NE Stephen's High Yield Exam 2 Deck

Question 1

What lobe is responsible for Emotion, motivation, personality, initiative?

Answer 1

Frontal lobe

Question 2

What cortex for tactile and proprioception information?

Answer 2

Primary somatosensory cortex

Question 3

What lobe is responsible for processing complex aspects of learning, memory and emotion?

Answer 3

Limbic lobe

Includes Cingulate gyrus & Parahippocampal gyrus

Question 4

What lobe is responsible for taste processing?

Answer 4

Insular Lobe

Question 5

What are the three ascending tracts in the SC and what information do they relay?

Answer 5

o Posterior columns
▪ Convey ipsilateral proprioceptive, tactile and vibratory information from the body (not the face) (ipsi before decussating in medulla

o Spinocerebellar tracts
▪ Information relays to cerebellum, thalamus, and motor cortex to influence efficiency of motor activity

o Anterolateral System
▪ Relays pain and temperature and non-discriminative touch from the body (not the face)

Question 6

What are the three descending tracts in the SC and what actions do they elicit?

Answer 6

o Corticospinal tract
▪ Controls voluntary, fine movements of the musculature

o Vestibulospinal tract
▪ Influence motor neurons innervating primarily axial and neck musculature

o Rubrospinal fibers
▪ Excite flexor motor neurons and inhibit extensor motor neurons

Question 7

Blood plasma vs. CSF concentrations of ions and substances

Answer 7

Equal concentrations: Na+ and HCO3

CSF higher: Mg2+, Cl-, and CO2

CSF lower: K+, Ca2+, protein, and glucose

Question 8

Flow of CSF

Answer 8

o Lateral ventricles🡪 interventricular foramen🡪 third ventricle🡪 cerebral aqueduct🡪 fourth ventricle🡪 Cisterna magna(median aperture) and Subarachnoid space (lateral aperture)
o Ends w/ absorption by arachnoid granulations/arachnoid villi (bulk flow & pinocytosis)

Question 9

What are the circumventricular organs?

Answer 9

Posterior pituitary aka Neurohypophysis (neural tissue)
Releases hormones into blood

Area Postrema (Close to surface of medulla)
Vomiting 

OVLT/Subfornical organ
Control of the body water/thirst/blood volume control. Need access to blood to detect osmolarity levels.

Question 10

Lateral Spinothalamic Tract (LSTT)

Spinothalamic = ALS

Answer 10

Contralateral pain/temp 2 sensory dermatomes below lesion

Question 11

Lateral Corticospinal Tract (LCST)

Answer 11

Contralateral Spastic paralysis Dorsal root (DR)
- because it is BEFORE the decussation (at inferior medulla- pyramids). CST lesion would be ipsilateral if it was AFTER the decussation.

also hyperreflexia, hypertonia, Babinski sign, clonus, and disuse atrophy.

Question 12

Fasc. Gracilis

Answer 12

Ipsilateral Proprioception/2-pt lower limb

Question 13

Fasc. Cuneatus

Answer 13

Ipsilateral Proprioception/2-pt upper limb

Question 14

Anterior White Commissure (AWC)

Answer 14

Bilateral Pain/temp anesthesia

(in shoulders/upper limb - may be part of syringomyelia)

Destruction of the anterior white commissure results in a bilateral loss of pain
and temperature sensations to the upper extremities (“yoke-like” anesthesia).

Question 15

Anterior Horn (AH)

Answer 15

Ipsilateral LMN paralysis

LMN paralysis results from the destruction of the lower motor neurons or the axons of one or more of the cranial or spinal motor nuclei. LMN paralysis is characterized by flaccid paralysis, areflexia. atonia, atrophy and fasciculations

Question 16

ALS

Answer 16

LMN and UMN paralysis

Question 17

Corticospinal Tract Lesion above decussation

Answer 17

Contralateral Spastic Hemiplegia

Note: Corticospinal tract are UMN. Lesions also lead to hyperreflexia, hypertonia, paralysis & disuse atrophy.

