Neuro final

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Questions and Answers

Which of the following accurately describes the anatomical orientation of the brain?

  • Rostral indicates posterior, while caudal indicates anterior.
  • Dorsal indicates superior, while ventral indicates inferior. (correct)
  • Ventral refers to the superior aspect, while dorsal refers to the inferior aspect.
  • Lateral refers to the midline, while medial is further away.

Damage to the brainstem that affects the basilar artery would most likely impact which of the following brain structures?

  • Medulla oblongata.
  • Hypothalamus.
  • Midbrain.
  • Pons. (correct)

Which of the following are key differences between regeneration in the central nervous system (CNS) and the peripheral nervous system (PNS)?

  • The CNS has limited regeneration due to glial scar formation and the PNS regenerates at a rate of about 1 mm per day. (correct)
  • The PNS has limited regeneration due to glial scar formation.
  • Both CNS and PNS regenerate equally due to similar mechanisms.
  • The CNS has better regeneration due to the presence of Schwann cells.

Which glial cell type is primarily responsible for myelination in the peripheral nervous system (PNS)?

<p>Schwann cells. (D)</p>
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What is the primary function of the Circle of Willis?

<p>To provide collateral circulation to the brain. (C)</p>
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Which of the following is a key function of the subarachnoid space?

<p>Houses cranial nerves and intracranial vasculature, and is filled with cerebrospinal fluid (CSF). (B)</p>
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Which diagnostic tool is most effective for differentiating between hemorrhagic and ischemic strokes?

<p>Head CT without contrast. (D)</p>
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Which condition is characterized by tissue death in the brain due to a disruption of blood supply?

<p>Stroke. (C)</p>
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Which of the dural sinuses is responsible for reabsorbing CSF into the bloodstream?

<p>Superior sagittal sinus. (A)</p>
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Which of the following is the correct flow of CSF through the ventricular system?

<p>lateral ventricles third ventricle cerebral aqueduct fourth ventricle (B)</p>
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Which brain structure serves as the primary relay station for sensory information traveling to the cerebral cortex?

<p>Thalamus. (A)</p>
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Which of the following thalamic nuclei is responsible for relaying visual information from the optic tract to the primary visual cortex?

<p>Lateral Geniculate Nucleus (LGN). (D)</p>
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What is the likely result of damage to the ventral posterolateral (VPL) nucleus of the thalamus?

<p>Contralateral sensory loss from the body. (B)</p>
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Which of the following is a primary function of the hypothalamus?

<p>Regulating hormone release and maintaining homeostasis. (A)</p>
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Which structure, when damaged, can result in hemiballismus, characterized by violent flinging of the limbs?

<p>Subthalamic nucleus. (C)</p>
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Which of the following best describes the function of the limbic system?

<p>Involved in emotion, memory, learning, and motivation. (D)</p>
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Which component of the basal ganglia receives input directly from the cerebral cortex?

<p>Striatum. (B)</p>
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What neurotransmitter is produced by the substantia nigra pars compacta (SNc) and is essential for controlling body movements?

<p>Dopamine. (C)</p>
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In the basal ganglia circuits, what is the effect of the direct pathway on thalamic output?

<p>Increases thalamic output. (A)</p>
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What is the key result of loss of dopamine-producing neurons in Parkinson's Disease?

<p>Muscle rigidity. (D)</p>
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Which of the following functions relates to the vestibulocerebellum?

<p>Maintaining balance and posture. (C)</p>
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What part of the brain is active while a motion is occurring using sensory information in order to adapt motor output, and controls execution of movement?

<p>Spinocerebellum. (C)</p>
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If a patient's cerebellum is damaged, and they have significant challenges with rapid alternating movements, which specific area is likely affected?

<p>Cerebellar hemispheres. (B)</p>
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The dorsal spinocerebellar tract (DSCT) carries what type of information to the cerebellum?

<p>Unconscious proprioception, ipsilateral. (B)</p>
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What is the only efferent output of the cerebellar cortex?

<p>Purkinje cells. (B)</p>
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Which reflex stabilizes gaze during head movements by moving the eyes in the opposite direction of the head's motion?

<p>Vestibulo-ocular Reflex (VOR). (D)</p>
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What is the initial synaptic target of the cochlear nerve (CN VIII) in the brainstem?

<p>Cochlear nuclei. (D)</p>
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Which structure in the eye functions as a diaphragm to control the amount of light that enters?

