001 SHELF NEURO 2011 high yield

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ch1
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fast anterograde
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NTs, membranous organelles/vescicles/200-400mmday, neurotubule-DEPENDENT, mediated by kinesin
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fast retrograde
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NGF, neurotropic viruses, toxins, mediate by dynein
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5 most common brain tumors
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GEMMS: glioblastoma-multiforme, ependymoma, medullablastioma, meningioma, schwannoma (benign)
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most fatal tumor
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glioblastoma-multiforme
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Most common
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glioblastoma-multiforme
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Most common NON- metastasize
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Meningioma: noninvasive, tumor of falx and convexity of hemisphere
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Medulloblastoma
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2nd most common posterior fossa tumor in children; may metastasize through CSF tracts.
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brain tumors in adults (most –least common)
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glioblastoma-multiforme, astrocytoma, meningioma
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brain tumors in children (most–least common)
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astrocytoma, medullablastoma, ependymoma
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In ventricles; 60% of brain tumors in spinal cord
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ependymoma
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glial cells
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non neuronal in nervous system: macro + micro glial, schwann, ependymal, tanycytes
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macro glial
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astrocytes + oligodendrocytes/CNS
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micro glial
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phagocytes/CNS
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schwann
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PNS
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ependymal
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in ventricles, choroid plexus, make CSF
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tanycytes
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involved in transport of ventricles and neuropil, project to hypothalamic nu–regulate gonadotropic hormone
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blood brain barrier
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tight jxns; infarcts destroy jxns–>vasogenic edema
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blood csf barrier
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tight jxns; permeable to insulin and prealbumin
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pigments/inclusions
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neuronal/nuclear: hirano bodies lewy bodies, cowdry type A inclusion bodies; cytoplasmic: neurofibrillary tangles, melanin/neuromelanin, negri bodies, lipofuscin granules
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hirano
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intraneuronal, rodlike, hippocampus, alzheimer
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Neurofibrillary tangles
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intracytoplasmic, degenerated neurofilaments, Alzheimer
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lewy bodies
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neuronal, Parkinson + (Alzheimer?)
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melanin/neuromelanin
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intracytoplasmic, loss of melanin in Parkinson
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cowdry type A inclusion bodies
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intranuclear, herpes simplex encephalitis
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negri bodies
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intracytoplasmic, rabies, in pyramidal and purkinje cells
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lipofuscin granules
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cytoplasmic, aging, from lysozymes
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free nerve endings receptors
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pain, thermo, above dermis basement membrane
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merkel disks/uncapsulated
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light touch, above dermis basement membrane
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encapsulated
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Meissener corpuscles/touch & 2PT discrimination, Pacinian corpuscle/vibration, below dermis basement membrane
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schwannoma case
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unilateralsensorineural hearing loss -lesion in CN8 (cerebellopontine); CN8 more common> CN5 or CN7
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ch2
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brainstem and spinal cord, ALAR PLATE
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lateral, sensory
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brainstem and spinal cord, BASAL PLATE
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medial, motor (memory tip: “Buffy/Basal Motor”)
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ALPHA-FETOPROTEIN/AFP
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in amniotic fluid and maternal serum. High: spina bifida, anencephaly; low: down syndrome
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neurocrest orgin
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PNS, skeletal and connective tissue components of pharyngeal arches, pigment cells, odontoblasts, aorticopulmonary septum of heart, parafollicular cells, chromaffin cells, and other nervous system cells
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modalities from lateral(sensory) to medial(motor)
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SSA, GSA, SVA, GVA- (sulcus limitans)- GVE, SVE, GSE //before limitans: Special before General, S before V; opposite after limitans: General before Special, V before S
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hindbrain/3rd primary vesicle
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METencephalon before MYELencephalon
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five secondary vesicles
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become adult derivatives (walls – cavities)
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telencephalon
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cerebral hemisphere – lateral ventricles
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diencephalon
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thalamus – 3rd ventricle
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mesencephalon
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midbrain – cerebral aqueduct
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metencephalon
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pons & cerebellum – upper part of 4th ventricle
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myelencephalon
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medulla – lower part of 4th ventricle
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anterior neuropore
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closure form lamina terminalis; failure–anencephaly
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posterior neuropore
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failure–spina bifida (occulta, meningocele-only subarachnoid exposed, miningomyelocele-spinal cord exposed, rachischisis-complete fissure)
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myelination begins at 4th month gestation
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corticospinal tract myelination completes by 2nd year postnatal; cerebral association cortex contt into 3rd decade; oligodendrocytes NOT in retina
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conus medullaris ends
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L3 newborn, L1 adult
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optic nerve and chiasma is similar to thalamus how?
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derived from diencephalon; optic fibers occupy choroid fissure; failure–coloboma iridis
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anterior pituitary
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adenohypophysis; rathke’s pouch derived; associated with congenital cystic tumor: craniopharyngioma
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posterior pituitary
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neurohypophysis; neuroectoerm derived
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1:1K, results from elongation and herniation of cerebellar tonsils through foramen magnum, blocking cerebrospinal fluid flow
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arnold-chiari malform type 2
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1:25K, result from riboflavin inhibitors, posterior fossa trauma or viral infx; dilaton of 4th ventricle from failure of foramina Luschka and Magendie to open
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dandy-walker malform
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1:1K, due to stenosis of cerebral aqueduct, excess CSF in ventricles and subarachnoid space; from maternal infx (cytomegalovirus and toxoplasmosis)
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hydrocephalus
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mental retardation, microcephaly and congenital heart dz; holoprosencephaly most severe
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Fetal alcohol syndrome
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failure of midline cleavage of forebrain–telencephalon has singular cavity; in trisomy 13/patau; corpus callosum may absent
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holoprosencephaly
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from bilateral hemispheric infarction secondary to occlusion of carotid arteries. Hemispheres are replaced by hugely dilated ventricles
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hydraencephaly
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tufts of hair in lumbosacral, clubfoot, UMN signs (legs don’t seem to work right)
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spina bifida case
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ch3
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T1 MRI
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Bone is black in T1 and T2 mri; this help differentiate an mri from CT; in T1, the outside white is actually fats.
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T1-nerve cells/gray matter=gray (hypointense); white matter=white (hyperintense)
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T2
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“negative” opposite of T1; fibers are black, cells are gray /lighter; fluid is white
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optic chiasm is above or below pituitary?
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above pituitary
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ch4
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location of dural venous sinuses
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btw periosteal and meningeal layers of dura mater
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subarachnoid space terminates at..
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level of second sacral vertebra; contains CSF
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subdural space
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traversed by bridging veins in cranium
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laceration of superior cerbral/bridging veins that drains to superior sagital sinus (that traverse btw dura and arachnoid)
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subdural hematoma
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epidural space
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cranial: contains meningeal arteries and veins; spinal: contains fatty areolar tissue, lymphatics and venous plexuses–site of anesthetic injection “paravertebral/saddle nerve block
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laceration of middle meningeal artery from maxillary artery (btw periosteal and meningeal layers of dura matter)
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epidural hematoma
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inflammation of pia-arachnoid area of brain, spinal cord or both. Kernig (knee flex pain) sign, fever, headache, nuchal rigidity; cause cranial nerve palsies and hydrocephalus. CSF findings: PMN leukocytes, dec glucose, inc protein
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Bacterial meningitis
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asceptic meningitis; fever, headache, nuchal rigidity, Kernig sign; CSF findings: lymphocytes, normal glucose, inc protein
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viral meningitis
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interventricular foramina (of Monro)
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communication btw two lateral ventricles and 3rd ventricle
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cerebral aqueduct (of Sylvius)
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blockage of duct btw 3rd and 4th ventricle cause noncommunicating hydrocephalus (excess CSF in 3rd ventricles)
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3 outlets: two lateral formaina (of Luschka) and one median foramen (of Magendie)
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communication btw subarachnoid space and 4th ventricle
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communicating hydrocephalus
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result from blockage w/in subarachnoid space (e.g. adhesions after meningitis)
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normal-pressure hydrocephaus
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CSF not absorbed by arachnoid villi; may occur secondary to posttraumatic meningeal hemorrhage; progressive dementia, ataxic gait, urinary incontinence (wacky, wobbly, and wet)
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hydrocephalus ex vacuo
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loss of cells in caudate nu (e.g. Huntington’s)
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pseudotumor cerbri
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benign intracranial hypertension; results from inc resistance to CSF outflow at arachnoid villi; obese,women,papilledema w/o mass,elevated CSF pressure,deteriorating vision
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CSF
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formed by choroid plexus, absorption through arachnoid villi into superior sagittal sinus–into circulation; presence of RBC (trauma or ruptured berry aneurysm)
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transtentorial/uncal herniation
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protrusion of brain through tentorial incisure; result in oculomotor paresis and contra hemiplegia
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transforaminal/tonsilar herniation
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protrusion of brain stem and cerebellum through foramen magnum; obtundation and death
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subfalcine/cingulate herniation
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below falx cerebri (vertical falx) headache, compression of ant. cerebral artery may result in contra leg weakness.
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subdural hematoma case
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common after acute deceleration injury/fall or auto accident, rarely skull fracture. Fell 4 wks ago, history of progressive weakness on R side, hemiparesis, reflex asymmetry
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ch. 5
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anterior spinal artery/ASA
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supplies blood for (5): 1. spinal cord and lower brainstem; 2. 2/3 of spinal cord, 3. medulla–pyramid, 4. medial lemniscus, and 5. root fibers of CN XII
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Medial Medulla//Medial medullary syndrome
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Effects: 1. pyramidal tract, 2. medial lemniscus, 3. hypoglossal nucleus. Produced by block of 1. PARAMEDIAN br. of VERTEBRAL and/or 2. anterior spinal arteries. Yields: 1. contralateral paresis , 2. deviation of the tongue to side of lesion, and, 3. usually loss of fine touch and vibratory sense on the contralateral side.
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internal carotid system—3 branches before splitting into MCA and ACA
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1. Ophthalmic artery, 2. Posterior communicating artery, 3. Anterior choroidal artery
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ophthalmic artery
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enters orbit with CN II, central artery of retina is a branch, occlusion=blindness
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posterior communicating artery
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Supplies: 1. hypothalamus and 2. ventral thalamus; aneurysm here is 2nd most common aneurysm of circle of willis; CNIII palsy
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anterior choroidal artery
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from internal carotid artery; perfuses: 1. lateral geniculate body, 2. globus pallidus, and 3. poterior limb of internal capsule
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anterior cerebral artery/ACA
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supplies medial surface of hemisphere from frontal pole to parietoocipial sulcus; irrigates paracentral lobule (has leg-foot area of motor and sensory cortices)
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anterior communicating artery
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MOST common site of aneurysm of circle of willis; cause bitemporal lower quadrantanopia
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medial striate arteries
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penetrating arteries of ACA; supply: 1. anterior portion of putamen and 2. caudate nu and 3. anteroinferior part of internal capsule
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middle cerebral artery
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Supplies: 1. lateral convexity of hemisphere (Broca’s, Wernicke’s) 2. face and arm areas of motor and sensory cortices, 3. frontal eye field
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lateral striate arteries
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penetrating branches of MCA; arteries of stroke, supply: 1. internal capsule, 2. caudate nu, 3. putamen, 4. globus pallidus.
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vertebral artery
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br. of subclavian, gives rise to: 1. anterior spinal artery, 2. posterior inferior cerebellar artery (PICA-supplies dorsolateral quadrant of medulla; this quadrant includes nu ambiguus /CN IX, X, XI, and inferior surface of cerebellum.)
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Lateral Medulla//Wallenberg’s syndrome
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Effects: 1. inf. cerebellar peduncle, 2. vestibular nu,3. trigeminal nu., 4. anterolateral system, 5. nu. ambiguus, 6. nu. solitarius, 7. descending sympathetic fibers. Produced by block of PICA (or vertebral a.) Yields: 1. ataxia, 2. nystasmus, 3. weakness of limbs , 4. pain/temperature loss, 5. Horner’s syndrome, 6. decreased taste hoarseness, 7. dysphagia on same side as lesion, 8. loss of pain/temperature on CONTRA body.
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basilar artery
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formed by two vertebral arteries; gives rise to: 1. PARAMEDIAN br. of pontine arteries, 2. labyrinthine artery, 3. anterior inferior cerebellar artery (AICA), 4. superior cerebellar artery, 5. posterior cerebral artery (PCA)
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Medial Pontine Basis-Tegmentum//Foville’s syndrome
