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Neuro II-p. 14-32

Thomadaki Fall 2010

What are hypokinetic disorders? Examples PROBLEMS WITH DIRECT PATHWAY Akinesia (parkinson's...trouble starting & stopping movement) Bradykinesia (slow movements also in parkinson's)
What are hyperkinetic disorders? Examples PROBLEMS WITH INDIRECT PATHWAY Dyskinesias (involuntary mvts) - chorea, ballismus, athetosis, dystonia
What is Chorea? Side effect of long term L. Dopa use Irregular involuntary twitching of extremeties (quick, jerky, non-repetitive/unpredictable movements)
What is Athetosis? Writhing, constant motion
What is Dystonia? Ususally genetic, occur with overuse. Severe spasm
What is parkinson's disease? Depletion of dopaminergive cells in Substantia Nigra causing breakdown of nigrostriatal circuitry.
What are two types of Parkinson's D/E? Typical - injury to dopaminergic cells in substantia nigra Atypical - same symptoms as typical but they don't subside when given L Dopa
What are the symptoms of Parkinson's D/E? Akinesia, Bradykinesia, Resting tremor, Cogwheel/lead pipe rigidity, Flexed posture, Mask-like facial expression, shuffling gait & impaired balance
What is the treatment for Parkinson's? Admin of L-DOPA (precursor to dopamine since dopamine doesn't cross BBB). Anticholinergic drugs (transplant of human dopamine cells, pallidotomy, GP I pacemaker, thalamectomy)
What is Huntington's D/E? Autosoma dominant hereditary d/e w/ an insidious onset in 4th or 5th decade of life, resulting from slow degeneration of neurons in striatum
What are symptoms of Huntington's D/E? Chorea - (eventually takes over all voluntary movement), dementia, behavioral or psychiatric disturbances
Prognosis of Huntington's D/E? 15-20 year after onset
What is Sydenham's Chorea? AKA? St. Vitu's Dance. Transient (reversible) childhood chorea associated with RHEUMATIC FEVER and affecting the striatum
What is Athetosis? Degeneration of globus pallidus resulting in constant, slow, sinous, writhing movements of DISTAL extremeties. Weak trunk
What is Ballsim? Lesion of subthalamic nucleus (usually caused by a small stroke) or it's connections. Results in contralateral involuntary movements of PROXIMAL extremeties
What is Wilson's D/E? Autosomal recessive disorder that results in abnormal metabolism of CU
Abnormal metabolism of CU in wilson's disease degenerates what? Liver & Basal Ganglia
Symptom of Wilson's D/E Kayser-Fleischer ring in cornea
What is Dystonia Musculorum Deformans Rare hereditary condition associated with injury of LENTIFORM NUCLEUS, resulting in co-contraction of antagonist and agonist muscles
What are focal dystonias? Include torticolis (repeated spasm of SCM & Trap), blepharospasm (spasm of upper eyelid) dysphonia (vocal cords), writer's cramp (hand)
Motor function of Basal Ganglia & cortical association area gather visual, auditory, proprioceptive, etc. information about the relative position of the body, the object and overall intention of movement
What areas do the basal ganglia & cortical association area include? Anterior Frontal Lobe Posterior parietal lobe
Function of Anterior Frontal Lobe Motor Designing
Function of Posterior parietal lobe Utilize space in emotion
What areas do the cerebellum and motor cortex include? Primary motor cortex (area 4, precentral gyrus) Premotor and supplementary motor cortices (Area 6)
What is the motor function of Cerebellum & motor cortex? Plan the sequence & timing of muscle contraction & relaxation to ensure smooth movement
Motor funcion of the brainstem & spinal cord Execute the movement
What are the two descending tracts? Lateral Pathway Ventromedial pathway
Lateral pathway influences what motor neurons? Motor neurons that innervate DISTAL muscles of the limbs
What tracts are in the lateral pathway? Lateral Corticospinal Tract Rubrospinal tract
Ventromedial pathway influences what motor neurons? Motor neurons that innervate AXIAL & PROXIMAL LIMB muscles
What tracts are in the ventromedial pathway? Ventral Corticospinal Tract Pontine & medullary reticulospinal tract Vestibulospinal tract Tectospinal tract
The corticobulbar tract is the major input of the __________ neurons in the ________. The input is mostly (uni/bilateral?) LMN, brainstem, bilateral
What areas in the brain are associated with the Corticospinal Tract? motor cortex areas 4&6 & somatosensory cortex
What is the pathway of the corticospinal tract? Motor & somatosensory cortex --> corona radiata --> posterio limb of internal capsule --> crus cerebri --> basilar pons --> pyramid/pyramidal decussation X lateral corticospinal tract --> synapses w/ ventral horn cells
Corticospinal tract innervates what muscles? distal primarily flexor muscles
What is the pathway of the rubrospinal tract? Red nucleus (under control of cortex) X in pons --> terminates in ventral horn cells (especially of cervical spine)
Rubrospinal tract functions are overtaken by _________ corticospinal tract
