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Which organs receive only sympathetic innervation?
- 1) sweat glands
- 2) piloerector muscles
- 3) most small blood vessels (well technically not organs).
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What is the organization of the PNS and SNS?
- - cell bodies in the brain stem or spinal cord
- - efferent axons leave these cell bodies and synapse on ganglia-->axons from these second order neurons then synapse on the target organ. (except the adrenal medulla).
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How is the adrenal medulla innervated?
directly by SNS preganglionic fibers.
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Where are the SNS cell bodies located?
intermediolateral cell column of the spinal cord from T1 to L2 (thoracolumbar system).
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Where are the cell bodies for the PNS?
CN nuclei 3,7,9 and 10 and the IML cell column at S2-S4 (craniosacral system).
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PNS Ganglia:
CN 3 has ganglion _____ and is destined for the _______ and _______
ciliary; ciliary muscle and sphincter pupillae
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PNS Ganglia:
CN VII _____ganglion with destination of ____ and ______ganglion with destination of ______ and _____
sphenopalatine; lacrimal gland
submandibular; submandibular and sublingual glands
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PNS Ganglia:
CN IX has _______ ganglion with destination ______
otic; parotid gland
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PNS ganglion:
CN X ______ ganglion with destination ____, ____, ____, ____, ____
multiple; heart, larynx, trachea, lungs, GI tract.
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What is the neurotransmitter for all preganglionic fibers in the autonomic nervous system?
Acetylcholine.
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THE SNS postganglionic fibers except for the sudomotor fibers use ____as the neurotransmitter.
NE
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Which nervous system is responsible for urine storage?
sympathetic
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Which neurotransmitter is needed to relax the detrusor muscle and contract the internal sphincter?
NE
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What is the Quantitative Sudomotor Axon Reflex Testing (QSART)?
- test of postganglionic sudomotor function.
- - can identify postganglionic sympathetic failure which can be seen in small fiber neuropathies.
- - can identify excess sweating which can be found with reflex sympathetic dystrophy.
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What are some tests of sympathetic vasomotor function?
- - tilt test (checking for HR and BP changes)
- - Valsalva (changes in BP)
- - Checking for BP changes with stressors such as exercise and cold
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What are the findings in Valsalva that would indicate sympathetic and parasympathetic dysfunction?
- - absence of the usual BP overshot in phase 4 suggest sympathetic NS dysfunction
- - HR usually drops following phase 4 due to increased vagal tone. lack of this reflex bradycardia suggests parasympathetic dysfunction.
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What are the characteristics of Chaga's Disease?
- autonomic neuropathy; orthostatic hypotension, bradycardia, megaesophagus, megacolon and congestive cardiomyopathy.
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What is the cause of Chaga's disease?
Trypanosoma cruzi, a parasite found in Central and South AMerica
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What are some autonomic nervous system abnormalities that can be seen in patients with diabetes?
- - postural hypotension
- - resting tachycardia
- - nocturnal diarrhea
- - delayed gastric emptying
- - impotence
- - distal anhydrosis
- - miotic pupils with a slow light reflex
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What is typically seen in patients with dopamine B-hydroxylase deficiency?
lack of norepinephrine
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What chromosome has the gene for dopamaine B hydroxylase deficiency?
9q34
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What is seen in neonates with dopamine B hydroxylase deficiency?
- - hypothermia
- - hypoglycemia
- - hypotension
-
What is seen in adults with dopamine B hydroxylase deficiency?
ptosis and orthostatic hypotension
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How can you treat postural hypotension in pts with Dopamine B hydroxylase deficiency?
with L-Dops which is DL-threo-dihydroxyphenylserine that is decarboxylated by dopa decarboxylase to NE.
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What are the characteristics of Fabry's Disease?
hypohidrosis, decreased tear and saliva production, gastrointestinal dysmotility and impotence.
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What can also be seen in Fabry's Disease?
- angiokeratoma, abdominal pain, lancinating pain in the extremities due to small fiber neuropathy and renal failure.
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What is Fabry's disease?
x- linked recessive sphingolipidosis due to alpha-galactosidase deficiency.
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What is common to all Hereditary Sensory and Autonomic Neuropathies (HSAN)?
lack of sensitivity to pain
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What is Riley-Day Syndrome?
- - Familial Dysautonomia (HSAN III)
- - autosomal recessive condition frequently found in Ashkenazi Jews.
- - due to a mutation in IkappaB kinase complex associated protein)
- - chromosome 9q31
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How does Riley-Day syndrome present?
at birth with hypothermia, hypotonia and poor feeding.
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Distinctive PE finding in HSAN III (Riley Day)?
absence of fungiform papillae on the tongue (lateral and tip) and lack overflow emotional tears.
-
What is Lambert Eaton Myasthenic Syndrome?
- NM jxn d/o due to ABs directed against P/Q type voltage gated ca channels.
- may be due to an underlying malignancy like small cell lung ca.
-
Lamber Eaton symptoms:
dry mouth, constipation, proximal muscle weakness, especially the thighs and decreased reflexes. strength may improve after exercise.
-
In what situations should hyperventilation with EEG not be performed?
- - hx of cerebrovascular disease
- - sickle cell disease or trait
- - CF
- - CHD
- - asthma
- - Moyamoya disease
-
In what situations can prolonged slowing occur?
-
What is delta frequency?
< 4 hz
-
what is theta frequency?
4-<8hz
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what is alpha frequency?
8-13 hz
-
what is beta frequency?
>13 hz
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What are Kappa waves and when do they occur?
low amplitude waves in the temporal regions of alpha or theta frequency. They occur during cognitive tasks/thinking
-
what are lambda waves and when do they occur?
positive sharp transients in the occipital area seen during visula scanning.
-
what is mu rhythm?
7 to 11 hz activity seen best over the centroparietal regions. it is attenuated by movement or thoughts of movement of the contralateral body.
-
What drugs can cause seizures in people who don't have epilepsy?
- clozapine
- meperidine overdose
- bupropion
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What is the cause of Subacute Sclerosing Panencephalitis?
Measles
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What are the states of SSPE?
- I: personality changes
- II: myoclonic jerks and further intellectual deterioration
- III: stupor, extrapyramidal signs, autonomic instability, ridigity, hyperactive reflexes
- IV: chronic vegetative state
-
What will the EEG show in stage II of SSPE?
high amplitude periodic sharp wave complexes every 4 to 15 seconds, usually generalized.
-
What are the EEG requirements for brain death?
- - at least 8 electrodes need to be used
- - sensitivity should be set for 2 microvolts
- - interelectrode distance should be at least 10cm
- impedance should be between 100 and 5000 ohms
- - low frequency filter should be set for < 1 hz
- - high frequency filter should be set for > 30 hz
- - duration of the study should be at least 30 minutes
-
For EMG: latency reflects:
the fastest conducting motor fibers
-
the amplitude in an EMG reflects:
the number of muscle fibers
-
the duration in EMG reflects:
the synchrony of muscle fiber firing.
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