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r‘ NEUROANATOMY

r‘ METC

r‘ Major landmarks, first orientation

r‘ Major landmarks: The four lobes

r‘ îrimary Areas

r‘ ivisions of îrimary Motor and Somatic Areas

r‘ î rieto-occipit l sulcus

a‘ Separates parietal from occipital lobe

* Calcarine sulcus- surounded by visual receptive area

r‘ ½lood supply

r‘   OF W  

r‘ ormed by two internal carotid arteries and 2 vertebral arteries at the base of the brain

r‘ unctions of the Cortex

 u e

1- Broc s Are

ʹ an area of the frontal lobe, usually in the left hemisphere, that directs the muscle movements involved
in speech

2- Werickes Are

ʹ a brain area involved in language comprehension and expression; usually in the left temporal lobe.

r‘ Specialization and Integration in Language

1- Visual cortex ʹ receives written words as visual stimulation.

2- Angular gyrus ʹ transforms visual representations into an auditory code.

3- Werickes re ʹ interprets auditory code.

4- Broc s re ʹ controls speech muscles via the motor cortex.

5- Motor cortex ʹ word is pronounced.

r‘ Lateralization
eft Hemisphere

Verb l competece

pe ki re i thiki & re soi

îrocesses ifo i sequece

Oe piece of  t t time

loic l

iht Hemisphere

Noerb l re s

omprehesio sp ti l rel tioships r i music emotio

îrocesses ifo. As hole

ituitie

r‘ Emotion and Lateralization

eft Hemisphere

r‘ mport t for the expressio of positie emotio

r‘  m e to the .H. le s to loss of the c p city of joy.

r‘ Acti tio i the .H. le s to teecies to ppro ch other people.

iht Hemisphere

r‘ mport t for the expressio of e tie emotio

r‘  m e to the .H. m y m ke people euphoric.

r‘ Acti tio i the .H. le s to teecies to ithr  from people.

r‘ The Homunculus

r‘ erebr l ortex:
Outer l yer of euros (1mm thick)

r‘ The Hind ½rain (Rhombencephalon)

r‘ Meull ʹ breathing, heart rate

r‘ îos ʹ sleeping, walking, dreaming


r‘ Reticular activating system (RAS)

r‘ rom stem reticular fibers

r‘ Modulates consciousness

r‘ istributes neuromodulators

ʹ alertness, attention

r‘ erebellum ʹ balance, coordination for the muscles

r‘ Mibr i / Meseceph lo

r‘ Extends fr pons to the diencephalon

r‘ The cerebral aqueduct is its cavity & connects the 3rd & 4th ventricles

r‘ Roof of midbrain called ͞tectum͟ & lies posterior to the cerebral aqueduct

r‘ Made up of 4 rounded bodies known as Corpora quadrigemina

r‘ The paired upper bodies serve as visual reflex centers for head & eyeball movements

r‘ The lower bodies are auditory relay centers

r‘ Æhe Forebr i ( îroseceph lo)

Æhe Hypoth l mus

a‘ ound inferior to the thalamus, forms the floor & part of the lateral walls of 3rd ventricle

a‘ Optic chiasm marks the crossing of the optic nerves

a‘ Infundibulum connects the pit. gld to the hypothalamus

a‘ Contains centers for body temp control, appetite & satiety, & water balance; regulates pituitary
gld & links nervous & endocrine systems; helps control autonomic system;

a‘ It is involved with drives associated with survival such as hunger, thirst, emotion, sex, and
reproduction

r‘ erebellum

r‘ behind the dorsal aspect of the pons and the medulla.

r‘ A midline portion, the ermis separates two lateral lobes, or cerebellar hemispheres.

r‘ consists of the J   J ‘& underlying J   


   
r‘ D eep cerebell r uclei are located within the white matter of the cerebellum

½ecause of the location of the fourth ventricle, ventral to the cerebellum, à ‘‘‘ ‘
‘ ‘
Ñ ‘ ‘  ‘   

r‘ Cerebellum

A.‘ î leocerebellum- consists of anterior lobe; controls gross movement of head & body

½.‘ Nepcerebellum- middle lobe; fine voluntary movements

C.‘ Archicerebellum- flocullonodular lobe; vestibular system

r‘ Cerebellar functions (C½î)

1.‘ coordinating skilled voluntary movements by influencing muscle activity,

2.‘ controlling equilibrium and muscle tone through connections with the vestibular system
and the spinal cord and its gamma motor neurons.

