Neurology Falcon Review 1 Flashcards
1
Q
What are the major structures of the brain
A
From anterior to posterior
- Telencephalon
- diencephalon
- Mesencephalon
- Metencephalon
- Myelencephalon
Remember the M’s being Alphabetical order.
2
Q
What develops from the telencephalon
A
Cerebral cortex
basal ganglia
3
Q
What develops from the diencephalon
A
Thalamus
hypothalamus
4
Q
What develops from the mesencephalon
A
Midbrain
– cerebral crura
– substantia nigra
– CN’s 3 and 4
5
Q
What develops from metencephalon
A
Cerebellum
Pons
CN’s 5, 6, 7, 8
6
Q
What develops from the myelencephalon
A
Medulla oblongata
CN’s 9, 10, 11, 12
7
Q
What are the main lobes of the cerebral cortex
A
Frontal
parietal
Occipital
temporal
8
Q
What is the function of the frontal lobe
A
Motor function problem-solving (executive function) spontaneity language impulse control social behavior largest in humans
9
Q
What is the general function of the parietal lobe
A
- awareness
2. spatial perception
10
Q
What is neglect syndrome
A
Results in the neglect of part of the body or space on the contralateral side; can impair many self-care skills such as dressing and washing
11
Q
What is Gerstmann’s syndrome
A
A left-sided lesion to the parietal lobe causing: – R/L confusion – Agraphia – Acalcula – Aphasia – visual agnosia
12
Q
What will a lesion to one side of the occipital lobe cause
A
Homonymous loss of vision with exactly the same “field cut” in both eyes
13
Q
What are the effects of a left temporal lobe lesion
A
Disturbs recognition of words
imperative memory of verbal material
14
Q
What are the effects of a right temporal lobe lesion
A
– can cause a loss of inhibition of talking
– inhibition of recall of music and drawing
15
Q
What are the functions of the temporal lobe
A
Sensory
language
memory
behavior
16
Q
What function does the precentral gyrus have
A
Motor strip
17
Q
What function does the Post Central gyrus serve
A
Somatosensory strip
18
Q
The central sulcus separates what 2 areas of the brain
A
The frontal from the parietal lobe
19
Q
What areas of the brain are separated by the lateral sulcus (sylvian fissures)
A
Separates frontal and parietal lobe from the temporal lobe
20
Q
What should always be identified from a sagittal view MRI
A
The central sulcus cerebellum Pons Medulla corpus callosum tonsils
21
Q
What may low-lying tonsils cause
A
Increased intra-cranial pressure
22
Q
Is the genu of corpus callosum anterior posterior
A
Anterior
the splenium of the corpus callosum is posterior
23
Q
On MRI T1 weighted sequence is CSF black or white
A
Black
24
Q
On an MRI T2 weighted sequence is CSF black or white
A
White
25
when is a CT bone window useful
For traumatic brain injury and skull fractures
26
When is a CT brain window useful
Hemorrhage and atrophy
27
What modality is useful for detecting demyelination disease and old infarcts
T2 weighted MRI
28
What 3 things are bright on axial CT brain window
Bone
blood
calcifications
29
What 2 brain regions are derived from the diencephalon
Thalamus
| hypothalamus
30
What is the role of the thalamus
Central relay station for all sensory and motor information EXCEPT OLFACTION
31
What is the role the hypothalamus
Sympathetic control
parasympathetic control
temperature control
satiety center
32
What is the Marcus-Gunn pupil
– paradoxical dilation of pupil with the light on the pupil
– caused by delay in conduction of the optic nerve typical of demyelinating disease such as MS
33
What is the only cranial nerve that innervates the contralateral eye
Trochlear nerve
| – supplies contralateral superior oblique
34
What will lesion of cranial nerve 7 demonstrate
It will affect the entire face on one side. A stroke will affect only the lower part of the face
35
What direction are afferent fibers traveling
Towards the CNS
36
what direction are efferent fibers traveling
Away from the CNS
| – effector nerves are efferent
37
What is cranial nerve 9
Glossopharyngeal nerve
38
What is the function of the glossopharyngeal nerve
Palatal muscles
palatal and pharynx sensation
taste of her posterior one 3rd of the tongue
gag reflex (afferent limb)
39
What is the function of the vagus nerve
Palatal muscles
pharynx and larynx sensation
parasympathetic to viscera (heart, G.I. tract)
gag reflex (efferent limb)
40
What is cranial nerve 12
Hypoglossal nerve
41
What are the 4 main arteries that carry blood to the brain
Carotids X2
