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Term 1

Formation of a Spinal Nerve1. outer _____ matter2. inner _____ matter3. dorsal horn is associated with whattype of neurons? 4. ventral horn is associated with whattype of neurons? 5. dorsal and ventral roots unite toform a ________

Definition 1

Formation of a Spinal Nerve1. outer white matter2. inner grey matter3. dorsal horn is sensory unipolarneurons concerned with generalsensation which have receptorsperipherally.4. ventral horn is motor multipolarneurons which synapse with effectororgan5. dorsal and ventral roots unite toform a spinal nerve

Term 2 Definition 2

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Term 2

1. two major branches of spinal n. 2. dorsal primary rami innervate.....

3. ventral primary rami innervate...

Definition 2

1. spinal n. has two major brancheswhich are the dorsal and ventralprimary rami (mixed nerves) 2. dorsal primary rami innervate:

-deep muscles of the back-dermatomes of posterior surfaceof neck and trunk

3. ventral primary rami innervateeverything else:

-all the skin and muscles of the UEand LE

-s/f muscles of the back-remaining muscles and

lateral/anterior dermatomes of thetrunk.

Term 3

#of spinal nerves

Definition 3

31 pairs




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Term 4

Describe the 2 modalities of GeneralSensation

What are the sensations of each

modalities?

Definition 4

Epicritic: precise and pinpoint1. fine touch

2. proprioception (muscle/tendonstretch and tension)

3. vibration

Protopathic: diffuse but quick asascends to CNS.

1. Pain (fast acute & slow chronic)2. Temperature

Term 5

Skeletal muscle has what type ofinnervation?

Definition 5

Motor AND sensory

Sensory receptors are associated withepicritic proprioception:

-Muscle spindles are stretch receptorsin muscle.

-Golgi tendon organs are tensionreceptors in tendons.

Term 6 Definition 6




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Term 6Sensory Vocab:

1. loss of all sensation

2. without pain.

3. ability to recognize an objectthrough sense of touch without visualcues, but involved memory (this is of

which modality?)

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

objects

Definition 6

1. loss of all sensation. anesthesia

2. without pain. analgesia

3. ability to recognize an objectthrough sense of touch without visual

cues (this is of which modality?).stereognosis (epicritic)

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

objects. Kinesthesia




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Term 7

1 - analgesia is related to whatmodality?

2-astereognosis and akinesthesia are

related to what modality?

Definition 7

1 - analgesia is related to whatmodality? protopathic

2-astereognosis and akinesthesia are

related to what modality? epicritic

Term 8

Sensory neurons1. of which root, what type of neuron.

Definition 8Sensory neurons

1. of which root, type of neuron. -dorsal root, unipolar

2. innervate what 2 structures- skin (dermis/epidermis for pain,

touch, temp, and pressure)




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1. of which root, what type of neuron.2. innervate what 2 structures

-skeletal muscle (stretch andtension)

Term 9

Sensory Receptors in Skin1. innervate what 2 layers2. naked nerve endings3. Pacinian Corpuscle

Sensory receptors in Skeletal Muscle

1. receptor of stretch/length2. receptors of tension

Definition 9Sensory Receptors in Skin

1. innervate what 2 layers - epidermisand dermis

2. naked nerve endings - nociceptors(pain receptors)

3. Pacinian Corpuscle - associatedwith pressure sense

Sensory receptors in Skeletal Muscle1. receptor of stretch/length - muscle

spindles IN MUSCLE2. receptors of tension - golgi tendon

organ (GTO) IN TENDONS




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Term 10Common Characteristics of the

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

-1º Neuron

1. unipolar or bipolar2. cell body location

3. peripheral process (part that goes tothe 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 location2. **axon immediately _______

3. ascends in CNS via ________4. Synapses where?

-3º Neuron

1. cell body location2. axon ascends via _____________

3. synapses in the________&________ of the ______lobe

in the somatosensory cortex forgeneral sensation.

Definition 10-1º Neuron1. unipolar

2. cell body location - dorsal rootganglion

3. peripheral process (part that goes tothe skin) associated with a a receptor

that responds specific stimulus4. central process enters the spinal

cord via the dorsal root5. synapses where? - CNS (spinal cordor brain stem depending on modality)6. Entire 1º neuron is unilat (located on

1 side of body)

-2º Neuron1. cell body location - CNS (spinal cordor brain stem depending on modality)2. **axon immediately decussates to

contralat side ¨this is definitely on test,bitches¨ - Dr. H

3. ascends in CNS via long ascendingtract (tract in brain and spinal cord

form white matter = bundles ofmyelinated axons).

