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Neurology Review
CM Neurology Review
| Question | Answer |
|---|---|
| Cells that often become malignant | Glial support cells |
| How many bones are there in the skull? | 22 |
| The only mobile bone of the skull | mandible, TMJ is a synovial joint |
| What technique can be used to evaluate children'ts intracranial space? | US |
| Name the three layers of the meninges from outside in | Dura Mater, Arachnoid Mater, Pia Mater |
| Describe the Pia Mater | Delicate internal layer, highly vascular, adheres to the brain |
| Which nerve hurts when you have a headache? | Cranial Nerve V |
| Where does the CSF travel? | Between the pia and arachnoid maters |
| Epidural Hematoma | Above or outside the dura mater. Usually caused by a rupture of the middle meningeal artery associated with traumaRemember the pterion?Surgical emergency |
| Subdural Hematoma | Insidious in onset, can take up to 2 weeks to develop. |
| Subarachnoid Hemorrhage | Worst headache of my life; starts with a thunderclap |
| Scalp Pneumonic | Skin, Connective Tissue, Aponeurosis, Loose areolar Tissue, Pericranium |
| Posterior Headache | C2, C3 |
| Anterior to ears headache | CN V |
| Blood supply to the scalp | External carotid |
| Language, abstract thinking, perception, movement, adaptive response are possible because of ______ | our cerebral cortex |
| Outermost cells of neocortex | Pyramidal cells (shaped like pyramids) |
| Afferent fibers connecting the contralateral hemisphere of the corpus | Commissural fibers |
| Main passageway for ascending and descending fiber tracts | Internal Capsule; thalamus, basal ganglia connected through this highway |
| Information center that remains constantly informed | Basal ganglia. Has a contralateral effect on movement. (cerebellum has an ipsilateral effect) |
| When this area is destroyed, no dopamine flows to the basal ganglia | Substantia Nigra. (Extrinsic dopamine can't cross blood-brain barrier, so give L-Dopa so body can synthesize dopamine. Immediate improvement, then wears off. Used in Parkinson's Disease) |
| ______ coordinates voluntary body movement and muscle tone | Cerebellum. When you have cerebellum dysfunction, you have jerky, uncoordinated movements |
| What is the effect of cerebellum on movement? | Ipsilateral, timing and force of contraction of voluntary muscles that result in smooth, coordinated movements |
| Spinocerebellar Tract | Ascending tract, Senses unconscious proprioception, Ipsilateral, 2 neuron system, receptor to cerebellum. More than one smaller tract then routes information to the cortex |
| What makes up the diencephalon? | Thalamus and Hypothalamus |
| Thalamus | Sensory relay and integrative center. Connects with cortex, basal ganglia, hypothalamus, brainstem |
| Where do all sensory tract from the body synapse before they are directed to the cortex? (except the olfactory) | Thalamus |
| Where is the final point where information can be transferred, inserted, modified, and/or coordinated before reaching the post central gyrus? | Thalamus |
| Hypothalamus - what does it control? | Autonomic Functions "bodily needs". Regulates homeostasis, coordinates neural and endocrine functions, emotions |
| Anterior hypothalamus | Anterior hypothalamus controls parasympathetic responses |
| Posterior hypothalamus | ; Posterior hypothalamus controls sympathetic responsesPosterior hypothalamus produces two hormones that are transmitted to the posterior pituitary for release; Oxytocin, ADH |
| The amygdala is a part of the ... | limbic system. Anatomic substrate for drive-related emotional behavior and memory. Bridge between the autonomic and voluntary responses to changes in the environment |
| Amygdala | Stimulation causes many emotions, most commonly fear. Involved in signaling stimuli related to reward, fear, motivationContributes to social functions such as mating,Emotional learning |
| Hippocampus | Required for the formation of long-term memories |
| ___ affects autonomic functions regulating heart rate and blood pressure, and contributes to cognitive processing including attention. (part of the limbic system) | Cingulate Gyrus |
| Part of the brainstem, central role in bodily and behavioral alertness. | Reticular Activating System. Ascending connections affect the function of the cerebral cortex, descending connections affect bodily posture and reflex mechanisms |
| What can take out the reflective activating system? | injury, herniation of the brainstem area |
| Where do general anesthetics work their effect? | on the reticular formation. Vital in controlling respiration, cardiac rhythms, and other essential functions. Crucial for maintaining the state of consciousness. Involved in circadian rhythm, bilateral damage can lead to coma. |
