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neuro Flashcards

1
Q

Cranial Nerves

A
  1. Olfactory
  2. Optic- sight
  3. Oculomotor - SR,IR,MR,IO, pupillary constriction, accomodation, eyelid opening
  4. Trochlear- SO (lesion = upward drift)
  5. Trigem- mm of mastication (masseter, temporalis, medial + lateral pterygoid); facial sensation (opthalmic, maxillary, mandibular); somatosensation ant 2/3 tongue
  6. Abducens: Lateral rectus (lateral eye mvmt)
  7. Facial: Temporal, Zygomatic, Buccal, Mandibular, Cervical – facial mvmt, taste ant 2/3 tongue, lacrimation, salivation (submand and sublingual glands), eyelid close, stapedius ear mm (courses through parotid gland)
  8. Vestibulocochlear: hearing, balance
  9. Glossopharyngeal: taste and somatosensation post 1/3 tongue, swallowing, salivation (parotid), carotid bodychemo and baro-receptors, stylopharyngeus (elevates pharynx, larynx)
  10. Vagus: taste from epiglottic region, swallowing, soft palate elevation, midline uvula, talking, coughing, aortic arch chemo and baroreceptors
  11. Accessory: head turning, shoulder shrugging (SCM, trapezius)
  12. Hypoglossal: tongue movement

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2
Q

CN nuclei

A
  • midbrain: III, IV
  • pons: V-VIII
  • Medulla: IX, X, XII
  • spinal cord: XI
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3
Q

vagal nuclei

A
  • nucleus Solitarius: visceral Sensory info (baroreceptors, gut distension, taste) — IX, X, VII
  • nuclues aMbiguus: Motor innervation of pharynx, larynx, upper esophagus — X,XI, XII
  • dorsal motor nucleus: autonomic (PS) fibers to heart, lungs, upper GI (think Motor = automobile = autonomic)
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4
Q

Cavernous sinus

A
  • collection of venous sinuses on either side of pituitary
  • contains CN III, IV, VI, V1 and V2, internal carotid a
  • cavernous sinus syndrome: opthalmoplegia and decreased corneal and maxillary sensation (visual acuity OK) –> furuncle on philtrum that becomes infected
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5
Q

Hypothalamus

  1. Lateral area
  2. Ventromedial area
  3. Anterior hypo (pre-optic area)
  4. Posterior hypo
  5. Suprachiasmatic nuclei
A
  1. Lateral: Hunger – destruction = anorexia (inhibited by leptin)
  2. Ventromedial area: Satiety — destruction = hyperphagia (stimulated by leptin)
  3. Anterior: parasympathetic, cooling, release GnRH
  4. Posterior: sympathetic, heating
  5. supra: circadian rhythm (retina perceives darkness –> suprachiasmatic nuclei secretes NE –> pineal gland secretes melatonin)
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6
Q

Sleep cycle

A
  • awake (eyes open): beta (highest frequency, lowest amplitude)
  • awake (eyes closed): alpha
  • N1: theta (light sleep)
  • N2: Sleep spindles and K complexes (deeper sleep, bruxism)
  • N3: delta (lowest freqency, highest amp) – deepest non-REM sleep; sleepwalking, night terrors, enuresis
  • REM sleep: beta – loss of motor tone, increase brain O2 use, variable BP and HR, dreaming, penile/clitoral tumescence
    • REM due to PPRF
    • occurs every 90 mins
  • alcohol, benzos and barbs = less REM and delta wave sleep
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7
Q

Thalamus

  1. VPL
  2. VPM
  3. LGN
  4. MGN
  5. VL
A
  1. VPL input= spinthothalamic + dorsal columns/medial lemniscus –> somatosensory cortex
  2. VPM input= trigem and gustatory pathway (face sensation and taste) –> somatosensory cortex **Make-up goes on face
  3. LGN input = CN II (vision) –> calcarine sulcus **Lateral = Light
  4. MGN input = superior olive and inferior colliculus (hearing) –> auditory cortex of temporal lobe **Medial = Music
  5. VL input= BG and cerebellum –> motor cortex
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8
Q

Limbic system

A
  • hippocampus, amygdala, fornix, mammillary bodies, cingulate gyrus
  • emotion, long-term memory, olfaction, behavior modification and ANS
  • Feeding, Fleeing, Fighting, Feeling and Fuck
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9
Q