3.‘ There is a somatotopic organization of body parts within the cerebellar cortex.

4.‘ Ô‘  ‘ ‘ Ñ ‘   ‘ ‘


Ñ ‘‘ ‘  ‘‘
 Ã.

r‘  m e to the cerebellum

r‘ Causes a lack of co-ordination:

1.‘ Speaking

2.‘ Walking

3.‘ Tremour

r‘ amage can result in ataxic or uncoordinated movement because of errors in the direction,
range, & rate of movement

r‘ Characteristic ͞drunken͟ or staggering gait

r‘ Speech slurred & there͛s dysmetria (overshooting)

r‘ Clinical dxtic test; ask pt to place a finger on his / her own nose.

r‘ (+) will miss mark & may miss several times before finding the target

r‘ erebell r troke

r‘ izziness, vomiting
r‘ Unsteady so that walking is impossible

r‘ îower, tone and reflexes normal

r‘ Area of blood in the cerebellum would show on a CT scan

r‘ Æhe Nerous ystem

1.‘ The spinal cord communicates with the sense organs and muscles below the level of the
head

r‘ Bell-M eie  - entering dorsal roots carry sensory information and the
exiting ventral roots carry motor information to the muscles and glands

r‘ ors l oot G li - clusters of neurons outside the spinal cord

r‘ Æhe pi l
or pi l Neres
 pi l eflexes

r‘ pi l or

r‘ Extends from foramen magnum to second lumbar vertebra

r‘ Segmented

1.‘ Cervical

2.‘ Thoracic

3.‘ Lumbar

4.‘ Sacral

r‘ Vives rise to 31 pairs of spinal nerves

r‘ Not uniform in diameter throughout length

r‘ ½lood Supply

r‘ Two posterior spinal arteries- supply the posterior 1/3 of the SC

r‘ Anterior spinal artery- anterior 2/3 of SC

r‘ Segmental arteries

r‘ eeder arteries

r‘ F
m‘ Shock absorbing fluid that fills ventricles, cavities within the brain & subarachnoid spaces
around the brain & SC

m‘ Most produced by cluster of capillaries known as CHOROI plexuses (projects fr pia matter into
ventricles)

r‘ Cross Section of Spinal Cord

r‘ Cross Section of Spinal Cord

r‘ White m tter:

r‘ Myelinated axons forming nerve tracts

r‘ issure and sulcus

r‘ Three columns:

r‘ Ventral

r‘ orsal

r‘ Lateral

r‘ Gr y m tter:

r‘ Neuron cell cell bodies, dendrites, axons

r‘ Horns͛:

r‘ îosterior (dorsal)

r‘ Anterior (ventral)

r‘ Lateral

r‘ Commissures:

r‘ Vray: Central canal

r‘ White

r‘ Gr y M tter: Or iz tio

r‘ ors l h lf ʹ sensory roots and ganglia

r‘ Vetr l h lf ʹ motor roots

r‘ orsal and ventral roots fuse laterally to form spinal nerves


r‘ our zones are evident within the gray matter ʹ somatic sensory (SS), visceral sensory (VS),
visceral motor (VM), and somatic motor (SM)

r‘ White M tter i the pi l or

r‘ ibers run in three directions ʹ ascending, descending, and transversely

r‘ ivided into three funiculi (columns) º‘ ‘  ‘ ‘  

r‘ Each funiculus contains several fiber tracts

r‘ iber tract names reveal their origin and destination

r‘ iber tracts are composed of axons with similar functions

r‘ White Matter in the Spinal Cord

r‘ îathways decussate (cross-over)

r‘ Most consist of two or three neurons

r‘ Most exhibit ñ   (precise spatial relationships)

r‘ îathways are paired (one on each side of the spinal cord or brain)

r‘ 
  
    ñ

r‘ pi l Neres

r‘ 31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal

- each peripheral nerve has 3 layers of CT

r‘ Epineurium ʹ outer tough fibrous sheath

- dense irregular CT, 1° of collagen fibers and fibrocytes

- forms the blood-nerve barrier

r‘ îerineurium ʹ composed of collagenous fibers, elastic fibers, and fibrocytes

- divides the nerve into fascicles (bundle of axons)

r‘ Endoneurium ʹ loose irregular CT

- capillaries from the perineurium provide oxygen and nutrients ot the axons and Schwann cells
of the nerve

