Module 6 & 7, Year 1 - Functional Neurology Flashcards
Name the area the primary motor cortex is found and its function
Frontal lobe
Conscious contralateral motor control; motor homunculus
Name the area the premotor cortex is found and its function
Frontal lobe
Integration of sensory and motor information for the performance of action.
Name the area the frontal eye fields are in and their function
Frontal lobe
Saccadic eye movement or visual searching; controls contralateral field
Name the area the dorsolateral prefrontal cortex is in and its function
Frontal lobe
Executive function
Name the area the orbitofrontal cortex is in and its function
Frontal lobe
Modulation of affective and social behavior, smell discrimination
Name the area the cingulate cortex is in and its function
Frontal lobe
Drive, motivation, environmental exploration
Name the area the Broca’s Area is in and its function
Frontal lobe
Motor control of speech
Name the area the primary somatosensory cortex is in and its function
Parietal lobe
Conscious sensation of touch, pain, temperature, vibration, proprioception; sensory homunculus
Name the area the parieo-insular vestibular cortex is in and its function
Parietal lobe
Perception of vertical upright and body schema
Name the area the primary auditory cortex is in and its function
Temporal lobe
Hearing
Name the area Wernick’s Area is in and its function
Temporal lobe
Perception of speech
Name the area the primary olfactory cortex & limbic association cortex are in and their function
Smell and emotion
Name the area the primary & secondary visual cortices are in and their function
Vision, depth, and visual association; dorsal pathway tells “where” and ventral pathway tells “what”
What is the function of the thalamus?
Relay center for all sensory input (minus smell)
T or F: The thalamus is the relay center for all sensory input.
False, MINUS SMELL, it is the relay center for all sensory input
What is the function of the basal ganglia?
General motor control, eye movements, cognitive function, emotional functions
What is the function of the caudate nucleus?
Learning, storing and processing memories
What is the function of the putamen?
Regulate movement and influence learning
What is the function of the globus pallidus?
Regulation of voluntary movement
What is the function of the subthalamic nucleus?
Inhibition and movement control (indirect pathway)
What is the function of the substantia nigra?
DA and GABA production
What is the function of the nucleus accumbens?
Reward circuit
What is the function of the ventral pallidum?
Reward and motivation
What is the function of the limbic system?
Emotions, olfactory, memory, homeostatic functions
What is the function of the midbrain (mesencephalon)?
Vertical eye movements, contains CN V, VI, VII, and VIII; pontine reticular formation (or cardiovascular control and pontine reticulospinal tracts), origin of the medial and lateral vestibulospinal tracts
What is the function of the medulla?
Contains CN IX, X, XI, and XIII; medullary reticular formation (or cardiorespiratory centers, medullary reticulospinal tracts), contains the pyramidal decussation of the corticospinal tract
What is the function of the cerebellum?
Planning and refinement of motor movement
What is the function of the vermis and flocculonudular lobe?
Motor control of midline structures; nucleus: fastigual nucleus; relay with vestibular nuclei
What is the function of the intermediate hemisphere of the cerebellum?
Motor control of the girdle muscles to distal joints (shoulders and hips to wrists and ankles)
Nucleus: Interposed nucleus (eboliform n. and globus n.)
What the function of the lateral hemisphere of the cerebellum?
Fine motor control of distal joints (hands and feet)
Motor planning and learning
Nucleus: dentate nucleus
What is the function of the vestibular system?
Balance (via CN VIII)
What is the function of the semicircular canals?
Info about angular/rotation velocity of the head
What is the function of the ampulla?
Info about angular/rotation velocity of the head
What is the function of the saccule?
Vertical translation velocity (gravity)
What is the function of the utricle?
Linear translation velocity (gravity)
What are the blood suppliers to the brain?
Internal carotid artery provides anterior blood supply.
Vertebrobasilar system provides posterior blood supply.
What removes metabolic waste from the CNS?
Both the venous system and cerebrospinal fluid.
