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220 Cards in this Set

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A functional test of the balance system, in which the patient is observed to see if
balance can be maintained with the eyes closed and feet close together.
Romberg's
positive romberg implies
dysfunction of either the vestibular system or proprioception
Inability to identify a stimulus on the side of the body contralateral to a parietal
lobe lesion, when it is presented simultaneously with a stimulus on the opposite
side of the body; sensory neglect.
extinction to double simultaneous stimulation
severely infected food ulcer
DM
steady deterioration in his ability to use his right arm since he awoke this morning
denied pain or numbness in his right arm or any other neurological symptoms
mild right facial droop
normal tone with decrease in distal muscle bulk and strength
right elbow flexion and extension are weak, and he can barely open his right hand fully
symmetric decrease in distal-to-proximal gradient: pin, touch, temperature, vibration
does not extinguish to double simultaneous stimulation
right biceps and knee jerks are brisker than left
no ankle jerk
right plantar extensor response
lacunar stroke
areflexia is common in
LMN probs
symmetric distal sensory loss is common in
peripheral neuropathies (DM)
hemisensory loss and hyperreflexia suggests
CNS dysfunction
what are the 4 brainstem dysfunction signs?
diplopia
dysphasia
dysarthria
dysmetria
cortical dysfunction signs
aphasia
apraxia
agnosia
anopsia
where can you get pure motor finding without any sensory abnormalities
left internal capsule
basis pontis
lacunar infarct
small vessel thrombosis
may be caused by DM and hypertension
what is a lacunar stroke?
small brain infarct caused by occlusion of small deep penetrating arterioles
where are the 4 most common locations for lacunar strokes?
internal capsule
pons
thalamus
basal ganglia
egeneration of the nuclei of the lower cranial nerves.
bulbar palsy
degeneration of nuclei of corticobulbar tracts bilaterally
dysfunction of pharynx, larynx tongue musculature caused by bilateral UMN lesions involving corticobulbar tracts or primary motor cortex
jaw jerk and gag reflexes are typically brisk
NO lesion to bulb
bulbar musculature may be weak
lesion to UMN innervation to bulb
pseudobulbar palsy
spontaneous contraction of an individual muscle fiber
fibrillation
Spontaneous contraction of all of the muscle fibers belonging to a single motor
unit that does not cause movement at a joint.
fasciculation
weakness in legs a yr ago
trouble holding head up
if drink too quickly, will cough and choke
spastic in upper and lower extremities
cannot lift head off bed
cannot lift arms above head
twitching under triceps and hand muscles
reflexes are brisk
clonus at knees and ankles bilaterally
plantar responses are extensor bilaterally
walks with stiff legs and stopped posture
chin almost resting on chest
amyotrophic lateral sclerosis
Lou Gehrig's disease
what is the prognosis for amyotrophic lateral sclerosis
Lou Gehrig's disease
poor
most die of respiratory failure within 3 yrs
spasticity (increased muscular tone)
Transient, velocity-dependent resistance to passive stretch of
muscle, followed by relaxation of the muscle, which results in a "clasp
knife" phenomenon. Spasticity may be seen with UMN lesions such as
stroke, multiple sclerosis, and motor neuron disease.
rigidity (also increased muscular tone)
Constant resistance to passive stretch of muscle that is
independent of the velocity of movement of the limb, resulting in a "lead
pipe" phenomenon. Rigidity may be seen in patients with Parkinson's
disease and in patients with other forms of parkinsonism.
clonus
repetitive contraction of muscle
frequently elicited in ankles of patients with extreme hyperreflexia when testing ankle jerk reflex
Clonus is due to UMN or LMN lesion?
UMN
suggests extreme hyperreflexia
LMN lesion would do what to tongue?
tongue atrophy with hypoglossal nucleus or nerve lesion
tongue has normal muscle power but difficulty protruding due to
UMN lesion
affects cortical control of tongue
what muscles are almost never involved in Lou Gehrig's disease/ALS?
extraocular muscles
urinary and bowel sphincter muscles
gene mutation for Lou Gehrig's/ALS
superoxide dismutase on chr 21
what happens to skeletal muscle in ALS?
