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what do you see in the CSF in MS?
increased IgG, oligoclonal bands
what are two symptoms of Metachromatic Leukodystrophy?
- 1. Motor and cognitive d/f
- 2. Seizures
what causes MLD?
arylsufatase A deficiency (a lysosomal storage dz)
Symptoms of Progressive Multifocal Leukoencenphalopathy?
- limb weakness
- cortical speech problems
what causes PML?
- JC virus
Sx of Central Pontine Myelinolysis?
- pseudobulbar palsy
- spastic quadriparesis
- mental changes
- +/- locked-in syndrome
Et of CPM?
- focal demyelination
- aggressive tx of hyponatremia
- EtOHics, severely malnourished, liver dz
Sx of Guillain-Barre?
- ascending inflammatory neuropathy of PNS myelin
- autonomic d/f
- cranial nn involvement
- sensory loss or pain
- absent or decreased rflxs
Et of GBS?
- campy....2/3 of pts have respiratory or GI dz 1-3 wks bpc
- elevated CSF protein with normal cell count: albuminocytologic dissociation
the primary vesicle forebrain becomes the...
- telencephalon and
the midbrain becomes the...
the hindbrain become the...
- metencephalon and
whats in the diencephalon?
- pineal gland
whats in the metencephalon?
what protein does anterograde transport use?
- ...its fast, at 400 mm per day
what protein does retrograde tpt use?
- ...tpts lysosomes and recycled membrane
what two features are seen in stillborn infants with oligohydramnios?
- pulmonary hypoplasia
what does the adenohypophysis derive from?
Rathke's Pouch; an outgrowth of oral ectoderm
three sx of normal pressure hydrocephalus
- gait apraxia
- urinary incontinence
What is a Nissl stain/body?
RER in neuron cell bodies
What type of fibers convey proprioception?
- 1a: spindle
- 1b: Golgi tendon organ
What type of fibers convey touch?
What type of fibers convey sharp pain and cold?
What fibers convey dull pain and warmth?
What is in the intermediate zone of the spinal cord from T1 to L2?
- preganglionic sympathetic neuron cell bodies
- the Clarke nucleus: sends unconscious proprio to cerebellum
What does the corticospinal tract do?
voluntary skeletal muscle
where does the corticospinal tract originate?
in the primary motor cortex, in the precentral gyrus of the frontal lobe
Where does the corticospinal cross?
in the brain stem, at the pyramidal decussation or the caudal medulla-spinal cord junction
Where is the first synapse of the CST?
in the ventral horn at the same level
What does a lesion of the corticospinal tract above the pyrimidal decussation cause?
what does the knee stretch reflex test?
what does the ankle stretch reflex test?
what does the biceps stretch reflex test?
- musculocutaneous nerve
what does the triceps reflex test?
what is a clasp-knife reflex characteristic of?
what does the the dorsal column-medial lemniscus system do?
- sensory info for discriminative touch
- joint position
- ...from trunk and limbs
From where does the DCML system originate, and how does it get into the cord?
the cell bodies are in the DRG, then they enter the cord via class 2 or A-beta fibers
What are the two parts of the DCML?
- the fasciculus gracilis from the feet
- and the fasciculus cuneatus from the arms
What are the 3 receptor cell types of the DCML?
- pacinian corpuscle
- meissner corpuscle
- muscle spindle
Where does the DCML decussate?
it synapses in the medulla, becomes the medial lemniscus and decussates?
Where does the medial lemniscus synapse?
in the ventroposterior-lateral nucleus of the thalamus, and then on to the post-central gyrus
What do lesions of the dorsal columns cause?
- loss of:
- joint position sense
- two-point discrimination
- astereognosis: inability to identify characteristics of an object
what does the spinothalamic tract do?
pain, temperature, crude touch
What is the route of the spinothalamic tract?
receptor - DRG - tract of lissauer - synapse in dorsal horn - cross in spinal cord at the ventral commissure - synapse in the VPL -
How does a lesion of the spinothalamic tract present?
Contralateral loss of pain and temperature
What does the spinocerebellar tract do?
mostly unconscious proprioception from muscle spindles and GTOs to the cerebellum
What does the dorsal spinocerebellar tract do?
input from the lower extremities and lower trunk
what does the cuneocerebellar tract do?
proprioception from upper extremities and trunk to the cerebellumj
What is the lesion and presentation of Polio?
- deg'n of LMN of both ventral horns
- flaccid paralysis
- muscle atrophy
lesion and presentation of Tabes Dorsalis?
- dorsal columns, pretectal nucleus
- bilateral dorsal column signs
- broad gait
- pos Romberg: sways with eyes closed
- Progressive Parasthesias Pain and Polyuria (or oligouria...)
- Argyle Robinson pupils
Pres and lesion location of ALS?
- progressive atrophy of ventral horn - muscle atrophy
- primary lateral sclerosis (corticospinal tract): spastic paralysis in lower limbs
- increased tone and reflexes
- flaccid paralysis in upper limbs
Pres and lesion in Anterior Spinal Artery occlusion?
- all but the dorsal column
- bilateral signs
- mid-thoracic, weakness, absence of pain and temperature
- BUT vibration and pressure remain
What is the cause and lesion in Subacute Combined Deg'n?
- Demyelination of the dorsal columns
- spinocerebellar tracts
- corticocpinal tracts
What is the cause, lesion, and presentation of Syringomyelia?
- cavitation of the cord, usually cervical
- bilateral loss of pain and temp at the level of the lesion
- eventually, muscle weakness, then flaccid paralysis and atrophy of the upper limb muscles due to destruction of ventral horn cells