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68 Cards in this Set
- Front
- Back
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Neurotransmitters of BRF: Serotonin
Name the locale, connections and function |
Locale: raphe nuclei
Connections: all over Functions: behaviour, mood, pain, blood flow |
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Neurotransmitters of BRF: Acetylcholine
Name the locale, connections and function |
Locale: BRF ACh groups
Connections: all over Functions: arousal, memory, ANS control, pain, dream |
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Neurotransmitters of BRF: Dopamine
Name the locale, connections and function |
Locale: substantia nigra, VTA
Connections: forebrain Function: behaviour, focus, pleasure, movement |
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Neurotransmitters of BRF: Noradrenaline
Name the locale, connections and function |
Locale: locus coeruleus
Connections: all over Function: ANS control, pleasure, blood flow, neural plasticity, global attention |
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What are the symptoms of a lesion of the BRF?
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Coma, gaze control, ANS control, vertigo, nausea
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Nystagmus may be caused by a lesion to which structures of the brainstem?
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Vestibular nuclei or medial longitudinal tract
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Speech deficit may be caused by a lesion to which structures of the brainstem?
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Nucleus ambiguous or corticobulbar tract
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What is the blood supply to most of the midbrain?
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PCA
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What is the blood supply to most of the pons (except lateral)
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Basilar artery
(AICA does lateral) |
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What does the vertebral artery supply?
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Medial medulla
(PICA does lateral) |
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Which tract connects the cortex to the the brainstem? Where does it travel? Unilateral or bilateral?
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Corticobulbar tract, through the internal capsule via the corona radiata
Generally bilateral |
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An upper motor neuron lesion to the facial nerve causes which distribution of sensory loss?
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Contralateral lower facial sensory loss
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Which cranial nerves are supplied by the nucleus ambiguus?
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CN IX, X, and XI motor efferents
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The nucleus of the solitary tract gives rise to which cranial nerve fibres?
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Upper: Taste: VII, IX and X
Lower: VS: IX and X |
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What is the second most medial group of nuclei in the brainstem? Name them from caudal to rostral
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Parasympathetics:
Edinger Westphal (III) Superior Salivary (VII) Inferior Salivary (IX) DMX (X) |
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What is the most medial group of nuclei in the brainstem? Name them from rostral to caudal
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Somatic motor:
XII VI IV III |
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Which group of nuclei lie between the somatic sensory and autonomic nuclei? Name them from rostral ato caudal
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Visceral/branchial motor:
Nucleus ambiguus (IX, X & XI) Facial motor Trigeminal motor |
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Where are the brainstem respiratory control centres?
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Medulla and dorsolateral pons
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What regulates the rate and depth of respiration?
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1) medullary chemoreceptors signalling pH, Pco2 and Po2 of arterial blood
2) afferent inputs from lung stretch receptors and arterial chemoreceptors (via IX and X) 3) inputs from higher centres e.g. motor cortex |
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Which pontine neurons inhibit inspiratory neurons?
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Pneumotaxic centre
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Which pontine neurons excite inspiratory neurons?
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Apneustic centre
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Where are the central chemoreceptors that sense arterial CO2?
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Retrotrapezoid nucleus (RTN) in caudal pons/rostral medulla
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How are respiratory patterns determined?
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Generated in CPG and influenced by forebrain and RTN (inputs from central and peripheral chemoreceptors)
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What is the effect of the Hering-Breuer reflex?
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Inspiration>
Excites pulmonary stretch receptors> Inhibits inspiration Therefore, limits inspiration by reducing depth of breathing and increasing rate |
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Which tonically active neurons supply sympathetic preganglionic neurons hence maintaining resting blood pressure?
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RVLM
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What is the pathway that allows carotid baroreceptors to regulate blood pressure?
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Increased BP>
Increased carotid baroreceptor firing> excit input to NTS via IX and X> excit input to CVLM> inhib input to RVLM> reduces activitiy of sympathetic preganglionic neurons> reduced SNA and BP |
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T/F Premotor sympathetic neurons in CVLM are divided into subgroups that regulate specific vascular beds
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False
The division is in the RVLM |
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What are the earliest signs of stroke seen on a CT scan?
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Loss of gray-white junction
Oedema (cytotoxic) Hyperdense MCA (thrombus) Mass effect (ventricular distortion) |
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What are the subacute changes of stroke seen in imaging? What is the best modality of imaging?
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Increased mass effect in first three days
Haemorrhagic transformation MRI better than CT |
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What percentage of haemorrhagic strokes show CT changes?
