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Block 6 - Neuroscience > Step 1: Neuro Awill's deck > Flashcards

Step 1: Neuro Awill's deck Flashcards

1
Q

Anterior spinal artery deficit

A

medial medullary syndrome - contralateral hemiparesis (lower extremities), medial leminscus (↓ contralateral proprioception), ipsilateral paralysis of hypoglossal nerve

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2
Q

PICA deficit

A

(lateral medullary syndrome, wallenberg’s) contralateral loss of pain and temperature, ipsilateral dysphagia, hoarsness, ↓ gag reflex, vertigo, diplopia, nystagymus, vomiting, ipsilateral horner’s, ipsilateral facial pain and temperature, trigeminal nucleus, ipsilateral ataxia

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3
Q

AICA deficit

A

(lateral inferior pontine syndrome) - Ipsilateral facial paralysis, ipsilateral cochlear ucleus, vestibular (nystagmus), ipsilateral facial pain and temperature, ipsilateral dystaxia (MCP, ICP)

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4
Q

Posterior cerebral artery deficit

A

contralateral homonymous hemianopia w/ macular sparing; supplie occipital cortex

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5
Q

Anterior cerebral artery defect

A

supplies medial surface of the brain, leg-foot area of motor and sensory cortices

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6
Q

Middle cerebral artery defect

A

Contralateral face and arm paralysis and sensory loss, aphasia (dominant sphere), left-sided neglect

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7
Q

Anterior communicating artery deficit

A

most common site of circle of Willis aneurysm; lesions may causes visual field defects

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8
Q

PCA deficit

A

common area of aneurysm, causes CNIII palsy

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9
Q

Lateral striate deficit

A

Divisions of MCA - supply internal capsule, caudate, putamen, globus pallidus. “arteries of stroke”; infarct of the posterior limb of the internal capsule causes pure motor hemiparesis

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10
Q

Watershed zones

A

between ACA/MCA, PCA/MCA. Damage in severe hypotension→ upper leg/upper arm weakness, defects in higher order visual processing

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11
Q

Basilar artery defect

A

infarct causes “locked-in syndrome” (CN III is typically intact)

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12
Q

Damage of stroke of anterior circle

A

general sensory and motor dysfunction, aphasia

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13
Q

Damage from stroke of posterior circle

A

cranial nerve deficits (vertigo, visual deficits), coma, cerebellar deficits (ataxia) dominant hemisphere (ataxia), nondominant (neglect)

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14
Q

Berry aneurysms

A

occur at bifurcations in circle of willis (most common ACA) 2. Rupture leads to hemorrhagic stroke/SAH 3. Assoc w/ adult polycystic kidney disease, Ehlers-Danlos syndrome and marfan’s. 4. Risk factors: advanced age, HTN, smoking, race (higher risk in blacks)

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15
Q

Charcol-Bouchard microaneurysms

A

associated with chronic hypertension, affects small vessels (in basal ganglia, thalamus)

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16
Q

Epidural hematoma CT

A

shows biconvex disk - not crossing suture lines - can cross falx, tentorium

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17
Q

Epidural hematoma

A

rupture of middle meningeal artery - often secondary to fracture of temporal bone. Lucid interval. Rapid expansion under systemic arterial pressure→ transtentorial herniation. CNIII palsy

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18
Q

Subdural haematoma imaging

A

crescent-shaped hemorrhage that crosses suture lines, Gyri are preserved since pressure is distributed equally. Cannot cross falx, tentorium

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19
Q

Subdural haematoma

A

rupture of bridging veins - slow venous bleeding. Delayed onset of symptoms. Seen in elderly individuals, alcoholics, blunt trauma, shaken baby

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20
Q

SAH

A
  1. rupture of an aneurysm or an AVM 2. patients complain of “worst headache of my life” 3. Bloody or yellow spinal tap 4. 2-3 days afterward there is a risk of vaspospasm due to blood breakdown products which irritate vessels (treat w/Ca channel blockers)
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21
Q

Parenchymal haematoma

A

caused by HTN, amyloid angiopathy. Lobar strokes all over the brain. DM and tumor. Typically occurs in basal ganglia and internal capsule.

