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Anatomy > Module 3 > Flashcards

Module 3 Flashcards

1
Q
  • Part of the Central nervous system (CNS)
  • 43 cm long, about the index finger in diameter
  • Extends after the foramen magnum up to about L1-L2 vertebrae
  • Cervical and lumbar enlargements for innervations to the limbs
  • Narrowest and roundest at the thoracic region
  • Extends caudally to end at about the level of L1 or L2 vertebrae as the conus medullaris
  • Extends to the sacrum as a thin stand of glial tissue called filum terminale
A

SPINAL CORD

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2
Q
  • From C4-T1 segments of spinal cord
  • Most of the ventral rami of spinal nerves arising from it form the brachial plexus of nerves that innervates the upper limbs
A

Cervical enlargement

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3
Q
  • From T11-L1 segments of spinal cord
  • The ventral rami of the spinal nerves arising from it make up the lumbar and sacral plexuses of nerves that innervate the lower limbs
  • The spinal nerve roots arising from lumbosacral enlargement and the medullary cone form the cauda equina
A

Lumbosacral enlargement

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4
Q
  • Cephalad to the spinal cord as the foramen magnum is the most distal portion of the brain
A

Medulla Oblongata

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5
Q
  • the distal or most inferior part of the spinal cord
A

Conus medullaris

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6
Q
  • A continuous canal up to the coccyx
  • Composed of the adjacent vertebrae
  • Superior 2/3: spinal cord + spinal nerves
  • Inferior 1/3: spinal nerves only (arranged collectively as the cauda equina
A

Vertebral Canal

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7
Q
  • bundle of spinal nerve roots running through the lumbar cistern
A

cauda equina

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8
Q

All the tissue of the nervous system can be divided into:

A
  1. Neurons
  2. Supporting tissue
  3. Glial connective tissue
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9
Q

Supporting tissue

A

Fibrous connective tissue contains:
Fibrocytes
Collagen and elastic fibers
Intercellular fluid
Various other cells (e.g. Schwann cells)

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10
Q

Glial connective tissue

A 
Consists of cells and intercellular fluid
Astrocytes
Oligodendrocytes
Microglia
Ependyma
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11
Q

DIFFERENTIAL GROWTH: BONY SPINE VS. SPINAL CORD

A
  1. Early embryonic changes
    Spinal cord extends up to the coccyx
    Magkasing-haba sila End of 8th week Coccygeal cord atrophies which later becomes the filum terminale
  2. Fetal stages
    Bony spine grows faster than the cord (relative cord ascension)
    Mas mabilis humaba yung bone than the cord kaya nagmumukhang pataas ang growth ng spinal cord
  3. At birth- Cord ends at L2 or L3 vertebrae
  4. In adult - Cord ends at L1 or L2 vertebrae
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12
Q
  • Vestigial cord
    o Or vestigial coccygeal spinal cord
    o Tail which holds the spinal cord to coccyx
  • Gial tissue
  • Pierces the dural sac through sacral hiatus to attach to the dorsal coccyx
  • Anchors the dural sac
A

FILUM TERMINALE

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13
Q

Three membranous connective tissue layers:

A
  1. Dura mater – next layer beneath the periosteum of the bone
  2. Arachnoid mater – next to the dura mater
  3. Pia mater – after subarachnoid space, intimately attached to gray matter
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14
Q
  • Are continuous membranes that collectively make up the leptomeninx (G. slender membrane)
  • Subarachnoid / Leptomeningeal space
A

Intermediate and internal layers (Arachnoid and pia mater)

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15
Q
  • Clear liquid similar to blood in constitution
  • Provides nutrients but has less protein and different ion concentration
  • Formed by choroid plexuses of the 4 ventricles of the brain
A

Cerebrospinal fluid (CSF)

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16
Q

o Between periosteum and dura
o Fat, venous plexus
o Additional layer in spinal cord
o Epidura – above dura (sa buto na)

A

Epidural Space

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17
Q

o Thick, tough outer meningeal layer
o Encloses dural sac
o Continuous with cranial dura
o Dense, bilaminar membrane also called the pachymenix (G. pachy – thick; menix – membrane)

A

Dura Mater

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18
Q

o Long tubular sheath within vertebral canal, from foramen magnum and ends at about S2
o Extends laterally up to intervertebral foramen as root sleeves pierced by exiting spinal nerve roots
o Merges with connective tissue sheaths of peripheral nerves:
 Dura – continuous with epineurium
 Arachnoid – continuous with perineurium
 Pia – continuous with endoneurium
o Caudally, anchored to the coccyx by the filum terminale
o Tension in the filum terminale stabilizes the spinal cord

A

Dural Sac

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19
Q

o Potential space
o Only gets filled after bleeding (hematoma formation)
o Pressure of CSF pushes the arachnoid to the dura. The space between the dura and arachnoid (subdural space) is only a potential space. Nagkakaspace lang siya if may blood from subdural hematoma.

