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Physiology - Hayley > Neurophysiology > Flashcards

Neurophysiology Flashcards

1
Q

What is the general function of the following lobes
Frontal, Parietal, Occipital, Temporal

A

Frontal Lobe - problem solving/higher function
Parietal Lobe - Spatial perception
Occipital Lobe - Vision
Temporal Lobe - Language and Information processing

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2
Q

How many layers does the cerebral cortex have

A

6

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3
Q

What type of neurons generate the EEG

A

Pyramydal

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4
Q

What layers of the cortex are pyramidal neurons located, and what layer is their cell body location

A

Cell body located in layer 5 and project to layer 1

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5
Q

What orientation are pyramidal neurons

A

Vertical

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6
Q

What charge will a cell be if it has an EPSP

A

Negative

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7
Q

What is the resulting charge of the scalp surface and thus the deflection on the EEG going to look like if there is an EPSP near the cell body of the pyramidal neurons

A

EPSP arriving to the cell body will make that end of the neuron negatively charged. This makes the top of the neurons positively charged.

Positive discharge on EEG is a NEGATIVE (downward) deflection

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8
Q

What ions are usually responsible for postsynaptic potentials

A

Na+/Ca2+

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9
Q

How long are EPSP

A

50ms

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10
Q

What is an example of a neurotransmitter that causes EPSP

A

NMDA and AMPA

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11
Q

What is an example of a neurotransmitter that causes IPSP

A

GABA

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12
Q

What is the thalamus role in generating EEG

A

The neurons that excite the pyramidal neurons come from the thalamus. So is the thalamus isn’t working, then there will be no excitation of pyramidal neurons and no EEG created

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13
Q

Where are the pacemaker cells of neuronal intrinsic rhythm located

A

In the thalamus

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14
Q

What is paroxysmal depolarizing shifts and what does this cause in the morphology of the EEG

A

These are sustained EPSPs that generate epileptiform spikes

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15
Q

What 3 anatomical landmarks are located at the beginning of measuring a head for EEG

A

Nasion (bridge of nose)
Inion (bump at the back of skull)
Preauricular points (middle of ears)

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16
Q

What is the minimum and ideal impedance of EEG electrodes

A

Ideally <5kΩ, minimum <10 KΩ

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17
Q

What is the maximum impedance difference we can have between a pair of electrodes in EEG

A

<5kΩ

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18
Q

What is the effect on artefact is the impedance of the electrode is high

A

High artefact

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19
Q

When measuring the head in the sagittal plane, what is the value of the interval between each electrode

A

10% of total sagittal plane length between nasion and first electrode, and inion and first electrode.
20% interval between the rest of the electrodes

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20
Q

When measuring the head in the horizonal plane, what is the value of the interval between each electrode

A

10% of total sagittal plane length between nasion and first electrode, and inion and first electrode.
20% interval between the rest of the electrodes

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21
Q

What amplifier is used in EEG machinery

A

Differential amplifiers

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22
Q

What is the usual sensitvity control set at in EEG machines

A

7-10uV

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23
Q

What would be the consequence of having the amplitude sensitivity control too high

A

There would be a decreased sensitivity to the signal

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24
Q

What is the sweep speed of EEG

A

30mm/s

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25
Q

What three filters are commonly used in EEG machines

A

High frequency filter, low frequency filter and notch filter

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26
Q

What is the role of the high frequency filter in an EEG and what frequency is the cut off usually set too

A

Used to remove high frequencies from the signal. Usually set to remove anything above 70Hz

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27
Q

What is the role of the low frequency filter in an EEG and what frequency is the cut off usually set too

A

Used to remove low frequencies from the signal. usually set to remove anything lower then 0.5Hz

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28
Q

What is the minimum sampling rate needed for EEG

A

256Hz

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29
Q

What is the Time Constant in EEG

A

Describes how much low frequency singal the high pass filter removes

Want a higher time constant when trying to detect slow waves pathologically (coma) and a lower time constant in areas of high artectact (sweating/movement)

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30
Q

What is the notch filter of an EEG usually set at

A

50Hz

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31
Q

What is bipolar longitudinal montage useful for seeing

A

Symmetry between left and right side of the brain

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32
Q

What is the transverse montage useful for viewing

A

To determine if activity has temporal/[parasagittal activity

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33
Q

How does the electrode relationships differ between bipolar montage and reference montage

A

Bipolar montage involved pairs of electrodes whereas reference montage involved one common reference electrode all the scalp electrodes are in refeerence too

