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397 Cards in this Set

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Circle of Willis
LOOK AT IT!!!!!
-Vertebral Arteries > Basilar Artery > Posterior Cerebral Arteries (Continue) > Posterior Communicating Arteries > Internal Cartoid Arteries > Anterior Cerebral Arteries

-Anterior Communicating Artery - Joins Anterior Cerebral Arteries
-Middle Cerebral Artery (Internal Carotid)
-Anterior Spinal Artery (Basilar or Vertebrals)
-Posterior Inferior Cerebellar Arteries (Vertebral)
-Anterior Inferior Cerebellar Arteries (Basilar)
-Superior Cerebellar Arteries (Basilar)
Which Artery supplies the Anterior Circulation of the Brain? What are the main arteries of the Anterior Circulation of the Brain?
-Internal Carotid
-ACA and MCA
Which Arteries supply the Posterior Circulation of the Brain?
Vertebral and Basilar Arteries
Where do the Anterior and Posterior Circulations of the brain meet?
Circle of Willis
What types of Disturbances would we expect to see with an ACA Lesion? Why? Which side?
-Leg and Foot
-Homunculus
-Contralateral
What types of Sensory and Motor (Homuncli) Disturbances would we expect to see with an MCA Lesion? Why? Which side?
-Hand, Arms, Face
-Homunculus
-Contralateral
What types of Disturbances would we expect to see with an PCA Lesion? Why? Which side?
-Visual Disturbances
-Affecting the Occipital Lobe
-Contralateral
The artery that supplies the Somatosensory cortex near the superior sagittal fissure is fucked up. Which artery is this? What types of problems would you expect?
-Anterior Cerebral Artery
-Sensory Impairment (Parathesia or Anesthesia) involving CONTRALATERAL foot
A patient is experiencing sensory problems on the right side of his face. You suspect it is a problem with blood supply. Which artery is likely involved? Which side?
-Middle Cerebral Artery
-Left Side
What is Locked-In Syndrome? A Lesion to which artery can cause this?
-Patient is aware and awake
-Cannot move or Communicate due to complete paralysis of nearly all voluntary muscles in the body except for the eyes
-Basilar Artery
A patient has interruption of Basilar Artery flow. What syndrome might they present with? What happens in this syndrome?
-Locked-In Syndrome
-Patient is aware and awake
-Cannot move or Communicate due to complete paralysis of nearly all voluntary muscles in the body except for the eyes
What is the Internal Capsule? What does it contain?
-Sheet of White Matter Lateral to the Thalamus
-Contains Axons from the Corticospinal Tract (CST)
Which artery is responsible for supplying the Internal Capsule?
MCA
What is the Genu of the Internal Capsule? What are its fibers responsible for?
-Bend
-Face
What are the Posterior Limb Fibers of the Internal Capsule responsible for?
Lower Body
-Falx Cerebri
-Falx Cerebelli
-Tentorium Cerebelli
-Falx Cerebri
-Falx Cerebelli
-Tentorium Cerebelli
Slide 19 - Imaging Vasculature
Slide 19 - Imaging Vasculature
What are some easy ways to recognize the MCA in an image?
-Huge
-Coming off the Internal Carotids
-Going Laterally
If an individual has a visual loss due to ischemia in the left occipital lobe, what major artery is likely compromised?
Left PCA
Slide 24 - Give the Arteries
Slide 25 - Answers
-A - MCA
-B - ACA
-C - Internal Carotid
-D - Basilar
Given an Image on the final, which side is right and which side is left?
Flipped from normal
MRI on Slide 26
-Identify Structures
-DON'T BE LAZY, GO LOOK AT THIS YOU PIECE OF SHIT
Answers on Slide 27
Where is the VPL found? VPL damage results in what type of deficits?
-Thalamus
-Interrupts Somatosensory Pathway and may lead to loss of conscious sensation of the contralateral side of the body
What is just medial to the Thalamus? Lateral?
-3rd Ventricle
-Internal Capsule
A stroke involving a Thalamogeniculate Artery will result in what?
-Loss of Sensation from the Opposite side of the Body
-Episodes of Spontaneous, Excruciating Pain on the Opposite Side
A patient comes in with Paralysis of his right leg and foot. He also has some sensory impairment of leg and foot. Ischemia from which artery could be the cause?
Left ACA
You are about to see a patient with Ischemia of his ACA. What types of symptoms would you expect to see?
-Paraesis or Paralysis of the Contralateral Leg and Foot
-Sensory Impairment Involving the Contralateral Leg and Foot
You are told that a patient's motor cortex for his upper body is experiencing ischemia. Which artery supplies this? What about for the lower body?
-Upper Body - MCA
-Lower Body - ACA
A patient comes in with Paralysis of his left face, hand, arm. He also has some sensory impairment in the same locations. Ischemia from which artery could be the cause?
Right MCA
If there is an Infarct in the Left Superior Division of the MCA, what can result?
Broca's Aphasia
-Expressive Aphasia
-Related to Speech Production
If there is an Infarct in the Left Inferior Division of the MCA, what can result?
Wernicke's Aphasia
-Receptive Aphasia
-Related to Interpretation of Speech
What is Broca's Aphasia? An Infarct in which artery can lead to Broca's Aphasia?
-Expressive Aphasia
-Difficulty saying what you want to say
-Dysarthria - Slow, Labored Speech
-Superior Division of Left MCA
What is Wernicke's Aphasia? An Infarct in which artery can lead to Wernicke's Aphasia?
-Receptive Aphasia
-Deficit of Auditory Comprehension
-Cannot monitor their own conversation
-Inferior Division of Left MCA
A patient comes in with slow, dysarticulated speech. Their words are slurred and they are aware of their problem. What's wrong? Infarct of what artery may have caused this?
-Broca's (Expressive) Aphasia
-Superior Division of Left MCA
A patient comes in with a deficient of auditory comprehension. They cannot monitor their conversation and they are unaware of their problem. What's wrong? Infarct of what artery may have caused this?
-Wernicke's (Receptive) Aphasia
-Inferior Division of Left MCA
What is Gerstmann's Syndrome? How does it result? Which artery is involved? Where in the brain? What are some symptoms?
-Lesion to Dominant (usually Left) Posterior Association Area
-Left MCA
-Parietal Lobe
-Finger Agnosia
-Agraphia (can't write)
-Alexia (can't read)
-Agnosia (can't synthesize, correlate, or recognize multisensory perceptions)
-Dyscalculia (problems with numbers)
A patient has a lesion to their Left Posterior Association Area in their Parietal Lobe. They exhibit finger agnosia, agraphia, alexia, agnosia, and dyscalculia. How old is Tom.
7
A patient has a lesion to their Left Posterior Association Area in their Parietal Lobe. They exhibit finger agnosia, agraphia, alexia, agnosia, and dyscalculia. What syndrome might they have?
Gerstmann's Syndrome
If a patient has language problems, what artery is likely affected? On which side? Why?
-MCA
-Dominant (Usually Left)
-Dominant side contains Language association areas
What will damage to the Posterior Association of the Dominant side lead to? Nondominant side?
-Gerstmann's Syndrome
-Hemineglect, Constructional Apraxia (drawing), Awareness of Body Image, Anosognosia (Denial or lack of awareness that there is anything wrong)
You are told that a patient has a Problem with their Posterior Assocation Area in their Parietal Lobe on their nondominant side. Which artery is likely involved? What symptoms might you see?
-Right MCA
-Hemineglect
-Constructional Apraxia
-Disturbances in the Awareness of the Body Image
-Anosognosia - Denial or lack of awareness that there is anything wrong
Which artery provides Blood Supply to the Pons?
Superior Cerebellar Arteries
Which arteries provide Blood Supply to the Medulla?
