Neuro Flashcards
1
Q
Cells of Nervous System
- dendritic cells: function
- microglia: strructure, function
- oligodendroglia: function, destroyed
- schwwann cells: function
- astrocytes: function -> BBB, lactate, glutamate, glycogen, ATP, K
- satellite cells
- epednymal cells
A
- APC of NS
- scant cytoplasm and irreg nuceli -> become larger with activation; will become multi-nuc giant cells in HIV
- myelinate mult CNS axons; destroyed in MS
- myelinate PNS
- form blood brain barrier, store glycogen, provide lactate, release glutamate, release ATP, control K levels
- support cell body in PNS
- produce CSF
2
Q
Neuron
- structure
- synaptophysin
- space concept
- time concept
- function
- red
A
- cell body contains large, central nucleus; contain nissl substance (basophilic granules),
- presynatic vesicles have synaptophysin and used as stain in IHC
- measures ability of impulse to travel down axon; low = slow, high=fast
- how quickly neuron voltage returns to baseline when stimulated; smaller = quicker to baseline, quicker it can transmit another AP
- functional unit of nervous sxs
- sign of irreversible damage -> can be caused by ischemia or hypoxia
3
Q
Axonal regeneration
- what is it
- part w/o contract
- pathway
A
- process of axonal regeneration after axons damaged
- is destroyed
- cell body becomes edematous, nuceli moves to periphery, increase in nissl substance -> if neurolemma is intact, growth occurs at rate of 1 mm a day
4
Q
Brain embryology
- pro
- Mes
- Rhomb
A
- tel (cerebrum) and di (thal, hypothal, pineal gland)
- Mesencephalon (mid brain)
- Met (pons and cerebllum), Mye (medulla)
5
Q
Brain Embryology
- fully formed
- reflexes
- how to measure
A
- 8 weeks
- present so that baby can swallow
- measure deepest most unobstructed part of womb w/ US; normal 8-18
6
Q
Potters
- caused by
- sxs
A
- bilateral renal agenesis
- limb deformity, flat face, pulm hypoplasia
7
Q
Polyhydraminos
- maternal cause
- fetal cause
- riley-day: type mutation, codes, epi, sxs, prognosis
- werdnig-hoffman
A
- DM
- obstruction
- AR, mutation of IKBKAP gene on chrom 9 -> codes for gene helpful in transcription; ashkenazi jew; auto neuropathy (no tears when crying), poor sucking, recurring vomiting (anti emetics), highly variable BP (keep hydrated w/ high sodium content), inappropriate perception to pain, heat and taste, mentation is normal; 30s
- AR, mutation of SMN1 gene on chrom 5, spinal-muscle atrophy
8
Q
BBB
- made of
- how to pass
- areas that do not contain
A
- tight junctions between endo cells and astrocyte podocytes
- transcellular movement; limited by fat solubility
- post pit, pineal gland, median eminence, area postrema (vomiting)
9
Q
Holoproencephaly
- what is it
- when does it noramlly occur
- assocaited w/
A
- incomplete division of forebrain into 2 hemis
- usually divides at 5th week of gestation
- hartfield syndrome (AD/XLD; holopro, ectrodactyly, cleft lip/palate) and patau (trisomy 13, microthalmia, cleft lip/ palate)
10
Q
Neural Tube
- formation
- notochrod
- close
- becomes
- Sonic hedge hog
- bone morphogenic protein
- closure: in head, in trunk
A
- neural plate is formed, notochord helps to form neural groove then converges forming neural fold -> then pinches off at the neural crest to form neural tube
- helps in formation of neural plate to neural groove; produces SHH; helps form axial skeleton; becomes nucleus pulposus
- at 4 weeks, 25 th is anterior neuropore and 27th day is post neuropore
- brain and SC
- produced by notochord and helps in dev of ventral axis; also plays role in dev of forebrain and dev of visual fields
- neural cells migrate, neural tube closes, overlying ectoderm closes vs ectoderm closes, neural tube closes, neural crest cells migrate
11
Q
Testing for neural tube defects
- which test
- when
- abnormal test
- AFP: increased caused by, decreased caused by
- estriol: represents, decreased =
- hCG: increased caused by
- anterior fails
- posterior fails
A
- triple test, measure hCG, AFP and estriol
- 16-18 wks
- fetal US, looking for incorrect dating -> if not then will do amnio
- increased = neural tube defects, ant abd wall defects (omphalocele -> covered, gastroschisis -> not covered) or mult gestation; decreased = downs -> karyotype
