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Neuro > Part dos 0425FA > Flashcards

Part dos 0425FA Flashcards

1
Q

damage to watershed zones

A

in severe hypotension.
upper leg/arm weakness.
defects in higher order visual processing.

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2
Q

what drives cerebral perfusion?

A

PCO2 (vessels dilate when PCO2 increases).

also affected by severe hypoxia.

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3
Q

tx of acute cerebral edema (stroke, trauma)

A

decrease ICP via therapeutic hyperventilation (decrease PCO2)

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4
Q

MCA stroke

A
  1. motor: contraparalysis of face and upper limb.
  2. sensory: contra loss of sensation of face and upper limb.
  3. Broca
  4. Wernicke

*if damage to nondominant (right) hemisphere - get hemineglect (of left side)

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5
Q

ACA stroke

A
  1. motor: contra paralysis of lower limb

2. sensory: contra loss of sensation of lower limb

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6
Q

lateral striate artery stroke

A

striatum, internal capsule: contra hemiparesis/hemiplegia.

common location of LACUNAR INFARCTS secondary to unmanaged HTN.

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7
Q

AComm lesion

A

saccular (berry) aneurysm.
impinge on cranial nn.

sx: visual field defects

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8
Q

PComm lesion

A

saccular (berry) aneurysm.

CN III palsy - eye is DOWN and OUT.

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9
Q

what is most common site for saccular (berry) aneurysm?

A

anterior communicating artery

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10
Q

what is most common complication of saccular (berry) aneurysm?

A

rupture leading to hemorrhagic stroke or subarachnoid hemorrhage

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11
Q

what is saccular (berry) aneurysm assoc. with?

A
  1. ADPKD
  2. Ehler Danlos syndrome
  3. Marfan

other RF: age, HTN, smoking, black race

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12
Q

Charcot Bouchard microaneurysm

A

assoc. with chronic HTN.

affect small vessels (basal ganglia, thalamus).

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13
Q

epidural hematoma

A

rupture of middle meningeal a.
often second to temporal bone fx.
LUCID interval.
rapid expansion under systemic arterial pressure = transtentorial herniation and CN III palsy.

CT: biconvex disk (lens), NOT crossing suture lines. can cross falx, tentorium.

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14
Q

subdural hematoma

A

rupture of bridging veins.
SLOW venous bleeding.
seen in elderly, alcoholics, blunt trauma, shaken baby.

CT: crescent shape, crosses suture lines. midline shift. preserved gyro. cannot cross falx, tentorium.

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15
Q

subarachnoid hemorrhage

A

rupture of berry aneurysm or AVM.
rapid and severe onset.
worse HA of my life.
spinal tap bloody or yellow (xanthochromic).

CT: 2-3 days later, risk of VASOSPASM due to blood breakdown (not seen but treat with NIMODIPINE) and rebleed (seen on CT).

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16
Q

intraparenchymal (hypertensive) hemorrhage

A

most commonly due to systemic HTN.
also due to amyloid antipathy, vasculitis, neoplasm.

occurs in basal ganglia and internal capsule but can be lobar.

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17
Q

most vulnerable to ischemic damage

A

hippocampus
neocortex
cerebellum
watershed areas

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18
Q

irreversible neuron injury (due to ischemia > 5 min)

A 
12-48 h: red neurons
24-72 h: necrosis, neutrophils
3-5 d: macrophages
1-2 w: reactive gliosis, vasc prolif
> 2 w: glial scar
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19
Q

ischemic brain disease: atherosclerosis

A

thrombi lead to ischemic stroke with subsequent necrosis. form cystic cavity with reactive gliosis.

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20
Q

ischemic brain disease: ischemic stroke

A

emboli block large vessels.
caused by Afib, carotid dissection, patent foramen ovale, endocarditis.

tx: tPA within 4.5 hrs IFF pt presents w/in 3 hrs of onset and has no major risk for hemorrhage

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21
Q

ischemic brain disease: ischemic stroke (LACUNAR)

A

block small vessels.

often second to HTN.