| Motivation and ability to pay attention comes from | frontal lobe |
| Dominant Hemisphere | Important for important comprehension and production in language. Most people have a left-dominant hemisphere |
| The inability to use language; loss of access to the symbols that we use to represent concepts | Aphasia |
| Broca's Aphasia | Few words, written or spoken, great difficulty producing them, most important words only "telegraphic mannner", less difficulty comprehending. MOTOR |
| Wernicke's Aphasia | able to produce written and spoken words, defective in their linguistic content. Word salad. More deficient in comprehension than Broca's |
| Amnestic confabulatory syndrome | Korsakoff's Psychosis. Gray matter destruction from chronic alcohol use. Relatively intact intelligence, inability to form new memories. Make up answers as they go along. |
| Headache definition | pain or pressure registered in non-nervous tissue structures such as meninges or arteries. Brain tissue has no sensation |
| At what level does the spinal cord end? | L1-L2 for most of us; vertebral canal is longer. |
| Ascending and descending pathways are found in which matter? | white matter. |
| Where is the needle inserted for lumbar puncture? | L4-L5 vertebrae (level of the iliac crest) to avoid spinal nerves |
| Which position must a patient be in when receiving anesthesia? | upright |
| Disorder in which two sides of the vertebral arches fail to fuse during development | Spina Bifida, usually in the lower vertebrae, results in an open vertebral canal. Spectrum of disability. |
| C1-C7 exit where in relation to their corresponding vertebrae | above |
| C8 exits where? | below vertebrae C7, all other spinal nerves exit below their corresponding vertebrae |
| Posterior roots | Afferent, sensory towards CNS |
| Anterior roots | Ventral, efferent, motor, away from CNS |
| Cervical Plexi | C1-C4 |
| Brachial Plexi | C5-T1 |
| Lumbar Plexi | L1-L4 |
| Sacral Plexi | L4-S4 |
| Coccygeal Plexi | S5-Co |
| area of skin supplied by a single spinal cord level | Dermatome. On one side of the body by a single dermatome. extends around the body posterior to anterior. Carries somatic sensory information from a specific area of skin on the surface of the body. Considerable overlap between dermatomes. |
| Shoulder Dermatome | C4 |
| Nipple line dermatome | T4 |
| Umbilicus Dermatome | T10 |
| Groin Dermatome | L1 |
| Portion of skeletal muscle innervated by a single spinal cord level | myotomes. Test myotomes by assessing muscle strength |
| Motor deficit lesion location | at or above the level of the corresponding spinal nerve, all nerve roots below the lesion are affected |
| Sensory deficits | lesion is at or above the level of the affected dermatome. All nerve roots below the lesion are affected |
| recurrent laryngeal nerve | Motor innervation to almost all intrinsic muscles of the larynx. Hoarse voice with lung CA can be due to a recurrent laryngeal nerve palsy caused by pressure from the tumor |
| Impulses originate in the precentral gyrus in large cell bodies called ___________ | pyramidal cells |
| Axons pass down through the internal capsule to the ________, then to the medulla | midbrain |
| Voluntary Muscle activity: 80-90% of the axons cross over and then descend the spinal cord in the | lateral corticospinal tract |
| Voluntary Muscle activity: 10-20% descend on the same side as the | anterior corticospinal tract. Body's mechanism of preserving some function in the case of injury |
| Where do you injection IM? | Upper outer quadrant to avoid sciatic nerve |
| Where do UMN and LMN synapse? | in the ventral motor horn |
| UMN travel where? | originate in teh motor cortex or brain stem and carry impulses down the corticopsinal tracts to the anterior grey horn |
| LMN travel where? | Connect the anterior gray horn to teh muscle fibers; these are the neurons that are part of the motor units |
| UMN paralysis | spastic, tight, no atrophy, no fasiculations, hypertonic reflexes, babinski may be present |
| LMN paralysis | Flaccid, atrophy of muscles, fibrillation and fasiculations, hypotonic reflexes. Babinski absent |
| What happenes to the LMN's if the UMN cells are damaged? | LMN is freed of control and fires excessively; fires in response to reflex stimuli (hyperreflexia), fires on its own (spasticity) |
| UMN diseases | Tumors of the brain and spinal cordStrokesMultiple SclerosisMeningitisCerebral palsyALS * |
| LMN Diseases | TraumaPolio1% progress to UMNBirth injuriesMuscular DystrophiesGuillain-Barre’ syndromeCarpal Tunnel syndromeMyasthenia gravisALS * |