The CST conveys descending motor information from the motor cortex. In the midbrain the CST comprises the middle 3/5’s of the crus cerebri. In the pons it is split into numerous fascicles by the pontine nuclei and pontocerebellar fibers. In the medulla, the CST forms the pyramids which partially decussate in the lower medulla. A unilateral lesion of the corticospinal tract is classically described as a contralateral spastic hemiplegia.

Question 18

Medial Lemniscus

Answer 18

Contralateral Proprioceptive/2-pt tactile Hemianesthesia

The ML conveys proprioceptive, vibratory, and two-point tactile discriminative information from the opposite 1⁄2 of the body. At the level of the upper pons and midbrain the ML also contains fibers that convey taste information from the ipsilateral 1⁄2 of the tongue and pharynx.

Question 19

Spinal Lemniscus

Answer 19

Contralateral Hemianalgesia (pain) & Hemianesthesia (sensory) (ONE SIDE OF BODY)

The SL conveys pain and temperature information from the opposite 1⁄2 of the body.
It is either lateral or posterolateral to the medial lemniscus.

Question 20

Descending Tract of V

Answer 20

Ipsilateral Hemianalgesia : (FACE)

Alternating hemianalgesia
- Alternating hemianalgesia is due to a lesion of the descending tract of V and the spinal lemniscus. This pattern is part of CPA and Wallenberg syndromes, which are discussed in NE2.

Note: a lesion of V would result in
complete anesthesia (FACE) and paralysis of the muscles of mastications.

The descending tract of V (trigeminal) conveys ipsilateral pain and temperature information from the face. It is located in the postero-lateral area of the medulla. The descending tract of V and the underlying descending nucleus of V are adjacent to the spinal lemniscus, which is slightly deeper. The descending tract and nucleus form the topographical structure called the trigeminal eminence. The fibers (primary axons) course just beneath the surface of the medulla and may be surgically cut for treatment of trigeminal neuralgia. The tract may be involved in Wallenberg and CPA syndromes

Question 21

Vestibular nuclei

Answer 21

Ipsilateral Vestibular signs (nystagmus, vertigo, nausea, etc.)

Question 22

Inferior cerebellar peduncle

Answer 22

Ipsilateral Cerebellar signs (+ Romberg, ataxia, dysmetria, etc.)

Question 23

Tract NOT involved in spinal cord lesions?

Answer 23

Corticospinal tract (located above the pyramidal decussation). Forms:

Lateral corticospinal tract, which would be involved before it is in Spinal cord

Question 24

Ventral Roots

Answer 24

Cause a LMN paralysis of associated motor dermatome: atonia, areflexia, fasciculation, and flaccid paralysis.

Question 25

Corticobulbar Tract *used for rehab post neurologic event (ex. stroke) go to somatic motor, not parasympathetic. so nerves like IV, VI

Answer 25

Supranuclear Facial Palsy - any lesion above CN V - needs to be intact for pt to listen and do the CN test. Pt needs to be attentive (tells go ahead and do action) 1. Corticobulbar fibers originate in the head region of precentral gyrus, 2. Course through the *genu* of the internal capsule and cerebral peduncles as *uncrossed CBT* • Unilateral lesions of uncrossed CBT result in contralateral supranuclear facial palsy 3. Decussate in lower pons (between V and VI) and descend in the lower brainstem as *crossed CBT* • Unilateral lesions below the decussation may result in some ipsilateral cranial nerve palsies. a. Unilateral lesions of the corticobulbar fibers result in denervation of the brainstem motor nuclei below the level of the lesion. Some motor nuclei such as part of the facial motor nucleus receive fibers from both hemispheres and, therefore, are not affected by unilateral lesions of the head region of the motor cortex or CBT. b. Unilateral lesions of the CBT above the level of the decussation results in a contralateral paralysis or paresis of the mimetic muscles of the lower half of the face (supranuclear facial palsy) as well as other cranial palsies due to denervation of the abducens nucleus, hypoglossal nucleus and the nucleus ambiguus. Lesions below the decussation result in ipsilateral cranial nerve palsies.

