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Neuroscience > Module E > Flashcards

Module E Flashcards

1
Q

Cerebellar Stroke

A

Location: vertebral artery

ROS: dysarthria, dysmetria, dysdiadokinesia, ipsilateral intention tremor, ipsilateral limb ataxia, ipsilateral rebound phenomenon, truncal ataxia *posterior lobe

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2
Q

Resting tremor

A

More apparent @ rest *indicator of Parkinson’s Dz

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3
Q

Spino-cerebellum Lesion

A

Location: anterior lobe

ROS: ipsilateral limb ataxia, gait ataxia w/ lurching to the side of the lesion

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4
Q

Lateral (Medullary) Reticulospinal Tract

A

Flexor biased Medullary reticular nuclei –>

*webbing between toes nociceptive reflex

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5
Q

Alpha-Latrotoxin

A

Cause: massive release of ACh, bite from black widow spider

ROS: venom acts at nerve endings causing tetanus

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6
Q

Dopa-induced dyskinesia

A

Arises during tx of Parkinson’s w/ L-dopa, choreatic movements predominate but also facial dystonias seen

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7
Q

Wernicke-Korsakoff Syndrome

A

Deficiency: Vit. B1 (Thiamine)

Cause: degeneration of anterior vermis and adjacent parts of remaining anterior lobe

ROS: dysmetria of legs (heel-to-shin test) and lurching gate, truncal ataxia and intention tremor

*also dysfunction of hypothalamus - Papez circuit

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8
Q

Cerebellar Cognitive Affective Syndrome (CCAS)

A

Cause: lesion of posterior lobe

ROS: emotional blunting, depression, disinhibition and psychosis, executive/visual-spatial/linguistic deterioration

*viewed as “dysmetria of thought”

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9
Q

Athetosis

A

Continuous slow writhing of body parts (Related to basal ganglia pathology, or hemiplegia)

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10
Q

Facial n. Lesion

A

LMN lesion

ROS: entire ipsilateral facial paralysis (Bell’s Palsy)

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11
Q

Alcoholic Polyneuropathy

A

ROS: numbness, tingling, burning feet and weakness *sensory and motor losses symmetric

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12
Q

Parkinson’s Dz

A

Cause: substantia nigra pars compacta

ROS: akinesia, masked facies, shuffling gate, loss of habituation to glabellar stimulation, resting tremor

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13
Q

Guillain-Barre Syndrome (GBS)

A

Acute idiopathic polyneuritis (following infection)

ROS: ascending bilateral paralysis and weakness, elevated proteins in CSF, nerve conduction decreases

Tx: FFP or IV Ig

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14
Q

Vestibulo-cerebellum Lesion

A

Location: flocculonodular lobe

ROS: nystagmus, tilted head, titubtion (head nodding), truncal ataxia (wide-based stance; impaired tandem walking)

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15
Q

Lead Poisoning

A

Risk: children < 6 yo

ROS: encephalopathy w/ diminished IQ, LD, MR, coma or death (In adults can cause memory/concentration problems and peripheral motor neuropathy)

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16
Q

Ballismus

A

Uncontrolled rotatory flinging movements involving the limbs (hemiballismus contralateral to injury to subthalamus) *lesion of subthalamic nucleus

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17
Q

Lateral Vestibulospinal

A

Extensor biased Lateral vestibular nucleus –> anterior horn

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18
Q

Central Medullary Syndrome

A

Cause: syrinx

ROS: segmental muscular atrophy (commonly hands affected), bilateral loss of PT in cape-like distribution

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19
Q

Midline cerebellar astrocytoma

A

Most commonly in children

ROS: broad-based stance w/ impaired tandem walking, nystagmus, truncal ataxia *flocculonodular lobe

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20
Q

Poliomyelitis

A

Cell body dz, affecting MNs of spinal ventral horns

ROS: unilateral ascending paralysis, transmitted by person-to-person contact

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21
Q

Tardive dyskinesia

A

Cause: exposure to some antipsychotics (DA receptors antagonists)

ROS: stereotypic oral movements

*crack heads

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22
Q

Unilateral Corticobulbar Lesion (facial nucleus)

A

*UMN lesion - “upper spares upper”

ROS: lower facial paralysis contralaterally

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23
Q

Diabetes Mellitus

A

ROS: loss of P/T in symmetric “stocking distribution” of LE, motor deficits asymmetrical

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24
Q

Spasmodic torticollis

A

Muscle spasm of SCM, involuntary contraction and may become hypertrophic

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25
Q

Lateral Medullary (Wallenberg/PICA) Syndrome

A

ROS: ipsilateral limb ataxia, vertigo, N/V, nystagmus (away from lesion), dysarthria, dysphasia, 👇🏽gag reflex, hiccups, P/T loss ipsilateral face and contralateral body, ipsilateral Horner’s Syndrome

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26
Q

Myasthenia Gravis

A

Cause: Ab’s cross-link ACh receptors

ROS: diplopia, ptosis, dysphasia, paralysis that is gradually worse throughout the day

*“waning” seen on EMG

Tx: ______stigmine

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27
Q

Spinal Shock

A

Cause: bilateral spinal damage (transection)

