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When this balance is disturbed, movement disorders occur. The BASAL GANGLIA... Control of ... to light on an object (touching nose with finger, for example) ...

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neuro for the not so neuro minded

NEURO-FOR-THE-NOT-SO-NEURO-MINDED

Barb Bancroft, RN, MSN, PNP

CPP Associates,

Chicago, IL

[email protected]

www.barbbancroft.com

the frontal lobes
Prime real estate of the brain

Comprises one-third of the cerebral cortex

This is your “Mother”

“No, negative, don’t, stop…” She is inhibitory..

Socialization

THE FRONTAL LOBES…
mom and socialization
“Mom” and socialization
  • Frontal lobes are not mature in babies and young children…it actually takes about 17-22 years for full maturity of the frontal lobes
  • “Don’t scratch, don’t pick, don’t dig..”
  • Judgment
  • Insight
frontal lobes
FRONTAL LOBES…
  • Alcohol and socialization
  • Loss of inhibitions with .05 blood alcohol levels
  • Baso-orbital region and the loss of inhibitions in patients with dementia
acetylcholine cognitive function
Acetylcholine…cognitive function
  • Alzheimer’s disease—90% of acetylcholine is lost with destruction of brain tissue
  • Amyloid plaques and neurofibrillary tangles
  • BAP v.s. TAU
  • Tumeric (cucurmin) and beta amyloid
  • Acetylcholinesterase inhibitors
alzheimer s
Alzheimer’s…
  • The Alzheimer’s brain
  • Cortical atrophy
  • Sulcal widening
  • Atrophy of gyri
  • Brain weight
quick mental status check
Quick mental status check…
  • Time and Change Test

Clock with hands—What time is it?

3 quarters, 7 dimes, 7 nickels—Can you give me change in the amount of $1.00?

97% negative predictive value if correct on both parts of the test

frontal lobes9
Frontal lobes…
  • Voluntary speech center
  • Dr. Pierre Paul

Broca

  • Broca’s aphasia
  • Non-fluent

aphasia—telegraphic, staccato speech

frontal lobes10
Frontal lobes…
  • Pre-central gyrus (motor cortex—upper motor neurons)
  • Voluntary movement center
upper motor neurons cs tract
Upper Motor Neurons/CS tract
  • Contralateral

hemiparesis

  • Pronator drift
  • Hemiparalysis (spastic

paralysis)

