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Patho II Final > Neuro Mod 5 > Flashcards

Neuro Mod 5 Flashcards

1
Q

Location of L and R thalami?

A

Lateral regions of diencephalon
“sit on top of the brainstem”

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2
Q

What is the diencephalon?

A

Inner portion of the brain surrounded by hemispheres

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3
Q

What structures make up the diencephalon?

A

Thalamus, hypothalamus, subthalamus, epithalamus (pineal body)

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4
Q

How to locate thalamus from transverse view?

A

Locate internal capsule –> thalamus & caudate are medial to IC

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5
Q

The thalamus is _____ to the caudate nucleus in transverse view

A

posterior

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6
Q

How to locate thalamus in frontal view?

A

Locate internal capsule –> thalamus & caudate nucleus are medial to IC

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7
Q

The thalamus is _____ to the caudate nucleus in frontal view

A

inferior

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8
Q

Blood supply to the thalamus?

A

Deep branches of the posterior cerebral artery (PAC) & posterior communicating arteries

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9
Q

Function of the thalamus?

A

Relays and regulates all sensory info except olfaction (CN1) and sends it to the cortex

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10
Q

All sensory info must reach the _____ before the brain can consciously detect, distinguish, and interpret sensory info (become aware)

A

Cortex

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11
Q

The thalamus acts as the gateway to what?

A

Consciousness

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12
Q

Visual pathway in the thalamus?

A

Eye -> thalamus -> primary visual cortex (area 17) -> secondary/associative visual cortices

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13
Q

Auditory pathway in the thalamus?

A

Ear -> thalamus -> primary auditory cortex (area 41) -> secondary/associative auditory cortices

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14
Q

Somatosensory pathway in the thalamus?

A

Body -> thalamus -> primary somatosensory cortex (area 3, 1, 2) -> secondary/associative somatosensory cortices

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15
Q

Basal ganglia (in thalamus) relays what info to the cortex?

A

Motor information (initiation and execution of movement)

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16
Q

Cerebellum (in thalamus) relays what info to the cortex?

A

Motor information (coordination of movement)

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17
Q

Limbic system (in thalamus) relays what info to the cortex?

A

Info related to fear, memory, learning, and other human behaviors/needs

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18
Q

Reticular connections (in thalamus) relays what info to the cortex?

A

Info that modifies and regulates consciousness, sleep/wake cycles, alertness, pain, etc.

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19
Q

The thalamus has _______ _______ that are responsible for relaying info to different regions of the cortex

A

Specific nuclei

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20
Q

Damage to one part of the thalamus can result in what?

A

Dysregulation of the sensory info that passes through that part of the thalamus

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21
Q

Where is the MGN (medial geniculate nucleus/body) located in the thalamus?

A

Medial bump in posterior thalamus

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22
Q

Where is the LGN (lateral geniculate nucleus/body) located in the thalamus?

A

Lateral bump in posterior thalamus

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23
Q

Where is the VPL (ventral posterior lateral) nucleus located in the thalamus?

A

Along lateral thalamus

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24
Q

Where is the VPM (ventral posterior medial) nucleus located in the thalamus?

A

Along medial thalamus

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25
Q

Where is the VL (ventral lateral) nucleus located in the thalamus?

A

Along lateral thalamus

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26
Q

Where does the MGN (medial geniculate nucleus/body) in the thalamus project info?

A

Primary auditory cortex (41)

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27
Q

Where does the LGN (lateral geniculate nucleus/body) in the thalamus project info?

A

Primary visual cortex (17)

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28
Q

Where does the VPL (ventral posterior lateral nucleus/body) in the thalamus project info?

A

Primary somatosensory cortex (3, 1, 2)

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29
Q

Where does the VPM (ventral posterior medial nucleus/body) in the thalamus project info?

A

Primary somatosensory cortex (3, 1, 2)

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30
Q

Where does the VL (ventral lateral nucleus/body) in the thalamus project info?

