Term
|
Definition
| Disordered contractions of agonist & antagonist muscles |
|
|
Term
| What is the term associated with ataxia (and most cerebellar disorders) that has to do with abnormal timing? with abnormal trajectories through space? |
|
Definition
-dysrhythmia
-dysmetria
-abnormal overshoot
-abnormal undershoot |
|
|
Term
| Give an example of when ataxia occurs |
|
Definition
| Trauma, brain injury, contre coup (affects vision in occipital lobe of cerebrum), ischemiaļ ataxia |
|
|
Term
| What constitutes the midline cerebellum and what are its fxns? |
|
Definition
-archicerebellum and paleocerebellum
-truncal movements |
|
|
Term
| What constitutes the neocerebellum and what are its fxns? |
|
Definition
-cerebellar hemispheres
-ipsilateral skilled movements (fine motor skills) |
|
|
Term
| What do lesions in the cerebellum cause? why? |
|
Definition
ataxia in ipsilateral (to side of lesion) extremities.
-bc because cerebellar connections are either ipsilateral, or cross twice, between the cerebellum and the spinal cord |
|
|
Term
| Why is a cerebellar stroke quick to heal? |
|
Definition
| cerebellum has redundant (recurrent) circuitries, so is quick to heal and/ or relearn. |
|
|
Term
| What are the 3 I's of a cerebellar stroke? |
|
Definition
-intact structure deprived of regulation (of motor and sensory tracts)
-ipsilateral
-improves with time |
|
|
Term
| What are some tests of ipsilateral skilled movements? |
|
Definition
pill rolling tremor
natural activities with (jerky) tremor
finger to nose
heel-down-shin
knee pat (pronate -supinate)
foot pat
rebound |
|
|
Term
| what are some tests to test cerebellar vermis/lesion? |
|
Definition
nystagmus
dysarthria
unsteadiness
gait |
|
|
Term
| What are 3 types of tremors observed in cerebellar digression? |
|
Definition
-intention tremor
-cerebellar- when intention becomes more severe towards target
-Parkinsonian- rolling a pill |
|
|
Term
| What does the neocerebellum (more lateral cerebellum) present clinically? (with ischemia and hemorrhage) |
|
Definition
incoordination (ataxia with movement of extremities)
cerebellar tremor |
|
|
Term
| What does the midline cerebellum present clinically? (with ischemia and hemorrhage) |
|
Definition
truncal symptoms:
unsteadiness (gait)
nystagmus
dysarthria (scanning speech) |
|
|
Term
| What are arteries that supply the cerebellum? From what do they branch? |
|
Definition
PICA (post. inferior cerebellar artery)
AICA (ant. inferior cerebellar artery)
SCA (superior cerebellar artery)
-all from the vertebro-bailar systems
-joins with vertebral vasculature to form the circle of willis. |
|
|
Term
| What does it mean if white areas present on an MRI/PET? |
|
Definition
|
|
Term
| What are some causes of cerebellar hemorrhages? (uncommon and usually in smaller vessels) |
|
Definition
-hypertension
-AVM
-hemorrhagic conversion of ischemic infarct |
|
|
Term
| Where do cerebro vascular issues come from? |
|
Definition
thrombus and embolus from periphery (carotids)
-carotids enter brain first due to their early positioning on the aorta. |
|
|
Term
| How are cerebellar hemorrhages presented clinically? |
|
Definition
Picture of increased intracranial pressure
Unsteadiness/ataxia
Hydrocephalus
Brainstem compression--> death |
|
|
Term
| How are cerebellar hemorrhages treated? |
|
Definition
|
|
Term
| in hydrocephalus, when there is a hamorrhage in the 4th ventricle, how does it get blocked? |
|
Definition
| due to small entrance hole to 4th ventricle, so CSF backs up in ventricles 1,2,3 |
|
|
Term
| What is the most common cause of stroke? |
|
Definition
|
|
Term
| Can TIA (temporary ischemia) occur in the cerebellum? |
|
Definition
| yes, but is more common in the cerebrum |
|
|
Term
| Can non-cerebellar ataxia occur? if so, how? |
|
Definition
Yes.
In the form of sensory ataxia.