A

Subdural Space

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20
Q

o Fibrous and elastic tissue
o Avascular
o Thick and sturdy enough to be handled
o Lines dural sac
o Encloses CSF
o Pushed against the dura by CSF pressure
o G. arachne – spider; cobweb + eidos – resemblance

A

Arachnoid Mater

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21
Q

o Arachnoid granulations extend to the pia

o Filled with CSF

A

Subarachnoid Space

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22
Q

o “Pinakaloob”
o Delicate transparent layer of flatcells covering of the outer surface of the cord
o Ensheaths cord and vessels
o Continues as the filum terminale caudally
o Has lateral extensions between dorsal and ventral roots, the denticulate ligament to the dura seen from foramen magnum up to about L2
o Continues distally as the coccygeal portion of the spinal cord and when it atrophies early in life, it becomes your filum terminale
o Thinner membrane that is highly vascularized by a network of fine blood vessels
o When the cerebral arteries penetrate the cerebral cortex, the pia follows them for a short distance forming a “pial coat” and a “periarterial space

A

Pia Mater

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23
Q

– anchors pia mater; extends to the dura

A

Denticulate ligament

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24
Q

(Pia Mater)

- holds the spinal cord steady

A

Denticulate ligament + filum terminale

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25
Q

o Terminal portion of dural sac (L2-S2)
o Contains CSF and the cauda equina
o Access point for lumbar puncture procedures

A

Lumbar cistern

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26
Q
  • Space between periosteum lining bony wall of vertebral canal and dura mater
  • Position of extradural (epidural) herniation
  • Contents: Fat (loose CT); Internal vertebral venous plexuses; Inferior to L2 vertebra, ensheathed roots of spinal nerves
A

Extradural (epidural)

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27
Q
  • Naturally occurring space between arachnoid mater and pia mater
  • Contents: CSF; Radicular, segmental, medullary and spinal arteries; Veins; Arachnoid trabeculae
A

Subarachnoid (leptomeningeal)

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28
Q

o Anesthetic directly into CSF
o Faster onset
o Shorter duration

A

Subarachnoid / Spinal Block

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29
Q

o Indwelling catheter inserted into epidural space
o Anesthetic bathes spinal nerves after they exit the dural sac
o Continuous
o Longer onset and duration

A

Epidural Block

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30
Q 
31 pairs:
o 8 cervical
o 12 thoracic
o 5 lumbar
o 5 sacral
o 1 coccygeal (may be absent)
A

SPINAL NERVES

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31
Q

BLOOD SUPPLY: 3 LONGITUDINAL ARTERIES

A

Ventral median artery (1): Anterior spinal artery

Paired dorso-lateral arteries (2): Posterior spinal arteries
o Receives segmental arteries (radicular arteries) at regular intervals from the aorta

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32
Q

– great anterior segmental medullary artery; the biggest feeder

A

Artery of Adamkiewicz

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33
Q
  • Anterior 2/3 of cord

- Union of branches of the posterior inferior cerebellar and vertebral arteries

A

Anterior Median Artery

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34
Q
  • Posterior 1/3 of cord

- Each is a branch of the ipsilateral posterior inferior cerebellar artery and vertebral artery

A

Paired Posterior Arteries

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35
Q
  • Spinal cord plexus in the subarachnoid space
  • Epidural (internal vertebra) plexus in the epidural space along the length of the vertebral column up to the foramen magnum
  • External venous plexus along the outside of the vertebral column communicating freely with the epidural plexus
    - Valveless, blood flow is bidirectional from spinal cord (away from the cord)
  • Regional network of veins of each spinal segment which eventually drain to the inferior vena cava
A

SPINAL VEINS: 3 LONGITUDINAL VENOUS SYSTEMS

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36
Q

Spread of Infection and Malignancy

A
  • The usual route of spread of malignancy and infection between abdomino-pelvic cavity and the spine
  • Pwede kumalat yung malignancy from spine to viscera and from viscera to the spine. Pero usually viscera to spine kaya common site ng metastasis and spine, both the cord and the bony vertebral column.
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37
Q

May be due to:
o Interruption (rupture)
o Compression (trauma, malignancy)
o Ischemia

Manifests as (depending on part of cord affected and may be complete or incomplete):
o Loss of sensation
o Loss of motor power
o Loss of autonomic function (e.g. bowel/bladder control)

A

LOSS OF SPINAL CORD FUNCTION

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38
Q
  • Lumbar spine nerves increase in size from superior to inferior, whereas the IV foramina decrease in diameter
  • L5 spinal nerve roots are the thickest and their foramina is the narrowest.
  • This increases the chance that these nerve roots will be compressed if osteophytes (bony spurs) develop, or herniation of an IV disc occurs
A

Compression of the Lumbar Spinal Nerve Roots

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39
Q
  • A radiopaque contrast procedure that allows visualization of the spinal cord and spinal nerve roots
  • CSF is withdrawn by lumbar puncture and replaced with a contract material injected into the spinal subarachnoid space and its extensions around the spinal nerve roots within the dural root sheaths.
A

Myelography

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40
Q 
Possible causes:
o Fractures
o Dislocations
o Fracture-dislocations
 Can lead to: muscle weakness and paralysis
A

Ischemia of Spinal Cord

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41
Q
  • Transection of the spinal cord results in loss of all sensation and voluntary movement inferior to the lesion
A

Spinal Cord Injuries

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42
Q

(Spinal Cord Injury)

  • No function below head level
  • A ventilator is required to maintain respiration
A

C1-C3

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43
Q

(Spinal Cord Injury)

