CNS Flashcards
(124 cards)
1
Q
What goes into midbrain?
A
Mesencephalon
2
Q
What goes to pons and cerebellum?
A
Metencephalon
3
Q
What goes in medulla?
A
Myelencephalon
4
Q
What goes into Thalamus?
A
Diencephalon
5
Q
What goes into Cerebral hemispher?
A
Telencephalon
6
Q
What causes anecephaly?
A
Failure of anterior neural tube
7
Q
What findings do you see in ancephaly?
A
Increased AFP
8
Q
What labs do you see in neural tube defects?
A
Increased AFP
INcreased AChE
9
Q
What causes holoprosenphaly?
A
SHH genes
Weeks 5-6
Associated with FAS, adn PATAU
10
Q
What is Chiari II?
A
Herniation of cerebellar tonsils
Associated with aqueductal stenosis and HYDROCEPHALUS
11
Q
What is DANDY Walker?
A
Agenesis of cerebelleum
12
Q
What do you see in Syringomyleia?
A
A blanket distrubtion (cape like)
Dude to Chiari I malfornation
Trauma
Tumors
MOST Common C8-T1
13
Q
How does the tongue 2/3 anterior develop?
A
Arch 1: Sensation V
Arch 2: Taste VII
14
Q
How does the tongue posterior 1/3 develop?
A
Arch 3: Sensation IX
Arch 4: Taste X
15
Q
What are the roles of astrocytes?
A
Physical support K metabolism Repair Remove excess NTs BBB Glycogen fuel reserve
REACTIVE GLIOSIS
Derived from NEUROECTODERM
16
Q
What do you see in HIV encephalitis?
A
Multinucleated cells (fused microglial cells)
17
Q
How do you discern microglia?
A
Can’t see them by Nissl stain
18
Q
What is the predominant type of glial cell in teh White matter?
A
Oligodendroglia
Myelinates CNS
Fried Egg appearnce
From NEUROECTODERM
Injured in: MS
- PML
- Leukodystrophies
19
Q
What is the difference between C fibers and Adelta fibers?
A
C: slow unmyelinated
Adelta: Fast, myelinated
Both sense pain and temp (skin, epidermis, some viscer
20
Q
What is the difference between meissner corpuscles and Merkle discs?
A
Meissern adapt quickly (HAIRLESS SKIN)
- Fine/light touch, position sense
Merkle adapt slowly (Finger tips, superficial skin)
- Pressure, deep static touch, body poisition
21
Q
Where is NorEpi made?
A
LOCUS CERULEUS (Pons)
- Increased in ANXIETY
- Decreased in DEPRESSION
22
Q
Where is DOPA made?
A
Ventral Tegmentum (midbrain) Substantia Nigra pars compacta (midbrain)
Increased in Huntingons
Decreased in Parkinson
Decreased in Depression
23
Q
Where is 5-HT made?
A
Raphe nuclei (pons, medulla, midbrain
Decreased in Anxiety
Decreased in Depression
24
Q
Where is ACh Made
A
Basal nucelus of Meynert
Increased in Parkinson’s
Decreased in Alzheimer’s
Decreased in Huntingons disease
25
Where is GABA made?
Nucelus accumbens (reward center, pleasure, addiction, fear)
Decreased in anxiety
Decreased in Huntington's
26
How do glucose and AA make it across the BBB?
They are transported by Carrier mediated transport
Area postrema: No BBB, vomiting center
OVLT: Osmotic sensing
Neurohypophysis: Allows ADH secretion
Infarction destroys tight junctions: Vasogenic edema
27
What does the Supraoptic nucleus do of the Hypothalamus?
Makes ADH
28
What does the paraventricular nucleus of the hypothalamus do?
Makes OXYTOCIN
29
What does the hypothalamus do?
TAN HATS
```
Thirst
Adenohypophysis (ant. pit)
Neurohypophysis (post pit)
Hunger
Autonomic
Temp
Sexual
```
30
What does the lateral area of the hypothalamus do?
