NEURO BLOCK 1 Flashcards
What does the word lancinating mean
Knife like radicular pain
What is diplopia
Double vision
What is dysphagia
Difficulty swallowing
What is parasthesia
Burning, tingling, pricking
What is dyskenesia
Involuntary movements
What is the cerebellar portion of your brain responsible for
Coordinated movements
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When lesions are here it causes
Altered coordination
Abnormal equilibrium
Dizzyness, vertigo
Tremors
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Thunderclap head ache, or “worst head ache of my life… think
Subarachnoid Hemorrhage
Sudden blindness think..
Amaurosis fugax/ hypoperfusion to the retinal circulation
Back pain worse at night, think..
Cancer
Loss of bowel or urinary control think..
Cauda equina
What are the criteria for a focused physical neuro exam
General impression Mental Status Cranial nerves Motor System Reflexes Sensory Coordination Gait
A score of less than 24 on a mini mental status exam indicates..
Cognitive D/o
List the Cranial nerves
Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear (auditory) Glossopharyngeal Vagus Spinal Hypoglossal
Decreased muscle tone is most commonly a sign of what..
Decreased tone is most commonly due to lower motor neuron or peripheral nerve disorders.
How are DTRs graded
4/4: hyperactive +/- clonus 3/4: exaggerated response 2/4: “normal” 1/4: diminished response 0/4: absent reflexes
How is strength graded
0 = no movement 1 = flicker or trace of contraction but no associated movement at a joint 2 = movement with gravity eliminated 3 = movement against gravity but not against resistance 4– = movement against a mild degree of resistance 4 = movement against moderate resistance 4+ = movement against strong resistance 5 = full power
What is the motor, reflex, and sensation for C5
Motor: deltoid
Reflex: biceps reflex
Sensation: Lateral upper arm
What is the Motor, Reflex, sensation for C6
Motor: Wrist extension
Reflex: Forarm reflex
Sensation: radial side of forearm and hand (first two digits)
What is the motor, reflex, and sensation for C7
Motor: wrist flexion
Reflex: tricep tendon
Sensation: middle of palm and middle finger
What is the motor, reflex, and sensation for C8
Motor: finger flexion
Reflex: none
Sensation: Ulnar side of forearm and had ( last two digits)
What is the motor, reflex, and sensation for L4
Motor: tibialis anterior
( foot inversion)
Reflect: patellar tendon
Sensation: medial side of the foot
What is the motor, reflex, and sensation of L5
Motor: extensor digitorum longus
Reflex: none
Sensation: middle of the food
(Majority of toes)
What is the motor, reflex, and sensation for S1
Motor: peroneus longus and brevis (Foot eversion) Reflex: Achilles’ tendon Sensation: Lateral portion of foot (Pinky toe)
What is babinski sign
with upper motor neuron lesions above the S1 level of the spinal cord, a paradoxical extension of the toe is observed, associated with fanning and extension of the other toes
What is the palmomental response
A primitive reflex
Contraction of mentalis muscle ipsilateral to a scratch stimulus diagonally applied to the palm
T4-5 dermatomes is where
Across the nipple line
T 10 dermatomes is where
Umbilicus
What nerve root moves the trapezius
C3-4
What is the most important part of a neuro exam
Observation of gait
What platelet count is a C/I for lumbar puncture
A count less than 20,000
When should warfarin be stopped prior to lumbar puncture
4-5 days prior
When should ticlopidine or Clopidogrel be stopped prior to Lumbar puncture
D/c 14 and 7 days respectively
What is the landmark for a Lumbar o puncture
L3-4
What is the principle complication of lumbar puncture
Headache
Tx approach to headache caused by lumbar puncture
Analgesics, caffeine or epidural blood patch
Are there any C/I to EEG
No
What are the 4 Indications for CT in neuro
Stroke or Sub Arac Hem
Tumor ( -/+ contrast)
Trauma
dementia
(Detect atrophy, hydrocephalus)
What is the definition of contrast nephropathy
A rise in serum creatinine of at least 0.5 mg/dL within 48 h of contrast administration is often used as a definition of contrast nephropathy
When should Creatinine testing be done for CT
Age >60
History of “kidney disease” as an adult, including tumor and transplant
Family history of kidney failure
Diabetes mellitus treated with insulin or other prescribed medications
Hypertension
Paraproteinemia syndromes or diseases (e.g., myeloma)
Collagen vascular disease (e.g., SLE, scleroderma, rheumatoid arthritis)
Solid organ transplant recipient
The American college of Radiology recommends GFR assessment with MRI on what criteria
Must be obtained within 6 weeks before MRI if:
A history of renal disease (including solitary kidney, renal transplant, renal tumor)
Age >60 years
History of hypertension
History of diabetes
History of severe hepatic disease, liver transplant, or pending liver transplant; for these patients, it is recommended that the patient’s GFR assessment be nearly contemporaneous with the MR examination.