-Anterior Spinal Artery
-Posterior Inferior Cerebellar Arteries
What does the Corticospinal Tract (CST) do? Above the Caudal Medulla, what side?
-Controls Body Movement
-Contralateral
What does the Dorsal Column Medial Lemniscus (DCML) do? Above the Caudal Medulla, what side?
-Fine touch, proprioception, vibration--Contralateral
What does the Spinothalamic Tract (STT) do? Above the Caudal Medulla, what side?
-Crude touch, pain, and temperature
-Contralateral
Look at Slide 46 for Rostral Medulla Locations of:
-STT
-DCML
-CST
-CN VIII
-CN IX
-CN X
-CN XII
GO FUCKING LOOK
Where does the Vestibulocochlear Nerve (CN 8) emerge from?
-Caudal Medulla on the Dorsal Side
Where does the Glossopharyngeal (CN 9) emerge from?
-Caudal Medulla on the Lateral Side
-Comes out near the Vagus Nerve (CN 10) and the STT
Where does the Vagus Nerve (CN 10) emerge from?
-Caudal Medulla on the Lateral Side
-Comes out near the Glossopharyngeal Nerve (CN 9) and the STT
Where does the Hypoglossal Nerve (CN 12) emerge from?
-Caudal Medulla on the Ventrolateral Side
-Fibers run along the Medial Lemniscus
-Emerge near the CST
Which artery supplies the Medial Medulla?
ASA
If the Anterior Spinal Artery was occluded, which Spinal Tracts would be affected? Which side would the patient experience problems??
-DCML and CST
-Contralateral Side
What the fuck does the Hypoglossal Nerve (12) do?
Muscles of the Tongue
A Patient comes in with tongue problems. They've been experiencing these problems for a long time and the muscles on the right side of their tongue seem to atrophied. The patient tells you that the problems started initially with paralysis of the right side of the tongue. What is the problem? Where? Which artery could be Involved?
-Hypoglosal Nerve Nucleus or Tract Lesion
-Medulla
-Anterior Spinal Artery
What is Medial Medullary Syndrome? How does it Occur? What is affected? What results?
-Problems with Medial Medulla
-Anterior Spinal Artery Occlusion
-Hypoglossal Nucleus or Nerve - Paralysis an Eventual Atrophy of the Tongue Ipsilateral to the Lesion
-CST (Medullary Pyramids) - Paralysis of Contralateral Arm and Leg
-Medial Lemniscus - Loss of Tactile Sense and Proprioception from Contralateral Arm and Leg
Which tracts are affected by Medially Medullary Syndrome? Which ones are not? What does this mean?
-Hypoglossal Nerve, DCML, CST
-SST
-Patient will still have crude touch, pain, and temperature sensation
What is another name for Lateral Medullary Syndrome?
Wallenburg Syndrome
What is another name for Wallenburg Syndrome?
Lateral Medullary Syndrome
What is Horner's Syndrome? How can it result? What other stuff happens? What artery could cause this?
-Loss of Pupil Dilation on Ipsalateral Side
-Due to Descending Sympathetic Fibers being hit
-Miosis, Ptosis, Anydrosis
-PICA
A patient comes in with ptosis, miosis, and lack of sweating (anhydrosis). What is wrong? Which nerve fibers are involved? What artery is likely involved?
-Horner's Syndrome
-Descending Autonomic Sympathetics on Ipsalateral Side
-PICA
What is the Nucleus Ambiguas? Where is found?
-A Motor Nucleus for CN9 and CN10
-Medulla - Next to STT
A patient has a Dysphagia, Dysarthia, and loss of gag reflex on the right side. Which cranial nerve(s) and nucleus/nuclei are involved? Which other tract might be involved due to its close proximity?
-CN9 and CN10
-Nucleus Ambiguas
-STT
A patient is experiencing hearing loss. Which cranial nerve is affected? Which artery might be involved?
-CN8 - Vestibulocochlear
-AICA
Where does the Trigeminal Nerve (CN 5) Emerge?
Lateral Pons
Where does the Abducens Nerve (CN 6) Emerge?
Ventromedial Pons
Where does the Facial Nerve (CN 7) Emerge?
Lateral Pons
What does the Abducens Nerve (CN 6) do?
Motor Innervation to Lateral Rectus
LOOK AT SLIDE 51 for CN V, VI, VII, and VIII
GOOOOOOO
What are some things that can cause Locked-In Syndrome? In the Pons, what is Hit? What is Spared?
-Bilateral Ventral Pontine Infarcts, Central Pontine Myelinolysis
-Hit - CST, Lower Corticobulbar, Abducens
-Spared - Medial Lemniscus, STT, Spinal Trigeminal, Facial Motor
What is Central Pontine Myelinolysis? What can you notice on an MRI? What types of patients is it often associated with?
-Demyelinating Condition associated with Rapid Correction of Hyponatremia
-Dark "I" in the Pons
-Alcoholics, Malnourished, Transplant Patients
Lesion to the Facial Motor Nucleus or Nerve. What Results?
Paralyzed Ipsalateral Face
Lesion to the Abducens Nerve and Lateral Gaze Center. What Results?
-Paralyzed Ipsalateral Eye with Loss of Lateral Gaze
-Loss of Ispalateral Conjugate Gaze
Lesion to the Medial Lemniscus that extends Anteriorly. Lesion is above the Caudal medulla. What Results?
Loss of FIne Touch, Bivration, and Proprioception from CL body
Lesion to the STT that extends medially and laterally. Lesion is above the caudal medulla. What Results?
Loss of Paint and Temp from CL Face and Body
Lesion to the main Trigeminal Nucleus that extends rostrally. What Results?
Loss of Fine touch and Vibration of Ipsalateral Face
Lesion to the Spinal Trigeminal Tract that extends laterally. What Results?
Loss of Pain and Temp from Ipsalateral Face
What is Nystagmus?
Involuntary Eye Movement
What is Involuntary Eye Movement known as?
Nystagmus
Lesion to Vestibular Division of CN8.
-Vertigo
-Nystagmus
Lesion to Cochlear Division of CN8.
-Tinnitus
-Hearing Loss
Lesion to Facial Nerve.
-Facial Weakness
-Loss of Taste Sensation, Salivation, and Tearing,
Go Look at Slide 56!
-CST
-Trochlear Nerve (CN 4)
-Occulomotor Nerve (CN 3)
-3 Comes out Anteriorly
-4 Crosses and goes Posteriorly
What the fuck does the Occulomotor Nerve do?
-Parasympathetics - Pupillary Sphincter and Ciliary Muscles
-Eye Muscles
What does the Trochlear Nerve do?
Superior Oblique Muscle
Where is the lesion site for Weber Syndrome? What happens?
-Oculomotor Nerve Palsy
-Contralateral Hemiparesis or Hemiplegia
A patient comes in with a Right Oculomotor Nerve Palsy. They also have Contralateral Hemiparesis or Hemiparesis. What do they have?
Weber Syndrome
Parinaud Syndrome Lesions. What results?
-Compression on Posterior Midbrain
-Vertical Gaze Center - Loss of Vertical Gaze, Eyes deviate downward
-Vergence Center - Nystagmas on Eye Convergence
-Posterior Commissure and Tectum - Loss Pupillary light of response, possibly with accomodation intact
A patient comes in with loss of vertical gaze. They exhibit nystagmous on eye convergence. They also have lost their pupillary light response. What's wrong with them?
Parinaud Syndrome
Meninges
Bad ass
Look at slide 62 for hematomas
Look at slide 62 for hematomas
Describe an Epidural Hematoma.
-Lens Shaped - Doesn't follow brain
-Middle Meningeal Artery
Describe a Subdural Hematoma.
-Crescent Shaped - Follows Brain
-Tearing of the Bridging Veins
Describe a Sub-Arachnoid Hematoma.