A tomy of îeripher l Nere


r‘ îeripher l istributio of pi l Neres

r‘ Each spinal nerve forms through fusion of dorsal and ventral nerve roots

r‘ istally all spinal nerves form 2 branches

- a dorsal ramus and a ventral ramus

r‘ Spinal nerves T1 to L2 contain 4 branches

- a dorsal ramus and a ventral ramus

- a white ramus and a gray ramus known as rami communicantes (communicating branches͛)

r‘  mi ommuic tes

r‘ Carry visceral motor fibers to and from a nearby autonomic ganglion associated with the
sympathetic division of the ANS

r‘ White r mus ʹ carries fibers to the ganglion

- contains preganglionic myelinated axons

r‘ Gr y r mus ʹ innervate glands and smooth muscles

- 2 groups of unmyelinated postganglionic fibers that leave the ganglion

r‘ ors l  Vetr l  mi

r‘ ors l r mus provides sensory innervation from, and motor innervation to, a specific segment
of the skin and muscles of the neck and back

r‘ Vetr l r mus supplies the ventrolateral body surface, structures in the body wall, and the limbs

r‘ istribution of sensory fibers within these rami illustrates the segmental division of labor

- each pair of spinal nerves monitors a specific region of the body surface known as a
dermatome

îeripheral istribution of Spinal Nerves (Motor ibers)

îeripher l istributio of pi l Neres (esory Fibers)

r‘ erm tom l M p

r‘ Skin area supplied with sensory innervation by spinal nerves


r‘ ermatomes

r‘ Area of skin innervated by the cutaneous branches of a single spinal nerve.

r‘ All segments except C1 have dermotomal distribution

r‘ j typically from 

r‘  typically from ë

r‘ Clinically important -damage to a spinal nerve or dorsal root ganglion produces a loss of
sensation

r‘ esory Nere Ær cts

r‘ Transmit action potentials from periphery to brain

r‘ Each pathway involved with specific modalities

r‘ 1st half of word indicates origin,

r‘ 2nd half indicates termination

r‘ î i

r‘ Types

r‘ eferre: Sensation in one region of body that is not source of stimulus

r‘ îh tom: Occurs in people who have appendage amputated or structure removed as


tooth

r‘ hroic: Not a response to immediate direct tissue injury

r‘ îeripheral Nervous System (îNS)

r‘ All nerves that leave the CNS

r‘ Two Modalities:

r‘ îeripheral Nervous System

r‘ esory Neres

(to the br i)

Carry messages from special reporters in the skin, muscles, and other internal and external sense organs
to the spinal cord and then to the brain
r‘ Motor Neres

(from the br i)

Carry orders from CNS to muscles, glands to contract and produce chemical messengers

r‘ îeripheral Nervous System

r‘ om tic N

Consists of nerves connected to sensory receptors and skeletal muscles

îermits voluntary action (writing your name)

r‘ Autoomic N

îermits the involuntary functioning of blood vessels, glands, and internal organs such as the bladder,
stomach and heart

r‘ Summary of unction of Cranial Nerves

r‘ r i l Nere : Olf ctory

r‘ Arises from the olfactory epithelium

r‘ îasses through the cribriform plate of the ethmoid bone

r‘ ibers run through the olfactory bulb and terminate in the primary olfactory cortex

r‘ unctions solely by carrying afferent impulses for the sense of smell

r‘ r i l Nere : Olf ctory

r‘ Cranial Nerve II: Optic

r‘ Arises from the retina of the eye

r‘ Optic nerves pass through the optic canals and converge at the optic chiasm

r‘ They continue to the thalamus where they synapse

r‘ rom there, the optic radiation fibers run to the visual cortex

r‘ unctions solely by carrying afferent impulses for vision

r‘ r i l Nere : Optic

r‘ Cranial Nerve III: Oculomotor


r‘ ibers extend from the ventral midbrain, pass through the superior orbital fissure, and go to the
extrinsic eye muscles

r‘ unctions in raising the eyelid, directing the eyeball, constricting the iris, and controlling lens
shape

r‘ The latter 2 functions are parasympathetically controlled

r‘ îarasympathetic cell bodies are in the ciliary ganglia

r‘ r i l Nere : Oculomotor

r‘ Cranial Nerve IV: Trochlear

r‘ ibers emerge from the dorsal midbrain and enter the orbits via the superior orbital fissures;
innervate the superior oblique muscle

r‘ îrimarily a motor nerve that directs the eyeball

r‘ r i l Nere V: Ærochle r

r‘ Cranial Nerve V: Trigeminal

r‘ Composed of three divisions

r‘ Ophthalmic (V1)

r‘ Maxillary (V2)

r‘ Mandibular (V3)

r‘ ibers run from the face to the pons via the superior orbital fissure (V1), the foramen rotundum
(V2), and the foramen ovale (V3)

r‘ Conveys sensory impulses from various areas of the face (V1) and (V2), and supplies motor fibers
(V3) for mastication

r‘ ‘ J or triemi l eur li

- Most excruciating pain known (?)

