USMLE 1 Neuroscience
Terms
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- Where are skeletal motor neurons and preganglionic autonomic neurons derived?
- Neural Tube
- What form postganglionic autonomic neurons and sensory neurons?
- Neural Crest cells
-
What do all ganglia contain?
(2) -
Sensory neurons
or
Postganglionic autonomic neurons
(both from neural crest cells) - Neural crest cells which migrate to the Adrenal Medulla to form postganglionic sympathetic neurons?
- Chromaffin cells
-
What type of defect in development causes an increase in
Alpha-feto protein? - Neural tube defect
-
Aside from the epidermis, hair and nails, what else does the Surface Ectoderm make?
(5)* -
A PILE:
Anterior Pituitary
Parotid gland
Inner ear
Lens of the eye
Enamel of teeth - Germ layer that forms the retina, CNS and pineal gland?
-
Neuroectoderm
(Neural tube) -
What (3) systems are formed by the Mesoderm?
What organs from other systems?
(3) -
Musculoskeletal
(all bone and muscle);
Cardiovascular
(heart, blood, lymph, vessels);
Reproductive organs
Organs:
Spleen;
Adrenal cortex;
Kidney and ureter - What part of the thyroid is formed by the Neural crest cells?
- Parafollicular (C) cells
- What germ layer forms every organ aside from the neurological, integumentary, musculoskeletal, reproductive and CV systems (and the spleen, adrenal and kidney)?
-
Endoderm
(every individual organ aside from those mentioned) - What germ layer makes the dura?
-
Mesoderm
(others from Neural crest) - Where are the preganglionic neuron cell bodies?
-
in the CNS
(postganglionic cell bodies are in the ganglion = PNS) - What drives all sympathetic preganglionic neurons?
- Hypothalamic fibers
- Which is Preganglionic versus Postganglionic: White rami or gray rami?
-
Pre = White
Post = Gray - The Otic ganglion supplies what nerve to where?
-
CN-9
to Parotid gland - What ganglion supplies CN-3 to the ciliary muscle and the pupillary sphinctor?
- Ciliary ganglion
-
What are the parasympathetic preganglionic neurons?
(7) -
CN-3;
CN-7;
CN-9;
CN-10
S-2;
S-3;
S-4 - What are the (5)* secondary vesicles and their adult derivatives from top to bottom?
-
Todd Detests STYs:
Telencephalon = Cerebral Hemispheres;
Diencephalon = Thalamus;
meSencephalon = Midbrain
meTencephalon = Pons / Cerebellum*;
mYelencephalon = Medulla - The (4) parts of the Ventricles are derived from which vesicles?
-
Telencephalon = Lateral
Diencephalon = Third
Mesencephalon = Aqueduct
Metencephalon = Fourth (top)
Myelencephalon = Fourth (bottom) - (3) Differential Dx of ailments that affect the axon in Retrograde Transport
-
Herpes virus;
Polio;
Tetnus toxin -
In Spina Bifida, where is the defect?
What prevents this? -
Vertebral arches
prevents it:
Folic Acid - difference b/t Meningocele and Meningomyelocele?
-
Meningocele = meninges only
Meningomyelocele = meninges and cord - which spinal formation defect is the most severe?
-
Spina bifida w/ Myeloschisis
(neural tube is open on the back--not covered w/ skin)
also called Rahischosis - Muscular demyelinating dz that affects only the Optic nerve in the CNS?
- Multiple Sclerosis
- Which CN exits dorsally?
-
CN-4
Trochlear nerve -
CNS cell:
physical support and repair; maintains BBB
what is the cellular marker? -
Astrocyte
marker:
GFAP -
CNS cell:
lines the ventricles - Ependymal cells
-
CNS cell:
only supportive CNS cell from the Mesoderm
what is its action? -
Microglia
(phagocytosis) -
CNS cell:
most common type of glial cell in white matter - Oligodendroglia
-
CNS cell:
cell associated w/ acoustic neuroma - Schwann cell
-
Sensory cell:
Light discriminatory touch on hairless skin (palms, soles, fingers) - Meissner's corpuscles
-
Sensory cell:
deep cell involved in pressure, coarse touch, vibration and tension - Pacinian corpuscle
-
Sensory cell:
in dermis of fingertips, hair follicles and hard palate for light, crude touch - Merkel's corpuscles
- which peripheral nerve layer is the permeability barrier and must be rejoined in microsurgery for limb attachment?
