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