question

Eloquence of the nervous system

answer

The idea that different areas of the NS are essential for integrating signaling for specific functions; if there is damage to an area, there will be a focal neurological deficit observed. Or: the symptoms from a neurologic lesion develop independently of the mechanism by which the lesion develops Or: etiology doesn't matter as much as location

question

What is delirium?

answer

An acute or sub-acute confused state which is usually transient and tends to fluctuate during the course of the day

question

What are the hallmark features of delirium?

answer

Attention deficits, memory deficits, executive function deficits, visuospatial deficits, language deficits

question

What are the two subtypes of delirium?

answer

Hyperactive: prominent hallucinations, agitation, hyperarousal; often w/ autonomic instability Hypoactive: withdrawn and quiet, prominent apathy and psychomotor slowing

question

What is the difference between aphasia and dysarthria?

answer

Aphasia is a disorder of language, while dysarthria is a disorder of speech. Aphasia is any problem with comprehension/production/communication of language (includes speech, reading, writing, or signs --> anything that is a representation of language). Dysarthria is a problem in the motor functions necessary for speech production.

question

What is Broca's area responsible for?

answer

Broca's area allows you to think of the right words and to program and coordinate the movements needed to produce sounds

question

What is Wernicke's area for?

answer

Wernicke's is responsible for the ability to comprehend language, including speech.

question

Where are Broca's and Wernicke's areas located?

answer

Broca's: left inferior frontal gyrus Wernicke's: posterior part of left superior temporal gyrus

question

What are different names for a bundle of axons in the CNS?

answer

tract, fasciculus, peduncle, or lemniscus

question

An occlusion of the ACA will result in strength and sensation loss where?

answer

the lower part of the body; ACA feeds the midline of the cerebral hemisphere

question

An occlusion to the MCA will mostly affect strength and sensation where?

answer

upper parts of the body; MCA feeds the lateral surface of the cerebrum

question

What do the posterior cerebral arteries supply?

answer

The medial and inferior surfaces of the occipital and temporal lobes, rostral midbrain and posterior thalamus.

question

What is within the frontal lobe?

answer

Motor cortex, prefrontal cortex; associated w/ complex cognitive function

question

What's in the parietal lobe?

answer

Somatosensory cortex; associated w/ perception and sensory stimuli

question

Temporal lobe

answer

Involved in auditory, olfactory and language functions

question

Occipital lobe

answer

Contains primary and association visual cortex

question

Where is the motor cortex located? Where is the sensory cortex located?

answer

Motor-precentral gyrus Sensory-postcentral gyrus

question

What are watersheds (or borderzones)?

answer

These are areas of the brain that lie at the edges of major cerebral arterial territories. They are the first to be deprived of blood flow in a cerebral hypo-perfusion event.

question

What are some features of borderzone infarcts?

answer

They account for about 10% of brain infarcts. Tend to be bilateral, and due to a decreased perfusion of distal regions of vascular territories. There are two types: external and internal.

question

How does a pt with a borderzone infarct typically present?

answer

Cortical blindness or loss of vision, delirium, weakness of shoulders/thighs but NOT of face, hands, or feet

question

Ischemia, hypoxia, infarct?

answer

Ischemia describes a decreased blood supply to an organ or body part --> this leads to hypoxia, which is a decreased amount of oxygen reaching tissues --> this causes an infarction, which is a localized area of necrosis

question

What things cause a hemorrhagic stroke?

answer

Burst brain aneurysm or weakened blood vessel leak

question

What is the only medical therapy approved for acute ischemic stroke?

answer

IV t-PA or alteplase

question

What are exclusions for administering tPA?

answer

-findings of hemorrhage -active internal bleeding -stroke, intracranial surgery or head trauma w/in 3 months -high blood pressure -CT findings of hemorrhage

question

What is sick sinus syndrome?

answer

dysfunction of the sinoatrial node, often secondary to senescence of SA node or surrounding myocardium

question

The dura dips down in between the cerebral hemispheres and between the cerebrum and cerebellum; what is it called at these points?

answer

Between cerebral hemispheres: falx cerebi Between cerebrum/cerebellum: tentorium cerebelli

question

Where does spinal fluid drain into?

