Midterm Flashcards
1
Q
blood supply to the brain
A
ICA
Vertebral A
2
Q
Circle of Willis Arteries
A
Anterior communicating A Anterior Cerebral A Middle Cerebral A Posterior Cerebral A ICA Posterior Communicating A Vertebrobasilar
3
Q
***Aneurysm
A
Ant. Communicating
4
Q
Stroke
A
Lat. Striate of MCA
5
Q
Dura layers
A
2 cranial
1 spinal
6
Q
Arachnoid
A
No blood vessels
7
Q
Spinal cord blood supply
A
2/3 Ant. Spinal A
1/3 Post. Spinal A
8
Q
Subarachnoid contents
A
CSF
9
Q
Subdural contents
A
bridging veins
10
Q
***Epidural hematoma
A
Middle Meningeal A
- lucid interval
- lens shaped
11
Q
Subdural Hematoma
A
no trauma/elderly
crescent shaped
(hyperdense=white/acute)
(hypodense=dark/old)
12
Q
***Subarachnoid Hemorrhage
A
aneurysm leakage
“worst headache of life”
blood stained CSF
13
Q
—Intracranial/Intracerebral Hemorrhage
A
lenticulostriate of MCA
loses consciousness
paralysis upon awakening
14
Q
emissary veins
A
valveless
15
Q
choroid plexus
A
produces CSF
formed by ependymal cells
16
Q
***CSF circulation
A
Lateral ventricles - foramen of monro Third Ventricle - aqueduct of sylvius Fourth Ventricle - foramen of luschka (lat.) - foramen of magendie (med) Subarachnoid space -> recirculation
17
Q
lumbar puncture
A
L4/L5
18
Q
Non-communicating Hydrocephalus
A
obstruction within ventricles
(ex. aqueductal stenosis)
enlarged head
19
Q
—Communicating Hydrocephalus
A
blockage in subarachnoid space
no reabsorption
—Findings: arachnoid granulation
20
Q
Normal Pressure Hydrocephalus
A
(communicatiing)
WACKY
WOBBLY
WET
21
Q
***Bacterial Meningitis
A
CLOUDY CSF increased WBC DECREASED GLUCOSE increased protein increased pressure
headache, fever, neck rigidity
22
Q
Viral encephalitis
A
clear or cloudy CSF
slightly elevated protein
normal glucase
23
Q
soma
A
nucleus
cytoplasm
NISSL BODIES
24
Q
dendrites
A
impulses TOWARDS cell body
proximal = NISSL distal = NO NISSL
25
Axon Hillock
NO NISSL
| Action Potential arises here
26
Multipolar neurons
motor
many processes
from soma
27
Golgi type 1
long
28
Golgi type 2
short
29
glial cells in PNS
Schwann cells
30
Myelination
increases conductance
decreases energy expense
protection
31
fast anterograde
KINESIN
32
fast retrograde
```
DYNEIN
neurotropic viruses (ex. herpes)
```
33
Neuropraxia
1st degree
transient block
full recovery
34
Axonotemesis
Axon damaged, but sheath intact
WALLERIAN DEGENERATION
functional recovery
35
Neurotemesis
5th degree
| complete section of the nerve trunk
36
***wallerian degeneration
distal to the site of damage on the axon
37
chromatolysis
cell body swells (edema)
| nucleus shifts peripherally
38
Nerve regeneration location
PNS ONLY
39
Axodendritic synapse
80% cerebral cortex
40
Axosomatic synapse
15% cerebral cortex
41
chemical synapse
one way
| slow
42
electrical synapse
bi-directional
fast
smooth & cardiac muscle
43
small clear vesicles
Ach
GABA
glycine
glutamate
44
small dense core vesicles
catecholamines
45
large dense core vesicles
neuropeptide
46
T-SNARE
SNAP25, Syntaxin
on Terminal membrane
47
V-SNARE
Synaptotagmin, Synaptobrevin
on synaptic vesicle
48
Excitatory Post-synaptic
| depol.