denervated muscle fibers are reinnervated by adjacent axon colleratl sprouts which all belong to a single motor unit
will be of same muscle fiber type
both seen in muscle biopsy specimens from pts with amyotrophic lateral sclerosis
diaphoresis
profuse sweating
pin sensation
sharp pain sensation when skin is touched with pt of a pin
plasmapharesis
blood is removed from body, cellular components are evacuated by using automatic blood cell separator device and plasma is returned to body by infusion
progressive limb weakness and numbness
numbness in palms then toes
swollen and prickly hands
no weakness denied bladder probs
numbness inside mouth
foods tasted salty
inability to bury his eyelashes fully when closing eye
unable to rise from chair without pushing with arms
weak hand grips bilaterally
decreased touch, temp, vibratory perception
no knee jerk on right
slight response on left
no ankle jerk
plantar responses are flexor
high glucose in CSF
high protein in CSF
Guillain Barre syndrome
guillain-barre
acute inflammatory demyelinating polyneuropathy
prognosis of guillain barre
good, recover weeks to months
tx for guillain barre
plasmapharesis
iv ig
close medical support
cardiac monitoring
demonstrate prolonged distal sensory and motor latencies and diffusely
slowed nerve conduction velocities. These findings are due to the severe
demyelination of peripheral nerves, which slows conduction of action
potentials in all peripheral nerves. In some patients with mild disease, the
result of the nerve conduction study may be normal in the early course of
the disease.
guillain barre syndrome
what bacteria often is an antecedent to guillain-barre?
campylobacter
how do you differentiate Guillain barre from MS?
Guillain-Barre is acute, monophasic and due to PNS demyelination
MS - chronic disease with exacerbation and remissions and is due to CNS demyelination
festinating gait
narrow based shuffling gate in which pts try to catch up with their center of gravity
essential tremor
involve head, outstretched hands, voice
resting tremor
involved part is at rest but absent or diminished when active movements are attempted
more pronounced tremor on right hand
quivering of chin
cogwheel rigidity
diminished finger taps
plantar response bilateral
normal cerebellar fxn
difficulty initiating/stoppig gait
small shuffling
arms swing
mild postural instability
TRAP
PD
cogwheel rigidity
resting tremor superimposed on lead pipe rigidity
A form of increased muscle tone in which there is a
constant resistance to passive stretch of a muscle throughout its range of
motion. Rigidity is typically seen with all forms of parkinsonism.
lead pipe rigidity
Another form of increased muscle tone in
which resistance to passive stretch of a muscle varies with the velocity of
stretch. Spasticity is seen with various upper motor neuron (UMN)
disorders such as stroke, multiple sclerosis, and amyotrophic lateral
sclerosis.
clasp-knife spasticity
spastic (scissor) gait is another narrow-based gait, which may be seen
with
bilateral UMN lesions
PD is due to loss of
dopamine containing neurons in SN
conventional therapy for PD
Anticholinergics, dopamine replacement
(carbidopa/levodopa), dopamine agonists (bromocriptine or pergolide),
selegiline, and amantadine.
experimental therapies for PD
Transplantation of fetal or adrenal medullary
cells to the caudate nucleus; pallidotomies; thalamotomies.
secondary causes of parkinsonism
drug induced -phenothiazines, haloperiodol, MPTP
degenerative: Striatonigral degernation, progressive supranuclear palsy, multisystem atrophy
vascular basal ganglia infarction
infectious - postencephalitic
dystonia
forceful, sustained contraction of group of muscles
palmomental reflex
A contraction of the superficial muscles of the chin produced on the same side as
the palmar area that is stimulated (also called “palm-chin reflex”).
glabellar reflex
A frontal release sign elicited by tapping the forehead repeatedly between the
eyebrows over the glabella and by observing for persistent blinking. It is
important to note that when this maneuver is performed, a normal individual will
blink once or twice.