4. Synapses where? - thalamus

-3º Neuron1. cell body location -thalamus

Term 11

CNS term for ¨nerve¨. Accumulation ofaxons that have a similar function.

Form bundles of white matter(myelinated axons) in CNS.

Definition 11

Tract

Term 12 Definition 121. Largest structure in diencephalon




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Thalamus1. Largest structure in _______ of the

brain.2. Serves as a ...

3. _____ matter existing bilaterally.4. Location of ____neuron and the

synapse of _____ neuron of generalsensory pathways.

1. Largest structure in diencephalonof the brain.

2. Serves as a relay center to/fromcerebral cortex.

3. Grey matter existing bilaterally.4. Location of 3º neuron and thesynapse of 2º neuron of general

sensory pathways.




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Term 13

The first level of consciousness forgeneral sensation occurs where?

Definition 13area 3,1,2 which is the somatosensory

cortex (comprised of laterally, thepostcentral gyrus and medially, the

posterior paracentral lobule of parietallobe)

Term 14

Sensory signals from the lowerextremity terminate where?

Definition 14

paracentral lobule

Term 15 Definition 15




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Fasciculus Gracilis & Fasciculus

Cuneatus

EPICRITIC PATHWAY:

Faciculus Gracilis (recieves epicriticinfo from T7 and below) & Fasiculus

Cuneatus ( from T6 and above)contribute to dorsal white matter of

spinal cord, aka dorsal column, whichare the axons of the primary neuron

which ascend in spinal cord andsynapse in medulla.




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Term 16

Medial Lemniscus

Definition 16

EPICRITIC PATHWAY:

Bundles of 2º neuronal axons of theepicritic pathway which begin in the

medulla and immediately decussate tocontralateral side to ascend through

the pons, midbrain, and synapse in thethalamus

Term 17

Describe the Epicritic Pathway (finetouch, proprioception, vibration) from:

1. Stimuli from T7 and below.2. Stimuli from T6 and above.

Definition 17Stimuli from 1º neuron enter the dorsalcolumn white matter of the spinal cord,

comprised of the fasciculus gracilis(which recieves stimuli from T7 andbelow) and the fasciculus cuneatus(which recieves stimuli from T6 and

above).

2º neurons begin in the medulla andimmediately decussate to contralateral

side via bundles of axons called themedial lemniscus. The information

ascends through the pons andmidbrain and synapses in theTerm 18 Definition 18




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1. If you injure the system superior todecussation, you should expect to seewhat neurological deficit? 2. If you injure the system inferior tothe decussation, you should expect tosee what neurological deficit?

1. Contralateral2. Ipsilateral neurological deficit from

below the level of injury.




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Term 19

When you are describing aneurological deficit, what is your

reference point?

Definition 19

The site of the lesion.

Term 20

What is special about C1 nerves?

Definition 20

C1 is only a motor nerve, there is nodermatome.





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1. Spinal Protopathic Pathwaymodalities

2. fast/acute pain tract3. slow/chronic pain tract

1. Spinal Protopathic Pathwaymodalities - pain, temperature, crude

touch

2. fast/acute pain tract - lateralspinothalamic tract (LST)

3. slow/chronic pain tract - anteriorspinothalamic tract (AST)




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Term 22

Spinal Protopathic Pathway (SpinalThalamic Pathway) vs. Spinal Epicritic

Pathway (Dorsal Column)

1. decussation location2. 1º neuron synapse

Definition 221.DECUSSATION

-Protopathic: segmental decussationat every level in the spinal cord via

anterior white commisure, specificallythe level in which it is recieved.

-Epicritic: decussates in medulla viamedial lemniscus.

2. 1º neuron synapse

-Protopathic: synapses in dorsal hornof gray matter

-Epicritic: synapses in medulla

Term 23

Describe the Spinothalamic Pathwayfor Protopathic Modalities of acutepain, temp, chronic pain, and crude

touch.

Definition 23Pain, temp, and crude touch stimulifrom 1º neuron synapse in dorsal

(posterior) horn.

2º neuron decussates and the samespinal level from which is was recievedvia the anterior white commisure andascends via the lateral spinothalamic

tract (fast/acute pain and temp) oranterior spinothalamic tract (slow,chronic pain and crude touch) and

synapses in the thalamus.

3º neuron ascends through pons,Term 24 Definition 24




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Where is the level of consciousness ofpain and temperature protopathic

modalities?Thalamus (vs. cortex for epicritic

pathways)




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Term 25

DESCRIBE THE NEUROLOGICALDEFICIT:

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 cordresults in...

