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BOARD PREP > Nervous System Structures > Flashcards

Nervous System Structures Flashcards

1
Q

The frontal eye field is located in what Brodman area?
What is its function?
Symptom of a lesion in this area?

A

area 8
conjugate eye movement to the opposite side (tracking objects, reading)
lesion: both eyes will deviate to the side of the lesion

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2
Q

People with Broca’s aphasia frequently also have damage to what structures?

A

muscles of the face and the arms

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3
Q

Where is Broca’s area located?
Wernicke’s area?

A

Broca: left frontal
Wernicke: left temporal

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4
Q

What defect occurs with damage to the right parietal lobe?

A

spatial neglect

  • contralateral (left) agnosia
  • can’t perceive object in part of space despite normal vision & somatic sensation

right sided spatial neglect is rare

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5
Q

Visual defects caused by parietal lesions?

A

optic radiations

quadrantic anopia (pie in the floor)

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6
Q

What type of hearing deficit is caused by a lesion to the primary auditory cortex?

Where is the primary auditory cortex?

A

“cortical” deafness

temporal lobe

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7
Q

What are the major structures located in the temporal lobe?

A
  • primary auditory cortex
  • Wernicke’s area
  • Olfactory bulb
  • Meyer’s loop
  • Hippocampus
  • Amygdala
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8
Q

What is psychomotor epilepsy?

Frequently associated with epilepsy occuring where?

A

sights, sounds & smells that aren’t there

temporal lobe epilepsy - can result from irritation of the olfactory bulb

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9
Q

What type of visual field defect is caused by a lesion in Meyer’s loop of the temporal lobe?

This could result from a stroke of what artery?

A

“pie in the sky”

quadrantic anopia

MCA stroke

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10
Q

What is the cause & symptoms of Kluver-Blucy syndrome?

Rare complication of what infectious disease?

A

damage to bilateral amygdala (rare complication HSV1 encephalitis)

hyperhpagia

hyperorality

inappropriate sexual behavior

visual agnosia

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11
Q

What is the major deficit from lesions of the occipital lobe?

Cause by a strok of what artery?

A

cortical blindness

PCA stroke

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12
Q

What type of visual defect is cause by a left or right PCA stroke?

A

homonymous hemianopsia

will often spacre the macula d/t the dual blood supply of the macula (MCA & PCA)

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13
Q

What vertebral level does the spinal cord end?

What is the name of this area?

A

L1/L2

conus medullaris -> leading to cauda equina

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14
Q

What type of cell bodies are found in the posterior horn?

A

Sensory neurons - receivin info from spinothalamic tract

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15
Q

What type of cell bodies are found in the anterior horn?

A

motor neurons

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16
Q

What infomation is being carried in the lateral corticospinal tract?

A

motor information

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17
Q

What infomation is being carried in the posterior/dorsal columns?

A

proprioception & vibraion

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18
Q

What infomation is being carried in the spinothalamic tract?

A

pain, temperature & touch

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19
Q

Describe the neuronal pathway of the spinothalamic tract:

A
  • 1st neuron: spinal root to cord
  • 2nd neuron: dorsal horn to thalamus
  • 3rd neuron: VPL thalamus to cortex

crosses the spinal cord where the sensory information enters

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20
Q

Describe the neuronal pathway of the dorsal column - medial lemniscus tract:

A
  • 1st neuron: spinal root (Meissner’s & Pacinian corpuscles) to cord
  • 2nd neuron: gracilis (lower); cuneatus (upper)
  • 3rd neuron: VPL to cortex

decussates in lower medulla

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21
Q

Describe the neuronal pathway of the corticobulbar tract:

A
  • 1st neuron: cortex to anterior horn
  • 2nd neuron: anterior horn to muscle

decussates in lower medulla

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22
Q

Polio destroys what cell types?

Symptoms?

A

anterior horn (lower motor neurons)

febrile illness & 4-5 days later w/ neuro symptoms

flaccid muscle tone (legs> arms)

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23
Q

What disease is very similar to polio but is genetic rather than infectious?

Presentation? Prognosis?