A

Primary and premotor cortex (4,6)

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31
Q

The MGN nucleus relays ______ info from _____ to ________

A

relays auditory info from brainstem to auditory cortex

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32
Q

The LGN nucleus relays ______ info from _____ to ________

A

relays visual info from eye (retina) to visual cortex

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33
Q

The VPL nucleus relays ______ info from _____ to ________

A

relays somatosensory info from spinal cord (body) to somatosensory cortex

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34
Q

The VPM nucleus relays ______ info from _____ to ________

A

relays somatosensory info from cranial nerves (head) to somatosensory cortex

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35
Q

The VL nucleus relays ______ info from _____ to ________

A

relays motor info from basal ganglia & cerebellum to motor cortices

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36
Q

What produces nociceptive pain/peripheral pain?

A

Non-neural tissue damage/injury

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37
Q

Process of nociceptive pain/peripheral pain?

A

Originates from nociceptive stimulation of peripheral nerve endings in injured/damaged non-neural tissue (tendon, muscle, bone) and provokes inflammatory/immune response (releases NT and cytokines that stimulate R’s)

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38
Q

What produces neuropathic pain?

A

Disease/injury to NS

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39
Q

What is neuropathic pain?

A

Sensation of pain (nociception) originating from dysfunctional/damaged nociceptive pathways in CNS (spinal cord, brainstem, thalamus, etc) or peripheral nerves

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40
Q

When is neuropathic pain referred to as central pain?

A

If the dysfunction to nociceptive pathways is in the CNS

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41
Q

What syndrome is an example of central neuropathic pain?

A

Thalamic pain syndrome (Dejerine-Roussy syndrome)

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42
Q

When does Thalamic pain syndrome occur?

A

After infarction of VPL of the thalamus or any of the CNS somatosensory pathways (internal capsule, brainstem)

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43
Q

Thalamic pain syndrome is considered what kind of stroke?

A

Lacunar or small vessel stroke

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44
Q

Symptoms of Thalamic pain syndrome?

A

Contralateral neuropathic pain/loss of sensation
*pain (shooting, burning, squeezing, stabbing, lacerating, freezing, cutting, throbbing)

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45
Q

With Thalamic pain syndrome, pain is abnormally provoked by what?

A

Normal stimuli/light touch, normal movement, temperature changes, stress

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46
Q

Where are basal ganglia structures located?

A

Diencephalon and midbrain (mesencephalon)

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47
Q

Anterior association areas in the brain receive sensory input from _____ _____ areas

A

posterior association areas

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48
Q

Anterior association areas in the brain receive physiological/emotional input from ______ _____ areas/ _____ system

A

Other prefrontal areas/limbic system

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49
Q

Which part of the brain makes the decision to act/sends decision to the premotor cortex?

A

Anterior association area

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50
Q

Which part of the brain assembles a motor plan for action?

A

Premotor cortices

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51
Q

The motor plan from the premotor cortices is sent to the primary cortex for what? What needs to be done before it reaches the primary motor cortex?

A

To activate muscles needed for execution of movement
**Needs to be modified and streamlined before getting here

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52
Q

Which structures modify/streamline final motor plans before primary motor cortex can activate muscles for voluntary motor movement?

A

Basal ganglia, cerebellum, thalamus

53
Q

Basal ganglia pathway?

A

Anterior assoc. area –> premotor/primary motor cortices –> basal ganglia –> thalamus –> premotor/primary motor cortices –> brainstem/spinal cord

54
Q

Lesions in the basal ganglia and cerebellum _____ motor function

A

Impair

55
Q

Are basal ganglia movement impairments the same as cerebellar motor impairments?

A

No, very different

56
Q

What kind of motor impairments w/ basal ganglia lesions?

A

Initiation & execution impaired, too much or too little movement (hyper or hypokinetic)

57
Q

What kind of motor impairments w/ cerebellar lesions?

A

Motor tone, balance/posture, coordination (synergy)

58
Q

The basal ganglia is a cluster of different _______ scattered throughout the _________?

A

Nuclei, diencephalon/midbrain

59
Q

Which nuclei make up the basal ganglia?

