Which CNs are motor, sensory and both?Motor: Trochlear, abducens, Occulomotor, accessory and hypoglossal<br>Sensory: Olfactory, Optic, Vestibulocochlear<br>Both: Trigeminal, Facial, Vagus, Glossopharyngeal
What are the 3 main arteries supplying the brain?"Anterior, Middle and Posterior cerebral artery<br><img src=""paste-efd7cba501c60ad35e327256d047ab999d84f184.png"">"
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-1-A.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-2-Q.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-2-A.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-3-A.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-4-Q.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""55f4e559a77b4a22bc3f173ed57a9da8-ao-4-A.svg"" /></div> <div id=""io-original""><img src=""tmpvg46u1q4.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
What is the main excitatory neurotransmitter in the brain?Glutamate
What is the main inhibitory neurotransmitter in the brain?GABA
What is the function of Ach?- Excitatory neurotransmitter<br>- Used by spinal cord neurones to control muscles and by brain to regulate memory
What is the function of dopamine?- Linked to feelings of pleasure and released in reward system<br>- Multiple other functions beyond reward
What is glycine?- Co-agonist with glutamate<br>- Inhibitory and excitatory effects
What is noradrenalines role in the CNS and PNS?<b>PNS: </b>Fight or flight response<br><b>CNS: </b>Regulates complex processes such as mood
What is seretonin?- Pain modulatory pathways<br>- Involved in mood, appetite and sensory perception
What are some examples of peptide neurotransmitters?- Substance P<br>- Cholecystokinin<br>- Somatostatin<br>- 5-HT<br>- Enkephalins
What are some examples of non-peptide neurotransmitters?- Noradrenaline<br>- GABA<br>- Glutamate<br>- Dopamine<br>- Acetylcholine
What are the non-peptide neurotransmitters classes?<b>Choline ester:</b> Acetylcholine<br><b>Monoamine: </b>Noradrenaline, 5-HT, Dopamine<br><b>Amino acid:</b> GABA, Glutamate
Where are non-peptide transmitters synthesized?- Pre-synaptic terminal from precursor molecules
What does the EPSP amplitude depend on?- Amount of transmitter released<br>- No. pre-synaptic fibres activated, intensity of stimulus<br>- If EPSP amplitude reaches threshold, AP generated
What can membrane depolarizations also result from?- Ca++ influx<br>- K+ channels closing<br>- efflux of Cl-&nbsp;
What can IPSPs also result from?- Opening of K+ channels
What is the function of the basal ganglia?- Regulate movement and process emotion, motivation, cognition info<br>- Regulate intensity of slow/stereotyped movements<br>- Inhibits antagonistic and unncecessary movements<br>- Switch motor programs (start/stop movement)
What are the neural structures within the basal ganglia?- <b>Caudate nucleus</b><br>- <b>Putamen</b><br>- Caudate + putamen = <b>corpus striatum</b><br>- <b>Globus pallidus</b><br>- Putamen + globus pallidus = <b>lentiform nucleus</b>
What are the functional motor associations of the basal ganglia?- Substancia niagra&nbsp;<br>- Subthalmic nucleus
Where is the caudate nucleus?"- C-shaped nuclei in frontal lobe<br>- Head region curves and extends to form elogated body tapering at tail and ending in temporal lobe<br><img src=""paste-2f86eb3028e1d1f3a0de6d42092cd167f39dcb20.jpg"">"
Where is the putamen found?"- Large rounded nuclei in forebrain<br>- Connected to caudate nucleus at head region of caudate<br><img src=""paste-53b955a0551e8bc9d1c274229783dd93c3195d8a.png"">"
What is the Globus pallidus?- Pale body made of two segments<br>- Internal segment sends output to thalamus<br>- External segment relays info between basal ganglia nuclei and internal globus pallidus
What is the internal capsule?- White matter structure which separates the lentiform nucleus and the caudate nucleus/thalamus
What is the blood supply to the caudate nucleus?"- Middle cerebral artery (body)<br>- Anterior cerebral body (anterior)<br><img src=""paste-9adffc61db6dfb99b6058ce982a772cadce5a9e2.png"">"
What is the blood supply to the putamen?"- Middle cerebral artery<br>- Anterior cerebral artery (anterior)<br><img src=""paste-9adffc61db6dfb99b6058ce982a772cadce5a9e2.png"">"
What is the blood supply to the globus pallidus?"- Middle cerebral artery<br>- Anterior choroidal<br><img src=""paste-9adffc61db6dfb99b6058ce982a772cadce5a9e2.png"">"
What is the blood supply to the internal capsule?"- Middle cerebral artery (middle)<br>- Anterior cerebral artery (anterior limb)<br>- Anterior choroidal (posterior limb)<br><img src=""paste-9adffc61db6dfb99b6058ce982a772cadce5a9e2.png"">"
What are the neuronal projections into the basal ganglia?"- Cerebral cortex<br>- Substancia nigra pars compacta<br><img src=""paste-8c01d5c05daf7e9bb3af1ddbe646ea5233746b1d.png"">"
What is the corticostriatal pathway?- Projections from cerebral cortex directly to caudate nucelus and putamen (striatus)<br>- Most projections from frontal/parietal cortex
What is the nigrostriatal pathway?- Dopaminergic input to caudate nucleus and putamen (striatum)
What is the main neuron type and neurotransmitter in the striatum?- Medium spiny neurons<br>- GABA
Where do medium spiny neurones recieve input from?- Cortical neurones (glutamatergic)<br>- Substancia nigra neurones (dopaminergic)<br>- Local circuit neurons in corpus striatum (GABAergic)
Where do axons from the medium spiny neurones converge?- On neurones in the globus pallidus and substancia nigra
What comprises the output zone of the corpus striatum?- Globus pallidus<br>- Substancia nigra
What are the projections from the striatum output zone to?- Subthalamic nucleus<br>- VA/VL thalamic nuclear complex<br>- Superior colliculus (eye movement)
What is the subthalamic nucleus?- Small paired nuclei below thalamus<br>- Recieves input from cerebral cortex/external globus pallidus<br>- Projects to internal globus pallidus and substancia nigra
What is the VA/VL thalamus complex?- Recieves input from internal globus pallidus&nbsp;<br>- Projects to motor areas of cerebral cortex<br>- Completes loop of neural circuitry in cerebral cortex
What is disinhibition?"- Cortical input to striatum is via excitatory glutamate neurones<br>- Corpus striatum and globus pallidus contain inhibitory GABAergic neurons<br>- When two inhibtory neurons in sequence, there is inhibiton of inhibition, excitation by double inhibition is <b>disinhibition<br></b><img src=""paste-3eaebe22cd4c6da0e042d1fe7fd269d9f2768b0d.png""><b><br></b>"
Describe the direct pathway in the basal ganglia?"- Caudate/Putamen (striatum) recieve excitatory glutamate input from cerebral cortex and dopaminergic input from substanica nigra<br>- Striatum (GABA) inhibits globus pallidus (internal segment) (GABA) which inhibits VA/VL thalamus through disinhibition<br>- Dishinibition causes thalamus to project to frontal cortex which initiates movement<br><img src=""paste-9ab20f49858ee7540436f723003cd4eab79b6451.png"">"
Describe the indirect pathway in the basal ganglia"- Cerebral cortex provides excitatory input to striatum<br>- Striatum inhibitory into globus pallidus (external segment)<br>- Projects to subthalamic nucleus via GABA, inhibitory<br>- This provides glutamate input into globus pallidus (internal)<br>- This decreases the inhibition from caudate and putamen (striatum)<br>- This causes less disinhibition of thalamus and therefore no excitation of frontal cortex<br><img src=""paste-3f1f35d225189d9b7755706a567c4c58f6adf527.png"">"
What basal ganglia pathway is active at rest or undergoing a repetitive movement eg. talking?- Direct pathway inactive<br>- Indirect pathway active<br>- When changing motor program, direct pathway becomes active
What receptor do the corpus striatum neurones express?- D1 or D2
How do D1 neurons activate motor program change?- D1increases cAMP, D2 decreases cAMP<br>- cAMP inc. sensitivity of corpus striatum neurons to glutamate excitatory input from cortex<br>- Increases inhibiton of globus pallidus int. (via direct pathway)<br>- Leads to disinhibition of thalamus and activates motor program change
What impact does dopamine have on the basal ganglia pathways?- Increases action of direct pathway via D1<br>- Decreases action of indirect pathway via D2
What is parkinsons characterised by?- Hypokinetic movement disorder so...<br>- Resting tremor<br>- Bradykinesia<br>- Muscular ridigity<br>- Minimal facial expression
"What causes the defects in motor function in parkinson's disease?""- Loss of domainergic neurons in substantia digra which innervate caudate and putamen<br>- 80% have to degenerate before clinical symtptoms<br>- Basal ganglia indirect pathway prominent<br><img src=""paste-ed607aead77fbe57cfba5ba74cd30962687b0129.png"">"
What are the treatments for early parkinsons?- When cardinal symptoms but no medication related complications<br>- Levodopa<br>- Dopamine agonists<br>- MAO-B inhibitors
What is the treatment for PD with motor/non-motor complications, medication-side effects and unrelieved symptoms?- COMT inhibitors<br>- Apomorphine<br>- Amantadine
What is the treatment for advanced life limiting PD with significant disability?- Deep brain stimulation
What is Huntingtons disease (hyperkinetic autosomal dom. disease) characterised by?- Mood alternations eg. depression<br>- Personality alterations eg. irritability, impulsive behaviour<br>- Defects in memory/attention<br><b>- Involuntary movements</b>
"What causes the defects in motor function in Huntington's disease?"- Loss of GABAergic neurons in corpus striatum which project and innervate globus pallidus
What is chorea?- Rapid, involuntary, jerky movements
What is athetosis?- Slow, inboluntary, smooth, writhing type movements
What is ballismus?- Rapid, involuntary, wild flinging-type movments
"How does huntington's affect the basal ganglia pathways?""- Shift to direct pathway<br>- Degeneration of GABA neurons, subthalamic to globus pallidus internal segment deminishes<br>- Less inhibition of thalamus so inc. excitation of fronal cortex<br><img src=""paste-3a3c20f265348707b568ecc477cecc4384a81415.png"">"
What is dysarthria?- Disorder affecting articulation
What is dysphonia?- Disorder affecting the voice
What is dysarthrophonia?- Disorder affecting voice and articulation
What is developmental specific language impairment?- Language disorder in children, all other developmental milestones may be normal
What is non-fluent and fluent aphasia?Non-fluent: Expressive, motor, anterior, eg. Broccas<br>Fluent: Receptive, sensory, posterior eg. Wernicke
What is anomia?- Difficulty remembering words
What is paraphasia?- Saying the wrong words
What is telegrammatism?- Difficulty forming sentances
What are the corticobasal ganglia cortical loops?"- Series of parallel and segregated loops, linking cortex and basal ganglia<br>- Convey various types of information<br><img src=""paste-16d2f6fab27f1d26696fd97f17984bbd2d61e148.png"">"
What is present in the neurons of the substancia nigra in PD?"- Lewy bodies (a-synuclein intracellular formations)<br><img src=""paste-c757f6c852f975a136653a4c94c9ba1935ce3fc7.png"">"
How can gradual dopaminergic nigral cell loss in PD be monitored?- Dopamine transporter imaging in the striatum<br>- Transporter is a marker of dopaminergic projections which can be labelled with SPECT ligands
What is micrographia?- Small handwriting
What are some non-motor features of PD?- Olfactory dysfunction<br>- Depression<br>- Psycotic symptoms<br>- Cognitive dysfunction<br>- Dementia&nbsp;<br>- Sleep distrubances<br>- Bladder/bowel dysfunction<br>- Speech and language changes
When can non-motor features of PD begin to occur?- 12-15 years before the onset of typical parkinsonian motor symptoms
What genes increase the risk of PD?- SNCA which codes for alpha-synuclein<br>- For PD patients, it aggregates into clumps (Lewy bodies) which lead to cell death
Why can MPTP lead to PD?- Methylphenyltetrahydropryridine<br>- Neurotoxic for dopaminergic neurones
Why is oxidative stress increaed in PD?- Dopamine highly oxidizable and produces free radicals and oxidation when metabolised
Describe the synthesis of dopamine"L-tyrosine -&gt; L-dopa -&gt; L-aromatic amino acid carmboxylase -&gt; dopamine<br><img src=""paste-9e7ee636433b200f622f3d5507a5159b7f5803a3.png"">"
What are the main dopaminergic pathways in the CNS?- Nigrostatial, links striatum to substancia nigra<br>- Mesolimbic, links nucleus accumbens and ventral tegmental area<br>- Mesocortical, links ventral tegmental to cortex
