Neurological Flashcards
Pre/Post central gyrus are also known as ____ and are on either side of the ____
Primary sensory/motor cortex on either side of the central sulcus
The Cerebellum is mostly associated with what function?
Coordination
What two areas make up the Diencephalon?
The Thalamus and Hypothalamus
What is the name of the white matter area that divides the hemispheres?
Corpus Callosum
What are the areas that make up the Corpus Callosum?
Genu at front with rostrum underneath, body in middle, splenium at the back.
What connects the 3rd and 4th ventricle and where is it located?
The cerebral aqueduct is located between the cerebellum and the medulla/pons
What is the main split down the middle of the brain called?
Longitudinal fissure
The ends of the Hippocampus are called the ____ and are associated with ____
Amygdala, emotion, especially fear
Where is CSF made?
In the choroid plexus of the ventricles
Which 2 layers form the subarachnoid space?
Arachnoid mater and pia mater
What is the path of CSF?
Lateral ventricles > Interventricular foramen > 3rd ventricle > Cerebral aqueduct > 4th ventricle > apertures > subarachnoid space > arachnoid granulations > super sagittal sinus
In what way does the spine continue down to the coccyx?
The pia mater continues down as the filum terminale
What types of neurons are present in the dorsal root?
Sensory
What types of neurons are present in the ventral root?
Motor
How many segments in spinal column?
31
Which feature helps to orient the spinal column
The VENTRAL fissure
The dorsal horn of the spinal grey matter holds mostly ___ cell bodies
sensory
The ventral horn of the spinal grey matter holds mostly ___ cell bodies
lower motor
Which suture joins the frontal bone with the parietal bone?
Coronal suture
Which suture joins the parietal bones together?
Sagittal suture
Which suture joins the occipital bone to the parietal bones?
Lamboid suture (think Lambda)
Name of the weak point of the temporal skull where the 4 bones (temporal, sphenoid, parietal and frontal) meet.
Pterion
Which suture joins the parietal bones to the temporal bones?
Squamous sutures
Where does the pituitary sit in relation to skull bones?
In the saddle shaped hypophyseal fossa of the sphenoid bone
Name of the un-ossified connections in a baby’s skull that can show signs of dehydration or raised ICP
Fontanelles
Describe the dura mater
2 layers - periosteal and meningeal - the gap forms the dural venous sinuses
Which layer of the meninges is avascular?
Arachnoid mater
Where does all venous drainage of the brain end up?
Jugular vein
Describe the neurological homunculus.
Most medial: feet + legs
Most lateral: tongue and face
Which area of the brain is used for comprehension and where is it located?
Wernicke’s area, dominant temporal lobe.
Which area of the brain is used to control speech and ‘find’ words, where is it located?
Broca’s, dominant frontal lobe.
The internal carotids immediately become which arteries in the Circle of Willis?
Middle Cerebral Arteries
3 main causes of delirium:
infection (UTI), medications, metabolic disturbances such as vitamin deficiency
What causes Wernicke’s encephalopathy?
Vitamin B1 (Thiamine) deficiency - often due to alcoholism (need it for myelin).
Which two cell types make myelin?
CNS - oligodendrocytes PNS - Schwann Cells
What are the layers of the scalp?
S - skin
C - connective tissue
A - aponeurosis
L - loose connective tissue
P - periosteum
Which layer of the scalp houses the arteries?
Layer 2 - connective tissue
Name the main branch of the internal carotid associated with the face, and which two arteries it branches into to supply the forehead.
The ophthalmic artery which becomes the supraorbital and supratrochlear arteries - only arteries of the face from the internal carotid
What are the main muscles of the eye?
Orbicularis oculi is the main one and the supercilliary muscles are also there for eyebrow movements.
Which muscles control the lips and cheeks?
Orbicularis oris for the lips and buccinator for the cheeks
What are the muscles of mastication?
Masseter, temporalis, pterygoids x2.
Which two cranial nerves control the face?
CN 5 and 7, trigeminal and facial
Which vertebral segments innervate the back of the head?
C2 and C3
What are the 3 trigeminal divisions?
ophthalmic, maxillary, mandibular (only mixed one - for eating)
What does the facial nerve do and what are its branches?
Expressions (motor), divided into 5 after the parotid gland: The Zebra Bit My Cat.
Temporal, Zygomatic, Buccal, Mandibular, Cervical
Main artery of the face and its root?
The facial artery, from the external carotid.
What is special about the facial vein?
VALVELESS - infection risk.
Where does all face lymph end up?
Deep cervical lymph nodes
Difference between dysarthria and dysphasia?
Dysarthria is difficulty with the motor aspects of speech, dysphasia is difficulty with language.
Dysphasia can be split into which 2 broad types?
Broca’s - non-fluent with difficulty finding words but sensical
Wernicke’s - fluent with incorrect words (word salad) - non-sensical.
