Neuro Flashcards
1
Q
Ectoderm differentiates into
A
neuroectoderm –> neural plate –> neural tube and neural crest cells
2
Q
Notochord becomes
A
nucleus pulposus of intervertebral disc in adults
3
Q
Alar plate
A
Dorsal
sensory
lateral nuclei
4
Q
Basal plate
A
Ventral
motor
Medial nuclei
5
Q
We begin with what three primary vesicles in embryonic development
A
Forebrain (prosencephalon) –> (telencephalon and diencephalon)
Midbrain (mesencephalon) –> Mesencephalon
Hindbrain (rhombencephalon) –> Metencephalon and myelencephalon
6
Q
The three primary vesicles become these 5 secondary vesicles. What do the 5 secondary vesicles become
A
Telencephalon (1st) Diencephalon (2nd) (rest is alphabetical order) Mesencephalon Metencephalon Myelencephalon
The 5 secondary vesicles become adult derivatives of walls and cavities
7
Q
Telencephalon becomes
A
Cerebral hemisphere and lateral ventricles
8
Q
Diencephalon becomes
A
Thalamus, hypothalamus, third ventricle
9
Q
Mesencephalon becomes
A
Midbrain and cerebral aqueduct
10
Q
Metencephalon becomes
A
Pons, cerebellum, upper part of 4th ventricle
11
Q
Myelencephalon becomes
A
Medulla and lower part of fourth ventricle
12
Q
Neural crest forms
A
PNS neurons and schwann cells
13
Q
Mesoderm forms
A
Microglia (like macrophages)
14
Q
Neural tube defects
A
Neuropores fail to fuse (4th week) and persistent connection between amniotic cavity and spinal canal
15
Q
What labs can you look at for neural tube defect detection
A
AFP elevated (except in spina bifida occulta) Increase in AChE as a confirmatory test
16
Q
Failure of caudal neuropore to close but no herniation. Usually seen at lower vertebral levels and the dura is intact. Associated with tuft of hair or skin dimple at level of bony defect
A
Spina bifida occulta
17
Q
Meninges (but no neural tissue) hernaites through bony defect and associated with spina bifida cystica
A
Meningocele
18
Q
Meninges and neural tissue herniate through bony defect
A
Meningomyelocele
19
Q
Also known as rachischisis. Exposed unfused neural tissue without skin/meningeal covering
A
Myeloschisis
20
Q
Failure of rostral neuropore to close. No forebrain, open calvarium. Can see polyhydramnios (no swalling center in brain)
A
Anencephaly
21
Q
Failure of the left and right hemispheres to separate. Moderate form shows cleft lip/palate, while more severe forms result in cyclopia. MRI can show a monoventricle and fusion of basal ganglia. What mutation and genetic defects is this related to?
A
Mutations in sonic hedgehog signaling pathway
Trisomy 13
Fetal alcohol syndrome
22
Q
Ectopia/displacement of cerebellar tonsils
A
Chiari I malformation
congenital, usually asymptomatic in childhood and manifests in adulthood with headaches and cerebellar symtoms
23
Q
Herniation of low lying cerebellar vermis and tonsils through foramen magnum with aqueductal stenosis causing hydrocephalus
A
Chiari II malformation
lumbosacral meningomyelocele is associated
24
Q
Agenesis of cerebellar vermis leads to cystic enlargement of 4th ventricle that fills the enlarged posterior fossa
A
Dandy-walker syndrome
associated with noncommunicating hydrocephalus, spina bifida
25
Cystic cavity within central canal of signal cord. Patient presents with cape like, bilateral symmetrical loss of pain and temperature sensation in upper extremities. Fine touch sensation is preserved
Syringomyelia - a cyst forms within your spinal cord. As this fluid-filled cyst, or syrinx, expands and lengthens over time, it compresses and damages part of your spinal cord from its center outward
Fibers crossing in anterior white commissure (spinothalamic tract) are typically damaged first
associated with chiari malformation
most common at C8-T1
26
CN for taste
CN VII, IX, X (solitary nucleus)
27
CN for pain in tongue
CN V3,IX, X
28
CN for Motor in tongue
CN X, CN XII
CN XII is to the hyoglossus that retracts and depresses the tongue, genioglossus which protrudes tongue, and styloglossuswhich draws tongue upward to create a trough for swallowing
CN X to the palatoglossus which elevates posterior tongue during swallowing
29
What brachial arches form the anterior 2/3 of tongue
1st and 2nd
sensation CN V3
Taste CN VII
30
What brachial arches formt he posterior 1/3 of tongue
3rd and 4th
Sensation and taste from CN IX
Extreme posterior is CN X
31
What kind of stain do you use to see the cell bodies and dendrites of neurons
Nissl stain which stains the RER
doesnt stain the axon because the axon does not have any RER
32
Injury to axon causes degeneration of axon distal to site of injury and axonal retraction proximally
Wallerian degeneration
allows for potential regeneration of axon (if in PNS)
macrophages remove debris and myelin
33
Most common glial cell type in CNS.