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22
Q

ischemic brain disease: hemorrhagic stroke

A

intracerebral bleeding.

caused by HTN, anticoag, cancer (abn vessels) or reperfusion after ischemic stroke (fragile vessels)

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23
Q

ischemic brain disease: TIA

A

brief reversible episode of neuro dysfunction lasting < 24 hrs.

due to FOCAL ischemia.

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24
Q

stroke imaging

A

diffusion weighted MRI: bright in 3-30 min for 10 days.

noncontrast CT: dark in 24 hrs.
bright indicates hemorrhage; DO NOT USE tPA.

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25
Q

normal pressure hydrocephalus

A

wet wobbly wacky = incontinence, ataxia, dementia.
increase subarachnoid space volume but NO INCREASE in CSF pressure.
reversible.

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26
Q

communicating hydrocephalus

A

decreased CSF absorption by arachnoid villi.
increased ICP, papilledema, herniation.

seen with arachnoid scarring after meningitis.

27
Q

obstructive (noncommunicating) hydrocephalus

A

structural blockage of CSF circulation within ventricular system.

seen with stenosis of cerebral aqueduct.

28
Q

hydrocephalus ex vacuo

A

appearance of increased CSF and ventricular enlargement in brain atrophy.
normal ICP. no triad.

seen with alzheimer, advanced HIV, Pick’s disease.

29
Q

spinal nerves

A 
8 cervical
12 thoracic
5 lumbar
5 sacral 
1 coccygeal
30
Q

intervertebral foramina

A

C1-C7 exit ABOVE corresponding vertebra.

all others exit BELOW.

31
Q

vertebral disk herniation

A

nucleus pulposis herniates through annulus fibrosis.

between L5 and S1.

32
Q

lumbar puncture

A

SC extends to lower border of L1-2.
subarachnoid space extends to lower border of S2.

performed in L3-4 or L4-5 interspaces at level of cauda equina.

33
Q

poliomyelitis

A

LMN lesions only.
destruction of anterior horn.
flaccid paralysis.

poliovirus - fecal oral route.
replicates in oropharynx, small int.

CSF: lymphocytic pleocytosis, slight increase in protein. no change glucose.

34
Q

Werdnig-Hoffman disease

A

LMN lesions only.
destruction of anterior horn.
flaccid paralysis.

aka infantile spinal muscular atrophy.
floppy baby syndrome.
tongue fasciculations.
death by 7 mos. 
AR inheritance.
35
Q

multiple sclerosis

A

mostly affects white matter of cervical region.
RANDOM, asymmetric lesions.
demyelination.

sx: scanning speech, intention tremor, nystagmus.

36
Q

ALS

A

combined UMN and LMN deficits.
NO SENSORY deficits. no cognitive/oculomotor changes.

fasciculations and eventual atrophy.
progressive and fatal.

may be due to defect in SOD1.
increase survival with RILUZOLE (decrease presyn glutamate release).

37
Q

complete occlusion of anterior spinal artery

A

spares dorsal columns and tract of Lissauer.

upper thoracic ASA territory is watershed. artery of Adamkiewicz supplies ASA below T8.

38
Q

tabes dorsalis (tertiary neurosyphilis)

A

degeneration of dorsal roots and dorsal columns.

impaired proprioception, locomotor ataxia.
Charcot’s joints (degeneration).
shooting/lightning pain.
Argyll Robertson pupils (accommodate but no rxn to light).
absent DTRs.
positive Romberg.
sensory ataxia.

39
Q

syringomyelia

A

damage to anterior white commissure (spinothalamic tract).

bilateral loss of pain and temp (C8-T1).

seen with Chiari types 1 and 2.
cyst can expand and affect other tracts.

40
Q

subacute combined degeneration

A

vit B12 neuropathy.
severe vit E deficiency.
Friedreich’s ataxia.

demyelination of dorsal columns, lateral corticospinal tracts, spinocerebellar tract.

sx: ataxic gait, hyporeflexia, impaired position and vibration sense.

41
Q

Friedreich’s ataxia

A 
AR trinucleotide (GAA) repeat d/o. FRATAXIN.
impaired mito function.
staggering gait. freq falling.
nystagmus.
dysarthria.
pes cavus (high arch).
hammer toes.
kyphoscoliosis in childhood.

COD: hypertrophic CM.

