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Nervous 2 Flashcards

1
Q

What are the meninges

A

The membranes that surround the brain and spinal cord

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2
Q

What are the three layers of the meninges

A
  1. Dura mater - tough outer for protection & support, attaching to cranium & periosteum & sacrum
  2. Arachnoid mater - collagen & elastic fibres, subdural space filled with interstitial fluid
  3. Pia mater - very thin layer containing blood vessels
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3
Q

What are the bridging veins of the skull

A

Layers of the dura mater of the meninges that creates venous sinuses aka repetitive ‘bridging’ appearance

Allows blood to drain out of the brain into the jugular veins

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4
Q

Where is cerebrospinal fluid found

A

Between the pia mater & arachnoid mater is the sub-arachnoid space is filled with the fluid
Ventricles of the brain & central canal of the spinal cord

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5
Q

What is a subdural haematoma

A

Venous bleed (from venous sinuses damage) - Slowly developing as low pressure system

More likely in alzheimers as shrinkage creates tension

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6
Q

What is a subarachnoid haemorrhage

A

Arterial bleed - rapid onset
“thunderclap headache”

Usually berry anuerysm associated

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7
Q

What is CSF

A

Made from filtered blood & mostly water with ions & glucose (colourless as blood cells are too large to filter through)

Ependymal cells produce at a rate of 500ml/day - brain can only contain about 150ml

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8
Q

Functions of CSF

A
  • supports & protects acting as a shock absorber
  • maintains uniform pressure around the brain
  • moistens
  • circulates nutrients (oxygen, glucose, ions) & wastes
  • optimal chemical environment for nerve signalling ie ions
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9
Q

What are the choroid plexi

A

A cluster of ependymal cells & network of capillaries found in the walls of ventricles
Produce csf & introduce via capillaries nutrients needed

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10
Q

What 2 arteries deliver blood to the brain

A

Vertebral & carotid

Brain uses 20% of bodys oxygen & glucose at rest - neurons die within minutes of being deprived of oxygen

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11
Q

What is the blood brain barrier

A

Protects the brain from toxins, harmful substances & bacteria that enter the bloodstream by Astrocytes maintaining tightness of the capillaries & junctions between cells

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12
Q

What substances can travel through the BBB

A
  • lipid soluble substances cross easily eg alcohol, anaesthetics
  • water soluble, usually just water which hydrates csf
  • glucose crosses by active transport
  • gases diffuse easily eg O2 CO2
  • ions diffuse slowly across
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13
Q

What cant travel through the BBB

A

Larger molecules
Blood cells, proteins, certain drugs

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14
Q

What are the 4 main regions of the brain

A
  1. Brainstem - divided into medulla oblongatta, pons & midbrain
  2. Diancephalon - thalamus, hypothalamus & epithalamus
  3. Cerebrum - sensory, motor outputs
  4. Cerebellum ‘little brain’
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15
Q

What is the foramen magnum

A

Hole that enters cranium, separates spinal cord (a continuation of) into the brainstem

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16
Q

Functions of the medulla oblongata

A

~ Contains respiratory & cardiac centres (regulating heartbeat & breathing)
~ Controls reflexes such as vomiting, sneezing & hicupping
~ contains four cranial nerves (9-12)
~ contains motor tracts (corticospinal)

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17
Q

What is the name of the motor tract found in the brainstem

A

Corticospinal tract - leading down out of brain

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18
Q

Functions of the pons

A

Helps control breathing
Four pairs of cranial nerves (5-8)
Relays motor tracts

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19
Q

Functions of the midbrain of the brainstem

A
  • contains the substantia nigra (contains neuromelanin which causes pigmentation) dopamine releaisng neuronz that help control subconscious muscle activities
  • eye reflexes & tracking
  • 2 cranial nerves (3&4) ^
  • auditory tracts
  • movement of head & neck
  • transfers motor tracts
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20
Q

Functions of thalamus

A

Core of the brain making up 80% of the diencephalon
‘Major relay centre’ to the cerebrum
Integrate sensory & motor info

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21
Q

Functions of the epithalamus

A

Contains pineal gland which secretes melatonin
Connects limbic system to other parts of the hrain