-"Worst Headache of my Life"
-Blood from Arteries within Pial Membrane
-Caused by Head Trauma or Aneurysm
A patient comes in with a Texaco Star shaped pattern in their MRI of brain. What the fuck is going on?
Sub-Arachnoid Hematoma
A patient has CSF displaced into the spinal canal, blood volume is reduced in the brain, displacement of brain tissue
Intracranial Mass
What is CPP?
That stupid class people took
What is CPP? How is it calculated?
-Cranial Perfusion Pressure
-CPP = MAP (Mean Arterial Pressure) - ICP (Intracranial Pressure)
What are the 2 major classes of herniation?
Based on Tentorial Notch
-Supratentorial
-Infratentorial
What is indicated by RBCs in the CSF? WBCs?
-Subarachnoid Hematoma or Traumatic Spinal Tap
-Infection
A patient comes in and complains of head pain. You take a CSF sample and that shit looks cloudy. What do you suspect?
Bacterial Meningitis
What are the Non-Neuronal Cells in the PNS? What do they do?
-Satellite Cells - Support Cell Bodies
-Schwann Cells - Secrete Neurotrophic Factors
What are the Non-Neuronal Cells in the CNS? What do they do?
-Oligodendrocytes
-Astrocytes
-Microglia - Scavengers
-Ependymal - Form Barrier between Compartment
What does the CST do? Where are its Neurons? Describe the Path. Look at Slide 77 for location of tracts.
-Motor
-UMN - In Motor Cortex, Crosses over at Caudal Medulla
-LMN - Cell Body is in the Anterior Horn of the Spinal Cord
What happens with an UMN Lesion of the Hypoglossal Nerve? What happens with an LMN Lesion of the Hypoglossal Nerve? What does this mean?
-Contralateral Atrophy and Deviation
-Ipsalateral Atrophy
-UMN Crosses
Where are the Cell bodies of LMNs located?
Anterior Horn of the SC
What are Alpha Motor Neurons? Why are they called Alpha Motor Neurons?
-LMNs
-Alpha Fibers are found on LMNs
What is a Fasciculation? What causes it?
-Spontaneous Firing of a Motor Neuron
-LMN dying
What is a Deep Tendon Reflex?
Stretch Reflex
What happens with a LMN Lesion to Deep Tendon Reflexes? What happens with an UMN Lesion?
-LMN - Hyporeflexia or Areflexia due to broken reflex circuit
-UMN - Hypereflexia
Muscle Spindle
-What happens when muscle is stretched?
-What happens when muscle is contracted?
-AP Frequency Increases
-Alpha + Gamma Neuron Coactivation (Tightens Spindle to continue detection)
What types of shit will you see with an UMN if its Acute? Chronic?
-Acute - Flaccid Paralysis
-Chronic - Hyperreflexia
What is a Clonus?
Rapid Alternating Contraction/Relaxation of a stretched muscle
What is Clasp Knife Rigidity? How does it work? What time of damage might be suspected?
-Describes resistant to passive movement of a joint when spasticity is present
-Muscles first resistant to the Movement (due to increased DTR)
-Resistance melts away rapidly (GTO-based reflex kicks in)
-Chronic UMN Damage
If a patient comes in and has a tough time initially moving their muscles that slowly melts away, what is this called? What type of damage would you expect?
-Clasp Knife Rigidity "Spastic Catch"
-Chronic UMN damage
What is ALS? What happens in ALS? What are some symptoms? Who is typically affected?
-Amyotrophic Lateral Sclerosis
-Progressive Degeneration of CSTs and Alpha Motor Neurons (Both UMNs and LMNs)
-Symmetric gait disturbance, limb weakness, change in reflexes
-Older patients
You have a new patient who is older. He complains of symmetric gait disturbance, limb weakness, and change in reflexes. He also has dysarthia and dysphagia with respiratory complications. What do you suspect?
Amytrophic Lateral Sclerosis (ALS)
Describe an Epidural Hematoma.
-Lens Shaped
-Doesn't go into Grooves
-Tearing of Middle Meningeal Artery
Describe a Subdural Hematoma.
-Tearing of the Bridging Veins
-Crescent-Shaped
-Follows grooves of brain
Describe a Sub-Arachnoid Hematoma
-"Worst headache of my life"
-Blood in the CSF
-Arteries within the Pial Membrane
What are the major causes of Neuropathy?
-Diabetes
-Alcohol
What is going on In Guillain-Barre Syndrome?
-Inflammatory Neuropathy
-Acute Paralytic Illness
What is a Polyradiculoneuropathy?
Neuropathy that affects Nerve Roots
What is a Neuropathy?
Functional Disturbances and/or pathological changes in the PNS
What type of Neuropathy is Carcot-Marie-Tooth Disease? How does a patient present?
-Hereditary
-Pes Cavus - High Plantar Arches with Hammer Toes and Atrophy of Foot Muscles
-Stork Leg (Inverted Wine Bottle) due to Weakness/Wasting in Lower Leg and Foot
-Foot Drop and Stepped Gait
A patient walks in Pes Caveus (High Plantar Arches and weak foot muscles), weak legs, and their foot looks like an inverted wine bottle (Stork Leg). What do they probably have?
Charcot-Marie-Tooth Disease
What is an Acoustic Neuroma? What symptoms would a patient with this shit have?
-Vestibular Schwannoma
-Tinnitus and Hearing Loss
Presynaptic Disorders are usually caused by what? What are they characterized by?
-Decrease in ability to release NT or Uncontrolled release of NT
-Warm Up Phenomenon
You suspect that a patient has a Disorder of NMJ. They exhibit warm up phenomenon which is characterize of what type?
Presynaptic
Postsynaptic disorders are usually caused by what? What are they characterized by?
-Decrease in Availability of ACh on Motor Endplate
-Fatigueability
What causes Lambert-Eaton Myasthenic Syndrome (LEMS) ? What are the symptoms associated with it? What is the treatment for it?
-Prevents Calcium entry and NT Release
-Autoimmune Disorder - Abs against VCCCs
-Symptoms - Muscle weakness, fatigue, diminished reflexes, autonomic dysfunctions
-Treatment - Plasmaphoresis to remove IgGs, suppress immune system, treat tumor
You are told about a patient who has a difficult time with calcium entry and NT release. He was muscle weakness and fatigue.
LEMS - Lambert-Eaton Syndrome
What type of disorder is LEMS? What about is Myasthenia Gravis?
-Presynaptic
-Postsynaptic
What the fuck is going on in Myasthenia Gravis?
-Muscle Weakness
-Due to Abs against AChR Receptos
-Increased Degradation of Receptors
A patient produces Abs to his ACh Receptors. What disorder does he have?
Myasthenia Gravis
At what level do CN 3 and 4 emerge? Which side? Which side do they Innervate?
-Midbrain
-3 - Anterior, Ipsalateral
-4 - Posterior, Contralateral
Which Cranial Nerve Emerges at the Level of the Midbrain and does Contralateral Innerveration
Trochlear Nerve (CN 4)
What are the only 2 Cranial Nerves that do Contralateral Innervation?
Optic and Trochlear
Which Cranial Nerves Emerge at the Level of the Pons?
5, 6, 7 (maybe 8)
Which Cranial Nerves Emerge at the Level of the Medulla?
9, 10 , and 12
What is the Edinger Westphal Nucleus? Where is it found?
-Parasympathetic Nucleus for CN III
-Medial to the Occulomotor Nucleus in the Midgrain
What is the Parasympathetic Nucleus for the Occulomotor Nerve? Where is found?
-Edinger-Westphal Nucleus
-Midbrain
Where is the Abducens Nucleus located?
Medial Pons
Where is the Nucleus Ambiguus? Which Cranial Nerves are involved?
