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Year 2 BB > Overview > Flashcards

Overview Flashcards

1
Q

Which CN is typically very thin?`

A

CNIV - trochlear

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2
Q

Two components of the DCML?

A

Gracile

Cuneate

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3
Q

What type of information is conveyed in the DCML?

A

Sensory - fine touch, vibration, two point discrimination, proprioception

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4
Q

Gracile conveys information from where?

A

Lower limb

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5
Q

Cuneate conveys information from where?

A

Upper limb

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6
Q

CNI - name and function

A

Olfactory nerve

Scent

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7
Q

CNII - name and function

A

Optic nerve

Sight

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8
Q

CNIII - name and function

A

Oculomotor nerve

Movement of eye muscles

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9
Q

CNIV - name and function

A

Trochlear nerve

Movement of Superior oblique eye muscle

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10
Q

CNV - name and function

A

Trigeminal nerve
V1, V2, V3 - innervation of different regions of the skin
V3 - innervation of muscles of mastication
Lingual nerve - general sensation to the anterior 2/3 of the tongue

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11
Q

CNVI - name and function

A

Abducens

Movement of the lateral rectus eye muscle

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12
Q

CNVII - name and function

A

Facial nerve

Movement of muscles of facial expression
Chorda tympani - special sensory to the anterior 2/3 of the tongue

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13
Q

CNVIII - name and function

A

Vestibulocochlear

Cochlear nerve - hearing
Vestibular nerve - balance

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14
Q

CNIX - name and function (x3)

A

Glossopharyngeal nerve

All sensation to the posterior 1/3 of the tongue
Sensation from the pharynx
Parasympathetic to the parotid gland

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15
Q

CNX - name and function

A

Vagus nerve

Mainly parasympathetic actions

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16
Q

CNXI - name and function

A

Spinal accessory nerve

Innervation of the SCM and the trapezius muscles

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17
Q

CNXII - name and function

A

Hypoglossal nerve

Motor innervation of the tongue

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18
Q

The four muscles of mastication are?

A

Masseter
Temporalis
Medial pterygoid
Lateral pterygoid

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19
Q

Five terminal branches of the facial nerve are?

A 
Temporal 
Zygomatic
Buccal
Mandibular
Cervical
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20
Q

Forehead wrinkling is absent in what type of damage?

A

LMN lesion

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21
Q

Forehead wrinkling is spared in what type of damage and why?

A

UMN lesion - dual innervation of the forehead

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22
Q

Three main nuclei of the basal ganglia are?

A

Caudate
Putamen
Globus pallidus

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23
Q

Lateral ventricle to the third ventricle is via?

A

Interventricular foramen

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24
Q

Third ventricle to the fourth ventricle is via?

A

Cerebral aqueduct

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25
Q

Corpus striatum consists of?

A

Caudate and putamen and globus pallidus

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26
Q

Accumbens located where?

A

Inferior to the caudate and anterior to the putamen

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27
Q

Two parts of globus pallidus are located where in relation to each other?

A

Globus pallidus interna - more inferiorly located

Globus pallidus externa - more superiorly located

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28
Q

Nucleus accumbens also known as?

A

Ventral striatum

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29
Q

Dorsal striatum consists of?

A

Caudate and putamen

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30
Q

Four functions of the basal ganglia

A

Regulate intensity of slow or stereotyped movements
Inhibit antagonist or unnecessary movement
Regulate attention and cognition
Motor program switch

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31
Q

Main neurone involved in the basal ganglia is?

A

Medium spiny neurone

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32
Q

Input to the MSN is?

A

Glutaminergic from the cortex

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33
Q

Output from the MSN is?

A

GABAergic

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34
Q

Two groups of GABAergic neurones in the basal ganglia express which receptors?

A

D1

D2

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35
Q

Dorsal striatum consists of?

A

Nucleus accumbens

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36
Q

Three actions of the D1 receptor

A

Increase cAMP
Increase sensitivity of striatal cells to glutamate
Project to the GPi directly via the direct pathway

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37
Q

D1/D2 - which is involved in the indirect/direct pathway?

A

Direct pathway - D1

Indirect pathway - D2

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38
Q

What is the action of dopamine at the D1 receptor?

A

Dopamine increases the action of the direct pathway - D1

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39
Q

What is the action of dopamine at the D2 receptor?

A

Dopamine decreases the action of the indirect pathway - D2

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40
Q

Function of the direct pathway is?

A

Activates motor program switch

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41
Q

Function of the indirect pathway is?

A

Blocks motor program switch

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42
Q

Overall action of dopamine at the basal ganglia

A

Dopamine increases action of direct pathway and decreases action of indirect pathway SO allows motor program change

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43
Q

Relation of dopamine to Parkinson’s?

A

PD - have reduced number of dopamine receptors and the person cannot facilitate movements

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44
Q

Death of cells where for PD?

A

Dopamine cells in the substantia nigra - input to the GPi and GPe

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45
Q

Level of cell death before PD presents is?

