Overview Flashcards
1
Q
Which CN is typically very thin?`
A
CNIV - trochlear
2
Q
Two components of the DCML?
A
Gracile
Cuneate
3
Q
What type of information is conveyed in the DCML?
A
Sensory - fine touch, vibration, two point discrimination, proprioception
4
Q
Gracile conveys information from where?
A
Lower limb
5
Q
Cuneate conveys information from where?
A
Upper limb
6
Q
CNI - name and function
A
Olfactory nerve
Scent
7
Q
CNII - name and function
A
Optic nerve
Sight
8
Q
CNIII - name and function
A
Oculomotor nerve
Movement of eye muscles
9
Q
CNIV - name and function
A
Trochlear nerve
Movement of Superior oblique eye muscle
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
11
Q
CNVI - name and function
A
Abducens
Movement of the lateral rectus eye muscle
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
13
Q
CNVIII - name and function
A
Vestibulocochlear
Cochlear nerve - hearing
Vestibular nerve - balance
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
15
Q
CNX - name and function
A
Vagus nerve
Mainly parasympathetic actions
16
Q
CNXI - name and function
A
Spinal accessory nerve
Innervation of the SCM and the trapezius muscles
17
Q
CNXII - name and function
A
Hypoglossal nerve
Motor innervation of the tongue
18
Q
The four muscles of mastication are?
A
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
19
Q
Five terminal branches of the facial nerve are?
A
Temporal Zygomatic Buccal Mandibular Cervical
20
Q
Forehead wrinkling is absent in what type of damage?
A
LMN lesion
21
Q
Forehead wrinkling is spared in what type of damage and why?
A
UMN lesion - dual innervation of the forehead
22
Q
Three main nuclei of the basal ganglia are?
A
Caudate
Putamen
Globus pallidus
23
Q
Lateral ventricle to the third ventricle is via?
A
Interventricular foramen
24
Q
Third ventricle to the fourth ventricle is via?
A
Cerebral aqueduct
25
Corpus striatum consists of?
Caudate and putamen and globus pallidus
26
Accumbens located where?
Inferior to the caudate and anterior to the putamen
27
Two parts of globus pallidus are located where in relation to each other?
Globus pallidus interna - more inferiorly located
| Globus pallidus externa - more superiorly located
28
Nucleus accumbens also known as?
Ventral striatum
29
Dorsal striatum consists of?
Caudate and putamen
30
Four functions of the basal ganglia
Regulate intensity of slow or stereotyped movements
Inhibit antagonist or unnecessary movement
Regulate attention and cognition
Motor program switch
31
Main neurone involved in the basal ganglia is?
Medium spiny neurone
32
Input to the MSN is?
Glutaminergic from the cortex
33
Output from the MSN is?
GABAergic
34
Two groups of GABAergic neurones in the basal ganglia express which receptors?
D1
| D2
35
Dorsal striatum consists of?
Nucleus accumbens
36
Three actions of the D1 receptor
Increase cAMP
Increase sensitivity of striatal cells to glutamate
Project to the GPi directly via the direct pathway
37
D1/D2 - which is involved in the indirect/direct pathway?
Direct pathway - D1
Indirect pathway - D2
38
What is the action of dopamine at the D1 receptor?
Dopamine increases the action of the direct pathway - D1
39
What is the action of dopamine at the D2 receptor?
Dopamine decreases the action of the indirect pathway - D2
40
Function of the direct pathway is?
Activates motor program switch
41
Function of the indirect pathway is?
Blocks motor program switch
42
Overall action of dopamine at the basal ganglia
Dopamine increases action of direct pathway and decreases action of indirect pathway SO allows motor program change
43
Relation of dopamine to Parkinson's?
PD - have reduced number of dopamine receptors and the person cannot facilitate movements
44
Death of cells where for PD?
Dopamine cells in the substantia nigra - input to the GPi and GPe
45
Level of cell death before PD presents is?
80% of SN dopamine cells dead before clinical signs of PD are seen
46
How can you recognise the substantia nigra?
Black region of the brain
| Nigra - black
47
Four cardinal motor signs of PD are?
