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Exam 4
Peripheral Nervous System
166
Pathology
Graduate
05/14/2011

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Cards

Term
These are parts of?
Cell body
Dendrites-receives info, passes messages
Axons-branch at their end
Definition
Neurons
Term
What stimulates depolarization of neuron which is transmitted?
Definition
Action Potential
Term
How is neuronal transmission done for an UNmylenated neuron?
Definition
Along the axon (Na rushes in axon, + charge changes and channels nearby open so more Na can rush in. passes down the axon
Term
How is neuronal transmission done for an mylenated neuron?
Definition
by saltatory conduction. AP generated by sum of all membrane potentials on dendrite or cell body. 2 types: stimulatory/inhibitory. Then synaptic integration. Nerve terminal reached.
Term
Types of graded membrane potentials in myelinated neuron transmission
Definition
Stimulatory: allows influx of Na and Ca
Inhibitory: allows influx of Cl-
Term
In a myelinated action potential: what happens if the sum of all graded membrane potentials (exc + inh) is high enuf
Definition
an action potential is started.
Term
What happens when the impulse in a myelinated axon reaches the axon terminal?
Definition
Depolarization opens voltage gated Ca+ channels and allows Ca+influx: triggers synaptic vesicles to release neurotransmitters
Term
Axonal Transport
Definition
flow of substances inside the neuron from the soma to the synaptic ending, can also be retrograde
Term
What type of neurotranmitters:
Acetylcholine
Glutamate (most common in brain)
Definition
Excitatory
Term
What neurotransmitter can cause a breakdown of normal excitatory signals, thus causing hi intracell Ca+ resulting in cell apoptosis/degeneration
Definition
Glutamate
Term
What type of neurotransmitter is the most common inhibitory ?
Definition
GABA
Term
Neuropeptides (neurotransmitters)
Definition
Substance P
Endorphins
Term
Monamine type neurotransmitters
Definition
Norepinephrine
Seratonin
Dopamine
Histamine
Term
Wrap around axons to form myelin sheath; gaps in myelination are Nodes of Ranvier, insulates and protects axons from Extracellular environment
Definition
Schwann cells (support cell of PNS)
Term
Two types of Lower (somatic) Motor Neurons (motor neurons from the spinal cord to skeletal muscle
Definition
Alpha motor neuron
Beta motor neuron
Term
Innervate muscle fibers; Nerve to muscle ratio varies 1:10 fine motor, 1:200 + course motor movement
Definition
Alpha motor neurons of the Lower Somatic motor neurons
Term
Innervates spindles. Neuromuscular Junction (terminal part of motor nerve, synaptic cleft and end plate of myo.
Definition
Type of lower somatic motor neurons.
Term
Types of Receptors in PNS
Definition
Cholinergic (nicotinic, muscarinic
Adrenergic (Alpha and beta adrenergic receptors)
Term
Cholinergic receptors are nicotinic where?
Definition
skeletal myos and post-ganglionic neurons
Term
Two types of muscle fibers alternately distributed
Definition
Type 1: slow twitch fibers "red myo", more dependent on fat catabolism; tonic contractions like weight bearing.
Type 2: fast twitch fibers "white myo", hi dependence on glycogen; rapid phase contractions like suddern movement.
Term
In Type 1 and Type 2 normal skeletal muscle, What determines the fiber type?
Definition
Motor neuron
Term
What do muscle spindles do in a normal skeletal muscle
Definition
Responds to muscle stretch
Maintain muscle Tone
Term
Disintegrating myelin engulfed by the schwann cell and macrophages, inferior myelin replacemnt causing further axonal injury
Definition
Neuronal injury of PNS: Injured myelin sheath causing segmental demyelination
Term
What happens to an injured myelin sheath in neuronal injury?
Definition
segmental demyelination; Schwann cell and macrophages engulf it. The myelin that replaces it is inferior, so get more axonal injury.
Term
What happens to a Schwann cell in neuronal injury?