What are the symptoms of a lateral pathway (UMN) injury? Paresis or paralysis/plegia but no immediate atrophy of muscles. Spasticity (hypertonia & hyperreflexia/clonus) Clasp knife rigidity Babinski sign (often see before spasticity) Absent superficial reflexes
What are the superficial reflexes? Cremasteric/anal wink/abdominal
Pontine Reticulospinal tract travels where? From reticular formation in pons to ventral horn cells bilaterally
Function of the Pontine Reticulospinal tract Facilitation of antigravity muscles (extensor of lower limb)
Medullary Reticulospinal tract travels where? From reticular formation in medulla to ventral horn cells bilaterally
function of the Medullary Reticulospinal tract Inhibits antigravity muscles
Vestibulospinal tract travels where? From vestibular nuclei to ventral horn cells bilaterally
Function of the Vestibulospinal tract Controls head & back muscles based on directional info it receives from vestibular apparatus in inner ear Facilitates upper and lower limb EXTENSORS
Tectospinal Tract travels where? From superior colliculus (which receives input from retina) X in medulla --> ventral horn cells
Function of Tectospinal Tract Turns head and eyes toward stimulus
Decorticate Triple flexion upper limbs + extension of lower extremeties (CST)
Decerebrate Tonic flexion of upper and lower limbs (CST& RST)
Lesion to brainstem above vestibular nuclei leads to what type of rigidity? Decerebrate
Lesion to cerebral hemisphere with intact brainstem leads to what type of rigidity Decorticate
Define motor unit 1 alpha motor neuron and all muscle fibers it supplies
Define motor neuron pool all alpha motor neurons that innervate a muscle
What motor neurons innvervate skeletal muscle? Ventral horn cells (Alpha and Gamma) & motor nuclei of CN
Alpha motor neurons innervate what type of skeletal muscle fibers? extrafusal (contractile muscle)
Gamma motor neurons innervate what type of skeletal muscle fibers? Intrafusal (muscle spindles)
What are symptoms of a lower motor neuron lesion? Paresis/paralysis/plegia; Atrophy; Fasciculations; hypo(a)tonia and hypo(a)reflexia
Define fasciculation Visible muscle twitching resulting from involuntary synchronus ctx of all the muscle fibers in a motor unit
Define fibrilation Spontaneous activity of one muscle fiber; not visible to eye
A fasciculation is a characteristic of what type of disease? slowly progressive
A fibrilation is a characteristic of what type of disease? Progressed muscle denervation or myopathy
What are the motor and sensory neurons in muscle spindle? Gamma = motor; Ia & II = sensory
Stretch reflex requires what NT? AcH
Ia inhibitory reflex requires what NT? Glycine
What are 3 types of intrafusal fibers (1) Nuclear Chain Fibers - thin fibers w/ nuclei arranged in single file; afferents incl Ia & II (2) Nuclear Bag Fibers - thicker fibers w/ nuclei grouped in central region--> (a) DYNAMIC (b) STATIC
What are static nuclear bag fibers? Slowly adapting stretch receptors; afferent include Ia & II
What are dynamic nuclear bag fibers? Sensitive to rate of change (rapidly adapting); afferents include Ia ONLY
Stretch reflex to is agonist/antagonist excitation/inhibition? agonist excitation
Ia Inhibitory reflex to is agonist/antagonist excitation/inhibition? antagonist excitation
Recurrent (Renshaw cell) inhibition reflex to is agonist/antagonist excitation/inhibition? Agonist inhibition
Ib reflex to is agonist/antagonist excitation/inhibition? agonist inhibition
What is the purpose of recurrent inhibition? To avoid overexcitation of agonist motor neuron pool
To avoid over excitation of agonist motor neuron pool alpha motor neurons synapses with what cell? Renshaw inhibitory cell
What is the response of a Renshaw Inhibitory Cell? withdraws the inhibition of Ia interneurons so that the antagonist is excited + agonist is inhibited
Where are golgi tendon organs located? jct between muscles & tendon, in series with extrafusal muscle fibers
Are golgi tendon organs sensory or motor? Sensory
Inhibitory reflex: Ia :: Golgi Tendon Organs: ? Ib proprioceptors
What is the difference between Golgi Tendon Organs & Renshaw Cells? Golgi - stops when injury to TENDON; Renshaw stops when injury to MUSCLE
Why doesn't golgi tendon need motor innvervation? Because it lengthens/straightens w/ muscle
Central axons of Ib fibers from __,__,__ synapse on a __ (inhibits/excites) ___ of ___ muscle in response to what? Golgi tendon organ, cutaneous receptors, joint receptors; Ib inhibitory interneuron; inhibits; alpha motor neuron pool; agonist; muscle tension
What occurs in the Flexion & Crossed Extension Reflex? Central axons of A-alpha nociceptors excite flexors of hurt lower limb (to flex knee) while exciting extensors of contralateral limb for support
Deep Sensibility pathway... FG (T6 & down) & FC (T6 & up) info ipsilat in SC -->Nuc. grac. & cuneat. --> IAF X ML --> Ventral post. lateral thalamic nuc. --> internal capsule --> somatosensory cortex
Somatosensory cortex contains what areas? Broadman's 3,1,2
