NEURO: Quiz 4 Flashcards

0
Q

Golgi tendon organ reflex (unloaded muscle)

    • Steps
    • Components
    • Purpose
A

Basic reflex:

(1) Muscle contracts
(2) Depolarize 1b afferent fiber
- - Carries signal into gray matter of spinal cord
(3) Synapse on 1b inhibitory interneuron
(4) Ib inhibitory interneuron synapses on alpha motor neuron
- - Inhibits efferent signal to muscle
(5) Muscle relaxes

Purpose:

    • Response to very fine changes in muscle force (e.g., soft hands)
      • Big response of big muscles in arm
      • Gentle response of muscles in hands

NOTE: Ib inhibitory interneuron excited/inhibited by various inputs;

    • Ib afferent
    • Other interneurons from:
    • Muscle spindle
    • Cutaneous receptors
    • Cortical paths
    • Inputs excite/inhibit IB inhibitory interneuron activity
      • In turn decreasing/increasing alpha MN activity
        • If it fires, it inhibits alpha MN
        • If it doesn’t, it excites alpha MN
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1
Q

Monosynaptic stretch reflex

    • Steps
    • Components
    • Grading
    • Clinical and functional roles
    • Latency
A

(1) Muscle stretched (e.g., tendon tap)
- - Muscle spindle stretched
(2) 1a afferent fiber depolarized by stretch
- - Annulospiral endings wrap intrafusal fibers (static and dynamic)
- - Detects change in muscle length
- - Impulse travels via DRG to spinal cord gray matter
(3) Ia synapses with alpha and gamma motor neurons (anterior horn)
- - Alpha MN sends signal to extrafusal fibers to contract
- - Gamma MN sends signal to ends of intrafusal fibers to contract
(4) Muscle contracts
- - Contractile ends of intrafusal pulls center taut
- - Muscle spindle remains sensitive to further stretch

Grading:
0 = no response
1 = decreased relative to other side
2 = normal
3 = exaggerated relative to other side
4 = hyperreflexive (clonus in extreme case)

Clinical role
– Test integrity of spinal cord circuity
Functional role
– Regulate muscle stiffness
– Correct/prevent small movement errors
Latency = Time to cross single synapse (~30 s)

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2
Q

Reciprocal inhibition

Autogenic inhibition

State dependent reflex reversal

A

Reciprocal inhibition
– In order for agonist to contract, antagonist must relax:
– Stretch muscle and depolarize 1a
– 1a synapses in SC gray matter:
– Alpha MN = excitatory signal to agonist
– Inhibitory interneuron – alpha MN = inhibitory signal to antagonist
– Result:
– Agonist contract
– Antagonist relax
NOTE: Occurs concurrent with gamma MN signal to muscle spindle intrafusal fibers (alpha-gamma coactivation)

Autogenic inhibition:

    • Unloaded muscle experiences sudden strenuous contraction
      • GTO Ib afferent synapses on Ib inhibitory interneuron
        • Ib inhibitory interneuron synapses on alpha motor neuron
          • Hyperpolarizes alpha motor neuron (inhibits its activity)
    • Muscle relaxes

State dependent reflex reversal:
– Loaded muscle (e.g., bearing weight) experiences sudden strenuous contraction
– GTO Ib inhibitory interneuron is INHIBITED
– Depolarizes alpha motor neuron (excites its activity)
– Muscle contracts
NOTE: SDRR also helped by:
– Sudden load also causes slight stretch of muscle (eccentric contraction)
– Muscle spindle facilitates contraction (increase alpha MN firing)
– Descending (motor) pathways also facilitate muscle contraction to prevent a fall

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3
Q

Muscle spindle

    • Definition
    • Location
    • Components
A

Definition:

    • Sensory receptor that detects change in muscle length (proprioceptive)
    • Conveys length info to the CNS via sensory neurons
      • Info processed by the brain to determine the position of body parts
      • Info activates MNs via the stretch reflex to resist muscle stretch

Location:

    • In parallel with muscle fibers (muscle cells) within muscle belly
    • Embedded in extrafusal muscle fibers

Components:
(1) Intrafusal fibers (3 types) (3-12 fibers per spindle)
– Dynamic nuclear bag
= Sensitive to small, rapid change in length
– Static:
= Sensitive to steady-state muscle length
– Static nuclear bag
– Nuclear chain
(2) Afferent fibers
– Type Ia afferent (annulospiral endings)
– Detect onset of stretch
– Carry impulse from dynamic and static fibers
– Type II afferent (flower spray endings)
– Sensitive to sustained stretch
– Carry impulse from static fibers
(3) Efferent fibers
– Cause ends of intrafusal fibers to contract when muscle contracts
– Center of fibers remain taut and sensitive to stretch
– Dynamic gamma motor neurons
– Signal to dynamic fibers
– Static gamma motor neurons
– Signal to static fibers