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Effects: 1. corticospinal, 2. corticobulbar trs, 3. facial colliculus, 4. abducens nu, 5. medial lemniscus. Produced by block of PARAMEDIAN br. of BASILAR artery, ventral and dorsal territories. Yields paresis of the contra. body, and inability to abduct the ipsi. eye; may yield ‘wrong-way eyes’, i.e., inability to direct gaze to the side of the lesion. Due to damage to: both the 1. abducens nu. and 2. internuclear neurons projecting thru MLF to opposite III nucleus. ARAS damage also likely.
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PARAMEDIAN br. of pontine arteries//from basilar
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supply base of pons (CORTICOSPINAL fibers and exiting root fibers of ABDUCENS)
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AICA/anterior inferior cerebellar artery
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Supplies: 1. caudal lateral pontine tegmentum (CN VII), 2. spinal trigeminal tract of CN V and 3. inferior surface of cerebellum
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Lateral Caudal Pons//AICA syndrome
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Effects: 1. middle cerebellar peduncle, 2. vestibular nu, trigeminal nu., 3. anterolateral system, 4. descending sympathetic fibers. Produced by block of AICA. yields ataxia, vertigo, nystagmus, pain-temperature loss on ipsilateral face, loss of pain-temperature sense to contralateral body, Horner’s syndrome, possibly ipsilateral hearing loss.
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labyrinthine artery
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in 15% of people from basilar, 85% from anterior inferior cerebellar artery (AICA)
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superior cerebellar artery
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1. dorsolateral tegmentum of rostral pons (i.e. rostral to motor nuc of CN V), 2. superior cerebellar peduncle, 3. superior surface of cerebellum and cerebellar nu, and 4. cochlear nu
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posterior cerebral artery/PCA
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Supplies: 1. midbrain, also 2. thalamus, 3. lateral and medial geniculate bodies and 4. occipital lobe (incl. visual cortex and inferior surface of temporal lobe, incl hippocampal formation); blockage results in contra hemianopia with macular sparing
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vision problems and horrible headache (acute), clumsiness and can’t read half the printed page of newspaper, history of hypertension and diabetes mellitus; complete hemianopia, contra face and limb sensory loss, CT presence of ischemic infarction w/ hemorrhagic change.
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posterior cerebral artery/PCA infarct case
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Midbrain Basis//Weber’s syndrome
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effects oculomotor nerve or fascicles produced by block of branches of PCA and/or top of the basilar artery. 3rd nerve palsy, pupil dilation (defect of Edinger Westphal//GVE PARASYMP pregang to ciliary ganglion ), poss. Hemiparesis
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Midbrain Basis+Tegmentum//Benedikt’s syndrome
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Effects: 1. oculomotor nerve, 2. red nucleus, and 3. sup cerebellar penduncle, 4. subs nigra. Produced by block of branches of PCA and top of the basilar artery. Yielding an ipsilateral CNIII palsy, contralateral ataxia and intention tremor, contralateral paresis of body, ‘central 7’ for contralateral face (corticobulbars).
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two sources of internal capsule blood supply
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anterior choroidal of internal carotid + lateral striate arteries of MCA
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2 veins of brain
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superior cerebral “bridging” veins (drains to superior sagital sinus) and great cerebral vein of Galen (drains deep cerebral veins into straight sinus)
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ch6
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gray rami communicans
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unmyelinated postgang symp fibers; all levels of spinal cord
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white rami communicans
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myelinated SYMP pregang fibers; T1-L3 (extent of lateral horn and IMLCC)
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ciliospinal center of Budge
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C8-T2, mediates symp innervation of eye
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intermediolateral nu cell column of lateral horn
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c8-L3, mediates entire SYMP of body
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nu dorsalis of Clark
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c8-L3, gives rise to dorsal spinocerebellar tract
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sacral parasymp nuc
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s2-4
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nu of accessory nerve
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c1-6
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phrenic nu
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c3-6
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cauda equina
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motor and sensory root in subarachnoid space below conus medullaris; exit vertebral canal through lumbar intervertebral and sacral foramina
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myotatic reflex
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monosynaptic ipsi muscle stretch reflex/MSR; interuption:areflexia; afferent is Ia fiber.
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lower back pain radiated down to foot x 2mo; absent R. ankle jerk, weakness of dorsiflex and plantar flex, dec pinprick over dorsum of foot; compression of first sacral nerve foot on L at level of L5-S1 vertebrae
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lumbar intervertebral disc herniation case
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ch7
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ANS
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autonomic output control
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by hypothalamus
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absence of ganglion cells in myenteric plexus, neural crest cells did not migrate into colon; dilation and hypertophy of colon with fecal retention
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megacolon/hirschsprung’s disease/congenital aganglionic megacolon
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jewish, auto-recessive, abnormal sweating, unstable bp, orthostatic hypotension, difficulty in feeding, progressive sensory loss, loss of neurons in autonomic and sensory ganglia
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familial dysautonomia/riley day syndrome
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painful, disorder of terminal arteries of extremities; idiopathic paroxysmal bilateral cyanosis of digits, Tx: preganglionic sympathectomy
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raynaud’s dz
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excessive parasymp tone
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peptic ulcer dz
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horner’s syndrome
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oculosympathetic paralysis
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shy-drager syndrome
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SYMP pregang neurons from IMLCC problem; orthostatic hypotension, anhidrosis, impotence, and bladder atonicity
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ACh release problems
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botulism, myasthenic syndrome
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ch8
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tracts of spinal cord
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ascending tracts
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1. posterior/dorsal column (gracile, cuneate)—2pt discrimination, vibration, 2. dorsal spinocerebellar tract, 3. ventral spinocerebellar tract, 4. anterlateral system//lateral spinothalamic tract//pain temp–sensory 5. ventral spinothalamic tract—crude touch, 6. Trigeminothalamic//CN V, VII, IX, X (ventral—FACE pain/temp & dorsal—FACE tactile discrimination and pressure)
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descending tracts
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1. lateral corticospinal tract, 2. hypothalamospinal tract, 3. rubrospinal tract, 4. reticulospinal 5. vestibulospinal tract, 6. ventral corticospinal tract
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The spinothalamic tract (LATERAL & VENTRAL)// ascending tracts
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is a sensory pathway originating in the spinal cord. It transmits information to the thalamus about pain, temperature, itch and crude touch. The pathway decussates at the level of the spinal cord, rather than in the brainstem like the posterior column-medial lemniscus pathway and corticospinal tract. The cell bodies of neurons that make up the spinothalamic tract are located in the spinal ganglia. These neurons receive input from sensory fibers that innervate the skin and internal organs.
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TRIGEMINOTHALAMIC TRACT (Anterior/ventral & dorsal )// ascending tracts
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pain, temperature, and crude touch pathway from the face, head and neck. It receives input from trigeminal nerve, facial nerve, glossopharyngeal nerve and vagus nerve (these are primary sensory neurons—1st order neurons).
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TRIGEMINOTHALAMIC TRACT//1st order neurons
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Input from trigeminal nerve, facial nerve, glossopharyngeal nerve and vagus nerve (these are primary sensory neurons—1st order neurons). After entering the pons the central projections of the first order neurons descend to the medulla, forming the spinal trigeminal tract and synapse in the spinal trigeminal complex.
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TRIGEMINOTHALAMIC TRACT//2nd order neurons
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Axons of the second order neurons cross the midline and terminate in the ventral posterior medial thalamus//VPM (as opposed to the ventral posterior lateral thalamus as in the dorsal column/medial leminscus and spinothalamic tract pathway) to mediate conscious sensation of pain and temperature from the face, head and neck.
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TRIGEMINOTHALAMIC TRACT//3rd order neurons
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The third order neuron in the thalamus then connects to the sensory cortex of the postcentral gyrus. The affective/motivational information is mediated by connections to reticular formation, midbrain, and the midline nuclei of the thalamus. The midline nuclei third order neurons then synapse to the cingulate and insular cortex.
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posterior/dorsal column–medial lemniscus pathway// ascending tracts
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tactile discrimination, vibration sensation, form recognition, jt and muscle sensation/conscious proprioception
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posterior/dorsal column–medial lemniscus pathway RECEPTORS
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pacinian and meissner’s tactile corpuscles, joint receptors, muscle spindles, golgi tendon organs
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posterior/dorsal column–medial lemniscus pathway 1ST NEURON
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in spinal/dorsal root ganglia all levels, project axon to MEDIAL root of entry zone of spinal cord; gives rise to gracile fasciculus/lower extremities, cuneate/upper, collaterals for spinal reflexes/myotatic, axons ascend in dorsal columns and terminate in gracile and cuneate nu of caudal MEDULLA
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posterior/dorsal column–medial lemniscus pathway 2ND NEURON
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in gracile and cuneate nu of caudal medulla; gives rise to axons and internal arcuate fibers that decussate and form bundle/medial lemniscus; medial lemniscus ascends through contra brain stem and terminates in VPL nu of thalamus.
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posterior/dorsal column–medial lemniscus pathway 3RD NEURON
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in VPL nu of thalamus, project through posterior limb of internal capsule to postcentral gyrus (primary somatosensory cortex/brodmann’s 3,1,2)
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posterior/dorsal column–medial lemniscus pathway TRANSECTION
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above sensory decussation: contra loss of posterior/dorsal column modalities; in the spinal cord: ipsi loss of post/dorsal column modalities
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lateral spinothalamic tract/Anterolateral system // ascending tracts
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pain and temp sensation
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lateral spinothalamic tract/Anterolateral system – RECEPTORS
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free nerve endings, receives from fast and slow conducting pain fibers A-d and C, respectively
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lateral spinothalamic tract/Anterolateral system- 1ST NEURON
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in spinal/dorsal root ganglia all levels, project axons to spinal cord through dorsolateral tract of Lissauer/LATERAL root entry zone to 2nd neuron
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lateral spinothalamic tract/Anterolateral system – 2ND NEURON
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in dorsal horn; give rise to axons that decussate in ventral white commissure and ascend contra lateral funiculus, axons terminate in VPL nu of thalamus
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lateral spinothalamic tract/Anterolateral system – 3RD NEURON
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in VPL nu of thalamus, project through posterior limb of internal capsule to postcentral gyrus (primary somatosensory cortex/brodmann’s 3,1,2)
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lateral spinothalamic tract/Anterolateral system – TRANSECTION
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contra loss of pain and temp BELOW lesion
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lateral corticospinal tract //descending tract
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voluntary skilled motor activity, primarily upper limbs, not fully myelinated until end of second year //babinski’s sign till then
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lateral corticospinal tract course
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arises from layer V of cerebral cortex from 3 cortical areas in equal aliquots:Brodman 6, 4, 3-1-2; 85% decussate at medulla pyramids; terminates contra (through interneurons) on ventral horn motor neurons
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lateral corticospinal tract transection
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above decussation: contra spastic paresis and babinski’s sign; in spinal cord: ipsilataral spastic paresis and babinski sign
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hypothalamospinal tract (Oculosympathetic pathway)//descending
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from hypothalamus to ipsi ciliospinal center of IMLCC at T1-2–>pregang symp here to superior cervical ganglion–>postgang symp here projects through tympanic cavity, cavernous sinus, superior orbital fissure to dilator muscle of iris; interruption: horner’s syndrome/ipsi
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pain on left side of chest and PROGRESSIVE weakness of left lower limb x2mo; weakness in left lower limb, spasticity and (progressive) hyperreflexia at knee and ankle, L side loss of 2pt discrimination, vibratory sense and proprioception below hip, loss of pain and temp sensation below T7 dermatome on right side; UMN lesion at T5-6, incomplete spinal cord lesion, hemisection of spinal cord, ipsi hemiplegia with contra pain and temperature deficits due to decussating fibers of spinothalamic tract
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spinal cord hemisection/brown sequard syndrome
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ch9
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lesions of spinal cord
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by transection of corticospinal tract or destruction of cortical cells of origin: spastic paresis, pyramidal signs/Babinski
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UMN lesions
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by damage to motor neurons: flaccid paralysis, areflexia, atrophy, fasciculations, fibrillations . Poliomyelitis or Werdnig-Hoffmann disease
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LMN lesions
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amyotrophic lateral sclerosis/ALS, Lou Gehrig; damage to corticospinal tracts, pyramidal signs, damage to LMNs with LMN symptoms, NO sensory deficits.
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combined UMN and LMN
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example: dorsal column disease/tabes dorsalis, has neurosyphilis, loss of tactile discrimination and position and vibration sensation, irritative involvement of dorsal root–>pain and paresthesias, Romberg sign/dorsal column ataxia
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SENSORY pathway lesions
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combined SENSORY and MOTOR:
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damage to: 1. dorsal columns (fasciculi gracile/leg and cuneate/arm)–ipsi loss of tactile discrimination and position and vibration sensation; 2. lateral corticospinal tract: ipsi spastic paresis, pyramidal signs below lesion; 3. lateral spinothalamic tract: contra loss of pain and temperature one segment below lesion; 4. hypothalamospinal tract at T1 and above: ipsi Horner’s syndrome (miosis, ptosis, hemianhidrosis, enophthalmos); 5. ventral/anterior horn: ipsi flaccid paralysis of innervated muscles.
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spinal cord hemisection/brown sequard syndrome
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COMPLETE SPINAL CORD SECTION
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Similar to hemisection (?) + will have bladder control problem (parasymp: CN 3,7,9, 10 and S2,3,4)
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ventral spinal artery occlusion
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causes infarction of anterior 2/3 spinal cord spares dorsal columns and horns; results in damage to: 1. lateral cortiocspinal tracts–bilateral spastic paresis with pyramidal signs below lesion, 2. lateral spinothalamic tracts–bilateral loss of pain and temperature sensation below lesion, 3. hypothalamospinal tract at T2 and above–bilateral Horner’s syndrome, 4. ventral/anterior horns (LMNs): bilateral flaccid paralysis of innervated muscles, 5. corticospinal tracts to sacral parasymp centers at S2-4–bilateral damage and loss of voluntary bladder and bowel control
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caused by pernicious/megaloblastic anemia, damage to: 1. dorsal columns/gracile and cuneate–bilateral loss of tactile discrimination and position and vibration sensation, 2. lateral corticospinal tracts–bilateral spastic paresis with pyramidal signs, 3. spinocerebellar tracts–bilateral arm and leg dystaxia
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subacute combined degeneration/B12—COBALAMIN neuropathy
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central cavitation of cervical cord, damage to: 1. ventral white commissure–damage decussating lateral spinothalamic axons–bilateral loss of pain and temp. 2. ventral horns–LMN lesions–flaccid paralysis of intrinsic muscles of hands
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syringomyelia
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same spinal cord pathology and symptoms as subacute combined degeneration
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friedreich’s ataxia
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plaques involve white matter of cervical segments of spinal cord; random and asymmetric
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multiple sclerosis
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PNS lesions
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Guillian Barre syndrome/acute idiopathic polyneuritis/post infectious polyneuritis; affects motor fibers of ventral roots and peripheral nerves, LMN symptoms
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Guillain-Barre syndrome
answer

