Term
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Definition
1. peripheral sensory neuron (up fasciculus gracilus or F. cuneatus) and synapses in the gracilus or cunate nucleus.
2. internal arcuate sensory (crossing midline) fibers up the medial lemniscus to VPL in thalamus.
3. from VPL in thalamus up to postcentral gyrus (4th/6 layer cortex) |
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Term
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Definition
| cutaneous sensory receptors, GTOs and muscle spindles |
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Term
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Definition
| location, intensity and nature of stimulus |
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Term
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Definition
| fast adapting, discriminative touch. carried in DCML |
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Term
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Definition
| slow adapting. read braille, carried in DCML |
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Term
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Definition
| fast adapting, vibration, dcml |
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Term
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Definition
| pressure, slow adapting, dcml |
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Term
| DCML blood supply in cord and medulla/medial lemniscus |
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Definition
posterior spinal artery off of posterior inferior cerebellar artery for DCML in cord.
Once in medulla and become medial lemniscus supplied by anterior spinal artery. |
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Term
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Definition
somatosensory association cortex.
starts putting things together, like, "ok we are feeling it on both sides" |
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Term
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Definition
sematosensory association cortex
coverging visual with touch and proprioception |
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Term
| secondary sematosensory area |
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Definition
| locking stuff into memory, |
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Term
| dorsal spinocerebellar tract |
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Definition
lower extermities
1. peripheral neuron - synapse at dorsal nucleus of clarke (T1-L2/L3) in cord at same level. ipsilateral
2.ascends in DSCT and enters cerebellum via inferior cerebellar peduncle. ipsalateral |
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Term
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Definition
upper extremities
1. perioerhal nerve/DRG cell body. comes in and ascends to the ACCESSORY CUNEATE NUCLEUS.
2. from accesoory cunate up cuneocerebellar tract into the ifnerior cerebellar peduncle.
all ipsilateral. |
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Term
| Ventral sinocerebellar tract. |
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Definition
lower extremities. carries information about overall activity.
1. begins in the cord at an interneuron. start in grey matter, crossesmidline and ascends in VSCT
2. ascends in VSCT, get up high in pons and cross midline and go into cerebellum through superior cerebellar peduncle |
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Term
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Definition
| proprioception - muscle spindle |
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Term
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Definition
| GTO( big, heavily mylineated) 100m/s |
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Term
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Definition
| touch - merkels meissners etc - 50m/s |
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Term
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Definition
| lightly myelinated pain and temp fibers 20m/s |
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Term
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Definition
| non myleinated pain and tem fibers -1m/s |
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Term
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Definition
pain sensors.
sense acid/H+, capascin, noxious temps |
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Term
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Definition
TRP channels,
Gq coupled receptors (sense pain via bradykinin, histamine, prostaglandins)
P2X receptors |
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Term
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Definition
| pain, detects ATP from lysed cells |
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Term
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Definition
A delta fibers -
early, sharp perception of well localized pain.
NO AFFECTIVE component |
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Term
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Definition
C fibers - polymodal receptors
slow pain transmission, diffuse aching pain.
AFFECTIVE COMPONENT! |
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Term
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Definition
| heightened sensations of pain after injury |
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Term
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Definition
occurs in dorsal horn, increased pain excitbility of projection neurons
2 mechanisms
1. windup (summation)
2. COX upregulation (transcription)- ALLODONIA associated with this |
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Term
| peripheral sensitization, primary and secondary. |
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Definition
primary is accumalted response to histamine, prostaglandins, ATP etc. not just the intial response, it is the continuing feedback increased response.
secondary is activation of nearyby uninjured neurons due to diffusion of histamine etc because of all the edema |
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Term
| 2 mechanims to attenuate pain transmission |
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Definition
1. gate theory - projecting A beta fibers when activated they activate an interneuron that inhibits pain fibers (synapse on a dorsal horn projection neuron). rub your head after you smash it effect.
2. descending imputs from raphe nuclei activate enkephalin containing internuerons in cord that inhibit the C fibers directly (synapse on the C fiber) |
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Term
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Definition
| somatic and visceral nociceptor afferents project to same second order spinothalamic neurons in the dorsal horn |
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Term
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Definition
lots of them. each one receives temp for like 2-5 degrees. some sense normal sense, some sense pain.
comapring these inputs from all over lets our brain know our temperature.