  • Quadriplegia (no function of upper and lower limbs)
  • Respiration occurs
A

C4-C5

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44
Q

(Spinal Cord Injury)

  • Loss of lower limb function combined with a loss of hand and a variable amount of upper limb function
  • May be able to self-feed or propel a wheelchair
A

C6-C8

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45
Q

(Spinal Cord Injury)

  • Paraplegia (paralysis of both lower limbs)
  • The amount of trunk control varies with the height of lesion
A

T1-T9

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46
Q

(Spinal Cord Injury)

  • Some thigh muscle function, which may allow walking with long leg braces
A

T10-L1

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47
Q

(Spinal Cord Injury)

  • Retention of most leg muscle function
  • Short leg braces may be required for walking
A

L2-L3

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48
Q
  • Divided into left and right hemispheres
  • Corpus callosum – commissural fibers that join the cerebral hemispheres
  • Median longitudinal fissure – incompletely separates the two hemispheres
A

CEREBRUM

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49
Q

Remember:

A

CEREBRAL CORTEX – GRAY MATER

CEREBRAL MEDULLA – WHITE MATER

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50
Q

LAYERS OF CEREBRUM (From superficial to deep)

A
  1. Molecular / Plexiform Layer - Horizontal cells of Cajal – spindle shape
  2. External Granular Layer - Small pyramidal cells, stellate and granulated cells
  3. External Pyramidal Layer - Medium-sized pyramidal cells
  4. Internal Granular Layer - Large pyramidal cells; Band of Ballerger
  5. Internal Pyramidal Layer
  6. Multiform / Polymorphic / Fusiform Layer - Inverted cells of Martinotti
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51
Q

(Classification of the Cerebral Cortex)

  • 90% of cerebral cortex
  • Also known as isocortex
  • Composed of 6 layers
A

Neocortex or isocortex

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52
Q

(Classification of the Cerebral Cortex)

Includes the cingulate gyrus and hippocampus

A

Mesocortex

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53
Q

(Classification of the Cerebral Cortex)

  • 10% of cerebral cortex
  • Composed of:
    o Paleocortex – olfactory cortex
    o Archicortex – hippocampus, dentate gyrus
A

Allocortex

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54
Q
  • Largest lobe
  • 1/3 of hemispheric’s surface
  • Lies anterior to the central sulcus of Rolando
  • Superior to the lateral fissure of Sylvius
A

Frontal Lobe

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55
Q
  • Primary motor area (BA 4)
  • 1/3 of corticospinal tract (CST) arises here
  • Function: Contralateral movements of face, arm, leg and trunk
A

Pre-central Gyrus

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56
Q

Manifestations of lesion in Pre-central Gyrus

A

o Monoplegia or hemiplegia
o Initial flaccid paralysis
o (+) Babinski reflex

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57
Q
  • Premotor area (BA 6)
  • Anterior to pre-central gyrus
  • 1/3 of Cortico Spinal Tract fibers originates here
  • Function:
    o Contralateral head and eye turning
    o Assumption of posture
    o Complex patterned movements infrequent rapid incoordinate movements
A

Superior Frontal Gyrus

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58
Q

Manifestation of lesion in Superior Frontal Gyrus

A
  • Contralateral paralysis of the head and eye movements
  • Head and eyes turn “toward” the diseases hemisphere
  • Spasticity
  • Increased tendon reflex added to primary motor lesion
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59
Q
  • Fontal eye field (BA 8)
  • Function:
    o Conjugate deviation of the eyes to the other side

Manifestation of lesion:
o Difficulty in voluntarily moving the eyes to the opposite side

A

Middle Frontal Gyrus

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60
Q
  • Broca’s Area - Pars orbitale and triangularis (BA 44 & 45)

o Function:

  • Expressive center for speech in the dominant hemisphere
  • Patterns of movement for muscles producing speech
  • Control motor speech

o Manifestation of lesion: Broca’s or motor aphasia

A

Inferior Frontal Gyrus

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61
Q
  • BA 9-12
  • Areas of higher cortical function
  • Lies rostral to the premotor and frontal eyefield areas
  • Has connections with the dorsomedial nucleus of the thalamus, hypothalamus, limbic lobe, anterior temporal area, and association areas of the parietal and occipital lobes
  • Function: Personality; Abstract thinking; Mature judgment; Foresight; Tactfulness; Self-control; Initiative; Socialization of certain autonomic functions and emotions; Monitor cortical plan of behavior
A

Prefrontal Area

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62
Q

Manifestation of lesion in Prefrontal Area

A

o Witzelsucht – inappropriate jocularity
o Akinetic mutism – severe loss of initiative with disinterest and unconcern
o Primitive reflexes – e.g. grasp, pout
o Frontal ataxia – disturbance of gait
o Paratonia – resistance to passive movements of limbs

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63
Q
  • Anteriorly bounded by the paracentral sulcus
  • Posteirorly bounded by the marginal branch of cingulate gyrus
  • Function: Cortical inhibition of bladder and bowel voiding
  • Manifestation of lesion: INCONTINENCE OF URINE AND FECES
A

Paracentral Lobule

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64
Q
  • An infection of the brain or spinal cord cuased by the spirochete Treponema palladium
  • Usually occurs in people who have had chronic, untreated syphilis, usually about 10-20 years after first infection
  • Develops in about 25-40% of persons who are not treated
  • Manifestation:
    o Lack of general sense of responsibility
    o Sloppiness in habits
    o Vulgar speech
    o Clownish behavior
A