-Medial Medulla
-9 and 10
Where is the Nucleus of the Solitary Tract? Which Cranial Nerves are involved?
Sensory Nucleus of 8, 9, and 10
What is the Nucleus that controls sensory innervation of 8, 9, and 10?
Nucleus of Solitary Tract
Which nucleus is responsible for parasympathetic innervation of CN 9 and 10?
Nucleus Ambiguus
What types of Symptoms would you expect with a Cranial Nerve 4 Lesion?
-Difficulty walking down steps
-Double Vision
-Come in with a head tilt
A patient comes in with double vision, head tilted, difficulty walking down steps. What do you suspect?
Trochlear Nerve Lesion
What types of Symptoms would you expect with a CN III Compression?
-Eye Down and Out - Can't counter Lateral Rectus and Superior Oblique
-Dilated Pupil - Loss of Parasympathetics
-Eyelid Droop
A patient comes in with their left eye looking down and out and it stuck in this position. Their pupils are dilated, and their eyelid is drooped. WTF is going?
CNIII Compression
Which Cranial Nerves are responsible for taste sensation?
-Glossopharyngeal Nerve (9) - Posterior 1/3 of Tongue
-Facial Nerve (7) - Anterior 2/3 of Tongue
Which Cranial Nerve is responsible for Taste Sensation to the Posterior 1/3 of the Tongue?
Glossopharyngeal Nerve 9
Which Cranial Nerve is responsible for Taste Sensation to the Anterior 2/3 of the Tongue?
Facial Nerve 7
What would you expect to happen due to a CN III Lesion?
-Eye would be Down and Out (ABducted)
-Ptosis
-Pupil Dilation
A patient has a dilated and unresponsive pupil What is this a sign of?
Occulomotor Nerve Compression
Which Cranial Nerve is most susceptible to problems due to increased ICP?
Abducens Nerve (CN6)
Describe the function of the MLF during looking left.
The Left Abducens Nuclei causes the Left Lateral Rectus to ABduct. Fibers from the right MLF (named for where it goes) connect to the right Occulomotor Nerve which causes the Right Medial Rectus to ADduct.
What is found in the PPRF (Paramedian Pontine Reticular Formation)?
Abducens Nucleus and MLF
If the Right MLF is damaged, what would you expect? What is this called?
-Loss of Conjugate Eye movement. The Right eye cannot ADduct.
-INO
What is INO (Internuclear Opthalmoplegia)? How does it happen?
-DIsorder of Conjugate Gaze
-MLF Lesion
A dinosaur walks into your office. He tells you that all of his internal anatomy above his head is human. He has a difficult time looking at you (down and in). What do you suspect?
Trochlear Nerve Lesion
What is responsible for Voluntary Saccades? Which side?
-Frontal Eye fields and Superior Colliculi
-Contralateral
What is a saccade?
quick, fast eye tracking like
Voluntary Saccades
Contralateral FEF
What is the Vestibulo-Ocular (VOR) Reflex? What function does it serve?
-Vestibular Nuclei Input
-Generates Eye Movements Equal and Opposite to Head Movements
-Keeps Images steady during head movement?
What reflex helps us keep images steady during eye movement? How?
-VOR (Vestibulo-Ocular Reflex)
-Generates Eye Movements Equal and Opposite to Head Movements
You brush a patients eye with a q-tip. What happens? What is this reflex called?
-Corneal Reflex
-Sensory - Opthalmic Division (V1) of the Trigeminal Nerve (V)
-Motor - Branch of Facial Nerve (VII) which causes contraction of the orbicularis Oculi muscles
Describe the Corneal Reflex.
-Sensory - Opthalmic Division (V1) of the Trigeminal Nerve (V)
-Motor - Branch of Facial Nerve (VII)
What is Bells Palsy? How does it happen? How might it happen?
-Loss of Muscles of Facial Expression
-Facial Nerve
-HSV-1
Patient has loss of muscles of facial expression. What might they have? What is this caused by?
-Bell's Palsy
-Facial Nerve
What results from a UMN Lesion of the Facial Nerve? Why? What about a LMN lesion?
-Contralateral Effects on the Lower Quadrant only - Upper Quadrant is controlled bilaterally from the cortex
-Ipsilateral Effects
What are the shared functions of Glossopharyngeal and Vagus Nerves?
Speech and Swallowing
Which 2 Nerves are Involved in the Gag Reflex? Which Nucleus?
-9 and 10
-Nucleus Ambiguus
What is the DCML responsible for? Go through all the neurons.
-1 - Dorsal Root Ganglion, Ascend in the Fasciculus Gracilis
-2 - Nucleus Gracilis in the Caudal Medulla, Internal Arcuate
-3 - VPM of Contralateral Thalamus. Projects to the SS Cortex
LOOK at SLIDE 140 for DCML!!!!!
GOOOOOOO
What is the Romberg Test?
Close eyes, see if they fall
What causes a positive Romberg test?
DCML problem
Describe the STT Neurons.
-1 - Dorsal Root Ganglion. Goes up or down a 1-2 levels
-2 - Dorsal Horn of SC. Cross at Anterior White Commissure, Ascend in CTT
-3 - VPL of Contralateral Thalamus, projects to Contralateral SS Cortex
What is the DCML responsible for? Go through all the neurons.
-1 - Dorsal Root Ganglion, Ascend in the Fasciculus Gracilis
-2 - Nucleus Gracilis in the Caudal Medulla, Internal Arcuate
-3 - VPM of Contralateral Thalamus. Projects to the SS Cortex
LOOK at SLIDE 140 for DCML!!!!!
GOOOOOOO
What is the Romberg Test?
Close eyes, see if they fall
What causes a positive Romberg test?
DCML problem
Read Slide 158
No Sympathetics in the brain. Come from lower. Pupil Dilation is Sympathetic. Patient will have Miosis (Pupil Constriction)
What is Horner Syndrome?What are some symptoms?
-Damage to Sympathetic Out-flow to the face.
Loss of Sweating
Pupil Constriction
Lid Droop
What is Syringomyelia? What are some typical findings?
-Damage to Central Cavity of SC
-Bilateral loss of Pain and Temperature Sensation - Due to STT crossing at Anterior White Commissure
What does the Basal Ganglia do?
Selection and Suppression of Movements
How does the Basal Ganglia Increase Motor Output?
-DIrect Pathway
-Decreases Basal Ganglia Output
-Increases Thalamic Activity
How does the Basal Ganglia Decrease Motor Output?
-Indirect Pathway
-Increases Basal Ganglia Output
-Decreases Thalamic Activity
What is the Basal Ganglia's effect on the Thalamus?
Inhibitory
What goes wrong in Parkinsons? What are some symptoms?
-Loss of Da Producing Neurons in Substantia Nigra
-Parkinson's patients are TRAPD
-Tremor (resting)
-Rigidity
-Akinesia (Hypokinesia, Bradykinesia)
-Posteral Instability (Flexed Posture, Festinating Gate)
-Dementia
A patient exhibits all of the following. What do they have?
-Tremor (resting)
-Rigidity
-Akinesia (Hypokinesia, Bradykinesia)
-Posteral Instability (Flexed Posture, Festinating Gate)
-Dementia
Parkinson's
Which pathway is disrupted in Parkinson's? What types of Neurons?
-Nigro-Striatal Pathways
-Dopamine Neurons
Drug Induced Parkinsons involved what drug?
MPTP - Synthetic Heroine COntaminant
What is Huntington's Disease? How does it result? What are its effects?
-Inherited disease of the CNS
-Degeneration of the Caudate and Putamen
-Progressive Dementia and Involuntary Choreic Movements
What causes the Dementia in Huntingtons?
Degeneration of Neurons in the Cerebral Cortex
What causes the Chorea in Huntingtons?
