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neuro Flashcards

1
Q

Neural development

A

Notochord induces overlying ectoderm to differentiate into neuroectoderm and form neural plate

Neutral plate gives rise to nueral tube and neural crest cells

Notochord becomes nucleus pulposus of intervertebral disc in adults

Alar plate (dorsal): sensory; regulated by TGF B (including BMP)

Basal plate (ventral): motor; regulated by SHH

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2
Q

Regional specification of developing brain

A

Telencephalon is the 1st part
Diencephalon is the 2nd
The rest are arracnged alphabetically: mesencephalon, metenncephalon, myelencephalon (Ms are in alphabetical order)

Midbrain and cerebral aqueduct- mesen cephalon

Meten myelencephalon

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3
Q

Central and peripheral nervous systems origins

A

Neuroepithelia in neural tube- CNS neurons, ependymal cells (inner lining of ventricles, make CSF) oligodenderocytes, astrocytes

Neural crest- PNS Schwall cells, glia, melanocytes, adrenal medulla

Mesoderm- Microglia (like Macrophagees)

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4
Q

Neural tube defects

A

increased aFP

increased achE

spinabifida occulta- lower vertebral levels, dura intact, with tuft of hair

Meningocele- meninges under skin
Myelomeningocele- plus CNS parts

Myeloschisis- no skin, SHIT we see spina cord
Anencephaly- polyhydramnios

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5
Q

holoprosencephaly

A

embryonic forebrain does not separate into 2 cerebral hemispheres during weeks 5-6
SHH gene is fucked up
other midline defects

Pituitary dysfunction (diabetes insipitus)

Parau syndrome trisomy 13

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6
Q

Lissencephaly

A

failure of neuronal migration - smooth brain, microcephaly ventriculomegaly

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7
Q

Posterior fossa malformation

A

Chiari 1 malformation- tonsils go in foramen magnum, usually asymptomatic in , headackes, with spinal cavitations

Chiari 2 malformation- vermis and tonsils –> aqueductal stenosis–> non communicating hydrocephalus

lumbosacaral meningoseel, more severe

Dndy Walker- agenesis of cerebellar virmis–> cystic enlargement 4th ventricle

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8
Q

Syringomyelia

A

cystic cavity (syrinx) within central canal of sp cord.

The fibers crossing at anterior white commissure (spinothalamic tract) are typically damaged first. Cape like bilateral loss of pain and temp sensation in upper extremities (fine touch preserved

Chiari 1 malformation association, Cervica> Throaci>lumbar

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9
Q

tongue development

A

1st and 2nd pharyngeal arches form anterior 2/3 (thus sensation via CN V3 taste via CN7)

3rd and 4th pharyngeal arches form posterior 1/3 (thus sensation and taste mainly via CN9 (glosopharyngeal) extreme posterior via CN X

Motor innervation is via CN 12 (hypoglossal) to hypoglossal retracts and depresses tongue), genioglossus (protrudes tongue), and styloglossus (draus sides of tongue upward to create a trough for swallowing

Motor innervation is via CNX to palatoglossus elevates posterior tongue during swallowing)

The Genie comes oudt of the lamp in style

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10
Q

Nissl stain and neurons

A

Nissl stains RER in cell bodies and dendrites

RER not present in axon

Neuron markers- neurofilament protein, synaptophysin

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11
Q

Astrocytes

A

Most common glial cell type in CNS
Physical support, repair, extracellular K buffer, removal of excess NTs, component of BBB, Glycogen fuel reserve buffer, Reactive gliosis in response to neural injury

Neuroectroderm
GFAP

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12
Q

Microglia

A

Phagocytic scavenger cells of CNS (mesodermal, monocyte)

Activation in response to tissue damage–> release of inflammatory mediators (NO, glutamate) Not readily discernible by Nissl stain

HIV infection microglia fuse to form multinucleated giant cells in CNS seen in HIV Associsates dementia

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13
Q

ependymal cells

A

ciliated simple columnar glial cells line ventricles

cilia beat CSF

microvilli CSF absorption, specialized ependymal cells (choroid plexus) produce CSF