Definition 251. a lesion in the L posterior limb of

internal capsule results in...R (contralateral) loss of general

sensation (both epicritic andprotopathic modalities).

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

R (contralateral) loss of generalsensation (both epicritic and

protopathic modalities.

3. A L hemi-lesion in 1 level of thespinal cord results in...

L (ipsilateral) loss of epicriticmodalities &

R (contralat) loss of protopathicmodalities BELOW THE LEVEL OF

INJURY

Term 26

Normal Voluntary Movement requireswhat 4 functioning systems?

Describe the mov't disorder

associated each system is injuredindividually.

Definition 261. LMN: multipolar neurons directly

synapsing on voluntary skeletalmuscle. Only motor neurons that

innervate skeletal muscle.-injury=flaccid paralysis

2. UMN: neurons associated withmotor cortex and brainstem, and

synapse on LMN.-injury=spastic paralysis

3. Basal Ganglia: grey matterbilaterally, subcortical structures (no

conscious awareness), neurons whichTerm 27 Definition 27




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Damage to what system of voluntarymovement results in....

1. flaccid paralysis2. spastic paralysis

3. dyskinesia4. ataxia

1. spastic paralysis - upper motor

neuron2. flaccid paralysis - lower motor

neuron3. dyskinesia - basal ganglia

4. ataxia - cerebellum




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Term 28

Alpha motor neurons:1. type of motor neuron

2. innervation3. physical characteristics (size,

myelination, polarity)4. conduction velocity

5. location

Definition 28Alpha motor neurons:

1. type of motor neuron - LMN

2. innervation - extrafusal skeletalmuscle fibers, aka muscle cells, whichcontrol muscle contraction across a

joint.

3. physical characteristics - large,heavily myelinatied multipolar neurons

4. conduction velocity - fast

5. location - all spinal nerves and allcranial nerves but I, II, VIII (olfactory,

optic, vestibulocochlear are onlysensory).

Term 29

Gamma motor neurons:

1. type of motor neuron2. innervation

3. physical characteristics 4. conduction velocity

5. location

Definition 29Gamma motor neurons:

1. type of motor neuron - LMN

2. innervation - intrafusal skeletalmuscle fibers, which are special fiberswithin muscle spindle that maintain the

spindle as an effective stretchreceptor.

3. physical characteristics -

myelinatied multipolar neuron, not aslarge as gamma.

4. conduction velocity - slower thanTerm 30 Definition 30

¨Oh Oh Oh, To Touch And




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Review the cranial nerves.

Which are purely sensory?

¨Oh Oh Oh, To Touch AndFeel A Girl's Vagina, Ah

Heaven¨

I - Olfactory - Purely SensorySense of smell

II - Optic - Purely Sensory

vision

III - OculomotorLevator palpebrae (eyelid open)




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Term 31

An unconscious response

Definition 31

Reflex

Term 32

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 antagonisticmuscle? (in this case the hamstring).

Definition 321. What receptor?

Muscle Spindle Stretch receptor(proprioceptor) within the muscle

(which stretches when you tap thepatellar tendon)

2. What and where is the sensory

neuron?1º neuron of epicritic pathway which

enters the dorsal horn

3. Where is the synapse betweensensory and motor neurons?

integrating center Term 33 Definition 33




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3 parts involved in DTRTesting sensory neuron function,

motor neuron function, and musclefunction.




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Term 34

Tendon Reflex1. occurs when?

2. what is the receptor?3. receptor innervation and path

4. what connects sensory and motorneuron?

5. what is the motor response?

Definition 341. occur when?

with excessive tension on muscletendon - it is a protective reflex

2. what is the receptor?

golgi tendon organ in the tendon(proprioceptor)

3. receptor innervation

sensory 1º neuron of epicritic systemwhich enters spinal cord via dorsal

horn

4. what connects sensory and motorneuron?

Interneuron of the integrating center

5. what is the motor response?RELAXES effector muscle

(and contracts antagonistic muscle)

Term 35

Withdrawal Reflex (when you touchsomething painful):

1. involves what sensory pathway?

2. What is the receptor and itsinnervation?

3. What is the motor response?4. What happens to stabilize the body

during the withdrawal reflex?

Definition 351. involves what sensory pathway?protopathic pathway (pain, temp) - a

protective reflex

2. What is the receptor and itsinnervation?

Nociceptor innervated by 1º neuron ofprotopathic pathway.

3. What is the motor response?

contracts many effector muscles towithdrawal from the pain.

4. What happens to stabilize the bodyTerm 36 Definition 36

LMN disease is characterized as




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LMN disease is characterized as_____________.