- Perineurium
- What cells make the CSF?
- Choroid plexus
-
What is the path of CSF to the Subarachnoid space?
(8) -
LM3 S4 LMS:
Lateral ventricle ->
Monroe (foramen) -> Third ventricle ->
Sylvius Aqueduct -> Fourth Ventricle ->
Luschka and Magendie foramen ->
Subarachnoid space -
Which is always abnormal in CSF:
Monocytes
Lymphocytes
PMNs -
PMNs
(bacterial meningitis) -
Dx:
Excessive dilation of ventricles - Hydrocephalus
-
At what level does the spinal cord end?
Subarachnoid space?
Where is lumbar puncture performed? -
Cord ends: L2
meninges end: S2
puncture: L3 - L5 - which part of the spinal cord is sensory versus motor?
-
Dorsal = Sensory
Ventral = Motor - in the spinal cord, where are the ascending and descending tracts versus the cell bodies?
-
White matter = Tracts
Gray = Cell bodies - Which horn of the spinal cord participates in reflexes?
- Dorsal horn
- Where is pressure, vibration, touch and proprioception in the spinal cord?
- Dorsal columns
- Where is the voluntary motor section of the spinal cord?
- Lateral corticospinal tract
- Where is the pain and temperature section of the spinal cord?
-
Spinothalamic tract
(anterior to the ventral horns) - Where are the cell bodies of an Upper Motor Neuron?
- UMN = Brain stem and Cerebral Cortex
- What connects the two hemispheres?
- Corpus Callosum
-
Where is it in cortex?
Vision - Occipital lobe
-
Where is it in cortex?
Hearing - Temporal lobe
-
Where is it in cortex?
Taste -
Insula
(below postcentral gyrus) -
Where is it in cortex?
Reading and writing - Angular gyrus
-
Where is it in cortex?
Primary Motor - Precentral gyrus
-
Where is it in cortex?
Primary Sensory - Postcentral gyrus
-
Where is it in cortex?
Wernicke's area - Temporal lobe, superior gyrus
-
Where is it in cortex?
Broca's area - Frontal lobe near lateral fissure
-
What structures does the needle go thru in a lumbar puncture?
(7) - Skin -> Ligaments -> Epidural space -> Dura mater -> Subdural space -> Arachnoid -> Subarachnoid space (for CSF)
- What is different if a lesion on the corticospinal tract occurs above versus below the pyramidal decussation (medulla)?
-
Above = Contralateral side weakness
Below = Ipsilateral side weakness - If you ask a patient to place their feet together and close their eyes, and the patient sways (positive Romberg sign), where is the lesion?
-
Dorsal columns
(if swaying w/ eyes open = cerebellar damage) - where does neuron 1 end in the Dorsal column-medial lemniscus pathway?
- Ipsilateral nucleus cuneatus or gracilis in Medulla
- Which of the major tracts crosses at the level of the entering first neuron?
- Spinothalamic tract
- where is the lesion anywhere along the spinothalamic tract in the cord or brainstem?
- Contralateral to signs
-
where is the first synapse in the spinothalamic tract?
where does the second neuron cross? -
Ipsilateral Dorsal gray matter at the entry level of the neuron
Second neuron crosses on the same level in the white commissure and ascend laterally - What is the Babinski sign?
