Term
| In the scheme, what are the 3 sources of pain? |
|
Definition
nociceptive (tissue damage)
neuropathic (abnormal neural activity)
psychogenic (psychiatric states) |
|
|
Term
| In the scheme, what are the 2 types/sources of nociceptive pain (that is, pain due to tissue damage)? |
|
Definition
|
|
Term
| In the scheme, what are the 2 types/sources of neuropathic pain (that is, pain due to abnormal neural activity)? |
|
Definition
Central Nervous System
Peripheral Nerves
Sympathetic Nervous System |
|
|
Term
| __________ pain is always pathological. |
|
Definition
| chronic (while acute pain may help us avoid or care for injury) |
|
|
Term
| __________ pain is always pathological. |
|
Definition
| chronic (while acute pain may help us avoid or care for injury) |
|
|
Term
| tends to be sharp, aching, burning or cramping in character (relatively non-specific). Also tends to be continuous, fluctuating in intensity, and exacerbated by manipulation of the affected tissues/area |
|
Definition
| Nociceptive pain (pain due to tissue damage) |
|
|
Term
| Tends to be burning, electrical, or shock like. Often sporadic and paroxysmal. May be associated with sensory ‘triggers’. Often associated with co-localized alterations of sensation |
|
Definition
|
|
Term
|
Definition
| pain with a normally non-painful stimulus (ex., pain when you gently stroke the affected area) |
|
|
Term
|
Definition
| Exaggerated pain in response to a stimulus that is normally painful (ex., excruciating pain in response to a light pinprick) |
|
|
Term
|
Definition
| unpleasant abnormal sensations--may involve allodynia, hyperalgesia, or an unpleasant or painful feeling with no stimulus at all |
|
|
Term
| pain tends to lack a clear and compelling correlation with the clinical history (mechanism of injury), physiologic patterns of pain distribution, associated signs, and expected evolution over time as seen with other pain types. It is often disproportionate in quality and severity (either with seemingly extraordinary misery or with description of severe pain but with ambivalent or indifferent affect) |
|
Definition
|
|
Term
| What are the temporal patterns of pain (2 main categories, with 2 or 3 subtypes)? |
|
Definition
Continuous (constant or fluctuating)
Intermittent (sporadic, periodic and/or circumstantial) |
|
|
Term
| What 3 questions do you want to ask about the distribution of pain? |
|
Definition
1. Where is the pain ‘centered’?
2. Does the pain radiate? If so, where?
3. Is the pain shifting over time? |
|
|
Term
| tends to be deep, vaguely localized, sharp or aching, and colicky (recurrent, crampy and spasmodic) |
|
Definition
| Visceral nociceptive pain |
|
|
Term
| tends to be discretely localized as well as sharp, aching, burning, throbbing, or cramping in character. Typically persistent, fluctuating, exacerbated by manipulation of affected tissues |
|
Definition
|
|
Term
| nociceptive pain in the skin, subcutaneous tissue, muscles, bones, and joints. |
|
Definition
|
|
Term
|
Definition
| If you lightly tap over an irritated nerve, you will elicit "pins & needles" at the ends of the nerve |
|
|
Term
| There is usually an initiating event, most often trauma, followed by the development (sometimes delayed by several days or even weeks) of severe regional pain, allodynia, and edema, as well as regionally abnormal and variable color, sweating and temperature |
|
Definition
| Complex Regional Pain Syndromes (aka sympathetic pain syndromes) |
|
|
Term
| regional trophic features due to lack of sympathetic innervation |
|
Definition
| to atrophy of skin and subcutaneous tissues (skin becomes shiny and smooth), brittle hair, fragile irregular nails, joint contractures, and osteopenia |
|
|
Term
| features of neuropathic pain + regional trophic features (skin becomes shiny and smooth, brittle hair, fragile irregular nails, joint contractures, and osteopenia) indicates |
|
Definition
| a Complex Regional Pain Syndrome (sympathetic pain syndrome) |