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~5%
MRI better |
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What are the features of an epidural haematoma as seen in imaging?
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D-shaped
Often skull fracture present Rapid (urgent) |
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What are the features of a subdural haematoma as seen in imaging?
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C-shaped
Slow (less urgent) Cause is generally ruptured bridging veins |
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What are the features of a subarachnoid haemorrhage as seen in imaging?
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Whispy, ill-defined cisterns
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What type of intracranial haemorrhage will usually result from an aneurysm rupture?
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Sub-arachnoid haemorrhage
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What is the ranking for stroke as a cause of adult disability and death?
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1st and 3rd respectively
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How long must symptoms last for a vascular event to be called a stroke?
(According to WHO definition) |
24 hours or leading to death
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What is the major cause of stroke?
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Atherosclerosis
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T/F Both age and gender are associated with prognosis following stroke
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True
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T/F Neglect is a typical sign of a cerebral lesion in the non-dominant parietal lobe
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True
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What are some typical means of stroke prevention?
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Lowering blood pressure
Antithrombotic agents Carotid revascularisation Warfarin anticoag Lipid lowering |
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T/F Rapid and full dose heparin should be used in acute stroke therapy
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False
Aspirin, however is an important first point of acute stroke therapy. Thrombolysis may also be used. |
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As a cause of stroke, what is the ratio of infarct : haemorrhage?
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4:1
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What is the most common site for a stroke causing atherosclerosis?
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Extracranial vessels, particularly ICA near the common carotid bifurcation
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What percentage of strokes are caused by haemorrhage?
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20%
80% are caused by infarct |
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What are the major sites for large artery intracranial atherothrombosis?
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Middle cerebral artery at origin
Basilar artery at end |
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What is the major site for large artery extracranial atherothrombosis?
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ICA near bifurcation
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Which substances prevent endothelial platelet adherence?
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NO and PGI2
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Which substance clears fibrin from endothelial surfaces?
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tPA
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Which endogenous substance breaks down fibrin?
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Plasmin (derived from plasminogen)
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What is the sequence of events following acute ischemia from large artery athero-thrombus?
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Glutamate release>
Increased intracellular calcium> Reactive intermediates cause damage AND Decreased energy production> Failure of ionic pumps and free radicals from mitochondria |
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What are the acute changes following brain infarct? What cells would you expect to find?
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Softening and swelling
Neutrophils |
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What are the post-acute changes following brain infarct? What cells are associated with this stage?
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Cavitation
Foamy macrophages (from 3 days clear debris) and reactive astrocytes (from 10 days) |
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T/F Below 30% normal cerebral blood flow neuronal electrical failure occurs
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True
15% is the threshold for membrane failure |
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T/F Lacunar infarcts are often clinically silent
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True
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Where do most infarcts caused by cerebral emboli occur?
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Middle cerebral artery
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Where do most infarcts due to global ischaemia occur?
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Between the territories of the middle and posterior or anterior cerebral arteries
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T/F Superficial intracerebral haemorrhage is often associated with hypertension
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False
Deep intracerebral haemorrhage is associated with hypertension |
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What causes the symptoms associated with subarachnoid haemorrhage?
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Raised ICP
Meningeal irritation |
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350,000 Australians had strokes in 2003. What proportion of stroke is potentially preventable?
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80%
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T/F Syncope and seizure are common presentations for stroke
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False
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What are common presenting signs and symptoms of stroke?
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Acute onset, previously well
Facial/arm/leg weakness Visual field disturbance Diplopia Speech disturbance |
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What are the risk factors for stroke?
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AF (greatest)
Hypertension Sedentary Diabetes Age Male Cholesterol Smoking EtOH |
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What is the penumbra?
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The ischemic but potentially salvageable area around infarcted tissue in stroke
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Which investigations should be performed acutely if ischaemic stroke is suspected?
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Vitals
CT angiography ECG EKG FBC Glucose EUC LFT |
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When should an endarterectomy be performed following carotid artery stenosis causing stroke?
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For high grade stenosis (otherwise aspirin best)
Within two weeks of stroke |
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What are the symptoms of a subarachnoid haemorrhage?
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Thunderclap headache
Meningism Possible focal deficit (CN III) Features of raised ICP (sometimes) |
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Trauma is generally causes what type of intracranial haemorrhage?
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Epidural
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What are the symptoms of a subdural haematoma?
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Balance problems
Seizure Confusion Headache Nausea/Vomit Focal neuro deficit |
