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Thomadaki Neuro II
NYCC Second half of Thomadaki final on vascular supply and stroke
| Question | Answer |
|---|---|
| cerebral arteries have the same name as | cerebral veins |
| all cerebral veins drain into the | dural venous sinuses |
| are there accompanying arteries for the dural venous sinuses? | no |
| 2 sets of invaginations of ______ that hug the brain | dura |
| the space between the 2 sets of dura invaginations hugging the brain is where the _______________ live | dural venous sinuses |
| familiarize: falx cerebri, tentorium cerebelli, falx cerebelli, straight sinus, sagittal sinus, cavernous sinus | Cavernous to sigmoid to internal jugular to superior vena cava |
| pathway of brain drain from cavernous sinuses: | cavernous to sigmoid sinus to internal jugular vein to superior vena cava |
| subdural hematoma means | venous bleed and meningeal artery bleed |
| 1st branch of subclavian artery heading north is | Vertebral artery |
| Vertebral artery path through cervical? | passes C7 and enters C6 transverse foramen to atlas where curves 90degrees on groove for vertebral artery and ascends through f. magnum |
| The vertebral artery off subclavian supplies the _________ brain. | posterior |
| what originating vessel supplies the anterior brain with blood? | internal carotid artery after it bifurcates off common carotid from R subclavian or L aortic arch |
| 2 contributing components of the circle of Willis | the site of overlapping blood supply from the Internal Carotid and the Vertebrobasilar artery |
| If you injure the blood supply somewhere along the Circle of Willis, you _______ (will/will not) lose blood supply. | will not. IT is a CIRCLE. |
| Through what bony foramen do the internal carotids enter the skull? | carotid canals |
| The INTERNAL CAROTID arteries arise from the common carotid arteries, enter the skull through the carotid canals, traverse the ___________ sinus and divide into the anterior and middle cerebral arteries. | cavernous |
| The INternal carotid arteries divide into the ________ & __________cerebral arteries. | anterior & middle |
| Describe the vertebral contribution to the Circle of Willis: | subclavian - vertebral - basilar (along brainstem) - PICA - AICA - Superior Cerebellar Artery - Posterior CEREBRAL Artery |
| Describe the carotid artery contribution to the Circle of Willis: | subclavian to carotid to internal carotid to Anterior CEREBRAL artery and Middle CEREBRAL artery |
| How are the internal carotid (anterior and middle cerebral arteries) connected to the basilar (cerebellar arteries)? | posterior and anterior communicating arteries |
| The brain constitutes ___% of total body weight | 2 |
| The brain constitutes 2% of the total body's weight, but it receives ___% of the total cardiac output and consumes ___% of the total oxygen the body uses. | 15 cardiac, 20 oxygen |
| Cerebral arterioles are capable of regulating in 2 ways: | 1-dilate when systemic pressure drops or arterial conc. of CO2 rises (hypercarbia), and 2-constrict when systemic pressure increases or arterial CO2 drops |
| most strokes are related to | stress |
| stress causes most | strokes |
| brain arterioles dilate when | sys pressure drops or CO2 rises (hyperbaria) and vice versa |
| inadequate blood supply (containing oxygen and glucose) | ischemia |
| prolonged ischemia results in | infarction |
| infarction | cell death |
| inadeqate oxygen supply | anoxia |
| 3 causes of stroke | Ischemia, Hemmorhage, Hypotension |
| bleeding as the result of an occlusion | stroke due to ischemia |
| blockage of an artery due to atherosclerosis or a blood clot) | occlusion |
| bleeding of an artery due to a ruptured aneurism or hypertension | stroke due to hemmorhage |
| bleeding as the result of not enough blood to the brain for a significant amount of time | stroke due to hypotension |
| 3 causes of stroke | ischemia (blockage), hemmorhage (rupture), hypotension (lack of blood) |
| what are common causes of ischemia | clot (most common), atherosclerosis, severe hypertension |
| #1 cause of ischemic stroke (blockage): | clot |
| Most common stroke (80% of all strokes) | Ischemic caused by a clot/blockage |
| Ischemic strokes are caused by a clot/blockage of one of 3 kinds: | thrombotic, embolic, lacunar |
| L.E.T. it clot: | Lacunar, Embolic, Thrombotic clots cause ischemic strokes |
| L.E.T. it clot - Lacunar: | tiny ischemic strokes causing clumsiness, weakness and emotional rollercoaster. |
| L.E.T. it clot - what kind of stroke constitutes 38% of all Thrombotic strokes and is most common subtype of Japanese | Lacunar |
| L.E.T. it clot - which one usually caused by a dislodged blood clot that has traveled through the blood vessels | Emboli |
| L.E.T. it clot - accounts for 25% of all strokes is associated with heart disorders, valves, atrial fibrillation, heart attacks | Emboli |
| L.E.T. it clot - during atrial fibrillation (15% of all embolic strokes), some blood may pool in the atria. Then what? | forms clot, breaks off, travels to brain, ergo embolic stroke caused by clot from atrial fibrillation |
| The main thing to remember about L.E.T. it clot strokes is that they are caused by | lack of blood/are called Ischemic |
| Rarely, _______ are formed from fat particles, tumor cells, or air bubbles that travel through the blood stream. | emboli |
| L.E.T. it clot - the stroke that occurs when an artery to the brain is blocked by a blood clot that formed as the result of atherosclerosis | Thrombosis |
| over 15% of strokes occur from __________ (sudden bleeding) in the brain | hemorrhage |
| In a healthy brain, neurons are protected from exposure to blood by the | blood-brain barrier |
| a wall of tiny vessels and astrocytic feet that protects the brain from exposure to blood | blood-brain barrier |
| In ___________ stroke, the blood-brain barrier is broken. | hemorrhagic |
| __________strokes are categorized by HOW and WHERE they occur. | Hemorrhagic |
| 3 types of Hemorrhagic strokes | Parenchymal, Subarachnoid, Arteriovenous malformations |
| H.A.P.S. (not Human Anatomy and Physiology Society but...) | Hemorrage: Arteriorvenous malformations, Parenchymal, Subarachnoid |
| Sudden bleeding (hemorrhage) means there's been a break in an artery. What are the side effects of hemorrhage at the molecular receptor level? | NMDA receptors - hemorrhage allows Ca++ to come in due to NMDA receptors being open, resulting in neuro/excitotoxicty |
| with a hemorrhage, ________ receptors are open, allowing Ca++ to flood in and cause excitotoxic reaction in brain | NMDA |
| H.A.P.S. strokes: | Hemorrhage is Arteriorvenous, Parenchymal, Subarachnoid |
| HAPS - these hemorrhagic strokes account for 5% of all strokes and occur when a blood vessel bursts (rupture of an aneurysm) and leaks into the subarachnoid space | Subarachnoid |
| HAPS - aneurysm bursts and fluid leaks into a meningeal space | Subarachnoid hemorrhagic stroke |
| HAPS - an abnormal connection between arteries and veins (venules and capillaries) which, if ruptures, can cause this kind of stroke | Arteriovenous malformation hemorrhagic stroke |
| HAPS - which stroke is most dangerous of the hemorrhagic strokes? | Subarachnoid (blood leaks into Cerebrospinal fluid). Sudden death, usually. |