|
|
Term
| Visceral nociceptive pain arises from restricted/encapsulated viscera and is primarily mediated by _______ receptors |
|
Definition
|
|
Term
| • Somatic nociceptive pain results from damage to body tissues and is due to direct stimulation of ___________________________ or ___________ receptors (functioning normally) |
|
Definition
peripheral nerve endings
sensory receptors |
|
|
Term
| According to the scheme, what are 3 sources of numbness? |
|
Definition
brain patterns
spinal cord patterns
nerve patterns |
|
|
Term
|
Definition
| "pins & needles"--a feeling of tingling, pricking or numbness |
|
|
Term
|
Definition
| peripheral neuropathy that is found in more than one place, but not over the whole body or in a stocking-and-glove pattern (those are polyneuropathy). Mononeuropathy multiplex is usually due to a systemic problem. |
|
|
Term
| typically associated with cranial nerve abnormalities and ‘crossed signs’ |
|
Definition
brainstem lesions
"crossed signs"--some signs are contralateral (because those tracts have already decussed) & others are ispilateral to lesion |
|
|
Term
typically result in impairment and alteration of sensation as opposed to complete sensory loss. They are also typically associated with relatively complex signs of “cortical sensory loss” such as:
o agraphesthesia
o astereognosis
o hemineglect |
|
Definition
| Somatosensory cortex lesions |
|
|
Term
|
Definition
| difficulty recognizing a written number or letter traced on one's palm or skin after parietal damage. |
|
|
Term
|
Definition
| inability to identify an object by touch without visual input |
|
|
Term
|
Definition
| failure to be aware of items to one side of space (ex., in severe hemineglect of the left side, may not be aware of people standing to your left, or may not shave left side of face) |
|
|
Term
| Discrete _________ lesions produce “pure” sensory syndromes (i.e. present exclusively with sensory features) more often than lesions in other brain areas. |
|
Definition
thalamic
(though internal capsule lesions may also show "pure" sensory syndromes) |
|
|
Term
| receives sensory inputs from the contralateral hemibody (opposite side of the body) |
|
Definition
| ventral posterolateral nucleus (VPL) of the thalamus |
|
|
Term
| receives sensory inputs from the contralateral face |
|
Definition
| ventral posteromedial (VPM) nucleus of the thalamus |
|
|
Term
| often result in complex syndromes combining “neighborhood” signs (cranial nerve dysfunction) and “long-tract” signs (affecting functions of the body and limbs). Typically there is a combination of “crossed” neighborhood and long-tract signs in patterns that relate to the specific level and distribution of the lesion |
|
Definition
|
|
Term
| What investigation(s) should you do into a sensory deficit that appear to arise from a brain lesion? |
|
Definition
1. always do a brain MRI (with & without injected contrast)
2. Additional studies as indicated by the clinical context and results of imaging |
|
|
Term
| What are some brain lesions that could cause sensory deficits? |
|
Definition
Stroke (ischemic or hemorrhagic)
Tumor/mass
Demyelinating disease
Vasculitis
etc. |
|
|
Term
| Often affects nerve fibers most severely furthest from their cell bodies – initially affecting fingers and toes |
|
Definition
|
|
Term
Ipsilateral weakness below lesion
Ipsilateral loss of position and vibration sensations
Contralateral loss of pain and temperature two levels below lesion, and at lesion ipsilaterally |
|
Definition
| Hemi-cord lesion (Brown-Sequard) |
|
|
Term
| Patient has a "suspended” cape distribution of pain and temperature sensory loss. Where is the lesion? |
|
Definition
Central cord
(Large central cord lesions may affect pain and temperature sensation below lesion, with sacral sparing) |
|
|
Term
Loss of pain and temperature sensations below the level of the lesion
May cause lower motor neuron weakness at the level of the lesion, but not below.
