Neurology Flashcards by Karin Golob

What are the components of the basal ganglia?

Thalmus

Caudate

Putamen

Lentiform nucleus

Amygdala

Subthalmic nucleus

Substantia Nigra

How well did you know this?

Not at all

Perfectly

When a patient tells you “something doesn’t move right,” what are the two categories to consider?

Weakness
Unwanted movement and clumsiness

How well did you know this?

Not at all

Perfectly

When a patient complains about weakness, what are the two categories that could cause that weakness?

Upper motor neuron
Motor unit
- Nerve or muscle is affected

How well did you know this?

Not at all

Perfectly

When a patient complains of unwanted movement or clumsiness, what are the two categories that may be the cause of their symptoms?

Cerebellum
Basal ganglion

How well did you know this?

Not at all

Perfectly

What symptoms will result from an Upper Motor Neuron disorder?

Muscles are not denervated!

Weakness

brain (hemiparesis)
spinal cord (paraparesis)

Childhood reflexes (Babinski)

Increased muscle tone

Increased tendon reflexes (myotatic)

Increased resistance to passive stretch

Spasticity/spastic paralysis

Slow Atrophy

How well did you know this?

Not at all

Perfectly

What symptoms will result from a motor unit disorder?

Weakness

Distal if nerve
Proximal if muscle
Focal if traumatic

Absence of childhood reflexes

Decrease in stretch reflexes

Atrophy of muscles

How well did you know this?

Not at all

Perfectly

What abnormal movements will be present in a basal ganglia disorder?

Tremor at rest

Shuffling gait

Rigidity

Postural instability

Turning movements of the trunk (athetosis)

How well did you know this?

Not at all

Perfectly

What abnormal movements will be present in a cerebellum disorder?

Tremor in motion

Broad based gait (as in Kuru)

Diminished tone

Nystagmus

Titubation (truncal tremor)

How well did you know this?

Not at all

Perfectly

What are the modalities of somatic sensation?

Pain (sharp) / Temperature (C and A delta, ALSTS)

Position / Vibration (I and II, posterior columns)

Fine touch (A delta or C, ALSTS)

How well did you know this?

Not at all

Perfectly

What sensation tests require cortical integration?

Two point descrimination

Simultaneous stimulation/extinction

Finger writing

Object recognition

How well did you know this?

Not at all

Perfectly

How do locations of sensory loss differ between brain, spinal cord, and PNS lesions?

Brain- Hemi sensory loss with cortical signs

Spinal Cord- Para sensory loss, dissociated

PNS- Distal and Focal

How well did you know this?

Not at all

Perfectly

Fast, focal CNS syndrome

Stroke:

Infarction (emboli in the heart or major vessels)

Hemorrhage

May improve with time

How well did you know this?

Not at all

Perfectly

Slow focal CNS syndrome

“Tumor syndrome”

Neoplasms

Granuloma/abcess (TB)

Orthopedic (spine)

Don’t improve with time

How well did you know this?

Not at all

Perfectly

Rapid diffuse CNS syndrome

Encephalopathy Syndrome

Infectious meningitis and encephalitis (viral and bacterial)

Acute cerebral anoxia (cardiac arrest, Vfib, Vtach, hemorrhage or hypoxia)

Subarachnoid hemorrhage

Intoxication

How well did you know this?

Not at all

Perfectly

Diffuse, slow, bilateral CNS lesions

Degenerative disorders=progressive loss of nerve cells in selected bilateral regions with no improvement over time

Cerebrum

Alzheimers: hippocampus and cortex
Parkinson’s disease: Substantia nigra

Cerebrum and spinal cord

Amyotrophic Lateral Sclerosis: anterior horn cells and descending motor pathways
Toxic and metabolic disorders like diabetes, alcoholism, and vitamin dificiencies

How well did you know this?

Not at all

Perfectly

Fast polyneuropathies

Guillian-Barre:

Autoimmune myelin disease
Ascending paralyis

Tx:
IV Ig or plasmapheresis

How well did you know this?

Not at all

Perfectly

Slow polyneuropathies

Axon Disorders:
Diabetes, Alcohol abuse, Thiamine Deficiency and many others

Myelin disorders:
Chronic Idiopathic Distal Polyneuropathy
B12 Deficiency

How well did you know this?

Not at all

Perfectly

Fast Focal Neuropathies

Trauma

Herpes (shingles)

Bells palsy, brachial plexitis, focal demyelination

Diabetes (neuron infarcts of CNIII, CNIV, femoral N.)

How well did you know this?

Not at all

Perfectly

Slow, focal mononeuropathies

Compression (roots, plexi, named nerves)

Neoplasm (schwannoma)

note: there are no neural neoplasms in the PNS because the bodies are found in the Dorsal Root Ganglion

How well did you know this?

Not at all

Perfectly

Synaptic disorders

Myasthenic disorders: slow, diffuse, inconsistant

Botulism: rapid and diffuse

Nerve agents: fast, diffuse, autonomic

How well did you know this?

Not at all

Perfectly

What are some congenital and acquired Muscle Disorders?

Congenital distrophies:
Duchenne’s (child)
Becker’s (teen)
Limb Girdle (adult)
Myotonic

Acquired distrophies:
Autoimmune (Polymyositis)
Endocrine

What are the three higher motor areas?

Motor cortex (MI)

Lateral premotor area (LPA)

Supplementary motor area (SMA MII)

When one decides to move what areas make up the pathway and in what order?