Astrocytes which are responsible for physical support, repair,extracellular K+ buffer, removal of excess NT, component of BBB, glycogen fuel reserve buffer
34
What are astrocytes derived from
neuroectoderm
35
Astrocyte marker
GFAP
36
Phagocytic scavenger cells of CNS that respond to tissue damage
HIV infected microglia fuse to form multiucleated giant cells in CNS
37
Glial cells with a ciliated simple columnar form that line the ventricles and central canal of spinal cord. Apical surfaces are covered in cilia (which circulate CSF) and microvilli (which help in CSF absorption)
ependymal cells
38
Function of myelin
Increase conduction velocity of signals transmitted down an axon
nodes of ranvier have high coentration of Na channels
39
What type of cells synthesize myelin the CNS (including CN I and II)
"COPS"
oligodendrocytes derived from neuroectoderm
1 oligodendrocyte per many CNS axons
40
What type of cells synthesize myelin in the PNS ( Including CN III-XII)
"COPS"
Schwann cells derived from neural crest
1 schwann cell per PNS axon
41
What type of cell is damaged in Guillian Barre syndrome
Schwann cells
42
What type of cell is damaged in MS, progressive multifocal leukoencephalopathy (PML), leukodystrophies
Oligodendrocytes
43
Free nerve endings
C- slow, unmyelinated fibers
Aδ- fast, myelinated fibers
skin, epidermis, some viscera
pain and temperature
44
Meissner corpuscles
Large myelinated fibers that adapt quickly
Gabrous (hairless)skin
dynamic, fine/light touch, position sense
45
Pacinian corpuscles
Large myelinated fibers that adapt quickly
Deep skin layers, ligaments, and joints
vibration and pressure
46
Merkel disc
Large myelinated fibers that adapt slowly
finger tips and superficial skin
pressure, deep static touch, position sense
47
Ruffini corpuscles
Dendritic ending with capsule; adapt slowly
finger tips, joints
pressure. slippage of objects along surface of skin, joint angle change
48
Peripheral nerve layers
Endoneurium (inner layer) - around single nerve fibers
Perineurium (around, blood nerve permeaility barrier) - surrounds each fasicle of nerve fibers
Epineurium (outer layer) - dense CT that surrounds entire nerve (fasicles and blood vessels)
49
inflammatory infiltrate in Guillain barre syndrome involves what layer of peripheral nerve
Endoneurium
50
Reaction of neuronal cell body to axonal injury that is concurrent with wallerian degeneration
Chromatolysis
changes reflect increased protein synthesis in an effort to repair the damaged axon
- Round cellular swelling
- Displacement of the nucelus to the periphery
- Dispersion of Nissl substance throughout the cytoplasm
51
Location of synthesis of ACh
Basal nucleus of Meynert
52
Location of synthesis of Dopamine
Ventral tegmentum, SNc
53
Location of synthesis of GABA
Nucleus accumbens
54
Location of synthesis of NE
Locus ceruleus
55
Location of synthesis of serotoning
Raphe nucleus
56
NT levels in anxiety
low GABA and serotonin
| high NE
57
NT levels in Depression
low dopamine, NE, serotonin
58
NT levels in schizo
high dopamine
59
NT levels in alzheimers dz
low ACh
60
NT levels in huntington disease
low ACh and GABA
| high Dopamine
61
NT levels in parkinson disease
low dopamine and serotonin
| high ACh
62
Meninges layers
```
Dura mater (from mesoderm)
Arachnoid mater (neural crest)
Pia mater (neural crest)
```
63
Epidural
a potential space between the dura mater and skull containing fat and blood vessels
64
The blood brain barrier is formed by 3 structures
- tight junctions between nonfenestrated capillary endothelial cells
- basement membrane
- astrocyte foot processes
65
Can glucose and AA cross the BBB
yes they cross slowly by carrier mediated transport mechanisms
66
Can non polar/lipid soluble substances cross the BBB
yes rapidly via diffusion
67
effect of infarction or neoplasm on BBB
destroys endothelial cell tight junctions causing vasogenic edema
68
Hypothalamus
maintains homeostasis
TAN HATS
```
Thirst
Adenohypophysis
Neurohypothysis
Hunger
Autonomic NS
Temperature
Sexual urgers
```
69
What parts of the hypothalamus are not protected by the BBB
OVLT which senses changes in osmolarity
Area postrema found in medulla and responds to emetics
70
Lateral nucleus (Hypothalamus)
hunger
+ ghrelin
- leptin
injury: lateral injury makes you lean
71
Ventromedial nucleus (Hypothalamus)
Satiety
+ leptin
injury: VentroMedial injury makes you Very Massive
72
Anterior nucleus (Hypothalamus)
Cooling and parasympathetics
"ANTartica"
73
Posterior nucleus (Hypothalamus)
Heating and sympathetics
"Hot Pot"
74
Suprachiasmatic nucleus (SCN) of Hypothalamus
Circadian rhythm
"charismatic people need to sleep"
75
Supraoptic and paraventricular nuclei (Hypothalamus)
Synthesize ADH and oxytocin
which are carried by neurophysins down axons to the posterior pituitary
76
Preoptic nucleus (Hypothalamus)
thermoregulation and sexual behavior
releases GnRH
77
Kallman syndrome (Hypothalamus)
failure of GnRH producing neurons to migrate from olfactory pit
78
Vomiting is coordinated by what? where is it located? where does it receive information from?
- nucleus tractus solitarius (NTS) in the medulla
- receives info from the chemoreceptor trigger zone (CTZ within area postrema in 4th ventricle), GI tract via vagus, vestibular system, CNS
79
The 5 major receptors in the CTZ
muscarinic (M1), dopamine (D2), histamine (H1),serotonin (5HT3), and neurokinin (NK-1)
80
____,____,____ antagonists used to treat chemotherapy induced vomiting
5HT3
D2
NK-1
81
____ and ____ antagonists used to treat motion sickness and hyperemesis gravidarum
M1 and H1
82
Circadian rhythm controls nocturnal release of ___, ____, ____, ____
ACTH
Prolactin
Melatonin
NE
SCN --> NE release---> pineal gland --> melatonin
SCN is regulated by the environment
83
Effect of alcohol, benzos, and barbiturates on sleep cycle
decrease REM sleep and delta wave sleep
84
Sleep cycle stages
Awake eyes open --> Beta (high f, low amp)
Awake eyes closed --> Alpha
Non-REM sleep
-Stage N1 (light sleep) --> theta
-Stage N2 (deeper sleep) --> sleep spindles and K complexes
-Stage N3 (deepest non-REM sleep, slow wave) --> Delta
-REM sleep --> Beta waves
85
What stage of sleep does bruxism occur
Stage N2 of non REM sleep
sleep spindles and K complexes
86
What stage of sleep does sleep walking, night terrors, and bedwetting occur
Stage N3 of non REM sleep
Delta wave
87
Stage of sleep where there is a loss of motor tone, increased brain O2 use, increased and variable pulse and blood pressure, increase ACh
REM sleep
occurs every 90 minutes and duration increases through the night
88
What stage of sleep do you experience dreaming, nightmares, penile/clitoral tumescence, and may serve a memory processing function
REM sleep
89
extraoccular movements are due to activity of
PPRF or paramedian pontine reticular formation or conjugate gaze center
90