When posterior column-medial lemniscus pathway is interrupted--> get loss of position sense.
-overshoot limbs
-broad, unsteady gait
-usually caused by peripheral neuropathy |
|
|
Term
| How can sensory ataxia be improved? |
|
Definition
| by visual feedpack: Positive Romberg |
|
|
Term
| How can sensory ataxia be improved? |
|
Definition
| by visual feedpack: Positive Romberg |
|
|
Term
| What kind of connection do fine motor skills and balance and movement have? |
|
Definition
|
|
Term
| How many pathways are there to the cerebellum (afferent)? away (efferent)? |
|
Definition
|
|
Term
| What are some differential diagnoses of ataxia (non-cerebellar) for adults? |
|
Definition
acute:
-toxic ingestion (alcohol)
-stroke
chronic?
-brain metastases
-chronic alcohol exposure
MS |
|
|
Term
| What are some differential diagnoses of ataxia (non-cerebellar) for children? |
|
Definition
acute:
-accidental drug ingestion
-varicella (chix pox)- associated cerebellitis
-migraine
chronic:
-astrocytoma or medullablastoma |
|
|
Term
| How does alcohol affect the brainstem? |
|
Definition
-hits brainstem first
-HR altered
-breathing altered
-gait altered |
|
|
Term
| What medicine do you give to heart failure pts? what does it do? |
|
Definition
| digitalis- makes heart contract more. |
|
|
Term
| What are the three cortexes surrounding the central sulcus? |
|
Definition
-primary (motor) cortex (precentral)
-premotor cortex (precentral and lateral)
-primary (sensory) cortex (postcentral) |
|
|
Term
| Ischemic areas cannot be clearly defined.. what are the areas of ischemia? |
|
Definition
umbra- dead
-surrounded by pen (part which is dying) |
|
|
Term
| A pt with Ca channel blocker has what side effects? |
|
Definition
-lack of impulses (Ca triggers impulses)
-constipation |
|
|
Term
| What is the lateral sulcus/ lateral fissure/ sylvian fissure? |
|
Definition
| -fissure or deeper sulcus bw temporal and frontal lobe |
|
|
Term
| Whaich area on the sensory homunculous is notedly big? |
|
Definition
| lips, because comes from a wide sulcus on the postcentral sensory gyri. |
|
|
Term
| What is the connection bw inhibitory and excitatory NTs? |
|
Definition
|
|
Term
| Which NT can be inhibitory and excitatory, depending on the area? |
|
Definition
L-Dopa
-too much, schizo
-too little, parkinsons |
|
|
Term
| What do gyri contribute to brain fxn? |
|
Definition
| give brain bigger surface area, so more sensory and motor areas can be covered. |
|
|
Term
| What do gyri contribute to brain fxn? |
|
Definition
| give brain bigger surface area, so more sensory and motor areas can be covered. |
|
|
Term
| What do gyri contribute to brain fxn? |
|
Definition
| give brain bigger surface area, so more sensory and motor areas can be covered. |
|
|
Term
| What is a big part of the motor homunculus? |
|
Definition
|
|
Term
|
Definition
| pins and needles sensation |
|
|
Term
| What becomes of efferent motor impulses? |
|
Definition
| crosses over and goes to spinal cord to spinal nerves. |
|
|
Term
| What did GABA-pentine do to Dr. Alli? |
|
Definition
gave him amnesia when he was on sterroids.
-also saw 4 wives. |
|
|
Term
| how do impulses cross over to and from the post and pre central cortex? |
|
Definition
sENSORY cORTEX:
-Left hemisphere receives input from right side of body
Motor Cortex:
-Left hemisphere controls body's right side. |
|
|
Term
| Which hemisphere is Broca's and Wernicke's area located in? |
|
Definition
|
|
Term
| What are the top 3 killers in U.S.? What is the silent killer? |
|
Definition
1-Heart Attack
2-Colorectal
3-Stroke
Silent: Hypertension |
|
|
Term
what are the 3 main cerebral arteries?