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22
Q

Most vulnerable parts to ischaemic brain

A

hippocampus, neocortex, cerebellum, watershed areas

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23
Q

Irreversible neuronal injury

A

red neurons (12-48 hours), necrosis+neutrophils (24-72 hours), macrophages (3-5 days), reactive gliosis+ vasc proliferation (1-2 weeks), glial scar (> 2 weeks)

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24
Q

Atherosclerosis (re: stroke)

A

thrombi lead to ischemic stroke with subsequent necrosis (red neurons) - forms cystic cavity w/reactive gliosis

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25
Q

Haemorrhagic stroke

A

intracerebral bleeding, often due to aneurysm rupture - may be secondary to ischmic stroke following reperfusion (↑ vessel fragility)

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26
Q

Ischaemic stroke

A

emboli block large vessels 2. Atrial fibrillation, carotid dissection, PFO, endocarditis, lacunar strokes block small vessels - secondary to HTN 3. Tx w/ tPA for 3 hours

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27
Q

Transient ischaemic attack

A

brief, reversible episode of neurologic dysfunction due to focal ischemia. Typically sx last for <24 hours

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28
Q

Stroke imaging characteristics

A

bright on diffusion weighted MRI from 3-30 min post stroke to 10 days. Dark on CT for 24 hours

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29
Q

Lateral ventricle to 3rd via

A

Foramen of Munro

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30
Q

3rd ventricle to 4th via

A

cerebral aqueduct

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31
Q

4th ventricle to subarachnoid space via

A

Foramina of Luschka (lateral), Foramen of Magendie (medial)

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32
Q

Normal pressure hydrocephalus

A

wet, wobbly and wacky - does not result in increase in subarachnoid space volume. Expansion of ventricles distorts the fibers of the corona radiata and leads to the clinical triad of dementia, ataxia and urinary incontinence ( a reversible cause of dementia in the elderly)

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33
Q

Communicating hydrocephalus

A

decreased CSF absorption by arachnoid villi leading to increased ICP, papilledema and herniation

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34
Q

Non-communicating (obstructive) hydrocephalus

A

caused by a structural blockage of CSF circulation within the ventricular system (e.g. Stenosis of the aqueduct of Sylvius)

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35
Q

Hydrocephalus ex vacuo

A

Appearance of increased CSF in atrophy (Alzheimer’s disease, advanced HIV, Pick’s disease) - Intracranial pressure is normal: triad is not seen

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36
Q

Lumbar puncture layers punctured

A
  1. Skin/superficial fascia 2. Ligamets (supraspinous, interspinous, ligamentum flavum) 3. Epidural space 4. Dura Mater 5. Subdural space 6. Arachnoid 7. Subarachnoid space (CSF)
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37
Q

Dorsal column 1st order neuron

A

Sensory nerve ending
To DRG cell body
To spinal cord ascend IL dorsal column

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38
Q

Dorsal column synapse 1

A

IL nucleus cuneatus or gracilis (medulla)

gracilis = lower limb as gracilis muscle is in the leg

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39
Q

Dorsal column 2nd order neuron

A

decussates in medulla

Then ascends contralaterally in medial lemniscus

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40
Q

Dorsal column synapse 2

A

VPL(ventral posterolateral nucleus) of thalamus

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41
Q

Dorsal column third order neuron

A

Sensory cortex

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42
Q

Spinothalamic tract function

A

Ascending pain and temperature sensation

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43
Q

Spinothalamic 1st order neuron

A

Sensory nerve ending (A-delta and C fibers) (cell body in DRG)
Then enters spinal cord

