Neuro Exam 3.4

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brau2308
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Neuro Exam 3.4
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2013-03-27 10:41:10
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neurology
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review of neuro lecture 4 for exam 3
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  1. Reticular formation
    diffuse nuclei of tegmentum of brainstem; primary integrating area of brainstem relating to consciousness
  2. Tegmentum
    elongated gray mass that extends b/w medulla and midbrain
  3. What is the primary global integration area of the brainstem?
    tegmentum
  4. What are the 3 zones/columns reticular formation?
    • Median
    • Medial
    • Lateral
  5. Which zone/column of the reticular formation is closest to midline?
    median
  6. Which zone/column of the reticular formation is the middle part?
    medial
  7. What is the median zone/column of the reticular formation responsible for?
    • pain modulation
    • inhibition of pain perception
  8. What structure is found in the median zone/column of the reticular formation?
    raphe nuclei
  9. What is the median zone/column of reticular formation's primary neurotransmitter?
    serotonin
  10. Where does the median zone/column of the reticular formation project to?
    spinal cord
  11. Why does the median zone/column of the reticular formation project to the spinal cord?
    to modulate pain transmission to conscious centers
  12. Is the median zone/column of the reticular formation important in ARAS?
    no
  13. Where is the medial zone/column of the reticular formation found?
    primarily in medulla and pons
  14. What is the function of the medial zone/column of the reticular formation?
    makes sense of input
  15. What is the function of the efferent component of the medial zone/column of the reticular formation?
    • influence basic activities of body:
    • sleep cycle
    • drowsiness
    • alertness
    • awareness
  16. What is contained in the medial zone/column of the reticular formation?
    nuclei
  17. Where can nuclei of the medial zone/column of the reticular formation project to?
    • hypothalamus
    • thalamus
    • spinal cord
    • other tegmental nuclei
    • cranial nerve nuclei
  18. Which tracts terminate with LMN of the medial zone/column of the reticular formation?
    rubrospinal and reticulospinal tracts
  19. What does the medial zone/column of the reticular formation add to ARAS?
    efferent component
  20. What does the lateral zone/column of the reticular formation add to ARAS?
    primary afferent component
  21. What is the function of the lateral zone/column of the reticular formation?
    recieves input from collaterals, neurons associated w/ major ascending pathways
  22. Is the lateral zone/column of the reticular formation an important part of ARAS?
    yes
  23. What does ARAS stand for?
    ascending reticular activating system
  24. What does ARAS control?
    various states of arousal
  25. What is ARAS?
    functional system of reticular formation
  26. What makes ARAS?
    medial and lateral zones/columns
  27. Where does ARAS recieve input from?
    • cranial nerves and CNS
    • ascending sensory systems from spinal nn
    • cerebral areas of cortex
    • cerebellum
  28. What are the functions of ARAS?
    • if ARAS is not working right, then cortex is not getting information:
    • sleep cycle
    • drowsiness
    • awareness
    • alertness
  29. What is the clinical significance of ARAS?
    anesthesia acts by hyperpolarizing neurons in ARAS to decrease output, thus deactivating nuclei in reticular formation by competing for binding sites