- Dorsiflexion of big toe and fanning of the others
- Landmark for a pudendal nerve block
- Ischial spine
- Landmark for lumbar puncture
- Iliac crest
-
CN responsible for:
movement of the face muscles -
CN-7
Facial -
CN responsible for:
sensation of the face -
CN-5
Trigeminal -
CN responsible for:
taste from anterior 2/3 or tongue -
CN-7
Facial -
CN responsible for:
taste from posterior 1/3 or tongue -
CN-9
Glossopharyngeal -
CN responsible for:
Tongue movement -
CN-12
Hypoglossal -
CN responsible for:
Mastication -
CN-5
Trigeminal -
CN responsible for:
Crying -
CN-7
Facial - Exit from the skull of the 3 parts of the Trigeminal nerve
-
Standing Room Only:
V-1: Superior Orbital Fissure
V-2: Rotundum (foramen)
V-3: Ovale (foramen) -
Which cross-section of the spinal cord has:
1. greatest amount of Gray matter
2. Lateral horns -
1. Lumbar
2. Thoracic -
Dx:
LMN symptoms bilaterally, including flaccid paralysis - Polio
-
Dx:
lesion in white matter of cervical spine due to demyelination; scanning speech, intention tremor, Nystagmus -
Multiple sclerosis
its a SIN to have MS:
Scanning speech,
Intention tremor;
Nystagmus -
Dx:
Bilateral dorsal column signs below lesion; positive Romberg; locomotive ataxia; reactive to accomodation but not light; shooting pain -
Tabes Dorsalis
(syphillis)
(accomodation but not light = Argyll Robertson pupils) -
Dx:
Everything gone except the dorsal columns -
Ventral Artery occlusion
(Anterior Spinal Artery) -
Dx:
Bilateral loss of pain and temp in upper extremities but still has touch -
Syringomyelia
(enlargement of central canal of spinal cord) -
Dx:
Combined upper and lower motor neuron deficits w/o any sensory deficit -
ALS
(Amylotrophic Lateral Sclerosis) -
Dx:
demyelination of dorsal columns, lateral corticospinal tract; ataxic gait; hyperreflexia; impaired position and vibration -
Vitamin B-12 neuropathy
(Friedrich's ataxia) -
Dx:
Non-fluent aphasia w/ intact comprehension -
Broca's aphasia
(BROken speech)
(Nonfluent/Expressive/Motor) -
Dx:
Fluent aphasia w/ impaired comprehension -
Wernicke's aphasia
(Wordy; Wernickies = "What?")
(Fluent/Receptive/Sensory) -
Dx:
Sudden flailing of one arm
where is lesion? -
Hemiballismus
lesion:
Contralateral Subthalamic Nucleus -
Dx:
Slow, writhing movements, especially in fingers
where is lesion? -
Athetosis
lesion:
Basal Ganglia -
Dx:
Sudden jerky purposeless movements
where is lesion? -
Chorea
lesion:
Basal Ganglia - (7)* functions of the Hypothalamus
-
TAN HATS:
Thirst and water balance;
Adenohypophysis;
Neurohypophysis;
Hunger;
Autonomic regulation / Circadian rhythm;
Temperature;
Sexual urges and emotions -
Nucleus in Hypothalamus:
Thirst and water balance -
Supraoptic
(holding a pee makes you feel water up past your eyeballs) -
Nucleus in Hypothalamus:
Destruction leads to Anorexia -
Lateral
(destroying "Lateral" makes you thin) -
Nucleus in Hypothalamus:
Destruction leads to hyperphagia and Obesity -
Ventromedial
(destroying makes you grow ventrally and medially) -
portion of Hypothalamus:
Regulates Parasympathetics
what else does it regulate? -
Anterior
also: Cooling when hot
[Wear a CAP when you are hot]
(Cooling - Anterior - Parasymp) -
portion of Hypothalamus:
Regulates Sympathetics
what else does it regulate? -
Posterior
also: Heat when cold -
Nucleus in Hypothalamus:
Destruction leads to Rage;
normally leads to pleasure -
Septal nucleus
(Septal = Sexual urges) - Which nucleus for ADH and Oxytocin?