A

80% of SN dopamine cells dead before clinical signs of PD are seen

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46
Q

How can you recognise the substantia nigra?

A

Black region of the brain

Nigra - black

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47
Q

Four cardinal motor signs of PD are?

A

Tremor at rest
Rigidity
Bradykinesia
Loss of postural reflexes

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48
Q

First line treatment for PD is? x3

A

Levodopa
Dopamine agonist
MAO-B inhibitors

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49
Q

Second line treatment for PD? x2

A

In addition to first line:
COMT inhibitors
Amandadine/apomorphine

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50
Q

Last line treatment for PD?

A

Deep brain stimulation

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51
Q

Three sites for DBS in PD?

A

Subthalamic nucleus
Zona incerta
Globus pallidus interna

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52
Q

What is Huntington’s disease?

A

Extra, unwanted movements

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53
Q

Cause of Huntington’s disease is?

A

Loss of GABA-ergic neurones in the striatum

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54
Q

Inheritance of Huntington’s disease is?

A

Autosomal dominant

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55
Q

Anatomically, where is the direct pathway in relation to the indirect?

A

The indirect pathway surrounds the direct

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56
Q

Which neurotransmitter is released from the globus pallidus? (e and i?)

A

GABA

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57
Q

Which neurotransmitter is released from the STN?

A

Glutamate

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58
Q

Which neurotransmitter is released from the striatum?

A

GABA (Remember MSN)

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59
Q

Draw out the direct and indirect pathways !!

A

Draw out the direct and indirect pathways !!

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60
Q

What is the lentiform nucleus?

A

Putamen + globus pallidus

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61
Q

Arterial supply to the basal ganglia?

A

Lenticulostriate arteries

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62
Q

Lenticulostriate arteries originate from where?

A

Middle cerebral artery

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63
Q

When looking down on sliced brain, the head of the caudate nucleus can be seen through which structure?

A

Can be seen through the lateral ventricle

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64
Q

Triangular shaped ventricle of the brain is which ventricle?

A

Third ventricle

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65
Q

Grey matter of the cerebellum is called?

A

Folia

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66
Q

Running through the centre of the cerebellum is the?

A

Vermis

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67
Q

Direction that the vermis runs is?

A

Medio-lateral

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68
Q

Three lobes of the cerebellum are?

A

Anterior lobe
Posterior lobe
Floculonodular lobe

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69
Q

The lobes of the cerebellum are located on what aspects of the cerebellum?

A

Anterior and posterior lobes are located on the posterior lobe view of the cerebellum

Floculonodular lobe is located on the anterior view of the cerebellum

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70
Q

What separates the anterior and posterior lobes from each other?

A

Primary fissure

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71
Q

What is located on the inferior view of the cerebellum?

A

Cerebellar tonsils

And also the vermis - curves around

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72
Q

Relation of the flocculonodular lobe to the ventricles of the brain?

A

Forms the roof of the fourth ventricle

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73
Q

Blood supply to the cerebellum via which arteries? x3

A

Posterior inferior cerebellar artery - PICA
Superior cerebellar artery

Also branches of basillar artery

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74
Q

Most common site for clinical infarct in an artery leading to the cerebellum is?

A

Hairpin bend of PICA

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75
Q

Function of superior cerebellar peduncle?

A

Output from the cerebellum

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76
Q

Function of middle cerebellar peduncle? - specific

A

Contralateral input to the cerebellum from cerebral cortex and cranial nerves

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77
Q

Function of inferior cerebellar peduncle?

A

Input to cerebellum from spinal cord

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78
Q

Input to cerebellum at the inferior cerebellar peduncle is via which tracts? x2

A

Dorsal and ventral spinocerebellar tracts

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79
Q

Which cerebellar peduncle is the largest?

A

Middle

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80
Q

Two components of the spinocerebellar tract are?

A

Dorsal

Ventral

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81
Q

Spinocerebellar tracts are ipsilateral or contralateral?

A

Dorsal - ipsilateral

Ventral - contralateral and then recrosses

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82
Q

Dorsal spinocerebellar tract carries what information?

A

Proprioception

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83
Q

Ventral spinocerebellar tract carries what information?

A

Information about state of reflexes and interneurones in the spinal cord

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84
Q

Cerebellar signs present on what side of the body compared to the lesion?

A

Cerebellar signs are always on the same side as the lesion

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85
Q

Deep cerebellar nuclei are?

A

F - fastigial
G - globose
D - dentate
E - emboliform

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86
Q

Anterior lobe of cerebellum is associated with which nucleus?

A

Fastigial and interposed (globose and emboliform)

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87
Q

Posterior lobe of cerebellum connects to which nucleus?

A

Dentate

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88
Q

Posterior lobes of the cerebellum may also be referred to as?

A

Cerebellar hemispheres

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89
Q

Flocculo-nodular lobes of the cerebellum is associated with which nucleus?

A

Pontine vestibular nucleus

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90
Q

Vermis of the cerebellum is associated with which nucleus?