Tremor at rest
Rigidity
Bradykinesia
Loss of postural reflexes
48
First line treatment for PD is? x3
Levodopa
Dopamine agonist
MAO-B inhibitors
49
Second line treatment for PD? x2
In addition to first line:
COMT inhibitors
Amandadine/apomorphine
50
Last line treatment for PD?
Deep brain stimulation
51
Three sites for DBS in PD?
Subthalamic nucleus
Zona incerta
Globus pallidus interna
52
What is Huntington's disease?
Extra, unwanted movements
53
Cause of Huntington's disease is?
Loss of GABA-ergic neurones in the striatum
54
Inheritance of Huntington's disease is?
Autosomal dominant
55
Anatomically, where is the direct pathway in relation to the indirect?
The indirect pathway surrounds the direct
56
Which neurotransmitter is released from the globus pallidus? (e and i?)
GABA
57
Which neurotransmitter is released from the STN?
Glutamate
58
Which neurotransmitter is released from the striatum?
GABA (Remember MSN)
59
Draw out the direct and indirect pathways !!
Draw out the direct and indirect pathways !!
60
What is the lentiform nucleus?
Putamen + globus pallidus
61
Arterial supply to the basal ganglia?
Lenticulostriate arteries
62
Lenticulostriate arteries originate from where?
Middle cerebral artery
63
When looking down on sliced brain, the head of the caudate nucleus can be seen through which structure?
Can be seen through the lateral ventricle
64
Triangular shaped ventricle of the brain is which ventricle?
Third ventricle
65
Grey matter of the cerebellum is called?
Folia
66
Running through the centre of the cerebellum is the?
Vermis
67
Direction that the vermis runs is?
Medio-lateral
68
Three lobes of the cerebellum are?
Anterior lobe
Posterior lobe
Floculonodular lobe
69
The lobes of the cerebellum are located on what aspects of the cerebellum?
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
70
What separates the anterior and posterior lobes from each other?
Primary fissure
71
What is located on the inferior view of the cerebellum?
Cerebellar tonsils
And also the vermis - curves around
72
Relation of the flocculonodular lobe to the ventricles of the brain?
Forms the roof of the fourth ventricle
73
Blood supply to the cerebellum via which arteries? x3
Posterior inferior cerebellar artery - PICA
Superior cerebellar artery
Also branches of basillar artery
74
Most common site for clinical infarct in an artery leading to the cerebellum is?
Hairpin bend of PICA
75
Function of superior cerebellar peduncle?
Output from the cerebellum
76
Function of middle cerebellar peduncle? - specific
Contralateral input to the cerebellum from cerebral cortex and cranial nerves
77
Function of inferior cerebellar peduncle?
Input to cerebellum from spinal cord
78
Input to cerebellum at the inferior cerebellar peduncle is via which tracts? x2
Dorsal and ventral spinocerebellar tracts
79
Which cerebellar peduncle is the largest?
Middle
80
Two components of the spinocerebellar tract are?
Dorsal
| Ventral
81
Spinocerebellar tracts are ipsilateral or contralateral?
Dorsal - ipsilateral
| Ventral - contralateral and then recrosses
82
Dorsal spinocerebellar tract carries what information?
Proprioception
83
Ventral spinocerebellar tract carries what information?
Information about state of reflexes and interneurones in the spinal cord
84
Cerebellar signs present on what side of the body compared to the lesion?
Cerebellar signs are always on the same side as the lesion
85
Deep cerebellar nuclei are?
F - fastigial
G - globose
D - dentate
E - emboliform
86
Anterior lobe of cerebellum is associated with which nucleus?
Fastigial and interposed (globose and emboliform)
87
Posterior lobe of cerebellum connects to which nucleus?
Dentate
88
Posterior lobes of the cerebellum may also be referred to as?
Cerebellar hemispheres
89
Flocculo-nodular lobes of the cerebellum is associated with which nucleus?
Pontine vestibular nucleus
90
Vermis of the cerebellum is associated with which nucleus?
Fastigial
91
What is meant by the interposed nucleus?
Globose and emboliform
92
Three functional zones of the cerebellum are?
Vestibulocerebellum
Spinocerebellum
Cerebrocerebellum
93
Vestibulocerebellum is composed of?
Floculonodular lobe
94
Spinocerebellum is composed of?
Anterior lobe and vermis
95
Cerebrocerebellum is composed of?