Neurosyphilitic Frontal Atrophy

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65
Q
  • Posterior to central sulcus

- Anterior to parieto-occipital sulcus

A

Parietal Lobe

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66
Q
  • PRIMARY SENSORY OR GRANULAR CORTEX (BA 3, 1, 2)
  • Concerned with tactile and kinesthetic sense from superficial and deep receptors and converge
  • Somatopically represented
  • Function: RECEIVES AFFERENT PATHWAYS FOR APPRECIATION OF POSTURE, TOUCH AND PASSIVE MOVEMENTS
A

Postcentral Gyrus

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67
Q

Manifestation of lesion in Postcentral Gyrus

A

o Contralateral impairment of touch, pressure and proprioception
o Disturbed postural and passive movement sensation
o Disturbed localization of touch with loss of 2-point discrimination
o Astereognosis – impaired appreciation of size, shape, texture and weight
o Preceptual rivalry – sensory inattention

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68
Q
  • Lies posterior to BA 3,1, 2 along superior border of Sylvian fissure
  • Manifestation of lesion: Impaired pain sensation
A

Secondary Somesthetic Area

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69
Q
  • Cortical association areas

- Mnemonic constellations for understanding and interpreting sensory signals

A

Inferior Parietal Lobule

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70
Q
  • BA 40

- Function: Understanding and interpreting sensory signals

A

Supramarginal Gyrus

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71
Q

 Manifestation of lesion in Supramarginal Gyrus

A

o Lesion on dominant hemisphere:
Tactile and proprioceptive agnosia

o Lesion on non-dominant hemisphere:
Confusion in left-right discrimination
Body image disturbance
Apraxia

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72
Q
  • Surrounds the ascending terminal part of the superior temporal sulcus
  • BA 39
  • Function: Association cortex which has connections with somesthetic, visual and auditory association areas
  • Manifestation of lesion:
    o Dominant hemisphere:
    Alexia
    Agraphia
A

Angular Gyrus

73
Q
  • Fibers of the optic radiation (lower visual field) pass through the parietal lobe
  • Manifestation of lesion: LOWER HOMONYMOUS QUADRANTINOPSIA
A

Visual Pathway in the Parietal Lobe

74
Q
  • Located at the roof of the lateral fissure of Sylvius

- Primary gustatory area (BA 43) – taste sensibility

A

Parietal Operculum

75
Q

Function: Numbers and calculations

Lesions can lead to:
Gertsmann’s Syndrome
o Confusion of right and left limbs
o Finger agnosia (difficulty in distinguishing finger from hand)
o Acalculia
o Agraphia
A

Dominant Parietal Lobe

76
Q

Function:

  • Body image and awareness of external environment
  • Visual and proprioceptive skills
  • Spatial orientation
Lesions can lead to:
Asomatognosia
Anosognosia
Dressing apraxia
Geographical apraxia
Constructional apraxia
Unaware of opposite limb
A

Nondominant Parietal Lobe

77
Q

o Superior temporal gyrus
Auditory cortex
Primary auditory area

o Superior temporal sulcus
o Middle temporal gyrus
o Inferior temporal sulcus
o Inferior temporal gyrus

A

Temporal Lobe

78
Q
  • Parallel with lateral sulcus

Manifestation of lesion:
o AUDITORY HALLUCINATIONS (by disease like complex partial seizure)
o VERTIGO (dizziness with sensations of turning movement of the body)

A

Superior Temporal Gyrus

79
Q
  • Located on transverse gyri of Heschl (several short oblique convolutions on the inner bank of the lateral sulcus)
  • Upper surface of the superior temporal gyrus under the lateral sulcus
  • BA 41 and 42
  • Function:
    Dominant hemisphere: Hearing language
    Non-dominant hemisphere: Hearing sound rhythm and music; Labyrinthine function
A

Primary Auditory Cortex

80
Q

Manifestation of lesion in Primary Auditory Cortex

A

o Cortical deafness
o Dominant hemisphere: difficulty hearing spoken words
o Non-dominant hemisphere: amusia – difficulty appreciating sound, rhythm and music
o Unilateral lesions have little effect on hearing (bilateral contribution of cranial nerve)

81
Q
  • Auditory association area (BA 22)
  • Function: Dominant hemisphere: language comprehension
  • Manifestation of lesion:
    Dominant hemisphere: Wernicke’s / receptive aphasia
A

Wernicke’s Area / Secondary Auditory Cortex

82
Q
  • Involved in memory and learning

- Lesions result in disturbance in memory and learning

A

Middle and Inferior Temporal Gyri

83
Q
  • Fibers of the optic radiation (upper visual field) pass through the temporal lobe
  • Manifestation of lesion: UPPER HOMONYMOUS QUADRANTINOPSIA
A

Visual Pathway in Temporal Lobe

84
Q
  • Pre-pyriformis and periamygdaloid area
  • Rostral part of parahippocampal gyrus
  • Uncus
  • Most medial protrusion of parahippocampal gyrus
  • Lateral olfactory stria
A

