Term
| -What constitutes the PNS? CNS? |
|
Definition
-cranial nerves(12) and spinal nerves (31)
-brain and spinal cord |
|
|
Term
| What is a satellite cell? |
|
Definition
| supports cell bodies within ganglia |
|
|
Term
| What is an oligodendrocyte? |
|
Definition
-myelin forming glial cells in the CNS
-Has extensions that form myelin sheaths around several axons.
-used for insulation |
|
|
Term
|
Definition
-most abundant glial cell
-contribute to BBB by connecting neurons and capillaries
-regulate external environment of K and pH
-Take up K from ECF, NTs released from axons and convert lactic acid for ATP producion |
|
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Term
|
Definition
-phagocytes
-migratory purposes |
|
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Term
| What are ependymal cells? |
|
Definition
-glial cell that
-secretes CSF
-lines ventricles within the brain
-fxn as neural stem cell
-can divide and progeny differentiate |
|
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Term
| What does the corpus callosum do? |
|
Definition
| functionally interconnects right and left cerebral hemispheres. |
|
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Term
| What are the gyri and sulci of the cerebral cortex? |
|
Definition
gyri- elevated folds
sulci- depressed grooves
these increase surface area |
|
|
Term
| What constitutes the forebrain? hindbrain? |
|
Definition
-cerebrum, basal ganglia, thalamus, hypothalamus
-pons, medulla and cerebrum |
|
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Term
| What is the gray matter composed of? white matter? |
|
Definition
-neuron cell bodies and dendrites, forms cerebral cortex
-myelinated
-consists of axon tracts
-3 types of tracts
-projection tracts: descending or ascending
-association tracts: from one region to another within the same hemisphere
-commissural tracts: corpus callosum- from one hemisphere to another. |
|
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Term
| What do each of the four lobes mainly do? |
|
Definition
frontal- voluntary motor activity, speaking, higher intellectual ability
parietal- process sensory information
occipital- vision
temporal- auditoryW |
|
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Term
| What is the fxn of the insula in the cerebral cortex? |
|
Definition
Implicated in memory encoding.
Integration of sensory information with visceral responses.
Coordinated cardiovascular response to stress |
|
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Term
| What are the main fxns of the following language associated areas? |
|
Definition
Broca's
-articulation of speech
-when damaged, can still comprehend speech but cannot articulate it
Wernicke's
-language comprehension
-in damage, speech is rapid without any meaning
Angular gyrus
-integration of auditory, visual and somatesthetic information
***Arcuate fasciculus:
To speak intelligibly, words originating in Wernicke’s area must be sent to Broca’s area. |
|
|
Term
|
Definition
-typical when lay down after dinner
-acid from stomach comes into esophagus and wears down lining |
|
|
Term
| What are the causes of dysphagia (impaired swallowing)? |
|
Definition
-gastric ulcer, esophageal strictures, local lesion as neoplasm
-neuromuscular (lesions of CN IX, X, XII, neuromuscular jxn, descending corticobulbar pathways) |
|
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Term
| How is swallowing and the gag reflex innervated? |
|
Definition
Vagus nerve (swallowing)
Gag Reflex: CNIX takes gag reflex to brain
CNX brings it back from brain. |
|
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Term
| What can strep throat lead to if goes on undetected? |
|
Definition
|
|
Term
| What does the accessory nerve (XI) innervate? |
|
Definition
Sternocleidomastoid muscle
trapezius muscle |
|
|
Term
| What are the effects of atropine? |
|
Definition
-dilates eye
-opposite effect of ACh (parasympathetic), so atropine is sympathetic |
|
|
Term
| What does trochlear nerve do? |
|
Definition
| Goes to extraocular muscle. |
|
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Term
| What does the oculomotor (CN III) innervate? trochlear (CN IV)? Abducens (CN VI)? |
|
Definition
-Eyelid (levator palpebrae), all extra-ocular muscles except superior oblique, constricts pupil, ciliary muscles of the lens (ALL PARASYMPATHETIC)
-Superior Oblique
-Lateral Rectus |
|
|
Term
| Why do diabetics develop retinopathy? |
|
Definition
| -due to microangiopathy (smaller blood vessels) |
|
|
Term
| What are the 3 Pairs of antagonist muscles of the eye? |
|
Definition
-medial rectus (adduction) & lateral rectus (abduction)
-superior rectus (elevation while abducting) & inferior rectus (depression while abducting)
-superior oblique (depression while adducting) & inferior oblique (elevation while adducting) |
|
|
Term
| What are the causes of diplopia? |
|
Definition
-mechanical (orbital fracture)
-disorders of extraocular muscles
-myasthenia graves
DISORDERS OF CRANIAL NERVES III, IV and VI |
|
|
Term
What are the causes of monocular diplopia?
