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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
Balance and coordination
Cerebellum
26
Lesion in the middle cerebellum causes
truncal ataxia
27
Brainstem consists of
Midbrain Pons Medulla
28
Cranial nerves originating in the midbrain
II III IV
29
Cranial nerves originating in the pons
V VI VII
30
Cranial nerves originating in the medulla
``` VIII IX X XI XII ```
31
Language is usually on the ______ side
Usually left sided | left handed ppl=right sided
32
If someone is having trouble speaking, assume the lesion is on the _____ side
Left side
33
Cross over at the pyramid in the lower medulla of the brainstem
Lateral corticospinal tract→ voluntary movement | Posterior columns→ vibration, proprioception
34
Cross over that the level of the spinal cord
Lateral spinothalamic tract→ pain, temperature
35
Which types of nerves do not cross over?
Corticobulbar tracts do not cross over | Cranial nerves do not cross over
36
Crossed signs
ipsilateral cranial nerve deficits and contralateral body weakness
37
In the case of crossed signs, the defect is on the ______ side
same side as the cranial nerve defects (ipsilateral cranial nerve defect) opposite side from weakness (contralateral weakness)
38
Brown sequard syndrome
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
Central cord syndrome
loss of pain + temperature
40
Anterior cord syndrome
paralysis, loss of pain + temperature
41
Posterior columns cord syndrome
loss of vibration + proprioception
42
Posterior and lateral columns cord syndrome
paralysis + vibration/proprioception
43
Cauda equina syndrome and Conus medullaris syndrome are ______
medical emergencies→ immediate neuroimaging + decompression
44
Cauda equina syndrome
``` More severe pain and weakness Asymmetric Severe radicular pain Flaccid LE paralysis Saddle anesthesia Late and less severe bowel and bladder problems ```
45
Conus medullaris syndrome
``` Less severe pain and weakness Symmetric Bilateral and perianal pain Mild to mod LE weakness Saddle anesthesia Early, severe bowel and bladder problems ```
46
Peripheral nervous system includes
lower motor neuron (LMN) peripheral nerve NMJ muscle
47
Peripherals nerves do motor/sensory/both?
Both
48
Ventral horn
Ventral horn→ ventral root→ spinal nerve: Dorsal ramus→ skeletal muscle of back Ventral ramus→ skeletal muscle of limbs + back
49
Symptoms of a lesion at the cortex
*aphasia* *neglect* hemianopia UMN hemiparesis hemisensory involving face + arm vs. leg
50
Symptoms of a lesion at the Subcortical structures→ Internal Capsule + Basal Ganglia
dense hemiplegia abnormal mvmts (chorea, ballism, tremor, cogwheeling)
51
Symptoms of a lesion at the cerebellum
Truncal vs limb ataxia and dysmetria
52
Symptoms of a lesion at the brainstem
CN palsies + crossed signs
53
Symptoms of a lesion at the spinal cord
Paraparesis, sensory level bowel/bladder involvement saddle anesthesia
54
Symptoms of a lesion at a lower motor neuron
No sensory involvement, fasciculations
55
Symptoms of a lesion at a peripheral nerve
Distal weakness + sensory involvement, usually stocking glove, areflexia or hyporeflexia
56
Symptoms of a lesion at the NMJ
Fatigability, no sensory involvement, normal DTRs
57
Symptoms of a lesion at the muscle
Proximal weakness, symmetric, no sensory involvement
58
Example of a lesion at the cortex
anterior cerebellar artery
59
UMN vs LMN: | weakness
UMN: spastic weakness LMN: flaccid weakness
60
UMN vs LMN: | reflexes
UMN: hyperreflexia LMN: hyporeflexia
61
UMN vs LMN: | other signs
UMN: babinski LMN: fasciculations
62
Cortical lesion and the middle cerebellar artery
Face/arm > leg
63
Cortical lesion and the anterior cerebellar artery
Leg > arm/face
64
Cortical lesions
Hemi sensory – motor deficit | Aphasia, Apraxia, Agnosia
65
Subcortical lesions
Dense unilateral motor or sensory deficit Face/arm and leg equally affected Movement disorders
66
VITAMIN CDE mnemonic for underlying pathology
``` Vascular Inflammatory Trauma Autoimmune Metabolic Infectious Neoplastic Congenital Drugs Epilepsy/seizures ```
67
Levels of arousal
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
Neuro exam includes....
``` Mental Status Neck/spine Cranial nerves Motor exam Sensory exam Reflexes Coordination Station and Gait ```
69
List the cranial nerves
``` 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
Neck Exam
Inspection, Auscultation, Nuchal rigidity
71
CN II (optic) exam
``` Visual acuity Color vision→ red desaturation Visual fields, Fundoscopic exam→ papilledema Pupillary reflex→ Direct + Consensual Afferent→ CN II (sensing light) ```
72
CN XI (spinal accessory) exam
Sternocleidomastoid→ head turning | Trapezius→ shoulder shrug
73
CN XII (hypoglossal) exam
"Stick out your tongue" Abnormal→ protruding tongue deviates to side of lesion (paralysis)
74
CN V (trigeminal) exam
1. Sensation to face 2. Muscles of mastication 3. Sensory limb of corneal reflex
75
CN III is functional if....
Efferent→ CN III response to light is intact
76
EOMS
``` 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
CN VII
Muscles of facial expression Motor limb of corneal reflex Eyelid closure→ lesion→ lack of closure
78
Central facial palsy
Damage in corticobulbar tract Contralateral lower facial muscles Upper face preserved
79
Peripheral nerve palsy
Lesions at or beyond stylomastoid foramen → ipsilateral upper and lower facial asymmetry
80
Corneal reflex
CN I afferent | CN VII efferent
81
Vestibulo-ocular reflex
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
Vestibulo-ocular reflex
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
The motor exam consists of
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
Sensory exam
``` Distal to proximal: Pin and thermal Touch Joint position Vibration sense ```
85
DTRs
``` Biceps→ C5, C6 Brachioradialis→ C6 Triceps→ C7 Patellar→ L4 Achilles Tendon→ S1 (+) Babinski→ abnormal plantar response→ UMN ```
86
Coordination exam
Finger-Nose-Finger (outstretched arm) Heel-Knee-Heel Thumb tapping/Toe tappin Rapid Alternating Movements
87
Station and gait exam
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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