Posterior lobe (cerebellar hemispheres)
96
Function of vestibulocerebellum? x3
Head and eye movement coordination to ensure stability of gaze
Balance of head - medial tract
Balance of body - lateral tract
97
Input to the vestibulocerebellum for it's function is via the? x2
Extra occular eye muscles
| Muscles of the neck
98
Output from the vestibulocerebellum is via the? x2
Medial longitudinal fasciculus
| Medial vestibulospinal tract
99
Function of the spinocerebellum?
Control of locomotion and limb coordination
100
Output from the spinocerebellum? x2
Lateral vestibulospinal tract
| Reticulospinal tract
101
Function of the cerebrocerebellum?
Coordination of movement initiated by the motor cortex e.g. speech, limbs, hand-eye coordnation
102
Cerebrocerebellum also known as?
Neocerebellum
103
Three major disorders caused by cerebellar damage are?
Floculonodular syndrome
Anterior lobe syndrome
Neocerebellar syndrome
104
Symptoms and signs of floculonodular syndrome? x7
```
Poor balance
Disordered eye movements
Nystagmus, ocular dysmetria
Poor visual pursuit (tracking)
Truncal ataxia - fall to one side of lesion
Ataxic gait
```
105
Those with floculonodular syndrome perform badly on what test?
Romberg test
106
Most common cause of floculonodular syndrome is? this most often occurs in whom?
Medulloblastoma in the fourth ventricle - in young children
107
Five symptoms of anterior lobe syndrome?
```
Incoordination of the limbs
Ataxia
Hypotonia
Dysdiadochokinesis
Depressed/pendular reflexes
```
108
Common cause of anterior lobe syndrome?
Alcoholism - malnutrition and lack of B vitamins
109
Five symptoms of neocerebellar syndrome?
```
Loss of hand-eye coordination
Dysmetria
Dysdiadochokinesis
Intention tremor
Slurred speech
```
110
Common cause of neocerebellar syndrome?
PICA infarct
111
Five symptoms of cerebellar stroke?
Headache, vertigo, nausea, vomiting
Eye changes
Dysarthria
112
Five symptoms of cerebellar stroke?
```
Headache, vertigo, nausea, vomiting
Eye changes
Dysarthria and dysphagia
Ataxia
Arm weakness (one side) and incoordination
```
113
Cerebellar stroke will affect what art of the cerebellum?
Whole cerbellar cortex on one side - global signs
114
What is dysarthria?
Motor disorder of speech - weakened muscles of the face, mouth and respiratory system
115
What is ataxia?
Loss of balance and coordination whilst walking
116
What type of intoxication mimics features of cerebellar damage?
Alcohol intoxication
117
Why does alcohol intoxication mimic features of cerebellar damage?
Cerebellum has many GABA-ergic interneurones
These are especially sensitive to the effects of alcohol
118
What does an EEG record?
Changes in voltage as a result of ionic current flowing within neurones in the cerebral cortex of brain
119
EEG waves are affected by what?
State of arousal
120
EEG wave amplitude can vary to what degree?
10-150
121
Where are the three EEG leads placed?
Occipital lobe
Frontal lobe
Third is a ground electrode
122
Four types of EEG waves are?
Alpha
Beta
Theta
Delta
123
Alpha waves in EEG are present when?
In most awake adults
124
Beta waves in EEG are present when?
When subject is awake and alert - mental task
125
When eyes are open - alpha or beta EEG waves predominate?
Beta waves have an increased amplitude
126
When eyes are closed - alpha or beta EEG waves predominate?
Alpha waves have an increased amplitude
127
Function of anterior and posterior lobes of the cerebellum?
Movement of the limbs (anterior)
| Movement of the trunk (posterior)
128
Function of the floculonodular lobe of the cerebellum?
Posture and balance
129
Cerebellum accounts for what percentage of total brain mass?
11%
130
Two non-motor functions of the cerebellum are?
Word association
| Puzzle solving
131
What is the arbour vitae of the cerebellum?
Distinctive white matter pattern at the centre of the cerebellum
132
Sensory information to the cerebellum is from which tract?
Spinocerebellar
133
Motor information to the cerebellum is from which tract?
Corticocerebellar
134
Six symptoms associated with cerebellar injury and way to remember this?
