the brainstem there is not a clear distribution of white and gray matter (T/F)
True
Axes of the nervous system
Parts of the cerebrum
Cortex (cerebral hemispheres) and diencephalon (thalamus)
Within the cortex: frontal, parietal, temporal and occipital lobes divided by fissures (sulcus)
Parts of brainstem
- Midbrain (mesencephalon)
- Pons
- Medulla oblongata
Pathways in nervous system (1 ascending, 2 descending)
- Main motor pathway: corticospinal tract.
- 2 main somatosensory pathways: anterolateral system (crosses at the spinal cord) and posterior column-medial lemniscus (crosses at the brainstem)
ALL OF THEM CROSS