<p>Iris. (A)</p>
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After crossing the optic chiasm, fibers from which portion of the retina remain on the same (ipsilateral) side?

<p>Temporal. (C)</p>
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A patient presents with vision loss in the temporal portions of both visual fields. Where is the most likely location of the lesion in the visual pathway?

<p>Optic chiasm (crossing fibers). (D)</p>
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Which of the following best describes neuroplasticity?

<p>The ability of the nervous system to reorganize its structure, function, and connections in response to various stimuli. (B)</p>
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Which of the following principles of neuroplasticity emphasizes that neural circuits not actively engaged tend to degrade?

<p>Use It or Lose It. (A)</p>
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What is "recovery" in the context of CNS injury?

<p>Restoring neuronal tissue function that was initially lost due to the injury. (B)</p>
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Which structure is defined as a group of neuron cell bodies located outside the central nervous system (CNS)?

<p>Ganglion (D)</p>
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In anatomical terms, what is the relationship between the dorsal and ventral aspects of the spinal cord?

<p>Dorsal is posterior; ventral is anterior (B)</p>
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What type of cut would divide the brain into anterior and posterior portions?

<p>Coronal cut (C)</p>
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Which of the following is a characteristic unique to the peripheral nervous system (PNS)?

<p>Presence of Schwann cells for myelination (B)</p>
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During neurulation, what do the alar components of somites eventually form?

<p>Dorsal (sensory) nerve roots (D)</p>
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Which glial cells myelinate axons in the CNS and can myelinate multiple axons at a time?

<p>Oligodendrocytes (C)</p>
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Astrocytes in the CNS perform which of the following functions?

<p>Regulating the concentration of ions and neurotransmitters (B)</p>
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Which of the following accurately describes the glial cell response in the central nervous system (CNS) following a demyelinating event?

<p>Limited regeneration occurs due to glial scar formation and inhibitory factors (A)</p>
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What cranial nerves are housed within the pons?

<p>V, VI, VII, and VIII (C)</p>
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Which of the following cranial nerves is responsible for taste sensation in the posterior one-third of the tongue?

<p>Glossopharyngeal nerve (IX) (D)</p>
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Which of the following functions is primarily controlled by the medulla oblongata?

<p>Heart rate, breathing, and digestion (B)</p>
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Which artery does NOT directly supply blood to the pons?

<p>Anterior spinal artery (C)</p>
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A patient presents with anosmia after a traumatic brain injury. Which cranial nerve was most likely affected?

<p>Olfactory nerve (I) (A)</p>
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Which cranial nerve controls elevation of the shoulder (trapezius) and head rotation?

<p>Spinal Accessory (XI) (D)</p>
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Upper motor neuron (UMN) lesions typically produce which of the following examination findings?

<p>Hypertonia and hyperreflexia (A)</p>
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A lesion affecting a peripheral nerve will result in muscle degradation and atrophy ______ to the site of the lesion.

<p>distal (B)</p>
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What is the primary function of the lateral corticospinal tract?

<p>Controlling voluntary movements, especially fine movements of distal extremities (A)</p>
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Which of the following describes the path of the corticobulbar tract?

<p>Originates in the motor cortex, passes through the corona radiata and internal capsule, terminates in various nuclei within the brainstem (C)</p>
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Which of the extrapyramidal tracts is responsible for head orientation in response to auditory stimuli?

<p>Tectospinal tract (A)</p>
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Which lobe contains the postcentral gyrus and processes sensory information such as touch and temperature?

<p>Parietal lobe (D)</p>
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Which of the following is a key function of the anterior cerebral artery (ACA)?

<p>Supplying the medial and superior surfaces of the frontal and parietal lobes (A)</p>
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A stroke affecting the middle cerebral artery (MCA) would likely result in:

<p>Contralateral weakness and sensory loss, especially in the arm and face (B)</p>
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Which dural sinus is directly responsible for reabsorbing CSF into the bloodstream?

<p>Superior sagittal sinus (A)</p>
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What is the correct order of the meninges, from the brain outwards?

<p>Pia mater, arachnoid mater, dura mater (D)</p>
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Hydrocephalus is characterized by

<p>A buildup of CSF in the brain, causing the ventricles to widen and put pressure on brain tissue. (D)</p>
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Which of the following best describes the location of the thalamus?

<p>Above the hypothalamus and above the pituitary gland (C)</p>
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Which of the relay nuclei is responsible for relaying auditory information?