| Vertebrals
42
What does the anterior cerebral artery supply to
Primarily supplies the frontal and medial aspect of the frontal and parietal lobes
43
What does the middle cerebral artery supply
The vast majority of the brain
– the lateral surface
– is a branch of the internal carotid
44
What are the 2 main branches of the middle cerebral artery
Anterior (Brocha's area)
| posterior (Vernicke's area)
45
The posterior cerebral artery is a branch of what vessel
Basilar artery
46
Lacuna stroke in the internal capsule will generate what symptoms
Will generally be a pure motor weakness
47
Lacunar stroke in the thalamus will have what signs and symptoms
typically sensory
48
Discuss the anterior spinal artery
It's a fusion of the vertebral arteries, located in the anterior median fissure, supplies the anterior 2/3 of the spinal cord
49
Discuss the posterior spinal arteries
their smaller arteries, derived from the PICA, they form plexus, and supplies the posterior 1/3 of the spinal cord
50
Discuss radicular arteries
They are from the aorta, send collaterals to the spinal cord, and forms the caudal most portion of the anterior spinal artery
51
The deep tendon reflexes the biceps test what nerves
C5, C6
52
The deep tendon reflexes for the brachioradialis test what nerves
C5, C6
53
The deep tendon reflexes for the triceps test what nerves
C7
54
The deep tendon reflexes for the knee test what nerves
L3, L4
55
The deep tendon reflexes for the ankle test what nerves
S1, S2
56
What neurons are in the dorsal horn
Sensory neurons
57
What neurons are in the ventral horn
Motor neurons
58
Discuss the spinothalamic tract
Responsible for pain and temperature
| crosses shortly after entering the cord
59
What is the function of the dorsal columns
joint position sense and two-point discrimination
| Crosses in the medulla
60
What is the corticospinal tract
Descending motor tract
– extension of internal capsule fibers
– decussate in the lower pyramid
– sends out fibers once it innervates alpha motor neurons
61
What is the dorsal column/medial lemniscus tract
Ascending – touch, position and vibration sensory
– Fasiculous cuneatous = arm
– Fasiculous gracilous = leg
– decussates in brainstem
62
what is the anteriolateral or spinothalamic tract
A sending – pain and temperature sensory
| –decussates immediately upon entering spinal cord
63
What is a brown-Sequard lesion
Deficit in pain perception is contralateral to the lesion, the other deficits (weakness, deficit and touch sensation) are ipsilateral
64
what are the symptoms of an upper motor neuron lesion
```
Weakness
increased reflexes
– Babinski sign
– Hoffman signs
increased tone (spasticity)
muscle hypertrophy
```
65
What is Babinski sign
Big toe dorsi flexes with stroking a bottom of the foot
66
What is Hoffman sign
Thumb moving inward with flicking of the middle finger of one hand
67
What are the symptoms of a lower motor neuron lesion
```
Weakness
decreased/absent reflexes
decreased tone (flaccid paralysis)
fasiculations
muscle atrophy
```
68
What are the four types of peripheral nerve fibers for motor function
Alpha
beta
Gamma
Delta
69
Discuss motor for full nerve fibers
Large size
| heavily myelinated, very fast conduction (30 to 110 m/s)
70
What type of sensation or motor function are associated with type A fibers
Various size a A fibers
| – proprioception, light touch, sharp pain, vibration
71
What type of motor sensation is associated with C fibers
Slow pain fibers
| – small size, no myelination, slow conduction
72
What kind of fibers are associated with autonomic's
B size fibers, some on nation, intermediate speed
73
what is an in the endoneurium
The peripheral nerves covering just outside of the neurilemma
74
What is the perineurium
The peripheral nerve covering around the fascicle
75
What is the epineurium
The peripheral nerve covering around the entire nerve
76
What is the function of the musculocutaneous nerve
Motor function
– elbow flexion
– supination
sensory field
– lateral forearm
77
What is the function of the radial nerve
Motor function
– forearm extension
– wrist extension
– finger extension
sensory field
– dorsal hand/thumb
78
What is the function of the median nerve
Motor function
– abductor pollicis brevis
– wrist flexion
– finger flexion
sensory
– ventral fingers/thumb exceptlateral fourth and fifth digit
79
What is the function of the ulnar nerve
Motor function