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34
Q

In a reference montage where is the reference electrode ideally placed

A

In an area that is electrically neutral or produces minimal interference

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35
Q

What is a expected EEG response to hyperventilation

A

Increased slow wave activity - increase in theta and delta wave appearence

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36
Q

What is the method of hyperventilation during EEG

A

3-4 breaths per 10 seconds for 3 minutes

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37
Q

What is hyperventilation a well known activator of

A

Absence seizure waveforms (3Hz/s spike wave)

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38
Q

What is the expected EEG activity of someone with photic stimulation

A

Epileptic abnormalities: high amplitude generated spike waves

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39
Q

What are the two most photosensitive seizures

A

Generalised tonic-colonic seizures
Juvenile Myoclonic Epilepsy

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40
Q

What is the effect of sleep deprivation on EEG

A

Increases the diagnostic yield of EEG and increases generalised discharges

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41
Q

What electrodes are eye blinking seen in on EEG

A

-vs deflection in Fp1 and Fp2

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42
Q

What frequency of artefact is expected during electrical interference

A

50Hz

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43
Q

Frequency of alpha waves

A

8-13Hz

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44
Q

Frequency of beta waves

A

> 13Hz

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45
Q

Frequency of theta waves

A

4-8Hz

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46
Q

Frequency of delta waves

A

0.5-1Hz

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47
Q

What is the dominant EEG wave in awake adults

A

Alpha

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48
Q

What does phase reversal tell us

A

The common electrode between the two phases is the location of electrical activity

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49
Q

When you describe EEG activity, what 3 factors should you always include

A

frequency, location and symmetry

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50
Q

What area of the brain should an EEG be dominant in a healthy adult

A

Posterior

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51
Q

What is MU rhythm and how can it be blocked

A

Type of alpha wave, but is usually asymmetrical and can be blocked by activating the collateral hand

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52
Q

What is a Lambda wave, what electrodes are they found in

A

Triangle ‘sail’ waves

Found over O1, O2, P3, P4, P5 (posterior region)

Seen with eyes are open

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53
Q

What cortex are lambda waves usually evoked from

A

Opitcal cortex

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54
Q

What happens to alpha waves when the eyes are opened in a healthy adult

A

The alpha waves should stop

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55
Q

What are vertex sharp waves and what sleep stage are they seen in

A

Seen in stage 1 sleep as you transition in stage 2

High altitude, V shaped waves, predominately seen in Cz

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56
Q

What are K complexes and what sleep stage do these occur in

A

Sharp vertical downwards reflections with and increase and slow deflection

Stage 2 sleep

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57
Q

What 4 changes to the EEG are expected in a coma patient

A

Increase in slow wave activity (delta/theta)
Triphasic Complexes
Suppression bursts
PLEDS
Delta Brush

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58
Q

What are PLEDS a indicator of

A

represent focal neurological damage

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59
Q

What does triphasic complexes indicate on EEG

A

Characteristic of a wide range of encephalopathy due to hypoxia

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60
Q

PLEDS and triphasic complexes will occur in a brain during what state

A

Coma

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61
Q

What is delta brush on an EEG

A

Superimposed higher frequency activity, associated with anti-NDMA encephalitis

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62
Q

What is the major change in an EEG throughout childhood

A

The amount of slow wave activity decreases

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63
Q

What are two specific EEG features specific to children

A

Alpha subharmonic and posterior slow waves

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64
Q

EIDEE (Otahara Syndrome)
- What is the age onset
- What type of seizures so they have
- EEG pattern

A

Onset < 3 months
Frequent seizures, usually just one type
Burst suppression pattern

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65
Q

IESS (Wests Syndrome)
- Age onset
- Type of seizure that occurs
- EEG characteristics

A

Onset 1-12 months
Epileptic spasms
EEG is characteristic of spasm (prominent EMG burst of <2sec) and hypsarrhythmia (chaotic, high amplitude, multifocal spikes)

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66
Q

What is the effect of brain structure and neurological condition of people with self-limited epilepcy

A

No structural or neurological impairment usually

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67
Q

At what stage in life do self-limited seizures tend to stop

A

Puberty

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68
Q

SeLECTS
- Age of onset
- Type of seizures
- EEG characteristics

A

Onset 4-10 years

Seizures are brief, usually nocturnal and involve the mouth and face a lot. Cant speak but can understand

EEG has centro-temporal spikes

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69
Q

SeLEAS
- Age onset
- Type of seizure
- EEG characteristic

A

Onset 3-6 years

Seizure frequency is low, focal autonomic seizure with or without impaired awareness

EEG - posterior-temporal spikes, particularly in occipital lobe

70
Q

COVE
- Age of onset
- Type of seizure
- EEG characteristics

A

Onset 8-9 years old

Seizures mostly visual

EEG has occipital spikes

71
Q

Lennox Gastaut Syndrome
- Age of onset
- Type of seizure
- EEG characterisitcs

A

Onset 18 months - 8 years

Tonic seizures + one other seizure type.

