Structural pathology of Wernike Encephalopathy?
Mamillary body necrosis
Temporal lobe encephalitis is caused by what kind of infection?
Herpes virus infection
Rapidly progressive dementia + myoclonic jerks =
4 tumors that form psamomma bodies
-Meningioma -Papillary thyroid carcinoma -Mesothelioma -Papillary serous carcinoma of the ovary or endothelium
Slow growing + Well circumscribed + Intracranial mass + Whorled pattern of cellular growth + Psamomma bodies =
S-100 positive tumors (2) What does it indicate?
-Schwannoma -Melanoma Indicates that it is of neural crest cell origin
Elongated cells + Regular oval nuclei + Biphasic growth pattern + S-100 positive =
Relapsing and remitting ocular problems and tingling + worse after heat =
-Ocular problems = optic neuritis, internuclear opthalmoplegia
Complication of a subarachnoid hemorrhage =
How does it present =
Presents as new onset confusion or focal neurological deficit. Not seen on CT.
Drug to prevent subarachnoid hemorrhage complication and its mechanism.
Nimodipine - selective Ca channel blocker
Cystic cavities in the brain are lined by =
Diagnosis of tetanus is made via
History and Physical only
Ascending (flaccid) paralysis after a febrile illness is what disease?
Guillain-Barre disease microscopic pathology
Endoneurial inflammatory infiltrate of macrocytes and lymphocytes
Hemangioma in the retina and/or cerebellum + Congenital cysts/neoplasms in the kidney, liver or pancreas =
Von Hippel Lindau
Cystic tumor in the cerebellum of a child =
Which kind of aneurysm rupture results in -> deep intraparenchymal hemorrhage + focal/acute neurological deficits + hypertension?
Rupture of _ results in a subdural (crescent shaped) hematoma + gradual onset of symptoms
cortical bridging veins
Wernike Syndrome triad = Reversible with _ treatment
Ocular dysfunction Ataxia Confusion Reversible with Thiamine treatment
Korsakoff Syndrome symptoms (2) =
Permanent memory loss
Young child + Precocious puberty + Perinaud syndrome + Obstructive hydrocephalus =
Perinaud Syndrome definition
paralysis of upward gaze
Transtentorial (uncal) herniation symptoms (3)
-Ipsilateral CN III damage => oculomotor nerve palsy + fixed/dilated pupil
-Contralateral LCST damage/Ispislateral cerebral peduncle damage
-Ipsilateral PCA damage => occipital cortex damage
What is the term for: monocular vision loss + pain on eye movement + afferent pupillary defect?
First area damaged by global cerebral ischemia
Pyramidal cells of the hippocampus
Cerebellar ataxia + Loss of position/vibration + Kyphoscoliosis + Hypertrophic cardiomyopathy =
Definition - xanthochromia
blood in the CSF
Definition - lissencephaly
Congenial absence of gyri on the brain. Clinically associated with severe mental retardation.
Definition - Hydrocephalus ex vacuo
Ventricular enlargement due to brain atrophy. Not accompanied by an increase in CSF pressure.
Etiology of Paraneoplastic Cerebellar Degeneration?
Most common CNS tumor in immunocompromised patients
Primary CNS lymphoma associated with EBV infection
Definition - Argyll Robertson pupils
small, irregularly shaped pupils that DO NOT react to light but DO constrict with accomodation
Vitamin E deficiency closely resembles what neurological disease?
Childhood cerebellar tumors (2)
-Medulloblastoma -Pilocytic Astrocytoma
Muscles most often affected in myasthenia gravis?
Extraocular muscles -> ptosis, diplopia
Nerve controlling hiccups?
Where does the phrenic nerve arise and innervate?
Arises from C3-C5 Innervates the diaphragm ipsilaterally
Symptoms of Normal Pressure Hydrocephalus (NPH) (3)
"Wacky, Wobbly, Wet" -dementia -ataxic gait -urinary incontinence
Term for abnormally slow relaxation of muscles
Alzheimer's disease: Where in the brain has markedly reduced acetylcholine levels? (2)
-Nucleus basalis of Meynert -Hippocampus
Acyclovir is used to treat what type of infections?