| HAPS - these strokes account for 10% of all strokes. Most often the result of Hypertension exerting excess pressure on artery walls already damaged from athersclerosis. | Parenchymal hemorrhagic stroke |
| Heart attack patients and those given blood anti-clotting agents or blood thinners are at a slightly higher risk for this type of stroke. | HAPS - Parenchymal hemorrhagic stroke |
| HAPS - the spilling of small, tiny vessels, usually due to hypertension from atherosclerosis, and more common in patients taking anti-coagulant/blood thinners | Parenchymal hemorrhagic stroke |
| Causes cerebral arterioles to constrict | Hypertension |
| Rarely, extreme ___________ reduces oxygen supply to the brain and causes a stroke. | HYPOtension |
| A heart attack, a major bleeding episode, an overwhelming infection, surgical anesthesia, or overtreatment of high blood pressure may cause this type of stroke | HYPOtension stroke due to reduced brain oxygen |
| Highest risk stroke states | why, home, of course! NC, SC, GA |
| What condition contributes to 70% of all strokes, the wider the spread between systolic and diastolic measurements presenting the greatest danger? | Hypertension |
| About 1 in 6 strokes is due to ____________________. | atrial fibrillation (then emboli as a result) |
| people who smoke a pack a day have almost ____x the risk for stroke as non smokers | 2.5 |
| Smoking increases the chance of what specific strokes? | ischemic and hemorrhagic |
| Weight related stroke factors include | diabetes and insulin-resistance, as well as a spare tire around the abdomen |
| Which cholesterol is important for stroke prevention? | HDL |
| What kind of patients who have cholesterol levels below 180 mg/dl are at risk for hemorrhagic stroke? | Hypertensive |
| Heavy alcohol is associated with what kind of stroke(s)? | Ischemic and hemorrhagic (same as smoking) |
| Mild to moderate alcohol use (1-7 drinks per week) is associated with low _________ stroke risk, though not __________ stroke risk. | ischemic (clot), hemorrhagic (bleed) |
| which stroke is associated with alcohol? | hemorrhagic (bleed) |
| Men who drink 3 or more cups of coffee per day have an increased stroke risk if they have a pre-existing ___________. | hypertension |
| Is coffee dangerous for men with normal blood pressure? | no |
| what street drugs heavily contribute to stroke risk? | coke and meth and steroids (yeah, show me your scrip for the steroids and I'll declassify it as a street drug) |
| what group is at a high risk for stroke due to emotional factors? | men who have more intense responses to emotional situations. |
| people under prolonged or frequent stress can experience an increase in blood pressure, which has been linked to an increase in stroke risk for what group? | Caucasian men in low socio-economic class |
| What emotional state is linked to higher mortality rates after stroke and higher incidence of occurrence in general? | depression |
| Severe depressed people had a 3 out of 4 risk for stroke, while moderately depressed had | 1 out of 4 (73% vs. 25%) |
| Depressed African American stroke risk percentage: | 160% |
| In those under 50, what is a risk factor for stroke, with women being greatest at risk between 45-65 while men were at risk under the age of 45? | People with migraines or severe headaches |
| In young women who take oral contraceptives, migraines increase the risk of stroke but only if those migraines are accompanied by ______. | auras |
| 3 stroke factors for young women | oral contraceptives, smoking, migraines WITH auras |
| 3 stroke risk factors for people with migraines | Raynaud's and decongestants, high homocysteine levels and B deficiencies |
| Abnormally high levels of the amino acid __________, which occur with deficiencies of vitamin B6, B12, and folic acid, are strongly linked to coronary artery disease and stroke. | homocysteine |
| Second highest risk factor for stroke, after high blood pressure | high homocysteine levels |
| What amino acid is always found in abnormally high levels after stroke, if they also have low B6, B12 and folic acid levels? | homocysteine |
| how do certain bacteria possibly play a role in atherosclerosis, heart disease, and stroke? | provoking inflammation response in arteries |
| chronic infection with ___________________ is linked with stroke and heart disease. Stroke patients were 3x more likely to have been recently exposed to a respiratory infection. | chlamydia pneumoniae |
| atherosclerosis is an infection after an | inflammation |
| what two diseases may cause ischemic stroke or heart disease? | peridontal gum disease and varicella zoster virus (chicken pox/shingles) |
| varicella zoster particularly noted for causing _____________ in children | cerebral vasculitis (inflamed brain blood vessels) |
| Symptoms of stroke depend on affected _________ | artery |
| What percentage of stroke or TIA patients who called their primary care physician were neither evaluated nor sent to the hospital within a month after the first event? | 1/3 (30%) |
| stroke signs: | Initial weakness followed by spasticity, with Babinski's sign at beginning |
| Motor stroke symptoms | initially flaccid, then spastic sets in. LMN work at 1st due to deep tendon reflexes, then flaccid paralysis then spastic. |
| The only UMN sign of a stroke initially: | Babinski's sign |
| TIA | Transient Ischemic (clot) Attack |
| a focal loss of neurological function that usually resolves within 24 hours | TIA -Transient Ischemic Attack |
| TIA's are mini-_______ strokes | ischemic |
| What causes the tiny mini-ischemic (clot) strokes associated with TIA's? | tiny emboli (often formed by pieces of calcium and fatty plaque) that lodges in an artery to the brain |
| Why isn't there long term damage with the mini-ischemic stroke of TIA? | the emboli is cleared or blood is rerouted & to quick restoration of blood supply |
| TIA's are the warning sign for | ischemic stroke |
| a TIA is to a stroke warning as ________ is to a heart attack warning | angina |
| 5% who have a TIA have a stroke within a ________, and 1/3 will have a stroke with in ____ years. | month, 5 years |
| Why are TIA's also warning signs for heart attacks? | because of the relationship bw atherosclerosis and coronary artery disease and stroke. |
| if a patient describes the visual effect of a shade being pulled down before his eye, he is experiencing low ______ levels due to a blockage of the | oxygen levels to eye due to blockage of Ophthalmic artery occlusion via occlusion of Internal carotid pathway/artery |
| the shade being pulled down over a patient's vision in one eye may be a symptom occlusion of the ophthalmic artery, in essence, a symptom of | TIA in the Carotid artery |
| Patient's with "shade down" eye symptoms (poor vision in one eye due to Ophthalmic artery blocked and lack of O2) may also have poor | night vision (TIA in carotid artery symptom) |
| When the cerebral hemisphere is affected by a TIA, a person can experience problems with | speech, have partial and temporary paralysis, tingling, numbness all usually on ONE SIDE of the body |
| Symptoms of TIA's in the basilar artery itself are usually | bilateral |
| Basilar artery TIA means | bilateral symptoms |
| Which artery affects cranial nerve 5-12? | basilar (brainstem symptoms) |
| loss of vision, temporary grey or blurry vision in both eyes symptom | TIA in basilar artery |
| tingling or numbness in the mouth, cheek, or gums | TIA in basilar artery |