-does not go away when pt closes one eye. |
|
Definition
-Ophthalmological disease
-Visual cortex disorders
-Psychiatric conditions |
|
|
Term
| What are the symptoms of complete oculomotor palsy (CNIII)? |
|
Definition
-Eye goes down (superior oblique) and out (lateral rectus) at rest
-complete ptosis (levator palpebrae lost)
-pupil dilated and unresponsive to light (parasympathetic component (Edinger Westphal fibers) |
|
|
Term
| What are the causes of oculomotor palsy (CN III)? |
|
Definition
- Diabetic neuropathy
- Compression of third nerve by aneurysm
- Head trauma (shearing forces damage the nerve)
- Herniation of medial temporal lobe over edge of tentorium cerebelli
- Ophthalmoplegic migraine
- Stroke in midbrain |
|
|
Term
| What are the causes of abducens nerve palsy? (lateral rectus) |
|
Definition
-microvascular neuropathy of DM
-head trauma
-aneurysm
-increased ICP (intracranial pressure)
IMPORTANT EARLY SIGN OF INCREASED ICP! (along with papilledema) |
|
|
Term
| What are the objective and subjective early signs of increased ICP? |
|
Definition
Subjective: (HIND)
-headache
-impaired alertness
-nausea
-double vision
Objective:
-blurred disc margins (papilledema)
-bilateral sixth nerve palsy |
|
|
Term
| What are the two muscles of the iris? their fxns? innervations? |
|
Definition
-radial and circular
-radial innervated by parasympathetic (CNIII)
-fxn: contracts to constrict pupil
-circular muscle innervated by sympathetic muscle
-fxn: contracts to dilate pupil |
|
|
Term
| What are some types of opiates? |
|
Definition
-intravenous
-morphine
-codeine |
|
|
Term
| What is ptosis and, what muscles are used and how are they innervated? |
|
Definition
-cannot close the eye
innervation:
-levator palpebrae superior (CN III)
and
-Muller's smooth muscle (sympathetic) |
|
|
Term
| What is a migraine and what are its trigger? |
|
Definition
-overreactability of neuron
-neurovascular system is highly excitable
-can be genetic
triggers:
-coffee
-light
-menstrual cycle
-noise |
|
|
Term
|
Definition
-recurrent
-familial
-nausea/ vomiting
-triggers (food, stress)
-aura from vasospasm
-unilateral (60%)
-throbbing
photophobia/ phonophobia |
|
|
Term
Symptoms of basilar migraine (in brain stem)
********* |
|
Definition
|
|
Term
| What are signs of meningitis? |
|
Definition
-headache
-fever
-photobia, phonobia
-lethargy
-nuchal rigidity (stiff neck)
-can;t touch chin to chest
-Kernig's sign (Flex hips and straighten kneespain in hamstrings
-Brudzinski's sign (neck flexion causes hips to flex) |
|
|
Term
| What is the emetic center? |
|
Definition
in brain, responsible for vomiting.
-with headache, should always ask about nausea.
- could mean brainstem is effected
-ICP could be high or bleeding could be occurring here. |
|
|
Term
| What are pneumotaxic and apneuistic? |
|
Definition
-tells you to inhale
-tells you to stop inhaling |
|
|
Term
| How can we make BP fall in heart pts? |
|
Definition
| Give them Ca channel blockers (Ca causes contraction, without this contraction, BP falls) |
|
|
Term
| What do we put in eyes to dilate them? |
|
Definition
|
|
Term
| What aa is inhibitory in the CNS? excitatory? |
|
Definition
-GABA (can increase this in the brain by taking diazapin which causes sleep)
-glutamate is excitatory |
|
|
Term
| What is dopamine used for? |
|
Definition
schizophrenia and parkinson's
Parkinson's- Ach antagonist and dopamine agonist |
|
|
Term
| What condition can serotonin regulate? |
|
Definition
depression.