What is a pet scan
Positron emission tomography
Functional imaging study
Demonstrates perfusion and metabolic activity
What is the use of Myeolgrpahy
Inject contrast through LP needle to visualize subarachnoid space
Evaluate degree of cord compression, AVMs, epidural abscesses, and tumors
Are sensory neurons afferent or efferent
Afferent
Are motor nuerons afferent or efferent
Efferent
Where is the development of the CNS and PNS
CNS is from the neural tube (Brian and spinal cord)
PNS is from the neural crest
At what week of fetal development does the Nervous system begin
Week 3
What is the first step in neural plate development
Thickening of the ectoderm
What happens after the ectoderm thickens in NS plate development
The neural plate folds inward forming a longitudinal groove or neural groove.
What are the 3 layers of the neural tube
The outer layer (marginal layer) cells develop into white matter.
The middle layer (mantle layer) cells develop into gray matter.
The inner layer (ependymal layer) cells eventually form the:
- Lining of the central canal of the spinal cord
- Ventricles of the brain.
White matter develops from…
The marginal layer of the neural tube
Gray matter develops from
The mantle layer of the neural tube
The lining of the central canal of the spinal sword and the ventricles of the brain develop from ..
The ependymal layer of the nueral tube
What does the nueral crest give rise to
Dorsal/posterior root ganglia of spinal nerves
Spinal nerves
Ganglia of cranial nerves.
Cranial nerves
Ganglia of the ANS
Adrenal medulla
Meninges
When does nueral tube closure happen ( at what week/ days )
26-28 days post conception
What are the 3 major neural tube defects
Anencephaly, Encephalocele, Menigomyelocele
What is anencephaly
Failure of the anterior neuropore to close.
Cranial bones fail to develop and brain degenerates
1:1000
2 to 4x more common in females than males
What is myleomenigiocele
AKA Spina bifida
Failure of the posterior neuropore to form.
Most commonly in the sacrolumbar region (80%)
What supplements can be added to reduce the RSK of neural tube deficits
Folic acid ( 0.4 mg q day) (one month prior to conception)
High risk? (4mg q day) (3 months prior to conception)
What are the 4 major parts of the Brain
Brain stem
Cerebellum
Diencephalon
Cerebrum
What are the 3 parts of the brain stem
Medulla
Pons
Midbrain
What are the two major parts of the diencephalon
Thalmus and the Hypothalmus
What is the connection between R and L hemispheres of the brain
The corpus Callosum
Destruction of the motor and pre motor cortex of the frontal lobe leads to..
Spastic paresis
Destruction of the frontal eye field of the frontal lobe leads to..
Ipsilateral deviation of the eyes
Where is brochas speech area located
In the posterior frontal gyrus of the dominant hemisphere
What are the results of damage to the prefrontal cortex
Destruction of the anterior 2/3 results in deficits in concentration, orientation, abstracting ability, judgment, and problem solving.
Destruction in other areas may cause loss of initiative, inappropriate behavior, gait apraxia, sphincteric incontinence.
Destruction of the orbital portion results in inappropriate social behavior such as use of obscene language or urinating in public
What is the result of damage to the primary auditory cortex in the temporal lobe
Loss of hearing (cortical deafness)
Where is wernickes speech area located
Posterior part of the superior gyrus of the temporal lobe
Where is meyers loop located and what happens if it is damaged
In the temporal lobe, and Interruption results in contralateral homonymous superior quadrantanopia (pie in the sky)
Where are the olfactory bulb, tract, and primary cortex located
In the temporal lobe, responsible for smell
Where is the hippocampal cortex located
In the temporal lobe
Bilateral lesions result in inability to consolidate short-term memory into long term memory.
What is prosopagnosia
Inability to recognize faces
A function of the inferiomedial occipitotemporal complex
What is asterognosis
The ability to ID objects by feel only
Close eyes and ID an object by touch
Where is the sensory cortex located
In the parietal lobe
What is the result of damage to the superior parietal lobe
Destruction results in contralateral astereognosis and sensory neglect
What is the result of damage to to the inferior parietal lobe
Leads to topographic memory loss, anosognosia, construction apraxia, dressing apraxia, contralateral sensory neglect, and contralateral hemianopia or lower quadrantanopia
What is the most common transmitter at postganglionic sympathetic neurons
NE
What is the major inhibitory NT of the brain
GABA
What is the major inhibitory NT of the spinal cord
Glycine
What is the major excitatory NT of the brain
Glutamate
What is the single most common finding in aphasia pts
Anomia ( a deficit of naming)
What is non fluent aphasia
Brocas
What is fluent aphasia
Wernickes
Neglect is a sign of..