A

Fastigial

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91
Q

What is meant by the interposed nucleus?

A

Globose and emboliform

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92
Q

Three functional zones of the cerebellum are?

A

Vestibulocerebellum
Spinocerebellum
Cerebrocerebellum

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93
Q

Vestibulocerebellum is composed of?

A

Floculonodular lobe

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94
Q

Spinocerebellum is composed of?

A

Anterior lobe and vermis

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95
Q

Cerebrocerebellum is composed of?

A

Posterior lobe (cerebellar hemispheres)

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96
Q

Function of vestibulocerebellum? x3

A

Head and eye movement coordination to ensure stability of gaze
Balance of head - medial tract
Balance of body - lateral tract

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97
Q

Input to the vestibulocerebellum for it’s function is via the? x2

A

Extra occular eye muscles

Muscles of the neck

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98
Q

Output from the vestibulocerebellum is via the? x2

A

Medial longitudinal fasciculus

Medial vestibulospinal tract

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99
Q

Function of the spinocerebellum?

A

Control of locomotion and limb coordination

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100
Q

Output from the spinocerebellum? x2

A

Lateral vestibulospinal tract

Reticulospinal tract

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101
Q

Function of the cerebrocerebellum?

A

Coordination of movement initiated by the motor cortex e.g. speech, limbs, hand-eye coordnation

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102
Q

Cerebrocerebellum also known as?

A

Neocerebellum

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103
Q

Three major disorders caused by cerebellar damage are?

A

Floculonodular syndrome
Anterior lobe syndrome
Neocerebellar syndrome

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104
Q

Symptoms and signs of floculonodular syndrome? x7

A 
Poor balance
Disordered eye movements 
Nystagmus, ocular dysmetria
Poor visual pursuit (tracking)
Truncal ataxia - fall to one side of lesion
Ataxic gait
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105
Q

Those with floculonodular syndrome perform badly on what test?

A

Romberg test

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106
Q

Most common cause of floculonodular syndrome is? this most often occurs in whom?

A

Medulloblastoma in the fourth ventricle - in young children

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107
Q

Five symptoms of anterior lobe syndrome?

A 
Incoordination of the limbs
Ataxia 
Hypotonia
Dysdiadochokinesis
Depressed/pendular reflexes
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108
Q

Common cause of anterior lobe syndrome?

A

Alcoholism - malnutrition and lack of B vitamins

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109
Q

Five symptoms of neocerebellar syndrome?

A 
Loss of hand-eye coordination
Dysmetria
Dysdiadochokinesis
Intention tremor
Slurred speech
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110
Q

Common cause of neocerebellar syndrome?

A

PICA infarct

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111
Q

Five symptoms of cerebellar stroke?

A

Headache, vertigo, nausea, vomiting
Eye changes
Dysarthria

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112
Q

Five symptoms of cerebellar stroke?

A 
Headache, vertigo, nausea, vomiting
Eye changes
Dysarthria and dysphagia
Ataxia
Arm weakness (one side) and incoordination
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113
Q

Cerebellar stroke will affect what art of the cerebellum?

A

Whole cerbellar cortex on one side - global signs

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114
Q

What is dysarthria?

A

Motor disorder of speech - weakened muscles of the face, mouth and respiratory system

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115
Q

What is ataxia?

A

Loss of balance and coordination whilst walking

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116
Q

What type of intoxication mimics features of cerebellar damage?

A

Alcohol intoxication

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117
Q

Why does alcohol intoxication mimic features of cerebellar damage?

A

Cerebellum has many GABA-ergic interneurones

These are especially sensitive to the effects of alcohol

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118
Q

What does an EEG record?

A

Changes in voltage as a result of ionic current flowing within neurones in the cerebral cortex of brain

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119
Q

EEG waves are affected by what?

A

State of arousal

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120
Q

EEG wave amplitude can vary to what degree?

A

10-150

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121
Q

Where are the three EEG leads placed?

A

Occipital lobe
Frontal lobe

Third is a ground electrode

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122
Q

Four types of EEG waves are?

A

Alpha
Beta
Theta
Delta

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123
Q

Alpha waves in EEG are present when?

A

In most awake adults

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124
Q

Beta waves in EEG are present when?

A

When subject is awake and alert - mental task

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125
Q

When eyes are open - alpha or beta EEG waves predominate?

A

Beta waves have an increased amplitude

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126
Q

When eyes are closed - alpha or beta EEG waves predominate?

A

Alpha waves have an increased amplitude

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127
Q

Function of anterior and posterior lobes of the cerebellum?

A

Movement of the limbs (anterior)

Movement of the trunk (posterior)

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128
Q

Function of the floculonodular lobe of the cerebellum?

A

Posture and balance

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129
Q

Cerebellum accounts for what percentage of total brain mass?

A

11%

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130
Q

Two non-motor functions of the cerebellum are?

A

Word association

Puzzle solving

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131
Q

What is the arbour vitae of the cerebellum?