```
DANISH
Dysdiachokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
```
135
What is the limbic system?
Group of cortical and subcortical nuclei
136
Where is the limbic system located?
Medial aspect of frontal, parietal and temporal lobes
137
Function of the limbic system is? x2
Rewarding and punishment in pleasure/pain
| Learning and memory
138
The type of learning/memory involved with the limbic system is?
Motivational/emotional
139
Three cortical regions of the limbic system are?
Orbito-frontal cortex
Cingulate cortex
Parahippocampal cortex
140
Location of orbitofrontal cortex?
Frontal lobe - medial
141
Location of cingulate cortex?
Parietal lobe - medial
142
Location of parahippocampal cortex?
Temporal lobe - medial
143
Two components of the cingulate cortex are?
Anterior cingulate
| Posterior cingulate
144
Most anterior part of the limbic system is?
Orbito-frontal cortex
145
Most posterior part of the limbic system is?
Posterior cingulate cortex
146
Most inferior part of the limbic system is?
Parahippocampal cortex
147
Blood supply to the limbic system via which arteries? x2
Anterior cerebral artery
| Posterior cerebral artery
148
The middle cerberal artery MAY supply what parts of the limbic system? x2
Top of the temporal lobe and orbital cortex
149
Anterior cingulate cortex activated in which two scenarios?
Experience of pain
| Depression
150
Two parts of the anterior cingulate cortex are?
Rostral
| Caudal
151
Function of rostral anterior cingulate cortex?
Registers quality of pain - how bad from 1-10
152
Function of posterior cingulate cortex?
What actions to take to deal with the pain
153
What is a cingulotomy?
Procedure of cutting into the cingulate gyrus
154
Why is a cingulotomy performed?
To reduce the emotional distress of pain
155
Function of orbito-frontal cortex?
How to avoid pain - how to behave to an anticipated threat
156
Excessive activity in the orbito-frontal cortex has been linked to which condition?
OCD
157
Function of posterior cingulate cortex?
Visuo-spatial memory
158
Loss of function in visuo-spatial memory is associated with which condition?
Alzheimer's
159
Function of parahippocampal gyrus?
Learning and memory
160
Four subcortical regions of the limbic system are?
Hippocampus
Amygdala
Accumbens nucleus
Septal nuclei
161
Hippoxcampus and amygdala are closely associated to which structure?
Inferior horn of the lateral ventricle
162
Septum pallucidum is?
Connection between the two fornices on either side
163
End point of the fornix is at the? x2
Mammillary body of the hypothalamus
| Septal nuclei
164
Pathway of information transmission in the limbic system is?
Cingulate cortex - parahippocampal gyrus - hippocampus - fornix - mammillary bodies of hypothalamus - anterior thalamus - cingulate cortex
165
Pathway of information transmission in the limbic system is known as?
Papez's circuit
166
What is retrograde amnesia?
Cannot access memories prior to the trauma
167
What is anterograde amnesia?
Cannot make new memories - failure to transfer new memories into long term memory
168
Cause of retrograde amnesia?
Damage to the cingulate gyrus
169
Cause of anterograde amnesia?
Damage to the hippocampus/loss of hippocampal function
170
Memory formation occurs where?
a
171
Memory storage occurs where?
a
172
Memory relay occurs where?
a
173
What is Korsakoff's syndrome?
Encephalopathy - brain damage
174
Cause of Korsakoff's syndrome?
B1 deficiency often in chronic alcoholics
175
B1 also known as?
Thiamine
176
Four symptoms of Korsakoff's syndrome are?
Anterograde amnesia
Some degree of retrograde amnesia
Confabulation
Apathy
177
Two areas that are damaged in Korsakoff's syndrome are?
Mammillary bodies
| Projection of mammillary bodies to the anterior thalamus
178
What will a patient typically experience during temporal lobe epilepsy?
Remain conscious but experience powerful emotions e.g. intense joy/fear
179
Kluver-Bucy syndrome is due to damage to?
The amygdala
180
Five symptoms of Kluver-Bucy syndrome?
```
Psychic blindness
Oral tendencies
Hypermetamorphosiss
Altered sexual behaviour
Emotional changes
```
181
Main symptom/sign of Kluver-Bucy syndrome?