- Caused by inflammation of nerve

- In severe cases, nerve is cut; relieves agony but results in loss of sensation on that side of the
face

r‘ r i l Nere V: Æriemi l

r‘ r i l Nere V : Abuces
r‘ ibers leave the inferior pons and enter the orbit via the superior orbital fissure

r‘ îrimarily a motor nerve innervating the lateral rectus muscle (abducts the eye; thus the name
 

r‘ r i l Nere V : F ci l

r‘ ibers leave the pons, travel through the internal acoustic meatus, and emerge through the
stylomastoid foramen to the lateral aspect of the face

r‘ Motor functions include;

r‘ acial expression

r‘ Transmittal of parasympathetic impulses to lacrimal and salivary glands (submandibular


and sublingual glands)

r‘ Sensory function is taste from taste buds of anterior two-thirds of the tongue

r‘ r i l Nere V : F ci l

r‘ acial Nerve (CN VII)

w‘ ‘½ ñ ñ: paralysis of facial muscles on affected side and loss of taste sensation

w‘ Caused by herpes simplex I virus

w‘ Lower eyelid droops

w‘ Corner of mouth sags

w‘ Tears drip continuously and eye cannot be completely closed (dry eye may occur)

w‘ Condition my disappear spontaneously without treatment

r‘ r i l Nere V : Vestibulocochle r

r‘ ibers arise from the hearing and equilibrium apparatus of the inner ear, pass through the
internal acoustic meatus, and enter the brainstem at the pons-medulla border

r‘ Two divisions ʹ cochlear (hearing) and vestibular (balance)

r‘ unctions are solely sensory ʹ equilibrium and hearing

r‘ r i l Nere V : Vestibulocochle r

r‘ r i l Nere : Glossoph rye l

r‘ ibers emerge from the medulla, leave the skull via the jugular foramen, and run to the throat
r‘ Nerve IX is a mixed nerve with motor and sensory functions

r‘ Motor ʹ innervates part of the tongue and pharynx, and provides motor fibers to the parotid
salivary gland

r‘ Sensory ʹ fibers conduct taste and general sensory impulses from the tongue and pharynx

r‘ r i l Nere : Glossoph rye l

r‘ r i l Nere : V us

r‘ 
J   
  ñ 

 J

r‘ ibers emerge from the medulla via the jugular foramen

r‘ The vagus is a mixed nerve

r‘ Most motor fibers are parasympathetic fibers to the heart, lungs, and visceral organs

r‘ Its sensory function is in taste

r‘ îaralysis leads to hoarseness

r‘ Total destruction incompatible with life

r‘ r i l Nere :
V us

r‘ r i l Nere  : Accessory

r‘ ormed from a cranial root emerging from the medulla and a spinal root arising from the
superior region of the spinal cord

r‘ The spinal root passes upward into the cranium via the foramen magnum

r‘ The accessory nerve leaves the cranium via the jugular foramen

r‘ îrimarily a motor nerve

r‘ Supplies fibers to the larynx, pharynx, and soft palate

r‘ Innervates the trapezius and sternocleidomastoid, which move the head and neck

r‘ r i l Nere  : Accessory

r‘ Cranial Nerve XII: Hypoglossal

r‘ ibers arise from the medulla and exit the skull via the hypoglossal canal
r‘ Innervates both extrinsic and intrinsic muscles of the tongue, which contribute to swallowing
and speech

r‘ If damaged, difficulties in speech and swallowing; inability to protrude tongue

r‘ r i l Nere  : Hypoloss l

r‘ îeripher l istributio of pi l Neres

r‘ Each spinal nerve connects to the spinal cord via two medial roots

r‘ Each root forms a series of rootlets that attach to the spinal cord

r‘  ñ ñ  
  
 and contain motor (efferent) fibers

r‘ ññ ñ  ñ ñ ñ 


ñ  and contain sensory
(afferent) fibers

r‘ pi l Neres:  mi

r‘ The short spinal nerves branch into three or four mixed, distal rami

r‘ Small dorsal ramus ʹ to back

r‘ Larger ventral ramus ʹ to plexuses/intercostals

r‘ Tiny meningeal branch ʹ to meninges

r‘ Rami communicantes at the base of the ventral rami in the thoracic region ʹ to/from
ANS

r‘ pi l Nere er tio:


B ck Aterol ter l Æhor x  Abomi l W ll

r‘ The back is innervated by ñ via several branches

r‘ The thorax is innervated by ventral rami T1-T12 as  Jñ  ñ

r‘ Intercostal nerves supply muscles of the ribs, anterolateral thorax, and abdominal wall

r‘ Nere îlexus

r‘ Complex interwoven network of nerves

r‘ Occurs in segments that control skeletal musculature of the neck and limbs

- peripheral distribution of the ventral rami do not directly proceed to their peripheral targets

r‘ Ventral rami of adjacent spinal nerves blend their fibers to produce compound nerve trunks
- formed during development when small skeletal muscles fuse to form larger muscles with
compound origins

- compound muscles contain sensory and motor fibers

- ventral rami converge and branch to form compound nerves

D M jor Nere îlexuses

r‘ eric l plexus

r‘ Br chi l plexus

r‘ umb r plexus

r‘  cr l plexus

r‘ eric l îlexus

r‘ Consists of cutaneous and muscular branches in the ventral rami of spinal nerves C1-C4, some
C5

r‘ The cutaneous branches innervate areas on the head, neck, and chest

r‘ The muscular branches innervate muscles of the neck and shoulder

r‘ Major nerve of this plexus the phrenic nerve provides the entire nerve supply to the diaphragm

eric l îlexus

r‘ Br chi l îlexus

r‘ ormed by -   Æ1 (C4 and T2 may also contribute to this plexus)

r‘ It gives rise to the nerves that innervate the   

r‘ Æruks  ors of Br chi l îlexus

w‘ Nerves that form brachial plexus originate from:

‘ superior, middle, and inferior trunks

‘ large bundles of axons from several spinal nerves

‘ lateral, medial, and posterior cords

‘ smaller branches that originate at trunks

r‘ Br chi l îlexus: Neres


r‘ ¯ ʹ innervates the deltoid and teres minor

r‘ ñJJ ñ ʹ sends fibers to the biceps brachii and brachialis

r‘    ʹ branches to most of the flexor muscles of forearm

r‘ j ʹ supplies the flexor carpi ulnaris and part of the flexor digitorum profundus

r‘  ʹ innervates essentially all extensor muscles

Æhe Æruks  ors of the Br chi l îlexus

r‘ Br chi l îlexus Or iz tio

r‘ Flo ch rt summ rizi rel tioships ithi the br chi l plexus -  she lies to the posterior
cor merely iic te th t the posterior iisio lie posterior to the terior iisios

r‘ umb r îlexus

r‘ Arises from (T12) 1-D and innervates the thigh, abdominal wall, and psoas muscle

r‘ The major nerves are the   and the 

r‘  cr l îlexus

r‘ Arises from D-D and serves the buttock, lower limb, pelvic structures, and the perineum

r‘ The major nerve is the ñJ  J, the longest and thickest nerve of the body

r‘ The sciatic is actually composed of two nerves: the   and the J   (peroneal)
nerves

r‘ Nerve plexuses - Summary

r‘ eric l ʹ C1-C4

r‘ îhrenic nerve

r‘ Br chi l ʹ C5 ʹ T1 (roots/trunks/divisions/cords)

r‘ Axillary, MC, median, ulnar, radial

r‘ umb r ʹ L1-L4

r‘ emoral, obturator

r‘  cr l ʹ L4-S4

r‘ Sciatic (common peroneal/tibial), pudendal


r‘ eflexes

r‘ A reflex is an immediate involuntary response to a specific stimulus

r‘ The neural writing͛ of a single reflex is referred to as a reflex arc


‘ ‘  
‘  ‘ ‘

1.‘ Their development (innate and acquired)

2.‘ The site where information processing occurs (spinal and cranial)

3.‘ The nature of resulting motor response (somatic and visceral or autonomic)

4.‘ The complexity of the neural circuit (monosynaptic and polysynaptic)