Cerebellum

A
  • Input
    • contralateral cortex via middle cerebellar peduncle
    • ipsilateral proproceptive info via inferior cerebellar peduncle
  • Output
    • to contralateral cortex via superior cerebellar peduncle
  • lateral lesions = extremities –> lesion= fall toward injured side (ipsilateral)
  • medial lesions = truncal ataxia, nystagmus, head tilting, deficits in truncal coordination, wide-based gait (bilateral motor deficits of axial and proximal limb musculature)
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10
Q

lesion to

  1. amygdala
  2. Frontal lobe
  3. Right parietal-temporal lobe
A
  1. Kluver-Bucy syndrome: hyperorality, hypersexuality, disinhibited behavior (part of limbic system
  2. disinhibition + deficits in concentration, orientation + judgement; re-emergence of primitive reflexes possible
  3. spatial neglet syndrome (agnosia of contralateral side of world) – assuming this is your non-dominant lobe (ie: you are R-handed)
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11
Q

Lesions to

  1. Left parietal-temporal cortex
  2. Reticular activating system
  3. Mammillary bodies
A
  1. Agraphia, acalculia, finger agnosia, L-R disorientation (Gerstmann syndrome) – assuming this is your dominant lobe
  2. reduced levels of arousal (ie: coma)
  3. Wernicke-Korsakoff: confusion, opthalmogplia, ataxia, memory loss with confabulation (alcoholics have thiamine deficiency)
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12
Q

Lesions to

  1. Cerebellar Hemisphere
  2. Cerebellar Vermis
  3. Subthalamic nucleus
A
  1. intention tremor, limb ataxia, loss of balance – ipsilateral deficits (fall towards side of lesion)
  2. truncal ataxia, dysarthria
  3. contralateral hemiballismus
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13
Q

Lesion to

  1. Hippocampus
  2. PPRF
  3. Frontal eye fields
  4. Superior Colliculi
A
  1. anterograde amnesia (can’t make new memories)
  2. eyes look AWAY from side of lesion
  3. eyes look TOWARDS lesion (you are looking directly at it)
  4. paralysis of upward gaze (Parinaud syndrome)
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14
Q

Broca and Wernicke aphasia

A
  • Broca: nonfluent aphasia with intact comprehension (can’t move your Boca) – inferior frontal gyrus of frontal lobe
  • Wernicke: fluent aphasia with impaired comprehension — superior temporal gyrus of temporal lobe
  • Non-dominant Broca aphasia: expressive dysprosity (can’t express)
  • Non-dominant Wernicke aphasia: receptive dysprosity (can’t comprehend)
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15
Q
  1. MCA
  2. ACA
  3. Lenticulostriate
A
  1. MCA- face + upper limb (motor and sensory cortex) temporal lobe (Wenicke) and frontal lobe (Broca)
  2. ACA- lower limb (motor and sensory cortex)
  3. Lenticulostriate: striatum, internal capsule – lesion= contralateral hemiparesis/hemiplegia of whole side
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16
Q
  1. ASA
  2. PICA
  3. AICA
A
  1. Medial medulla: Lateral corticospinal tract (contralateral hemiparesis of U and L limb) + medial lemniscus (decreased contralateral proprioception)
  2. Lateral medulla (Wallenberg syndrome) – nucleus ambiguus (dysphagia, hoarseness), loss of pain and temp from ipsilateral face and contralateral body (trigeminothalamic and spinothalamic tract), ipsilateral Horner (sympa fibers), vomiting + vertigo (vestibular nuclei), ataxia + dysmetria (inferior cerebellar peduncle)–
    1. “Dont pick a (PICA) horse (hoarseness) that cant eat (dysphagia) or feel pain”
    2. no mm weakness!
  3. Lateral pons: facial nucleus (paralysis of face) – “facial droop means AICA’s pooped”; ipsilateral Horner’s; ataxia + dysmetria (middle and inferior cerebellar peduncles)
    1. differs from Lateral medullary syndrome by facial paralysis
17
Q
  1. PCA
  2. Basilar artery
  3. ACom
  4. PCom
A
  1. occipital cortex, visual cortex (contralateral hemianopia with macular sparing)
  2. central pons + medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular CN nuclei, PPRF (“Locked-in syndrome”)
    • 4 = berry aneurysm
18
Q

Brown-Sequard Syndrome

A
  • hemisection of SC
  • ipsilataral UMN signs below level of lesion (corticospinal tract)
  • ipsilateral LMN signs at level of lesion
  • ipsilateral loss of tactile, vibration and proprioception below level of lesion (dorsal column)
  • contralateral pain and temp loss below level of lesion (spinothalamic tract)
19
Q

visual field defects

  1. R optic nerve
  2. R optic chiasm
  3. R tract
  4. R Meyer’s loop
  5. R dorsal optic radiation
  6. PCA infarct
  7. central scotoma
A
  1. anopia of R eye
  2. bitemporal hemianopsia (craniopharyngioma)
  3. L homonymous hemianopia
    • *once you are behind the optic chiasm everything reverses
  4. L upper quadrant anopia
    • R. temporal lobe lesion, MCA
  5. L lower quadrant anopia
    • R parietal lobe lesion, MCA
  6. L hemianopia with macular sparing
  7. macular degeneration