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4
Q

Golgi tendon organ (GTO)

    • Definition
    • Purpose
    • Location
    • Components
A

Definition:
– Sensory receptor sensitive to TENSION
– Sensitive to small changes in force
– Constantly active
Purpose:
– Coordinates large and small force production at various muscles to complete a task
– Provides CNS with time info about muscle force changes
Location:
– In SERIES with muscle fiber
– Within musculotendinous junction
Components:
– Type Ib afferent fibers
– Endings intertwined with collagen fibers of tendon
– Collagen pinches nerve endings when muscle contracts

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5
Q

Alpha and gamma MN coactivation

    • Muscle stretch
      • Proprioceptive information
    • Muscle contraction
    • Muscle steady-state length
A

Muscle stretch:

    • Extrafusal muscle fibers stretch
      • Muscle spindle stretched in middle
      • Ia afferent depolarizes (increases firing rate to CNS)
    • Proprioceptive information to CNS:
      • Change in muscle length
      • Change in position of limb
      • Speed of change

Muscle contraction:

    • Ia afferent synapses on:
      • Alpha MN – Extrafusal fibers contract
      • Gamma MN – Intrafusal fiber ends contract (stretch middle)
        • Muscle spindle remains taut and sensitive to stretch
      • Sends info to CNS about limb position change

Muscle steady-state length:
– Type IIa fibers increase firing rate
– Equal to firing rate of type Ia
– Provide constant background noise to CNS
– Type I then resets itself so it is able to respond to sudden change in length
NOTE: Occurs during very short period between stretch and contraction

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6
Q

Propriospinal tracts

    • Definition
    • Purpose (e.g., role in reflexes)
A

= Intrinsic circuits of the spinal cord

    • Intersegmental spinal tracts along edge of gray matter
    • Connect all segments of the spinal cord

Purpose:

    • Coordinate and synchronize reflex activity on both sides of body
      • Make polysynaptic reflexes possible, including movements between:
        • Proximal and distal segments of one limb
        • Upper and lower limbs
        • Lower limbs on each side of body
    • Carry proprioceptive info (e.g., Lissauers Tract)
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7
Q

Flexor withdrawal - Crossed extension reflex

    • Polysynaptic
      • Multi-level
      • Bilateral
A

Polysynaptic = > 1 level involves interneuronal pathway

    • Multilevel = Mass flexion ipsilateral to stimuli (flexor withdrawal)
    • Bilateral = Mass flexion ipsilaterally and extension contralaterally (crossed extension)

Pathway:
S1: Painful stimulus – Free nerve ending
– A-Delta fiber stimulated (sharp, fast pain)
– Connects to Lissauers tract – ASCEND
L5: Collateral fiber – SYNAPSE
– Excitatory interneuron (ipsilateral) – SYNAPSE
– Alpha motor neuron to knee flexors (hamstrings)
– Ipsilateral knee FLEXION
– Signal continues along Lissauers Tract – ASCEND
L4: Collateral fiber – SYNAPSE
– Excitatory interneuron (contralateral) – SYNAPSE
– Alpha motor neuron to hip extensors
– Contralateral hip EXTENSION
– Signal continues along Lissauers Tract – ASCENDS
L2: Collateral fiber – SYNAPSE
– Excitatory interneuron (ipsilateral) – SYNAPSE
– Alpha motor neuron to hip flexors
– Ipsilateral hip FLEXION

NOTE: Contralateral extension occurs to keep us from falling when leg flexes

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8
Q

Central pattern generator

A

= Neural network that produces rhythmic output without sensory feedback
– Exists for all rhythmic movements in animals (e.g., walking, breathing, swimming)

In humans:

    • Flexor withdrawal/crossed extension reflex forms basis for walking CPG
      • Spinal cord produces stepping gait w/o cortical input (e.g., below spinal cord lesion)
      • Can replicate normal walking ability using reflexes
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9
Q

UMN syndrome disorders

    • Hyperreflexia
    • Spastic paralysis

LMN syndrome disorders

    • Hyporeflexia
    • Flaccid paralysis
A

UMN syndrome:

    • Hyperreflexive = Increased or exaggerated reflexes
    • Spastic = Increase in resistance to passive stretch (excess tone)
      • Velocity dependent
      • Most often in anti-gravity muscles (UE flexors and LE extensors)
    • Disorders affect UMN (CNS) control of reflexes
      • Stroke
      • Multiple sclerosis
      • Cerebral palsy
      • Spinal cord injury
      • Traumatic brain injury