snout reflex
frontal release sign elicited by repeated tapping upper lip and by observing the puckering of lips
chorea
irregular unpredictable brief jerky movements that flit from one body part to another in a continuous random sequence
myoclonus
spontaneous twitches of a group of muscles that moves a limb across a joint
tic
quick stereotypic jerk of a group of facial/limb muscles
athetosis
slow writhing involuntary movements of proximal limbs and trunk
hemiballism
spontaneous ballistic irregular movements of arm and leg on one side of body
suicide gesture
violent outbursts
marked emotional lability
periods of depression and apathy
suicide attempts
poor calculations and visuospatial skills
poor modulation of speech
eyebrow elevation
grimacing
pursing
dystonic posturing of neck and upper body
normal bulk and power in all 4 extremities
reflexes are brisk -jaw jerk
flexor plantar responses bilaterally
bilateral palmomental, glabellar, snout reflexes
erratic and lurching gate
Huntington's
autosomal dominant on chr 4
5 causes of chorea
Drug-induced (levodopa [L-dopa], cocaine, phenothiazines)
• Neurodegenerative (Huntington's disease [HD], benign senile chorea)
• Infectious (Sydenham's chorea—poststreptococcal)
• Cerebral infarction (involving the basal ganglia)

inflammatory - systemic lupus erythematosis, chorea gravidarum
clinical triad for HD
chorea, dementia, psychosis
what will cause atrophy of the head of caudate?
HD
27 yo dizzy, difficulty walking
episodes of numbness in legs, poor handwriting, staggering gait
deteriorating gait
double vision off to right side
pale right optic disc
horizontal nystagmus
increased muscle tone in lower extremities
right ataxia
loss of vibratory perception and proprioception at toes
relapsing and remitting neuro symptoms
Multiple sclerosis. She has more than one lesion and at least
one previous episode. This illustrates dispersion of lesions in time and
space, which is the crucial criterion for diagnosing MS.

optic neuritis
INO
cerebellar ataxic gait
sensory ataxic gait
what is the prognosis of MS?
Variable. Her course may continue to be relapsing and
remitting, she may stabilize, or she may develop the chronic progressive
form of the disease.
lipohyalinosis
The neuropathologic changes noted in the small arteries that result in small
cerebral infarctions.
intention tremor
tremor is intensified/exhibited when attempting coordinating movements
dizziness
difficulty walking
nausea, dizziness, vertigo
flat optic discs with copper wiring
pupils are equal and symmetrically reactive to light
intention tremor on right finger to nose and heel to shin testing
reflexes are normoactive and symmetrical
gait is broad based
stroke
brainstem compression which may lead to cerebellar tonsillar herniation
Horner’s syndrome results from a denervation of the postganglionic sympathetic nerve in the eye. As such, which of the following drugs would be unable to cause mydriasis in the eye of a Horner’s patient?
amphetamine
loss of sympathetic stimulation means that amphetamine, an indirect (prejunctional) sympathomimetic cant use its usual sympathetic pathway
which is NOT mediated by PNS?
lacrimation
contraction of trigone sphincter in bladder
slowing of AV nodal conduction
urinary frequency
accomodation
contraction of trigone sphincter in the bladder
all of the following are muscarinic receptor mediated responses except:
bronchial dilation
miosis
bradychadia
diaphoresis (sweating)
defecation
bronchial dilation
this vascular effect is PNS-mediated:
1. dilation of skeletal muscle vasculature
2. drop of diastolic pressure
3. drop in venous pressure
4. penile erection
5. dilation of cardiac coronary arteries
penile erection
which of the following receptor mediated baroreceptor reflex at the level of both sympathetic ganglia and adrenal medulla?
1. nicotinic
2. muscarinic
3. alpha1
4. beta1
5. dopamine
nicotinic
which of the following is under control SNS?
a. sweating
b. miosis
c. bronchoconstriction
d. bradycardia
e. peptic acid secretion
sweating
receptor mediating sympathetic dilation of renal vascular bed
DOPAMINE
currently touted as a new treatment for excessive sweating
Botulinum toxin
dilation of vessels in skeletal muscle contraction of cutaneous vessels and positive inotropic and chronotropic responses on the heart are actions of:
Ach
Epi
Iso
NE
Reserpine
Epi
how would you increase kidney perfusion? what drug?
dopamine
cocaine overdose
which CV response is expected?
cocaine is indirect adrenergic agonist that blocks the reuptake of NE and dopamine by blocking NET
INCREASE cardiac force of contraction
following reserpine tx, which drug would have NO EFFECT?
isoproterenol
albuterol
amphetamine
ephedrine
aspirin
amphetamine - bc indirect mechanism
healthy adult man accidently takes metoprolol orally
about 1 hr later, he begins very actively participating in a basketball game.
