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DU PA Neuro Ana/appr

DU PA Neuro Anatomy Review/Approach to the Neuro Patient

symptom of "light headed" may be indicative of cardiac insufficiency
symptom of "off balance" may be indicative of cerebellar or posterior column disfunction
small lesions in high traffic areas such as the brain or spinal cord may lead to widespread neurologic disfunction
pain is usually due to a lesion of the peripheral nervous system
aphasia is usually due to a lesion of the central nervous system
degenerative diseases progress gradually
vascular diseases progress rapidly
location: limb clumsiness ipsilateral cerebellar hemisphere
location: unsteadiness of gait or posture midline cerebellar structures
location: slowness of voluntary movement substantia nigra and striatum
location: involuntary movement striatum, thalamus, subthalamus
location: unilateral weakness or sensory complaints contralateral cerebral hemisphere
location: language disfunction left hemisphere (frontal and temporal)
location: spatial disorientation right hemisphere (parietal and occipital)
location: anosognosia (lack of insight into deficit) right hemisphere (parietal)
location: hemivisual loss contralateral hemisphere (occipital, temporal, and parietal)
location: flattening of affect or social disinhibition bihemispheric (frontal and limbic)
location: alteration of consciousness bihemispheric (diffuse)
location: alteration of memory bihemispheric (hippocampus, fornix, amygdala, and mammillary bodies)
location: double vision midbrain and pons
location: vertigo pons and medulla
location: alteration of consciousness midbrain, pons, medulla (reticular formation)
location: weakness and spasticity (ipsilateral) and anesthesia (contralateral) below a specific level corticospinal and spinothalamic tracts
location: unsteadiness of gait posterior columns
location: bilateral (can be asymmetric) weakness and sensory complaints in multiple contiguous radicular distributions central cord
location: weakness and wasting with muscle twitching (fasciculation) but no sensory complaints anterior horn of spinal cord (diffuse or segmental)
location: weakness and sensory loss confined to a known radicular distribution (pain, a common feature, may spread) cervical, thoracic, lumbar, and sacral
example: autosomal dominant Huntington's disease
example: autosomal recessive Friedreich's ataxia
example: sex-linked recessive Duchenne's muscular dystrophy
example: sporadic genentic Down syndrome
example: intrinsic neoplastic glioblastoma
example: extrinsic neoplastic metastatic melanoma
example: paraneoplastic cerebellar dengeneration
example: stroke thrombotic, embolic, lacunar, hemorrhagic
example: structural arteriovenous malformation
example: inflammatory cranial arteritis
example: bacterial Meningococcal meningitis
example: viral herpes encephalitis
example: protozoal toxoplasmosis
example: fungal cryptococcal meningitis
example: helminthic cysticercosis
example: prion Creutzfeldt-Jakob disease
example: central degenerative Parkinson's disease
example: central and peripheral degenerative amyotrophic lateral sclerosis
example: autoimmune, central demylinating multiple sclerosis
example: autoimmune, peripheral demyelinating Guillain-Barre syndrome
example: autoimmune, neuromuscular junction myasthenia gravis
example: endogenous, toxic/metabolic uremic encephalopathy
example: exogenous, toxic/metabolic alcoholic neuropathy
example: psychogenic hysterical paraparesis
__ is most often used to investigate seizures, and is also used to evaluate brain death electroencephalography
__ are commonly used in the evaluation of probable multiple sclerosis visual-evoked potential studies
Alertness or state of awareness of the environment level of consciousness
the ability to focus or concentrate over time on one task or activity attention
recent or short term memory covers __ minutes, hours, or days
remote or long-term memory refers to intervals of years
awareness of personal identity, place, and time; requires both memory and attention orientation
sensory awareness of objects in the environment and their interrelationships (external stimuli), also refers to internal stimuli such as dreams or hallucinations perceptions
