Nervous System Disorders Flashcards

1
Q

What are of the brain is most affected by Alzheimer’s disease?

A

Hippocampus and cortex

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2
Q

What area of the brain is affected by Parkinson’s disease?

A

The dopamine producing substantia nigra

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3
Q

What part of the brain is affected by Vitamin B12 deficiency?

A

Dorsal columns and corticospinal tracts

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4
Q

What​ reaction​ of​

neurons​ to injury​ involves​ red neurons​ that lack nissl?

A

Acute neuronal injury

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5
Q

What reaction of neurons to injury involves central chromatolysis?

A

Axonal injury

This reaction indicates crisis

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6
Q

The changes that occur in the distal axon during neuronal injury?

A

Wallerian degeneration

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7
Q

What cells are associated with infections such as polio, viral encephalitis and rabies?

A

Negri bodies

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8
Q

What is the wear and tear pigment that accumulates in neurons due to age and chronic hypoxia?

A

Lipofuscins

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9
Q

What disorder is associated with Lewy bodies?

A

Parkinson’s disease

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10
Q

What is associated with neurofibrillary tangles and beta amyloid plaques?

A

Alzheimer’s

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11
Q

Cherry red spot is associated is associated with what metabolic storage disease?

A

Tay Sachs and Niemann-Picks

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12
Q

What is the function of astrocytes?

A

Repair and produce glial scars

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13
Q

What is the function of micro glia?

A

Phagocytes of the CNS that increase in response to injury and infection

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14
Q

What is the function of oligodendrocytes?

A

Produce myelin for the CNS

They can wrap multiple axons (unlike Schwann cells of the PNS)

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15
Q

What is a common disease that affects the oligodendrocytes?

A

MS

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16
Q

What is the most common cause of brain edema? What are two other possible causes?

A

Vascular (vasogenic) edema and swelling

Could also be SOL or cytotoxic (increased cell water due to injury)

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17
Q

How does vascular edema lead to brain edema?

A

Vascular edema leads to increased vascular permeability that can leak into the brain and cause swelling

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18
Q

What are contributing causes of edema?

A
  • infection
  • ischemia
  • trauma
  • metabolic disturbances
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19
Q

What happens to the CSF and ventricles in hydrocephalus?

A

Volume of CSF increases

Ventricles dilate

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20
Q

What is it called when ventricles are expanded secondary to atrophy of the brain (CSF pressure is not increased)?

A

Hydrocephaly ex vacuo

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21
Q

Hydrocephalus ex vacuo is often seen in what conditions?

A

Brain atrophy due to alcohol abuse or Alzheimer’s disease

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22
Q

What is obstructive hydrocephaly?

A

Non-communicating, i.e. CSF does not reach subarachnoid space due to INTERNAL blockage

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23
Q

What are some possible causes of obstructive hydrocephaly?

A
  • Tumors, abscess or other SOL

- scarring/obstruction of ventricular system

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24
Q

What is communicating hydrocephaly?

A

CSF enters the subarachnoid space but the circulation or absorption is blocked EXTERNALLY

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25
Q

What are some causes of communicating hydrocephaly?

A
  • Scars of arachnoid granulation and/or meninges from bacterial meningitis or hemorrhage
  • thrombi, neoplasms or other obstruction of cerebral (dural) venous sinuses and associated veins
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26
Q

What are early manifestations of increased intracranial pressure?

A

Headache
Mental dullness
Nausea
Vomiting

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27
Q

What is papilledema?

A

Swelling of optic disc due to compression and obstruction of central retinal vein

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28
Q

What causes distortion of the cranial vault and vertebral columns and can injure underlying structures?

A

penetrating/crushing Trauma

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29
Q

Interstitial bleeding due to blunt trauma?

A

Contusion (bruise)

Ex: coup/counter coup

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30
Q

Tearing of brain surface with bleeding into surround region?

A

Laceration

This is a closed head injury that causes edema and swelling

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31
Q

Common closed head injury in the absence of bleeding?

A

Concussion

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32
Q

What is meningitis?

A

Infection of the meninges and CSF

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33
Q

When severe, what are systemic sign of meningitis?