EEG - slow spike patterns (<2.5Hz) in awake state, in sleep there is paroxysm fast activity

72
Q

What are the effects on cognitive and neurological development in developmental encephalopathies

A

Development is usually impaired

73
Q

Landau Kleffner Syndrome
- Age of onset
- Characteristic behavioural change
- EEG characteristics

A

Onset 2-12 years

Language and motor regression

EEG - in wakefulness EEG is normal, in sleep there is high frequency spike wave discharges

74
Q

Lennox Gastaut Syndrome, Landau Kleffner Syndrome, EIDEE and IESS are all what types of epilepsy syndromes

A

Developental Encephalopathies

75
Q

SeLECTS, SeLEAS and COVE are all what type of epilepsy syndromes

A

Self-limited

76
Q

Childhood absence epilepsy
- Age of onset
- Seizures + trigger
- EEG characteristics

A

Onset 4-10 years old

Seizures multiple times a day, 3-20 seconds long, severe loss of awareness. Triggered by hyperventilation.

2.5 - 5Hz generalised spike wave, clean on onset, clean on offset

77
Q

What is the effect on cognitive development with those with genetic generalized epilepsy syndromes

A

No change in development

78
Q

Juvenile absence epilepsy
- Age of onset
- Seizures
- EEG characteristics

A

9-13 onset

Seizures less then daily, complete loss of consciousness. Hyperventilation triggers

EEG not as neat at childhood absence epilepsy - irregular discharges in background, 3-5.5Hz generalized spike wave

79
Q

Juvenile Myoclonic Epilepsy
- Triggered by
- Seizures
- EEG characteristics

A

triggered by sleep deprivation

Seizures can be tonic or tonic-conic or absent seizures

EEG - bilateral polyspike discharged and not as regular as childhood epilepsy

80
Q

What is the most common epilepsy syndrome with adolescent and adult onset

A

Juvenile Myoclonic Epilepsy

81
Q

What is a seizure

A

Sudden alteration of behaviour due to temporary change in the electrical functioning of the brain

82
Q

What is the ILAE definition of epilepsy

A

Two unprovoked seizures 24 hours apart, or one unprovoked seizure and a probability of further seizures of <60% after two unprovoked seizures

83
Q

What two factors are associated with seizure relpase

A

Presence of cerebral lesion
Epileptiform abnormalities in a EEG

84
Q

What is idiopathic epilepsy

A

A group of epileptic disorders believed to have strong genetic basis.

No structural abnormalities

85
Q

What are 4 treatment appraches to epilepsy

A

Anticonvulsant medication
Vagal nerve stimulation
Ketogenic diet
Surugry

86
Q

What observations do we rely on in an EEG to show epilepsy due to the low chance of observing a clinical seizure

A

Inter-ictal discharges (IEDs)
Specific paroxysmal discharge

87
Q

How can we increase the yeild of detecting IEDs in EEG

A

Sleep deprivation

88
Q

What is a focal aware seizure

A

A seizure that has started in one small region of the brain, a person is fully aware but may not be able to talk/respond

89
Q

What are the symptoms of temporal lobe seizures

A

Patients tend to report sensation of deja vu

Automatisms (repetative movements)

90
Q

What is a Jacksonian March Seizure

A

Frontal lobe seizure - arises from primary motor cortex (causes clonic twitching with LOC)

91
Q

For seizures arising in the supplementary motor cortex, what is the symptoms

A

Deviation of the head and eyes associated with tonic elevation of the contralateral arm

91
Q

What sort of seizures often occur out of sleep

A

Frontal lobe seizures

92
Q

How come frontal lobe seizures can be hard to see on EEG

A

The front lobe seizures often arise in an area of the brain which is relatively inaccessible to scalp EEG

Due to the large muscle movements that occur in frontal lobe seizures, the muscle signals can distort the EEG