-lack of it causes depression
-serotonin increased when you do excercise |
|
|
Term
| What does histamine cause? |
|
Definition
|
|
Term
| How can Nitric Oxide be a friend or a foe? |
|
Definition
friend- viagra
mechanism: -acts via cyclic GMP, Produces NO2 to penile artery--> dilation-->pressure falls-->brings in blood
-can be used to treat hypertension
-if to much NO2- apoptosis and stroke. |
|
|
Term
| What does substance P control? |
|
Definition
Pain.
-produces endorphins to increase threshold of pain |
|
|
Term
| What does angiotensin do? |
|
Definition
-vasoconstriction
-Treats hypertension |
|
|
Term
| What are supratentorial lesions? |
|
Definition
numbness in hand
Tentorium- hypothetical division of forebrain and hindbrain. |
|
|
Term
| What are infratentorial lesions? |
|
Definition
motor, sensory, respiratory and circulatory ligament lesions.
Tentorium- hypothetical division of forebrain and hindbrain. |
|
|
Term
| What are the effect of dysfxn in the left hemisphere? right hemisphere? |
|
Definition
L: Loss of thinking ability, analytical skills, communication skills
R: Behavior, spatial orientation, interference with mobility |
|
|
Term
|
Definition
tingling sensation
numbness
'pins and needles' |
|
|
Term
| What is a transient ischemic attack? |
|
Definition
| stare for 20 seconds and don't remember what happened. |
|
|
Term
| You know a person had a stroke when they have deviation of any of the following.. |
|
Definition
|
|
Term
| What are 3 ways to look at the brain and how do they work? |
|
Definition
X-Ray computed tomography (CT)
-Obtained from x-ray absorption by tissues of different densities
Positron-emission tomography (PET)
-Radioisotopes that emit positrons are injected into blood stream
-allows the pinpointing of brain cells that are most active
-for brain metabolism and drug distribution
Magnetic Resonance Imaging (MRI)
-protons (H+) respond to a magnetic field-->emit a radio wave signal when stimulated.
-monitors brain fxn. |
|
|
Term
| How can a PET scan help you treat a stroke pt? |
|
Definition
-Since PET tells you about brain metabolism can look what % of brain is affected.
-this will change the way you treat |
|
|
Term
| What substances can easily be moved into the BBB? what about those that are cannot permeate BBB? |
|
Definition
Lipid soluble substances:
O2, CO2, steroid hormones,anesthetic, alcohol
Water soluble substances:
glucose, aa's, ions (but are many glucose transporters) |
|
|
Term
| How are mlcls moved selectively through endothelial cells of BBB? |
|
Definition
-DIFFUSION
-Active transport
-endocytosis
-excytosis |
|
|
Term
| Name 2 antihistamines and their relationship with the BBB? |
|
Definition
Benadryl
-lipophilic, readily crosses
-slowed rxn time or central side effects
Claritin
-less iliophilic
-does not cross BBB
-therefore less sedative. |
|
|
Term
|
Definition
K
Na
H
Ca
HCO
glucose
-very little protein, no RBC
-if blood present, then probably trauma to head. |
|
|
Term
|
Definition
-hemorrhage
-trauma
-edema
-infection
-tumor, excessive amount of CSF. |
|
|
Term
| How do you examine CN V? (TRIGEMINAL) |
|
Definition
Cotton wisp/ sharp object across face.
Palpate masseter muscles
With recurrent pain from chewing or talking... do MRI to rule out mass or MS |
|
|
Term
| how do you examine CN VII (Facial)? |
|
Definition
COWS
-close pt's eyes
-examiner tries to open eyes
-wrinkle forehead
-smile |
|
|
Term
|
Definition
Na blocker
-do not have any APs- cell death
-paralysis, no movement |
|
|
Term
| Describe the treatment of conductive vs. sensorineural hearing loss |
|
Definition
Conductive (waves are not coming in properly)
-hearing aide.
