NT Flashcards
Monamines
Dopamine, Serotonin (5HT), Norepinephrine and Eprinephrine
Dopamine is considered what type of pathway
“reward” pathway and addiction
Dopamine Synthesis
tryosine to dopa to dopamine
Dopamine Degradation
monamine oxidase (MOA) and catechol-O-methyl transferase (COMT)
Ganglion
Collection of nerve cell bodies outside the CNS
Nuclei
Collection of nerve cell bodies in the CNS
What type of NT is serotonin
Monamine
Glycine is ________ AA
Neutral/Inhibitory GABA
Aspartate is ______ AA
Excitatory
Circle of Willis connects _______ and _______
caratoid and basilar arterties
The pia mater contains _______ plexuses
choroid
Midbrain also called
Mesencephalon
Hindbrain consists
Metencephalon (cerebellum & pons) & Myelecephalon (medulla)
What part of the brain contains the thalamus and the hyperthalamua?
Forebrain
Short preganglionic and long post ganglionic neurons
Sympathetic
Long preganglionic and short post ganglionic neurons
Parasympathetic
Preganglionic axons neurotransmitter
Acetylocholine both branches (cholinergic)
Postganglionic axons neurotransmitter
Sympathetic - norepinephrine (adrenergic)
Parasympathetic - release acetylcholine
Cholinergic Receptors
Receptor for Ach
Nicotinic, Muscarinic
Medulla also called
Myelencephalon
What kind of tract is pyramidal (corticospinal)
Descending motor tract
Pyramidal upper motor neurons arise
cortex and descends to cross over and decussate at the medulla (pyramids)
Another motor tract
extrapyramidal (outside of the pyramidal)
They r involved in non-volu expressions of the fine motor & postural control
extrapyramidal
Synapse with final motor neurons of ventral (gray) horn
extrapyramidal
Receptor senses a stimulus (from environment or inside body)
Reflex Arc
Stressor Reponse (BP, HR, MVO2, EF, CO, Circulating BV) - threat response Increase Muscle Blood Flow Bronchodilation (oxygenation) Liver Glycolysis (lactic acid) Adipose Lipolysis (FFA) Distance VIsion Sexual Climac (2nd phase)
Sympathetic Reponses
Digestion Anabolism (growth) Near Vision Voiding, Defecation Sexual Excitation (1st phase)
Parasympathetic Reponses
Parasympathetic end organ receptors
Muscarinic
NO
Released by some parasympathetic neurons and gas that causes blood vessel vasodilatated
Parasympathetic: Post synaptic neuron release
ACh, NO
Sympathetic: Post synaptic neuron release
Norepinephrine (NE)
Epinephrine (EP)
Dopamine (DA)
Acetylcholine (ACh)
Dorsal, afferent
Sensory pathway
Ventral, efferent
Motor Pathway
Brings info to spinal cord
Afferent Sensory neuron
Spinal cord sends out ______ to the body to a(n) __________ that accomplishs the action
motor neuron
effector organ
_____ develops from dorsal thickening of ectoderm to form neural plate
CNS
With maturity, cerebral maturity suppresses primitive lower brain & spinal cord reflexes
CNS maturity
Spinal Reflexes Stepping Sucking Rooting Palmar Grasp
Primitive Reflexes
Some aging effects of the NS
Decreased # neurons
Degeneration cerebra & cortex tiss, degen of nerve proteins
Loss of brain tiiss, reduced inhibition spinal cord
Reappearance of primitive reflexes
Deficits in taste & Smell
Decreases in Vision
Gait changes - shorter, shuffling, no associated arm swinging
Falls in elderly
Pain Neuroanatomy: Actions occurs in body & CNS
effector organ
Pain Neuroanatomy
Reflex arc loop system (afferent IN, efferent OUT),
Types of nociceptors
Skin - mechanoreceptors, thermal receptors
Joint - mechanoreceptors, silent
Visceral - mechanoreceptors, silent, chemical, thermal
Silent (“deep”) - found in skin & deep tiss
Tissue injury is painful bc release of chemicals of _______ & includes ________
inflammation
includes: vasoactive peptides (bradykinins), prostaglandins, histamine, lymphokines, serotonin (5HT), substance P
Derived from large molecule in brain called POMC
endorphins & dynorphins (strongest)
Inhibit pain transmission w/in CNS
endorphins & dynorphins
Spreads pain locally
Substance P
Sympathetic NS Activation
ascending pain impulses can’t make it 2 higher CNS levels
Reduce awareness of pain in a crisis to respond in emergency
Improves pain tolerance and clinical correlate: reduced tolerance for pain in depressed persons & improved tolerance in ppl given antidepressants
Serotonin
Pts do not get use to the pain and CNS response (limbic system) worsens
Chronic Pain
Pain is dull and poorly localized in this body system