-
ADH = Supraoptic
Oxytocin = Paraventricular -
Portion of Thalamus:
Visual -
Lateral Geniculate Nucleus
(LGN)
(Lateral for Light) -
Portion of Thalamus:
Auditory -
Medial Geniculate Nucleus
(MGN)
(Medial for Music) -
Portion of Thalamus:
Body sensations - pressure, touch, vibration -
Ventral Posterior Lateral
(VPL)
V = Vibration
P = Pressure
L = Light touch -
Portion of Thalamus:
Facial sensation -
Ventral Posterior Medial
(VPM)
[Very Pleasant Mug (face)] -
Portion of Thalamus:
Motor -
Ventral Lateral/Anterior nuclei
(VL/VA)
[Volumes of Lifting and Aerobics] - Major relay for ascending sensory info that ultimately reaches the cortex
- Thalamus
- Portion of the brain responsible for Feeding, Fighting, Feeling, Flight and F-cking
-
Using "LIMBS" for all 5 F's:
Limbic system - Portion of the brain tha is important for voluntary movements and making postural adjustments
- Basal Ganglia
-
Where does the Direct and Indirect pathway of DA from Substantia Nigra go to first?
Second?
Third? -
First:
both to Putamen
Second:
Direct (+) = Globus Pallidus Internal (GPi)
Indirect (-) = GPe
Third:
GPi -> Thalamus or Pedunculopontine nucleus in spine
GPe -> GPi or Subthalamic Nucleus (to GPi) -
Numbered areas of Brain:
1. 1,2,3
2. 4
3. 6
4. 8 -
1. Sensory
2. Motor
3. Premotor
4. Frontal eye fields -
Numbered areas of Brain:
1. 17
2. 22
3. 41, 42
4. 44, 45 -
1. Principal Visual cortex (occipital)
2. Assoc Auditory (Wernicke)
3. Primary Auditory
4. Motor Speech (Broca) -
Lesion:
lack of social judgement - Frontal lobe
-
Brain Vessel:
Leg and foot area of the motor and sensory cortices; medial surface of the brain - Anterior Cerebral artery
-
Brain Vessel:
supplies the trunk, arm and face of the motor and sensory cortices; Wernicke and Broca's areas; Lateral aspect of the brain - Medial Cerebral artery
-
Brain Vessel:
may cause visual field defects; most common Circle of Willis aneurysm - Anterior Communicating artery
-
Brain Vessel:
causes CN-3 palsy - Posterior Communicating artery
-
Brain Vessel:
division of middle cerebral artery; "arteries of stroke"; supply internal capsule, caudate, putamen, globus pallidus - Lateral Striate
- what would a stroke in the anterior part of the circle of willis give?
-
sensory and motor dysfunction;
aphasia -
How would a stroke in the posterior part of the circle of willis present?
(3) - cranial nerve deficits, coma, ataxia
- Main vein return of the CSF
- Superior Sagittal sinus
- what protects a clavical fracture from a brachial plexus injury?
- Subclavius muscle
- Initial sign of an acute appendicitis appears in what dermatome?
-
T-10
(at the belly butTEN) - what nerve refers gall bladder pain to the right shoulder?
- Phrenic nerve
- dermatome for the Inguinal Ligament
- L1 = IL
-
what monitors muscle length?
muscle tension? -
Length = muscle Spindles
Tension = Golgi Tendon organs -
What are the Thenar and Hypothenar muscles?
(3 each) -
Thenar = Thumb
OAF (Oppose, Abduct, Flex)
POLLICIS
Hypothenar is pinky
OAF
DIGITI MINIMI - (4)* muscles that the Radial nerve innervates
-
BEST ("great extensor nerve"):
Brachioradialis;
Extensors of wrist and fingers;
Supinator;
Triceps - (3) Vagal Nuclei and their function (and any assoc CN)
-
nucleus Solitarius = Sensory of viscera (incl taste)
CN-7, 9, 10
nucleus aMbiguus = Motor of pharynx and esophagus
CN-9, 10, 11
Dorsal Motor = Parasymp to heart, lungs and UGI - What cranial nerves have exits through the sphenoid bone?
- CN-2 to CN-6
-
what cranial nerves pass through the Cavernous Sinus?