Loss of all sense of fear
182
Electrical stimulation of the amygdala in humans results in what?
Fear or anxiety
183
Amygdala is embedded in whcih cortex?
Entorhinal
184
Relation of amygdala to the sympathetic nervous system?
Amygdala - fear - can activate sympathetic nervous system fight or flight response
185
Effect of amygdala damage on emotion recognition?
Cannot recognise fearful expressions or different degrees of emotions
186
Where do the septal nuclei lie?
Basal of the septum pallucidum
187
Septal nuclei merge into which nucleus?
Basal nucles/nucleus of Meynert
188
Ventral striatum is composed of?
Septal nucleus
Accumbens nucleus
Nucleus of Meynert/basal nucleus
189
Nucleis accumbens is part of which dopaminergic pathway?
Mesolimbic dopamine pathway
190
Function of the ventral striatum?
Initiation and termination of behaviours/motor actions that trigger reward pathways
191
Blockage of dopamine receptors in the accumbens may be useful in the treatment of what?
Addictive behaviours
192
How can you differentiate between alpha and beta waves on an EEG?
Beta waves have a much greater frequency
193
When are alpha waves active?
Awake and resting individual
194
When are beta waves active?
Awake with mental activity
195
When are theta waves active?
Sleeping
196
When are delta waves active?
Deep sleep
197
Relation of the thalamus to the putamen on lateral aspect?
Thalamus is deeper to the putamen
198
Relation of thalamus to the third ventricle?
Thalamus is lateral to the third ventricle on either side
199
Percentage of blood supply to the bran is from which arteries?
80% - internal carotid arteries
| 20% - vertebral arteries
200
What is the blood supply to the anterior part of the brain?
Internal carotids
201
What is the blood supply to the posterior part of the brain?
Vertebral arteries
202
Vertebral arteries originate from where?
Subclavian arteries
203
Vertebral arteries enter the skull through which foramen?
Foramen magnum
204
Terminal branches of the internal carotid arteries/anterior circulation is? x2
Anterior cerebral
| Middle cerebral
205
Terminal branches of the vertebral arteries/posterior circulation is? x1
Posterior cerebral artery
206
The classic circle of Willis is seen in what percentage of people?
34.5%
207
What is the biggest branch of the internal carotid artery?
MCA
208
Branches of the MCA that supply the basal ganglia are?
Lenticulostriate arteries
209
MCA supplies which region of the cortex?
Lateral portion of the brain (majority)
210
ACA supplies which region of the cortex?
Middle and anterior medial portion of the brain
211
PCA supplies which region of the cortex?
Posterior medial portion of the brain
212
MCA/ACA/PCA - supply to the caudate nucleus?
Anterior cerebral artery
213
MCA/ACA/PCA - supply to the putamen?
Middle cerebral artery
214
MCA/ACA/PCA - supply to the thalamus?
Posterior cerebral artery
215
MCA/ACA/PCA - supply to the globus pallidus?
Middle cerebral artery
216
MCA/ACA/PCA - supply to the internal capsule?
Posterior internal capsule - posterior cerebral artery
217
MCA/ACA/PCA - supply to the midbrain?
PCA
218
Blood supply to the pons?
Pontine arteries from the basillar artery
219
Blood supply to the medulla?
PICA
220
Cerebral veins/arteries - which ones pierce through the dura mater?
Veins
221
MCA/ACA/PCA - supply to the thalamus?
Posterior cerebral artery
222
Function of arachnoid granulations is? x2
Allow CSF to flow into the venous blood of sinuses
| Prevents back flow of blood into the subarachnoid space
223
Majority of the cerebral blood flow will drain to which sinus?
Superior sagittal
224
Straight sinus is between which cerebral veins?
Inferior sagittal and confluence
225
All (most) dural sinuses eventually drain into which vein?
Internal jugular vein - 80%
226
Where will the remaining 20% of dural venous blood drain to?
Facial vein to the external jugular vein
227
Infarct of the temporal lobe can lead to damage to which two regions?
Broca's area
| Wernicke's area
228
Presentation of MCA stroke?
Neglect syndrome - one side
| Global aphasia
229
Define global aphasia?
Cannot produce words and have trouble understanding words
230
Why do MCA stroke patients have global aphasia?