How are dopaminergic compounds used to manage parkinsons?- Compensate directly for dopaminergic deficit<br>- Eg.&nbsp;<b>L-DOPA</b>, biosynthetic precursor combined with peripherally acting DOPA decarboxylase inhibitors<br>- Eg. dopaminergic agonsits such as <b>ropinirole</b>
What can be used to protect residual dopamine against oxidation?- MAOB inhibitors eg. Orphenadrine
What are the adverse effects of L-DOPA?"- Nausea/vomiting<br>- Postural hypertension<br>- Psychosis<br>- Excessive day-time sleepiness<br>- Impulse-control disorders<br><br>- ""On-off"" effect, efficacy becomes unpredictable<br>- ""Wearing-off"" (end-of-dose deterioration)<br>- Dysknesia, dystonia&nbsp;"
What therapy is offered to PD patients?- Physiotherapy<br>- Speech and language therapy<br>- Occupational therapy
How can PD be managed with surgery?- Deep brain stimulation<br>- Stimulation of certain structures/targeted lesions such as subthalamic nucleus
What would causes a juvenile onset of huntingtons?- Mutated huntingtin gene on chromosome 4<br>- Leads to abnormal repeats of glutamine<br>- &gt;36 means a gain of function, &gt;60 repeats leads to juveline onset
"What are the pathological changes in huntingon's disease?"- Cortical atrophy<br>- Striatal degeneration<br>- Medium spiny neurons lost (striato-pallidal and striato-nigral)
What are the mechanisms underlyinh neurodegeneration in Huntingtons?- Excitotoxicity<br>- Loss of neurotrophi factors<br>- Accumulation of aggregates of huntintin protein<br>- Dysregulation of gene transcription<br>- Increased oxidative stress<br>- Synaptic abnormalities
What are the symptoms of huntingtons?- Choeric movement<br>- Gait abnormalities<br>- Lack of coordination<br>- Weight loss<br>- Sleep disturbance<br>- Cognitive impairment, poor attention/memory difficulties
"What is the pharmacological management for huntington's disease"- <b>Vesicular amine transporter inhibitor:</b> tetrabenazine<br>- <b>Antidopaminergic drugs:</b> haloperidol, olanzapine<br>- <b>Antidepressent drugs: </b>citalopram, fluoxetine, sertraline
Which regions of the cortex are involved in motor control?- All of the frontal lobe
What does the middle cerebral artery supply?- Lateral surface of the frontal, parietal and temporal lobes
What occurs in strokes occluding the MCA?- Almost all one side of the frontal lobe is affected<br>- Severe motor disability in all contralateral body except lower limb (supplied by ACA)
What is the result of a proximal infarction of MCA?- Affects blood supply to basal ganglia via lenticulostriate and motor cortex<br>- More disabiling than stroke affecting motor cortex alone
What do primary motor cortex lesions lead to?- Paralysis followed by variable degree of recovery and possible spasticity or dystonia<br>- Larger lesions lead to loss of ability to make certain movements, weakness, clumsiness and fatigue<br>- Smaller lesions can lead to good recovery of motor skills but motor weakness/fatigue will always be present
What occurs in damage to the premotor cortex?- Motor apraxia, normal reflexes and no weakness but difficulty completing complex motor tasks<br>- Damage to one side may produce minimal symptoms as contralateral can take over some functions of damaged area
What is the supplementary motor area?- Medial part of area 6<br>- Respond to visual, auditory, tactile stimuli when stimuli used as signals to start a movement of series of movements
What is the function of the frontal eye fields?- Area 8, motor control to extraoccular eye muscles<br>- Contruct motor programs to help recognise objects quickly
"What can damage to Broca's area lead to?"- Motor aphasia<br>- Patient has difficulty generating spoken words and linking word strings into complex sentances
What can lesions of the frontal eye fields lead to?- Oculomotor apraxia<br>- Difficulty moving eyes horizontally and quickly<br>- Struggle following moving object with eyes<br>- Often turn head to compensate
Why do so many corticospinal axons arise from the somatosensory cortex?- Modulate somatosensory input<br>- Eg. suppress nociceptive reflexes
What is the dorsolateral prefrontal cortex?- Involved in movement planning and evaluating possible future actions, called executive functions<br>- Dorsolateral frontal lesions lead to patients being apathetic, personality changes, lack of planning/sequencing task ability<br>- If left hemsphere affected, poor working memoery for verbal information<br>- If right hemisphere affected, poor spacial information
What is the orbitofrontal cortex?- Control/inhibition of motor responses associated with limbic system (responses to hunger, thirst, sexual drives)<br>- Disinhibition leads to pseudopsycopathic behaviour (impulsiveness, sexual disinhibition, lack of concern for others)
Why is the corticospinal vulnerable to stroke damage?- Passes through internal capsule where it is particularly vulnerable
What is the corticobulbar tract?"- Arises in face region of primary motor cortex<br>- Terminates on crnail nerve nuclei (III,IV,V,VI,VII) for cortical control of muscles of eyes and face<br>- Also terminates on cells of pontine nuclei, reticular formation and red nucelus<br>- Lower face innervated by contralateral<br>- Forehead bilateral so can still move after contralateral stroke<br><img src=""paste-cb9aef94396956fa796c505e2083893a980b7556.png"">"
Where does decussation of the pyramidal tract occur?- Uppermost spinal cord (C1-C5) into anterior and lateral corticospinal tracts<br>- If brain injured above spina cord/medulla junction, motor deficit of opposite side<br>- If injured below, motor deficit on the same side
What do the lateral and anterior corticospinal tracts do?"Lateral: Monosynaptic connections with motor neurons of thumb and digits, spinal interneurons initiate other muscles<br>Anterior: Terminates in cervical cord, controls voluntary movements of the neck<br><img src=""paste-b9cee9c7b50b8eda0522b6dcfc1d72c9b08f9843.png"">"
What is the reticulospinal tract?"- Arises in reticular formation of pons and medulla<br>- Projects diffusely bilaterally down spinal cord<br>- Autonomic control (drives respiration, phrenic nerve)<br><img src=""paste-0f9fe7127cae3e6cab70ae30bf63d45af5a02722.png"">"
What is the lateral vestibulospinal tract?"- Originates in vestibular nuclei in upper medulla/lower pons<br>- Porjects ipsilaterally to antigravity muslces of lower body and limbs<br>- Tonically active when upright, controls posture/balance<br><img src=""paste-28f90d1a560522d34d6c480e527c9f2daec4774b.png"">"
What is the rubrospinal tract?"- Originates in red nucleus in brainstem<br>- Crosses in medulla and projects adjacent to corticospinal tract<br>- Terminates primarily in cervical/thoaccic so UL control<br><img src=""paste-93ad688f78bbc733dfaf616f34b4be2ce44e85b4.png"">"
What is the tectospinal tract?- Coordinates head/eye movements in response to visual/auditory stimuli<br>- Originates in superior colliculus (also recieved afferents from retina)
What is the medial vestibulospinal tract?- Continution of medial longitudinal fasciculus<br>- Mediates reflex co-ordination of head/neck muscles with extraoccular eye muscles&nbsp;<br>- Maintain objects in view despite body movement
What is spasticity?"- Abnormally inc. muscle tone, can't relax muscles"
What is clonus?- Jerky contractions of particular muscle following sudden stretching of muscle
What is hyperreflexia?- Abnormally brisk tendon reflex is seen in 1+ muscles
What is decerebrate ridigity?"- Neck, arm, extensors tonically hyperactive<br><img src=""paste-a3d42193a62898558275ce3d6833e42ddd101096.png"">"
What is decorticate ridigity?"- Less severe, some flexion in arms<br>- Damage to corticospinal tract<br>- Moving head tirggers extension in arm towards and flexed<br><img src=""paste-1271ca1834b1dc3508ba3b670e8e93cfbbd4c268.png"">"
What causes decorticate or decerebrate ridigity?- Motor cortex has an inhibitory input to the extrapyramidal system<br>- If corticospinal tract damaged above pons, loss of inhibitory input to reticular formation and vestibular nuclei leads to hyperactivity in extrapyramidal tracts causing hyperactive stretch reflexes and spasticity
What are the acute effects of lesions of motor cortex?- Motor weakness and quick fatigue even if recovery<br>- Persisting spasticity, hemiplegic dystonia (persistent arm flexion and leg extension)<br>- Clasp-knife reflex characteristic of chronic cerebral motor lesions
What is spinal shock?- Occurs after acute damage to spinal cord that includes damage to any descending tracts
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-1-A.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-2-Q.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-2-A.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-3-A.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-4-Q.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-4-A.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-5-Q.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-5-A.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-6-Q.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-6-A.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-7-Q.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""caf8771aa26641608bd38d7ec66f0244-ao-7-A.svg"" /></div> <div id=""io-original""><img src=""tmpxqsg7f8e.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
What are findings for an upper motor neuron lesion?"<img src=""paste-f13f08c8e61aceb577fb162f8cdf01c1481b8721.png"">"
What are findings for a lower motor neuron lesion?"<img src=""paste-f13f08c8e61aceb577fb162f8cdf01c1481b8721.png"">"
What dermatomes does the tricep reflex test?C7
What dermatomes does the bicep reflex test?C5-C6
What dermatomes does the supinator reflex test?C5-C6
What reflexes are tested in the LL and what dermatomes do they test?Babinski, L5/S1<br>Ankle jerk S1<br>Knee jerk L3/4
What divides the ant. and post. lobes of the cerebellum?"Primary fissure<br><img src=""paste-8a6248145af5d8ba1d72c8d3cd9a52c4ad05a491.png"">"
What is the cerebellum midline called?Vermis
"What is the area labelled Pf?<br><img src=""paste-9571686bf1dc132f6bc272c2ba5f27f14a0368d4.png"">"Flocculus
What are the 3 main arteries which supply the cerebellum?"- Superior cerebellar artery (2)<br>- Anterior inferior cerebellar artery (4)<br>- Posterior inferior cerebellar artery (most common infarct site,7)<br><img src=""paste-8329886ddc71775231e2b8a68fcf2160fbb01e70.png"">"
What are the three layers in the cerebellar cotex?1. Outer molecular layer with mostly axons<br>2. Purkinje layer with row of purkinje cells<br>3. Granule cell layer, thick containing vast no. of granule cells
What inputs/outputs do the cerebellar peduncles recieve?"<b>Superior cerebellar perduncle: </b>Outputs of cerebral cortex<br><b>Middle cerebellar peduncle:</b> Input from contralateral cerebral cortex and cranial nerves<br><b>Inferior cerebellar peduncle:</b> Input fibes from spinal cord<br><img src=""paste-11ec40ac2642bd8e6dee63342b52b38cf954026e.png"">"
What inputs does the cerebellum recieve from the spinal chord?<b>Posterior spincerebellar tract:</b> Ipsilateral, passes into brainstem and cerebellum in inf. cerebellar peduncle on the same size (info from proprioceptors, joints/muscle spindles etc.)<br><br><b>Anterior spincerebellar tract: </b>Contralateral, information about state of reflexes in spinal cord
What are the cerebellar inputs/outputs routed through?"- Deep cerebellar nuceli<br>- Medial to lateral, fastigial, globose, emboliform, dentate<br><img src=""paste-65aa36f93226d958da6a4ceec6bafce26b27c5aa.png"">"
What does the cerebellar post. lobe connect to?Dentate nuclei
What does the cerebellar ant. lobe connect to?Globose and emboliform nuclei
What does the fastigial nucleus connect to?Vermis
What des the flocculo-nodular lobe connect to?Lateral vestibular nuclei of the pons
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-1-A.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-2-Q.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-2-A.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-3-A.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-4-Q.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""3cfe35c0d1f4476aba009ee29c0abe2a-oa-4-A.svg"" /></div> <div id=""io-original""><img src=""tmpffqy5f7m.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
What does cerebellar damage produce?Instability and errors in voluntary movement eg. Extraocular eye muscles causing nystagmus
What are the 3 functional zones in the cerebellum?1. <b>Vestibulocerebellum</b> (flocculonodular lobe and lateral vestibular nucleu)<br><br>2. <b>Spinocerebellum</b> (anterior lobe, vermis, fastigial, globose and emboliform nuclei)<br><br>3. <b>Neocerebellum</b> (post. lobe and dentate nucleus)