Neural Organization- Monosynaptic and îolysynaptic Reflexes

r‘  î tters of Neur l ircuits i Neuro l îools

1.‘ ierece:

r‘ spreads stimulation to many neurons or neuronal pools in CNS

2.‘ oerece:

r‘ brings input from many sources to single neuron

r‘  î tters of Neur l ircuits i Neuro l îools

3.‘ eri l processi:

r‘ moves information in single line

r‘ î r llel processi:

r‘ moves same information along several paths simultaneously

r‘  î tters of Neur l ircuits i Neuro l îools

5.‘ eerber tio:

r‘ positive feedback mechanism

r‘ functions until inhibited

r‘ eflex ctiity

r‘ 5 components of a reflex arc


r‘ Receptor

r‘ Sensory neuron

r‘ Integration center (CNS)

r‘ Motor neuron

r‘ Effector

r‘ pi l eflexes

r‘ Range in increasing order of complexity:

r‘ monosynaptic reflexes

r‘ polysynaptic reflexes

r‘ intersegmental reflex arcs:

r‘ many segments interact

r‘ produce highly variable motor response

r‘ Monosynaptic Reflexes

r‘ Have least delay between sensory input and motor output:

r‘   stretch reflex (such as patellar reflex)

r‘ Completed in 20ʹ40 msec

r‘ Muscle Spindles

r‘ The receptors in stretch reflexes

r‘ ½undles of small, specialized ñ muscle fibers:

r‘ innervated by sensory and motor neurons

r‘ Surrounded by ñ muscle fibers:

r‘ which maintain tone and contract muscle

r‘ îostural Reflexes

r‘ îostural reflexes:

r‘ stretch reflexes
r‘ maintain normal upright posture

r‘ Stretched muscle responds by contracting:

r‘ automatically maintain balance

r‘ îolysynaptic Reflexes

r‘ More complicated than monosynaptic reflexes

r‘ Interneurons control more than 1 muscle group

r‘ îroduce either EîSîs or IîSîs

r‘ The Tendon Reflex

r‘ îrevents skeletal muscles from:

r‘ developing too much tension

r‘ tearing or breaking tendons

r‘ Sensory receptors unlike muscle spindles or proprioceptors

r‘ Withdrawal Reflexes

r‘ Move body part away from stimulus (pain or pressure):

r‘   flexor reflex:

r‘ pulls hand away from hot stove

r‘ Strength and extent of response:

r‘ depends on intensity and location of stimulus

r‘ Reciprocal Inhibition

r‘ or flexor reflex to work:

r‘ the stretch reflex of  ñ J (extensor) muscle must be 


   (reciprocal
inhibition) by interneurons in spinal cord

r‘ Crossed Extensor
Reflexes

r‘ Occur simultaneously, coordinated with flexor reflex

r‘   flexor reflex causes leg to pull up:


r‘ crossed extensor reflex straightens other leg

r‘ to receive body weight

r‘ maintained by reverberating circuits

r‘ Integration and Control of Spinal Reflexes

r‘ Though reflex behaviors are automatic:

r‘ processing centers in brain can facilitate or inhibit reflex motor patterns based in spinal
cord

r‘ Higher centers of brain incorporate lower, reflexive motor patterns

r‘ Automatic reflexes:

r‘ can be activated by brain as needed

r‘ use few nerve impulses to control complex motor functions

r‘ walking, running, jumping

r‘ Superficial reflexes

r‘ Stroking of the skin elicits muscle contraction

r‘ Involves functional upper motor pathways as well as cord level reflex arcs

r‘ îlantar reflex (L4-S2)͙½abinski is normal in infants

r‘ Usually indicative of CNS damage in adults

r‘ Abdominal reflex (T8-T12)

r‘ Absent with corticospinal lesion

r‘ Spinal Reflexes

r‘ pi l eflexes

r‘ Spinal Reflexes

r‘ Spinal Reflexes

r‘ Spinal Reflexes

r‘ pi l Motor îror ms

r‘ ise ses Affecti the Motor ystem


r‘ Spinal Cord Trauma: Transection

r‘ Cross sectioning of the spinal cord at any level results in total motor and sensory loss in regions
inferior to the cut

