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Step 1 > Neurology- anatomy > Flashcards

Neurology- anatomy Flashcards

0
Q

Trace a drop of CSF to the subarachnoid space

A

:Produced by the ependymal cells of the choroid plexus

  • lateral ventricles thru foramen of monroe to the 3rd ventricle
  • 3rd ventricle thru cerebral aqueduct to the 4th ventricles
  • 4th ventricle thru either lateral foramen of luschka or medial foramen of magendie to subarachnoid space
  • subarachnoid space thru arachnoid granulations into dural sinuses
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1
Q

Describe the dural venous drainage

A
  • superior sagital sinus
  • the great vein of galen joins the inferior sagital sinus resulting in the straight sinus
  • straight sinus + superior sagital sinus + occipital sinus join at the confluence of sinuses
  • confluence of sinuses gives rise to the transverse sinuses –> sigmoid sinus –> internal jugular vein
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2
Q

Contents of cavernous sinus

A

: located on either side of the pituitary; collects blood from superficial cortex and eye and drains into the superior pertrosal sinus –> sigmoid sinus –> internal jugular
-contains branch of internal carotid a., CN III, IV, V1, V2, VI & post ganglionic sympathetic en route to orbit

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3
Q

Patient: Opthalmoplegia, decreased corneal and maxillary sensation with normal visual acuity

A

Cavernous sinus syndrome: usually due to mass effect, fistula, thrombosis
- CN VI most commonly affected
Recall: opthalmoplegia means weakness or paralysis of EOM

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4
Q

Anterior circulation of the brain

A

:result of the internal carotid; includes the ACA and MCA

  • on the left ICA is a branch from the aortic arch
  • on the right ICA is a branch off the brachiocephalic a.
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5
Q

Anterior cerebral artery

A

:ACA; supplies anteromedial surface of frontal and parietal lobe
-Lesion: contralateral paralysis leg > arm & contralateral sensory loss leg > arm

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6
Q

Middle cerebral artery

A

:supplies lateral surface of temporal and parietal lobes, optic radiations
-Lesion: Motor= contralateral arm, face paralysis; Sensory = contralateral arm and face loss of sensation; Optic radiations: homonymous hemianopsia; Speech= produce Broca’s or Wernickes aphasia (dominant hemisphere usually left); Hemineglect= contralateral neglect (usually right sided lesion, resulting in neglect of the left side)

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7
Q

Lenticulostriate artery

A

:branch of the MCA, supplies the striatum & internal capsule
-Lesion: contralateral hemiparesis/hemiplegia (weakness)

-Most common location of lacunar infarcts secondary to unmanaged hypertension

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8
Q

Posterior Circulation of the brain

A

: result of the vertebral arteries

  • vertebral arteries arise as branches of the subclavian artery’s
  • give rise to ASA, basilar artery, PICA, AICA, SCA, PCA
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9
Q

Anterior spinal artery

A

:supplies the lateral CST, medial lemniscus, caudal medulla = CN XII

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10
Q

Medial medullary syndrome

A

: contralateral hemiparesis, decreased contralateral proprioception, ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)
-caused by infarct of paramedian branches of ASA and vertebral arteries

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11
Q

Posterior inferior cerebellar artery

A

:PICA; supplies posterior inferior cerebellum & lateral medulla = vestibular nuclei, lateral spinothalamic tract, descending (spinal) trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle

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12
Q

Lateral medullary syndrome

A

vomiting,vertigo, nystagmus, decreased in pain & temp (protopathic) sensation from ipsilateral face and contralateral body, dysphagia, hoarseness, decreased gag reflex, ipsilateral horner sundrome, ataxia, dysmetria
Note: nucleus ambiguus effects are specific to PICA

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13
Q

Anterior inferior cerebellar artery

A

:AICA; supplies middle and inferior cerebellar peduncles & lateral pons= CN nuclei, vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers

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14
Q

Lateral pontine syndrome

A

: vomiting, vertigo, nystagmus, paralysis of face, decreased lacrimation and salivation, decreased taste from anterior 2/3 of tongue, decreased corneal reflex. Face - decreased pain and temp (protopathic) sensation. Ipsilateral diminished hearing, ipsilateral horner syndrome, ataxia, dysmetria
Note: facial nucleus effects are specific to AICA lesions

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15
Q

Posterior cerebral artery

A

:PCA; supplies occipital cortex, visual cortex

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16
Q

Lesion to PCA

A

:contralateral hemianopia with macular sparing

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17
Q

Basilar artery

A

:supplies pons, medulla, lower midbrain, CST, CBT, ocular cranial nerve nuclei, PPRF

