Neurology 2 Flashcards
Separates Left and Right Cerebellar Hemisphere
Vermis
“Tree of Life”
Arbor Vitae
Deep Nuclei (medial to lateral)
Fastigial > Globose > Emboliform > Dendate
Deep Nuclei: Oval
Emboliform
Deep Nuclei: Round
Globose
Deep Nuclei: Largest
Dentate
Deep Nuclei: Situated at Vermis
Fastigial
Layers of Cerebellum
Molecular, Purkinje, Granular
Cell located OUTSIDE the molecular layer
Stellate Cell
The type of neuron located in the Purkinje layer
Golgi Type I neuron
Three general functions of the Cerebellum
Coordination, Balance, Tone
Cell located INSIDE the molecular layer
Basket Cell
Generalized muscle weakness
Asthenia
Difficulty in speaking
Dysarthria
Involuntary rhythmic oscillatory movement of the eye
Nystagmus
Abrupt movement after removing resistance
Rebound Phenomenon
Excessive head and neck movement
Titubation
Difficulty in judging distance
Dysmetria
Difficulty doing rapid alternating movements
Dysdiadochokinesia
Movement decomposition
Dysnergia
Lack of muscle control or coordination of voluntary movements
Ataxia
Type of dysarthria seen in cerebellar patients
Scanning speech
Type of nystagmus seen in cerebellar patients
Central Nystagmus
Type of nystagmus seen in patients with CN 8 affectation
Peripheral Nystagmus
Type of tremor seen in cerebellar patients
Intention Tremor
Description for Central Nystagmus
Pendular, Persists, Verticle
Description for Peripheral Nystagmus
Positional, Horizontal
Tone seen in cerebellar patients
Hypotonia
3 Anatomic Lobes of Cerebellum
Anterior, Flocculonodular, Posterior
Phylogenetic term of Anterior Lobe
Paleocerebellum
New name for Posterior Lobe
Cerebrocerebellar
Phylogenetic term of Flocculonodular Lobe
Archicerebellar
New name for Anterior Lobe
Spinocerebellar
Phylogenetic term of Posterior Lobe
Neocerebellar
New name for Flocculonodular Lobe
Vestibulocerebellar
Lobe for Balance and Equilibrium
Flocculonodular/Archicerebellum/Vestibulocerebellar
Lobe for Coordination
Posterior/Neocerebellum/Cerebrocerebellar
Lobe for muscle tone and posture
Anterior/Paleocerebellum/Spinocerebellum
Lobe: Nystagmus
Flocculonodular/Archicerebellum/Vestibulocerebellar
Lobe: Dyssynergia
Posterior/Neocerebellum/Cerebrocerebellar
Lobe: Hypotonia
Anterior/Paleocerebellum/Spinocerebellum
Lobe: Intention Tremor
Posterior/Neocerebellum/Cerebrocerebellar
Lobe: Titubation
Posterior/Neocerebellum/Cerebrocerebellar
Lobe: Trunk and Limb ataxia
Anterior/Paleocerebellum/Spinocerebellum
Lobe: Dysequilibrium
Flocculonodular/Archicerebellum/Vestibulocerebellar
Lobe: Dysdiadochokinesia
Posterior/Neocerebellum/Cerebrocerebellar
Lobe: Oldest
Flocculonodular/Archicerebellum/Vestibulocerebellar
Lobe: Newest and Largest
Posterior/Neocerebellum/Cerebrocerebellar
Type of nuclei found in Flocculonodular Lobe
None
Type of nuclei found in Anterior Lobe
Emboliform and Globose
Type of nuclei found in Posterior Lobe
Dentate
Other name for Superior Cerebellar Peduncle
Brachium Conjunctivum
Brainstem connection of Middle Cerebellar Peduncle
Pons
Other name for Inferior Cerebellar Peduncle
Brachium Restiformis / Restiform Body
Brainstem connection of Inferior Cerebellar Peduncle
Medulla
Other name for Middle Cerebellar Peduncle
Brachium Pontis
Brainstem connection of Superior Cerebellar Peduncle
Midbrain
Location of CN 1
Telencephalon
Location of CN 9, 10, 11, 12
Medulla
Cranial Nerves found in Pons
CN 5, 6, 7, 8
Cranial Nerves found in Midbrain
CN 3, 4
Location of CN 2
Diencephalon
Other name for the TECTUM of midbrain
Corpora Quadrigemina
3 parts of Midbrain
Anterior, Posterior and Lateral
Structures located in Posterior Midbrain
Superior and Inferior Colliculus
Structures located in Lateral Midbrain
Superior and Inferior Brachium
Composition of Lateral Geniculate Body
Superior Colliculus + Superior Brachium
Composition of Medial Geniculate Body
Inferior Colliculus + Inferior Colliculus
Midbrain and Thalamic structure for VISION
Superior Colliculus + Superior Brachium = Lateral Geniculate body
Midbrain and Thalamic structure for AUDITORY
Inferior Colliculus + Inferior Colliculus = Medial Geniculate Body
What are the structure Pons connects?