A

Werdnig-Hoffman Disease

“floppy baby syndrome” & tongue fasiculations

death in few months

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24
Q

MS affects what cell types?

A

mostly cervical white matter

relapsing & remitting pattern

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25
Q

What cell types are affected in ALS?

Symptoms?

A

combo upper & lower motor neurons (lose anterior horn & corticobulbar tracts)

NO sensory symptoms

will have UMN symptoms: spasticity & exaggerated reflexes as well as LMN symptoms: wasting & fasciculations

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26
Q

Classic presentation & prognosis ALS?

Treatment?

A

40-60 dysphagia

usually fata 3-5 years (aspiration pneumonia)

Treatment: riluzole (decrease glutamate release neurons)

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27
Q

Familial cases of ALS are due to mutations in what enzyme?

A

Zinc copper superoxide dismutase deficiency

leads to increased free radical damage

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28
Q

What are the only sensory infomation that stay in tact in an ASA stroke?

A

vibration & proptioception

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29
Q

Presentation of ASA stroke?

A

spinal shock - flaccid bilateral paralysis below lesion

later: LMN damage at point of lesion, UMN damage below lesion (hyperreflexia & spasticity)

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30
Q

What is Tabes Dorsalis?

A

manifestation tertiary syphilis

demyelination posterior columns & loss of dorsal roots

lose proprioceptive ability & lose reflexes (d/t loss of DR)

pt. will also have Argyl Robertson pupils

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31
Q

What are Argyl Robertson pupils?

They are seen in what conditions?

A

very small pupils that do not react to light, but do react to accomodation

Tabes Dorsalis (tertiary syphilis)

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32
Q

What is Syringomelia? Where does it usually occur?

A

fluid-filled space in spinal column

damages spinothalamic fibers as they are crossin midline - bilateral loss of pain & temp

usulaly C8-T1 (arms/hands) - ONLY affect level of the lesion (b/c doesnt affect tracts)

Can expand to affect anterior horn (muscle weakness) & lateral horn (loss of sympathetic innervation - Horner syndrome)

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33
Q

What conditions are commonly associated with syringmyelia?

A

kyphoscoliosis

can be trauma induced (can occur years later) or congenital (Chiari malformation)

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34
Q

What is the cause & symptoms of subacute combined degeneration?

A

vitamin B12 deficiency

leads to demyelination of the posterior columns (vibration/proprioception) & loss of lateral motor columns

slowly progressive - weakness, ataxia (may not have macrocytosis)

35
Q

Describe Brown-Sequard syndrome;

A

loss of half of the spinal cord (trauma/tumor)

lose pain & temp on contralateral side

lose motor, position & vibrational sense on ipsilateral side

36
Q

How are the symptoms at the level of the lesion different in Brown-Sequard syndrome?

A

level of lesion - complete sensory loss & LMN loss

37
Q

What additional symptoms is seen in Brown-Sequard syndrome if the lesion is above T1?

A

Horner syndrome (constricted pupil, eyelid droop)

38
Q

Causes & symptoms of cauda equina syndrome:

A

compression cauda equina (massive disk rupture, trauma, tumor)

severe low back pain & saddle anesthesia

loss of anocutaneous reflex w/ bladder and bowel dysfunction

normal babinski

39
Q

What symptoms are more commonly seen in conus medularis syndrome as opposed to cauda equina syndrome?

A

perianal anesthesia (bilateral)

impotence

40
Q

What information is being carried in the medial lemniscus?

A

proprioception & vibration

(connected to the posterior columns)

41
Q

The red nucleus is important for what functions?

What if there is a lesion?

Where is it located?

A

fine tuning movements

tremor & ataxia

midbrain

42
Q

What cranial nerve is located in the midbrain?

A

oculomotor nerve

43
Q

What tracts are located in the cerebral peduncle?

Results of a lesion?

Where is it located?

A

corticospinal & corticobulbar

UMN paralysis of the face & lower extremities

midbrain

44
Q

Wahat is the importantce of the medial longitudinal fasiculus?

Result of a lesion?

A

conjugate gaze

problems with lateral gaze

45
Q

At what level of the spinal cord does a stroke that causes Benedikt syndrome occur? What structures are damaged?