What is the area called where the motor neuron meets the muscle fiber?
Neuromuscular junction
Functional unit of the nervous system
Neuron cellular level
What tests and treatment would serve a practice member recovering from a stroke? What area is this rebuilding?
L-test, UPDRS, and MRI
Mirror exercises will help build the primary motor cortex
Practice member states he has a hard time following along with mass, particularly doing the actions. Luria sequencing shows problems with mirroring actions. What is the problem and what is a good treatment?
Practice member shows signs of apraxia, a compromised premotor cortex, integrating sensory and motor information.
Continue with Luria sequencing, but add duel tasking to it as well (stimulates frontal lobe)
A practice member walks in with makeup on one half of her face. Visual eye test shows a loss of saccadic eye movement to the left side. What is the problem and what is a potential solution?
This is evidence of hemineglect, ignoring a partial side of the eye field due to a lesion in opposite side of the brain.
The hemistim app stimulates the lost visual field, encouraging rebuilding of the frontal lobe eye fields.
A practice member states he is having trouble remembering what his wife told him to do, like things at the grocery store or chores around the house. What would be a good test to do
Luria alternating figures test would confirm a problem with preservation in the dorsolateral prefrontal cortex, where executive function happens.
A treatment to help rebuild this area would be puzzles and alternate sequencing training.
If a practice member had a difficult time with refraining from talking and also noticed having decreased sensitivity to smell, what kind of problem are you suspecting? Is there an exercise that would help rebuild this deficiency?
A lesion to the orbitofrontal cortex could lead to social behavioral disinhibition and anosmia.
Testing for this could be go-no-go test. Treatment that would help is stroop exercises.
A practice member has been coming into the office, but showing signs of depression, talking about grim subjects and not acknowledging your inquiries. What should be done? What underlining brain issue could be considered?
Continuing to observe and record history. It is okay to try to motivate the practice member, but additional help, such as counselor or psychological help, is needed.
A lesion to the cingulate cortex, the frontal lobe region responsible for drive, motivation, and exploration, is a possibility.
Over the last several visits, a practice member has had difficulty expressing his pain in words; it is clearly aggravating him. What area of the brain could be affected? What steps could you start taking?
Broca’s area could potentially be involved.
Continue observing and see if an MRI has been ordered. Stimulating the fascial and tongue areas could help, as well as recommending 5g/day creatine.
“Speech”, “Aphasia”
Broca’s area
“Drive”, “Motivation”
Cingulate Cortex
“Social Behavior”, “Smell discrimination”
Orbitofrontal cortex
“Executive function”
Dorsolateral prefrontal cortex
“Saccadic movements”
Frontal eye fields
“Motor and Sensory integration”
Premotor cortex
“Motor homunculus”
Primary motor cortex
What is the function of the primary somatosensory cortex?
Conscious sensation of touch, pain, temperature, vibration, proprioception
aka “Sensory Homunculus”
What is the function of the parieo-insular vestibular cortex?
Perceiving being vertically upright and body schema
A practice member is unable to perceive objects with his fingers. Additionally, his signature is illegible. What tests would you want to run? What area of the brain is in question? What treatment can be done?
Point localization test and a MRI would be helpful for ruling out Gertsmann’s Syndrome.
The primary somatosensory cortex of the parietal lobe is in question.
Mirror therapy or graphethesia exercises to remap the body part would be helpful.
A practice member with a history of stroke comes in with a laterally bend spine walks heavy footed on the left and pushes himself up with his left arm when getting off of the table. What are these manifestations/syndromes called? What region of the brain does it involved? What is the best course of action?
The loss of vertical uprightness are manifested through Pusher’s syndrome and Pisa’s syndrome. This is associated with the parieo-insular vestibular cortex, which was affected by the blood buildup on the brain from the stroke.
Continue to monitor, record history, seeing the original MRI (and maybe a follow up) would be helpful. Treatment will involved feedback training of subjective visual vertical and stroke treatment.