A

Distinctive white matter pattern at the centre of the cerebellum

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132
Q

Sensory information to the cerebellum is from which tract?

A

Spinocerebellar

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133
Q

Motor information to the cerebellum is from which tract?

A

Corticocerebellar

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134
Q

Six symptoms associated with cerebellar injury and way to remember this?

A 
DANISH
Dysdiachokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
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135
Q

What is the limbic system?

A

Group of cortical and subcortical nuclei

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136
Q

Where is the limbic system located?

A

Medial aspect of frontal, parietal and temporal lobes

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137
Q

Function of the limbic system is? x2

A

Rewarding and punishment in pleasure/pain

Learning and memory

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138
Q

The type of learning/memory involved with the limbic system is?

A

Motivational/emotional

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139
Q

Three cortical regions of the limbic system are?

A

Orbito-frontal cortex
Cingulate cortex
Parahippocampal cortex

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140
Q

Location of orbitofrontal cortex?

A

Frontal lobe - medial

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141
Q

Location of cingulate cortex?

A

Parietal lobe - medial

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142
Q

Location of parahippocampal cortex?

A

Temporal lobe - medial

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143
Q

Two components of the cingulate cortex are?

A

Anterior cingulate

Posterior cingulate

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144
Q

Most anterior part of the limbic system is?

A

Orbito-frontal cortex

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145
Q

Most posterior part of the limbic system is?

A

Posterior cingulate cortex

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146
Q

Most inferior part of the limbic system is?

A

Parahippocampal cortex

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147
Q

Blood supply to the limbic system via which arteries? x2

A

Anterior cerebral artery

Posterior cerebral artery

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148
Q

The middle cerberal artery MAY supply what parts of the limbic system? x2

A

Top of the temporal lobe and orbital cortex

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149
Q

Anterior cingulate cortex activated in which two scenarios?

A

Experience of pain

Depression

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150
Q

Two parts of the anterior cingulate cortex are?

A

Rostral

Caudal

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151
Q

Function of rostral anterior cingulate cortex?

A

Registers quality of pain - how bad from 1-10

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152
Q

Function of posterior cingulate cortex?

A

What actions to take to deal with the pain

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153
Q

What is a cingulotomy?

A

Procedure of cutting into the cingulate gyrus

154
Q

Why is a cingulotomy performed?

A

To reduce the emotional distress of pain

155
Q

Function of orbito-frontal cortex?

A

How to avoid pain - how to behave to an anticipated threat

156
Q

Excessive activity in the orbito-frontal cortex has been linked to which condition?

A

OCD

157
Q

Function of posterior cingulate cortex?

A

Visuo-spatial memory

158
Q

Loss of function in visuo-spatial memory is associated with which condition?

A

Alzheimer’s

159
Q

Function of parahippocampal gyrus?

A

Learning and memory

160
Q

Four subcortical regions of the limbic system are?

A

Hippocampus
Amygdala

Accumbens nucleus
Septal nuclei

161
Q

Hippoxcampus and amygdala are closely associated to which structure?

A

Inferior horn of the lateral ventricle

162
Q

Septum pallucidum is?

A

Connection between the two fornices on either side

163
Q

End point of the fornix is at the? x2

A

Mammillary body of the hypothalamus

Septal nuclei

164
Q

Pathway of information transmission in the limbic system is?

A

Cingulate cortex - parahippocampal gyrus - hippocampus - fornix - mammillary bodies of hypothalamus - anterior thalamus - cingulate cortex

165
Q

Pathway of information transmission in the limbic system is known as?

A

Papez’s circuit

166
Q

What is retrograde amnesia?

A

Cannot access memories prior to the trauma

167
Q

What is anterograde amnesia?

A

Cannot make new memories - failure to transfer new memories into long term memory

168
Q

Cause of retrograde amnesia?

A

Damage to the cingulate gyrus

169
Q

Cause of anterograde amnesia?

A

Damage to the hippocampus/loss of hippocampal function

170
Q

Memory formation occurs where?

A

a

171
Q

Memory storage occurs where?

A

a

172
Q

Memory relay occurs where?

A

a

173
Q

What is Korsakoff’s syndrome?

A

Encephalopathy - brain damage

174
Q

Cause of Korsakoff’s syndrome?

A

B1 deficiency often in chronic alcoholics

175
Q

B1 also known as?

A

Thiamine

176
Q

Four symptoms of Korsakoff’s syndrome are?

A

Anterograde amnesia
Some degree of retrograde amnesia
Confabulation
Apathy

177
Q

Two areas that are damaged in Korsakoff’s syndrome are?

A

Mammillary bodies

Projection of mammillary bodies to the anterior thalamus

178
Q

What will a patient typically experience during temporal lobe epilepsy?

A

Remain conscious but experience powerful emotions e.g. intense joy/fear

179
Q

Kluver-Bucy syndrome is due to damage to?

A

The amygdala

180
Q

Five symptoms of Kluver-Bucy syndrome?