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44
Q

Spinothalamic tract synapse 1

A

IL gray matter in spinal cord

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45
Q

Spinothalamic 2nd order neuron

A

Decussates at anterior white commissure

Then ascends contralaterally

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46
Q

Spinothalamic tract synapse 2

A

VPL of thalamus

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47
Q

Spinothalamic 3rd order neuron

A

Sensory cortex

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48
Q

Lateral corticospinal tract function

A

descending voluntary movement of contralateral limbs

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49
Q

Lateral corticospinal tract 1st order neuron

A

UMN (cell body in primary motor cortex)
Descends IL (through internal capsule) until decussating at caudal medulla (pyramidal decussation)
Descends contralaterally

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50
Q

Lateral corticospinal tract synapse 1

A

cell body of anterior horn of spinal cord

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51
Q

Lateral corticospinal tract second order neuron

A

LMN (leaves spinal cord)

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52
Q

Lateral corticospinal tract synapse 2

A

Neuromuscular junction

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53
Q

UMN disease signs

A

weakness, hyperreflexia, increased tone, (babinski, spastic paralysis, clasp knife spasticity)

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54
Q

LMN lesion signs

A

1.weakness, 2. atrophy, 3. fasciculation (twitching) , 4. hyporeflexia, 5. low tone

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55
Q

Romberg test

A

the subject stands with feet together, eyes open and hands by the sides. Then the subject closes the eyes while the examiner observes for a full minute.

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56
Q

Brown-Sequard syndrome

A
  1. Ipsilateral UMN signs below hemisection lesion (corticospinal tract) of spinal cord 2. IL loss of tactile, vibration proprioception sense (dorsal column) below lesion 3. CL pain and temp loss below lesion ( spinothalamic) 4. IL loss of all sensation at level of lesion 5. LMN signs at level of lesion. 6. If lesion above T1 = Horner’s syndrome
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57
Q

Horner’s syndrome

A

sympathectomy of face 1. Ptosis 2. Anhidrosis 3. Miosis - assoc w/ lesion of spinal cord above T1

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58
Q

Muscle spindle monitor

A

Muscle length

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59
Q

Golgi tendon monitor

A

Muscle tension

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60
Q

Biceps reflex

A

C5 nerve root

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61
Q

Triceps reflex

A

C7 nerve root

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62
Q

Patella reflex

A

L4 nerve root

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63
Q

Achilles reflex

A

S1 nerve root

64
Q

Babinski reflex

A

dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life.

65
Q

Moro reflex

A

“hang on for life” reflex —abduct/extend limbs when startled, and then draw together - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

66
Q

Rooting reflex

A

movement of head toward one side if cheek or mouth is stroked (nipple seeking) - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

66
Q

Suckling reflex

A

sucking response when roof of mouth is touched - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

67
Q

Palmar/plantar reflexes

A

curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

68
Q

Pineal gland

A

melatonin secretion, circadian rhythms.

69
Q

Superior colliculi

A

conjugate vertical gaze center.

70
Q

Inferior colliculi

A

auditory.

71
Q

Palmar/plantar reflexes

A

curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

72
Q

Spinothalamic tract function

A

Ascending pain and temperature sensation

73
Q

Spinothalamic 1st order neuron

A

Sensory nerve ending (A-delta and C fibers) (cell body in DRG)
Then enters spinal cord

74
Q

Pineal gland

A

melatonin secretion, circadian rhythms.

75
Q

Spinothalamic tract synapse 1

A

IL gray matter in spinal cord

76
Q

Superior colliculi

A

conjugate vertical gaze center.

77
Q

Spinothalamic 2nd order neuron

A

Decussates at anterior white commissure

Then ascends contralaterally

78
Q

Inferior colliculi

A

auditory.