A
Stiff neck
Headache
Photophobia
Rash
Fever
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34
Q

What disease is characterized by purulent (septic) exudates in the meninges?

A

Acute pyogenic (bacterial) meningitis

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35
Q

Which is more severe: viral/lymphocytic or bacterial/pyogenic meningitis?

A

Pyogenic

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36
Q

What is the most common meningitis in adolescents and young adults?

A

Neisseria meningitidis (meningococcus)

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37
Q

What are som opportunistic pathogens that can cause acute pyogenic meningitis in immunodeficient people?

A

E. Coli
H. Influenzae
Strep. Pneumonia

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38
Q

What disease is characterized by elevated lymphocytes and proteins in the CSF and is aseptic?

A

Acute lymphocytic (viral) meningitis

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39
Q

What are some possible viruses that can cause acute lymphocytic meningitis?

A

Mumps
Echo virus
Epstein Barr
Herpes simplex II

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40
Q

What disease is characterized by increased mononuclear cells and protein in the CSF as well as subarachnoid space being filled with exudates that become fibrotic?

A

Chronic meningitis

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41
Q

Which type of meningitis causes insidious and progressive headaches, malaise, vomitting?

A

Chronic meningitis

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42
Q

What are some possible causes of chronic meningitis?

A
  • TB
  • Fungi such as histoplasmosis
  • Brucellosis, a slow acting bacteria
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43
Q

What is the most common type of encephalitis?

A

Viral

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44
Q

The turning of all or part of an organism in a particular direction in response to an external stimulus.
Ex: what determines which neurons or parts of the brain are affected (selected) by encephalitis

A

Tropism - selectivity is poorly understood

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45
Q

Examples of disease that cause encephalitis

A
  • arbor virus
  • childhood infections such as measles, rubella, chicken pox
  • HSV I and II
  • poliomyelitis
  • rabies
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46
Q

What is the most common epidemic form of viral encephalitis?

A

Arbor virus

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47
Q

An unconventional agent that causes encephalopathy and is characterized by microscopic vacuolization of brain tissue known as spongiform degeneration.

A

Prions

48
Q

Subacute spongiform encephalopathy from infection with prions that causes extensive atrophy of areas of gray matter

A

Creutzfeldt Jacob disease

49
Q

What prion disease can be acquired by consuming infected animals?

A

Mad cow disease aka bovine spongiform encephalopathy

50
Q

Focal bacterial infection that can be caused by hematogenous dissemination and local extension

A

Abscess

51
Q

What are some causes of abscesses in the CNS?

A
  • sinus infection
  • dural venous sinus infection
  • penetrating injury
  • surgery
52
Q

Focal nodular infection consisting of macrophages, giant cells, etc. that leads to local, expansive and destructive lesions

A

Granulomas

53
Q

What is the most common cause of granulomas in the CNS?

A

TB when it extends to the meninges

Fungi and syphilis are other causes

54
Q

Collapse of vertebral bodies as seen in Pott’s disease (TB of the spine) leads to what finding?

A

Gibbous deformity

55
Q

What are other common names for stroke?

A

Apoplexy

CVA - cerebrovascular accident

56
Q

Focal loss of neurological function of vascular origin that lasts more than 24 hours and/or leads to death

A

Stroke

57
Q

Sudden focal and reversible neurological (sensory and motor) disturbances due to disruption of blood supply (often emboli) that last less than 24 hours

A

TIA transient ischemic attacks

58
Q

What is the most common cause of stroke?

A

ischemic infarcts (focal loss of neurological function due to vascular origin) accounts for 75-90% of strokes

59
Q

Ischemic infarcts are mostly caused by what?

A

Atherosclerotic disease

60
Q

Other than atherosclerotic disease, what are the other causes of ischemic infarcts?

A
  • inflammatory arthritis
  • arterial spasm
  • dissecting aneurysm
61
Q

What are atherosclerotic lesions associated with ischemic infarcts?

A

Thrombi

62
Q

Fragments of atherosclerotic plaques that are carried into smaller vessels

A

Emboli

63
Q

Ischemia of the entire brain (usually caused by hypotension events such a heart failure or shock) generally causes what?

