review? Flashcards
what separates the spine in halfs
ant med fissure
post med sulcus
what gray horn is present only in the thoracic and upper lumber spine
Lateral
spinothalamic tract is ascending or descending?
ascending
corticospinal is ascending or descending?
descending
what nerve innervates the diaphragm
phrenic C3,4,5 keeps pt alive
what spinal nerves are called the intercostal nerves?
T2-T11
how long does it take to damage brain cells without O2
4 min
What supplies the circle of wilis with blood
internal carotids
where is the CSF produced
Corriod plexus
where is CSF reabsorbed
Arachniod vili
where is the hypothalamus, thalamus and the pineal gland located
diencephalon
where in the brainstem is CN 3 and 4 located
midbrain
loss of this neuron can lead to Parkinson’s
substantia nigra
what part of the brain does proprioception and equilibrium
cerebellum
what connects the right and left spheres of the brain
corpus callosum
what a re the layers of the cerebrum
Cortex
basal ganglia
folds in the cerebeum are called
gyri
the grooves are called
sulci
promary somato sensory area
postce
What specialized area controls speech
broachas speech area
what is known as the emotional part of the brain
limbic system
what is the name of CN 8
vestibulocochlear or acoustic
what CN covers taste
7 and 9
what CN controlls movement of the tongue
12 hypoglossal
what spinothalamic tract
1) Light touch sensation
2) Deep pressure sensation
Anterior
What Spinothalamic tract?
1) Pain Sensation
2) Temperature (hot vs cold) sensation
Lateral
That regulates Temp
Hypothalamus
what neurotransmitter does the sympathetic division release
epinephrine and norepinephrine
what neurotransmitters does the ANS release
acetylcholine (ACh) or norepinephrine (NE)
Sympathetic division extends from that spinal cord segments
T1-L2
Axons in the S division synapse with post ganglionic neurons at what
a sympathetic trunk ganglion
graphethesia is part of what sensory
cortical
what special tests are done durring a neuro exam
brudzinski
kernig
nuchal rigidity
what presents as a thunderclap headache
subarachnoid bleed
1) Most prevalent headache
2) Bilateral headaches
3) Often occurs daily
4) Characterized as “vice-like” in nature
5) Often exacerbated by emotional stress, fatigue, noise, glare
6) May be associated with hypertonicity of neck muscles.
Tension Headaches
What is it if pt presents with this
Ptosis, miosis, anhidrosis
Horner syndrome
what headache
1) Usually affects middle aged men but can also affect women
2) Intense unilateral pain that starts around the temple or eye
3) Patients is often restless and agitated due to the pain
4) Episodes often occur 15 minutes to 3 hours
5) Usually occur seasonally and attacks are grouped together
cluster
Mainline tx for cluster headache
Inhaled 100% oxygen for 15 minutes is initial treatment of choice
what dose of Sumatriptan can you give for cluster
Dose: SubQ Initial: 6 mg; may repeat if needed ≥1 hour after initial dose
(maximum: 6 mg per dose; two 6 mg injections per 24-hour period)
for your migraine opt if nsiads didn’t work what would you give your pt
sumatriptan or zolmitriptan
what type of headache is experienced a few days after injury
post traumatic headache
pt reports with chronic headaches but has always been using nsaids
med overuse headache
what type is formerly known as complex partial seizure
Focal seizure with impaired awareness
what type is formerly known as simple partial seizure
Focal seizure with retained awareness
What sezure is the most common type of generalized seizure and lasts 1-2 min
tonic clonic grandmal
what is also known as Absence seizure
petit mal
Treatment for active seizure
Diazepam 5 mg IV/IM Q5-10 minutes; do not exceed 30 mg
Definition: Single seizure lasting more than or equal to 5 minutes or 2 or more seizure between which there is an incomplete recovery of consciousness
Status eplilepticus (EMERGENCY)
what are the two major branches of the internal carotid
1) Anterior cerebral artery (ACA)
2) Middle cerebral artery (MCA)
pt comes to you with stroke like symptoms that disapear when they see you
TIA
3 subtypes of Ischemic Stroke
Systemic hypoperfusion
Embolic
Thrombotic
way to determine the difference between TIA or CVA
MRI
UNLESS pressure is above systolic of ___ and/or diastolic of in which case you should lower the pressure by 15%
220
120
what do you use to lower BP
Labetalol
how would you treat a TIA
aspirin after talking to MO
Initial interventions for ischemic stroke
Maintain oxygenation > 94%
Elevate head of bed to ~30 degree
DDX for RLS
Volitional movements
Akathisia:
Nocturnal leg cramps
if Glasgow score Less than 8,
intubate
(in which episodes of deep breathing alternate with
periods of apnea) may occur with bi-hemispheric or diencephalic disease or in
metabolic disorders.
Cheyne-Stokes respiration
______hyperventilation occurs with lesions of the brainstem tegmentum.
Central neurogenic
_______ breathing (in which there are prominent end-inspiratory pauses) suggests damage at the pontine level
Apneustic breathing
breathing (a completely irregular pattern of breathing with deep and shallow breaths occurring randomly) is associated with lesions of the lower
pontine tegmentum and medulla.
Atactic breathing
What is it called when injury will be present at site of impact as well as opposite side from rebound
motion
Coup-contrecoup
Bleed between dura mater and skull
Epidural hematoma
bleed between dura mater and arachnoid mater
Subdural hematoma
Middle meningeal artery commonly causes this bleed
Epidermal Hemorrhage
Most common Intercrainial bleed at 20%
Subdural hemorrhage
__________ subdural hematoma presents 1-2 days after onset
accute
_______subdural hematoma presents 15 days or more after onset
Chronic
if pt complains of perianal numbness what should you expect
cauda equina
is first muscle relaxants first line tx for spinal injury
no
First-line treatments for radiculopathy include:
modified activities; NSAIDs and other analgesics
When would you refer a pt for carpal tunnel
If symptoms persist more than 3 months despite conservative treatment, including the use of a wrist splint OR if thenar muscle weakness or atrophy develops.
Bells palsy vs stroke
In a stroke, there is NO
paralysis of the forehead
traid for meningitis
(a) Fever
(b) Nuchal rigidity
(c) Change in mental status
Meningitis vs encephalitis
In meningitis cerebral function usually____
remains normal
____ is characterized by what we traditionally recognize as a pain that is caused by a noxious stimuli
Nociceptive pain
____ pain is most commonly described as tingling, pins and needles, burning, shooting electric like shocks
Neuropathic pain
Medications that inhibit pain transmission
1) Tylenol
2) NSAID
3) Capsaicin
Medications that inhibit descending pain modulation
1) Gabapentin
2) Tricyclic antidepressants
3) SNRIs
Tx short term insomnia
Educate and reassurance may be all that is needed
What type of vertigo
Onset is gradual; no associated auditory symptoms; often presents with other neurologic signs and symptoms like ataxia, dysarthria, dysphagia, focal or
lateralized weakness
Central:
What type of vertigo
Onset is sudden; often associated with tinnitus and hearing loss; horizontal nystagmus may be present.
Peripheral
For evaluating vertigo what PE test is used
Dix-Hallpike testing