What does the vestibulocerebellum do?- Vestibular nuclei and flocculonodular lobe<br>- Co-ordinates head and eye movements<br>- Balance of head on body (medial vestibulospinal tract) and balance of body on the ground (lateral vestibulospinal tract)
What occurs in vestibulocerebellar injury?- Flocculonodular syndrome<br>- Poor balance, swaying gait, nystagmus<br>- Commonly caused by medulloblastoma, common malignant tumor in children
What is the function of the spinocerebellum?- Co-ordinates locomotor movements<br>- Damage causes anterior lobe syndrome, ataxia (hypotonia, depressed reflexes and ataxic gait)
What is the function of the neocerebellum?- Co-ordinates speech, voluntary hand/arm movement and hand-eye co-ordination<br>- Output to motor thalamus (ventro lateral nucleus) and red nucleu
What are the signs of neocerebellar syndrome?- Loss of hand-eye co-ordination<br>- Dysmetria, inacurrate reaching with intention tremor<br>- Slurred speech<br>- Loss of cognitive eye movement (active scanning)
What are the global signs of a cerebellar stroke?- Headache, vertigo, nausea, vomiting<br>- Eye movement problems (nystagmus, ptosis)<br>- Dysarthia and dysphagia<br>- Ataxia<br>- Arm weakness and incoordination
What is the difference between nociceptive and neuropathic pain?<b>Nociceptive</b>: Musculoskeletal/visceral, responds to analgesic treatment<br><b>Neuropathic</b>: After traumatic brain injury/spinal cord injury, chronic maladaptive pain, may respond poorly to analgesics
What can be used for pain control targets at the first synapse?- Cyclooxygenase-2&nbsp;<br>- NOS<br>- Glutamate receptors (NMDA and non-NMDA)
What are some structures activated by nociceptive stimuli?- Spinal cord<br>- Thalamus<br>- Somatosensory cortex<br>- Insula<br>- Amygdala<br>- Prefrontal cortex<br>- Hippocampus
What factors influence pain perception?- Cognition (distraction, attention)<br>- Mood (depression, anxiety)<br>- Context (beliefs, expectation, placebo)<br>- Genetics
What are the endogenous opioid systems and receptors?Endogenous systems: <b>Proopiomelanocortin</b>-derived, <b>proenkephalin</b>-derived, <b>prodynorphin</b>-derived<br><br>Opioid receptors: Mu, Delta, Kappa, Nociceptin/orphanin receptor
Describe the mechanism of action of morphine"- Activation of potassium conductance and decreased calcium conductance<br>- Decreased exciticity and decreased release of neurotransmitters<br><img src=""paste-5c594454b321de65ce915b78e15cd01dd13666c5.png"">"
What are some examples of opioid drugs?- Morphine<br>- Fentanyl<br>- Methadone<br>- Pentazocine
What are the effects of opioids?CNS: Analgesia, resp. depression, lethargy, euphoria, nausea<br>CVS: Hypotension<br>GI: Delayed gastric emptying, decreased biliary and pancreatic secretions
Describe the analgesic ladder1. Non-opioids and adjuvant drugs<br>2. Moderate efficacy opioids, non-opioids and adjuvant drugs<br>3. High efficacy opioids, non-opioids and adjuvant drugs
What is the mechanism of action of paracetemol?- Reduces active oxidized form of COX-2<br>- Analgesic, antipyretic but limited anti-inflammatory
What are examples of NSAIDS and their mechanisms of action?- <b>Aspirin</b>, COX1 and 2 inhibitor, anti-inflammatory/analgesic/antipyretic<br>- <b>Ibuprofen</b>, COX1/2 inhibitor, analgesic and anti-inflammatory
What are examples of anticonvulsant drugs?- Carbamazepine<br>- Sodium valproate<br>- Pregabalin
What is an example of a tricyclic antidepressent?- Amitriptyline<br>- Used for neuropathic pain, cancer pain
What are some examples of local anaesthetics? What is their risk?- Lignocaine, bupivacaine, prilocaine<br>- Block Na channels<br>- Can risk systemic toxicity, hypotension, resp. depression, bradycardia
What are examples of inhaled anaesthetics?- Halothane<br>- Enflurance<br>- Isoflurane<br>- Nitrous oxide
What are examples of IV anaesthetics?- Propofol<br>- Thiopental<br>- Etomidate<br>- Ketamine<br>- Midazolam
What is trigeminal neuralgia?- Common facial pain, painful neuropathic and often misdiagnosed<br>- Sudden shock-like unilateral pain<br>- Caused by compression/distortion or stretching of nerve V root fibres by branch of ant. or post. inferior cerebellar artery
How is trigeminal neuralgia treated?- Carbamazepine (Na channel blocker)<br>- Baclofen (GABA agonist)<br>- Phenytoin (Na channel blocker)<br>- Velproate (Na channel blocker)<br>- Clonazepam (benzodiazepine)
Define seizureAbnormal, paroxsymal change in electrical activity of the brain which reflects large scale synchronous discharges of neuronal networks
Define epileptogenesis- Process by which normal brain function progresses towards generation of abnormal electrical activity
Define epilepsyNeurological disorder which represents a brain state that supports recurrent, unprovoked seizures
What are the 3 receptor systems for the vestibular system?- Eyes<br>- Genereal procrioceptive/cutaneous receptors in muscles/joints/tendons<br>- Vestibular apparatus, receptors in inner ear
What is the endocochlear potential?"Endolymph: High K, low Na<br>Perilymph: Low K, high Na (CSF)<br><img src=""paste-02a605b92e3111037ea50ec8e2a44cbc682e27a3.png"">"
Describe the function of the cillia in the ampulla of the semicircular ducts"- Endolymph moves in oppositve direction to head<br>- Top links on cillia in ampulae moved in one direction, Na channel opens and become depolarised and hyperpolarised when reversed<br>- Detects kinetic sensitivity, rotation/acceleration, bilateral signalling, angular acceleration<br><br><img src=""paste-1c324e0ca88da650ecc1a0c842597655361de6dd.png"">"
Describe the function of the otoconia in the utricular and saccular maculae"- Small calcium carbonate crystals in gelatenous mass<br>- Activate cillia which in turn activate vestibular nerve fibres<br>- Influenced by gravitational forces<br>- As endolyph moves, some hyperpolarised, some depolarised<br><img src=""paste-0ed7aa79648a0ce920e7b6404a062f50d172a910.png""><br><img src=""paste-4e8adc94f1e9c1f1204ab86018006f000e24f5b7.png"">"
How do the utricular and saccular maculae create a 3D representation of static position?"Utricles: Hair cells polarized towards striola which divides macula into medial and lateral halves<br>Saccules: Hair cells polarized away from striola, into anterior and posterior halves<br><br>Together creates 3D representation of direction of linear force<br><img src=""paste-a3ca6b39582d9d7ec2d290e759e32f2a65b5b785.png"">"
What do the saccule and utricle allow?- Sense of gravity<br>- Tilt of head<br>- Linear acceleration<br>-&nbsp;<b>Utriculus horizontal</b><br>-&nbsp;<b>Sacculus verticle</b>
What 3 cranial nerves link in the medial longitudinal fasiculus?Occulomotor 3<br>Tochlear 4<br>Abducens 6
Describe the vestibulo-ocular reflex- Endolymoh moves in opposite direction to rotation due to inertia<br>- This causes inhibition and excitation in the extraoccular muscles on each side<br>- This stabilizes images on the retina during head movement
What causes spontaneous nystagmus?- Pathological<br>- Damage to vestibular apparatus, brainstem, cerebellum
How does the function of the hair cells in the semicurcular cells and the utricle/saccule differ?<b>Semicircular canals, ampulla crista:</b> Kinetic sensitivity, sensitive to head rotation, angular acceleration, changes in velocity<br><b>Utricle/saccule, otolithic organs: </b>Utriculus, horizontal, sacculus, verticle, gravity, tilt of head, linear acceleration
What are the 4 vestibular nuclei?"- Superior, medial, lateral, descending<br><img src=""paste-a597c69f870e9cc673eaaa676d9949c3b72fa50c.png"">"
What do the lateral and medial vestibular spinal tracts do?<b>Lateral</b>: Control positioning of limbs/postural muscles (ampulla)<br><b>Medial</b>: Control positioning of head/neck muscles (utriculus)
What are some peripheral vestibular pathologies?"- Kenetosis (motion sickness)<br>- Benign paroxysmal positional vertigo<br>- Meniere's disease"
What are the symptoms of vestibular system defect?- Nystagmus<br>- Nausea<br>- Dizziness<br>- Disequilibrium<br>- Vertigo
What are the causes of vestibular system defect?- Inner ear/nerve infections<br>- Tumours<br>- Vascular insufficiency<br>- Trauma<br>- Endolymph imbalance
How can you test for benign paroxysmal positional vertigo?"- Hallpike Manoeuvre<br>- Lower head to table and turn to one side, watch for nystagmus<br><img src=""paste-e7bc322d743c45e4d7cb8e9023bd2eb947e4ac67.png"">"
What are the general features of a tonic-clonic seizure?<b>Pemonition</b> (vague sense)<br><b>Pre-tonic-clonic phase</b> (few jerks)<br><b>Tonic phase</b> (tonic contraction of axial musculature, upwards eye deviation, jaw contraction, resp. muscle contraction-cyanosis)<br><b>Clonic phase</b> (jerks of increasing amplitude followed by relaxation, sphincters may open)<br><b>Postictal period</b> (generalized lethargy, dec. muscle tone, headaches, muscle soreness)
How is epilepsy diagnosed?- 2+ seizures (witness account essential)<br>- Important to rule out TIA/syncope<br>- Structural/function aspects EEG
What structural changes occur in epilepsy?"- Reorganisation of the hippocampal tissue in temporal tobe<br>- Loss of neurons, distrotion and compression of layers, gliosis, different tract orientation<br><img src=""paste-f846eee89b2eb0483cda89734752d7cd1aae9649.png"">"
What cellular changes occur in epilepsy?- Sprouting of mossy fibres of granule cells may leads to reverberant excitatory circuits<br>- Neurogenesis can occur, triggered by seizures and lead to aberrant circuits<br>- Loss of chandelier cells which are GABAergic, control activity of cortical pyramidal cells, increases risk of abnormal excitatory activity of pyramidal cells
What are secondary causes of epilepsy?- Traumatic brain injury<br>- Stroke<br>- Aneurism<br>- Brain tumour<br>- CNS infection
What are the 3 cellular mechanisms linked to epilepsy development?Abnormal neuronal excitatory (ion channels)<br>Decreases neuronal inhibitiron (GABA dependent)<br>Increased neuronal excitation (Glutamate-dependent)
What role do glial cells have in the development of epilepsy?"- Resposible for glutamate transport and clearance through EAAT1 and EAAT2&nbsp;<br>- Dysfunction can cause inc. excitability<br><img src=""paste-4169157421743360a3990795cbde1f57235898ec.png"">"
What contributes to epileptogenesis?- Neuroinflammation<br>- BBB breakdown<br>- Epigenetic changes<br>- Network/synaptic changes<br>- Gliosis<br>- Oxidative stress
What are some examples of antiepileptic drugs?<b>NA channels: </b>Phenytoin, Carbamazapine, Sodium valproate<br><b>Calcium channels: </b>Ethosuximide, Gabapentin
What does zero-order kinetics mean?"- Cannot only eliminate a certain amount of drug over a certain amount of time, constant drug amount is eliminated per time unit<br>- Any increase over this amount can't be eliminated and can cause toxicity"
What antiepileptic drugs target GABA receptors ?<b>Benzodiazepines</b>, GABAa receptors, positive allosteric modulators eg. Clonazapam<br><b>Barbiturates</b>, GABAa receptor eg. Phenobarbitone, stiripentol
What antiepileptic drugs target GABA metabolism and reuptake?"<img src=""paste-6fe1280dfe1dbd4d74f2877d3c32e092aa89dd6a.png"">"
What are the future possibilites for epilpesy treatment?<b>Neuromodulation: </b>Vagal nerve stimulation, deep brain stimulation<br><b>Ketogenic diet: </b>High fat, low carbs<br><b>New anti-epileptic drugs: </b>Cannabidiol<br><b>Long-term EEG prediction: </b>Wearable device which can detect upcoming seizures
What are the primary and secondary causes of intra cranial haemorrhage?Primary: Hypertension<br>Secondary: Trauma, tumour, AV malformation, venous thrombosis, vasculitis, coagulopathy, drugs (e.g. cocaine)
What are the complications of intra cranial haemorrhage?- Local damage<br>- Local mass effect/herniation<br>- Raised intra cranial pressure<br>- Hydrocephalus
How are intra cranial haemorrhages managed?- Establish cause (imaging)<br>- Stop aspirin/warfarin<br>- Treat complications (ICP management, surgery)<br>- Treat risk factors e.g. high BP<br>- Rehabilitation
What causes ischaemic stroke?- Atherosclerosis (carotid stenosis)<br>- Cardiac embolic stroke / AF<br>- Arteriolarsclerosis<br>- Carotid dissection
What are risk factors for stroke?- Age, male, race<br>- Smoking, weight, inactivity, alcohol<br>- Hypertension, hypercholesterolaemia, diabetes, vascular disease, AF, genetics/ family history