A

Caudate nucleus, Nucleus accumbens, Putamen, Globus pallidus (external/internal), Subthalamic nuclei, Substantia nigra

60
Q

Where is the substantia nigra nucleus located?

A

Midbrain of brainstem

61
Q

The globus pallidus is located _____ to the putamen

A

Deep

62
Q

The nucleus accumbens is the junction between which two nuclei?

A

Caudate and putamen

63
Q

Caudate nucleus (basal ganglia) features?

A

Horn shaped, wraps around other basal ganglia structures (amygdala located near one end)

64
Q

Putamen (basal ganglia) features?

A

Oval shaped structure that caudate wraps around, lateral to most other basal ganglia nuclei

65
Q

Nucleus accumbens (basal ganglia) features?

A

Located at junction of caudate/putamen, difficult to identify and individual structure, **Role in pleasure/reward processing

66
Q

Globus pallidus (basal ganglia) features?

A

External & internal, medial to putamen, triangular shape in frontal view

67
Q

Subthalamic nuclei (basal ganglia) features?

A

Inferior to thalamus

68
Q

Substantia nigra (basal ganglia) features?

A

Located in midbrain of brainstem

69
Q

What basal ganglia structures can be seen in a vertical slice of the brain?

A

Top to bottom: Caudate -> Putamen -> Globus pallidus -> Subthalamic -> Substantia nigra

70
Q

What basal ganglia structures can be seen in a horizontal slice of the brain?

A

Front to back: Caudate -> Putamen -> Globus pallidus (external -> internal) -> thalamus

71
Q

In transverse and frontal views, the caudate nucleus is ____ to the internal capsule

A

Medial

72
Q

In transverse and frontal views, the thalamus is ____ to the ____ internal capsule

A

Medial to posterior internal capsule

73
Q

In transverse and frontal views, putamen/globus pallidus are located _____ to the IC and _____ to putamen in the “triangle” on frontal view

A

Lateral, medial

74
Q

What two structures are referred to as the striatum?

A

Caudate and putamen

75
Q

What two structures are referred to as the lenticular nucleus?

A

Globus pallidus and putamen

76
Q

Majority of the basal ganglia structures are supplied by small penetrating branches of which artery?

A

MCA (middle cerebral artery)
*known as lenticulostriate arteries

77
Q

A smaller potion of the basal ganglia is supplied by small penetrating branches of which artery?

A

ACA (anterior cerebral artery)

78
Q

Function of the basal ganglia?

A

Initiate/execute movement

79
Q

What are the 3 functional loops of the basal ganglia?

A

Motor (modifies motor plan), Association/cognitive (learning/choosing best way to initiate/execute), Limbic (emotional input that influences movement)

80
Q

Motor loop pathway of basal ganglia?

A

premotor/motor cortex –> sends motor plan to putamen –> putamen sends plan to other nuclei to analyze/modify –> copy of plan is sent through direct (promotes movement) and indirect pathways (suppress movement) in basal ganglia –> globus pallidus internus packages final plan –> sends to thalamus –> relays final plan to motor cortex/appropriate muscles acitvated

81
Q

Purpose of direct pathway supporting movement in basal ganglia motor pathway?

A

make sure final plan includes instructions to promote muscle movement needed to execute movement in best possible way

82
Q

Purpose of indirect pathway suppressing movement in basal ganglia motor pathway?

A

make sure final plan includes instructions to suppress muscle movement NOT needed to execute specific movement in best possible way

83
Q

Direct pathway of basal ganglia? Which NT affect this?

A

Putamen connects directly to globus pallidus internus (GPi) –> stimulates direct pathway
*dopamine & glutamate: stimulate direct pathway/movement
*Ach inhibits pathway/suppress movement

84
Q

Indirect pathway of basal ganglia? Which NT affect this?

A

Putamen connects indirectly to globus pallidus internus (GPi):
Putamen –> GPe –> STN –> GPi
*dopamine: inhibits indirect pathway/promotes movement
*Ach and glutamate: stimulate indirect pathway/suppress movement

85
Q

Role of substantia nigra in motor loop pathway/modifying movement?