– Interossei
sensory
– fourth and fifth digits
80
What is the function of the femoral nerve
Motor
– iliopsoas
– quadriceps
sensory
– upper lateral thigh
81
What is the function of a sciatic nerve
Motor
– knee flexion
– plantar flexion
sensory
– back of the thigh
– sole of the foot
82
What is the function of the common peroneal nerve
Motor
– peroneous brevis
– tibialis anterior
– extension hallicus
sensory
– anterior lower leg
– dorsumof foot
83
What cranial nerves are associated with the parasympathetic nervous system
Craniosacral outflow
– III, VII, IX, X
– sacral 2 through 4
84
What enables the diffuse, nonselective generalization of the sympathetic nervous system
Adrenal medulla
85
What is the sympathetic effects on eye physiology
Contracts the radial muscle (alpha-1)
| relaxes the ciliary muscle (B-2)
86
What are the parasympathetic effects on eyephysiology
Contracts the sphincter muscle
| contracts the ciliary muscle
87
What is the autonomic influence to the ventricles
Sympathetic's
– increase contractility, conduction and automaticity
parasympathetic's
– there is no parasympathetic innervation to the ventricles
88
What is the parasympathetic influence on the bladder
The contracts the detrusor muscle
relaxes the trigone and sphincter
89
What is the third leading cause of death
Stroke
90
What is the difference between a stroke and a transient ischemic attack (TIA)
Stroke: infarction of brain tissue due to lack of blood flow
TIA: temporary neurologic deficit due to relative ischemia that improves with blood supply is restored (symptoms usually lasting less than one hour typically 20 minutes)
91
What is the pathophysiology of a stroke
Ischemic – 85%
| hemorrhagic – 15%
92
What are the causes of a focalcerebral ischemia
1. Embolic
2. Thrombotic
3. Cryptogenic
93
What is the cause of global cerebral ischemia
Hypotension
94
What is the number one risk factor for an ischemic stroke
Hypertension
other risk factors include diabetes, tobacco, prior stroke, heart disease, hypercholesterolemia, age
95
What is CADASIL
Cerebral autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy
– notch 3 gene
– associated with a stroke at a younger age
96
Was the major cause of thrombosis
Atherosclerosis
97
What are the risk factors for atherosclerosis
```
Age
male
hypertension
smoking
diabetes
hypercholesterolemia
```
98
One of the common sites affected by thrombosis
Carotid bifurcation
origin of middle cerebral artery
Basilar artery
99
What is aphasia
Inability to use or understand language due to a lesion in the brain
100
What isAlexia
Inability to perceive written words
101
What is agraphia
Inability to write words, not related to weakness or sensory deficit
102
What is dysarthria
Slurred or stuttering speech due to motor weakness of incoordination, while language is intact
103
What is apraxia
Inability to carry out a large motor tasks, not due to motor or sensory deficits or inability to understand
104
What is ataxia
Impairment in the performance and coordination of movements, not due to weakness
105
What is dysphagia
Difficulty swallowing due to motor weakness or incoordination
106
Where is the lesion generally associated with a pure motor hemiplegia
Contralateral pons or internal capsule lacune
107
Where is the lesion with a pure sensory stroke
Contralateral thalamus lacune
108
what is the presentation of a middle cerebral artery syndrome
Hemiparesis (face and arm greater than the leg), aphasia (left; neglect syndrome more common on the right) sensory loss, hemianopsia, eye deviation
109
What is the anterior cerebral artery syndrome presentation
Lower extremity weakness and sensory loss, incontinence, limb apraxia
110
What is the posterior cerebral artery syndrome
Homonymous hemianopsia
| sensory loss
111
What imaging modality is better for determining cranial bleeds
CT is better
112
What criteria is used for grading of a stroke
NIH stroke scale
113
How soon after stroke will MRI be positive
Within five minutes of a stroke and will stay positive for up to two weeks
114
When should CADASIL testing be done
In a patient less than 40 years old with no risk factors
– skin biopsy
– hypercoagulable workup
115
What is the treatment for an ischemic stroke
1. ABC's
2. Blood pressure control
– SBP less than 180
– DBP less than 140
3. Anti-platelets
– aspirin
4. Anticoagulation
– heparin (use only in afib and dissection)
5. Thrombolytics