Primary Olfactory Area

85
Q
  • Above tentorium cerebella
  • Separated from parietal lobe by the parieto-occipital sulcus
  • Consists of the lateral occipital gyro; Cuneus; Calcimine sulcus; Lingual gyrus
  • Involved in visual perception
A

Occipital Lobe

86
Q

Manifestation of lesion in Occipital Lobe

A

o Cortical lesion: Homonymous hemianopsia
o Occipital lobe: Central hemianopsia involving the macula
o Anton’s Syndrome - Results from extensive damage of the striate cortex
Cortically blind (denial na bulag ka)
Area 17 – bulag ka
Area 18, 19 – may nakikita pero hindi alam kung ano yun

87
Q
  • Located on the banks of the calcarine sulcus
  • BA 17
  • Function:
    o Perception from contralateral half of visual field
    o Receives impulses from temporal half of the ipsilateral retina and nasal half of the contralateral retina
  • Manifestation of lesion: CORTICAL BLINDNESS IN CONTRALATERAL VISUAL FIELD
A

Primary Visual Cortex

88
Q
  • Lies adjacent and anterior to primary visual cortex
  • BA 18, 19
  • Function: Visual perception; Visual reflexes (i.e. visual fixation)
  • Manifestation of lesion: Visual agnosia
A

Secondary Visual Area

89
Q
  • Impairment in recognition of visually presented objects

- It is not due to a deficit in vision (acuity, visual field, and scanning), language, memory, or low intellect

A

Visual agnosia

90
Q
  • Olfactory Sulcus separates lateral orbit gyri and medial gyrus rectus
  • Olfactory bulb and tract inferior to the olfactory sulcus
A

Inferior Surface of the Cerebrum

91
Q
  • Island of Reil
  • Buried in the depths of the lateral sulcus
  • Can only be seen when temporal and frontal lobes are separated
  • A triangular cortical area with the apex directed toward and downward to open into the lateral fissure
  • Covered by the gyri breves and longus, nearly parallel to lateral sulcus
  • Limen insula – opening leading to insular region
  • Temporal, frontal, and parietal opercular regions cover the insula
A

Insula

92
Q
  • Includes in the depths of the lateral sulcus a diverse group of medial and basal telencephalic structures, which represent those regions of the cerebral cortex having the most direct connections with the hypothalamus
  • Defense reactions such as fear or rage – integrated diffusely
  • Include: hippocampus, amygdala, and septal nuclei
A

LIMBIC SYSTEM

93
Q
  • Parts of the limbic lobe and diencephalon
  • Concerned with emotion
  • HF -> Fornix -> Mammillary Bodies -> Mammillothalamic Tract -> Anterior Nuclear Group of the Thalamus -> Cingulate Gyrus
A

PAPEZ CIRCUITRY

94
Q
  • Bilateral lesion destroying the amygdala and hippocampus in male monkeys
  • Manifestations:
    o Psychic blindness
    o Hypermetamorphosis
    o Hyperorality
    o Hypersexuality and loss of sexual preference
    o Reversal of individual behavioral patterns
    o Marked absence of emotional response
    o Loss of facial expressions and vocal protests
A

Kluver-Bucy Syndrome

95
Q
  • Profound loss of the ability to acquire new information
  • Seen in bilateral damage of the medial temporal lobe
  • Also seen in Korsakoff’s psychosis (Lesions involving mammillary bodies and dorsomedial nucleus of the thalamus)
A

Anterograde Amnesia

96
Q

(CLASSIFICATIONS OF SENSORY NEURONS)

  • Stimulus comes from the skin, joints, tendons, skeletal muscles and bones which are carried towards the CNS
  • Can be found in both the cerebral and spinal ganglia
A

General Somatic Afferent (GSA)

97
Q

(CLASSIFICATIONS OF SENSORY NEURONS)

  • Stimulus comes from the visceral organs
  • Found in both the spinal and visceral ganglia
A

General Visceral Afferent (GVA)

98
Q

(CLASSIFICATIONS OF SENSORY NEURONS)

  • Stimulus comes from the olfactory and gustatory areas, which are related to the digestive system
  • Found only in cerebral ganglia
A

Special Visceral Afferent (SVA)

99
Q

(CLASSIFICATIONS OF SENSORY NEURONS)

  • Stimulus comes from the visual, auditory and vestibular areas
  • Derived from the body wall during development (ectoderm)
  • Found in cerebral ganglia
A

Special Somatic Afferent (SSA)

100
Q
  • innervate skeletal muscles of myotomic origin
A

General Somatic Efferent (GSE)

101
Q
  • If effector is a skeletal muscle of brachiometric origin (muscles of facial expression, mastication, phonation and deglutition
  • innervate smooth muscle of the viscera, intraocular muscles, heart, salivary glands
A

General Visceral Efferent (GVE)

102
Q
  • innervate skeletal and cardiac muscle derived from brachial arches
A

Special Visceral Efferent (SVE)

103
Q 
SVA
Sensory Neuron (SN): Olfactory cells
Association Neuron (AN): Mitral cells of olfactory bulb
Function (F): Smell
Dysfunction (DF): Anosmia
A

CN I – Olfactory Nerve

104
Q 
SSA
SN: Rods and cones
AN; Bipolar cells of retina
F: Vision
DF: Blindness
A

CN II – Optic Nerve

105
Q

SN: Gasserian (Semilunar)
AN: Spinal Nucleus (pain); Main Sensory (touch); Mesencephalic nucleus in Jaw (proprioception)
F:
- Sensation forehead pain; Touch forehead
- Cheek pain and touch
- Jaw pain, touch and proprioception