r‘ î r plei ʹ transection between T1 and L1

r‘ Xu riplei ʹ transection in the cervical region

r‘ ÆH NjOOG A AM NAÆ ON

r‘ NjOOG A AM

r‘ MNÆA ÆAÆj

r‘ AN A NV

r‘ MOÆO AM

r‘ ÆNGÆH

r‘ GA Æ

r‘ BA

r‘ F

r‘ NAÆ ON

r‘ MNÆA ÆAÆj

r‘ eel of osciousess

r‘ Awake and alert

r‘ Agitated

r‘ Lethargic

r‘ Arousable with

r‘ Voice

r‘ Getle stimul tio

r‘ î iful/iorous stimul tio

r‘ Comatose

r‘ ANGjAG
r‘ FjN 

r‘ NAM NG

r‘ îÆ Æ ON

r‘ A NG

r‘ W Æ NG

r‘ OMîHN ON

Aphasia vs. dysarthria

r‘ MMO

r‘ MM AÆ

r‘ A A MAj OF AÆÆNÆ ON AÆH ÆHAN MMO

r‘ MOÆ

r‘ - OBJ Æ AÆ 0/-/ M NjÆ

r‘ H ÆO A VNÆ

r‘ îONA VNÆ

r‘ O NÆAÆ ON

r‘ îON

r‘ NOÆ WHO ÆH A BjÆ WHO Oj A

r‘ îA 

r‘ Æ M

r‘ OÆH OGN Æ V FjN Æ ON

r‘ A jAÆ ON

r‘ ABÆA Æ ON

r‘  M A Æ / FFN 

r‘ JjGMNÆ

r‘ îONA Æ/BHAV O
r‘ AN A NV

r‘ AN A NV AM

r‘ - OFA ÆO

r‘ ONÆ j A NO Oj Æ Mjj

r‘ OFF MON ÆA Æ

r‘ - OîÆ

r‘ V jA A j Æ

r‘ V jA F 

r‘ FjNO Oî AM

r‘ AN A NV AM

r‘ / V/V O jMOÆO ÆO HA ABj N

r‘ îjî A îON

r‘  MOVMNÆ

r‘ † A NA îO Æ ON

r‘ OBV   FO îÆO 

r‘ V - Æ GM NA

r‘ MOÆO - JAW ÆNGÆH

r‘ N - A -  V  ON

r‘ AN A NV

r‘ V - FA A

r‘ OBV FO FA A AMMÆ

r‘ FOHA W NK NG   Oj WH Æ/îj K

r‘ V - VÆ BjA

r‘ A j Æ

r‘  NN WB
r‘ AN A NV

r‘ / - GOOîHANGA VAGj

r‘ GAG

r‘  - î NA A O

r‘ ÆNO  OMAÆO  M.

r‘ ÆAî j Mj 

r‘  - HîOGOA

r‘ ÆONGj ÆNGÆH

r‘  GHÆ  ÆHjÆ ÆONGj ÆO FÆ

r‘ MOÆO AM NAÆ ON

r‘ ÆNGÆH

r‘ ÆNGÆH

r‘ GA 0 - 

r‘ 0 - NO MOVMNÆ

r‘ 1 - F K

r‘ 2 - MOVMNÆ W ÆH GAV Æ MOV

r‘ - - MOVMNÆ AGA NÆ GAV Æ

r‘ D - MOVMNÆ AGA NÆ  ÆAN 

r‘  - NOMA ÆNGÆH

r‘ ÆNGÆH AM

r‘ jîî AN OW ÆM Æ 

r‘  ÆA AN îO MA Mj 

r‘ G î ÆNGÆH  A îOO  N NG ÆOO FO ÆNGÆH

r‘ jBÆ WAKN

r‘ ÆO WAK H WAK


r‘ OjÆ OF HA 

r‘ î KN BN

r‘ Motor ex m cot

r‘ ubtle sis of e kess o cortic l/subcortic l b sis

r‘ îro tor rift

r‘ Orbiti

r‘ G it e lu tio

r‘ clue  lki  turi

r‘ x mples of borm l  it

r‘ Hih stepp e

r‘ W li

r‘ Hemip retic

r‘ huffli

r‘ Æurs e bloc

r‘ Mj  OBVAÆ ON

r‘ AÆOîH

r‘ FA jAÆ ON

r‘ ABNOMA MOVMNÆ

r‘ ÆMO

r‘ Æ

r‘ W ÆH AM OjÆÆÆ H

r‘ NÆNÆ ON

r‘ HOA

r‘ AÆHÆO 

r‘ ABNOMA îOÆj
r‘ BA FjN Æ ON

r‘ Aî  AÆNAÆ NG MOVMNÆ

r‘ F NG ÆO F NG ÆO NO ÆÆ NG

r‘ H ÆO H N

r‘ GA Æ

r‘ ÆANM

r‘ omber i

r‘ Stand with feet together - assure patient stable - have them close eyes

r‘ Romberg is positive if they do worse with eyes closed

r‘ Measures

r‘ Cerebellar function

r‘ Frequetly poor b l ce ith eyes ope  close

r‘ îroprioception

r‘ Frequetly o orse ith eyes close

r‘ Vestibular system

r‘ F

r‘ Mj  ÆÆ H F (î ÆNON F)