Degeneration of the Basal Ganglia
Patient has Dementia, Cognitive Personality Changes, and Chorea. What the fuck is their problemsssss?
Huntingtons
What will the brain of a Huntington's patient look like?
Decreased Caudate, Putamen, and Cerebral Volume with Increased Ventricles
What is Hemiballismus? What causes it?
-Unintentional, Forceful Flinging Movements of the arms and leg
-STN Hit
What is Unintentional, Forceful Flinging Movements of the arms and leg?
Hemiballismus
STN Hit + Unintentional Forceful flinging movements = what?
Hemiballismus
What is Dystonia?
-Persistence of a Postural Abnormality
-Sustained Posture or Position of any part of the boyd
What is Wilson Disease a disorder of? What is affected? What is its hallmark? What can result?
-Disorder of Copper Metabolism
-Affects Brain and Liver
-Kayser-Fleischer Ring (Copper Colored Ring) around the Cornea
Disorder of Copper Metabolism affecting brain and liver.
Wilson Disease
What are the Normal functions of the Cerebellum?
-Execution of Planned Motor Acts
-Establishes direction, timing, and force of planned motor acts
-Compares intended movements with ongoing movement
-Involved in motor learning
Which brain structure is involved in the following:
-Execution of Planned Motor Acts
-Establishes direction, timing, and force of planned motor acts
-Compares intended movements with ongoing movement
-Involved in motor learning
Cerebellum
If a patient has a cerebellar dysfunction, on which side will their symptoms manifest?
Ipsalateral
What are some symptoms of Cerebellar Dysfunction?
-Intention Tremor
-Disequilibrium - Loss of balance, gate and trunk dystaxia
-Dyssnergia - loss of coordination, nystagmus
A patient comes in exhibit all of the symptoms below. Which brain structure might be malfunctioning?
-Intention Tremor
-Disequilibrium - Loss of balance, gate and trunk dystaxia
-Dyssnergia - loss of coordination, nystagmus
Cerebellum
Which part of the Cerebellum is selectively damaged in alcoholics? What symptoms result?
-Vermis
-Gait Ataxia without Limb Ataxia
Gait Ataxia without Limb Ataxia
Vermis Cerebellum David Wong
Monkey
Banana
Which part of the Cerebellum is selectively damaged in alcoholics? What symptoms result?
-Vermis
-Gait Ataxia without Limb Ataxia
Gait Ataxia without Limb Ataxia
Vermis Cerebellum David Wong
Monkey
Banana
Where in the brainstem do Serotenergic pathways originate from?
Raphe Nuclei
Where in the brainstem do NE pathways originate from?
Locus Ceruleus and Lateral Tegmental Area
Where in the brainstem do Dopaminergic pathways originate from?
SNc (Substania Nigra Compacta) and VTA (Ventral Tegmental Area)
What is an EEG? What does in measure? What types of stuff is it usually used for?
-Electroencephalogram
-Cortical Activity
-Sleep States and Seizure evaluation
What does a Normal EEG taken from a quiet, awake individual look like?
Asynchronous, Low Voltage, Fast Activity
How many different stages of sleep are they? How are they characterized on an EEG?
-1 - Theta Rhythms
-2 - Sleep Spindles
-3 and 4 - Delta Rhythms
-5 - REM Sleep - Beta Rhythm, which is characteristic of a waking state
Which stage (#) is REM sleep? What type of sleep rhythm is seen? What is this characteristic of?
-5
-Beta Rhythm
-Waking State
In which stage of sleep does dreaming typically occur?
REM
Why do you only go through all the sleep stages once when you sleep?
You usually don't. You usually go through them multiple times since you sleep more than 2 hours a night.
Why is REM Sleep called "Paradoxical Sleep"?
Because in some ways REM Sleep is deeper than stage 4 sleep but in others it closely resembles the awake state
During which stage of sleep is Sleep-Walking typically seen? Which stage (#) is this?
-Deep Slow Wave Sleep (SWS)
-3 and 4
What are the names of each stage of sleep?
-1 - Drowsy Sleep
-2 - Light Sleep
-3 and 4 - Deep Slow Wave Sleep
-5 - REM Sleep
What is Insomnia?
Can't Sleep or fall asleep
What are some causes of Insomnia?
-Anxiety, Depression, STRESS, Pain
-Fear of David Wong
-Side effects of meds, alcohol, poor sleep habits
-Disruption of circadian rhythms?
-Age?
What are some effects that result from insomnia?
-Problems with Memory and Concentration
-Potential Link with CV Disease
-4x Increase in Likelihood of Depression
-Impaired Job and Home Performance
A patient exhibits all of the following. What might they be suffering from?
-Problems with Memory and Concentration
-Potential Link with CV Disease
-Depression
-Impaired Job and Home Performance
Insomnia
What is Obstructive Sleep Apnea? What happens? What can cause it?
-Brief Periods of Interrupted Breathing During Sleep
-Woken up all the fucking time during sleep
-Overweight, Heavy Snoring
What is Narcolepsy? What causes it?What are some symptoms?
-Enter REM SLeep Directly from the Waking State
-Loss of Orexin (Hypocretin)
-EDS - Excessive Daytime Sleepiness
-Cataplexy - Sudden loss of muscle tone in awake state
-Hallucinations while falling or awakening from sleep
-Sleep Paralysis
Loss of Orexin can lead to what?
Nacrolepsy
What is Cataplexy? Which disorder is it associated with?
-Sudden Loss of Muscle Tone in awake state
-Narcolepsy
What are the Ascending Pathways of the Reticular System Associated with? Descending Pathways?
-Attention, Arousal, and Consciousness
-Motor, Reflex, and Autonomic Function
Which pathways of the Reticular Formation are associated with the following:
-Attention
-Arousal
-Consciousness
Ascending Pathways
Which pathways of the Reticular Formation are associated with the following:
-Motor Function
-Reflex Function
-Autonomic Function
Descending Pathways
What are the Functions of the Reticular Formation?
-Activates the Cerebral Cortex (Arousal and Wakefulness)
-Integrates Cranial Nerve Reflexes
-Modulates Pain (Intrinsic Analgesic System)
-Influences Voluntary Movements
-Regulates Autonomic Nuclei
-Integrates Respiration and Sleep
Which brain structure is responsible for the following:
-Activates the Cerebral Cortex (Arousal and Wakefulness)
-Integrates Cranial Nerve Reflexes
-Modulates Pain (Intrinsic Analgesic System)
-Influences Voluntary Movements
-Regulates Autonomic Nuclei
-Integrates Respiration and Sleep
Reticular Formation
What 3 things are involved in consciousness?
Alertness
Attention
Awareness
What causes the Persistent Vegetative State? What is lacking?
-Severe, Diffuse Cerebral Cortical Damage with Brainstem Function Intact ("Cerebral Death")
-No Evidence of awareness, responsiveness, or interaction with environment
What the fuck is going on in a Coma? What can cause it?
-Unconscious
-NOT Sleep, Fainting/Syncope, Innattention
-Diffuse Axonal Injury
What is the Decorticate Posture in Coma? How does it result?
-Arms up and chest
-Damage above the Red Nucleus
What is the Decerebrate Posture in Coma? How does it result?
-Arms down
-Damage below the Red Nucleus - Rubrospinal Tract (Flexor Bias ) is now Offline
Based on the information that the Decorticate and Decerebrate postures result from damage above and below (respectively) the red nucleus, what type of shit is the red nucleus likely contain?
Descending Motor Pathways
What is the Reticulospinal Tract involved in?
-Motor Tract
-Feed forward
-Extensor Bias
What is the Vestibulospinal Tract involved in?
-Motor Tract
-Feedback adjustments
-Arm and Leg Extension Bias
-Damage Seen in Decerebrate Rigidity
Which tract is likely cut during Decerebrate position? How do you know this?