Symptoms?

A

midbrain

CN3, meidal lemniscus, red nucleus

contralateral loss of proprioception/vibration & involuntary movements (ataxia/tremor), ipsilateral eye will be down, out & dilated

46
Q

At what level of the spinal cord does a stroke that causes Weber syndrome occur? What structures are damaged?

Symptoms?

A

midbrain

CN3, corticospinal tract, corticobulbar tract

contralateral hemiparesis, looking down, out & with a dilated pupil, along with pseudobulbar palsy (UMN CN motor weakness, exaggeraged gag reflex, tongue spastic, spastic dysarthria)

47
Q

At what level of the spinal cord does a stroke that causes Parinaud syndrome occur? What structures are damaged?

Symptoms?

A

posterior midbrain

superior colliculus & pretectal area

vertical gaze palsy & pseudo Argyl-Robertson pupils

48
Q

What are the major causes of Parinaud syndrome?

What complications should you look out for?

A

pinealoma/germinoma of pineal region

cerebral aqueduct obstruction (non-communicating hydrocephalus, compression from pineal tumor)

49
Q

The nuclei of what cranial nerves are located in the pons?

A

CNVIII, CNVII, CNVI, CNV

50
Q

What are the 3 structures in the pons required for lateral gaze?

A

nucleus CNVI, MLF, PPRF

51
Q

What are the general features of meidal pontine syndromes?

A

lose: corticospinal tract, CNVI, CNVII

contralateral hemeparesis, can’t look to the affected side, facial weakness/droop on affected side

52
Q

What are the general features of lateral pontine syndromes?

A

lose: vestibular nuclei, spinothalamic tract, spinal CNV nucleus, CNVII nucleus, sympathetic tract, cochlear nuclei

nystabmus/vertico, loss of contralateral pain/temp, ipsilateral face pain/temp, ipsilateral facial droop & loss of corneal reflex, Horner syndrome, deafness

53
Q

Lateral pontine syndreom is classically caused by a stroke in what artery?

A

AICA

54
Q

What is the function of the nucleus soltarius & dorsal motor nucleus CNX?

Where are they located?

A

where autonomic info comes in from places like the aortic arch & carotid body

medulla

55
Q

What is the function of the nucleus ambiguous?

Where is it located?

A

shared motor nucleus of CVIX, CNX, CNXI

medullla

56
Q

What CN nuclei are located in the medulla?

A

nucleus soltarius, dorsal motor nucleus CN X, nucleus ambiguous, CNXII, spinal nucleus & tract CNV, CNVIII

57
Q

What structures are damaged in medial medullary syndrome?

symptoms?

A

corticospinal tract, medial leniscus, CNXII

contralateral hemiparesis, contralateral loss of proprioception/vibration, flaccid paralysis of tongue (deviation to side of lesion)

58
Q

A stroke of what arters is most commonly the cause of medially medullary syndrome?

A

anterior spinal artery

59
Q

What structures are damaged in lateral medullary syndrome?

What is the other name for lateral medullary syndrome?

symptoms?

A

vestibular nuclei, sympathetic tract, spinothalamic tract, spinal CNV nucleus, nucleus ambiguous

Wallenberg Syndrome

nystagmus/vertigo, horner’s syndrome, loss of contralateral pain/temp, hoarseness/dysphagia

60
Q

Stroke of what arter is most commonly associated with lateral medullary syndrome?

A

PICA

61
Q

What information does a loss of pain & temp to the face tell you about localizing a lesion?

A

CNV

localize to ipsilateral lateral

(big nucleus- not necessarily pons)

62
Q

What sign indicating damage to CNVIII nucleus help you localize to the pons?

A

hearing loss

do NOT use vestibular signs to localize to the pons

63
Q

What is the only sense in the body that does not go through the thalamus?

A

smell

64
Q

What is the pathway to the brain of the olfactory nerve?

Originates from what embryonic structure?

A

cribiform plate of the ethmoid bone

diencephalon

65
Q

What is the pathway to the brain for the optic nerve?

