Formation of a Spinal Nerve

1. outer _____ matter

2. inner _____ matter

3. dorsal horn is associated with what type of neurons? 

4. ventral horn is associated with what type of neurons? 

5. dorsal and ventral roots unite to form a  ________

1. two major branches of spinal n. 

2. dorsal primary rami innervate.....

3. ventral primary rami innervate...

Describe the 2 modalities of General Sensation

What are the sensations of each modalities?

Sensory Vocab:

1. loss of all sensation

2. without pain.

3. ability to recognize an object through sense of touch without visual cues, but involved memory (this is of which modality?)

4. related to movement, perception of angle of joint, and relative weight of objects

1 - analgesia is related to what modality?

2-astereognosis and akinesthesia are related to what modality?

Sensory Receptors in Skin

1. innervate what 2 layers

2. naked nerve endings

3. Pacinian Corpuscle

Sensory receptors in Skeletal Muscle

1. receptor of stretch/length

2. receptors of tension

Common Characteristics of the

3-neuron General Sensation Pathway (includes epicritic and protopathic):

-1º Neuron

1. unipolar or bipolar

2. cell body location

3. peripheral process (part that goes to the skin) associated with a _______

4. _____enters the spinal cord via the _____

5. synapses where?

6. Entire 1º neuron is unilat or bilat?

-2º Neuron

1. cell body location

2. **axon immediately _______

3. ascends in CNS via ________

4. Synapses where?

-3º Neuron

1. cell body location

2. axon ascends via _____________

3. synapses in the ________&________ of the ______lobe in the somatosensory cortex for general sensation.

CNS term for ¨nerve¨.  Accumulation of axons that have a similar function.  Form bundles of white matter (myelinated axons) in CNS.

Thalamus

1.  Largest structure in _______ of the brain.

2.  Serves as a ...

3.  _____ matter existing bilaterally.

4. Location of ____neuron and the synapse of _____ neuron of general sensory pathways.

Sensory signals from the lower extremity terminate where?

Fasciculus Gracilis & Fasciculus Cuneatus

Describe the Epicritic Pathway (fine touch, proprioception, vibration) from:

1. Stimuli from T7 and below.

2. Stimuli from T6 and above.

1. If you injure the system superior to decussation, you should expect to see what neurological deficit?

2. If you injure the system inferior to the decussation, you should expect to see what neurological deficit?

1. Spinal Protopathic Pathway modalities

2. fast/acute pain tract

3. slow/chronic pain tract

Spinal Protopathic Pathway (Spinal Thalamic Pathway) vs. Spinal Epicritic Pathway (Dorsal Column)

1. decussation location

2. 1º neuron synapse

DESCRIBE THE NEUROLOGICAL DEFICIT:

1.  a lesion in the L posterior limb of internal capsule results in...

2. a lesion in the L pons results in...

3. A L hemi-lesion in the spinal cord results in...

Normal Voluntary Movement requires what 4 functioning systems?

Describe the mov't disorder associated each system is injured individually.

Damage to what system of voluntary movement results in....

1. flaccid paralysis

2. spastic paralysis

3. dyskinesia

4. ataxia

Alpha motor neurons:

1. type of motor neuron

2. innervation

3. physical characteristics (size, myelination, polarity)

4. conduction velocity

5. location

Gamma motor neurons:

1. type of motor neuron

2. innervation

3. physical characteristics 

4. conduction velocity

5. location 

Review the cranial nerves.

Which are purely sensory?

Myostatic Stretch Reflex (knee jerk)

1. Associated with what receptor?

2. What and where is the sensory neuron?

3. Where is the synapse between sensory and motor neurons?

4. Where is the cell body location of the motor neuron?  What is its path?

5. What happens to the antagonistic muscle? (in this case the hamstring).

Tendon Reflex

1. occurs when?

2. what is the receptor?

3. receptor innervation and path

4. what connects sensory and motor neuron?

5. what is the motor response?

Withdrawal Reflex (when you touch something painful):

1. involves what sensory pathway?

2. What is the receptor and its innervation?

3. What is the motor response?

4. What happens to stabilize the body during the withdrawal reflex?

LMN disease is characterized as _____________.

1. status of voluntary muscle (2)

2. Muscle tone (4)

3. Status of superficial and deep reflexes (2)

4. effects of lesion

5. lesion location (2)

6. types of injury (3)

Primary Motor Cortex

1. aka

2. location

3. what is directly posterior to this region?

1. motor innervation of upper extremity

2. motor innervation of lower extremity

3. motor tract of UE & LE

4. motor tract of head region.  concerned with synapsing what?

Corticospinal Tract

1. UMN synapse on what, where?

2. cortex is what side of the body?

3. system location and trauma

Corticospinal Tract (Motor function)

1. aka

2. From the motor cortex, the _____ neuron coarses through the ___________ en route pyramids of the medulla

3. what % of fibers decussate, where does the decussation occur, and what tract do the fibers end up in after the decussation?

4. where do the fibers that don't decusatte descend?

5. where does the synapse with LMN occur?

UMN Disease is characterized as __________.

1. Status of voluntary muscle (2)

2. Muscle tone

3. Superficial Reflex status

4. Deep Reflex Status

5. Effects of lesion

6. lesion location

7. types of injury (4)

A babinski sign (dorsiflexion and fanning of the toes) is indicative of what disease?

In what population of patients is this a normal response?

Is it UMN or LMN disease?