ACh, Nor-adrenaline
49
Inhibitory Post-synaptic
| hyperpol.
GABA, Glycine
50
***Peripheral synapse
nAChR (only excitatory)
51
***Myesthenia Gravis
nAChR at NMJ
increased anti-MuSK Ab
thymoma
52
***Lambert Eaton
Ca channels at pre-synaptic terminal
| SCLC
53
***Botulism
cleaves SNARE at pre-synaptic membrane
54
Infantile Botulism
associated with honey
| type A&B
55
Wound Botulism
associated with black tar heroin
56
Tetanus
```
protease cleaves SNARE proteins
muscle hyperexcitation (tetanic contractions)
```
57
neurotransmitter vs neuromodulator
neurotransmitter
elicits specific response
neuromodulator
not directly cause EPSP or IPSP
58
excitatory receptor
NMDA
59
inhibitory receptor
GABA
60
degradation of neurotransmitter
acetylcholinesterase
61
ionotropic receptor
ligand gated
62
metabotropic receptor
GCPR
63
basal plate
anterior/ventral horn
| motor
64
alar plate
posterior/dorsal horn
| sensory
65
Procencephalon
telencephalon -> cerebral hemispheres
diencephalon -> thal., hypothal., subthal., neuropit.
66
Mesencephalon
mibrain
67
Rhombencephalon
Metencephalon -> pons, cerebellum
Myencephalon -> medulla
68
cyst adjoining choroid plexus
roof plate
| decreased CSF
69
Anencephaly
anterior/rostal neuropore
| partial/complete absence of brain
70
Encephalocele
portions of anterior neuropore
sac-like protrusion
mental retardation
71
holoprosencephaly
failure of midline cleavage
| seen in fetal alcohol & Patau
72
microcephaly
less than third percentile
73
Spina bifida
posterior/caudal neuropore
74
Spina bifida occulta
defect in vertebral arches
| tuft of hair
75
Spina bifida cystica
dysraphism
76
---Spina bifida meningocele
```
meninges project
(no mental defect)
```
77
Spina bifida myelomeningocele
meninges and spinal cord project
78
Spina bifida myeloschisis
open neural tube
79
MSAFP
```
>2.5 = neural tube defect
<0.4 = down syndrome
```
80
---Arnold Chiari Syndrome
herniation of cerebellum
type 1 - asymptomatic
type 2 - lumbar myelomeningocele
81
Syring(hydro)myelia
spinothalamic tract
| loss of pain & temp
82
Dandy Walker Syndrome
Dilated 4th ventricle
Water on the brain
Small vermis
83
Meissners Corpuscle
fast touch
pressure
vibrations of HAIRLESS SKIN
84
Merkel cells
slow touch
| pressure
85
---Pacinian corpuscle
fast
pressure
DEEP VIBRATION
86
Ruffini endings
SKIN STRETCH
| slow
87
***free nerve endings
TEMPERATURE
88
two point discrimination test
used for dorsal column medial lemniscus
| proprioception
89
acuity
less convergence = better acuity
90
temporal summation
increase in AP ON A SINGLE FIBER
91
spacial summation
increase in PARALLEL FIBERS
92
phasic
fast
93
tonic
slow
94
---***Dorsal Column Medial Lemniscus
fine touch, vibration, proprioception
fasciculus cuneatus = arm (lateral)
fasciculus gracilis = leg (medial)
CROSSES @ MEDULLA
ipsilateral
95
---Antereolateral spinothalamic tract
pain, temperature, crude touch
```
CROSSES IMMEDIATELY (@ gray matter of spinal cord)
contralateral
```
96
final target structure of inferior olivary nucleus and what do they terminate on
cerebellar cortex
terminated on purkinje fibers
97
dorsal column lesion
positive Romberg (with eyes closed)
| if eyes open = cerebellar
98
spinothalamic lesion
contralateral loss of pain and temp
99
A(gamma)
fast pain
myelinated
cold
100
---C fiber
slow pain
UNMYELINATED
hot
101
VR1