A 
Psychic blindness
Oral tendencies
Hypermetamorphosiss
Altered sexual behaviour
Emotional changes
181
Q

Main symptom/sign of Kluver-Bucy syndrome?

A

Loss of all sense of fear

182
Q

Electrical stimulation of the amygdala in humans results in what?

A

Fear or anxiety

183
Q

Amygdala is embedded in whcih cortex?

A

Entorhinal

184
Q

Relation of amygdala to the sympathetic nervous system?

A

Amygdala - fear - can activate sympathetic nervous system fight or flight response

185
Q

Effect of amygdala damage on emotion recognition?

A

Cannot recognise fearful expressions or different degrees of emotions

186
Q

Where do the septal nuclei lie?

A

Basal of the septum pallucidum

187
Q

Septal nuclei merge into which nucleus?

A

Basal nucles/nucleus of Meynert

188
Q

Ventral striatum is composed of?

A

Septal nucleus
Accumbens nucleus
Nucleus of Meynert/basal nucleus

189
Q

Nucleis accumbens is part of which dopaminergic pathway?

A

Mesolimbic dopamine pathway

190
Q

Function of the ventral striatum?

A

Initiation and termination of behaviours/motor actions that trigger reward pathways

191
Q

Blockage of dopamine receptors in the accumbens may be useful in the treatment of what?

A

Addictive behaviours

192
Q

How can you differentiate between alpha and beta waves on an EEG?

A

Beta waves have a much greater frequency

193
Q

When are alpha waves active?

A

Awake and resting individual

194
Q

When are beta waves active?

A

Awake with mental activity

195
Q

When are theta waves active?

A

Sleeping

196
Q

When are delta waves active?

A

Deep sleep

197
Q

Relation of the thalamus to the putamen on lateral aspect?

A

Thalamus is deeper to the putamen

198
Q

Relation of thalamus to the third ventricle?

A

Thalamus is lateral to the third ventricle on either side

199
Q

Percentage of blood supply to the bran is from which arteries?

A

80% - internal carotid arteries

20% - vertebral arteries

200
Q

What is the blood supply to the anterior part of the brain?

A

Internal carotids

201
Q

What is the blood supply to the posterior part of the brain?

A

Vertebral arteries

202
Q

Vertebral arteries originate from where?

A

Subclavian arteries

203
Q

Vertebral arteries enter the skull through which foramen?

A

Foramen magnum

204
Q

Terminal branches of the internal carotid arteries/anterior circulation is? x2

A

Anterior cerebral

Middle cerebral

205
Q

Terminal branches of the vertebral arteries/posterior circulation is? x1

A

Posterior cerebral artery

206
Q

The classic circle of Willis is seen in what percentage of people?

A

34.5%

207
Q

What is the biggest branch of the internal carotid artery?

A

MCA

208
Q

Branches of the MCA that supply the basal ganglia are?

A

Lenticulostriate arteries

209
Q

MCA supplies which region of the cortex?

A

Lateral portion of the brain (majority)

210
Q

ACA supplies which region of the cortex?

A

Middle and anterior medial portion of the brain

211
Q

PCA supplies which region of the cortex?

A

Posterior medial portion of the brain

212
Q

MCA/ACA/PCA - supply to the caudate nucleus?

A

Anterior cerebral artery

213
Q

MCA/ACA/PCA - supply to the putamen?

A

Middle cerebral artery

214
Q

MCA/ACA/PCA - supply to the thalamus?

A

Posterior cerebral artery

215
Q

MCA/ACA/PCA - supply to the globus pallidus?

A

Middle cerebral artery

216
Q

MCA/ACA/PCA - supply to the internal capsule?

A

Posterior internal capsule - posterior cerebral artery

217
Q

MCA/ACA/PCA - supply to the midbrain?

A

PCA

218
Q

Blood supply to the pons?

A

Pontine arteries from the basillar artery

219
Q

Blood supply to the medulla?

A

PICA

220
Q

Cerebral veins/arteries - which ones pierce through the dura mater?

A

Veins

221
Q

MCA/ACA/PCA - supply to the thalamus?

A

Posterior cerebral artery

222
Q

Function of arachnoid granulations is? x2

A

Allow CSF to flow into the venous blood of sinuses

Prevents back flow of blood into the subarachnoid space

223
Q

Majority of the cerebral blood flow will drain to which sinus?

A

Superior sagittal

224
Q

Straight sinus is between which cerebral veins?

A

Inferior sagittal and confluence

225
Q

All (most) dural sinuses eventually drain into which vein?

A

Internal jugular vein - 80%

226
Q

Where will the remaining 20% of dural venous blood drain to?

A

Facial vein to the external jugular vein

227
Q

Infarct of the temporal lobe can lead to damage to which two regions?

A

Broca’s area

Wernicke’s area

228
Q

Presentation of MCA stroke?

A

Neglect syndrome - one side

Global aphasia

229
Q

Define global aphasia?

