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2nd Year - Systems 3 > Neuro anatomy > Flashcards

Neuro anatomy Flashcards

1
Q

Medulla oblongata

A

Viewed from dorsal surface of brainstem - gracile (medial) and cuneate (lateral) tubercles, round swellings on either side of midline - contain dorsal column nuclei, ascending sensory tract pathways

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2
Q

Sensory

A

Dorsal column:

  • fasciculus gracilis - T7 down
  • fasciculus cuneatus - T6 up
  • ipsilateral
  • fine touch, vibration, proprioception

Spinocerebellar:

  • proprioception
  • to cerebellum

Spinothalamic tract (= anteroateral):

  • contralateral
  • to thalamus
  • crude touch, pain, temperature

Three order neurones - 1st is DRG to medulla, 2nd is medulla to thalamus, 3rd is thalamus to post central gyrus

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3
Q

Fourth ventricle

A

Diamond shaped rhomboid fossa forms floor

Limits:

  • lateral - middle cerebellar peduncle
  • anterior - superior cerebellar peduncle
  • posterior - gracile + cuneate tubercles
  • inferior - obex
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4
Q

Tectum

A

Superior part of midbrain, above aqueduct

4 small swellings of grey matter, colliculi:

  • superior colliculus for vision
  • inferior colliculus for audio
  • reflex movement towards sight/sound
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5
Q

Third ventricle

A

In diencephalon

  • walls by thalamus and hypothalamus

+ epithalamus (containing pineal body) and subthalamus (both too small to see)

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6
Q

Thalamus

A

Symmetrical, two halves joined at interthalamic adhesion, flattened disc on medial surface

On either side of third ventricle

Each half is divided into anterior, medial, lateral parts by sheets of white matter

Contain nuclei for info to and from cerebral cortex

  • specific nuclei to restricted cortical areas
  • non-specific nuclei diffuse across cortex
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7
Q

Thalamic nuclei

A

Anterior nuclear group - from mamillary bodies to cingulate cortex (limbic system circuit of Papez)

Central posterior group - sensory information

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8
Q

Pineal body

A

In epithalamus

Endocrine gland

Synthesises melatonin

For circadian rhythm

Inhibitory effect on gonads

Often calcifies with age

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9
Q

Internal capsule

A

Contains cerebral cortical projection fibres
To and from frontal lobes - most anterior

Parietal fibres in between
To and from temporal/occipital lobes - posterior

Retrolenticular capsule: auditory to temporal (front), optic to occipital cortex (back)

Wraps around:

  • caudate nucleus (head and tail)
  • lentiform nucleus (inc globus pallidus and putamen)
  • thalamus
  • anterior and posterior horns of lateral ventricle
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10
Q

Somatosensory cortex

A

Primary - SI, Brodmann’s 1,2,3

  • postcentral gyrus
  • somatotopic representation of body

Secondary - SII
- extends posteriorly behind primary cortex down to lateral sulcus

Somatosensory association cortex - Brodmann’s 5
- posterior to primary cortex in superior part of parietal lobe

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11
Q

Brain cancer

A

15/100,000 new cases per year, prevalence increasing

50-70yo most common, but gliomas at any age

PRIMARY - 130 types, glioma most common

SECONDARY - 10x more common
- Skin Lung Kidney Breast Gastrointestinal
some love killing brain glioma

40% live to one year

Symptoms

  • raised ICP - headache, papilloedema, nausea and vomiting
  • focal neurological deficit - cranial nerve palsy, weakness
  • seizure
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12
Q

Locations of brain tumours and their effects

A

FRONTAL - personality change, difficulty planning, hemiparesis

TEMPORAL - hallucinations, seizure, word finding difficulty

PARIETAL - aphasia, sensory loss, agnosia

CEREBELLAR - ataxia, poor coordination, vertigo, diplopia

OCCIPITAL - visual loss

PITUITARY - bitemporal visual loss, endocrine changes

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13
Q

Sensory peripheral neuropathy

A

Glove and stocking distribution

Affecting touch, pain, temperature

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14
Q

Motor cortex

A

Includes:

  • primary motor cortex - Brodmann’s 4 - precentral gyrus and area immediately in front
  • premotor cortex - Brodmann’s 6 - immediately in front and to lateral surface of motor cortex, close connections with it
  • supplementary motor area - superior and medial surfaces of hemisphere above PMC

-> for voluntary movements of opposite side of body
upper/medial part - lower limb, perineum
lower/lateral part - trunk, upper limb, neck, head

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15
Q

Ventral pons and medulla

A

PONS
Groove (containing basilar artery) runs through
Middle cerebellar peduncles are striations out

MEDULLA
Partially divided by anterior median fissure
Pyramids immediately lateral to fissure on each side, mark position of underlying corticospinal/pyramidal tract fibres
80% corticospinal fibres decussate here
Olive to side of each pyramid - swellings containing inferior olivary nucleus, which are connected to contralateral cerebellar circuits to influence movement

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16
Q

Motor

A

Corticospinal tract (pyramidial):

  • voluntary movement below neck (corticobulbar for above neck)
  • in lateral tract, contralateral (90%)
  • in anterior tract, ipsilateral (10%)

Rubrospinal tract:

  • from red nucleus
  • unimportant in humans, upper limb flexion?

