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neuro patho Flashcards

1
Q

what are the time frames of fetal development

A

Pre-embryonic: fertilization to 2wks
Embryonic: 2-8wks
Fetal: >8wks

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2
Q

what stage do the majority of organs develop

A

embryonic

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3
Q

when is neuro development

A

2-20wks

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4
Q

what are blastomeres

A

cells from first mitotic division

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5
Q

what is a morula

A

The spherical embryonic mass of blastomeres formed before the blastula and resulting from cleavage of the fertilized ovum.

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6
Q

what is a blastocyte

A

when a cavity forms in the morula

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7
Q

which develops last (ectoderm, endoderm, mesoderm)

A

mesoderm

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8
Q

where are the ectoderm, endoderm, mesoderm formed

A

Ectoderm(Upper lip)
Endoderm (Lower lip)
mesoderm froms between them

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9
Q

what is the synchiotrophoblast

A

epithelial covering of the trophoblast that forms deep into the endometrial lining to establish nutrient circulation between the embryo and the mother

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10
Q

what is the cytotropoblast

A

inner layer of the tropoblast. deep to the synchiotrophoblast

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11
Q

what develops from the ectoderm

A

Sensory Organs
Epidermis
Nervous
System

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12
Q

what develops from the mesoderm

A 
Dermis
Muscles
Skeleton
Urogenital Systems
Circulatory System
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13
Q

what develops from the endoderm

A

GI System
Liver
Pancreas
Respiratory System

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14
Q

what is neurulation

A

process of neural tube(spinal cord) formation

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15
Q

what is primary neurulation

A

infolding of neural plate

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16
Q

what is secondary neurulation

A

sacral and cocyxgeal formation

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17
Q

what portion of the neural plate is the last to close

A

inf region

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18
Q

what should occur by the 3rd week

A

dorsal midline ectoderm thickens to form neural plate

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19
Q

when should the ecoderm folds touch and close

A

touch at 21 days

close at 27 days

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20
Q

what do neural crest cells form

A 
PNS, 
Posterior root ganglia
Sensory:  cranial nerves
Autonomic ganglia
Adrenal medulla
Melanocytes
Pancreatic Islets
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21
Q

what are radial glial cells

A

important for migrating neuroblasts and pivotal in CNS formation

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22
Q

what do the bumps on the ectoderm represent

A

each bump is a somite and represent dermatomal development of the dermis

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23
Q

what is colchicine and what is its SE

A

drug used for gout. cnat use in child bearing age women bc it blocks microtubules causing neurotube defects

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24
Q

what is the notochord

A

defines the long axis
orients vertebrae
nucleus pulposus
cell adhesive molecules

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25
Q

what is the alar plate

A

sensory

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26
Q

what is the basal plate

A

motor

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27
Q

what is polyneuronal development

A

migration of cells in the fetal stage
>50% die in the process of migration
Usually completed by 25th week

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28
Q

when does myelination occure (specifically Corticospinal tracts and Cortical association fibers)

A

Begins 4th month of gestation and finished by 3 years of age.
Corticospinal tracts myelinated by 2 years
Cortical association fibers by 3 years of age

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29
Q

what are association fibers

A

allow one cortex to make connections for fine motor skills

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30
Q

what are the causes and defects associated with closure 1

A

Folic acid deficiency
Metabolic teratogens
causing Spinal Bifida

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31
Q

what are the causes and defects associated with closure 2

A

Maternal hyperthermia
Folic acid deficiency
Metabolic teratogens
causing Anencephaly

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32
Q

what are the causes and defects associated with closure 3

A

Usually resistant

causing Mid-facial clefts

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33
Q

what are the causes and defects associated with closure 4

A

Maternal hyperthermia

causing Cephalocele

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34
Q

what are the causes and defects associated with closure 5

A

Valproic acid exposure

causing Sacral Meningocele

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35
Q

what is meningoencephalocele

A

meninges and brain tissue out of skull bc altered cranium closure

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36
Q

what is meningocele

A

meninges out of skull bc altered cranium closure

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37
Q

what is meningohydoencephalocele

A

meninges,ventricle, and brain tissue out of skull bc altered cranium closure

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38
Q

what are the characteristics of anencephaly

A

cerebral hemispheres replaced by vascular tissue making a frog like appearance
Protruding eyes:
Prominent nose
Long Arms
Most die in utero or within 1 week after birth
Rostral neuropore fails to close
Brainstem usually intact

