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PGHY 350 > neuro review > Flashcards

neuro review Flashcards

1
Q

what is kernicterus?

A

crossing of bilirubin over the BBB

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2
Q

what cell makes up the BBB?

A

astrocytes

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3
Q

what is a uncal cranial hernia?

A

uncal - refers to lower area of the brain such as the cerebellum

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4
Q

papilledema and ipsilateral pupil unresponsiveness (causing dilation) are symptoms of?

A

Increased ICP

ipsilateral dilation = result of impaired PNS

ptosis is also a symptom

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5
Q

what is the cushings reflex?

A

increased BP
decreased HR
decreased RR

response to cranial ischemia, causes increased ICP with time

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6
Q

what occurs if there is a supratentorial lesion?

A

supratentorial = above the tentorium
- these lesion result in specific problems

infratentorial lesions are widespread

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7
Q

lesion to the right hemisphere affects?

A

left is for logic

right side lesion = R-art (music, language, art)

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8
Q

lesion to the
lateral spinal tract
ventral spinal tract
causes?

A

lateral –> (Lipsi) –> ipsilateral issue
ventral –> (CV) –> contralateral issue

these are upper MOTOR neuron lesions
- spastic paralysis

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9
Q

lesion to LMN is ipsi or contra?

A

ipsi always - causes flaccid paralysis

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10
Q

lesion to
dorsal column
spinothalamic column
causes?

A

dorsal –> crosses at medulla –> therefore ipsilateral issue
spinothalamaic –> usually contralateral

these are sensory lesions
cranial nerve lesions are also sensory

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11
Q

dorsal column detects?

spinothalamic detects?

A

dorsal –> fine touch, presssure, stretches

spinothalamic –> pain and heat and gross touch

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12
Q

What do I mean when i say, optic nerve fibres want to follow their visual fields?
explain inner and outer retina neurons

A

the inner retina views the outer field (peripheral)
since the neuron wants to follow the the visual field, it crosses over the optic chiasm

the outer retina views the inner field, therefore (right eye views left inner field) –> the neuron does not want to cross over

draw the diagram

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13
Q

what is hemianopia?

A

when there is loss of half the visual field in one or both eyes

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14
Q

what is dysarthria and agnosia?

A

dysarthria –> problems with speech articulation probably from a motor problem

agnosia - loss of recognition abilities

these are aphasia’s –> troubles with reception or expression

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15
Q

what is a transient ischemic attack?

A

temporary, localized occlusion of a vessel in a brain - last less than 1 hour

consciousness retained. This is a sign of stroke

smoking + contraception use may cause this + other obvious precipitating factors

symptoms - paresthesia, muscle weakness, and visual disturbances

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16
Q

what is a cerebrovascular accident? what 3 main causes?

A

this is a stroke - total occlusion of a vessel leading to infarction of nerve tissue in brain - necrosis

  1. ischemic - atheroma obstructs vessel
  2. embolus - thrombosis
  3. Hemorrhagic - can cause vasospasm and increased ICP
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17
Q

one sign of CVA onset is contralateral muscle paresis. Why?

A

the occlusion is affecting upper motor neurons. these neurons always cross over (either in medulla for lateral tract or in the SC for the [CV] ventral tract) –> therefore, impairment in brain leads to contralateral muscle weakness

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18
Q

what is the seqeual of a stroke in terms of muscle weakness?

A
  1. starts with flaccid paralysis

2. becomes spastic paralysis

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19
Q

what is an expanding penumbra?

A

the penumbra is the space near the area of damage. this expands after a stroke and then subsides later

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20
Q

what is a berry aneurysm?

A

an aneurysm that occurs in the circle of Willis

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21
Q

what is nuchal rigidity?

A

a symptom of an aneurysm –> stiff extended neck

immense headache, hemorrhage, photophobia, slurred speech, confusion

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22
Q

what is a contrecoup contusion?

A

contusion = bruising of the brain due to small vessel ruptures

contrecoup - brain rebounds off of impact and bruises opposite side of brain

concussion –> severe brain movement leading to short LOC, amnesia, etc.

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23
Q

what is the difference between an epidural and subdural hematoma?

A

epidural –> occurring in brain meningeal arteries. LOC occurs within one hour

subdural –> occurring in meningeal veins or arachnoid tissue, can be acute or subacute (weeks of development)

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24
Q

what is a subarachnoid hemorrhage?

A

occurs at the base of the brain –> blood mixes with CSF. NO hematoma occurs

contrasts to a intracerebral hemorrhage which occurs may cause a hematoma.

25
Q

what are otorrhea, rhinorrhea, and otorrhagia?

A

otorrhea - ear discharge
rhinorrhea - nose discharge
otorrhagia - ear bleeding

26
Q

neck hyperflexion is?

A

when the neck bends too far forward

27
Q

interference of the phrenic nerve via C3-C5 SC vertebrae is significant b/c?

A

phrenic nerve is important for respiration muscles

28
Q

SC injury progression? (3)

A
  1. spinal shock - no impulses at all
  2. flaccid paralysis
  3. spastic paralysis when reflexes are regained

2 is essentially a apart of 1

29
Q

what else occurs in spinal shock?

A

flaccid paralysis
major loss of ANS action, esp. SNS –> low BP
(with cervical injury)
eventually inflammation subsides and spastic movements are regained.