TRPs can be activated by foods and stuff. |
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Term
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Definition
antibody to MBP
optic neuritis often first sign.
classic presentation is a relapsing remitting presentation.
demylinated areas come and go on MRI near lateral ventricles. |
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Term
| MS microscopy of active lesion |
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Definition
| axons are preserved, myeline is gone, hypercellular with macrophages |
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Term
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Definition
| areas of remyelination in MS |
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Term
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Definition
| hypocellular and gliotic with loss of oligonedrocytes |
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Term
| Progressive multifocal leukoencephalopathy (PML) |
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Definition
JC virus
immunocompromoised patients
looks like MS
ATYPICAL ASTROCYTES, lipid laden macs, viral inclusions. |
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Term
| central pontinemyelinolysis |
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Definition
rapid correction of hyponatremia in ER leads to loss of myeline with perservation of axons.
often fatal. |
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Term
| acute disseminated encephalomyelitis (ADEM) |
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Definition
viral syndrome or vaccination (like for small pox), then you get lesions that lookd like MS or PML plaque (mutlifocal white matter lesions on MRI)
PERIVASCULAR CHRONIC INFLAMMATION on microscopy |
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Term
| Gliomatosis cerebri (anaplastic astrocytoma) |
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Definition
diagnosed as ADEM up front. MRI has white areas in both grey matter and white matter.
anaplastic astrocytoma in multiple lobes is called gliomatosis cerebri |
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Term
| charcot-marie-tooth disease |
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Definition
PNS demyelinating process
mutation in peripheral myelin protein 22.
onion bulb appearance of neuron
pt has muscle atrophy, family history of similar disease and ROPEY nerves that you can feel. |
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Term
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Definition
immune attack of peripheral myelin
usually follows gi or respiratory infeciton. can be bacterial or viral.
loss of sensation/tingling starts at feet and works up.
only 1/10 have long term problems, it gradually heals on its own over a 1 year period. |
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Term
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Definition
| stretch neurons due to shaking or trauma. microtubules collapse in an area and axonal transport gets backe dup. |
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Term
pin prick test spinal level.
what is spinal level? |
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Definition
| lowest dermatome with intact sensation |
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Term
| what type of nerves test pin prick sensation? |
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Definition
| C fibers and A delta fibers of the ALS |
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Term
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Definition
pain fibers come in, ascend 1-2 levels in lissauer's tract. synapse with their 2nd order neuron. the 2nd order neuron crosses the midline via the anterior white commisure adn ascends in ALS to VPN in the thalamus.
from vPL through internal capsule to the postcentral gyrus |
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Term
| Midline lesion of spinal cord at anterior white commisure, what do you see? |
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Definition
| bilateral pain loss below the lesion. |
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Term
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Definition
| cavitation that grows out bilaterally - the last dermatomes to become affected are the sacral dermatomes. |
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Term
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Definition
| where the A delta fibers synapse with their 2nd order (heavily myelinated very fast) neurons. |
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Term
| posterior limb of internal capsule perfused by? |
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Definition
| lateral lenticulostriates and ant. choroidal artery |
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Term
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Definition
same as spinothalamic - it is carrying pain fibers, lissaures tract to ALS, BUT spinoreticular pathway stops at pontomedullar junction instead of going up to thalamus.
synapses at RETICULAR FORMATION at pontomedullar junction. then it ascends up to thalamus at INTRALAMINAR NUCLEI, it then extends to entire cortex.