Damage to both Broca's and wernicke's areas
231
Four symptoms of ACA stroke?
Contralateral sensorimotor loss below the waist
Urinary incontinence
Personality defects
Split-brain syndrome (damage to corpus callosum)
232
Three symptoms of PCA stroke?
```
Contralateral homonymous hemianopsia
Reading and writing deficits
Impaired memory (temporal lobe)
```
233
TIA resolves within what length of time?
24 hours
234
TIA is a warning sign of what?
Stroke or heart attack
235
Three types of extra-axial bleeds i.e. outside of the brain?
Epidural/extradural haematoma
Subdural haematoma
Subarachnoid haematoma
236
Epidural bleed looks like?
Concave lense
237
Epidural bleed arterial/venous?
Arterial
238
Epidural bleed fast or slow?
Fast
239
Epidural bleed between which two structures?
Dura and skull
240
Epidural bleed presentation?
Brief lucid period following trauma and then unconsciousness
241
Epidural bleed can cause compression of which CN?
CNIII - occulomotor
242
Epidural bleed may cause a loss of vision in which visual field?
Visual field opposite to lesion
243
Subdural bleed looks like?
Crescent shape
244
Cause of subdural bleed?
High speed acceleration and deceleration
245
Subdural bleed fast/slow?
SLOW - does not present for about two weeks
246
Subdural bleed arterial/venous?
Venous
247
Differnetiate between subdural and epidural bleeds other than shape of bleed?
Subdural can cross the suture lines
248
Subdural bleed between which two structures?
Dura mater and arachnoid mater
249
Subarachnoid haematoma presentation?
Severe headache
Vomiting
Confusion
Lowered level of consciousness
250
Common cause of subarachnoid haematoma?
Burst aneurysm
251
Subarachnoid haematoma fast or slow?
Fast
252
Three types of cerebral aneurysms are?
Saccular
Fusiform
Berry
253
What is Wallenberg syndrome?
Ischaemic stroke to PCIA
254
What is Wallenberg syndrome also known as?
Lateral medullary syndrome
255
Presentation of Wallenberg syndrome?
SUDDEN ONSET
Horner syndrome
Vertigo, nystagmus, nausea and vomiting
256
Patient has a stroke and presents with ipsilateral Horner's syndrome - which artery is most likely to have been affected?
PICA
257
Five layers of the scalp and way to remember these?
```
SCALP
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Pericranium
```
258
What is a brain contusion?
Superficial bruising
259
Brain contusions are associated with which type of extra-axial bleed?
Subdural
260
Expressive aphasia is Broca's or Wernicke's aphasia?
Broca's
261
Receptive aphasia is
Wernicke's
262
Imaging of the brain - what will be used?
MRI
263
Comminutive types of fractures to the skull?
Depressed
Compound
Closed
Comminutive
264
What is diffuse axonal injury?
Term given to widespread damage to axons caused by acceleration of the head
265
PICA comes off of which artery?
Vertebral artery
266
Cranial nerves that innervate the brainstem are? x2
CNXI
| CNXII
267
Central sulcus of the brain separates which two lobes?
Frontal
| Parietal
268
Somatosensory region of the brain is located in which lobe?
Parietal
269
Motor movement region in the brain is located in which lobe?
Frontal
270
Hearing and memory region is located in which lobe of the brain?
Temporal
271
Vision region is located in which lobe of the brain?
Occipital
272
Lateral/sylvian fissure separates which two lobes of the brain?
Frontal and tempiral
273
Primary cortex area just anterior to the central sulcus is?
Primary motor cortex
274
Primary cortex area just posterior to the central sulcus is?
Primary sensory cortex
275
Which of the primary cortex areas are mostly medial rather than lateral?
Primary visual cortex
276
Function of Broca's area?
Language expression
277
Function of Wernicke's area?
Language comprehension
278
Function of DCML?
Discriminative touch
279
Function of corticospinal tract?
Motor
280
Function of spinocerebellar tract?
Proprioception
281
Function of spinothalamic tract?
Pain and temperature
282
DCML crosses over where?
Medulla
283
Corticosinal tract crosses over where?
Spinomedullar junction
284
Spinocerebellar tract crosses over where?
No functional crossover
285
Spinothalamic tract crosses over where?
Sinal cord
286
Major inhibitory neurotransmitter in the brain is?