Which do most strokes involve? |
|
Definition
middle, anterior and posterior cerebral arteries
-middle (MCA) |
|
|
Term
| When would you administer adenosine into MCA? |
|
Definition
-hypoxic baby after childbirth (more common at high altitudes)
-MI
-A-fib |
|
|
Term
| What are the 3 branches of the MCA? |
|
Definition
superior, inferior and deep
See slide 16, from Neuro-midterm ppt
KNOW WHRE ALL CEREBRAL ARTERIES ARE TO COMPARE TO HOMUNCULUS |
|
|
Term
| What do the MCA deep branches supply? What 3 problems can be associated here? |
|
Definition
-basal ganglia
-production of dopamine
-dopamine issues can occur: schizo, parkinon's and huntington's |
|
|
Term
| From inferior to superior, what are the sensory homunculi on the precentral (motor) cortex? |
|
Definition
swallowing
tongue
jaw
lips (big)
face (big)
eyelid/ball
Brow
Neck
Thumb and fingers (big)
Hand (big)
wrist
elbow
shoulder
trunk
hip
knee
ankle
toes |
|
|
Term
| From inferior to superior, what are the sensory homunculi on the postcentral (sensory) cortex? |
|
Definition
-introabdominal
-pharynx
-tongue
-teeth, gums, jaw
-lips (big) (upper lip bigger)
-face
-nose
-eye
-thumb and fingers (index is biggest)
-hand
-wrist
-forearm
-elbow
-arm
-shoulder
-head
-neck
-trunk
-hip
-leg
-feet (big)
-toes
-genitals |
|
|
Term
| WHat results in an infarct of the Left MCA? |
|
Definition
Right hemiplegia, right hemianesthesia, right homonymous hemianopsia
Left gaze preference
Global aphasia |
|
|
Term
| WHat results in an infarct of the Right MCA? |
|
Definition
Left hemiplegia, left hemianesthesia, left homonymous hemianopsia
Right gaze preference
Left hemineglect |
|
|
Term
| Which MCA area is affected most? why? |
|
Definition
| inferior MCA, bc of gravity |
|
|
Term
| What is the same word for ipsilateral? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the 3 types of aphasia (with lost repetition), and what area in the brain is the cause? |
|
Definition
expressive (Broca's)- cannot express what he is thinking
-mostly nouns and verbs (telegraphic speech)
-often with right hemiparesis
receptive (Wernicke's)- cannot comprehend
-speech is fluent (but no meaning)
-unaware of deficit
conductive (lesion in area bw receptor and motor area)
-repetition affected
-reserved comprehension |
|
|
Term
| What are the two conditions of aphasia associated with preserved repetition? |
|
Definition
isolation syndrome-
-destruction of zones bw ACA, MCA and PCA
-motor and receptive areas isolated from rest of the cortex of same hemisphere
partial isolation syndrome |
|
|
Term
| Where is Broca's located? Wernicke's? |
|
Definition
-anterior to the central sulcus
-posterios to central sulcus
-have reiprochal relaitonship |
|
|
Term
| What happens when there is an infarct to the ACA? |
|
Definition
|
|
Term
| What are 2 basal ganglia? |
|
Definition
| putamen and globus pallidus |
|
|
Term
| What happens in a PCA infarct? |
|
Definition
contralateral homonymous hemianopia
-if infarct is bilateral- cortical blindness |
|
|
Term
| Why is cortical blindness called cortical blindness? |
|
Definition
| bc involves occipital lobe. |
|
|
Term
| What is a watershed infarct and what are the most susceptible to? |
|
Definition
Infarction of the cerebral cortex in an area of blood supply between two major cerebral arteries.
-ischemia |
|
|
Term
| How can watershed infarcts lead to systemic drop in BP? |
|
Definition
When infarct is in 2 watershed zones:
bw ACA and MCA
bw MCA and PCA |
|
|
Term
| what is man-in-the-barrel syndrome? |
|
Definition
-disproportionate weakness to both arms while everything else still works.