-due to issues with external ear canal
Sensorineural (neural issues)
-can use cochlear implant.
-caused by cochlear disorders and CNVIII |
|
|
Term
| Where does aN acoustic neuroma occur, and what are its effects? |
|
Definition
-where CN VIII enters internal auditory meatus
-grows in bony canal, then to cerebellopontine angle.
-Causes tinnitis and unsteadiness
-eventually affects CNV and CNVII |
|
|
Term
|
Definition
| gravity pulls at blood of peripherals (inner ear) and causes lightheadedness |
|
|
Term
|
Definition
-is a lesion somewhere in the vestibular pathway:
From Labyrinth -->Vestibular nerve-->Vestibular nuclei-->Parietal cortex.
-first 2 are peripheral disorders
-last 2 are central disorders |
|
|
Term
| What are some causes of vertigo? |
|
Definition
peripheral:
-benign positional (upon change of position) vertigo (most common)-- OTOLITHS PUSH AGAINST CAPULA
-vestibular neuronitis (longer lasting, either viral or inflammatory)
-Meniere's diseases
Central:
-Vertebrobasilar cerebrovascular event
-Posterior fossa tumors
-MS
-Drugs / toxins
-Seizures |
|
|
Term
| How should you treat inflammation (such as in vestibular neuronitis)? |
|
Definition
-short dose of sterroids
-gives localized effects
-orally gives systemic effects (not-preferable) |
|
|
Term
| How do you know if there is an ipsilateral vagal lesion? |
|
Definition
Say "Ahhhhhhhh"
-no palate elevation on that side, and uvula goes to opposite side |
|
|
Term
| How is the gag reflex innervated? |
|
Definition
CN IX takes gag reflex back to brain
CN X brings it back from the brain |
|
|
Term
| What are the causes of dyspahgia? |
|
Definition
-esophageal strictures
-local lesions on following:
-CN IX, X, XII
-neuromuscular jxn
-descending corticobulbar pathways |
|
|
Term
What are the types of dysconjugate gaze diplopia?
(does not go away when cover one eye) |
|
Definition
Exotropia: abnormal lateral deviation of one eye
Esotropia: abnormal medial deviation of one eye
Hypertropia: vertical deviation of an eye |
|
|
Term
What are the types of dysconjugate gaze diplopia?
(does not go away when cover one eye) |
|
Definition
Exotropia: abnormal lateral deviation of one eye
Esotropia: abnormal medial deviation of one eye
Hypertropia: vertical deviation of an eye |
|
|
Term
|
Definition
palsy of superior oblique muscle
-worse when affected eye looks nasally
-worse with down gaze
-improved by tilting head away from affected eye.
***when try to read a book, affected eye looks up, and will not go completely laterally |
|
|
Term
| What happens if there is a lesion in CN III in the efferent parasympathetic pathway? |
|
Definition
This is a lesion in the Edinger- Westphal nucleus to pupillary constrictor muscle.
-causes unilaterally dilated pupil |
|
|
Term
| What is horner's syndrome? |
|
Definition
-lesion anywhere along sympathetic pathway to CN III (eye and face)
INCLUDING:
- lateral brainstem
- spinal cord
- T1 or T2 roots (Pancoast syndrome)
- sympathetic chain
- carotid plexus
- cavernous sinus
- orbit
RESULTS IN:
-ptosis
-miosis
-anhidrosis |
|
|
Term
|
Definition
loss of innervation to muller's muscle of upper lid
-seen in Horner's Syndrome |
|
|
Term
|
Definition
Loss of sympathetic innervation to pupillary dilator muscle
-seen in Horner's Syndrome |
|
|
Term
|
Definition
decreased sweating of the ipsilateral face and neck
-skin feels smoother on affected side to due to decreased moisture.
-seen in Horner's Syndrome |
|
|
Term
| What effect do the following drugs have on the pupil? |
|
Definition
Opiates-pinpoint pupils
Barbituates-small pupils
Anticholinergic agents (scopolamine, atropine)- dilated pupils |
|
|
Term
| What is Adie's myotonic pupil? |
|
Definition
Degeneration of the ciliary ganglion
-mid-dilated pupil that reacts poorly to light |
|
|
Term
| What are some causes of ptosis? |
|
Definition
Horner’s syndrome
Cr III palsy
Myasthenia gravis
Pseudoptosis ! (Bell’s Palsy widened palpebral fissure: may think opposite eye has ptosis) |
|
|
Term
| What is a nystagmus? Describe the 2 types. |
|
Definition
INVOLUNTARY RHYTHMIC MOVEMENTS OF THE EYE.
