Term
|
Definition
Skull
Meninges - dura, arachnoid, pia
CSF
BBB |
|
|
Term
| What is the subdural space needed for? |
|
Definition
| Where drainage of CSF and venous blood occurs |
|
|
Term
| What is the innermost layer of meninges? |
|
Definition
| Pia mater (traverses sulci & gyri) |
|
|
Term
| What is located within the subarachnoid space? |
|
Definition
| CSF; area is continuous throughout entire CNS |
|
|
Term
|
Definition
| Choroid plexus of 3rd and 4th ventricles |
|
|
Term
| Structures within forebrain |
|
Definition
| Prosencephalon = cerebral cortex + basal ganglia + diencephalon (thalamus & hypothalamus) |
|
|
Term
|
Definition
| Intellect, personality, motor & premotor cortex, Broca's area |
|
|
Term
|
Definition
| Somatosensory cortex, high level sensation |
|
|
Term
|
Definition
| Memory & auditory sensation, Wernicke's area |
|
|
Term
| Which side of the body is controlled by each cerebral hemisphere? |
|
Definition
Controls the CONTRALATERAL side
L hemisphere - controls R side
R hemisphere - controls L side |
|
|
Term
| L hemisphere vs. R hemisphere |
|
Definition
L hemisphere = logic & analytical skills
R hemisphere = creativity, art and emotins |
|
|
Term
| L hemisphere vs. R hemisphere |
|
Definition
L hemisphere = logic & analytical skills
R hemisphere = creativity, art and emotions |
|
|
Term
| Pyramidal vs. Extrapyramidal System |
|
Definition
Pyramidal = CTS tracts from motor cortex
Extrapyramidal = basal ganglia |
|
|
Term
|
Definition
Primitive structures which regulate emotion and feelings
Often battles with logical control of cerebrum |
|
|
Term
| What is the cerebellum needed for? |
|
Definition
| Need to coordinate balance, equilibrium & movement |
|
|
Term
| What is the thalamus needed for? |
|
Definition
| Takes incoming sensory information from periphery and relays to correct locations in brain |
|
|
Term
| What is the main function of the hypothalamus? |
|
Definition
Maintain HOMEOSTASIS (temperature, hunger, thirst)
Also involved in endocrine and autonomic function |
|
|
Term
| What system is located throughout the brainstem and what is it's function? |
|
Definition
Reticular activating system - responsible for maintaining normal arousal
Damage can lead to coma |
|
|
Term
| Two main sets of arteries which supply blood to the brain? |
|
Definition
| Internal carotids & vertebral arteries |
|
|
Term
| Neural supply from internal carotids... |
|
Definition
Branch into:
Anterior Cerebral - frontal lobe
Middle Cerebral - parietal & temporal lobes |
|
|
Term
| Neural supply from vertebral arteries... |
|
Definition
Join to form basilar artery at base of skull (supplies cerebellum & brainstem)
Branch to R and L posterior cerebral arteries - supply to occipital lobe |
|
|
Term
| What is the blood supply to the lobes of the brain? |
|
Definition
Frontal = anterior cerebral
Parietal & Temporal = middle cerebral
Occipital = R and L posterior cerebral |
|
|
Term
| What is responsible for forming the BBB? |
|
Definition
| Astrocyte end foot processes wrap around capillaries in CNS |
|
|
Term
| What substances are prevented from passing through the BBB? |
|
Definition
| Ones that are too large, too charged, and NOT lipid soluble (need to be lipophilic to pass) |
|
|
Term
| Protection to spinal cord |
|
Definition
| Vertebrae, meninges, and CSF in subarachnoid space |
|
|
Term
| At what level does the spinal cord end? |
|
Definition
|
|
Term
| White matter vs. gray matter and sensory vs. motor neurons in spinal cord |
|
Definition
WHITE matter TRACTS surround GRAY matter core (note opposite as brain, as gray matter forms exterior with white matter connections between hemispheres)
Sensory neurons in dorsal/posterior roots, motoneurons in ventral/anterior roots |
|
|