-due to bilateral supratentorial brain lesions caused by watershed infarcts |
|
|
Term
| What are some causes of man-in-the-barrel syndrome? |
|
Definition
| cerbral vascular disorders, cardiac and extracardiac surgeries, and pons and spinal cord involvement, bilateral brachial paralysis |
|
|
Term
| What is a Transient Ischemic Attack? (TIA) |
|
Definition
Temporary narrowing of a vessel followed by return of flow before permanent damage occurs
-lasts less than 24 hours |
|
|
Term
| What are some causes of TIA? |
|
Definition
-thrombus
-embolism- occluding vessel but then dissolving
-vasospasm
-cerebrovascular disease |
|
|
Term
| How do you tell if it was TIA or other transient neurological deficits? |
|
Definition
-typical vascular pattern remains (MCA, ACA, PCA)
-but positive for stroke risk factors? |
|
|
Term
| What are some stroke risk factors? |
|
Definition
Smoker
Hypertension
DM
Hypercholesterolemia
Heart disease, especially atrial fibrillation
Prior athersclerotic history
Positive family history |
|
|
Term
| What are some causes of transient loss of consciousness? |
|
Definition
-basilar artery TIA
-seizure
-orthostasis
-cardiogenic syncope (due to vasovagal syncope or arrhytmia) |
|
|
Term
|
Definition
|
|
Term
| What does a "stroke" refer to? |
|
Definition
-hemorrhagic event
-ischemic infarction of brain
-can become hemorrhagic |
|
|
Term
| Uschemic strokes can be due to... |
|
Definition
|
|
Term
What are some sources of embolic infarcts?
good to know so future strokes may be prevented |
|
Definition
-thrombotic material
-fat or cholesterol emboli from trauma to bones or arterial walls
-disc emboli in cervical trauma
-amniotic fluid emboli during childbirth
-contaminants in IV drugs
-air emboli in deep sea divers |
|
|
Term
| What are the 3 types od thrombotic emboli? |
|
Definition
-Cardioembolic (A-fib, MI, lack of closure of patent foramen ovale, septic emboli)
-artery to artery
-dissection of carotid or vertebral leads to thrombus to embolus |
|
|
Term
| How does a patent foramen ovale cause thrombotic emboli? |
|
Definition
| venous thromboembolism is allowed to bypass lungs and go directly from right to left heart, and then to the brain. |
|
|
Term
| Where do large vessel infarcts occur? |
|
Definition
|
|
Term
| Where do small vessel infarcts occur |
|
Definition
sometimes called lacunar infarcts (resemble small lakes)
-in deep vessels of basal ganglia, thalamus, internal capsule, medial portions of brainstem |
|
|
Term
| What is the cause of a lacunar infarct and what are they occluded by? |
|
Definition
-hypertension
-liphyalinosis, atherosclerosis, thrombus, embolus |
|
|
Term
| What happens in this lacunar syndrome: ataxic hemiparesis? |
|
Definition
| damage to proprioceptive cerebellar circuitry |
|
|
Term
| What happens when a lacune is thalamic? |
|
Definition
| contralateral somatosensory deficits |
|
|
Term
| What happens in basal ganlion lacunae? |
|
Definition
|
|
Term
| Seizure occur in about __% of stroke pts. |
|
Definition
|
|
Term
| Carotid stenosis occurs where? what is this cause usually? |
|
Definition
just after carotid bifurcation
-atherosclerosic disease
-thrombi formed here can embolize distally giving rise to TIA's and strokes of:
-MCA
-ACA
-opthalmic artery (with monocular vision loss) |
|
|
Term
| How do you find carotid stenosis? |
|
Definition
| listen for bruits (whooshing sound) |
|
|
Term
| How can occlusion of an ICA (internal carotid artery) be asymptomatic? |
|
Definition
when pt has good collateral flow via
-Anterior and Posterior communicating arteries
(on either side of ICA) |
|
|
Term
| what is a carotid endarterectomy? |
|
Definition
artheromatous material is shelled out from ICA
-stroke treatment
-not always permanent |
|
|
Term
| What can cause a tear in an intimal layer of carotid or vertebral arteries? what can this progress to? |
|
Definition
trauma, cough, sneeze
-a flap protrudes into vessel lumen
-stenosis ensues
-thrombus formed - can embolize |
|
|
Term
| What is the treatment of thrombi or emboli? |
|
Definition
anticoacgulants
examples: aspirin, warfarin. |
|
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