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Year 2 > Neuro HARC > Flashcards

Neuro HARC Flashcards

1
Q

The anterior cerebral circulation emerges from?

A

the internal carotid arteries

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2
Q

The posterior cerebral circulation emerges from?

A

Vertebral arteries

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3
Q

An occlusion of the _____ _______ ______results in loss of strength and sensation in the lower part of the body due to the distribution of the homunculus on the pre-central gyrus of the frontal lobe

A

anterior cerebral artery

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4
Q

An occlusion of the ______ _____ _______predominately affects strength and sensation in the upper regions of the body.

A

An occlusion of the middle cerebral artery predominately affects strength and sensation in the upper regions of the body.

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5
Q
A
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6
Q

Arterial vasculature of the Brain

A
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7
Q

_____ _____ _____arise from the first portion of the anterior cerebral artery

A

Medial striate arteries arise from the first portion of the anterior cerebral artery

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8
Q

____ ____ _____ arise from the first part of the middle cerebral artery

A

lateral striate arteries arise from the first part of the middle cerebral artery

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9
Q

Blockage of the circulation in the vertebral and basilar arteries affects the circulation to what specific area of the cerebrum? Symptoms shown may result in visual loss and dizziness. Explain your answer

A

Because the vertebrobasilar circulation becomes the posterior cerebral arteries which supply the visual cortex as well as the cerebellar arteries supplying the cerebellum, hence the dizzines

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10
Q

An occlusion of which area of the circle of Willis would cause total unilateral blindness?

A

Ophthalmic artery

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11
Q

An occlusion of the basilar artery at the junction of the two posterior cerebral arteries will result in?

A

Total blindness

because the posterior cerebral arteries supply the visual cortex

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12
Q

What are the three main arteries that supply the cerebellum?

A

Posterior inferior cerebellar artery (PICA)

Anterior inferior cerebellar artery (AICA)

Superior cerebellar artery (SCA)

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13
Q
A
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14
Q

What can lead to specific cerebellar dysfunction?

A

Occlusion of the cerebellar circulation

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15
Q

Symptoms of cerebellar dysfunction include:

A
  • Wide-based ataxia: tilting/falling to the same side as the cerebellar lesion and poor coordination of movement, including slurred speech
  • Dysmetria: overshooting when reaching for a target
  • Dysdiadochokinesia: inability to perform rapid alternating movements (finger tapping)

• Intention Tremor: evident during purposeful movements

• Nystagmus: rapid involuntary movements of the e

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16
Q

How do the cerebellar arteries supply the brainstem on their way to the cerebellum?

A

Because the cerebellar arteries arise from the vertebrobasilar system (which sits on the brainstem), they send additional arteries supplying the brainstem before terminating at the cerebellum

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17
Q

Specific areas of cerebellar cortex supplied by cerebellar arteries

A

Green: SCA territory

Yellow: AICA territory

Red: PICA territory

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18
Q

To view the blood supply of the brain, ________ _______can be injected to view whether a vessel is blocked or leaking or in an abnormal form due to a tumour or haemorrhage

A

To view the blood supply of the brain, contrast material can be injected to view whether a vessel is blocked or leaking or in an abnormal form due to a tumour or haemorrhage

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19
Q
A
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20
Q

: Which subclavian artery would you inject with contrast to demonstrate both carotid and vertebral circulation?

A

Right

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21
Q

Contrast injection into the left vertebral artery shows up on which side of the brain – left or right?

A

Both

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22
Q

If you inject the right carotid artery in an angiogram, how would get the contrast medium to enter the left anterior and middle cerebral arteries

A

Compress the left carotid artery – the pressure difference would push the dye into the left side of the circulation through the anterior communicating artery.

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23
Q

What is the dural venous sinuses?

A

a collection of spaces created by the folding of two layers of the dura mater

They are responsible for collection of the venous blood from the Central Nervous System and surrounding tissues.

