Year 4 Recap Flashcards

1
Q

What are the exits and entrances to the skull compartment?

A

-Foramina (Foramen Magnum- spinal cord to brainstem)
-Fossa
=Anterior cranial
=Posterior cranial (cerebellum and brainstem)
=Middle cranial (temporal lobes)

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2
Q

Lobe functions

A
  • Executive function: frontal
  • Memory: temporal
  • Visuo-spatial: parietal
  • Language: fronto-temporal
  • Vision: occipital
  • Coordination: cerebellum
  • Pre-central gyrus= MOTOR
  • Post-central gyrus=SENSORY
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3
Q

Areas of deep grey matter

A
  • Basal ganglia

- Thalamus

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4
Q

Location of spinal cord tracts

A
  • Left and right dorsal/ posterior columns (ascending proprioception)
  • Antero-lateral aspect: ascending spinothalamic axons (temperature and pain)
  • Lateral descending upper motor neurone axons
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5
Q

Describe arterial circulation to the brain

A
-Anterior
=L and R carotid
-Circle of Willis anastomosis
(DRAW)
-Posterior
=R+L vertebral= basilar= cerebellum and brainstem
-Prone to embolism
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6
Q

What arteries supply the deep grey structures?

A
  • Lenticulo-striate arteries= basal ganglia and internal capsule
  • Prone to thrombosis due to hypertension or diabetes
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7
Q

Describe the venous circulation of the brain

A
  • Cerebral veins drain into venous sinuses (superior sagittal, inferior sagittal)
  • Then drained into internal jugular vein
  • Thrombotic events= raised ICP
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8
Q

Describe the ventricle system and CSF

A
  • Lateral connected to third= Foramen of Munro
  • Third to Fourth= Cerebral Aqueduct
  • All into central spinal canal
  • 15-20ml CSF in ventricles, volume increases with age
  • Choroid plexus produces CSF in ventricles
  • Absorbed in subarachnoid space into venous sinuses
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9
Q

Describe the location of LMN to head/neck muscle

A
  • Cell bodies= brain stem nuclei

- Axons= cranial nerves

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10
Q

Describe the location of LMN supplying the limb and trunk muscles

A
  • Cell bodies in cord anterior horns

- Axons= roots= peripheral nerves

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11
Q

Describe the location of UMN

A
  • Cell bodies= brain (for classical UMN system in pre-central gyrus)
  • Axons= cortico-bulbar (through internal capsule to brain stem LMN)/ cortico-spinal (spinal cord LMN, crossing in lower medulla so control contralaterally)
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12
Q

Why is the corticobulbar UMN different to corticospinal UMN?

A
  • A need for bilateral UMN control

- Reflex arcs typically involve different cranial nerves

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13
Q

Facial nerve examples of facial movements

A
-Upper face
=Eye closure
=Eyebrow elevation
=Frowning
-Lower face
=Lip closure
=Mouth elevation
=Pouting
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14
Q

Describe UMN control of the facial nerve

A
  • R UMN controls L lower face and all upper face (vice versa with L UMN)
  • A unilateral UMN lesion causes weakness of lower half of other side of face (as upper face has bilateral innervation)
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15
Q

What other examples of different innervation of the head/neck muscles are there?

A
  • Ipsilateral UMN control of Sternomastoid
  • Bilateral UMN control of jaw movements
  • Eye movements: looking left or right
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16
Q

What are the components of the extrapyramidal system?

A
-Basal ganglia
=caudate nucleus
=putamen
=globus pallidus
=subthalamic nucleus 
=substantia nigra
-Certain brain stem nuclei
=red nucleus
=reticular formation
=vestibular nuclei
=olive
=superior colliculus (eye movements)
-Connections to cerebral cortex, cerebellum and LMN
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17
Q

What is the most important EPS loop?

A

-Striatum-Substantia nigra- Striatum loop

=Degenerates in Parkinson’s disease

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18
Q

What are the roles of the basal ganglia?

A
  • To facilitate movements that are required and appropriate in particular contexts
  • To inhibit movements that are unwanted and inappropriate in particular contexts
  • To organise individual movements into complex, sequenced actions
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19
Q

Symptoms of basal ganglia disease

A

-Abnormal motor control
=Bradykinesia/ Akinesia (can be action-specific)
-Alterations in muscle tone (rigidity)
-Abnormal involuntary movements (tremor, chorea)

20
Q

Examples of sensory modalities and how they ascend to the brain

A
  • Simple and discriminative touch
  • Pain and temperature (cross at point of entry and ascends in antero-lateral spinothalamic tracts)
  • Proprioception/ joint position sense (DORSAL COLUMN= ascends same side and crosses to other side at top of brain)
  • Vibration
21
Q

Describe the somatosensory pathway from limbs and trunk

A
  • Receptor
  • Sensory axon runs into peripheral nerve-root to cell body in dorsal root ganglion
  • DRG to spinal cord in white matter tracts to brain
22
Q

How might hemi-cord lesions present differently to a transverse cord lesion?