UMN syndrome:

    • Hyporeflexive = Diminished or absent reflexes
      • Flaccid = Decrease in resistance to passive stretch (no tone)
    • Disorders affect peripheral part of reflex loop:
      • Afferent: Sensory neuropathy (e.g., diabetes)
      • Efferent:
          • Poliomyelitis (anterior horn cells)
          • AIDP (acute inflammatory demyelinating polyneuropathy or Guillan Barre)
          • ALS
          • Botulism

NOTE: Paralysis = inability to move; paresis = weakness

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10
Q

Descending motor pathways

A

= UMN tracts descending from brain or brainstem to spinal cord
– Regulate (inhibit) spinal reflexes to prevent interference with movement

Lateral corticospinal = from primary motor cortex
Rubrospinal = from red nucleus
Vestibulospinal = from pons and medulla
Reticulospinal = from reticular system
Anterior corticospinal = from primary motor cortex

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11
Q

Visual deficits

    • Single eye blindness
    • Bitemporal hemianopsia
    • Nasal hemianopsia (R/L)
    • Homonymous hemianopsia (R/L)
    • Homonymous inferior quadratic hemianopsia (R/L)
    • Homonymous superior quadratic hemianopsia (R/L)
    • Homonymous hemianopsia with macular preservation (R/L)
A

Causes:
– Single eye blindness = Optic neuritis, trauma
– Bitemporal hemianopsia = Damage to optic chiasm (e.g., pituitary tumor)
– Nasal hemianopsia (R/L) = Pressure from aneurysm of ICA (most lateral fibers)
– Homonymous hemianopsia (R/L):
– Anterior choroidal artery dysfunction
– Tumor or abscess of temporal lobe
– Homonymous inferior quadratic hemianopsia (R/L) = Superior opposite side visual cortex
– Occipital or parietal lobe tumor
– Homonymous superior quadratic hemianopsia (R/L) = Inferior opposite side visual cortex
– Occipital or temporal lobe dysfunction
– Homonymous hemianopsia w/ macular preservation (R/L)
= Visual cortex except most posterior pole
– Posterior cerebral artery dysfunction, trauma, tumor

Named for deficits in visual field:

    • Right, left or bilateral
    • Temporal or nasal
    • Homonymous = both eyes affected on same side
    • Hemianopsia = half visual field is blind
    • Anopsia = blindness
    • Quadratic = one quadrant affected only
    • Superior or inferior
    • Macular preservation = central field unaffected
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12
Q

Cochlear hair cells

    • Location
    • Gelatinous material
    • Stimulus

Vestibular hair cells

    • Locations (2)
    • Gelatinous material
    • Stimulus
A

Cochlear:

    • Location = Organ of Corti (in basilar membrane)
    • Gelatinous = Tectoral membrane (overlays Organ of Corti)
    • Stimulus = Sound
Vestibular:
Semi-circular canals --
-- Location = Christae (inside ampullae)
-- Gelatinous = Cupula (inside ampullae)
-- Stimulus = Angular acceleration (head rotation)

Saccule and utricle (otolithic organs)–

    • Location = Macula (within otolithic organs)
    • Gelatinous = Otolithic membrane (with CaCO3 otoconia)
    • Stimulus = Linear acceleration (up/down, ant/post, lateral)
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13
Q

Vestibulocochlear hair cells

    • Anatomy
    • Locations
    • Depolarization/Hyperpolarization
A

= Common sensory transducers for auditory and vestibular systems
Anatomy:
– Cell body with cilia in gelatinous material
– Stereocilia = 1000s per cell (short)
– Kinocilium = 1 per cell (long)
– Tip links = connect cilia
– CN VIII at base (cochlear or vestibular branch)
Locations:
– Cochlea – Organ of Corti
– Vestibular apparatus
– Semicircular canals – Christae (within ampullae)
– Saccule and utricle – Macula (within otolithic organs)
Depolarization/Hyperpolarization:
– Movement of perilymph at a given frequency
– Kinocilium bends away from stereocillia (EXPANSION)
= Stereocilia bend TOWARD kinocilium – DEPOLARIZE
= Impulse sent via CN VIII to brain
– Kinocilium bends towards stereocillia (COMPRESSION)
= Stereocillia bends AWAY from kinocillium – HYPERPOLARIZE
= No impulse sent

NOTE: Each section of basilar membrane is most sensitive to a given frequency of sound b/c of orientation of hair cells attached to membrane (different hair cells depolarize or hyperpolarize at different frequencies)