*note: upper quadrant visual info goes through the temporal lobe to the lingual gyrus, while lower quad info goes through the parietal lobe to the cuneus gyrus

20
Q

Medial Medullary syndrome

A
  • lesion of anterior spinal a or vertebral a
  • pyramids: contralateral spastic paresis
  • medial lemniscus: contralateral loss of tactile, vibration, proprioception
  • CN XII signs: ipsilateral flaccid paralysis of tongue with tongue deviation to side of lesion
21
Q

Lateral medullary syndrome

A
  • lesion of PICA (Wallenberg Syndrome)
  • inferior cerebellar peduncle – ipsilateral limb ataxia
  • vestibular nuclei: vertigo, N+V, nystagmus (away from side of lesion)
  • Nucleus ambiguus (CN IX,X): ipsilateral paralysis of larynx, pharynx, palate –> dysarthria, dysphagia, loss of gag reflex
  • spinal trigrem tract and spinothalamic tract: loss of pain/temp (ipsilateral=face; contralateral=body)
  • descending hypothalamics: ipsilateral Horner’s

**dont pick (PICA) a horse (hoarseness) that can’t eat (dysphagia) or feel pain (spinothalamic tract)”

22
Q

Medial Pontine syndrome

A
  • lesions to paramedian branches of basilar a
  • corticospinal tract: contralateral spastic hemiparesis
  • medial lemniscus: contralateral loss of proprioception, touch, pressure + vibration
  • CN VI signs: internal strabismus of ipsilateral eye –> diplopia on attempted lateral gaze to affected side

** same long tract signs as medial medullary syndrome but CN VI localizes it to pons

23
Q

lateral pontine syndrome

A
  • AICA (caudual pons) or SCA (rostral pons)
  • facial nucleus: ipsilateral facial paralysis; ipsilateral loss of taste (ant 2/3 tongue), lacrimation, salivation and corneal reflex
  • CN V (rostral pons): complete anesthesia if ipsilatera face, loss of mm of mastication
  • spinal trigem and spinothalamic tract: pain/temp loss of ipsilateral face and contralateral body
  • CN VIII: nystagmus, N+V, hearing loss
  • descending hypothalamic tract: ipsilateral Horner

**same long tracts as lateral medullary but nucleus of CN VII localizes it (rostral pons)

24
Q

Medial midbrain (Weber) syndrome

A
  • branches of PCA
  • fibers of CN III: “down and out”
  • corticospinal tract: contralateral spastic hemiparesis
  • corticobulbar tract: contralateral hemiparesis of lower face
25
Q

dorsal midbrain syndrome

A
  • Parinaud syndrome
  • pineal tumor compressing superior colliculi
  • paralysis of upward gaze (superior colliculi)
  • noncommunicating hydrocephalus (cerebral aqueduct)
26
Q

radiculopathy

  1. L2/L3
  2. L4
A
  1. L2/L3 motor = iliopsoas (hip flexion)
    • sensory= below groin - above knee
  2. L4 motor= vastus medialis and lateralis (quads = knee extension)
    1. sensory = over knee and medial side of leg and foot but sparing great toe
27
Q

radiculopathy

  1. L5
  2. S1
A
  1. L5 motor = gluteus mm (hip abduction), tibialis anterior (dorsiflexion and inversion)
    • sensory= shin area + dorsum of foot (including great toe)
  2. S1 motor = weakness of gastrocnemius or hamstrings (semitendonosus, semimembranosus and biceps femoris)
    • sensory= down back of leg, last 2 toes (top and bottom)
28
Q

radiculopathy

  1. C5 root
  2. C6 root
A
  • C5 motor= deltoid (arm abduction); sensory = area of deltoid
  • C6 motor = biceps (forearm flexion); sensory medial aspect of arm and thumb
29
Q

Radiculopathy

  1. C7 root
  2. C8 root
A
  • C7 motor= triceps; sensory down the back of the arm in the middle + middle finger
  • C8 motor= hand mm; sensory = lateral aspect of arm and last 2 fingers (extends above the wrist- as opposed to ulnar nerve which doesnt extend past wrist)

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