| headache in back of head with dizziness, nausea and vomiting symptoms | TIA in basilar artery |
| difficulty swallowing or inability to speak clearly symptoms | TIA in basilar artery |
| weakness in the arms and legs, sometimes causing a sudden fall symptoms of | TIA in basilar artery |
| Why are most of the symptoms of the basilar artery concerning the head, inside the mouth, eyes, balance, enunciation, weakness? | Basilar artery TIA would affect CN's V-XII (trigeminal, abducent, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal) |
| Basilar TIA's are ___________, while Carotid TIA's are __________. | Basilar are bilateral symptoms while Carotid are unilateral symptoms. |
| The larger the clot (ischemic), the more _______ the episode. | sudden |
| The _______ of symptom onset of a major ischemic (clot) stroke may indicate its source. | SPEED!!!!!! |
| If a major ischemic stroke is caused by a large _______, the onset will be sudden. Headache and seizures can occur within seconds. | embolus |
| An embolus is a dislodged | thrombus |
| When a thrombosis causes a stroke, the onset usually occurs | more gradually, over minutes to hours, maybe days to weeks |
| Coma is possible with | thrombosis as the cause of a major ischemic stroke |
| L.E.T. it clot | Lacunar, Embolus, Thrombosis are types of ischemic strokes involving clots |
| H.A.P.S. | Hemorrhagic stroke types: Arteriovenous malformation, Parenchymal, Subarachnoid |
| which of these is slow onset with abrupt headaches, nausea, light sensitivity:cerebral, subarachnoid, parenchymal, or aneurysm | subarachnoid (cerebral and parenchymal are the same thing, while an aneurysm has fixed eyes, rigidity, stupor, maybe coma) |
| headache, nausea ad vomiting, altered mental states are all symptoms of | cerebral/parenchymal hemorrhage stroke (HAPS) |
| vomiting and altered mental state are symptoms of what kind of stroke? | cerebral/parenchymal hemorrhage (HAPS) |
| global neurologic abnormalities (sensory, motor, speech, vision) and vomiting are symptoms of what kind of stroke? | Subarachnoid hemorrhage (HAPS) |
| what kind of stroke did Bret Michaels have? | subarachnoid (global neurological problems, abrupt headaches, nausea and vomiting, light sensitivity) |
| the most dramatic stroke | aneurysm rupturing |
| terrible headache, neck stiffness, vomiting, altered state, fixed eyes in one direction, stupor/rigidity/coma are signs of | Aneurysm! |
| neck stiffness and EYES FIXED IN ONE DIRECTION | aneurysm hemorrhage |
| vomiting and GLOBAL NEUROLOGICAL abnormalities (speech, motor, sensory, vision) | Subarachnoid hemorrhage |
| ALTERED MENTAL STATE and headache with vomiting | cerebral/Parenchymal hemorrhage |
| As many as 31% of the elderly experience silent _________________- | brain infarctions |
| small strokes that cause no apparent symptoms but are major contributors to mental impairment in the elderly | silent brain infarctions |
| silent brain infarctions in the elderly cause | multi-infarct dementia |
| Smokers and people who are hypertensive are particularly at risk for _______________, eventually causing multi-infarct dementia. | silent brain infarctions (mini strokes with no apparent symptoms) |
| multi-infarct dementia is associated with | UTI's in the elderly |
| a sudden reversible loss of consciousness and postural tone (otherwise known as fainting) | syncope |
| most common cause of syncope | hypotension (vasovagal phenomenon) |
| syncope results from temporary | global cerebral ischemia |
| causes of syncope (fainting): 4 | hypotension (#1), decreased cardiac output (bradycardia or occlusion), blood and metabolic disorder (anemia, hypoglycemia, diabetes), CNS (epilepsy, stroke) |
| 4 causes of syncope | hypotension, decreased cardiac output, metabolic/blood disorder, CNS problem |
| 90% syncope is just fainting but the other 10% is either | seizure or stroke |
| terminal branch of the carotid artery tha traverse the carotid canal at the base of the skull and enters the middle cranial fossa beside the dorsum sellae of the sphenoid bone. | Internal Carotid artery |
| THe internal carotid artery runs forward in the __________ sinus, then turns upward on the medial side of the ant. clinoid process and enters the subarachnoid space by piercing the dura mater and arachnoid. | Internal carotid artery |
| artery which, after piercing dura and arachnoid, courses backward below the optic nerve and finally turns upward immediately lateral to the optic chiasma. | Internal carotid artery |
| The artery under the Anterior perforated substance that divides into the middle and anterior cerebral arteries. | Internal carotid artery |
| why would occlusion of the Internal Carotid artery (ICa) result in ipsilateral blindness? | because the Ophthalmic artery is a branch of the ICa |
| hypophysial arteries supply | posterior pituitary and are a branch of ICa |
| Ophthalmic artery supplies the _? and is a branch of the _? | eye and other orbital contents, frontal area of the scalp, frontal and ethmoid paranasal sinuses, and parts of the nose, is a branch of the ICa |
| why would occluding the ICa cause ipsilateral blindness | Ophthalmic artery is a branch of the ICA supplying the eye and front of scalp. It passes through the optic foramen with the optic nerve. |
| posterior communicating artery is a branch of the ___? and helps form the _? | branch of the ICa and runs backward to join the proximal part of the posterior cerebral artery, thereby forming part of the Circle of Willis. |
| Anterior CHOROIDAL is a branch of the _? and supplies the _? | branch of ICa, supplies the optic tract and lateral geniculate body, & internal capsule |
| The _______________ has a vast range, including the optic tract, uncus, amygdala, hippocampus, globus pallidus, LGN, and anterior limb of internal capsule. | anterior CHOROIDAL (LGN & Internal capsule) |
| blindness of ipsilateral eye | ICa due to its ophthalmic artery branch |
| occlusion of ophthalmic artery branch of ICa | blindness in ipsilateral eye |
| The occlusion of the ICa may extend into the territories of what 2 main arteries? | Anterior Cerebral Artery (ACA) and Middle Cerebral Artery (Mica) |
| if you occlude the ICa, nothing gets to the | cerebrum |
| dimming, "shade down", color changes or scotomas - all monocular - suggest | occlusion of ICa because it gives off the Ophthalmic branch |
| Occluding the ICa means nothing gets to the cerebrum. What body losses/symptoms would occur? | Contralateral spastic paralysis and sensory loss of the body and face, due to no more ICa supply to motor and sensory cortex |
| contralateral spastic paralysis and sensory loss of the body and face | ICa due to its motor and sensory cortex supply |
| why would occlusion of the ICa cause aphasia if the dominant hemisphere is affected? | Because the Anterior Cerebral artery (Broca's) and Mica (Wenicke's) are branches of ICa. If the Anterior Cerebral Artery is cut off, then Broca's (expressive) results. If the Middle cerebral artery is cut off, then Wernicke's (receptive) results. |
| Dominant hemisphere usually affected by Broca's (ACA) or Wernicke's (Mica) if the internal carotid artery is occluded. | Usually the left side is dominant (language) |
| internal carotid artery occlusion that causes Broca's (ACA) and Wernicke's (Mica) is called | global aphasia |