Prefrontal cortex (decision to move)

Activates the higher motor areas, Basal Ganglia, and Cerebellum

Cerebellum and basal ganglia provide inputs to the thalamus

Thalamus provides inputs to the higher motor areas along with the prefrontal cortex

Higher motor area activate the UMN which travels down the spine to synapse with the LMN in the anterior horn

LMN then innervates muscles

What kinds of inputs do LMNs get in the ventral horns?

UMN

Cortical and brainstem decending pathways
Pattern generators

DRG

Pain fibers (via interneurons)
Muscle spindle

Renshaw Cells

Where to the cell bodies of LMNs live in the CNS?

Ventral horn (alpha motor neurons) Brainstem (Cranial nerve motor nuclei)

How are the spinal cord LMNs arranged?

Somatotopically in the grey matter of the anterior horns Dorsal Flexors Ventral Extensors Medial Proximal Lateral Distal

Where do the Upper Motor Neurons (UMNs) live?

Cerebral cortex (motor cortex primarily) Brainstem

What are the two motor pathways in the spinal cord?

Medial and lateral decending systems

What does the lateral descending system influence?

Individual muscles of distal extremities Controls fine, skilled movements Ipsilateral

What does the Medial Descending System influence?

Axial and proximal muscle groups Balance and postural control Bilateral (crosses over in the anterior white commisure)

Where do fibers of the lateral corticospinal tract, originate, descend, and cross over?

Cerebral motor cortex Lateral Funiculus Pyramidal decussation in the spinomedullary junction

What does the Rubrospinal tract do?

Facilitates activity of the upper limb flexors

Where does the rubrospinal tract originate, terminate and cross over?

Originates in the red nucleus (hense rubro) Crosses in the midbrain Terminates in the later portion of the ventral horn at the cervical levels (flexion of upper limbs only)

Where does the anterior corticospinal tract originate, cross over, and terminate?

Cerebral motor cortex 90% cross over at spinomedulary junction, many cross over at the level of termination Terminate by the lower cervical levels

What is the function of the anterior corticospinal tract?

Postural movements of the head and upper extremity. Bilateral innervation

Where does the medial vestibulospinal tract originate, terminate, cross over, and what is its role?

Originates in the medial vestibular nucleus in the pons and medulla Terminates by the end of the cervical cord Crosses over in the medulla coordinates head movements with eye movements

Where does the lateral vestibulospinal tract originate, terminate, cross over and what is its function?

Originates in the lateral vestibular nucleus of the pons Terminates in the sacral region Does not cross over (descends ipsilaterally) Facilitates extension of upper and lower limbs for balance

Where does the pontine reticulospinal tract originate, terminate, cross over and what is its function?

Originates in the pontine reticular nucleus Runs down entire legnth of cord does not cross over (ipsilateral) facilitates axial/proximal musculature for postural adjustments

Where does the medullary reticulospinal tract originate, terminate, cross over and what is its function?

Originates in the medullary reticular nucleus (gigantocellular reticular nucleus) Runs entire legnth of cord Crosses over in the medulla and runs bilaterally Inhibits axial/proximal musculature (role in sleep atonia)

What is decerebrate rigidity and what causes it?

extensor posturing of upper and lower limbs and neck along with plantar flexion of feet and toes Caused by transection of the brainstem near the midbrain/pons junction or an infratentorial lesion leads to unopposed action of the LVST (and the RST to a lesser extent). The lesion knocks out the red nucleus

What is decorticate ridgidity and what causes it?

Flexion of the arms and wrists, extension of the LE and plantar flexion of feet and toes It is caused by a supratentorial lesion that knocks out the decending corticalrubral and corticoreticular fibers in the posterior limb of the internal capsule. The red nucleus is still intact

What symptoms will result from a lower motor neuron lesion?

Muscles are denervated Flaccid paralysis Reduced muscle tone Reduced myotaxic reflex Rapid atrophy

What's the difference between fasciculation and fibrillation?

**Fasciculation** twiching of an entire motor unit due to improper alpha motor neuron depolarization. It's big enough to see with the naked eye **Fibrillation** Twitching of only one muscle fiber that's not big enough to see with the naked eye Detected through EMG Caused by denervation

Patient has Babinski, increased muscle tone, increased tendon reflexes, and increased resistance to passive stretch in the right lower limb. Where is the lesion?

Left Medial Motor Cortex

Patient has Babinski, increased muscle tone, increased tendon reflexes, and increased resistance to passive stretch in the right upper limb, trunk and lower face. Where is the lesion?

Left Lateral Motor Cortex

Patient has Babinski, increased muscle tone, increased tendon reflexes, and increased resistance to passive stretch in the left side of the entire body and lower half of left face. Where is the lesion?

Right Ventral Midbrain

Patient has Babinski, increased muscle tone, increased tendon reflexes, and increased resistance to passive stretch in the right side of the body. Where is the lesion?

Left ventral medulla

Patient has Babinski, increased muscle tone, increased tendon reflexes, and increased resistance to passive stretch in the left arm, trunk, and lower limb. Where is the lesion?

Left lower cervical Cord

Where does polio attack?

LMNs of anterior horn

Amyotrophic Lateral Sclerosis attacks which neurons?

Upper and lower motor neurons

Spasticity is associated with damage to which neurons?

Upper motor neurons

Weakness is associated with damage to

Both upper and lower motor neurons