<p>Medial Geniculate Nucleus (MGN) (C)</p>
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Damage to the thalamus can lead to impairments in sensory perception. Which thalamic nuclei are most directly involved in relaying somatic sensory information from the body and head, respectively?

<p>VPL and VPM (B)</p>
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Which area of the diencephalon serves as a main link between the endocrine and nervous systems?

<p>Hypothalamus (D)</p>
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Which component of the basal ganglia plays a crucial role in motor integration, body movement accuracy, and limbic-associated functions, and is also the only glutamatergic (excitatory) structure in the basal ganglia?

<p>Subthalamic Nucleus (B)</p>
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Which structure inhibits the other thalamic nuclei?

<p>Thalamic reticular nucleus (A)</p>
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What is the overall effect of dopamine on the basal ganglia circuits?

<p>Promotes movement by enhancing the direct pathway and inhibiting the indirect pathway (A)</p>
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Damage to which part of the cerebellum leads to impaired proprioception, incoordination, and difficulties with rapid alternating movements?

<p>Spinocerebellum (Intermediate Zone) (D)</p>
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The dorsal spinocerebellar tract (DSCT) carries what type of information, and to what location?

<p>Unconscious proprioception to the cerebellum (B)</p>
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Where does the vestibular portion of CN VIII enter the brainstem?

<p>Ponto-medullary junction (C)</p>
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What is the role of the ciliary muscle?

<p>Regulates the shape of the lens to focus light onto the retina. (A)</p>
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Lesions to the optic radiation result in

<p>Contralateral homonymous hemianopsia (A)</p>
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Which principle of experience-dependent neuroplasticity highlights the importance of making rehabilitation specific to the desired functional outcome?

<p>Specificity (A)</p>
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What does "compensation" mean in the context of CNS injury?

<p>Achieving a task using alternative strategies or neural tissue when the original function cannot be fully restored (C)</p>
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Which of the following best describes the anatomical relationship between the terms 'rostral' and 'caudal' in the context of the spinal cord?

<p>Rostral indicates structures closer to the brainstem, while caudal refers to structures closer to the tail end. (C)</p>
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Which of the following structures is exclusively part of the peripheral nervous system (PNS)?

<p>Ganglion (B)</p>
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During embryonic development, which of the following primary vesicles gives rise to the thalamus and hypothalamus?

<p>Prosencephalon (B)</p>
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The alar plate and basal plate are components that influence the layout of dermatomes. Which of the following adult structures are derived from the alar components of somites?

<p>Dorsal (sensory) nerve roots of the spinal cord. (D)</p>
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What functional significance does the decussation of vertical tracts in the medulla oblongata have on motor and sensory processing?

<p>It results in contralateral control, where one side of the brain controls the opposite side of the body. (C)</p>
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Which of the following cranial nerves is responsible for controlling the muscles of facial expression and taste sensation in the anterior two-thirds of the tongue?

<p>Facial nerve (VII) (D)</p>
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Damage to what region of the brainstem would most likely affect cranial nerves involved in hearing and balance?

<p>Pons (D)</p>
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A patient presents with weakness in shoulder elevation and difficulty rotating their head. Which cranial nerve is most likely affected?

<p>Spinal accessory nerve (XI) (C)</p>
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A patient exhibits hypertonia, hyperreflexia, and generalized weakness in multiple muscle groups. These signs indicate damage to which type of neuron?

<p>Upper motor neuron (UMN) (D)</p>
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Which of the following statements best describes the function of the lateral corticospinal tract?

<p>It primarily controls voluntary movements, especially fine, skilled movements of the distal extremities. (D)</p>
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Which of the following best describes the function of the tectospinal tract?

<p>It is responsible for head orientation in response to auditory stimuli. (C)</p>
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According to the cortical homunculus, which body parts have a disproportionately large representation in the primary motor cortex?

<p>Hands, face, and tongue (C)</p>
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Which artery supplies the lateral surface of the cerebral hemispheres, including motor and sensory areas for the face and arm?

<p>Middle cerebral artery (MCA) (A)</p>
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If a patient has a stroke affecting the posterior cerebral artery (PCA), what type of deficit is most likely to result?

<p>Visual disturbances (A)</p>
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What is the correct sequence of venous drainage in the brain, starting from the cerebral veins?

<p>Cerebral veins → dural sinuses → internal jugular veins (D)</p>
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What is the order of the meningeal layers from the brain outwards?

<p>Pia mater, arachnoid mater, dura mater (D)</p>
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What is the primary function of the choroid plexus?