GABA
287
Major excitatory neurotransmitter in the brain is?
Glutamate
288
Primary motor cortex is located where?
Immediately anterior to the central sulcus
289
Lesion to primary motor cortex presents how?
Paralysis/paresis of specific muscle group
290
Primary motor cortex is area number?
4
291
What is remapping/neuronal plasticity?
Motor homonculus/map adjusts slightly to compensate for damage to another region
292
Stroke of MCA affects what region of the brain?
Almost all of one side of the frontal lobe
293
One region MCA stroke does not affect in the body?
Does not affect lower limb (different blood supply)
294
Blood supply to the lower limb is?
Anterior cerebral artery
295
Blood supply to basal ganglia is?
Lenticulostriate arteries from MCA
296
What is apraxia?
Difficulty performing complex motor tasks e.g. tying shoelaces
297
Apraxia occurs as damage to what two regions?
```
Premotor cortex (6)
Supplemntary motor cortex (8)
```
298
Stroke to only one side of the brain may not present that greatly - why?
Contralateral area may be able to compensate
299
Broca's area regulates what muscles?
Muscles controlling speech - programming of words
300
Damage to Broca's area results in?
Motor aphasia
301
What is motor aphasia?
Patient cannot verbalise complex sentences - tend to stick to one word sentences
302
Damage to frontal eye fields results in?
Oculomotor apraxia
303
What is oculomotor apraxia?
Difficulty moving eyes horizontally and in following an object
304
Presentation of oculomotor apraxia?
Patients will turn their head more to compensate for lack of eye movement
305
Common cause of oculomotor apraxia?
Bilateral lesions of frontal eye fields
306
Where is the somatosensory cortex?
Immediately posterior to the central sulcus
307
Function of somatosensory cortex? x2
Modulation of sensory input
| Modulation of reflex e.g. suppression of nociceptive reflexes
308
Prefrontal cortex is located where?
Most anterior region of the cortex
309
Function of prefrontal cortex? x2
Planning (of movement)
| Executive functions - problem solving, judgment
310
Symptoms of prefrontal cortex lesions? x3
Apathy
Personality changes
Lack of ability to plan/sequence actions or tasks
311
Location of orbitofrontal cortex?
Anterior and inferior
Inferior to the prefrontal cortex
312
Function of orbitofrontal cortex?
Involved with the limbic system
313
Two regions that project into the motor thalamus are?
Basal ganglia
| Cerebellum
314
Motor thalamus projects to where?
Motor cortex
315
Motor thalamus is also known as?
VL thalamic nucleus
316
Why is corticobulbospinal tract susceptible to stroke?
Travels through the internal capsule - particularly prone
317
Red nucleus is located where?
Midbrain of brainstem
318
Corticobulbospinal tract is composed of which two tracts?
Corticobulbar tract
| Corticospinal tract
319
Three terminations of the corticobulbar tract?
Pontine nuclei
Reticular formation
Red nucleus
320
Motor decussations occur where in the spinal cord?
In the upper spinal cord
321
Injury to the brain above the spinal cord - where is motor deficit?
Contralateral side
322
Injury to the spinal cord - where is motor deficit?
Same side
323
Damage to the corticospinal tract in teh spinal cord results in what?
Loss of control of hands and fingers
324
Red nucleus gives rise to which tract?
Rubrospinal tract
325
Rubrospinal tract descends to where?
Motor thalamus
326
Function of interneurones?
Modulate strength and activity of reflex pathways
327
Only upper motor neurones that act directly on lower motor neurones are? x4
Driving muscles of thumb, fingers, lips and tongue
328
Function of tectospinal tract/optic tectum?
Coordination of voluntary head and eye movements
329
Function of the medial vestibulospinal tract?
Mediates involuntary (reflex) coordination of the head and the neck
330
What is spasticity?
Abnormally increased muscle tone
Increased tendon reflexes
331
Spasticity is a result of UMN or LMN lesion?
UMN lesion
332
What is clonus?
Series of jerky contractions of the muscle following sudden stretching
333
What is hyperreflexia?
Abnormally brisk tendon reflexes
334
Position of the arms in decorticate posturing?
Flexed
335
Decorticate posturing occurs due to damage to what?