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-1-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-2-Q.svg""></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-2-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-3-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-4-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-4-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-5-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-5-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-6-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-6-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-7-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-7-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-8-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-8-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-9-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-9-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-10-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-10-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-11-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-11-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-12-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-12-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-13-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-13-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-14-Q.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""97c91223ec12408ab862cef8c41d4011-oa-14-A.svg"" /></div> <div id=""io-original""><img src=""tmp1b8hym99.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
What symptoms occur in a stroke affecting anterior circulation?"- Unilateral motor deficit<br>- Homonymous hemianopia<br>- Higher cerebeal function (dysphagia)<br><img src=""paste-937b409579b64068fc4aa178ddfe6d0df226b62e.png"">"
What symptoms occur in a stroke affecting posterior circulation?"- Pure hemianopia<br>- Cerebellar signs<br>- Diplopia and CN palsy<br>- Bilateral/crossed sensory-motor signs<br><img src=""paste-a8a0d86ea3602756bda4837792898b0804414155.png"">"
Which fibres carry pain?A-delta and C
What is the difference between primary and secondary headaches?<b>Primary:</b> Diagnosis made on history in absence of physical signs<br><b>Secondary: </b>Diagnosis made on history in the presence of physical signs
What is meant by a normal headache?- Tension-type headaches<br>- Disappear soon after noxious/potentially noxious stimulus ceased<br>- Band-like, bilateral, tightness/pressure/dull ache<br>- Mild to moderate, not aggravated by movement, 30mins-severeal days
What are symptoms of a migraine?- Light bothers you<br>- Headache limits ability to work/study/live<br>- Feel nauseated or sick
What are the main types of migraine?<b>Episodic: </b>&lt;15 days/month<br><b>Chronic: </b>&gt;5 days+/month for more than 3 months, at least 8days/month have features of migraine headache
What is the relationship between 5HT and migraines?- Increases urinary metabolites in migraine attacks<br>- Drugs that deplete 5HT trigger migraine<br>- 5HT infusions relieve migraine
What is migraine aura?- 99% visual distrubances, sensory/speech/language symptoms<br>- Gradual development<br>- Complete reversibility, resolves before headache onset<br>- No motor weakness
What causes a migraine aura?"- Cortical spreading depression<br>- Transient and local supression of spontaneous electrical activity in the cortex which moves slowly across the brain<br><img src=""paste-1ebd0f5201ec5bc69a261f8ea670e5fdad8c2c4d.png"">"
What are the phases of a migraine?<b>Premonitory:</b> Food craving/tired/hightened perception/fluid retention<br><b>Aura</b><br><b>Headache: </b>nausea/vomiting/lethargy/sensitive to stimuli/difficulty focusing<br><b>Resolution: </b>deep sleep/medication/vomiting<br><b>Recovery:</b> limited food tolerance/tired
Describe the pathophysiology of a migraine?- Dilated meningeal arteries release inflammatory neuropeptides<br>- CGRP released (potent vasodilator)<br>- Activates nerve pathways, send pain signals to trigeminal ganglion<br>- Peripheral sensitization in trigeminal ganglion mediates throbbing pain<br>- Transmits pain to SpV (spinal trigeminal nucleus caudalis) in brainstem&nbsp;<br>- Central sensitization mediates allodynia<br>- Pain impulses from brainstem to thalamus<br>- Thalamus to cortex, decodes messages percieved as pain
What drugs treat migraines?- <b>5HT agonists </b>eg. sumatriptan, zolmitriptan<br>- Ditans<b> (5HT1F agonists)</b>, lasmiditan<br>-&nbsp;Gepants<b> (CGRP receptor antagonists)</b>, rimegepant, acute, antogepant, prevention<br>- <b>CGRP monoclonal antibodies</b>, prevent vasodilation, Erenuamb
What % of cardiac output goes to the brain?15%
What % of 02 and glucose goes to the brain?20% O2&nbsp;<br>25% glucose
What are common variations of the circle of willis?- One posterior communicating smaller<br>- One anterior communication larger
When do the communicating arteries open?- When one side has a decreased pressure<br>- In order to perfuse opposite side, in emergencies to prevent hypoxia
What do the vertebral arteries supply?- Spinal cord (post and ant spinal arteries)<br>- Dorsal medulla of brainstem (PICA)
What does the basillar artery supply?- Pons<br>- Cerebellum
What does the posterior cerebral artery supply?- Inf. and medial aspects of temporal and occipital cortex<br>- Thalamus and post. internal capsule<br>- Midbrain
Describe the superficial venous drainage of the brain"- Superficial cerebral veins cross subarachnoid space<br>- Pierce dura and enter venous sinuses<br>- Arachnoid granulations allow CSF to flow into venous blood of sinuses and prevents backflow of blood into sub-arachnoid space<br><img src=""paste-e0975e6b8f216d3e69f0be720050c8b38513c26d.png"">"
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-1-A.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-2-Q.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-2-A.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-3-A.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-4-Q.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-4-A.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-5-Q.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-5-A.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-6-Q.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""f16464e9463d479485d926921519916e-oa-6-A.svg"" /></div> <div id=""io-original""><img src=""tmpunmm250h.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
What are the major causes of stroke?- Athersclerosis<br>- Hypertnsion<br>- Anrism<br>- Elderly<br>- Head injury<br>- Alcoholics
What are the symptoms of a MCA stroke?"<b>Dominant hemisphere: </b>Global aphasia, sensorimotor loss on contralateral face, upper limb and trunk<br><b>Non-dominant hemisphere:</b> Neglect syndrome<br><img src=""paste-9f3f6c4a851e1ce81994ba2a4e046f9035397475.png"">"
What are the symptoms of a ACA stroke?- Contralateral sensoriomotor loss below waist<br>- Urinary incontinece<br>- Personality defects<br>- Split-brain syndrome
What are the symptoms of a PCA stroke?- Contralateral homonymous hemianopsia<br>- Reading/writing deficits<br>- Impaired memory
What are symptoms of TIA?<b>Anterior circulation:</b> Motor weakness, hemi-sensory loss, dysarthria, transient monocular blindness<br><b>Posterior circulation: </b>Vertigo, diplopia, ataxia, amnesia
What are the 3 extra-axial bleeds?"<b>Epidural hematoma</b> (between dura and skull): Traumatic, rapid arterial bleeding<br><b>Subdural hematoma</b> (between dura and arachnoid) :Rupture to bridging veins, Traumatic/aging, 40-60% mortality<br><b>Subarachnoid hematoma</b> (between arachnoid and pia): Spontaneous, ruptured aneurysm or head injury, most frequent<br><img src=""paste-3e1c591354defc026bf43b43d7702aa68293afa0.png""><img src=""paste-8ecb0a0076b59a62a213923bfc26cdebd3922548.png"">"
How do epidural hematomas present and how are they diagnosed?"<b>Symptoms: </b>Present with lucid period followed by unconciousness, rapid arterial bleed, compresses intracranial structures, compesses CNIII, weakness of extremities, loss of vsual field opposite to lesion<br><b>Diagnosis: </b>CT or MRI, often middle meningeal, complex lens<br><img src=""paste-dc26c7c4576df174b009e6e8d6345320a06f4284.png"">"
How do sub dural hematomas present and how are they diagnosed?"- Acute, subacute or chronic (high-speed acceleration/deceleration)<br><b>Symptoms:</b>&nbsp;Irritability, seizures, headache, numbness, disorientation, slow onset<br><b>Diagnosis: </b>CT scan, cresent shaped concave, cross suture line<br><img src=""paste-38052f0d6472b2e4758aaf48c77bbb52fe5ee303.png""><img src=""paste-e54d0a3bf47db8515bb9c3d2639d5faa50602fc3.png"">"
What are the symptoms of subarachnoid hematoma and how are they diagnosed?"<b>Symptoms:</b> Severe headache, vomiting, confusion, lowered conciousness<br><b>Diagnosis:</b> CT- white signal diffuse over sulci on both sides, lumbar puncture-evidence of blood<br><img src=""paste-6d46ce690be3b5178400ca04053d92b185acf594.png"">"
What are the causes of subarachnoid hematomas?"- Ruptures of cerebral aneurysms (saccular or fusiform)<br><img src=""paste-43581a86d5d1c723b052755f4ab3ffda22d9b63e.png"">"
What are the 4 processes of pain signalling?"1. Transduction (noxious stimuli into electrical activity at nerve endings)<br>2. Transmission (popogation of impulses along pain pathways)<br>3. Perception (discrimination/affect/motivation)<br>4. Modulation (+ and - modulation)<br><img src=""paste-1e5d2aa8b5fca320f9d11b1b291a289661a90fc9.png"">"
What nociceptors are activated by temperature, acid, capsaicin?TRPV1
What nociceptors are activated by pH changes?ASIC (Acid-sensing ion channel)
What nociceptors are activated by cold and menthol?TRPM8
What causes congenital insensitivity to pain?Loss of Na v 1.7 (sodium channel subunit)
What causes inherited erythromelalgia (IE)?"- Mutation of SCN9A gene (encodes sodium channel, Nav1.7)<br>- Painful neuropathy involving chronic burning pain in hands and feet<br><img src=""paste-58c9fdcde2b8b9c2d4eacb111b8e52a699056dae.png"">"
What does the speed of axon transmission depend on?- Myelination<br>- Axon diameter
What fibres carry sharp, stinging pain?- Myelinated Ad(delta) fibres
What fibres carry diffuse and persistent burning pain?Unmyelinated C fibres
What causes loss of sensory afferents?<b>Diabetic neuropathy:</b> High blood glucose can damage nerve fibres<br><b>CIP with anhydrosis: </b>TRKA gene mutation, encode for tyrosine kinase 1 receptor for nerve growth factor. NGF supports nociceptive sensory neurons survival so lack NGD-dependent Ad and c-fibres
Where do AB fibres predominantly terminate?Deeper dorsal horn
Where do Ad and C fibres predominantly terminate?Superficial dorsal horn
What are the 2 tracts within the spinothalamic tract?- Anterior spinothalamic<br>- Lateral spinothalamic
What does the anterior spinothalamic tract conduct?- Crude light touch and pressure
Where does the anterior spinothalamic tract innervate 3rd order neurons?"Ventral posterior lateral and ventral posterior inferior nucleus of the thalamus<br><img src=""paste-fdbeb04a254d57ef5da4345b5b0c3908eaed1f0d.png"">"
What does the lateral spinothalamic tract conduct?Pain and temperature
Where does the lateral spinothalamic tract innervate 3rd order neurons?- <b>Mediodorsal nucleus</b> of the thalamus which innervates anterior cingulate cortex (emotion/motivation)<br>- <b>Posterior thalamus </b>which innervates rostral insula (emotion/unpleasentness)
What regions of the brain percieve pain?<b>Limbic system: </b>Subjective sensations of pain &amp; pleasure<br><b>Reticular nuclei of thalamus: </b>Arousal/descending control of nociceptor input<br><b>Periquiductal grey: </b>Descending pain modulation<br><b>Reticular formation:</b> Alterting cerebral cortex and focus attention on pain
Which tracts control the unpleasentness and intensity aspect of pain?Unpleasentness, lateral STT<br>Intensity, anterior STT
What role does the amygdala have in pain?- Aversion, emotional memory and respons
What role does the insula have in pain?- Pain map, interoception, homeostatic ajustment, emotion
What role does the nucleus accumbens have in pain modulation?Mediates pain and pleasure, hypothalamus (reward and addiction levels)
What role does the rostral ventromedial medulla (raphe nucleus) have in pain modulation?- Contain serotonergic and non-serotonergic fibres travel down spinal cord
What role does the periaqueductal grey have in pain modulation?Pain relief coordination centre (electrical stimulation abolish pain)