capsaicin, temps > 43 Celsius
102
why do we rub an injury
only a finite amount of pain and touch stimuli can be processed at a time
103
Gate theory
AB block pain
| C cause excitation/pain
104
interneurons inhibit pain via
serotonin
105
Hyperalgesia
increased sensitivity
106
hypoalgesia
decreased sensitivity
107
analgesia
loss of pain sensation
108
allodynia
excessive response to even mild stimuli
109
anterior cerebral occlusion
homunculus -> lower limbs
110
posterior spinal artery arises from
PICA (posterior inferior CEREBELLAR artery)
111
Multiple Sclerosis (MS)
autoimmune, demyelinating disorder of CNS AXONS
scanning speech, intention tremor, nystagmus
increased IgG, MBP, leukocytes
MRI = multifocal plaques in white matter
112
---Guillain-Barre Syndrome
autoimmune, demyelinating
associated with infections (ex. FLU)
no fever, ascending paralysis
increased CSF protein ->
albuminocytological disssociation
113
---Charcot-Marie-Tooth disease
demyelinating Schwann cells (connexin)
foot deformities
preserved C FIBER
114
anterior to the central sulcus
precentral gyrus = motor
115
posterior to the central sulcus
postcentral gyrus = sensory
116
medial homunculus
feet area
117
UMN
brain stem, cerebral cortex
118
LMN
ventral horn, cranial nerve nuclei
119
***lateral corticospinal tract
crosses at medulla
| DISTAL/LOWER LIMBS
120
***ventral corticospinal tract
crosses at spinal cord
| TRUNK/PROXIMAL LIMBS
121
role of cerebellum
movement
122
basal ganglia
fine tunes movement
123
final common pathway
LMN
124
vestibulospinal tract
EAR (balance)
125
reticulospinal tract
posture
126
rubrospinal tract
RED NUCLEUS
| precise upper limb movement
127
tectospinal tract
eyes
128
***α motor neurons
make skeletal muscles CONTRACT
129
***γ motor neurons
make muscle spindles more sensitive to STRETCH
130
***α motorneurons
innervate EXTRAFUSAL skeletal muscle fibers
131
***γ Motoneurons
innervate specialized INTRAFUSAL muscle fibers
132
Nuclear bag fibers
1a, dynamic γ
larger, and their nuclei are accumulated in a central (“bag”) region
133
Nuclear chain fibers
1a, 2, static γ
smaller, and their nuclei are arranged in rows (“chains”)
134
α-γ motor coactivation
γ-motor discharge ↑es along with ↑ed discharge of α-MN
135
***Golgi Tendon Organ
group Ib afferent fibers
inhibitory neurons
changes in FORCE
***inhibit the α motoneurons
136
muscle spindle reflex
contraction -> HOLD WEIGHT
137
Golgi Tendon Organ Reflex
muscle relaxation and load DROP
138
spinal reflex
Stretch reflex
139
cranial reflex
pupillary light reflex
140
***monosynaptic reflex
single synapse between the afferent and efferent
ex. PATELLAR REFLEX
141
polysynaptic reflex
two or more synapses
| through an interneuron
142
tonic stretch reflex
maintains posture
143
S1-2 reflex
ankle jerk
1, 2 buckle my shoe
144
L3-4 reflex
knee jerk
3, 4 kick the door
145
C5-6 reflex
biceps and supinator jerks
5, 6 pick up sticks
146
C7 reflex
triceps jerk
7, 8 shut the gate
147
C8 reflex
finger jerk
7, 8 shut the gate
148
inverse stretch reflex
inhibitory interneuron relaxes effector & contracts antagonist
149
withdraw reflex
flexion of stimulated limb
150
crossed extensor reflex
flexion of stimulated limb
| extension of opposite limb
151
Babinski sign
Normal in children under 18 months of age
after age 18 months, indicates an interruption of the corticospinal tract.