What sensations comprise deep sensibility? Proprioception, vibration, 2-pt discrimination, pressure, touch
Proprioception from lower body runs in what tract? Spinocerebellar
How do you test for deep sensibility? Vibration tuning fork on dermatomes; Position sense of upper extremeties; Romberg's test
Neuro tests will determine if injury is in __, __ or ___ PNS, SC or Brainstem & up
Neur exams tests what 4 things? (1) CN (if no sx then can't be in brainstem); (2) Muscle (3) Reflex (4) Sensation
With an injury to Spinal Nerve there will be LO DS &/or P&T to... Same side as injury
With an injury to SC there will be LO DS &/or P&T to... P&T on one side, DS on other side
With an injury to Brain there will be LO DS &/or P&T to... Contralateral to injury. Whole body affected
Anterolateral system is made up of what 3 tracts? Spinothalamic, Spinoreticular, Spinomesencephalic
Anterolateral system is involved in perception of what? Pain & temperature
P& T fibers enter the ____ & end in the _____ tract of lissauer, dorsal horn
What fibers are associated with pain? C & A-delta (slower fibers)
Vibration testing assesses what in the periphery and what centrally? Periphery = A-alpha & A-beta; Central = Dorsal column/med. lemniscus
Pain testing assesses what in the periphery and what centrally? Periphery = C + A-delta; Central = LSTT
P&T fibers cross in the ___ and ends in the ____ then run through the ____ and end in the ____ cortex Ventral white commissure; ventral posterior lateral thalamic nucleus; interal capsule; somatosensory
The limbic system includes higher control of what? (1) autonomic fx (2) homeostasis (3) reproduction (4) emotion (5) motivated behavior (6) learning
What are the 2 components of the limbic system? Limbic lobe & Limbic system
What comprises the limbic lobe? Septal area, cingulate gyrus, parahippocampal gyrus, hyppocampus & amygdala, uncus
What comrises the limbic system? Limbic lobe & all its subcortical & cortical connections (hypothalamus, thalamus, brainstem reticular formation, epithalamus, olfactory cortex, prefrontal cortext)
Limbic system is AKA? Papez Circuit
What are the components of the Hippocampal Formation? Part of parahippocampal gyrus, hippocampus, dentate gyrus, subiculum
What are the afferents of hippocampal formation? Entorhinal area of parahippocampus gyrus --> Contralateral hippocampus via hippocampal commissure, Amygdala, Thalamus, Locus coeruleus Raphe nuclei Ventral tegmental area
What structure has Norepinephrine? Locus coeruleus
What structure(s) has(ve) serotonin? raphe nuclei, ventral tegmental area
What is the entorhinal area? Primary olfactory cortex. It immediately excites hippocampus
What is the efferent pathway of hippocampal formation? Fornix --> septal area & mammilary bodies of hypothal. -from mam. bodies-> ant. nuc. of thalamus --> cingulate gyrus
Function of hippocampal formation? Holds a map of SPACIAL MEMORY (passage of learning & short term memory into long term memory)
Symptoms of a lesion to hippocampal formation? Defects in explicit memory & spacial orientation
What are the types of memory? EXPLICIT (declarative...the facts) & IMPLICIT (non-declarative...how you do something)
What are examples of EXPLICIT MEMORY? Episodic (events); semantic (facts)
What part of the brain deals with explicit memory? Medial temporal lobe
What are examples of implicit memory and what part of the brain controls it? Priming [neocortex] Procedural (skills & habits) [striatum] Emotional responses to associative learning [amygdala] Musculoskeletal responses to associative learning [cerebellum]
What are examples of amnesia? Retrograde Anterograde Global Modality specific
Hippocampus is the ___ memory as Cortex is to ___ memory short term; long term
What information passes through the amygdala? (afferents) Autonomic, sensory, auditory & visual information
Efferent information in the amygdala goes where? via stria terminalis --> septal nuclei & hypothalamus, brainstem & cortex
What is the function of the amygdala? "affective perception of sensory stimuli" (what a sensory stimulus makes you feel like. Gets you ready to react. Gets info before it becomes conscious)
What are the symptoms of a lesion to the amygdala Diminished capacity for fear conditioning
What causes Kluver Bucy Syndrome? and what are the symptoms? Cutting out both temporal lobes (incl amygdala & hippocampal formation) Symptoms = visual agnosia, hyperorality, hypersexuality, docility, apathy, bulimia, memory deficit
What causes Korsakoff's psychosis? What are the symptoms? Thiamine deficiency leading to destruction of 3rd ventricle. Symptoms = anterograde and progressively retrograde amnesia
What are some conditions that affect the temporal lobe? Temporal lobe epilepsy, olfactory hallucinations, visual hallucinations (deja vu), gustatory & auditory hallucinations, lip smacking, motor acts, amnesia that can last for several hours, sometimes aggressive behavior; schizophrenia; alzheimers (see notes)
Created by: mrw2013