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14
Q

Ear structures

    • Outer ear
    • Middle ear
    • Inner ear
A

Outer ear (air filled)

    • Auricle = Ear lobe
    • External auditory meatus = Ear canal
    • Tympanic membrane = Border with middle ear

Middle ear (air filled)

    • Ossicles = Bony structures
      • Malleus (hammer) = Attached to tympanic membrane
      • Incus (anvil)
      • Stapes (stirrup) = Attached to oval window
    • Eustachian (Pharyngo-Tympanic) tube = Connects ear to throat
    • Oval and round window = Border with inner ear (superior and inferior)

Inner ear (fluid filled): Contains membranous labrynthe (cochlea and VA)
– Vestibular apparatus
– Semicircular canals = Angular acceleration
– Anterior, posterior, and horizontal
– Otolithic organs (utricle and saccule) = Linear acceleration
– Cochlea = Auditory structure
– CN VI (Facial) and VIII (Vestibulocochlear)
= Exit via internal auditory meatus

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15
Q

Cochlea structures

A

– Basilar membrane
= Horizontal division of scala tympani and media
– Contains Organ of Corti
– Organ of Corti = Sensory receptor
– Embedded in basilar membrane
– Contains hair cells
– Overlain by gelatinous tectoral membrane
– Converts mechanical vibration (perilymph movement) to electrical signal)
– Tectoral membrane = Gelatinous material over Organ of Corti
– Creates drag in fluid
– Causes cilia of hair cells to move (depolarize or hyperpolarize)
– Spiral ganglion = Cochlear end of CN VIII
– Receives impulses from depolarized hair cells
– Relays impulse to auditory (i.e., cochlear) nerve (first order neuron)

Spaces (superior to inferior):

    • Scala vestibuli = Contains perilymph (surrounds tube)
      • Reisnners membrane at base
    • Scala media = Contains endolymph (middle of tube)
      • Basilar membrane at base
    • Scala tympani = Contains perilymph (surrounds tube)

Associated bony structures:

    • Bony core = Surrounds membranous cochlea
    • Petrous ridge = Petrous portion of temporal bone contains cochlea
    • Internal auditory meatus = Passage for CNs VII and VIII
16
Q

Retina visual pathway

A
    • Light – External to internal (passes through 3 layers)
      • Pigment epithelial cells (base of retina) = Sensory receptors
        • Rods and cones = First order neurons – DEPOLARIZE
          • Rods (100-125 million) = Vision in low intensity light
          • Cones (6-7 million) = Color vision and visual acuity
          • Bipolar cells = Second order neurons – DEPOLARIZE
          • Ganglion cells = Third order neurons – DEPOLARIZE
            • Optic nerve (CN II) to visual cortex

NOTE: Light first passing through layers helps filter and diminish light (otherwise would be too bright to interpret)

17
Q

Visual pathway: Ganglion cells – Visual cortex

Visual field:

    • Peripheral vision
    • Central field of vision
    • Middle field of vision
    • Upper vs. lower
    • Right vs. left
A

Ganglion cells = Third order neurons

    • Form OPTIC NERVE (at optic disc) – Exit eye
    • Optic nerves bifurcate at OPTIC CHIASM
        • Fibers transmit to side of brain where light hit retina
    • Fibers from both eyes merge in OPTIC TRACT
    • Synapse at LATERAL GENICULATE body = Fourth order neurons
    • Travel posteriorly via OPTIC RADIATIONS
    • End in visual cortex of occipital lobe (upper/lower calcarine cortex)

Visual field – Visual cortex:

    • Peripheral vision – Anterior
    • Central field vision – Posterior (occipital pole)
    • Middle field vision – Middle
    • Upper visual field – Lower retina and visual cortex
    • Lower visual field – Upper retina and visual cortex
    • Right visual field – Left retina and visual cortex
    • Left visual field – Right retina and visual cortex
18
Q

Pupillary light reflex pathways

    • Parasympathetic
    • Sympathetic
A

Constriction (parasympathetic)

    • Light – Retina
      • Optic nerve
      • Optic tract
      • THROUGH lateral geniculate
      • Brachium of superior colliculli
      • SYNAPSE tectal nuclei (superior colliculli) on 2 neurons (one per eye)
        • 2 SYNAPSES Edinger-Westphal nucleus (of oculomotor nucleus)
          • Preganglionic parasympathetic neurons (one per eye)
        • 2 SYNAPSES ciliary ganglia (one per eye)
          • Ciliary nerves (one per eye)
        • Sphincter pupillae muscles – PUPIL CONSTRICTS