How is pain modulated?"- Descending inhibitory pain pathway, serotonergic fibres (release 5-HT) with cell bodies in rostal ventromedial medulla&nbsp;<br>- Terminate in dorsal horn, synapse onto primary afferent fibres/projection neurons/interneurones (these release 5-T and noradrenaline)<br>- Activation of interneurons will inhibit activation of projection neurons so less pain<br>- Inactivation of primary afferents and projection neurons inhibits STT so less pain<br><img src=""paste-e89db0d86b4e9ae5009a59644e6c49faf1834b35.png"">"
What are endogenous opioids and how do they reduce nociceptive neurotransmission?- Endorphins, enkaphalins, dynorphins<br>- Bind to Mu, delta, Kappa receptors<br>- Activation of interneurons releases endogenous opioids which bind to opioid receptors and cause dec. in excitation at dorsal horn so reduce nocieptive neurotransmission
What is peripheral sensitisation?Increased sensitivity to an afferent nerve stimuli at peripheral site
What is central sensitisation?Increased sensitivity to afferent nerve stimuli at central nervous system site
What is allodynia?Condition where pain caused by non-noxious stimulus eg. Feather
What is hyperalgesia?- Abnormal increased pain sensitivity caused by noxious stimulus eg. hot water on sunburn
What cuases peripheral sensitisation?- During injury, chemical mediators (ie. cytokines) can activate nociceptors and activate intracellular signalling mechanism which upregulates ion channels<br>- Incs. membrane pot. closer to depolarisation threshold<br>- Therefore more sensitive to activation
What cuases central sensitisation?- Continuous ativation of projection neurons activates intracellular signalling mechanism<br>- Causes upregulation of ion channels, inc. membrane pot. closer to depolaisation threshold&nbsp;<br>- Therefore more sensitive to activation
What is ectopic and ephatic peripheral sensitization?"- Transmission induced pain&nbsp;<br><img src=""paste-6ab9ea5ade2cafecc4b2675bf64d22cdabe4e211.png"">"
What is collateral sprouting-induced pain?"<img src=""paste-aabdec3661edd4df4cff028216891bd7167b7e3e.png"">"
"Explain the difference between dementia and Alzheimer's""<b>Dementia:</b> Progressive condition not disease, cognitive defects such as memory impairment, aphasia, inability to plan or initiate complex behaviour<br><b>Alzheimer's: </b>Degenerative brain disease, most common form of dementia, causes memory loss, disorientation, mood/personality changes, marked by brain neuron degeneration in cerebral cortex"
What are the pathological hallmarks of alzheimers?"- Senile plaques, beta-amyloid<br>- Neurofibrillary tangles<br><img src=""paste-77fec0153dd46b990ab0a88157624e91f1123643.png"">"
"What are the 3 stages of Alzheimer's disease?"<b>Early:</b> Mild memory loss, difficulty planning/organising, repeated questions<br><b>Moderate:</b> Difficulty remembering names, confusion, toilet accidents, mood changes, repetitive/impulsive behaviour<br><b>Severe: </b>Speech loss, weight loss, stop eating/swallowing
Describe the 7 stages of cognition lossNo impairment, normal<br>Very mild, normal age-related loss<br>Mild decline, mild loss noticed by friends/family<br>Moderate cognitive decline, short term memory loss/personal details<br>Moderate-severe, help with daily tasks, significant confusion, unsafe drive<br>Severe, difficulty recognising family members, personality changes<br>Very severe, terminally ill, communication limited, physical loss
"How is Alzheimer's diagnosed?"- Normal blood tests<br>- Not caused by mood disorder<br>- No other causes by brain imaging<br>- Clear memory loss shown by testing<br>- Evidence of impact on daily function
"What neuropsycological tests are used for Alzheimer's disease?"- GPCOG (Gp assesment of cognition)<br>- MMSE (Mini-mental status examination)
"What are the issues with using MRI for alzheimer's brain imaging?"- High cost<br>- Unpleasent, noisy, claustrophobic<br>- Unsuitable for pacemakers/metallic implants<br>- Increasing patient age so reduced diagnostic accuracy
"What neuroimaging techniques can be used for Alzheimer's diagnosis?""<b>CT scan: </b>detects patterns of atrophy<br><b>DaTscan: </b>indicate dopaminergic neurone activity via binding of radioactive lofupane onto presynaptic dopamine transporter<br><b>FDG-PET: </b>Fluorodeoxyglucose positron emission tomography, indicate neuronal activity via glucose metabolism<br><img src=""paste-a6cce43e4a1a54e873fa507b7604532a6a219a4a.png"">"
"What is alzheimer's disease characterised by in a FDG-PET scan?"Hypometabolism in temporal, parietal, frontal regions and posterior cingulate cortex
What is frontotemporal dementia characterised by in a FDG-PET scan?Hypometabolism in prefrontal areas, cingulate gyri and anterior temporal regions
What is Lewy body dementia characterised by in a FDG-PET scan?Hypometabolism in occipital cortex
How do amyloid B protein plaques occur?- Amyloid B deposited extracellularly in grey matter<br>- AB monomers aggregate into oligomers which form fibrils
What is the difference in amyloid precursor processing in normal and alzheimer brains?"<b>Healthy:&nbsp;</b>APP cleaved by a-secretase producing sAPPa, cleaved by y-secretase to P3, sAPP important for neuronal growth/plasticity<br><b>AD brain: </b>APP cleaved by B-secretase to produce sAPPb, cleaved by y-secretase to Ab peptides of various oengths, Ab42&nbsp; can form oligomers and fibrils<br><img src=""paste-07ff3eeb7eaf847c1d1f69234094763aebeabd37.png"">"
How does tau protein hyperphosphorylation cause AD?"- Tau deposited intracellularly into neurons of AD brains (important for cytoskelton structure, axonal transport, neurite extension/formation)<br>- In AD, tau hyperphosphorylation of tay causes it to detatch from microtubules, the become unstable and so loose microtubule functions<br>- Phosphorylated tau aggregate intracellularly as neurofibrillary tangles cause synaptic loss and neuronal death<br><img src=""paste-9e798bd42bf2bf4de6a639cc901cb8979fbc6ad9.png"">"
What are risk factors for AD?- Familial, before 65, PSEN1, PSEN, APP mutations<br>- Late onset, APOE mutation (some protect, other alleles increase)<br>- &gt;65, Trisomy 21 (carried APP gene), head injury, cardiovascular disease, smoking, obesity, diabetes. high BP
Describe the cholinergic hypothesis"- Basal/rostal forebrain contain colinergic pathways, project to thalamus<br>- Ach important for learning/memory and it's decreased (as well as choline acetyltransferase that synthesises it) in AD<br>- Degeneration of cholinergic neurons in basal forebrain associated with decreased cholinergic neurotransmission in cerebral cortex, dec. cognitive function<br>- Treat with Acetylcholinesterase inhibitiors (donepezil) inhibit ACh breakdown"
Describe the glutamatergic hypothesis- Glutamate involved learning/memory<br>- Neurotoxocity associated with over-excitation of NMDA receptors<br>- Amlyoid B blocks glutamate uptake (EEAT) , increasing levels in synaptic cleft, keeps activating NMDA, excessive intracellular calcium, causes cell death<br>- NMDA receptor antagonist (memantine) blocks current flow through NMDA channel so reduced neuronal excitability so reduced death
What are examples and side effects of acetylcholinesterase inhibitors?Donepzil, Galantamine (nausea, vomiting, loss of appetite)
What are examples and side effects of NMDA receptor antagonists?Memantine (headache, dizziness, constipation)
What are non-pharmacological therapies for AD?<b>Cognitive stimulation therapy:</b> memory/problem solving<br><b>Physical/social stimulation: </b>Daily activities eg. preparing a meal<br><b>Reminiscence therapy:</b> Talking about past, music, photos
How is BPSD treated?- Non-pharmacological interventions (reduce overcrowding, anxiety, hallucinations, sleep distrubance)<br>- Lowest dose/shortest duration, depression (sertraline), anxiety (paroxetine), Hallucinations (apriprazole), Sleep disturbance (zolpidem)
What are the symptoms of majoy depression?- Psycomotor retardation<br>- Fatigue<br>- Less concentrated<br>- Less intrest in social activity<br>- Depressed mood<br>- Feeling guilty/worthless<br>- Suicidal ideation<br>- Insomnia<br>- Weight loss/decreased appetite<br>- Lack of intrest
What regions of the brain are associated with depression?- Amygdala<br>- Ventrolateral prefrontal cortex<br>- Dorsolateral prefrontal cortex<br>- Medial prefrontal cortex<br>- Striatal regions<br>- Hippocampus
What is 5-HT transporter polymorphism associated with?- An increased risk of major depression after significant life events
What are the major types of antidepressents?- Tricyclic antidepressants<br>- Monoamine oxidase inhibitors<br>- Selective serotonin reuptake inhibitors<br>- Reversible monoamine oxidase inhibitors
What are tricyclic antidepressants?- Clomipramine, imipramine, desipramine<br>- Inhibit reuptake of amines with affinity for H1, muscarinic, a1 and a2 adrenoreceptors<br>- Adverse effects: Dry mouth, blurred vision, constipation, urinary retention, fatigue, sedation, weight gain, dizziness, loss of libido, arrhythmias
What are monoamine oxidase inhibitors?- Phenlzine, iproniazid<br>- Non-selective MAOa versus MAOb<br>- Interacts with tryamine food eg. mature cheese, red wine, beer<br>- Hepatotoxicity
What are SSRIs?- Citalopram, fluoxetine, paroxetine<br>- Increased selectivity for serotonin reuptake<br>- No anticholinergic activity/cardiotoxic effects, safe in overdoses<br>- Adverse effects: Nausea, headaches, GI issues, inc. aggression, insomnia, anxiety, sexual dysfunction
What are reversible monoamine oxidase inhibitors?- Moclobemide<br>- Selective for MAOa<br>- Adverse effects: nausea, agitation, confusion
What is the default mode network?- Network of brain regions active when brain at wakeful rest<br>- Involved in self-reference thoughts and negative recurrent thoughts<br>- Increased connectivity in depression
Why is there a delay of action in antidepressants?- Tricyclic drugs inhibit amine reuptake<br>- Immediate inc. leads to activation of somatic neuronal autoreceptors<br>- This decreases neurone firing rate<br>- During first week, desentizisation occurs<br>- Neurons return to normal firing rate<br>- Inhibition of reuptake continues and amine levels continue to be high = full efficacy
What is antidepressant drug discontinuation syndrome?- Condition occurs after abrupt cessation of treatment<br>- Prevented by gradual discontinuation<br>- Insomnia, anxiety, nausea, headaches, agitation, mood swings
How is lithium used in bipolar disorder treatment?- Maintenance treatment, mood stabiliser<br>- Renal and thyroid function need to be checked throughout<br>- Side effects: Thirst, nausea, fine tremor, polyuroa, weight gain, oedema, acne
What are non-pharmacological treatments for mood disorders?- Electroconvulsive therapy<br>- CBT<br>- Vagal nerve stimulation<br>- Deep brain stimulation (brodmann area 25)
What is a traumatic brain injury?- Non-degenerative, non-cognitive insult to brain from external mechanical force<br>- Possibly leading to permenant/temporary cognitive/physical/psychosocial impairment&nbsp;<br>- Associated diminished/altered conicousness
What is a penetrating injury?- Foreign object eg.bullet enters brain causing focal damage
What is a closed head injury?- Blow to the head<br>- Skull fracture, contusion (bruise), hematomas (blood clots), lacerations (tear), diffuse axonal injury (nerve damage)
What is a blast injury?- Explosion eg.bomb creates fast moving pressure which passes through brain and damages axons/vasculature
What is a focal injury?"- Coup (at site)<br>- Contrecoup (opposite site)<br><img src=""paste-ee3fc15fcc0de8427bbf33a69b360ecbb0bcf642.png"">"
How is a traumatic brain injury diagnosed?- Glasgow coma scale&nbsp;<br>- Low GCS has strong correlation with morbidity/mortality, can be affected by other factors eg. intoxication<br>- Loss of conciousness scale<br>- Post traumatic amnesia
How is traumatic brain injury diagnosed?- Non-enhanced computerized tomography scan (CT) in triage, all unconcious patients require CT to head and C-spine, quick, easy, sensitive to brain injury<br>- MRI when unexplained CT&nbsp;
Why are ICP bolts given to unconcious patients?- To measure intracranial pressure<br>- As brain enclosed in fix skull, a mass increase reduces CSF and cerebral blood flow, causing ischemia and cell death<br>- Inc ICP can cause herniation
What are the 6 types of herniation?"- Uncal<br>- Central<br>- Cingulate<br>- Transcalvarial<br>- Upward cerebellar<br>- Downward cerebellar<br><img src=""paste-7c74d569737b25fcb4e606a7402aca0747c2b285.png"">"
What are the symptoms of brain herniation?- Dilated pupils<br>- Headache<br>- Drowsiness<br>- High BP<br>- Loss of conciousness<br>- Loss of reflex<br>- Seizures<br>- Decorticate or decerebrate posturing