Regulates hunger
Inhibited by LEPTIN
Destruction: Anorexia
31
What does the VM area of the hypothalamus do?
Senses when you are full
Stimulated by Leptin
Destruction (craniopharyngioma): Eat too much (get fat)
32
What does the anterio hypo do?
Temp reg, COOLING
| Parasympathetic
33
What does you posterior hypo do?
It heats you up
Sympathetic
Become cold blooded if this is knocked out
34
What does the Suprachiasmatic nucleus do?
It regulates circadian rhythm
35
Circadian rhytm works how?
It regulates the release of ACTH, Prolactin, melatonin, norepi
SCN-NE-Pineal-Melatonin
Regulated by light
36
What happens during REM sleep?
EOM activated by PPRF (paramedian pontine reticular formation
Every 90minutes
Duration increases through night
37
What does alch, BZ, and Barbs do to sleep?
Decrease REM and Delta wave sleep (more tired feeling)
38
How do you treat bedwetting?
ADH (desmopressin)
39
What stage do night terrors, sleep walking and bedwetting occur?
Stage N3: delta wave
40
When does bruxism occur (grinding teeth)?
Stage N2: S wave
41
What is responsible for the 5 Fs?
Feeding, Fleeing, Fighting, Feeling, Sex
Limbic System (hippocampus, amygdala, fornix, mamm bodies, cingulate gyrus)
42
How does the cerebellum function?
Modulates movements
Input: contralateral cortex (middle peduncle)
- Ipsilateral proprioceptive from DCML through inferior peduncle
Output: Contralateral cortex
- Purkinje cells-Deep nuclei-contralat cortex via SUPERIOR PEDUNCLE
43
What is the order of deep nuclei lateral to medial?
Dentate, emboliform, globose, fastigial (DONT EAT GREASY FOOD)
44
What happens in a ipsilateral lesion of cerebellum?
Ipsilateral falls
45
What happens in medial lesions?
Truncal ataxia (wide based gait), nystagmus, head tilting,
bilateral motor deficits
46
How does D act on the basal ganglia?
Inhibitor has D2 receptor: Inhibits activation when DA comes
Stimulator has D1 which activate it that causes movement
47
What is athetosis?
Slow writhing movements
Lesion in Basal ganglia
48
What is chorea?
Sudden jerky movements
Lesion is Basal ganglia (huntingtons)
49
What is essential tremor?
High frequency tremor (sustained posture)
Worsened with movement
- Treatment: B blockers, primidone
50
What is dystonia?
Sustained involuntary contractions
Writer's crap
- Blepharospasm (eyelid twitch)
51
What is hemibasllismus?
Sudden wild flailing
Contralater subthalamic nucleus (LACUNAR STROKE)
Contralateral lesion
52
What is intention tremor?
Slow zigzag motion with extension or pointing
Cerebellar dysfunction
53
What is myoclonus/
Sudden brief uncontrolled contraction
| Hiccups: Renal liver failure, or metabolic disturbance
54
What is resting tremor?
Uncontrolled movement of distal appendage, alleviated by intentional movement
Seen in Parkinson's disease
occurs as pill rolling tremor
55
What are characteristics of Huntington's disease?
Chorea,
Depresion
Agitation
Dementia
Increased DA
Decreased GABA
Decreased ACh
Atrophy of caudate nucleus (ex vacuo dilation)
CAG repeats (Chromosome 4)
56
What is Kluver Bucy Syndrome?
Lesion of AMYGDALA
HSV-1 encephaltis
HYPERPHAGIA, Hypersexual, Hyperorality
57
What happens in frontal lobe lesion?
Deficit in concentration, orientation, judgment,
reemergence of primitive reflexes
58
What happens if non dominant parietal temporal complex hurt?
