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what structures are part of the CNS?
brain and spinal cord
what structures are part of the PNS?
spinal nerves, cranial nerves, and peripheral nerves
what is the function of the frontal lobe?
movement, reasoning, and behavior
what will damage to the frontal lobe cause?
changes in mood and cognition
contralateral skeletal deficits
what is the function of the parietal lobe?
sensations
what will damage to the parietal lobe cause?
contralateral cutaneous sensation deficits
what is the function of the temporal lobe?
language, memory, and hearing
what will damage to the temporal lobe cause?
apraxia, aphasia, amnesia, and auditory
what is the function of the occipital lobe?
vision
what will damage to the occipital lobe cause?
visual disturbances (spots, deficits, etc)
where is Broca’s area located?
lower left frontal lobe
what is the function of Broca’s area?
speech production
what will damage to Broca’s area cause?
expressive aphasia
unable to create gramatically-complex sentences
slow, effortful use of nouns and verbs
what is Wernicke’s area located?
posterior left superior temporal lobe
what is the function of Wernicke’s area?
understanding of written and spoken language
what will damage to Wernicke’s area cause?
receptive aphasia
speech is effortless and fluent, but may seem nonsensical
what is the function of the hippocampus?
new memory formation
involved in mental illness
what is atrophied in Alzheimer’s dementia?
hippocampus
what is atrophied in schizophrenia and severe depression?
hippocampus
what hormone acts on the hippocampus?
estrogen
what is the function of the thalamus?
relay (integration) station for motor and sensory info
EXCEPT OLFACTION
regulation of state of consciousness, alertness
what is the function of the hypothalamus?
secretes hormones for regulation of homeostatic functions, such as thirst, urine output, temperature, and hunger
what is the most common cause of Wernicke’s encephalopathy?
thiamine (vit B1) deficiency, secondary to chronic alcohol use
what are the signs / symptoms of Wernicke’s encephalopathy?
confusion, ophthalmoplegia, and ataxia
how is Wernicke’s encephalopathy diagnosed?
clinical + thiamine (vit B1) levels
how is Wernicke’s encephalopathy treated?
replace thiamine
what are the components of the brain stem?
midbrain, pons, and medulla
what is the function of the brainstem?
relays messengers from upper and lower CNS
control centers for cardiorespiratory (vital signs) and digestive systems
regulation of muscle reflexes, equilibrium, and posture
what CNs originate in the brainstem?
CN III - XII
where is the reticular formation located?
brainstem
what is the reticular activating system (RAS)?
set of connected nuclei
what is the function of the reticular activating system (RAS)?
filters and prioritizes sensory info to…
regulate arousal
regulate transition from sleep to awake to alert
what is the function of the midbrain?
directs gaze and sound center, and refines movement
what CNs originate in the midbrain?
CN III - IV
where do most corticospinal tracts cross?
medulla oblongata
what CNs originate in the medulla oblongata?
CN IX - XII
what CNs originate in the pons?
CN V - VIII
what results from damage to the medulla oblongata?
contralateral hemiplegia
what CNs originate from the base of the forebrain?
CN I - II
what components make up the basal ganglia system?
amygdala and substantia nigra
what is the function of the amygdala?
emotion and fear
what disease is associated with the basal ganglia system?
Parkinson’s
what is the function of the basal ganglia system?
maintain muscle tone
coordinates movement
suppresses useless movements
coordinates gait and posture
what results from damage to the basal ganglia system?
changes in tone (hypertonicity)
involuntary movements
bradykinesia
changes in gait and posture
what is the function of the substantia nigra?
produces dopamine
what is the function of dopamine?
key role in “control” of movements
what is Parkinson’s disease?
degenerative CNS disorder, most common after age 50
what are the signs / symptoms of Parkinson’s disease?