What is the difference between decorticate and decerebrate?"<b>Decorticate: </b>Damage to cerebral cortex/internal capsule<br><b>Decerebrate: </b>Damage to midbrain, brainstem/pons (legally dead)<br><img src=""paste-a66ef646cf025618366362bbf800a482ad05079b.png"">"
What is an epidural haematoma?"- Blood clot between skull and outer dural layer<br>- Mostly middle meningeal artery damage<br>- Lemon shape CT<br>- Yong adults with skull fracture, good prognosis when evacuated<br><img src=""paste-39bbcf47ce3d7b062d01d3a67ebf0a1c8175b40c.png"">"
What is a subdural haematoma?"- Blood clot in dubdural space between dura and arachnoid<br>- Damaged bridging cortical veins<br>- Seen as banana cresent on CT<br>- Occurs in all ae groups and requires rapid evacuation<br><img src=""paste-3d0eec8c805f92c84046a9e77f9a4b6cb10363f4.png"">"
What is a subarachnoid haematoma?"- Blood clot in subarachnoid space<br>- Damage in cerebral sulci<br>- White in CT<br>- Often seen in skull fractures and cerebral contusions<br>- Older middle age (&lt;60)<br><img src=""paste-8295d4d99d78a6906b5d16cbbefbd8b144613529.png"">"
What is an intracerebral haematoma?"- Blood clot in parenchyma of brain<br><img src=""paste-a9ea7a15d245eba0c8f47538ff52aaea283f0e25.png"">"
What are clinical signs of a seizure?- Strange body movement (shaking/stiffness)<br>- Unresponsiveness and staring<br>- Sudden tiredness or dzziness<br>- Not being able to communicate/understand others
What is the difference between early and late post-traumatic seizures?<b>Early: </b>Within 1st week of TBI<br><b>Late:</b> After 1st week of TBI
How is traumatic brain injury managed?<b>Mild:</b> Observe for 24hrs<br><b>Moderate: </b>Transfer to neurosurgery and ICU<br><b>Severe:</b> Seizure prophylaxis (phenytoin), induce coma/sedation to prevent secondary brain injury by reduce ICP, prevent seizures, elderly on warfarin to prevent ischemic stroke
What is used when ICP&gt;20mmHg?- <b>Hyperosmolar therapy </b>(short term)<br>- Hypertonic saline creates osmotic gradient to allow water to shift from extravascular space to intravascular space across BBB<br>- <b>Extraventricular drainage</b> (long term)
How is uncontrollable increased ICP treated?"- Decompressive craniectomy<br>- Provide space for brain to swell<br>- Skull bone flap placed in subcutaneous pocket in abdomen or cyropreservation in freezer for months/years<br>- Put back when brain swelling reduced<br>- Bleeding, infection, seizures, further brain damage<br><img src=""paste-e806d7c39cfdde3f8129022042f3b8649a17350a.png"">"
How do you manage patients with severe TBI?- Phenytoin, seizure prophylxis<br>- Propofol, benzodiazepines, sedation and analgesia<br>- Extraventricular drain<br>- Mannitol/Hypertonic saline
What is the ascending reticular activating system?- Important for alerting/arousal (wakefullness/awareness)<br>- Involves rostral brain stem tegmentum eg. pontine tegmentum, diencephalon ie thalamus, projects to cerebra cortex
What parts of the hypothalamus are important for arousal/sleep?<b>Tuberomammillary nucleus:</b> Promotes arousal<br><b>Ventrolateral preoptic nucleus:</b> Promotes sleep
What regulates the circadian clock?- Suprachiasmatic nucleus
What can cause disorders of conciousness?- Structural brain lesions (ischemic stroke, tumour, haemorrhage)<br>- Metabolic and nutritional disorders (organ failure, hypoglycaemia)<br>- Exogenous toxins (drugs, cocaine)<br>- CNS infections, septic illness (bacterial meningitis)<br>- Seizures<br>- Temperature-related effects (hypothermia, fever)<br>- Trauma (concussion, diffuse axonal injury)
What are the 3 levels of consciousness?1. Comatose, asleep and unconscious<br>2. Vegetative state, awake and unconcious<br>3. Minimally concious state, awake and some consciousness
What is a comatose state?- Lasts a few weeks, rarely longer than a month<br>- Complete unresponsiveness with eyes close and cannot be aroused<br>- Different to stupor where strong stimuli elicits a response
What is locked-in syndrome?- Unresponsiveness and eyes closed but retains eye movement and fully concious<br>- Primarily due to ventral pons injury, interupting corticospinal/corticobulbar tracts causing quadriplegia and anarthria<br>- Often misdiagnosed with coma
What is akinetic mutism?- Condition of apparent alertness along with lack of almost all motor functions including speech, gestures, facial expression<br>- Frontal lobe, basal ganglia, mesencephalothalamic regions affected
What is vegetative state?- Spontaneous eye-opening signalling wakefulness but no evidence of purposeful behaviour<br>- <b>Persistent:</b> 1 month at least<br>- <b>Permenant: </b>at least 12 months after traumatic injury or 3 months after non-traumatic causes
What is minimally concious state?- Severely altered conciousness with definite but sutle and inconsistent behavioural evidence of self/environmental awareness<br>- Recognise yes/no, simple verbal/commands, smile/use hairbrush
What is the difference between confusional and post-confusional state?<b>Confusional: </b>Interactive communication, amnesia, hypokinetic, labile behaviour<br><b>Post-confusional: </b>Resoltuion in amnesia, cognitive impairments in higher levels, attention/memory retrieval, deficits in self-awareness/social awareness, achieve functional independence in daily self care
How are persistent vegetative states managed?- Immediate stabilization, ABC<br>- Admisison to ICU<br>- Supportive measures, control ICP, tracheostomy<br>- Establish cause, TBI, high blood glucose<br>- Taking care, feeding via CANH, prevent bed sores/muscle atrophy
How can you ass3ss conciousness?- Auditory event-related potential (Identify mismatch negativity, auditory change in monotomous sound sequence, 10% unnoticed in healthy individuals)<br>- PET scan to see glucose uptake<br>- Blood oxygenation level dependent imaging, cerebral blood flow
What is the treatment for persistent vegetative state?<b>Avoid sensory deprevation by:</b><br>- Audio, music, voices of family<br>- Tactile, massage, feather, sandpaper<br>- Visual, snow globe, blinking light<br>- Taste, spices onto tongue, ice pop<br>- Olfactory, cologne, vinegar<br><br><b>Amantadine: </b>Weak NMDA receptor antagonist and blocks dopaminergic reuptake, mechanism not understood<br>- 200mg twice daily, improves functional recovery rate
How could zolpidem be used for persistant vegetative state?- Indirect GABAa receptor agonist<br>- Paradoxical effect of increase in arousal for insomnia drug<br>- Loss of active inhibition from striatum allows GPi to tonically inhibit thalamus so thalamocortical overactivity
How can vagal stimulation be used for PVS?- Using vagus nerve stimulation to activate thalamo-cortical network-pontine tegmentum<br>- Implant fitted to vagus nerve at neck level for stimulation<br>- Move from PVS to MCS, can track objects, response to simple stimuli
What does the limbic system consist of?"- Cortical and subcortical nuclei on medial aspect of frontal/parietal/temporal<br>- <b>Cingulate cortex </b>in frontal/parietal lobes<br>- <b>Parahippocampal cortex </b>in medial temporal lobe<br><img src=""paste-4131ef7755430bba85a5d68212b06a05f73fb111.png"">"
What is the blood supply to the limbic system?- Frontal/parietal cingulate cortex supplied by anterior cerebral artery<br>- Parahippocampal cortex supplied by posterior cerebral artery
What is the function of the limbic system?- Mediates sense of reward/pleasure for things which promote survival (eating/drinking/sex) and sense of pain, unhappiness, misery<br>- Rewarded/punished so involved in memory and learning
What is the role of the anterior cingulate cortex?- Evaluates degree of pleasure/pain in outcome of an action and suggests and appropriate form of remedial action to be implemented by the motor system
What is the function of the posterior cingulate cortex?- Successful retrieval of memories with strong emotional significance
What is the role of the parahippocampal gyrus?- Aquisition of new memories
What do the output tracts of the hippocampus form?"- The fornix<br>- Anterior end folds fown vertically and ends up in mamillary body of hypothalamus<br><img src=""paste-2eccbd89346f7092262701c5b9004a787238c75c.png"">"
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-1-A.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-2-Q.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-2-A.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-3-A.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-4-Q.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-4-A.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-5-Q.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""4c93ba4fc9ad4a5cbf70481cc2e4e4d5-oa-5-A.svg"" /></div> <div id=""io-original""><img src=""tmpaqt7nrjz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
Describe the loop of neuronal connections between the hippocampus and cingulate cortex"Cingulate cortex -&gt; parahippocampal cortex -&gt; hippocampus -&gt; along fornix to mamillary bodies -&gt; from hypothalamus to anterior thalamus -&gt; cingulate cortex<br><img src=""paste-f7745a2e1ab2425ea2527d9a8c51189d5f5dd1a2.png"">"
"What is the Papez's circuit?"- Loop between hippocampus, cingulate cortex<br>- Associated with expression of emotion and formation of memories
What is the function of the hippocampus?- Enables proper storage of memory and labels new experience<br>- Loss of function causes failure to transfer new exeriences into long term memories (anterograde amnesia)
What are the symptoms of kluver-bucy syndrome?"- Phychic blindness<br>- Oral tendacies<br>- Hypermetamorphosis<br>- Altered sexual behaviour<br>- Emotional changes<img src=""paste-97da4d0ff066704e46c2b359c193c9ee4fe94e7f.jpg"">"
How does the amygdala activate the PNS?"- Stria terminalis, fibre tract to hypothalamus<br>- Hypothalamus sends commands to reticular formation<br>- Activated reticulospinal tract and thus sympathetic nervous system<br><img src=""paste-e51031b48e22fc3e63ffa52f227216228fbc8e28.png"">"
What is the function of the amygdala in memory?- Gives an emotional label to memory<br>- Labels as pleasent/unpleasent&nbsp;<br>- Can then trigger approach/avoidance behaviour and autonomic responses
What is the function of the insula?- Decides if an event is worth remembering and activates memorising process<br>- Maybe involved in retreval
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""bdb7bc45ff6a4679b165390f1a0041af-oa-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmpnjpk05yk.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""bdb7bc45ff6a4679b165390f1a0041af-oa-1-A.svg"" /></div> <div id=""io-original""><img src=""tmpnjpk05yk.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""bdb7bc45ff6a4679b165390f1a0041af-oa-2-Q.svg"" /></div> <div id=""io-original""><img src=""tmpnjpk05yk.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""bdb7bc45ff6a4679b165390f1a0041af-oa-2-A.svg"" /></div> <div id=""io-original""><img src=""tmpnjpk05yk.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""bdb7bc45ff6a4679b165390f1a0041af-oa-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmpnjpk05yk.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""bdb7bc45ff6a4679b165390f1a0041af-oa-3-A.svg"" /></div> <div id=""io-original""><img src=""tmpnjpk05yk.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
What are the cortical components of the limbic system?- Cingulate, parahippocampal, insula cortex
What are the subcortical components of the limbic system?- Hippocampus, amygdala, accumbens, septal nuclei
Breifly outline a model of memory"<img src=""paste-9016ff8179efc8a05525b14a4a63c300b81b0a07.png"">"
Describe the mesocorticolimbic dopamine pathway"- Ventral tegmental area projects dopaminergic fibres<br>- Project from brainstem to accumbens nucleus<br>- Called reward pathway as activated when recieve a reward<br><img src=""paste-71587946d58bf8157bcd4d4d4f601fde05107565.png"">"
Outline the mental state examination- Appearance and behaviour<br>- Speech and form of thought<br>- Mood (subj and obj and risk)<br>- Perceptions, thought content, delusions, passivity<br>- Cognition<br>- Insight
What signs and symptoms can come up in a MSE?- Psychoses, schiophrenia, delusional disorder<br>- Affective disroders, depression, bipolar<br>- Neuroses, anxiety, OCD<br>- Learning disability<br>- Dementia<br>- Intoxication<br>- Eating disorders
What are the advantages and disadvantages of categorising mental disorder?<b>Advantages:</b> Diagnosis, guidance for treatment, patient explaination, demystification<br><b>Disadvanatges: </b>Labelling/stigma, illusion of udnerstanding, obscures socio-cultural factors, co-morbidity?
