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Need to know what is being affected in the nervous system (anatomy): didn’t cover this in detail.
3 tracts:
corticospinal: voluntary
Corticobulbar tract and cerebellar tracts: there is a voluntary component, but not entirely. Lift a cup of coffee: we don’t
think about how many fibres are recruited, we don’t account for gravity, weight of object, don’t have to think about
steadying the movement, proprioception. Some of this movement is not voluntary, and these tracts take care of it.
Cerebellar is feedback loop.
DYSRAPHIC DISORDERS
Anencephaly: 1-5 in 1000
End of neural tube doesn’t form.
Meningocele: Cyst is lined with meninges, but does not contain neural tissue. Small surgery can deal with this, you are
just removing a cyst.
A bit less severe: will have spina bifida occulta. Mesenchyme usually wraps around neural tube and becomes bone. If it
doesn’t fuse, it is “bifid”: has 2 ends instead of fusing. Covered with deep fascia and superficial fascia, and is often
covered with a bit of hair. Least severe of conditions presented. Child will walk, survive.
Meningomyelocele: Contains spinal cord. Can’t remove this once it forms… can’t push it back in, can’t cut it out. Nerves
are irritated, will die, when they are pushed along a longitudinal plane. Have to relieve the pressure.
Myelocele: most severe. No covering over spinal cord. CSF has leaked out. Not viable. May reach term but will not
survive.
Spina bifida aperta: is a smaller area than myelocele. Like spina bifida occulta without any covering.
HYDROCEPHALUS
Cycle of CSF: Made in ventricles of brain and circulates around brain and spine. Net flow that comes from the ventricles,
and it has to leave in the same amount. Net gain will lead to hydrocephalus. Too much fluid and fontanelles haven’t
closed? Head will enlarge.
If this happens after fontanelles close, there is no room to grow. Pressure atrophy.
Dandy-Walker Malformation
Luschka and Magendie are foramena that connect through the cerebellum (?) Cerebellum is not there in the slide that we
saw. Severe motor co-ordination problems, but compatible with life. Huge ventricles on CT scan.
PHAKOMATOSES
Tuberous Sclerosis
Grey matter is cell bodies, white matter is myelinated axons. Distinction between grey and white matter is lost.
Moles are hamartomas. If they are in non-vital place, no problem. In vital place, they cause epileptic seizure.
May see facial nodules in these patients.
Neurofibromatosis
Two types: different gene.