A

-Right hemi-cord lesion
=Impaired simple touch and proprioception on right
=Impaired spinothalamic on left
-Transverse
=All sensory modalities impaired at site of lesion

23
Q

What are the aspects of vision?

A
  • Colour vision
  • Visual acuity
  • Visual field
24
Q

Describe colour vision defects

A
  • Congenital/ acquired

- Acquired= optic neuritis (inflammation of optic nerve)

25
What is visual acuity?
- Measure of the clarity of vision - Spatial resolution - Refractive errors common, neurologists interested in non-correct visual acuity
26
What is visual field?
-Actual extent of vision in space
27
Describe the visual pathway
- Conjunctiva, cornea, aqueous humour, lens, vitreous humour - Retina - Optic nerve, optic chiasm, optic tract, lateral geniculate nucleus, optic radiation, visual cortex
28
What are the features of the retina?
- Rods= dim, black and white - Cones= bright, colour - Photosensitive ganglion cells= reflex) - Macula= 6mm diameter, yellow oval spot near centre specialised for high acuity vision, 13 degree of central field - Fovea= 1.5mm pit in macula centre so area of greatest VA and colour vision, 3 degrees of central field
29
How does visual space affect optic nerve information?
- Visual information from right visual space hits temporal retina of left eye and nasal retina of right eye - Nasal retina= temporal field and vice versa - Nasal retina so temporal field information crosses to other side in optic chiasm
30
How are major optic defects classed?
- Pre-chiasmal: lost all data from one eye (uni-ocular visual loss) - Chiasm: lost half the data cross (bitemporal hemianopia, pituitary tumours) - Post-chiasm: loose all left visual space data on right post chiasmal area and vice versa (homonymous hemianopia)
31
What are the components of the human ear?
``` -Outer =Pinna =Auditory canal =Tympanic membrane -Middle (small air-filled chamber) =x3 ossicles -Inner ear =hearing and vestibular receptors in membranous labyrinth within bony labyrinth in temporal bone ```
32
What are the components of the inner ear?
- Cochlea (hearing) - Utricle and saccule (vestibular) - Horizontal, anterior and posterior canal (vestibular)
33
What nerves innervate the inner ear?
-Cochlear nerve -Vestibular nerve =Vestibulo-cochlear nerve (8th cranial) to medulla-pons junction
34
What is the vestibular function?
- Perception of position and motion - Static gravitational orientation - Motion in space
35
What components reflect rotations and linear translations and how?
``` -The semi-circular canals (rotation= vertical, sagittal plane and frontal plane axis) =Motion causes flow of fluid within them =Fluid flow stimulates hair cells =Hair cells generate electrical impulses -Otoliths (utricle, saccule)= linear translations =otoliths sit on hairs of hair cells =Motion causes otolith to move =Movement bends hairs =Hair cells generate electrical impulses ```
36
What are the clinical aspects of hearing and vestibular damage?
- Tinnitus and hearing loss | - Vertigo and imbalance/ unsteadiness
37
What are the functions of the cerebellum?
-Motor control =Input of motor and sensory information =Outputs motor control- constant adjustments to actions -Cognitive functions
38
What are the areas of cerebellar control?
- Hemisphere: unilateral limb (ipsilateral so not crossed) | - Midline: trunk, posture, gait
39
Describe ataxic syndrome
- Ataxia of upper limbs - Ataxia of lower limbs - Truncal ataxia - Gait ataxia - Dysarthria (incoordination of tongue) - Nystagmus (eyes) - SENSORY/ MOTOR/ CEREBELLAR/ BRAINSTEM problem
40
What are the dimensions of consciousness?
- Wakefulness (arousal)= the capacity for consciousness | - Awareness= the content of consciousness
41
What does consciousness depend on?
-Intact and interacting... =Brainstem Reticular Activating system (arousal) ==activate thalamus and cerebral cortex =Cerebral hemispheres (awareness)
42
What causes loss of arousal?
``` -Brainstem problems =Structural damage to brainstem =Secondary impairment to brainstem (coning) =Drugs =Widespread brain damage ```
43
What causes loss of awareness?
-Cortical damage =widespread cortical malfunction =relatively intact brain stem
44
What are the cognitive domains?
- Consciousness - Attention, concentration and orientation - Language - Memory - Visuo-spatial function - Executive function
45
What are the main areas of wakefulness?
-Ascending RF of pons and midbrain -Certain thalamic nuclei -Posterior hypothalamus -Basal forebrain =reduced cortical activation in NREM sleep (REM sleep very localised in contrast)
46
What is the glymphatic system?
-Functional waste clearance pathway in the vertebrate CNS =reflects on glial cells =similar to lymphatic system
47
Describe the glymphatic system
- Para-arterial route allows CSF to enter the brain parenchyma - ISF (interstitial fluid) removed from the interstitial compartments of the brain/cord - Exchange of solutes between CSF and ISF driven by arterial pulsation - System regulated, during sleep, by the expansion and contraction of brain extracellular space - ISF removal: soluble proteins, waste products, excess extracellular fluid - Best in slow wave sleep