MO inferiorly + Midbrain superiorly & R-L cerebellar Hemisphere
Part of Pons: Secretes Serotonin
Raphne Nucleus
Part of Pons: Inhibits Inspiration
Pneumotaxic Center
Part of Pons: Secretes Norepinephrine
Locus Coeruleus
Location of Pnemotaxic Center
Upper Pons
Part of Pons: Stimulates Inspiration
Apneustic Center
Location of Apneustic Center
Lower Pons
Genu of facial nerve winding around abducent nucleus
Facial Trigone
7 responsibility of Medulla Oblongata
Respiration, Vomiting, Coughing, Sneezing, Blood Pressure Regulation, Vagal and Vasomotor Center
Part of MO: Sensation of touch, pressure, vibration in UE
Cuneate Nucleus
Part of MO: Cardioinhibitory
Nucleus Ambiguus
Part of MO: Largest and main site of communication
Olivary Nucleus
Part of MO: CN 7 & 9
Salivatory Nucleus
Part of MO: Respiratory / baroreceptor
Nucleus Solitarius
Part of MO: 9 & 10
Nucleus Ambiguus
Part of MO: 7, 9, & 10
Nucleus Solitarius
Part of MO: Sensation of touch, pressure, vibration in LE
Gracilis Nucleus
Junction where Medulla Oblongata became a Spinal Cord
Foramen Magnum
2 level of decussation in Medulla Oblongata
Pyramids (Lower 3rd: CTS) and Medial Lemnisci (Medial 3rd: Dorsal Column)
Decussation of Pyramids
Motor
Decussation of Medial lemnisci
Sensory
Two enlargement of Spinal Cord
Cervical and Lumbar
SC ends in what level in children?
L3
“Horse’s tail”
Cauda Equina
Prolongation of pia matter that is attached in coccyx`
Filum Terminale
SC ends in what level in adult?
L1
Cone-shaped tapered of SC where it tapers off at level of lower border of L1
Cons Medullaris
Level of Filum Terminale
S2-3
Length of Male Spinal Cord
48 cm
Length of Female Spinal Cord
45 cm
Law states that anterior spinal nerve roots contain only motor fiber and posterior roots contain only sensory fibers and the nerve impulses are conducted in only one direction in each case
Bell-Magendie Law
VEMDAS
Ventral, efferent, Motor & Dorsal, Afferent Sensory
Rexed Lamina I
Lissauer Tract
Rexed Lamina: For epricritic sensations: stereognosis. conscious proprioception and kinesthesia
III-IV / Nucleus Proprius
Rexed Lamina VII
Clarke’s / Dorsal Column
Rexed Lamina: Situated at anterior horn cell
VIII-IX
Rexed Lamina III, IV
Nucleus Proprius
Rexed Lamina: Largest and receives unconcious proprioception
VII / Clarke’s Column
Rexed Lamina: receives noxious stimulus
V-VI
Rexed Lamina II
Substantia Gelatinosa
Rexed Lamina: receives noxious stimulus in viscera
V
Rexed Lamina X
Central Canal
Rexed Lamina: Receives noxious and thermal stimuli
Lissauer’s Tract
Rexed Lamina: High concentrations of substance P and opiate receptors
II / Substantia Gelatinosa
Rexed Lamina: Remnant of Spinal Canal
X / Central Canal
Rexed Lamina: receives noxious stimulus in skin
VI
Rexed Lamina: Modulates motor activity (gamma)
VIII / Motor Neuron Pools
Rexed Lamina: Contains alpha and gamma motor neurons
X / Anterior Horn Cell
Meninges of the brain
Dura Mater. Arachnoid Mater and Pia Mater
“Pachymenix”
Dura Mater
“Leptomeninges”
Arachnoid and Pia Mater
Most common post-traumatic cause of CP
Meningitis
Produces CSF
Choroid Plexus
Main Drainage of CSF
Arachnoid Villi
3 functions of CSF
Protection, Nutrients, Regulates ICP
Normal ICP
60-150 mmHg
CSF FLOW
(1) Chroroid Plexus (2) 2 Lateral Ventricle (3)Foramen of Monroe (4) 3rd Ventricle (5) Cerebral Aqueduct (6) 4th Ventricle (7) Foramen of Lushka & Magendie (8) Spinal Canal (9) Subarachnoid Space (10) Arachnoid Villi
Medial and Lateral Opening
Medial (1) = Magendie; Lateral (2) = Lushka
What level does Subarachnoid Space ends?
S2-3
ICP extends in what cranial nerve?
