Test 2 Review Flashcards
1
Q
Left MCA Superior
A
- Right face & arm weakness (in some cases sensory loss)
- Brocas Aphasia
2
Q
Right MCA Superior
A
- Left face & arm weakness
- Left hemineglect (to a variable extent)
3
Q
Left MCA Inferior
A
- Wernicke’s Aphasia
- Right Visual Field Deficits
4
Q
Right MCA Inferior
A
- Profound Left Hemineglect
- Left Visual Field Deficits
- Right Gaze
5
Q
Left MCA Deep
A
- Right Pure Motor Hemiparesis
- Larger infarcts may produce “cortical” deficits such as Aphasia
6
Q
Right MCA Deep
A
- Left Pure Motor Hemiparesis
- Big Infarct> L Hemineglect
7
Q
Left MCA Stem
A
- R. Hemiplegia
- R. Hemianesthesia
- R. Homonymous Hemianopsia
- Global Aphasia
- L. Gaze @ Onset
8
Q
Right MCA Stem
A
- L. Hemiplegia
- L. Hemianesthesia
- L. Homonymous Hemianopsia
- Profound Hemineglect
- R. Gaze @ Onset
9
Q
Left ACA
A
- Right LE Weakness & Sensory Loss
- Transcortical Motor Aphasia
- Variable Frontal Lobe Dysfunction (release signs)
10
Q
Right ACA
A
- LeftLE Weakness & Sensory Loss
- Left Hemineglect
- Variable Frontal Lobe Dysfunction (release signs)
11
Q
Left PCA
A
- R. Homonymous Hemianopia
- L. Occipital Cortex: Alexia w/o Agraphia
- L. Thalamus & Internal Capsule: Aphasia
12
Q
Right PCA
A
- L. Homonymous Hemianopia
- Smaller Branches: Sensory Loss, Hemiparesis
13
Q
Alexia w/o Agraphia (Left PCA)
A
-Inability to see or read words but able to write
14
Q
CSF Disorders
A
- Increased ICP
- Hydrocephalus
- Ventriculoperitoneal Shunt
15
Q
Ventriculoperitoneal Shunt (CSF Disorders)
A
Treats excess CSF by helping it drain
-May be seen for clients with CP, spina bifida, or head injuries
16
Q
Posterior Blood Supply
A
Aorta> Subcalvian A. Vertebral A.> Basilar A.> PCA
17
Q
Anterior Blood Supply
A
AORTA> COMMON CAROTID> INTERNAL CAROTID> ACA & MCA
18
Q
Cushings Triad
A
- Hypertension
- Bradycardia
- Irregular Respiration
19
Q
Transient Ishemic Attach
A
- Area of temporarily blocked blood flow (blood clot in MCA, blockage in internal carotid)
- Neurologic deficit lasting less than 24 hours caused by temporary brain ischemia
- Typical Duration: 10 min
- Warning signs for larger ishemic injury to brain and predictor of CVA
20
Q
Lateral Motor Systems
A
Distal Limb Movements, Flexors
- Lateral Corticospinal Tract
- Rubrospinal Tract
21
Q
Medial Motor Systems
A
Proximal Limbs/Trunk Movements, Extensors
- Anterior Corticospinal Tract
- Vestibulospinal Tract
- Reticulospinal Tract
- Tectospinal Tract
22
Q
Site of Origin: Lateral Corticospinal Tract (Lateral Motor Systems)
A
Primary Motor Cortex and other fronal and parietal lobe areas
(BA: 4, Precentral Gyrus)
23
Q
Site of Decussation: Lateral Corticospinal Tract (Lateral Motor Systems)
A
Pyramidal Decussation at the cervicomedullary junction
(85-90% of fibers decussate at pyramidal decussation and cross to other side of body; 10% remain ipsilateral and join medial tract (anterior corticospinal)
24
Q
Levels of Termination: Lateral Corticospinal Tract (Lateral Motor Systems)
A
Entire cord (predominantly at cervical and lumbosacral enlargements)
25
Function: Lateral Corticospinal Tract (Lateral Motor Systems)
Movement of contralateral limbs
26
Site of Origin: Rubrospinal Tract (Lateral Motor Systems)
Red Nucleus, magnocellular division
27
Site of Decussation: Rubrospinal Tract (Lateral Motor Systems)
Ventral Tegmental Decussation, in the midbrain
28
Levels of Termination: Rubrospinal Tract (Lateral Motor Systems)
Cervical Cord
29
Function: Rubrospinal Tract (Lateral Motor Systems)
Movement of contralateral lumbs (function is uncertain in humans)
30
Site of Origin: Anterior Corticospinal Tract (MedialMotor Systems)
Primary Motor Cortex and supplementary motor area
| remaining 10-15% of fibers that did not cross over to follow lateral corticospinal tract
31
Site of Decussation: Anterior Corticospinal Tract (Mediall Motor Systems)
Bifurcates at Spinal Cord
32