SMART
shuffling gait
mask like (poker) face
akinesia
rigidity (“cog wheeling”)
tremor (“pill rolling”)
what is the function of the cerebellum?
coordinate motor activity
maintain muscle tone
maintain equilibrium
control posture
gait changes
what results from damage to the cerebellum?
intention tremors
dysmetria
dysdiadochokinesia
rigidity
impaired equilibrium
impaired posture
impaired gait
what is dysmetria?
impaired point to point coordination
what is dysdiadochokinesia?
inability to perform rapid alternating movements
what is white matter?
myelinated axons
what is gray matter?
nerve cell bodies
what is the spinal cord?
mass of nervous tissue within the vertebral column composed of white and gray matter
what is the function of the anterior (ventral) horn?
motor
what is the function of the posterior (dorsal) horn?
sensory
what is the function of the spinal cord?
mediates deep tendon reflexes (DTRs)
is the descending pathway motor or sensory?
motor
is the ascending pathway motor or sensory?
sensory
what makes up the descending motor pathway?
pyramidal pathway
corticospinal pathway
corticobulbar pathway
extrapyramidal pathway
what structure do the pyramidal pathways pass through?
medulla
what makes up the ascending sensory pathway?
spinothalamic pathway
posterior columns
what is the function of the corticobulbar pathways?
innervate several CNs
what is the function of the corticospinal pathways?
mediates voluntary movement and integrates skilled movements
where do the corticobulbar and corticospinal pathways originate?
motor cortex
where does the corticobulbar pathway descend?
brainstem, terminating on CN nuclei
where does the corticospinal pathway descend?
medulla, then crosses to terminate on anterior horn cells
what results from destruction to the corticospinal tract?
reduction or loss of function below the injury
where is motor impairment seen with corticospinal damage above the crossover?
opposite side (contralateral)
where is motor impairment seen with corticospinal damage below the crossover?
same side (ipsilateral)
what is the function of the extrapyramidal system?
modules / regulates movement
what are the major components of the extrapyramidal system?
basal ganglia
brainstem (MPM)
cerebellum
where are upper motor neurons found?
CNS, motor cortex to spinal cord
where are lower motor neurons found?
PNS, spinal cord to muscle / gland
what results from damage to the upper motor neurons?
lose ability to send regulated messages to muscles
what results from damage to the lower motor neurons?
directly lose innervation
what can cause upper motor neuron dysfunction?
CVA, tumors
what can cause lower motor neuron dysfunction?
herniated discs
what symptoms are associated with upper motor neuron dysfunction?
spasticity
hypertonic
hyper-reflexia (++ DTRs)
pathologic reflexes
disuse atrophy (LATER)
what symptoms are associated with lower motor neuron dysfunction?
ipsilateral weakness
flaccidity
fasciculations
hypotonic
hypo-reflexia (—DTRs)
NO pathologic reflexes
early denervation atrophy
what can cause extrapyramidal dysfunction?
Parkinson’s
what symptoms are associated with extrapyramidal tract dysfunction?
no paralysis
resting tremor
hypertonic (RIGIDITY)
normal to decreased
NO pathologic reflexes
normal strength
what is the function of the sensory pathways?
relay information from skin, tendons, muscles, and viscera regarding pain, temperature, crude touch, vibration, and position
what is the pathway that sensory information takes to be processed?
receptors —> posterior horn —> thalamus —> parietal lobe
what senses are carried by the spinothalamic tracts?
crude touch, pain, and temperature
what senses are carried by the posterior columns?
fine touch, vibration, and position
what are sensory dermatomes?
a band of skin innervated by the sensory root of a single spinal nerve
where does C2-3 innervate?
posterior head / neck
where does C6 innervate?
thumb
where does C7 innervate?
middle finger
where does C8 innervate?
little finger
where does T1 innervate?
inner forearm
where does T2 innervate?
upper inner arm
where does T4 innervate?
nipple
where does T10 innervate?
umbilicus
where does L1 innervate?
groin
where does L3 innervate?
knee
where does L4 innervate?
medial malleolus
where does L5 innervate?
toes 1-3, dorsum of foot
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