| __________ is a chronic, progressive, degenerative disease that attacks the lateral corticospinal tract. | Amyotrophic Lateral Sclerosis (ALS), moves from LMNs to UMNs, leads to muscle weakness, muscle wasting, hyperreflexia. Spares sensations and intellect. No cause/no cure. Lou Gehrig's Disease |
| Cerebral Palsy | Spectrum of neurological disorders that appear in infancy or early childhood that affect body movement and coordination but won't worsen over time. |
| What is the usual etiology of Cerebral Palsy? | Congenital |
| UMN damage leads to | motor disorders |
| Scissored gait is a feature of which disorder? | Cerebral Palsy. |
| ________ is a highly infectious disease caused by a virus. It invades the LMN and can cause total paralysis. | Poliomyelitis. LMN can't contract, flaccid paralysis. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. Treatment is symptomatic. |
| Edward Salk made a vaccine for | Polio |
| _______ test the integrity of nerve pathways | Reflexes. Can be used to test somatic sensory and motor nerves in an unconscious patient. |
| Absent reflexes | If absent, indicates damage to sensory function, internuclear connection, or motor functionWith anesthesia reflexes disappear in predictable sequence, helping determine if patient is sufficiently sedated |
| What makes up the pyramidal system? | Basal Ganglia and Cerebellum |
| Basal Ganglia Dysfunction | Meaningless unintentional movement occurring unexpectedly. Chorea, Athetosis (snakelike), Hemiballismus (flailing movement), tremors at rest. |
| Basal Ganglia dysfunction affects which side compared to the location of the lesion? | Contralateral |
| Cerebellar Disorders | Awkwardness with intentional movement. Hypotonia, decreased DTRs, Aesthenia, Dysmetria, Dysdiadocokinesis, Intention tremor, Speech disorders, Ataxia. Pendular Reflex |
| Cerebellar Disorders affeects which side of the body in relation to the lesion? | Ipsilateral side |
| What is the progression of cerebellum destruction? | Anterior to posterior. Legs are anterior, so function destroyed first. Develop broad-based, staggering gait. Ataxia, uncontrolled leg movements. Anterior lobe syndrome |
| It’s role is to maintain a stable internal environment in conjunction with the endocrine system | Autonomic Nervous System; entirely motor. Most functions are carried out below the conscious level. Primary function is to regulate blood flow |
| Belladonna poisoning symptoms | Dilated pupils, sensitivity to light, blurred vision, tachycardia, loss of balance, headache, rash, flushing, dry mouth and throat, slurred speech, urinary retention, constipation, hallucinations, delerium, and convulsions |
| Ascending spinal tracts | Lateral spinothalamic, Anterior Spinothalamic, Dorsal Columns |
| ________ tract senses pain and temperature | Lateral Spinothalamic. 3 neuron system. Receptors in the dermis. Nerves enter spinal cord and cross over almost immediately. Lesion results in a loss of sensation contralaterally BELOW the level of the lesion |
| Senses light tough and pressure | Anterior Spinothalamic Tract. Nerves enter spinal cord adn cross over almost immediately. Lesion results in a loss of sensation contralaterally below the level of the lesion |
| Senses conscious proprioception, stereognosis, and vibration | Posterior, dorsal columns. Nerves enter spinal cord and initially travel up the same side. Cross over at junction of spinal cord and brainstem. |
| Posterior dorsal columns 1st order neuron lesion | results in loss of sensation ipsilaterally |
| 2nd or 3rd order neuron injury in posterior dorsal column | contralateral loss of sensation |
| Referred Chest pain may be felt | In the left arm |
| Referred Ureter pain may be felt | inguinal region |
| Referred Diaphragm pain may be felt | Shoulder |
| Ectopic pregnancies may refer pain to | the shoulder |
| Appendicitis may refer pain to | umbilicus |
| Most common CNS tumor in children (ages 4-8) | Medullablastoma. First signs are ataxia, stumblin, falls. |
| Fixed pupil is a result of | CN III palsy. UMN damage to occulomotor nerve. Parasympathetic fibers damaged so pupil can't constrict. Also, LMN fibers are damaged so muscles -- levator palpebrae can't work resulting in ptosis. |
| Shining a light into one eye can distinguish between damage to | CN II and CNIII damage, or damage to the brainstem |
| Which nerve controls direct pupillary light reflex? | CN II |
| Which nerve controls the consensual pupillary light reflex? | CN III |
| If pupils are non-reactive or asymmetric | it's a brainstem problem |
| Gag reflex is controlled by | CN IX and X |
| What is the importance of NPO 8-12 hours prior to surgery? | Under anesthesia, the gag reflex (CN IX and X) are inactivated. If patient vomits, then they would aspirate contents into open bronchus |
Created by:
ltm12