most likely reflex response expected would be:
increased arterial pressure
metaprolol is a beta1 blocker
A new drug blocks the release of neurotransmitter at sympathetic ganglia. The mechanism of action is most likely similar to
botulinum toxin
A patient is concerned that she might have taken too many diet pills that have hydrocyamphetamine (an indirect-acting sympathomimetic agent that does not enter the CNS) What would you check for to determine if she has?
tachycardia
a 15 yo old female is diagnosed with asthma
which of the following would be best to prescribe for treatment?
albuterol
A 62 year old male is in surgery for knee replacement. His systolic and pulse pressure drop dramatically. Which of the following might be best administered to treat this?
dopamine (intropin) - dose dependent, increase renal blood flow, cardiac stimulant
A 35 year old woman is in the ER with symptoms of anaphylaxis following a bee sting. Her medical history includes mild hyperthyroidism. She is not taking any medications. Epinephrine is administered. Which of the following might concern you
untreated hyperthyroidism makes the heart more sensitive to epinephrine
12 yo old male needs local anesthetic for a minor surgery. which of the following is most likely to be administered with local anesthetic?
epinephrine
85 yo male presents with dizziness upon standing. history of BPH. take prazosin
you suggest he change to tamsulosin. why?
tamsulosin works best in the prostate so he probably will not have dizziness
25 yo female with no symptoms. she is an actress but gets very nervous and shaky. which of the following would relieve shakiness?
propanolol
pt presents with prolactin secreting adrenoma. which of the following would you prescribe?
bromocriptinea
a 62 yo male presents with complaint urinating every 20 minutes esp at night. prescibe
tamsulosin - uroselective alpha1a
blocks alpha1 -decreasing smooth muscle contraction in blood sphincter
also used to treat BPH (more selective than Prazocin)
female found to have excess IOP, come about gradually. what would you use to treat?
propanolol - used to treat wide angle glaucoma
contraindication of using propanolol
COPD
bc it can cause bronchospasms, bronchoconstriction contraindicated in asthma, COPD
adverse effect of most concern when taking Prazosin
Syncope
why? alpha 1 blocker can cause orthostatic hypotension therefore may cause dizziness
A 48 yr-old male has begun to experience progressive difficulty walking and also complains of progressive muscle weakness that affects his speech and swallowing. His motor exam reveals spasticity and clonus when testing his ankle jerk reflex, bilateral plantar extensor responses, and fasciculations and atrophy in some muscle groups
UMNs M
Mass lesions that displace nervous system structure so severely that they are shifted from one compartment to another produces a condition called
Herniation
tonsillar herniation causes
respiratory and cardiovascular collapse
brain herniations include
subfalcine
uncal
tonsillar
central
common symptoms and signs of elevated ICP include
headache
papilledema
altered mental status
cushing triad
nausea and vomiting
Cushing triad
hypertension
bradycardia
irregular respiration
which of the following herniation sites causes mydriasis and ptosis?
transtentorial-uncal (CN3)
69 yo presents with headache
physician notices that his right pupil is dilated and his right eye deviates down and out. which of the following represents the most likely location of the lesion?
right oculomotor nerve
a patient arrives in ER with paresis of right lower facial muscle and right upper extremity, inability to adduct left eye, left ptosis, left mydriasis
tongue deviates to right when protruded.
where is the most likely lesion?
left midbrain
tongue deviates to contralateral side
right lower face
suggest what kind of lesion?
right lower face
what explains the symptoms of oculomotor nucleus? UMN or LMN?