demyelination and edema, upper cervical root/C4 and respiratory paralysis, caudal cranial nerve with facial diplegia 50% cases, elevated protein causes papilledema, sensory fibers affected–paresthesias, protein in CSF elevated but without pleocytosis/albuminocytologic dissociation.
question

intervertebral disk herniation
answer

L4 or 5 to S1 interspace 90% cases; C5-6 or C6-7 10% cases//prolapse of nucleus pulposus through defective anulus fibrosus and into vertebral canal; nucleus pulposus impinges on spinal roots–spinal root symptoms (paresthesias pain, sensory loss, hyporeflexia and muscle weakness)
question

cauda equina syndrome/spinal roots L3 to C0
answer

nerve root tumor/ependymoma or dermoid tumor or lipoma of terminal cord// severe radicular unilateral pain, sensory distribution in unilateral saddle-shaped area, unilateral muscle atrophy and absent quadriceps (L3) and ankle jerks (S1), unremarkable incontinence and sexual fxns, gradual and unilateral onset.
question

conus medullaris syndrome/S3 to C0
answer

intramedullary tumor/ependymoma; pain, bilateral, sensory distribution in bilateral saddle-shaped area, unremarkable muscle changes, normal quadriceps and ankle reflexes, severely impaired incontinence and sexual fxns. Sudden and bilateral onset.
question

ch10
answer

brain stem
question

medulla medial structures
answer

1. hypoglossal nu of CN XII, 2. medial lemniscus (crossed fibers from gracile and cuneate nu), 3. pyramid (corticospinal fibers)
question

medulla lateral structures
answer

1. nu ambiguus (CN IX, X, XI), 2. vestibular nu (CN VIII), 3. inferior cerebellar peduncle (dorsal spinocerebellar, cuneocerebellar and olivocerebellar tracts), 4. lateral spinothalamic tract (spinal lemniscus), 5. spinal nu and tract of trigeminal nerve
question

pons
answer

has dorsal tegmentum and ventral base
question

rostral midbrain
answer

dorsal tectum, intermediate tegmentum, base; aqueduct lies btw tectum and tegmentum
question

corticonuclear/corticobulbar fibers
answer

project bilaterally to all motor cranial nerve nuclei except facial nucleus. Upper face: bilateral corticonuclear input, lower face only contra corticonuclear input.
question

ch 11
answer

cranial nerves
question

olfactory/CN I
answer

SVA, unmyelinated axons of biopolar neurons, enters cavity through cribiform plate of ethmoid bone; 1st-olfactory receptor cells, 2nd-mitral cells of olfactory bulb/principal cells, excitatory,Glutaminergic, project through olfactory tract and lateral olfactory stria to primary olfactory cortex/Brodmann 34 and amygdale
question

olfactory pathway lesions
answer

from olfactory groove meningiomas–ipsi anosmia; lesions of parahippocampal uncus–olfactory hallucinations
question

: ipsi ANOSMIA, ipsi optic atrophy, contra papilledema; anterior fossa meningioma
answer

foster kennedy syndrome
question

optic nerve/CN II
answer

SSA, tract of diencephalon, nonregenerable
question

oculomotor nerve/CN III
answer

GSE: moves eyes; GVE : constricts pupil, accommodates, converges; exits brain stem from interpeduncular fossa of midbrain, passes cavernous sinus, enters orbit through superior orbital fissure
question

muscles innv. by CN III
answer

GSE: medial, superior, inferior rectus, inferior oblique and levator palpebrae (upper eyelid); GVE: pregang parasymp–edinger westphal nu to ciliary ganglion of orbit, ciliary ganglion postgang para to sphincter pupillae/miosis and ciliary muscle/accommodation
question

oculomotor paralysis/palsy
answer

from transtentorial herniation (tumor, subdural or epidural hematoma); denervation of levator palpebrae–ptosis; denervation of extraocular muscles–diplopia when look in direction of paretic muscle, eye down and out (unopposed action of lateral rectus/CN6 and superior oblique/CN 4); interruption of pre parasymp innv./internal ophthalmoplegia–dilated, fixed pupil and paralysis of accommodation/cycloplegia;
question

other CN III impairment
answer

Example 1. transtentorial/uncal herniation— inc supratentorial pressure compression/stretching oculomotor nerve (1. sphincter pupillae fibers affected–dilated, fixed pupil; 2. somatic efferent fibers affected–external strabismus/exotropia); Example 2. aneurysms of carotid and posterior communicating arteries compress CN III within cavernous sinus or interpeduncular cistern—affect peripheral pupilloconstrictor fibers (uncal herniation); Example 3. diabetes mellitus/diabetic oculomotor palsy–oculomotor nerve, damages central fibers and spares sphincter pupillae fibers
question

CN IV/Trochlear
answer

GSE, pure motor, superior oblique–depresses, intorts, abducts eye; arises from contra trochlear nu of caudal midbrain, decussates beneath superior medullary velum of midbrain and exits brain stem DORSAL surface-caudal to inferior colliculus, encircles midbrain enters orbit through superior orbital fissure
question

CN IV paralysis
answer

extorsion of eye and weakness of downward gaze, vertical diplopia when looking down, head tilting to compensate for extorsion
question

CN V/trigeminal
answer

SVE: from motor nuc of trigeminal nerve in lateral midpontine tegmentum, innv. muscles of mastication; GSA: provides sensory innv to face, mucous membranes of nasal and oral cavities and frontal sinus, hard plate, deep structures of head, innv. dura of ant. and middle cranial fossae/supratentorial dura
question

lesions of CN V
answer

loss of general sensation/hemianesthesia from face and mucous membranes of oral and nasal cavities; loss of corneal reflex/afferent limb, CN V-1; flaccid paralysis of muslces of mastication; deviation of jaw to weak side (unopposed opposite lateral pterygoid muscle); paralysis of tensor tympani–hypoacusis/partial deafness to low-pitched sounds; trigeminal neuralgia/tic douloureux–recurrent paroxysms of sharp stabbing pain in branch(es) of the nerve.
question

CN VI/abducens
answer

GSE: lateral rectus-abducts eyes; nu in dorsomedial tegmentum of caudal pons; exiting intraaxial fibers pass through coriticospinal tract; lesion–alternating abducent hemiparesis
question