| why would occlusion of the ICa cause contralateral spastic paralysis and loss of sensation to body and face? | Contralateral because of decussation, loss of both sensory and motor because ICa supplies precentral (sensory) and postcentral (motor) gyri |
| If the non-dominant hemisphere is affected (usually the right hemisphere) by ICa occlusion which cuts off ACA and Mica, what is the result on this non-dominant side? | Astereognosis/Neglect (personal neglect syndrome) due to parietal lobule starved |
| what lobule is affected in personal neglect/astereognosis syndrome and what artery is occluded? | parietal lobule is starved by neglect of ICa and non-dominant side if MCA |
| Which artery branch of the ICa goes to the uncus, hippocampus, lateral geniculate body and Internal capsule? | Anterior CHOROIDAL (LGN & internal capsule) |
| LGN & internal capsule supplied by | anterior CHOROIDAL |
| capsular stroke | anterior CHOROIDAL |
| whole body (throughout!) due to VDPP and motor tracts going through the internal capsule will be affected by an infarction of the | anterior CHOROIDAL |
| throws a clot into the internal capsule and causes contralateral spastic paralysis and sensory loss of the body (contralateral hemiplegia & sensory abnormalities) | anterior CHOROIDAL |
| contralateral homonymous hemianopsia is? | loss of contralateral visual field (entire half) |
| contralateral homonymous hemianopsia caused by | anterior CHOROIDAL because of LGN |
| why does infarction of anterior CHOROIDAL cause contralateral homonymous hemianopsia? | because it supplies the LGN |
| contralateral hemiplegia and sensory abnormalities plus contralateral homonymous hemianopsia is caused by and means what? | caused by anterior CHOROIDAL, means contralateral spastic paralysis of whole body and sensory loss to body and face due to anterior CHOROIDAL supplying internal capsule and loss of contralateral one half of visual field due to ant. CHO supplying LGN |
| corticospinal and corticobulbar tracts run through the | posterior internal capsule a |
| corticospinal and corticobulbar tracts run through the posterior limb of the internal capsule and are affected by an infarction of the | anterior CHOROIDAL and Internal Carotid artery |
| smaller terminal branch of ICa | Anterior Cerebral Artery (ACA) |
| The two Anterior Cerebral Arteries almost meet at the midline, where they are joined together by | anterior communicating artery |
| what joins the left and right ACA's? | the anterior communicating artery |
| Special branch of the anterior cerebral artery given off just proximal to the ACA | medial striate artery (Recurrent artery of Heubner) |
| recurrent artery of Heubner is also called | Medial, not middle!, Striate artery |
| Medial striate artery is also called? and is a branch of? | recurrent artery of Heubner, branch of ACA |
| artery which penetrates the anterior perforated substance to supply the head of caudate (ventral), adjacent putamen, and the ANTERIOR limb and GENU of the internal capsule | Recurrent artery of Heubner, a branch of the ACA |
| artery which supplies the anterior perforated substance and the anterior limb of internal capsule | Recurrent artery of Heubner (supplies two anteriors: the anterior perforated substance and the anterior limb of internal capsule so it is recurrent/redundant) |
| which artery gives off branches that supply the olfactory bulb and tract, and the orbital surface of the frontal lobe? | Anterior Cerebral Artery (ACA) |
| Why would the ACA supply the distal leg? | because the homonuculus of the medial brain over the precentral (motor) and postcentral (sensory) gyri is the lower extremity |
| supplies the medial surfaces of the frontal an parietal lobes | ACA |
| occlusion of this artery causes paralysis and sensory deficits in the contralateral leg and perineum | ACA |
| commonly, affected patients have urinary incontinence caused by inadequate perineal sensation and defective cortical control of the pelvic floor musculature | ACA (Grandpa before his death?) |
| Along with contralateral paralysis and sensory deficits of the leg and perineum, if the occlusion is in the proximal part blocking the Recurrent artery of Heubner, the patient has contralateral UMN weakness of face, tongue, and upper limb | ACA |
| For class, an occlusion of the ACA means: | distal leg and perineum, contralateral spastic paralysis and sensory loss with urinary incontinence, mental confusion, and abuila (apathy and muteness) |
| ACA occlusion causes contralateral spastic paralysis and sensory loss affecting mainly distal leg and perineum (urinary incontinence) due to cutting off supply to __________? | the Paracentral Lobule |
| ACA occlusion causes mental confusion due to affecting ? | prefrontal lobe |
| Abuila, a behavioral disturbance characterized by apathy and muteness is caused by an ACA infarct to the ? | prefrontal lobe (same one that causes mental confusion) |
| What is necessary for Abuila to occur? | bilateral affect of genu of corpus callosum so bilateral prefrontal lobe = Abuila |
| what artery supplies the entire midline and a little bit of the top? | ACA |
| paracentral lobule injury, such as an ACA infarction, would cause | motor and sensory loss to entire contralateral lower body, including spastic paralysis, and mainly affecting the distal leg and perineum |
| often associated with mental confusion and dysphasia | ACA, due to prefrontal lobe affect |
| The arteries that supply the cortex | Anterior Cerebral Artery (ACA), Middle cerebral artery (Mica) and the POSTerior cerebral artery (POSTcereal) |
| Artery that runs deep in the lateral sulcus between the frontal and temporal lobes | Mighty Mica |
| which artery supplies the paracentral lobule? | ACA |
| which artery supplies the parietal lobe? | Mighty Mica |
| Which artery, when bilaterally occluded, causes Abuila via the prefrontal lobe? | ACA |
| territory of distribution includes most of the primary motor cortex, premotor cortex, the FRONTAL EYE field, and the primary somatosensory area. | Mighty Mica |
| why are the motor and sensory cortex for the lower limb and perineum excluded from Mighty Mica (Middle Cerebral Artery) territory? | the lower limb and perineum are ACA's territory, more to the medial part of the brain on the homonculus |
| contralateral paralysis most noticeable in the lower part of the face and in the arm | Mighty Mica will sock you in the mouth if he don't like ya! |
| If Mighty Mica occluded on dominant side (usually LEFT), what happens? | Broca's, Wernicke's or Global (both) aphasia (Mica) |
| If Mighty Mica occluded on RIGHT parietal lobe (non-dominant side)? | Astereognosis/Neglect syndrome (Mica) |
| Mighty Mica cuts off the pre-motor cortex? | Apraxia (Mica) |
| disorder caused by damage to specific areas of the cerebrum, characterized by loss of the ability to execute or carry out learned purposeful movements,[1] despite having the desire and the physical ability to perform the movements. | Apraxia (Mica)"pre-" motor means before the motor so the planning you need to execute a task is not available |
| Disorder of motor planning caused by Middle Cerebral artery occlusion | Apraxia (Mica) |
| Middle cerebral artery occlusion symptoms: | contralateral homonymous hemianopsia, aphasia (B, W, or global), Apraxia, acute paresis of contra/affected side, Astereognosis/Neglect syndrome, Contra spastic paralysis and sensory of upper extremity |