Cortical D/o of the right frontal or parietal lobes
What are the components of the basal ganglia
the globus pallidus
The Putamen make up the lentiform nucleus and combined with the
The caudate nucleus
make up the corpus straitum
What is the function of the basal ganglia
Coordianate muscle aditivo y
Damage to the basal ganglia results in..
Damage to the basal ganglia results in uncontrollable shaking (tremor), muscular rigidity (stiffness), and involuntary muscle movements.
(All Parkinson’s criteria eg: Cogwheel stiffness)
Parkinson’s:
dopamine-producing neurons of the basal ganglia degenerate
Huntington’s disease:
damage to the corpus striatum
What is the “master control for the ANS”
Hypothalmus
Also controls the pituitary gland
What is the epithalmus
The pineal gland
What are the 5 structures that make up the limbic system
Amygdala Cingulate Gyrus Midbrain Raphae Locus Ceruleus Hippocampus
What is the function of the limbic cortex
Emotion, eating, and reproduction
What is the function of the amygdala
Chief role in the memory of emotional experiences
Central role in behavioral responses to fear
What is the role of the hippocampus
Integrator of incoming novel and unpleasant stimuli.
Connects w/ temp. lobe closely
May predict the next event based on what has already happened.
What are the 3 functions of the cerebellum
Sensory perception
Coordination
Motor control
Do lesions in the cerebellum lead to paralysis
No
Instead they cause feedback D./o
Posture
Equilibrium
Motor Learning
Like ataxias
What is the difference between the pyramidal and extra pyramidal functions of the midbrain
Tracts responsible for movement pass through here
Pyramidal:
Voluntary movements
Extrapyramidal:
Involuntary movements
Posture/adjustments/coordination
Where is the RAS located and what is its function
The pons Contains the RAS and controls respirations
Is the Consciousness center
Where does the spinal cord extend to (what vertebra)
L1-2
Gray matter in the spinal cord is what
Nerve cell bodies
White matter in the spinal cord is what
Mylienated nerves
Where do Upper motor nuerons originate
In the cortex and Brain stem
Where do Lower motor nuerons originate
Begin in the anterior horn of the spinal column
In the spinal cord:
The anterior root has what kind of fibers
The posterior root has what kind of fibers
Anterior: motor (efferent)
Posterior: sensory (afferent)
What is the function of the coticospinal tract
Voluntary motor activity
What is the function of the spinothalamic tract
Pain, temp, light/crude touch, pressure
What is the function of the dorsal columns of the spinal tract
Fine touch, 2 point discrimination, and proprioception
How do the spinthalamic tract and dorsal column ascend up the spinal cord
Spinothalamic: enter and cross midline immediately
Ascend to the thalamus in the spinothalamic tract, on opposite side
Dorsal columns: Sensory impulses ascend up the same side as fibers enter the cord
Fibers cross the midline at medulla
Cord lesions of the corticospinal tract produce
Ipsilateral S/s
Cord lesions of the dorsal columns produce
Ipsilateral S/s
Cord lesions of the spinothalamic tract produce
Contralat s/s
What is the blood flow through the circle of Willis
- Internal carotid artery
- Vertebral artery
- Cavernous sinus
- Carotid canal
- Anterior cerebral artery
- Posterior cerebral artery
Poor circulation in the anterior cerebral artery affects what area
The lower limb area of the motor cortex
Poor perfusion to the middle cerebral artery has effects where
Affects the face and upper limb
are of the motor cortex
Also affects the dominant language hemisphere
Occlusion of either the ACA or MCA may lead a devastating stroke
Poor profusion to the basilar artery has effects where r
Leads to both Left and Right PCA
Occlusion of the vertebrobasilar system leads to “drop attacks”
Complete occlusion results in blindness
What are the 4 vessels that make up “posterior circulation:” of the brain
The superior cerebellar artery
The posterior inferior cerebellar artery
The anterior inferior cerebellar artery
And the basilar artery
What are the 3 layers of the meninges
Dura mater: outermost layer
Arachnoid mater: lies above the subarachnoid space
Pia mater: the delicate inner layer that directly covers the brain
Where is CSF secreted from
Secreted by choroid plexus, absorbed in subarachnoid space
What is an encephaloele
Nueral tube defect
Anterior pore defect
Least common of the 3 NTD
Classification is based on location
Occipital is the most common encephalocele
What is the function of the ANS
Regulates glands, smooth muscle, cardiac muscle
Sympathetic: fight or flight
Fibers exit spinal cord at T1-L2
Parasympathetic: Restorative, conserve energy
Fibers exit through CN III, VII, IX, X, and S2-S4 to gut and bladder
Hypothalamus provides the master control for ANS