“Upright”, “Pusher’s, “Pisa’s”
Parieo-insular vestibular cortex
“Conscious”, “Sensory homunculus”
Primary somatosensory cortex
What is the function of the primary auditory cortex?
Hearing
What is the function of Wernick’s area?
Perception of speech
What is the function of the primary olfactory cortex?
Smell
What is the function of the limbic association cortex?
Emotion
A practice member has had a hard time understanding what you tell them during a check. She hears you, but describes it as “not being able to distinguish your voice from talk in the other room.” What tests would be appropriate? What region of the brain is involved? What treatment could benefit?
Sound localization test and a MRI analyzing the frontal and temporal lobes for atrophy would confirm suspected frontotemporal dementia.
The area in question is the primary auditory cortex.
Treatment would focus on superior field hemistim with sound in contralateral ear and increased dose of omega 3’s.
A practice member keeps asking you to repeat what you are saying while looking straight at you. What area is in question? What is the appropriate continuation?
Wernick’s Area
Continue to observe. A MRI to evaluate the area would be beneficial.
A practice member comes in panicked and insists had Covid-19. She did not run a fever nor had any head pressure, but she did lose her sense of smell. Her husband reports she has been unusually uptight over the last several weeks after she “bumped her head.” What area of the brain is suspect? How could you further investigate?
Primary olfactory cortex and limbic association cortex is in question. Continue to observe. MRI would confirm damage to the region.
What is the function of the primary & secondary visual pathways?
Vision, depth and visual association; the dorsal pathway tells you “where” and the ventral pathway tells you “what”
A practice member appears to have trouble seeing things - walking partly into walls and having to get on the table with a lot of feeling around. CN II & III tests appears normal. He is offended by the question and exclaims, “Of course, I can see, doc. You’re blind!” What condition do you suspect? What further testing would confirm your suspicion? How would you start treating it?
Cortical blindness is suspect, but you could make a case for Anton’s Syndrome (denial of cortical blindness). A lesion to the occipital lobe would be suspect.
Blind spot mapping and visual evoked potential testing would both confirm, but MRI would definitively show a lesion to the occipital region.
Treatment, if practice member can see some, should include visual motor and sensory inputs.
“Vision”, “Depth”
Primary and sensory visual cortices
“Relay center”
Thalamus
A practice member who had a stroke a few months back has restarted care. One of the problems she states that has not improved is she cannot see out of her right eye and everything smells burnt. CN II & III tests appear normal. How would you explain these symptoms? What would confirm your diagnosis? What treatment could begin today?
Stroke could cause a number of brain issues including dysfunction of the thalamogeniculate artery, causing Dejerine-Roussy Syndrome as described.
MRI would confirm this diagnosis.
Mirror therapy would be an active step following a stroke. Psychological counseling may also be needed if practice member is stressed by these changes.
________ is to Parkinson’s as subthalamic nucleus is to _______.
Substantia nigra is to Parkinson’s as subthalamic nucleus is to Huntington’s or Dystonia.
What is the midbrain’s function?
Vertical eye movements, contains the substania nigra and periaquaductal grey area (pain reguation), origin of the tectospinal tract and rubrospinal tract
What area of the brainstem would you expect to have dysfunction for a practice member with anxiety? How would you test it? What treatments may help?
Midbrain
Vertical plane smooth pursuit
Breathing exercises, vertical sinusoidal VOR movements
“Homeostasis”, “Psychogenic”
Limbic system
What area of the brainstem would you suspect dysfunction for someone with POTS? What tests would confirm? What exercises could you start?
Pons
Modified tilt table test and horizontal eye movements.
Horizontal sinusoidal VOR movements, lateral gaze holding, breathing exercises.
“Mesencephalon”, “substania nigra”
Midbrain
“Pontine reticular formation”, “Vestibulospinal tracts”
Pons
Contains CN V, VI, VII, VIII
Pons
Contains CN IX, X, XI, XII
Medulla
“Medullary reticular formation”, “Wallenburg Syndrome”
Medulla
What is dolichoectasis? How does it apply to the upper cervical region? What would be the best way to confirm this?