1. status of voluntary muscle (2)2. Muscle tone (4)

3. Status of superficial and deepreflexes (2)

4. effects of lesion5. lesion location (2)6. types of injury (3)

LMN disease is characterized asflaccid paralysis

1. status of voluntary muscle (2)

-paralysis-paresis

2. Muscle tone (4)-absent

-hypotonicity (decreased)-fasciculations (occur 1st, mini

twitches)-fibrillations (occur later, inobservable)




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Term 37

Poliomyelitis is a disease of....

Definition 37

Poliomyelitis is a disease of LMNs

Term 38

Primary Motor Cortex1. aka

2. location

Definition 38Primary Motor Cortex

1. aka AREA 4

2. location precentral gyrus (laterally)and anterior paracentral lobule(medially) of the FRONTAL lobe.




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2. location3. what is directly posterior to this

region?

Term 39

1. motor innervation of upper extremity2. motor innervation of lower extremity

3. motor tract of UE & LE4. motor tract of head region.

concerned with synapsing what?

Definition 391. innervation of upper extremity -

Cervical Enlargement (Brachial Plexus)

2. innervation of lower extremity -lumbar and sacral enlargement

3. motor tract of UE & LE -

corticospinal tract

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

corticobulbar tract synapses LMNsfrom brainstem to cranial nerves.




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Term 40

Corticospinal Tract1. UMN synapse on what, where?2. cortex is what side of the body?

3. system location and trauma

Definition 40

Corticospinal Tract1. UMN synapse on LMN in the spinalcord2. cortex is connected to contralateralside3. from cortex to cord, system islocated close to the peripheral surface,easily injured in trauma

Term 41

What systems coarse through theposterior limb of the internal capsule?

(3)

Definition 41

1. Epicritic Pathway - sensory: finetouch, proprioception, vibration

2. Protopathic Pathway - sensory:

pain, temp

3. UMN of corticospinal tract - motor





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Injury to the internal capsule willNEVER cause UMN or LMN disease.

Injury to the internal capsule willNEVER cause LMN disease. *Only theUMN coarses through posterior limb of

internal capsue = UMN disease.




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Term 43Corticospinal Tract (Motor function)

1. aka2. From the motor cortex, the _____

neuron coarses through the___________ en route pyramids of the

medulla3. what % of fibers decussate, where

does the decussation occur, and whattract 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?

Definition 431. aka - pyramidal tract

2. From the motor cortex, the uppermotor neuron coarses through the

posterior limb of the internal capsuleen route pyramids of the medulla

3. where does the decussation occur?pyramidal decussation in the medulla

involves about 85% of the fibers,which descend via lateral white matter(lateral corticospinal tract) of the spinal

cord

4. where do the fibers that don'tdecusatte descend?

anterior corticospinal tract of spinalcord (which decussate later) not on

exam

5. where does the synapse with LMNoccur?

spinal gray matter

Term 44

UMN Disease is characterized as__________.

1. Status of voluntary muscle (2)

2. Muscle tone3. Superficial Reflex status

4. Deep Reflex Status5. Effects of lesion6. lesion location

7. types of injury (4)

Definition 44UMN Disease is characterized as

spastic paralysis

1. Status of voluntary muscle (2)-paralysis-paresis

2. Muscle tone-hypertonicity (rigidity, increased tone)

3. Superficial Reflex status

-Babinski sign - dorsiflexion andfanning of the toes (this is normal for

prewalking child b/c corticospinal tractTerm 45 Definition 45




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A babinski sign (dorsiflexion andfanning of the toes) is indicative of

what disease?

In what population of patients is this anormal response?

A babinski sign (dorsiflexion andfanning of the toes) is indicative of

what disease?UMN Disease

In what population of patients is this anormal response?

Children in pre-walking stage b/c thecorticospinal tract has not fully

developed yet.




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Term 46

Is it UMN or LMN disease?

1. peripheral nerve/rootlet injury2. injury to posterior limb of internal

capsule3. CVA

4. Multiple Sclerosis5. Poliomyelitis

6. Tumors7. Trauma

8. A lesion in the CNS

Definition 46Is it UMN or LMN disease?

1. peripheral nerve/rootlet injury - LMN2. injury to post limb of internal cpsule

- UMN3. CVA - UMN or LMN

4. Multiple Sclerosis - UMN5. Poliomyelitis - LMN

6. Tumors - UMN7. Trauma - UMN or LMN

8. A lesion in the CNS - UMN or LMN

Term 47

Where is the lesion?Left-sided...

-spastic hemiplegia-loss of all general sensation

Definition 47R-sided Lesion of the posterior limb of

the internal capsule results inCONTRALATERAL motor and sensory

neuro deficits.