Get hemispatial neglect (agnosia of contralateral side of the world
59
What happens if dominant parietal temporal complex hurt?
Agraphia, Acalculia, Finger agnosia, Left-right disorietnation
GERSTMANN SYNDROME
60
What is RAS hurt?
Midbrain
| Reduced levels of arousal/wakefulness
61
What happens in Wernicke Korsakoff syndrome?
Due to thiamine deficiency (B1)
```
Confusion
Opthalomplegia
Ataxia
Memory loss
Confabulation
Personality chagnes
```
62
What happens if subthalamic nucleus hurt?
Contralateral hemiballism
63
What is paramedian pontine reticular formation hurt?
Eyes look away from lesion
64
What is Frontal eye fields are hurt?
Look towards the lesion
65
What ventilation intervention helps in Increased ICP situations?
Hyperventilation, decreased pCO2 helps lower ICP
- What causes fainting in Hyperventilation attacks (anxiety)
Brain perfusion most regulated by pCO2
- Lower the CO2 the lower the CBF
66
How do you calculate Cerebral perfusion pressure (CPP)?
CPP= MAP-ICP
If CPP=0 then there is no perfusion, equals death
MAP: 2/3 diastolic+1/3 systolic
67
What is the most common cause of stroke in the lenticul striate artery?
Hit the midbrain (contralaeral hemiparesis and hemiplegia)
Due to HTN mostly
68
What does a stroke in the ASA produce?
Medial Meullary Syndrome (contralateral hemiparesis and contralateral proprioception
Ipsilateral hypoglossal dysfunction (lick your wounds)
69
What happens if PICA hit by stroke?
Lateral medullary syndrome (wallenburg)
Don't PICK a HORSE (hoarseness) that can't eat (dysphagia)
Vomiting, vertigo, nystagmus, decreased pain and temp (ipsilateral face, contralateral body, dysphagia, hoarseness, decreased gag reflex, ipsilateral HORNER's, ataxia, dysmetria
Lateral medulla
Inferior Cerebellar peduncle
70
What if AICA hit by stroke?
Lateral Pontine Sydrome
Hits the lateral pons (CN nuclei, vestiulbar nuclei, facial nucleus, ST nucleus, cochlear nuclei, sympathetic fibers)
Vomiting, vertigo, nystagmus
paralysis of face
71
What if PCA hit?
OCcipital cortex
Visual cortex
Contralateral hemianopia with macular sparing
72
What happens if basilar artery is hit?
Pons, medulla, lower midbrain, Corticospinal/bulbar hit, ocular crainial nerves, paramedian pontine reticular formation
Preserved conciousness but LOCKED IN
73
What is ACom hit?
Most common site of aneurysm
Saccular berry aneursm (visual field defect)
74
What is PCom hit?
Common site of saccular aneurysm
CNIII palsy, down and out with ptosis and mydriasis
75
What is the disease associated with saccular aneurysms?
Ehlers'Danlos syndrome
ADPKD
RF: advanced age
HTN
Smoking
Black
76
What causes central post stroke pain?
Neuropathic pain due to thalamic lesions
Initial paresthesias followed by ALLODYNIA (pain at non painful stimulus) dysesthesia (abn sensation)
10% stroke
77
How long until irrevesrible damage seen in brain?
5 minutes of hypoxia
78
What are the most vunerable spots to ischemia?
Hippocampus
Neocortex
Cerebellum
Watershed zones
Must do non contrast CT to make sure it's not hemorrhagic before giving thrombolytics
79
What do you see in 12-48 hours of infarct?
Red Neurons
80
What do you seen in 24-72 hours post infarct?
Necrosis, PMNs
81
What do you see in 3-5 days?
Macrophages (microglia
82
What do you see in 1-2 weeks?
Reactive gliosis, vascular proliferation
83
What do you see in greather than 2 weeks?
Glial Scar (looks like empty portion)
84
When do you give tPA in ischemic stroke?