Ventralposterolateral nucleus (thalamus)
Input: spinothalamic and dorsal columns/medial lemniscus
Senses: vibration, pain, pressure,proprioception, light touch, temperature
Destination: primary somatosensory cortex
91
Ventralposteromedial nucleus ((thalamus)
Input:Trigeminal and gustatory pathway
Senses: Face sensation, taste
Destination: primary somatosensory cortex
92
Lateral geniculate nucleus ((thalamus))
Input:CN II, optic chiasm, optic tract
Senses: vision
Destination: Calcarine sulcus
lateral ...think "light"
93
Medial geniculate nucleus ((thalamus))
Input:superior olive and inferior colliculus of tectum
Senses: Hearing
Destination: auditory cortex of temporal lobe
medial...think "music"
94
Ventral lateral nucleus (thalamus)
Input: Basal ganglia
Senses: Motor
Destination: Motor cortex
95
Limbic system is responsible for
emotion, long term memory, olfaction, behavior modulation, ANS function
5 F: Feeding, Fleeing, Fighting, Feeling, (Fucking)Sex
96
Structures of the limbic system
hippocampus, amygdala, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, entorhinal cortex
97
Mesocortical (Dopaminergic pathways)
decreased activity causes negative symptoms
98
Mesolimbic (Dopaminergic pathways)
inceased activity causes positive symptoms
primary target of antipsychotic drugs which decrease positive symptoms
99
Nigrostriatal (Dopaminergic pathways)
decreased activity causes extrapyramidal symptoms
significantly affected by mvoement disorders and antipsychotic drugs
100
Tuberoinfundibular(Dopaminergic pathways)
decreased activity causes increase in proalctin and decreased libido, sexual dysfunction, galactorrhea, gynecomastia
101
Input into cerebellum
contralateral cortex via middle cerebellar peduncle
ipsilateral proprioceptive info via inferior cerebellar peduncle from spinal cord
102
Output into cerebellum
The only output of cerebellar cortex is the purkinje cells which are always inhibitory --> deep nuclei of cerebellum --> contralateral cortex via superior cerebellar peduncle
103
Deep nuclei from lateral to medial
Dentate, Emboliform, Globose, Fastigial
104
Lateral lesion to cerebellum
Affects LATERAL structure
voluntary movement of extremities
fall toward injured side (ipsilateral)
105
Medial lesion to cerebellum
affects MEDIAL structures
truncal ataxia (wide based cerebellar gait) , nystagmus, head tilting.
Bilateral motor defects affecting axial and proximal limb musculature
106
Basal ganglia
voluntary movements and making postural adjustments
107
Basal ganglia's striatum =
putamen (motor) + caudate (cognitive)
108
Basal ganglia's Lentiform =
putamen + globus pallidus
109
Basal ganglia's D1 receptor
direct pathway
Dopamine binds to D1 to stimulate the excitatory pathway
110
Basal ganglia's D2 receptor
Indirect
Inhibitory pathway
Dopamine binds to D2 to inhibit the inhibitory pathway and increase motion
111
Direct (excitatory) pathway
Substantia nigra input stimulates the striatum causing GABA release
The release of GABA inhibits GABA release from the GPi (globus pallidus)
This causes DISINHIBITION of thalamus and therefore increased movement
112
Indirect (inhibitory) pathway
Substantia nigra input stimulates the striatum which releases GABA that DISINHIBITS the subthalamic nucleus via GPe inhibition
Subthalamic nucleus stimulates the GPi (globus pallidus) to inhibit the thalamus and therefore decreases movement
113
What is cerebral perfusion primarily driven by
PCO2
hypoxemia increases CPP only if PO2 <50 mmHg
CPP is directly proportional to PCO2 until PCO2>90 mmhg
114
Cerebral perfusion pressure equation
MAP-ICP
if CCP=0 then braindeath
115
How does therapeutic hyperventilation affect the CCP (cerebral perfusion pressure)
It causes a drop in PCO2 which results in vasoconstriction and ultimately decreased cerebral blood flow and drop in intracranial pressure (ICP)
116
Anterior cerebral artery supplies
anteromedial surface
117
Middle cerebral artery supplies
lateral surface
118
Posterior cerebral artery supplies
posterior and inferior surfaces
119
Watershed zones in the brain
between anterior cerebral/middle cerebral (cortical border zone)
between posterior cerebral/middle cerebral (cortical border zone)
Superficial and deep vascular territories of the middle cerebral artery (internal border zone)
120
circle of willis pathway
The vertebral arteries join to form the basilar artery
the basilar artery bifurcates into the posterior cerebral artery
the posterior cerebral artery communicates with the middle cerebral artery with the posterior communicating branch
The middle cerebral artery joins the anterior cerebral artery to form the internal carotids
121
Dural venous sinuses drain into
internal jugular vein
122
Dural venous sinus drainage pathway
Superior sagittal sinus, straight sinus, and occipital sinus. join to form the confluence of sinuses
Then proceeds to drain into the left and right transverse sinuses. --> sigmoid --> jugular foramen --> internal jugular vein
123
Venous sinus thrombosis
Patient presents with the signs and symptoms of increased ICP
can lead to venous hemorrhage
124
Ventricles
The lateral ventricles drain into the third ventricle via the right and left interventricular foramina of monro
The third ventricle (chicken head) then drains into the 4th ventricle via cerebral aqueduct of sylvius
The 4th ventricle drains into the subarachnoid space via the foramina of luschka (lateral) and the foramina of Magendie (medial)
125
CSF made by
ependymal cells of choroid plexus
then reabsorbed by arachnoid granulations and then drains into dural venous sinuses
126
CNs and where they exit from
4 exit above the pons - 1,2,3,4
4 exit the pons-5,6,7,8
4 are in the medulla - 9,10,11,12
4 nuclei are medial - 3,4,6,12 (factors of 12)
127
Pineal gland
melatonin secretion and circadian rhythms
128
Superior colliculi
direct eye movements to stimuli or objects of interest
129
Inferior colliculi
auditory
note: superior is eyes and inferior is ears. The eyes are above the ears
130
Cranial nerve nucleis
located in tegmentum portion of brain stem (between the dorsal and ventral portions)
Midbrain - nuclei of CN 3 and 4
Pons- nuclei of CN 5,6,7,8
Medulla- nuclei of CN 9,10,12
Spinal cord- nuclei of CN 11
131
Cranial nerve pathway: CN I
cribriform plate
132
Cranial nerve pathway: CN 2
optic canal
133
Cranial nerve pathway: CN 3,4,6,V1
Superior orbital fissure
134
Cranial nerve pathway: V2
foramen rotundum
135
Cranial nerve pathway: V3
foramen ovale
136
Cranial nerve pathway: Middle meningeal A
foramen spinosum
137
Cranial nerve pathway: CN 7 and 8
internal auditory meatus
138
Cranial nerve pathway: CN 9,10,11 jugular vein
jugular foramen
139
Cranial nerve pathway: CN 12
hypoglossal canal
140
CN types (sensor vs motor)
CN 1-12
```
Some
Say
Marry
Money
But
My
Brother
Says
Big
Brains
Matter
Most
```
141
CN for taste from anterior 2/3? posterior 1/3?
