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Flashcards in Clinical and Identifying Lesions Deck (71)
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1

Describe the 4 clinical levels of nervous system

1. Supratentorial - cerebral hemispheres and intracranial portions of CN 1,2
2. Infratentorial - brainstem, cerebellum, intracranial portions of CN 3-12
3. Spinal: spinal cord
4. Peripheral: all CN, ANS, spinal nerves, dorsal and venral roots

2

Describe fnc of Suprtentorial level

Segmental:
vision
olfaction
language
memory
cognition
pituitary gland - autonomic funcs

Longitudinal:
S & M in face, trunk, limbs to CONTRALATERAL side
autonomic fncs via hypothalamus

3

Contralateral vs ipsilateal vs bilateral

contra: opposite side
ipsi: same side
bi: both sides

4

Describe supratentorial lesion

-loss of higher fncs
-increased intracranial pressure: headaches, altered mental state, nausea vomitting, papilledema, diplopia, aphasia, seizures, neglect, apraxia, visual field defects
-CONTRA defecits to face and body

5

Describe fnc of Infratentorial level

Segmental:
IPSIlateral fncs of CN 3-12
resp, cardiac
coordination (cerebellar)
postural control
consciousness, sleep

Longitudinal:
CONTRA sensory and motor to body
autonomic fncs

6

Describe infratentorial lesion

Cross signs: IPSIlateral face but contralateral body affected

7

Describe fnc of spinal level

Segmental: sensory, motor, autonomic at that level
Longitudinal: descending motor and autonomic; ascending sensory

8

Describe spinal lesion

-loss fnc at level (and below)
-dermatomal/myotomal distribution of loss
-BILATERAL deficits
-radicular pain, incontinence
-no face of CN deficits

9

Describe fnc of peripheral level

-sensory, motor, or autonomic of specific nerve
-no longitudinal fncs

10

Describe peripheral lesion

-IPSIlateral loss
-usually one side, localized
-pain
-motor weakness to muscles
-dermatomal sensory loss

11

Signs of Epidural hematoma? What type of imaging used?

-initially ok, then rapid onset - deteriorates within hours
-common: middle meningeal artery
-blood lentiform shape on imaging, held in place by periosteum and sutures
-CT

12

Signs of subdural hematoma? What type of imaging used?

-CT
-acute: acute blood is bright in subdural space, mass effect, midline shift
-subacute: blood broken down so now ISOdense so time has passed
-chronic: blood is darker than tissue

13

What is a coup vs contre-coup injury?

cerebral contusions
coup: injury under impact site
conte-coup: injury on opposite side due to motion of brain after impact

14

What is Myasthenia gravis? What are clinical manisfistations? Complications? Tests?

-autoimmune disease of NMJ
-IgG antibody binds nicotinic ACh receptor
-maybe due to thymus
-motor weakness due to decreased safety factor for AP threshold
-fatigability - better in morning
-ocular weakness: extraocular movements, ptosis, dipoplia (not pupils)
-bulbar: 9,10,11: disarthria, disphygia, slurred speech
-myasthenic crisis - resp failure
-test for diagnosis: give AChE inhibitor, ice pack on eye > improves symtoms

15

What is Lambert-eaton syndrome

-autoimmune - IgG against presynaptic Ca channels
> Ach vesicles not released
-muscle weakness
-gradual proximal > distal leg
-minimal ocular/bulbar symptoms
-Test for Dx: exercise improves symptoms
-Tx: blck Na channels to sustain depolrization > incrase cellular Ca

16

What is ALS? Signs and symptoms?

-amyotrophic lateral sclerosis
-degeneration of ant horn cells, cst, corticobulbar neurons
-UMN and LMN signs
-fasiculations, cramps, atrophy, dysarthri, dysphagia
-sensory adn eyes OK
-no cure, supportive therapy

17

What are examples of mononeuropathies?
signs?

-Entrapment: Carpal tunnel syndrome, meralgi paresthetica, femoral nerve entrapment
-Bell's palsy
-CN III palsy

Signs of neuropathy:
-distal weakness
-atrophy
-hyporeflexia
-sensory loss
-normal muscle enzymes
-nerve conduction study slowing

18

What is Guillian Barre Syndrome?

-demyleniation due to inflammatin
-ascending weakness from leg, sensory loss, bilateral facial palsies
-Rx: immune globulin

19

What are signs of myopathy? (vs neuropathy)

myopathy:
weakness proximal (affect larg muscles)
atrophy if advanced
normal reflexes until advanced
normal sensory
normal nerve conduction
increased muscle enzymes
muscle biopsy

20

Pyramidal vs extrapyramidal motor fncs:

Pyramidal:
issues with spastic tone, weakness, hyperreflexia

Extrapyramidal:
issues with involuntary movements, rigidity, brdykinesia
(no weakness, reflex issues)

21

What can cause postural instability?

Basal ganglia - parkinson's
Vestibulocerebellar
Vestibular
Visual
Proprioception

22

What is criteria for Parkinson's? for IPD?

-Bradykinesia + at least 1 of rigidity, rest tremor, postural instability
-at least 3 of: _ and no exclusions
unilateral first
70-100% response to ldopa
ldopa response more than 5 yrs
ldopa induced chorea
rest tremor
progressive degeneration
disease will last >10 yrs

23

4 Motor and 6 non-motor features of PD?

Motor:
-TRAP
-speech and bulbar dysfnc
-gait difficulties
-dystonia

Non-motor:
-sleep disturbances
-fatigue
-anxiety/depression
-cognitive slowing
-autonomic
-sensory - pain

24

What is pathology of parkinson's?

-dopaminrgic neurons in substantia nigra pars compacta die
-histo: see lewy bodies
-low Da > less inhibition on globus pallidus interna > more inhibition effect on thalamus > less activation of cortex
-this is already at stage 3 of degeneration when we clinical pick it up

25

What is the genetic link to PD?

many
ex: LRRK2 muttion - high in Ash. Jewish popn
Parkin mutation

26

What are Parkinson Plus disorders?

Other neurodegenerative diseses with parkinsonism features:
MSA
PSP
CBD
Wilson's - high Cu

27

What is MSA? Symptoms? what do we see on MRI?

Multi system Atrophy
-rarer than IPD
-type P (striato nigral)
-type C (cerebellar)
-type A (autonomic)
all progress to P

-orthostatic hyptotnesion
-urinary impotence
-rigidity - symmetric
-postural instability
-cerebellar issues
-midline dystonia
-stridor
-speech - high pitched
-swallowing
-dementia

-see atrophy of putamen - iron deposits. DARKer
-Hot cross bun sign on cerebellum - cross is WHITE

28

What is PSP? symptom? what do we see on imaging?

Progressive supranuclear palsy
-later onset >50yrs
-early falls
-symmetric bradykinesia
-difficulty swallowing, speaking
-axial rigidity
-GAZE

MRI: hummingbird sign - atrophy of midbrain

29

What is CBD?

Cortical Basal ganglion degeneration
-apraxia
-alien limb
-usually limb
-cortical sensory loss

30

What are 2ry causes of parkinsonism?

-Infection: encephalitis
-Drugs: antipsychotics, lithium
-infarcts
-tumours
-head injury
-hydrocephalus