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Neurology
Unit 1: Embryonic and Pediatric Development
| Question | Answer |
|---|---|
| Embryonic development occurs within the __________ trimester | First |
| Fetal development occurs during the _________ and _________ trimester | Second and third |
| Implantation widow is days ________ post-ovulation | 6-10 days |
| For about the first week after the egg is fertilized, there is no ____________________ with the embryo | Maternal blood exchange |
| At week 1 the fertilized egg begins dividing. The entire nervous system will form from the _________ | Neural plate |
| The human embryo during week 3 is about 1-1.5 mm long. Almost all you see is the neural plate. The line in the middle of the embryo is the _________ | Neural groove |
| At 4 weeks, the embryo sits on top of a big yolk sac. The yolk sack becomes the _______ and ______. The plate now folds to form a hollow neural tube which will eventually become the ____ and ______. The embryo is now 2 - 3.5 mm long. | Umbilical cord, placenta, brain, spinal cord. |
| (4 weeks continued) The neural plate can be seen folding down the middle of the back, beginning to form the ________ | Neural tube |
| As the neural groove furrows down, the neural plates come to the ________ so that they may _______, and the tube will eventually close completely at each end. | Midline, merge. |
| What directions does the neural tube close? | It closes at the midline first, then the cephalic point, and ends at the caudal point. |
| During week 8/9, with the tube still open, the _______ will cover the tube leaving it to develop further. | Ectoderm |
| The neural tube will begin to close before _________ | Week 9 |
| Folic Acid Deficiency | Lack of Vitamin B9 |
| Folic acid deficiencies tend to be linked with | Neural tube deficits |
| Week 4-6 at the brain end - the tube expands to form how many vesicles? | 3 |
| What are the three primary brain vesicles? | Prosencephalon, Mesencephalon, Rhombencephalon |
| The Prosencephalon forms the _____ brain | Forebrain |
| The Mesencephalon forms the ______ brain | Midbrain |
| The Rhombencephalon forms the _____ brain | Hindbrain |
| Each primary area of the three vesicles continues differentiating to become the mature elements of the _______ | CNS |
| The Prosencephalon, Mesencephalon, and Rhombencephalon are then going to split into how many vesicles? | 5 |
| The Prosencephalon splits into two secondary vesicles: | Telencephalon and Diencephalon |
| The Telencephalon forms the? | Cerebral cortex and Basal ganglia |
| The Diencephalon forms the? | Thalamus and Hypothalamus |
| The Mesencephalon forms the? | Mesencephalon (Tectum) |
| The Rhombencephalon splits into two secondary vesicles: | Metencephalon and Myelencephalon |
| The Metencephalon forms the? | Pons and Cerebellum |
| The Myelencephalon forms the? | Medulla oblongata & Cerebellum |
| The neural tube continues to extend on after Rhombencephalon and eventually forms the? | Spinal cord |
| During week 6, what is formed and visible? | the brain and spinal cord of the human embryo. Also visible are the heart and placental cord containing placental blood vessels. |
| Week 9 is the complete development of the? | Neural tube |
| By the end of the first trimester, the fetus is formed, everything is in its place and now things just need to? | Grow and develop |
| The first trimester sets up everything for the | Second trimester |
| During the second trimester is where we see the biggest ______ growth | Brain |
| Sylvian/lateral fissure | Fissure which differentiates our frontal lobe from our temporal lobe |
| In the second trimester, what fissure appears? | Sylvian fissure |
| During the second trimester, the fluid space is filled with? | Cerebrospinal fluid (CSF) |
| During the third trimester the brain continues to grow. The surface area of our ________ starts to form and change. It starts to go from a smooth surface to begin to ______. The ______ and ____ begin to form | Cerebral cortex, wrinkle, gyri, sulci |
| How do the Gyri and Sulci begin to form? | Millions of cells are pushed into the cortex, increasing the surface area |
| Fissure | A groove |
| Gyrus | A fold |
| During the third trimester, the mother needs a lot of what to prevent embryonic development? | Iodine from salt |
| Children with Iodine Deficiency Disorders (IDD) can have? | Stunted growth, intellectual disability, and speech & hearing deficits. |
| IDD in pregnant women cause | Miscarriage, stillbirth and intellectual disability children. |
| A ______ of iodine is all a person requires in a lifetime. Why? | Teaspoon. Because iodine cannot be stored for long periods by the body, tiny amounts are needed regularly. |
| The third, the second trimester and the third trimester are mainly spent on? | Growing in size and developing the structures that were already fully formed within that first trimester |
| When does myelination occur? | Birth to 25 years after birth. |