(5) -
eye muscle nerves (CN-3, 4, 6)
and
V-1 and V-2 -
What vessel passes through the cavernous sinus?
Which is the only "free floating" cranial nerve in the cavernous sinus? -
Internal carotid
CN-6 -
Definition:
takes venous blood from the eyes and superficial cortex to the internal jugular; also houses the pituitary - Cavernous sinus
- (3) muscles that close the jaw
-
M = Munch:
Masseter;
teMoralis;
Medial pterygoid -
muscle that lowers the jaw
what are all muscles of mastication innervated by? -
Lowers = Lateral pterygoid
Innervated: V-3 - What are the "glossus" muscles innervated by?
-
all except PALATOglossus are innervated by the hypoGLOSSal nerve (Palat = vagus)
Palat = vagus
-glossus = hypoglossal - What are the "palat" muscles innervated by?
-
all except Tensor veli Palatini are innervated by the Vagus (Tensor = V-3)
Palat = Vagus
TENSor was too TENSE and is V-3 - what innervates each of the eye muscles?
-
LR6 SO4 R3:
Lateral Rectus = CN-6
Superior Oblique = CN-4
Rest = CN-3 -
Movement of following eye muscles:
1. Superior Oblique
2. Superior Rectus
3. Inferior Oblique
4. Inferior Rectus -
1. DOWN nasal
2. up lateral
3. UP nasal
4. down lateral
Rectus = Lateral (like LR)
Oblique = Opposite direction - CN and nuclei involved in a normal pupillary light reflex
-
CN-3 -> Pretectile nuclei ->
Edinger-Westphal nuclei -
Sounds and CN used to test:
1. palate elevation
2. tongue
3. lips -
1. Kuh-kuh (CN-10)
2. La-la (CN-12)
3. Mi-mi (CN-7) - Extraocular eye movements during REM is due to what area of the brain?
-
Paramedian Pontine Reticular Formation
(PPRF) - Aphasia w/ poor repitition and good comprehension; fluent speech
-
Arcuate Fasciculus
(connects Wernicke to Broca) -
Dx:
Hyperorality, hypersexuality, disinhibited behavior
where is lesion? -
Kluver-Bucy syndrome
lesion:
bilateral Amygdala -
Where is lesion?
Spacial neglect syndrome - Right parietal lobe
-
Where is lesion?
Tremor at rest, chorea, athtosis - Basal Ganglia
-
Where is lesion?
Truncal ataxia, dysarthria -
Cerebellar Vermis
(Vermis is central and affects Central part of body) -
Where is lesion?
Coma - Reticular Activating system
-
what type of amyloid is w/ alzheimers?
what chromosome/allele w/ familial form?
(2) -
Beta-amyloid
Chrom 1, 14, 19 - APOE4 allele
Chrom 21 - p-App gene -
Dx:
dementia, aphasia, parkinsonian aspects
what is sign/protein problem?
where is problem in brain (lobes)? -
Pick's Dz
Pick bodies = TAU protein
Frontal or temporal lobes only -
MCC of dementia in elderly?
2nd MCC? -
MCC = Alzheimers
2nd MCC = Multi-infarct dementia -
Dx:
chorea, dementia
what part of brain is atrophied?
what chromosome problem?