-Rubrospinal Tract
-Arm and Leg Extension Bias in the Tract
-Dr. Best's slides said so
Which tract?
-Motor Tract
-Feed forward
-Extensor Bias
Reticulospinal
Which tract?
-Motor Tract
-Feedback adjustments
-Arm and Leg Extension Bias
-Damage Seen in Decerebrate Rigidity
Vestibulospinal Tract
Glasgow Coma Scale
-3 - out
-3-8 - Severe Head Injury, Coma
-9-12 - Moderate Head Injury
-13-15 - Mild Head Injury
If a patient has absence of Grimacing or Eye Opening, which Cranial Nerves might you suggest a problem with?
Afferent 5 (Trigeminal)
Efferent 7 (Facial)
If a patient has absence of the Corneal Reflex, which Cranial Nerves might you suggest a problem with?
5 and 7
If a patient has absence of the Light Reflex, which Cranial Nerves might you suggest a problem with?
2 and 3
If a patient has absence of the Oculovestibular Response, which Cranial Nerves might you suggest a problem with?
3, 4, 6, 8
If a patient has absence of their Gag Reflex, which Cranial Nerves might you suggest a problem with?
9 and 10
Based on the information that the Decorticate and Decerebrate postures result from damage above and below (respectively) the red nucleus, what type of shit is the red nucleus likely contain?
Descending Motor Pathways
What is the Reticulospinal Tract involved in?
-Motor Tract
-Feed forward
-Extensor Bias
What is the Vestibulospinal Tract involved in?
-Motor Tract
-Feedback adjustments
-Arm and Leg Extension Bias
-Damage Seen in Decerebrate Rigidity
Which tract is likely cut during Decerebrate position in coma? How do you know this?
-Vestibulospinal
-Arm and Leg Extension Bias in the Tract
-Dr. Best's slides said so
Which tract?
-Motor Tract
-Feed forward
-Extensor Bias
Reticulospinal
Which tract?
-Motor Tract
-Feedback adjustments
-Arm and Leg Extension Bias
-Damage Seen in Decerebrate Rigidity
Vestibulospinal Tract
Based on the information that the Decorticate and Decerebrate postures result from damage above and below (respectively) the red nucleus, what type of shit is the red nucleus likely contain?
Descending Motor Pathways
What is the Reticulospinal Tract involved in?
-Motor Tract
-Feed forward
-Extensor Bias
What is the Vestibulospinal Tract involved in?
-Motor Tract
-Feedback adjustments
-Arm and Leg Extension Bias
-Damage Seen in Decerebrate Rigidity
Which tract is likely cut during Decerebrate position in come? How do you know this?
-Rubrospinal
-Arm and Leg Extension Bias in the Tract
-Dr. Best's slides said so
Which tract?
-Motor Tract
-Feed forward
-Extensor Bias
Reticulospinal
Which tract?
-Motor Tract
-Feedback adjustments
-Arm and Leg Extension Bias
-Damage Seen in Decerebrate Rigidity
Vestibulospinal Tract
Glasgow Coma Scale
-3 - out
-3-8 - Severe Head Injury, Coma
-9-12 - Moderate Head Injury
-13-15 - Mild Head Injury
If a patient has absence of Grimacing or Eye Opening, which Cranial Nerves might you suggest a problem with?
Afferent 5 (Trigeminal)
Efferent 7 (Facial)
If a patient has absence of the Corneal Reflex, which Cranial Nerves might you suggest a problem with?
5 and 7
If a patient has absence of the Light Reflex, which Cranial Nerves might you suggest a problem with?
2 and 3
If a patient has absence of the Oculovestibular Response, which Cranial Nerves might you suggest a problem with?
3, 4, 7
If a patient has absence of their Gag Reflex, which Cranial Nerves might you suggest a problem with?
9 and 10
If someone shoots cold water in your right ear what normally happens? Due to what reflex? What happens if there is bilateral compromise of the reflex? How is this tested?
-Brain thinks you turned your head left
-Eyes move right and then return to middle
-Vestibulo-Ocular Reflex
-Eyes and Head go the same way
-Calorics testing
What does Calorics testing test?
-VOR
-Water in Ear - Left Ear as example
-Cold Water - Brain interprets as head movement away from cold water (to the right); Eyes move left and then back to midline
-Warm Water - Brain interprets as head movement toward warm water (to the left); Eyes move right and then back to midline
What is the normal response to cold water in the left ear? What about warm water?
-Cold - Brain thinks you turned your head to the right. Result - Saccade back to left
-Warm - Brain thinks you turned your head to the left. Result - Saccade back to right
If 1 Eye does not ADduct on Spontaneous Eye Movements or in response to Reflex Maneuvers, what type of lesion would you suspect?
MLF
How can you tell the difference between brain death and coma?
Presence of Brainstem reflexes
What is a Simple Partial Seizure? How do they occur? What are some symptoms?
-Small but Local Progress to Generalized Vague Locations
-Aura-Auditory or Visual Hallucinations
-Emotional Experience
-Legs or face may Twitch
-DOES NOT IMPAIR CONSCIOUSNESS
How long is conscious lost for in a Simple Partial Seizure?
It isn't lost
What happens in a Complex Partial Seizure? What is affected? What are some symptoms
-ALTERED CONSCIOUSNESS
-Psychomotor or Temporal Lobe
-Sensory, Motor and ANS Symptoms
-Blank stare, Confusion, no recollection of seizure
What is the main difference between a Simple and Complex Partial Seizure?
Loss of Consciousness in Complex
Different types of Generalized Seizures - Describe:
-Absence (petit mal)
-Myclonic
-Tonic Clonic
-Atonic
Different types of Generalized Seizures - Describe:
-Absence (petit mal) - Occur in children, last seconds, loss of activity and not responsive
-Myclonic - Large jerky movements
-Tonic Clonic - Alternating Intense Contraction and Relaxation, Hoarse cry out, confused, sore
-Atonic - Drop attacks
Which type of Generalized Seizure is described?
1) Alternating Intense Contraction and Relaxation, Hoarse cry out, confused, sore
2) Drop attacks
3) Occur in children, last seconds, loss of activity and not responsive
4) Large jerky movements
1) Tonic Clonic
2) Atonic
3) Absence (petit mal)
4) Myclonic
What does "Generalized" in Generalized Seizure refer to?
-Seizure of both hemispheres
-Not local
Where do Sympathetics come off the CNS?
T1-L2
Where do Parasympathetics come off the CNS?
CNS and S2-S4
Describe the Preganglionics and Postganglionics in the Sympathetic Nervous System. Length? NT? Synapse?
Preganglionics
-Short
-ACh
-In Ganglia

Postganglionics
-Long
-NE (usually)
-Target Organ
Describe the Preganglionics and Postganglionics in the Parasympathetic Nervous System. Length? NT? Synapse?
Preganglionics
-Long
-ACh
-On Organ

Postganglionics
-Short
-ACh
-Target Organ
What NT is typically used in Somatic Motor Neurons? What type of receptor
-ACh
-Nicotinic
What type of Receptor do Preganglionic Sympathetics act on? Postganglionics?
-Preganglionic - Nicotinic
-Postganlgionic - Adrenergic
What type of Receptor do Preganglionic Parympathetics act on? Postganglionics?
-Preganglionic - Nicotinic
-Postganlgionic - Muscarinic
Describe the different components of Urinary Bladder Control and what each one does.
-Pontine Micturition Center (via Reticulospinal Tract) - General Coordination, like UMN
-Sympathetic (T10-L2) - Stop Pee
-Parasympathetics (S2-S4) - Pee
-Somatic Motor (S2-S4) - Stop Voluntarily
What role does the Pontine Micturition Center play in Urinary Bladder Control? How?