CN VI paralysis
answer

most common results from long periopheral course of nerve, meingitis, subarachnoid hemorrhage, late-stage syphilis, trauma; convergent medial strabismus esotropia-inability to abduct; horizontal diplopia with max separation of double images when look toward paretic lateral rectus
question

CN VII/facial
answer

pharyngeal arch 2; GSA, GVA, SVA, GVE, SVE: SVE –muscles of facial expression, SVA–taste, GVE: salivation, lacrimation, (GSA or GVA?): general sensation from external ear
question

CN VII SVA component/taste
answer

cell in geniculate ganglion, projects to solitary tract and nu–>VPM of thalamus–>gustatory cortex of parietal lobe/parietal operculum; innv taste buds from ant. 2/3 tongue through (intermediate nerve, chorda tympani, lingual nerve (CN V-3), central gustatory pathway.
question

CN VII GVE parasymp
answer

lacrimal, submandibular, sublingual glands; pregang parasymp in superior salivatory nu of caudal pons; lacrimal pathway: superior salivatory nu projects through intermediate and greater petrosal n. to pterygopalatine ganglion–>lacrimal gland of orbit; submandibular pathway: superor salivatory nu projects through intermediate n and chorda tympani to submandibular ganglion–>submandibular and sublingual glands
question

CN VII SVE
answer

facial nu, loops around abducent nu of caudal pons, exits brain stem in cerebellopontine angle, enters internal auditory meatus, traverses facial canal, br. To stapedius m of middle ear, exits skull through stylomastoid formaen, innv. muscles of facial expression and stylohyoid m., posterior belly of digastric m and stapedius m.
question

CN VII lesions
answer

1. flaccid paralysis of muslces of facial expression/upper + lower face, 2. loss of corneal reflex/efferent orbicularis m –corneal ulceration, 3. loss of taste, 4. hyperacusis/increased acuity to sounds due to stapedius paralysis, 5. Bell’s palsy/peripheral facial paralysis-by trauma or infx/upper and lower face, 6. crocodile tears syndrome/lacrimation during eating–aberant regeneration of SVE fibers, 7. supranuclear/central facial palsy-contra weakness of lower face, sparing of upper, 8. bilateral facial nerve palsies-Guillain-Barre syndrome, 9. Mobius’ syndrome-congenital facial diplegia/CN VII and convergent strabismus/CN VI
question

CN VIII/vestibulocochlear
answer

SSA; vetibular n.-maintains equilibrium and balance, cochlear n-mediates hearing; exits brain stem at cerebellopontine angle and enters internal auditory meatus; confined to temporal bone
question

vestibular n.
answer

assoc. w/ cerebellum/flocculonodular lobe and ocular motor nu; regulates compensatory eye movt.; 1st order sensory bipolar neurons in vestibular ganglion in fundus of internal auditory meatus; projects peripheral processses to hair cells of cristae of semicircular ducts and hair cells of utricle and saccule, projects central processes to 4 vestibular nu of brain stem and flocculonodular lobe of cerebellum, conducts efferent fibers to hair cells from brain stem; lesion–disequilibrium, vertigo, nystagmus.
question

cochlear n.
answer

1st order sensory bipolar neurons in spiral/cochlear ganglion of modiolus of cochlear, w/in temporal bone, projects peripheral processes to hair cells of organ of Corti, projects central processes to dorsal and ventral cochlear nu of brain stem conducts efferent fibers to hair cells from brain stem; lesions: hearing loss/sensorineural deafness, tinnitus; acoustic neuroma/schwannoma of cochlear n. causes deafness
question

CN IX/glossopharyngeal
answer

GSA, GVA, SVA, SVE (stylopharyngues ), GVE (parasymp, parotid gland); sensory, with CN X, XI, XII mediates taste, salivation, and swallowing; mediates input from carotid sinus–has baroreceptors for arterial blood pressure, mediates input from carotid body–has chemoreceptors for CO2 and O2 of blood; pharyngeal arch 3
question

CN IX lesion
answer

loss of gag/pharyngeal reflex/interruption of afferent limb, hypersensitive carotid sinus reflex/syncope, loss of general sensation in pharyns, tonsils, fauces, back of tongue, loss of taste from posteror 1/3 tongue, glossopharyngeal neuralgia–severe stabbing pain in root of tongue
question

CN X/vagal
answer

pharyngeal arch 4 and 6; GSA, GVA, SVA, SVE, GVE; mediates phonation, swallowing, elevation of palate, taste, and cutaneous sensation from ear; innv. viscera of neck, thorax and abdomen;
question

CN X lesions
answer

1. ipsi paralysis of soft palate, pharynx, larynx-leads to dysphonia/hoarseness, dyspnea, dysarthria, dysphagia; 2. loss of gag/palatal reflex (efferent); 3. anesthesia of pharynx and larynx leads to unilateral loss of cough reflex; 4. aortic aneurysms or tumors of neck + thorax compress vagal nerve lead to cough, dyspnea, dysphagia, hoarseness, chest/back pain; 5. complete laryngeal paralysis-fatal if it is bilateral/asphyxia; 6. parasympathetic “vegetative” disturbances: bradycardia (irritative lesion), tachycardia (destructive lesion), dilation of stomach; 7. oculocardiac reflex-pressure on eye slows heart rate/afferent of CN V-1 and efferent of CN X; 8. carotid sinus reflex-pressure on carotid sinus slows heart rate/bradycardia (efferent of CN X)
question

CN XI/accessory/spinal accessory
answer

SVE; mediates head and shoulder movt and innv. laryngeal m.; has cranial and spinal division
question

CN XI cranial division/accessory portion
answer

from nu ambiguus of medulla, exits medullar from postolivary sulcus and joins vagal n; innv. intrinsic m. of larynx through inferior/recurrent laryngeal n. except cricothyroiid m.
question

CN XI spinal division/spinal portion
answer

from ventral horn of cervical segments C1-6; roots exit spinal cord laterally btw ventral and dorsal spinal roots; innv. sternocleidomastoid m. and trapexius m.
question

CN XI lesions
answer

paralysis of sternocleidomastoid m-difficulty in turning head to contra side; paralysis of trapezius m-shoulder droop and inability to shrug shoulder; paralysis and anesthesia of larynx if cranial root is involved
question

CN XII/hypoglossal
answer

GSE; tongue movt; arises from hypoglossal nu of medulla, exits medulla in preolivary sulcus; innv. intrinsic and extrinsic m. of tongue; extrinsic m. are genioglossus, styloglossus, and hyoglossus.
question

CN XII lesion
answer

transection–hemiparalysis of tongue; protrusion causes tongue to point toward lesioned/weak side (unopposed opposite genioglossus m);
question

ch 12
answer

trigeminal system
question

trigeminal system
answer

sensory innv to face oral cavity and supratentorial dura through general somatic afferent GSA, also innv muslces of mastication through special visceral efferent SVE (CN V-3)
question

trigeminothalamic pathways
answer

1. ventral trigeminothalamic tract: pain temp from face and oral cavity (1st neuron/trigeminal ganglion–>spinal tract of trigeminal nerve and synapse on neuron in spinal nu of trigeminal nerve–>decussating axons that terminate in contra VPM nu–>through posterior limb of internal capsule to face area of somatosensory cortex/Brodmann 3,1,2) 2. dorsal trigeminothalamic tract: tactile discrimination and pressure sensation from face and oral cavity, receives from Meissner’s and Pacinian (1st neuron in trigeminal ganglion synapse in principal sensory nu–>neuron here projects to VPM–>VPM projects through posterior limb internal capsule to face area somatosensory Broadmann 3,1,2)
question

trigeminal reflexes
answer

1. corneal/consensual disynaptic reflex; 2. jaw jerk reflex monosynaptic myotatic reflex//hyperreflexia indicates UMN lesion; 3. tearing/lacrimal reflex–result of corneal or conjunctival irritation; 4. oculocardiac reflex–pressure on globe results in bradycaria
question

trigeminal lesions
answer

Trigeminal neuralgia/tic douloureux; Tx–carbamazepine
question

cavernous sinus
answer

has internal carotid artery, CN III, IV, V-1,2, VI, postgang symp fibers to orbit
question

Ch13
answer

auditory system
question

auditory system/exteroceptive special somatic afferent system
answer

detect 20-20KHz ; derived from otic vesicle (from otic placode – a thickening of surface ectoderm)
question

bipolar cells of spiral/cochlear ganglion
answer

project to hair cells of organ of Corti; nerve to nuclei
question

cochlear nuclei
answer

(at jxn of medulla and pons), receive input from cochlear nerve; project contra to superior olivary nu and lateral lemniscus
question

superior olivary nu
answer

sound localization, receives bilateral input from cochlear nuclei; projects to lateral lemniscus
question

trapezoid body
answer

in pons; contains decussating fibers from ventral cochlear nu
question

lateral lemniscus
answer

receives from contra cochlear nu and superior olivary nu
question

nu of inferior colliculus
answer

receives from lateral lemniscus; projects through brachium of inferior colliculus to medial geniculate
question

medial geniculate body
answer

receives from nu of inferior colliculus; projects through internal capsule as auditory radiation to primary auditory cortex, transverse temporal gyri of Heschl of superior temporal gyrus (cortex)
question

transverse temporal gyri of Heschl
answer

contain primary auditory cortex/Brodmann’s 41, 42; gyri in depths of lateral sulcus
question

Weber’s test
answer

fork at vertex of skull; normal: hears equally on both sides; unilateral conduction deafness hears vibration more loudly in affected ear; unilateral partial nerve deafness hears vibration more loudly in normal ear.
question

Rinne test
answer

compares air and bone conduction; fork on mastoid process until vibration is no longer heard; then fork in front of ear. Normal–hears vibration in air after bone conduction is gone; positive Rinne test: sound conduction is normal, i.e. AC > BC
question

brain stem auditory evoked potentials/BAEPS
answer

clicks present to each ear; scalp electrodes and computer generate a series of 7 waves associated with specific areas of auditory pathway
question

ch 14
answer

vestibular system
question

vestibular system
answer

derived from otic vesicle (from otic placode), maintains posture and equilibrium and coordinates head and eye movt.
question

kinetic labyrinth/3 semicircular ducts
answer

respond to angular acceleration and deceleration of head, hair cells respond to endolymph flow
question

static labyrinth/utricle + saccule
answer

respond to position of head with respect to linear acceleration, pull of gravity
question

vestibular ganglion
answer

in fundus of internal auditory meatus; bipolar neurons in this ganglion project to hair cell, project their central processes as vestibular nerve/CN VIII to vestibular nu and flocculonodulare lobe of cerebellum
question

vestibular reflexes
answer

vestibular/horizontal nystagmus, postrotatory/horizontal nystagmus, caloric nystagmus/stimulationof horizontal ducts
question

vestibular horizontal nystagmus
answer

fast phase in direction of rotation; slow phase in opposite direction//FSSO (fast same direction; slow opposite direction)
question

postrotatory
answer

opposite that of vestibular horizontal nystagms: fast phase in opposite direction of rotation; slow phase in direction of rotation; patient past-points and falls in direction of previous rotation
question

caloric nystagmus
answer

normal: COWS; eyes deviate to the opposite side of cold water injection
question

caloric nystagmus in UNCONSCIOUS PATIENTS
answer

brainstem intact: deviation of eyes to side of COLD irrigation; bilateral MLF transaction: deviation of abducting eye to side of cold irrigation; lower brain stem damage to vestibular nu: no deviation of eyes
question

