NeuroII- phathophysiology-Cohen

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  1. Phineas Gage had an iron rod affect the left side of his frontal lobe in 1848, what changed?
    major changes in behavior, personality, and speech.
  2. What does localization of function and lateralization refer to with the brain?
    left hemisphere has different functions then the right, and different areas preform different functions, such as Broca's area and Wernicke area.
  3. Where is Broca's area?
    Left Frontal lobe
  4. Where is Wernike's area?
    Left temporal lobe
  5. What is Brodmann's area 8 for?
    Helps control eye movement.  Damage to this part of brain will cause eye to deviate toward the side of injury.  the roll of brodmann's 8 in healthy individual is to move eyes toward opposite side.  (8 looks like a pair of glasses)
  6. What is the role of Brodmann's area 4?
    It is the primary motor cortex.  Anterior to the Central Sulcus.
  7. What is the role of Brodmann's area 3?
    • It is located posterior to the Central sulcus as the somatosensory portion of the brain.  Lesions affecting the primary somatosensory cortex produce characteristic symptoms including: agraphesthesia, astereognosia, hemihypesthesia, and loss of vibration, proprioception and fine touch (because the third-order neuron of the medial-lemniscal pathway cannot synapse in the cortex). It can also produce hemineglect,
    • if it affects the non-dominant hemisphere. Destruction of brodmann area
    • 3, 1, and 2 results in contralateral hemihypesthesia and astereognosis.
    • It could also reduce nociception, thermoception, and crude touch, but, since information from the spinothalamic tract is interpreted mainly by other areas of the brain (see insular cortex and cingulate gyrus), it is not as relevant as the other symptoms
  8. What is the role of Brodmann's area 41?
    The auditory cortex, the primary auditory area of the brain.  Located in the temporal lobe on the superior portion, loss of both sides results in complete cortical defness.  Only slight deffness results from loss of one side.
  9. What is the role of Brodmann's area 44?
    Pars opercularis, part of the frontal cortex, anterior to the premotor cortex, phonological and syntactic processing, also known as Broca's area.  Broca's aphasia is also known as expressive aphasia, "they know what they want to say, they just can't say it."
  10. What is Wernicke's aphasia?  Also known as receptive aphasia.
    Affects Brodmann's area 22, and the patients cannot interpret/understand written or spoken language.
  11. What is the Role of Brodmann's area 17?
    Located in the occipital lobe, used for visual cortex.
  12. What are the functions of the frontal lobe?
    • Movement
    • Reasoning
    • Behavior
    • Memory
    • Personality
    • Planning
    • Decision Making
    • Judgement
    • Initiatie
    • Inhibition
    • Mood
  13. What is the function of the parietal lobe?
    • tell right from left
    • calculations
    • sensations
    • reading
    • writing
  14. What is the role of the occipital lobe?
  15. What is the role of the temporal lobe?
    • language comprehension
    • behavior
    • memory
    • hearing
    • emotions
  16. What is the role of the cerebellum?
    • balance
    • coordination
    • fine muscle control
  17. What is the role of the pituitary gland?
    • hormones
    • growth
    • fertility
  18. What is the role of the brain stem?
    • Breathing
    • blood pressure
    • hearbeat
    • swallowing
  19. What is the function of the Corpus Callosum?
    Also known as the colossal commissure, a wide flat bundle of neural fibers under the cortex.  connects the right and left hemispheres.
  20. What is the funcition of the basal ganglia?
    Works in conjuction with the primary motor cortex and the corticospinal tracts to control motor function.  Also called the extrapyramidal system. Dz of the basal ganglia include PD, movement disorders, and often damaged in stroke or tumor.
  21. What are the components of the basal ganglia?
    Caudate, Putamen (together called STRIATUM), Globus Pallidus I and II, Thalamus.
  22. Where are the Red nucleus, Subthalamic nucleus, and Substantia nigra found?
    Midbrain of brainstem.
  23. What is the role of the limbic system?
    important in emotions like fear, happiness, and rage.  Connects to basal ganglia and nucleus ccumbens.  DZ include schizophrenia, depression, bipolar dz, epilepsy, drug addiction.  Also may have role in memory and maternal behavior.
  24. Vital centers for cardiovascular function, respiration, and sleep/wake cycle are found where?
  25. What part of the brainstem do you find CNs 3 and 4?  What are they?  What do they do?