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39
Q

what is spina bifida occulta

A

failure of dorsal vertebrae to close
10% of population(L5-S1)
usually asymtomatic

40
Q

what is spina bifida-Meningocele

A

usually no deficits

41
Q

what is spina bifida-meningomyelocele

A

part of cord gets outside

always defects

42
Q

what is myeloschisis

A

spina bifida with no overlying skin

cord exposed on surface

43
Q

what is arnold chiari

A

inf cerebellum and medulla protrude through foramen magnum

44
Q

what are the manifestations of arnold chiari

A 
asymptomatic
CN defect (usually IX-XII)
cerebellar defect
hydrocephalus 
migraine
45
Q

what is holoprosencephaly

A

Single large ventricle with fusion of midline structures, including thalami.
Affected fetuses and neonates typically have severe facial defects, such as cyclopia

46
Q

what are possible causes of holoprosencephaly

A

Underlying chromosomal abnormalities, such as trisomy 13, or maternal diabetes mellitus are possible causes, but some cases are sporadic.

47
Q

what are the somatic senses

A

Pain
Temperature
Crude touch/pressure
Discriminatory touch

48
Q

what is stereognosis

A

the ability to perceive and recognize the form of an object

49
Q

what is graphesthesia

A

ability to recognize writing on the skin purely by the sensation of touch

50
Q

nociception

A

Recognition and signaling of a deleterious stimuli

51
Q

pain

A

Conscious awareness of the nociceptive event

52
Q

suffering

A

Emotional and behavioral sequelae

53
Q

deafferentiation pain

A

pain due to loss of sensation of an afferent fiber

54
Q

hyperalgesia

A

increased sensitivity to stimulation

55
Q

what causes pain afferent nerve endings

A

“naked nerve endings” activated by thermal, mechanical, or chemicals increasing Na permeability= inc APs

56
Q

what chemicals can activate afferent pain nerves

A

H+, bradykinin, histamine, prostaglandin, hypoxia

57
Q

what are A-delta fibers (location, stimuli, type of pain, size, myelination, speed)

A 
afferent pain neuron
Location:  	body surface/skin
Stimuli: mechanical, thermal, chemical
Type of pain: sharp, prickly
Large diameter
Myelinated
5-30 m/sec
58
Q

what are C-fibers (location, stimuli, type of pain, size, myelination, speed)

A 
Location: deep skin/ tissue
Stimuli: thermal, mechanical, chemical 	
Type of pain: aching, burning	
Large diameter
Unmyelinated
.5-2 m/sec
59
Q

what is Lissauers tract

A

Afferent pain fibers go a few segments up or below before crossing over

60
Q

where would pain and temp loss in reguards to a spinal cord lesion

A

typically 2 segments down from lesion not at the lesion

61
Q

where do I, II, and IV lamina send signals to

A

I and II- to brain

IV- reflex(not to brain)

62
Q

why does chronic pain cause insomnia

A

the C-fibers signal the RAS on the way to the thalamus.

63
Q

what is the pathway of the neospinothalmic tract

A

RAS
Thalamus(VPL)
Somatosensory cortex
Pain localization and intensity

64
Q

what is the pathway of the paleospinothalmic tract

A 
RAS (more than neospinothalmic)
Thalamus(VPL
Limbic (emotion, inc aggression with chron pain)
Somatosensory 	Cortex
Emotional 	response to pain
65
Q

what is the Periaqueductal gray

A

in the midbrain
activated by Mu-R
release Enkephalin and neurotension at the Raphe Nucleus in the medulla

66
Q

what does the raphe nucleus do

A

activated from periaqueductal gray

releases 5-HT and Enkephalin at terminal afferent neuron to block release of substance P and block pain

67
Q

what does 5-HT do

A

causes more enkephalin release

68
Q

what does enkephalin do

A

endogenous opiod that blocks substance P release to block pain

69
Q

what does Fentinil do

A

used in epidurals to bind opiod Mu-R and prevent substance P release= block pain

70
Q

why do they give tricyclic antidepressents for chr pain

A

block seratonin, dopamine, NE reuptake to alleviate pain

Keeps seratonin around so Enkephalin can block substance P

71
Q

what is the danger of epidurals and intrathecal(sub arachnoid) opiod administration