79
Q

Spinothalamic tract synapse 2

A

VPL of thalamus

80
Q

Dorsal column synapse 1

A

IL nucleus cuneatus or gracilis (medulla)

gracilis = lower limb as gracilis muscle is in the leg

81
Q

Spinothalamic 3rd order neuron

A

Sensory cortex

82
Q

Dorsal column 2nd order neuron

A

decussates in medulla

Then ascends contralaterally in medial lemniscus

83
Q

Dorsal column synapse 2

A

VPL(ventral posterolateral nucleus) of thalamus

84
Q

Lateral corticospinal tract function

A

descending voluntary movement of contralateral limbs

85
Q

Lateral corticospinal tract 1st order neuron

A

UMN (cell body in primary motor cortex)
Descends IL (through internal capsule) until decussating at caudal medulla (pyramidal decussation)
Descends contralaterally

86
Q

Dorsal column third order neuron

A

Sensory cortex

87
Q

Spinothalamic tract function

A

Ascending pain and temperature sensation

88
Q

Lateral corticospinal tract synapse 1

A

cell body of anterior horn of spinal cord

89
Q

Lateral corticospinal tract second order neuron

A

LMN (leaves spinal cord)

89
Q

Spinothalamic 1st order neuron

A

Sensory nerve ending (A-delta and C fibers) (cell body in DRG)
Then enters spinal cord

90
Q

Lateral corticospinal tract synapse 2

A

Neuromuscular junction

91
Q

Spinothalamic tract synapse 1

A

IL gray matter in spinal cord

92
Q

UMN disease signs

A

weakness, hyperreflexia, increased tone, (babinski, spastic paralysis, clasp knife spasticity)

93
Q

Spinothalamic 2nd order neuron

A

Decussates at anterior white commissure

Then ascends contralaterally

94
Q

LMN lesion signs

A

1.weakness, 2. atrophy, 3. fasciculation (twitching) , 4. hyporeflexia, 5. low tone

95
Q

Spinothalamic tract synapse 2

A

VPL of thalamus

96
Q

Romberg test

A

the subject stands with feet together, eyes open and hands by the sides. Then the subject closes the eyes while the examiner observes for a full minute.

97
Q

Spinothalamic 3rd order neuron

A

Sensory cortex

98
Q

Brown-Sequard syndrome

A
  1. Ipsilateral UMN signs below hemisection lesion (corticospinal tract) of spinal cord 2. IL loss of tactile, vibration proprioception sense (dorsal column) below lesion 3. CL pain and temp loss below lesion ( spinothalamic) 4. IL loss of all sensation at level of lesion 5. LMN signs at level of lesion. 6. If lesion above T1 = Horner’s syndrome
99
Q

Lateral corticospinal tract function

A

descending voluntary movement of contralateral limbs

100
Q

Horner’s syndrome

A

sympathectomy of face 1. Ptosis 2. Anhidrosis 3. Miosis - assoc w/ lesion of spinal cord above T1

101
Q

Lateral corticospinal tract 1st order neuron

A

UMN (cell body in primary motor cortex)
Descends IL (through internal capsule) until decussating at caudal medulla (pyramidal decussation)
Descends contralaterally

102
Q

Muscle spindle monitor

A

Muscle length

103
Q

Lateral corticospinal tract synapse 1

A

cell body of anterior horn of spinal cord

104
Q

Golgi tendon monitor

A

Muscle tension

105
Q

Lateral corticospinal tract second order neuron

A

LMN (leaves spinal cord)

106
Q

Biceps reflex

A

C5 nerve root

107
Q

Lateral corticospinal tract synapse 2

A

Neuromuscular junction

108
Q

Triceps reflex

A

C7 nerve root

109
Q

Patella reflex

A

L4 nerve root

110
Q

UMN disease signs

A

weakness, hyperreflexia, increased tone, (babinski, spastic paralysis, clasp knife spasticity)

111
Q

Achilles reflex

A

S1 nerve root

112
Q

LMN lesion signs

A

1.weakness, 2. atrophy, 3. fasciculation (twitching) , 4. hyporeflexia, 5. low tone

113
Q

Babinski reflex

A

dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life.

114
Q

Romberg test

A

the subject stands with feet together, eyes open and hands by the sides. Then the subject closes the eyes while the examiner observes for a full minute.