positive =
big toe extends
corticospinal tract interruption
152
LMN lesion
peripheral nerve lesion
153
UMN lesion
spinal cord lesion
154
LMN lesion symptoms
** flaccid paralysis
NO BABINSKI
** areflexia (no deep tendon reflex)
fasciculations
decreased muscle tone
** atrophy of muscle(s)
loss of voluntary movements
small area of body affected
155
UMN lesion symptoms
** spastic paresis
** hyperreflexia
** BABINSKI SIGN PRESENT
increased muscle tone
clasp knife reflex
disuse atrophy of muscles
decreased speed of voluntary movements
large area of body affected
156
***Complete Spinal Sensory Syndrome
*loss of bladder and bowel control
Bilateral lower motor neuron paralysis and muscular atrophy (damage to the neurons in the anterior gray columns)
Bilateral spastic paralysis below the level of the lesion. A bilateral Babinski sign is present (interruption of the corticospinal tracts on both sides of the cord)
Bilateral loss of all sensations below the level of the lesion (bilateral destruction of the ascending tracts in the posterior white columns)
loss of pain, temperature, and light touch sensations (section of the lateral and anterior spinothalamic tracts on both sides)
157
***Tabes dorsalis
tertiary syphilis or neurosyphilis
loss of vibration sensation, two-point discrimination, and conscious proprioception
Romberg sign
*Argyll Robertson pupils
158
***Posterior Column Syndrome
Both side of dorsal column affected
Loss of sense of position & vibration
interruption to posterior spinal artery.
159
Anterior Spinal Artery Syndrome
Bilateral lower motor neuron paralysis
Bilateral spastic paralysis below the level of the lesion
Bilateral loss of pain, temperature, and light touch sensations below the level of the lesion
Tactile discrimination and vibratory and proprioceptive sensations are preserved
160
***Brown Sequard Syndrome
*paralysis on one side, loss of pain and temp on the other
Ipsilateral lower motor neuron paralysis in the segment of the lesion and muscular atrophy
Ipsilateral spastic paralysis below the level of the lesion
Spastic paralysis
Ipsilateral band of cutaneous anesthesia in the segment of the lesion
Ipsilateral loss of tactile discrimination and of vibratory and proprioceptive sensations below the level of the lesion
Contralateral loss of pain and temperature sensations below the level of the lesion
161
***Syringo(hydro)myelic Syndrome
* C8-T1
* shawllike/ Cape and Shawl distribution (caused by the interruption of the lateral spinothalamic tracts as they cross the midline in the anterior gray and white commissures)
Tactile discrimination, vibratory sense, and proprioceptive sense are normal
LMN weakness
bilateral spastic paralysis of both legs
162
***Poliomyelitis
Acute viral infection of the neurons of the anterior gray columns and the motor nuclei of the cranial nerves
* respiration may be threatened
* leads to paralysis and wasting of the muscles
Progressive infantile muscle atrophy (Werdnig Hoffmann disorder) and Juvenile Hereditary LMN disease (Kugel berg Walender disease)
163
***Subacute Combined Degeneration
deficiency of enzymes necessary for vitamin B 12 absorption
pernicious anemia
defects in both sensory and motor function
Disturbance in motor function includes upper motor neuron
positive Babinski
Dysfunction which may include a weakness of the lower limbs and an ataxic gait
164
***Amyotrophic Lateral Sclerosis Lou Gehrig’s disease
*disease confined to the corticospinal tracts and the motor neurons of the anterior gray columns of the spinal cord
progressive muscular atrophy, paresis, spasticity, positive BABINSKI RESPONSE and fasiculations
165
brain stem central core
reticular formation
| controls sleep
166
Midbrain
supplied by PCA
CN 3, 4
Tectum
superior colliculi = visual