92
Q

Symptoms of occipital lobe seizures

A

Blindness, visual field loss, visual misconception, visual hallucination

93
Q

What hemispheres of the brain does a generalised seizure usually affect

A

Both

94
Q

Explain the two phases of a tonic-colonic seizure

A

Tonic - stiffening of muscles, eyes open, tounge/cheek biting

Colonic - jerking movements, incontinence

95
Q

What is the well known activator of absence seizures in EEG

A

Hyperventilation

96
Q

What is the characteristic EEG pattern seen in absence seizures

A

3Hz/s spike wave

97
Q

What is status epilepticus

A

Condition in which prolonged/recurrent seizures accompany persistent altercation of the neurological state

98
Q

What is the ILAE definition of status epilepticus

A

Seizure with 5 minutes or more of continuous clinical and/or electrographic activity OR
recurrent seizure activity without recovery between seizures

99
Q

What is ictal-interictal continuum

A

Discharges that are epileptiform and continuous but dont fufill the criteria for an EEG seizure

100
Q

What is an example of an ictal-interictal continuum

A

Triphasic complexes (initial small negative sharp discharges followed by large positive sharp discharges with subsequent negative wave)

101
Q

What two conditions can triphasic complexes indicate

A

Hepatic enchephalopathy
Uremic encephalopathy

102
Q

What are PLEDS

A

Defined as unilateral focal spikes or sharp waves occuring at an approximately regular interval

103
Q

What does PLEDS tell us about the state of the cerebellum

A

That it is intact

104
Q

What condition can PLEDS indicate

A

Herpes Simplex Enchephalitis

105
Q

How do you measure the nerve conduction velocity when doing a nerve conduction study

A

Distance between the two stimulating points / (proximal latency - distal latency)

106
Q

What measurements/methods are used by physiologists in IOM

A

Evoked potentials (motor and somatorsensory)
Direct cortical and subcortail stimulation
Triggered EMG

107
Q

What horn in the spinal cord is connected to motor nerve

A

Anterior horn

108
Q

What nerves, sensory or motor, have ganglia and what are these ganglia called

A

Sensory nerves are connected to dorsal root ganglia

109
Q

What are the most vulnerable sensory fibres too pathology

A

Large myelinated fibres

110
Q

What is the amplitude of the AP determined by

A

The strength of the AP (number of axons propagating the signal)

111
Q

If there is a decrease in amplitude of the nerve conduction study, what does this suggest

A

Loss of axons

112
Q

If there is a decrease in velocity of the nerve conduction study, what does this suggest

A

Loss of myelin

113
Q

What do F waves tell us about on nerve conduction study

A

Tell us about the conduction up at the level of the spinal cord

114
Q

What do H waves in nerve conduction studies tell us

A

This is the sensory response when the motor nerve is activated (comes slightly after the motor wave as the sensory fibre has to go across a synapse)

115
Q

What nerve is measured in carpel tunnel nerve conduction studies

A

Median nerve

116
Q

What are some typical findings on a nerve conduction study for carpel tunnel

A

Prolonged latency in motor and sensory nerves
Normal ulnar nerve conduction rules out other conditions

117
Q

What is an example of focal neuropthy

A

Carple Tunel

118
Q

What is the most common presentation of motor nerve study patients

A

Weakness

119
Q

What are some syptoms of people have a nerve condution study

A

Tingling/numbness, burning or shooting pain, loss of sensation, muscle weakness, coordination problems

120
Q

What is polyneuropathy

A

Symmetrical loss of neural fibres

121
Q

What sort of sensations so A-alpha and A-beta fibres sense

A

Mechanical - mechanoreceptors

122
Q

What sort of sensory result will there be in neuropathy of small fibres

A

Pain and burning

123
Q

What is Lillian Barry Syndrome

A

Infection that affects the nerves and causes respiratory failure

124
Q

What is an example of demylinating neuropathy of motor nerves

A

Lillian Barry Sydnrome

125
Q

What pathway is pain signalling transmitted within

A

Somatosensory

126
Q

Pain signalling is facilitated by what type of neurotransmitters

A

Excitatory - substance P, glutamate, CGRP

127
Q

Allodyina

A

Painful response to non-noxious stimuli

128
Q

Where does descending neural inhibition of pain originate from

A

PAG

129
Q

What part of the spinal cord does descending pain inhibition synapse too

A

Dorsal Horn

130
Q

What fibres inhibit pain in the gate control theory

A

A-beta

131
Q

What neurotransmitter is released in gate control theory of pain inhibtion

A

GABA

132
Q

What is neuropathic pain

A

Pain arisen as a direct consequence of lesion of disease affecting the somatosensory system