the logic, coherence, and relevance of the patient's thought as it leads to selected goals; how people think thought processes
what the patient thinks about, including level of insight and judgement thougth content
awareness that symptoms or disturbed behaviors are normal or abnormal insight
process of comparing and evaluating alternatives when deciding on a course of action, reflects values that may or may not be based on reality and social conventions or norms judgment
an observable, usually episodic, feeling or tone expressed through voice, facial expression, and demeanor affect
a more sustained emotion that may color a person's view of the world mood
mood is to affect as climate is to __ weather
a complex symbolic system for expressing, receiving, and comprehending words language
assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have two or three dimensions higher cognitive functions
toward the CNS afferent
away from CNS efferent
superior or toward the cranium rostral
inferior or toward the sacrum caudal
anterior or front of body ventral
posterior or back of body dorsal
thick outer layer of meninges dura mater
thin middle layer of meninges thin middle layer
delicate, highly vascular layer of meninges pia mater
usually caused by a rupture of the middle meningeal artery associated with trauma epidural hematoma
usually due to a rupture in the veins that drain into the dural sinuses subdural hematoma
most often associated with head trauma subdural hematoma
may take 24 hours to 2 weeks to fully develop subdural hematoma
presents with a "thunderclap" and the "worst headache of my life" subarachnoid hemorrhage
nourishes neuronal tissue, removes metabolic wast, extends into subarachnoid space surrounding cranial nerves and spinal cord CSF
main passageway for ascending and descending fiber tracts in the brain. Almost all neural traffic to and from the cerebral cortex passes through it internal capsule
when this area is destroyed, no dopamine flows to the basal ganglia. This leads to parkinson's disease substantia nigra
the cerebellum has an __ effect on movement ipsilateral
if the __ is damaged there is no paralysis, just slow, clumsy, tremulous, uncoordinated movements cerebellum
relay station of the brain. Contains the thalamus, and hypothalamus diencephalon
all sensory tracts from the body synapse in the thalamus before being directed to the cortex except __ olfactory
controls autonomic functions, regulates homeostasis, coordinates neural and endocrine functions hypothalamus
emotional behavior and memory, bridge between the autonomic and voluntary responses to change in the environment limbic system
involved in signaling stimuli related to reward, fear, motivation. Emotional learning limbic system
required for the formation of long-term memories hippocampus
contributes to cognitive processing including attention cingulate gyrus
part of the brainstem, plays a central role in bodily and behavioral alertness. Crucial for maintaining the state of consciousness reticular activating system
A clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma concussion
inability to use language, loss of access to the symbols that we use to represent concepts aphasi
few words written or spoken. Less difficulty comprehending. Broca's aphasia
able to produce written and spoken words. More deficient in comprehension. Wernicke's aphasia
gray matter destruction from chronic alcohol use. Korsakoff's psychosis
pain or pressure registered in non-nervous tissue structures such as meninges or arteries headahce
spinal cord ends at L1-L2
for a lumbar puncture the needle is inserted between the __ vertebrae (the level of the iliac crest) to avoid spinal nerves L4-L5
disorder in which two sides of the vertebral arches fail to fuse during development, results in an open vertebral canal spina bifida
dermatomal area of groin is innervated by L1
dermatomal area of shoulder is innervated by C4
dermatomal area of nipple line is innervated by T4
dermatomal area of umbilicus is innervated by T10
myotome of shoulder C5-6
myotome of elbow C6-7
myotome of hand C8-T1
myotome of hip flexion L1-2
myotome of knee extension L3-4
myotome of knee flexion L5-S2
myotome of plantar flexion S1-2
hoarse voice with lung CA can be due to a __ palsy caused by pressure from the tumor recurrent laryngeal nerve