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14
Q

Myelin

A

increased conduction velocity of signals transmitted–> saltatory conduction of AP at the nodes of Ranvier, where there are high concentration of Na channel

in CNS (including CN2) myelein is synthesized by Oligodendrocytes- in PNS myelin is synthesized by Schwann cells

Wraps and insulates axons, oligodendrocytes myelinate multiple parts of the axon

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15
Q

Schwann cells

A

Promote axonal regeneration, derived from neural crest

Each shwann cell myelinates only 1 PNS axon, injured in guillein Barre syndrome

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16
Q

Oligodendrocytes

A

myelinate axons of neurons in CNS each oligodendrocyte can myelinate many axons

Predominant type of glial cell in white matetr

Neuroectoderm , fried egg appearance histologically injured in MS, PMLm leukodystrophy

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17
Q

Sensory receptors

A

Free nerve endings (A delta plane is fast, but a taxC is Slow)- all skin, epidermis, some viscera, pain and temp
A delta- fast myelinated fibers
C slow- unmyelinated

Meissners corpuscle- large myelinated fibers, adapt quickly, Glabrous (hairless skin)- Dynamic, fine/light touch, position sense, low frequency vibration

Pacinian corpuscles- large, myelinated fibers; adapt quickly, deep skin layers, ligaments, joints, High frequency vibration, pressure (DEEP meissners)

Merkel discs- large myelinated fibers- adapt slowly, finger tips and superficial skin, Pressure, deep static touch (shapes edges, position sense- (Merkel has a K in it with lots of edges and bends)

Ruffini corpuscles- Dendritic endings with capsule, adapt slowly, finger tips joints- pressure, slippage of ocjects along surface of skin, joint angle change

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18
Q

Peripheral nerve

A

Endoneurium- thin, supportive connective tissue that ensheathes and supports individual myelinated nerve fibers

Perineurium- blood nerve Permeability barrier, surrounds a fascicle of nerve fibers

Epineurium- dense connective tissue that surrounds entire nerve, fascicles and blood vessels

Endo, Peri Epi (outer)

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19
Q

Chromatolysis

A

Reaction of neuronal cell body to axonal injury. Changes reflect increased protein synthesis in effort to repair the damaged axon, Characterized by:
round cellular swelling, displacement of nucleuys to periphery, dispersion of nissl substance throughout cytoplasm

Wallerian degeneration- disintegration of the axon and myelin sheal distal to site of axonal injury with macrophages removing debris

Proximal to the injury, the axon retracts, and the cell body sprouts new protrusion that grow toward other neurons for potential reinnervation, serves as prep for axonal regeneration and functional recobery

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20
Q

Neurotransmitter sites of synthesis and diseases

A

Acetylcholine- Basal nucleus of meynert (decreased in alzheimers, huntington, and increased in parkinson)

Dopamine- Ventral tegmentum, SNc- decreased in Depression and parkinsons, increased in schizophrenia and huntington

GABA- Nucleus accumbens- decreased in anxiety and huntington

NE- Locus Ceruleus in pons

Sir Raphe (serotonin - raphe nuclues)
No 4 Loko for me (norepi - locus ceruleus)
Aggumbens, the c’s kinda look like g’s (GABA - accumbens)
Ace the test like a nerd (Ach - basal nucleus of Meynert)

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21
Q

Meninges

A

Dura- thick outer closest to skull, derived from mesoderm
Arachnoid mater-middle layer contains web like connections, derived from neural crest
Pia mater- thin fibrous inner layer also from neural crest

CSF Flows in the subarachnoid space located between arachnoid and pia mater, epidural space- between dura and skull, middle meningeal artery injueyr

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22
Q

BBB

A

Prevents circulating blood substances (bacteria, drugs) from reaching the cSF/CNS formed by 3 structures
Tight junctions between nonfenestrated endothelium, basement membrane and astrocyte foot processes