Lat. corticospinal tract upper motor neuron weakness and urinary incontinence with large lesions |
|
Definition
|
|
Term
Loss of position and vibration sense below the level of the lesion
May involve adjacent lateral corticospinal tract and give upper motor neuron weakness. |
|
Definition
|
|
Term
| A deficiency in ________ can cause a posterior cord lesion (with loss of position and vibration sense below the level of the lesion) |
|
Definition
|
|
Term
| tabes dorsalis is caused by a ___________ (posterior/anterior/central) cord lesion |
|
Definition
|
|
Term
| Why is visceral pain often referred to somatic structures? |
|
Definition
| Because the primary afferant neuron of the visceral tissue and the somatic tissue may synapse onto the same secondary neuron in the spinal cord |
|
|
Term
anatomist : leg
lay person : __________ |
|
Definition
|
|
Term
| all 4 muscles of front leg are innervated by the _____________ nerve |
|
Definition
|
|
Term
| large nerve that travels down the back of the thigh |
|
Definition
|
|
Term
| Behind the knee, the sciatic splits into the _________ nerve (which travels down the back of the knee & top of the leg) & the ___________ nerve (which travels down the lateral side of the knee & top of the leg) |
|
Definition
tibial
common fibular (peroneal) |
|
|
Term
| nerve that travels down the back of the knee before splitting near the top of the back of the leg |
|
Definition
|
|
Term
| What nerve arises behind the knee & travels down the middle of the leg, lateral to the tibia? |
|
Definition
|
|
Term
| All 4 muscles in the front of the leg contribute to what action? |
|
Definition
|
|
Term
| What 2 muscles on the front of the leg invert the foot (turn the sole inward)? |
|
Definition
tibialis anterior
extensor hallucis longus |
|
|
Term
| What 2 muscles on the front of the leg evert the foot (turn the sole of the foot outward)? |
|
Definition
extensor digitorum longus
fibularis tertius |
|
|
Term
| What muscle of the front of the leg extends all toes but the big toe? |
|
Definition
| extensor digitorum longus |
|
|
Term
| What muscle in the front of the leg extends the big toe? |
|
Definition
|
|
Term
| What muscle originates on the upper two-thirds of the lateral surface of the tibia and inserts on the ankle & top of the medial foot big toe side)? |
|
Definition
|
|
Term
| What nerve innervates the tibialis anterior? |
|
Definition
|
|
Term
| What does the tibialis anterior do? |
|
Definition
| dorsiflexes and inverts foot (turn sole inward) |
|
|
Term
| What muscle originates on the top of anterior of tibia and inserts on the top of the toes? |
|
Definition
| extensor digitorum longus |
|
|
Term
| What nerve innervates the extensor digitorum longus? |
|
Definition
|
|
Term
| What does the extensor digitorum longus do? |
|
Definition
| extends toes, dorsiflexes & everts foot (turns sole outward) |
|
|
Term
| What originates on the lower third of anterior of tibia and inserts on the top of foot on little-toe side? |
|
Definition
|
|
Term
| What nerve innervates the fibularis tertius? |
|
Definition
|
|
Term
| What does the fibularis tertius do? |
|
Definition
| dorsiflexes & everts foot (turns sole outward) |
|
|
Term
| What muscle originates on the medial of anterior of fibula and inserts on the top of big toe? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What nerve innervates the extensor hallucis longus? |
|
Definition
|
|
Term
| the outer covering of the brain; just deep to the skull |
|
Definition
| dura mater (“tough mother”) |
|
|
Term
| What are reflections of the dura mater? |
|
Definition
| invaginations that go down into the brain & separate parts of the brain (ex., falx cerebri, tentorium cerebelli, diaphragm sellae) |
|
|
Term
| What are reflections of the dura mater? |
|
Definition
| invaginations that go down into the brain & separate parts of the brain (ex., falx cerebri, tentorium cerebelli, diaphragm sellae) |
|
|
Term
| A reflection of the dura matera that separates the right & left cerebral hemispheres |
|
Definition
|
|
Term
| A reflection of the dura mater athat separates occipital lobe of the cerebrum from the cerebellum. |
|
Definition
|
|
Term
| Reflection of the dura mater that forms a circular wall around the stalk of the pituitary gland |
|
Definition
|
|
Term
| The brain covering just deep to the dura mater. |
|
Definition
| arachnoid mater (“spider mother”) |
|
|
Term
| From bottom to top, name the parts of the brain stem |
|
Definition
[Spinal Cord]
Medulla Oblongata
Pons
Midbrain
[Thalamus,
Cerebrum] |
|
|
Term