Left-sided...a) spastic hemiplegia -

Corticospinal tract UMNb) loss of all general sensation -Epicritic (medial lemniscus) &

Protopathic pathways




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Term 48

Where is the lesion?Right-sided...

-loss of fine touch, DTRs, & vibration-loss of pain and temp sensation

-spastic hemiplegia

Definition 48L-sided lesion of the pons (part of

brainstem) results inCONTRALATERAL motor and sensory

neuro deficits.

Right-sided...a) loss of fine touch, DTRs, &

vibration - Epicritic (mediallemniscus)

b) loss of pain and temp sensation- Protopathic pathwayc) spastic hemiplegia -

Corticospinal tract UMN




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Term 49

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 tempsensation.

Definition 49L-sided hemi-lesion of the L1 spinal

segment results in IPSILATERALepicriticand UMN deficits &

CONTRALATERAL protopathic deficitsBELOW THE LEVEL OF INJURY.

Waist and below...

a) L sided loss of fine touch, DTRs,& vibration-Dorsal column system

(epicritic)b) R sided loss of pain and temp

sensation-spinothalamic tract(protopathic)

c) L sided spasticparalysis-corticospinal tract (UMN)

Term 50 Definition 501. a lesion in the posterior limb of

internal capsule-Corticospinal Tract (UMN):




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State the neurological deficit of...

1. a lesion in the posterior limb ofinternal capsule

2. a lesion in the pons (brain stem)3. a hemi-lesion of a spinal segment

-Corticospinal Tract (UMN):contralateral spastic hemiplegia

-Contralateral loss of ALL generalsensation (epicritic & protopathic)

2. a lesion in the pons (brain stem)

-Medial Lemniscus: contralat loss ofepicritic modalities (fine touch,

proprioception, vibration)-anterior & lateral spinothalamic tracts:contralat loss of protopathic modalities

(pain & temp)-Corticospinal Tract (UMN): contralat

spastic hemiplegia

3. a hemi-lesion of a spinal segmentLosses below level of injury:

-dorsal column: ipsilat loss of epicriticmodalities

-spinothalamic: contral loss ofprotopathic modalities

-corticospinal (UMN): ipsilateralspastic paralysis

Term 51

When will LMN disease mask UMNdisease?

Definition 51

When all the LMNs to a muscle groupare injured, you will clinically be able tosee THAT SPECIFIC muscle grouphaving flaccif paralysis. Eg: Assume we have a Lesion thataffects 3-4 spinal segments of anteriorhorn, which damages MANY of motorneurons: Ipsilat flaccid paralysis for affectedmuscles, Everything else has spastic

Kark

Highlight




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Term 52

Amyotrophic Lateral Sclerosis1. affects what neuronal systems?

2. Neuro deficits seen

Definition 52

1. Corticospinal Tract: UMN and LMN2. Neuro deficits:

-LMN = ipsilat flaccid paralysis ofmuscle groups corresponding to

affected spina segments.-UMN = ipsilateral spastic paralysis

inferior to the affected spinal segments

Term 53

superior alternating hemiplegia

what are the neuro deficits you willsee?

Definition 53 CST and CNIII injury:

1. Contralat Spastic Hemiplegia (UMN -

SCT)

2. Ipsilateral Flaccid Paralysis (LMN -CNIII) of SR, MR, IR, IO extraocular

muscles, levator palpebrae superioris(upper eyelid), and CNIII

parasympathetic loss (pupilconstriction & accomidation).

This results in CNIII palsy= down and

out eyeball with dilated pupil.Term 54 Definition 54CST and CNVI (Abducens) injury:

Kark

Highlight




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Middle Alternating Hemiplegia

What are the neuro deficits seen?

CST and CNVI (Abducens) injury:

1. Contralat spastic hemiplegia (UMN-CST)

2. ipsilateral flaccid paralysis of lateralrectus muscle (LMN- CNVI Abducens)




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Term 55

Inferior Alternating Hemiplegia

What are the neuro deficits seen?

Definition 55CST and CNXII (hypoglossal) injury:

1. Contralateral Spastic Paralysis (UMN

- CST)

2. Ipsilateral Flaccid Paralysis oftongue muscles (LMN - CNXII) tongue

deviates to side of lesion

Note the wasted left side of the tongue anddeviation to the left suggesting a left lower

motor neurone lesion.

Term 56Pt sticks out his tongue and you noticeit deviates to the right. On the left side

of the body, Pt has increasedresistance to passive stretch when

moved with more speed, muscles havepersistent spasms, and exaggerated

DTRs.

What does this suggest?