Term
| How many roots does each spinal nerve have and where are they located? |
|
Definition
| Each spinal nerve has 2 roots - ventrally motor and dorsally sensory |
|
|
Term
| How many pairs of spinal nerves are there? |
|
Definition
|
|
Term
| How many dermatomes are there and what innervates each one? |
|
Definition
| 30 dermatomes in total, innervated by afferent fibers (sensory) from DRG in spinal nerves |
|
|
Term
| Myelin synthesizing cells of PNS vs. CNS |
|
Definition
PNS = Schwann cells
CNS = Oligo's |
|
|
Term
| Difference in neural regeneration in PNS vs. CNS |
|
Definition
CNS environment post-injury is toxic, inhibitory to axonal regrowth
In contrast, PNS environment facilitates axonal regeneration via Schwann cell and macrophage functions |
|
|
Term
| What does damage to the soma of a neuron cause? |
|
Definition
|
|
Term
| NT & receptor used by preganglionics in sympathetic vs. parasymp. |
|
Definition
SAME FOR BOTH
Both pregang release ACh and it acts on NICOTINIC receptors on postgang membrane |
|
|
Term
| Postganglionic NT's in sympathetic vs. parasympathetic |
|
Definition
Sympathetic - NE acting on B-adrenergic
Parasympathetic - ACh acting on muscarinic |
|
|
Term
| Pathology of supratentorial lesions |
|
Definition
Occur above tentorium cerebelli (in cerebral hemispheres)
Often see a discrete loss of SPECIFIC function; non-fatal usually |
|
|
Term
| Pathology of infratentorial lesions |
|
Definition
Occur below tentorium cerebelli (in brainstem)
Small lesion = WIDESPREAD impairment
Fatal if it affects CV and cardiorespiratory function |
|
|
Term
|
Definition
Numbness/weakness on one side of body (contralateral to side of stroke)
Loss of vision or dimness, particularly in one eye
Transient receptive & expressive aphasia
Dizziness, headache, loss of balance |
|
|
Term
| Damage to motor cortex... |
|
Definition
Damage to these motor neurons (pyramidal), causes loss of voluntary movement on CONTRALATERAL side of body
Spastic paralysis/hyperreflexia on contralateral side |
|
|
Term
| Damage to ventral motoneurons of SC... |
|
Definition
| See weakness/numbness/paralysis on IPSILATERAL side of body |
|
|
Term
| What has the largest amount of space in the somatosensory cortex devoted to it? |
|
Definition
| The fingers - highly innervated |
|
|
Term
Differences in symptoms of:
1. Optic nerve damage
2. Optic chiasm damage
3. Optic tract damage |
|
Definition
1. Loss in vision to one eye
2. Complete blindness - lose all connection to occipital lobe
3. Visual field deficits - lose visual field contralateral to side of damage |
|
|
Term
| Damage to R occipital lobe/R optic tract causes? |
|
Definition
| Loss of all sight in L visual field |
|
|
Term
|
Definition
Also called non-fluent/motor aphasia
Cannot express language but can understand it
Due to Broca's area damage |
|
|
Term
|
Definition
Also called sensory/fluent aphasia
Cannot understand language, but can express it (not due to visual or hearing defect)
Due to damage to Wernicke's area in temporal lobe |
|
|
Term
| 4 precipitating factors for seizures |
|
Definition
| Hypoxia, Hemorrhage, Inflammation, Stimuli |
|
|
Term
| Most dangerous type of herniation in the brain? |
|
Definition
| Cerebellar - pushes down onto brainstem |
|
|
Term
| Early signs of increased ICP |
|
Definition
| Vomiting (if medulla affected), loss of consciousness, severe headache, papilledema (bulging optic disc) |
|
|
Term
| Vital signs seen in increased ICP |
|
Definition
Cerebral ischemia creates hypoxic environment in brain
Cushing's Reflex - systemic vasoconstriction (increased pulse pressure) and vasodilation of cerebral BVs
Slowed baroreceptor response to cause bradycardia
Overall - systemic vasoconstriction & bradycardia; cerebral vasodilation |