“Thunderclap headache” is a red flag for which presentation?
Subarachnoid haemorrhage.
What is Cushing’s Triad?
A triad of symptoms present during raised ICP (HYPER BRADY BRADY) - HTN, bradypnea, bradycardia
How to diagnose meningitis?
Lumbar puncture
Where would a lesion be that caused temporal vision loss?
Optic chiasm - bitemporal hemianopia
Where would a lesion be that caused monocular vision loss?
In the eye anatomy or the pre-chiasm nerves
Where would a lesion be that caused field vision loss?
In the brain - likely stroke.
Explain Babinski’s reflex.
Stimulation of sole of the foot should cause scrunched toes, upgoing toes indicates a UMN issue.
What are the 3 spinal tracts and which senses do they carry?
Spinothalamic - pain and temp (early decussation)
Dorsal column - vibration and proprioception
Spino cerebellar - coordination (think cerebellum)
Function of hypothalamus?
Homeostasis
Function of thalamus?
Info integration
What are Glia, and what are some examples?
Glia are non-neuronal nervous tissue.
1. Astrocytes - regulate/upkeep
2. Microglia - phagocytes
3. Oligodendrocytes/schwann cells - myelin
Describe the grey and white matter distribution of the CNS.
Brain has grey on the outside and white on the inside (like a kinder surprise, head is egg shape). Spine is opposite
What are the 4 types of mechanoreceptors and what are each of their depths?
Meissner and Merkel (surface) (MnMs on surface) and Ruffini and Pacinian areas (deep).
Which mechanoreceptors are slow and which are fast?
Angela Merkel likes it rough and slow = Merkel and Ruffini are slow.
Pacinian and Meissner are rapid.
What is the mnemonic for cranial nerve function?
Some Say Marry Money But My Brother Says Big Brains Matter Most
What is the mnemonic for cranial nerve names? (PG13+)
Oh Oh Oh To Touch And Feel A Girl’s Vagina, Ah Heaven.
Olfactory, Optic, Oculomotor, Trochlear, Trigeminial, Abducens, Facial, Auditory, Glossopharyngeal, Vagus, Accessory, Hypoglossal.
What will histology show 12-24 hours after a stroke?
Red Neurons
An issue with which artery can cause bitemporal hemianopia?
Anterior communicating artery
Rupture of an aneurysm in the circle of willis will cause what type of bleed?
Subarachnoid haemorrhage
Which layer of the vessel is broken in a true aneurysm and which in a dissection?
Media in aneurysm, intima in dissection.
Which group of diseases increase the risk of cerebral aneurysms?
Any connective tissue issue such as Polycystic Kidney Disease or Marfans
How would you describe an epidural hematoma?
Red lemon, usually trauma. Often young people.
How would you describe an subdural hematoma?
Blue banana, can be chronic, often older people
What is the pattern of a subarachnoid haemorrhage on a CT?
Bright tracks along the sulci and fissures, often due to aneurysm. Looks like a STAR.
What is the pattern of a intraparenchymal bleed on a CT?
inside brain, often circular.
Which cranial nerve is impacted most by raised ICP?
CN3, oculomotor, down and out eyes direction, blown out pupils.
What type of Hypersensitivity is MS and what is the typical presentation?
Type IV, delayed, young person with optic neuritis.
Where do monosynaptic neuron relationships occur?
Only with stretch receptors and the motor neuron the same muscle
Chronic pain is also called?
Neuropathic pain
Visual hallucinations are typical of what?
Delirium
Which vertebrae correspond to the sympathetic nervous system and which correspond to the parasympathetic?
T and L for symp, S and C for para.
Where are the nuclei and ganglia of the sympathetic nervous system?
Nuclei initially in the intermediolateral nucleus of spinal grey matter, ganglia are in para-vertebral (sympathetic latter) or pre-vertebral
Where are the parasympathetic ganglia?
Brainstem nuclei for C and intermediolateral nucleus for S
Where does the middle meningeal artery come from?
External carotid > Maxillary > Middle Meningeal
Why does a Basilar Artery stroke cause locked-in syndrome?
The basilar artery supplies the pontine arteries, so without blood supply to the pons. Pons is needed to relay info.
Which neurotransmitters are used by the pre-ganglionic and post-ganglionic neurons of the sympathetic and parasympathetic systems?
Symp: pre: Ach(N) and post: NA
Para: pre: Ach(N) and post: Ach(M)
What is the main neurotransmitter for pain?
Glutamate
Which part of the vertebral columns are devoted to sensory areas and which to motor?
Dorsal is always sensory. Dorsal root = sensory. Dorsal horn - sensory.
Ventral is movement.
Which memory types are reduced by age vs by dementia
Episodic memory is reduced by age and procedural memory is reduced by dementia.