Definition 56Right-sided lesion causingINFERIOR ALTERNATING

HEMIPLEGIA:

-LMN injury involving CN XII-hypoglossal ipsilaterally.




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-CST injury causing spastic paralysis

contralaterally.

Term 57

Corticobulbar Tract1. 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 inthe_____ ) results in what neuro

deficit?

Definition 57Corticobulbar Tract

1. arises from ¨head¨portion of primarymotor cortex

2. axons coarse through genu of the

internal capsule

3. axons terminate (synapse) on theLMNs (cranial nerves) in the brain stem

4. Injury to this system superior to theFacial Nucleus (which is located in the

pons) results in what neuro deficit?




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Term 58

Neurological deficits associated withinjury to the genu of the internal

capsule.

Definition 58

contralat spastic paralysis for thelower muscles of facial expression. From the interenet: LMN of brainstemreceive bilat corticobulbar input. Unilatlesions have no effect on head/neckmuscles clinically except thosemuscles which are bilat: 1) contralatlower facial paralysis, and 2) contralgenioglossus tongue muscle (tonguedeviates to affected side).Summary:a lesion involving all of thecorticospinal and corticobulbar fibersfrom the left cerebral cortex produces

1. Right hemiparesis (weakness ofthe right upper and lower limbs).

2. Weakness of the right face belowthe forehead.

3. Deviation of the tongue to theright upon protrusion (transient).

Term 59

cerebellum1.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 andresulting motor disorders.

Definition 59cerebellum

1.function - coordination of voluntarymovement; monitors and comparesintention and actual movement and

sends out corrective feedback.Term 60 Definition 60




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Pt presents with following sx,where is the disorder?

-hypertonicity

-intention tremor-dysmetria (past pointing)

-dysdiodochokinesia (difficulty withRRAMs)

-asynergia/dyssynergia (lack ofsmoothness) -dysarthria (difficulty

with speech)

Posterior Lobe (cerebrocerebellum) ofCerebellum




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Term 61

1. Truncal ataxia - where is thedisorder?

2. Gait ataxia --where is the disorder?

-involves input from what type ofreceptors?

-in what population is thisdegeneration seen?

Definition 611. Truncal ataxia - where is the

disorder?Flocculonodulae Lobe of Cerebellum

(Vestibulocerebellum)

2. Gait ataxia --where is the disorder?Anterior Lobe of Cerebellum

(Spinocerebellum)-involves input from what type of

receptors?proprioceptors

-in what population is thisdegeneration seen?

alcoholics

Term 62

5 areas of basal ganglia*Don't Memorize, this is FYI*

Definition 62

•Caudate Nucleus

•Putamen

•Globus Pallidus

•Subthalamic Nucleus

•Substantia Nigra





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Term 63

Basal Ganglia1. 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

Definition 63Basal Ganglia

1. Functions - muscle tone, posture,gross movement, programmedmovement, cognitive aspect of

movement and sequencing, suppressunwanted movement

2. Influence contralateral musculature.

3. Injury/Disease characterized by

contralateral dyskinesias

4. Name 4 disorders of basal ganglia




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Term 64

Parkinson's Disease

1. Disorder of what region

2. 5 clinical signs (tone, movementinitiation & speed, tremors,

expression)

Definition 64Parkinson's Disease

1. Disorder of what region - basalganglia (decr stimulation from decr

dopamine)

2. 5 clinical signs-lead pipe rigidity

-akinesia (hesitancy initiatingmovement)

-bradykinesia-rest tremors

-masked expression

Term 65Pain Categories

1. tranduced from peripheral receptorsthat are being destroyed

2. damage to peripheral or central

nerves (give two examples ofdiseases)

3. sharp & abrupt. Lasts minutes to

weeks. Eventually dissapates if causeis alleviated.

4. unresolved acute pain.

Definition 65Pain Categories

1. Nocioceptive pain - tranduced fromperepheral receptors that are being

destroyed

2. Neuropathic Pain - damage toperipheral or central nerves (eg. Carpal

Tunnel Syndrome, MS)

3. Acute - sharp & abrupt. Lastsminutes to weeks. Eventually

dissapates if we can alleviate thecause.Term 66 Definition 66




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Learned Pain1. strong ________ component2. generated by ______ centers

3. involves ________changes withinthe CNS

Learned Pain1. strong affective component (pt's

mood)2. generated by supraspinal centers

3. involves plastic changes within theCNS (responding to stimulation)




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Term 67

Anterolateral System (ALS)1. Transmits which modalities

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

what tracts.

