Neuroanatomy Flashcards
Lateral spinothalamic :
- function
- receptor type
- nerve fibre type
- path:
- lesion results
- tests pain, hot/cold
- receptors are Free Nerve Ending
- sharp pain = A delta fibers
- Dull pain = C fibers
Ascends in lateral white column & crosses within 1-2 segments then finishes in parietal lobe
Half cord lesion:
- ipsilateral loss at that level, contra loss below
Anterior spinothalamic
- function
- receptor type
- fibre type
- path
- half cord lesion results
- crude touch + pressure
- Ruffini corpuscles, Merckle discs, free nerve endings
- A delta + A beta fibers
Ascends in anterior white column, crosses 1-2 segments , ends in parietal lobe
Half cord lesion :
- ipsilateral loss at level, contralateral loss below lesion level
Dorsal column medial lemniscus
- Function
- receptor type
- fibre type + path
- lesion above or below medulla results
- 2 point discrimination, fine touch, vibration, sterognosis
- Pacinian corpuscles (vib), Merckel’s discs, Meistersinger (fine touch),
- A beta fibers that cross in the brain stem and finish in parietal lobe
Lesion:
- below medulla: ipsilateral loss
- above medulla; contralateral loss
Lesion:
List of the Ascending and descending tracts
Ascending:
1) lateral spinothalamic
2) anterior spinothalamic
3) dorsal columns (medial lemniscus)
Descending:
1) lateral corticospinal
2) Anterior Conrticospinal
Lateral Corticospinal tract:
Primary motor tract
- 90 % cross in pyramids (medulla of brainstem)
- synapses in Anterior Horn in grey matter of SC, leaves as alpha motor neutron to the neuromuscular junction
Lesion:
- above medulla where they cross: loss of voluntary mvmt contralateral to lesion
Anterior Corticospinal tract
Primary motor
- 10% that cross at level of innervation
Lesion Of one side:
- loss of 10% voluntary movement contralateral to lesion
List of Cerebellar arteries:
1) Internal Carotid
2) Anterior Cerebral
3) Middle Cerebral
4) Posterior Cerebral
5) Vertebral
6) Superior cerebellar
7) Anterior-Inferior Cerebellar
8) Posterior- Inferior Cerebellar
Internal Carotid Artery
- fxn
- deficits
Fxn: supplies Ant, Mid, Post Cerebral arteries
Deficits:
- contralateral hemiplagia/ sensory disturbances
- global aphasia
- mentally slow
- gaze palsy
- partial Horner’s syndrome
ACA - deficits
Deficits:
- weakness + sensory loss of contralateral limbs
- initiation of speech via Broca’s area
- Motivation + emotional problems (frontal lobe)
- potential L side neglect if R was affected
MCA deficits
Deficits:
- Contralateral hemiplegia, hemisensory loss, hemianopia
- Contralateral Neglect
- Aphasia
- Apraxia (motor planning disturbance)
- speech dysfunction (broca’s area)
- impaired hearing
PCA
- fxn
- deficits
- supplies occipital lobes
Deficits:
- vision problems, CN III palsy,
- Contralateral hemiplegia
- Chorea (abnormal volt movements [dancing])
- Hemiballism (involuntary flinging of extremities)
- difficulty with naming and colors
- hemisensory impairment
Vertebral artery
- fxn
- important branches
- two join to form Basilar Artery
Branches: important for strokes
- PICA (largest), AICA, PCA (posterior cerebral)
Superior cerebellar artery
- fxn
- deficits
Supplies:
- Anterior lobe, Vermis, superior 1/3 of posterior lobe
"Anterior love disease": Deficits: - Proprioception - Ataxia - Horner's syndrome: droopy eyelids, red face - Contralateral sensory loss
Anterior-Inferior Cerebellar Artery (AICA)
- fxn
- Deficits
Supplies: Cerebral Peduncles, Flocculus, deep cerebellar nuclei
Deficits:
Gait difficulties, trunk imbalance, abnormal head posture, occulomotor dysfunction.
- ipsilateral limb ataxia
- ipsilateral Horner’s
- facial weakness
- paralysis of lateral gaze
- Contralateral sensory loss of limbs and trunk
Posterior-Inferior Cerebellar Artery
- fxn
- deficits
Supplies: Inferior 2/3 of posterior lobe, tonsils, vermis/ nodules
Deficits:
- Dysarthria (poor verbal articulation [motor issue])
- dysmetria
- Ipsilateral limb ataxia
- Vertigo
- Nystagmus
- Ipsilateral Horner’s
- sensory loss of Pain and temp of face
- pharyngeal/ laryngeal paralysis
- Contralateral Pain temp loss of trunk
- paralysis of vertical eye movements and reduced pupil reflex
Broca’s Aphasia
- location
- impairment
“Expressive Aphasia”
- left frontal lobe
Impairment:
- dysarthria (verbal articulation), but can understand speech fine
Wernicke’s Aphasia
- location
- impairment
- types
” Receptive Aphasia”
- Left Temporal lobe
Impairment:
- speaks normal but words don’t make sense (word salad)
Types:
- somatosensory: located in both parietal lobes
- visual: located in both occipital lobes
- auditory: temporal lobes
- olfactory: temporal lobes
Left CVA impairments
Decreased:
- R-side muscles affected.