LMN
term for all motor neurons innervating a single muscle
motor neuron pool
global description of cerebellum function
coordination achieved by error detector, consultant, and corrector
synonym for monosynaptic reflex
myotatic
deep tendon reflex
stretch reflex
size principle dictates that these motor units will be recruited first during a muscle contraction
Type I
small, slow motor units
motor disorder in which levels of muscle sarcolemma protein called dystrophin are low and defective leading to pseudohypertrophy of calf muscles and muscle weakness
Duchenne's Muscular dystrophy
Language disorder that carries the common name “word salad”
Wernicke's aphasia
fluent aphasia
Used in skeletal muscles to detect the tension force of muscle contraction and found in series with extrafusal fibers
Golgi tendon organ
utosomal dominant neurodegenerative condition characterized by progressive choreiform movements, dementia, and psychiatric disturbances and affected area
Huntington’s Chorea and atrophy of striatum
Nucleus Accumbens
Term that decribes clumsy and irregular execution of rapidly alternating movements
dysdiadochokinesis
The region labeled A receives input from these neurons in this region/structure
Dentate nucleus – receives input from cerebrocerebellum pathway
Purkinje neurons from the lateral cerebellar hemisphere
region of cerebellum associated with right sided dysmetria, intention tremor, scanning speech
right hemisphere
Division of the cerebellum that influences balance and vestibuloocular reflexes and the two motor paths influenced by this region
flocculonodular lobe and LCST and MLF
VOR-ascending MLF
muscle tone following a long term LMN lesion
hypotonia, flaccid
Name of a repetitive reflex contraction of muscle, frequently elicited in ankles of patients with extreme hyperreflexia indicative of uMN lesion
clonus
function of muscle spindle
senses velocity and length of stretch
decorticate posturing another name is
flexor bias
Ultimate action of Ib afferent fibers from Golgi tendon organs on a motor neurons
inhibition
muscle groups controlled by motoneurons in region (cross section of spinal cord)
medial trunk muscles
proximal (truncal muscles)
The lateral descending motor pathways have their major motor influence on this musculature
distal extremity musculature
event that sustains the sensitivity of the sensory region of the intrafusal fibers
coactivation
this efferent neuron adjust the gain of the stretch reflex
gamma
State of reflexes following a long term UMN lesion
hyperreflexia
Name of disease characterized by masked expression, shuffling gati, difficulty in initiating movements, pill rolling tremor of hands, and rigidity of limbs
parkinson's
In the motor system referred to as the final common pathway, and when damaged will cause these chronic signs
alpha motor neuron
weakness
atrophy
fasciculations
decreased tone and reflexes
(LMN characteristics)
Disorder characterized by violent flinging movements of right limbs and flaccid muscles between movements and the nucleus and side affected
Hemiballism
Left subthalamic nucleus
The structure central to imparting emotional significance to a sensory experience
amygdala
Damage to these structures results in anterograde amnesia
Hippocampus
And parahippocampus gyrus (medial temporal lobe) and or medial diencephalic system and mammillary bodies
Synaptic mechanism strongly considered to be a cellular substrate of learning and memory
LTP
LTD
Four psychiatric disorders putatively attributed to limbic system dysfunction
schizophrenia
anxiety
depression
OCD
Sensory hallucinations, automatisms, impaired consciousness, aphasias, and memory problems are indicative of dysfunction in these specific areas
Temporal lobe seizures or stroke
Possibly Cingulate cortex and or orbitofrontal cortex
3 categorical functions and associated areas of association cortices
Recognition-temporal
attention-parietal
planning-pre-frontal
what lobe involved in recognition?
temporal
what lobe is involved in planning?
pre-frontal
what lobe is involved in attention?
parietal
Lesion of the non-dominant hemisphere produces _____________ while lesions of the dominant hemisphere produce _________________
Neglect (spatial attention)

Aphasia and apraxia (impairment of language, analytical skills, complex motor skills)
a lesion limited to just the angular gyrus on dominant hemisphere can produce this deficit
alexia with agraphia
lesion of this pathway is necessary to get alexis WITHOUT agraphia
splenium of the corpus callosum
Symptoms of prefrontal cortex lesions
Disinhibition
Abulia
Inappropriate affect
Impulsivenes
Emotionally labile
Limited insight
Poor planning and judgment
Altered personality (self)
An elderly woman is brought to the ER by her friend because of sudden onset of nausea, dizziness, vertigo, and difficulty walking. History reveals a 15 year history of hypertension. The neurological exam revealed the following:
1. PEERL
2. Nystagmus
3. Decreased muscle tone on the right arm and leg.
4. Intention tremor on right. Difficulty performing the finger-to-nose and hell-to –shin testing.
5. Reflexes normal, no Babinski sign
6. Leans to the right when walking, unsteady tandem gait.
This extrampyramidal area when damaged causes truncal ataxia and an unsteady tandem gait
Midline area of the cerebellum
If damaged, these medullary nuclei can be responsible for development of vertigo, nausea, and dizziness
Vestibular complex in medullar (vestibular
This spinal nucleus and tract provides cerebellar proprioceptive input from the lower leg and trunk
Clark’s nucleus and the dorsal spinocerebellar tract
Difficulty in performing on the right side the finger to nose and heel to shin testing (appendicular ataxia) indicates a lesion to this region
right intermediate (right cerebellar hemisphere)
PICA infarction causes what syndrome?
lateral medullary syndrome
How do you different PICA from SCA?