ch 15
answer

visual system
question

ganglion cells of retina
answer

axons of these cells form optic nerve/CN II, contra nasal hemiretina and ipsi temporal hemiretina project to one lateral geniculate body.
question

optic nerve
answer

projects through optic canal and cross at optic chiasm; transection BEFORE optic chiasm causes ipsi blindness, loss direct pupillary light reflex (consensual reflex intact b/c efferent constriction is by CNIII pre gangciliary post ganglion); transection of ipsi temporal +nasal hemiretina tract + contra nasal (inferior portion) hemiretina –> ipsi blindness and contra upper temporal quadrant visual field defect/junction scotoma //can’t see left visual field and right upper temporal quadrant
question

optic chiasm
answer

central of chiasm: decussating fibers from two nasal hemiretinas, lateral of chiasm: noncrossing fibers from two temporal hemiretinas; projects fibers to suprachiasmatic nu of hypothalamus; midsagittal transection/pressure (from pituitary tumor)–>bitemporal visual fields hemianopia ; bilateral lateral compression –>binasal visual fields hemianopia
question

optic tract
answer

fibers from ipsi temporal + contra nasal hemiretina–>projects to: ipsi lateral geniculate body (allow you to see L or R visual field), pretectal nu, superior colliculus; transection causes contra hemianopia (cut left tract can’t see right temporal + left nasal visual field=can’t see things from the right hemifield/right field)
question

lateral geniculate body
answer

receives input from: 1. layer VI of striate cortex/Brodmann 17, 2. ipsi temporal hemiretina and contra nasal hemiretina ((body is 6 Layered nu; 1,4,6 receive contra/crossed; 2,3,5 receive ipsi/noncrossed)); projects through geniculocalcarine tract to layer IV of primary visual cortex/Brodmann 17
question

geniculocalcarine tract/visual radiation
answer

projects through two divisions to visual cortex: upper & lower division/Meyer’s loop
question

upper division of visual radiation
answer

projects to upper bank of calcarine sulcus/CUNEUS; input from superior retinal quadrants/inferior visual field quadrants; transection–contra lower quadrantanopia; lesions of both cunei–lower altitudinal hemianopia
question

lower division of visual radiation
answer

course anteriorly then posteriorly to end in lower bank of calcarine sulcus/LINGUAL GYRUS; input from inferior retinal quadrants/superior visual field quadrants; transection–contra upper quadrantanopia/pie in the sky; transection of both lingual gyri causes upper altitudinal hemianopia
question

visual cortex/brodmann 17
answer

on banks (upper=cunei; lower=lingual gyrus) of calcarine fissure; lesions cause contra hemianopia w/macular sparing; posterior area–macular input/central vision, intermediate area–paramacular input/peripheral input, anterior area–monocular input
question

lesion of left Meyer’s loop/visual radiation to inferior bank of calcarine sulcus
answer

results in upper right homonymous quadrantanopia/right pie in the sky; can’t see top right quadrant; Homonymous hemianopsia, or homonymous hemianopia occurs when there is hemianopic visual field loss on the same side of both eyes–>total loss of L or R field
question

pupillary light reflex
answer

ganglion cells of retina project axon to pretectal nuclei in midbrain–>pretectal nu projects through posterior commissure crossed and uncrossed fibers to accessory oculomotor/edinger-westphal–>edinger-westphal nu gives rise to pregang parasymp fibers exit midbrain with CN III and synapse with postgang parasym neurons of ciliary ganglion–>ganglion gives rise to postgang parasymp that innv sphincter muscle of iris–>constrict pupil with light stimulus enter optic nerve.
question

optic nerve lesion and pupillary light reflex
answer

LOSS direct pupillary light reflex/ RESULT in dilation (consensual reflex intact–bc pupillary light pathway goes through pretectal nucleus to communicate to contra CN III nu Edinger Westphal–>ciliary ganglion–>sphincter pupillae–>pupil constriction);
question

pupillary dilation pathway
answer

symp; interruption will cause–Horner’s syndrome
question

hypothalamic neurons of paraventricular nu
answer

project to ciliospinal center T1-2 of IMLCC of spinal cord
question

ciliospinal center of Budge T1-2
answer

projects pregnag symp through symp trunk to superior cervical ganglion
question

superior cervical ganglion
answer

projects postgang symp through perivascular plexus of carotid system to dilator muslce of iris. Postganglionic sympathetic fibers pass through tympanic cavity and carernous sinus and enter orbit through superior orbital fissure
question

near reflex and accommodation
answer

question

cortical visual pathway
answer

from primary visual brodmann 17 to visual assoication cortex brodmann 19
question

visual association cortex/brodmann 19
answer

project through corticotectal tract to superior colliculus and pretectal nu
question

superior colliculus and pretectal nu
answer

project to oculomotor complex of midbrain (rostral accessory/edinger westphal-pupillary constriction through ganglion; caudal accessory/edinger westphal-contraction of ciliary muscle, inc refractive power of lens; medial rectus subnucleus of CN III-convergence)
question

frontal eye field
answer

in posterior part of middle frontal gyrus/brodmann 8; regulates VOLUNTARYsaccadic eye movt; stimulation/irritation causes contra deviation of eyes/away from lesion; destruction causes transient ipsi conjugate deviation of eyes/toward lesion.
question

occipital eye fields
answer

in brodmann 18 + 19 of occipital lobes; cortical centers for INVOLUNTARY smooth pursuit tracking; stimulation causes contra conjugate deviation of eyes
question

subcortical center for lateral conjugate gaze
answer

in abducent nu of pons; receives from contra frontal eye field; projects to: 1. ipsi lateral rectus m. and 2. through medial longitudinal fasciculus/MLF to contra medial rectus subnucleus of oculomotor complex
question

subcortical center for vertical conjugate gaze
answer

in midbrain at level of posterior commissure; rostral interstitial nu of MLF, associated with Parinaud’s syndrome
question

MLF syndrome/internuclear ophthalmoplegia
answer

damage/demyelination to MLF btw abducent and oculomotor nu; causes (contra) medial rectus palsy on attempted lateral conjugate gaze and monocular horizontal nystagmus in abducting eye; convergence is normal; common in multiple sclerosis
question

one and a half syndrome
answer

bilateral lesions of MLF and unilateral lesion of abducent nu; only lateral rectus fxn during lateral conjugate gaze.
question

argyll robertson pupil
answer

pupillary light-near dissociation; absence of miotic rxn to light (both direct and consensual), preservation of miotic rxn to near stimulus/accommodation-convergence; syphilis and diabetes
question

horner’s syndrome
answer

transection of oculosymp pathway at any level; miosis, ptosis, apparent enophthalmos and hemianhidrosis
question

relative afferent/marcus gun pupil
answer

from lesion of optic nerve (afferent limb); eye unaffected can cause affected eye to contrict??
question

transtentorial
answer

uncal herniation; result of inc supratentorial pressure (brain tumor or hematoma); pressure cone forces parahippocampus uncus through tentorial incisure–>forces contra crus cerebri against tentorial edge/Kernohan’s notch and puts pressure on ipsi CN III and posterior cerebral artery: 1. ipsi hemiparesis (pressure on corticospinal tract in contra crus cerebri); 2. fixed and dilated pupil, ptosis, and down and out eye (pressure on ipsi oculomotor n.); 3. contra homonymous hemianopia (compression of posterior cerebral artery which supplies visual cortex)
question

papilledema/choked disk
answer

noninflammatory congestion of optic disk from inc ICP, caused by brain tumors, subdural hematoma or hydrocephalus; does not alter visual acuity, but cause bilateral enlarged blind spots; asymmetric and greater on side of supratentorial lesion.
question

ch16
answer

lesions of brain stem
question

lesions of medulla
answer

question

medial medullary syndrome
answer

ASA syndrome; corticospinal tract–contra babinsky, contra spastic hemiparesis, contra medial lemniscus–contra loss of tactile vibration from trunk and extremities, hypoglossal nu or intraaxial root fibers/CN XII–ipsi flaccid hemiparalysis of tongue//tongue protrude to side of lesion/weak side
question

lateral medullary/wallenberge; dissociated sensory loss
answer

PICA syndrome; affected structures: 1. vestibular nu–nystagmus, nausea, vomitting, vertigo; 2. inferior cerebellar peduncle–ipsi cerebellar signs (dystaxia, dysmetria/past pointing, dysdiadochokinesia); 3. nu ambiguus of CN IX, X, XI–ipsi laryngeal, pharyngeal, palatal hemiparalysis/loss of gag reflex/efferent limb, dysarthria, dysphagia, dysphonia/hoarseness; 4. glossopharyngeal nerve roots–loss of gag reflex/afferent limb; 5. vagal nerve roots–same as nu. ambiguus lesion; 6. spinothalamic tracts/spinal lemniscus–contra loss of pain and temerature sensation from trunk and extremities; 7. spinal trigeminal nu and tract–ipsi loss of pain and temp of face; 8. descending sympathetic tract–ipsi Horner’s syndrome
question

lesions of pons
answer

(next 6)
question

1. medial inferior pontine syndrome
answer

occlusion of PARAMEDIAN branches of basilar artery: corticospinal tract–contra spastic hemiparesis, medial lemniscus–contra loss of tactile sensationo trunk + extremities, abducent nerve roots–ipsi lateral rectus paralysis
question

2. lateral inferior pontine syndrome
answer

AICA syndrome; 1. FACIAL nu and intraaxial n. fibers–ipsi facial n. paralysis, ipsi loss of taste from ant. 2/3, ipsi loss of lacrimation and reduced salivation, loss of corneal dn stapedial reflexes/efferent limb 2. COCHLEAR nu and intraaxial n. fibers–unilateral central deafness 3. VESTIBULAR nu and intraaxial n. fibers–nystagmus, nausea, vomiting and vertigo 4. spinal nu and tract of TRIGEMINAL nerve.–ipsi loss of pain and temp from face 5. middle and inferior CEREBELLAR peduncles–ipsi limb and gait dystaxia 6. ANTEROLATERAL system/spinothalamic tracts/spinal lemniscus–contra loss of pain and temp from trunk and extremities 7. descending SYMPATHETIC tract–ipsi Horner’s syndrome
question

3. medial longitudinal fasciculus/MLF syndrome/internuclear ophthalmoplegia
answer

interrupts fibers from contra abducent nu that project through MLF to ipsi medial rectus subnucleus of CN III; medial rectus palsy on attempted lateral conjugate gaze and nystagmus in abducting eye; convergence ok; multiple sclerosis
question

4. facial colliculus syndrome
answer

pontine glioma or vascular accident; internal genu of CN VII and nu of CN VI under facial colliculus
question