A

can diffuse upward and stop breathing

72
Q

how do local anesthetic agents work

A

block Na channels

73
Q

what is lidocaines and Marcaines(bupivicaine) MSD

A

Lido=5-7mg/Kg
Marcaine= 2-3 mg/kg
(can use the higher doses if epi is used bc keeps it local)

74
Q

what is the toxicity from Lidocaine

A

CNS before cardiac
CNS: twitch, tinnitus, Sz
Cardiac:heart block

75
Q

what is the toxicity from Marcaine

A

Cardiac before CNS (need to be on cardiac monitor. watch for vfib)

76
Q

what is 1% lido

A

1g/100ml or 10mg/mL

77
Q

how do NSAIDs dec pain

A

block prosteglandin production

78
Q

how does a cordotomy help pain

A

lateral spinothalmic tractotomy= loss of pain on one contralateral side one to 2 segments down
Temporary relief

79
Q

What is a Rhizotomy

A

cut dorsal root to prevent pain but also blocks other sensory

80
Q

what does a lesion of intralaminar nuclei do

A

decreases suffering type of pain and leaves the acute pain

81
Q

what does a VPL lesion cause

A

Lesion is in thalamus causing contralateral loss of all sensory

82
Q

what does a VPM lesion cause

A

lesion is in the thalamus causing contralateral loss of facial sensory

83
Q

what is radicular pain vs local pain

A

radicular pain is along a dermatome

84
Q

what is thalamic syndrome

A

Posteriolateral branch of posterior cerebral artery (anterior thalamus OK)
Loss of sensation opposite side of body bc VPL and VPM blocked
Ataxia
Usually damage to internal capsule
After insult there is hemianesthesia followed by burning pain after several weeks

85
Q

how does the cerebellum and thalamus maintain balance

A

cerebellum compares intended action to actual act and makes adjustments. Adjustments are sent through thalamus to upper motor cortex.

86
Q

what is the pain component of complex regional pain syndrome(reflex sympathetic dystrophy)

A

Out of proportion to injury
Burning, numbness, tingling, itching
May be confined to dermatomal or diffuse (less diffuse and of a vascular distribution)
Usually distal
Superficial nonnoxious stimuli: ie air accentuates pain
Behavioral changes: seclusion/withdrawn

87
Q

what is the circuit of continuing pain in complex regional pain syndrome

A

Pain= inc SNS= dec circulation=hypoxia/inc H+=inc Pain

88
Q

what is CRPS I

A

triggerd by tissue inj with no identified nerve inj

AKA reflex sympathetic dystrophy(RSD)

89
Q

what is CRPS II

A

Associated with nerve inj

AKA causalgia

90
Q

what is the 2nd component of complex regional pain syndrome

A 
unspecified abnormalities of sensation, motor function and blood flow 
Soft puffy edema
Skin color  changes
Cold or warm 
Joint limitations
91
Q

what is the 3rd component of complex regional pain syndrome

A 
Sweating and trophic changes in the skin and soft tissue
Excessive moisture or dryness
Increased hair or nail growth
Osteoporosis(dec circulation)
Muscle atrophy(dec circulation)
92
Q

what are the three types of pain from complex regional pain syndrome

A

1Algodystrophy: pain and all features of dystrophy
2Dystrophy without pain
3Sympathetically maintained pain, not exhibiting dystrophic changes

93
Q

what is the 1st stage of complex regional pain syndrome

A

pain is in the limb.
distribution is not compatible with single nerver, trunk, or root lesion
vasomotor disturbance
radiology normal

94
Q

what is the 2nd stage of complex regional pain syndrome

A

progressive soft tissue edema, thickening of skin, mm wasting

95
Q

is the 3rd stage of complex regional pain syndrome

A

limitation of movement, contractures, bone demineralization

96
Q

what is the Tx of complex regional pain syndrome

A 
Medications
-Phenoxybenzamine hydrochloride (alpha blocker)
-Clonidine (alpha 2 agonist)
-GABA analogs
Nerve blocks
-Inject into dorsal root ganglion

Pathophys (15 decks)

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