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NEUROLOGICAL PRINCIPLES Flashcards

1
Q

Signs of UMN lesions

A

Weakness - extensors weaker than flexors in the arms, flexors weaker than extensors in legs
Hyper-reflexia + positive Babinski sign
Spasticity
Slight or absent muscle wasting
No fasciculations

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2
Q

Signs of LMN lesions?

A

Marked atrophy
Fasciculations
Reduced tone
Weakness/decreased power
Hyporeflexia + Absent plantar response

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3
Q

Ascending spinal tracts?

A

Dorsal column medial lemniscal
Posterior spinocerebellar
Anterior spinocerebellar
Spinal-olivary
Anterior and lateral spinothalamic

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4
Q

Descending spinal tracts?

A

Anterior and lateral corticospinal
Medial and lateral reticulospinal
Rubrospinal
Vestibulospinal
Tectospinal

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5
Q

Function of dorsal column pathway?

A

Fine touch, proprioception and vibration

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6
Q

Function of anterior spinothalamic tract?

A

Crude touch and pressure

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7
Q

Function of lateral spinothalamic tract?

A

Pain and temperature

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8
Q

Types of spinocerebellar tracts?

A

Dorsal spinocerebellar tract.
Ventral spinocerebellar tract.
Posterior external arcuate fibers.
Rostral spinocerebellar tract.

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9
Q

Posterior spinocerebellar tract function?

A

Proprioceptive information from lower limb and trunk

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10
Q

Anterior spinocerebellar tract function?

A

Proprioception from the lower limbs

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11
Q

Cuneocerebellar tract function?

A

Proprioceptive infromation from the upper limbs

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12
Q

Which ascending pathways are conscious?

A

Dorsal column
Spinothalamic

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13
Q

Which ascending pathways are unconscious?

A

Spinocerebellar
Spinotectal
Spinoreticular
Spinal-olivary

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14
Q

Function of spinotectal pathway?

A

enables us to orient our eyes and move our head toward the relevant stimulus

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15
Q

Function of spino-olivary pathway?

A

Proprioceptive information from muscles and tendons

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16
Q

Function of spinoreticular tract?

A

To increase our level of arousal in response to pain or temperature

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17
Q

Neuronal pathway of dorsal column medial lemniscal tract?

A

First order neuron - peripheral axons recieve signal inputs from skin and enter the Fasciculis gracilis (if <T6) or fasciculis cuneatus (if T6 or above). They synapse in the nucleus gracilis or nucleus cuneatus in the medulla respectively

Second order neuron - axons from nucleus gracilis and nucleus cuneatus decussate within the medulla and then travel up the contralateral medial lemniscus to the thalamus

Third order neuron - axons from the thalamus go through the internal capsule and terminate in the primary somatosensory cortex of the post central gyrus

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18
Q

Neuronal pathway of the spinothalamic tract?

A

First order neurones - arise from the sensory receptors in the periphery, enter the spinal cord via dorsal grey horn. They ascend 1-2 vertebral levels and then synapse at the substantia gelatinosa in the tip of the dorsal horn

Second order neurones - these fibres decussate and now form 2 distinct tracts the anterior and lateral spinothalamic tract. These run alongside each other and travel superiorly within the spinal cord, synapsing in the thalamus

Third order neurones - they ascend from the ventral posterolateral nucleus of the thalamus, travel through the internal capsule and terminate at the sensory cortex

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19
Q

What are the 2 main groups of descending (motor) spinal tracts?

A

Pyramidal and extrapyramidal

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20
Q

What are pyramidal spinal tracts?

A

Tracts that originate in the cerebral cortex carrying motor fibres to the spinal cord and brainstem
Responsible for voluntary control of the musculature of the body and face
They travel through the pyramids

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21
Q

What are extrapyramidal tracts?

A

Spinal tracts that originate in the brainstem, carrying motor fibres to the spinal cord
Responsible for the involuntary and automatic control of all musculature e.g. tone and balance
Dont travel through pyramids

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22
Q

How many neurones are typically involved in descending spinal tracts?

A

2 - UMN and LMN

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23
Q

What are the 2 pyramidal spinal tracts?

A

Corticospinal tracts and corticobulbar tracts

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24
Q

Function of corticospinal tracts?