CN 2 = (+) Papilledema
Branches of ICA
Ophthalmic, ACA, MCA, Post Communicating, Choroidal
Branch of ICA: Terminal branch
ACA and MCA
Branch of ICA: First Branch
Ophthalmic
Branch of ICA: Connects anterior circulation to posterior circulation
Posterior Communicating
Branch of ICA: Supplies lateral geniculate body, optic tract, internal capsule
Choroidal
Branch of ICA: Largest
MCA
Lesion of Ophthalmic Artery
Amaurosis Fugax (temporary blindess)
Lesion of ACA
LE > UE & Face affectation
Lesion of MCA
LE < UE & Face affectation
5 Branches of Basilar Artery
AICA, Pontine, Labyrinthine, SCA, PCA
Branch of Basilar Artery: Supplies superior cerebellum, pineal gland and pons
AICA
Branch of Basilar Artery: Terminal Branch
PCA
Branch of Basilar Artery: Supplies Inner Ear
Labyrinthine
Branch of Basilar Artery: 1st branch
AICA
Branch of Basilar Artery: Supplies Occipital Lobe
PCA
Branch of Basilar Artery: Supply Pons
Pontine
Lesion in PCA
Vision Problem
6 Branches of Vertebral Artery
Meningeal, Posterior Spinal, Anterior Spinal, Medullary, Muscular, PICA
Branch of Vertebral Artery: Largest
PICA
Branch of Vertebral Artery: Supplies 1/3 of SC
Posterior Spinal Artery (2)
Branch of Vertebral Artery: Supplies 2/3 of SC
Anterior Spinal Artery (1)
Branch of Vertebral Artery: Supplies Vermis and Cerebellum
PICA
Lesion in PICA
Horner’s Syndrome
Horner’s Syndrome
I/L: Nystagmus + Sensory problem in the face & C/L: Body and Limb
Blood supply from aorta in thoracic and upper lumbar levels
Radicular Artery of Adamkiewics
Radicular Artery of Adamkiewics supplies what part of the SC
Lower 2/3 of SC
Balint Syndrome
Optic Ataxia, Simultagnosia, Opthalmoplegia
Inability to stand
Astasia
Inability to walk
Abasia
Two reflexes seen in ACA stroke patients
Palmomental and Gegenhalten Reflex
Lack of will or initiative and can be seen as a disorder of diminished motivation
Abulia
Lack the ability to move or speak
Akinetic Mutism
Stroke: C/L hemiparesis and Hemianesthesia
MCA and ACA
Stroke: Inhibited Neurogenic Bladder
ACA
Stroke: UE & Face > LE
MCA
Stroke: Visual Defect
PCA
Stroke: Thalamic Pain Syndrome
PCA
Stroke: Aphasia
MCA
Stroke: Gegenhalten and Palmomental Reflex
ACA
Stroke: Balint Syndrome
PCA
Stroke: Astasia and Abasia
ACA
Stroke: Anton
PCA
Denial of Blindness
Anton
Stroke: Pseudobulbar Effect
ACA
Stroke: Apraxia
MCA
Stroke: Abulia and Akinetic Mutism
ACA
R or L PCA: Prosopognosia
Both
R or L PCA: Difficulty in judging depth and distance
Right
R or L PCA: Color Agnosia
PCA
“Thalamic Pain Syndrome”
Dejerine Rousy
Brainstem Stroke: CN III
Weber and Benedikt
Area affected of Millard Gubler
Lateral Pons
Area affected of Wallenberg Stroke
Lateral Medulla
Brainstem Stroke: CN 6-7
Millard-Gubler
Brainstem Stroke: Bilateral Basal Pons
Locked In Stroke
Area affected of Benedikt Stroke
Tegmentum MB
Brainstem Stroke: Medial Basal Midbrain
Weber
Brainstem Stroke: CN 5, 10
Wallenberg
Brainstem Stroke: CN ALL
Locked-in
Relatively strong synergy patterns in LE
Extension
Relatively strong synergy flexion LE
Hip Flexion
UE Flexor Synergy
Scapular Retraction, Shoulder ABER, Elbow Flexion , FA Supination, Wrist and Fingers Flexion
LE Extensor Synergy
Hip EXADIR, Knee Extension, Ankle PF, Foot Inversion, Toes Flex & Add
Relatively strong synergy flexion UE
Elbow Flexion
Relatively strong synergy patterns in UE
Flexion
Spared Muscles in Synergy
FLATS EDEMA: Finger Extensors, Lats Dorsi, Ankle Evertors, Teres Major, Serratus Anterior
Relatively strong synergy Extension UE
Shoulder ADIR and FA Pronation
UE Extensor Synergy
Scapular Protraction, Shoulder ADIR, Elbow Extension, FA Pronation, Wrist and Fingers Flexion
LE Flexor Synergy
Hip FABER, Knee Flexion, Ankle DF, Foot Inversion, Toes Ext & Abd
Relatively strong synergy Extension LE
Knee Extension and Ankle PF
Recovery Stage of Spasticity Range
1-7
Recovery Stage of Spasticity I
Flaccidity
Recovery Stage: Marked Spasticity
III
Recovery Stage of Spasticity VII
Normal
Recovery Stage: Waning of Spasticity
V
Recovery Stage of Spasticity VI
Disappearance of Spasticity
Declining of Spasticity
IV
Recovery Stage of Spasticity II
Beginning of Spasticity
Recovery Stage: (+) Gross Movements
IV
Recovery Stage: (+) Complex Movements
V
Recovery Stage: (+) Isolated Movements
VI