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24
Q
A
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25
Q

1: Why is the junction of the superior sagittal sinus and the superior cerebral veins a common site for subdural haematoma? HINT – it is not usually caused by trauma…

A

Caused by ageing or alcohol abuse.

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26
Q

What is danger triangle of the face?

A

The danger triangle of the face consists of the area from the corners of the mouth to the bridge of the nose, including the nose and maxilla.

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27
Q

What is meningitis?

A

Meningitis is an infection/inflammation of the protective membranes that surround the brain and spinal cord (meninges).

It can affect anyone, but is most common in babies, young children, teenagers and young adults

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28
Q

Is Meningitis caused by bacterial or viral infection?

A

can be both

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29
Q

In adults, meningitis is normally caused by the meningococcal bacteria, which normally lives in the nasopharynx – how could it move from the nasopharynx to infect the meninges of the brain?

A

Infected sinuses, infected middle ear cavity or infected mastoid air cells (mastoiditis). Or they can enter through the venous plexus of the face (pterygoid plexus) or dural venous sinuses because veins here do not have valves to stop infection spreading upwards

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30
Q

____ _____ is normally an indication of the onset of meningitis

A

Kernig’s sign is normally an indication of the onset of meningitis

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31
Q

What is the Kernig’s sign?

A

it is an ability to straighten out the leg when the hip is flexed to 90° as a result of extreme stiffness in the posterior compartment of thigh (hamstrings).

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32
Q

: In some cases (if there is no sign of raised intra-cranial pressure), a lumbar puncture is performed to diagnose meningitis - in the region of the lumbar cistern of CSF, which membrane is in closest apposition to the arachnoid membrane – the dura mater or pia mater?

A

Dura mater

– because when you stick a needle in you will feel a “pop” as the needle pierces the dura warning you to stop otherwise you may go too far and insert the needle into the spinal cord as the arachnoid and pia are incredibly thin membranes

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33
Q

What are the layers of the scalp?

A

Skin

Connective Tissue

Aponeurosis - (ociptialis and frontialis muscles)

Loose connective Tissue

Periosteum

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34
Q

Layers of SCALP

A
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35
Q

What muscle does the aponeurosis attach to? What is the nerve supply of this muscle?

A

Occipitofrontalis m.

CN VII

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36
Q

What is Hydrocephalus?

A

Enlargement of ventricles. Hydrocephalus is characterised by an excessive amount of CSF in the cranial cavity. The excess fluid puts pressure on the brain, which can damage it.

37
Q

CSF is normally produced in the _______ of the brain and flows downwards and outwards into the central canal of the spinal cord and the _______ _______where it is reabsorbed

A

CSF is normally produced in the ventricles of the brain and flows downwards and outwards into the central canal of the spinal cord and the sub-arachnoid space where it is reabsorbed

38
Q

What are the causes of hydrocephalus in children?

A

congenital abnormality of the brain,

meningitis

cranial haemorrhage blocking the flow of CSF

39
Q

The later stages of hydrocephalus can be very noticeable in young children because of the presence of the _______ _________ of the skull which have not yet ossified allowing for dramatic expansion of the cranial vault.

A

The later stages of hydrocephalus can be very noticeable in young children because of the presence of the cartilaginous fontanelles of the skull which have not yet ossified allowing for dramatic expansion of the cranial vault.

40
Q

What is a major symptom of hydrocephalus?

A

Raised intra cranial pressur

41
Q

Why should you never perform a lumbar puncture on someone with a raised intra-cranial pressure?