3-4.5 hours post onset
Reduce risk with medical therapy: aspirin, clopidogrel
- Optimum control of BP, blood sugars, lipids,
Treat conditions that increase risk (afib)
85
What is the order of CSF in brain?
Lateral ventricles-- Foramen of Monro-- 3rd ventricle--cerebral aqueduct--4th ventricle -- Subarachnoid via (lateral is lushka, media is magendie)
86
What lesion in the spinal cord is caused by 3 syphilis?
Tabes dorsalis
Degeneration of DCML
Charcot joints, shooting pain, argyll roberston pupils (reduce to accomodation but NOT light)
Exam: Positive romberg test but no DTRs
87
What causes Friedreich ataxia?
```
GAA repeat (chromosome 9)
Frataxin (iron binding protein)_
Impaired mitochondria
Degenration of spinal tracts
Staggering gait
Frequent Falls
DM
Hypertrophic CARDIOMYOPATHY
```
kyphoscoliosis
88
What is Spinal Muscular Atrophy (Werdnig-Hoffman disease)?
Congenital degeneration of AH of spinal cords- LMN lesion
FLOPPY BABY
Marked hypotonia with tongue fasciulations
Autosomal recessive
Age of death 7 months
89
Which nuclei are medial?
III, IV, VI, XII (purely motor)
90
What do the superior colliculi do?
Vertical Conjugate gaze
91
What do inferior colliculi do?
Auditory
92
What is parinaud syndrome?
Paralysis of Vertical conjugate gaze due to lesion of superior colliculi
(stroke, pinealoma, hydrocephalus)
93
What goes through the foramen rotundum?
V2
94
What goes through the foramen ovale?
V3
95
What goes through the superior orbital fissure?
CN III, IV, VI, V1, opthalmic vein, sympathetics
96
What goes through the optic canal?
CNII, Opthal artery, central retinal vein
97
What are the vagal nuclei?
Nucleus solitarius (Visceral Sensory, inormation (taste), baroreceptors, gut distension) VII, IX, X
Nucleus aMbiguus (motor innervation of pharynx, larynx, upper esophagus (IX, X, XI)
Dorsal motor nucleus: Parasympathetics to heart, lungs, upper GI X
98
What nerves sit inside the Cavernous sinus?
III, IV, VI, V1, V2
Internal carotid artery
Postganglionic sympathetic fibers pass through also
99
What is Cavernous sinus syndrome?
Opthalomoplegia
Decreased Corneal sensation (V1 missing)
Horner Syndrome (sympathetic go through)
Decreased Maxillary sensation
Due to pituitary tumor that has grown too big
Carotid cavnerous fistula
Or Cavernous sinus thrombosis due to Infection
CN VI is most susceptible to injury ( lateral rectus)
100
Which sounds hit the base of the cochlea?
High Frequency sounds Thin and Rigid
Low frequency hit the apex (near helicotrema) becuase they hair are wide and flexible
101
What are the test results for Conductive hearing loss?
Rhinne: Abnormal (bone >air)
Weber: Localizes to affected ear
102
What are the test results of sensoneural hearing loss?
Rinne test: Normal (air>bone)
| Weber: Localizes to unaffected ear
103
What diseases are associated with bell's palsy/
```
Lyme
Herpes
Herpes zoster (Ramsay hunt syndrome)
sarcoidosis
Tumors
Diabetes
```
Treatment: Corticosteroids
104
What are associated with uveitis?
Inflammatory conditions (IBD)
HLA-B27 stuff
Sarcoidosis
Rheumatoid arthritis
Juvenile idiopathic arthritis
105
What is seen in dry Macular degeneration?
Deposits of yellow extracellular material
Retinal Pigment epi (drusen)
Prevent: MULITVITAMIN
106
What is seen in wet macular degeneration?
Choroiddal neovascularization
Treat: anti-VEGF (ranibizumab) or laser
107
What are the types of Diabetic retinopathy?