| capsular stroke with contralateral homonymous hemianopsia due to LGB and contralateral spastic paralysis and sensory loss of the body and face | Anterior CHOROID (C for Capsule and Choroid) |
| patient's eyes are literally looking at the disaster, stuck in the direction of the affected side... | Mighty Mica (acute paresis, as if looking away from paralyzed side in horror) |
| right parietal lobe artery and symptom | Mica - Astereognosis/Neglect |
| internal capsule artery and symptom | Anterior CHOROID (C for Choroid and Capsule) - contralateral spastic paralysis and sensory loss to whole body and face |
| LGB artery and symptom | Anterior CHOROID (C for Capsule and Choroid) - contralateral homonymous hemianopsia |
| motor and sensory cortex artery and symptom | Mica - contralateral spastic paralysis and loss of the face and upper extremity, since Mica supplies outside of brain/upper extremity/FACE on homunculus |
| optic radiation artery and symptom | Mica - contralateral homonymous hemianopsia (same as LGB for Anterior CHOROID) |
| frontal eye field artery and symptom | Mica - acute (1-2 day) paresis of contralateral conjugate gaze in the direction of the affected side, away from the paralyzed side as if in horror |
| dominant hemisphere artery and symptom | left side: Mica: Broca's (expressive), Wernicke's (receptive), or global (both) aphasia |
| non-dominant hemisphere RIGHT parietal lobe artery and symptom | Mica: Astereognosis/Neglect |
| premotor cortex artery and symptom | Mica: Apraxia (want to move but can't -disorder of motor planning) |
| paracentral lobule artery and symptom | ACA: contralateral spastic paralysis and sensory loss affecting mainly distal leg sensory and lower half motor and perineum (due to ACA supplying |
| prefrontal lobe artery and symptom | ACA: mental confusion |
| bilateral prefrontal lobe artery and symptom | ACA: abulia (apathy and muteness - no fight left in there) requires bilateral ACA infarction at genu of corpus callosum |
| longitudinal fissure | separates the cerebral hemispheres |
| lateral fissure | separates the temporal lobes from the cerebrum, turns into supramarginal gyrus |
| the vertebral artery is a branch of the | subclavian artery |
| how does the vertebral artery ascend? | via the transverse foramina of Cervical vertebrae |
| the arteries that deeply penetrates the medulla | Vertebral arteries |
| The artery that forms when the vertebral arteries merge at the base of the pons | Basilar artery |
| The artery linking the two vertebral arteries and running down betweent the pyramids of the brainstem | anterior spinal artery |
| Where does the Basilar artery end? | when it divides into the posterior cerebral artery (POST cereal) |
| A single _______________ artery is formed by a contribution from each vertebral artery (a twin is formed on the other side). | Anterior spinal |
| artery that supplies the inferior surface of temporal lobes, and calcarine and parieto-occipital sulci. | Posterior cerebral artery (POST cereal) |
| POSTerior cerebral artery (POST cereal) supplies the calcarine sulcus. Why is this especially important? | all the primary and some of assoc. cortex for vision are supplied by POSTerior cerebral artery (POST cereal) |
| Distal occlusion of the POSTerior cerebral artery: (3) | contralateral homonymous hemianopsia with sparing of the macula (striate cortex), contralateral homonymous lower quad hemianopsia with macula sparing (cuneus), contralateral homonymous uppper quad with macula sparing (lingula) |
| Bilateral occlusion of the POSTerior cerebral artery: (worst) | Alexia - inability to read (Splenium), Anton's - failure of blind person to recognize he is blind (basilar junction) |
| Proximal occlusion of the POSTerior cerebral artery: (3) Think of where this artery begins at the pons and where it goes close to its origins | Contralateral sensory loss (anesthesia) or THALAMIC SYNDROME (all is pain), Hemiballism (subthalamic nucleus), Midbrain symptoms |
| Brainstem stroke (medulla and pons)is instantly | fatal, or results in coma due to failure of central control of respiration |
| Reticular formation fails during a _________ stroke | brainstem |
| large infarction of the ventral pons causing paralysis of all voluntary movements except of the EYES (depresses all corticospinal and corticobulbar but because it's below the midbrain, you still have your EYES). | Locked-in Syndrome/brainstem vascular stroke |
| Medial stroke of either medulla or pons and lateral stroke of either medulla or pons are similar in symptoms. What tells you where it is? | cranial nerve dysfunction gives away location |
| brainstem stroke symptom/syndrome | locked-in syndrome - paralysis of all voluntary muscles except eye movements (CN III spared) |
| Medial medulla and pons have what arteries? | anterior spinal artery (medulla) and the pontine arteries (pons) |
| vertebral paramedian | anterior spinal artery |
| basilar paramedian | pontine arteries |
| brainstem pathways | corticospinal and deep sensibility (VDPP) |
| long axis pathways of the brainstem vs. horizontal pathways | long: corticospinal and VDPP, horizontal are defined by cranial nerves |
| which nerves are brainstem corticospinal? (MEDIAL) | III, VI, XII (3.6.12) |
| which nerves are brainstem lateral spinothalamic? (LATERAL) | 5,7,8,9,10,11 |
| common symptoms of medial medulla and pons (to anterior spinal artery and pontine arteries): | Contralateral spastic paralysis of body (corticospinal tract fibers run through pons and pyramid and are medial), contralateral loss of deep sensibility (medial lemniscus is medial) |
| what DON'T you lose with medial syndrome of medulla and/or pons? | Pain & Temperature so don't lose the face |
| two common medial syndromes shared by medulla and pons: | contralateral Paralysis to body only (corticospinal fibers in basilar pons/pyramid) and Contralateral loss of deep sensibility/VDPP from body only (medial lemniscus travels through both pons and medulla). Not lose face. |
| Contralateral spastic paralysis (corticospinal fibers) and Contralateral loss of deep sense (MLF) is common to: | Medial syndromes of BOTH Medulla and Pons |
| Medial syndrome of the pons only include (2): | medial strabismus (INFERIOR pons @cerebellopontine angle) and internuclear ophthalmoplegia (SUPERIOR pons at MLF) |
| medial cranial nerves of pons? | VI at INFERIOR pons |
| medial syndrome of pons causes medial strabismus. Why? | CN VI Abducens of INFERIOR pons (LR6, SO4)3 so lateral rectus affected as paralysis of ipsilateral gaze because all cranial nerves are ipsi except Trochlear/4 and optic after it decussates. |
| medial strabismus due to medial syndrome of? | INFERIOR pons at CN VI |
| what does medial syndrome of pons do to the eyes if affected at inferior pons? | Causes MEDIAL STRABISMUS of INFERIOR pons: paralysis of horizontal gaze to the side of the lesion (ipsilateral) due to CN VI Abducent affect of lateral rectus |
| Internuclear ophthalmoplegia is caused by | medial syndrome affecting pons at MEDIAL LONGITUDINAL FASICULUS (MLF) paramedian pontine reticular formation SUPERIOR pons |
| Lateral rectus muscle fails in medial syndrome due to | CN VI Abducens of INFERIOR PONS being on medial pons so stuck gaze opposite to stroke (cranial nerves are ipsilateral except trochlear) |