PICA has more brainstem involvement
SCA if extensive might affect CN6
SCA is more restrictive and usually does not have any brainstem signs
A 60 yo dock worker was brought to the ER unconscious after he had collapsed while loading a truck. After regaining consciousness severl days later, an exam was performed with following:
Weakness of both R limbs
Hypertonicity of both R limbs
Increased Deep Tendon Reflexes on R side
Dysarthria
Deviation of tongue to L when protruded
Loss of position sense, pressure and 2 pt discrim touch on the R side of body
left medial medullary syndrome aka laternating hemiparesis
what infarcts can cause medial left medullary syndrome?
left branch ASA in caudal medulla
paramedian branches of VA
Synaptic effect elicited by DA in striatum when acting on D1 (direct path) and D2 (indirect path) receptors
D1-stimulatory
D2-inhibitory
striatum directly projects fibers to these 2 major nuclei
GP and SNpr
2 major brainstem descending nuclear groups that increase extensor tone
pontine reticulospinal nuclei
LVS nuclei
The striatum directly projects fibers to these two major nuclei
neocortex
SNpc
This region of CNS degenerates in Wilson’s disease, a defect in metabolism of Cu that results in tremor, rigidity, and choreiform, athetotic movements, wing beating tremor and a characteristic brown ring around iris (Keiser-Fleshcher ring)
basal ganglia
6. A 74 yo woman with hx of atrial fibrillation suddenly develops slurred speech and dysarthria, R side weakness, weak movements of R face, while sparing the forehead. Rightward tongue deviation was evident. No evidence of sensory deficits including cortical. Name the dx and only two sites possible to explain symptoms of this case
a. Pure hemiparesis and L post limb of IC or Left ventral pons anterior to CN 7 (lacunar infarct likely lenticulostriate [common] anterior choroidal or thalamoperforator artery)
N2O methoxyflurane
agent associated with highest risk of hepatitis
Halothane
agent associated with tonic-clonic seizures
Enflurane
agent that maintains CO, systemic and coronary vasodilation and has reduced risk of catecholamine-dependent arrythmias
isoflurane
agent with highest risk of nephrotoxicity and the metabolite responsible for damage
methoxyflurane, F-
IV agent that has CNS excitatory effects but produces the least adverse CV effects
etomidate
IV agent that requires a lipid diluent (emulsidicant) because it is water soluble
propofol
IV agent that causes cardiac stimulation leading to increased blood pressure, heart rate and CO
ketamine
Agent that in large doses produces general anesthesia requiring mechanical ventilation but frequently used to provide analgesia with other anesthetics
fentanyl
agent that is associated with emergence phenomena of hallucinations and vivid dreams
ketamine
agent causing vasodilation resulting in a decline in BP
propofol
agent used to treat malignant hypothermia
dantrolene
agent used to reverse Versed (midazolam) anesthesia
Flumazenil
Agent that can be used for mask induction due to not being pungent
Sevoflurane
Agent associated with Compound A generation at low flow rates
A cortical electrical discharge producing a neurological symptom
or sign.
seizure
a seizure associated with motor activity
convulsion
A chronic neurological disorder manifested by recurrent seizures.
epilepsy
A cortical electrical discharge producing a neurological symptom
or sign.
seizure
A seizure limited to a single focal area of brain;
consciousness is typically preserved. The symptoms of a partial seizure
reflect the part of the brain that is discharging
partial (focal) seizure
a seizure associated with motor activity
convulsion
A seizure involving both hemispheres; consciousness
is lost.
generalized seizure
A chronic neurological disorder manifested by recurrent seizures.
epilepsy
A seizure limited to a single focal area of brain;
consciousness is typically preserved. The symptoms of a partial seizure
reflect the part of the brain that is discharging
partial (focal) seizure
A seizure involving both hemispheres; consciousness
is lost.
generalized seizure
aura
simple partial seizure without motor movements; it is usually
the initial symptom of a complex partial seizure.
what is the cause of seizures?
A seizure represents an abnormal electrical discharge of the brain, usually
arising from an area of injured cortex.
why sweat and dilate pupils during seizure?