A

Ischemic encephalopathy

64
Q

Where are ischemic encephalopathy infarcts found?

A

Can involve entire brain or may be limited to more susceptible parts or in the “watershed” regions of the brain and spinal cord

65
Q

What are the two types of spontaneous (non traumatic) hemorrhages?

A
  • Intracerebral

- Subarachnoid

66
Q

What is the peak incidence of intracerebral hemorrhage?

A

60 years

67
Q

Where are common locations of intracerebral spontaneous hemorrhage?

A
  • basal ganglia
  • internal capsule
  • brain stem
68
Q

What accounts for over 50% of brain hemorrhage cases?

A

Hypertension

69
Q

Other than intracerebral hemorrhage, what are CNS effects of hypertension?

A
  • arteriolar sclerosis with occlusion of small penetrating arteries and arterioles causing lacunar infarcts
  • rupture of small penetrating arteries giving rise to slit hemorrhages
  • acute hypertensive encephalopathy
  • multi-infarct dementia
70
Q

What is the most common cause of subarachnoid hemorrhage?

A

Rupture of congenital berry aneurysms

71
Q

Where are berry aneurysms located?

A

Circle of Willis

72
Q

What is typically caused by rupture or lacerations of the middle meningeal artery?

A

Epidural hematoma

73
Q

What is the “lucid interval”?

A

The absence of neurological manifestations during the first few hours after epidural hematomas?

74
Q

What is typically associated with rupture of small communicating veins between cortex and dural venous sinuses that accumulates in a potential space between the dura and arachnoid?

A

Subdural hematoma

75
Q

What are the clinical symptoms present with Parkinsonism?

A
  • festinating gait
  • pill-rolling tremor
  • mask-like facies
76
Q

Spontaneous onset of Parkinsonism in the absence of exposure to toxic agents that commonly begins in middle age and progresses slowly

A

Idiopathic Parkinson’s disease (paralysis agitates)

77
Q

What type of Parkinsonism is more common in younger subjects and is the result of exposure to dopamine antagonists, vascular disease or repeated head trauma?

A

Parkinsonism secondary to encephalitis

Characterized by depletion of substantia nigra with formation of neurofibrillary tangles

78
Q

Condition associated with degeneration of cortical neurons and substantia nigra resulting in dementia and Parkinsonism.

A

Diffuse Lewy body disease

79
Q

Loss of cortical function leading to profound dementia, progressive memory loss and motor dysfunction is characteristic of what disease?

A

Alzheimer’s

80
Q

What are the characteristic microscopic features of Alzheimer’s disease?

A
  • increased neuritic plaques (neurofibrillary tangles and amyloid plaques) in the cerebral cortex as well as granulovacuolar degeneration
81
Q

What is a common cause of death in Alzheimer’s?

A

Aspiration pneumonia due to decreased motor function

82
Q

What is ex vacuo?

A

Ventricular dilation mainly in frontal, temporal and parietal regions of atrophied dementia brains

83
Q

Upper motor neuron lesion results in what kind of paralysis?

A

Spastic

84
Q

Lower motor neuron lesion results in what kind of paralysis?

A

Flaccid

85
Q

Most common motor neuron disorder that affects both upper and lower motor neurons but generally does not affect sensory elements?

A

Amyotrophic lateral sclerosis (ALS)

86
Q

In ALS, where is the loss of motor neurons most striking?

A

Anterior horn cells of spinal cord, cranial motor neurons and upper motor neurons known as Betz cells

87
Q

What is the most common cause of selective demyelination in the CNS?

A

MS

88
Q

What is the most common neurological disorder associated with young adults, especially women?

A

MS

89
Q

65% of patients with MS exhibit was marker?

A

HLA antigens of the D class

90
Q

Although the etiology of MS is not fully understood, what are 4 mechanisms that appear to contribute?

A
  • host susceptibility: 1st order relatives of those with MS have 15x greater risk
  • exposure to certain infectious agents
  • higher temperature latitudes
  • autoimmunity to components of the myelin sheath
91
Q

The demyelinating plaques seen in MS are commonly found in what locations?