Dilation (Sympathetic)

    • Hypothalamus – T1-4 – Lateral horn – Ventral root
      • White rami communicantes – Sympathetic chain
      • Superior cervical ganglia – SYNAPSE
      • Postganglionic neurons – Carotid plexus (arteries)
      • Dilator pupillae muscles – PUPIL DILATES

NOTE: Dilation can also occur just by decreasing parasympathetic input

19
Q

Accommodation reflex

    • Components
    • Pathway
A

= Process in which clear visual image is maintained as gaze shifts far to near

Components:

    • Lens thickens (becomes rounder)
    • Pupil constricts
    • Eyes converge (ADD)

Pathway:

    • Visual (occipital) cortex –
      • Superior colliculli (tectal nuclei) – 2 SYNAPSES (one per eye)
      • Oculomotor nucleus (2 synapses per eye = 4 total)
        • Parasympathetic fibers
            • Edinger-Westphal nucleus
              • Ciliary ganglion – Ciliary nerves
          • Sphincter pupillae (constriction) and ciliary muscles (lens accommodation)
        • Somatic fibers
          • Somatic nuclei
            • Medial rectus muscles (ADD of eyes)
20
Q

Eye movements

    • Muscle(s)
    • Test
    • Nerve
A

Elevation

    • Superior rectus – CN III (Oculomotor)
    • Inferior oblique – CN III (Oculomotor)
    • H-Test

Depression

    • Inferior rectus – CN III (Oculomotor)
    • Superior oblique – CN IV (Trochlear)
    • H-Test

Abduction
– Lateral rectus – CN VI (Abducens)

Adduction
– Medial rectus – CN III (Oculomotor)

Extorsion = Rotate eye away from nose

    • Inferior oblique – CN III (Oculomotor)
    • Tilt head (watch for eye alignment)

Intorsion = Rotate eye toward nose

    • Superior oblique – CN IV (Trochlear)
    • Tilt head (watch for eye alignment)
21
Q

Gaze movements:

    • Definition
    • CNS centers
    • Conjugate
      • Saccades
      • Smooth pursuit
      • Vestibulo-ocular reflex
      • Optokinetic movements
    • Disconjugate
      • Vergence
      • Fixation
A

Conjugate = Eyes move same direction
– Saccades
= Rapid, steplike movements used to acquire image on fovea (700-900 deg/s)
– Frontal eye field and superior colliculli
– Smooth pursuit
= Slow tracking of object
– Frontal eye field and superior colliculli
– Vestibulo-ocular reflexes
= Hold image on fovea during head movement (all directions)
– Very short latency
– Oscillopsia = absence of reflex (jerky vision)
– Semicircular canal – CN VIII – Vestibular nuclei
– Optokinetic movements
= Track and re-acquire slow moving objects
– Optokinetic nystagmus = beating eyes tracking fast moving objects
– Vestibular nuclei

Disconjugate = Eyes move opposite

    • Vergence = Keep object in focus as it moves near or far
      • Convergence = Both eyes ADD as object approaches
      • Divergence = Both eyes ABD as object moves away
      • Superior colliculli

– Fixation
= Maintenance of focus on object
– Higher cortical centers suppress brainstem activity

22
Q

Gaze movement pathway

    • General pathway
    • CNS centers
A
Pathway:
-- Movement trigger
  = Gaze shift -- FEF, SC, VN
  = Object moves -- FEF, SC
-- Brainstem centers 
  -- Pontine reticular formation
  -- Medullary reticular formation
-- Medial longitudinal fasciculus
  -- CN nuclei: Trochlear, Oculomotor, Abducens, (Accessory) 
-- Eye muscles -- Movement execution 
-- Cerebellum and basal ganglia -- Movement refinement ("rehearsal")

CNS Centers:

    • FEF Frontal eye field = Plans movement
    • Superior colliculli = Triggers movement
    • Vestibular nuclei = VO reflex and Optokinetic movements
      • NOTE: VOR pathway = SCC – CN VIII – VN – Brainstem – MLF – CNs
    • Brainstem centers (PRF, MRF) = Program movement
    • Cerebellum = Refines timing of movement
    • Basal ganglia = Refines amplitude of movement
23
Q

Vestibular cerebellum

    • Structures
    • Roles
A

Structures:

    • Nodulus = Anterior center
    • Flocculi = Anterior, inferior to cerebral peduncles
    • Cerebral peduncles
    • Oculomotor vermis = Medial, posterior

Roles:

    • Gaze stability
    • Postural stability

NOTE: Damage causes “gaze-based ataxia”
– Over and undershooting when tracking object