A

CN V - Trigeminal Nerve

106
Q 
SVA
SN: Geniculate ganglion
AN: Nucleus of solitary tract
F: Taste (in anterior 2/3 of tongue)
DF: Decrease taste
A

CN VII – Facial Nerve

107
Q

SSA
SN - AN: Vestibular ganglion - Vestibular
Spiral ganglion - Dorsal and ventral cochlear nuclei
F: Balance and equilibrium; Hearing
DF: Disequilibrium, vertigo Decrease hearing

A

CN VIII – Vestibulocochlear Nerve

108
Q

SVA - Inferior petrosal ganglion - Nucleus of solitary tract
GVA - Inferior petrosal ganglion - Nucleus of solitary tract
GSA - Superior petrosal ganglion - Spinal nerve of CN V

Function:
SVA: Taste (in posterior 1/3 of tongue)
GVA: Sensation in pharynx, tongue, carotid reflex
GSA: Sensation in back ear

Dysfunction: Decrease taste; Decrease gag reflex; Decrease sensation

A

CN IX – Glossopharyngeal Nerve

109
Q

SVA - Inferior nodose - Nucleus of solitary tract
GVA - Inferior nodose - Nucleus of solitary tract
GSA - Superior jugular - Spinal nucleus of CN V

Function:
SVA: Taste in posterior pharynx
GVA: Sensation in pharynx, larynx, thoracic and abdominal viscera
GSA: Sensation in external auditory meatus

Dysfunction: Decrease sensation; Decrease sensation in auditory

A

CN X – Vagus Nerve

110
Q

Main Oculomotor Nucleus (GSE)
- Extraocular muscles EXCEPT lateral rectus and superior oblique

Edinger-Westphal Ncleus (GVE) via ciliary ganglion
- Ciliary muscle and sphincter pupillae muscles

A

CN III – Oculomotor Nerve

111
Q 
Motor Neuron (MN): Trochlear Nucleus (GSE)
Effector (E): Superior oblique
A

CN IV – Trochlear Nerve

112
Q

MN: Motor Nucleus of CN V (SVE)
E: Muscles of mastication

A

CN V – Trigeminal Nerve

113
Q

MN: Abducens Nucleus (GSE)
E: Lateral rectus muscle

A

CN VI – Abducens Nerve

114
Q

MN: Superior Salivatory Nucleus (GVE) via:

  • Sphenopalatine ganglion
  • Submandibular ganglion
  • Facial Motor Nucleus

E: Lacrimal gland, submandibular and sublingual glands Mimetic muscles

A

CN VII – Facial Nerve

115
Q

MN: Inferior Salivatory Nucleus (GVE) via: Otic ganglion
E: Parotid glands

A

CN IX – Glossopharyngeal Nerve

116
Q

MN: Motor Nucleus (GVE) via: Parasympathetic terminal ganglia
E: Visceral organs and glands

A

CN X – Vagus Nerve Dorsal

117
Q

MN: Spinal Accessory Nucleus (SVE)
E: SCM and Trapezius muscles

A

CN XI – Spinal Accessory Nerve

118
Q

MN: Hypoglossal Nucleus
E: Tongue muscles and genioglossus

A

CN XII – Hypoglossal Nerve

119
Q

MN: Nucleus Ambiguus
E: Muscles of mastication and deglutition

A

CN IX, X, and XI

120
Q
  • These are structure made up of anterior rami of the spinal cord joined together
    1. Cervical plexus
    2. Brachial plexus
    3. Lumbar plexus
    4. Sacral plexus
A

Plexuses

121
Q
  • Formed by the anterior rami of the 1st 4 cervical nerves
  • Rami are joined by connecting branches = loops
  • Lie in front of the origins of levator scapulae and scalenus medius muscles
  • Covered in front by the prevertebral layer of deep cervical fascia and related to the internal jugular vein
A

CERVICAL PLEXUS

122
Q

Cutaneous Branches of the Cervical Plexus

A
  • Lesser occipital nerve
  • Great auricular nerve
  • Transverse cutaneous nerve
  • Supraclavicular nerve
123
Q

(Cervical Plexus)

Muscular branches to the neck muscles:

A
  • Prevertebral muscle
  • Sternocleidomastoid (proprioceptive, C2 - 3)
  • Levator scapulae (C3 – 4)
  • Trapezius (proprioceptive, C3 – 4)
124
Q
  • C1 (C1 fibers adjoining hypoglossal nerve) + Descending cervical nerve (C2 & C3)
  • branches C1 + C2 + C3 – supplies omohyoid, sternohyoid, and sternothyroid.
  • C1 from hypoglossal nerve – supplies thyrohyoid and geniohyoid
A

Ansa cervicalis

125
Q
  • ONLY motor supply of Diaphragm
  • Sensory to pleura, peritoneum of central diaphragm, pericardium
  • Proprioception to diaphragm
  • from C3, C4, C5
  • formed at lateral border of scalenus anterior at level of cricoid cartilage
A