Definition
repaired/replaced
Term
destruction of the axon with secondary disintegration of myelin sheath > axonal degeneration
Definition
Axonal injury in PNS neuronal injury
Term
Degeneration of axon distal to axonal injury; new terminals sprout from prox segment and uses the Schwann cell pathway
Definition
Wallerian degeneration
Term
Wallerian degeneration
Definition
Axonal injury: destruction with secondary disintegration of myelin sheath
_degeneration of axon DISTAL to axonal innury, new term sprouts from prox. segment
Term
With axonal injury, if the injury occurs above the hilium, what happens to the axon?
Definition
death, can't be replaced
Term
In PNS neuronal injury: Denervation atrophy
Definition
decrease in muscle cell numbers (atrophy, weak);
Receptors in denervated fibers spread across muscle membrane
-Fasciculations-spontaneous discharge
-Fibrillations-spontaneous contraction
Term
Decrease in muscle cell content
Receptors in denervated fibers spread across muscle membrane (spontaneous discharge or contraction)
Definition
Denervation atrophy of PNS neuronal injury
Term
Neighboring axons extend sprouts to reinnervate denervated myocytes
Definition
Reinnervation: may lose some fine motor movement,
assumes the myo fiber type of the innervating neuron
Term
Axonal injury of CNS, cranial nerves
Definition
Wallerian degeneration and sprouting
Proper guidance for sprouts is lacking
Neuronal loss-can't be replaced
Term
Wallerian degeneration and sprouting
Proper guidance for sprouts is lacking
Neuronal loss-can't be replaced
Definition
Cranial nerves-axonal injury
Term
Neuropathies
Botulism
MG
Postpolio
Definition
Types of PNS and Neuromuscular Junction Disorders
Term
Sensory or Motor; sensory symptoms associated with single or multiple peripheral nerves
Definition
Neuropathies
Term
Sensory symptoms and deficits associated with a single peripheral nerve
Definition
Mononeuropahy
Term
Sensory symptoms and deficits associated with multiple peripheral nerves: symmetric sensory loss affects legs more than arms.
Definition
Polyneuropahy
Term
??: botulism, MG, postpolio
Definition
Types of neuropathies
Term
Reactivation of latent chicken pox virus in sensory nerve ganglia of spinal cord, secondary to decreased immunity
Definition
Shingles
Term
Affects SENSORY nerve ganglia of spinal cord
Definition
shingles
Term
Patho: inflammatory response to virus
Definition
neuronal injury and loss
Term
clinical: vesicular skin eruption in the distribution of sensory dermatomes, Radicular pain,burning and tingling
Definition
Shingles
Term
Acute inflammatory neuropahy: immunologic reaction directed at spinal nerve root and peripheral nerve myelin
Definition
Guillian Barre Syndrome
Term
reaction directed at spinal nerve root and peripheral nerve myelin
Definition
GBS
Term
Patho: T-cell mediated auto-immune response against myelin; infiltration of lymphocytes and macrophages, that then segmentally demyelination. Result: decreased nerve conduction velocity or complete loss of nerve conduction. Inflamm damages axons
Definition
GBS
Term
Lymphocytes migrate thru endoneural vessels and surround nerve fiber, not myelin sheath or axon
Definition
Stage 1 GBS
Term
Macrophages show up and segmental demylenatin begins, but not into axon yet
Definition
Stage 2 GBS
Term
Myelin sheath and some axon damage. Muscle begins to develop denervation atrophy
Definition
Stage 3 GBS
Term
Extensive axon damage. some irreversible; Inflammatory /cytokines also damage axon
Definition
Stage 4 GBS
Term
Etiology: Ascending paralysis, distal 1st.; autonomic instability, hi protein levels in cerebral spinal fluid. prolonged recovery
Definition
GBS