-General Coordination, like UMN
-via Reticulospinal Tract
What role do Sympathetics play in Urinary Bladder Control? Where do they come from?
-Stop Peeing
-T10-L2
What role do Paraympathetics play in Urinary Bladder Control? Where do they come from?
-Pee
-S2-S4
What role do Somatic Motor Fibers play in Urinary Bladder Control? Where do they come from?
-Stop Voluntarily
-S2-S4
What is Lower Motor Neuron Bladder? What causes it? Why? What results?
-Nonreflex or Autonomous Bladder
-Sacral Spinal Cord or Cauda Equina Lesion (Similar to LMN)
-No Parasympathetic to start Peeing
-Urinary Retention - Fills to Max Capacity and then Dribbles
-Overflow Incontinence
A patient comes in complaining about peeing. They feel pressure in their bladder and when they pee, they only pee a little bit. What the fuck is going on? Why?
Lower Motor Neuron Bladder
-Nonreflex or Autonomous Bladder
-Sacral Spinal Cord or Cauda Equina Lesion (Similar to LMN)
-No Parasympathetics to start Peeing
-Urinary Retention - Fills to Max Capacity and then Dribbles
-Overflow Incontinence
What is Upper Motor Neuron Bladder? What causes it? Why? What results?
-Autonomic Reflex Bladder
-Loss of Pontine Micturition Center (Similar to UMN Lesion)
-Loss of General Coordination
-Hyperactive Bladder - Empties Reflexively and not completely
A patient comes in complaining about peeing. They are peeing all the time but they don't seem to fully empty their bladder. You suspect some type of nerve problem. What would it be?
Upper Motor Neuron Bladder
-Autonomic Reflex Bladder
-Loss of Pontine Micturition Center (Similar to UMN Lesion)
-Loss of General Coordination
-Hyperactive Bladder - Empties Reflexively and not completely
What would you suspect is wrong in an individual with an Atonic Bladder? How would you treat them?
-Spinal Shock Immediately following Injury
-MUST Catheterize
What type of Bladder problem is associated with Overflow Incontinence?
Lower Motor Neuron Bladder
What causes Uninhibited Bladder?
-Loss of Cortical Input
Describe the Micturation Reflex.
1) Stretch Receptors fire
2) Parasympathetic Neurons Fire; Motor Neurons Stop Firing
3) Smooth Muscle contracts Internal Sphincter passively pulled open. External Sphincter relaxes
What initiates the Micturation Reflex?
Stretch Receptors fire
Describe the Micturation Reflex.
1) Stretch Receptors fire
2) Parasympathetic Neurons Fire; Motor Neurons Stop Firing
3) Smooth Muscle contracts Internal Sphincter passively pulled open. External Sphincter relaxes
In the Micturation Reflex, what happens after stretch receptors are activated?
-Parasympathetic Neurons Fire (Pee)
-Motor Neurons Stop
In the Micturation Reflex, what happens after Parasympathetic Neurons Fire and Motor Neurons Stop Firing?
-Smooth Muscle Contracts the Internal Sphincter and it is passively pulled opne
-External Sphincter Relaxes
-YOU PEE!!!!!
What is the main function of the Hypothalamus?
Homeostasis
What is Leptin? What is its function? What happens when it is lost?
-Hormone Produced in Adipose Tissue
-Inhibits Food Intake and Energy Expenditure
-Obesity, Diabetes, Sterility
How could decreased Leptin result in Obesity?
-Leptin is produced in Adipose Tissue
-Inhibits Food Intake and Energy Expenditure
-Loss of Leptin - Eat More, Get Fat
Which part of the Hypothalamus is the Heat Dissipation Center?
Anterior Hypothalamic Nuclei
Which part of the Hypothalamus is the Heat Conservation Center?
Posterior Hypothalamic Nuclei
What is the function of the Anterior Hypothalamic Nuclei?
Heat Dissipation Center
What is the function of the Posterior Hypothalamic Nuclei?
Heat Conservation Center
What might a lesion to the Anterior Hypothalamic Nuclei cause? Why?
-Hyperthermia
-Loss of Heat Dissipation Center
What might a lesion to the Posterior Hypothalamic Nuclei cause? Why?
-Inability to raise core temperature
-Loss of Heat Conservation Center
Describe the Micturation Reflex.
1) Stretch Receptors fire
2) Parasympathetic Neurons Fire; Motor Neurons Stop Firing
3) Smooth Muscle contracts Internal Sphincter passively pulled open. External Sphincter relaxes
What initiates the Micturation Reflex?
Stretch Receptors fire
Describe the Micturation Reflex.
1) Stretch Receptors fire
2) Parasympathetic Neurons Fire; Motor Neurons Stop Firing
3) Smooth Muscle contracts Internal Sphincter passively pulled open. External Sphincter relaxes
In the Micturation Reflex, what happens after stretch receptors are activated?
-Parasympathetic Neurons Fire (Pee)
-Motor Neurons Stop
In the Micturation Reflex, what happens after Parasympathetic Neurons Fire and Motor Neurons Stop Firing?
-Smooth Muscle Contracts the Internal Sphincter and it is passively pulled opne
-External Sphincter Relaxes
-YOU PEE!!!!!
What is the main function of the Hypothalamus?
Homeostasis
What is Leptin? What is its function? What happens when it is lost?
-Hormone Produced in Adipose Tissue
-Inhibits Food Intake and Energy Expenditure
-Obesity, Diabetes, Sterility
How could decreased Leptin result in Obesity?
-Leptin is produced in Adipose Tissue
-Inhibits Food Intake and Energy Expenditure
-Loss of Leptin - Eat More, Get Fat
Which part of the Hypothalamus is the Heat Dissipation Center?
Anterior Hypothalamic Nuclei
Which part of the Hypothalamus is the Heat Conservation Center?
Posterior Hypothalamic Nuclei
What is the function of the Anterior Hypothalamic Nuclei?
Heat Dissipation Center
What is the function of the Posterior Hypothalamic Nuclei?
Heat Conservation Center
What might a lesion to the Anterior Hypothalamic Nuclei cause? Why?
-Hyperthermia
-Loss of Heat Dissipation Center
What might a lesion to the Posterior Hypothalamic Nuclei cause? Why?
-Inability to raise core temperature
-Loss of Heat Conservation Center
Describe the Pupillary Reflex. Neurons/Nerves in the pathway? What is the Direct Reflex? What is the Consensual Reflex?
-Constriction of both pupils when light is shone
-Optic Nerve is Sensory --> Projects to Edinger-Westphal Nucleus --> Motor is Occulomotor Nerve
-Direct - Each Pupil constricts when light is shone directly into that eye
-Consensual - each pupil constricts when light is shone into the other eye
What is the direct pupillary reflex?
Each Pupil constricts when light is shone directly into that eye
What is the consensual pupillary reflex?
Each pupil constricts when light is shone into the other eye
What happens to the Direct and consensual Pupillary Light Reflexes when the Optic Nerve is lesioned?
-Direct Reflex - Disappears - No Sensory for the light
-Consensual Reflex - Remains intact since sensory from other eye
What happens to the Direct and consensual Pupillary Light Reflexes when the Occulomotor Nerve is lesioned?
-Direct Reflex - Lost (Only contralateral eye constricts)
-Consensual Reflex - Lost for same reasons
Which Nerve is responsible for hearing? Be specific.
Cochlear division of Vestibulocochlear Nerve
What is an Acoustic Neuroma? What results?
-Schwann Cell Tumor of the COchlear Nerve
-Deafness, Vertigo, nausea, tinnitus, nystagmus
What is an Acoustic Neuroma? Which Nerves are affected?
-Schwann Cell Tumor of the COchlear Nerve
-Vestibulocochlear (both divisions) and Facial
Which Cranial Nerve regulates COmpensatory Eye Movements?