Glucose and AAs cross slowly by carrier-mediated transport mechanisms

Non polar/ lipid soluble substances cross rapidly via diffusion

Area postrema in medulla, OVLT (osmoreceptors in Posterior pituitaray) no BBB, infarct or neoplasm destroys endothelial cell tight junctions –> vasogenic edema Hyper osmolar agent (mannitol)can disrupt of medication permeability

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23
Q

Vomiting center

A

coordinated by nucleus tractus solitarius in the medulla, which recieves info from the chemoreceptor trigger zone (CTZ, located within area postrema in 4th ventricle, GIT (via vagus nerve ), vestibular system and CNS

CTZ receives 5 major receptors- Muscarinic (M1), dopamine (D2), histamine (H1), Serotonin 5HT3, Neurokinin NK1 receptors

5HT3, D2 and NK1 antagonists used to treat chemotherapy- induced vomiting
H1 and M1 antagonist treat motion sickness; H1 antagonist treat hyperemesis gravidarum

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24
Q

sleep physiology

A

Sleep cycle is regulated by circadian rhythm, which is driven by suprachiasmatic nucleu of the hypothalamus

Circadian rhythm controls nocturnal release of ACTH, prolactin, melatonin, NE SCN–> NE release–> pineal gland–> increased melatonin

SCN regulated by Light
2 stages- rapid and non rapin REM

Alcohol, benzos, and barbiturates– decreased REM sleep and N 3 sleep ne also decreases REM sleep

Benzos are useful for night terrors and sleepwalking by N3 decrease and decrease REM sleep

25
Q

Sleep stages

A

Awake open eyes- Alert, active mental concentration, Beta (highest frequency, lowest amplitude),

Awake, eyes closed- Alpha waves

Non REM sleep -
N1- light sleep- Theta waves
N2- deep sleep when bruxism (twoth grinding occurs, Sleep spindles and K complexes
N3- Deepest non REM sleep, slow wave sleep, sleepwalking, night terrors, bedwetting occur wee and flee in N3. Delta lowest freq, highest amp

Rem Sleep- toss of motor tone, increased brain O2 use, increased AcH, dreaming, nightmares and erection, memory processing function, Paramedian pontine reticular formation/ conjugate gaze center), every 90 minutes and duration increases throught night, Betaelderly decreased, and N3, depression increases

At night BATS Drink Blood

26
Q

Hypothalamus

A

Maintains homeostasis by regulating the hormones
Thirst and and water balance, controlling adenohypophysis (anterior pituitary), and neurohypophysis (posterior pituitary) release of hormones produced in the hypothalamus, and regulating Hunger, Autonomic nervous system, Temperature and sexual urges

Inputs (areas not protected by BBB, OVLT (senses changes in osmolarity), area postrema (found in dorsal medulla, respinds to emetics)

27
Q

Lateral nucleus

A

Hunger- destruction–> anorexia, FTT stimulated by ghrelin, inhibited by leptin

Lateral injury makes you lean

28
Q

Ventromedial nucleus

A

Satiety, Destruction– hyperphagia, Stimulated by leptin

Ventromedial injury makes you very massive

29
Q

Anterior nucleus

A

Cooling parasympathetic, AC- Anterior Cooling

30
Q

Posterior nucleus

A

Heating sympathetic- Heating controlled by Posterior nucleus - Hot pot

31
Q

Suprachiasmatic nucelus

A

Circadian rhythm- SCN is a Sun censing nucleus

32
Q

Supraoptic and paraventricular nuclei

A

Synthesize ADH and oxytocin
SAD POX- supraoptid ADH, Paraventricular- oxytocin

ADH and oxytocin are carried by neurophysins down axons to posterior pituitary, where these hormones are stored and released

33
Q

Pre optic nucelus

A

thermoregulation, sexual behavior, releases GnRH

Failure of GnRH -producing neurons to migrate from olfactory Pit- Kallmann syndrome

34
Q

Thalamus

A

major relay for all ascending sensory information except olfaction

35
Q

VPL (Ventral Postero-Lateral nucelus)