<p>Producing cerebrospinal fluid (CSF) (D)</p>
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What structure connects the lateral ventricles to the third ventricle?

<p>Interventricular foramen of Monro (D)</p>
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What is the function of the reticular nuclei (Thalamic Reticular Nucleus - TRN) in the thalamus?

<p>Modulating the activity of other thalamic nuclei by inhibiting them (D)</p>
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A patient presents with contralateral sensory loss after a stroke. Damage to which of the following thalamic nuclei is most likely responsible for this deficit?

<p>Ventral posterolateral (VPL) Nucleus (D)</p>
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What are the primary components of the epithalamus?

<p>Pineal gland, habenular nuclei, and stria medullaris (C)</p>
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Which structure involved in motor control is directly modulated by dopamine?

<p>Striatum (C)</p>
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In the basal ganglia indirect ('No-Go') pathway, what is the effect of the globus pallidus external (GPe) on the subthalamic nucleus (STN)?

<p>Inhibition (B)</p>
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Which of the following best describes the function of the spinocerebellum (intermediate zone) of the cerebellum?

<p>Goal-directed movement and trunk control (B)</p>
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What type of information is carried by the dorsal spinocerebellar tract (DSCT), and where does it terminate?

<p>Unconscious proprioception; cerebellar cortex (C)</p>
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What is the function of Purkinje cells in the cerebellum?

<p>Provide the only efferent output from the cerebellar cortex. (C)</p>
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A patient is experiencing vertigo, dizziness, and imbalance. Which part of the vestibulocochlear nerve (CN VIII) is likely affected, and where does this nerve enter the brainstem?

<p>Vestibular portion; ponto-medullary junction (C)</p>
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Which structure in the eye is responsible for refracting light into the eye, acts as a protective barrier and maintains transparency?

<p>Cornea (D)</p>
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What is the primary function of the vestibulo-ocular reflex (VOR)?

<p>To maintain stable visual fixation during head motion (C)</p>
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After the optic chiasm, fibers carrying information from which part of the retina project ipsilaterally?

<p>Temporal retina (B)</p>
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A patient has a lesion located in the left optic tract. Which visual field deficit would you expect?

<p>Right homonymous hemianopsia (B)</p>
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Which principle of experience-dependent neuroplasticity supports the idea that actively using impaired functions can lead to improvement?

<p>Use it and improve it (C)</p>
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What does 'compensation' refer to in the context of recovery from CNS injury?

<p>Achieving a task using alternative strategies or neural tissue (D)</p>
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According to the principles of neuroplasticity, what statement is true regarding intensity of rehabilitation training?

<p>Higher intensity training can produce greater functional gains, but overuse early after injury might worsen function. (B)</p>
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Flashcards

Nucleus

A group of neurons within the CNS that share a similar function.

Ganglia/Ganglion

A group of neurons outside the CNS, essentially within the PNS, that share a similar function.

Tract

A bundle of axons within the central nervous system (CNS).

Nerve

A bundle of axons outside the central nervous system (CNS), essentially within the peripheral nervous system (PNS).

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Afferent

Information arriving in the body, generally sensory information.

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Efferent

Information exiting the body.

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Gray Matter

Darker tissue of the brain and spinal cord, mainly composed of cell bodies.

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White Matter

Paler tissue of the brain and spinal cord, mainly composed of axons.

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Somatic Nervous System

Afferent and efferent information via skeletal muscles in the external environment, generally under conscious control.

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Autonomic Nervous System

Afferent and efferent information via smooth muscles and glands in the internal environment, generally automatic.

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Sulcus/Sulci

Grooves of the brain.

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Gyrus/Gyri

Folds or ridges of the brain.

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Dorsal

More superior aspect of the brain. The posterior aspect of the spinal cord.

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Ventral

More inferior aspect of the brain. The anterior aspect of the spinal cord.

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Rostral

More anterior towards the nose in the brain. More superior towards the brainstem in the spinal cord.

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Caudal

More posterior towards the back of the head in the brain. More inferior towards the tail end of the spinal cord.

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Medial

The portion of the brain in the midline.

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Lateral

The portion of the brain that is further away from the midline.

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Horizontal Cut

A transverse cut of the brain or spinal cord.

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Sagittal Cut

A vertical cut of the brain or spinal cord.

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Coronal/Frontal Cut

A vertical cut of the brain or spinal cord, from front to back.

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Central Nervous System (CNS)

Consists of the brain and spinal cord.

