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Unit 3 Clin Med III > L14: Neuroanatomy > Flashcards

L14: Neuroanatomy Flashcards

1
Q

Layers of the meninges from outermost to innermost

A

Dura
Arachnoid
Pia

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2
Q

2 layers of the dura mater

A

Periosteal layer→ stays on bone
Meningeal layer→ on meninges, folds into brain tissue creating:
Falx cerebri
Tentorium cerebelli

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3
Q

The _____ of the dura mater forms the falx cerebri and the tentorium cerebelli

A

Meningeal layer

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4
Q

3 herniation syndromes

A

Subfalcine herniation→ causes lateral pressure opposite hernia
Uncal transtentorial herniation→ causes downward + lateral pressure
Tonsillar herniation→ causes downward pressure

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5
Q

Presentation of Epidural hematoma

A

LOC→ lucid interval→ rapid deterioration

it’s an artery so rapid bleeding

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6
Q

Epidural hematoma affects which vessel?

A

middle meningeal artery

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7
Q

Besides the classic lenticular form on CT, what else might you see with an epidural hematoma?

A

Brainstem is compressed, ventricle is “effaced” (midline shift)

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8
Q

Subdural hematoma affects which vessels?

A

Bridging veins

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9
Q

Subdural hematoma presentation

A

Slow onset over 2-3 weeks→ HA, Confusion, problems with speech, drowsiness
Crescent shape on CT

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10
Q

Enlarged ventricle temporal horns indicates

A

Blood in ventricle obstructing flow of CSF

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11
Q

Hydrocephalus presentation

A 
Overproduction of CSF→ large ventricles
Wet→ urinary incontinence
Wacky→ AMS
Wobbly→ gait→ “magnetic gait” 
Normal pressure as there is no blockage of CSF
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12
Q

Diagnosis and treatment of hydrocephalus

A

Diagnosis→ 3 LP to pull off fluid→ measure walking speed

Treatment→ shunt

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13
Q

Branches of the aorta that supply the brain

A

Brachiocephalic artery→ right common carotid→ internal + external carotids
Left common carotid→ internal + external carotids
Subclavian arteries→ vertebral arteries→ join to form basilar artery→ joins circle of Willis

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14
Q

Circle of Willis

A

Connect anterior + posterior, right + left circulations→ allows for compensations in blockages

Anterior + posterior→ basilar artery + anterior cerebral arteries
Right + left internal carotid arteries join circle

Breaks off into anterior cerebral arteries, middle cerebral arteries, + posterior cerebral arteries

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15
Q

Veins in the brain

A

Superior sagittal sinus
Transverse sinus
Cavernous sinus

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16
Q

Which nerve run through the cavernous sinus, and how does a patient present if they’re compressed?

A

CN III, IV, V1, V2, VI (no CN V3)

III, IV, VI→ control of EOMS, if compressed→ ophthalmoplegia

V1, V2→ facial sensation, if compressed→ numbness

Cavernous fistula→ eye pain, double vision, proptosis (bulging), chemosis, EOM paralysis, decreased facial sensation, orbital bruit

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17
Q

The Neuroaxis refers to

A

CNS components vs PNS components

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18
Q

The central nervous system is composed of

A 
Cortex/upper motor neuron (UMN)
Subcortical
Brainstem
Cerebellum
Spinal cord
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19
Q

In a seizure, the patient has _____ which causes them to look ______

A

Increased activity on one side

They “look away” from the seizure

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20
Q

In a stroke, the patient has _____ which causes them to look ______

A

Decreased activity on one side

They “look at” the lesion

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21
Q

executive functions, thinking, planning, organizing, problem solving, emotions and behavioral control, personality

A

Frontal lobe

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22
Q

Outer cortex upper motor neurons

A

homunculus of arms, legs, face→ lesions tend to have focal deficits

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23
Q

Subcortical upper motor neurons

A

internal capsule deep in basal ganglia→ a small stroke here can cause generalized and widespread weakness