Term
Toxins bind to peripheral nerve endings
Definition
Botulism
Term
Toxins binding to peripheral nerve endings block synaptic release of ACh
Definition
Botulism
Term
Clinical: weakness, blurred vision, dipolopia, dysphasia, paralysis of resp and skeletal muscle
Definition
Botulism
Term
autoimmune disorder of neuromuscular transmission
Definition
Myasthenia Gravis
Term
Etiology: Genetic, THYMIC abnormalities
Definition
Myasthenia Gravis
Term
Patho: Antibodies against nicotinic ACh RECEPTORS (muscle and post-ganglionic neurons)-lead to loss of functional AChR:
ACh receptors blocked/destroyed, less myo contraction, affects ocular
Definition
Myasthenia Gravis
Term
Clinical: weakness first noticed in extrtaocular myos, ptosis and diplopia., Fluctuating weak and fatigued. Improves with rest, AChesterase inhibitors
Definition
Myasthenia Gravis: dx based on response to Tensilon, presence of antibodies and repetitive single fiber EMG
Term
Histology: Loss of post synaptic receptors at motor end plate
antibodies (IgG) to AChR
scattered lymphocytes around motor end plates
Definition
Myasthenia Gravis
Term
Etiology: previous viral polio infection
Definition
Post polio syndrome
Term
Neuronal fatigue, new neuronal loss; original disease caused nerve cell death; neurons that were not affected innervate orphaned myo; remaining had years of hi use and enlarged added stress, these malfunction and permanent weakness occurs
Definition
Post Polio Syndrome
Term
Genetic defect that STOPS the formation of dystrophin
Definition
MD
Term
Disorders of? MD, myotonic dystrophy, toxic myopathies
Definition
Muscle disorders
Term
What anchors the sarcomere to the sarcolemma cell membrane in myocytes?
Definition
Dystrophin
Term
Poorly anchored sarcomeres tear during contraction of acrin and mycin linking. regenerative myo is defective so makes it worse
Definition
MS
Term
Clinical: starts age 2-5, w/c by 7-12. muscle weakness begins in POSTURAL myos (pelvic and shoulder), delayed sitting/walking, clumsiness/falling. later myo atophy, severe wasting, contractures, heart failure
Definition
DMD
Term
Histology: degeneration, necrosis and phagocytosis of muscle fibers. fat and connective tissue replace the myo fibers; cognitive impairment
Definition
DMD
Term
Postural muscles involved (pelvic, shoulders)
Definition
DMD
Term
elevated CK, serum creatinine kinase levels
Definition
DMD
Term
Patho: Genetic defect diminishes the amount of dystrophin and molecular weight; allows anchorage of myo to cell membrane but genetic alterations impair long term function
Definition
Becker MD
Term
Clinical: begins late child or teen, progresses slowly, PROXIMAL myo weak, cardiac disease, altered dystrophin size
Definition
Becker MD
Term
Proximal Muscle involvement
Definition
Becker MD
Term
sustained involuntary contraction of a group of myos with delayed rx
Definition
Myotonic Dystrophy
Term
nucleotide CTG repeats itself, next generation repeats increase and symptoms start younger
Definition
Myotonic Dystrophy
Term
Protein levels in myo alter muscle fiber structure and function
Definition
Myotonic Dystrophy
Term
Clinical: weak and wasting of voluntary myos of face, neck and distal arm/legs. involuntary contracition of myos, with delayed relaxing; atrophy of myos of face, ptosis and cataracts;
Definition
Myotonic Dytrophy
Term
Histology: variation in muscle fiber size, degeneratin, necrosis, phagocytosis of myo fibers; changes in MUSCLE SPINDLE
Definition
Myotonic dystrophy
Term
31 pairs of spinal nerves, both sensory and motor, supplies and receives info
Definition
Spinal cord
Term
What cell bodies are located in plexus/ganglia near the spinal cord?