anterior 2/3 - facial
| posterior 1/3 -glossopharyngeal
142
Nucleus solitarius (vagal nuclei)
visceral sensory info
CN 7,9,10
S=sensory
143
Nucleus ambiguus (vagal nuclei)
motor innervation of pharynx, larynx, upper esophagus
CN 9,10,11
M=muscle
144
Dorsal motor nucleus (vagal nuclei)
sends autonomic (parasympathetic) fibers to heart, lung, upper GI
CN 10
145
Cranial nerve reflex: corneal
afferent: V1 opthalmic (nasociliary branch)
efferent: bilateral VII (temporal branch: orbicularis oculi)
146
Cranial nerve reflex: lacrimal
afferent: V1
efferent: VII
147
Cranial nerve reflex: jaw jerk
afferent: V3
efferent: V3
148
Cranial nerve reflex: pupillary
afferent: II
efferent: III
149
Cranial nerve reflex: Gag
afferent: IX
efferent: X
150
Muscles of mastication and their innervation
3 muscles needed to close jaw: masseter, temporalis, medial pterygoid
1 muscle opens: lateral pterygoid
nerve: V3
151
Do spinal nerves exit above or below the vertebrae?
C1-C7 exit above
C8 below C7
Rest below
152
Where does the spinal cord end for adults
at the lower border of L1-L2
but the subarachnoid space extends to lower border of S2 vertebra
153
At what level do you do a lumbar puncture
L3-L4 or L4-L5
"to keep the spinal cord alive, keep the spinal needle between L3 and L5"
154
Spinal cord and associated tracts: corticospinal (Descening) and spinothalamic (Ascending)
legs (lumbosacral) are lateral in lateral corticospinal, spinothalamic tracts
155
Spinal cord and associated tracts: dorsal colum
Dorsal columns - pressure, vibration, fine touch, proprioception
arms outside - fasciculus cuneatus (upper body, arms)
legs insidem - fasciculus gracilis (lower body, legs)
156
Spinothalamic tract
lateral spinothalamic tract - pain and temp
| Anterior spinothalamic tract - crude touch, pressure
157
Corticospinal tract
lateral corticospinal tract - voluntary motor
| Anterior corticospinal tract-voluntary motor
158
Dorsal column tract
1st order neuron: sensory nerve ending enter dorsal root ganglion and ascend spinal cord ipsilaterally in dorsal column
Synapse: nucleus gracilis, nucleus cuneatus of ipsilateral medulla
2nd order neuron: decussates in medulla and ascends contralaterally as the medial lemniscus
Synapse: VPL (thalamus) --> sensory cortex
159
Spinothalamic tract pathway
1st order neuron: sensory nerve ending (Aδ and C fibers) to dorsal root ganglion and enter spinal cord
Synapse: ipsilateral gray matter of spinal cord
2nd order neuron: decussayes in spinal cord as the anterior white commissure ascends contralaterally
synapse: VPL (thalamus) --> sensory cortex
160
Lateral corticospinal tract pathway
1st order neuron: UMN ; cell body in primary motor cortex descends ipsilaterally through posterior limb of internal capsule. Decussate at caudal medulla and descend contralaterally
synapse 1: cell body of anterior horn of spinal cord
2nd order neuron: LMN leaves spinal cord
Synapse 2: NMJ --> mm fibers
161
______ tracts synapse and then cross
ascending
162
Cremasteric reflex
L1 L2
| testicles move
163
Anal wink reflex
S3 S4
| winks galore
164
triceps reflex
C7 C8
165
baby reflex where abducts/extends arms when startled and then draw together
Moro reflex
166
baby reflex where move head towards one side if cheek or mouth is stroked
nipple seeking due to rooting reflex
167
Sucking response when roof of mouth is touched in infant
sucking reflex
168
curling fingers if palm is stroked in infant
palmar reflex
169
dorsiflexion of large toe and fanning of other toes with plantar stimulation in baby (babinski)
plantar reflex
170
Stroking alone one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of lower body toward stimulated side
galant reflex
171
Landmarks for dermatomes:
| C2,C3,C4,C6,T4,T7,T10,L1,L4,S2,S3,S4
```
C2 - posterior half of skull
C3- turtle neck shirt
C4-low collar shirt
C6-includes the thumb (thumbs up sign on left hand looks like a 6)
T4-at the nipple
T7-xiphoid process
T10-umbilicus
L1-inguinal ligament
L4-includes the kneecaps
S2,S3,S4-penile and anal zone sensations
```
172
Eye looks towards (destructive)side of lesion. Location?
Frontal eye fields
173
Disinhibition and deficits in concentration, orientation, and judgement. Location?
Lesion in frontal lobe
174
Eye looks away from side of lesion during irritative seizure.Location?
frontal eye fields
175
Eyes look away from side of lesion. Ipsilateral gaze palsy where they are unable to look towards side of lesion. Location?
Paramedian pontine reticular formation
176
Internuclear ophthalmoplegia (impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction). Seen with MS. Location?
Medial longitudinal fasciculus
177
Gerstmann syndrome. Agraphia, acalculia, finger agnosia, left/right disorientation. Location?
Dominant parietal cortex
178
Hemispatial neglect syndrome - agnosia of the contralateral side of the world. Location?
Nondominant parietal cortex
179
Anterograde amnesia - cant make new memories . Location?
Hippocampus B/L
180
Parkinsons, huntington dz : tremor at rest, chorea, athetosis. Location?
Basal ganglia
181
Contralateral hemiballismus. Location?
Subthalamic nucleus
182
Confusion, ataxia, nystagmus, ophthalmoplegia, memory loss as anterograde and retrograde, confabulation, personality changes. Syndrome? Location?
wernicke korsakoff syndrome
mammollary bodies b/l
183
Disinhibited behavior related to HSV-1 encephalitis. Syndrome? Location?
Kluver Bucy syndrome
amygdala b/l
184
Vertical gaze palsy, pupillary light near dissociation, lid retraction, convergence-retraction nystagmus. Syndrome? Location?