A

Releases dopamine in putamen w/ net effect to promote movement

86
Q

Role of putamen in motor loop pathway/modifying movement?

A

Cells release Ach w/ net effect to suppress movement

87
Q

Basal ganglia motor loop pathway in healthy individual?

A

Balance of NT, appropriate signaling in putamen for initiation/execution in best possible way

88
Q

Basal ganglia motor loop pathway in disease/pathology that decreases dopamine?

A

Hypokinetic disorder, allows Ach to dominate in putamen, suppresses movement
*difficulty initiating/executing movement

89
Q

Basal ganglia motor loop pathway in disease/pathology that decreases Ach?

A

Hyperkinetic disorder, allows dopamine to dominate in putamen, promotes too much movement
*constant initiation/execution of abnormal movements

90
Q

Movement disorders of the basal ganglia are characterized by what?

A

Movement speed

91
Q

Most movement disorders of the basal ganglia cease during ____

A

Sleep

92
Q

Bradykinesia/hypokinesia characteristics?

A

Slowed movement

93
Q

Rigidity characteristics?

A

Inc. resistance, passive ROM, bi-directional, non-velocity or amplitude dependent
Lead pipe: resistance persists throughout ROM
Cogwheel: periodic resistance at different points throughout ROM

94
Q

Rigidity vs. spasticity?

A

Rigidity not speed (velocity) dependent but spasticity is

95
Q

Dystonia characteristics?

A

Involuntary (sustained or intermittent) muscle contraction that cause: twisting and repetitive movements, abnormal postures (or both)
*slower than athetosis
*can affect one muscle, group, or entire body (ex. cervical dystonia)

96
Q

Athetosis characteristics?

A

Slow, continuous, involuntary writhing movement, prevents maintenance of stable posture
*Writhing twisting of limbs (hands/feet), trunk, or face

97
Q

Chorea characteristics?

A

Ongoing, random appearing sequence of one or more involuntary movements/movement fragments
*continuous dance-like involuntary movement
*quality may vary (jerky to fluid)

98
Q

Choreathetosis characteristics?

A

Athetosis movements combine w/ chorea type movement

99
Q

Ballismus (hemi-ballismus) characteristics? Hemi-ballismus is associated w/ lesion of which nuclei?

A

Flailing, flinging, or rotary movements of proximal limbs
*hemi-ballismus assoc. w/ subthalamic nuclei lesion (STN, part of indirect pathway)

100
Q

Tic characteristics? (motor vs vocal?)

A

Repeated, individually recognizable, intermittent movements
*fragments are briefly suppressable but usually assoc. w/ urge to perform movement
*motor: face/neck MC, less frequent w/ extremities
*vocal: sounds or words (commonly obscene)

101
Q

Tremor characteristics? (resting vs intention?)

A

Rhythmic back and forth or oscillating involuntary movement about a joint axis
*resting: occurs at rest in postural position, once movement starts tremor diminishes
*intention: occurs as arm approaches object, stops when arm at rest in postural position

102
Q

Myoclonus characteristics?

A

Sequence of repeated, often not rhythmic, brief shock-like jerks d/t sudden involuntary contraction/relaxation of one or group of muscles
*sudden, short circuit or shock like, vary in intensity/frequency

103
Q

Clonus characteristics?

A

Muscular spasm involving repeated, often rhythmic, rapid contraction/relaxation
*often unidirectional
*quick stretch or deep tendon reflex may stimulate clonus in upper motor neuron (UMN) lesion

104
Q

Common findings of hypokinetic movement disorders?

A

Bradykinesia, freezing, rigidity, postural instability
*Parkinson’s

105
Q

Parkinson’s is a neurodegenerative disease that results in what?

A

Hypokinetic motor dysfunction: bradykinesia, difficulty initiating movement, freezing, increased muscle tone/rigidity, resting tremor, decreased voluntary movement (micrographia, dec. facial expression, monotone speech)

106
Q

Non-motor symptoms of parkinsons?