42
Q

Brown Sequard syndrome

A

hemisection of SC.

  1. ipsi UMN signs below lesion (lateral corticospinal)
  2. ipsi LMN signs at level of lesion (lateral corticospinal)
  3. ipsi loss of vibration, proprioception, pressure below lesion (dorsal column)
  4. contra loss of pain and temp below lesion (spinothalamic)
  5. ipsi loss of all sensation at level of lesion

*Horner syndrome if lesion is above T1

43
Q

Horner syndrome

A

sympathectomy of face. lesion of SC above T1.

  1. Ptosis: slight drooping of eyelid (superior tarsal m.)
  2. Anhidrosis: absence of sweating (also have flushing of affected side due to vasodilation)
  3. Miosis: pupil constriction

“PAM is horn-y”

44
Q

causes of Horner

A

Brown sequard syndrome
pancoast tumor
late stage syringomyelia

45
Q

oculosympathetic pathway

A

disrupted in Horner.

hypothalamus to IMLCC to superior cervical ganglion to pupil/smooth muscle of eyelids/sweat glands of forehead, face.

46
Q

lesion: amygdala (bilateral)

A

Kluver-Bucy syndrome - hyperorality, hypersexuality, disinhibited behavior

assoc. with HSV 1

47
Q

lesion: frontal lobe

A

disinhibition and deficits in concentration, orientation, judgment

may have reemergence of primitive reflexes

48
Q

lesion: right parietal lobe

A

spatial neglect syndrome - agnosia of contralateral side of world

49
Q

lesion: reticular activating system (MIDBRAIN)

A

reduced levels of arousal and wakefulness (COMA)

50
Q

lesion: mammillary bodies (bilateral)

A

Wernicke Korsakoff syndrome

Wernicke: confusion, ophthalmoplegia, ataxia

Korsakoff: memory loss, personality changes, confabulation

51
Q

lesion: basal ganglia

A

tremor at rest, chorea, athetosis

52
Q

lesion: cerebellar hemisphere

A

intention tremor, limb ataxia - IPSI DEFICITS
fall toward side of lesion

*lateral sx = limbs

53
Q

lesion: cerebellar vermis

A

truncal ataxia, dysarthria

*medial/central sx = trunk

54
Q

lesion: subthalamic nucleus

A

contralateral hemiballismus

55
Q

lesion: hippocampus

A

ANTEROGRADE AMNESIA - inability to form new memories

56
Q

lesion: paramedian pontine reticular formation (PPRF)

A

eyes look AWAY FROM side of lesion

57
Q

lesion: frontal eye fields

A

eyes look TOWARD lesion

58
Q

ASA stroke

A
  1. lateral corticospinal tract: contra hemiparesis of lower limbs
  2. medial lemniscus: decreased contra proprioception
  3. caudal medulla, hypoglossal n: ipsi hypoglossal dysfunction (tongue deviates ipsi)
59
Q

PICA stroke

A
  1. LATERAL MEDULLA
    lateral spinothalamic tract, spinal trigeminal nucleus: decrease pain, temp, sensation in limbs/face.
    vestibular nuclei: vomiting, vertigo, nystagmus.
    nucleus ambiguus: dysphagia, hoarseness, decrease gag reflex.
    symp fibers: ipsi Horner’s syndrome.
  2. inferior cerebellar peduncle: ataxia, dysmetria
60
Q

lateral medullary (Wallenberg) syndrome

A

nucleus ambiguus effects specific to PICA lesion

61
Q

AICA stroke

A
  1. LATERAL PONS
    vestibular nuclei: vomiting, vertigo, nystagmus.
    facial nucleus: paralysis of face, decreased lacrimation and salivation, decreased taste from ant 2/3 of tongue, decreased corneal reflex.
    spinal trigeminal nucleus: decrease pain and temp sensation of face.
    cochlear nuclei: ipsi hearing loss.
    symp fibers: ipsi Horner’s syndrome
  2. middle and inferior cerebellar peduncles
62
Q

lateral pontine syndrome

A

facial nucleus effects specific to AICA lesions

63
Q

PCA stroke

A

occipital cortex and visual cortex: contralateral hemianopia with macular sparing

Neuro (15 decks)

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