| What part of the brain is just above the brainstem? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where are the 5 lobes of the cerebrum? |
|
Definition
Frontal lobe—top-front of head
Parietal lobe—top-back of head
temporal lobe—sides of head (top of ears)
insular—located deep to frontal & parietal lobes
occipital lobe--back/bottom of head |
|
|
Term
| The frontal lobe is separated from the parietal lobe by the __________________. |
|
Definition
|
|
Term
| The parietal lobe is separated from the occipital lobe by the _________________. |
|
Definition
|
|
Term
| The parietal lobe is separated from the temporal lobe by the _______________ |
|
Definition
|
|
Term
| a raised squiggly bit of the cerebral cortex |
|
Definition
|
|
Term
| the cerebral gyrus that directs voluntary movements |
|
Definition
| pre-central gyrus (aka motor cortex) |
|
|
Term
| the cerebral gyrus that projects sensory information in conscious awareness |
|
Definition
| post-central gyrus (sensory cortex) |
|
|
Term
| a groove or depression in the cerebrum |
|
Definition
|
|
Term
|
Definition
|
|
Term
| the sulcus that runs coronally at about front-of-ears plane; divides frontal lobe from parietal lobe |
|
Definition
|
|
Term
| runs transverse a little above eyebrow level; divides temporal lobe from frontal & parietal lobes |
|
Definition
|
|
Term
| runs coronally at back bit of brain; divides occipital lobe from parietal & temporal lobes |
|
Definition
|
|
Term
| What is above/in front of the midbrain & below the cerebrum? |
|
Definition
| the thalamus (dencephalon) |
|
|
Term
|
Definition
|
|
Term
| midbrain + pons + medulla = |
|
Definition
|
|
Term
| below the thalamus & above the pons |
|
Definition
|
|
Term
| above/forward of the medulla & below/behind the midbrain |
|
Definition
|
|
Term
| a wide, flat bundle of neural axons (white matter) that connects the left & right hemispheres of the cerebrum |
|
Definition
|
|
Term
| a bundle of axons that cross the midline to connect with the same area on the contralateral side |
|
Definition
|
|
Term
| a bundle of axons that cross the midline to connect with a different area on the contralateral side |
|
Definition
|
|
Term
| Most nerves connecting the right & left cerebral hemispheres pass thru the corpus callosum, but there are other pathways. The second most important pathway is the ___________________. |
|
Definition
|
|
Term
| channels that connect the paired lateral ventricles with the third ventricle at the midline of the brain |
|
Definition
| intraventricular foramina |
|
|
Term
| What are the 4 ventricles of the brain: |
|
Definition
lateral ventricles (2)
third ventricle
fourth ventricle |
|
|
Term
| a thin, roughly triangular, vertical membrane separating the lateral ventricles of the brain |
|
Definition
|
|
Term
| connects 3rd ventricle to 4th ventricle |
|
Definition
|
|
Term
| one of three principal openings in the subarachnoid space between the arachnoid and pia mater layers of the meninges surrounding the brain; receives CSF from the 4th ventricle |
|
Definition
|
|
Term
| connects the fourth ventricle into the cisterna magna |
|
Definition
| median aperture of Magendie |
|
|
Term
| connects the fourth ventricle into the cisterna magna |
|
Definition
| median aperture of Magendie |
|
|
Term
| a bundle of axons with the same origin, termination, & function |
|
Definition
|
|
Term
| the “roof” of a ventricle in the brain |
|
Definition
|
|
Term
| the “floor” of a ventricle in the brain |
|
Definition
|
|
Term
| a large bundle of axons arranged in a stalk-like or column-like structure |
|
Definition
|
|
Term
| a rounded elevation in the brain |
|
Definition
|
|
Term
| a structurally well-defined bundle of axons |
|
Definition
|
|
Term
| Name the cerebral nerves in order. |
|
Definition
(Old Opie Occasionally Tries Trigonometry, And Feels Very Gloomy, Vague, and Hypoactive)
I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facials
VIII Vestibulocochlear
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal |
|
|
Term
| Which cerebral nerves are motor, which are sensory, and which are both? |
|
Definition
(Some Say Marry Money, But My Brother Says Big Boobies Matter Most)
I Olfactory--sensory
II Optic--sensory
III Oculomotor--motor
IV Trochlear--motor
V Trigeminal--both
VI Abducens--motor
VII Facials--both
VIII Vestibulocochlear--sensory
IX Glossopharyngeal--both
X Vagus--both
XI Accessory--motor
XII Hypoglossal--motor |
|
|
Term
| 3 pairs of pillars of axons that connect the cerebellum to the brainstem |
|
Definition
|
|
Term
| Connects the midbrain to the cerebellum |