|
|
Term
| Which CN is responsible for controlling pupil size & response? |
|
Definition
|
|
Term
| Visual deficits of increased ICP... |
|
Definition
If occulomotor nerve is impinged upon (CN III), see pupil size & response
IPSILATERAL pupil is fixed & dilated, eventually both affected |
|
|
Term
| Most common type of brain tumors? |
|
Definition
Usually are glial cell derived (astrocytomas are most common)
Also, most brain tumors are benign |
|
|
Term
| Difference in borders of benign & malignant brain tumors |
|
Definition
Benign - easier to remove b/c of defined borders
Malignant - harder to remove b/c of less defined borders |
|
|
Term
| T or F - Tumors often metastasize OUT of the brain? |
|
Definition
| FALSE. Malignant tumors stay within brain, but multiply many times w/in CNS |
|
|
Term
| Different classes of strokes & descriptions |
|
Definition
Embolic - cerebral artery blocked by embolus
Ischemic - gradual narrowing of artery due to arteriosclerosis
Hemorrhagic - usually intracranial hemorrhage |
|
|
Term
| What is the type of damage seen to the body during a stroke? |
|
Definition
See UNILATERAL damage to the CONTRALATERAL side of body as stroke
E.g. CVA in R hemisphere cause localized L side of body dysfunctions |
|
|
Term
| What type of stroke is most common? |
|
Definition
|
|
Term
| Difference between time of occurrence of hemorrhagic vs. ischemic strokes? |
|
Definition
Ischemic - typically occur at rest; due to gradual narrowing of cerebral arteries
Hemorrhagic - typically occur during exertion, rapid increase in BP |
|
|
Term
| At what point does neural damage from a stroke become irreversible? |
|
Definition
|
|
Term
| Where is apoptosis first seen in CVAs? |
|
Definition
In the core of the infarct (apoptotic core)
Over time, cells in penumbra also undergo apoptosis if treatment is not immediate |
|
|
Term
|
Definition
First see electrolyte and NT irregularities - glutamate causes hyperexcitability of neurons (excessive firing)
Ischemia prolongs leading to infarction, and an apoptotic core forming in the center of the infarct
Without treatment, apoptosis spreads to cells in penumbra |
|
|
Term
| What can lead to visual neglect? |
|
Definition
|
|
Term
| Where is the damage that has occurred causing visual neglect? |
|
Definition
| Damage to ATTENTIONAL system of brain, NOT visual system |
|
|
Term
| What kind of neglect with R parietal lobe damage cause? |
|
Definition
| Neglect of L visual field (L-sided neglect is most common) |
|
|
Term
|
Definition
| Obesity, DM II, HTN, high cholesterol, etc. |
|
|
Term
| How can the penumbra be rescued in treating a CVA? |
|
Definition
Previously though glutamate antagonists would be helpful - ineffective
Now use hypothermia induced coma - slows metabolic processes of brain |
|
|
Term
| What type of infection is meningitis and what are the associated symptoms & Rx? |
|
Definition
BACTERIAL INFECTION (common in youth and elderly)
See cloudy CSF (leukocytosis), headaches, stiff back, nuchal rigidity, vomiting
Need aggressive antibiotics & anti-inflammatory drugs (and quarantine, as is highly contagious) |
|
|
Term
| What is the most common cause for a brain abscess? |
|
Definition
| Peripheral infiltration of bacteria from open head wound (e.g. compound skull fracture) |
|
|
Term
| Mortality rate of brain abscess? |
|
Definition
|
|
Term
| Infection of parenchyma of CNS? |
|
Definition
|
|
Term
|
Definition
Infection of parenchyma of CNS, usually also affects glia
VIRAL ORIGIN
E.g. Western Equine, Lyme disease, West Nile, St. Louis |
|
|
Term
|
Definition
Bite from rabid animal; bacteria travels up peripheral nerves to CNS
Inflammation and necrosis of neural tissue
Early intervention with vaccine can treat |
|
|