MEDIATES AFFECTIVE/EMOTIONAL COMPONENT OF PAIN |
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Term
| thalamic interlaminar nuclei AKA? |
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Definition
| centromedian nucleus (CM) |
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Term
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Definition
goes up ALS to the PERIAQUEDUCTAL GRAY.
it then activates descending pathwasy that dampin pain input.
from PAG, a glutamtergic neurond escends to medulla, ultimately activating the locus cereulus in the pons. these NE fibers from the LC synapse on primary pain afferents and activate K+ channesl that hyperpolarize the cell and inhibit pain transmission. |
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Term
| descending norandrenergic mechanism |
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Definition
part of spinomesencephalic tract.
it is where the descending glutamatergic neuron from the PAG snapses with interneurons in the medulla that ascend to activate norandrenergic neurons in the PONs.
these neurons descend and synapse on primary pain afferents. these norandrenergic neurons inhibit the primary pain afferents by opening a K+ channel that hyperpolarizes the cell.
ALSO activates the descending seratonergic mechanisms |
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Term
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Definition
area in pons. only source of norandernergic neurons in the brain.
part of the spinomesencephalic tract. |
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Term
| descending serotonergic mechanisms |
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Definition
descending glutamatergic neurons from
PAG synapses at the NUCLEUS RAPHE MAGNUS (in the medulla). seratonergic neurons descend from NRM to dorsal horn and activate ENKEPHALNERGIC INTERNEURONS in the dorsal horn.
these enkephalnergic interneurons inhibit 2ndorder projection neurons in the ALS pathway. |
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Term
| limbic projections that upregulate PAG |
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Definition
| amygdala projects down to PAG. think about GI in a foxhole with his legs blown off-- he doesn't feel it. amygdala is the reason. |
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Term
| 3 places exogenous opiates can activate opoid neurons. |
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Definition
| PAG, enkephalanergic interneurons and limbic cortex |
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Term
premotor area and
supplemental motor area |
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Definition
activate milliseconds before our primary motor cortex when we initiate movement.
they are involved in selecting the appropriate subesets of upper motor neurons for the task. |
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Term
| sequence of activation of brain areas when preforming a movement. |
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Definition
1. supplemental motor area.
2. premotor area and still some SMA
3. primary motor cortex.
4. somatosensory cortex (conscious appreciation of movement) |
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Term
| where is motor memory stored? |
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Definition
| basal ganglia and cerebellum |
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Term
| what happens when you have a lesion to area 6 (SMA/PMA) |
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Definition
| Apraxia (the motor function of the arm is intact, but the arm can't engange in a perviously learned movement, like tying shoes). |
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Term
| What gives information to area 6? |
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Definition
| Area 5 and 7 most importantly. |
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Term
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Definition
| when a patient cannot follow the command of a clinician. He may be able to do it spontaneously but not following a command |
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Term
| where can the lesions of apraxias be mapped besides area 6? |
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Definition
| parietal lobe where nruons are projection to area 6. |
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Term
| function of lateral corticospinal tract |
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Definition
| to LMN pools for distal limb muscles and digits - complex fractionated movements requiring dexterity and agility |
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Term
| function of rubrospinal tract, vestibulospinal tract and tectospinal tract |
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Definition
| to LMN polls for proximal limbs and antigravity muscles - posture and upright stance |
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Term
| function of reticulospinal tract |
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Definition
| to LMN pools for axial muscles - posture |
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Term
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Definition
The final neuron of all the upper motor neuron pathways.
include Alpha motor neurons (to extrafusal fibers) and GAMMA motor neurons (to intrafusal fibers).
LMNs basically |
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Term
| 3 ways LMN activity is regulated |
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Definition
1. upper motor neurons
2. sensory neurons
3. central pattern generators
remember: LMN pools are tonically inhibited unless you really need to use it. |
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Term
| central pattern generators |
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Definition
local circuit neurons forming segmental or multi-segmental AUTONOMOUS INTERNEURONAL CIRCUITS in brainstem and central cord gray..
in the lumbar enlargement the abulation CPG exists, it can function without supraspinal or sensory input.
not a reflex- acts like a computer program for ambulation. - acts bilaterally across the midline. |
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Term
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Definition
cat with cord transection on a treadmill.
you send electrical singals up a neuron in the leg and it will induce the cat to walk via the CPG |
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Term
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Definition
| ataxia, dysmetria, intention tremor, asynergia, dysdiadochokinesia |
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Term
| look at slide 28 of the 2010motor review lecture |
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Definition
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Term
| what layer of the 6 layered neocortex recieves sensory input? |
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Definition
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Term
| what layer of the 6 layered neocortex is the source of output motor neurons? |
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Definition
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Term
| what are the big cells in layer 5? |
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Definition
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Term
| ventralcorticospinal tract |
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Definition
UMNs that remain ipsilateral. only goes to cervical areas.