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Peripheral Nervous System (PNS)

Includes cranial nerves, peripheral nerves, anterior portion of the spinal cord, and cauda equina.

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Oligodendrocytes

Glial cells that produce myelin in the central nervous system.

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Schwann cells

Glial cells that produce myelin in the peripheral nervous system.

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Function of Autonomic Nervous System

Processes and integrates information, generates responses

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Gastrulation

Formation of three layers: ectoderm, mesoderm, and endoderm.

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Neurulation

Roughly 3 to 4 weeks after gestation.

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Location of Central Nerves

Located within the brain and spinal cord (CNS).

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Location of Peripheral Nerves

Located outside the brain and spinal cord (PNS).

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CNS Regeneration

Glial scars inhibit regrowth.

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PNS regeneration

Schwann cells secrete chemicals to attract axons.

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Astrocytes

Star-like shape. Typically found in the gray matter of the CNS.

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Microglia

Derived from bone marrow and found in the CNS.

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Central Nervous System

Consists of the brain and spinal cord. May be referred to as the upper motor neuron system.

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Ganglia

Neuron cell bodies in the PNS form this.

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Dura Mater

The outermost layer, a thick, tough, and inelastic membrane (“tough mother”).

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Arachnoid Mater

The middle layer, a thin, wispy, avascular membrane beneath the dura mater (“spider web-like”).

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Pia Mater

The innermost layer, a very delicate, thin membrane that tightly adheres to the surface of the brain and spinal cord (“tender mother”).

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Tissue death

A stroke is characterized by this in the brain due to a disruption of blood supply.

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Thalamus

The largest part of the diencephalon making up about 80% of it.

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Hypothalamus

Located deep within the brain, below the thalamus and above the pituitary gland, sitting above the brainstem, about the size of an almond.

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Subthalamus

A small region located below the thalamus.

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PNS components

Cranial nerves, peripheral nerves, anterior portion of the spinal cord and cauda equina

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Fourth Week

Brain Development starts around this week

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Epithalamus

Connects the limbic system to other brain areas

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Head CT

To differentiate between hemorrhagic and ischemic strokes

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Hemorrhagic conversion

A potential complication after an ischemic stroke.

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Olfactory Bulbs

Process information about smells.

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Relay Nuclei

Transmits specific sensory information directly to the cerebral cortex.

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Neuroplasticity

The ability of the nervous system to respond to stimuli by reorganizing its structure, function, and connections.

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Recovery

Restoration of neuronal tissue function initially lost due to injury.

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Central Sulcus

Delineates the frontal lobe from the parietal lobe.

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Superior Sagittal Sinus

Largest, drains blood from the brain's hemispheres.

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Multiple sclerosis (MS)

Stripped off by the body's immune system (a central demyelinating event)

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Guillain-Barré syndrome

Stripped off (a peripheral demyelinating event)

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Pons

Located inferior to the midbrain and superior to the medulla

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Function of the Corticospinal Tract

Primarily controls voluntary movements, especially fine, skilled movements of the distal extremities.

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Tectospinal Tract

Responsible for head orientation in response to auditory stimuli

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Circle of Willis

A network of arteries located in the subarachnoid space that surrounds the pituitary gland and optic chiasm.

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Study Notes

### Circle of Willis
- A network of arteries in the subarachnoid space, surrounding the pituitary gland and optic chiasm
- Provides collateral circulation to the brain to maintain continued blood flow even if a major artery is blocked
- Main components include right and left anterior cerebral arteries, anterior communicating artery, right and left internal carotid arteries, right and left posterior cerebral arteries, right and left posterior communicating arteries, basilar artery, and vertebral arteries
- Common variations occur with 50-90% of people

### Arterial Vasculature of the Brain
- Internal Carotid Arteries supply anterior parts of the brain which include most of the cerebral hemispheres
    - Middle Cerebral Artery (MCA) branches off the internal carotid artery providing lateral surface of the cerebral hemispheres with motor and sensory data and is the most common site of stroke
    - Anterior Cerebral Artery (ACA) branches off the internal carotid artery and the medial and superior surfaces of the frontal and parietal lobes, with motor and sensory areas for leg and foot
- Vertebral and Basilar Arteries (Vertebrobasilar System) supply posterior parts of the brain, including the brainstem, cerebellum, and occipital lobe
    - Vertebral Arteries ascend through the vertebrae and enter the skull
    - Basilar Artery is what forms by the joining of the two vertebral arteries and leads to branches that supply the pons and cerebellum, as well as the Posterior Cerebral Artery (PCA) branches off supply the occipital lobe
    - Superior Cerebellar Artery (SCA), Anterior Inferior Cerebellar Artery (AICA), Posterior Inferior Cerebellar Artery (PICA) drive supply in the cerebellum, PICA is a classic location for a stroke as its the first branch off the vertebral artery.