A

Because you would introduce a pressure difference into the bottom of the vertebral column and the brain tissue would move down to occupy the space making the brainstem slide down clivus which could cause trauma to the vital centres of the brainstem and ultimately death

42
Q

Development of the Neural Tube

A
43
Q

Improper closure of the openings can result in neural tube defects such as _______or _______

A

Improper closure of the openings can result in neural tube defects such as spina bifida or anencephaly

44
Q

The dorsal portion of the neural tube contains an ____ plate which is primarily associated with _______

A

The dorsal portion of the neural tube contains an alar plate which is primarily associated with sensation

45
Q

Ventral portion of the neural tube contains the ______ plate which is associated with ______ ______

A

Ventral portion of the neural tube contains the dorsal plate which is associated with motor function

46
Q

Name the derivatives from each layer of the developing embryo?

A

Ectoderm - central nervous system, the peripheral nervous system, epithelia such as skin, hair and nails.

Mesoderm - connective tissues such as cartilage, bone, tendons, muscle (both striated and smooth), blood and lymph vessels, the kidneys, the gonads, the spleen and the serous lining of the body cavities.

Endoderm - lining of the respiratory and GIT systems, liver, thymus, thyroid, parathyroids, pancreas and the lining of the urinary system

47
Q

Cerebrospinal fluid is produced by?

A

the choroid plexus

48
Q

How is the chorid plexus formed?

A

the vessels of the pia mater come into contact with the ependymal lining of the central canal of the neural tube (there is no intervening nervous tissue).

49
Q

To what specific part of the spinal cord does CSF exit from the foramen of Magendie into?

A

Cisterna magna

50
Q
A
51
Q
A
52
Q

The choroid plexus is formed by the close contact of the ______ mater and the _______ cells which then secrete CSF into the sub-arachnoid space

A

The choroid plexus is formed by the close contact of the pia mater and the ependymal cells which then secrete CSF into the sub-arachnoid space

53
Q

In the cranial cavity and along parts of the spinal cord, there are dilations in the sub-arachnoid space called ________ which allow a large collection of CSF to collect

A

In the cranial cavity and along parts of the spinal cord, there are dilations in the sub-arachnoid space called cisterns which allow a large collection of CSF to collect

54
Q

What are the sub-arachnoid cisterns?

A
  • Cisterna Magna
  • Pontine cistern
  • Cerebellopontine cistern
  • Lumbar cistern
55
Q

At what vertebral level should a lumbar puncture be performed in the adult?

In the child? Explain the reasoning for your answer.

A

Adults below L2 and Children below L4.

Spinal cord stretches to accommodate body size in postnatal growth.

56
Q

What is papilledema?

A

Papilledema is a condition in which increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell.

57
Q

What are causes of papilloedema?

A
  • Raised intracranial pressure from a tumour, an abscess or meningitis
  • Retinal vein obstruction from thrombosis or compression
  • Optic neuritis (inflammation of the optic nerve)
  • Accelerated hypertension
58
Q

What is the function internal capsule?

A

White matter highway of tracts leaving and entering the brain from the brainstem, thalamus and cerebral cortex – particular the corticospinal and corticobulbar tracts in the posterior limb

59
Q

What pathways are found in the posterior limb

A

Corticospinal tract

60
Q

What structure is found medial to the posterior limb?

A

Thalamus

61
Q

What structure is lateral to the internal capsule?

A

Lentiform nucleus made up of the putamen and the globus pallidus

62
Q

What is the blood supply of the internal capsule and why is it relevant?

A

Lenticulostriate arteries – they are small so if they become blocked or haemorrhage, can lead to a catastrophic impact (stroke)

63
Q

: Obstruction of the right carotid artery causes weakness and loss of sensation on the left side of the body (and vice versa) – why?

A

Because the corticospinal tract mostly decussates at the level of the medulla oblongata

64
Q

Name four structures the lateral striate arteries supply?

A

Internal capsule, corpus striatum, anterior thalamus and lentiform nucleus

65
Q

Which regions of the brainstem are each of the cerebellar peduncles attached?

A

Superior cerebellar peduncle to the midbrain, middle cerebellar peduncle to pons and inferior cerebellar peduncle to the medulla oblongata.