|
Definition
| superior cerebellar peduncle |
|
|
Term
| Connects the pons to the cerebellum |
|
Definition
| middle cerebellar peduncle |
|
|
Term
| Connects the medulla to the cerebellum |
|
Definition
| inferior cerebellar peduncle |
|
|
Term
| an area of white matter in the brain that separates the caudate nucleus and the thalamus from the lenticular nucleus; all sensory pass through this to get to the thalamus & all motor tracts pass through this on the way from the thalamus |
|
Definition
|
|
Term
| can feel pain, but don’t feel distress about pain |
|
Definition
|
|
Term
| when a joint tends to get injured b/c you can't feel pain in the joint |
|
Definition
|
|
Term
| paint tends to be tightly localized (most important) or in a recognizable pattern; typically sharp, aching, throbbing or burning |
|
Definition
| Nociceptive (tissue damage) pain |
|
|
Term
| A type of pain that is not as localized as somatic/nociceptive; Pain may be referred |
|
Definition
| visceral pain (due to problems in organs or other internal structures) |
|
|
Term
| Inside the spine, there are some crossovers in synapses. What can this lead to with regard to pain? |
|
Definition
|
|
Term
| Tends to be paroxysmal (subject to sudden attacks or sudden worsening); Pain that is sharp, shooting, radiating, or electrical; May be related to sensory stimulus sometimes, and sometimes not |
|
Definition
| Neuropathic pain (due to abnormal neural activity) |
|
|
Term
| Neuropathic more discrete if due to __________ injury than if due to more ___________ injury |
|
Definition
|
|
Term
| Complex regional pain states with other symptoms such as loss of hair, moist clammy skin, redness, degradation & poor growth of nails, hyperpathic limb |
|
Definition
| sympathetic neuropathic pain |
|
|
Term
| If pain is due to a cerebral cortex lesion, then the lesion will be ______________ (ipsilateral/contralateral) to the pain |
|
Definition
|
|
Term
| receives info from spinothalamic tract and the medial leminiscus of the dorsal-column-medial leminiscus pathway; projects this sensory information to the post-central gyrus (sensory cortex) |
|
Definition
| Ventral posterolateral nucleus (VPL) of the thalamus |
|
|
Term
| Pain due to __________ lesion is contralateral to lesion; most noticeable in face, distal limbs |
|
Definition
|
|
Term
| Pain due to thalamic lesion may involve hemiplegia if the ___________________ is involve |
|
Definition
|
|
Term
| Pain due to thalamic lesion may involve hemianopia if the ___________________ is involve |
|
Definition
|
|
Term
| Nucleus of the thalamus that receives information from the trigeminothalamic tract & projects to the post-central gyrus |
|
Definition
| Ventral Posteromedial Nucleus (VPM) of the thalamus |
|
|
Term
| Pain with ipsilateral neighborhood signs and contralateral long-tract signs indicates a lesion in _____________________ |
|
Definition
| the brainstem (crossed signs are specific to segment/level of lesion) |
|
|
Term
| What sensory losses are seen in Brown-Sequard? |
|
Definition
complete anesthesia ipsilateral to lesion from level of lesion to a few levels down
Loss of pain contralateral beginning a couple of levels down
Loss of light touch, proprioception, & vibration ipsilateral to lesion from level of lesion down. |
|
|
Term
| Where does a lesion occur that causes “suspended” cape distribution of pain & temperature sensory loss? Why does it cause that pattern of sensory loss? |
|
Definition
In the center of the cord.
Affects pain & temp nerves as the decuss across the cord. |
|
|
Term
| A neoplasm or cyst in the center of the spinal cord that causes a cape-like distribution of pain & temperature loss. |
|
Definition
|
|
Term
| What sensory losses does an anterior cord lesion cause? |
|
Definition
| Loss of pain & temp below level (spinothalamic tract is anterior) |
|
|
Term
| What sensory losses does a posterior cord lesion cause? |
|
Definition
Loss of fine touch, proprioception & vibration sense below level
(those are in the dorsal column in the posterior part of the cord) |
|
|
Term
| Vitamin ________ deficiency causes dorsal column sensory loss. |
|
Definition
|
|
Term
| causes vesicular rash on one dermatome/myotome |
|
Definition
|
|
Term
| Why is the peroneal nerve particularly subject to damage? |
|
Definition
| because it's near the knee |
|
|
Term
| What pattern of sensory loss is seen in systemic toxicity, and why? |
|
Definition
loss of pain starts at feet, then hands, slowly moves up the limbs
b/c tocxicity kills ends of longest axons first. |
|
|