A

from spinothalamic and dorsal columns/medial leminsuc

Vibration, Pain, pressure, Proprioception, Light touch, temperature

goes to 1’ somatosensory cortex

36
Q

Ventral posterMedial nucleus

A

Trigeminal and gustatory pathway, Face sensation, tast

1’ somatosensory cortex, Makeup goes on the face

37
Q

Lateral geniculate nucleus

A

CN 2, optic chiasm, optic tract- to 1’ visual cortex (calcarine sulcus)

Vision
Lateral for light

38
Q

Medial geniculate nucleus

A

Superior Olive and inferior colliculus of testum

Hearing

Auditory cortex of temporal lobe

Medial– music

39
Q

Ventral lateral nucleus

A

Cerebellum, basal ganglia

Motor
Motor cortex

40
Q

Limbic system

A

Collection of neural structure involved in emotion, long term memory, olfaction, behavior modulation, ANS function

Hippocampus, amygdala, mammry anterior thalalamuc
Thalamic nuclei, cingulate gyrus, entorihnal cortex

Feeding Fleeing Fighting, Feeling Fucking

41
Q

Dopaminergic path

A

drugs (anipsychotics) and movement disorders, parkinson)

Mesocortical negative symptoms, antipsychotics have limited effect

Mesolimbic positive symptoms

Nigrostriatal- extrapyramidal symptoms, dopainergeic

Tuberoinfundibular- prolactin libido

42
Q

Cerebellum

A

movement, coordination and balance

Input from contralateral cortex via middle cerebellar peduncle, ipsilateral proprioceptive information via inferior cerebellar peduncle from spinal cord

Output- the only output of cerebellar cortex is the purkinje cells, always inhibitory–> deep nuclei of cerebellum–> contralateral cortex via superior cerebellar peduncle

Deep nuclei (lateral -> medial) Dentate, Emboliform Globose, Fastigial

Lateral lesions- affect voluntary movements of extremities, fall toward injured side

Medial lesions- tuncal ataxia, wide gate, nystagmus, head tilting, bilateral issues proximal structures

43
Q

basal ganglia

A

important in voluntary movements and adjusting posture

Receives cortical input, provides negative feedback to cortex to modulate movement

Striatum= putamen + Caudate (cognitive)
Lentiform= putamen + globus pallidus

Direct (excitatory) pathway- SNc input to the striatum via the nigostriatal dopaminergic pathway releases GABA, which inhibits GABA release from the GPi, disinhibiting the Thalamus via GPi (increased motion) D1 Receptor (DIRECT)

The Indirect (inhibitory) pathway- SNc input to the striatum via the nigrostriatal dopaminergic pathway releases GABA that disinhibits STN via GPe inhibition, and STN Stimulates GPi to inhibit the thalamus (decreases motion)

Dopamine binds D1, stimulating the excitatory pathway, and to D2 inhibiting pathway–> increased motion

44
Q

Cerebral perfusion

A

Relies on tight auto-regulation
Primarily driven by PcO2

Therapuetic hyperventilation–> decreased PcO2–> vasoconstriction–> decreased cerebral blood flow decreases ICP

increased CO2 –> vasodilation

decreased blood pressure or increased ICP–> decreased cerebral perfusion pressure

45
Q

Watershed zones

A

Cortical border zones occur between anterior and middle cerebral and posterio and middle cerebral arteries

internal border zones between the superficial and deep vascular territories of the middle cerebral artery

proximal and lower extremity weakness
higher order vision if PCA.MCA

46
Q

Dural venous sinuses

A

large venous channels that run through the periosteal and meningeal layers of the dura mater, drain blood from cerebral veins and receive CSF from arachnoid granulations, empty into internal jugular vein

Venous sinus thromboembolism

increased ICP – can lead to venous hemorrhage, associated with hypercoagulable states (pregnancyOCP use, factor V leidin)

47
Q

Path of ventricular CSF to venous system

A

Foramen of Megendie and Foramina Luschka go to subarachnoud space, where its reabsorbed by arachnoid granulationsin venous sinus to internal jugular vein

48
Q

CNs and where they come from

A

4CN are above pons (1 2 3 4)
4 CN ext at the pons (5 6 7 8 )
4 are in medulla (9 10 11 12)
4 nuclei are medial (3 4 6 12