Reticulospinal tract:

  • from reticular formation
  • for visceral functions eg awake, breathing, maintaining muscle tone

Vestibulospinal tract:

  • from vestibular nuclei
  • for anti-gravity posture, limb extensors

Tectospinal tract:

  • from tectum
  • for reflex movements of head and neck to visual and auditory stimuli
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17
Q

Basal nuclei

A

Caudate nucleus (comma shaped mass grey matter)- striatum

Putamen (darker, lateral) - striatum, lentiform nucleus

Globus pallidus (lighter, medial) - lentiform nucleus

Subthalamic nucleus

Substantia nigra - black line between crus cerebri, destroyed in Parksinson’s so no dopamine

Claustrum - immediately deep to insular cortex, separated by extreme capsule

-> for practise, planning movement, intitiating movement. Gatekeeper, to inhibit or allow movement.

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18
Q

Cerebellum

A

Hindbrain

Two ovoid hemispheres joined in midline by median vermis

Outer cortex - highly folded layer grey matter

Inner core - white matter surrounding deep nuclei

Primary fissure separates anterior and posterior lobes

Tonsils at base of cerebellum - if raised ICP then shift down, coning, into foramen magnum

Flocculo-nodular node (posterior lobe)

  • floccules each side, nodule in middle
  • vestibular information
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19
Q

Examining cerebellar function

A

DANISH P

D - dysdiadochokinesis

A - ataxic gait

N - nystagmus (towards side of lesion)

I - intention tremor

S - slurred speech (dysarthia)

H - hypotonia

P - past pointing (dysmetria)

All signs ipsilateral to lesion!

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20
Q

Meningitis

A

Purpuric (non-blanching) rash - leeching of RBCs from vessels

Pus accumulates at meninges, so raised ICP

Stretching neck is painful, reduced consciousness

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21
Q

Cranial nerves and their roots in the brain

A

Olfactory - forebrain

Optic - forebrain

Occulomotor - midbrain

Trochlear - midbrain

Trigeminal (opthalmic, maxillary, mandibular) - pons hindbrain

Abducens - pons hindbrain

Facial - medullary-pontine junction hindbrain

Vestibulocochlear - medullary-pontine junction hindbrain

Glossopharyngeal - medulla hindbrain

Vagus - medulla hindbrain

Accessory - medulla hindbrain

Hypoglossal - medulla hindbrain

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22
Q

Olfactory nerve

A

Through cribiform plate

Special sense of smell - sensory only

Anosmia caused by infection/inflammation, nasal polyps, head trauma + associated fracture, frontal tumour

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23
Q

Optic nerve

A

Through optic canal

Special sense of sight - sensory nerve only

Clinically assess acuity + colour vision, fundoscopy, light reflex, accomodation, visual fields