Question 26

Lateral Lemniscus

Answer 26

Unilateral lesions of the lateral lemniscus, inferior colliculus, brachium of the inferior colliculus and medial geniculate body result in: Bilateral diminution of hearing with a more prominent hearing loss in the contralateral ear. The LL conveys bilateral auditory information, but predominantly information from the opposite ear. It is located in the lateral aspect of the brainstem

Question 27

Medial longitudinal fasciculus

Answer 27

Internuclear Opthalmoplegia Named for side of the non-adducting eye. Patients with this syndrome have an abnormal response to horizontal gaze in the direction opposite the side of the lesion. Unilateral lesions of the MLF result in an impairment or loss of adduction (MR) of the ipsilateral eye, and a nystagmus of the abducting eye Ex. Left INO Patient shows normal horizontal gaze to the left. However, during horizontal gaze to the right, the left eye does not adduct and the right eye shows nystagmus. MLF conveys vestibular influences from the maculae utricle and saccule, and cristae ampullaris to the cranial nerves III, IV, VI; and fibers for the oculomotor system. - Critical in aligning gaze with head position.

Question 28

Optic tract

Answer 28

Contralateral homonymous hemianopia. Unilateral lesions of the lateral geniculate body, complete optic radiations or visual cortex result in a contralateral homonymous hemianopsia. The figure shows a left homonymous hemianopia, which would indicate a lesion on right visual pathway, i.e., optic tract, lateral geniculate body or complete optic radiations.

Question 29

How to test Abducens nerve

Answer 29

Internal strabismus

Question 30

How to test & Deficit CN I

Answer 30

Specific olfactory challenges Anosmia

Question 31

How to test & Deficit CN II

Answer 31

Visual fields, light reflexes, acuity Visual fields, light reflexes, acuity

Question 32

How to test & Deficit CN IV

Answer 32

Cardinal signs of gaze. Inability to adduct & depress. Complete ptosis, External Strabismus, Pupil dilation

Question 33

How to test & Deficit CN V

Answer 33

Sensory to face. Motor of massester and temporalis mm. Anesthesia to face; paralysis of masseter & temporalis mm.

Question 34

How to test & Deficit CN VI

Answer 34

Cardinal signs of gaze. Lateral Gaze Internal strabismus

Question 35

How to test & Deficit CN VII

Answer 35

Muscles of facial expression. Bell's Palsy; inability to raise eyebrow, close eye, smile, purse lips

Question 36

How to test & Deficit CN VIII

Answer 36

Hearing and vestibular function Unilateral impaired hearing; deafness, vestibular disturbances

Question 37

How to test & Deficit CN IX

Answer 37

Oropharyngeal sensation; gag reflex Oropharyngeal sensation; diminished gag reflex (So is having sensation bad?) Gag reflex helps distinguish between sensory (IX) and motor (X).

Question 38

How to test & Deficit CN X

Answer 38

Laryngoscopy, check for impaired palatal elevation dysphonia (abnormal voice, hoarseness), dysphagia (swallowing difficulties) motor function of palate and larynx.

Question 39

How to test & Deficit CN XI

Answer 39

Shrug shoulders; flex & rotate head opposite affected m. Inability to shrug shoulder (trap) or flex and rotate head opposite affected muscle (SCM)

Question 40

How to test & Deficit XII

Answer 40

Protrude tongue (look for possibledeviation) Paralysis, fasciculations, deviation of protruded tongue to affected side.

Question 41

Subdural hematoma

Answer 41

Trauma to the head can cause intracerebral or extra-cerebral bleeding such as subdural or epidural hematomas. The *bridging veins* are involved in this case resulting in a SubDural Hematoma. Vs. epidural hematoma with middle meningeal a.