Phrenic nerve

126
Q
  • injury to one side pushes the ipsilateral diaphragm up resulting to atelectasis
A

Phrenic nerve

127
Q
  • formed in the posterior triangle
  • Union of C5, C6, C7, C8 and T1
  • 5 roots = 3 trunks = 6 divisions = 3 cords
  • Divided into roots, trunks, divisions, and cords
  • Cords and most of branches lies in axilla
  • Surrounded by Axillary sheath, from prevertebral fascia
  • Cords lie above & lat. the 1st part of Axillary A
A

Brachial Plexus

128
Q

Brachial Plexus: Roots to Trunks

A

C5 + C6 -superior or upper trunk
C7 -middle trunk
C8 + T1 - inferior or lower trunk

129
Q

Brachial Plexus: Division to Cord

A

ALL posterior divisions unite - posterior cord
Anterior division of upper and middle trunk unite - lateral cord
Anterior division of lower trunk - medial cord

130
Q

So why do we call it posterior, lateral and medial cord? This is in relation to what structure?

A

Axillary artery

Posterior cord is seen posteriorly in axillary artery.
Lateral cord is seen lateral to axillary artery
Medial cord is medial to axillary artery.

131
Q

5 Terminal Branches of Brachial Plexus

A
  1. MUSCULOCUTANEOUS NERVE - Anterior / Flexor compartment of arm
  2. AXILLARY NERVE - Deltoid, Teres minor
  3. RADIAL NERVE - Posterior / Extensor compartment of arm and forearm
  4. MEDIAN NERVE - Anterior / Flexor compartment of forearm EXCEPT Flexor carpi ulnaris and medial half of Flexor digitorum profundus Medial half of FDP – ulnar nerve Lateral half of FDP – median nerve
  5. ULNAR NERVE - Intrinsic muscles of hand
132
Q

Thenar Vs Hypothenar Muscles

A

Thenar Muscles - Median Neve

Hypothenar Muscles - Ulnar Nerve

133
Q
  • joined by intercostobrachial nerve

- supplies skin on the medial side of arm

A

Medial cutaneous nerve of arm (T1)

134
Q
  • supplies skin medial side forearm
A

Medial cutaneous nerve of forearm (C8, T1)

135
Q
  • supplies the subscapularis

- lower part supplies the Teres muscle

A

Upper and Lower Scapular nerve

136
Q
  • supplies the Latissimus dorsi
A

Thorcodorsal nerve

137
Q

2 Nerve Supply of the Brachioradialis

A

Musculocutaneous and Radial Nerve

138
Q
  • Largest branch of brachial plexus
  • At axillary area, gives branches to: long and medial head of triceps and posterior cutaneous nerve of arm
  • At the spiral groove gives branches to:
  • medial and lateral head triceps and anconeus
  • lower lateral cutaneous nerve of arm
  • posterior cutaneous nerve of forearm
A

Radial nerve

139
Q

Quadrilateral Space Borders and Contents

A 
BORDERS
Upper: Teres Minor
Medial: Long head of the Triceps
Inferior: Terje Major
Lateral: Near the neck of the humerus

CONTENTS: Axillary Nerve and Posterior Circumflex Artery

140
Q
  • Upper lesion of the Brachial Plexus
  • Due to excessive displacement of head to the opposite side and depression of shoulder on the same side
  • injury to C5 and C6 roots
  • suprascapular nerve, nerve to subclavius, musculocutaneus nerve, and axillary nerve will be functionless
A

Erb-Duchenne Palsy

141
Q

Muscles paralyzed in Erb-Duchenne Palsy

A

1) Supraspinatus and Infraspinatus
2) Subclavius
3) Biceps brachii, greater part of brachial, Coracobrachialis
4) Deltoid and Teres minor

142
Q
  • limb hang limply by the side, medially rotated
  • forearm is pronated
  • likened to a porter/waiter’s tip
  • loss of sensation lateral side of arm
A

Erb-Duchenne Palsy

143
Q
  • lower lesions of brachial plexus
  • due to excessive abduction of the arm
  • T1 is injured
  • ulnar and medial nerve are affected all the small muscles of the hand
  • loss sensation medial side of the arm
A

Klumpke palsy

144
Q
  • extensor digitorum un-opposed ->extends the metacarpophalangeal joint
  • flexor digitorum superficialis and profundus un-opposed -> flex middle and terminal phalanges respectively
    = Claw hand
A

Klumpke palsy

145
Q
  • injury to long thoracic nerve
  • injury by blow to posterior triangle or by mastectomy
  • inability to rotate the scapula -> difficulty of raising the arm above the head
A

Winged scapula

146
Q
  • injured by crutch pressing upward, shoulder dislocation or fracture of surgical neck of humerus.
  • present as impaired shoulder abduction, loss sensation of lower half of deltoid, deltoid wasting
A

Axillary nerve injury

147
Q

Location of Fracture and Nerve Affected

A
  1. Surgical neck of humerus - Axillary Nerve
  2. Supracondylar ridge - Median Nerve
  3. Radial / Spiral groove - Radial Nerve
  4. Medial epicondyle - Ulnar Nerve
148
Q
  • Uncommon because it is protected by the muscles
  • May be compressed as it passes through the Coracobrachialis muscle
  • Manifestations:
    o Weakness in flexion of forearm at the elbow
    o Weakness in supination
A

