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USMLE Neurology > Brain lesions, strokes, aphasia, aneurysms > Flashcards

Brain lesions, strokes, aphasia, aneurysms Flashcards

(54 cards)

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1
Q

What are the effects of a frontal lobe stroke?

A
  • Disinhibition + judgement affected
  • Deficits in concentration
  • Orientation affected
  • Possible reemergence of primitive reflexes
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2
Q

What way do the eyes look in a frontal eye field lesion?

A

Toward brain lesion

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3
Q

Where is the paramedian pontine reticular formation?

A

Nuclei in dorsal part of pons

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4
Q

The PPRF talks to the contralateral CNIII via what?

A

MLF

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5
Q

A lesion in the PPRF causes what?

A

Horizontal gaze palsy
- Eyes look away from brain lesion

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6
Q

What clinical finding will be found in a MLF lesion (e.g due to MS)?

A

Internuclear opthalmplegia
- Impaired adduction of ipsilateral eye
- Nystagmus of contralateral eye with abduction

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7
Q

Inability to write and perform maths (agraphia, acalculia) may occur with a lesion to where?

A

Dominant parietal cortex

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8
Q

What are the possible features of a lesion to the dominant parietal cortex?

A
  • Agraphia
  • Acalculia
  • Finger agnosia
  • Left-right disorientation
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9
Q

What syndrome may cause a dom. parietal cortex lesion (agnosia, acalculia)?

A

Gerstmann syndrome

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10
Q

Agnosia to the contralateral side of the world occurs with a lesion to where?

A

Non-dominant parietal cortex
- Hemispatial neglect syndrome (usually after stroke)

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11
Q

Anterograde amnesia or the inability to form new memories is caused by a lesion to where?

A

Hippocampus (bilateral)

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12
Q

What diseases may create lesions in the basal gnaglia?

A
  • Parkinsons
  • Huntington
  • Wilson
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13
Q

A lesion in the subthalamic nucleus will cause what?

A

Contralateral hemiballismus
- Hyperkinetic involuntary movement disorder characterized by intermittent, sudden, violent, involuntary, flinging, or ballistic high amplitude movements in arms, legs

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14
Q

Wernicke-Korsakoff syndrome is due to a lesion where?

A

Mammillary bodies (bilateral)

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15
Q

What are the features of Wernicke-Korsakoff?

A
  • Confusion
  • Ataxia
  • Nystagmus
  • Opthalmoplegia
  • Memory loss (anterograde, retrograde amnesia)
  • Confabulation, personality changes
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16
Q

What part of the brain is affected in Kluver-Bucy syndrome?

A
  • Amygdala (bilateral)
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17
Q

What are the features of Kluver-Bucy syndrome and what causes it?

A
  • Hyperphagia, hypersexuality, hyperorality
  • HSV-1 encephaitis
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18
Q

A lesion of the dorsal midbrain will produce what syndrome with what features?

A

Parinaud syndrome
- Vertical gaze palsy
- Pupillary light-near dissociation
- Lid retraction
- Convergence-retraction nystagmus

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19
Q

A reticular activating system (midbrain) lesion causes what?

A

Reduced levels of arousal and wakefulness (often from coma)

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20
Q

What are the effects of a cerebellar hemisphere lesion?

A
  • Intention tremor
  • Limb ataxia
  • Loss of balance
  • Ipisliateral deficits
  • Fall towards side of lesion
    Affects laterally
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21
Q

What are the effects of a cerebellar vermis lesion?

A
  • Truncal ataxia (wide-based, drunkedn-sailor gait)
  • Nystagmus
    Central lesion -> affects centrally
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22
Q

What is cerebellar vermis lesion associated with?

23
Q

Decorticate (flexor) posturing (flexion of arms, extension of legs) is due to a lesion where?

Study These Flashcards
A

Above the red nucleus

24
Q

Decerebrate (extensor) posturing (extension of arms, flexion of legs) is due to a lesion where?