answer

The superior sagittal sinus

question

What is the pathway for CSF in the brain?

answer

It is produced by the choroid plexi found within the walls of each of the ventricles --> it flows from the lateral ventricles through the interventricular foramina into the third ventricle, then through the cerebral aqueduct to the fourth ventricle --> CSF exits the brain via a middle foramen and two lateral foramena to enter the subarachnoid space --> exits subarachnoid space via the arachnoid villi into the superior sagittal sinus

question

What results in a subdural hemorrhage?

answer

Tearing of the bridging veins

question

What causes an epidural hemorrhage?

answer

Blood collection between the periosteal layer and the meningeal layer of the dura. Often the result of tearing arteries, particularly the middle meningeal artery.

question

Spinothalamic tract

answer

This is the pathway for pain and temp. Fibers cross over to opposite half of cord almost immediately, ascend to thalamus and are then sent to the cortex

question

What connects Broca's and Wernicke's areas?

answer

The arcuate fasciculus

question

Transcortical motor aphasia

answer

Affects frontal lobe around Broca area, but not Broca area. Repetition is intact; speech is nonfluent but comprehension is intact

question

Stroke risk factors

answer

Atrial fibrillation, sleep apnea, HTN, CAD, hyperlipidemia, atherosclerosis, diabetes

question

Obstructive sleep apnea disorder

answer

Have to have at least 5 periods of apnea lasting at least 10 seconds

question

precentral sulcus

answer

primary motor cortex

question

postcentral sulcus

answer

primary somatosensory cortex

question

Cingulate gyrus

answer

part of limbic system; emotion formation and processing, learning, memory

question

Caudate nucleus

answer

part of basal ganglia

question

Lentiform nucleus

answer

Caudate wraps around it; it is comprised of the putamen and the globus pallidus

question

What does the primary motor cortex do?

answer

Recruits a single muscle to perform simple, localized execution of movement

question

What do the premotor and supplementary motor areas do?

answer

These areas orient and prepare the body for action; they recruit groups of muscles and allow for performance of complex actions

question

What are the three main connections between cerebellum and brain stem?

answer

Superior cerebellar peduncles: connect to midbrain Middle cerebellar peduncles: connect to pons Inferior cerebellar peduncles: connect to medulla

question

What deficits are seen in tertiary syphilis? What areas are affected?

answer

Proprioceptive loss and pain (pain due to posterior root irritation)--particularly affecting lower extremities. The area that the lesion affects includes the posterior columns (fasciculus gracilis and cuneatus), and may extend to the posterior (or dorsal) root and even to the dorsal root ganglia

question

What deficits are seen in pernicious anemia? What anatomical area is affected?

answer

Pernicious anemia is B12 deficiency anemia Proprioceptive loss and UMN weakness The lesion affects the posterior columns, as well as the corticospinal tract (probably the lateral, as it lies closer to the posterior columns); B12 is needed for myelination so it causes issues with that

question

What deficits are seen in polio? Why?

answer

These patients present with weakness, atrophy, fasciculations, fibrillations, hyporeflexia. These are all LMN signs. Polio attacks anterior horn cells; this is where UMN synapse with LMN and where the LMN cell bodies lie--attacks there will damage LMN

question

What is Wernicke's aphasia? What is a common cause?

answer

speech is fluent, but not comprehensible pt unaware, not frustrated reading and writing often impaired, cannot repeat Common cause: embolism to inferior division of dominant MCA

question

Broca's aphasia? Common causes?

answer

speech is nonfluent, slow, interrupted, usually dysarthric no repetition writing is impaired pt. aware of problem Common cause: superior division of MCA

question

What is conduction aphasia?

answer

Lesion between Broca's and Wernicke's; language comprehension is intact and speech is fluent Cannot repeat, name, or write

question

What is global aphasia?

answer

Lesion of Broca's, Wernicke's, and the arcuate fasciculus Often caused by proximal occlusion of the MCA Cannot read, write, or repeat words

question

What is transcortical motor aphasia?

answer

Frontal lobe around Broca's area is impaired, but Broca's, Wernicke's and arcuate fasciculus remain intact Unable to initiate convo, repetition is intact Common cause: infarction in watershed zone between ACA-MCA

question

What is transcortical sensory aphasia?