what NT problem? -
Huntington's Dz
CAG repeats on chrom 4 =
Caudate (C) loses ACh (A) and GABA (G) -
Dx:
Tremor at rest, Rigidity, Akinesia, Postural instability
what is sign in brain? -
Parkinson's
(TRAPped in body)
sign: Lewy Bodies -
Dx:
"floppy baby", tongue fasciculations, median age of death is 7 months
where is problem? -
Werding-Hoffmann Dz
prob: degeneration of Anterior horns -
Dx:
CSF has lymphocytic pleocytosis w/ slight protein elevation. Virus is recovered from stool or throat - Poliovirus
- classic triad of Multiple Sclerosis
-
SIN:
Scanning speech;
Intention tremor / Incontinence
Nystagmus - Tx for MS
- Beta-interferon
-
Dx:
demyelinating dz seen w/ AIDS
what virus? -
Progressive Multifocal Leukoencephalopathy
(PML)
virus: JC virus -
Dx:
symmetric ascending muscle weakness due to demyelination of PNS; diplegia, CV irregularities; papilledema
Causes (2) -
Gullian-Barre syndrome
causes:
Herpesvirus;
Campylobacter infection -
Tx for Gullian-Barre
(2) -
First line:
Respiratory support
also:
plasmapheresis -
Seziure type:
Consciousness intact - Simple Partial
-
Seziure type:
Blank stare - Absent (Petite mal)
-
Seizure type:
Quick, repetitive jerks - Myoclonic
-
Seizure type:
Alternating stiffening and movement - Tonic-Clonic (Grand mal)
-
Seizure type:
Stiffening - Tonic
-
Seizure type:
"drop" seizures - Atonic
-
Intracranial hemorrhage:
CT shows "biconcave disk" not crossing suture lines -
Epidural hematoma
(middle meningeal artery) -
Intracranial hemorrhage:
CT shows crescent-shaped hemorrhage that crosses suture lines -
Subdural hematoma
(bridging veins) -
Intracranial hemorrhage:
"worst HA of life", bloody spinal tap -
Subarachnoid hemorrhage
(berry aneurysm) - (3) Dx assoc w/ berry aneurysms
-
APKD;
Ehlers-Danlos;
Marfan's - what are clinical presentations of brain tumors due to?
-
Mass effects
(seizures, dementia, etc) - MCC brain tumor in adult
- Glioblastoma multiforme
-
Dx:
"butterfly glioma" - can cross the corpus callosum - Glioblastoma Multiforme
-
Dx:
"Pseudopalisading" tumor cells boarder the areas of necrosis and hemorrhage - Glioblastoma Multiforme
-
Dx:
spindle cells concentrically arranged in whorled pattern of this brain tumor; psammoma bodies; arises from arachnoid cells; on surface - Meningioma
-
Dx:
"fried egg" cells - round nuclei w/ clear cytoplasm in frontal lobes - Oligodendroglioma
-
Dx:
childhood brain tumor; diffusely infiltrating; posterior fossa; Rosenthal fibers - eosinophilic corkscrew appearance - Pilocytic Astrocytoma
-
Dx:
childhood brain tumor; rosettes or pseudorosettes; radiosensitive; neuroectodermal origin - Medulloblastoma
-
Dx:
perivascular pseudorosettes; rod-shaped blepharoplasts; MC in ventricles - Ependymoma
-
Dx:
childhood brain tumor w/ foamy cells and high vascularity
what is it assoc with?
what is the ectopic production? -
Hemangioblastoma
assoc w: Von Hippel-Lindau
ectopic: EPO -> polycythemia -
Dx:
benign childhood tumor from Rathke's pouch and can cause bitemporal hemianopsia - Craniopharyngioma
-
Dx:
Ipsilateral loss of all sensation; contralateral loss of pain and temp - Brown-Sequard syndrome
-
Dx:
Ptosis, anhidrosis, miosis of face
Can be associated w/ spinal cord lesion above what level? -
Horners syndrome
(PAM is Horny)
w/ spine above T-1 -
Nerve w/ site of injury:
Shaft of humerus - Radial
-
Nerve w/ site of injury:
Supracondyle of humerus - Median
-
Nerve w/ site of injury:
Medial epicondyle - Ulnar
-
Nerve w/ site of injury:
Surgical neck of humerus - Axillary
-
Dx:
loss of triceps brachii, brachioradialis, extensor carpi radialis longus -
Radial nerve injury
(Radial = wRist drop) -
Dx:
no loss of power in any arm muscles; loss of forearm pronation, wrist flexion, finger flexion, several thumb movements, thenar atrophy -
Median nerve injury
("Pope's Blessing" = cross in the median) -
Dx:
impaired wrist flexion and adduction, and impaired adduction of the thumb and last two fingers -
Ulnar nerve injury
(Claw hand) -
Dx:
Anterior shoulder dislocation; loss of deltoid action - Axillary nerve injury
-
Dx:
difficulty flexing elbow; loss of function of coracobrachialis, biceps, and brachialis muscles (and biceps reflex) - Musculocutaneous nerve injury
- Bracial plexus is assoc w/ what 5 spinal nerves?