Question 42

Vestibular Schwannoma

Answer 42

o Benign tumor originating from Schwann cells of the vestibular root o Typically in cerebellopontine angle --> Impinges on structures traversing the internal acoustic meatus (CN 7,8 and labyrinthine a.) o Slow-growing, hearing loss, gait difficulties, tinnitus Examination: UPDATE FROM LAST REVIEW

Question 43

Cerebellopontine Angle (CPA) Syndrome

Answer 43

Critical identification as acoustic neuromas are common tumors of the posterior cranial fossa in adults. This mass causes CPA. Deaf, vestibular problems, bell's palsy, etc. The cerebellopontine angle syndrome is a distinct neurological syndrome of deficits that can arise due to the closeness of the cerebellopontine angle to specific cranial nerves.[1] Indications include unilateral hearing loss (85%), speech impediments, disequilibrium, tremors or other loss of motor control. The cerebellopontine angle cistern is a subarachnoid cistern formed by the cerebellopontine angle that lies between the cerebellum and the pons. It is filled with cerebrospinal fluid and is a common site for the growth of acoustic neuromas or schwannomas.

Question 44

Dorsal Roots

Answer 44

Anesthesia of corresponding sensory dermatome or diminish motor reflexes including muscle tonicity. Atonic bladder and painless retention of urine.

Question 45

External hydrocephalus

Answer 45

Gyri atrophy, enlarged sulci. Dementia. accumulation of CSF in the subarachnoid space. It may be supratentorial, infratentorial, or both.

Question 46

Communicating hydrocephalus

Answer 46

Obstruction or clog of tentorial notch. CSF getting into subarachnoid space. Communicating is when CSF still able to go out of ventricles to subarachnoid space.

Question 47

Normal Pressure Hydrocephalus

Answer 47

**Magnetic gait.** shuffling gait where feet "sticking to floor." Memory impairment (transient), frontal lobe release. Urinary incontinence. Recover after lumbar puncture.

Question 48

Lateral Reticulospinal Tract (LRST)

Answer 48

Transection of the spinal cord above S2 interrupts the lateral reticulospinal tracts to the sacral autonomic nucleus, and the patient is unable to voluntarily void his bladder, i.e., there is urinary retention. After spinal shock, the bladder reflex may return without voluntary control, and the patient will have automatic reflex voiding or a *reflex bladder.*

Question 49

Syringomyelia or Central Cord Syndrome

Answer 49

anterior white commissure. Central cord sysdrome may be caused by cavitation (syrinx) or intramedullary mass or infarct. Occlusion of the great anterior artery (Artery of Adamkiewicz), which usually originates from the left posterior intercostal artery a lumbar vertebral levels (LV9-12). Bilateral loss of pain and temp of upper extremities.

Question 50

Spinal Cord Sensory and Motor Tracts/Structures

Answer 50

``` Sensory: Dorsal Root Posterior columns Lateral spinothalamic tract AWC ``` Motor: Lateral corticospinal tract Anterior Horn Lateral reticulospinal tract

Question 51

Brain Stem Sensory and Motor Tracts/Structures

Answer 51

``` Sensory: Spinal Lemniscus Medial Lemniscus Lateral Lemniscus Descending tract of V ``` Motor: Corticospinal tract Corticobulbar tract Special Systems: Medial longitudinal fasciculus

Question 52

Trigeminal Lemniscus

Answer 52

Contralateral loss of pain/temp (Face) (Vs. a descending tract of V lesion would cause ipsilateral loss of pain/temp in face). The TL conveys pain, temperature, and crude tactile sensations from the opposite 1⁄2 of the face. It is located between the medial lemniscus and the spinal lemniscus.