A

Dementia/cognitive dysfunction, psychosis, hallucinations, mood disorders, sleep disturbances, fatigue, pain/sensory dysfunction, olfactory, GI, ANS dysfunction, derm findings (Seborrhea)

107
Q

Pathophys of Parkinson’s?

A

Depigmentation, neuronal loss, proteinopathy, gliosis *particularly in substantia nigra pars compact

108
Q

Proteinopathy of Parkinsons?

A

a-synuclein (aSyn) found in neurons, progressive accumulation causes neuron death/gliosis in substantia nigra/other regions of cortex
*form Lewy bodies

109
Q

Lewy bodies from parkinsons in the substantia nigra respresent _____ of neurons and lead to ______ deficiency in the putamen

A

Death/atrophy, dopamine defiency

110
Q

Lewy bodies from parkinsons found in the cortex can cause ______ symptoms

A

Non-motor

111
Q

What is Lewy body dementia?

A

Accumulation of aSyn lewy bodies in cortex but spare the substantia nigra (dementia sx w/o hypokinetic motor sx)

112
Q

Posture with Parkinson’s?

A

Stooped w/ head/neck forward, knees flexed, UE flexed w/ fingers extended

113
Q

Gait with Parkinsons?

A

Rigidity, bradykinesia
difficulty initiating steps, decreased stride length (Marche a petit pas), festination (involuntary inclination to take accelerating steps), freezing

114
Q

Common findings of hyperkinesia movement disorders of the basal ganglia?

A

Dystonia, athetosis, chorea, ballismus, myoclonus, tics, tremor

115
Q

What it Huntington’s disease?

A

Inherited degenerative neurological dz causing: choreiform movement, dementia, behavioral changes

116
Q

Prognosis of Huntingtons?

A

Progressive neurodegeneration leads to death w/in 10-30 yrs post sx onset

117
Q

Proteinopathy of Huntingtons?

A

Huntington protein normally found in neurons throughout brain/body
*aggregates formed from mutated huntington protein accumulates w/in neuron (from abnormal huntington gene) and causes neuronal death in caudate & putamen (and other areas of CNS)

118
Q

Pathophys of caudate and putamen in huntingtons?

A

Atrophy, ventricles enlarge, loss of neurons decrease Ach in putamen

119
Q

WHO ICF classification for pre-manifest/prodermal huntingtons & physiotherapy aim?

A

Pathology, aim: advise appropriate physical activities

120
Q

WHO ICF classification for early stage huntingtons & physiotherapy aim?

A

Impairments, aim: delay onset of mobility restriction

121
Q

WHO ICF classification for mid stage huntingtons & physiotherapy aim?

A

Activity restriction, aim: maintain function and delay further degeneration

122
Q

WHO ICF classification for late stage huntingtons & physiotherapy aim?

A

Participation restriction, aim: limit impact of complications

123
Q

Posture of huntingtons?

A

Asymmetric, distorted, choreiform sit/stand postures

124
Q

Gait of huntingtons?

A

Irregular, jerky, involuntary movement in all extremities
*ambulating can accentuate involuntary movements
*choreiform gait

125
Q

What is tardive dyskinesia?

A

Delayed onset of sx of hyperkinetic dyskinesia characterized by involuntary/uncontrolled movement especially of the mouth, tongue, trunk, limbs
(tics, writhing movement, etc)

126
Q

How does tardive dyskinesia develop?

A

S/E of prolonged use of antipsychotics, schizophrenia meds, depression meds, parkinsons meds, antiseizure meds, etc
*pt may be put on drug holiday to prevent/tx (3-6 mos), effect of drugs can be “tardive” (dyskinesia may appear or continue after drugs no longer taken)

127
Q

What is tourettes syndrome?

A

Motor and vocal tics (pathology not completely understood, but elevated dopamine considered significant role)

128
Q

Clinical criteria for dx of tourettes?

A

-Presence of both motor/vocal tics
-Tics every day for >1yr
-No remission of tics for >3mos
-Sx cause distress/impairment of function
-Age of onset <18
-Sx not d/t drugs or other condition

Patho II Final (4 decks)

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