Week 7.2 Flashcards
What is the posterior association area?
a cortical region responsible for processing multimodal sensory information from multiple first order association cortices
What are the two divisions of the posterior association area?
- dorsal stream: unconscious, relationship between objects
- ventral stream: conscious, object recognition
Which hemisphere is a person’s dominant hemisphere?
that which is responsible for symbolic reasoning (language)
The Folstein MMSE fails to test what two parts of the brain in any significant way?
executive functioning and the non-dominant hemisphere
How do we test the non-dominant hemisphere?
construction tasks
What is Broca’s area? Where is it in relationship to Wernicke’s area?
- anterior to Wernicke’s area
- functions in speech production
What is the purpose of the direct fascicle between Wernicke’s and Broca’s areas?
allows you to repeat something without understanding it
What three aspects of language do we typically assess?
- fluency
- comprehension
- repetition
How does Broca’s aphasia present?
- comprehension intact
- non-fluent
- unable to repeat
How does Wernicke’s aphasia present?
- fluent, nonsensical speech
- repetition absent
- comprehension absent
What is conduction aphasia?
intact comprehension and fluency but absent repetition
What is a trans-cortical sensory aphasia?
a lesion that disconnects Wernicke’s area from the posterior association cortex
How does trans-cortical sensory aphasia present?
- fluent speech
- repetition in tact
- comprehension absent
Why are trans-cortical sensory and motor aphasias common?
because the tracts that connect Wernicke’s and Broca’s to the rest of the cortex often reside in watershed zones
What is alexia without agraphia?
- speech fluency and comprehension in tact
- ability to write in tact
- ability to read is absent
What causes alexia without agraphia?
one between the visual association cortex and Wernicke’s area caused by a PCA stroke that also affects part of the corpus callosum
Alien hand syndrome is often the result of damage to what part of the brain?
the non-dominant hemisphere
How is dementia defined?
an acquired persistent intellectual impairment involving at least three domains: language, memory, visuospatial, emotion, executive
What is the primary difference between a cortical and a subcortical dementia?
subcortical is more likely to have motor signs
Fronto-temporal dementias often leave what abilities intact?
- memory
- language
- construction
Focal dementias are more likely than diffuse ones to have what sort of etiology?
a non-degenerative one
What are two non-degenerative etiologies for subcortical dementia?
- subcortical infarcts
- multiple sclerosis
What are the four most prevalent causes of dementia?
- Alzheimer’s
- Parkinson’s
- Dementia with Lewy Bodies
- Vascular Dementia
What is a primary headache?
a headache without a known cause
Which structures in the cranium are capable of sensing pain?
- orbits
- paranasal sinuses
- teeth
- dural sinuses
- blood vessels
What is a migraine?
a severe headache
What is a common migraine?
an episodic migraine with two or more of unilateral, throbbing, nausea, photophobia and phonophobia
What is a classic migraine?
a migraine with aura
What are the most common kinds of aura that precede migraines?
- visual hallucinations
- a unilateral tingling
What is the current hypothesis of what causes migraines?
abnormal innervation of large vessels by trigeminal nerve leads to peripheral pain sensitization
What is the distinguishing feature of an ophthalmoplegic migraine?
third nerve palsy
What is an acephalic migraine?
aura without the following headache, common in older patients
What is status migrainosus?
a migraine lasting longer than three days
What are some treatments for migraines?
- NSAIDs/narcotics
- triptans
- antiemetics
- caffeine
What are triptans?
5HT agonists used as abortive treatments for headaches
What are some migraine prophylactics?
- antiepileptics
- antidepressants
- beta blockers
- botulinum toxin
How are tension-type headaches treated?
- stress management
- exercise
- TCAs
- SSRIs
- NSAIDs
What is a transformed migraine?
a form of chronic migraine in which frequency increases until the individual has a continuous low-grade headache between migraines as well
What often causes chronic migraines?
the overuse of abortive treatments (most often opioids) by physicians rathe than prophylaxis
Describe a cluster headache.
- severe, unilateral and per-orbital
- temporally clustered
Chronic secondary headaches are often due to what?
- degenerative joint disease of the neck
- TMJ
- sinus disease
- psychologic problems
- refractive eye problems
What might suggest a sinister cause of chronic headaches?
- new onset after 35
- focal neural findings and altered mental status
- elevated ICP
- inflammation, fever, or neck stiffness
What are two sinister causes of secondary recurrent headaches?
- pseudotumor cerebri
- giant cell arteritis
What is a pseudo tumor cerebri?
resistance to flow in the arachnoid villi causing headaches
What are the symptoms of pseudo tumor cerebri?
- headahe
- episodic blurred vision
- papilledema
- normal head imaging
How does giant cell arteritis present?
- over 50
- temporal artery tenderness
- elevated ESR
What are some possible causes of acute severe headache?
- meningitis
- subarachnoid hemorrhage
- mass lesion
What is the internal medullary lamina?
a white mater tract that divides regions of the thalamus
What are the thalamic motor nuclei?
VA and VL
What are the limbic nuclei of the thalamus?
Anterior and MD
Where does input into the VPL and VPM come from?
the DCML/ALS and face, respectively
The MD nucleus of the thalamus receives input from where?
the olfactory system
The MGN nucleus of the thalamus receives input from where?
the inferior colliculus and projects to the primary auditory cortex
What is the pulvinar nucleus?
a thalamic nucleus that receives a broad, multi sensory input and has a broad output to alert us to new visual stimuli
The VPL receives input from __ and projects to the ___.
- from DC/ML and ALS
- to the somatosensory cortex
Which thalamic nucleus is part of the Papez circuit?
the anterior nucleus
Korsakoff’s syndrome involves damage to which thalamic nucleus?
the mediodorsal nucleus
A lesion to the pulvinar nucleus of the thalamus causes what?
neglect syndrome
Thalamic pain occurs following occlusion of what vessel?
the thalamogeniculate artery (branch of PCA)
What is thalamic pain syndrome?
a thalamogeniculate occlusion causes a small lacunar stroke that results in contralateral sensory loss followed some time later by an excruciating, intractable pain
What are the three parts of the internal capsule?
- anterior limb
- genu
- posterior limb
What fibers are carried in the anterior limb of the internal capsule?
- frontoponteine fibers for cerebello-thalamo-cortico-pontine feedback
- other corticothalamic fibers
What fibers are carried in the gene of the internal capsule?
corticobulbar fibers
What fibers are carried in the posterior limb of the internal capsule?
- corticospinal
- somatosensory, visual, and auditory