A

Cannot produce words and have trouble understanding words

230
Q

Why do MCA stroke patients have global aphasia?

A

Damage to both Broca’s and wernicke’s areas

231
Q

Four symptoms of ACA stroke?

A

Contralateral sensorimotor loss below the waist
Urinary incontinence
Personality defects
Split-brain syndrome (damage to corpus callosum)

232
Q

Three symptoms of PCA stroke?

A 
Contralateral homonymous hemianopsia
Reading and writing deficits
Impaired memory (temporal lobe)
233
Q

TIA resolves within what length of time?

A

24 hours

234
Q

TIA is a warning sign of what?

A

Stroke or heart attack

235
Q

Three types of extra-axial bleeds i.e. outside of the brain?

A

Epidural/extradural haematoma
Subdural haematoma
Subarachnoid haematoma

236
Q

Epidural bleed looks like?

A

Concave lense

237
Q

Epidural bleed arterial/venous?

A

Arterial

238
Q

Epidural bleed fast or slow?

A

Fast

239
Q

Epidural bleed between which two structures?

A

Dura and skull

240
Q

Epidural bleed presentation?

A

Brief lucid period following trauma and then unconsciousness

241
Q

Epidural bleed can cause compression of which CN?

A

CNIII - occulomotor

242
Q

Epidural bleed may cause a loss of vision in which visual field?

A

Visual field opposite to lesion

243
Q

Subdural bleed looks like?

A

Crescent shape

244
Q

Cause of subdural bleed?

A

High speed acceleration and deceleration

245
Q

Subdural bleed fast/slow?

A

SLOW - does not present for about two weeks

246
Q

Subdural bleed arterial/venous?

A

Venous

247
Q

Differnetiate between subdural and epidural bleeds other than shape of bleed?

A

Subdural can cross the suture lines

248
Q

Subdural bleed between which two structures?

A

Dura mater and arachnoid mater

249
Q

Subarachnoid haematoma presentation?

A

Severe headache
Vomiting
Confusion
Lowered level of consciousness

250
Q

Common cause of subarachnoid haematoma?

A

Burst aneurysm

251
Q

Subarachnoid haematoma fast or slow?

A

Fast

252
Q

Three types of cerebral aneurysms are?

A

Saccular
Fusiform
Berry

253
Q

What is Wallenberg syndrome?

A

Ischaemic stroke to PCIA

254
Q

What is Wallenberg syndrome also known as?

A

Lateral medullary syndrome

255
Q

Presentation of Wallenberg syndrome?

A

SUDDEN ONSET
Horner syndrome
Vertigo, nystagmus, nausea and vomiting

256
Q

Patient has a stroke and presents with ipsilateral Horner’s syndrome - which artery is most likely to have been affected?

A

PICA

257
Q

Five layers of the scalp and way to remember these?

A 
SCALP
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Pericranium
258
Q

What is a brain contusion?

A

Superficial bruising

259
Q

Brain contusions are associated with which type of extra-axial bleed?

A

Subdural

260
Q

Expressive aphasia is Broca’s or Wernicke’s aphasia?

A

Broca’s

261
Q

Receptive aphasia is

A

Wernicke’s

262
Q

Imaging of the brain - what will be used?

A

MRI

263
Q

Comminutive types of fractures to the skull?

A

Depressed
Compound
Closed

Comminutive

264
Q

What is diffuse axonal injury?

A

Term given to widespread damage to axons caused by acceleration of the head

265
Q

PICA comes off of which artery?

A

Vertebral artery

266
Q

Cranial nerves that innervate the brainstem are? x2

A

CNXI

CNXII

267
Q

Central sulcus of the brain separates which two lobes?

A

Frontal

Parietal

268
Q

Somatosensory region of the brain is located in which lobe?

A

Parietal

269
Q

Motor movement region in the brain is located in which lobe?

A

Frontal

270
Q

Hearing and memory region is located in which lobe of the brain?

A

Temporal

271
Q

Vision region is located in which lobe of the brain?

A

Occipital

272
Q

Lateral/sylvian fissure separates which two lobes of the brain?

A

Frontal and tempiral

273
Q

Primary cortex area just anterior to the central sulcus is?

A

Primary motor cortex

274
Q

Primary cortex area just posterior to the central sulcus is?

A

Primary sensory cortex

275
Q

Which of the primary cortex areas are mostly medial rather than lateral?

A

Primary visual cortex

276
Q

Function of Broca’s area?

A

Language expression

277
Q

Function of Wernicke’s area?

A

Language comprehension

278
Q

Function of DCML?

A

Discriminative touch

279
Q

Function of corticospinal tract?

A

Motor

280
Q

Function of spinocerebellar tract?

A

Proprioception

281
Q

Function of spinothalamic tract?

A

Pain and temperature

282
Q

DCML crosses over where?

A

Medulla

283
Q

Corticosinal tract crosses over where?

A

Spinomedullar junction

284
Q

Spinocerebellar tract crosses over where?