- reflects fetal and placental function, decreased= placental insuff
- increased -> mult gestation, hydatdiform mole (complete = w/ egg -> cluster of grapes, partial = 2 sperm) or choriocarcinoma
- anencephaly or encephalocele
- spina bifida occulta, meningocele, meningomyelocele
12
Q
Anencephaly
- what is it
- why
- exposed
- signified by
- prognosis
A
- absence of forebrain
- failure of cephalic end of neural tube to close
- brain tissue
- high AFP in maternal serum
- death right after birth
13
Q
Encephalocele
- what is it
- why
- location
- associated w/
- other neuro problems
- tx
A
- brain and meninges protrude through opening in skull
- failure of neural tube to close
- midline -> middle of skull, forehead to noe, occiput of skull
- craniofacial abnormalities
- hydrocephalus, spastic qudraplegia, microcephaly, dev delay, visual disorder
- close defect, remove all non functional tissue and fix craniofacial deformity
14
Q
CSF
- how is it made
- vitamin needed to make it
- enzyme needed; what other organs need this
- how does it get backed up
- function
- flow
- MC area of stenosis; caused by
- diff from plasma
A
- secreted by ependymal cells in choroid plexus and through blood vessels in ventricular walls
- vit A -> pseudotumor cerebri; if too much vit A too much CSF will be made
- carbonic anhydrase -> kidney, RBC, GI, muscle, brain, eye
- protecttion, buoyancy, prevents ischemia, provides chemical stability
- choroid plexus in lat ventricles -> foramen of monroe -> 3rd ventricle -> cerebral acqueduct -> 4th ventricle -> lateral foramen of luschka and medial foramen of megendie -> subarachnoid layer -> spinal canal -> dural sinuses -> arachnoid granulations -> back into blood
- aqueduct; TB and meningitis
- less bicarb, more, Cl ,acidic pH
15
Q
Deceleration Injuries
- coup injuries
- countercoup injuries
- dx
- what happens after concusion; importance
A
- CSF able to get to frontal bone before brain to try and cushion blow
- brain hits occipital bone
- non contrast CT -> new blood will be white
- increase in CSF to try and decrease further damage; if 2nd injury will increase CSF today and pt could herniate brain stem
16
Q
Cerebral Perfusion Pressure
- what is it
- increase in ICP
A
- Mean arterial pressure - ICP
- will decrease perfusion -> either decrease ICP or increase BP to increase perfusion to brain
17
Q
Shaken Baby Syndrome
- what is it
- epi
- signs
- sxs
- considered
A
- abusive head injury -> coup-counter coup injuries
- younger than 12 mnth
- retinal hemmorrhages
- normal to comatose
- child abuse
18
Q
Chemoreceptor Trigger Zone
- also called
- location
- stimulation
- concussion
- tx
A
- area postrema
- 4th ventricle
- dopamine
- compresses and will cause N/V
- dimenhydrinate (h1 blocker -> OTC for motion sickness), prochlorperazine (typical Anti-psych), promethazine (H1 blocker), ondansetron ( serotonin blocker)
19
Q
Hydrocephalus
- communicating: what is it; flow; enlargement of; newborns; children; adults
- non-communicating: what is it, ventricles, newborn caused by, children caused by, adult/elderly caused by
- normal pressure: what happens, ICP, sequelae, sxs
A
- due to CSF over production or lack of reabsorption; flow is intact; all ventricles enlarged; newborns -> vessels have not retracted causing increase in CSF; children - failure to reabsorb CSF -> secondary to meningitis; adults - pseduotumor cerebri
- obstruction to normal CSF flow; some ventricles atrophied and other enlarged; newborn - type 2 arnold chiari, hereditary aqueduct stenosis, toxoplasmosis, children: meningitis/ TB; adults and elderly: CA; irritability, increased head circumference, poor feeding, enlarged ventricles on CT
- decreased CSF absorption -> increased CSF vol -> ventricular enlargement; no increase in ICP bc of brain atrophy; ventricles push against periventricular pathways disrupted; wacky, wobbly, wet
20
Q
Syncope
- what is it
- auto dyfunction: what is it, sequelae, MCC, vs orthostatic
- new born
- elderly
- shy dragger
A
- fainting/ passing out
- increased PS tone and decreased symp tone; poor reaction to drop in BP -> DM, ortho will pass out after delay
- riley day syndrome -> brady cardia/ sinus pause secondary to pacemaker issue