What is drug abuse?- Pattern of drug use in which users consume the substance in amounts or using methods which are directly/indirectly harmful to themselves/others
What is drug dependence?- Adaptive state which develops after repeated drug use, resulting in withdrawal symptoms upon cessation
What is drug tollerance?- The diminishing effect of a drug which results after repeated administration at a set dose<br>
What is psychological dependence?- Dependence involving emotion-motivational withdrawal symptoms (depression, restlessness)
What is physical dependence?- Dependence involving significant physical-somatic withdrawal symptoms (fatugue, nausea, pain, seizures)
What are examples of class A,B and C drugs?A: Heroin, methadone, cocaine, ecstasy, LSD, magic mushrooms<br>B: Amphetamines, ketamine, codeine, cannabis<br>C: Benzodiazepines, anabolic steroids
What receptors do opiates act on?Mu and delta opioid receptors
What receptors does cocaine act on?Dopamine, noradrenaline and dopaminergic uptake systems
What receptors does ethanol act on?GABAa and NMDA receptors
What receptors does nicotine act on?Nicotinic receptors
What is the mesolimbic pathway?"- Dopaminergic projection from ventral tegmental area to nucleus accumbens<br>- Essential in reward and drug-dependence<br><img src=""paste-04f217148a4cf013761f2ab1947a9819c8f40dde.png"">"
What are the stages in the addiction cycle?- Binge/intoxication (positive reinforcement)<br>- Withdrawal/negative effect (negative reinforcement)<br>- Preoccupation/anticipation (conditioned positive and negative reinforcement)
What mechanisms underly withdrawal?"- Drug abuse causes up-regulation of opioid peptide dynorphin<br>- Activation of kappa opioid receptors trigger dysphoria, reducing dopamine release<br><img src=""paste-ffbd7e716f10875a4a3f0e3ac18f912deb23bcec.png"">"
What brain structures are involved in development of drug dependence?"- Ventral tegmental area<br>- Nucleus accumbens<br>- Amygdala<br>- Insula<br>- Prefrontal cortex<br>- Hippocampus<br><img src=""paste-c95529fa43a5bc47a203d37964571e164e732e55.png"">"
Which processes associated with the prefrontal cortex are impaired in addicts?- Self control<br>- Emotional regulation<br>- Motivation<br>- Attention and flexibility<br>- Working memory<br>- Descision making<br>- Awareness and insight<br>- Learning and memory<br>
What defines hazardous drinking?- Over 5units/day for men<br>- Over 3units/day for women
What are the acute and long-term consequences of alcohol abuse?- GI haemorrhge<br>- Gastritis<br>- Peptic ulcer disease<br>- Pancreatitis<br>- Alcoholic liver disease<br>- Peripheral neuropathy<br>- Cerebral atrophy<br>- Chronic atrial fibrillation<br>- Hypoglycaemia<br>- Alcoholic ketoacidosis
What are the cellular targets of MDMA (ecstacy)?- 5-HT uptake systems<br>- Dopamine uptake system<br>- 5-HT2 receptors<br>- H2 histamine receptors<br>- A2 adrenergic receptors
What are the symptoms of acute MDMA toxicity?- Temperature elevation<br>- Disseminated intravascular coagulation<br>- Inc. renal water absorbtion<br>- Hyponatraemia<br>- Central oedema
What are cannabinoid CB1 receptors?- Widespread distribution in CNS<br>- Most abudent G protein-coupled receptor in mammalian brain
What are the risks of cannabis use?- Increased risk of schizophrenia and major depression<br>- Gateway drug<br>- Depression, memory problems, paranoid are heritable
How is addiction managed?- Detoxification (eliminate drug from body)<br>- Psycological support-counseling<br>- Medication when available<br>- Evaluation and treatment for mental health problems<br>- Long term follow up
What are the clinical uses of hypnotics and anxiolytics?- Relief of anxiety states<br>- Induction of sleep<br>- Sedation and amnesia<br>- Control withdrawal states in addiction<br>- Muscle relaxation<br>- Severe behavioural disturbance
What controls the circadian rhythm?- Suprachiasmatic nucleus in hypothalamus<br>- Inc. activity during light phase, decreased in dark
What controls wakefuless and sleep?Wakefullness: Cholinergic systems and monoaminergic projections<br>Sleep: GABA and galanin neurons
What are the types of insomnia?- Transient (jetlag)<br>- Short-term (illness, bereavement, stress)<br>- Chronic (3 weeks +)
What drugs are used for insomnia?<b>Benzodiazepines </b>(short acting) eg. diazepam (but long half life)<br><b>Z-drugs </b>eg. zaleplon
What are unwanted effects of benzodiazepines?- Change in sleep patterns<br>- Daytime sedation<br>- Rebound insomnia<br>- Tolerance<br>- Dependence (withdrawral with nausea, anxiety, cramps)
What is a non-pharmacological intervention for chronic insomnia?CBT
What is the orexin system?- Orexin is a peptide produced in the hypothalamus<br>- Orexin A and B<br>- Effects mediated by orexin OX1 and OX2<br>- Regulates arousal, appetite and wakefulness<br>- Deficiency in orexins = narcolepsy
What key structures are involved in anxiety disorders?"- Amgdala<br>- Bed nucleus of stria terminalis<br>- Insula<br>- Anterior cingulate<br>- Prefrontal cortex<br>- Ventral hippocampus<br>- Thalamus<br><img src=""paste-375cc22d7b4914de30c3f77aefcfbdca3747f74a.png"">"
What genes are associated with panic disorder?- Cholecystokinin (CCK)<br>- CCKb receptors<br>- 5-HT2 receptor
What are the types of anxioltyics?- SSRIs (fluoxetine)<br>- SNRIs (venlafaxine)<br>- Benzodiazepines (lorazepam)<br>- 5-HT1a agonists (buspiron)<br>- B-adrenoceptor agonists (propranolol)
Why are barbiturates not used for anxiety?- Major drug dependence/tolerance<br>- Induction of liver microsomal enzymes<br>- Fatal toxicity in overdose<br>- Accumulation causes drowsiness/disorientation/ataxia<br>- Withdrawal syndrome, agitation, insomnia, depression, seizures
Describe the mechanism of action of benzodiazepines?- Positive allosteric modulators<br>- Diazapam potentiates GABA induced hyperpolarization
What is given for benzodiazepine overdose?- Flumazenil<br>- Antagonist at binding sites but has sort half-life
How is generalized anxiety disorder treated?- Buspirone<br>- Venlafaxine (SNRI)<br>- Fluoxetine (SSRI)<br>- Pregabalin<br>- CBT
What are the complications of benzodiazepines in the elderly?- Psychomotor impairment<br>- Risk of falls<br>- Daytime drowsiness<br>- Intoxication<br>- Amnesia<br>- Depression<br>- Respiratory problems<br>- Abuse and dependence
What is declerative and non-declarative memory?"<img src=""paste-3ad55fca3a578e42f1ef96976df76c9498ba7965.png"">"
What is anterograde amnesia?- New events not transferred to long-term memory<br>- Deficit in learning subsequent to onset of disorder
What is retrograde amnesia?"- When someone can't recall events before the onset of amnesia"
What is dissociative amnesia?- Blocking out of critical personal information, usually of traumatic or stressful nature
What are the causes of amnesia?- Physical trauma<br>- Infections<br>- Drug/alcohol abuse<br>- Reduced blood flow to brain<br>- ECT, epilepsy, anoxia can affect short term/working memory
Describe the impact of Mg on NMDA receptors- NMDA receptor binds glutamate and channel opens, Mg blocks channel unless depolarised<br>- When depolarised, Mg expelled and Na and Ca enter<br>- Depolarisation needed to remove Mg achieved by activating synapse repeatedly as during LTP and LTD
How are both LTP and LTd calcium dependent?- Kinases involved in LTP insensitive to Ca so need a big Ca change to be activated<br>- Phospatases involved in LTD more sensitive to Ca and activated by small Ca changes
How can syapse transmission be changed?"- Change amount of glutamate released<br>- Change no of AMPA receptors (or phosphorylation state)<br>- Change no of synapses<br>- Change probability of glutamate release (inc. remediation)<br><img src=""paste-782e6fd9ce6d1230dff2d3325dcd83f036959634.png"">"
How can brain arousal be measured?- Electroencephalograph (EEG)<br>- Average activity of hundreds/thousands of nerve cells
What is a normal waking EEG compared to a&nbsp;seizure?"- High frequency low amplitude (neurons firing out of phase so cancel out so appears desynchronised)<br>- High amplitude during seizure (firing in phase, synchronous (somthing may be wrong) so high amplitude)<br><img src=""paste-3efc0b965e282b2f0ba3255783aa749ae0109160.png"">"
When are alpha,beta and gamma waves recorded on ECG?Alpha: Alert at rest with eyes closed<br>Beta: Normal alert waking (high frequency beta)<br>Gamma: Highly alert and concious
How does sleep affect an EEG?"- Deeper sleep, lower frequences and higher amplitudes<br><img src=""paste-b6e4b185df89c052c8e3599014e4ffb4bef7d35d.png"">"
What is the function of slow wave sleep?- Increased growth and maintenance of immune, nervous, skeletal and muscular systems<br>- Growth hormone secreted mostly during slow wave sleep, most long bone growth<br>- Wound repair&nbsp;<br>- Influx of CSF flushes out waste products eg. amyloid proteins&nbsp;
What is melatonin?"- Free radical scavenger&nbsp;<br>- Maintains GABA function and prevents seizures<br>- Released during slow wave sleep from pineal gland<br><img src=""paste-2fda77cbf221a5b140b7c46e16045d2eca9e62c4.png"">"
What is the function of REM sleep?"- Memory consolidation<br>- Removing junk and defragmenting memories<br>- Coping with life's stresses"
What controls sleep and wakefulness?- Hypothalamuc decides when we need sleep, sends commands to pons to turn off reticular frmation acitivity, triggering sleep<br>- Chemicals in blood can Eg. adenosine induces sleepiness, caffine is an antagonist at A1 adenosine receptors, ghrelin and low blood glucose inhibit sleep, high leptin increases sleepiness<br>- Suprachiasmatic nucleus stimulates sleepiness after long exposure to light
What are chemical factors which maintain wakefulness?"- Orexins found in posterior hypothalamus which excite monoamine neurons in the brainstem<br>- Tuberomamillary nucleus release histamine which project to reticular formation and cerebral cortex<br>- When signals from preoptic and suprachiasmatic nucleu inhibit histamine and orexin neuons, sleep occurs<br><img src=""paste-e7bc3c6c73e02da54195f084fa562e8fcfdf0d30.png"">"
Which neurons in reticular formation contribute to wakefulness?Cholinergic cells in pedunculopontine nucleus<br>Noradenergic cells in locus coeruleus<br>Serotoninergic cells in raphe nuclei
Which reticular formation neurons are active during REM and slow wave sleep?Slow wave: Cholinergic, noradrenergic and serotoninergic decreased<br>REM: Cholinergic active but norad and serotonin neruones dec.