Parinaud syndrome
Dorsal midbrain
185
reduced levels of arousal and wakefulness. Location?
reticular activating system (midbrain)
186
Intention tremor, limb ataxia, loss of balance; damage to cerebellum --> ipsilateral deficits; fall towards side of lesion. Location?
Cerebellar lesion
187
Decorticate (flexor) posturing - flexion of UE and extension of LE. Location?
Lesion above the red nucleus
188
Decerebrate (extensor) posturing - extension of UE and LE. Location?
Lesion below the red nucleus
worse prognosis that decorticate posturing
189
Truncal ataxia (wide based, drunken sailor gait), dysarthria. Location?
Cerebellar vermis
vermis is centrally located and affects the central body
chronic alcohol use
190
Irreversible brain damage occurs ____ minutes after hypoxia. Most vulnerable structures?
5 minutes
hippocampus (most), neocortex, cerebellum (purkinje cells), watershed area
191
CT or MRI for Ischemia of the brain?
CT detects ischemic changes in 6-24 hrs
| diffusion weighted MRI within 3-30 min
192
Histologic features of ischemia after:
1) 12-24 hrs
2) 24-72 hrs
3) 3-5 days
4) 1-2 weeks
5) > 2 weeks
1) eosinophilic cytoplasm +pyknotic nuclei (red nucleus)
2) necrosis + neutrophils
3) macrophages (microglia)
4) Reactive gliosis (astrocytes) + vascular proliferation
5) glial scar
193
What kind of necrosis do you see in ischemic stroke
liquefactive
194
Thrombotic ischemic stroke most commonly occurs at the
MCA
195
What is the treatment protocol for tPA
if within 3-4.5 hours of onset
and no hemorrhage/risk of hemorrhage
196
Brief reversible episode of foal neurologic dysfunction without acute infarction (neg MRI) with the majority resolving in <15 minutes.
Transient ischemic attack
Deficits are due to local ischemia
197
Preterm baby presents with altered level of consciousness, bulging fontanelle, hypotension, seizures, coma
Neonatal intraventricular hemorrhage-bleeding in the ventricles
germinal matrix- a highly vascularized layer within the subventricular zone
Due to reduced glial fiber support and impaired autoregulation of BP in premature infants
198
Epidural hematoma is commonly due to ____ at the _____. Presents with scalp hematoma and rapid intracranial expansion, this can result in ___________. CT shows a ______ hyperdense blood collection that _______ suture lines
middle meningeal artery trauma at the pterion
Transtentorial herniation --> CN III palsy
biconvex(lentiform)
does not cross suture lines
199
Subdural hematoma is due to rupture of _______ and can be acute due to trauma ( ____ on CT) or chronic due to cerebral atrophy (_______ on CT). ______ shaped hemorrhage that _____ the suture lines
bridging veins
hyperdense on CT for acute
hypodense on CT for chronic
Crescent shaped hemorrhage that crosses the suture lines
can cause a midline shift
200
Patient presents with the worst headache of his life and has bloody/yellow (xanthochromic) spinal tap
Sub arachnoid hemorrhage
due to trauma or aneurysm
201
This hemorrhage is caused by systemic hypertension which causes a hypertensive hemorrhage.
Intraparenchymal hemorrhage
most often at the putamen of basal ganglia due to the lenticulostriate vessels
hypertensive hemorrhage (charcot bouchard microaneurysm --> lacunar strokes)
202
Patient presents with contralateral paralysis and sensory loss - face and upper limbs. What artery is involved and where is the stroke?
Middle cerebral artery at the motor and sensor cortices
203
Patient presents with aphasia
Middle cerebral artery
Temporal lobe (wernickes area)
dominent left hemisphere
204
Patient presents with hemineglect
middle cerebral artery
temporal lobe
nondominant right side
205
Patient presents with contralateral paralysis and sensory loss in lower limb and urinary incontinence
Anterior cerebral artery
at motor and sensory cortices
206
Patient presents with contralateral paralysis and absence of cortical signs.
Lenticulostriate artery at the striatum and internal capsule
207
Common location of lacunar infarcts due to hyaline arteriosclerosis secondary to unmanaged hypertension
lenticulostriate artery at the striatum and internal capsule
208
Patient presents with cotnralateral paralysis of the upper and lower limbs
lateral corticospinal tract
anterior spinal artery
209
Patient presents with decreased contralateral proprioception
medial lemniscus
anterior spinal artery
210
Patient presents with ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)
caudal medulla - hypoglossal nerve
anterior spinal artery
211
Patient presents with dysphagia, hoarseness, and decreased gag reflex
Lateral medulla at the nucleus ambiguus (CN 9,10,11)
posterior inferior cerebellar artery
212
Patient presents with vomiting and vertigo and nystagmus
vestibular nuclei
posterior inferior cerebellar artery and anterior inferior cerebellar artery
213
Patient presents with decreased pain and temperature sensation from contralateral body and ipsilateral face
Lateral spinothalamic tract, spinal trigeminal nucleus
posterior inferior cerebellar artery
214
Patient presents with ipsilateral horner syndrome
sympathetic fibers due to posterior inferior cerebellar artery or anterior inferior cerebellar artery
215
Patient presents with ipsilateral ataxia, dysmetria
inferior cerebellar peduncle
posterior inferior cerebellar artery
216
Patient presents with paralysis of face (decreased lacrimation, salivation, taste from anterior 2/3 of tongue)
Lateral pons; facial nucleus
Anterior inferior cerebellar artery
217
Patient presents with ataxia and dysmetria
middle and inferior cerebellar peduncles
anterior inferior cerebellar artery
218
Patient presents with decreased pain and temperature sensation from contralateral body and ipsilateral face
spinothalamic tract
spinal trigeminal nucleus
anterior inferior cerebellar artery
219
Patient presents with ipsilateral sensorineural deafness, vertigo
labyrinthine artery
anterior inferior cerebellar artery
220
Patient presents with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss.