- sick sinus syndrome
- 50-60 yrs old, autonomic problems and parkinson sxs
21
Q
Ortho hypotension
- caused by
- what happens
- when standing
A
- hypovolemia so not enough blood to compensate
- systolic drops 20, diastolic drops 10, HR goes up 10-20 bpm
- gravity pulls blood down to feet -> less blood to heart -> less blood to baroreceptors -> decrease PS to heart -> increase HR and contractility of heart
22
Q
Vasovagal syncope
- what is it
- pathway
- how is this triggered
- pilots
A
- body over reacts to stimulus
- decreased venous return -> decreased LV filling -> heart going to squeeze hard to get vol out to have normal perfusion (increase sympathetics) -> so much blood pushed out that it stretched baroreceptor -> heart slows down, heart contractility decreases and vasodilates -> pt passes out
- valsava, fear
- when going through high g turns supposed to do valsava to prevent blood from leaving head
23
Q
Bells palsy
- what is it
- caused by
- sxs
- types/ localization
A
- facial nerve inflammation or damage at geniculate ganglion in facial canal
- herpes, zoster, lyme dx, sarcoid
- weakness or paralysis of all muscles on one side of face; eyelids will not close -> tear production decreases; saliva will pool and leak out of corner of mouth; complain of numbness but facial sensation is intact
- lesion is above nucleus outside of facial canal-> spares forehead; lesion is in facial canal and all fibers have joined together -> affects forehead
24
Q
Muscles of the eye
- sup oblique
- inf oblique
- sup rectus
- inf recuts
- lat rectus
- med rectus
A
- down and out
- up and out
- up
- down
- outward
- inward
25
Q
Hypoglossal
- function
- runs
A
- tongue moevement
- transverse over internal carotid a
26
Q
Taste
- ant 2/3
- post 1/3
A
- CN 7 -> facial
- CN 9 -> glossopharyngeal
27
Q
Brachial plexus
- spinal levels
- divided
- n to subclavius
- dorsal scapular
- long thoracic
- suprascapular
- pec
- subscapular
- thoracodorsal
- axillary
- radial
- musculocutaneous
- median
- ulnar
- prox vs distal damage to n
- erbs palsy: caused by, causes, sxs, also called
- Klumpe palsy: caused by, sxs
A
- 5 roots -> 3 trunks -> 6 divisions -> 3 cords -> 4 branches
- c 5,6 -> stabilizes shoulder girdle
- c5; rhomboid (stabilize shoulder girdle) , levator sacpulae ( ADducts scapula)
- c5, c6, c7; serratus ant (rotates scapula); winged
- c5,c6; suprapinatus (inital abduction of arm) infraspinatus (rotates arm laterally)
- C5-T1; pec major (ADduction and medial rotation), pec minor (pull scapular forward and down
- c5, c6; teres major (medial rotation, ADduction, extension), subscapularis
- c6-8; lat (arm extension, ADduction, medial rotation)
- c5,6; teres minor (lat rotation of arm), deltoid (abduction of arm); ant shoulder dislocation, surgical neck fracture
- c5-t1; ar,/forearm extensors; saturday night palsy (wrist drop), humeral fracture
- c5-7; arm flexor
- c6-T1; forearm flexor, pronator; prox damage will give popes blessing
- c8-T1; adductor pollicis; prox damage will give claw hand
- if problem is distal cannot extend and problem is proximal cannot flex
- c5-6 injury -> dystonia; decreased sensation, paralysis of deltoid, bicep, infraspinatus –> flexion of hand and internal rotation; waiters tip
- c8-t1 lesion; paralysis of hand and horners syndrome
28
Q
Phrenic nerve
- from
- innervates
- irritation
- something pushing
- right path
- left path
A
- C 3, 4, 5
- diaphragm
- causes hiccups
- run along ant scalene, over brachiocephalic a, post to subclavian v, crosses anterior to root of lung, leaves thorax through vena cava hiatus in diaphragm
- passes over pericardium of left ventricle and pierces diaphragm separately
29
Q
Angular gyrus function
A
- language,number processing, spatial recognition
30
Q
limbic lobe function
A
- process emotion, forms new memories, motivation, olfaction
31
Q
corpus callosum
- function
- wafarin
A
- connects hemispheres, allows comm
- degeneration of corpus callosum (teratogenic)
32
Q
caudate nucleus
- location
A
- lateral to lateral ventricle and sup to thalamus
33
Q
herniation
- what is it
- transtentorial
- subfalcine
- tonsillar
- central
- transcalvarial
- upward/transtentorial
A
- brain passes through opening at base of skull