How do the noradrenergic locu coeruleus cells control alertness?- Locus coeruleus contols sympathetic nervous system but projects rostrally to cerebral cortex and activates central sympathetic system, controlling alterness and attention<br>- When switched off we are inattentive to outside world
What causes sleep atonia?- Switching off of noradrenaline and serotonin systems<br>- Nucleus in pons dends commands down reticulospinal tract to block the corticospinal tract completely by excitation of spinal inhibitory interneurons
How can different antidepressants affect sleep?SSRIs: Maintain high serotonin which interferes with REM sleep<br>TCAs: Promote sleep due to blocking histamine H1 receptors
What is deep brain stimulation?- Electrodes places stereotactically into deep brain structures
What is DBS used for?- Parkinsons, essential tremor and dystonia (NHS funded)<br>- Epilepsy, chronic neuropathic pain (individually funded)<br>- Depression, dementia, eating disorders, addiction (experimental)
"What is the criteria for DBS in parkinson's disease?"- Idiopathic PD with 4 classical symptoms<br>- No sensory issues or weakness<br>- Still require Ldopa treatment<br>- Physically fit for surgery<br>- Realistic expectations (not a cure, helps motor symptoms)
What is essential tremor?- Brain disorder causing part of your body to tremor uncontrollably
What is dystonia?- Brain disorder with sustained or repetitive muscle contractions resulting in twisting and repetitive abnormal movements or fixed postures
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-1-Q.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-1-A.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-2-Q.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-2-A.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-3-Q.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-3-A.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-4-Q.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-4-A.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-5-Q.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <div id=""io-footer""></div> <script> // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "" <div id=""io-header""></div> <div id=""io-wrapper""> <div id=""io-overlay""><img src=""6da96c8a4f644732abccffb426eef927-oa-5-A.svg"" /></div> <div id=""io-original""><img src=""tmpy8z_7ynz.png"" /></div> </div> <button id=""io-revl-btn"" onclick=""toggle();"">Toggle Masks</button> <div id=""io-extra-wrapper""> <div id=""io-extra""> </div> </div> <script> // Toggle answer mask on clicking the image var toggle = function() { var amask = document.getElementById('io-overlay'); if (amask.style.display === 'block' || amask.style.display === '') amask.style.display = 'none'; else amask.style.display = 'block' } // Prevent original image from loading before mask aFade = 50, qFade = 0; var mask = document.querySelector('#io-overlay>img'); function loaded() { var original = document.querySelector('#io-original'); original.style.visibility = ""visible""; } if (mask === null || mask.complete) { loaded(); } else { mask.addEventListener('load', loaded); } </script> "
What areas of the brain can be stimulated by DBS to help tremor?"- Zona incerta&nbsp;<br>- Subthalamic nucleus<br><img src=""paste-c186d2bee857b090b92cc4526be557c12b8c4f6e.png"">"
What areas of the brain can be stimulated by DBS to help dystonia and tremor?"- Globus pallidus internal<br><img src=""paste-aa344148b9b429da8e65a858685440e6c3c6801f.png"">"
What other conditions can DBS treat?- Epilepsy (reduce not eliminate seizures)<br>- Chronic neuropathic pain<br>- Major depressive disorder<br>- Addiction (nucleus accumbens)
What are the issues with using DBS for psychiatric disorders?- High cost of treatment<br>- Autonomy<br>- Unsure about mechanism<br>- Can change personal identity
What are the pros of DBS?- No deaths from use<br>- Improve temor<br>- Reversible<br>- Continuous symptom control<br>- Decrease medication use
What are the cons of DBS?- 2-3% risk brain haemorrhage<br>- 15% risk of tempporary transplantation problems<br>- May experience tingling<br>- Migration of electrode<br>- Worsening of tremor when stimulation stopped<br>- No guarantee
What are the 4 hypothess for the mechnism of action of DBS?1. Inhibition hypothesis, inhibits local neuronal firing, removing spontaneous discharge from GPi<br>2. Excitation hypothesis<br>3. Disruption hypothesis, disrupts abnormal info flow through GPi<br>4. Neuro-network modulation hypothesis
What is cognitive learning?- Expectations and emotions from what you know determine your learning behaviour
What is biological learning?- Biology determines your thoughts, moods and actions<br>- High dopamine means lecture experience better!
What is psychodynamic learning?- Early childhood experiences determine your learning behaviour
What is humanistic learning?- Individuals desire to discover knowledge and understanding<br>
What is behavioural learning?- Environmental stimuli reflect learning behaviour<br>- All friends studying, you want to study
What is observational learning?Process of learning through watching others, retaining information and replicating the observed behaviours
What is classical conditioning?- Association of an involuntary response and a stimulus
What is emotional conditioning?- Subject associates a perceptual information to an emotional response<br>- Stage fright, test anxiety
What is operant conditioning?- If a behaviour is followed by positive/negative response then the behaviour will be repeated/discontinued
What is the difference between flooding and implosion therpay?<b>Flooding:</b> Actual exposure to stimulus or its image or fear, patient locked in room full of spiders<br><b>Implosion: </b>No direct contact to stimulus, imagined scene exaggerated by therapist
What therapy is used to treat classical conditioning?- Aversion therapy<br>- Flooding/implosion therapy<br>- Systemic desensitization
What therapy is used to treat operant conditioning?- Token economy<br>- Contingency management<br>- Extinction
What are the symptoms of schizophrenia?Positive: Hallucinations, delusions, agitations, disorganised thinking<br>Negative: Introversion, apathy, low self-esteem, personal neglect<br>Cognitive: Poor memory (particularly working memory), attnetion deficit, executive dysfunction
What are the structural changes in schizophrenia?- Increased size of ventricles<br>- Smaller mesial temporal lobe structures<br>- Grey matter loss and hypofrontality
Why does schizophrenia start?- Decreased synaptic spines and decreased dendrite complexity<br>- Abnormalities in formation and maturation of brain circuits<br>- Childhood trauma, urban living, migration, cannabis use
How is brain matter affected in schizophrenia patients?- Pro inflammatory cytokines elevated in prefrontal cortex, increased loss of cortical grey matter<br>- Reduced oligodendrocyte density in patients, decreased white matter integrity
How are the dopaminergic pathways affected in schizophrenia?"- Hyperactivity in mesolimbic pathway<br>- Hypoactivity in the mesocortical pathway<br><img src=""paste-964933d9bcb8f1f182d0e6694fe7a440e4f2ba65.png"">"
What antipsycotics are used to treat schizophrenia?- Chlorpromazine<br>- Thioridazine<br>- Fluphenazine<br>- Haloperidol<br>- Flupenthixol<br>- Clozapine, blocks D4<br>- Aripiprazole, partical D2 agonist
What are the side effects of antipsychotic drugs?"- Rise in prolactin (sexual dysfunction, galactorrhoea, amenorrhoea)<br>- Weight gain<br>- Dyslipidemia<br>- Type 2 diabetes&nbsp;<br><img src=""paste-dcb8f05dcda286de0076ac0fa87cefe6884b51ca.png"">"
What are the rare complications of antipsychotics?<b>Neuroleptic malignant syndrome: </b>Potentially lethal, muscle ridigity, tremor, confusion, autonomic instability<br><br><b>Tardive dyskinesia:</b> Irreversible, involuntary movements of lips/jae/face/consatant chewing
Briefly describe the process of carcinogenesis"<img src=""paste-88adfda3da7dafb867103bb7d9014bd73d1b7920.png"">"
What are the types of DNA damage and how are they repaired?- Reactive O2 species, X-rays, spontaneous reactions and alkylating agents (usually methylation) repaired by <b>base excision repair</b><br>- UV lights, ciggarette smoke, polycyclic hydrocarbons, repaired by <b>nucleotide excision repair</b><br>- Replication errors during S, G1, G2 repaired by <b>mismatch repair</b><br>- UV light, X-ray, anti-tumour agents, repaired by <b>homologous recombination</b>
What are the hallmarks of cancer cells?- Angiogensis (upregulation of VEGF)<br>- Growth signals not required for growth/survival<br>- Unresponsive to growth-inhibitory signals<br>- Evasion of apoptosis<br>- Avoid immune detection<br>- Ability to invade and metastasise
Give examples of proto-oncogene mutations- Translocation mutation, bcl-2 follicular lymphoma<br>- Gene amplification mutation, HER2 breast cancer<br>- Point mutations, c-Fos or c-H-ras
What signalling pathways are affected in cancer?- MAPK/RAF pathway, proliferation and apoptosis regulation affected<br>- PI3 kinase pathway, cell growth, proliferation, angiogenesis and metabolism affected
What occurs when Ras is continually active?- Inc. PI3K -&gt; Inc. Akt -&gt; Survival of cancer cells<br>- Inc. RAP/MAPk -&gt; inc. MEK -&gt; Inc. ERK -&gt; Proliferation
Give examples of oncogenes"Growth factors: EGF, VEGF<br>Growth factor receptors: EGFR, HER2<br>Signal-transduction proteins: K-ras, B-raf<br>Transcription factors: c-myc, c-fos<br>Anti-apoptotic proteins: bcl-2<br><img src=""paste-95b9ffec02a797030f1130d780353c14cf0c2b91.png"">"
Give examples of tumour suppressor genes<b>Gatekeeper</b> (act to directly regulate cell proliferaton): p53 prevents cells leaving g1, pRB pro-apoptotic<br><b>Caretaker</b> (regulate cell cycler eg.checkpoints,DNA repair and apoptosis): BRCA, MMR, Bax (pro-apoptotic)
Describe what occurs when p53 is mutated"- P53 prevents accumulation of mutation, both copies need to be mutated for loss of function<br>- Normally p53 interacts with mdm2 which inactivates it<br>- DNA damage, severeal pathways lead to dissociation of p53 and mdm3<br>- Activated p53 promotes cell cycle arrest or apoptosis<br><img src=""paste-988ac9d4d66fccee956e055618dbd80cb9c46e6e.png"">"
What are the clinical features of benign tumours?- Slow growing<br>- Non-invasive<br>- Non-metastasising and well differentiated
What are the clinical features of malignant tumours?- Fast growing, numerous/abnormal mitotic figures<br>- May ulcerate on the surface<br>- Local invasion<br>- Metastatise<br>- Weight loss, anorexia, anaemia
How does low and high grade prostatic intraepithelial neoplasia present histologically ?"Low grade: Nuclei not prominent, tissue appears normal, intact basal layer<br>High grade: Large nuclei, hyperchromasia, prominent nucleoli, scattered basal cell periphery<br><img src=""paste-8a76229d3d2936a3695123cdd6fad105f6b99988.png"">"
How can invasion and metastasis be identified histologically?"Invasve breast cancer: Irregular infiltrative borders without well-defined capsule, intense stromal reaction (ECM and growth factors)<br>Metastatic breast carcenoma: Aggregates of tumour cells within substance of the node, dilated lymphatic channel<br><img src=""paste-efd94c6cb673e0423654ed5fcd46f18bb284503e.png"">"
Why do patients not attend screening?- Feel fine/self-percieved low risk<br>- Fear/embarrassment<br>- Too busy<br>- Prior negative experience eg. Pain/false positives<br>- Poor access, language barriers, mental ill health