Osmotic demyelination occurs in what brain structure?
central pons "Central Pontine Myelinolysis"
Opsoclonus-Myoclonus syndrome is associated with what tumor?
How to get decerebate (extensor) posturing?
Lesion to the brainstem at/below the level of the red nucleus (rostral midbrain)
How to get decorticate (flexor) posturing?
Lesion to the brainstem above the level of the red nucleus (rostral midbrain) ex: cerebral hemisphere
"Endoneurial inflammatory infiltration" refers to what disease?
"Endoneurial arteriolar hylanization" refers to what disease?
Diabetic microangiopathy of endoneurial arterioles. Leads to nerve ischemia and peripheral neuropathy.
Most common CN affected by diabetic mononeuropathy = Symptoms (3) =
CN III -> acute onset diplopia + down and out position of the eye + ptosis
Pathology of Diabetic Mononeuropathy of CN III
Ischemic nerve damage to the core of the nerve, therefore affecting only the somatic fibers, not the autonomic/parasympathetic fibers. Pupillary reflex stays intact.
Viruses that invade the dorsal root ganglia and their locations (3)
HSV 1 - above the waist HSV 2 - below the waist, genital region VZV - thoracic or trigeminal dermatomes
Waterhouse-Friderichsen Syndrome =
N. meningitidis infection leading to DIC, septic shock and hemorrhagic destruction of the adrenal glands
Patients with Neisseria infections have what kind of immune impairment?
C5-C9 deficiency which leads to an inability to form the MAC
Definition - Synaptophysin
Protein found in the synaptic vesicles of neurons, neuroendocrine cells and neuroectodermal cells. CNS tumors of neuronal origin are synaptophysin positive.
2 main causes of ring-enhancing lesions in HIV patients
-Toxoplasma gondii - multiple lesions
-Primary Central Nervous System Lymphoma (PCNSL) - solitary, due to EBV
Congenital toxoplasmosis symptom triad =
-Hydrocephalus -Intracranial calcifications -Chorioretinitis
1 year old full term infant brought into ED with a large and full anterior fontanelle and bilateral retinal hemorrhages. Mom says baby rolled off bed. What is the diagnosis?
Abusive head trauma.
Name the muscles in the ear and their innervation (2)
-Stapedius muscle - CN VII -Tensor tympani muscle - CN V
Sciatic nerve spinal roots
Role of axillary nerve (3)
-Motor to deltoid muscle -Motor to teres minor muscle -Sensory to skin over lateral shoulder
Lesion to what nerve(s) cause = contralateral spasticity + hyperreflexia + paresis?
What nerve is at risk during an appendectomy? What does that nerve innervate?
Illiohypogastric nerve. It innervates -motor to anterolateral abdominal muscles -anterior branch - sensory to the skin above the pubic region -lateral branch - sensory to the skin of the gluteal region
Injury to the R temporal lobe results in what kind of visual defect?
Injury to Meyer's loop that carries the lower retinal fibers that contain information from the upper visual field. Contralateral superior quadrantanopia = "pie in the sky defect"
What are the changes seen in the "axonal reaction" (4)
-Cell swelling -Nucleus moves into periphery -Nissl substance displaced throughout cell -Increased protein synthesis
What is a "Marcus Gunn pupil"?
-Caused by optic nerve damage or retinal injury -When light is shone into the affected eye, there is decreased bilateral light reflex (decreased pupillary constriction) -Tested with "swinging flashlight test"
3 D's of Botulinum Toxin ingestion?
-Diplopia -Dysphagia -Dystonia
Innervations of CN V =
V1 = opthalmic branch -> eye sensation V2 = maxillary -> muscles of mastication V3 = mandibular -> anterior 2/3 tongue sensation
What nerve is responsible for foot drop + steppage gate?
Common peroneal nerve Spinal roots L4-S2
What is the motor function of the obturator nerve?
Adduction of the thigh Spinal roots L2-L4
When preforming an interscalene nerve block to anesthetize the brachial plexus, what other nerve is involved?