Definition
spinal cord neurons
Term
Responsible for voluntary fine motor movement; synapse with alpha motor neuron
Definition
Corticospinal tract: part of pyramidal upper motor neurons
Term
Upper Motor Neurons: Motor system
Definition
Cerebella
Pyramidal (corticospinal tract, corticobulbar tract,
extrapyramidal tract
Term
Cell bodies originate in cerebral cortex and go down the brain and cord WITHOUT synapsing in basal ganglia: synapse with Alpha motor neurons; responsible for fine motor movement
Definition
Corticospinal tract (part of pyramidal motor system)
Term
Cell bodies originate in cerebral cortex and go down brainstem and synapse with motor nuclie of cranial nerves; Fine motor movement, controls face and tongue
Definition
Corticobulbar tract of pyramidal part of motor system of upper motor neurons
Term
cell bodies originate in different parts of brain and synapse IN basal ganglia. Neurons descend down brain and spinal tract; Regulates VOLUNtary movement, INVOLuntary gross body movements; maintains posture
Definition
Extrapyramidal tract of Pyramidal tract of Motor System: upper motor neurons
Term
Fibers pass directly into the DORSAl COLUMN of the cord and goes up same side: medulla>thalamus>cerebral cortex
Definition
Sensations of position and vibration and fine touch
Term
Sensations of position and vibration and fine touch pass ?
Definition
dorsal column, up same side, medulla, thalamus, cortex
Term
Sensations of pain and temp to DORSAL HORN,
Definition
synapse with secondary neuron in cord, cross opposite and goes up to LATERAL spinothalamic tract>thalamus>cortex
Term
sensations of crude touch and pressure pass to
Definition
DORSAL HORN, synapse with seond nuron in cord, CROSS over , go up anterior spinothalamic tract to thalamus>cortex
Term
General quality of sensation at thalamic level is perceived at what level, and what level makes fine distinctions?
Definition
general thalamac, fine distinctions made in cortex (homunculus)
Term
How pain becomes conscious
Definition
Nociception
1) transuction
2) transmission
3) perception of pain
4) Modulation
Term
nociceptors
Definition
bare sensory endings for pain
Term
nociceptors respons to noxious mechanical, hermal, inflamm mediators and start an action potential: Pain impulse;
Definition
Transduction phase of pain
Term
bradykinin, prostaglandins; substance P, leukotrienes, serotonin
Definition
Inflammatory mediators of pain
Term
pain impulse travels from A and C peripheral nerve fibers (first order neurons) to DORSAL HORN in cord
Definition
Transmission phase
Term
Myelinated nerve fibers that are FAST conducting
Definition
A-delta nerve fibers
Term
Unmylinated nerve fibers are SLOW conducting pain
Definition
C nerve fiers
Term
First pain travels to dorsal horn in cord; synapses with secondary neuron in cord and CROSSES over; goes up cord thru Lateral spinothalamic and spinoreticular tracts: synapses 3rd to carry info to other brain and cortex;
Definition
Transmission phase of pain
Term
Reticular system, Thalamus, Somatosensory Cortex, Limbic system
Definition
Perception of pain in the brain, locations
Term
Sends info to limbic system, integrates the autonomic response
Definition
Reticular system (part of pain perception)
Term
Localizes the pain
Definition
Thalamus-part of pain perception stage
Term
Characterizes and interprets pain
Definition
Somatosensory Cortex: transmission phase of pain
Term
Emotional and behavioral response to pain
Definition
Limbic system: Perception of pain phase
Term
Three pathways in the MODULATION phase of pain that INHIBIT pain
Definition
Cortex
Midline
Dorsal Horn
Term
Descending path to thalamus and periaqueductal gray (PAG) matter, descending path from thalamus to PAG
Definition
Cortex: pathway to inhibit pain transmission
Pain Modulation phase
Term
descending path from thalamus to PAG; periaqueductal gray matter-located in midbrain; sends signals to midline raphe nucleus in medulla
Definition
Cortex: pathway
Pain Modulation phase
Term
raphe nucleus in medulla that sends signal down cord and synapse in dorsal horn to INHIBIT the release of excitatory neurotransmitters of pain
Definition
MIDLINE pathway that inhibits pain
Pain Modulation phase
Term
