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year 2 sem 1 > wk 3 neurology > Flashcards

wk 3 neurology Flashcards

1
Q

perception

A
  • the way we perceive our environment
  • dorsal stream - where
  • ventral stream - what - sends info to temporal lobe
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2
Q

anterior visual pathway

A
  • Photons come in through the pupils
  • Get to back of eye to cause electrical signal
  • Travel through anterior visual pathway to occipital cortex
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3
Q

attention

A
  • Part of cognitive functions called EXECUTIVE functions
  • Reflective of frontal lobe functioning (PFC)
  • Dysfunction is key sign in delirium (acute confusional state)
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4
Q

types of attention

A
  • focused attention
  • sustained attention
  • selective attention
  • alternating attention
  • divided attention
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5
Q

bottom up perception

A

stimulus quality and accuracy of perception

- “garbage in garbage out”

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6
Q

top down perception

A

influence of action

- we see what were looking for

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7
Q

areas in the brain linked to memory

A

in occipital lobe

  • site of visuo-spatial sketch-pad
  • looped around for further processing if necessary
  • connected to prefrontal cortex
  • phonological lope
  • auditory stimuli
  • Broca’s and wernicke’s areas connection
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8
Q

areas of the brain linked to working memory

A
  • prefrontal cortex
      • episodic buffer
  • in parietal lobe
      • spatial and 3D processing
      • linked to prefrontal cortex
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9
Q

hippocampus

A
  • important in converting short-term memory to long-term mems
  • gates prod. of long-term mems
  • damage to it results in anterograde amnesia - can’t make any more long-term mems
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10
Q

procedural memories

A

split between basal ganglia
- important for repetitive and frequent actions
cerebellum
- important for skilled movement eg playing piano

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11
Q

declarative memories

A
  • facts, data, events etc
  • not localised to any part of brain
  • stored loosely throughout cerebral cortex
  • small mems from hippocampus are transferred to neocortex in a distributive way - usually during sleep
  • memory problems can be caused by sleep disorders
  • in dementia memory loss graceful
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12
Q

reasoning

A

-reflect highly developed (pre)frontal lobes in humans

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13
Q

sequence of events in brain when planning movement

A
  • info from parts of brain (visual perception, auditory perceptions from back of brain etc)
  • shuttled forward to prefrontal cortex (interpretation/ a plan for movement)
  • then to premotor cortex (how muscles are going to move/ sequencing)
  • then to PMC (movement of muscles/ action)
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14
Q

goal setting

A

evolutionary goals

  • self maintenance - heat, thirst, hunger
  • self-propagation - affiliation and sex
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15
Q

where do goals come from

A 
bottom up goals
- limbic system
top down goals 
- prefrontal cortex
- gives cognitive feelings - beliefs and emotions
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16
Q

limbic system

A 
collection fo structures deep in the brain - from the diencephalic and mesencephalic structures embryologically
contains the...
-hypothalamus
-nucleus accumbent
-medial forebrain bundle
-ventral tegmental area
-amygdala
If objects are useful to goals limbic system gives pos. emotion
if harmful give neg. emotion
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17
Q

amygdala

A
  • negative emotions such as fear and anxiety
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18
Q

Salience

A

the limbic drive to invest perceptual resource in significant stimuli

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19
Q

the anterior stream

A

on top of ventral and dorsal streams

  • so what stream
  • decides if low level info is worth investing ventral stream energy to figure out what we’re looking at
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20
Q

If the limbic system and prefrontal lobe decide to invest in a percept…..

A

2 responses…
1- limbic system activates the hippocampus
- if something is useful or harmful then good to make a longterm memory for future guidance
2- pathway to frontal lobe - attentional control centre activated
- signals from ACC activate ventral stream
- tell ventral stream to figure out what input is

Next…

  • integrate all the diff. info
  • send to frontal lobe to figure out what to do
  • sequence activity
  • send sequence to PMC to instruct muscles to move
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21
Q

where does value lie in perception

A

1- we can learn from it

2- it can guide future actions

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22
Q

how we “make a plan”

A

1- a ‘best-guess’ about what reality currently is
2- a commitment to some goal (top down, bottom up motivation)
3- hypothesis generation
4- action in the world
5- dynamic monitoring of whether or not goal is getting closer or further away