can't be clinically tested. |
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Term
| corticobulbars go through what part of the internal capsule? |
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Definition
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Term
| corticospinasl go thorugh where in the inernal capsule? |
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Definition
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Term
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Definition
|
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Term
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Definition
| all the stuff below neck for the most part |
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Term
| where do the corticobulbars and corticospinals decussate? |
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Definition
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Term
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Definition
amyotrophic lateral sclerosis
cognition is spared
middle aged men.
have BOTH UMN and LMN signs.
so, fasciculations and hyperreflexia |
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Term
| subacute combined degeneration (pernicious anemia, b12 deficiency) |
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Definition
symmeitracl demylination of dorsal columns and corticospinals.
upper motor neuron signs and loss of dorsal column modalities - these 2 combined. |
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Term
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Definition
| as 1a fibers fire they feed back to the alpha motor neurons. |
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Term
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Definition
| 1b fibers in GTO, when they are stretched too much they feed back and inhibit alpha motor neurons. so you can't break you're muscle. |
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Term
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Definition
| afferents detect pain and excite the ipsilateral limb to withdraw from painful stimulus. |
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Term
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Definition
co-excited interneurons
cross midline and synapse contralaterally on
interneurons mediating contralatertal extensor excitation and flexor inhibition
so, you withdraw the hurt limb and the opposite limb bases you. |
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Term
| what type of touch is carried by ALS? |
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Definition
| pain, temp and crude touch |
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Term
| advanced neurosyphillis (tabes dorsalis) |
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Definition
bilaterally symmetrical dorsal column sensory loss.
positive rhombergs sign. |
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Term
| subacute combined degeneration (pernicious anemia) |
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Definition
B12 malabsorption
bilaterally symmetric demyelinating myelopathy
see, dorsal column degeneration and lateral corticospinal tracts.
so UMN signs and sensory loss. |
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Term
|
Definition
cognition spared
combo of LMN and UMN signs.
progressive disease
men in their middle ages. |
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Term
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Definition
bilateral LMN signs.
polivirus trasnports retrograde using dyenin and lyses the cell body. |
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Term
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Definition
anterior spinal arteries loss of perfusion.
lose ALS, lateral cortical spinals, ventral horn. but sparing of dorsal column modalities
central disc hernation is common cause.
also, artery of adamkiewicz injury - supplies lower 2/3 of cord around T10 |
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Term
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Definition
watershed damage btwn perfusion territories of anterior and posterior spinal arteries.
loss of pin prick sensation - sacral area being last to go.
LMN signs for the area involved.
UMN signs for areas below th elesion. |
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Term
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Definition
these are LMNs so you see LMN signs.
sensory and motor
think of disc herniation
saddle anestesia - loss of pin prick sensation over sacral dermatomes.
urinary incontinence - involvemnt of post gang parasympathetics. |
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Term
can you have inflammation in the endomysium for any physiologic reason?
what about the epimysium. |
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Definition
no to endomysium, inflammation is that tissue is always pathologic.
yes to epimysium |
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Term
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Definition
abnomormal sarcomere proteins polymerize (nemline bodies) and make muscle not function.
this is a floppy baby syndrome. it is a congenital myopathy. |
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|
Term
young adult with muscle weakness.
you look at their muscle under EM and the see mitochondrial "parking lot inclusions." diagnosis? |
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Definition
| mitochondrial myopathy - ragged red fibers |
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Term
|
Definition
axonal degeneration leads to angular atrophic muscle fibers.
and then reinnervation leads to muscle fiber type grouping.
you get this with ALS |
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Term
|
Definition
paraneoplastic
pt have a rasha nd myositis, often around eyes, lips and nose.
perfascicular atrophy, nuclei look bigger, cell is smaller |
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Term
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Definition
just inflamation in the several muscles.