medial medullary syndrome
anterior spinal artery - paramedian brances
and or vertebral arteries
221
Patient presents with facial droop
Lateral pontine syndrome
facial nucleus affects are specific to AICA (anterior inferior cerebellar artery)
222
Patient presents with hoarseness and dysphagia
Lateral medullary (wallenberg) syndrome
nucleus ambiguus effects are specfic to PICA lesions (posterior inferior cerebellar artery)
223
Patient presents with locked in syndrome
Basilar artery
lesion at pons, medulla, lower midbrain
(RAS) reticular activating system spared and therefore preserved consciosness
224
Patient presents with quadriplegia and loss of voluntary facial,mouth, and tongue movements
corticospinal and corticobulbar tracts
basilar artery
225
Patient presents with loss of horizontal but not vertical eye movements
Ocular cranial nerve nuclei, paramedian pontine reticular formation
basilar artery
226
Patient presents with contralateral hemianopia with macular sparing. Alexia without agraphia (dominant hemisphere)
Occipital lobe
posterior cerebral artery
227
Central post stroke pain syndrome
Neuropathic pain due to thalamic lesions
initial paresthesias followed in weeks to months by allodynia (oridinarily painless stimuli cause pain) and dysesthesia ont he contralateral side
228
This injury is caused by traumatic shearing forces during rapid acceleration and or deceleration of the brain
Diffuse axonal injury
coma, vegetative state
can have punctate hemorrhages
229
What hemisphere does aphasia usually involve
left hemisphere (dominant)
230
Broca
expressive aphasia
Broken speach "broca"
inferior frontal gyrus of frontal lobe
231
Wernicke
Receptive aphasia
Wordy but makes no sense
Superior temporal gyrus of temporal lobe
also associated with right superior quadrant visual field defect
232
Conduction aphasia
poor speech repetition
damage to arcuate fasciculus
233
Global aphasia
arcuate fasciculus, broca an wenicke areas affected
234
Saccular/berry aneurysms commonly occur at
junction of the anterior communicating artery and anterior cerebral artery
associated with ehlers danlos syndrome and autosomal dominant polycystic disease
235
Rupture of berry aneurysms
subarachnoid hemorrhage causing focal neurologic deficits
236
anterior communicating artery compression
bitemporal hemianopia due to compression of optic chiasm
237
anterior communicating artery rupture
ischemia in anterior cerebral artery
contralateral lower extremity hemiparesis sensory deficits
238
Middle cerebral artery rupture
contralateral UE and Lower facial hemiparesis sensory deficits
239
Posterior communicating artery compression
ipsilateral CN III palsy causing mydriasis or blown pupils
"down and out eye"
ptosis
240
Where do partial (focal) seizures commonly originate. What are the different types
medial temporal lobe
simple partial - consciousness intact
complex partial - impaired consciousness and automatism
241
status epilepticus
>= 5 min or recurring
242
Generalized (diffuse) seizures types
absence (petit mal) - 3 hz, no postictal
myoclonic - quick repetitive jerks
tonic-clonic - grand mal alternating stiffening and movement
tonic-stiffening
atonic-drop seizures, like fainting
243
Migraines are due to irritation of what?
CN V
meninges
blood vessels (release of substance P, calcitonin gene related peptide, vasoactive peptides)
244
Akathisia
Restlessness and intense urge to move
245
Asterixis is due to
due to hepatic encephalopathy or wilson disease
246
Slow snake like writhing movements ,especially in the fingers
Athetosis
basal ganglia
247
Chorea is due to a lesion in the
basal ganglia
248
Sustained involuntary muscle contractions
dystonia
i.e. writers cramp
249
High frequency tremor with sustained posture. Worse with movement or when anxious
Essential tremor
250
Slow zigzag motion when pointing/extending toward a target
intention tremor
due to cerebellar dysfunction
251
Uncontrolled movement of distal appendages (esp in hands). tremor alleviated by intentional movement and occurs at rest
substantia nigra (parkinsons disease)
252
Parkinsons disease involves the ________. ______ is a drug that is metabolized to _____ which is toxic to the same structure
Loss of dopaminergic neurons of the substantia nigra pars compacta
MPTP --> MPP +
253
Parkinsons symptoms
TRAPs
```
Tremors (pill rolling)
Rigidity
Akinesia or bradykinesia
Postural instability
Shuffling gait
```
also see lewy bodies (alpha synuclein)
254
Trinucleotide repeat and gene affected in huntingtons dz
CAG
HTT gene on chromosome 4
"hunt has 4 letters"
255
huntington disease involves atrophy of ____ via binding of _____ and _____ excitotoxicity. Lab values consist of
caudate and putamen with ex vacuo ventriculomegaly. Neuronal death via NMDA-R binding and glutamate excitotoxicity
high dopamine
low GABA and ACh
256
Why do downs pts have a higher risk of alzheimers
APP (amyloid precursor protein) is cleaved to make amyloid beta
APP is coded on chromosome 21
257
alzheimers disease involves widespread cortical atrophy ,especially the ________. There is a ______ in ACh and _____ increases the risk of sporadic form.
hippocampus w/e narrowing gyri and widening sulci
decrease in ACh
APOE4 increases risk of sporadic
APOE3 decreases risk of sporadic
258
Alzheimers pathology
senile plaques due to amyloid beta plaques
Neurofibrillary tangles - intracellular hyperphosphorylated tau protein = insoluble cytoskeletal elements (number of tangles correlates with degree of dementia)
259
This dementia presents with early changes in personality and behavior (behavioral variant) or aphasia (primary progressive aphasia)
frontotemporal dementia/picks disease
inclusions of hyperphosphorylated tau (round pick bodies) or ubiquitinated TDP-43
260
This dementia presents with cognitive and motor symptoms onset < 1 year apart
lewy body dementia
lewy bodies composed of alpha synuclein (intracellular eosinophilic inclusions)
if not <1 year apart then it is dementia secondary to parkinsons disease
261
Vascular dementia
result of multiple arterial infarcts and or chronic ischemia
stepwise decline in cognitive impairment and then late onset memory impairment
262
Rapidly progressive dementia with myoclonus and ataxia. Periodic sharp waves on EEG and increase in 14-3-3 protein in CSF
Creutzfeldt-jakob disease
spongiform cortex
Prions
263
Increased ICP without cause on imaging. Lumbar puncture shows increased opening pressure and provides temporary headache relief. Diplopia due to CN 6 palsy and impaired optic nerve axoplasmic flow
idiopathic intracranial hypertension or pseudotumor cerebri
risk factors: female, tertracyclines, obesity, vitamin A excess, danazol
264
communicating hydrocephalus
decreased CSF absorption by arachnoid granulations
265
Normal pressure hydrocephalus
elderly
elevated only episodically
expansion of ventricles destorys the fibers of the corona radiata --> triad of urinary incontinence, gait apraxia, cognitive dysfunction
266
noncommunicating hdrocephalus
structural blockage of CSF circulation due to tumor etc
267
ex vacuo centriculomegaly
appearance of increased CSF but is actually due to decreased brain tissue and neuronal atrophy
ICP is normal and normal pressure hydrocephalus triad (urinary incontinence, gait apraxia, cognitive dysfunction) is not seen
268
Autoimmune inflammation and demyelination of CNS (brain and spinal cord) with subsequent axonal damage. What disease? what are common symptoms?