…..more…
Right CVA
Decreased:
- spatial pattern awareness
- recognition of faces
- emotional content of language (monotone)
- discrimination of smells
- HEMI-NEGLECT of the LEFT
- musical and artistic awareness
List of Cranial Nerves:
1) Olfactory
2) Optic
3) Occulomotor
4) Trochlear
5) Trigeminal
6) Abducens
7) Facial
8) Vestibular
9) Glossopharyngeal
10) Vagus
11) Accessory
12) Hypoglossal
Mnemonic:
Oh, oh, oh, to touch and feel very good velvet and Hypoglossal
CN I:
- fxn
- deficits
Olfactory
Damage:
- via frontal lobe lesion
- anosomia (loss of smell)
CN II:
- fxn
- damage
Optic - vision
Damage:
- Hemianopsia: visual field loss of the same side of both eyes
- myriad of issues…
CN III
Occulomotor - pupillary reflex
- MM: medial Rectus, superior & inferior Rectus, and inferior oblique
Damage:
- absence of pupillary constriction reflex
- difficulties with accommodation
- Horner’s syndrome (drooping eye lid [ptosis])
- decreased sweating of the face
- redness/ conjunctiva of eyes
CN IV
Trochlear
- MM: superior oblique
Fxn: - turns adducted eyes downward
CN V
Trigeminal:
V1) Opthalamic: sensory of scalp and forehead
V2) Maxillary: Sensory for cheeks, upper lip
V3) Mandibular: Sensory for lower face + muscles of mastication
CN VI
Abducens:
- Turns eyes out via Lateral Rectus mm
CN VII:
- fxn
- damage
Facial nerve:
- parasympathetic control of lacrimal, submandibular, sublingual gland,
- Taste to anterior 2/3 of tongue
- Facial motor mm
- sensation behind ear
Damage:
- inability to close eye, droopy corner of mouth, difficulty speaking
UMN lesion: Contralateral lower Half of face lost
LMN lesion: ipsilateral total paralysis the side of face
CN VIII
Vestibular:
fxn: balance, gaze stability, auditory
Damage:
- vertigo, nystagmus, deafness
CN IX:
- Fxn
- deficits
Glossopharyngeal: - Swallowing mm ( stylo-pharyngeal mm) - Taste of posterior 1/3 of tongue - phonation - sensory to uvula (gag sensation??) - receives carotid bodies info (chemo/baroreceptors) Damage: - horse or nasal voice - Swallowing difficulties
CN X:
- fxn/ deficits
Vagus:
- muscle to Larynx, Pharynx
- parasympathetic to all but adrenal gland (HR, peristalsis, sweating)
- gag reflex (uvula??)
- motor to uvula deviation to one side = LMN lesion of opposite side
- elevates soft palate
CN XI
- fxn
- tract
- lesions
Accessory:
- innervated Traps and SCM
Tract: Corticobulbar, exit through jugular foramen
Damage:
- UMN Lesion: weak trap contralateral + weak SCM ipsilaterally
- LMN Lesion: weak trap and SCM ipsilaterally
- inability to shrug ipsilaterally or turn head to opposite side
CN XII:
- fxn
- fibre tract
- deficits:
Hypoglossal: tongue movements
- Corticobulbar tract
Damage: - UMN Lesion: tongue away (crossed)
- LMN lesion: tongue towards lesion
- dysarthria
Neuro- impairment level outcome measures
1) Motor control/ strength: MMT or Fugl-Meyer
2) Cognition and perception: mini-mental state exam or MOCA
3) Tone and Spasticity: Modified ashworth (tardieu for peads)
4) Sensation: body diagram, Nottingham sensory assessment
Neuro Rehab goals
1) maintain: participation, activity, body structure and function
2) Prevent: complications
3) Reversal of impairments: as appropriate, neuro plasticity
4) adaptation to impairments: aids, compensatory movements
Neuro Activity level outcome measures
1) Gait: 6MWT, 10 m walk, DGI, observational analysis
2) Balance: BERG, Fullerton, community balance and mobility scale, BESTest measure, functional reach
3) Upper extremity: DASH,
4) other: Barthel index, Chedoke stroke ax, COVS, Functional independence measure (fim), motor assessment scale, patient specific functional scale, ABC, stroke impact scale,
Discuss neuroplasticity
Use it or lose it, use it and improve it, specificity, repetition, intensity, time matters, salience, age matters, transference, interference, no drug alone will improve neuroplasticity, interventio needs to be paired with behaviour: task specific, goal oriented practice, dose? 6 hrs/day
List of basic sensation tests
1) Visual field testing
2) Papillary light reflex
3) Accomodation
4) Ptosis
5) eye movements
6) Smooth pursuits
7) Saccades
8) Nystagmus