It is elongating, distending, and tortuous changes of an artery.
It is notable in the vertebrobasilar artery especially because it can compress the medulla, affecting the entire ANS.
MRI is the gold standard confirmation of this test. A sensory exam of the nucleus ambiguus (dysphagia, dysphonia, and dysarthria) is recommended.
This is a 911 emergency as stroke may be imminent.
A practice member has exceptional shaking when reaching out with his arm. Finger-nose-finger test is all over the place. What is your suspicion? What would confirm this diagnosis? What interventions could you start with?
Ataxia is suspect of a cerebellar lesion, which would be confirmed with a MRI w/o contrast.
Adjust and finger-nose-finger exercises would benefit to rebuild neural pathways.
“Refine movements”, “Ataxia”
Cerebellum
“Fastigual nucleus”, “Midline movement”
Vermis and flocculonudular lobe
“Girdle muscle control”, “Eboliform & globus nuclei”
Intermediate hemisphere
“Hands & feet”, “Fine motor control”
Lateral hemisphere
A practice member tells you she had to pull her car over to the side of the road due to a sudden hit of vertigo that lasted about 15 minutes. This has occurred several times over the last few months. What do you suspect is going on? How would you confirm? How would you treat?
Benign paroxysmal positional vertigo could be caused by labyrinthitis peripherally (using dix-hallpike test) or centrally (rhombergs test) by vestibular neuronitis, pressure on CN VIII. MRI would confirm either. Normal hearing test and videonystagmography can be used as well.
Treatment for a peripheral problem would by Eply’s maneuver and centrally mondified senor interaction balance exercises.
Explain the function of the semicircular canals.
Superior canal manages balance with nodding, posterior canal manages head tilt balance, and the horizontal canal manages head rotation balance
Explain the function of the saccule.
Orientation and balance with vertical head movement
Explain the function of the utricle
Orientation and balance with horizontal head movement
“Classic Migraine”, “Red desaturation”
Arterial problem
Anterior blood supply to brain
Internal carotid artery
Posterior blood supply to brain
Vertebrobasilar system
“Idiopathic intracranial hypotension”, “CNS waste removal”
Venous system and CSF
What test would you do if IIH was suspect?
Fundoscopic exam (normal cup:disc ratio 1:2, vein:artery 2:1), MRI w/o contrast, lumbar puncture
Supplementation for myasthenia gravis
Omega 3, trisomal glutathione, tumeric, vitamin D
Supplementation for multiple sclerosis
Omega-3, trisomal glutathione, tumeric, vitamin D, magnesium threonate
Which embryological developmental region is most pertinent to chiropractors?
Ectoderm
Gives rise to digestive tract, kidneys, and lungs
Endoderm
Gives rise to circulatory system, skeletal muscle, bone, connective tissue, and genitourinary system
Mesoderm
Gives rise to the epidermis, hair, nails, cornea, brain, spinal cord, retina, nerves, adrenal medulla
Ectoderm
Notochord forms from the ________ after gastrulation is complete.
Mesoderm
What is the notochords role in formation of the neural tube?
The notochord causes the ectoderms inward folding at the neural plate, which will fuse and give rise to the autonomous neural tube.
What is the role of the notochord following the formation of the neural tube?
It will become the nucleus pulposus of the intervertebral discs.
What happens to the mesoderm following the formation of the notochord?
It will differentiate into somites, the precursors of the axial skeleton and skeletal muscles.
Region of dopamine production
Substantia nigra and ventral tegmental area
Region of serotonin production
Raphe nuclei
The forebrain gives rise to the…
Telencephalon (which gives rise to the cerebral hemispheres and olfactory lobes)
Diencephalon (which gives rise to the Thalamus and Hypothalamus)
The midbrain gives rise to the…
Mesencephalon (which gives rise to the midbrain)
The hindbrain gives rise to the…
Metencephalon (which gives rise to the pons and cerebellum)
Myelencephalon (which gives rise to the Medulla)
Which glial cells support the CNS? What is the function of each?