    3- Oculomotor, moves muscles of the eye such as superior rectus, inferior rectus, medial rectus, inferior oblique levator palpebrae superiouris (upper eye lid muscle)

    4-Trochlear nerve, moves the superior oblique muscle of the eye, makes the eye look down
  26. Where are CNs 5, 6, 7, 8 located? What are they and what do they do?

    5- Trigeminal nerve, responsible for sensation of the face and biting/chewing.  Opthalmic, maxillary, and mandibular branch (both sensory and motor). 

    6- Abducens, controls lateral rectus muscle of the eye.

    7- Facial, controls facial expression muscles and taste for the anterior 2/3 of tongue.

    8- Vestibulocochlear, transmits sound and equilibrium information from the inner ear to the brain.
  27. Where are CNs 9, 10, 11, 12 located?  What do they do and what is their name?
    Medulla oblongata

    9- Glossopharyngeal, has 5 function. sensory for skin of external ear, sensory for taste of posterior 1/3 of tongue, information of carotid sinus/carotid body, innervation of parotid gland, motor to the stylopharyngeus muscle.

    10- Vagus, supplies parasympathetic fibers to most organs of body, nothing after the 2nd segment of the transverse colon.  some skeletal muscles like levator veli palatini and cricothyroid, others.

    11- Accessory, innervates the sternocleidomastoid and trapezius muscles. 

    12- Hypoglossal, control of the tongue speech and food, swallowing,
  28. What is the function of the Reticular Activating system?
    collection of poorly described nuclei in medulla and pons.  Maintains consciousness and relays info about state of body to sensory and motor cortices.  Involved in the sleep and wake cycle.
  29. Where to the radiations of the reticular formation go to?
    from midbrain to cerebral cortex.
  30. Where is the VERMIS found and what does it connect?
    Vermis is found in midline of cerebellum and connects the two hemispheres.
  31. With the Cerebellum, there is a nucleus that is very important, what is it and what does it do?
    Dentate, responsible for planning, initiation and control of voluntar movements.  Crucial for posture, equilibrium, conscious and subconscious movement.  great density of neurons, often site of dz and metastatic cancer.
  32. What is the "Double Cross" of the Cerebellum?
    Each hemisphere of the cerebellum coordinates movement on its own side.  info leaves cerebellum via superior cerebellar peduncle, crosses brainstem on way to thalamus on other side.  Thalamus sends info to the motor cortex on its side.  via the corticospinal tracts, which cross at the bottom of brainstem, control muscles on same side as the original cerebellar hemisphere.
  33. What blood vessels provide the brain with the anterior circulation?
    carotid arteries
  34. What blood vessels provide circulation for the posterior of the brain?
    Vertebral Arteries
  35. Strokes are most commonly found in which branches of brain circulation?
    Middle Cerebral Arteries
  36. What is the main artery that supplies blood to the brainstem?
    Basilar artery.  the vertebral arteries join together to form the basilar artery that then splits into the posterior cerebral (after the circle of willis)
  37. What are the veins of the brain called?
  38. Hillary Clinton had a serious brain infarct.  What kind was it?
    Venous infarct.  Can be caused by infections, meningitis, bony sinuses, mastoid sinuses or from pregnancy or childbirth
  39. what is the connection from the 3rd to the 4th ventricle?