Multiple sclerosis
acute optic neuritis or painful unilateral visual loss associated with marcus gunn pupil
Brain stem/cerebellar syndromes
pyrimidal tract weakness - pattern of weakness in the extensors (upper limbs) or flexors (lower limbs)
symptoms are exacerbated with increase body temp (i.e. during exercise)
269
Multiple sclerosis has increased ____ and ____ in the CSF. What is the gold standard test? What is diagnostic?
IgG and myelin basic protein in CSF
gold standard test is the MRI
oligoclonal bands are diagnostic. Periventricular plaques (Areas of oligodendrocyte loss and reactive gliosis)
270
Massive axonal demyelination in pontine white matter secondary to rapid osmotic changes. Results in acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness
Osmotic demyelination syndrome or central pontine myelinolysis
can cause locked in syndrome
271
If you correct Na too fast from low to high
osmotic demyelination snydrome
272
If you correct Na too fast from high to low
cerebral edema/herniation
273
Acute inflammatory demyelinating polyradiculopathy is a subtype of ? affects what nerves? what are labs like?
most common subtype of guillian barre syndrome
affects peripheral nerves including CN 3- 12 and motor fibers
Increased CSF protein with normal cell count (albuminocytologic dissociation)
274
Acute disseminated (postinfectious) encephalomyelitis
multifocal inflammation and demyelination after infection or vaccination
rapidly progressive multifocal neurologic symptoms that alter mental status
275
Hereditary motor and sensory neuropathy. Defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath. Associated with foot deformities, lower extremity weakness, and sensory deficits. What disease is this?
Charcot marie tooth disease
276
What is the most common type of charcot marie tooth disease
CMT1A caused by the PMP22 gene duplication
277
Demyelination of CNS due to destruction of oligodendrocytes. Rapidly progressive, usually fatal and dominates the parietal and occipital areas. Visual symptoms are common
Progressive multifocal leukoencephalopathy
278
_________ is a neurological disorder indicated at birth by a port-wine stain birthmark on the forehead and upper eyelid of one side of the face. The birthmark is caused by an overabundance of capillaries around the _________ just beneath the surface of the face. Neurological symptoms include seizures (side of the body opposite the birthmark) that begin in infancy and may worsen with age. There may be intermittent or permanent muscle weakness on the same side.
Sturge-Weber syndrome aka encephalotrigeminal angiomatosis
trigeminal nerve
abnormal blood vessels on the brain surface and the loss of nerve cells and calcification of underlying tissue in the cerebral cortex of the brain on the same side of the brain as the birthmark. --> neurological symptoms
ipsilateral leptomengeal angioma --> seizures/epilepsy
episcleral hemangioma --> increased IOP --> glaucoma
279
What is the pathophys of sturge weber syndrome
developmental anomaly of neural creast derivatives due to somatic mosaicism for an activating mutation in one copy of the GNAQ gene
280
What is tuberous sclerosis and what is the genetic mutation that causes it
tuberous sclerosis is a disorder that results in growth of numerous benign tumors in many parts of the body
due to TSC1 mutation on chromosome 9
OR TSC2 on chromosome 16
which is a tumor suppressor gene
281
Clinical presentation of tuberous sclerosis
HAMARTOMAS
```
Hamartomas in CNS and skin
Angiofibromas
Mitral regurg
Ash leaf spots
Cardiac Rhabdomyoma
Autosomal dominant
Mental redardation
Renal angiomyolipoma
Seizures
Shagreen patches
Subependymal giant cell astroctomas and ungual fibromas
```
282
Neurofibromatosis type 1 clinical presentation? genetic mutation?
condition that causes tumors to form in brain, spinal cord, nerves. Cafe au lait spots, cutaneous neurofibromas, optic gliomas, pheochromocytomas, lisch nodules
mutation in NF1 tumor suppressor gene on chromosome 17
aka Rechlinghausen disease
283
What is defective in neurofibromatosis type 1
mutation in NF1 tumor suppressor gene which normally codes for neurofibromin, a negative regulator of RAS
284
Neurofibromatosis type 2
mutation in NF2 tumor suppressor gene on chroosone 22
bilateral acoustic schwannomas, juvenile cataracts, meningiomas, ependymomas
285
Disease that results in tumors and fluid filled sacs (cysts) in different parts of the body. Especially the kidney and pancreas. What disease is this? what is the mutation?
Von hippel lindau disease
deletion of VHL gene on chromosome 3p
pVHL ubiquitinates hypoxia inducible factor 1a
- Hemangioblastomas in retina, brainstem, cerebellum, spine
- Angiomatosis
- renal cell carcinomas,Bilateral
- pheochromocytomas
286
Glioblastoma multiforme
Grade 4 astrocytoma
common and highly malignant. Found in cerebral hemispheres and can cross corpus callosum.
GFAP+
on histology there are pseudopalisading pleomorphic tumor cells
287
Oligodendroglioma is most often in the ___ and has a ______ capillary pattern?
frontal lobes
chicken wire
288
Primary adult brain tumor that is extra axial (external to the brain parenchyma) and may have a dural attachment. What tumor is this? what is the cell of origin? histology?
meningioma
Arachnoid cell origin
spindle cells concentrically arranged in whorled pattern
psammoma bodies(laminated calcifications)
289
Hemangioblastoma is most often found in ___ and is associated with ______ when found with retinal angiomas. Can also result in secondary polycythemia due to ______ production
cerebellum
Von hippel lindau syndrome
Erythropoietin
290
Hemangioblastoma cell of origin
blood vessel origin. Closely arranged, thin walled capillaries with minimal intervening parenchyma
291
Hyperplasia of only one type of endocrine cells found in pituitary
pituitary adenoma
most commonly lactotrophs --> prolactinoma
somatotrophs (GH) --> acromegaly/gigantism
Corticotrophs (ACTH) --> cushings disease
Thyrotrophs (TSH)
Gonadotrophs (FSH,LH)
292
Nonfunctioning pituitary adenoma presents with
mass effect
bitemporal hemianopia due to pressure on optic chiasm, hypopituitarism, headache
293
Prolactinoma in women presents with
galactorrhea, amenorrhea and decreased bone density due to suppression of estrogen
294
Prolactinoma in men presents with
low libido and infertility
295
Schwannomas are classically at the ________ and involve CNs ____ and ____ but can be along any peripheral nerves
cerebellopontine angle
CNS 8 and 7 (often localized to CN8 in internal acoustic meatus --> vestibular schwannomas found in NF-2)
296
Schwannoma cell origin? and marker?