5. (pons) lesions of internal genu of facial nerve
answer

cause ipsi facial paralysis, ipsi loss of corneal reflex
question

6. (pons) lesions of abducent nu
answer

cause lateral rectus paralysis, medial convergent strabismus, horizontal diplopia
question

lesions of midbrain
answer

next 3
question

dorsal midbrain/parinaud syndrome
answer

pinealoma or germinoma of pineal region; 1.superior colliculus and pretectal area–paralysis of upward and downward gaze, pupillary disturbances, absence of convergence 2. cerebral aqueduct–noncommunicating hydrocephalus
question

paramedian midbrain/benedikt syndrome
answer

affected: 1. oculomotor n. roots/intraaxial fibers–complete ipsi oculomotor paralysis, eye abduction and depression by intact lateral rectus/CN VI and superior oblique/CN IV, ptosis (levator palpebrae superioris) and fixation and dilation of ipsi pupil (complete internal ophthalmoplegia) 2. dentatothalamic fibers–contra cerebellar dystaxia with intention tremor 3. medial lemniscus–contra loss of tactile sensation from trunk + extremities
question

medial midbrain/weber’s syndrome
answer

affected: 1. oculomotor n. roots/intraaxial fibers–complete ipsi oculomotor paralysis, eye abduction and depression by intact lateral rectus/CN VI and superior oblique/CN IV, ptosis (levator palpebrae superioris) and fixation and dilation of ipsi pupil 2. corticospinal tracts–contra spastic hemiparesis 3. corticonuclear fibers–contra weakness of lower face/CN VII, tongue to weak side/CN XII, palate/CN X, upper face spared, uvula and pharyngeal wall are pulled toward normal side/CN X
question

acoustic neuroma/schwannoma
answer

benign intracranial tumor, affected: 1. vestibulocochlear n/CN VIII–tinnitus and unilateral nerve deafness; 2. vestibular nerve of CN VIII–vertigo, nystagmus, nausea, vomitting, unsteadiness of gait; 3. facial n/CN VII–facial weakness and loss of corneal reflex/efferent limb; 4. spinal tract of trigeminal n/CN V–paresthesia, anesthesia of ipsi face and loss of corneal reflex/afferent limb; 5. neurofibromatosis type 2 (bilateral acoustic neuromas)
question

jugular foramen syndrome
answer

glomus jugulare tumor, inner ear tumor, compression of CN IX, X, XI; affected: 1. glossopharyngeal n/IX–ipsi gag reflex, ipsi loss of pain, temp, taste in tongue 2. vagal n/CN X–ipsi paralysis of soft palate and larynx, ipsi loss of gag reflex 3. accessory n/XI–paralsysi of sternocleidomastoid (inability to turn head opposite side), paralysisof trapezius (shoulder droop, inability to shrug shoulder)
question

locked-in syndrome
answer

lesion of base of pons (infarction, trauma, tumor, demyelination); corticospinal and corticonuclear tracts affected bilaterally; oculomotor and trochlear nerves not injured; conscious and may communicate through vertical eye movt.
question

central pontine myelinolysis
answer

lesion of base of pons affects corticospinal and corticobulbar tracts; assoc. w/ alcohlism or rapid correction of hyponatremia; spastic quadriparesis, pseudobulbar palsy, mental changes; may become “locked-in”
question

“top of the basilar” syndrome
answer

embolic occlusion of rostral basilar artery, optic ataxia and psychic paralysis of fixation of gaze/Balint’s syndrome, ectopic pupils, somnolence, cortical blindness, w/ or w/o visual anosognosia/Anton’s syndrome
question

subclavian steal syndrome
answer

thrombosis of L. subclavian artery prox to vertebral artery; blood shunted retrograde down L vertebral artery into L subclavian artery; transient weakness and claudication (pain cause by little blood flow) of left arm on exercise and vertebrobasilar insufficiency/vertigo,dizziness
question

cerebellopontine angle
answer

jxn of medulla, pons, cerebelllum; CN VII and VIII; five brain tumors and one cyst (SAMEE):Schwannoma, arachnoid cyst, meningioma, ependymoma, epidermoid
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ch17: thalamus
answer

division of diencephalon-integrates sensory and motor systems
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anterior nucleus
answer

hypothalamic input from mamillary nu through mamillothalamic tract; projects to cingulate gyrus and part of Papez circuit of emotion of limbic system
question

mediodorsal/dorsomedial nu
answer

reciprocally connected to prefrontal cortex; connections w/ intralaminar nulei; input from amygdale, substantia nigra, temporal neocortex; lesion–memory loss (Wernicke-Korsakoff syndrome; mediodorsal nu role in expression of affect, emotion, behavior/limic fxn
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centromedian nu
answer

largest intralaminar nu; reciprocally connected to motor cortex/Brodmann 4; input from globus pallidus, projects to striatum/caudate nu and putamen and projects diffusely to entire neocortex
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pulvinar
answer

largest thalamic nu; reciprocal connections w/ association cortex of occipital, parietal, posterior temporal lobes; input from lateral and medial geniculate bodies and superior colliculus; role integration of visual, auditory, somesthetic input; destruction of dominant pulvinar–sensory dysphasia
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ventral tier nuclei
answer

ventral anterior nu, ventral lateral nu, ventral posterior nu (VPL + VPM
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ventral anterior nu
answer

input from globus pallidus and substantia nigra, projects diffusely to prefrontal cortex, orbital cortex, and premotor cortex/Brodmann 6
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ventral lateral nu
answer

input from cerebellum/dentate nu, globus pallidus, and substantia nigra; projects to motor cortex/brodmann 4 and supplementary motor cortex/brodmann 6]
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ventral posterior nu
answer

nu of termination of general somatic afferent/touch,pain,temp and special visceral afferent/taste; has 2 subnuclei: VPL–receives spinothalamic tracts and medial lemniscus, projects to somesthetic/sensory crotex/brodmann 3,1,2 VPM–receives trigeminothalamic tracts and projects to somesthetic/sensory crotex/brodmann 3,1,2; gustatory pathway from solitary nu projects via central tegmental tract to VPM and thence to gustatory cortex of: postcentral gyrus/brodmann 3b, frontal operculum and insular corex; taste is ipsi.
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metathalamus
answer

lateral and medial geniculate body
question

lateral geniculate body
answer

visual relay nu; input from optic tract, projects to primary visual cortex/brodmann 17
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medial geniculate body
answer

auditory relay nu (think of MEDIA!); input from brachium of inferior colliculus, projects to primary auditory cortex/brodmann 41-42
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reticular nu of thalamus
answer

surrounds thalamus as thin layer of GABA neurons, lies btw external medullary lamina and internal capsule; receives excitatory collateral input from corticothalamic and thalamocortical fibers; projects inhibitory to thalamic nu from which it receives input; role in normal electroencephalogram readings
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blood supply of thalamus
answer

1. posterior communicating artery, 2. posterior cerebral artery (thalamoperforating + thalamogeniculate arteries), 3. anterior choroidal artery
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internal capsule
answer

layer of white matter separating caudate nuc and thalamus medially from lentiform nu (putamen + globus pallidus) laterally; ant limb is btw caudate nu and lentiform nu; genu contains corticonuclear fibers; posterior limb is btwn thalamus and lentiform nu, post limb has corticospinal/pyramid fibers as well as visual, auditory raditation, sensory/pain,temp, touch
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blood supply of internal capsule
answer

*ant limb: medial striate branches of ACA and lateral striate/lenticulostriate branches of MCA; *genu: direct branches from internal carotid artery or pallidal branches of anterior choroidal artery; *post lim: branches of ant. chroidal artery adn lenticulostriate branches of MCA
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ch18 hypothalamus
answer

division of diencephalon; 3 systems: ANS, endocrine, limbic; maintain homeostasis
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hypothalamic nuclei and their fxns
answer

(next 11)
question

medial preoptic nu
answer

regulates release of gonadotropic hormones from ant. pit; sexually dimorphic nu, development depends on testosterone levels
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suprachiasmatic nu
answer

input from retina; role in circadian rhythms
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posterior hypothalamic nu
answer

thermal regulation/conservation and inc heat production; lesions– inability to thermoregulate—(think: POIKILOTHERMIA!!)
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anterior hypothalamic nu
answer

temp regulation, stimulates parasymp; destruction results in hyperthermia (think: anterior=head; HOT HEADS!!)
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paraventricular nu
answer

synthesizes ADH, oxytocin, CRH; gives rise to supropticohypophyseal tract–projects to autonomic nuclei of brain stem and all levels of spinal cord; destructions–diabetes insipidus/watery urine
question

supraoptic nu
answer

makes ADH, oxytocin
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dorsomedial nu
answer

stimulated–savage behavior
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ventromedial nu
answer

satiety center, stimulated–inhibits urge to eat; bilateral destruction results in hyperpphagia, obesity and savage behavior
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arcuate/infundibular nu
answer

contains neurons that make factors that stimulate or inhibit action of hypothalamus; gives rise to tuberohypophysial tract that terminates in hypophyseal portal system of infundibulum/medium eminence; contains neurons that produce Dopamin/prolactin inhibiting factor
question

mamillary nu
answer

input from hippocampal formation through postcommissural fornix; projects to anterior nu of thalamus through mamillothalamic tract (part of Papez circuit). Patients with alcoholism or Wernike’s encephalopathy/B1-thiamine deficiency/have lesions in mamillary nu
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lateral hypothalamic nu
answer

stimulated–induce eating; lesions–anorexia and starvation; (think: L for Labia/Lips)
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major fiber systems of hypothalamus
answer

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fornix
answer

largest projection to hypothalamus; projects from hippocampal formation to mamillary nu, ant. nu of thalamus, and septal area; fornix then projects from septal area to hippocampal formation
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medial forebrain bundle
answer

traverses entire lateral hypothalamic area; interconnects orbitofrontal cortex, septal area, hypothalamus, and midbrain
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mamillothalamic tract
answer

projects from mamillary nu to ant nu of thalamus/part of Papez circuit
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stria terminalis
answer

major path from amygdala; interconnects septal area, hypothalamus, and amygdala
question

supraopticohypophysial tract
answer

conducts fibers from supraoptic and paraventricular nuclei to neurohypothalamus, and amygdala
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tuberohypophysial/tuberoinfundibular tract
answer

conducts fibers from arcuate nu to hypophyseal portal system
question

hypothalamospinal tract
answer

contains direct descending autonomic fibers; fibers influence pregang symp neurons of intermediolateral cell column and preganglionic neurons of sacral parasymp nu; interruption above first thoractic segment T1 causes Horner’s
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anterior hypothalamus
answer

has excitatory effect on parasymp nervous system
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posterior hypothalamus
answer

has excitatory effect on symp
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temp regulation
answer