A

No functional crossover

285
Q

Spinothalamic tract crosses over where?

A

Sinal cord

286
Q

Major inhibitory neurotransmitter in the brain is?

A

GABA

287
Q

Major excitatory neurotransmitter in the brain is?

A

Glutamate

288
Q

Primary motor cortex is located where?

A

Immediately anterior to the central sulcus

289
Q

Lesion to primary motor cortex presents how?

A

Paralysis/paresis of specific muscle group

290
Q

Primary motor cortex is area number?

A

4

291
Q

What is remapping/neuronal plasticity?

A

Motor homonculus/map adjusts slightly to compensate for damage to another region

292
Q

Stroke of MCA affects what region of the brain?

A

Almost all of one side of the frontal lobe

293
Q

One region MCA stroke does not affect in the body?

A

Does not affect lower limb (different blood supply)

294
Q

Blood supply to the lower limb is?

A

Anterior cerebral artery

295
Q

Blood supply to basal ganglia is?

A

Lenticulostriate arteries from MCA

296
Q

What is apraxia?

A

Difficulty performing complex motor tasks e.g. tying shoelaces

297
Q

Apraxia occurs as damage to what two regions?

A 
Premotor cortex (6)
Supplemntary motor cortex (8)
298
Q

Stroke to only one side of the brain may not present that greatly - why?

A

Contralateral area may be able to compensate

299
Q

Broca’s area regulates what muscles?

A

Muscles controlling speech - programming of words

300
Q

Damage to Broca’s area results in?

A

Motor aphasia

301
Q

What is motor aphasia?

A

Patient cannot verbalise complex sentences - tend to stick to one word sentences

302
Q

Damage to frontal eye fields results in?

A

Oculomotor apraxia

303
Q

What is oculomotor apraxia?

A

Difficulty moving eyes horizontally and in following an object

304
Q

Presentation of oculomotor apraxia?

A

Patients will turn their head more to compensate for lack of eye movement

305
Q

Common cause of oculomotor apraxia?

A

Bilateral lesions of frontal eye fields

306
Q

Where is the somatosensory cortex?

A

Immediately posterior to the central sulcus

307
Q

Function of somatosensory cortex? x2

A

Modulation of sensory input

Modulation of reflex e.g. suppression of nociceptive reflexes

308
Q

Prefrontal cortex is located where?

A

Most anterior region of the cortex

309
Q

Function of prefrontal cortex? x2

A

Planning (of movement)

Executive functions - problem solving, judgment

310
Q

Symptoms of prefrontal cortex lesions? x3

A

Apathy
Personality changes
Lack of ability to plan/sequence actions or tasks

311
Q

Location of orbitofrontal cortex?

A

Anterior and inferior

Inferior to the prefrontal cortex

312
Q

Function of orbitofrontal cortex?

A

Involved with the limbic system

313
Q

Two regions that project into the motor thalamus are?

A

Basal ganglia

Cerebellum

314
Q

Motor thalamus projects to where?

A

Motor cortex

315
Q

Motor thalamus is also known as?

A

VL thalamic nucleus

316
Q

Why is corticobulbospinal tract susceptible to stroke?

A

Travels through the internal capsule - particularly prone

317
Q

Red nucleus is located where?

A

Midbrain of brainstem

318
Q

Corticobulbospinal tract is composed of which two tracts?

A

Corticobulbar tract

Corticospinal tract

319
Q

Three terminations of the corticobulbar tract?

A

Pontine nuclei
Reticular formation
Red nucleus

320
Q

Motor decussations occur where in the spinal cord?

A

In the upper spinal cord

321
Q

Injury to the brain above the spinal cord - where is motor deficit?

A

Contralateral side

322
Q

Injury to the spinal cord - where is motor deficit?

A

Same side

323
Q

Damage to the corticospinal tract in teh spinal cord results in what?

A

Loss of control of hands and fingers

324
Q

Red nucleus gives rise to which tract?

A

Rubrospinal tract

325
Q

Rubrospinal tract descends to where?

A

Motor thalamus

326
Q

Function of interneurones?

A

Modulate strength and activity of reflex pathways

327
Q

Only upper motor neurones that act directly on lower motor neurones are? x4

A

Driving muscles of thumb, fingers, lips and tongue

328
Q

Function of tectospinal tract/optic tectum?

A

Coordination of voluntary head and eye movements

329
Q

Function of the medial vestibulospinal tract?

A

Mediates involuntary (reflex) coordination of the head and the neck

330
Q

What is spasticity?

A

Abnormally increased muscle tone

Increased tendon reflexes

331
Q

Spasticity is a result of UMN or LMN lesion?

A

UMN lesion

332
Q

What is clonus?

A

Series of jerky contractions of the muscle following sudden stretching

333
Q

What is hyperreflexia?

A

Abnormally brisk tendon reflexes

334
Q

Position of the arms in decorticate posturing?

A

Flexed

335
Q

Decorticate posturing occurs due to damage to what?