Question 53

Lateral Corticospinal Tract

Answer 53

Ipsilateral spastic paralysis, hyperreflexia, hypertonia, Babinski sign, clonus, and disuse atrophy

Question 54

Central Pathway Location

Answer 54

Anterior: UMN (CST) Antero-lateral: Pain/temp (SL) Midcentral: Proprio/2pt (ML) Postero-median: Vestibular (MLF)

Question 55

* Supratentorial external hydrocephalus | * Infratentorial external hydrocephalus

Answer 55

Supratentorial is most commonly associated with senile atrophy of the cortex, e.g., Alzheimer's disease. • Infratentorial is seen in combination with communicating hydrocephalus

Question 56

Internal Hydrocephalus

Answer 56

noncommunicating hydrocephalus Caused by obstruction of" – interventricular foramen (third ventricle choroid plexus ependymoma), – cerebral aqueduct (midbrain astrocytoma) – medial and lateral foramina (Arnold Chiari malformation) Results in dilation of the ventricle(s) proximal to the obstruction. – It may be present in combination with an infratentorial external hydrocephalus (communicating hydrocephalus) May involve enlargement of ventricle(s) proximal to obstruction

Question 57

Internal Hydrocephalus

Answer 57

noncommunicating hydrocephalus

Question 58

Communicating hydrocephalus

Answer 58

Obstruction of the subarachnoid space at the level of the tentorial notch may prevent the flow of CSF from infratentorial to supratentorial regions. --> cannot be resorbed into superior sagittal sinus. Clogged. The result is hypertrophy of the ventricles (internal hydrocephalus), and an accumulation of CSF in the infratentorial subarachnoid space (external hydrocephalus).

Question 59

Secondary to a subarachnoid hemorrhage blood in the CSF may occlude the ___ and result in _____.

Answer 59

Arachnoid villi, secondary (chemical) Meningitis

Question 60

Parkinson's Disease Signs

Answer 60

``` Bradykinesia Tremor during rest Rigidity Masked face, "Reptilian Gaze" Glabellar Reflex Postural Embarrassment Autonomic effects Cognitive changes ```

Question 61

Parkinson's Disease Due to Degeneration of

Answer 61

Substantia nigra, globus pallidus, brainstem RF and postganglionic sympathetic neurons.

Question 62

Huntington's Chorea Signs

Answer 62

Onset: age 30-40 Choreiform movements Severe dementia Choreoathetosis Behavioral disturbances Choreiform Movements - jerking or writhing movements, called, or what appear to be minor problems with coordination Choreoathetosis is a movement disorder that causes involuntary twitching or writhing. It's a serious condition that can affect your posture, walking ability, and everyday movement. More severe cases can cause permanent disability.

Question 63

Huntington's Chorea Due to Degeneration of

Answer 63

Autosomal dominant disorder (chromosome 4). Degeneration of corpus striatum and cerebral cortex results in excessive dopaminergic influence in the degenerated striatum or loss of inhibition from the GABAnergic neurons of the striatonigral pathway.

Question 64

Hemiballism

Answer 64

Contralateral violent, flailing movements of the proximal musculature of both the upper and lower extremities. Unilateral lesions of the subthalamus result in a reduction or loss of glutamate inhibition upon the globus pallidus.

Question 65

Medial UMN Tracts Tectospinal

Answer 65

Neck muscles Postural movements from visual stimuli

Question 66

Medial UMN Tracts Medial reticulospinal

Answer 66

Ipsilateral LMNs to postural muscles and | limb extensors

Question 67

Medial UMN Tracts Lateral vestibulospinal

Answer 67

Ipsilateral LMNs innervating postural muscles and limb extensors

Question 68

Medial UMN Tracts Medial vestibulospinal

Answer 68

Postural muscles of the cervical and | thoracic levels

Question 69

Lateral UMN tracts Rubrospinal

Answer 69

Upper limb flexors

Question 70

Lateral UMN tracts Lateral reticulospinal

Answer 70

Facilitates flexor motor neurons and inhibits | extensor motor neurons