1. ant hypothalamus–regulates/maintains body temp, destruction–hyperthermia; 2. posterior hypothalamus–helps produce and conserve heat, destruction–inability to thermoregulate
question

water balance regulation
answer

paraventricular nu–ADH
question

Food intake regulation
answer

2 hypothalamic nuclei role in appetite: 1. ventromedial nu-stimulated– inhibits urge to eat/destruction–hyperphagia,obseity,savage behavior 2. lateral hypothalamic (think “lips for eating”)-stimulate–induces urge to eat/destruction–starvation and emaciation
question

diabetes insipidus
answer

polyuria, polydipsia; hypothalamic syndrome; lesions of ADH pathways to posterior pituitary
question

syndrome of inappropriate ADH secretion
answer

From over secretion of ADA; leads to hyponatremia; lung tumors or drug therapy/eg. Carbamazepine, chlorpromazine
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craniopharyngioma
answer

congenital tumor from remnants of Rathke’s Pouch; calcified; most common supratentorial tumor in children and most common cause of hypopituitarism in children; 1. pressure on chiasm–bitemporal hemianopia 2. pressure on hypothalamus–hypothalmic syndrome/adiposity,diabetes insipidus,disturbance of temp regulation,somnolence
question

pituitary adenomas
answer

intracranial tumor; amenorrhea, galactorrhea from a prolactin secreting adenoma; 1. pressure on chiasm–bitemporal hemianopia 2. pressur eon hypothalamus–hypothalamus syndrome
question

ch19
answer

limbic system
question

orbitofrontal cortex
answer

mediates conscious perception of smell; reciprocal connections with mediodorsal nu of thalamus; interconnected through medial forebrain bundle w/ septal area and hypothalamic nuclei
question

dorsomedial mediodorsal nu of thalamus
answer

reciprocal connections w/ orbitofrontal and prefrontal cortices and hypothalamus; receives input from amygdala, role in affective behavior and memory
question

ant. nu of thalamus
answer

input from mamillary nu through amillothalamic tract and fornix; projects to cingulate gyrus and major link in Papez circuit
question

septal area
answer

telencephalic structure; reciprocal connections with hippocampal formation through fornix and w/ hypothalamus through medial forebrain bundle; projects through stria medullaris (thalami) to habenular nu
question

limbic lobe
answer

includes subcallosal area, paraterminal gyrus, cingulate gyrus and isthmus, and parahippocampal gyrus, includes uncus; contains hippocampal formation and amygdaloid nuclear complex.
question

hippocampal formation
answer

sheet of archicortex jelly rolled into parahippocampal gyrus; fxn in learning, memory, recognition of novelty; receives input through entorhinal cortex and projects output through fornix; Major structures: 1. dentate gyrus–3 layered archicortex–contains granule cells that receive hippocampal input adn project output to pyramidal cells of hippocampus and subiculum; 2. hippocampus/cornu Ammonis–3 layered archicortex; contains pyramidal cells that project through fornix to septal area dn hypothalamus; 3. subiculum–receives input through hippocampal pyramidal cells; projects through fornix to mamillary nuclei and anterior nucleus of thalamus.
question

amygdaloid complex/amygdala
answer

basal nu underlies parahippocampal uncus; stimulated–human fear and signs of symp overactivity, animal cessation of activity and heightened attentiveness; lesion–placidity and hypersexual behavior
question

amygdaloid complex/amygdala input & output
answer

input: from sensory association cortices, olfactory bulb and cortex, hypothalamus and septal area, and hippocampal formation; output: through stria terminalis to hypothalamus and septal area; also to dorsomedial nu of thalamus
question

hypothalamus reciprocal connection
answer

with amygdala
question

limbic midbrain nuclei and associated NTs
answer

ventral tegmental area/Dopamine; raphe nuclei/Serotonin; locu ceruleus/NE
question

papez circuit
answer

includes: 1. hippocampal formation 2. mamillary nu 3. ant. thalamic nuc 4. cingulate gyrus/brodmann 23-24 5. entorhinal area/brodmann 28
question

Limbic System Structures “The Papez Circuit”//according to Dr. Mize
answer

1. Limbic Cortex: cingulate gyrus, parahippocampal gyrus, entorhinal cortex, orbitofrontal cortex 2. Hippocampal Formation 3. Amygdala 4. Septal nuclei, nucleus accumbens 5. Hypothalamus (mammillary bodies) 6. Thalamus: anterior and dorsomedial nu
question

kluver-bucy syndrome
answer

bilateral ablation of anterior temporal lobes including amygdaloid nuclei; psychic blindness/visual agnosia, hypoerphagia, docility/placidity, hypersexuality
question

amnestic/confabulatory syndrome
answer

bilateral infarction of hippocampa formation i.e. hippocampal branches of posterior cerebral arteries and ant. choroidal arteries of internal carotid arteries; anterograde amnesia; memory loss suggests hippocampal pathology
question

Foster kennedy syndrome
answer

meningioma of OLFACTORYgroove (Foster Kennedy—think Foul-smelling sKunk); compresses olfactory tract and optic n; ipsi anosmia and optic atrophy and contra papilledema as a result of inc ICP
question

hippocampus
answer

most epileptogenic part of cerebrum; lesions-psychomotor attacks; sommer’s sector sensitive to ischemia
question

bilateral transection of fornix
answer

acute amnestic syndrome/i.e. inability to consolidate short-term memory into long-term
question

wernicke’s encephalopathy
answer

thiamine/B1 deficiency; triad: ocular disturbances and nystagmus, gait ataxia, mental dysfxn; pathologic features: mamillary nuclei, dorsomedial nuclei of thalamus, periaqueductal gray and pontine tegmentum
question

Strachan’s syndrome
answer

high dose thiamine therapy (thiamineATP production; think “high strung//high energy”); triad: spinal ataxia, optic atrophy, nerve deafness
question

bilateral destruction or removal of cingulate gyri
answer

loss of initiative and inhibition and dulling of emotions; memory ok; lesions of ant. cingulate gyri–placidity; cingulectomy to Tx severe anxiety and depression
question

Benzodiazepines
answer

enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA), which results in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, muscle relaxant and amnesic action. Useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal and as a premedication for medical or dental procedures. Short- and intermediate-acting –treatment of insomnia; longer-acting benzodiazepines –treatment of anxiety.
question

ch20 cerebellum (3 primary fxns)
answer

1. maintenance of posture and balance, 2. maintenance of muscle tone, 3. coordinationof voluntary motor activity
question

3 cerebellar peduncles
answer

1. superior: major output from cerebellum– the dentatothalamic tract (tract terminates in ventral lateral nu of thalamus; one major afferent pathway–VENTRAL spinocerebellar tract 2. middle: receives pontocerebellar fibers, project to neocerebellum/pontocerebelllum 3. inferior: 3 major afferent tracts (DORSAL spinocerebelllar tract, CUNEOcerebellar tract, OLIVOcerebellar tract from contra inferior olivary nu)
question

3 layers
answer

1. molecular, 2. purkinje, 3. granule
question

purkinje cells
answer

output from cerebellar cortex/ inhibitory output/GABA to cerebellar and vestibular nuclei; excited by parallel and climbing fibers and inhibited by GABAergic basket and stellate cells
question

granule cells
answer

excite/Glu Purkinje, basket, stellate, and Gogli cells; inhibited by Golgi cells and excited by mossy fibers
question

parallel fibers
answer

axons of granule cells; fibers extend into molecular layer
question

mossy fibers
answer

afferent excitatory fibers of spinocerebellar, pontocerebellar, and vestibulocerebellar tracts; terminate as mossy fibers rosettes on granule cell dendrites; excite granule cells to discharge through parallel fibers
question

climbing fibers
answer

afferent excitatory/Aspartate of olivocerebellar tract; fibers from contra inferior olivary nu; terminate on neurons of cerebellar nuclei and dendrites of Purkinje cells
question

cerebellar pathways
answer

question

purkinje cells of cerebellar cortex
answer

project to cerebellar nuclei (e.g. dentate emboliform, globose, fastigial nuclei)
question

dentate nucleus
answer

major EFFECTOR nu; give rise to dentatothalamic tract that projects through SUPERIOR cerebellar peduncle to contra ventral lateral nu of thalamus; decussation of superior cerebellar peduncle is in caudal midbrain tegmentum
question

ventral lateral nu of thalamus
answer

receives dentatothalamic tract; projects to primary motor cortex of precentral gyrus/Brodmann 4
question

motor cortex/motor strip/brodman 4
answer

input from ventral lateral nu of thalamus, projects as corticopontine tract to pontine nuclei
question

pontine nuclei
answer

input from motor cortex; axons project as pontocerebellar tract to contra cerebellar cortex, where they terminate as mossy fibers–completing circuit
question

cerebellar dysfxn
answer

triad: 1. hypotonia, 2. dysequilibrium, 3. dyssynergia (loss of coordinated muscle activity; dysmetria, intention tremor, failure to check movts. Nystagmus, dysdiadochokinesia, dysrhythmokinesia; cerebellar nystagmus is coarse; more pronounced when pt looks fwd to side of lesion)
question

cerebellar syndromes and tumors
answer

question

ant. vermis syndrome
answer

leg region of ant lobbe; atrophy of rostral vermis; caused by alcohol abuse; gait, trunk and leg dystaxia
question

post. Vermis syndrome
answer

flocculonodular lobe; brain tumors in children common cause/medulloblastomas or ependymomas; truncal dystaxia
question

hemisphereic syndrome
answer

cerebellar hemisphere; result of brain tumor/astrocytoma or abscess/secondary to otitis media or mastoiditis; arm, leg, gait dystaxia and ipsi cerebellar signs
question

cerebellar tumors
answer

1. astrocytomas, 2. medulloblastomas 3. ependymomas–4th ventricle common–obstruct CSF–hydrocephalus; children–70% brain tumor in posterior fossa; adults–70% brain tumor in supratentorial compartment
question

ch21
answer

basal nuclei/ganglia and striatal motor system
question

Know the major sources of arteries which penetrate into the basal structures of the forebrain and diencephalon, including the recurrent artery of Huebner (ACA), anterior choroidal artery (int. carotid), the lenticulostriate arteries (MCA); and the thalamopenetrating and thalamogeniculate arteries (PCA)
answer

*Recurrent artery of Heubner – comes off of the ACA. Feeds most anterior aspect of the putamen and the head of the caudate nucleus*Anterior Choroidal – comes off Internal Carotid. Supplies the cadual aspects of the putamen and the tale of the caudate.*Lenticulostriates – branch off the MCA. Innervate middle aspects of the putamen, globus pallidus, and broad regions of the caudate nucleus.*Thalamoperforating arteries – branch from PCA. Supplies bulk of the thalamus excluding the posterior portion*Thalamogeniculate arteries – from PCA. Supplies the posterior portion including the Lateral geniculate nucleus(visual system) and Medial geniculate nucleus(auditory system)
question

basal nuclei/ganglia
answer

caudate nu, putamen, globus pallidus
question

striatum
answer

caudate nu & putamen
question

corpus striatum
answer

lentiform nu + caudate nu
question

lentiform nu
answer

globus pallidus + putamen
question

claustrum
answer

lies btw lentiform nu and insular cortex; reciprocal connections btw sensory cortices/visual cortex
question

parkinson dz
answer

degenerative; affects substania nigra and its projections to striatum (to stimulate movt.); depletion of dopamine in substantia nigra and striatum; loss of melanin-containing dopaminergic neurons in substantia nigra; lewy bodies, progressive supranuclear palsy.
question