"gatekeeper", received INHIBItory signals from raphe nucleus; pain can be modulated by stimulation of large sensory afferents from skin that block the impulse and pain
Definition
DORSAL HORN pathway to inhibit pain transmission; Pain Modulation phase
Term
Modulation of pain pathway neurotransmitters
Definition
Endorphins, enkephalins, dynorphins, seratonin and norepinephrine, GABA
Term
Patho: Peripheral: sensitization of nociceptors; enhanced response to noxious stimulation, newly acquired response to stimuli; damaged or diseases nerve, axonal sprouts, extopic foci that fire, upregulation of receptors
Definition
Peripheral patho of pain
Term
Patho: sensitization of second order neurons; triggered by less stimuli, augmented strength of stimulus --summation/windup--prolonged discharge, spontaneous impulse
Definition
Central NS at dorsal horn, patho of pain
Term
patho: densitization of second neurons; activate more neurons to contuct impulse; loss of inhibitory interneuron activity
Definition
CND response to pain at dorsal horn
Term
Sensitization of third order neurons; reorganization neural connections
altered perception of pain

altered perception of pain
Definition
Central Brain patho to pain
Term
patho: central gray matter microscopic hemorrhages; white matter axonal edema, decreased perfusion, inflamm response, necrosis and scar tissue forms
Definition
Spinal cord trauma
Term
Clinical: spinal shock, parapegia or quadraplegia, antunomic dysreflexia
Definition
Spinal cord trauma
Term
normal activity of spinal cord ceases at and below level of injury; complete loss of reflex function (skeletal, bladder, bowel, etc)
Definition
spinal shock. clinical of spinal trauma
Term
hyperactivation of the sympathetic nervous system in response to noxious stimulation of sensory receptors below level of the cord lesion
Definition
Autonomic dysreflexia
Term
weakness and degeneration of the annulus fibrosus and pos longitudinal ligament causing bulging or protrusion of nucleus pulposus into spinal cord
Definition
Herniated intervertebral disk
Term
where do most herniations occur, compromising the spinal nerve root producing pain?
Definition
Posterolatererally
Pain can also be due to irritation, inflammation of dural membranes
Term
Types of spinal cord injuries
Definition
Brown Sequard Syndrome
herniated intervertebral disk
Term
occurs with trauma to or lesions that involve 1/2 the cord, usually cervical area;
Definition
Brown Sequard Syndrome
Term
loss of proprioception on same side as lesion; loss of pain and temp opposite side, Loss of voluntary motor function from corticospinal tract on the same side
Definition
Brown Sequard Syndrome
Term
Cyst, tumor or trauma that injures the central gray matter of the cord
Definition
Syringomyelia (central cord syndrome)
Term
Loss of motor power and sensation of the level of the lesion; and across shoulders and upper arms for cervical cord lesions
Definition
syringomyelia, central cord syndrome
Term
Main part of CNS
Definition
brain
Term
parts of cerberum
Definition
cerebral hemispheres and cortex
Term
Names of lobes
Definition
Frontal Parietal Temporal Occipital
Term
Parts of brain involved in emotional experiences and survival behavior
Definition
Limbic System: border around diencephalon, and hippocampus and amygdala
Term
Part of brain important to cognition and emotion
Definition
Basal Ganglia: includes caudate nucleus and putamen; lies lateral to the thalamus
Term
Anterior, posterior and flocculonodular lobes
Definition
cerebellum
Term
structure surrounding the 3rd ventricle and forming the inner core of the cerebrum
Definition
Diencephalon
Term
4 parts of diencephalon, and form inner core of cerebrum
Definition
Thalamus
Hypothalamus
Subthalamus
Pituitary/Pineal body
Term
Brainstem parts
Definition
MIdbrain, pons, medulla, Reticular formation
Term
Collection of nerve cell bodies WITHIN brainstem
Definition
Reticular formation
Term
regulates vital reflexes, maintain wakefulness, awareness, alertness and then projects to thalamus
Definition
Reticular formation (collection of nerve cell bodies WITHIN brainstem)
Term
Protective structures of CNS
Definition
Cranium, meninges(membranes covering brain and spinal cord); cerebrospinal fluid and ventricular system, CNS blood supply, Blood brain barrier