Somatic (bone, ligaments, tendons, muscle, fascia)
“Referred” pain, diff to localize, aching
Visceral - internal organs
Injury 2 skin with high conce of nerve endings allowing for good localization (lacerations, burns)
Cutaneous
Burning, tingling and hypersensitivity 2 touch or cold, lancinating
Neuropathic
Burning, itching
Inflammatory
Caused by injury 2 body tiss
Surgical trauma, infection/Inflam
Nociceptive
Abnormalities in nerves, spinal cord / brain
Neuropathic
Entirely or mostly related to psychological disorder (rare)
Psychogenic
Increase painful sensation in reponse to additional noxious stimuli; amplification or pain due to injury or inflammation
Hyperalgesia
Pain for stimulus that does not normally produce pain
Allodynia (light touch, sunburn)
Constant bombant of 2nd order neurons in dorsal horn, neuron previously carried touch sensation (Abeta) now carrys pain , neuropathich pain syndromes as well as chronic pain that is undertreated
Wind up Pain
ABCDE Pain
Ask about pain regularly
Believe report of pain & relief agents
Choose pain control options appropriately
Deliver interventions (timely, coordinated)
Empower pts & family members 2 control course pain management
What maintains internal environment
Hypothalamus
Part of limbic system
Hypothalamus
If 2 cold is stimulated
Thyroid
When stimulated produces throxine, which stimlated adrenal medulla, produces nonepine/ epine causing sympathetic activation
Thyroid
If 2 hot ______ pathway is shut down and _____ system is more dominant
TRH/TSH and parasympathetic system
Active and multiphase process
Sleep
To keep awake ______ sends out signals & 2 go 2 sleep ______ must be inhibited
SCN (supra-chiasmatic nucleus)
Inhibition of SCN is initiated by _____ production & synthesized by _______
melatonin
pineal gland
Four stages of NREM
1: light sleep & alpha waves (5% of total sleep)
2. Sleep spindles & slower (50% )
3. delta waves & sleep spindles (10%)
4. Only delta waves - deepest (10%)
SWS
slow - wave sleep
occurs in stage 3 & 4 NREM
neocortex probably occurs
______ memory improved after a deep sleep
Declarative (fact-based)
_____ sleep occurs every 90 min after 1st 1-2 hrs deep sleep
REM
20-25% Total sleep
REM
During increased cerebral blood flow & steroid released
REM
Controlled by pontine reticular formation
REM
Sleeping pattern of newborns
16-17 hrs, mostly REM
Primary sleep disorders
Dyssominia (insomnia) and Pasrasomnia (nightmare)
hypocretin/orexin deficiency
narcolepsy
10-20 minutes long
narcolepsy
Sudden loss of muscle tone
Cataplexy
Includes other sym - cataplexy, hallucinations, sleep paralysis
narcolepsy
Occur just b4 sleeping (hypnagogic) or right after waking up (hypnopompic)
Hallucinations
Breathing related sleep disorders
Sleep apnea syndromess (SAS)
Occurs more than 30 times per 8 hrs sleep
Hypopnea/apnea
Not related 2 airway blockage
occurs usually w/other cardia / neurological diagnoses - elderly
Central sleep apnea (CSA)
Form of central apnea
AW obstruction in obese
Pickwickian Syndrome
Obstructive and central
Mixed type sleep apnea
_____ ppl have 45% greater risk of HTN
sleep apnea syndromes
_______ ppl have increased risk of MI and stroke
sleep apnea syndromes
Micro sleeps during the day contributing to injury & fatigue
sleep apnea syndromes
Treatment includes avoid alcohol & sedatives, wt loss
Oral appliance
+ airway pressure - forcing air thru nasal passages
Surgery
sleep apnea treatments
Disorder includes jet lag, shift work, delayed sleep phase
Circadian rhythm sleep disorders
Childhood Parasomnias
Nightmare, night terrors. somnabulism (sleepwalking disorder) - during stage 3 or 4 NREM
Mental and behavioral health diagnoses looked up in here
Diagnostic & statistical manual
Includes variety disorders like Asperger’s
Autism
diagnosis can b made b4 age 3 sometimes as early as 12-18 months
Autism
Assessment scoring tool for Autism
M-CHAT
May develop seizure disorder
Autism
Seizure disorder
Epilepsy
brain waves occur at different frequencies
Epilepsy
Diagnosis test of Epilepsy
EEG
Type of seizure that is widespread electrical discharge affecting both sides of brain; often genetic
Generalized
Type of seizure that is abnormal electrical discharge in only 1 part of brain
Partial
Occurs in Asian men
SUNDS syndrome (sudden unexplained nocturnal death syndrome) also Brugada Syndrome
Used assess / evaluate coma