A

optic canal of sphenoid bone

66
Q

In addition to moving the eye, the oculomotor nerve also has what functions?

A

innervates levator palpebrae (elevates eyelid)

carries parasympathetic fibers that innervates sphincter pupillae (constricts pupil)

67
Q

How do patients with a trochlear nerve palsy compensate for the resulting double vision?

A

head will be tilting away from the affected side

(b/c trochlear nerve internally rotates eyeball)

68
Q

How does the jaw deviate in a trigeminal nerve palsy?

A

toward affected side

69
Q

Afferent & Efferent nerves in corneal reflex?

A

afferent: trigeminal V1 (sensation)
efferent: VII (blink)

70
Q

Symptoms of a VII palsy?

A

loss of corneal reflex (motor part)

loss of taste to anterior 2/3 tongue

hyperacusis (stapedius paralysis)

71
Q

What test do you perform on unconsious patients to determine if CNVIII is working?

Describe the test

A

Dolls eye test

head rotates from side-to-side with eyelids held open

“positive” - eyes stay fixed & do not turn with head (both CNVIII are working)

“negative” - eyes move with head - indicates lesion

Inject cold water

b/c cold water disrupts CNVIII function

if working- eye will turn slowly toward ear with cold water & then quickly away

if CNVIII not working - no slow toward

if cortex is not workign - slow toward but no fast away

72
Q

Symptoms of a CNIX palsy?

A

loss of gag reflex

loss of taste on posterior 1/3 tongue

loss of sensation upper pharynx/tonsils

b/c innervates carotid bodies - tricks body into thinking low BP, so you will see increased HR, vasoconstriction & increased BP

73
Q

Symptoms of a vagus nerve palsy?

A

hoarseness, dysphagia, dysarthria

loss of gag reflex

loss of sensation pharynx & larynx

weak side of palate collapses (uvula deviates away from affected side)

d/t unopposed sympathetic stimulation of heart - increased HR

74
Q

What cranial nerves are being tested with the following sounds? This is due to what associated function?

“kuh kuh kuh”

“mi mi mi”

“la la la”

A

“kuh kuh kuh”: CN X, raise palate

“mi mi mi”: CN VII, move lips

“la la la”: CNXII, move tongue

75
Q

The recurrent laryngeal nerve ascends toward larynx through what structures?

The L & R branches loop around what structures respectively?

These nerves are classically compressed in what conditions?

A

btw trachea & esophagus (tracheoesophageal groove)

L: aortic arch

R: right subclavian

dilated left atrium (mitral stenosis)

aortic dissection

76
Q

If you cut V1, can you still produce tears?

A

yes - you can produce emotional tears (b/c CNVII is still in tact)

but you cannot produce reflexive tears

77
Q

afferent & efferent nerves in gag reflex?

A

afferent: CN IX
efferent: CN X

78
Q

What is the “jaw jerk” reflex & which nerves are involved?

A

place finger on patient chin & tap finger - jaw will jerk upward

V3 sense & V3 jerk

79
Q

afferent & efferent nerves involved in pupillary light reflex?

A

afferent: CNII
efferent: CNIII

80
Q

What is the only tongue muscle not innervated by CNXII?

It is innervated by what muscle?

A

palatoglossus

CNX

81
Q

What nerves provide sensation & taste to the tongue?

A
  • sensation
    • ant 2/3: V3 (mandubular)
    • post 1/3: CNIX (glossopharyngeal)
    • tongue root: CNX (vagus)
  • taste
    • ant 2/3: CNVII (facial)
    • post 1/3: CNIX (glossophayngeal)
    • tongue root, larynx & upper esophagus: CNX
82
Q

What cranial nerves exit via the middle cranial fossa?

Provide their specific exit points as well.

A
  • CNII: optic canal
  • CNIII, IV, V1, VI: superior orbital fossa
  • V2: foramen rotundum
  • V3: foramen ovale
83
Q

What cranial nerves exit via the posterior cranial fossa?

Provide their specific exit points as well.

A
  • CNVII, VIII: internal auditory meatus
  • IX, X, XI: jugular foramen
  • XI & brainstem: foramen magnum
  • XII: hypoglossal canal

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