Quiz #2 Flashcards
brain waves
delta: cortex during sleep
theta: hippocampus during attention, cortex during sleep
alpha: cortex relaxed with eyes closed
beta: cortex during attention
gamma: cortex and hippocampus during information processing (maybe memory consolidation)
anterolateral system - 3 categories
1) neo-spinothalamic: sharp pain, temp and crude touch – reach consciousness
2) paleospinothalamic/ spinoreticular tract: dull aching pain, older pathway, may be felt at level of thalamus and cerebral cortex (central tegmental tract - CTT) - projects to intralaminar nucelus of thalamus
3) spinomesencephalic: modulation of pain
neospinothalamic tract
first order: dorsal root ganglion
–enter tract of lissauer 2-3 segments above entry
second order: spinal dorsal horn
—cross to anterior white commisure (opposite side)
third orderL VPL nucleus of thalamus
second order neurons lie in lamina 1,2,5 of dorsal horn
syringomyelia
cyst in central part of spinal cord – if it involves the area of anterior white commisure = bilateral, symetrical loss and pain and temp 2-3 segments below the lesion
Brown-sequard syndrome
hemisection of the spinal cord =
- loss of all sensations on the SAME side at the level of the lesion
- loss of dorsal column sensations (fine touch and proprioception) below the lesion at the SAME side
- loss of pain and temp sensations carried in ALS 2-3 segments below the lesion on OPPOSITE side
trigeminal nerve - CN 5
V1: opthalmic - tip of nose, top of eyes, forehead
V2: maxillary: underside of nose, upper lip, bottom of eyes, cheek
V3: mandibularL lower lip, jaw, part of ear
trigeminal nuclei
principal/chief:
- fine touch and proprioception – second order fo to VSTT - cross to other side
spinal nucelus - 2nd order
-pars oralis (upper 1/3): fine touch, pressure,
- pars interpolar and pars caudalis: lower part = pain, temp, crude touch
mesencephalic: only first order inside brain stem, failed to migrate out
- - jaw reflex
3rd order is in VPM of thalamus, then pass through internal capsule to primary sensory cortex
layout of facial innervation
V1 - most ventral
more dorsal is V2 and most dorsal is V3
also, concentric: perioral – more rostral, further away from mouth is more caudal
uncal herniation
trans-tentorial: triad 1) blown pupil - CN3 compression 2) hemiparesis 3) lethargy, coma, etc --> reticular activating system
managing coma
ABCs IV access administer naloxone, thiamine, dextrose neuro exam - pupils blood tests for electrolytes and tox, organ function CT scan of head
brain deat h
1) coma
2) absennce of brainstem reflexes
3) apnea
local anesthetics
all act on sodium channels
- more hydrophobic = more potent
amide and ester aromatic groups
amide: lidocaine, other “icanes”
esters: procaine, other non-I “caines”
too much: metallic taste, numbness, CNS, cardio probs
nitrous oxide
very high MAC (105%) and very LOW potency, low solubility — good because doesnt stick around so easy to reverse, but have to put on O2 afterwards or else bad news bears - use NO for second gas effect - speeds up onset
IV general anethietics
more soluble = more potent - mostly GABA – chloride channels (propofol) - potentiate
also NMDA - ketamine – glutamate, antagonize
drugs not effective for partial epilepsy
ethosuximde and methsuximde (they sux) – only good for absence
drugs for general
pheno, phenytoin, valproic, topiramate, perapemel, ethosux
NOT carbamazepine, gabapentin, pregablain, and such
— these will actually make generalized (myoclonics) WORSE
anti ep drug side effects
perampanel - homicidal ideation
phenytoin: gingival hyperplasia, hirsuitism
carbamazepine –> hyponatremia
valproate: weight gain, hep failure – also tetratogenic
topiramte - weight loss and sweating
some are inducers: phenobarb, phenytoin, carbameza, topiramte –> make other drugs less effective
some are inhibitorsL valproate - make other drugs more effective
carbamezepine is an autoinducer - have to increase the dose
when people get old (less protein) give them less – pregnancy they may need more - mass
effects of cerebral ischemia
protein synthesis and gene expression goes down
then acidosis, water shifts, glutamate release, electrical fialrue
then membrane fialure and neuronal death
early effects: Ca dependent enzymes, free radiacals, mitochondrial failure
delayed effects: changes in gene expression - hypoxia
cell injury from excess of calcium
best drugs for general seizures
levitiracem, valproate, lamotrigine
best drugs for partial seizures
lamotrigine, levitiracem, and oxcarbezepine
drugs that make generalized seizures worse
carbamezepine, gabapentin, oxcarbezepine, pregablin, tigabine
phenobarbitol
GABA receptor increase synaptic inhibition
- works for general and partial
- P450 – liver inducer
- liver failure
- not great for preg
phenytoin
acts on Na channels
- good for general and partial
- SJS, giginval hyperplasia, lupus
carbamazepine
Na channels
- partial NOT general (makes them worse)
- hepatic inducer
- hyponatremia and aplastic anemia
valproate
multiple mechanisms partial and general liver inducer liver tox, weight gain neural tube defects
ethosuximde
Cacium channels
absence seizures
liver - CY3A
- allergy SJS, and blood problems (pregnancy C category so maybe not the worst
methsuximide similar
levitiracem
SV2a - synaptic vesicle thing - exocytosis
- general and partial
- mood swings
oxcarbazepine
Na channels
partial NOT general
hyponatremia
liver CYP3A
perapamel
AMPA glutamte receptor antagonist
partial and general
agression and homicidal ideaton
