Week 6 Flashcards
2 types of declarative memory
- episodic memory - recalls events
- semantic memory - recalls facts/information
Guideline for Dementia Eval
- General cognitive Screen - MMSE
- depression screen
- structural imaging - rule out structural causes
- labs: CBC, CMP, LFT, TSH, B12
- special: RPR, FDG-PET, genetic testing
procedural memory
working memory
prospective memory
procedural memory: unconsciously learned skills
working memory: manipulation of information
prospective memory: remembering to remember
which lobe is being tested in the following assessments?
List learning (MMSE)
Copy (visual memory)
recall later (visual memory)
List learning (MMSE) - dominant medial temporal lobe Copy (visual memory) - biparietal lobes recall later (visual memory - non-dominant medial temporal lobe
Frontal lobe function tests
Preservation: mnmnmnmnmn
set shifting - Trails: 1 Sunday 2 Saturday….
response inhibition - Stroop: colored words
Phonemic Fluency: F-word in 60 secs quality vs quantity
Deferential Dx of Dementia
VITAMINS C D
vascular, infection, trauma, autoimmune, metabolic/toxic, inflammation, neoplastic, seizure, congenital/developmental (inherited), degenerative
What are the 2 components of Nystagmus
smooth pursuit
saccade
*nystagmus is described in terms of the direction of saccade
What are the accessory oculomotor nuclei and their functions
riMLF - integrator for vertical saccade
INC
PPRF - integrator for horizontal saccade
pretectal area
All the inputs to VNC
vestibular input:
crista (semicircular canals) terminate in S, MVN
maculae (sacculus and utriculus) terminate in LVN
spinovestibular input:
from all level of spinal cord - proprioreceptive input
cerebellar input:
vestibulocerebellum(floccular node) –> FN –> VNC –> VST
spinocerebellum (vermis) –> fastigial nucleus –> VNC–> ReSt, VST
from bilateral fastigial via juxarestiform body
accessary oculomotor input:
from visual cortical areas via accessary oculomotor nuclei
Cortical area that have voluntary saccade control
dorsolateral prefrontal cortex
FEF
posterior parietal cortex
Cortical area that can smooth tracking moving objects
temporal eye field
occipital cortex
voluntary saccade scheme
PPC, FEF –> superior colliculus –> PPRF –> VI –> III
vestibulo-thalamo-cortical tract
cortical perception of movement (3a, 2b)
peripheral vs central lesion on vestibular
peripheral lesion:
CN VIII, unilateral peripheral lesion: vertigo, nausea, unsteadiness ( fall towards the side of lesion, nystagmus opposite to lesion
central lesion:
VNC lesion, absent vertigo, Romberg (fall away from lesion), nystagmus towards lesion
Saturday night palsy
- schwann cells are damaged in area of compression
- AP can’t propagate across compression site: conduction block - neuropraxia!
- requires several hours of compression
- recover by local dismantling and rebuilding of myelin sheath
Wallerian degeneration
- cell body swells & RNA synthesis increases
- immediate failure of AP, but delayed loss of distal responsiveness
- myelin degeneration and axonal atrophy in 5 days
- axonotmesis/ neurotmesis
aberrant reinnervation
some axons end at different destination than original during reinnervation of surviving axons
How to fix denervation
- regeneration of injured axon
- sprouting : reinnervation
Neuropathy
dysfunction in motor, sensory or autonomic function alone
Define radicle
radicle = dorsal and ventral roots + spinal nerve
radiculopathy
nerve becomes compressed in the spinal foramen by
- herniated nucleus pulposus (soft disc)
- osteophyte (hard disc)
Radiculopathy
Sx corresponds to myotome/ dermatome/ sclerotome of compressed nerve
2 types of plexopathy
- brachial
- lumbosacral
- pattern of involvement in a limb > individual nerve/root lesion
Mononeuropathy
abnormality of individual peripheral nerve
- can be compression/ trauma
- e.g. bell’s palsy, carpal tunnel syndrome, cubital syndrome….