  30. What makes up the afferent input of ARAS?
    lateral column of reticular formation
  31. What makes up the efferent component of ARAS?
    medial column
  32. What are the outcomes of ARAS?
    • sleep cycle
    • drowsiness
    • alertness
    • awareness
  33. What is a conscious experience?
    you are aware of feelings, ideas, dreams, and thoughts
  34. What are the states of consciousness?
    • normal consciousness
    • lethargy
    • stupor
    • coma
  35. What level is normal consciousness?
    level 1
  36. What is speech like at the normal consciousness state?
    spontaneous (voluntary) speech at a normal rate
  37. What is motor activity like at the normal consciousness state?
    normal voluntary and reflex somatic motor activity
  38. What are the eyes like in the normal consciousness state?
    open, normal oculomotor activity
  39. What levels is lethargy?
    • level 2
    • level 3
  40. What is speech like in level 2 lethargy?
    spontaneous sentences, spoken slowly
  41. What is motor activity like at level 2 lethargy state?
    decreased speed of voluntary motor activity
  42. What are the eyes like in level 2 lethargy state?
    open, decreased oculomotor activity
  43. What is speech like in level 3 lethargy?
    spontaneous words, spoken infrequently
  44. What is motor activity like at level 3 lethargy?
    decreased speed and coordination of voluntary motor activity
  45. What are the eyes like in level 3 lethargy?
    open or closed; decreased oculomotor activity
  46. What are the levels of the stupor state of consciousness?
    Levels 4-6
  47. What is speech like in level 4 stupor?
    vocalization only to stimuli that cause pain
  48. What is motor activity like at level 4 stupor?
    marked decrease in spontaneous motor activity
  49. What are the eyes like in level 4 stupor?
    generally closed, some spontaneous eye movement
  50. What is speech like in level 5 stupor?
    no vocalization
  51. What is motor activity like in level 5 stupor?
    appropriate defensive movements (generally flexor) to movements that cause pain
  52. What are the eyes like in level 5 stupor?
    generally closed
  53. What is speech like in level 6 stupor?
    no vocalization
  54. What is motor activity like in level 6 stupor?
    mass movements to stimuli that cause pain
  55. What are the eyes like in level 6 stupor?
    closed, decreased spontaneous conjugate eye movement
  56. What level is the coma state of consciousness?
    level 7
  57. What is speech like in coma?
    no vocalization
  58. What is motor activity like in coma?
    decrebrate posturing to stimuli that causes pain, or no response
  59. Decerebrate posturing:
    postural change that occurs in some comatose pts consisting of episodes of axial rigidity, rigid extension of limbs, internal rotation of UEs, and marked PF of feet
  60. What are the eyes like in coma?
    eyes closed, absent spontaneous eye movements
  61. What scale is used to grade comas?
    Glasgow Coma Scale
  62. What is a coma?
    extensive damage to cerebral cortex; general sensations do not get there
  63. In addition to damage of the cerebral cortex, where else may damage occur from a coma?
    reticular formation of midbrain and upper pons, and thalamus
  64. What part of the reticular formation is damaged during coma?
    nuclei of reticular formation, not ascending pathway
  65. What happens to information in the reticular formation during coma?
    info goes up to the thalamus, but collaterals are not synapsing w/ nuclei of reticular formation, so there is no info in the brainstem
  66. What is a toxic coma?
    caused by medications, drugs
  67. Can liver failure cause coma?
    yes, build up of high levels of toxins which are toxic to neurons.  Renal failure can do the same thing
  68. What is the range of the Glasgo coma score?
    3-15
  69. What does the Glasgow coma score mean?
    high is good; low is bad
  70. What is the criteria for the Glasgow coma score?
    • best eye movement (4 pts)
    • best verbal response (5 pts)
    • best motor response (6 pts)
  71. What are the cardinal signs for cerebral death?
    • coma
    • absence of brain stem reflexes
    • apena
  72. What is the prerequisite to cerebral death?
    all appropriate diagnostic and therapeutic procedures have been performed
  73. What is the criteria to be present (from cerebral death) for 30 minutes at least 6 hours after the onset of coma and apnea?
    • coma with cerebral unresponsivity
    • absence of brain stem reflexes
    • apenea
    • cephalic reflexes
    • EEG silence
  74. Cerebral unresponsivity:
    state in which pt doesn't respond purposefully to externally applied stimuli, obeys no commands, and does not utter sounds spontaneously or in response to a painful stimulus
  75. Apnea:
    absence of spontaneous respiration, manifested by need for controlled ventilation for at least 15 minutes
  76. Cephalic reflexes:
    papillary, corneal, oculoauditory, oculovestibular, oculocephalic, ciliospinal, snout, pharyngeal, cough, and swallowing
  77. EEG silence:
    EEG w/ absence of electrical potentials of cerebral origin
  78. What are the different waking states?
    • alert wakefulness
    • relaxed wakefulness
    • relaxed drowsiness
  79. What is the alert wakefulness of the waking state?
    • awake, alert, eyes open
    • Beta rhythm >13 Hz/sec
  80. What is the relaxed wakefulness of the waking state?
    • awake, relaxed (not alert), and eyes open
    • Alpha rhythm, 8-13 Hz/sec
  81. What is the relaxed drowsiness of the waking state?
    • fatigued, tired, eyelids may narrow/close, head may droop, lapses of alertness and attention, and still awake but not asleep
    • decrease in alpha wave amplitude and some decrease in frequency--closer to the 8 Hz
  82. Is sleep a part of ARAS?
    yes
  83. Sleep is a form of:
    attentiveness
  84. What is sleep?
    altered state of consciousness: the brain is still aware of the environment and still receives input and is very active processing sensory info
  85. What is the Sleep-Wake cycle?
    natural endogenous cycle/rhythm of the body
  86. Cyclic:
    the natural physiologic processes (HR, BP) that vary throughout the day
  87. Sleep-Wake cycle tunes your body to:
    day and night (circadian cycle)
  88. What are the parts of the circadian cycle?
    • suprachiasmatic nucleus
    • sleep center
  89. What does the suprachiasmatic nucleus contain?
    retinal cells sensitive to light
  90. Where is the suprachiasmatic nucleus located?
    hypothalamus, above optic chiasm
  91. What does the suprachiasmatic nucleus do?
    maintain circadian rhythm and biological clock
  92. What does the primary biological clock allow?
    the body to stay w/in cycle
  93. What is sleep influenced by?
    suprachiasmaatic nucleus (it is not dependent upon it)
  94. Where is the sleep center located?
    w/in reticular formation of pons
  95. Is the sleep center excitatory or inhibitory in nature?
    inhibitory, puts us in a sleep state
  96. What does the sleep center interact with?
    ARAS (excitatory) as a feedback loop
  97. What does the sleep center involve?
    a slow accumulation and dissipation of transmitter substances (NT/NM)