  • Head injury, stroke,tumors
slide12
“And that’s why we always stand to the side when we check reflexes…”
  • Hyperreflexia
  • Babinski—extensor plantar reflex
temporal lobes
TEMPORAL LOBES…
  • Wernicke’s area—reception of speech
  • Do you understand what I am telling you?
  • Interpretation of speech and sounds
  • Coins jingling in pocket
  • Auditory agnosia
temporal lobes14
TEMPORAL LOBES…
  • Cranial Nerve VIII (Acoustic Nerve) “hears” for you…(primary sensory modality)
  • The Superior Temporal Gyrus (STG) interprets what you are hearing (higher cortical function)
  • What am I hearing?
temporal lobes15
TEMPORAL LOBES…
  • Cranial Nerve I “smells” for you (primary sensory modality)
  • The uncus interprets what you are smelling (higher cortical function)
  • The uncus is connected to the hippocampus (memory)
temporal lobes16
TEMPORAL LOBES…
  • Inferior surface of frontal and temporal lobes--a meningioma displacing the olfactory nerve (cranial nerve 1)
  • Loss of smell
  • Loss of inhibitions (baso-orbital frontal lobe)
temporal lobes17
TEMPORAL LOBES…
  • An “aura”—the beginning of a temporal lobe seizure with a funny taste or smell (rotten eggs)
  • Anosmia—loss of smell or the loss of the ability to interpret smell may be the first sign of a neurodegenerative disease (PD, DAT)
temporal lobes18
TEMPORAL LOBES…
  • Déjà vu—feeling like you’re been there before
  • Jamais vu—familiar place becomes totally unfamiliar
  • Hallucinations—seeing or hearing something that is not there
  • Illusions—distortion of an ongoing stimuli
  • Drugs and hallucinations—boosting dopamine triggers hallucinations—drugs for Parkinson’s disease, hallucinogenic drugs and mushrooms, ETOH withdrawal, Herpes encephalitis
  • Marijuana and illusions
temporal lobes19
TEMPORAL LOBES…
  • Self-preservation and preservation of the species—the autonomic nervous system
  • The 4 F’s…fight, flight
  • Feeding activities
  • And….
sexual function in the brain and dopamine
Sexual function in the brain and dopamine…
  • SSRIs increase serotonin and you’re happy, but…
  • When serotonin goes up, dopamine goes down
temporal lobes22
TEMPORAL LOBES…
  • Self-preservation and preservation of the species—The other 2 F’s
  • Flight—Fright (epi, NE)
  • Episodic dyscontrol syndrome—TBI patients
temporal lobes23
TEMPORAL LOBES…
  • Recent memory (hippocampus)
  • Remember 3 items…
  • Red ball, clock, tennis shoe
  • Repeat them after me…
  • Red ball, clock, tennis shoe
  • Continue with exam for 10 minutes and ask them to repeat those 3 items
  • Post-traumatic stress disorder (cortisol receptors)
  • Depression and neurogenesis
loss of hippocampal cell function
Loss of hippocampal cell function
  • Loss of recent memory
  • This is the first neurologic function to go with the aging process
  • When does this process begin?
  • When do you reach your peak mental capacity?
temporal lobes25
TEMPORAL LOBES…
  • Partial complex seizures—altered state of consciousness; most common cause is a closed head injury; also consider a history of shaken baby syndrome; mid-forceps delivery
  • Automatisms
  • Semi-purposeful behavior
parietal lobes
PARIETAL LOBES…
  • Integration of tactile sensations—touch, pressure, vibration, and proprioception (do you know where your left buttocks is, right now?)
parietal lobes testing
PARIETAL LOBES..testing
  • Double simultaneous stimuli—kids vs. adults
  • Touch two areas at the same time..
  • Kids will always neglect their body and will recognize touch on the face
  • The neglect syndrome in adults
parietal lobes testing28
PARIETAL LOBES..testing
  • Ability to localize stimuli
  • Sharp vs. dull
  • Tests for proprioception
  • Graphesthesia
  • Apraxia—example: a dressing apraxia

ideomotor apraxia

constructional apraxia

abstraction
Abstraction…
  • What does “Don’t cry over spilled milk” mean?
  • HUH?
  • How are a car, plane and boat alike?
  • Cow, horse, and pig?
occipital lobes
OCCIPITAL LOBES…
  • Visual integration—problems manifest as cortical blindness (visual agnosia)
  • Do you see this object?
  • If they can see it, CN2 (the optic nerve)
  • What is it? The occipital cortex
slide31
QUIZ…
  • What were those 3 items I asked you to remember?
the basal ganglia33
Paired nuclei at the base of the brain

50:50 balance between acetylcholine and dopamine

All dopamine is made in the substantia nigra from melanin

Gamma-amino butyric acid (GABA) keeps dopamine in check

The basal ganglia…

Caudate nucleus

Globus pallidus

Substantia nigra

Subthalamic nucleus

dopamine
Dopamine
  • Dopamine levels decrease with aging gradually—we all slow down (loss of 45%)
  • Dopamine loss of greater than 80% results in signs and symptoms of Parkinson’s disease
the basal ganglia35
The BASAL GANGLIA

The functions of the basal ganglia depend on a balance between various neurotransmitters