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22
Q

Functions of the hypothalamus

A

Hormone regulation & homeostasis
Receives sensory info (ie viscera & smell)
Controls the ANS
Controls body temp
Regulates emotional & behavioural patterns (limbic) , eating & drinking & regulation of circadian rhythms

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23
Q

Functions of the cerebellum

A

Proprioception
Maintains posture & balance
Coordinates Skilled movements
Correction of errors during movement eg learning bike/instrument
Also thought role in cognition & language
Alters motor behaviour by altering circuits eg muscles

1/2 brains total neuron content - 50 billion

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24
Q

What can impact/damage cerebellum

A

Alcohol
Coeliac disease
Thiamine (vitamin B1) deficiency

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25
What is ataxia
Imbalance - lack of muscle coordination Stumbling, unsteadiness, slurred speech, intention tremor (hand tremor) Common signs of cerebellar disease
26
Functions of the cerebrum
Sensory perception Motor control of skeletal muscles Contains grey matter & white matter Two hemispheres - left & right
27
What connects the left & right hemispheres of the cerebrum
The corpus callosum
28
What is the corticospinal tract
Motor neuron axons join and the tracts cross over ‘decussates’ in the medulla oblongatta Hemispheres control opposite sides of the body
29
Frontal lobe fx
Motor skills Motor cortex
30
Temporal lobe fx
Hearing
31
Parietal lobe fx
Sensory cortex
32
Occipital lobe fx
Vision Optical nerve has to travel all way to back of brain hence used for observing brain function, if something is damaged
33
What is the limbic system
Formed of interconnected structures including parts of the cerebrum, diancephalon & midbrain + hypothalamus, hippocampus & amygdala Becomes active when dealing with emotional responses to our environments
34
How much cardiac output does the brain receive
20% of body’s cardiac output (around 750ml a minute) The brain has a very limited ability to store oxygen or glucose, therefore a constant supply is necessary Thus cardiovasc health important for brain health
35
What is the circle of willis
Where the two arterial systems (2 carotid from front & 2 vertebral from back) that supply the brain meet A common location for aneurysms to develop “berry” = subarachnoid haemorrhage
36
First sensory cranial nerves
1 olfactory - unmyelinated 2 optic
37
cranial nerves involved in eyes
2 optic - sensory (densely myelinated) 3 oculomotor - 4 out of 6 eye muscles 4 trochlear, rotates eyes 6 abducens, abducts eyeball
38
Trigeminal nerve fx
Facial sensations- mastication 3 branches Opthalmic = over eyes Maxillary = across cheeks & nose Mandibular = around jaw
39
Vestibulocochlear cranial nerve fx
Hearing & balance in ears
40
Glossopharyngeal nerve fx
Taste, swallowing, tongue sensation
41
Vagus nerve fx
“Wandering nerve” extensive length, largest nerve ALL Sensory INFO in chest & abdomen (heart, GI, lungs) In the Parasympathetic ns Lowers blood pressure, heart rate Increase digestive motility
42
Accessory nerve fx
Sternocleidomastoid & trapezius movement
43
Hypoglossal nerve fx
Tongue movement & speech (underneath)
44
Damage to any optic nerves can cause
Strabismus (one eye crossed) Ptosis (drooping of upper eyelid) Diplopia (double vision)
45
Injury to vagus nerve can cause
Tachycardia, dysphagia Vaso-vagal (fainting) - syncope = hyperstimulated nerve drops blood pressure
46
What area does the spinal cord begin
Foramen magnum
47
What is the cauda equina
Consists of spinal nerves that continue beyond the conus where the cord terminates (at L2)
48
Which spinal tracts involve motor impulses
Descending tracts, sent out via anterior VENTRAL horn Involves voluntary & involuntary movement Coordination, posture, balance
49
What spinal tracts involve sensory info
Transmit impulses from skin, tendons, muscles & joints Touch, vibration, proprioception Received via posterior DORSAL horn
50
What are the two sensory ascending spinal tracts
Both ascending 1. Dorsal columns = light touch, vibration, proprioception 2. Spinothalamic tract = pain & temperature
51
What is the corricospinal tract
One motor tract of brain, descending Involved with voluntary movements
52
What is a reflex arc
A fast, automatic, unplanned sequence of actiond that occurs in response to a stimulus