ROS: initially transient areflexia and flaccid paralysis caudal to lesion (LMN symptoms)

*lasts about 2 weeks post-injury

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28
Q

Stages of Parkinson’s

A
  1. Unilateral
  2. Bilateral w/ preserved postural reflexes
  3. Bilateral w/ loss of postural reflexes
  4. Severe disability but w/ some movement
  5. Akinesia
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29
Q

Anterograde Transneural degeneration

A

Degeneration distal to the axotomy (cut nerve)

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30
Q

Amyotrophic Lateral Sclerosis (ALS/Lou Gherig’s Dz)

A

Destroys LMNs and eventually parts of corticospinal and corticobulbar tracts in the primary motor area

ROS: descending paralysis, delayed onset (middle-age pt)

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31
Q

Syndenham Dz

A

Cause: rheumatic fever in childhood

ROS: choreatic movements, recovery after a bout 6 wks

*75% of cases are female

32
Q

Huntington Dz

A

Defect: degeneration of striato-pallidal neurons expressing D2 receptors –> increasing thalami output = triggering hyperkinesias

ROS: emotional dysregulation, uncontrolled grimacing and other facial/oral muscle involvement, hands showing choreatic activity assuming a “piano playing” posture, delayed onset (middle-aged pt)

Dx: “boxcar ventricles” seen on imaging where striata cell degeneration allows enlargement of lateral ventricles

33
Q

Postural tremor

A

May arise only when certain posture is assumed, not usually seen at rest, usually bilateral, seen maximally at trajectory

34
Q

Anterior Spinal Artery Syndrome

A

Lesions: anterior horn cells, lateral and anterior corticospinal tract, ALS (P/T)

ROS: spastic paraparesis, bilateral extensor plantar response, bilateral loss of PT below level of the lesion, urine retention, impaired sexual function

35
Q

Lateral Corticospinal Tract

A

Flexor-biased (Layer 5 –> lateral spinal cord)

36
Q

Medial Medullary Syndrome

A

Artery: anterior spinal a.

ROS: contralateral spastic paresis body, contralateral TVP loss body, ipsilateral flaccid paralysis of tongue, and ipsilateral tongue deviation

37
Q

Internal Capsule Infarction

A

ROS: contralateral UMN syndrome (hyperreflexia, clonus, extensor plantar, spastic paralysis) and contralateral somatosensory loss, contralateral deviation of tongue, bilateral eye deviation towards side of the lesion

38
Q

Chorea

A

Brief, purposeless, irregular jerky movements

*basal ganglia dz (striatum - Huntington’s) (Sydenham dz - childhood rheumatic fever)

39
Q

Medial Vestibulospinal

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A

Extensor biased Medial vestibular nucleus –> alpha MNs @ CS and TS levels of cord

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40
Q

Wallerian Degeneration

A

Degeneration of the nerve that was transacted (axotomy)

41
Q

Louis-Bar Syndrome

A

AR - chromosome 11 *aka Ataxia Telangiectasia

Cause: degeneration of cerebellar purkinjie cells

ROS: delayed dev of motor skills (walking, talking, facial movements), immunocompromised, skin and eyes with small dilated blood vessels

42
Q

Medial Midbrain (Weber) Syndrome

A

Artery: PCA (interpeduncular/paramedian rami of PCA)

ROS: ipsilateral CN 3 palsy (eye deviated down and out), ipsilateral dilated and fixed pupil, contralateral hemiplegia of UE and LE, contralateral lower face paresis, contralateral tongue paresis, ipsilateral INO

43
Q

Drug-induced Parkinsonism

A

Arises w/ agents that suppress dopaminergic transmission, symptoms dissipate within 3 wks of withdrawal

44
Q

Muscular Dystrophy

A

X-linked (DMD/BMD)

Defect: dystrophin gene

ROS: muscle weakness

45
Q

Fasciculations

A

irregular spontaneous contractions of the muscle fibers forming motor units

*seen in LMN syndrome (ALS - fasciculations of tongue)

46
Q

Myotonia Congenita

A

Cause: fewer Cl- channels expressed in membrane

ROS: slow muscular relaxation causing muscle stiffness and hypertrophe

47
Q

Fibrillations

A

Spontaneous electrical events (visible on EMG)

48
Q

Subthalamic nucleus lesion

A

Decreased excitation of GPi so decreased inhibition of THL, increased cortical excitation leading to contralateral hemiballismus

49
Q

Decerebrate Posture

A

Lesion: caudal to red nucleus
Impaired: corticospinal, corticobulbar, rubrospinal

Intact: lateral (medullary) reticulospinal, medial (pontine) reticulospinal, and vestibulospinal

50
Q

Brown-Sequard Syndrome

A

ROS: ipsilateral LMN syndrome @ the level, ipsilateral UMN syndrome below the level, loss of PT contralaterally below the level, loss of TVP ipsilaterally below the level

51
Q

UMN Lesion

A

Above lesion: contralateral sx Below lesion: ipsilateral sx ROS: hyperreflexia, extensor plantar response (expressed when corticospinal tract disrupted), clonus, first flaccid then later spastic paralysis