Vestibulocochlear Nerve
Describe how the Ear recognizes changes in position?
-Otolithic Membrane (crystals) respond to gravity
-Connected to the Utricle via the Macula
-Deflection of Macula causes Hyperpolarization
-Utricle is sensitive to changes in motion
How does the Ear recognizes changes in position?
-Otolithic Membrane (crystals) respond to gravity
-Connected to the Utricle via the Macula
-Deflection of Macula causes Hyperpolarization
-Utricle is sensitive to changes in motion
What allows the Ear to recognize position? Which portion detects Angular Movements? Which portion defects Linear Acceleration?
Cochlea
-Semicircular Canals - Angular Acceleration
-Utricle and Saccule - Linear Acceleration
A patient is experiencing disequilibrium, vertigo, and nystagmus. Which cranial nerve might have a lesion?
Vestibulocochlear
What are some symptoms that may result from a Vestibulocochlear Nerve Lesion?
Disequilibrium
Vertigo
Nystagmus
What is Conductive Hearing Loss? What can cause it?
-Problems that impair the ability of vibrations to reach the organ of corti
-Middle Ear Infection, Obstruction
What is Sensorineural Hearing Loss? What can cause it?
-Problems that impair the ability of the hair cells or the cochlear nerve to respond
-Damage from Noise Exposure, Vestibulocochlear Nerve Tumor, Degeneration of Hair Cells
What is Central Hearing Loss?
-Lesion of Primary Auditory Cortex or Wernicke's Area
Describe the Weber Test? What happens with Conductive Loss? What about Sensorineural Loss?
-Tuning fork on head
-Lateralizes Hearing problems
-Conductive - The bad ear is louder because conductive problem masks ambient noise in room
-Sensorineural - The good ear is louder because it can't be detected in the bad ear
Describe the Weber Test? What happens with Conductive Loss? What about Sensorineural Loss?
-Tuning fork on head
-Lateralizes Hearing problems
-Conductive - The bad ear is louder because conductive problem masks ambient noise in room
-Sensorineural - The good ear is louder because it can't be detected in the bad ear
Describe the Rinne Test. How does it work? What happens with Conductive Loss? What about Sensorineural Loss?
-Compares Air Conduction vs. Bone Conduction in an ear
-Conductive - Good Ear AC >BC, Bad Ear BC > AC because it can't be conducted normally
-Sensorineural Loss - AC > BC for both
Describe the Rinne Test. How does it work? What happens with Conductive Loss? What about Sensorineural Loss?
Describe the Rinne Test. How does it work? What happens with Conductive Loss? What about Sensorineural Loss?
Increases in Engolymph.
Affects Vestibular and Cochlear Systems
What is Meniere's Disease? What symptoms result?
-Increased Pressure in the Membranous Labyrinth of the Ear
-Hearing Loss and Vertigo
Which disorder results in increased pressure in the membranous labyrinth of the ear? What symptoms result?
-Meniere's Disease
-Hearing Loss and Vertigo
What is Dementia? How is it characterized? How can you tell the difference between Dementia and Delirium?
-"Deprived of ind")
-Serious loss of cognitive ability in a previously-unimpaired person, beyond what might be expected from normal aging
-Slow Insidious Onset and Progressive Course
-Dementia - Patient can cell whats going on; Delirium - cannot
What is Delirium?
-Fluctuating Consciousness and Impaired Attention
-Acute Onset
How is Dementia due to Normal Pressure Hydrocephalus treated?
-Shunt to divert CSF
-Reverse Dementia
-DUH
What type of disorder is Alzeheimer's? What are its major features? How is it diagnosed?
-Neurodegenerative Disorder
-Progressive Memory Impairment, Disordered Cognitive Function, Altered Behavior, Progressive Decline in Language Function
-Sufficient Numbers of Plaques and Tangles
A patient exhibits Progressive Memory Impairment, Disordered Cognitive Function, Altered Behavior, and Progressive Decline in Language Function. What the fuck is wrong with them?
They are either:
A) A Cubs Fan
B) Suffer from Alzheimer's Disease
What are the Neurofibrillary Tangles in Alzheimer's due to?
-Intraneuronal Bundles of Tau Protein
Which mutations are commonly associated with Alzheimer's Disease?
-APP (Amyloid Precursor) Gene on Chromosome 21
-Presenilin 1 (PS1) Gene on Chromosome 14
-Presenilin 2 (PS2) Gene on Chromosome 1
Certain APOE genotypes play a role in Alzheimer's. Which one(s) are protective and which one(s) are risk factors?
-Risk Factor - APOE4
-Protective - APOE e2
What happens to neurons in AD? Which Neurons?
-Selective Loss of ACh Neurons
-From Deep Nuclei in the Septum to Hippocampus and Basal Nucleus of Meynert to the Cerebral Cortex
Which neurodegenerative disorder usually exhibits Selective Loss of ACh Neurons from Deep Nuclei in the Septum to Hippocampus and Basal Nucleus of Meynert to the Cerebral Cortex?
Alzheimers
Compared to Healthy brain, what effects are seen in a brain of an individual with severe AD?
Severely enlarged ventricles, cortical, and hippocampal shrinkage
You perform a brain scan and your patient shows severely enlarged ventricles and degeneration of the caudate and putamen. What da problem is?
Huntingtons
What is the general function of the Frontal Lobe?
-Personality
-Higher Centers for Voluntary Motor Activities
What is the general function of the Parietal Lobe?
Peripheral Sensations
What is the general function of the Temporal Lobe?
-Smell
-Taste
-Hearing
What is the general function of the Occipital Lobe?
Vision
In which lobe of the brain is the primary motor cortex located?
Frontal Lobe
Which lobe of the brain is responsible for general functions including:
-Personality
-Higher Centers for Voluntary Motor Activities
Frontal Lobe
In which lobe of the brain is the somatosensory cortex located?
Parietal Lobe
Which lobe of the brain is responsible for general functions including:
-Smell
-Taste
-Hearing
Temporal Lobe
Which lobe of the brain is responsible for general visual functioning?
Occipital Lobe
What the shit do Broca's Area and Wernicke's area play a role in?
Language
What do the Anterior Cingulate Gyrus, Amygdala, and Hippocampus form together?
Limbic Lobe
What type of stuff is the Anterior Cingulate Gyrus (Anterior Cingulate Cortex) involved in?
Pain
What type of stuff is the Amygdala involved in?
Anger and Fear Response
What type of stuff is the Anterior Hippocampus involved in?
Memory and Emotion
Which portion of the LImbic Lobe is involved in Pain processing?
Anterior CIngulate Gyrus (Anterior Cingulate Cortex)
Which portion of the LImbic Lobe is involved in anger and the fear response?
Amygdala
Which portion of the LImbic Lobe is involved in memory and emotion?
Hippocampus
What is Sensitization?
-Receptors respond more easily - Threshold has decreased
-Respond mot strongly to a given stimulus
What is called when receptors respond more strongly to a given stimulus?
Sensitization
What is Hyperalgesia?
Increased response to painful inputs
What is Allodynia?
Pain resulting from normally non-nocioceptive stimuli
What is pain resulting from normally non-nocioceptive stimuli?
Allodynia
What are some Endogenous Pain Control Mechanisms?
-Enkephalinergic Interneurons
-Noradrenergic Projections
-Canniboid Receptors
-Sertonergic Projections
-Endogenous Opiods
What is Referred Pain?
-Pain of Visceral or Parietal Origin perceived as Somatic Pain
-Somatic Region to which the pain is referred is always a dermatome innervated by the same dorsal roots that supply the irritated structure
What types of symptoms will one experience with Normal Pressure Hydrocephalus?
Delirium
How the heck is Normal Pressure Hydrocephalus normal?
Pressure is increased but normalizes