PENDULAR
-Oscillations equal in rate in both directions
Central vision lost early in life
JERK
-alternate bw slow and fast movements
-named for which direction fast movement is in.
-can be drug induced or from brainstem lesions |
|
|
Term
| What is the first thing you do when someone has a headache? |
|
Definition
check blood pressure
-could be hypertension related (and thus, stress related) |
|
|
Term
| Why is a lumbar puncture done? What should happen before this LP? |
|
Definition
-CSF samples
-measuring CSF pressure
-to remove CSF in hydrocephalus (therapeutic)
-to introduce drugs/ contrast material
before LP:
-evaluate for increased ICP
-examine for papilledema
-CT scan or MRI |
|
|
Term
| What does blood in CSF indicate? |
|
Definition
- subarachnoid hemorrhage
- hemorrhagic herpes encephalitis
- a traumatic tap (more blood in first tube than in last) |
|
|
Term
| After centrifuging CSF blood... |
|
Definition
yellow- if has been in CSF for several hours
clear-with traumatic tap
bacteria present- could be meningitis or MRSA |
|
|
Term
| What is temporal arteritis? |
|
Definition
INFLAMM OF TEMPORAL ARTERIES AND ARTERIES TO THE EYES
-50 yrs +
-visual disturbances (abrupt)
-jaw claudication (pain with exertion)
-ESR (erythrocyte sedimentation rate) elevated
Treatment with sterroids |
|
|
Term
| What is polymagia rheumatica? |
|
Definition
Subacute or chronic onset of aching and morning stiffness in the shoulders, hip girdles, neck and torso in patients over the age of 50.
Some patients also complain of malaise, fatigue, anorexia, weight loss. |
|
|
Term
| What does the venous sinus system do? |
|
Definition
drains head
-superior
-inferior
-occipital
-jugular |
|
|
Term
| What is anterograde amnesia? Retrograde? |
|
Definition
| -Difficulty remembering new facts & events occurring AFTER lesion onset |
|
|
Term
| What are the characteristics of postconcussive syndrome? |
|
Definition
-variable headaches
-dizziness
-fatigue
-inability to tolerate alcohol, noise, emotional excitement and crowds
-can persist for months to years
-treatment resistant
-does not occur in children
-augmented by compensation problems. |
|
|
Term
| Brain contusions (bruises) |
|
Definition
Bruising caused by hitting inner ridges!
2 types:
-coup: surface of brain beneath point of impact
flung against side of brain it was struck (from bouncing off coup site of injury)
-contrecoup: bruise on opposite side of impact
pulled against opposite side of impact |
|
|
Term
| What are the clinical effects of aneurysmal rupture? |
|
Definition
-Explosive catastrophic headache
-Meningeal irritation
-Focal neurologic deficits from vasospasm
-Impaired alertness,
-->coma,
-->death |
|
|
Term
| What is an ischemic stroke? |
|
Definition
| clot stops blood supply to an area of the brain |
|
|
Term
| What is an ischemic stroke? |
|
Definition
| clot stops blood supply to an area of the brain |
|
|
Term
|
Definition
| Anything abnormal that occupies volume within the cranial vault. |
|
|
Term
| How are brain tumors presented clinically? |
|
Definition
Increased ICP
Seizures
Focal Symptoms |
|
|
Term
| what are the clinical effects of an uncal (medial temporal lobe) herniation? |
|
Definition
Herniates downward through tentorial space
-compresses CN III
-blown pupil
-compression of cerebral peduncles
-hemiplegia
-distortion of midbrain reticular formation
-diminished alertness |
|
|
Term
| When and how do psuedotumor cerebris usually occur? |
|
Definition
headache patients
-usually females
-overweight
-adolescent
-menstrual irregularities
-normal CT scan or MRI
-DUE TO elevated CSF PRESSURE, but no tumor/mass present! |
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|