133
Q

What are some causes of neuropathic pain

A

Peripheral origin - nerve injury, neuropathy, entrapment syndromes

Central origin - stoke, spinal cord injury, parkinsons

134
Q

Where in the somatosensory cortex map is the upper limbs located

A

Mid line

135
Q

Where is the auditory cortex located

A

Just above the ears

136
Q

What is averaging and how does this help in evoked potentials

A

This averages out the noise in a signal so we are able to observe the small signals that are produced in evoked potential studies

137
Q

Where is the stimulating and recording areas in a somatosensory evoked potential study

A

Stimulate a peripheral nerve

Record over brain, spine and limb

138
Q

What is the commonly evoked nerve in lower limb evoke nerve studies

A

Posterior tibial nerve (ankle)

139
Q

What is the commonly evoked nerve in upper limb evoke nerve studies

A

Median Nerve (wrist)

140
Q

Prolongation of latency in evoked potentials usually indicates what

A

Delayed signal transmission often due to demyelination or nerve damage

141
Q

What positions are used to record spinal cord responses in upper limb and lower limb evoked potential study

A

Upper limb (N13) - cervical spine (C5)

Lower limb (N22) - Lumbar spine (L1-L3)

142
Q

What electrodes are used for measuring scalp signals in upper and lower evoked potential studies

A

Upper - C3 or C4 (contralateral to the stimulated side)

Lower - Cz midline

143
Q

What are the reference electrodes used in evoked potential studies

A

Fz (foorehead) or Ear (A1/A2)

144
Q

What 3 electrodes are used for visual evoked potentials (VEP)

A

Occipital scalp - O1, O2, Oz

145
Q

What are the location of the recording electrodes of brainstem auditory evoked potentials

A

Vertex (Cz) - midline scalp

146
Q

What is the p100 in visual evoked potential

A

The primary positive peak occurring around 100ms

147
Q

A prolonged p100 latancy in visual evoked potentials is common in what pathology

A

Multiple Sclerosis

148
Q

What is the N135 in visual evoked potentials

A

The large positive deflection following p100 in visual evoked potentials

149
Q

What is the N75 in visual evoked potentials

A

The large positive deflection before p100 in visual evoked potentials

150
Q

What 2 types of stimuli are used in visual provoked potentials

A

Pattern reversal and flash stimulation

151
Q

What are symptoms of multiple sclerosis

A

Bad peripheral vision, pressure in eyes, sports in vision

152
Q

What is the key waveform we are interested in brainstem auditory evoked potentials

A

V - Represents conduction through the central visual pathways to the visual cortex.

153
Q

What are changes expected to see in EEG of coma patients

A

Generalised slowing (increase in delta and theta activity)
Burst suppression pattern
Triphasic Waves
Isoelectric Line
Epileptiform Activity

154
Q

What are favourable prognosis EEG signs in coma

A

Active EEG (spindles, alpha)
Responsiveness

155
Q

What are unfavourable prognosis EEG signs in coma

A

Suppression bursts and isoelectric line

156
Q

What is the difference between spike waves and sharp waves in epileptiform

A

Spike waves last less than 70 ms

Sharp waves last longer then 70 ms

157
Q

List 4 different types of epileptiform

A

Spike waves
Sharp Wave
Polyspikes
PLEDS

158
Q
A
159
Q
A
160
Q

What things do we need to consider in a surgury environment when doing IOM

A

Effects of anaestaia
Poor baselines at times
Lots of noise in theatre

161
Q

What is the advantage of MEP’s that makes them good to use in a surgury setting

A

They have a large signal-to-noise ratio so they can record the MEPs without averaging

162
Q

What type of stimulation is used in MEPs in IOM

A

High frequency multiple pulse anodal stimulation

163
Q

What is mode is used for motor MEPs in IOM

A

Monopolar

164
Q

Where to the best MEPs come from during IOM and why

A

Fingers and toes due to the large cortical representation of these areas

165
Q

What is the delay in the NMJ due too

A

Biochemical properties that enable the AP to travel across the synapse - including neurotransmitter release, diffusion, receptor activation and muscle membrane depolarisation which are inherently slower processes then a signal flowing through a single nerve fibre

166
Q

What nerves are not Mylinated

A

Autonomic Nerves

167
Q

What physiological event does P100 in VEP signify

A

Represents conduction through the central visual pathways to the visual cortex.

168
Q

What would be the pathology associated with a decrease or absence in VEP

A

Optic Neuritis (damage and loss of axons in optic nerves)

Physiology - Hayley (9 decks)

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