so pt comes in with weakness in upper and lower extermity, we do biospy and see endomesial chronic inflammation - it is polymyositis. |
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Term
| xlinked duchenne and becker muscular dystrophy |
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Definition
dystrophin gene mutation. - dystrophin connects cell to ECM
pseudohypertrophy of calf muscles.
excessive connective tissue in the endomesium - cells look round instead of octogonal. |
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Term
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Definition
low grade brain tumor in kids OR adults with NF1
it is a cystic lesion with an enhancing mass in there.
it shows up in cerebellum
the most common PRIMARy brain tumor |
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Term
| pliocytic astrocytoma histo |
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Definition
| spindled cells, hypocellular, rosenthal fibers |
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Term
|
Definition
most common malignant pediatric CNS neoplasm.
SHH problem - arise from external granular cell layer (which is apoptosising in kids)
just a big cerebellar mass |
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Term
|
Definition
small round blue cell tumors
highly cellular
high n/c ratio
mitotic figures
FORMING ROSETTES |
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Term
|
Definition
solid enhancing mass IN the spinal cord
low grade |
|
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Term
|
Definition
| enhancing solid mass in 4th ventricle (looks just like a medulloblastoma) low grade |
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Term
|
Definition
| spinled, hyeprcellular, cells radiating to blood vessels - bicycle tire |
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Term
|
Definition
associate with von hippel lindau
huge cyctic lesion with a small enhancing mass in cerebellum.
looks like pliocytic astrocytoma but this is in ADULTS, like 35 yrs. |
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Term
| von hippel lindau syndrome |
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Definition
mutiple renal cell carcinomas in both kidneys (remember no mets to kidneys).
also pheochromocytomas and hemangioblastomas. |
|
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Term
|
Definition
alcoholism.
cerebellum becomes small.
vermis atrophied compared to infior vermis.
pt has a WIDE BASED GATE.
SMALL CEREBELLUM AND WIDE FOLIA on gross and imaging. |
|
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Term
| does the cerebellum have direct connections to LMNs? |
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Definition
|
|
Term
|
Definition
|
|
Term
| inputs to interposed nuclei come from? |
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Definition
| intermediate parts of cerebellar hemispheres |
|
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Term
| inputs to dentate nuclei come from? |
|
Definition
| largest of the cerebellar nuclei, recieves inputs from cerebellar hemispheres. |
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Term
| fastigal nucleus recives inputs from |
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Definition
|
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Term
|
Definition
control of proximal trunk muscles.
lesions causes unsteady gait (truncal ataxia) |
|
|
Term
| function of flocculonodular lobes |
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Definition
lesion causes vertigo, nasua, vomiting, abnormal eye movement.
(involved in vestibulo ocular control) |
|
|
Term
| intermediate part of cerebellum |
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Definition
| appendicular ataxia when lesioned - distal appendicular muscle control. |
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Term
| lateral part of cerebellum |
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Definition
| involved in planning the motor program for extrmities -can have large lesion and minimal deficits. |
|
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Term
| ataxia in cerebellum is ipsilateral or contralateral to the cerebellar lesion? |
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Definition
| ipsilateral due to double crossed pathways. |
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Term
| molecular layer of the cerebellum |
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Definition
| basket and stellate interneurons that are excited by granule cell neurons and form inhibitory synapses on purkinje cells |
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Term
|
Definition
small layer- all output from the cerebellar cortex ic carried by these cells.
they form inhibitory synapses on the deep cerebellar nuclei and vestibular nuclei |
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Term
| granule cell layer of cerebellum |
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Definition
granule cells form excitatory synapses on purkinje cells.
golji cells are interneurons that provide feedback inhibition to the granule cells. |
|
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Term
|
Definition
| from brainstem nuclei and form excitatory synapses on granule cell dendrites |
|
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Term
|
Definition
| from the contralateral inferior olivary n ucleus - snapses onto purkinje cell body and proximal dendriticy trees forming powerful EXCITATORY synapses |
|
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Term
| pontocerebellar fibers path |
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Definition
from cortex to pons are the corticopontine fibers. (ipsilateral)
then from pons the fibers travel to the contralaterael middle cerebellar peduncle and give rise tot he mossy fibers |
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