The phrenic nerve also passes through the interscalene sheath
What two thing are measured to detect a neural tube defect?
-Alpha-fetoprotein = in the amniotic fluid and maternal serum
-Acetylcholinesterase = in the amniotic fluid
Vocal cords are controlled by what nerve?
CN X - Vagus nerve, Recurrent laryngeal nerve branch
Main antigenic component of N. meningitidis?
Most common cause of spontaneous lobar hemorrhages in the elderly?
Amyloid angiopathy - caused by A-beta amyloid deposition in the walls of vessels.
Common brain locations of amyloid angiopathy hemorrhages (2)
-Occipital lobe -> homonymous hemianopsia -Parietal lobe -> contralateral hemisensory loss
Nerve most commonly affected by ill-fitting crutches ("crutch palsy")
Radial nerve Spinal roots C5-T1
Rathke's pouch is derived from?
Ectoderm -> surface ectoderm
Posterior pituitary is derived from?
Ectoderm -> neural tube
What is the "length constant/space constant" of a nerve?
A measure of how far along an axon an electrical signal can propagate. Smaller constant = Less propagation distance
What is the "time constant" of a nerve?
A measure of the time it takes to change the membrane potential. Smaller constant = Faster membrane potential change time
Location of a femoral nerve block?
Patients with Down Syndrome are at an increased risk for what neurological disease?
Early onset Alzheimer's disease
Area Postrema - location and function
Location = dorsal surface of the medulla at the caudal end of the 4th ventricle Function = samples chemicals in the blood, chemoreceptor trigger zone, controls vomiting
Treatment for essential tremor =
What is the main distinguishing feature of Atypical depression compared to Major depression?
Mood reactivity - a positive event WILL improve mood of someone with atypical depression
Pellagra - cause and symptoms
Cause = Niacin deficiency Symptoms = dementia, dermatitis, diarrhea
Class of drug prescribed for insomnia without depressive symptoms =
Definition of pica
Compulsive consumption of a non-food or non-staple food source for >1 month. Seen in pregnancy and school children. May be associated with a nutritional deficiency. Substances consumed: -earth/soil -raw starch (flour, cornstarch) -ice
Which antidepressant has the side effect of painful erections for >4 hours?
First line treatment for Bulimia nervosa?
First line treatment for PTSD?
First line treatment for OCD?
a=optic chiasm (CN II)
b=oculomotor nerve (CN III)
c=trochlear nerve (CN IV)
d=abducens nerve (CN VI)
e=opthalmic nerve (CN V1)
f=maxillary nerve (CN V2)
g=anterior cerebral artery
f=internal carotid artery
35 year old male, increasingly depressed, grimaces intermittently, rigid jerking and purposeless movements of the fingers, increasingly impulsive
Constipation that is not reversible with over the counter laxatives. Malfunction of which nerve =
Pelvic splanchnic nerve innervates the anal sphincter
“Pelvic splanchnic 2-4 keeps the shit above the floor”
Sudden onset R arm weakness + difficulty speaking + no other symptoms + completely resolved in 20 minutes
tremor that is alleviated by intentional movement is seen in what disease
slow, zig zag tremor when pointing/extending towards a target.
problem is located where?
Sleep terrors occur during _ sleep.
Nightmares occur during _ sleep.
Sleep terrors - slow wave sleep (non-REM therefore no recollection)
Nightmares - REM sleep
Somatic symptom disorder - unconscious or conscious?
Conversion disorder (Functional neurological symptom disorder) - unconscious or conscious?
Unconscious - patient seems indifferent to the symptoms but the symptoms are debilitating
Malingering - unconscious or conscious?
Conscious - looking for secondary gains
Munchausen syndrome or Munchausen syndrome by proxy - unconscious or conscious?