| if BOTH eyes are affected by medial strabismus due to fail of lateral rectus, then it's a | stroke at the pons level of CN VI Abducens so medial syndrome symptom of INFERIOR PONS |
| If only one eye is affected by medial strabismus, is it a stroke or a CN lesion? | CN lesion of VI Abducens at INFERIOR PONS |
| where is the MLF? | Along the median pons at the back in the tegmentum (next to the: paramedian pontine reticular formation (PPRF) |
| an infarct of the anterior spinal artery/vertebral paramedian artery of the medulla: | Medial syndrome of medulla: contralateral spastic paralysis (corticospinal), contralateral loss of deep sense (medial lemniscus), ipsilateral paralysis of tongue pointing to lesioned side (CN XII) |
| contralateral spastic paralsyis of body due to corticospinal fiber presence in this area and contralateral loss of deep sense due to MLF in this area signifies: (no loss of P&T) | Medial syndrome of BOTH pons and medulla (P&T is in the spinothalamic tract laterally so is spared in medial syndrome) |
| medial strabismus with stuck gaze opposite of lesion indicates a possible infarction of: | inferior pontine arteries affecting CN VI Abducent (or lesion to facial colliculus but this would have facial n. symptoms) |
| loss of the ability to move the ipsilateral eye outward (abduction). | medial strabismus from medial pons/pontine arteries blow of CN VI |
| Where must the pons be affected in medial syndrome in order to produce internuclear ophthalmoplegia? | upper! @ MLF at paramedian pontine reticular formation of the superior pons |
| The control of conjugate gaze is mediated in the brainstem by the medial longitudinal fasciculus (MLF), a nerve tract that connects the three extraocular motor nuclei (_____________, _______________, _____________) into a single functional unit. | abducens, trochlear, oculomotor /(LR6,SO4)3 |
| If the MLF is affected by middle pons syndrome, what happens and where is the infarct? | superior pons medial at MLF which affects (LR6,SO4)3/abducens,trochlear, and oculomotor with INTERNUCLEAR OPHTHALMOPLEGIA |
| Conjugate gaze palsy refers to an inability of both eyes to move in the same direction at the same time.It can be associated with a lesion of the | PPRF (paramedian pontine reticular formation) at MLF so internuclear ophthalmoplegia |
| convergence is preserved but horizontal diplopia (double vision) occurs since affected eye cannot abduct. Occurs with injury to PPRF at MLF during median pons syndrome | internuclear ophthalmoplegia |
| If the medulla instead of the pons is involved in medial syndrome (anterior spinal artery if medulla), then what is the symptom? | ipsilateral tongue paralysis due to CN XII Hypoglossal n. level |
| PONS blood vessel lesions (5) | contralateral spastic paralysis of body (c.s.fibers), contralateral loss of deep sense (medial lemniscus), Nystagmus (CN III), Medial strabismus (CN VI), Internuclear ophthalmoplegia (MLF - PPRF) |
| MEDULLA blood vessel lesions (3) | Contralateral spastic paralysis of body (corticospinal fibers), Contralateral loss of deep sense (medial lemniscus), Ipsilateral tongue paralysis (CN XII) |
| Lateral Syndrome of Medulla and Pons involves what 2 arteries? | PICA (medulla) and AICA (pons) |
| PICA/medulla and AICA/pons artery lesion is called: | Lateral Syndrome of Medulla/PICA and Pons/AICA |
| If both Medulla/PICA and Pons/AICA are involved, 6 symptoms: | Contralateral loss of Pain & Temp of body (lateral spinothalamic t.), Ipsi loss of P&T (medulla for spinal tract of V and pons for touch), Nystagmus (lateral 4th ventricle), Cerebellar sym (inf. cer ped - 6), Ipsi Horner's Syndrome(stellate gang/ret form) |
| contralateral loss of pain and temperature from body due to lateral syndrome of medulla and pons | PICA and AICA; lateral spinothalamic tract for pain and temp |
| ipsilateral loss of pain and temperature and touch from face due to lateral medulla and pons syndrome: | PICA and AICA; Affects Trigeminal V nuclei: spinal tract of Trigeminal n. in medulla and Chief sensory nucleus in pons |
| nystagmus due to lateral syndrome of medulla and pons: | PICA and AICA; lateral 4th ventricle would affect CN VIII Vestibulocochlear |
| cerebellar symptoms due to lateral syndrome of medulla and pons | PICA and AICA; due to INferior cerebellar peduncle involvement: ataxia, intention tremors, dysmetria, dysdiadochokinesia, pendular reflexes, hypotonia) |
| Ascending tracts arise from the Vestibular nucleus (VN) and terminate in the III, IV and VI nuclei, which are important for visual tracking | MLF |
| carries information about the direction that the eyes should move. | MLF |
| It yokes the cranial nerve nuclei III (Oculomotor nerve), IV (Trochlear nerve) and VI (Abducens nerve) together | MLF |
| and integrates movements directed by the gaze centers (frontal eye field) and information about head movement (from cranial nerve VIII, Vestibulocochlear nerve) | MLF |
| It is an integral component of saccadic eye movements as well as vestibulo-ocular and optokinetic reflexes. | MLF |
| form of involuntary eye movement. It is characterized by alternating smooth pursuit in one direction and saccadic movement in the other direction | nystagmus |
| 1.the Vestibulocochlear (8th cranial) nerve about head movements,2.gain adjustments from the flocculus of the cerebellum,3.head and neck propioceptors and foot and ankle muscle spindle, via the fastigial nucleus. | Inputs to the Vestibular nucleus that maintain gaze |
| This syndrome is characterized by sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct | Lateral medullary/Wallenburg's syndrome is PICA only includes all of Medulla/PICA and Pons/AICA plus dysphagia, hoarseness, uvular dev or absence of gag reflex (nucleus ambiguus, CN X), loss of taste (solitary nucleus/7.9.10) |
| Cerebellar symptoms induced by lateral syndrome Medulla/PICA and Pons/AICA: | Inferior cerebellar peduncle: ataxia, intention tremors, dysmetria, dysdiadochokinesia, pendular reflexes, hypotonia) |
| Inferior cerebellar peduncle symptoms (Lateral Syndrome of AICA/pons and PICA/medulla both): | HAPDID Hypotonia, Ataxia, Pendular reflexes, Dysmetria, Intention tremor, Dysdiadochokinesia |
| HAPDID cerebellar | Inferior Cerebellar peduncle PICA/AICA medulla/pons lateral syndrome: Hypotonia, Ataxia, Pendular reflexes, Dysmetria, Intention tremor, Dysdiadochokinesia |
| Ipsilateral HORNER's syndrome due to PICA/Medulla and AICA/Pons Lateral Syndrome: | Reticular formation: ptosis, miosis, anhydrosis, enophthalmos, hiccup |
| Reticular formation lesion means | Horner's syndrome ptosis, miosis, anhydrosis, enophthalmos, hiccup |
| miosis | constricted pupils |
| ptosis | droopy eyelid |
| anhydrosis | can't sweat |
| enophthalmos | recession of the eyeball within the orbit |
| hiccup | reticular formation problem assoc with Horner's |
| The clinical features of Horner's syndrome can be remembered using the mnemonic, "Horny PAMELa" for Ptosis, Anhydrosis, Miosis, Enophthalmos and Loss of ciliospinal reflex.[ | Horney PAMELa(includes Hiccup from notes) |
| The __________ zone of the medulla contains the pyramids, internal arcuate fibers and/or medial lemniscus, and CN XII (nucleus and exiting fibers). | anterior |
| The anterior zone of the medulla contains the: | pyramids, medial lemniscus/internal arcuate fibers, and CN XII Hypoglossal |
| what does the anterior zone of the medulla contain? | pyramids, medial lemniscus, CN XII Hypoglossal |