A

Corticospinal tract in the midbrain

336
Q

Position of arms in decerebrate posturing?

A

Arms extended

337
Q

Decerebrate posturing occurs due to damage to what?

A

Injury to brain at the level of the brainstem - corticospina/ruprospinal tracts

338
Q

Decereberate/decorticate posturing - which is more dangerous?

A

Decerebrate

339
Q

Clasp-knife reflex indicates what lesion?

A

Chronic cerebral motor lesion

340
Q

Babinski indicates what damage?

A

Corticospinal damage

341
Q

Presentation of damage to the spinal cord is known as?

A

Spinal shock

342
Q

Damage to corticospinal tract presents as? x2

A

Paralysis/weakness of voluntary movement

Hyperactive tendon reflexes

343
Q

Damage to reticulospinal tract presents as? x3

A

Loss of bladder/bowel control
Loss of temperature regulation
Loss of blood pressure regulation

344
Q

Damage to vestibulospinal tract presents as? x1

A

Loss of ability to stand upright/balance properly

345
Q

UMN lesion - increased or decreased muscle tone?

A

Increased

346
Q

LMN lesion - increased or decreased muscle tone?

A

Decreased

347
Q

Five motor symptoms of PD?

A 
Rigidity
Resting tremor
Bradykinesia
Gait freezing
Problems wth balance
348
Q

One of the earliest non-motor symptom of PD is?

A

Loss of sense of smell

349
Q

Late non-motor symptom of idiopathic PD is?

A

Dementia

350
Q

Three targets of DBS in PD?

A

Subthalamic nucleus
Thalamus/zona incerta
Globus pallidus interna

351
Q

Three phases of DBS?

A

Electrode insertion
Pulse generator insertion
DBS adjustment

352
Q

What scan of the brain should be undertaken prior to DBS?

A

MRI

353
Q

What type of anaesthesia should be administered prior to DBS?

A

General anaesthesia

354
Q

What is dystonia?

A

Movement disorder causing muscle spasms and contractions

355
Q

Site of DBS for dystonia?

A

Globus pallidus interna

356
Q

Site of DBS for pain?

A

Sensory thalamic nuclecus

PAG

357
Q

Site of DBS for epilepsy?

A

Anterior thalamic nucleus

358
Q

Site of DBS for deperession?

A

Subgenual cingulate gyrus

359
Q

DBS funded for use in only what in teh UK?

A

Only funded for use in movement disorders in the UK

360
Q

Site of DBS in tremor? x3

A

Thalamic nucleus
Zona incerta
Subthalamic area

361
Q

Which region of the basal ganglia can DBS be carried out for treatment of PD?

A

Globus pallidus interna

362
Q

What is meant by consciousness?

A

State of full awareness of the self and one’s relationship to the environment

363
Q

What is meant by vegetative state?

A

Full arousal but no awareness - look like they are awake but not aware

364
Q

What is meant by minimal consciousness state?

A

Full arousal and some degree of awareness

365
Q

Stages of vegetative state? x4

A

Coma
Vegetative state
Persistent vegetative state
Permanent vegetative stage

366
Q

Timeline for vegetative stage stages?

A

Coma - 2/3 weeks
Vegetative stage - 4 weeks
Persistent vegetative stage - 6 months
Permanent vegetative state

367
Q

Define permanent vegetative state

A

Longer than twelve months following trauma and longer than six months following anoxia

368
Q

Anatomical changes causing vegetative stage? x3

A

Widespread subcortical white matter cell death
Damage to the thalamus
Disconnection from fronto-parietal cortex

369
Q

What is akinetic mutism?

A

People lack motivation to respond to anything - can visually track and can talk or move normally if htey have to but tend not do

370
Q

Cause of akinetic mutism?

A

Injury to white matter cingulate gyrus - frontal lobe

371
Q

What is meant by a coma?

A

Temporary state of unconsciousness

372
Q

Three diagnostic criteria for vegetative state?

A

Cycles of eye opening adn closing
Complete lack of self or environment
Complete or partial preservation of hypothalamic adn brainstem autonomic functions

373
Q

Two forms of imaging used for vegetative state?

A

Electrophysiology

MRI

374
Q

Two forms of electrophysiology used for vegetative state?

A

EEG - electrical activity of the brain

ERP - even related potentials - listen to headphones and look for response

375
Q

Three factors affecting recovery from vegetative state

A

Time spent in vegetative state
Age
Type of brain injury e.g. hypoxic has poor prognosis

376
Q

Two medications used for treatment of vegetative state?

A

Amantadine

Zolpidem

377
Q

DBS location for vegetative state?

A

Central thalamus

378
Q

Dysdiachokinesis presents in what type of brain damage? x2

A

Damage to the anterior lobe and also to the posterior lobe of the cerebellum

379
Q

Define dysmetria

A

Overshooting movements

380
Q

Define dysarthria

A

Poor articulation of speech

Year 2 BB (36 decks)

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