Definition 67Anterolateral System (ALS)

1. Transmits which modalitiesProtopathic (pain and temp)

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

what tracts to cause what response?

a) reticular formation viaspinoreticular tract - in brainstem,

consists of cells that modulatepain.

a) periaqueductal gray (PAG) viaspinomesencephalic tract - in

mesencephalon, gives usendogenous endorphines to shut

off pain projection neurons atreticular formation; also, in

situations of chronic stimulationcan turn on pain progression

centers in reticular formation toincrease amount of pain.

c) Spinothalamic tract - thalamus

projects to cortex, resulting in

Term 68

4 components of pain

Definition 68

1) prior experience2) context3) emotion

4) frequency of stimulation = plasticity





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Plastic Changes from Chronic Pain

1) in PNS (1)

2) in CNS (5)

1) peripheral hypersensitivity- lower sensitivity of dorsal root

primary afferent neurons

2) central hypersensitivity- pain projection neurons

- reticular formation- periaquaductal grey

- thalamus/hypothalamus- cerebral hemispheres (sensorycortex and frontal lobe to create

personality changes)




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Term 70

describe peripheral hypersensitivitycauses of the ¨wind up¨of the CNS to

transmit pain1. activitation of...

2. threshold lowering of...3. conversion of...

4. degeneration of...

Definition 70describe peripheral hypersensitivitycauses of the ¨wind up¨of the CNS to

transmit pain

Peristant stimulation of primarynociceptors causes...

1. activitation of dormant nociceptorsin skin

2. threshold lowering of projection

neurons, causing them to fire with lessstimuli

3. conversion of multimodal dorsal

horn neurons to pain projectionneurons

4. degeneration of inhibitory

interneurons that are normallystimulated by rubbing a painful area.

Term 71

2 results of peripheralhypersensitivity/plastic changes:

Definition 71

2 results of peripheralhypersensitivity/plastic changes:

1. Allodynia - painful response to

normally painless stimulation.2. Spontaneous Pain/Spinal Memory





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Phantom Limb Pain is what type ofpain?

What is the best type of anesthesia to

reduce the occurence of phantom limbpain?

Learned pain

General Anesthesia + SupplementalSpinal Block (to shut down spinal

transmission for prevention of plasticchanges).




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Term 73

Increased input from primary afferentnocioceptors trigger the following

cellular changes (3)

Definition 73

1. Increased dendritic arborization2. Increased sprouting of dendritic

spines3. Increased numbers of synapses

Term 74CNS hypersensitivity of pain

1. pain modulation centers that havethe ability to inhibit or excite dorsal

horn pain projection neurons.

2. receives descending info fromhypothal and cerebral cortices and

sends excitatory input to RVM.

3. processes all sensory input (exceptolfaction) and relays to conscious

level.

Definition 741. Rostral Ventral Medulla (RVM) - pain

modulation centers that have theability to inhibit or excite dorsal horn

pain projection neurons.

2. Periaqueductal Grey (PAG) -receives descending info from

hypothal and cerebral cortices andsends excitatory input to RVM.

3. Thalamus - processes all sensoryinput (except olfaction) and relays to

conscious level.Term 75 Definition 75




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Term 75Hypothalamus

Frontal and Prefrontal corticesInsular cortexLimbic lobeAmygdala

.....are all structures sensitized byincreased nocioceptive input & allproject to the_____, which sends

excitatory input to the ________, whichcan either inhibit (during acute pain) orexcite (during chronic pain) the dorsal

horn pain projection neurons.

Definition 75Hypothalamus

Frontal and Prefrontal corticesInsular cortexLimbic lobeAmygdala

.....are all structures sensitized byincreased nocioceptive input & allproject to the periaqueductial grey

(PAG), which sends excitatory input tothe Rostral ventral medulla (RVM),

which can either inhibit or excite thedorsal horn pain projection neurons.




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Term 76

This structure is sensitized byincreased nociceptive input and

involves emotion.

This lays within the above structureand is involved in extreme/emphatic

emotion.

(These two structures influence whypeople with pain are in severe

emotional distress.)

Definition 76Limbic Lobe - This structure is

sensitized by increased nociceptiveinput and involves emotion.

Amygdala - This lays within the above

structure and is involved inextreme/emphatic emotion.

(These two structures influence why

people with pain are in severeemotional distress.)

Term 77

Why are there no 1st order neurons inlearned chronic pain?

Definition 77

There is no need for an externalnociceptive stimulus b/c the pain painpathway is so strong it functions on its

own.





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What is the best way to preventlearned pain?

Treatment of Learned Pain? (2)

PreventionStop the source of the pain, which

prevents plastic changes.