answer

affects temporal lobe around Wernicke's, but Wernicke's is spared Repetition is preserved, speech is fluent but with paraphasia and echolalia Cannot read or write Lesion located in posterior parietooccipital lobe

question

What is transcortical mixed aphasia?

answer

Broca's, Wernicke's, and arcuate fasciculus are intact but the surrounding regions are affected Like global aphasia except that they can repeat

question

What is anomia? What is typically damaged in this type of aphasia?

answer

Anomia usually involves damage to the angular gyrus which is involved in transferring visual information to Wernicke's area and in memory retrieval. Anomia basically involves difficulty finding the right word...comprehension and repetition are intact while the person has a hard time understanding written language or pictures

question

Cortical watershed strokes vs. subcortical watershed strokes

answer

Cortical often from embolism..don't always have hypoperfusion Subcortical are white matter infarcts that usually arise from hypoperfusion in areas between deep and superficial MCA zones or superficial systems of MCA and ACA

question

What is syringomyelia?

answer

Either congenital (Chiari malformation Type 1) or acquired ; degenerative disease of the central cord of brain stem (etiology unknown). Most lesions are between C2-T9, but can descend or ascend from those levels. Because the lesion is at the central cord, it damages the anterior white commissure, and thereby affects the crossing spinothalamic tract, causing pain-temp loss at the level just a few above the lesion (spinothalamic ascends before crossing). Pain and temp loss is in a "cape-like" distribution because of level of lesion. The lesion may spread from the central part of the cord and compress other areas, such as motor areas (think lateral corticospinal particularly).

question

What symptoms are associated with nucleus ambiguus problems?

answer

Hoarseness and difficulty swallowing

question

What is the classical syndrome of the PICA? Symptoms and associated nuclei or tract causing problem

answer

Cerebellar dysfunction w/ right-sided ataxia (right spinocerebellar tract), loss of pain-temp on right face (injury to spinal tract and nucleus of right CN5) and left upper and lower extremities (right spinothalamic tract), hoarseness and difficulty swallowing (right nucleus ambiguus), loss of taste on right (right nucleus solitarius), vertigo and nystagmus (irritation of vestibular nuclei).

question

Arteries responsible for lateral and medial midbrain?

answer

PCA takes care of all midbrain

question

Arteries for lateral and medial pons?

answer

lateral: AICA medial: Basilar

question

Arteries for lateral and medial medulla?

answer

lateral: PICA medial: ASA (anterior spinal arteries)

question

What deficits are associated with each of the CN? (3-12)

answer

3: eye turned out and down 4: eye unable to look down when looking @ nose 5: ipsilateral face sensory loss 6: ipsilateral eye abduction loss 7: ipsilateral facial weakness/droop 8: ipsilateral deafness 9: ipsilateral pharynx sensation loss 10: ipsilateral palatal weakness 11: ipsilateral shoulder weakness 12: ipsilateral tongue weakness

question

What are the four medial in the rule of 4's and what deficits are associated with each?

answer

Motor nuclei: ipsilateral CN motor loss Medial lemniscus: contralateral proprioception and vibration loss Motor pathway: contralateral weakness MLF: ipsilateral INO (lateral rectus works but medial does NOT, so problems with adduction)

question

What are the four lateral in the rule of 4's and what deficits are associated with each?

answer

Sympathetic: ipsilateral Horner's syndrome Spinothalamic: contralateral pain/temp loss Spinocerebellar: ipsilateral ataxia Sensory to face: pain/temp loss in ipsilateral face

question

What are poliomyelitis and Werdnig-Hoffmann? How are their presentations different?

answer

LMN lesions. These are congenital degenerations of the anterior horns of the spinal cord. "Floppy baby" with hypotonia and tongue fasciculations. Infantile type = young death Autosomal recessive inheritance. Poliomyelitis present with asymmetric weakness, whereas W-H is symmetric weakness.

question

What parts of the spinal cord are spared in a complete occlusion of the ASA?

answer

The posterior portions of the spinal cord, so the dorsal columns and Lissauer tract (where spinothalamic enters the cord). UMN deficits below the lesio, LMN at level, loss of pain and temp below lesion

question

What is tabes dorsalis?