The inferior olivary nucleus of the medulla oblongata communicates with the cerebellum through the inferior cerebellar peduncle. This helps to coordinate signals that regulate motor coordination and learning

66
Q

Can you identify a reason for the atrophy/malformation of the cerebellum in this image?

A

Degenerative diseases such as multiple sclerosis

67
Q

What are the three main ataxia?

A
  1. Cerebellar ataxia
  2. Sensory ataxia
  3. Vestibular ataxia
68
Q

What is Cerebellar ataxia?

A

Cerebellar ataxia: is an inability to coordinate gait, balance, limb and eye movement

69
Q

What is Sensory ataxia?

A

: is a loss of coordination, not by damage to the cerebellum, but by the loss of the sensory input into the cerebellum or cerebrum. The loss of coordination is especially pronounced when the eyes are closed.

70
Q

What is Vestibular ataxia?

A

: is indicative of damage in the vestibular system and symptoms are characteristic of vestibular disease – vertigo, nausea and vomiting

71
Q

What are the symptoms are associated with cerebellar lesions?

A

Stumbling, wide based and unsteady gait

  • Impaired coordination of trunk, arms, and legs
  • Repetitive eye movements
  • Trouble with fine motor tasks
  • Slurred speech and changes in vocal tone and pitch
72
Q

In which part of the brain do the pre-motor and motor areas reside?

A

Frontal lobe.

73
Q

? Can you think of any conditions/disorders which may result in a damage to a specific area of the cerebral cortex resulting in acquired apraxia?

A

TBI, stroke, Alzheimer’s, brain tumours and other degenerative neurological disorders

74
Q
A
75
Q

What would be the most likely cause of Hemiplegia?

A

UMN/LMN lesion depending on other characteristics

76
Q

What would be the most likely cause of Parkinson’s gait?

A

Parkinson’s disease (neurodegenerative disorder)

This disorder is caused by a deficiency of dopamine in the basal ganglia circuit leading to motor deficits

77
Q

What would be the most likely cause of Cerebellar ataxia?

A

mimics alcohol intoxication; gluten ataxia, MS, CNS vasculitis

78
Q

What would be the most likely cause of Neuropathic gait?

A

Common fibular nerve damage, ALS, CMT disease

79
Q

What would be the most likely cause of Sensory ataxia?

A

dorsal columns disorder and diabetes

80
Q
A
81
Q

How does sensory information enter the spinal cord?

How does motor information leave the spinal cord?

A

Sensory information enters the spinal cord via the dorsal horn

Motor information leaves the spinal cord via the ventral horn.

82
Q

When do the motor neurons in the corticospinal tract transition from upper to lower?

A

Following the synapse with the motor neuron cell bodies in the ventral horn.

83
Q

Why do we have cervical and lumbar enlargements?

A

Cervical enlargement is the source of the large spinal nerves that form the brachial plexus and supply the upper limb.

The lumbar enlargement is the source of large spinal nerves that form the lumber plexus and supply the lower limb.

84
Q

What is paraplegia?

A

weakness of both legs

85
Q

What is hemiplegia?

A

weakness of one side of the body

86
Q

Compression of the spinal cord can lead to _______

A

Compression of the spinal cord can lead to paraplegia

87
Q

If an individual suffers from quadriplegia but not paralysis of the head and neck musculature, at what level of the vertebral column would the spinal cord compression be located?

A

Compression must be below C4 – most likely starting at C5, initial origin of the brachial plexus, as the upper limb is compromised in quadriplegia.

88
Q

An individual suffers from quadriplegia but not paralysis of the head and neck musculature.

Would this type of injury be classified as an upper or lower motor neuron lesion?

A

UMN Lesion – Spinal cord is being compressed as opposed to a set of peripheral nerves branching from the ventral horn which is more indicative of a lower lesion. To be certain, more details would be required in terms of the type of paralysis the patient is presenting with amongst other signs.

89
Q
A

Year 2 (33 decks)

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