  98. Why is sleep an active process?
    sleep is not the absence of wakefulness; the brain is not inactive
  99. What happens during sleep?
    • there is not an overall massive inhibition of neuronal activity
    • neurons continue to fire and some areas of the brain are more active than others
    • blood flow and oxygen demand do not decrease
  100. What is the purpose of sleep?
    • 'catch-up time'
    • important in long-term chemical and structural change that brain must undergo to make learning and memory possible
    • purposes of adaptations of organisms
  101. What does it mean that sleep is "catch-up time"?
    represents a period of rest for specific elements, during which time they can replenish substrates important for generation of AP (upregulation and downregulation of genes)
  102. What is an example of the purposes of adaption of organisms that occur during sleep?
    animals are asleep in burrows, nothing will eat you
  103. What are the different EEG frequencies (rhythms)?
    • beta
    • alpha
    • theta
    • delta
  104. What is the range for beta EEG rhythms?
    13 Hz and up
  105. What is the range for alpha EEG rhythms?
    13-8 Hz
  106. What is the range for theta EEG rhythms?
    8-4 Hz
  107. What is the range for delta EEG rhythms?
    2 Hz
  108. Does slow wave sleep involve REM sleep?
    no, non-REM sleep
  109. How does one enter slow wave sleep?
    from one of the stages of wakefulness
  110. What are the characteristics of slow wave sleep?
    • no complex dreams
    • primarily used for rest
    • muscle tension is reduced but not eliminated
    • movement minimal but possible
  111. How many stages are there in slow wave sleep?
    4
  112. How long does it take to go through all 4 stages of the slow wave sleep?
    30-40 minutes
  113. What are the characteristics of the stages of slow wave sleep?
    each stage is repeatable and has an EEG pattern characterized by slower frequency and higher amplitude than previous stage
  114. Describe stage I of slow wave sleep:
    • light sleep, easily aroused by moderate stimuli
    • alpha-rhythm reduced to partial theta rhythm (4-8 Hz/sec)
  115. Describe stage II of slow wave sleep:
    • further lack of sensitivity to activation and arousal
    • primarily theta-rhythm (4-8 Hz/sec)
  116. Describe stage III of slow wave sleep:
    • deep sleep, activation and arousal requires vigorous stimulation
    • theta wave (4-8 Hz) activity, as well as delta wave (about 2 Hz/sec)
  117. Describe stage IV of slow wave sleep:
    • true/deep sleep; arousal requires vigorous stimulation
    • predominantly delta rhythm (2 Hz)
  118. When does REM sleep occur?
    after one cycle of slow wave sleep, but can occur at every stage of sleep
  119. What is eye activity like during REM sleep?
    burst eye movement activity superimposed over slow, rolling eye movement
  120. How often does REM sleep occur?
    every 90 minutes and last about 20 minutes (at 13+Hz/sec)
  121. Why is REM sleep a paradox?
    because EEG resembles that of a person who is awake, and oxygen use is higher than when you are awake
  122. Why is REM sleep a deeper state of sleep?
    • based on criteria for external arousability
    • --takes immense external stimuli to wake up; noise/movement
  123. What is the lightest state of REM sleep based on?
    • criteria for internal arousability
    • --little internal stimuli required to wake up; dream/heartburn/full bladder, etc
  124. What happens to muscles during REM sleep?
    profound loss of muscle tone (hypotonia/flaccidity/paralysis) throughout the body
  125. Which muscles do not have hypotonia during REM sleep?
    • mm of respiration
    • mm of eye movement
    • mm of inner ear (stapedius mm)
  126. What is the function of the stapedius mm?
    modulate sound--modulates eardrum (dampens activity of sound transmission)
  127. When do dreams occur?
    only in REM sleep
  128. When are penile and clitoral erection common during sleep?
    REM
  129. What are some problems of sleep?
    • nightmares
    • narcolepsy
    • REM sleep behavior disorder
    • sleepwalking
    • night terrors
    • bed wetting
    • snoring
    • insomnia
    • pathological conditions which interrupt ARAS
    • bruxism
    • obstructive sleep apnea
    • sleep deprivation
  130. narcolepsy:
    manifest REM; unintentional sleep episode w/ REM (amphetamines)
  131. REM sleep behavior disorder:
    excessive, vivid dreams w/ movement
  132. Sleepwalking:
    usually occurs during stage IV of non-REM sleep; body wakes up before mind does; not usually during REM sleep
  133. Night terrors:
    wake up screaming (Stage IV)
  134. Bed wetting:
    may occur at any stage; becomes a problem if continues after age 16
  135. Snoring:
    any stage; generally occurs w/ obesity b/c oropharynx has lost space
  136. Insomnia:
    defect of ARAS; often age-related
  137. Obstructive sleep apnea:
    • blockage of airway; common in obese
    • stop breathing for 20-30 seconds, and then take a deep breath
    • can't die b/c respiratory reflex will take over
    • really never reach stage IV, so people are always tired
  138. Sleep deprivation:
    intentional absence of sleep

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