Conscious - looking for primary gain of attention
Person who is preoccupied with needing things a certain way, needs to control everything around them and that is "just the way they are"
Obsessive compulsive PERSONALITY
Person with compulsions that they know are not reasonable btu they cannot help but do them (inconsistent with their own beliefs)
Obsessive Compulsive DISORDER
Mild depression (at least 2 SIG E CAPS symptoms)
Lasts at least 2 years
Symptoms of Major Depressive Disorder
SIG E CAPS - need at least 5 for at least 2 weeks
loss of Interest (anhedonia)
Guilt/feelings of worthlessness
Appetite/weight changes (loss)
Psychomotor retardation or agitation
Patient must also report depressed mood
Milder bipolar disorder
Fluctuates beween minor depression and hypomania
Lasts at least 2 years
Hypomania + Depression
At least 1 manic episode with or without hypomania or depression
Note: depressive symptoms do not have to be present for the dx to be made
Same as mania (DIG FAST) except the mood symptoms are not severe enough to cause marked impairment
No psychotic features
Lasts 4 consecutive dasy
DIG FAST - need at least 3 and needs to markedly impair functioning
Flight of ideas
increased in goal-directed Activities/Agitation
decreased need for Sleep
Hallucinations or delusions without a major mood episode + periods of concurrent mood episode with schizophrenic symptoms lasting for > 2 weeks
There are no periods of time when there is just the mood disorder. There must be times when there are just schizophrenic symptoms though.
- Flat affect
- Social withdrawal
- Lack of motivation
- Lack of speech or thought
Negative symptoms of Schizophrenia
Treated with second generation anti-psychotics
- Hallucinations (auditory)
- Disorganized speech
- Disorganized/Catatonic behavior
Positive symptoms of Schizophrenia
Treated with both first and second generation anti-psychotics
Dementia ECG - normal or abnormal?
Waxing and waning consciousness + acute onset + abnormal ECG =
Dissociative amnesia =
Unable to recall important personal ifnormation subsequent to a severe trauma or stress
Girl who at age 3 begins to developmentally regress and loses verbal skills. Begins to have ataxia and wrings her hands constantly.
-X linked dominant- males die in utero
Withdrawal symptoms - hypersomnolent, hyperphagic, withdrawn, psychomotor retardation, vivid dreams =
-Breif psychotic disorder
-Breif psychotic disorder = <1 month
-Schizophreniform disorder = 1-6 months
-Schizophrenia = >6 months
Medulla - nuclei of CN IX, X, XII
Pons - nuclei of V, VI, VII, VIII
The presence of what proteins increases the risk for early onset Alzheimer's?
- APP (amyloid precursor protein, chr 21)
An increased amount of ApoE2 increases/decreases the risk for Alzheimer's?
An increased amount of ApoE4 increases/decreases the risk for Alzheimer's?
Increases the risk
“Bright red fovea centralis that is surrounded by a contrasting white macula”
Cherry red macula spot
Seen in: Tay Sachs (no abdominal findings), Niemann Pick (hepatosplenomegaly)
Mechanism of phenytoin gingival hyperplasia =
Increased PDGF -> increases proliferation of gingival cells and alveolar bone
N. meningitidis endotoxin =
Outer membrane lipooligosaccharide (LOS)
Blood levels of LOS correlate with mortality
Oligoclonal bands of IgG seen on CSF fluid indicates a dx of
Initial resistance to passive extension followed by a sudden release of resistance =
“Clasp knife spasticity” - seen in an UMN lesion
Prion transformation: _ structure to _ structure
Beta pleated sheet
Viral esophagitis + Pneumocystis pneumonia is diagnostic for
Esophagitis = CMV
Pneumonia = PJP
Patient is likely at risk for other immunocompromised/AIDs defining illnesses
Demyelination of posterior columns + LCST =
Subacute combined degeneration - vitamin B12 deficiency
“Combined” = degeneration of ascending AND descending tracts
Bilateral wedge shaped strips of necrosis over the cerebral convexity, parallel and adjacent to the longitudinal cerebral fissure
Hypoxic-ischemic encephalopathy (Global cerebral ischemia)
Results in watershed infarcts
Surgical deep brain stimulation of chronic Parkinson’s patients targets what 2 structures. Mechanism?
Structures: STN or GPi
Stimulation inhibits the nuclei therefore putting the circuitry onto the "yes movement" circuit by disinhibiting the thalamus
What nerve is vulnerable to injury in the posterior triangle of the neck?