CN 5 exits via Standing Room Only (superior orbital fissure, Rotdundum, Ovale

49
Q

Vagal nuclei

A

Nucleus Tractus Solitarius (Visceral Sensory information (taste baroreceptors, gut distention (7 9 10)

Nucleus aMbiguous- Motor innervation of pharynx, larynx, upper esophagus, swallowing palate elevation 9 10 11

Dorsal motor nucleus- Sends autonomics (parasympathetic fibers heart lungs upper GI) 10

50
Q

Cranial nerve reflexes

A

Corneal reflex- V1 opthalmic (nasociliary branch)–> Bilateral 7 of temporal branch)

Lacrimation- V1 –> 7

Jaw jerk V3 –> V3

Pupillary- 2 –> 3
Gag 9-> 10
Cough 10-> 10

51
Q

Mastication muscles

A

3 muscles close the jaw- Masseter, teMporalis, Mediall pterygoid

1 opens- Lateral pterygoid

Lateral lowers

all are innervated by V3

52
Q

Spinal nerves

A

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Nerves C1-C7 exit above the vertebrae
C8 belowC7 and above T1

All aother below

53
Q

Spinal cord- lower extent

A

in adults, spinal cord ends at lower border of L1-L2 vertebrae

Subarachnoid Space extends to lower S2
Lumbar punbtuire L3-L4 L4-L5

Needle passes thru skin, fascia and fat, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, duramater, arachnoid, Subarachnoid

54
Q

Spinal cord and associated tracts

A

Legs (lumbosacral) are lateral in lateral corticospinal, spinothalamic tracts, thoracic spinal cord has intermediate column

Dorsal columns are organized with hands at sides and legs inside

Ascending dorsal columns- fasiculus gracilis and cuneteus (lower and upper body with pressure, vibration, fine touch, proprioception)

Ascending lateral spinothalamic tract (pain and temperature, Sacral on out, cervical medial). Anterior spinothalamic tract (crude touch, pressure)

DESCENDING
Anterior corticospinal tract- voluntary motor

Lateral corticospinal tract (voluntary motor sacral on out cervical in middle)

55
Q

Ascending Dorsal column

A

Pressure vibration, fine touch, proprioception

1st order neurons: sensory nerve ending–> bypasses pseudounipolar cell body in dorsal root ganglia–> enters spinal cord–> ascends ipsilateral in dorsal columns

Synapse 1: Nucleus gracilis and cuneatus in the ipsilateral medulla

2nd order neuron: Decussates in medulla–> Ascends contralaterally as the medial lemniscus

VPL and the thalamus–> sensory cortex

56
Q

Spinothalamic tract

A

Function: Lateral pain and temperature
Anterior: Crude touch, pressure

1st order neuron: sensory nerve ending (A delta and C fibers–> bypasses pseudounipolar cell body in dorsal root ganglion –> enters spinal cord

1st synapse: ipsilateral gray matter (spinal cord)

2nd order neuron: decussates in spinal cord as the anterior white commisure –> ascends contralaterally

ends at VPL and sensory Cortex

57
Q

Lateral corticospinal tract

A

Descending tract
Volunary movement of contralateral limbs

Upper motor nuerun: cell body in 1’ motor cortex–> descends ipsilaterally through posterior limb of interal capsule and cerebral peduncle, most fibers decussate at caudal medulla (pyrimidal decussation)–> descends contralaterally

Cell body of anterior horn (spinal cord)

LMN leaves spinal

NMJ mesucle fibers

58
Q

Primitive reflects

A

CNS reflex that are present in infants but disappear in 1st year

Moro reflex- hang on for life reflex- abduct/ extend arms when startled, and then draw together

Rooting reflex- movement of head toward side of cheek or mouth, nipple seeking

Sucking reflex
Palmar reflex- curling of fingers
Plantar reflex- dorsiflextion of large toe and fanning with plantar stimulation, Babinski is when its present in adulthood
Galant reflex- spine

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