    What is the exit from the 4th ventricle called?
    cerebral aqueduct

    Cisterna magna
  40. A patient with increased volume of the ventricles has this condition:
    Hydrocephalus.  Can be benign, serious, or fatal with complete blockage.
  41. Superfical to deep, what are the layering of the meninges?
    • Dura mater
    • Arachnoid
    • Subarachnoid space
    • pia mater
  42. what is the meninge tightly attached to the surface of the brain and spinal cord?
    pia mater
  43. The arteries of the CNS are found in between what two layers of meningies?  What is the space called?
    Between pia mater and arachnoid in the subarachnoid space.
  44. With meningitis, infection is truly of what layers/
    pia mater and arachnoid
  45. What nerve is found at C3-5?
    phrenic nerve- innervates the diaphragm
  46. What do C5-T1 innervate?
    upper extremity, especially c6 and c7
  47. What is the dermatome of T10?
  48. where does the spinal cord end?
    lower border of L1 vertebral body
  49. L2-S1 innervate what?
    lower extremity, L5 and S1 are clinically important
  50. What is the main descending tract of the spinal cord?
    Cortical spinal
  51. What ascending tract is responsible for information on pain, temperature, and crude touch?
    Lateral and anterior spinothalamic
  52. What ascending tract provides information on proprioception, vibration, discriminative touch, and two point discrimination?
    Gracile and cuneate fasciculi (posterior Columns)
  53. At what level to the spinothalamic tracts cross and what information do they carry?
    Cross at the level that they enter the spinal cord via substantia gelatinosa and ascend spinal cord on opposite side.  Carry pain and temperature.  synapse in the ventralposterior thalamus.
  54. Where do the posterior columns/medial lemniscus tract cross and what information do they carry?
    Carry proprioception and vibration via the gracile and cuneate fasciculi.  Ascend the spinal cord on the same side that they enter until they reach the brainstem and cross as the medial lemniscus tract to the thalamus.
  55. Where do the optic nerves first synapse on their way to the primary visual cortex?
    Lateral geniculate nucleus
  56. What are some reasons for sudden vision loss?
    • Retinal detachment
    • vitreous hemorrhage
    • central retinal artery occlusion
    • CVA (Stroke)
    • Trauma
  57. What are some reasons for gradual loss of vision?
    • age
    • cataracts
    • glaucoma
    • HIV-CMV infections
    • Autoimmune dz
    • Diabetes
    • Congenital
    • Macular Degeneration
    • Neoplasm
    • Pseudotumor cerebri
  58. Loss of either the left or right visual field is called?

    What is the most common reasons?
    Homonymous hemianopia

    stroke, tumor, or trauma to one occipital lobe
  59. Loss of the upper or lower half of either visual field is called?

    Where would you find the trauma?

    • Upper- dz of temporal lobe
    • lower- dz of parietal lobe
  60. With cortical blindness, where is the problem most likely?

    What will the patient tell you?
    tragic, uncommon disorder due to bilateral occipital dz.  usually emboli to posterior cerebral ateries

    Patient denies they are blind.
  61. your patient complains of "tunnel vision".  What should you check?
    Bitemporal hemianopia

    Check for a pituitary gland tumor compressing the optic chiasm.  Affect the medial half of the retina axons.
  62. This nucleus helps with contra lateral pupillary reflex:
    Edinger westphal nucleus
  63. Your patient cant move the eyes upward, what do they have?

    What if they were quite elderly?
    Parinauds Syndrome

    May not be pathologic, elderly can have normal loss of upward vision
  64. Your patient has damage to Brodmann's area 8 on their left side.  which direction would the eyes move?
    Look to the left.  Brodmann's 8 pushes the eyes.
  65. What would a lesion to the visual center of teh pons look like in a patient?
    the pons pulls the eyes.  (pull, pons).  an injury on the left would leave the eyes looking to the right
  66. there are multiple reasons for diplopia, can you name a couple?
    • palsies of CN 3, 4, 6.
    • Myasthenia gravis
    • Multiple sclerosis
    • stroke
    • damage to medial longitudinal fasiculus, connects cranial nerve 3 to contralateral CN4.
  67. What muscle is innervated by CN4?
    superior oblique
  68. What muscles are innervated by CN3?
    • superior rectus
    • medial rectus
    • inferior rectus
    • inferior obique
  69. What muscle is innervated by CN6?
    lateral rectus
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NeuroII- phathophysiology-Cohen
Dr. Putthoff and Cohn notes.
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