CN XI -> damage causes weakness of the trapezius = impaired abduction of the arm above horizontal, drooping shoulder, winged scapula
Viral meningitis causes (3)
- Enteroviruses (Polio, Coxsackie, Echo)
- Arboviruses (Cali encephalitis, Hanta, Rift valley)
Bony spicule shaped deposits on retina +vision loss beginning with night blindness =
Fundoscopy: crinkling of retina + changes in vessel direction. Loss of vision like a curtain being drawn down.
Grayish-green subretinal membrane and subretinal hemorrhages in a 67 yo smoker who is having vision problems
Wet, age related macular degeneration
Treatment = VEGF inhibitors
HTN + intracerebral bleed
Hypertensive vasculopathy -> lenticulostriate arteries - charcot bouchard aneurysm -> rupture -> inhibits basal ganglia -> contralateral hemiparesis + hemisensory loss + headache + nausea (symptoms are gradual)
Lesion in the ventromedial nucleus in the hypothalamus
Lesion = always hungry -> hyperphagia, obesity
Ventromedial nucleus = satiety center
Stimulated by leptin
Lesion in the lateral hypothalamus nucleus
Lesion = never hungry -> anorexia
Lateral nucleus = hunger center
Inhibited by leptin
3 brain tumors that are GFAP+
- Astrocytomas (adults and kids)
- Oligodendrogliomas (adults)
- Ependymomas (kids)
Acute onset worst headache of my life =
Subarachnoid hemorrhage from a berry aneurysm
Microglial nodules in the brain + multinucleated giant cells + dementia =
HIV associated dementia
Parkinson's disease/Lewy body dementia
Round circular tau proteins =
Tangles of tau protein =
Amyloid in the brain + Dementia
R sided frontal lobe lesions
L sided frontal lobe lesions
Apathy and depression
Round pearly mass behind tympanic membrane + conductive hearing loss in that ear + intermittent ear discharge
-Squamous cell debris
-Congenital or acquired
-May erode middle ear structure
On ophthalmoscopic exam: arteriovenous nicking, flame shaped hemorrhages, cotton-wool spots
HTN retinal hemorrhages
What happens to the ciliary muscles and zonular fibers and the lens during accommodation?
Ciliary muscles contract -> zonular fibers relax -> lens thickens -> able to focus on near images
Conductive Rinne and Weber test?
Rinne: bone > air on affected side
Weber: lateralizes to affected side
Sensorineural Rinne and Weber test?
Rinne: air > bone (normal)
Weber: lateralizes to unaffected side
What CN? Motor of submandibular and sublingual gland?
What CN? Sensation of tonsillar region, Sensation of inner surface of tympanic membrane, Motor of parotid gland?
Noise exposure induced hearing loss is caused by damage to
Damage to hair cells in the organ of corti
Loss of high frequency hearing first
Lacunar infarcts in the deep brain are caused by
Immediate CT imaging does not show the infarct because it is so small
A few weeks later, the necrotic tissue becomes a cystic space and can now be seen
Anterior communicating aneurysm symptoms (3)
-bitemporal hemianopsia (compression of optic chiasm)
-visual acuity problems (compresion of optic nerves in optic chiasm)
-rupture (thunderclap headache) -> contralateral lower extremity hemiparesis and sensory deficits
Posterior communicating aneurysm symptoms (3)
ipsilateral CN III palsy
-down & out eye
Middle cerebral artery aneurysm
MCA ischemia = contralateral upper extremity and facial hemiparesis, sensory deficits
Acute stress disorder diagnosis timeline
Greater than 3 days but less than 1 month
acute stress disorder -> PTSD
PTSD diagnosis timeline
Greater than one month
acute stress disorder -> PTSD
A drop in PaCO2 does what to cerebral vasculature?
Vasoconstricts cerebral vasculature -> reducing cerebral blood flow -> reducing intracerebral pressure
Afferent limb of the light reflex
optic nerve, optic tract (-> pretectal nucleus in midbrain)
-damage to the retina, optic nerve or optic tract will inhibit the light reflex
Efferent limb of the light reflex
parasympathetic fibers of the occulomotor nerve (CN III)