52
Q

Lambert-Eaton Syndrome

A

Cause: insufficient release of ACh bc Ab’s cross-link the voltage-gated Ca2+ channels in motor nerve terminals

ROS: progressively improves throughout the day w/ repetitive contractions bc finally there will be sufficient ACh in cleft *LE is assoc. w/ pulmonary oat cell carcinoma *shows “waxing” on EMG (“eaton wax paper”)

53
Q

Cerebro-cerebellum Lesion

A

Location: Posterior lobe

ROS: ataxia, dysarthria, dysdiadokinesia, dysmetria, hypotonia, intention tremor, rebound phenomenon

54
Q

Beta-Bungarotoxin

A

Cause: reduced ACh release due to vemon of snake

ROS: acts on proteins in nerve terminals involved in exocytosis

55
Q

Medial Pontine Syndrome

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A

Artery: paramedian branches of basilar a.

ROS: contralateral spastic hemiparesis, contralateral loss of TVP, ipsilateral CN6 palsy (aka medial strabismus), ipsilateral gaze paralysis

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56
Q

Essential tremor

A

Prompts misdiagnosis of Parkinson’s, can resemble intention or resting tremor

57
Q

LMN Syndrome

A

Ipsilateral sx

ROS: hyporeflexia or areflexia, flaccid paralysis, atonia/hypotonia of muscles, atrophy of muscles, fasciculations, fibrillations (seen on EMG)

*“Ahh-FF” = atrophy, hypotonia, hyporeflexia, fasiculations, fibrillations

58
Q

Botulism

A

Cause: decreased ACh release by inhibiting presynaptic proteins involved in exocytosis

ROS: paralysis of all somatic muscles

59
Q

Decorticate Posture

A

Lesion: rostral to red nucleus

Impaired: corticospinal and corticobulbar

Intact: rubrospinal, lateral (medullary) reticulospinal, medial (pontine) reticulospinal

60
Q

Curare (delta-tubocurarine)

A

Cause: blocks postsynaptic ACh receptors

ROS: non-depolarizing muscle relaxant that blocks ACh receptors at NMJ

*plant alkaloid (works same as pancuronium)

61
Q

Lateral Pontine Syndrome

A

Artery: AICA

ROS: loss of P/T contralateral body, vertigo, N/V, nystagmus, ipsilateral facial paralysis, loss of P/T ipsilateral face, ipsilateral hearing loss, ipsilateral Horner Syndrome

62
Q

Chromatolysis

A

Dilution of somatic organelles w/ enlargement and displacement of nucleus (precedes apoptosis)

63
Q

Intention (kinetic) tremor

A

Apparent with purposeful movement, seen maximally at endpoint (e.g. finger-to-nose worse when approaching the nose)

*cerebellar lesion

64
Q

Lateral (Pontine) Reticulospinal

A

Extensor biased Pontine reticular nuclei –> ipsilateral ventral horn

*when webbing between fingers/toes pinched, nociceptive reflex mediated by this tract

65
Q

Retrograde Transneural Degeneration

A

Degeneration upstream from the axotomy (nerve that was cut)

66
Q

Rubrospinal Tract

A

Flexor biased (upper extremities) Red nucleus –> Lateral brainstem/cord

67
Q

Leprosy (Hansen dz)

A

Cause: mycobacterium leprae (skin lesion -> IF -> unmyelinated axons)

ROS: loss of PT, muscle weakness Tx: abx

68
Q

Where do diseases act on the nerve? (ALS, Polio, LE, MG, MD, etc.)

A
69
Q

Foville Syndrome

A

Cause: occlusion of paramedian branches of Basilar a.

ROS: ipsilateral CN6 palsy, contralateral UMN syndrome, both TVP and PT loss in contralateral body, ipsilateral CN7 palsy (ipsilateral upper/lower face paralysis), bilateral hearing loss

70
Q

Syringomyelia

A

Cause: syrinx disrupting central canal of spinal cord

ROS: bilateral loss of PT starting 2 levels below (in a “cape-like” distribution), LMN syndrome

71
Q

Dopa-induced Dyskinesia

A

Cause: tx of Parkinson’s

ROS: choreatic movements, facial dystonias

72
Q

Drug-induced Parkinsonism

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A

Cause: agents that suppress dopaminergic transmission

ROS: parkinsonism

*dissipates within wks of withdrawal from the causal med

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73
Q

Uncal Herniation

A

Cause: space occupying mass/hemorrhage

ROS: ipsilateral occulomotor palsy (pupil dilation), compression of crus cerebri causing contralateral hemiplegia, contralateral extensor plantar response

*supratentorial = decorticate posturing

*infratentorial = decerebrate posturing

74
Q

Subdural Hematoma

A

Traumatic rupture of bridging veins

*crescent-shape on CT

75
Q

Prodromal Parkinson’s Symtoms

A

Hyposmia, ANS dysfunction, REM sleep disorder

76
Q

Parkinson’s Treatments

A

L-DOPA, D1 or D2 agonists, muscarinic antagonists, ablation of Sth or GPi

Neuroscience (4 decks)

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