Voluntary muscle activity-impulses originate in the precentral gyrus in large cell bodies called __ pyramidal cells
intrinsic hand flexors and extensors ulnar nerve
deltoid axillary nerve
biceps musculocutaneous nerve
triceps, wrist and hand extensors radial nerve
most forearm flexors/pronators median nerve
adductor muscles of thigh obturator nerve
iliopsoas, quadriceps femoral nerve
tibialis anterior, peroneal peroneal nerve
gastrocnemius, posterior tibialis tibial nerve
spastic, no atrophy, no fasciculations or fibrillations, hypertonic reflexes, babinski may be present Upper motor neuron paralysis
flaccid, atrophy, fibrillation and fasciculations may be present, hypotonic reflexes, babinski absent Lower motor neuron paralysis
coarse muscle twitching fasciculations
fine barely visible twitch of a single muscle fiber fibrillations
if absent, indicates damage to sensory function, internuclear connection, or motor function reflexes
tests the integrity of nerve pathways reflexes
mediates arm abduction at the shoulder C5
mediate flexion at the elbow and the biceps reflex C5 and C6
mediates wrist extension C6
mediates elbow extension and the triceps reflex C7
mediates leg extension at the knee and the patellar tendon L4
mediates dorsiflexion at the ankle L5
mediates plantar flexion at the ankle and the achilles tendon reflex S1
meaningless unintentional movement occuring unexpectedly (chorea, athetosis, hemiballismus, tremors at rest) signify __ basal ganlia dysfunction
awkwardness with intentional movement (hypotonia, decreased DTR, aesthenia, dysmetria, intention tremor, ataxia, speech disorders) indicates __ cerebellar disorder
sudden jerky, purposless movements chorea
slow writhing movements of fingers and wrist primarily athetosis
sudden wild, flailing movement of one arm hemiballismus
decreased skeletal muscle tone hypotonia
muscles are mildly fatigued and tire more easily aesthenia
inability to gauge distance, power, or speed of movement dysmetria
impaired ability to stop one action and start another dysdiadocokinesis
senses pain-temperature. nerves enter spinal cord and cross over almost immediately. Lesion results in a loss of sensation contralaterally below the level of the lesion lateral spinothalamic tract
senses light touch and pressure. nerves enter spinal cord and crosses over almost immediately. Lesions result in a loss of sensation contralaterally below the level of the lesion anterior spinothalamic tract
senses conscious proprioception, stereognosis and vibration. Nerves enter spinal cord and initially travels up the same side. Cross over at junction of spinal cord and brainstem. posterior/dorsal columns
CN: smell olfactory (I)
CN: vision optic (II)
CN: all eye muscles except those supplied by IV and VI oculomotor (III)
CN: superior oblique muscle trochlear (IV)
CN: external rectus muscle abducent (VI)
CN: sensory:face, sinuses, teeth, etc.motor: muscles of mastication trigeminal (V)
CN: muscles of the face facial (VII)
CN: inner ear vestibuloccochlear (VIII)
CN: motor: pharyngeal musculature, sensory: posterior part of tongue, tonsil, pharynx glossopharyngeal (IX)
CN: motor: hear, lungs, bronchi, gastrointestinal tractsensory: heart, lungs, bronchi, trachea, larynx, pharynx, gastrointestinal tract, external ear vagus (X)
CN: muscles of the tongue hypoglossal (XXI)
CN: sternocleidomastoid and trapezius muscles accessory (XI)
CN involved with diplopia CN's II, IV, VI
CN involved with decreased facial sensation CN V
CN involved with decreased strenght/drooping of the face CN VII
CN involved with deafness and dizziness CN VIII
CN involved with dysarthria and dysphagia CN's IX, X, XII
CN involved with decreased strength in neck and shoulder CN XI
pronator drift assesses subtle corticospinal lesion
light touch assesses posterior columns
pain assesses spinothalamic tract
joint position sense assesses posterior column
vibration assesses posterior column
graphesthesia assesses cortical sensory
double simultaneous stimulation assesses cortical sensory
two point discrimination assesses posterior columns, cortical sensory
deep tendon reflexes __ in upper motor neuron involvment increased
deep tendon reflexes __ in lower motor neuron involvement decreased
Created by: bwyche