1. peripheral nerve/rootlet injury

2. injury to posterior limb of internal capsule

3. CVA

4. Multiple Sclerosis

5. Poliomyelitis

6. Tumors

7. Trauma

8. A lesion in the CNS

Where is the lesion?

Left-sided...

-spastic hemiplegia

-loss of all general sensation

Where is the lesion?

Right-sided...

-loss of fine touch, DTRs, & vibration

-loss of pain and temp sensation

-spastic hemiplegia

Where is the lesion?

Waist and below...

-L sided loss of fine touch, DTRs, & vibration.

-L sided spastic paralysis.

-R sided loss of pain and temp sensation.

State the neurological deficit of...

1. a lesion in the posterior limb of internal capsule

2. a lesion in the pons (brain stem)

3. a hemi-lesion of a spinal segment

When will LMN disease mask UMN disease?

Amyotrophic Lateral Sclerosis

1. affects what neuronal systems?

2. Neuro deficits seen

superior alternating hemiplegia

what are the neuro deficits you will see?

Middle Alternating Hemiplegia

What are the neuro deficits seen?

Inferior Alternating Hemiplegia

What are the neuro deficits seen?

Pt sticks out his tongue and you notice it deviates to the right.  On the left side of the body, Pt has increased resistance to passive stretch when moved with more speed, muscles have persistent spasms, and exaggerated DTRs.

What does this suggest?

Corticobulbar Tract

1. arises from __________

2. axons coarse through_________.

3. axons terminate (synapse) on the ____ in the _________.

4. Injury to this system superior to the Facial Nucleus ( which is located in the_____ ) results in what neuro deficit?

cerebellum

1.function (compares what mov't and does what?)

2.influences ipsilateral or contralateral musculature?

3. direct injury results in what deficit?

4. 3 segments/lobes of cerebellum and resulting motor disorders.

Pt presents with following sx, where is the disorder?

-hypertonicity

-intention tremor

-dysmetria (past pointing)

-dysdiodochokinesia (difficulty with RRAMs)

-asynergia/dyssynergia (lack of smoothness) -dysarthria (difficulty with speech)

1. Truncal ataxia  - where is the disorder?

2. Gait ataxia -

-where is the disorder?

-involves input from what type of receptors?

-in what population is this degeneration seen?

5 areas of basal ganglia

*Don't Memorize, this is FYI*

Basal Ganglia

1. Functions *This is FYI, don't memorize*

2.Influence ipsilat or contralat musculature?

3. Injury/Disease characterized by...

4. Name 4 disorders of basal ganglia

Parkinson's Disease

1. Disorder of what region

2. 5 clinical signs (tone, movement initiation & speed, tremors, expression)

1. tranduced from peripheral receptors that are being destroyed

2. damage to peripheral or central nerves (give two examples of diseases)

3. sharp & abrupt.  Lasts minutes to weeks.  Eventually dissapates if cause is alleviated.

4. unresolved acute pain. 

5. chronic pain that creates a circuitry of pain without external stimuli.

Learned Pain

1. strong ________ component

2. generated by ______ centers

3. involves ________changes within the CNS

Anterolateral System (ALS)

1. Transmits which modalities

2. Pain projector neurons (nociceptors) in dorsal horn of spinal grey can project to what 3 areas via what tracts.

Plastic Changes from Chronic Pain

1) in PNS (1)

2) in CNS (5)

describe peripheral hypersensitivity causes of the ¨wind up¨of the CNS to transmit pain

1. activitation of...

2. threshold lowering of...

3. conversion of...

4. degeneration of...

2 results of peripheral hypersensitivity/plastic changes:

Phantom Limb Pain is what type of pain?

What is the best type of anesthesia to reduce the occurence of phantom limb pain?

CNS hypersensitivity of pain

1. pain modulation centers that have the ability to inhibit or excite dorsal horn pain projection neurons.

2. receives descending info from hypothal and cerebral cortices and sends excitatory input to RVM.

3. processes all sensory input (except olfaction) and relays to conscious level.

Hypothalamus

Frontal and Prefrontal cortices

Insular cortex

Limbic lobe

Amygdala

.....are all structures sensitized by increased nocioceptive input & all project to the_____, which sends excitatory input to the ________, which can either inhibit (during acute pain) or excite (during chronic pain) the dorsal horn pain projection neurons.

This structure is sensitized by increased nociceptive input and involves emotion. 

This lays within the above structure and is involved in extreme/emphatic emotion.

(These two structures influence why people with pain are in severe emotional distress.)

What is the best way to prevent learned pain?

Treatment of Learned Pain? (2)

what is the major arterial supply to the dura matter?

What is the pathology when it ruptures?

What are the large veins on the cerebral cortex that drain into the venous sinuses?

What happens when they rupture?

Internal Carotid System - Major Branches (4)

1. retina

2. optic tract, lateral geniculate nucleus, posterior limb internal capsule (do you remember what this contains??)

3. medial surface of cerebral cortex

4. lateral surface of cerebral cortex

Anterior Cerebral Artery Syndrome

results in what neuro deficits.

Middle Cerebral Artery Branches (2):

1. supplies basal ganglia, internal capsule, optic radiations

2. supplies frontal, parietal, temporal lobes.

Middle Cerebral Artery Syndrome

1, 2, 3) Describe the 3 neuro deficits, not specific to the the R or L hemisphere.

4) Neuro deficit specific to the L cerebral hemisphere

5) Neuro deficit specific to the R cerebral hemisphere.

Vertibrobasilar System

1. vertebral artery system branches (3)

2. basilar artery branches (4)

Circle of Willis

1. formed by what arteries

2. completely formed in what % of population.