Study These Flashcards
A

Below red nucleus

25
What are the most vulnerable areas of the brain furing hypoxia (watershed-areas)?
- Hippocampus - Neocortex - Cerebellum (purkinje) cells Vulnerable Hippos Need Pure Water
26
What kind of necrosis occurs in the brain as a result of stroke?
Liquefactive
27
How soon after onset of stroke is tPA given?
3-4.5 hrs after onset (if no risk of hemorrhage)
28
How soon after an attack do tPAs usually resolve within?
15 mins
29
Where does a neonatal intraventricular hemorrhage occur?
Germinal matrix (highly vascularised layer within subventricular zone)
30
What will be seen on US in neonatal hemorrhage?
Blood in ventricles
31
Why are neonates vulnerable to intraventricular hemorrhage?
Reduced glial supprt Impaired autoregulation of BP Decreased vit K
32
What is the most common site for a thrombus to form in the brain?
MCA
33
What kind of hematoma may cause transtentorial herniatio and CN III palsy?
Scalp hematoma
34
What kind of hematoma causes a biconvex (lentiform) blood collection which does not cross suture line?
Epidural hematoma
35
What kind of hematoma causes a crescent shaped hemorrhage crosses suture lines?
Subdural
36
What kind of hematoma will have a bloody or yellow (xanthochromic) LP?
Subarachnoid
37
What kind of hemorrhage will may cause vasospasms due to blood breakdown or rebleed 3-10 days after infarction?
Subarachnoid
38
What drug is used to prevent vasospams?
Nimodipine
39
What can intraparenchymal hemorrhages be caused by? (6)
- Systemic HTN (most commonly) - Amyloid angiopathy (recurrent lobar hemorrhagic stroke in elderly) - Vascular malformations - Vasculitis - Neoplasms - May be secondary to repurfusion injury in ischemic stroke
40
Where do intraparenchymal hypertensive (Charcot-Bouchard) hemorrhages most often occur?
- Putamen of BG (lenticulostriate vessels) Then: - Thalamus, pons, cerebellum
41
What are the symptoms of a lenticulostriate artery stroke?
- Contralateral paralysis - Absence of cortical signs (e.g. neglect, aphasia, visual field loss)
42
What is Central postroke pain syndrome?
Neuropathic pain due to thalamic lesions - Initial paresthesias followed in weeks and months by: - Allodynia (pain w/o stimuli) - Dysthesia (altered sensation) on contralateral side
43
How common is central postroke pain syndrome?
~ 10% of stroke patients
44
What is Diffuse axonal injury due to? (what kind of injury -> what does this cause)
Rapid acceleration/deceleration of the brain i.e motor vehicle accident Causes: - Traumatic shearing of white matter tracts -> vegatitive state / coma
45
What will be seen on MRI in Diffuse axonal injury?
Multiple lesions (punctate hemorrhages) involving white matter tracts
46
What is the difference between aphasia and dysarthria?
- Aphasia: higher order language deficit - Dysarthria: motor inability to produce speech
47
A patient is speaking in a 'word salad' that makes no sense what kind of aphasia do they have?
Wernicke (receptive) aphasia - Sup temporal lobe of gyrus
48
Conduction aphasia is due to a lesion where>
Arcuate fasiculus
49
What conditions are associated with saccular aneurysms?
- Aut Dom Polycystic Kidney Disease - Ehlers-Danlos syndrome
50
What kind of aneurysm will not be visible on angiography?
Charcot-Bouchard microaneurysm - Hemorhagic intraparenchymal stokes
51
What temperatures will heat stroke occur at usually?
> 40 deg C (104F)
52
What are the complications of heat stroke?
- CNS dysfunction (eg confusion) - End-organ damage - Acute respiratory distress syndrome - Rhabdomyolysis
53
What is the management of heat stroke patients?
- Rapid external cooling - Rehydration - Electrolyte correction
54
When can a seizure be considered status epilepticus?
> 5 mins or recurring seizures that may result in brain injury

USMLE Neurology (19 decks)

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