Term
| Primary symptom of Tetanus? |
|
Definition
|
|
Term
| What do the bacteria attack in poliomyelitis? |
|
Definition
|
|
Term
|
Definition
VIRAL infection associated with children taking ASA (Aspirin)
Causes increased ICP & hepatomegaly |
|
|
Term
|
Definition
Autoimmune response from VIRAL INFECTION
Causes PNS inflammation
Starts in peripheral nerves of legs, then ascends up trunk |
|
|
Term
|
Definition
Dormant chicken pox virus in DRG of adults re-emerges and attacks spinal nerve
Causes rash on IPSILATERAL side of body in the affected DERMATOME |
|
|
Term
|
Definition
Mild blow to the head, with reversible damage
May see amnesia and headache following
Occurrence makes subsequent more likely |
|
|
Term
|
Definition
BLUNT (not sharp) blow to the head
Rupture of small surface BVs causes BRAIN BRUISE
May see some residual damage |
|
|
Term
| Which type of skull fracture poses the greatest risk of infection? |
|
Definition
Compound (exposure of environment to neural tissue due to break in skin)
May lead to brain abscess |
|
|
Term
| Type of fracture with CSF leaking from nose & ears? |
|
Definition
Basilar fracture - due to tearing of meninges at base of skull
Often from whiplash damage |
|
|
Term
|
Definition
Compound fracture w/ communited break; depressed flat spot at site of fracture
Fragments may push into neural tissue - ischemia & increased ICP |
|
|
Term
| Primary injury to head injury: |
|
Definition
Neuronal or glial death from impact of trauma
Damage from BV from trauma
NEEDS TO BE DUE DIRECTLY FROM TRAUMA of injury |
|
|
Term
| Secondary injury to head injury |
|
Definition
Increased ICP from edema/hemorrhage
Vasospasm - blood from hemorrhage causes spasm of local BVs
Ischemia - leading to necrosis |
|
|
Term
| Where is SCI most common? |
|
Definition
In flexible regions
C1-C7
T12-L2 |
|
|
Term
| Which ligaments are damaged in hyperflexion vs. hyperextension of neck in SCI? |
|
Definition
Hyperflexion = post. long
Hyperextension = ant. long |
|
|
Term
| Which spinal cord lesions can affect respiration? |
|
Definition
| Lesions in C3-C5, affect phrenic nerve - goes to diaphragm to control breathing |
|
|
Term
|
Definition
See NO function at or below level of injury (no autonomic, sensory/motor); also inflammation at injury may see loss of function above also
HYPOREFLEXIA (flaccid paralysis) |
|
|
Term
| Symptoms of Post-Spinal Shock Recovery |
|
Definition
Start to gain innervation, some autonomic reflexes return (bladder and bowel incontinence)
HYPERREFLEXIA develops - spastic paralysis (but still no voluntary movement)
Check dermatome sensation to assess degree of damage |
|
|
Term
| Progression of autonomic dysreflexia |
|
Definition
Begins with stimulus (bladder distension, pain) which ascends to level of injury
Causes SNS activation - systemic vasoconstriction functions to INCREASE BP, headache, vision problems
CANNOT get efferent inhibitory output from baroreceptors to lower
Activate paraysmpathetic innervation via CN X to slow HR (bradycardia)
NEED to remove stimulus to lower BP |
|
|
Term
| What causes the slowed HR seen in autonomic dysreflexia? |
|
Definition
Vagal nerve innervation to the heart
Need to use CN because spinal reflexes cannot travel below level of injury |
|
|
Term
| What is hydrocephalus often secondary to in adults? |
|
Definition
|
|
Term
| Differences in types of hydrocephalus |
|
Definition
Non-Communicating - due to blockage of CSF drainage, usually in ventricles
Communicating - due to absorption deficit by sinuses |
|
|
Term
| Predisposing factors to spina bifida |
|
Definition
Gestational DM
Vit A or folate deficiency in utero |
|
|
Term
| Contrecoup vs. Direct Brain Injury |
|
Definition
Direct - caused by acceleration or deceleration injuries