| What to myelinated axons do? | Connect areas of the brain to other areas of the brain |
| Neuronal Proliferation | The process by which billions of cells are generated |
| Gyri and sulci appear by _____ weeks | 24 |
| Neurons proliferate and migrate to | Specific areas of the brain |
| Neurons must establish ________ with other neurons and become integrated into __________ | Connections, neural networks |
| For brain development, the most critical period is from | 3-16 weeks |
| Apoptosis | The death of cells which occurs as a normal and controlled part of an organism's growth or development. |
| Many neurons die ______ | Naturally |
| ________ can disrupt migration | Teratogens |
| After we are born and the neurons have already migrated and they're ready to start firing, we see that the _______ of the neurons start sprouting out and connecting to other neurons | Dendrites |
| Dendritic sprouting | Growth of dendrites |
| Dendritic pruning | Elimination of dendrites |
| Neurons don’t _______, the connections (synapses) are ________ | Die, pruned |
| Dendrites will die if they do not ________. They will then be cleaned up by? | Connect, glial supporting cells |
| Age for Cortical Organization and Synapse Formation | 5 months to years |
| Once neurons arrive at intended spot, what happens? | They sprout dendrites and axons |
| Synapses begin to form where? | Between neurons |
| Synaptic pruning eliminates | Unneeded connections |
| Failure in the pruning stage can lead to? | Polymicrogyria |
| Polymicrogyria | Too many gyri in the cerebral hemispheres |
| What are the critical/Sensitive Periods of Development? | 0-3 years old, 12 years old |
| What Critical/Sensitive Development occurs during 0-3 years old? | Neuronal connection and pruning |
| What Critical/Sensitive Development occurs at 12 years old? | Increase in dopamine with underdeveloped parts of the brain (frontal lobe) leading to making harmful decisions |
| During Adolescent Brain Development, the ______ is fully developed | Amygdala |
| What is associated with the Amygdala | Emotions |
| For adolescents, they have larger _______ responses to positive reinforces | Dopamine |
| In adolescents, what is the last part of the brain to connect leading to poor judgement? | Prefrontal cortex |
| Adolescent Brain Development is important to SLPs for two reasons: | -Individual vs group therapy. -Neuroplasticity. |
| Neural tube defects occur when the neural tube? | Fails to fuse together |
| Anencephaly | Absence of the cranial vault at birth with the cerebral hemispheres completely absent or reduced to small masses attached to the base of the skull. |
| Anencephaly often results in miscarriage, why? | Because you cannot develop any further without those major parts of the nervous system |
| Spinal Bifida | A birth defect in which an area of the spinal column doesn't form properly, leaving a section of the spinal cord and spinal nerves exposed |
| What are the types of spinal bifida? | Spina Bifida, Meningocele, and Myelomeningocele |
| Meningocele | When a fluid-filled sac protrudes from an opening in a fetus’s back. |
| Myelomeningocele | The most common and serious form of spina bifida where the spinal cord and nerves protrude from the back in a sac that is exposed to the amniotic fluid. |
| Spina bifida often accompanies? | Arnold-Chiari II malformation |
| What occurs if Arnold-Chiari II malformation accompanies spina bifida? | The baby’s hindbrain herniates or descends into the upper portion of the spinal canal in the neck. This herniation of the hindbrain blocks the circulation of cerebrospinal fluid, causing hydrocephalus, which can injure the developing brain |
| Hydrocephalus | Accumulation of fluid in the brain |
| Agenesis of the Corpus Callosum | A congenital condition where you’re missing or partially missing the corpus callosum |
| Microcephaly | A rare neurological condition in which an infant's head is much smaller than the heads of other children |
| In Microcephaly, what vesicles did not form like they should have? | Prosencephalon or mesencephalon |
| Holoprosencephaly | Failure of the prosencephalon to sufficiently divide into cerebral hemispheres |
| Holoprosencephaly results in? | A single-lobed brain structure, severe skull and facial deficits |
| Schizencephaly | A rare congenital brain malformation in which abnormal slits or clefts form in the cerebral hemispheres of the brain |
| Lissencephaly | A rare congenital condition that causes a developing brain to appear smooth instead of having gyri or sulci |
| Why doesn't Lissencephaly have as many neurons? | The lack of surface area of the brain that is needed |
| What is the response of this reflex: Asymmetrical tonic neck reflex | Infant extends limbs on chin and flexes on occiput side when turning head |
| What is the response of this reflex: Symmetrical tonic neck reflex | Infant extends arms and flexes legs with head extension |
| What is the response of this reflex: Positive support reflex | Infant bears weight when balls of feet are stimulated |