53
What are vertebral foramina
Holes in the vertebra where spinal nerves exit the vertebral column
54
What is hydrocephalus
Excess csf causing brain swelling - raised intracranial pressure
55
What is meningitis
Meningeal inflammation causing brain swelling & raised pressure
56
What is encephalitis
Inflammation of brain tissue causing brain swelling & raised pressure
57
What is papiloedema
Bulging of the optic disc - seen only with opthalmoscopy - sign of raised intracranial pressure
58
Key sign of raised intracranial pressure
Vomiting often without nausea prior Due to medulla being pushed into foramen magnum
59
Most common causes of meningitis
Viral (90%) eg herpes simplex Bacterial Immuno-compromised eg elderly, HIV Brain tumour (Typically lasts 4-72hrs)
60
Photophobia
Strong sensitivity to light Strong sign of meningitis alongside other symptoms
61
Petechiae, non-blanching
Small purple/red spots on the skin as a result of tiny haemorrhages Non-blanching = not disappearing with a finger/glass Key sign of bacterial meningitis
62
What is kernigs sign
Pain & resistance to knee extension when laying with hips fully flexed Sign of meningitis
63
What is brudzinskis sign
Neck flexion upon lying causes flexion of hip & knee Sign of meningitis
64
What are antipyretics
Lowers body temp Used for meningitis
65
What is a cerebral contusion
Bruise Traumatic brain injury causing bruising of the brain with ruptured vessels & oedema
66
What is a coup
Injury to the site of impact of head
67
What is a contracoup
Damage to the brain at a site contra-lateral to the site of trauma The skull acts to stop acceleration of the brain away from the site of impact, causing damage on opposite side
68
What can an absent knee jerk/ankle jerk indicate
Either normal or peripheral nerve damage/compression/sciatica Disc herniation Hypothyroidism
69
What is babinskis sign
A cutaneous reflex where sole of the foot is stroked upwards If toes fan out this is positive & indicates corticospinal tract damage such as MS or Motor Neuron Disease (Normal reaction in infants up to 2yrs)
70
What is a cervicogenic headache
Originates from the neck, pain radiates from the back of the head
71
What is a TMJ headache
Tempera-mandibular joint headache Stress-related ie cleched jaw Grinding teeth can indicate parasitic infection
72
What is a cluster headache
Extremely painful caused by facial pain of trigeminal nerve Aka suicide headache
73
Headache red flags
— Uncharacteristic & first onset over 50 yrs — “Thunderclap” headache — Non-blanching rash, positive kernig/brudzinski sign = meningitis — worsening morning headache, uneven pupils, double/tunnel vision, papilloedema, vomiting with no nausea = raised intracranial pressure
74
What is epilepsy
Sudden, hyper-excitable & uncontrolled neuronal activity in the brain Symptom of a disease, most commonly triggered by hypoglycaemia/calcaemia
75
Petit mal epilepsy
Non-convulsive Lasts 10-30 secs “day dreaming child at school”
76
Grand mal epilepsy
Convulsive ‘tonic clonic’ Tonic = contraction of all muscles which can cause fall Clonic = rapid contraction & relaxation of muscles causing convulsions
77
What is spina bifida ‘Occulta’ / ‘cystica’
Embryological disease, usually b12 deficient Incomplete closure of the spinal column around the spinal cord, most common at lumbosacral junction Either ‘occulta’ = overlying skin intact ‘Cystica’ = visible cystic mass
78
What is the straight leg test indicative of
Sciatic/herniated disc Pain felt up to 45 degrees of raising someones leg whilst lying down
79
What is aspartame
An artificial sweetener that is a documented neurotoxic Can cause weight gain instead of loss Linked to widespread neurological damage & variety of symptoms/conditions including MS, Parkinsons, balance problems etc
80
What neurological examinations can assess function
— signs eg tremor, rigidity — motor testing — cranial nerve exam — dorsal columns test: light touch, vibration, proprioception/balance — spinothalamic tract: pin prick, temperature — gait analysis (walking) & rombergs (proprioception) — cutaneous & deep tendon reflexes
81
What is rombergs test
Assesses proprioception Stand feet together (indicates good cerebellar function if possible) Upon closing eyes if patient sways indicates positive sign = damage of dorsal columns in spinal cord (often b12 deficient)

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