A
  • optic nerve and chiasm
  • periventricular white matter
  • brain stem
  • cerebral peduncles
  • dorsal columns of spinal cord
92
Q

What are the three clinical variants of MS?

A
  • acute progressive
  • chronic progressive
  • relapsing-remitting

Listed in order of shortest to longest survival

93
Q

Syphillis affects tha CNS during which stage?

A

Tertiary (15-350 years following primary infection) = neurosyphillis

94
Q

What are the three CNS manifestations of tertiary syphillis?

A
  • paresis
  • tabes dorsalis
  • meningeo-vascular lesions known as gummas
95
Q

What is paresis as seen in neurosyphillis and what are the clinical effects?

A

Progressive neuronal loss with cerebral atrophy resulting in dementia, behavior change, tremors, memory loss and Argyll-Robertson pupil

96
Q

What is tabes dorsalis as seen in neurosyphillis and what are the clinical effects?

A

Fibrosis and gliosis of posterior columns of spinal cord resulting in painful paresthesias, ataxia/loss of deep tendon reflex, Charcot joint bladder dysfunction

97
Q

Primary tumors of the CNS are commonly derivatives of what cell type?

A

Glial cells

98
Q

What is the difference between extra-axial and intra-axial tumors of the CNS?

A

Extra-axial tumors arise outside of the CNS

Intra-axial tumors arise from within the CNS

99
Q

CNS tumors that arise from outside the CNS and cause compression on the brain and spinal cord such as pituitary tumors?

A

Extra-axial tumors

100
Q

Intra-axial tumors of the CNS most often arise where in adults?

A

Supratentorial location in the cerebral hemisphere (70%)

101
Q

Intra-axial tumors of the CNS most often arise where in children?

A

Intratentorial location in the cerebral hemispheres (70%)

102
Q

There are three major classes of intra-axial CNS tumors. What are they?

A
  • gliomas
  • medulloblastomas
  • neuroblastomas (although most are extra-axial, they can be intra-axial)
103
Q

Medulloblastomas and neuroblastomas are more common in what age group?

A

Kids

104
Q

What glioma is the most common intra-axial tumor?

A

Astrocytoma

105
Q

What is associated with neurosyphillis meningeo-vascular lesions?

A

Chronic meningitis with scarring and obliterating arthritis

106
Q

A small vascular tumor of the adrenal medulla that causes irregular secretion of epi/norepi leading to attacks of HBP, palpitations and HA.

A

Pheochromocytoma and type of neuroblastic tumor of the CNS

107
Q

What vitamin deficiency are vegans at risk for, that causes myelin degeneration and loss of axons in the PNS?

A

Vitamin B12 (thiamine) deficiency

108
Q

What is the distribution of neuronal damage in polyneuropathy?

A

Affects multiple neurons in wide patterns. Initially symmetrical and peripheral (glove and stocking distribution)

109
Q

What is the most common cause of polyneuropathy?

A

Diabetes

110
Q

What is the distribution of neuronal damage in mononeuropathy?

A

Affects single or isolated group of neurons

111
Q

What causes mononeuropathy?

A

Localized mechanical factors or other isolated pathology such as compression or entrapment

112
Q

In diabetic neuropathy, sensory fibers are most greatly affected, however autonomic fibers can also be affected in 20-40% of chronic diabetes. This contributes to what?

A

Bladder, bowel and cardiovascular disturbances, visceral pain and sweating anomalies

113
Q

What are some common toxins that can cause neuropathy?

A
  • diphtheria (exotoxins)
  • lead
  • mercury
  • uremia
  • arsenic
114
Q

Bell Palsy is caused by inflammatory swelling and compression of which nerve?

A

CN 7, facial nerve

115
Q

Most common acute paralytic disease with inflammatory mechanism in young adults

A

Guillain-Barré syndrome

116
Q

Acute onset and rapid progression of weakness from distal to proximal muscle groups due to neuropathy, usually following acute influenza/pharyngitis in young adults?

A

Guillain-Barré syndrome

117
Q

Spontaneous episodes of lightning pain affecting one or more divisions of CN 5 that may be precipitated by light stimulation of skin of face or mouth

A

Tic douloureux