| what artery supplies the anterior zone of the medulla (pyramids, medial lemniscus, CN XII Hypoglossal)? | Anterior spinal artery |
| lesion of anterior spinal artery of medulla oblongata is called "alternating" because the symptoms are: | contralateral spastic paralysis (pyramids), contralateral loss of deep sense except pain and temp (medial lemniscus), ipsilateral tongue paralysis tongue points to lesion side (CN XII Hypoglossal) |
| what does the medial pons contain? | corticospinal tract, medial lemniscus, CN's VIII & VI (both lower), MLF at upper only |
| medial pons contents | corticospinal tract, medial lemniscus, VI and VIII lower only, MLF upper only |
| medial pons syndrome | contralateral spastic paralysis of body (corticospinal fibers), contralateral loss of deep sensibility (medial lemniscus), medial strabismus/loss of abduction LR6 (CN VI), nystagmus (VIII), internuclear ophthalmoplegia (MLF gaze follow off [LR6SO4]3) |
| medial pons arteries | basilar artery, pontine arteries from it |
| ventral pons lesion is the worst. What do you get? | Locked-in syndrome. Eyes only spared. |
| Which pons lesion is worst and what is syndrome? | Ventral, Locked-in, eyes spared |
| Arteries supplying lateral pons and medulla? | Vertebral artery via its two branches: Medulla is Posterior Inferior Cerebellar Artery (PICA) and Pons is Anterior Inferior Cerebellar Artery (AICA) |
| If both PICA of the medulla and AICA of the pons infarct, what syndrome occurs? | Lateral syndrome of Pons (AICA) and Medulla (PICA) |
| Lateral syndrome of Pons (AICA) and Medulla (PCIA) results always in what 6 basic symptoms: | Contraloss of P&T from body (spinothalamic), Ipsi loss of P&T&touch from face(nucleus of spinal tract of V/medulla and chief sen nucleus of V/pons), Nystagmus (vestibular nuc), Cerebellar (ICP), Ipsi Horner's (reticular f.), 6.Hiccup (reticular f.) |
| say the 6 symptoms of lateral syndrome always present: | contralateral loss of P&T from body, IPSIlateral loss of P&T&Touch from face, Nystagmus, Cerebellar symptoms, Horner's, hiccup |
| Lateral syndrome involving Medulla would be what arteries? | Vertebral artery of that side and PICA of that side |
| Latera syndrome involving Medulla is what arteries and specifically, what symptoms in additon to standing 6 for Lateral Syndrome of Pons/AICA and Medulla/PICA? | Vertebral/PICA. Standing 6 for Lateral syndrome + dysphagia, hoarseness, uvular deviation or absence of gag reflex (CN X) and loss of taste (Solitary tract/nucleus) = Wallenburg's Syndrome |
| What is Lateral syndrome specific to medulla called? | Wallenburg's syndrome |
| Wallenburg's syndrome: | lateral syndrome standing 6 + CNX: dysphagia, hoarseness, loss of gag reflex or uvular deviation away from lesion/to the good side and Solitary nucleus/tract: loss of taste |
| standing 6 symptoms of lateral syndrome of pons/AICA and medulla/PICA: | contralateral loss of P&T to body, ipsilateral loss of P&T&Touch to face, Nystagmus, Cerebellar symptoms (HAPDID), Horner's (PAMELa's horny), Hiccup |
| Lateral Syndrome of pons/AICA and medulla/PICA specific to Lower Pons, besides the standing 6 for lateral syndrome: | Lower Pons is AICA involvement: standing 6 for lateral syndrome + Bell's palsy/ipsilateral facial paralysis (CN VII Facial) and Deafness (cochlear nuclei) |
| which syndrome specifically involves vestibular nuclei? Cochlear nuclei? | Vestibular is standing 6 general symptoms of Lateral Syndrome of pons/AICA and medulla/PICA while cochlear nuclei is lower pons/AICA lateral syndrome + standing 6 |
| lower pons lateral syndrome artery and affect if stroke | AICA = standing 6 for lateral syndrome general + Bell's palsy/ipsilateral facial paralysis (CN VII Facial) and DEAFNESS! (cochlear nuclei) |
| MIDpons lateral syndrome artery and affect if stroke: | AICA = standing 6 for lateral syndrome general + inability to chew and jaw deviation (CN V Trigeminal) |
| MIDpons lateral syndrome symptoms of AICA stroke with standing 6: | inability to chew and jaw deviation to the paralyzed side (CN V Trigeminal) |
| what nerve is the only nerve of the MIDpons? | Trigeminal |
| What happens to Trigeminal nerve if AICA stroke at midpons? | standing 6 of lateral syndrome + inability to chew/jaw deviation to paralyzed side due to peripheral involvement of CN V (UMN would show few signs because other side would compensate but peripheral is ipsilateral) |
| lateral medullary syndrome is called? artery? | Wallenburg's, PICA and vertebral arteries |
| Pray to Parinaud like you've seen God: | Dorsal midbrain syndrome involves Pinealoma also called Parinaud's: paralysis of upward gaze, loss of pupillary/light reflex due to no blood to pretectal nucleus (bilateral part of light reflex before E.W. nucleus) |
| What runs through the crus cerebri? | corticospinal, corticobulbar |
| Stroke involving branches of Posterior Cerebral artery: | WEBER's at crus cerebri: contralateral paralysis of face and body (corticospinal & corticobulbar) + ipsilateral oculomotor palsy (ptosis, mydriasis, lateral strabismus) |
| also known as dorsal midbrain syndrome is a group of abnormalities of eye movement (upward gaze locked) and pupil dysfunction (mydriasis). | Parinaud's Syndrome (the father of Fr. ophthamology) |
| Most common lesion producing Parinaud's syndrome: | pinealoma |
| A pinealoma may present upward gaze with caused by the compression of the vertical gaze center in the midbrain tectum at the level of the superior colliculus and cranial nerve III. | Parinaud's caused by pinealoma is upward gaze and loss of pupillary light reflex/mydriasis |
| (superior alternating hemiplegia) is a form of stroke characterized by the presence of an oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. | Weber's: contralateral spastic paralysis of body and face (corticobulbar and corticospinal in crus cerebri) + Ipsilateral oculomotor palsy(ptosis, mydriasis, lateral strabismus of CN III involvement) |
| Where does Weber's happen? | posterior perforated substance area between crus cerebri so involves crus cerebri and CN III |
| Where does Parinaud's happen? | dorsal midbrain due to pineal tumor pressing on tectum and CN III |
| Parinaud's-pineal-pray, Weber's- | contralateral spastic paralysis of body and face (crus cerebri contains corticobulbar and corticospinal) + Ipsilateral oculomotor nerve palsy (ptosis, mydriasis, lateral strabismus) |
| Weber's is also called | ventral midbrain syndrome |
| Pray to Parinaud's pineal is also called | dorsal midbrain syndrome |
| C for Central is Claude's syndrome: | Posterior Cerebral artery branches: ipsilateral oculomotor n. palsy (p,m,ls)- Hemiballism - contralateral loss of ALL sensation (pain, temp, vibration, postion) |
| C for Central is Claude's syndrome of the midbrain involving posterior cerebral artery: | 1.Ipsilateral Oculomotor palsy (CN III is ptosis, mydriasis, lateral strabismus), 2.Hemiballism (subthalamic nucleus), 3.Contralateral loss of ALL sensation (pain, temp, vibration, position due to medial lemniscus and spinothalamic tracts) |
| Weber's/ventral combined with C for Claude's central = | Benedikt syndrome |
| where are ANS preganglionic fibers? | clustered in the CNS |
| where are ANS postganglionic fibers? | clustered in a ganglion outside the CNS |
| which has a ratio of fibers 1:3? | parasympathetic |