Contrecoup - rebound injury on the contralateral side of the direct injury (caused by bounce back) |
|
|
Term
|
Definition
Occulta - no fusion of spinous processes, but no herniation
Meningocele - lack of fusion and herniation; external sac filled only with CSF
Myelomeningocele - lack of fusion with herniation of spinal cord and meninges into sac |
|
|
Term
| What leads to spina bifida in the vertebral column of the developing fetus? |
|
Definition
| Failure of spinous processes in fusing, get herniation of meninges and SC |
|
|
Term
| Group of disorders marked by brain damage during the perinatal period...? |
|
Definition
|
|
Term
| 3 different classifications of cerebral palsy |
|
Definition
| Spastic, Dyskinetic, Ataxic |
|
|
Term
|
Definition
65% of cases
Damage to motor cortex/CTS tracts (pyramidal) of brain
Therefore causes HYPERREFLEXIA (lack of inhibition to spinal reflexes) |
|
|
Term
| Dyskinetic Cerebral Palsy |
|
Definition
25% of cases
Damage occurs in basal ganglia & extrapyramidal tracts
See impaired coordination and fine motor control |
|
|
Term
|
Definition
Only 5% of cases
See damage to cerebellum - loss of balance, coordination and posture |
|
|
Term
| Which type of cerebral palsy is most common? |
|
Definition
|
|
Term
|
Definition
Excessive and uncontrollable neuronal discharge
Often due to hypoxia, hemorrhage, infection, certain stimuli |
|
|
Term
| Primary vs. Secondary Seizures |
|
Definition
Primary - inherent in person themselves (idiopathic)
Secondary - due to other condition, EtOH withdrawal, electrolyte imbalance |
|
|
Term
|
Definition
Petit-Mal seizures; common in children
Last 5-10 seconds, see zoned out look with transient facial movements
Brief loss of awareness with no memory of event |
|
|
Term
|
Definition
Tonic-Clonic seizures
In prodrome see twitching and nausea; followed by aura - visual or auditory sensation before loss of consciousness
Strong TONIC muscle contraction (complete rigidity), then get clonic stage - muscles alternately contract and relax
Person returns confused and fatigued
Memory exists up until the end of the aura, then nothing |
|
|
Term
|
Definition
Phenytoin - anticonvulsant; may combine with barbiturates to lower dosage
Avoid precipitating factors
CANNOT stop it once it has started |
|
|
Term
| Why is Parkinson's more prevalent now? |
|
Definition
| Because of the aging population (people are living longer) |
|
|
Term
| 4 main associated symptoms of Parkinson's |
|
Definition
Tremors (often at rest)
Rigidity in limbs/trunk
Bradykinesia (slowed movements)
Postural instability (impaired balance) |
|
|
Term
|
Definition
Lose striatal neurons in substantia nigra of the basal ganglia; use DOPAMINE as NT
Striatal neurons involved in control of movement
Also see loss of some neurons which use NE |
|
|
Term
| Treatment for Parkinson's |
|
Definition
L-dopa - dopamine precursor which crosses BBB
MAO-B/COMT inhibitors - prevent dopamine breakdown in synapses
Anticholinergics - decrease ACh to reduce tremors & rigidity (relax muscle)
DBS - stimulate striatal neurons remaining in basal ganglia |
|
|
Term
| Which motor tracts are affected in Parkinson's? |
|
Definition
| Extrapyramidal tracts (basal ganglia) |
|
|
Term
| Type of neuronal loss in Parkinson's vs. MS? |
|
Definition
Parkinson's = specific population lost (striatal neurons in substantia nigra)
MS = diffuse neuronal loss due to demyelination |
|
|
Term
|
Definition
See demyelination of brain, SC, and cranial nerve axons (slows impulses)
Also see INFLAMMATORY plaques form (periodically flare up; periods of remission and exacerbation) |
|
|
Term
|
Definition
|
|
Term
| What may be the underlying pathology of MS? |
|
Definition
| May be autoimmune - may be due to autoimmune destruction of myelin |