answer

This is caused by tertiary syphilis. Degeneration of dorsal columns and roots which leads to impaired proprioception and poor coordination. Charcot joints, shooting pain, Argyll Robertson pupils (do NOT constrict to light)

question

Vitamin B12 deficiency

answer

Demyelination of spinocerebellar tracts, lateral corticospinal tracts, and dorsal columns --> ataxic gait, paresthesia, impaired position/vibration sense

question

What is often the cause of cauda equina syndrome?

answer

Compression of spinal roots from L2 and below (often by intravertebral disk herniation or tumors). Unilateral radicular pain, absent knee and ankle reflex, loss of bladder and anal sphincter control

question

Brown-Sequard syndrome

answer

Presents with: 1) ipsilateral sensation loss AT lesion level 2) ipsilateral LMN signs AT level 3) ipsilateral UMN signs BELOW lesion 4) ipsilateral loss of proprioception, vibration, light touch, tactile sense BELOW lesion 5) contralateral pain, temp, crude touch BELOW lesion

question

Friedrich Ataxia

answer

Trinucleotide repeat on chromosome 9--GAA. This encodes frataxin, which is an iron binding protein. Leads to mitochondria functioning problems. Presentation: muscle weakness, loss of DTRs, vibratory sense, proprioception. Staggering, falling, nystagmus, dysarthria, hypertrophic cardiomyopathy (this is what causes death).

question

What is the presentation of a CN 5 lesion? (motor)

answer

Jaw deviates towards lesion b/c the opposite pterygoid is unopposed

question

What is the presentation of CN 10 lesion?

answer

Uvula deviates away from the lesion

question

What is the presentation of CN 11 lesion?

answer

Weakness turning head to contralateral side of lesion, with shoulder droop on side of lesion.

question

CN 12 lesion presentation

answer

tongue deviates toward side of lesion

question

Noise-induced hearing loss

answer

Damage to hair cells in organ of Corti. Loss of high-frequency hearing occurs first. (Makes sense because they are closest to base of cochlea).

question

What are the demyelinating or dysmyelinating diseases?

answer

Guillain-Barre (autoimmune that destroys Schwann cells) || Acute disseminated encephalomyelitis (after infection or vaccination) || Charcot-Marie-Tooth disease (defective production of proteins involved in myelin sheath) || Krabbe disease (lysosomal storage disesase, buildup of galactocerebroside and psychosine destroys sheath) || Metachromatic leukodystrophy (buildup of sulfatides due to lysosomal storage disease, leads to destruction of sheath) || Progressive multifocal leukoencephalopathy (destruction of oligodendrocytes) ||

question

Neurofibromatosis Type I

answer

Caused by a mutation in the NF1 tumor suppressor gene on chromosome 17 --> normally codes for neurofibromin. Autosomal dominant, 100% penetrance. Presentations: cafe-au-lait spots, cutaneous neurfibromas, optic gliomas, pheochromocytomas, Lisch nodules (in iris)

question

Neurofibromatosis type II

answer

Mutation in NF2 tumor suppressor gene on chromosome 22 (Merlin gene), autosomal dominant. Findings: bilateral acoustic schwannomas, juvenile cataracts, meningiomas, ependymomas

question

Optic canal

answer

CN2, ophthalmic artery -middle cranial fossa

question

Superior orbital fissure

answer

CN3, 4, 6, V1, superior ophthalmic vein -middle cranial fossa

question

Foramen spinosum

answer

MMA and vein CN V3 -middle cranial fossa

question

Foramen ovale

answer

CN V3, lesser petrosal nerve, accessory meningeal artery, otic ganglion -middle cranial fossa

question

Foramen rotundum

answer

CN V2 -middle cranial fossa

question

Foramen magnum

answer

ASA, PSA, vertebral arteries, medulla, meninges, dural veins -posterior cranial fossa

question

Hypoglossal canal

answer

CN 12 -post. cranial fossa

question

Jugular foramen

answer

CN 9, 10, 11, internal jugular vein -post. cranial fossa

question

Internal acoustic meatus

answer

CN 7, 8, labrynthine artery -post. cranial fossa

Clinical Neuroanatomy Made Ridiculously Simple (+ other nuggets) – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards