Workbook questions 1 - The brain

Question 1

Akinesia

Answer 1

Absence or loss of power of voluntary

movements

Question 2

Loss of purposeful movements despite
the preservation of muscular power,
sensation and co-ordination

Answer 2

Apraxia

Question 3

Agnosia

Answer 3

Impaired communication by speech

Question 4

Areflexia

Answer 4

Absence of reflexes

Question 5

Ataxia

Answer 5

Loss of muscular co-ordination.

Question 6

Bradykinesia

Answer 6

Slowness of movement

Question 7

Dysphagia

Answer 7

Difficulty in swallowing

Question 8

Slowing or slurring of speech
due to loss of co-ordination of
muscles of speech.

Answer 8

Dysarthria

Question 9

Any disorder of voice production

Answer 9

Dysphonia

Question 10

Dysdiadochokinesis

Answer 10

Difficulty in doing

repetitive movements

Question 11

Dyslexia

Answer 11

Showing a level of
reading/writing below
expected for measured IQ

Question 12

What is anencephaly? How does it arise?

Answer 12

Due to its complex embryology, abnormal development of the brain is common (about 3 in 1000 births) most result from a failure of the rostral neuropore to close. In the most serious congenital abnormality, anencephaly, there is a more or less complete absence of the brain.

Question 13

What would be the consequences of a failure of the neural fold to fuse in the lumbosacral region of spinal cord? What is this condition called?

Answer 13

Most congenital abnormalities of the spinal cord arise from a failure of the caudal neuropore to close. The commonest condition is called spina bifida when the vertebral arch fails to grow normally and to fuse.

Question 14

What condition arises if (a) the meninges herniate through the unfused region of the lumbar spine?

Answer 14

spina bifida meningocele

Question 15

What condition arises if (b) the cord and meninges herniate through the unfused region of the lumbar spine?

Answer 15

Spina bifida myelomeningocele or simply myelomeningocele

Question 16

What condition arises if too much cerebrospinal fluid accumulates in the ventricles of the brain?

Answer 16

An imbalance between the production and absorption of the CSF leads to an accumulation of fluid in the ventricles of the brain. This accumulation of fluid may cause a significant expansion of the head - hydrocephalus.

Question 17

How is hydrocephalus corrected after birth?

Answer 17

Normally a drain is inserted - a shunt - which shifts CSF into the jugular vein or peritoneum

Question 18

Identify vertebrae L3 & L4 on a skeleton - why is this an important landmark when planning a lumbar puncture?

Answer 18

• L3 & L4 is defined by the supracristal plane, an imaginary line joining the crests of both hips
• This is palpable as the top of the hips
• The spinal cord is shorter than the vertebral canal. The cord ends at vertebral level L2/L3 (or L1/2 in some texts) whilst the vertebral canal, now called the lumbar cistern and containing fibres of the corda equina extends to S2/S3. In a lumbar puncture a sample of CSF is drawn from the lumbar cistern by inserting a needle between L3 & L4 where there is no danger of damage to the spinal cord.
• To give an epidural block an anaesthetic agent is introduced into the lumbar cistern to block sensation in structures innervated by the cordal equina.

Question 19

Would you use a different landmark to give a lumbar puncture in a baby? Why?

Answer 19

• In the early foetus the spinal cord fills the vertebral canal.
• As growth proceeds the vertebrae grow faster than the cord so that at birth the spinal cord ends at L3
• As most neural tissue is laid down at birth, during growth, neural tissue only matures .
• Differential growth through adolescence brings the cord to its adult position i.e. ending at the level L1/L2 or L2/3, bearing in mind inter-individual variation.

Question 20

vertebral fracture at T12 may paralyse the bladder. Why is this, bearing in mind that the bladder is innervated by nerves arising from spinal cord segments S2 - S4?

Answer 20

Because the spinal cord is shorter than the vertebral column, the correspondence between the origin of the spinal nerves and their entry/exit to the vertebral column is progressively lost toward the caudal end. Therefore spinal nerves entering/leaving through foramen in lumbar and sacral vertebrae, enter the spinal cord at positions equivalent to vertebral level T11 - to L1. Fractures in this region may affect structures innervated by lower spinal cord segments

Question 21

Give 3 Reasons Why Familiarity With the ventral (or inferior) aspect of The Brain is important

Answer 21

1) Almost all cranial nerves emerge from the brain from its ventral aspect. Vulnerability of
the base of the skull to impact trauma means that cranial nerves and ventral brain structures are equally vulnerable to such injuries.

2) The relationship between the pituitary, hypothalamus and optic nerves are immediately obvious when the brain is seen from this aspect. Effects of hypothalamic tumours on neuronal function can be better understood with familiarity of the ventral aspect of the brain
3) The uncus is readily seen from this aspect of the brain. The close relationship between the uncus and oculomotor nerve is obvious here. Thus, it makes anatomical sense to predict that uncal herniation naturally leads to impairment of peripheral targets of the oculomotor nerve