|
|
Term
| Motor system affected in ALS vs. Parkinson's? |
|
Definition
ALS = pyramidal (lateral CTS tracts)
Parkinson's = extrapyramidal (basal ganglia) |
|
|
Term
|
Definition
| Degeneration of lateral CTS tracts leads to FLACCID paralysis - if lower motor neurons affected, progressive muscle weakness eventually gets to respiratory function (asphyxiate) |
|
|
Term
| Onset of myasthenia gravis in men vs. women |
|
Definition
Women = 20-30
Men = older than 50 |
|
|
Term
| What type of condition is myasthenia gravis? |
|
Definition
Autoimmune condition
IgG antibodies attack ACh receptors at neuromuscular junction causing muscle weakness and fatigue
Skeletal muscle weakness starting in face, then arms & trunk |
|
|
Term
| Where does muscle weakness begin in myasthenia gravis? |
|
Definition
| Facial and ocular muscles, then moves to arms & trunk, progresses to lose control of muscles for swallowing & respiration |
|
|
Term
| Cognitive function of those with myasthenia gravis? |
|
Definition
COMPLETELY NORMAL
Because IgG only attacks AChR at neuromuscular junctions, nothing centrally |
|
|
Term
| What type of disorder is Huntington's? |
|
Definition
Autosomal dominant
Remains in population because of late onset |
|
|
Term
| Type of degeneration seen in Huntingtons? |
|
Definition
Progressive brain atrophy in basal ganglia and frontal cortex (both involved in motor function)
Lose GABA neurons - lose balance between excitatory and inhibitory innervation (excitatory dominates) leading to spastic & jerky movements |
|
|
Term
| Most common form of dementia? Other forms? |
|
Definition
Alzheimer's is the most common
Also see - Creutzfeldt-Jakob (from infectious prion), AIDS, vascular |
|
|
Term
| Link between Alzheimer's and plaques? |
|
Definition
| ALL Alzheimer's patient have amyloid plaques post-mortem, BUT not all people with plaques develop Alzheimer's |
|
|
Term
| What is the progression of Alzheimer's in the brain? |
|
Definition
| Starts in entorrhinal cortex (temporal lobe), then see plaque formation in hippocampus with mild memory loss, finally progresses to frontal cortex also to affect personality, cognitive functions, and motor skills |
|
|
Term
| Which areas of the brain are affected in Alzheimer's? |
|
Definition
Loss of cognitive function due to temporal lobe (entorrhinal cortex) and frontal lobe atrophy
Loss of memory due to plaque formation in hippocampus |
|
|
Term
| Cognitive function of those with Schizophrenia? |
|
Definition
| Doesn't appear to affect cognitive function - those with it can still function at a high level cognitively |
|
|
Term
| Positive and Negative Symptoms of Schizophrenia |
|
Definition
Positive - delusions & hallucinations; delusions of grandeur/persecution & visual/auditory hallucinations are most common
Negative - flat affect, lack of speech, anhedonia |
|
|
Term
| What is the cause of schizophrenia? |
|
Definition
| EXCESS dopamine (note it is opposite to Parkinson's) |
|
|
Term
| Dopamine levels in brain in schizophrenia vs. Parkinson's? |
|
Definition
Parkinson's = dopamine deficit due to loss of striatal neurons
Schizophrenia = dopamine excess |
|
|
Term
| Treatment of schizophrenia? |
|
Definition
Anti-psychotics - decrease dopamine level in the brain
However, if taken in excess may cause Parkinsonian like symptoms because of dopamine deficit
Also, see poor compliance with drugs typically |
|
|
Term
| Unipolar vs. Bipolar Depression |
|
Definition
Unipolar = major depression
Bipolar = alternating depression & mania |
|
|
Term
| Treatment for depression? |
|
Definition
Tricyclic's - block NE uptake at synapses
SSRI's - block serotonin uptake at synapses
MAO inhibitors - prevent NE breakdown at synapses
DBS/ECT |
|
|