Corticospinal tract in the midbrain
336
Position of arms in decerebrate posturing?
Arms extended
337
Decerebrate posturing occurs due to damage to what?
Injury to brain at the level of the brainstem - corticospina/ruprospinal tracts
338
Decereberate/decorticate posturing - which is more dangerous?
Decerebrate
339
Clasp-knife reflex indicates what lesion?
Chronic cerebral motor lesion
340
Babinski indicates what damage?
Corticospinal damage
341
Presentation of damage to the spinal cord is known as?
Spinal shock
342
Damage to corticospinal tract presents as? x2
Paralysis/weakness of voluntary movement
| Hyperactive tendon reflexes
343
Damage to reticulospinal tract presents as? x3
Loss of bladder/bowel control
Loss of temperature regulation
Loss of blood pressure regulation
344
Damage to vestibulospinal tract presents as? x1
Loss of ability to stand upright/balance properly
345
UMN lesion - increased or decreased muscle tone?
Increased
346
LMN lesion - increased or decreased muscle tone?
Decreased
347
Five motor symptoms of PD?
```
Rigidity
Resting tremor
Bradykinesia
Gait freezing
Problems wth balance
```
348
One of the earliest non-motor symptom of PD is?
Loss of sense of smell
349
Late non-motor symptom of idiopathic PD is?
Dementia
350
Three targets of DBS in PD?
Subthalamic nucleus
Thalamus/zona incerta
Globus pallidus interna
351
Three phases of DBS?
Electrode insertion
Pulse generator insertion
DBS adjustment
352
What scan of the brain should be undertaken prior to DBS?
MRI
353
What type of anaesthesia should be administered prior to DBS?
General anaesthesia
354
What is dystonia?
Movement disorder causing muscle spasms and contractions
355
Site of DBS for dystonia?
Globus pallidus interna
356
Site of DBS for pain?
Sensory thalamic nuclecus
| PAG
357
Site of DBS for epilepsy?
Anterior thalamic nucleus
358
Site of DBS for deperession?
Subgenual cingulate gyrus
359
DBS funded for use in only what in teh UK?
Only funded for use in movement disorders in the UK
360
Site of DBS in tremor? x3
Thalamic nucleus
Zona incerta
Subthalamic area
361
Which region of the basal ganglia can DBS be carried out for treatment of PD?
Globus pallidus interna
362
What is meant by consciousness?
State of full awareness of the self and one's relationship to the environment
363
What is meant by vegetative state?
Full arousal but no awareness - look like they are awake but not aware
364
What is meant by minimal consciousness state?
Full arousal and some degree of awareness
365
Stages of vegetative state? x4
Coma
Vegetative state
Persistent vegetative state
Permanent vegetative stage
366
Timeline for vegetative stage stages?
Coma - 2/3 weeks
Vegetative stage - 4 weeks
Persistent vegetative stage - 6 months
Permanent vegetative state
367
Define permanent vegetative state
Longer than twelve months following trauma and longer than six months following anoxia
368
Anatomical changes causing vegetative stage? x3
Widespread subcortical white matter cell death
Damage to the thalamus
Disconnection from fronto-parietal cortex
369
What is akinetic mutism?
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
Cause of akinetic mutism?
Injury to white matter cingulate gyrus - frontal lobe
371
What is meant by a coma?
Temporary state of unconsciousness
372
Three diagnostic criteria for vegetative state?
Cycles of eye opening adn closing
Complete lack of self or environment
Complete or partial preservation of hypothalamic adn brainstem autonomic functions
373
Two forms of imaging used for vegetative state?
Electrophysiology
| MRI
374
Two forms of electrophysiology used for vegetative state?
EEG - electrical activity of the brain
| ERP - even related potentials - listen to headphones and look for response
375
Three factors affecting recovery from vegetative state
Time spent in vegetative state
Age
Type of brain injury e.g. hypoxic has poor prognosis
376
Two medications used for treatment of vegetative state?
Amantadine
| Zolpidem
377
DBS location for vegetative state?
Central thalamus
378
Dysdiachokinesis presents in what type of brain damage? x2
Damage to the anterior lobe and also to the posterior lobe of the cerebellum
379
Define dysmetria
Overshooting movements
380
Define dysarthria
Poor articulation of speech