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24
Q

perception, making sense of the world, arithmetic, spelling

A

parietal lobe

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25
Q

Balance and coordination

A

Cerebellum

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26
Q

Lesion in the middle cerebellum causes

A

truncal ataxia

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27
Q

Brainstem consists of

A

Midbrain
Pons
Medulla

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28
Q

Cranial nerves originating in the midbrain

A

II
III
IV

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29
Q

Cranial nerves originating in the pons

A

V
VI
VII

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30
Q

Cranial nerves originating in the medulla

A 
VIII
IX
X
XI
XII
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31
Q

Language is usually on the ______ side

A

Usually left sided

left handed ppl=right sided

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32
Q

If someone is having trouble speaking, assume the lesion is on the _____ side

A

Left side

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33
Q

Cross over at the pyramid in the lower medulla of the brainstem

A

Lateral corticospinal tract→ voluntary movement

Posterior columns→ vibration, proprioception

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34
Q

Cross over that the level of the spinal cord

A

Lateral spinothalamic tract→ pain, temperature

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35
Q

Which types of nerves do not cross over?

A

Corticobulbar tracts do not cross over

Cranial nerves do not cross over

36
Q

Crossed signs

A

ipsilateral cranial nerve deficits and contralateral body weakness

37
Q

In the case of crossed signs, the defect is on the ______ side

A

same side as the cranial nerve defects (ipsilateral cranial nerve defect)

opposite side from weakness (contralateral weakness)

38
Q

Brown sequard syndrome

A

Unilateral spinal cord damage:

Contralateral loss of pain, temperature, light touch (lateral spinothalamic tract has already crossed over)

Ipsilateral loss of motor, vibration, position, deep touch (posterior column hasn’t crossed over yet. LMN affected at level of lesion)

39
Q

Central cord syndrome

A

loss of pain + temperature

40
Q

Anterior cord syndrome

A

paralysis, loss of pain + temperature

41
Q

Posterior columns cord syndrome

A

loss of vibration + proprioception

42
Q

Posterior and lateral columns cord syndrome

A

paralysis + vibration/proprioception

43
Q

Cauda equina syndrome and Conus medullaris syndrome are ______

A

medical emergencies→ immediate neuroimaging + decompression

44
Q

Cauda equina syndrome

A 
More severe pain and weakness
Asymmetric
Severe radicular pain
Flaccid LE paralysis
Saddle anesthesia
Late and less severe bowel and bladder problems
45
Q

Conus medullaris syndrome

A 
Less severe pain and weakness
Symmetric
Bilateral and perianal pain
Mild to mod LE weakness
Saddle anesthesia 
Early, severe bowel and bladder problems
46
Q

Peripheral nervous system includes

A

lower motor neuron (LMN)
peripheral nerve
NMJ
muscle

47
Q

Peripherals nerves do motor/sensory/both?

A

Both

48
Q

Ventral horn

A

Ventral horn→ ventral root→ spinal nerve:

Dorsal ramus→ skeletal muscle of back

Ventral ramus→ skeletal muscle of limbs + back

49
Q

Symptoms of a lesion at the cortex

A

aphasia
neglect
hemianopia
UMN hemiparesis
hemisensory
involving face + arm vs. leg

50
Q

Symptoms of a lesion at the Subcortical structures→ Internal Capsule + Basal Ganglia

A

dense hemiplegia
abnormal mvmts
(chorea, ballism, tremor, cogwheeling)

51
Q

Symptoms of a lesion at the cerebellum

A

Truncal vs limb ataxia and dysmetria

52
Q

Symptoms of a lesion at the brainstem

A

CN palsies + crossed signs

53
Q

Symptoms of a lesion at the spinal cord

A

Paraparesis, sensory level
bowel/bladder involvement
saddle anesthesia

54
Q

Symptoms of a lesion at a lower motor neuron

A

No sensory involvement, fasciculations

55
Q

Symptoms of a lesion at a peripheral nerve

A

Distal weakness + sensory involvement, usually stocking glove, areflexia or hyporeflexia

56
Q

Symptoms of a lesion at the NMJ

A

Fatigability, no sensory involvement, normal DTRs

57
Q

Symptoms of a lesion at the muscle

A

Proximal weakness, symmetric, no sensory involvement

58
Q

Example of a lesion at the cortex

A

anterior cerebellar artery

59
Q

UMN vs LMN:

weakness

A

UMN: spastic weakness
LMN: flaccid weakness

60
Q

UMN vs LMN:

reflexes

A

UMN: hyperreflexia
LMN: hyporeflexia

61
Q

UMN vs LMN:

other signs

A

UMN: babinski
LMN: fasciculations

62
Q

Cortical lesion and the middle cerebellar artery

A

Face/arm > leg

63
Q

Cortical lesion and the anterior cerebellar artery

A

Leg > arm/face

64
Q

Cortical lesions

A

Hemi sensory – motor deficit

Aphasia, Apraxia, Agnosia

65
Q

Subcortical lesions

A

Dense unilateral motor or
sensory deficit
Face/arm and leg equally affected
Movement disorders