Term
parts of ? Dura mater; Arachnoid membrane and subarachnoid space, pia mater
Definition
Meninges-protective part of CNS
Term
Produced by ependymal cells in choroid plexus, reabsorbed into venous circ thru arachnoid villi
Definition
CSF and ventricular system-protective part of CNS
Term
What regulates blood flow within CNS
Definition
CO2
Term
Tight junctions between capillary endothelial cell; encircling astocyte feet; entry of substances from blood into CNS is controlled by ependymal cells in choroid plexuses
Definition
Blood Brain barrier
Term
What controls entry of substances from the blood into the CNS
Definition
ependymal cells in the choroid plexuses
Term
Support cells of the CNS
Definition
Neuroglia: astrocytes, oligodendrocytes; microglia
Term
astrocytes; oligodendrocytes, microglia
Definition
Neuroglia-support cells of the CNS
Term
provides nutritional support to CNS; helps regulate blood flow to provide O2 to neurons; provides structural support to neurons; maintains blood brain barrier; inflamm response to CNS injury; regulates extra cellular conc of neurotransmitters
Definition
Astrocytes (support cell of the CNS, type of neuroglia)
Term
Participates in response to CNS injury by releasing cytokines, multiplies in #, involved in tissue repair and scar tissue formation
Definition
Astrocytes (support cell of CNS, type of Neuroglia)
Term
Provides structural support of neurons of CNS
Definition
Astrocytes (support cell of CNS, type of Neuroglia); also nutritional support, provides O2 if needed
Term
Regulates extracellular concentrations of neurotransmitters in the CNS: help terminate neuronal responses to glutamate
Definition
Astrocytes (support cell of CNS, type of Neuroglia)
Term
Helps terminate neuronal responses to glutamate in CNS by regulating concentrations of neurotransmitters
Definition
Astrocytes (support cell of CNS, type of Neuroglia)
Term
Wraps around axons to form myelin sheath
Definition
Oligodendrocytes-support cell of CNS, type of neuroglia
Term
Oligodendrocytes-support cell of CNS, type of neuroglia: How does it support the CNS?
Definition
Wraps around axons to form myelin sheath
Term
Phagocytic cells of the brain, acts as the brain immune cells
Definition
Microglia, type of neuroglia, support cell of CNS
Term
What happens with lowered amounts of dopamine?
Definition
excitatory signal sent to the motor cortex is replaced with an inhibitory one
Term
overall net effect of corto-basal ganglia loop
Definition
excitatory
Term
Less production of dopamine, corto-basal ganglia loop is inhibited in what disease?
Definition
Parkison's disease
Term
If Schwann cell sheath pathway, can re-innervate?
Definition
Yes, in PERIPHERAL system neuronal injury
No Schwann cell sheath, no reinnervate
Term
Central NS
Definition
less likely to reinnervate, as no pathway formed.
Term
Wallerian degeneration
Definition
new sprouts, Schwann cell sheath pathway used.
Term
peripheral
Definition
nerves connecting myos
Term
decreased myo contraction from decremental response with repeated stimulation
Definition
Myasthenia gravis: AChR, destruction of receptors, so ACh not available.
Term
Very high serum creatinine kinase levels
Definition
Duchenne's MD
Term
Ischemic strokes
Definition
Do not have ability to move Na back into the cell and K out with repolarization: why block is there. no depol, get Na into the cell.
Term
Too much Na in cell
Definition
glutamate can't move in as no osmotic gradient, in ischemic stroke TOO much glutamate and K out of the cell. K stim more glutamate--stimulates Ca release to depolarizes, get hi Ca in nuron damage
Term
Too much Ca causes neuronal injury in ischemia
Definition
ischemic stroke: initial loss of cell loss around site of infarction of ischemic stroke: glutamate toxicity
Term
Glutamate stimulates Ca, and Calcium causes?
Definition
Neuronal death in ischemic stroke
Term
autoimmune attack in peripheral nerve myelin
Definition
MG
Term
MS
Definition
problem in brain with mylein
Term
neuritic placque, AMYloid Beta peptid production, and neurofibrillary tangles
Definition
need ALL three for alzheimers, when breaksdown forms AB ABNORMAL,
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