23
Q

what does top down and bottom up motivation mean

A 
top down
- PFC influence
- higher order volitions
- more philosophical and deep
bottom up
- limbic influence 
- primary volitions
- insights from addiction, compulsions, personality disorders
- more basic
24
Q

wernicke-geschwind model for language

A 
Broca
- frontal lobe
- production of language
Wernicke
- parietal temporal occipital junction (PTO)
- comprehension
AF (arcuate fasciculus)
- connects B&W
25
Q

what side of the brain are centres for language

A
  • On the left for about 80%
  • On the right for about 10%
  • On both side for about 5%
26
Q

damage to language areas

A 
Broca
- 'expressive' aphasia
- inability to find word you're looking for
Wernicke
- 'receptive' aphasia
- patients aren't able to understand
- talk alot but nonsense as not self-monitoring
AF
- 'conductive' aphasia
- relatively normal
- unable to repeat something
can't join up the understanding with the action
27
Q

clinical aphasia (associated damage)

A
  • Fluent – Wernicke or ‘phonological loop’

- Non-fluent – Broca’s, or output paths

28
Q

cognitive assessments

A 
MMSE
- very limited, poorly responsive other than in advanced dementia
Addenbrooke's Cognitive Examination III
- useful takes ~20 mins
- scored out of 100
29
Q

what are the big 5 personality traits

A 
oppeness
conscientiousness
extroversion
agreeableness
neuroticism
30
Q

neural theories behind the big 5 personalities

A 
Openness 
-Highly sensitive to DA spikes in PFC
Conscientiousness
-High connectivity within PFC centres
Extroversion
-Good face recognition (VC) and connectivity to amygdala
-High serum oxytocin
Agreeableness
-Good recognition of facial emotion expression
-Enlarged superior temporal gyrus
Neuroticism
-High connectivity from amygdala to PFC (fear/anxiety inc.)
31
Q

clinical relevance of the big 5 personalities

A 
Openness
-Mixed reports of relationship to health
Conscientiousness
-Increased life success and subjective wellbeing
-More likely to adhere to treatment
Extroversion 
-Increased subjective wellbeing
Agreeableness
-Increased subjective wellbeing
Neuroticism
-Increased risk of mood disorders
-Increased risk of substance misuse disorders
32
Q

the autonomic nervous system

A
  • Controls internal environment
    oWorks together with the endocrine system
    oControls important functions not under voluntary control
33
Q

divisions of the ANS

A

-Sympathetic – “fight, flight, or fright”
o Activated during exercise, excitement and emergencies

-Parasympathetic – “rest and digest”
o Concerned with conserving energy

  • Innervate mostly the same structures
  • Cause opposite effect
  • Maintain homeostasis
34
Q

spinal outflows of ANS

A

-Parasympathetic c
o Cranial-sacro outflow
-Sympathetic
o Thoraco-lumbar outflow

35
Q

enteric NS

A

Intrinsic collections of neurones within the wall of the digestive tract, and can function independently of the CNS or PNS.
- run from mouth to anus through alimentary tract

36
Q

SNS - basic organisation

A

oIssues from T1-L2
oPreganglionic fibres from the lateral grey horn of spinal cord
oSupplies visceral organs and structures of superficial; body regions
oContain more ganglia than the parasympathetic divisions

37
Q

sympathetic trunk ganglia

A

oLocated on both sides of the vertebral column
oLinked by short nerves into sympathetic trunks
oJoined to ventral rami by white and gray rami communicans
oFusion of ganglia -> fewer ganglia than spinal nerves

38
Q

pre-vertebral ganglia of the SNS

A

the second neurone in sympathetic chain
oSome will run through sympathetic chain without synapsing to prevertebral ganglia
Prevertebral ganglia occur only in abdomen and pelvis
Lie anterior to the vertebral columns
Main ganglia include – coeliac, superior mesenteric, inferior mesenteric, inferior hypogastric ganglia

39
Q

pharmacology of SNS

A

-Vast majority of neurotransmitter used in the symp. System is nor-adrenaline
-Recepotors….
oAlpha 1 located most smooth muscle in arterioles causing vasoconstriction
oAlpha 2 located on coronary arteries causing vasodilatation
oBeta 1 located on cardiac muscle causing increased contractility
oBeta 2 found in sino-atrial node to increase heart rate, in some smooth muscle in arterioles (esp. skeletal muscle ) causing vasodilation and in smooth muscle of bronchi causing bronchodilation