Chronic hyperglycemia
Nonproliferative: Damaged capillaires leak blood
- Treat: Control blood sugar, macular laser
Proliferative: Chronic hypoxia results in NEW BVs
- Treat: photocoag, anti-VEGF
108
What do you see in Central retinal artery occlusion?
Painless monocular vision loss
| Retinal cloudy with CHERry RED SPOT
109
What happens in retinitis pigmentosa?
Starts with Night Blindness
(Rods affected first)
Bone spicule-shaped deposits
110
What causes retinitis?
CMV, HSV, HZV
Associated with immunosuppression (AIDS, corticosteroids)
111
What nucleus is associated with miosis/
Edigner westphal nucleus to short ciliary nerves to sphincter muscles
112
How does mydriasis work?
1rst neuron: Hypothalamus to ciliospinal C8-T2
2nd Neuron: Exit at T1 to superior cervical ganglion (travels near apex of lung)
3rd Neuron: Plexus along internal carotid, through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilator muscles
- Innervated smooth muscle of eyelids as well and sweat glands of forehead and face
113
What is a Marcus Gann Pupil?
Afferent pupilary defect
Optic nerve damage or severe retinal injury
Decrease in bilateral pupillary constriction when light is shone in affected eye (test with swinging light test)
114
What causes CNIII damage?
Both Motor and Parasympathetic components
Motor: Affected by vascular disease (DM: glucose-sorbitol) due to difficusion of inferior fibers
Parasympathetic: PCA aneurysm, uncal herniation
-Diminished or absent pupillary light reflex, blown pupil (down and out gaze)
115
What happens in CN IV damage?
Eyes upward (contralateral gaze) head tilt towards side of lesion Cant go down stairs)
116
What happens in CN VI damage?
Medialy directed eye that can't abduct
117
What are disease modifying drugs in MS?
B-interferon, natalizumab
Treat acute flares with IV steroids
Symptomatic treatment: Neurogenic bladder (catheter, muscarinic antagonist
- Spasticity: Baclofen, GABAb receptor agonist
- Pain: Opioids
118
What happens in Krabbe Disease?
Lysosomal storage disease
Deficiency in galactocerebrosidase, buildup of galactocerebroside that destroys myelin sheath
Periphearl neuropathy, developmental delay, optic atrophy, globoid cells
119
What happens in metachromatic leukodystrophy?
Lysosomal storage disease
AR
Most commonly due to arylsulfatase A deficiency
Buildup of sulfatides- impaired production and destruction of myelin sheath
Central and peripheral demyelination with ATAXIA, DEMENTIA
120
What is Charcot-Marie-TOOTH disease?
Autosomal Dominant
Defective production of proteins involved in structure of peripheral nerves or myelin sheath
Scoliosis and Foot deformities (HIGH/FLAT arches)
121
What is adrenoleukodystophry?
X linked genetic
Disrupts metabolism of VLC fatty acids
Excessive buildup in nervous system, adrenal glands
Progressive disease that leads to long-term coma/death with adrenal gland crisis
122
Sturge Weber syndrome
Congenital disorder (non inherited)
Neural crest derivative anomaly
Activating mutaiton of GNAQ
```
Port wine stain on face
Ipsilateal leptomeningeal angioma
Seizures/epilepsy, intellectual disability, episcleral hemangioma
Increased IOP
Early onset glaucoma
```
123
Tuberous sclerosis
```
HAMARTOMAS
Hamartomas of CNS, skin
Angiofibromas
Mitral regurg
Ash-leaf spots
Cardiac Rhabomyoma
AUTOSOMAL DOMINANT
Mental retardation
```
124
NF1
```
Cafe au lait spots
Lisch nodules
Cutaneous neurofibromas
Optic gliomas
Pheochromocytomas
```
Mutated NF1
AD
Chromosome 17, neurofibromin reg of RAS