Levels of Termination: Anterior Corticospinal Tract (Medial Motor Systems)
Cervical and Upper Thoracic Region
33
Function: Anterior Corticospinal Tract (Medial Motor Systems)
Control of Bilateral Axial and Girdle Muscles (proximal muscles)
34
Site of Origin: Vestibulospinal Tract (Medial Motor Systems)
Medial: Medial and Inferior Vestibular Nuclei
Lateral: Lateral Vestibular Nucleus
35
Site of Decussation: Vestibulospinal Tract (Medial Motor Systems)
Medial: Bifurcates immediately at Medial Vestibular Nucleus
-Descends Bilaterally
Lateral: N/A
-Descends Ipsilateral
36
Levels of Termination: Vestibulospinal Tract (Medial Motor Systems)
Medial: Cervical and Upper Thoracic Cord
Lateral: Entire Cord
37
Function: Vestibulospinal Tract (Medial Motor Systems)
Medial: Positioning of Head and Neck
Lateral: Balance (whole body)
38
Site of Origin: Reticulospinal Tract (Medial Motor Systems)
Pontine: Pontine Reticular Formation
Medullary: Medullary Reticular Formation
39
Site of Decussation: Reticulospinal Tract (Medial Motor Systems)
N/A
40
Levels of Termination: Reticulospinal Tract (Medial Motor Systems)
Entire Cord
| -Both Pontine & Medullary: Enter anterior horn, synapse on medial LMN
41
Function: Reticulospinal Tract (Medial Motor Systems)
Automatic Posture and Gait related movements
42
Site of Origin: Tectospinal Tract (Medial Motor Systems)
Superior Colliculus (tectum of midbrain)
43
Site of Decussation: Tectospinal Tract (Medial Motor Systems)
Crosses Immediatley at: Dorsal Tegmental Decussation, in the midbrain
-Descends contralateral, enters anterior horn ends in cervical cord
44
Levels of Termination: Tectospinal Tract (Medial Motor Systems)
Cervical Cord
45
Function: Tectospinal Tract (Medial Motor Systems)
Coordination of Head and Eye Movement (uncertain in humans)
| movements in response to auditory and visual stimuli
46
Lateral Corticospinal Tract & Anterior Corticospinal Tract
- Corticospinal Fibers: Originate in Cortex
- Corticobulbar Fibers: Projects from cortex, to brainstem, to cranial nerve (moves face, tongue, pharynx, larynx, trapezium, and STM)
- All remaining motor tracts originate in brainstem and descend to spinal cord
47
Signs of UMN Lesions
```
Weakness: Yes
Atrophy: No
Fasciculations: No
Reflexes: Increased
Tone: Increased
```
48
Signs of LMN Lesions
```
Weakness: Yes
Atrophy: Yes
Fasciculations: Yes
Reflexes: Decreased
Tone: Decreased
```
49
UMN vs. LMN (&both)
UMN: Primary Lateral Sclerosis, CVA, CP
LMN: Spinal Muscular Atrophy (SMA), Polio, MD, Guillain-Barre Syndrome, Neuropathies
Both: Amyotropic Lateral Sclerosis (ALS) aka Lou Gehrig's & Multiple Sclerosis (MS)
50
Amyotropic Lateral Sclerosis (Both UMN & LMN Affected)
- Respiratory Failure/Death
- Onset 50s-60s years old
- Death within 5 years of diagnosis
51
Multiple Sclerosis (Both UMN & LMN Affected)
Breakdown of myelination
52
Posterior/Dorsal Column Medial Leminiscal Pathway (PCML/DCML)
Function: Vibration, Joint Position, Fine Touch
T6 and above: Fasciculus Cunteatus
T6 and below: Fasciculus Gracilis
Decussation: Internal Arcuate Fibers (Lower/Caudal Medulla)
Synapse: At VPL of thalamus before traveling to primary somatosensory cortex (BA: 1, 2, 3 & postcentral gyrus)
53
Anterolateral System (ALS)
Function: Pain, Temperature, Crude Touch
Decussation: Anterior Commissure (spinal cord)
Synapse: At VPL of thalamus before traveling to primary somatosensory cortex (BA: 1, 2, 3 & postcentral gyrus)
-A pain: Sharp, ACUTE pain
-C pain: Chronic pain, "ouch" sensation
54
Group 1: A-alpha
DCML
-Golgi Tendon Organs and Muscle Spindle Fibers: Proprioception
(Quick Feedback, High Myelination, Large Diameter, Muscle to SC)
55
Group 2: A-beta
DCML
-Muscle Spindle: Proprioception
-Meissners Receptors: Superficial Touch (light)
-Merkels Receptors: Superficial Touch (2pt discrimination)
-Pacinian Corpuscle: Vibration, Deep Touch
-Ruffini Ending: Vibration, Deep Touch
(corpuscle of ruffini ending: stretch of skin)