– tPA (only use in first three hours)
6. Rehabilitation
– continued for months to years
116
What is the criteria to use tPA
– Clinical diagnosis of the stroke
– age greater than 18
– time to TP administration less than three hours from onset of symptoms
– head CT without evidence of hemorrhage or large stroke
117
What are the contraindications for the use of tPA
any indication for the potential of increased bleeding
118
What are some approaches to secondary prevention of a stroke
1. Antiplatelet agents
– Aspirin
– clopidogrel
– dipyridamol
2. Anticoagulation for atrial fibrillation or clot
3. Carotid endartectomy In appropriate patients
4. Correcting high-risk causes
119
What are the causes for intracerebral hemorrhage
```
Hypertension
mass lesions
vascular malformations
amyloid angiopathy
cocaine/amphetamine use
```
120
Were the causes for a subarachnoid hemorrhage (SAH)
Aneurysms
| trauma
121
What is the most common site for hypertensive hemorrhage
```
Basal ganglia (50-60%)
thalamus
pons
cerebellum
lobar (cortex)
associated with atherosclerosis and diastolic blood pressure greater than 110
```
122
What is the treatment for hemorrhagic stroke
```
1. Reverse coagulopathy
– FFP for elevated PT/PTT
– platelets for thrombocytopenia
2. Control blood pressure
– labetalol is the drug of choice
3. Identify underlying structural abnormalities
– tumors (MRI with contrast)
– AVM's (cerebral angiography)
```
123
What are the clinical features of the subarachnoid hemorrhage
thunderclap headache
meningismus
altered mental status
124
What are the common sites for cerebral aneurysms
```
Anterior communicating
posterior communicating at the ICA
MCA (distal greater than proximal)
ICA at ophthalmic
Basilar apex
```
125
What are the clinical features of a berry aneurysm
Most frequently complication during the fifth decade
– large aneurysms can present as mass lesion with symptoms related to compression of neurologic structures
– third nerve palsy (involving the pupil) the eye will be down and out
– if the pupil'sis spared, then likely infarction of the nerve, seen in diabetics
126
What imaging should be done for a patient suspected of a subarachnoid hemorrhage
1. Noncontrast CT of the head
2. If CT scan is negative, lumbar puncture is indicated
– examined tubes one and four for red blood cell count
3. Patients with positive CT scan or lumbar puncture should have cerebral angiogram
127
What is the Hunt and Hess scale
Measure of clinical status for hemorrhagic patients
I: asymptomatic or mild headache
II: moderate to severe headache, nuchal rigidity, cranial neuropathies
III. Confusion, lethargic, mild focal deficits
IV: stupor or hemiparesis
V: comatose or posturing
128
What is the treatment for an SAH/aneurysm
– Clip or coil identified aneurysm
– treatment vasospasm
– treatment hydrocephalus
129
What is hydrocephalus
Dilation of ventricular system with increase cerebrospinal fluid volume
– communicating or not communicating
130
What is the difference between nine communicating and non-communicating hydrocephalus
Communicating: third ventricle is open, the fourth ventricle is proportionally dilated
– blockage of CSF exit, either at arachnoid granulation's or foramen's of Magendi or Luska
non-communicating: 4th ventricle not involved
– compression of third or lateral ventricles by mass or mass effect from edema
both can results in herniation is not treated
131
What is the Monroe doctrine with regards to increased intracranial pressure
"Brain in a box"
– skull contains brain, CSF, blood
– there's no room for expansion and an increase in pressure displaces something
132
what are the herniations associated with an increased cranial pressure
1. Subfalcine
– cingulate gyrus displaced underneath the falx to opposite side
2. Transtentorial (Uncal)
– medial aspect of temporal lobe is compressed against the tentorium cerebelli
3. Tonsillar herniation (most serious)
– displacement of cerebellar tonsils through the foramen magnum. Compression of medullary respiratory centers leading tocommaand death
133
What is the treatment for increased intracranial pressure
1. Raise head of bed 45°
2. Hyperventilation (PCO2 25-30 mm Hg) normal is 40
3. Mannitol (2 g/kg)
4. Hypertonic saline
5. IV steroids if due to a tumor
6. Intraventricular drain.
134
What a factor will hyperventilation have on intracranial pressure
Hyperventilation will reduce ICP