18
Q

Locked in syndrome

A

lesion to the basilar artery = preserved consciousness and blinking, quadaplegia, loss of voluntary facial, mouth and tongue movements

19
Q

Anterior communicating artery

A

:ACom

  • most common lesion is saccular (berry) aneurysm which can lead to a stroke
  • usually results in visual field defects
20
Q

Posterior communicating artery

A

: common site of saccular aneurysm leading to CN III palsy = eye is down and out with ptosis and pupil dilation

21
Q

Limbic system

A

Structures include: hippocampus, amygdala, fornix, mamillary bodies and cingulate gyrus
Function: emotion, long-term memory, olfaction, behavior modulation, and autonomic nervous system
-major output is to the hypothalamus to control ANS and neuroendocrine secretions

22
Q

Input to the cerebellum

A
  • Contralateral cortex via middle cerebellar peduncle
  • Ipsilateral proprioceptive information via inferior cerebellar peduncle from spinal cord (input nerves = climbing fibers and mossy fibers)
23
Q

Cerebellar output

A
  • Sends information to contralateral cortex to modulate movement
  • output nerves = purkinje cells -> deep nuclei of cerebellum -> contralateral cortex via superior cerebellar peduncle
24
Q

Deep nuclei of the cerebellum

A

Dentate, Emboliform, globose, fastigial

“dont eat greasy foods”

25
Q

Lateral lesions of the cerebellum

A

propensity to fall toward injured (ipsilateral) side

26
Q

Medial lesions of the cerebellum

A

:lesion of the vermis, fasigial nuclei) and/or flocculonodular lobe result in truncal ataxia, nystagmus and head tilting

  • may have a wide based cerebellar gait and deficits in truncal coordination
  • midline structures result in bilateral motor deficits affecting axial and proximal limb musculature
27
Q

Papez circuit

A

hippocampus -> fornix -> mammillary bodies -> anterior nucleus of thalamus -> cingulate gyrus -> hippocampus

28
Q

Structures of the basal ganglia

A

Striatum (caudate + putamen), globus pallidus, substantia nigra, subthalamus
Note: lentiform nucleus ( putamen + globus pallidus)

29
Q

Direct pathway of basal ganglia

A 
motor cortex (glutamate) --> striatum (GABA) --> inhibits globus pallidus interna = inhibiting an inhibitory signal 
-GPi communicates to thalamus via VL, so thalamus is free to communicate to motor cortex --> motor function carried out
30
Q

What role does the Substantia nigra play in movement?

A

: activates the direct pathway via D1 dopamine receptors and inhibits the indirect pathway via D2 dopamine receptors

31
Q

Indirect pathway of the basal ganglia

A 
Motor cortex (glutamate) --> Striatum (GABA) -> inhibits GPe which disinhibits GPi (GABA) -> inhibits the thalamaus (VL) 
-so motor function not carried out
32
Q

How does the subthalamus modulate movement?

A 
Motor cortex (glutamate) -> activates subthalamus --> activates GPe 
-so motor function suppressed via inhibition of the thalamus mediated by GPe
33
Q

Primitive reflexes

A
  • present in healthy infant, disappear within 1st year

- inhibited by frontal lobe in mature adult; lesion to frontal lobe causes loss of inhibition

34
Q

Moro reflex

A

abduct/extended limbs when started and then draw together

35
Q

Rooting reflex

A

movement of head toward one side if cheek or mouth is stroked (nipple seeking)

36
Q

Sucking reflex

A

sucking response when roof of mouth is touched

37
Q

Galant reflex

A

Stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of lower body toward stimulated side

38
Q

Plantar reflex

A

dorsiflexion of large toe and fanning of other toes with plantar stimulation = “babinski sign”

39
Q

Outer ear

A

Visible portion ear (pinna), includes auditory canal and tympanic membrane
-transfers sound waves via vibration of TM

40
Q

Middle ear

A

:air filled space with three bones called ossicles (malleus, incus, stapes)
-ossicles conduct and amplify sound from TM to inner ear

41
Q

Inner ear

A

Snail shaped, fluid filled cochlea; contains basilar membrane that vibrates secondary to sound waves
-vibration transduced via specialized hair cells -> auditory nerve signaling -> brainstem

42
Q

Low frequency (low pitch) sound detected where on the basilar membrane?

A

apex near helicotrema (wide and flexible)

43
Q

High frequency sound heard detected where on the basilar membrane?

A

base, thin and rigid

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