### Brain's Venous System
- Drains oxygen-depleted blood away and returns it to the body.
- Consists of cerebral veins and dural sinuses.
    - Cerebral Veins drain blood from the brain and empty into the dural sinuses through the superficial veins and deep veins, draining the surfaces of the cerebral hemispheres to the internal structures
    - Venous channels located within the dura mater
        - Dural Sinuses are formed by a separation of the two layers of the dura mater that is within the reflections of falx cerebri
        - Blood from cerebral veins and cerebrospinal fluid (CSF) all drain here
        - Key components include the Superior Sagittal Sinus has the largest collection, drains blood from brain's hemispheres, extends from the occipital bone while CSF is reabsorbed into  stream here
        - Transverse Sinuses receive blood from the superior sagittal sinus with the Sigmoid Sinuses and Internal Jugular Veins drive that, with a return blood to the body.
- Cerebral veins -> dural sinuses -> internal jugular veins; specifically: superior sagittal sinus - transverse sinuses -> sigmoid sinuses -> internal jugular veins is the pathway
- Damage to sinuses can lead to increased intracranial pressure

### Cranial Meninges
- Three layers of membranes that cover, protect, and anchor the brain and spinal cord while supporting fluid and nerves, and the circulation
    - Layers from inside out are pia, arachnoid, and dura mater and are PAD like the subacrnym
    -  Dura Mater is the outermost layer, the thickness, and the toughness of this creates an the name for tough mother,
        - Has two layers with periosteal being closest to the skull for the outer part, plus meningeal with closest to the brain
        - Forms dural reflections: falx cerebri separates cerebral hemispheres, tentorium cerebelli - separates cerebrum from cerebellum, falx cerebelli - separates cerebellar hemispheres
        - Attached to the inner surface of the skull and vertebrae to mechanically protect the brain.
    - Arachnoid Mater is in the middle layer in its wispy and spiderweb-like form of an avascular membrane
        - Connective tissue trabeculae project and connect to the pia mater
        - Cushion is through CSF in space for cushioning
        - Barrier to substances and plays a role in reabsorption with bridges over the sulci, creating triangular spaces.

### Lesions and Pathology of Brain Structure and Tissue
- Pia Mater is thin layer that is directly adjacent the  surface of the brain and spinal cord
        - It is highly vascularized and helps with blood-brain structure
        - It helps with CSF and cortical surfaces and gyri patterns
    - Meningeal Spaces are: 
        - Epidural Space with vertebrae with blood vessels, spinal roots, and lymphatics
        - Subdural Space is the thin mater where trauma causes the layer to break
        - Subarachnoid Space contains the blood

### Pathophysiology Stroke
- Stroke is generally where tissue death has occurred and disrupts proper blood flow.
    - Ischemic Strokes generally are 80% of all occurrences with the primary function disrupting blood flood by embolism
    - Hemorrhagic Strokes are the ruptures and vessel breaks with roughly a 20% share

### Stroke Examinations
- Examinations such as the NIH Stroke Scale are used along with head exams
- Head exams such as CAT are used to determine between what specific stroke impacts

### Ischemic Strokes
- The main goal is to restore blood flow
- Therapies need to be introduced with fast procedures to achieve restoration of blood flow
- Hemorrhagic conversion is a risk that blood vessel rupture

### Revisit Clinical Stroke
- Clinical indications typically derive from what is affected with the arteries.
    - Middle Cerebral Stroke: Can influence arm, limbs, faces; also speech or hemineglect can stem
   as the lateral brain is hit
    - Posterior Arteries impact the visual cortex
    - Vertebral can impact speech and double vision plus other cognitive declines 

### Cerebral Structures
- Cortex controls outer function
- The deepest groove defines the Longitudinal Feature
- The Transverse part separates from the cerebrum.
    - There are multiple parts that factor the different brain levels
    -  Functions: Control panel for behavior and complex thinking, managing thinking,
emotions, personality, judgment, self-control, which stem from multiple substructures
    - Parietal Lobe: Sensory and spacial orientation processes are also affected
    - Temporal, Occipital, and Insular functions also can stem from injury
- **

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