Nervous System

Question 1

70-80% of all cerebrovascular accidents are?

Answer 1

Acute Ischemic Brain Infarct (Stroke)… 60 yr old men

Question 2

Acute Ischemic Brain Infarct (Stroke) most common cause?

Answer 2

• **Cerebral atherosclerosis

- other causes are embolization from left cardiac chamber, thrombosis from carotid artery

Question 3

Hemorrhagic infarct occurs when there is?

Answer 3

bleeding into the area of infarction

Question 4

Most common sites of Primary Brain Parenchymal

Hemorrhage are?

Answer 4

 Basal Ganglia (70%)
 Cerebellum
 Pons region of brainstem

Question 5

three types of Intracranial Hemorrhage?

Answer 5

1. Primary brain parenchymal hemorrhage
2. Subarachnoid hemorrhage
3. Vascular malformations

Question 6

Transient Ischemic Attacks

(TIAs) caused by?

Answer 6

small atheromatous emboli or platelet-fibrin aggregates

Question 7

Transient Ischemic Attacks

(TIAs) is an important predictor of?

Answer 7

subsequent infarction.
— 1/3 of patients with TIAs will develop cerebral infarcts
within 5 years.

Question 8

Primary Brain Parenchymal

Hemorrhage most common cause?

Answer 8

Hypertension
– Associated with 50% of
cases.
—causes hyaline arteriosclerosis in small vessels making them more prone to rupture

Question 9

Most common cause of

SAH is rupture of

Answer 9

saccular (berry) aneurism
– 80% in internal carotid artery (circle of Willis)
– 20% in vertebrobasilar
artery system

Question 10

What is seen secondary to reperfusion of ischemic tissue or after dissolution of intravascular occlusions?

Answer 10

Hemorrhagic infarct

** Acute Ischemic Brain Hemorrhagic Infarct (Stroke)

Question 11

Epidural (Extradural) Hemorrhage (Hematoma) cause?

Answer 11

tearing of the middle meningeal artery

Question 12

Contusion

Answer 12

Hemorrhages in superficial brain parenchyma caused by blunt trauma

Question 13

Subdural Hemorrhage (Hematoma) tears occur where?

Answer 13

in bridging veins of meninges, NOT an artery as in epidural hematoma

Question 14

Subdural Hemorrhage (Hematoma) often associated with?

Answer 14

brain atrophy – greater vein mobility

Question 15

define Concussion

Answer 15

A clinical, not pathologic entity

• *ANATOMIC LESIONS NOT SEEN
• temporary damage to the reticular activating system

Question 16

Subdural Hemorrhage (Hematoma) between?

Answer 16

dura mater and arachnoid mater

Question 17

1) Epidural (Extradural) Hemorrhage (Hematoma) commin in?
2) Acute Ischemic Brain Infarct (Stroke)
3) Subarachnoid Hemorrhage
Saccular or “berry” Aneurism
4) Subdural Hemorrhage (Hematoma)
5) Multiple Sclerosis

Answer 17

1) children
2) 7th decade and in males
3) Women before 50
4) older peeps on anticoagulants and infants with thin walled veins
5) female 20-40

Question 18

What may have a “lucent” period followed by rapid clinical deterioration cerebral edema and herniation?

Answer 18

Epidural (Extradural) Hemorrhage (Hematoma)

*** neurosurgical emergency!

Question 19

Coup contusion vs Contrecoup contusion

Answer 19

Coup contusion – site of
blow

Contrecoup contusion –
opposite the site of impact

Question 20

Aseptic meningitis

Answer 20

Lymphocytic (Viral) Meningitis

Question 21

Acute Pyogenic Meningitis
vs Lymphocytic (Viral) Meningitis spinal fluid

Answer 21

acute= Neutrophils increased, glucose decreased

Lymphocytic (Viral)= glucose normal, no bacteria, no neutrophiles, lymphcytes increased

Question 22

true or false… Lymphocytic (Viral) Meningitis is self-limiting

Answer 22

true

*Usually self-limiting as opposed to those caused by bacteria and fungus

Question 23

Chronic Meningitis caused by normally? what is HIV present?

Answer 23

Mycobacterium tuberculosis

*immunodeficiency present= Crytococcus

Question 24

Viral Encephalitis examples?

Answer 24

• • Arboviruses - short for arthropod-borne virus.
• • West Nile virus, a flavivirus, best known
• • St. Louis & California encephalitis, western andeastern equine encephalitis

Question 25

Herpes simplex I (HSV)

Answer 25

* most common cause of sporadic viral encephalitis in USA * Causes hemorrhagic * necrotizing encephalitis * treat with antiviral agents * * 1/3 of infections

Question 26

Herpes simplex 2 (HSV)

Answer 26

* neonates born to women with active genital lesions * Devastating encephalitis * 2/3 of infections

Question 27

Anencephaly

Answer 27

hypoplastic or absentcranial vault

Question 28

Sina Bifida

Answer 28

incomplete closure of embryonic neural tube

Question 29

in Neural Tube Defects what is elevated in respect to gestational age?

Answer 29

Maternal alpha fetoprotein

Question 30

One of the most malignant | of all tumors, but rarely metastasizes?

Answer 30

Astrocytoma – “Glioblastoma Multiforme”

Question 31

Arises from nerve sheath cells?

Answer 31

Acoustic Schwannoma (Neuroma) -Schwann cells of cranial nerve VIII within the external auditory canal - dizzy, hearing loss, NF-2

Question 32

most common demyelinating | disease? involves what?

Answer 32

Multiple Sclerosis | ** Autoimmune disease involving T-cell mediated injury to myelin sheaths

Question 33

Demyelinated areas called

Answer 33

plaques

Question 34

most common cause of | dementia in the elderly?

Answer 34

Alzheimer’s Disease | (HIV most common cause in young adults in the USA)

Question 35

Involves dopamine secreting neurons of the substantia nigra

Answer 35

Parkinsonism

Question 36

Lou Gehrig’s disease

Answer 36

``` Progressive degenerative disorder involving the upper & lower motor neurons of the pyramidal system. *** Motor neuron disease ```

Question 37

Lou Gehrig’s death from?

Answer 37

respiratory insufficiency and infections

Question 38

most common life-threatening diseases of the | peripheral nervous system?

Answer 38

Guillain-Barre Syndrome

Question 39

“Pill rolling” tremor

Answer 39

Parkinsonism

Question 40

1) Type I (NF-1) aka? | 2) Type 2 (NF-2) aka?

Answer 40

1) von Recklinghausen disease 2) bilateral acoustic or central neurofibromatosis

Question 41

Hyperphosphorylated “Tau” | protein and extracellular Beta Amyloid plaques?

Answer 41

Alzheimer’s Disease

Question 42

Neurofibromatosis Type 1

Answer 42

- most common - chromo 17 - cafe-au-lait spots - overactivity of the RAS oncogene - oral neurofibromas, enlarged fungiform papillae and mandibular foramina

Question 43

Lisch Nodules | Dendritic Melanocytic Hamartomas

Answer 43

Neurofibromatosis Type 1 (NF-1)

Question 44

Neurofibromatosis Type 2

Answer 44

-chromo 22 - disrupts normal tumor suppressor function - affects merlin - Neurofibromas rarely found - Bilateral acoustic neuromas (schwannomas) involving VIII nerve leading to hearing loss - Café au lait spots and Multiple meningiomas (benign tumors of the meninges)