- C5, C6, C7, C8, T1
- what is the order of the (5)* main nerves as they come off the brachial plexus (top to bottom)?
-
CAMel RUn:
musculoCutaneous;
Axillary;
Median;
Radial;
Ulna -
Dx:
limb hangs at side, medially rotated and forearm is pronated
where is problem?
what is common cause? -
Erb-Duchenne Palsy
("Waiter's Tip")
C5 and C6 (upper trunk) injury
occurs as delivery trauma - What innervates the lateral and anterior foot?
-
PED = Peroneal Everts and Dorsiflexes
Deep Peroneal = Anterior
Superficial Peroneal = Lateral - What innervates the posterior foot and plantar flexes?
-
TIP = Tibial Inverts and Plantarflexes
(can't stand on TIPtoes) - what nerve corresponds to L3-L4?
- Femoral
-
Dx:
delivery causes atrophy of thenar, hypothenar and interosseous muscles, sensory deficit on medial forearm, dissapearance of radial pulse w/ movement of head to opposite side
what is compressed?
(2) -
Thoracic Outlet Syndrome
(Subclavian artery and inferior Trunk (C8, T1) of brachial plexus) - Which is the only sympathetic that secretes ACh?
- Sweat gland
-
How do you tell where a CN-12 lesion is?
(3 steps) -
1. have person stick tongue out to determine if flaccid or spastic paralysis
2. look to which side it deviates
3. LMN (flaccid) deviates toward side of lesion; UMN (spastic) deviates away from side of lesion
(Lmn = Lick your wound (same side)) - what/where is Deviation of CN-5 lesion?
- Jaw towards lesion side
- Test for unilateral lesion of cerebellum?
- Rhomberg - patient falls Toward side of lesion
- Deviation of CN-10?
- Uvula deviates AWAY from side of lesion
-
Deviation of CN-11?
(2) -
Shoulder droop on side of lesion
weakness on turning head to contralateral side - what (2) CN have UMN and LMN symptoms if there is a lesion?
-
CN-7
CN-12 -
which CN problem?
Palatal sagging and vocal cord paralysis - CN-10
-
(4) nuclei associated w/ CN-9
which deals w/ the gag reflex? -
Spinal V
Solitarius (tongue)
Inf. Salvitory (Parotid)
Ambiguus (gag reflex) - A tumor of the internal jugular at the petrosus temporal bone would have an effect on what CN?
- CN-9, 10, 11
- what ganglion / nerve does a right turn inside the skull?
- Geniculate ganglion of the Facial nerve
-
Dx:
brain tumor causing truncal ataxia, wide-based gait, projectile vomiting - Meduloblastoma
- in a Webber hearing test, how do you tell what type of problem it is if the sound localizes to one side?
-
Ipsilateral = Conduction loss
Contralateral = Sensorineural loss - what is the specific ganglia for the tear-producing part of CN-7?
-
Pterygopalatine ganglion
(spit = submandibular gang)
(all 3 originally from Superior salivary nuclei) - how do you know if patient has UMN or LMN CN-7 lesion?
-
UMN - contralateral LOWER face only
LMN - Ipsilateral UPPER and LOWER face
(Bells Palsy) -
what Dx can you see Bell's Palsy?
(5)* -
ALexander BELL w/ STD
AIDS;
Lyme dz;
Sarcoid;
Tumors;
Diabetes -
Herniation syndromes:
can compress cerebral artery -
Cingulate herniation
(under falx) -
Herniation syndromes:
Coma and death can result when it compresses brainstem - Central Transtentorial herniation
-
Herniation syndromes:
medial, temporal lobe herniation - Uncal
-
Herniation syndromes:
herniates into foramen magnum - Cerebellar tonsillar
-
Dx:
contrlateral hemiparesis, ipsilateral dilated pupil, ipsilateral gaze preference, caudal displacement of brainstem (Duret hemorrhages) - Uncal herniation
- where is lesion for a Left homonymous hemianopia
- right optic tract
- Where is the substantia nigra and VTA located?