r‘ GA 0 - 

r‘ 0 - ABNÆ

r‘ 1 - îNÆ W ÆH  NFO MNÆ

r‘ 2 - NOMA

r‘ - - NHAN 

r‘ D - jNjÆA N ONj

r‘  - jÆA N ONj

r‘ M / Æ
r‘ B î

r‘ BA H OA A 

r‘ Æ î

r‘ KN

r‘ ANK

r‘ OÆH F

r‘ jpper motor euro ysfuctio

r‘ BAB NK

r‘ preset or bset

r‘ toes ooi/ flexor pl t r respose

r‘ HOFMAN

r‘ JAW JK

r‘ Frot l rele se sis

r‘ GAî

r‘ NOjÆ

r‘ j K

r‘ îAMOMNÆA

r‘ ÆON

r‘ N A  A NOMA

r‘ OGWH NG

r‘ Aî KN F

r‘ NO AM

r‘ NO AM

r‘ V BAÆ ON

r‘ 12 hz tui fork


r‘ JO NÆ îO Æ ON N

r‘ î N î K

r‘ ÆMîAÆj

t rt ist lly  moe proxim lly

r‘ H GH OÆ A NAÆ ON

r‘ GAîHÆH A

r‘ ÆOGNO 

r‘ OjB  MjÆANOj Æ MjAÆ ON

r‘ BAOÆH A

r‘ ÆÆj

r‘ Vlasgow Coma Scale:


What is it?

r‘ eveloped by neurosurgeons in 1974

r‘ Xuantifies level of consciousness

r‘ ¯  ‘ ‘ à : traumatic and/or vascular injuries

or infections

r‘ Ý  ‘: hepatic or renal failure, hypoglycemia, diabetic ketosis, toxic


ingestion

r‘ Assess initial level of consciousness

r‘ Assess changes in level of consciousness

r‘ Helps guide treatment and predict outcome

r‘ Vlasgow scoring

r‘ Verbal response in children

r‘ îosturing

r‘ ecorticate

r‘ Upper extremity flexion with lower extremity extension


r‘ Mesencephalic region or corticospinal tract damage

r‘ ecerebrate

r‘ Upper and lower extremity extension

r‘ ½rainstem damage below the red nucleus

r‘ îrogressive

r‘ Uncal or tonsilar herniation

r‘ Stimulation

r‘ Eye opening

r‘ Name spoken loudly

r‘ Verbal response

r‘ îerson, place, time

r‘ Motor response

r‘ ingernail bed pressure

r‘ Supraorbital pressure

r‘ Hand crosses midline and above clavicle

r‘ Sternal rub

r‘ Vlasgow score

r‘ Score range

r‘ Extubated: 3 ʹ 15

r‘ Intubated: 3 ʹ 11T

r‘ Clinical presentation

r‘ Normal: VCS = 15

r‘ Comatose: VCS ч 8

r‘ ead: VCS = 3

r‘ Vrading of head injury


r‘ Minor: VCS ш 13

r‘ Moderate: VCS 9 ʹ 12

r‘ Severe: VCS ч 8

r‘ Example report

r‘ VCS 9 = E2 V4 M3 at 07:35

r‘ îrognosis

r‘ îrognosis variability

r‘ îast medical history

r‘ Age, previous neurological problems

r‘ Injury

r‘ Type and location, depth, duration of coma, presence of low blood pressure, oxygen
levels

after the injury

r‘ Current findings

r‘ îhysical examinations, radiological studies of

the brain

r‘ Clinical correlate (revisited)

r‘ The patient͛s eyes, initially closed, opened to the sound of his name.

r‘ Eye opening

r‘ 3

r‘ When asked where he was, the patient said ͞my shoes to change.͟

r‘ Verbal response

r‘ 3

r‘ The patient moved all of his fingers and toes when prompted.

r‘ Motor response

r‘ '
r‘ Score

r‘ VCS 12 = E3 V3 M' at 1':34

r‘ Head injury severity

r‘ Moderate