Glasgow Coma Scale (GCS); peds & adult versions
Early death (neuro-endocrine failure) resulting
Dementias
ABCs of Dementia
Activity (Function)
Behavior
Cognition - memory & Lang, new info & problem solving, perception, abs thinking
Types of dementia
Alzheimer
Lewy-body
Vascular
Lewy body dementia
associated with abnormal lewy bodies seen on histology, seen alone or with things like parkinson’s
vascular dementia
multi-infarct dementia
caused by same risk factors as any CV disease
Other conditions that may cause dementia include
slow viruses (mad cow), tumors, underactive thyroid, alcoholism
Deep tendon reflexes (DTR)
In: suddenly stretched by tap w/finger or rubber hammer; mechanoreceptons (spindle fibers in muscle) send afferent (sensory) info 2 spinal cord
Out: spinal cord sends efferent (motor) impulses to muscle via gamma neurons & muscle contracts
Brain ________ deep tendon reflexes
inhibits
y can accentuate reflex during an exam by reinforcement
W/in the CNS
UMN lesion
UMN lesion
mild weakness, disuse atrophy muscles, accentuated deep tendon reflexes, hypertonia, spasticity
Brain ______ spinal cord reflexes
Suppresses
Brain unable 2 suppress spinal cord reflexes
Disinhibition
Outside CNS
LMN lesion
Autosomal Dominant abnormality, ultimately leads to death of neurons & imbalance in basal ganglia w/overactive dopaminergic pathways
Sym: progressive chorea & dementia
starts in adulthood
tx - antagonize dopamine 2 slow progression; no cure
Huntington’s Disease
(genetic)
brain degeneration
Parkinson’s Disease
associated w/depression & development of Lewy Body type dementia
decreased dopamine in basal ganglia
Parkinson’s Disease
Any focal neurologic deficits on clinical exam (temp or permanent)
Traumatic Brain Injury (TBI)
Types of TBI
Diffuse Axonal Injury (DAI) brainstem contusion
Focal Injury (contusions)
Coup Injury
Contre-Coup Injury
Shaken baby sydrome; MVA r examples of TBI
Diffuse Axonal Injury (DAI)
Type of TBI - blunt (closed) or open (penetrating) trauma
Most deaths from head trauma
Focal Injury
Blow to frontal skull
Coup injury
blow to occipital skull & brain strikes inner liner shaped frontal bones on rebound, causing frontal damage also
Contre-Coup
Pathophysiology - decreased dopamine, inhibitory (dopaminergic) neurons - imbalance of too much cholinergic and GABA influence; lack of dopamine causes disinhibition - may see constant baseline increased muscle activity leading to rigidity temor
Parkinson’s
AKA abusive head trauma (ABT)
shaken baby syndrome
Long term complications include: deafness, blindness, seize disorder, mental retardation & cerebral palsy
shaken baby syndrome
Symptoms lasting less than 24 hrs
Transient Ischemic Attack (TIA)
Types of stroke
Ischemic (thrombotic - blood clot)
Hemorrhagic (intracranial bleed)
Embolic (traveling clot from another location n body)
Cryptogenic (hidden)
85-90% of strokes in adults
often due to atherosclerosis in carotid vessels
Ischemic (thrombotic - blood clot)
5-10% of strokes
Hemorrhagic (intracranial bleed)
Rare Stroke
Embolic (traveling clot from another location n body)
Very few (<5%)
not obvious causes
includes embolic strokes
Cryptogenic
FAST
Face - face look uneven
Arm - 1 arm hanging down
Speech - Slurred speech
Time - Call 911 now
Strokes n infants
intraventricular hemorrhage (IVH) and hypoxic-ischemic encephalopathy (HIE); low blood pressure
Childhood Stroke
Usually due to trauma or blood disorders - sickle cell anemia
Disorders of the neuromuscular junction
Degenerative Disease
Rare Syndromes - Lambert-Eaton, pseudochilnesterase deficiency, myasthenia gravis)
Autoimmune attack against ACh receptors on skeletal muscle
Myasthenia Gravis
Male:Female ration 2:3
My include thymus disorders
Myasthenia Gravis
Transmitted my mother; lasts 1-10 weeks, treat supportively until abates
Progressive reduced muscle strength with repeated muscle use, the improvement after rest
sym start once # of AChR is 30% of normal
Myasthenia Gravis
Demylenating Disorder - loss of myelin around neurons in the CNS
MS
Over accumulation of neurotransmitter glumate in CNS causing excito-toxicity of anterior horn cells in spinal cord
ALS (Lou Gehrigh’s Disease)
Neurons that would normally innervate skeletal muscle die and lose of lower motor neuron (LMN) function with muscle paresis;
eventually loses ability to speak, swallow and breathe
ALS (Lou Gehrigh’s Disease)