- medial temporal lobe herniates through gap between crus cerebri and tentorium -> goes from ant fossa to post fossa; ipsi 3rd n palsy, pupillary dilation
- cingulate gyrus herniate under the falx cerebri; abnormal posturing and coma
- cerbellar tonsils displace through foramen magnum and compress medulla; alt LOC, abnormal ext, abnormal breathing patterns -> apnea, circulatory collapse
- diencephalon and parts of temporal tobe squeezes through notch in tentorium cerebelli -> stretch basilar a -> duret hemm -> fatal
- brain herniates through fracture or surgical site in skull
- result of increased pressure in posterior fossa causing upward movement of cerebellum; fixed/ dilated pupil, altered LOC
34
Q
Broca Area
- location
- function
- aphasia
A
- frontal lobe in dominant hemi
- language comprehension, speech-associated gestures, action recognition and production
- inability to generate speech with continues understand
35
Q
Frontal Lobe Dementia
- also known as
- caused by
A
- Picks dx
- Tau protein, TDP43
- personality changes, behavior changes, language problems, muscle/ motor dusturbances
36
Q
Alzheimer’s
- what is it
- gross brain appearance
- micro changes
- angiopathy
- extended care
- NT
A
- slow progressive memory loss
- atrophied
- neurofibrillary tangles (intra cellular) and senile plaques (extra cellular) from APP w/ core composed of beta amyloid
- amyloid deposits in vascular walls and damages media and adventitia of cerebral vessels causing thickening of basal membrane -> stenosis of lumen
- when pt and family cannot perform functions of daily living
- decreased Ach in hippocampus and nuc basalis
37
Q
Parietal lobe
- dominant side
- left responsible for
- destruction left
- non-dominant
- right responsible
- destruction right
A
- left
- long term memory and process of sensory info
- verbal
- right
- intellectual processor of sensory, visospatial
- apraxia (cant plan muscle moving_ and hemineglect
38
Q
Occipital
- function
- brodmann area
A
- visual processing center
- 17
39
Q
Temporal
- role
- wernicke
- meyers loop
- seizure
- amygdaloid nuc
- inferior medial occipital-temporal cortex
A
- primary auditory area
- in dom hemi -> can say words but they do not make any sense
- optic radiation -> contralateral homo quadrantanopia
- smell something bc has olfaction
- KB syndrome
- retention of visual memories
40
Q
Kluver- Bucy Syndrome
- side
- HIPHIP
A
- bilateral
- hypermetamorphosis (excess/rapid change of idea), increased oral exploratory behavior (put everything in mouth), placditiy (no aggression), hypersex and phagia, impaired memory and psychic blindness (objects in visual field treated inappropriately)
41
Q
Blood supply of head and neck
- dual supply to brain
- internal bifurcation
- ant cerebral
- middle cerebral
- lenticulo striate
- vertebrals become
- post cerebral
- PICA
A
- internal carotid and vertebral a
- circle of willis (ant cerebral, middle cerebral)
- medial portion -> only frontal lobe of cerebrum
- lateral portion of cerebrum -> frontal, parietal and temporal lobes
- white matter, thal, basal ganglia; susceptible to chronic HTN and diabetes; lacunar infarcts
- basilar a -> ends as post cerebral a
- supply occiput, communicate with ant and middle cerebral forming circle of willis
- wind backwards behind medulla and goes to underside of cerebellum where it splits to medial (between 2 hemis of cerebllum) and lat (inferior surface of cerebellum)rul
42
Q
Rule of 4 to brain
- 4 strx in midline
- 4 strx on side
- 4 CN medulla, 4 in pons and 4 above pons
- 4 motor nuclei midline
A
- motor pathway (corticospinal tract), medial lemniscus (contralateral loss vibration and proprioception), medial long fasiculus (failure to ADduct ipsi eye to nose and nystag of contra eye as if it look lateral), motor nuc (ipsi loss of CN affected - 3, 4, 6, 12)
- ## spinocerebellar pathway (ipsi ataxia of arm and leg), spinothalamic pathway (contra pain and temp of arm/ leg), sensory nuc of 5th (ipsi alteration of pain and temp on face), symp pathway (ipsi horner syndrome)
43
Q
Epidural Trauma
- artery
- MCC
- sxs
- CT
- tx
A
- middle meningeal a
- fracture of temporal bone
- lucid interval
- lens shaped bleed
- neurosurgery consult for craniotomy