MPTP-induced parkinsonism
answer

analog of meperidine/demerol; destroys dopaminergic neurosn in substantia nigra
question

hungtinton’s dz/chorea
answer

inherited auto dominant; single gene defect on chrom. 4; degeneration of cholinergic and GABA neurons of striatum; gyral atrophy in frontal and temporal lobe
question

glutamate excitotoxicity
answer

glu released in striatum binds receptors on striatal neurons–>AP; Glu is bound to NmethylDaspartate receptor instead of being removed from extracellular space by astrocytes–>lots of influx of Ca and cell death, neuronal death in cerebrovascular accidents/stroke; choreiform movts, hypotonia, progressive dementia
question

syndenham’s chorea/st. vitus dance
answer

girls, after rheumatic fever, chorea
question

chorea gravidarum
answer

during 2nd trimester of pregnancy; history of sydneham chorea
question

hemiballism
answer

from vascular lesion of SUBTHALAMIC nu; violent contra flinging movt of one or both extremities
question

hepatolenticular degeneration/wilson’s dz
answer

auto recessive; defect in metabolism of Cu; gene on chrom 13; choreiform or athetotic movt, rigidity, wingbeating tremor; lesions in lentiform nu; copper deposition in limbus of cornea–corneal Kayser-Fleischer ring–pathognomonic sign; deposition of Cu in liver–multilobar cirrhosis; psychosis, personality disorders, dementia; low serum ceruloplasmin, elevated urinary excretion of CU, inc CU in liver biopsy; Tx: penicillamine chelator
question

tardive dyskinesia
answer

repetitive choreic movt affects face and trunk; Tx: phenothiazines, butyrophenones or metoclopramide
question

ch 22 cerebral cortex
answer

thin, gray covering of both hemispheres of brain; 2 types: 1. neocortex/90%, allocortex/10%; motor cortex is thickest/4.5mm; visual cortex thinnest/1.5mm
question

neocortex
answer

6 layers: II & IV–mainly afferent, V & VI mainly efferent; IV–internal granular layer; VI: internal pyramidal layer–>corticobular, corticospinal and corticostriatal fibers; IV contains giant pyramidal cells of Betz/in Brodmann 4; VI: multiform layer–major source of corticothalamic fibers, gives rise to projection, commissural and association fibers
question

fxnal areas of cerebral cortex
answer

frontal lobe, parietal lobe, temporal lobe, occipital lobe
question

frontal lobe
answer

motor cortex/brodmann 4 and premotor cortex/brodmann 6, frontal eye field/brodmann 8, broca’s speech area/brodmann 44-45, prefrontal cortex/brodmann 9-12 and 46-47
question

parietal lobe
answer

sensory cortex/brodman 3,1,2; superior parietal lobule/brodmann 5 and 7; inferior parietal lobule of DOMINANT hemisphere (Gerstmann syndrome: R and L confusion, finger agnosia, dysgraphia, dyslexia, dyscalculia, contra hemianopia/lower quadrantanopia); inferior parietal lobule of NONDOMINANT hemisphere (topographic memory loss, anosognosia, construciton apraxia, dressing apraxia, contra sensory neglect, contra hemianopia/lower quadrantanopia
question

temporal lobe
answer

1. primary auditory cortex/brodmann 41-42; 2. Wernicke’s speech area in dominant hemisphere/brodmann 22 (repetitive, fluent aphasia, no comprehension); 3. Meyer’s loop (pie in the sky); 4. olfactory bulb, tract and primary cortex/brodmann 34; 5. hippocampal cortex/archicortex (difficulty short-term into long-term; 6. anterior temporal lobe (including amygdaloid nu, bilateral damage: Klaver-Bucy); 7. inferomedial occipitotemporal cortex, bilateral lesions: inability to recognize once-familiar faces/prosopagnosia
question

olfactory bulb, tract and primary cortex/brodmann 34
answer

ipsi anosmia; irritative uncus lesion/psychomotor epilepsy–olfactory and gustatory hallucinations; olfactory groove meningiomas (anosmia, foster kennedy syndrome); esthesioneuroblastomas/olfactory neuroblastomas)
question

occipital lobe
answer

bilateral lesions–cortical blindness, unilateral lesions–contra hemianopia/quadrantanopia
question

Human Memory System
answer

1. Medial Temporal Lobe System: subserves declarative memory. Includes hippocampal structures as well. 2. Medial Diencephalic System: subserves declarative memory. Involves mammillary bodies, anterior and dorsomedial nu. of thalamus, cingulate cortex. 3. Neostriatal System: subserves procedural memory. Habits, motor skills 4. Prefrontal Cortex: working memory
question

focal destructive hemispheric lesions and symptoms
answer

question

Aphasias
answer

are disorders of language that result mainly from lesions in the lateral aspect of the left hemisphere. Aphasias may be caused by a stroke involving superficial branches of the left middle cerebral artery (MCA). Patients with an aphasia commonly have agraphia and difficulty in repetition or naming.
question

cerebral dominance
answer

determined by Wada test; sodium amobarbital/Amytal injected into carotid artery; if pt becomes aphasic–anesthetic was administered to dominant hemisphere
question

dominant hemisphere
answer

usually Left hemisphere; vocal naming; propositional language (grammar,syntax,semantics), speech and calculation
question

nondominant hemisphere
answer

usually Right hemisphere; 3D spatial perception and nonverbal ideation; allows superior recognition of faces
question

corpus callosum syndrome/lesions
answer

question

split brain syndrome
answer

disconnection syndrome–from transection of corpus callosum
question

anterior corpus callosum lesion
answer

akinetic mutism or tactile anomia
question

posterior corpus callosum/splenium lesion
answer

alexia (don’t know how to say) w/o agraphia (can write)
question

callosotomy
answer

Tx for drop attacks/colloid cyst of 3rd ventricle
question

ch 23
answer

NTs
question

ACh
answer

in basal nu of Meynert (area degenerates in Alzheimer’s Dz)
question

catecholamines
answer

DA, Epi, NE
question

serotonin/5HT
answer

in raphe nuclei of brain stem//depression and insomnia
question

opioid peptides/endogenous opiates
answer

endorphins (b-endorphin in brain) in hypothalamus, enkephalins (in globus pallidus, role in pain suppression)
question

nonopioid neuropeptides
answer

substance P (pain transmission) concentrated in substantia nigra, substance P is reduced in pts with Hungtingon’s dz; 2. somatostatin–inc in Huntington’s dz
question

amino acid transmitters
answer

inhibitory: GABA (purkinje, stellate, basket, golgi cells of cerebellar cortex), glycine; excitatory: Glu (NMDA receptors–longt term potentiation/memory process, kindling and seizure activity, neurotoxic in certain conditions, Glu excitotoxicity), aspartate, nitric oxide
question

parkinson dz
answer

degeneration of DA neurons in pars compacta of substantia nigra; reduction of DA in striatum and substantia nigra
question

hungtinton’s dz/chorea
answer

loss of ACh and GABA neurons in striatum/caudatoputamen
question

Alzheimer’s dz
answer

Degeneration of cortical neurons and cholinergic neurons in basal nucleus of Meynert; (Brain Areas Affected: medial temporal cortex, hippocampus, n. basalis of Meynert, locus coeruleus, Raphe nuclei, frontal ctx.); loss of choline acetyltransferase//loss of ACh transmitter in cerebral cortex; Some causes: 1. Amyloid precursor transmembrane protein (APP), 2. APOE, 3. Generation of plaques; characterized in the brain by abnormal clumps (amyloid plaques) and tangled bundles of fibers(neurofibrillary tangles) composed of misplaced proteins. Senile Plaques: composed of Ăź-amyloid deposits, usually contained within the extracellular space. Due to cleavage by Ăź secretase enzyme. Produces apoptosis. Neurofibrillary tangles: composed mainly of hyperphosphorylated microtubule- associated Tau proteins w/i neurons.
question

Mechanism of Alzheimer’s DZ (Misfolded proteinsplaque)
answer

1. Abnormal cleavage by Ăź-secretase enzyme 2. Îł-scretase cleaves Intracellular terminus 3. APOE4 associates with an increase in amyloid plaques and neurofibrillary tangles (NFTs); ApoE gene in Chromosome 19, 34kDa protein/ transports cholesterol in the blood, In brain – ApoE is produced by astrocytes; also in CSF (i) stressors/injurious agentsinc APOE to repair or remodel the damaged neurons.(ii) Neuronal APOE is cleaved by proteolysis to generate C-terminal-truncated fragments; (iii) APOE4 fragments cause cytoskeletal changes, such as Tau phosphorylation and NFT formation. (iv) APOE4 induces mitochondrial dysfunction, whereas changes in the cytoskeleton and mitochondria contribute to neurodegeneration.
question

myasthenia gravis
answer

autoantibodies against ACh receptor on skeletal muscle; block postgang ACh binding site; muscle use cause fatigue
question

lambert-eaton myasthenic syndrome
answer

presynaptic defect of ACh release; weakness of limb muscles but not bulbar muscles; neoplasms, strength improves with use
question

ch 24
answer

apraxia, aphasia, dysprosody
question

apraxia
answer

inability to perform motor fxn in presence of intact motor and sensory systems and normal comprehension
question

ideomotor apraxia/idiokenetic apraxia
answer

loss of ability to perform intransitive or imaginary gestures; can’t do complicated motor task/saluting,blowing a kiss; lesion in Wernicke’s, Bucco-facial or facial-oral apraxia–idiomotor apraxia, facial apraxia most common apraxia
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ideational apraxia/ideatory apraxia
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inability to show use of real objects (can’t do multistep sequence), misuse of obj. due to disturbance of identification/agnosia; lesion in Wernicke’s
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construction apraxia
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inability to draw geometric figure, if draws only right half of clock/hemineglect–lesion is located in R inferior parietal lobule
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gait apraxia
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inability to use lower limbs properly; difficulty in lifting feet from floor, a frontal lobe sign seen with normal-pressure hydrocephalus (gait apraxia, dementia, incontinence)
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aphasia
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impaired communication by speech, writing, or signs/loss spoken language; lesions in dominant hemisphere
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types of aphasia
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broca’s motor aphasia, Wernicke’s sensory phasia, conduction aphasia, transcortical motor aphasia, transcortical mixed aphasia, transcortical sensory aphasia (fluent, repetition, no comprehension), global aphasia, thalamic aphasia (thought disorder–schiz, chronic drug-induced psychosis)–fluent paraphasic speech, comprehension and repetition is ok.
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Broca’s aphasia/Types of Language Disorders:
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Disturbance in speech production. Expressive or motor aphasia. Non-fluent, agrammatical.
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Wernicke’s aphasia/Types of Language Disorders:
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Disturbance in comprehension. Receptive or sensory aphasia. Fluent but with paraphasias
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Conduction aphasia/Types of Language Disorders:
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Difficulty in translating what is heard into an appropriate response. Disturbances of repetition and spontaneous speech. Produced by damage to arcuate fasciculus, other pathways.
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Transcortical aphasia/Types of Language Disorders:
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sensory or motor; similar to Broca’s or Wernicke’s but repetition is spared. Produced by watershed infarcts.
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Global Aphasia/Types of Language Disorders:
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major disturbance in all language functions.
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Anomic aphasia/Types of Language Disorders:
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disturbance in the production of single words, especially nouns. Intact comprehension, repetition.
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basal ganglia
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lesions of ANTERIOR basal ganglia–nonfluent aphasia; lesion of POSTERIOR basal ganglia result in fluent aphasia
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watershed infarcts
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infarction of boundary zones of ant, middle, post cerebral arteries; areas vulnerable to hypoperfusion–may separate Broca and Wernicke’s speech areas from surrounding cortex; cause motor, mixed and sensory transcortical aphasias
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dysprosody
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nondominant hemi language deficit; affected: emotionality, inflection, melody, emphasis, gesturing
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expressive dysprosody
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lesion to BROCA area but in nondominant hemisphere; can’t express emotion or inflection in speech
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receptive dysprosody
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lesions to WERNICKE, in nondominant hemisphere; can’t comprehend emotionality or inflection in speech they hear

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