TreatmentNSAIDS

Dorsal Column stimulation (dorsalhorn multimodal neurons can transmit

pain or proprioception - treadmilltraining swtiches them back to

proprioception)




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Term 79

Pain transmission is decreased withincreased ________ input. Why?

Definition 79

Pain transmission is decreased withincreased propriospinal input.

Why?

Dorsal horn multimodal neurons cantransmit pain or proprioception.

Chronic pain results in plastic changesof the conversion of the multimodal

neurons to pain receptors. Treadmilltraining swtiches them back to

proprioception.

Term 80

What % of all neuro deficits areattributed to vascular problems?

Definition 80

50%





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Term 81

what is the major arterial supply to thedura matter?

What is the pathology when it

ruptures?

Definition 81Middle Meningeal Artery - major arterial

supply to the dura matter

Pathology: Epidural Hematoma hasclassic bulging inward shape.




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Term 82

What are the large veins on thecerebral cortex that drain into the

venous sinuses?

What happens when they rupture?

Definition 82Cerebral Bridging Veins - large veins

that drain into the venous sinuses

Term 83

A rupture of superficial branches of theanterior, middle, and posterior cerebral

arteries causes what?

Definition 83A rupture of superficial branches of theanterior, middle, and posterior cerebral

arteries causes a subarachnoidhematoma.





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Term 84

The circle of willis is formed by what 2arterial systems, known as the "dual

system"?

Definition 84Internal Carotid SystemVertebrobasilar System




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Term 85

Internal Carotid System - MajorBranches (4)

1. retina2. optic tract, lateral geniculatenucleus, posterior limb internal

capsule (do you remember what thiscontains??)

3. medial surface of cerebral cortex4. lateral surface of cerebral cortex

Definition 85Internal carotid artery branches:

1. Opthalmic artery: retina

2. Anterior choroidal artery: optic tract,lateral geniculate nucleus, posterior

limb internal capsule (post limbcontains neurons of the epicritic

dorsal column pathway andprotopathic spinothalamic pathway -

sensory pathways!)

3. Anterior Cerebral artery: medialsurface of cerebral cortex

4. Middle Cerebral artery: lateralsurface of cerebral cortex

Term 86 Definition 86Anterior Cerebral Artery Syndrome

1. Contralateral hemiplegia orhemiparesis of the lower extremity




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Anterior Cerebral Artery Syndromeresults in what neuro deficits.

2. Contralateral epicritic andprotopathic sensory deficits from the

lower extremity

REMEMBER: Anterior cerebral artery

supplies the medial surface of thecerebral cortex as shown below:

Term 87

Middle Cerebral Artery Branches (2):1. supplies basal ganglia, internal

capsule, optic radiations

2. supplies frontal, parietal, temporallobes.

Definition 87Middle Cerebral Artery Branches1. Lenticulostriate Arteries: basal

ganglia (bradykinesia, chorea), internalcapsule, optic radiations




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Term 88

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 Lcerebral hemisphere

5) Neuro deficit specific to the R

cerebral hemisphere.

Definition 88Middle Cerebral Artery Syndrome

1. Contralateral hemiplegia orhemiparesis

2. Contralateral epicritic andprotopathic sensory deficits

(lenticulostriate a. branch suppliesinternal capsule)

3. Homonymous hemianopsia(L or R)

(lenticulostriate a. branch suppliesoptic radiations)

This is an example of L. Homonymous Hemianopsia

4. Aphasia: Left cerebral hemisphere

5. Spatial perception disorders: Right

Term 89

Vertibrobasilar System1. vertebral artery system branches (3)

2. basilar artery branches (4)

Definition 89Vertibrobasilar System

1. vertebral artery system branches:-Anterior spinal artery

-2 Posterior spinal arteries-Posterior inferior cerebellar artery

Term 90 Definition 901. Bilateral sensory and motor signs




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Vertebrobasilar Artery Syndromes (5)

1. Bilateral sensory and motor signs

2. Inferior alternating hemiplegia(medulla)

--contralateral hemiplegia of arm & leg (pyramid—corticospinal fibers)

--contralateral loss position sense, vibration,discrim. touch

(medial lemniscus) --deviation of tongue to ipsilateral side when

protruded; muscle atrophy (CN XII hypoglossal nerve in medulla or CN

XII nucleus)




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Term 91

Circle of Willis1. formed by what arteries

2. completely formed in what % ofpopulation.

Definition 91

1. Anterior Cerebral Arteries (2),anterior communicating artery, internal

carotid arteries (2), posteriorcommunicating arteries (2), posterior

cerebral arteries (2)

2. Completely formed in 20% ofpopulation




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