115
Q

Moro reflex

A

“hang on for life” reflex —abduct/extend limbs when startled, and then draw together - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

116
Q

Brown-Sequard syndrome

A
  1. Ipsilateral UMN signs below hemisection lesion (corticospinal tract) of spinal cord 2. IL loss of tactile, vibration proprioception sense (dorsal column) below lesion 3. CL pain and temp loss below lesion ( spinothalamic) 4. IL loss of all sensation at level of lesion 5. LMN signs at level of lesion. 6. If lesion above T1 = Horner’s syndrome
117
Q

Rooting reflex

A

movement of head toward one side if cheek or mouth is stroked (nipple seeking) - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

118
Q

Horner’s syndrome

A

sympathectomy of face 1. Ptosis 2. Anhidrosis 3. Miosis - assoc w/ lesion of spinal cord above T1

119
Q

Suckling reflex

A

sucking response when roof of mouth is touched - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

120
Q

Muscle spindle monitor

A

Muscle length

121
Q

Palmar/plantar reflexes

A

curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

122
Q

Golgi tendon monitor

A

Muscle tension

123
Q

Pineal gland

A

melatonin secretion, circadian rhythms.

124
Q

Biceps reflex

A

C5 nerve root

125
Q

Triceps reflex

A

C7 nerve root

126
Q

Superior colliculi

A

conjugate vertical gaze center.

127
Q

Patella reflex

A

L4 nerve root

128
Q

Inferior colliculi

A

auditory.

129
Q

Achilles reflex

A

S1 nerve root

130
Q

Babinski reflex

A

dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life.

131
Q

Moro reflex

A

“hang on for life” reflex —abduct/extend limbs when startled, and then draw together - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

132
Q

Rooting reflex

A

movement of head toward one side if cheek or mouth is stroked (nipple seeking) - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

133
Q

Suckling reflex

A

sucking response when roof of mouth is touched - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

134
Q

Palmar/plantar reflexes

A

curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion

135
Q

Pineal gland

A

melatonin secretion, circadian rhythms.

136
Q

Superior colliculi

A

conjugate vertical gaze center.

137
Q

Inferior colliculi

A

auditory.

138
Q

Cranial nerve nuclei

A

located in tegmentum portion of brain stem (b/w dorsal and ventral portions 2. Lateral nuclei are sensory Medial are motor 3. Midbrain III,IV, 4. Pons - V, VI, VII, VIII 5. Medulla IX, X, XI, XII

139
Q

Corneal reflex

A

afferent V1 ophthalmic (nasociliary branch: levator palpebrae), efferent VII (temporal branch: obicularis oculi)

140
Q

Jaw jerk reflex

A

afferent V3 (sensory-muscle spindle of masseter) efferent V3 (motor of masseter)

141
Q

Pupillary reflex

A

Afferent II, efferent III

142
Q

Gag reflex

A

afferent IX, efferent IX and X

143
Q

Nucleus AMbiguous

A

M is for Motor

Vagal nucleus - motor innervation of pharynx, larynx and upper esophagus (swallowing, palate elevation) - IX, X, XI

144
Q

Dorsal Motor Nucleus

A

sends autonomic (Parasympathetic) fibers to heart, lungs, upper GI

145
Q

Nerve through cribiform plate

A

CN I

146
Q

Passes through optic canal

A

CN II, ophthalmic artery

147
Q

Passes through SoF

A

CN III, IV, V1, VI, sympathetic fibers

148
Q

Passes through foramen rotundum

A

V2

149
Q

Passes through foramen ovale

A

V3

150
Q

Passes through foramen spinosum

A

middle meningeal artery

151
Q

Passes through internal auditory meatus

A

VII, VIII

152
Q

Passes through jugular foramen

A

CNIX, X, XI, jugular vein

153
Q

Passes through foramen magnum

A

spinal roots of CNXI, brain stem, vertebral arteries

154
Q

Passes through cavernous sinus

A

CNIII, IV, V1,V2 and VI and postganglionic sympathetic fibers en route to the orbit.

155
Q

Cavernous sinus syndrome

A

opthalmoplegia, ophthalmic and maxillary sensory loss - due to mass effect

Block 6 - Neuroscience (8 decks)

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