inferior colliculi = auditory
167
Pons
supplied by basilar artery
CN 5, 6, 7, 8
168
Medulla Oblongata
Supplied by PICA
CN 9, 10, 11, 12
169
Lateral Medullary Syndrome of Wallenberg
supplied by PICA
- Dysphagia and dysarthria
- Analgesia and thermoanesthesia (ipsilateral)
- Vertigo, nausea, vomiting, and nystagmus
- Ipsilateral Horner syndrome
- Ipsilateral cerebellar signs
- Contralateral loss of sensations of pain and temperature
170
***Medial Medullary Syndrome
supplied by Vertebral A
- Contralateral hemiparesis
- Contralateral impaired sensations of position and movement and tactile discrimination (medial lemniscus)
- Ipsilateral paralysis of tongue muscles with deviation to the paralyzed side when the tongue is protruded (hypoglossal nerve)
171
Pontine Hemorrhage
supplied by the basilar artery
* - pupils may be pinpoint
- facial paralysis on the side of the lesion
- paralysis of the limbs on the opposite side
172
***Weber Syndrome
supplied by PCA
*** an ipsilateral oculomotor paralysis, coupled with a contralateral upper motor neuron paralysis
- dilated, unresponsive pupil, a drooping eyelid, and an eye that deviates downward
173
Benedikt Syndrome
DCML
*** ipsilateral paralysis of the oculomotor nerve as well as a tremor of the opposite limb, coupled with possible somatosensory loss in the contralateral side of the body
174
Gaze Palsy (Pariaud’s Syndrome)
- upward gaze paralysis, possible nystagmus with downward gaze, light-near dissociation, large pupil, abnormal elevation of the upper lid, and paralysis of accommodation
175
CN I
Olfactory Nerve
sensory
smell
damage:
Results in anosmia (loss of olfactory sensation)
176
CN II
Optic nerve
sensory
vision
damage:
papilledema, optic atrophy
177
CN III
Oculomotor Nerve
eye movement*
Somatic motor (inferior oblique and superior, inferior, and medial rectus muscles) - all except SO & LR
damage:
eye cannot be moved up, down, or inward ->
At rest, eye rotates laterally (external strabismus)
178
CN IV
Trochlear Nerve
motor
superior oblique muscle (in eye)
damage:
double vision and impairs ability to rotate eye inferolaterally ->
at rest, eye up and in
179
CNV
Trigeminal Nerve
*sensory of face
damage:
* Trigeminal neuralgia (TN) is considered to be one of the most painful afflictions known to medical practice
(associated with dentist visit)
180
CNVI
Abducens Nerves
*primarily motor: lateral rectus muscle (in eye)
damage:
Abducens nerve paralysis, eye cannot be moved laterally ->
At rest, eyeball rotates medially (internal strabismus)*
181
CNVII
Facial Nerve
mixed innervation
*taste of anterior 2/3 of tongue
damage:
* Bells Palsy
182
***CNVIII
Vestibulocochlear Nerves
sensory
*hearing and equilibrium
damage:
*ipsilateral deafness
dizziness, rapid involuntary eye movements, loss of balance, nausea, and vomiting
183
CNIX
Glossophangeal Nerves
mixed innervation
*taste of posterior 1/3 of tongue
damage:
*impaired swallowing and taste
184
CNX
Vagus Nerve
mixed innervation
* motor: heart, lungs, bronchi, GIT
sensory: heart, lungs, bronchi, trachea, *larynx, *pharynx, GIT, external ear
* ONLY CN THAT TRAVELS BELOW BRAINSTEM
damage:
hoarseness or loss of voice
*difficulty swallowing and impaired digestive system motility
185
CNXI
Accessory Nerves
motor
*trapezius and sternocleidomastoid muscles
damage:
Shrugging the shoulder (role of trapezius muscle) becomes difficult
186
***CNXII
Hypoglossal Nerves
primarily motor
*movement of tongue
damage:
(points) toward affected side,
causes difficulties in speech and swallowing
187
***Bell's palsy
LMN
paralysis or severe weakness of the nerve that controls the facial muscles on the side of the face - the facial nerve or seventh cranial nerve
** NO FOREHEAD WRINKLES
188
Supranuclear lesion
UMN
** FOREHEAD WRINKLES