| preganglion ANS terminals release __________ mediated by ____________ receptors | Ach, N-Ach (nictotinic) |
| substance P and neurotensin, somatostatin, enkephalins are examples of | neuropeptides (released from both pre- and postganglionic terminals) |
| postganglionic sympathetic terminals release __________ | Norepinephrine to noradrenergic receptors |
| postganglionic parasympathetic terminals release | Acetylcholine (parasympathetic is all Ach) but the receptors are MUSCARINIC |
| what does Ach do to the heart/muscarinic receptors | slows it down - remember: muscarinic receptors are only in the parasympathetic system postganglions |
| what do the parasympathetic and sympathetic systems innervate? | cardiac, smooth, and glandular and mediate visceral reflexes |
| enteric is | digestive/autonomy |
| Pregang SYMPATHETIC located in the | intermediolateral gray of T1-L2 |
| pregang sympathetics located in the intermediolateral gray of ___-____ | T1-L2 |
| how do preganglionic SYMPs exit the spinal cord? | ventral root, then briefly join spinal nerve and ventral ramus, but form a white rami communicantes and enter the paravertebral sympathetic ganglia |
| where do the white rami communicates of T1-L2 lead? | paravertebral sympathetic ganglia |
| Preganglionic ___________ fibers synapse with the __________ chain ganglia at the Same, Higher (T1-T5) or lower level (T5-L2). | sympathetic, sympathetic |
| What levels are considererd upper sympathetic chain ganglia? | T1-T5 |
| What levels are considered lower sympathetic chain ganglia? | T5-L2 |
| levels of sympathetic chain ganglia | T1-L2 |
| Once presympathetic fibers from white rami communicans enter the sympathetic chain ganglia from T1-L2, how does the second command get out? | postganglionic fibers FORM the gray rami communicantes and enter the ventral ramus. They can either go dorsal or ventral rami to their peripheral blood vessels, sweat glands, and arrectores pilorum muscles of the body wall and limbs |
| The postganglionic sympathetics of T1-L2 innervated strictly: | body wall and limbs: peripheral blood vessels, sweat glands, arrectores pilorum muscles |
| POSTgan SYMPathetics from cervical ganglia innervate | cranial blood vessels, sweat glands, hair follicles, glands and VISCERAL organs of the head and thorax [heart and lungs] |
| how do postganglionic sympathetics cervical ganglia of the head and thoracic viscera get their instructions? | via cranial nerves or direct plexuses |
| lesion of the Superior Cervcial Ganglion | Horner's syndrome (ptosis, miosis, anhidrosis, enophthalmos) |
| lesion of the Reticular formation in the medulla | Horner's syndrome (ptosis, miosis, anhidrosis, enophthalmos) |
| Horner's syndrome is caused by | Lateral Syndrome of Pons/AICA and Medulla/PICA (standing 6), or Superior Cervical Ganglion or REticular Formation in medulla |
| How are splanchnic nerves formed? | Preganglionic sympathetics bypassing cervical ganglia and form greater, lesser, least and lumbar (pelvic) splanchnic nerves |
| Where do the lesser, greater, least and lumbar splanchic nerves synapse? | They skip the cervical ganglia and head to prevertebral ganglia (coeliac, superior mesenteric, inferior mesenteric) so they can innervate the organs of the gut |
| The coeliac, superior mesenteric and inferior mesenteric pelvic splanchnic nerves innervate what? | abdominal and pelvic organs (GI, pancreas, liver, kidney, gladder, genitalia) |
| Some fibers of the splanchnic nerves not only bypass the cervical ganglia but also the prevertebral ganglia and don't innervate abdominal or pelvic organs. These special guys do what? | innervate the adrenal medulla which releases Epinephrine and Norepinephrine into circulations! |
| location of preganglionic PARAsympathetic cells | 3,7,9,10 (Oculomotor, Facial, Glossopharyngeal, Vagus) and Intermediolateral gray of S2-S4 |
| Name the 5 preganglionic cells clusters of the brainstem | Edinger-Westphal nucleus [III], Superior Salivatory nucleus [VII], Inferior Salivatory nucleus [IX], Dorsal Motor nucleus [X], Nucleus Ambiguus [X] |
| 5 brainstem clusters, 4 cranial nerves: | Oculomotor is Edinger-Westphal nucleus, Facial is Superior Salivatory nucleus, Glossopharyngeal is Inferior Salivatory nucleus, Vagus is Dorsal Motor nucleus and Nucleus AMBIGUUS |
| Trace Facial n. parasympathetic trail: | Superior Salivatory nucleus - Facial n. VII - pterygopalatine ganglion - lacrimal gland & mucous/serous glands of nasopharynx AND Superior Salivatory nucleus - Facial n. VII - to Submandibular ganglia - submandibular and sublingual salivary glands |
| Facial parasympathetic trail to lacrimal | Superior salivatory nucleus - Facial n. VII - pterygopalatine ganglion - lacrimal gland (via trigmenial) |
| Facial parasympathetic trail to submandibular and salivatory | Superior salivatory nucleus - Facial n. VII - submandibular ganglion - submandibular and sublingual salivary glands |
| Trace CNIII parasymp | Edinger-Westphal to Oculomotor III to ciliary ganglion to sphincter pupillae and cilliary muscles |
| Trace CN IX parasympathetic trail | Inferior salivatory nucleus - Glossopharyngeal n. IX - otic ganglion - parotid!!! |
| Trace Vagus X parasympathetic | Dorsal motor nucleus and Nucleus AMbiguus - VAGUS n. X - diffuse thoracic and abdominal ganglia - heart, esophagus, lungs, stomach, liver, gall bladder, pancreas, foregut and midgut derivatives |
| intermediolateral columns _______ for parasympathetic innervation | S2-S4 |
| S2-S4 intermediolateral cell column gives rise to ________________ parasympathetic fibers which, via the pelvic splanchnic nerves, innervate the descending sigmoid colon and pelvic viscera. | preganglionic |
| how are the Sigmoid colon and pelvic viscer innervated parasympathetically? | S2-S4 intermediolateral cell column - pelvic splanchnic nerves - sigmoid and pelvic viscera |
| controls the fcn of the GI tract, pancreas, and gall bladder | enteric nervous system |
| two components of Enteric | Meissner's/submucosal between circular and mucosa and Auerbach's/myenteric (muscles external long and circular) |
| Auerbach's | myenteric ('my' as in found between muscles of the enteric sys) |
| Meissner's | submucosal |
| The __________nerve conveys visceral chemosensory info about taste | Facial |
| the Facial nerve conveys visceral chemosensory info about __________ | taste |
| The glossopharyngeal nerve conveys information from the ___________and _______ viscera | head and neck |
| which CN conveys information from the head and neck viscera? | Glossopharyngeal IX |
| nerve that conveys information about thoracic and abdominal viscera | CN X Vagus |
| the Facial VII, Glossopharyngeal IX and Vagus X all converge sensory information to what nucleus in the brainstem? | Solitary nucleus (7.9.10 I was alone when I ate/8 it) |
| Solitary nucleus takes 7.9.10 info and does three things: | 1.direct reflex auto via X and spinal cord nuclei, 2.reticular form & periaqueductal grey for homeostasis, 3.hypothalamus then thalamus-amygdala-cortex |
| What does the hypothalamus do with the information it receives from the Solitary nucleus (7.9.10)? | controls brainstem and spinal cord nuclei that control temperature, heart rate, blood pressure, breathing, feeding and metabolic rate, and by ENDOCRINE release of hormones that influence autonomic fcn. |
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