Musculocutaneous Nerve Lesions

149
Q
  • As a result of a spinal fracture of midshaft of humerus
  • Wristdrop
    o Weakness in ability to extend the hand at the wrist
    o Loss of extension at the MP joints of all digits
  • May experience pain and paresthesia in skin over the first dorsal interosseous muscle between the thumb and index finger
  • Supination may be weakened BUT NOT LOST
  • Extension of the forearm is spared
A

Radial Nerve Lesions

150
Q
  • Cause: Supracondylar fracture of humerus; Compression between heads of pronator trees muscle
  • Manifestation:
    Altered sensation in lateral 3½ digits and thenar eminence
    Weakness in flexion at wrist
    Flexion of lateral fingers and flexion of thumb
    HAND OF BENEDICTION
A

Median Nerve Lesions: Proximal

151
Q
  • Cause: Lunate dislocation
  • Manifestation:
    Altered sensation in lateral 3½ digits
    Numbness and pain over palmar aspects of thumb, index, and middle fingers
    APE HAND
A

Median Nerve Lesions: Distal

152
Q
  • burning pain lateral 3 ½ finger
  • weakness of thenar muscles
  • relieved by decompressing flexor retinaculum
A

Carpal tunnel syndrome (Median Nerve Injury)

153
Q

– fracture of medial epicondyle

  • At the elbow
  • unable to adduct and abduct the fingers
  • unable to grip paper placed between
  • impossible to adduct thumb
  • Froment’s sign
  • claw deformity (main en griffe)
  • Benediction sign (ulnar nerve palsy)
A

Injury to ulnar nerve

154
Q

Strong contraction of flexor pollicis longus and flexing the terminal phalanx

A

Positive Froment’s sign

155
Q
  • nervous pathway supplying the lower limb
  • formed in the Psoas muscle
  • from anterior rami of upper 4 lumbar nerves
A

Lumbar Plexus

156
Q

Nerves emerging from Medial border of Psoas:

A
  • Obturator nerve

- 4th lumbar root of lumbosacral trunk

157
Q

Nerves emerging from lateral border of Psoas:

A
  • Iliohypogastric nerve
  • Ilioinguinal nerve
  • Lateral cutaneous nerve
  • Femoral nerve
158
Q

Nerve emerging from Anterior Border of Psoas:

A
  • Genitofemoral nerve
159
Q
  • skin of the lower part of anterior abdominal wall
A

Iliohypogastric nerve

160
Q
  • skin of the groin and the scrotum or labium majus
A

Ilioinguinal nerve

161
Q
  • skin lateral surface of thigh
A

Lateral cutaneous nerve of thigh

162
Q
  • largest branch of lumbar plexus

- supplies the anterior compartment of the thigh

A

Femoral nerve

163
Q
  • supplies the medial compartment of the thigh
A

Obturator nerve

164
Q

Genitofemoral nerve – divides into the ff:

A

Genital branch - supplies the cremaster

Femoral branch – small area on anterior surface of skin of the thigh; involved in cremasteric reflex

165
Q 
Lies in the posterior pelvic wall in front of piriformis
From anterior rami of L4 to S4
Branches to lower limb
- Sciatic nerve
- Superior gluteal nerve
- inferior gluteal nerve
- nerve to quadratus femoris
- nerve to obturator internus
- posterior cutaneous nerve of thigh
A

Sacral Plexus

166
Q
  • largest nerve of the body
  • supplies the posterior thigh, leg and foot
  • give off branches: Tibial artery and common peroneal nerve
A

Sciatic nerve (L4 – S3)

167
Q
  • supplies the gluteus medius, gluteus minimus, and tensor fascia latae
A

Superior gluteal nerve

168
Q
  • supplies the gluteus maximus
A

Inferior gluteal nerve

169
Q
  • supplies the quadratus femoris and inferior gemellus
A

Nerve to quadratus femoris

170
Q
  • supplies the obturator internus and superior gemellus
A

Nerve to obturator internus

171
Q
  • supplies the skin of buttocks and back of thigh
A

Posterior cutaneous nerve

172
Q
  • supplies the muscle of perineum and external anal sphincter; skin in perineum
A

Pudendal nerve

173
Q
  • supplies the piriformis muscle
A

Nerve to piriformis

174
Q
  • sacral part of parasympathetic system

- distributed to pelvic viscera

A

Pelvic splanchnic nerve

175
Q
  • supplies lower medial buttocks
A

Perforating cutaneous nerve

176
Q
  • Susceptible to damage from an IM injection in lower medial quadrant of gluteus maximus muscle
  • Gluteus maximus may be compressed as a result of a posterior dislocation of the femur
  • L5 and S1 roots are commonly compressed
    o Pain that radiates into the L5 and S1 dermatomes of the leg and foot
A

Sciatic Nerve Injury

177
Q
  • Weakness in flexing leg at the knee and plantarflex at the ankle
  • Can’t stand on tiptoes
  • Paresthesia on skin of posterior leg, sole and lateral foot
A

Tibial Nerve Lesions

178
Q
  • May be performed to suppress labor pain by anesthetizing the pudendal nerve as it crosses the ischial spine
  • Pain of childbirth is transmitted through sensory fibers of S2-S5
A

Pudendal Nerve Block

Anatomy (10 decks)

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