- Midbrain
- how can you tell if CN-4 lesion is on the nerve or the nucleus?
-
Nerve = head-tilt away from lesion
Nucleus = head-tilt towards lesion -
Dx:
small irregular pupil that does not react to light but does to accomodation
what to Dx is it seen in? -
Argyll-Robertson the diabetic hooker w/ syphillis:
"Accomodates but does not react"
seen in:
Diabetes;
Syphillis -
visual field defect:
right temporal lobe lesion or Meyer's loop - Left upper quadrantic anopsia
-
visual field defect:
right upper (cuneate) calcarine fissure -
Left lower quadrantic anopsia
(w/ macular sparing) -
visual field defect:
right occipital lesion - Left hemianopia w/ macular sparing
-
Dx:
person cannot move right eye to left lateral but can converge both eyes to center
what muscle and CN involved?
what Dx is it commonly seen in? -
lesion of Medial Longitudinal Fasciculus (MLF)
(medial rectus palsy, normal w/ convergence; CN-3, CN-4)
MLF w/ MS -
NT changes:
Anxiety
(3) -
Inc NE
Dec GABA
Dec 5-HT -
NT changes:
Depression
(2) -
Dec NE
Dec 5-HT -
NT changes:
Alzheimer's - Dec ACh
-
NT changes:
Huntington's Dz
(2) -
Dec GABA
Dec ACh - If you shine a light in patient's right eye and both pupils constrict, then shine it in left eye and they both dilate, where is the lesion?
- Left Retinal outflow tract of Optic nerve
- Difference b/t MRI T1 and T2
-
T1 = Black water
T2 = white water -
Order of deep cerebellar nuclei from lateral to midline
(4)* -
Dont Eat Greesy Food
D
E
G
F -
In the cerebellum:
where are the parallel fibers?
Dendrites of Purkinje cells? -
Parallel = Granular layer
Dendrites of Purkinje = Molecular layer - Bridge b/t thinking brain and emotional brain
- Cingulate
- regulates placement and memory
- Hippocampus
- Regulates reward system; important in drug addiction
- Nucleus Accumbens
- where is the most likely place of a lesion for Aphasia?
- Temporal lobe
- What is the electrolyte flow for depolarization of hair cells in the cochlea?
- K+ into the cell depolarizes
- What receptor measures steady pressure on the skin?
- Ruffini endings
- What receptor measures vibration on the skin?
- Pacinian corpuscle
- what tracts are in the Inferior (3), Middle (1) and Superior (2) cerebellar peduncles?*
-
DIBs On TVS in the PM:
Inferior - Dorsal (cord); vestiBulocerebellar; Olive
Superior - Tectocerebellar; Ventral
Middle - Pontocerebellar -
when a person moves his head to the right, what happens in the semicircular canal?
(2) -
both (R and L) bend away from the Kinocilium;
Cupula moves to opposite side -
when light strikes the eye, what are the steps?
(6) -
Light -> CIS changes to TRANS ->
Inc Rhodopsin -> Inc Transducin ->
Dec cGMP -> Dec Na+ -> Hyperpolarization - if nystagmus is a symptom of a cerebellar lesion, where is the lesion?
- Flocculonodular lobe
- what is the equation for intensity of hearing?
- Intensity = 20 x log (sound/threshold)
-
what are two places in the ear that hear high-frequency sounds?
example of a low-frequency place? -
Base:
Oval window
Round window
(Apex - Helicotrema - hears low sounds) - what occurs with the biceps and triceps regarding Ia and Ib fibers when flexing the biceps?
-
Flex biceps:
Bicep -
Ia Dec firing (compressed);
Ib Inc firing (tension/contract);
Triceps -
Ia Inc firing (stretched);
Ib has no change