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24
Q

Lesions of visual pathways

A

Total blindness of one eye - ipsilateral optic nerve damage

Bitemporal hemianopsia (can only see middle) - optic chiasm

Ipsilateral nasal hemianopia (lost medial one side) - part of optic nerve cut

Contralateral hemianopsia (one side of both eyes lost) - optic tract

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25
Occulomotor nerve
Through superior orbital fissure Motor - symp and parasymp to all muscles of eye except LR6SO4 Clinically tested with light reflexes and assessment of eye movements Palsy -\> dilated pupil, unresponsive to light, no accomodation, down and out eye, ptosis Palsy may be from aneurysm/atherosclerosis in basilar artery
26
Trochlear nerve
Through superior orbital fissure Motor to superior oblique Palsy -\> diplopia, esp looking down
27
Trigeminal nerve
OPTHALMIC - through superior orbital foramen - sensation to upper face MAXILLARY - through foramen rotundum - sensation to middle face MANDIBULAR - through foramen ovale - sensation to jaw and temporal regions, anterior 2/3 tongue - motor to muscles of mastication Clinically assess - touch across face, clench jaw and feel muscles of mastication
28
Abducens nerve
Through superior orbital fissure Motor to lateral rectus Palsy -\> unable to look laterally, diplopia
29
Facial nerve
Through internal auditory meatus and stylomastoid foramen Sensory - taste to anterior 2/3 tongue Motor - muscles of facial expression Parasympathetic - salivary and lacrimal glands Clinically assess - facial expressions x 5 UMN lesion -\> forehead sparing LMN lesion -\> Bell's palsy of whole face
30
Vestibulocochlear nerve
Through internal auditory meatus Sensory - balance and auditory Clinically assess - balance, Rhine's test (conduction), Weber's test (centre, localisation)
31
Glossopharyngeal nerve
Through jugular foramen Sensory - pharynx and ear, taste and sensation to posterior 1/3 tongue Motor - swallow, salivation to parotid Clinically assess with vagus
32
Vagus nerve
Through jugular foramen Sensory - pharynx, larynx, external ear, trachea, oesophagus Motor - swallow, speech (recurrent laryngeal) Parasymp - viscera Clinically assess with glossopharyngeal - look for uvula deviated away from lesion, speech ok, watch swallow
33
Accessory nerve
Through jugular foramen Two roots: - cranial - joins vagus after leaving brainstem - spinal - emerges then descends through foramen magnum Motor - sternocleidomastoid, trapezius Clinically assess - turn head, shrug shoulders against resistance
34
Hypoglossal nerve
Through hypoglossal canal Motor - tongue Clinically assess - tongue movements, push against cheek (tongue deviates towards affected side)
35
Sensory/motor function of cranial nerves
Sensory only - I, II, VIII Motor only - III, IV, VI, XI, XII Both - V, VII, IX, X
36
Eye
Bones of orbit: zygomatic most lateral, sphenoid, ethmoid, lacrimal, maxilla most medial and floor, + frontal bone above 6 muscle move eye Levator palpebrae superioris opens eyelid controlled by occulomotor, orbicularis occuli closes controlled by facial nerve 3 layers over eyeball: sclera, choroid, retina
37
Ear
Information -\> dorsal and ventral cochlear nuclei -\> inferior colliculus -\> medial geniculate nucleus -\> auditory cortex Tensor tympani and stapedius controlled by V3 trigeminal and branch of facial nerve, tense tympanic membrane to dampen sound Malleus, then incus then stapes hits oval window, ossicles
38
Speech areas
Wernicke's area - part of temporal lobe surrounding auditory cortex - perception and understanding of speech - lesions -\> receptive aphasia Broca's area - inferior part of temporal lobe - production of words (motor) - lesions -\> expressive aphasia Superior speech cortex - supplementary motor area
39
Subarachnoid haemorrhage
Thunderclap headache - berry aneurysm bursts - regard as SAH until proven otherwise 10/10 pain, confusion, neck stiffness following Associated with many other conditions
40
Brachial plexus
C5 and C6 -\> superior trunk (suprascapular nerve arises) C7 -\> middle trunk C8 and T1 -\> inferior trunk (long thoracic nerve arises from C5-7) (dorsal scapular nerve arises straight from C5) Branches from each -\> posterior cord (superior subscapular, thoracodorsal, inferior subscapular arise here) Superior trunk gains branch from middle, -\> lateral cord (lateral pectoral nerve arises here) Inferior trunk continues -\> medial cord (medial pectoral, medial cutaneous of arm, medial cutaneous of forearm) MUSCULOCUTANEOUS - from lateral cord MEDIAN - from lateral and medial cords joining AXILLARY - from posterior cord RADIAL - from posterior cord ULNAR - from medial cord
41
Clockwise from C4 C5, C6, C7, C8, T1 Long thoracic nerve Superior subscapular, thoracodorsal, inferior subscapular Medial pectoral, medial cutaneous of arm, medial cutaneous of forearm Ulnar, Median, Radial, Axillary, Musculocutaneous Lateral pectoral nerve Terminal nerves, cords, divisions, trunks, roots
42
Causes and consequences of damage to nerves of the brachial plexus
Axillary - shoulder, eg dislocation -\> numbness/weakness in shoulder, can't abduct arm Radial - mid humerus fracture -\> wrist drop Musculocutaneous - rare -\> weak flexion and supination of forearm Median - wrist -\> loss of flexion in proximal and distal interphalangeal joints of digits 2 + 3 Ulnar - elbow (funny bone) -\> claw hand, no fine motor control
43
Upper/lower brachial plexus injuries
UPPER - neck stretched, eg fall from motorbike - waiter's tip LOWER - underarm stretched, eg hanging from tree - claw hand
44
Terminal nerves of brachial plexus roots
Median and radial - all roots C5-T1
45
Lumbar plexus
L1-L5 I twice got laid on Friday: Iliohypogastric (larger) - L1 Ilioinguinal - L1 Genitofemoral (through psoas) -L1-2 Lateral cutaneous (under inguinal ligament) - L2-3 Obturator (obturator foramen) - L2-4 Femoral (through femoral triangle) - L2-4
46
Sacral plexus
S1-4 (L4 + L5 join to form lumbosacral trunk) Some irish sailor pesters Polly: Superior gluteal - L4-S1 Inferior gluteal - L5-S2 SCIATIC (fibular (anterior/lateral) and tibial (posterior) parts) - L4-S3 Posterior femoral cutaneous (skin posterior thigh) - S1-3 Pudendal (reenters via lesser sciatic foramen) - S2-4 - 'S234 keeps the shit off the floor' All exit via greater sciatic foramen
47
Causes and consequences of damage to the lumbosacral plexus
FEMORAL - femoral triangle (hip fracture, psoas absess) -\> weak quadriceps, numbness in medial thigh and anterolateral side leg OBTURATOR - childbirth/pelvic/abdominal surgery -\> parasthaesia + numbness of medial thigh, weak adduction, posture + gait problems SCIATIC - slipped disc/intramuscular infection of buttock/damage in groin or knee -\> weak knee flexion/plantar flexion/inversion COMMON PERONEAL - Zenker's paralysis (fracture of fibular neck) -\> foot drop, dorsal + lateral sensation loss on foot TIBIAL - knee dislocation, damage to popliteal fossa -\> no plantarflexion or toe flexion, weak inversion
48
Compartments of the leg
ANTERIOR - dorsiflexion, inversion (with posterior also) - deep peroneal nerve - anterior tibial artery LATERAL - eversion - superficial peroneal nerve - branch posterior tibial artery POSTERIOR - plantarflexion, inversion (with anterior also) - tibial nerve - branch posterior tibial artery
49
Upper and lower motor neurones
UMN - from cerebral cortex and brainstem - corticospinal and corticobulbar tracts are descending pathways to control LMNs - lesions eg stroke, intracranial bleed, cerebral palsy, MS, traumatic brain injury LMN - cranial nerves from brainstem and spinal nerves from ventral horn of the spinal cord - named nerves to specific muscles - lesions eg MND, specific nerve palsy, peripheral neuropathy, poliomyelitis
50
Peripheral neurological exam
INSPECTION TONE - increased UMN, decreased LMN lesion POWER - decreased UMN, specific decrease LMN lesion REFLEXES - brisk UMN, diminished LMN (Babinski sign UMN) SENSATION COORDINATION + clonus UMN, wasting/fasciculations LMN
51
Femoral nerve block
Local anaesthesia to femoral nerve supplying periosteum of femur - after femur neck/shaft fracture, knee or hip surgery CAREFUL - close proximity to major vessels - patient supine - draw line pubic tubercle to ASIS - needle in 2cm below inguinal ligament, 1cm lateral to femoral artery - feel two pops, fascia lata and fascia iliaca - pull back, ensure not in artery or vein - inject LA
52
Subdural haematoma
From moderate-severe blunt head trauma/falls -\> shearing injuries due to rotational or linear forces (likely tear of bridging veins between cortex and dural venous sinuses) Presentation: ACUTE - shortly after head injury SUBACUTE - 3-7day delay - lucid interval, then deterioration and loss of consciousness CHRONIC - 2-3week delay - gradual progression of anorexia, nausea + vomiting, neurological deficit Worse in the elderly - cerebral atrophy puts pressure on veins - and in those with impaired clotting CT shows crescent shape
53
Extradural haematoma
Likely middle meningeal artery ruptured, after blow to pterion 4x more likely in men, also in children and age 40-50 peaks Presentation: - high velocity head trauma - loss of consciousness - associated skull fracture - lucid interval, then sudden deterioration 10-15% mortality! Disc of blood pushing into brain tissue on CT
54
Association fibres
Run entirely in one hemisphere: 'U' (SHORT) FIBRES - between adjacent areas of cortex SUPERIOR LONGITUDINAL FASCICULUS - in core of hemisphere, to connect frontal parietal and occipital lobes CINGULUM - in cingulate gyrus extending to parahippocampal gyrus, to connect distant regions of cortex INFERIOR LONGITUDINAL FASCICULUS - connect temporal and occipital lobes + external capsule - between claustrum and putamen + extreme capsule - between claustrum and insular cortex
55
Commissural fibres
To a) unite cerebral hemispheres, bring together the two halves of the body as well as auditory and visual fields and b) unite areas of cortex which function in only one hemisphere CORPUS CALLOSUM - largest - has genu (anterior), body, splenium (posterior), rostrum (inferior arch) ANTERIOR COMMISSURE - thick bundle of white matter, between interventricular foramen to base of optic stalk/fornix - crosses midline horizontally between lamina terminalis POSTERIOR COMMISSURE - small bundle fibres at junction of midbrain to diencephalon, above tectum - fibres between superior colliculi and pretectal nuclei (important for vertical movements of eye) HIPPOCAMPAL COMMISSURE - at join of crus of fornix, cross midline inferior to splenium of corpus callosum
56
Projection fibres
INTERNAL CAPSULE - corticopectal axons (originate outsie telencephalon, project to cerebral cortex) - cortigofugal axons (arise from cerebral cortical cells, project to downstream targets)
57
Limbic system
Includes: Hippocampus Cingulate gyrus, cingulum, fornix Hypothalamus + mamillary bodies Amygdala Circuit of Papez is the circle of connections: Hippocampal formation ← Cingulate gyrus ↓ ↑ Mamillary bodies → Anterior nuclei of thalamus For learning, memory, emotion (affected in Alzheimer's, schizophrenia, epilepsy)
58
Components of limbic system
Hippocampus - rounded elevation in floor of inferior horn of lateral ventricle - infolding of cortex, with grooves giving 'paw-like' appearance - white matter fibres above stretch to become fornix Cingulate gyrus + cingulum - immediately dorsal (above) and parallel to corpus callosum Fornix - attached below septum pellucidum, fuse in midline and project back behind anterior commissure to mamillary bodies Mamillary bodies - contains mammillary nuclei of hypothalamus Hypothalamus - forms side wall and floor of third ventricle - centre for homeostasis and control of autonomic and neuroendocrine systems Amygdala - anterior and slightly superior to anterior hippocampus - receives major direct input from olfactory bulb
59
Ventricles
CSF produced by ependymal cells in choroid plexus, found in lateral, third and fourth ventricles CSF is colourless, some protein, few cells No -ve feedback system, so obstruction -\> hydrocephaly CSF enters subarachnoid spaces via lateral (foramen of Luschka) and medial (foramen of Magendie) apertures in 4th ventricle, then CSF circulating around the brain is reabsorbed via arachnoid granulations mainly in superior sagittal sinus (higher hydrostatic pressure in subarachnoid space than in venous sinus system)
60
61
Hydrocephalus
Increased volume of CSF in ventricles OBSTRUCTIVE = non-communicating - obstruction in ventricles - due to blood or space occupying lesion NON-OBSTRUCTIVE = communicating - usually reduced CSF reabsorption - infection, cancer - rarely increased CSF production - choroid plexus papilloma
62
Symptoms of hydrocephalus
BABY (unfused sutures) - fast head circumference growth - irritable - tense fontanelles - increased tone, rigidity - treat with surgery for ventriculostomy (drill hole in skull) or shunt to peritoneal cavity ADULT (fused sutures) - acute onset - headache, nausea + vomiting, papilloedema - chronic (normal pressure hydrocephalus) - wet, wacky, wobbly (urinary incontinence, dementia, ataxia) - treat acute onset with surgery for ventriculostomy (drill hole in skull) or shunt to peritoneal cavity - treat normal pressure with repeated lumbar punctures (never acute, as -\> coning, death)
63
Appearance of Alzheimer's brain
CORTICAL ATROPHY: Frontal - impaired executive function Temporal - impaired language HIPPOCAMPAL DESTRUCTION -\> impaired memory (appear enlarged ventricles)
64
Alcohol and memory
Disrupts formation of new long term memories by disrupting connections to and from hippocampus (established memories unaffected) - dose-dependent Chronic alcohol intake -\> thiamine (B1) deficiency, -\> direct damage to neurones and neuroglia ACUTE PHASE - Wernicke's encephalopathy - ataxia, confusion, opthalmoplegia - potentially reversible CHRONIC PHASE - Korsakoff's amnesia - general cerebral atrophy -\> amnesia, mamillary body damage -\> confabulation, thalamic nuclei links to limbic system damage -\> apathy -\> brain appears as in Alzheimer's
65
Multiple sclerosis
Lesions disseminated in time and space Optic nerve lesion -\> reduced visual acuity Internal capsule lesion -\> paraesthesia and limb weakness Brainstem/spinal cord lesion -\> bladder dysfunction Cerebellum lesion -\> ataxia and tremor

2nd Year - Systems 3 (10 decks)

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