Schwann cell origin
S-100 marker
297
Pilocytic astrcoytoma - location, gross and histological findings
most common primary brain tumor in childhood. Cystic + solid
usually in the posterior fossa
glial cell origin, GFAP+, Rosenthal fibers, corkscrew fibers
298
Medulloblastoma - location, gross, and histological findings
most common malignant brain tumor in childhood
usually in the cerebellum and can compress the 4th ventricle. Can send drop metastases to spinal cord
on histology see homor wright rosettes
299
Ependymoma are most commonly found in the ______ and can cause ________. They are of _____ cell origin
4th ventricle
hydrocephalus
ependymal
300
on histology for ependymoma you see
perivascular pseudorosettes
rod shaped blepharoplasts (basal ciliary bodies) found near nucleus
301
This tumor is derived from the remnants of the rathke puch (ectoderm)
Craniopharyngioma - supratentorial tumor
can cause bitemporal hemianopia
calcification is common
cholesterol crystals found in motor oil like fluid within tumor
302
Tumor of pineal gland that can result in vertical gaze palsy
pinealoma
parinaud syndrome (compression of tectum causes vertical gaze palsy)
can also cause obstructive hydrocephalus
Precocious puberty in males due to beta hCG production
303
Cingulate (subfalcine)hernaition under falx cerebri can compress ?
anterior cerebral artery
304
Transfentorial (Central/downward) hernaition can cause caudal displacement of?
brain stem and thus rupture of paramedian basilar artery branches --> duret hemorrhages
usually fatal
305
Uncal (medial temporal lobe) herniation can cause compression of
ipsilateral CN III and contralateral crus cerebri against kernohan notch
causes contralateral CN III palsy and/or ipsilateral hemiparesis
306
Cerebellar tonsillar herniation into foramen magnum
coma and death if compress brainstem
307
LMN lesion vs UMN lesion
```
LMN = everything lowered
UMN = everything up
```
308
Congenital degeneration of anterior horns of psinal cord causing a LMN lesion that causes symmetric weakness. What disease is this? what is the clinical presentation? what is the mutation?
Spinal muscular atrophy / Werdnig-Hoffmann disease
"floppy baby" with marked hypotonia (flaccid paralysis) and tongue fasciculations
Mutation in SMN1
309
Lou Gehrig disease/ amyotrophic lateral sclerosis (ALS) is due to a defect in ________
superoxide dismutase 1
UMN and LMN deficits (LMN due to anterior horn involvement)
310
Complete occlusion of anterior spiinal artery
UMN deficit below lesion due to corticospinal tract
LMN at level of lesion due to anterior horn
loss of pain and temp sensation below the lesion due to spinothalamic tract involvement
311
due to tertiary syphilis --> degeneration of dorsal columns and roots resulting in progressive sensory ataxia (impaired proprioception --> poor coordination)
Tabes dorsalis
+ Romberg sign and absent DTRs
associated with cahrcot joints, shooting pain, argyll robertson pupils
312
Syrinx expands and damages anterior white commissure of spinothalamic tract and causes
syringomyelia - bilateral symmetrical loss of pain and temperature sensation in cape like distribution.
seen with chiari I malformation
313
Vitamin B12 deficiency causes ________ which is the demyelination of spinocerebellar tracts, lateral corticospinal tracts, and dorsal columns
subacute combined degeneration (SCD)
Ataxic gait, paresthesia, impaired position/vibration sense
314
Cauda equina syndrome
compression of spinal roots L2 and below, often due to intervertebral disc herniation or tumor
unilateral radicular pain, absent knee and ankle reflex, loss of bladder and anal sphincter control, saddle anesthesia
315
Pt presents with LMN lesion symptoms due to a _____ virus that replicates in the oropharynx and small intestine before spreading via bloodstream to the CNS. CSF shows increased WBC and slight increase in protein. Glucose unchanged in CSF
poliomyelitis due to poliovirus
infection causes destruction of cells in anterior horn of spinal corn (LMN death)
316
Brown -sequard syndrome
hemisection of spinal cord
1) ipsilateral loss of all sensation at level of lesion
2) ipsilateral LMN signs at level of lesion
3) ipsilateral UMN signs below level of lesion due to corticospinal tract damage
4) ipsilateral loss of proprioception, vibration, light touch, and tactile sense below level of lesion due to dorsal column damage
5) contralateral loss of pain, temperature, and crude touch below level of lesion due to spinothalamic tract damage
6) if lesion above T1 then may have ipsilateral horners syndrome
317
Genetic pathophys in Friedreich ataxia
GAA on chromosome 9 in gene that encodes frataxin (iron binding protein)
leads to impairment in mitochondrial functioning
318
Patient presents with staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammar toes, diabetes mellitus, hypertrophic cardiomyopathy. Patient had kyphoscoliosis as child
Friedreich ataxia
degeneration of lateral corticospinal tract (spastic paralysis),spinocerebellar tract (Ataxia), dorsal columns (decrease vibratory sense, proprioception), and dorsal root ganglia (loss of DTRS)
319
CN V motor lesion
jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle
320
CN X lesion
uvula deviates away from side of lesion
321
CN XI lesion
weakness turning head to contralateral side of lesion
| shoulder droop on side of lesion
322
CN XII lesion
LMN lesion
tongue deviates toward side of lesion due to weakened tongue mm on affected side
"lick your wounds"
323
Patient presents with facial paralysis affecting the contralateral side and only involves the lower fascial muscles. Forehead spared
UMN lesion
motor cortex, connection from motor cortex to facial nucleus in pons
324
Patient presents with facial paralysis affecting the ipsilateral side and involves the upper and lower muscles of facial expression. The forehead is not spared and so the patient cannot wrinkle their forehead
LMN lesion
facial nucleus or anywhere along the CN 7
patient will present with incomplete eye closure resulting in dry eyes, corneal uclerations
hyperacusis,loss of taste sensation to anterior tongue