Astrocyte - maintain extracellular environment, remove excess neurotransmitters, direct neural growth, induce blood-brain barrier
Oligodendrocyte - creates myelin
Microglia - immune surveillance and phagocytosis
Ependymal cell - create and circulate cerebrospinal fluid (CSF)
Which glial cells support the PNS? What is the function of each?
Satellite cell - maintain extracellular environment, remove excess neurotransmitters, direct neural growth
Schwann cell - create myelin
Connects the two brain hemispheres…
Corpus callosum
Region that give conscious awareness…
Cerebral cortex
Brodmann area 4 is associated with what region of the brain?
Primary motor cortex
Brodmann area 6 is associated with what region of the brain?
Premotor cortex
Brodmann area 8 is associated with what region of the brain?
Frontal eye fields
Brodmann area 45-49 is associated with what region of the brain?
Dorsolateral prefrontal cortex and orbitofrontal cortex
Brodmann areas 24 and 32 are associated with what region of the brain?
Cingulate cortex
Brodmann’s area 44 is associated with what region of the brain?
Broca’s area
Broadmann’s area 1, 2, & 3 are assocaited with what region of the brain?
Primary somatosensory cortex
Brodmann’s areas 19, 37, 39, and 40 are associated with what region of the brain?
Parieto-insular vestibular cortex
Brodmann’s area 41 is associated with what region of the brain?
Primary auditory cortex
Brodmann’s areas 28, 34, 35, 35, and 38 are associated with what region of the brain?
Primary olfactory cortex and limbic association cortex
Brodmann’s areas 17, 18, 19 are associated with what region of the brain?
Primary and secondary visual cortex
CN I
Olfactory nerve - sense of smell
CN II
Optic nerve - sense of sight
CN III
Oculomotor nerve
Motor control of extra-ocular muscles superior, inferior, and medial rectus
Parasympathetic to sphincter pupillae and ciliary muscles
CN IV
Trochlear nerve - motor control of superior oblique muscle
CN V
Trigeminal nerve
V1 - ophthalmic (sensory)
V2 - maxillary (sensory)
V3 - mandibular (sensory and motor - muscles of mastication)
CN VI
Abducens nerve - motor control to lateral rectus muscle
CN VII
Facia nerve
Sense of taste for anterior 2/3rds of tongue
Motor to the muscles of facial expression
Parasympathetic to lacrimal, nasal, palatine, submandibular, and sublingual glands
CN VIII
Vestibulocochlear nerve - balance and hearing control
CN IX
Glossopharyngeal nerve
Sense of taste for posterior 1/3rds of tongue
Sensory to nasopharynx, oropharynx and to the adenoid, palatine tonsil, auditory tube, and middle ear
Parasympathetic to parotid salivary gland
CN X
Sensory to laryngopharynx and larynx
Motor to muscles of soft palate, pharynx and larynx
Parasympathetic to chest organs and to GI tract and associated organs from oesophagus to mid-transverse colon
CN XI
Spinal accessory nerve - motor to SCM and upper trapezius
CN XII
Hypoglossal nerve - motor to muscles of the tongue
Describe a trochlear nerve palsy manifested
Head tilt away from affected eye to correct extorsion
Chin tuck corrected with looking up to correct hypertropia
Motor system of the reticular formation that controls locomotion and posture
Reticulospinal
Motor system of the reticular formation that controls postural response to vestibular input
Vestibulospinal
Motor system of the reticular formation that controls head and eye movements
Tectospinal
Motor system of the reticular formation that controls postural and voluntary control of flexor muscles
Rubrospinal
Part of the vestibulospinal tract that supports head and neck position…
Medial vestibulospinal tract
Sensory system that controls proprioception, vibration, fine touch, discriminative touch
Posterior column-medial lemniscal tract