A

Voluntary motor control of the body and limbs

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25
Structure of the corticospinal tracts?
Cerebral cortex receives input from primary motor cortex, premotor cortex, supplementary motor area and some input from somatosensory area Neurones converge and descend through the internal capsule They then pass through thr midbrain, pons and enter the medulla In the caudal part of the medulla the tract divides into the lateral and anterior corticospinal tract 80% - Fibres within the lateral corticospinal tract decussate an then descend into the spinal cord, terminating in the ventral horn at all segmental levels. From the ventral horn, LMN go on to supply the muscles of the body 20% - Fibres within the anterior corticospinal tract remain ipsilateral, descending into the spinal cord. They decussate and terminate in the ventral horn of the cervical and upper thoracic segmental levels
26
Anterior vs lateral corticospinal tract functions?
Anterior - movement of muscles of trunk, neck and shoulders Lateral - movement of muscles in limbs
27
Corticobulbar tracts function?
Innervates muscles of the face, head and neck
28
Structure of corticobulbar tract?
Primary motor cortex receives a range of inputs and these fibres converge and pass through the internal capsule to the brainstem Neurones terminate on the motor nuclei of CN where they synapse with LMN which carry the motor signals to the muscles of the face and neck
29
Does the corticobulbar tract supply unilateral or bilateral innervation to motor neurones?
Bilateral Except for: CN VII CN XII Both only provide contralateral innervation
30
Which extrapyramidal tracts decussate and therefore provide contralateral innervation?
Rubrospinal and tectospinal
31
Function of vestibulospinal tracts?
Vestibular nuclei receptive input from organs of balance and tracts convey this information to the spinal cord, where it remains ipsilateral Fibres control balance and posture by innervating anti-gravity muscles via LMN
32
What are anti-gravity muscles?
Flexors of arms Extensors of legs
33
2 reticulospinal tracts?
Medial and lateral
34
Where does the medial reticulospinal tract rise from and what is its function?
Arises from the pins Facilitates voluntary movements and increases muscle tone
35
Where does the lateral reticulospinal tract rise from and what is its function?
Arises from the medulla Inhibits voluntary movements and reduces muscle tone
36
Where does the Rubrospinal tract rise from and what is its function?
Originates from the red nucleus in the midbrain Thought to play a role in the fine control of hand movements (Remember with rubrix cube)
37
Where does the tectospinal tract rise from and what is its function?
Arises in superior colliculus of the midbrain which receives input from optic nerves Coordinates movements of the head in relation to vision stimuli
38
Does the dorsal spinocerebellar tract decussate?
No
39
Does the anterior spinocerebellar tract decussate?
Yes twice so it remains ipsilateral
40
Signs of UMN lesion?
Flexion of UL and extension of LL Hypertonia - clasp knife spasticity Pyramidal weakness Brisk reflexes Scissor or hemiplegic gait
41
What is pyramidal weakness? What causes it?
Weakness that preferentially spares the antigravity muscles e.g. weakness of upper limb extensors and lower limb flexors Caused by UMN lesions
42
What is clasp knife spasticity?
This is an initial resistance when attempting passive movement of the extremities, followed by a rapid decrease in resistance Commonly due to UMN lesions
43
What is scissoring gait?
Aka diplegic gait Knees and thighs pressed together or crossing each other whilst walking. In an attempt to overcome this adduction, the pt circumducts both legs during the swing phase Cased by spasticity in the hip adductors Associated with UMN lesions Bilateral!
44
What is hemiplegic gait?
gait in which the leg is held stiffly and abducted with each step and swung around to the ground in front, forming a semicircle Caused by UMN lesions Unilateral!
45
If a patient has all four limbs affected, where in the spinal cord is the lesion likely?
Cervical region
46
If a patient has only the lower limbs affected, where in the spinal cord is the lesion likely?
In the thoracic region
47
If a patient has respiratory diffiuclties, where in the spinal cord is a lesion likely?
Above C3
48
Causes of spinal cord lesions?
MS Neuromyelitis optica Infections Subacute combined degeneration of the cord Spinal ischaemia e.g. stroke Intrinsic neoplasm Hereditary spastic paraparesis Fracture Prolapse disc Haematoma Osteomyelitis or discitis Abscess Metastatic disease Myeloma
49
Which cranial nerves are not considered peripheral nerves?
CN I and CN II These are considered extensions of CNS
50
What gait is commonly seen in LMN lesions?
High stepping or foot-drop gait
51
Symptoms and signs of cerebellar disorders