30
Q

what is the prominent issue with motor SC damage

A

ipsilateral damage - which would be a part of the lateral tract

31
Q

explain autonomic dysreflexia in SC injuries

A

noxious stimuli occurs that the brain normally inhibits (e.g. full stomach –> reflex wants to throw up or increase gastric motility, but brain says chill)

however, after SC injury, there is an increases SNS response to this noxious stimuli (when cervical SC is fine), which causes increased BP. baroreceptors feel this and cause bradycardia through the unaffected PNS vagal nerve.

same as Cushing’s reflex in ICP progression but no decrease in RR

Will not occur in cervical injury since then ANS function decreases and BP actually decreases

32
Q

t or f, cerebral palsy (CP) is a motor and cognitive problem and it is progressive

A

false, its only a motor problem and its NOT progressive

33
Q

how does CP arise

A

genetic mutation or during perinatal distress usually involving fetal hypoxia (aspiration, severe hemorrhage , vascular occlusion)

34
Q

what are 3 causes of fetal kernicterus (which is linked to causing CP)

A
  1. fetal switch from gamma to beta Hb -> excess bilirubin
  2. Rh incompatibility - mom attacks fetal Rh –> accumulates RBC waste
  3. hypoglycaemia during development
35
Q

explain the moro reflex, dysarthria, and strabismus

A

moro reflex is a fetal response to falling. if it persists then it indicates CP
dysarthria - expressive dysfunction due to motor dysfunction
strabismus - inability to coordinate eye movement equally

36
Q

spastic CP
what
where
characteristic symptom

A

result of hyperreflexia due to decreased brain inhibition –> the motor units cause contraction with no other signals
where –> pyramidal (medulla)
characteristic symptom –> scissor gait –> bent inward knees due to constant contraction

37
Q

dyskinetic CP
what
where
characteristic symptom

A

loss of fine motor control (i.e. dexterity)
where - basal nuclei (extrapyramidal)
characteristic symptoms: choreiform movements and writhing / athetoid movements

38
Q

Ataxic CP
what
where
characteristic symptom

A

Ataxic = decreased movement
where - cerebellum
characteristic symptom = poor balance and therefore a wide stance

39
Q

what is believed to be the cause of seizures?

A

brain cells have a lower excitatory threshold than normal

affects mainly children

can be general - whole brain
can be partial - focal

40
Q

what is an absence seizure?

A

aka petit mal
it is a generalized seizure (affects whole brain)
brief loss of awareness, staring, ‘out of it’
no memory of the event

41
Q

what is a tonic/clonic seizure? stages?

A

aka grand mal

  1. prodromal stage - altered aura
  2. LOC
  3. ictal phase
    - tonic –> sustained muscle contractions. starts as flexion and becomes extension after
    - clonic –> jerky movements of alternating contraction / relaxation
  4. post-ictal phase - sleepiness
42
Q

what is status epilepticus?

A

recurrent seizures with LOC - dangerous

43
Q

what is a partial seizure?

A

focal seizure characterized by repeated motor activity and altered sensations –> THERE IS NO LOC here. typically effects one side of the body –> distinguishes it from an absence seizure

44
Q

what is a Jacksonian seizure?

A

clonic <> starts in one location of body and progresses in a direction

45
Q

what are the two drug mechanisms used to treat seizures, what is the main drug known.

A
  1. Na + blockers –> Dilantin

2. GABA agonists

46
Q

what is a major side effect of dilantin?

A

gum hyperplasia

47
Q

what is multiple sclerosis? what does it affect?

A
  • autoimmune disease causing demyelination of your central NS neurons - includes spinal neurons
  • affects both sensory and motor neurons esp. ventricles, brain stem, and optic nerve
48
Q

what actually causes the pathology in MS?

A

immune response lays down too much scar tissue

49
Q

explain diplopia and scotoma

A

these are signs of MS
diplopia = double vision due to unequal transmission times of the 2 optic nerves (not the same as strabismus which is uneven motor control of eyes - sign of CP)

scotoma - blurred vision in centre of visual field (outer retina)

50
Q

t or f, females are more affected by MS

A

true

51
Q

what does gadolinium MRI do?

A

gadolinium should not cross BBB –> if it does, diagnosis of MS

52
Q

t or f, both MS and cerebral palsy are motor and cognitive pathologies

A

false - CP is only motor, MS affects sensory, motor, and ANS.

53
Q

what is Parkinson’s disease? what causes it? where does it occur? deficiency / aggregation?

A

Parkinson’s disease is characterized by a deficiency in dopamine. This is caused by the aggregation of alpha-synuclein proteins which interfere with dopamine vesicle packaging.

Parkinson’s affects the basal nuclei –> substantia nigra

primarily a motor function problem

54
Q

what is the name of the aggregated alpha-synuclein inclusions?

A

lewy bodies

55
Q

what is festination in PD?

A

aka shuffle gait –> people with PD have trouble getting movements going –> so when they walk they shuffle.

hyperkinesia and hypokinesia are also symptoms of PD

56
Q

what is PD’s treatment?

A

L-dopa to cross BBB

L-dopa decarboxylase inhibitors to increase BA

57
Q

what is Huntington’s Disease? deficiency / aggregates? Where does it occur?

A

disease of the striatum of the basal nuclei (whereas Parkinson’s was a disease of the substantia nigra and MS of the optic nerves and brain stem)

characterized by a GABA deficiency – less inhibition
- basal nuclei responsible for disinhibition

–> results in chorea, jerky movements, later cognitive issues

–> aggregates of Huntingtin protein

58
Q

What is ALS?

A

strictly motor neuron death –> typically of lateral spinal tract.

men are more affected

20% linked to SOD1 mutation

59
Q

t or f, ALS starts in distal limbs usually

A

true

PGHY 350 (10 decks)

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