66
Q

VITAMIN CDE mnemonic for underlying pathology

A 
Vascular
Inflammatory
Trauma
Autoimmune
Metabolic
Infectious
Neoplastic
Congenital
Drugs
Epilepsy/seizures
67
Q

Levels of arousal

A

Alert
Lethargic→ can be aroused with mild stimuli)
Stupor→ can be aroused only with vigorous and repeated stimuli
Obtunded
Coma→ unarousable even with vigorous and repeated stimuli
Best to use a specific statement about their activity

68
Q

Neuro exam includes….

A 
Mental Status
Neck/spine
Cranial nerves
Motor exam
Sensory exam
Reflexes
Coordination
Station and Gait
69
Q

List the cranial nerves

A 
I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abduces
VII. Facial
VIII. Vestibulocochlear
IX. Glossopharyngeal
X. Vagus
XI. Spinal accessory
XII. Hypoglossal
70
Q

Neck Exam

A

Inspection, Auscultation, Nuchal rigidity

71
Q

CN II (optic) exam

A 
Visual acuity
Color vision→ red desaturation 
Visual fields, 
Fundoscopic exam→ papilledema
Pupillary reflex→ Direct + Consensual
Afferent→ CN II (sensing light)
72
Q

CN XI (spinal accessory) exam

A

Sternocleidomastoid→ head turning

Trapezius→ shoulder shrug

73
Q

CN XII (hypoglossal) exam

A

“Stick out your tongue”

Abnormal→ protruding tongue deviates to side of lesion (paralysis)

74
Q

CN V (trigeminal) exam

A
  1. Sensation to face
  2. Muscles of mastication
  3. Sensory limb of corneal reflex
75
Q

CN III is functional if….

A

Efferent→ CN III response to light is intact

76
Q

EOMS

A 
CN III→ “all the rest”
Medial Rectus
Superior Rectus
Inferior Rectus
Inferior Oblique
Opens eyelid→ lesion→ ptosis

CN IV→ Superior Oblique

CN VI→ Lateral rectus

77
Q

CN VII

A

Muscles of facial expression
Motor limb of corneal reflex
Eyelid closure→ lesion→ lack of closure

78
Q

Central facial palsy

A

Damage in corticobulbar tract
Contralateral lower facial muscles
Upper face preserved

79
Q

Peripheral nerve palsy

A

Lesions at or beyond stylomastoid foramen → ipsilateral upper and lower facial asymmetry

80
Q

Corneal reflex

A

CN I afferent

CN VII efferent

81
Q

Vestibulo-ocular reflex

A

CN VIII (afferent) + CNs VI+III (efferent)

Normal→ Head rotated to right, eyes move to left
Abnormal→ Head rotated to right, eyes follow→ brainstem damage

82
Q

Vestibulo-ocular reflex

A

CN VIII (afferent) + CNs VI+III (efferent)

Normal→ Head rotated to right, eyes move to left
Abnormal→ Head rotated to right, eyes follow→ brainstem damage

83
Q

The motor exam consists of

A

Bulk→ atrophy, hypertrophy, fasciculations

Abnormal movements:
Tone→ spasticity, rigidity, flaccidity
Spasticity→ UMN lesion→ velocity dependent,
Rigidity→ Basal ganglia lesion→ velocity independent, cogwheel rigidity
Strength→ proximal to distal testing

84
Q

Sensory exam

A 
Distal to proximal: 
Pin and thermal
Touch
Joint position
Vibration sense
85
Q

DTRs

A 
Biceps→ C5, C6
Brachioradialis→ C6
Triceps→ C7
Patellar→ L4
Achilles Tendon→ S1
(+) Babinski→ abnormal plantar response→ UMN
86
Q

Coordination exam

A

Finger-Nose-Finger (outstretched arm)
Heel-Knee-Heel
Thumb tapping/Toe tappin
Rapid Alternating Movements

87
Q

Station and gait exam

A

Observe posture
Romberg test
Observe gait and arm swing
Heel walk, Toe walk, Tandem gait

Unit 3 Clin Med III (3 decks)

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