DANISH: Dysdiadochokinesia, dysmetria, ‘drunk’ appearance Ataxia Nystagmus Intention tremor Slurred speech Hypotonia and hyporeflexia
52
Causes of cerebellar syndrome?
Friedreich's ataxia, ataxic telangiectasia neoplastic: cerebellar haemangioma stroke alcohol multiple sclerosis hypothyroidism drugs: phenytoin, lead poisoning paraneoplastic e.g. secondary to lung cancer
53
Functions of the frontal lobe?
Intellectual function e.g. planning, problem solving, decision making, judgement Praxis (the ability to perform skilled or learned movements) Inhibition Bladder continence Saccadic eye movements (quick simultaneous movements of both eyes that shifts the centre of gaze from 1 part of the visual field to another) Motor function Expression of language (Brocas area)
54
Functions of the temporal lobe?
Encoding of memories Processing auditory, visual, olfactory and language sensory input
55
Functions of the parietal lobe?
The major sensory processing hub for the brain Recieve and process sensory input e.g. touch, pressure, heat, pain, smell, sight
56
Functions of the occipital lobe?
Major visual processing region
57
Functions of the cerebellum?
Coordinates gait Maintains posture Controls muscle tone ans voluntary muscle activity Basically it receives information from the sensory systems and regulates control of movements
58
Where are primary motor neurones situated?
In the primary motor cortex which is in the pre central gyrus This is Brodmann area 4
59
Describe how the neurones are situated topographically in the motor cortex?
They form the motor homonculus Face and mouth are near the Sylvian fissure Arm and hand are at the mid portion of the primary motor cortex The trunk is near the apex of the brain Leg and foot areas are in the part of the primary cortex that dips into the longitudinal fissure
60
Describe where in the brainstem the cranial nerves are?
Midbrain - III and IV Pons - V, VI, VII, VIII Medulla - IX, X, XI and XII
61
Function of the substantia nigra in the brainstem?
Dopamine production
62
Function of the red nucleus in the brainstem?
Involved in limb control and motor coordination E.g. in a vertebrate without a significant corticospinal tract, gait is mainly controlled by the red nucleus - less useful in primates E.g. crawling of babies is controlled by this
63
What is Weber syndrome?
Midbrain stroke syndrome A form of stroke that affects the medial portion of the midbrain - mainly caused by occlusion of a branch of the posterior cerebral artery
64
What is wallenberg’s syndrome?
Lateral medullary syndrome Stroke in the lateral portion of medulla. Caused by occlusion of posterior inferior cerebellar artery
65
Brainstem functions?
Site of origin of CN nuclei 3 to 12 Dopamine production Coordination of movement Respiratory centre Cardiac centre Reticular activating system Conduit for white matter tracts - motor, sensory, coordination, eye movements
66
What are the 3 anatomical lobes of the cerebellum?
Anterior lobe Posterior lobe Flocculonodular lobe
67
What are the 3 functional divisions of the cerebellum?
Cerebrocerebellum Spinocerebellum Vestibulocerebellum
68
Function of the cerebrocerebellum?
Involved in planning movements and motor learning - receives inputs from cerebral cortex and pontine nuclei and sends outputs to thalamus and red nucleus Regulates coordination of muscle activation and is important in visually guided movements
69
Function of the spinocerebellum?
Regulates body movements by allowing for error correction Maintenance of tone
70
Function of the vestibulocerebellum?
Controls balance and ocular reflexes Receives inputs from the vestibular system and sends outputs back to the vestibular nuclei
71
If a limb weakness is fatigable where is the likely pathology occuring?
Neuromuscular junction
72
What is autonomic dysreflexia?
A clinical syndrome that occurs in pt who have a spinal cord injury at or above T6 Afferent signals most commonly triggered by faecal impaction or urinary retention cause a sympathetic spinal reflex via thoracolumbar outflow. This results in an unbalances physiological response characterised by extreme hypertension, flushing & sweating above the level of the spinal cord lesion, agitation, bradycardia In untreated cases severe consequences of extreme hypertension can occur e.g. haemorrhagic stroke
73
What is Hoffman test?
When doctor flicks the fingernail of the middle finger down and the thumb will flex = indicates UMN lesion and is likely cervical
74
What does past pointing in finger-nose coordination test tell you?
Pt has dysmetria - sign of cerebellar damage
75
What spinal level is the biceps brachii reflex?
C5 and C6
76
What spinal level is the triceps brachii reflex?
C6, C7, C8
77
What spinal level is the brachioradialis reflex?
C5, C6, C7
78
What spinal level is the quadriceps femoris reflex?
L2, L3, L4
79
What spinal level is the Achilles tendon reflex?
S1, S2

NEUROLOGY (16 decks)

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