GABA--

dopamine:acetylcholine

50:50

When this balance is disturbed, movement disorders occur

the basal ganglia36
The BASAL GANGLIA…
  • Control of movement, initiation and cessation of movement
  • Postural reflexes—the righting reflex
clinical symptoms
Clinical symptoms
  • Resting tremor (70%)—unilateral or bilateral (unopposed acetylcholine in Parkinson’s patients)
  • Rigidity (decreased dopamine) (vs. spasticity of stroke patients)
  • Loss of voluntary movements (spontaneous)
  • Bradykinesia (decreased dopamine) (check gait)
  • Postural instability (sternal push)
  • Presence of severe seborrheic dermatitis suggests PD (unopposed acetylcholine)
  • Anosmia
huntington s chorea chromosome 4
Huntington’s chorea…chromosome #4
  • Excess dopamine due to the loss of GABA-minergic input from the degeneration of the caudate nucleus
  • Chorea—rapid, jerky movements of muscle groups
  • Dementia
  • Neuroleptic drugs to block dopamine
other movement disorders
Other movement disorders
  • Tourette’s syndrome
  • Athetoid Cerebral Palsy
  • Tardive dyskinesia
the cerebellum
Coordination

Synergy

Balance

Equilibrium

The cerebellum…
the cerebellum42
The cerebellum…
  • Romberg test—stand up with your feet together and close your eyes
  • Tandem walk
  • Close your eyes and touch your finger to your nose
  • Rapid alternating movements
the cerebellum43
The cerebellum…
  • Truncal ataxia—wide, staggering gait
  • Dysdiadochokinesia—inability to make rapid alternating movements
  • Dysmetria—inability to light on an object (touching nose with finger, for example)
  • Dysarthria
  • Puppet-like movements
the cerebellum45
The CEREBELLUM…
  • Multiple sclerosis
  • Down syndrome
  • Spinocerebellar ataxia
  • (The cerebellum is not “strictly” motor—it also monitors sensory input from “the outside”—may play a role in autism and schizophrenia)
the brainstem the bulb
The BRAINSTEM…(the “bulb”)
  • Cardiorespiratory center—C2, C3 “Hangman’s fracture)
  • ARAS (Ascending reticular activating system)
  • Cranial Nerves III – XII (I and II are not located in the brainstem)
the brainstem the bulb48
The BRAINSTEM…(the “bulb”)
  • II (Optic) and III (Oculomotor)—light reflex, accommodation, and the optic disk (papilla)
the brainstem the bulb49
The BRAINSTEM…(the “bulb”)
  • II (Optic) and III (Oculomotor)—light reflex, accommodation, and the optic disk (papilla)
  • The Argyll Robertson pupil—it will accommodate but not react (to light)
the brainstem51
The BRAINSTEM…
  • V (Trigeminal) and VII (Facial)
  • Corneal reflex—touch cornea with a cotton wisp and the patient blinks
  • VII (Bell’s palsy)—paralysis of facial muscles – smile, puff cheeks, frown
the brainstem52
The BRAINSTEM…
  • IX (Glossopharyngeal) and X (Vagus)
  • The gag reflex
  • The uvula
  • Closing off nasopharynx—say “K, K, K”
  • Cleft palate
the peripheral nervous system
The PERIPHERAL NERVOUS SYSTEM
  • Dermatome chart
  • Stocking-glove distribution with peripheral neuropathy
  • The reflex arc—S1,2 (Achilles), L3,4(Patellar), C5,6 (Biceps),
  • C7,8 (Triceps)
neuromuscular junction
Neuromuscular junction
  • Disease of the neuromuscular junction—myasthenia gravis
  • Muscle weakness—consider thyroid disease, drug-induced myopathy, polymyositis, inherited muscular dystrophies
the reflex arc
The reflex arc…
  • Sensory information into the spinal cord
  • Synapses in same spinal cord segment
  • Sent right back out via lower motor neuron to
  • Peripheral motor nerve
  • S1,2 (Achilles); L3,4 (Patellar); C5,6 (Biceps); C7,8 (Triceps)
  • 50% of the elderly (over 75) do NOT have an Achilles reflex
disease of the lower motor neuron or it s pathway to the peripheral nervous system
Disease of the lower motor neuron or it’s pathway to the peripheral nervous system
  • Diabetes, alcoholism (thiamine deficiency), trauma, B12 deficiency
  • Heavy metals
  • Chemotherapy
  • others
thanks
Barb Bancroft, RN, MSN, PNP

CPP Associates, Inc.

Chicago, IL.

[email protected]

www.barbbancroft.com

Thanks.
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