The seizure spreads to involve the hypothalamus, the head nucleus for the
sympathetic nervous system. The seizure causes excitation of the
hypothalamus, thereby increasing sympathetic outflow. Both sweating and pupillary dilatation are symptoms of increased sympathetic activity.
most common side effects of elevated phenytoin are
nystagmus and gait ataxia

when the dosage of phenytoin is lowered, these symptoms will be reversed
postictal state
period of disorientation and fatigue (and occasionally
focal weakness) that follows a seizure.
EEG
recording of cortical electrical activity from the surface of the
scalp. Most of the activity recorded in the EEG consists of extracellular
current flow associated with summated postsynaptic potentials in
synchronously active pyramidal cells of the cerebral cortex.
simple partial seizure
consciousness if fully preserved
complex partial seizure
consciousness is altered but not lost entirely
primarily generalized seizure
involve both hemispheres from the start of seizure
secondarily generalized seizure
begins focally then spread through corpus callosum to involve both hemisphere
pathophysiology of absence seizures
Absence seizures are subcortical, centrencephalic seizures that are thought
to originate in the brain-stem reticular formation or intralaminar thalamic
nuclei.
Absence seizures are primary generalized seizures that do not have a focal
onset.
absence seizures are frequently proceeded by what?
hyperventilation
Absence seizures are commonly precipitated by hyperventilation because
the resultant hypocapnea activates thalamocortical pathways.
why no aura for absence seizure?
Absence seizures are generalized from the outset and have an abrupt onset
without an aura. Only partial seizures can start with an aura.
paraphasia
The misuse of spoken words or word combinations; a form of aphasia.
anomia
inability to remember the names of objects
perseveration
Continued repetition of a word or phrase, or repetition of answers that are not
related to successive questions asked
aphasia, acalculia
dysfunction of what?
left hemisphere
geographic disorientation
dysfunction of what?
right hemisphere
impaired memory and cognitive
function
dysfunction of what?
bihemispheric
long term memory resides in the
association cortex
includes large areas of the parietal, temporal, occipital, and frontal lobes
that associate and integrate primary motor, sensory, visual, and auditory
modalities. This integrative function also includes the storage of long-term
information.
short term memory resides in the
hippocampus
The inability to perform tasks or activities in the presence of
preserved motor, sensory, and cerebellar functions (e.g., dressing, gait,
grooming).
apraxia
he inability to recognize familiar or common environmental
stimuli in the presence of preserved motor, sensory, and cerebellar
functions (e.g., colors, faces, body parts).
agnosia
paratonic rigidity
The inability to relax a limb when it is
passively moved
short term memory resides in the
hippocampus
The inability to perform tasks or activities in the presence of
preserved motor, sensory, and cerebellar functions (e.g., dressing, gait,
grooming).
apraxia
he inability to recognize familiar or common environmental
stimuli in the presence of preserved motor, sensory, and cerebellar
functions (e.g., colors, faces, body parts).
agnosia
paratonic rigidity
The inability to relax a limb when it is
passively moved
what do frontal release signs suggest?
Frontal release signs suggest diffuse forebrain dysfunction; they are
typically seen in Alzheimer's disease and in bihemispheric strokes.
confabulation
A behavioral reaction to memory loss in which the patient fills in memory gaps
with inappropriate words.
heel-to-shin testing
A test of leg coordination in which the heel of one leg is run smoothly down the
other shin, and speed, accuracy, and any tremor are noted.
lesion site of broca's aphasia
left frontal region
limited to posterior part of inferior frontal gyrus
lesion site of wernicke's aphasia
posterior superior temporal regions of left hemisphere with extension into inferior parietal lobule
lesion site of conduction aphasia
arcuate fasciculus in left hemisphere
often involve supramarginal and lower postcentral gyri
lesion site of global aphasia
large lesion of left middle cerebral artery territory that includes frontal, temporal, parietal lobes
lesion site of left frontal lobe anterior/superior/below Broca's
transcortical motor aphasia
transcortical sensory aphasia lesion site
left posterior temporal occipital lobe
mixed transcortical phasia (isolation of speech area) lesion site
extensive cortical damage to both cerebral hemispheres with relative preservation of perisylvian cortex
transcortical aphasia-lesions are ____in location
extrasylvian in location
the primary language cortex is not damagd but the areas of the brain that project to language cortex are damaged