| What is the response of this reflex: Tonic labyrinthine reflex | Infant may retract shoulder and extend neck and trunk with neck flexion; tongue thrust reflex may occur |
| What is the response of this reflex: Segmental rolling reflex | Infant may roll trunk and pelvis segmentally with rotation of head or legs |
| What is the response of this reflex: Galant reflex | Infant arches body when skin of back is stimulated near vertebral column |
| What is the response of this reflex: Moro reflex | Infant may adduce arm and move it upward, followed by arm flexion and leg extension and flexion |
| Rooting: Stimulus, age of appearance and disappearance | Perioral face region is touched, birth, 3-6 months |
| Suckling: Stimulus, age of appearance and disappearance | Nipple in mouth, birth, 6-12 months |
| Swallowing: Stimulus, age of appearance and disappearance | Bolus of food in pharynx, birth, persists |
| Tongue: Stimulus, age of appearance and disappearance | Tongue or lips being touched, birth, 12-18 months |
| Bite: Stimulus, age of appearance and disappearance | Pressure on gums, birth, 9-12 months |
| Gag: Stimulus, age of appearance and disappearance | Tongue or pharynx being touched, birth, persists |
| Grasping reflexes | When you place an object or finger in a baby's palm, they will automatically close their fingers around it |
| Startle reflexes | When a baby feels like they are falling, they will extend their arms, legs, and fingers outward, then quickly bring them back toward their body |
| Babinski reflex | When the sole of a baby’s foot is stroked, their toes fan out and the big toe moves upward |
| If the Babinski reflex returns later in life, what does that indicate? | A sign of neurological change or impairment |
| Rooting and Suck reflexes | When a baby’s cheek is touched, they turn their head toward the touch and open their mouth to search for a nipple. Once something is in their mouth, they begin to suck automatically |
| The Moro reflex is elicited by | Dropping the head |
| The Moro reflex is pathologic if: | It’s pathologic in the presence of a persistent symmetrical abduction and upward movement of the arms with fingers splayed, followed by flexion of the arms in clasp manner as the child's back arches |
| Rooting reflex is elicited by | Stimulating the cheek lateral to the mouth |
| In the rooting reflex, from birth, the infant normally does what? | Turn the head toward the stimulus and then grasps the stimulus in the mouth |
| The rooting reflex is pathologic if: | The reflex is pathologic if it is absent at birth or if it persists beyond the fourth month |
| The Symmetrical tonic reflex is elicited by | Passively extending and flexing the neck five times |
| The Symmetrical tonic reflex is pathologic if: | Pathologic in the presence of obligatory arm extension or leg flexion with neck extension for more than 60 seconds |
| Asymmetrical Tonic Neck Reflex (ATNR) is elicited by | Turning the head to each side for 5 seconds. This movement is repeated five times to each side |
| Asymmetrical Tonic Neck Reflex (ATNR) is pathologic if: | Pathologic in the presence of obligatory extension and flexion of limbs for more than 60 seconds |
| Positive Support Reflex is elicited by | Suspending the child so that the balls of the feet can be bounced on a flat surface |
| Positive Support Reflex is pathologic if: | The reflex is pathologic if the child remains on his or her toes and cannot move out of the position for 60 seconds or more |
| Why Are These Reflexes Important (1) | If present, the persistent oral reflexes can interfere with feeding behavior. |
| Why Are These Reflexes Important (2) | BUT, little or no correlation exists between the presence and number of abnormal oral and pharyngeal reflexes and the severity of dysarthria in cerebral palsy. |
| Why Are These Reflexes Important (3) | You can’t help a child improve articulation by working on feeding |
| True or false, The startle reflex is helpful for the newborn to find nutrition | False |
| True or false, Neuronal connections within the brain are arbitrary | False |
| True or false, Oftentimes, neural tube defects can be assessed by taking a sample of amniotic fluid, or by performing an ultrasound | True |
| True or false, The neurons in the developing brain know where to go and how to develop based on the baby's genetics | True |
| True or false, Learned activities represent solidified neuronal connections | True |
| True or false, Normal grasp reflexes for newborns allow the fingers or toes to wrap around a tactile stimulator | True |
| True or false, By testing a newborn's reflexes, clinicians are able to assess how well the newborn's nervous system is performing | True |
| True or false, The Babkinski reflex continues through adulthood | False |
| True or false, The central nervous system is formed from the neural tube | True |
| True or false, Anencephaly is a severe type of neural tube defect | True |
Created by:
RachelJClark
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