-Hair Receptor: Touch and Vibration
56
Group 3: A-delta
```
Lateral Spinothalamic (ALS)
-Bare Nerve Endings: Pain (sharp), Temperature (cold), Itch
```
57
Group 4: C
Lateral Spinothamalic
-Bare Nerve Endings: Pain (dull&achy), Temperature (warm), Itch
(Small, Unmyelinated)
58
Transverse Cord Lesion
No sensation and movement below level of injury (T4 would be able to use arm and trunk)
59
Hemicord/Brown-Sequard Syndrom (BSS)
-A rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side
-Hemicord Lesion: Left or right side of spinal cord
(motor&DCML: ipsilateral, ALS: contralateral)
60
Small Central Cord Lesion
- ALS Tract
- Loss of pain and temperature
- Lesion affects decussation at anterior commissure
61
Large Central Cord Lesion
- Sensory and motor
| - Genital Sparing
62
Posterior Cord Lesion
- Only DCML affected
| - Loss of vibration, proprioception, and fine touch
63
Anterior Cord Lesion
- ALS & Motor Tracts
- Loss of pain & temp
- Motor Loss
64
ASIA Exam
American Spinal Cord Injury Association Impairment Scale
-Standardized sensory and motor assessment to determine sensory and motor level for each side of body, single neurological level of injury (NLI) and whether injury is complete or incomplete (light touch or pin prick sensory)
65
Assess Myotome and Dermatome Level
**ZONE OF PARTIAL PRESERVATION (or what is absent)
66
A-E Motor and Sensory Function (asia exam)
- A (complete)-no motor or sensory function is preserved in sacral segments S4-S5
- B (incomplete)- sensory but not motor function is preserved below the neurological level and includes the sacral segments (S4-S5)
- C (incomplete)-motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade of <3.
- D (incoplete)-motor function is preserved b below the neurological level, and at least half of key muscles below neurological level have muscle grade of >=3
- E (normal)-motor and sensory functions are normal.
67
Plegia (asia exam)
C4: Quadraplegia
C6: Quadraplegia
T6: Paraplegia
L1: Paraplegia
68
Upper Extremities (asia exam)
```
C5: Elbow Flexors
C6: Wrist Extensors
C7: Elbow Extensors
C8: Finger Flexors
T1: Finger Abductors
```
69
Lower Extremities (asia exam)
```
L2: Hip Flexors
L3: Knee extensors
L4: Ankle Dorsiflexors
L5: Long Toe Extensors
S1: Ankle Plantar Flexors
```
70
Head and Neck Control and Sensation (asia exam)
- C1-C3: Preserved head and neck sensation, some neck control, respirator dependent
- C4: Good head and neck sensation and motor control, preserved scapular elevation, diaphragmatic movement respiration
- C5: Preserved full head and neck control and sensation, some shoulder strength, shoulder external rotation, shoulder abduction to 90 degrees, elbow flexion and supination
- C6: Fully innervated shoulder movement, forearm pronation, wrist extension
71
Spinal Shock
A state of areflexia (absence of deep tendon reflexes) occurs after SCI
- Includes flaccid paralysis, loss of tendon reflexes, loss of autonomic function.
- Longer the shock, more severe the injury.
- Loss of muscle tone and spinal reflexes below level of injury,
72
Autonomic Dysreflexia
- Life-threatening emergency if left unattended and occurs after spinal shock resolves.
- At or above T6 causes imbalance reflex sympathetic discharge, uncontrolled hypertension.
73
Symptoms of Autonomic Dysreflexia
- Severe Hypertension
- Bradycardia
- Severe Headache
- Vasodilation
- Profuse sweating above lesion level
74
Causes of Autonomic Dysreflexia
- Bladder
- Bowel
- Skin infection
- Tight Clothing
- Other Pain
- Sexual Activity
- Cramps
- Labor
- Ovarian cysts
- Abdominal Conditions
- Bone Fractures
75
Orthostatic hypertension
```
(Postural Hypotension)
-Occurs with SCI at T6 and above
Caused by:
-Interruption to sympathetic outflow to periphery and abdomen
-Drop in BP
-Dizziness
-Pallor
-Excessive sweating above lesion
-Blurry Vision.
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