40
Q

parasympathetic NS outflow - cranial outflow

A 
oComes from nerves in brainstem
oInnervates organs of the head, neck, thorax, and abdomen
oPreganglionic fibres run via
Oculomotor nerve (III)
Facial nerve (VII)
Glossopharyngeal nerve (IX)
Vagus nerve (X)
41
Q

parasympathetic NS outflow - cranial outflow - outflow via the vagus nerve

A

Fibres innervate the visceral organs of the thorax and abdomen
Stimulates – digestion, red. In HR and BP
Preganglionic cell bodies
•Located in dorsal motor nucleus
Ganglionic neurons
•Confined within the walls of organs being innervated
oCell bodies located in cranial nerve nuclei in the brain stem

42
Q

parasympathetic NS outflow - sacral outflow

A

oSupplies remaining abdominal and pelvic organs
oEmerges from S2-S4
oInnervates organs of pelvis and lower abdomen
oPreganglionic cell bodies
Located in visceral motor region of spinal gray matter
oFrom sphlanchnic nerves

43
Q

pharmacology of the Parasympathetic System

A

Acetylcholine (Ach) binds to nicotinic and muscarinic receptors

44
Q

comparison of Autonomic and somatic motor system

A

Somatic

  • One motor neuron extends from the CNS to skeletal muscle
  • Axons are well myelinated, conduct rapidly

Autonomic
-Chain of 2 motor neurons
oPreganglionic neuron
oPostganglionic neuron
-Conduction is slower due to thinly or unmyelinated axons
-Autonomic ganglia close to the viscera being innervated

45
Q

anatomical differences of the sympathetic and parasympathetic divisions

A

Arise from different regions of the CNS

  • Sympathetic – also called the thoracolumbar division
  • Parasympathetic – also called the cranio-sacral division

Length of postganglionic fibres

  • Sympathetic – long postganglionic fibers
  • Parasympathetic – short postganglionic fibers
Branching of axons
-Sympathetic axons – highly branched 
o	Influences many organs
-Parasympathetic axons – few branches 
o	Localised effect
46
Q

differences in the neurotransmitters in the ANS

A

Neurotransmitters of Autonomic Nervous System
-Neurotransmitter released by preganglionic axons
oAcetylcholine for both branches (cholinergic – nicotinic receptors)

-Neurotransmitter released by postganglionic axons
oSympathetic – most release noradrenaline (adrenergic)
oParasympathetic – release acetylcholine (muscarinic receptors)

47
Q

the adrenal medulla

A

The role of the adrenal medulla in the sympathetic division –

  • Major organ of symp. Nervous system
  • Secretes adrenaline and noradrenaline
  • Stimulated to secrete by pre-ganglionic sympathetic fibres
48
Q

central control of the ANS

A

oReticular formation exerts most direct influence
 Medulla oblongata
 Periaqueductal gray matter
oControl by the hypothalamus and amygdala
 Hypothalamus – main integration center of the ANS
 Amygdala – main limbic region for emotions
oControl by cerebral cortex

49
Q

clinical manifestations of ANS

A
  • Eg in diabetes its important
  • Dizziness, dry mouth or eyes, fatigue, gastric disturbance, malnutrition, constipation and diarrhoea, sexual dysfunction
50
Q

Horner’s Syndrome

A
  • Miosis
  • Ptosis (drooping eyelid)
  • Lots of sweating same side of face
  • Redness of conjunctiva
  • From interruption of symp. Flow to that eye
  • Lesion of symp fibres centrally or peripherally

-Causes…
oCarotid artery dissection, brainstem stroke, syringomyelia

51
Q

Syncope

A
  • Vasovagal syncope – simple faint, seen commonly in young people with no underlying illness
  • Sudden vasodilation often caused by strong emotion
o	Peripheral resistance decreases in arterioles and blood pressure falls
o	Cardiac rate fails to increase
o	Vagal stimulation leading to bradycardia and perspiration
o	Increased peristalsis
o	Yawning
o	Nausea 
o	Pallor
o	Salivation
52
Q

Orthostatic Hypotension

A
  • Like vasovagal syncope but brought on by getting up from reclines pos. or standing still for long periods
  • Mild staggering, falling, loss of consciousness
53
Q

Problems with bladder control

A
  • Prime eg of autonomic dysfunction
  • Common in MS (75%)
  • Main symptoms are urgency, frequency, and urge on incontinence
  • Main cause is overactivity of detrusor muscle, involuntary bladder contraction gives rise to feeling of need to void immediately despite bladder vol. being low.
54
Q

tests for abnormality of the ANS

A

-Pupil reactions
-Postural BP response
o By bedside – a fall >30mmhg systolic and >15mmhg diastolic is abnormal
-Variation of HR with deep breathing (sinus arrhythmia)
-Lacrimal function

year 2 sem 1 (13 decks)

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