What are the causes of delirium?
Mnemonic: DELIRIUM
D - drugs
E - Electrolytes
L - lack of drugs
I - infection
R - reduced senses
I - intracranial pressure
U - urinary retention
M - MI
What type of incontinence do UTI’s cause?
Urge incontinence, vs stress.
What is the anterior attachment of the falx cerebri meningeal layer?
Ethmoid bone crista galli (it’s like a fin)
What bones form the boundaries of the nasal cavity?
Roof - ethmoid bone
Floor = maxillary bone and Palatine
Back = Sphenoid and Palatine
What bones form the boundaries of the oral cavity?
Roof = maxillary bone and palatine
Floor = mandibles
Which cranial nerve innervates the superior portion of the nasal cavity?
CN 1 - Olfactory
Describe the distribution of conchi (turbinates), meatuses and paranasal sinuses.
3x conchi on each side to humidify air, a meatus under each conchi with gaps (foramen) into the sinuses. Frontal sinus, ethmoid sinus, sphenoid sinus, maxillary sinus.
Describe the innervation of the paranasal sinuses?
Frontal, sphenoid and ethmoid are all the ophthalmic branch of the trigeminal (hence eye pain in sinus infection), the maxillary sinus is innervated by the maxillary branch of the trigeminal (hence cheek pain).
Describe the vascularisation of the nasal cavity?
Front: facial artery
Back: sphenopalatine artery
Bottom: palatine artery
Top: ethmoid arteries
ALL EXTERNAL CAROTID
Describe the innervation of the nasal cavity?
Top half = ophthalmic of trigeminal
Bottom half = maxillary of trigeminal
EXCLUDING CN1 AREAS
Describe the motor innervation of the tongue muscles (internal and external)
All are hypoglossal (CN12) apart from the palatoglossus muscle which is vagus (CN10).
Describe the innervation of the teeth?
Top: superior alveolar (maxillary trigeminal)
Bottom: inferior alveolar (mandibular trigeminal)
What are the areas of the larynx and where does the larynx start and end?
Hyoid bone, thyroid cartilage and cricoid cartilage. It starts at the epiglottis and ends at the cricoid cartilage -C6 (trachea).
Describe the distribution and function of the vocal cords.
The arytenoid cartilages sit on top of the cricoid cartilage (below Adam’s apple) and attach to the vocal cords (vocal ligaments). There are false vocal cords (vestibular folds) above to protect the true vocal cords. Moving the arytenoids closing together allows for sound.
Explain why ‘posterior’ parts of the larynx are used for breathing.
The posterior thyroid cartilage is deficient in cartilage to allow air through and the posterior cricoarytenoid muscle pulls the vocal cords apart to allow for air to pass through.
Describe the innervation of the larynx?
It’s all vagus (CN10) - the recurrent laryngeal is interesting because it descends into the thorax before returning to come back up - will cause a hoarse voice if damaged in surgery.
Describe the vascularisation of the larynx?
Done by the laryngeal arteries which come from the thyroid arteries.
What is the function of the salpingopharyngeus muscle?
To open the foramen in the nasal cavity the leads to the eustachian tubule to equalise pressure in the middle ear.
Which nerve(s) control the gag reflex?
Sensory - glossopharyngeal (CN9)
Motor - vagus (CN10)
Mnemonic for the external carotids:
Seven Loud Femmes Arguing Over PMS
S uperior thyroid
L ingual
F acial
A scending pharyngeal
O ccipital
P posterior auricular
M axillary
S uperficial temporal
What are the 3 deep fascial layers of the neck and the 3 ‘V’ compartments of the neck?
Investing fascia, pretracheal, prevertebral.
3 V’s: visceral, vertebral, vascular
The investing fascia splits to encapsulate which muscles?
The SCM and the Traps
Which major vessels lie between the platysma and the investing fascia?
External and Anterior Jugular veins (internal are in carotid sheath)
The investing fascia tightly hugs the vertebral fascia and the vertebrae at what level?
C7
Why are the layers and connection points of the pretracheal fascia clinically relevant?
An infection of the visceral but NOT muscular pretracheal fascia can spread to the pericardium as the visceral compartment connects to the pericardium (starts at hyoid).
What are the connection points for the vertebral fascial compartment of the neck?
Bottom of the skull to the axilla of the arm.
What key features are in the carotid sheaths?
Common/internal carotid, internal jugular vein, vagus nerve, lymph nodes.
What are the hyoid muscles of the pretracheal muscular fascia used for and how many are there?
Used for swallowing and eating, 4x below the hyoid and 4x above. Most have hyoid in the name except diagastric and sternothyroid).
What is the progression of the first branch of the external carotid?
Becomes the superior thyroid artery to supply most of the thyroid and then becomes superior laryngeal for the larynx.