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Flashcards in Neuro Deck (186):
1

a. Which part of the CNS/PNS originates from mesoderm?
b. Which part originates from neural crest?

a. Microglia
b. PNS neurons, Schwann cells

2

Why would Acetylcholinesterase be elevated from neural tube defects?

The fetal AchE in CSF transudates across defect in amniotic fluid

3

Anencephaly associations

Maternal type 1 diabetes
Decreased maternal folate

4

Holoprosencephaly mutation signaling

Mutation in sonic hedgehog pathway

5

Which conditions is holoprosencephaly seen in?

Patau syndrome (trisomy 13)
Fetal alcohol syndrome

6

What sensation is lost with Syringomyelia?

Cape-like bilateral loss of PAIN and TEMP sensation in upper extremities

7

Syringomyelia associations

Chiari malformations
Trauma
Tumors

8

Which muscle elevates posterior tongue during swallowing? Innervated by?

Palatoglossus innervated by CN X

9

What is a Wallerian degeneration? What does this allow for?

When there is injury to axon there is degeneration distal to injury and axonal retraction proximally that allows for potential regeneration of axon (if in PNS)

10

Which axons are unmyelinated?

Autonomic post ganglionic
Afferent heat sensation
Afferent slow burning pain
1st order bipolar olfaction nerves

11

Role of Schwann cells

Myelinate ONE PNS axon
Promote axonal regeneration

12

Location of acoustic neuromas

Internal acoustic meatus

13

Which cell is injured in MS, PML and leukodystrophies?

Oligodendroglia

14

Where are Meissner corpuscles located? What do they sense?

Glabrous (hairless) skin - senses dynamic, light touch, position sense

15

Where are Merkel discs located? What do they sense?

Finger tips, superficial skin - senses pressure, deep static touch (shapes, edges), position sense

16

Which sensory receptors adapt quickly?
Which adapt slowly?

Meissner corpuscles and Pacinian corpuscles adapt quickly
Merkel discs and Ruffini corpuscles adapt slowly

17

What is synthesized in Locus ceruleus?

NE

18

What is synthesized in Ventral tegmentum and substantial nigra pars compacta? (Midbrain)

Dopamine

19

What is synthesized in Raphe nuclei of pons, medulla and midbrain?

Serotonin (5-HT)

20

What is synthesized in Basal nucleus of Meynert?

Ach - Basal nucleus of Meynert degenerates in Alzheimers

21

What is synthesized in nucleus accumbens?

GABA

22

Which areas of brain don't have blood brain barrier?

This allows molecules in blood to affect brain function or neurosecretory products to enter circulation
Area postrema - vomiting after chemo
OVLT - osmotic sensing
Neurohypophysis - ADH release

23

How do infarction and neoplasm affect the blood brain barrier?

They destroy the endothelial cell tight junctions --> this leads to vasogenic edema

24

Where is area postrema located? Important for what?

Located in dorsal medulla at caudal end of 4th ventricle

25

Which hypothalamic nucleus makes ADH?

Supraoptic nucleus

26

Which hypothalamic nucleus makes oxytocin?

Paraventricular nucleus

27

Which hypothalamic nucleus might be damaged in an anorexic person?

Lateral area (also causes failure to thrive)

28

Which hypothalamic nucleus is damaged in hyperphagia?

Ventromedial area

29

Hypothalamic nucleus for cooling, parasympathetic

Anterior (think of A/C)

30

Hypothalamic nucleus for sympathetic, heating

Posterior (Zap your posterior you become poikilotherm)

31

Hypothalamic nucleus responsible for Circadian rhythm

Suprachiasmatic nucleus (Master clock)

32

Hypothalamic area that secretes GnRH

Pre-optic

33

Hypothalamic area causing savage behavior, obesity

Dorsomedial nucleus

34

What regulates suprachiasmatic nucleus?
What does SCN activation cause?

SCN regulated by environment
SCN --> NE release --> pineal gland --> melatonin

35

Causes of decreased REM sleep

Alcohol, BDZs, Barbiturates
Norepinephrine

36

Treatment for sleep enuresis

Oral desmopressin (ADH)
Imipramine (second line bc of S/E)

37

Treatment for night terrors and sleepwalking

BDZs

38

a. Beta waves
b. Alpha waves
c. Theta waves
d. Sleep spindles and K complexes
e. Delta waves

a. Awake and REM sleep (high frequency, low amplitude)
b. Awake with eyes closed
c. Light sleep (Stage 1)
d. Stage 2 - Bruxism
e. Stage 3/4 nonrem - sleepwalking, night terrors, bedwetting (lowest frequency, highest amplitude)

39

What happens during REM sleep?

Loss of motor tone
Increased brain O2 use
Variable BP and pulse
Dreaming
Penile/clitoral tumescence

40

Sleep changes in depressed patients

Decreased slow wave
Increased REM
Decreased REM latency

41

Which info does VPL relay?

Sensory info from body (Very Painful Legs mnemonic)

42

Which info does VPM relay?

Sensation from face (Very Painful Mouth)

43

Which info does LGN relay?

Vision (Lateral = Light)

44

Which info does MGN relay?

Hearing (Medial = Music)

45

Function of Limbic system

Fucking, Feeding, Feeling, Fighting, Fleeing

46

a. Correcting hypernatremia too quickly
b. Correcting hyponatremia too quickly

a. Cerebral edema/herniation
b. Osmotic demyelination syndrome (central pontine myelinolysis)

47

Vascular lesion resulting in complete contralateral sensory loss and proprioceptive defects that lead to falls

Thalamic syndrome (damage to VPL and VPM)

48

Lesion location causing athetosis

Basal ganglia (Huntington)

49

Lesion location causing chorea

Basal ganglia (Huntington)

50

Treatment of essential tremor

Beta blocker, Primidone

51

Lesion causing hemiballismus

Contralateral subthalamic nucleus

52

Loss of neurons in substantia nigra pars compacta

Parkinson disease

53

Atrophy of caudate nuclei with ex vacuo dilation of frontal horns on MRI

Huntington disease

54

Increased dopamine, decreased GABA, decreased Ach

Huntington disease
CAG repeats = Caudate loses Ach and GABA (CAG)

55

Hyperphagia, hypersexuality, hyperorality

Kluver Bucy syndrome (bilateral amygdala lesion)

56

Hemispatial neglect syndrom

Lesion in non-dominant parietal temporal cortex

57

Gerstmann syndrome

Agraphia, acalculia, finger agnosia, left-right disorientation
DOMINANT parietal temporal cortex lesion

58

a. Damage to Paramedian pontine reticular formation
b. Damage to frontal eye fields

a. Eyes look AWAY from side of lesion
b. Eyes look TOWARD lesion

59

pCO2 effects on cerebral blood flow

Increased CO2 --> VASODILATION --> increased blood flow
Decreased CO2 --> decrease in cerebral perfusion (can cause neurologic signs)
(Patients with cerebral edema hyperventilate to decrease ICP)

60

pO2 effects on cerebral blood flow

Perfusion is constant between pO2 50-100
Severe hypoxia (

61

Common location of lacunar infarcts secondary to unmanaged HTN

Lenticulostriate arteries in striatum, internap capsule

62

ASA stroke - Area of lesion and symptoms

1. Lateral corticospinal tract - contralateral hemiparesis of upper and lower limbs
2. Medial lemniscus - Decreased contralateral proprioception
3. Caudal medulla - Hypoglossal nerve - Causes ipsilateral hypoglossal dysfunction

63

Medial medullary stroke cause

Infarct of paramedian branches of ASA and vertebral arteries

64

Lateral medullary (Wallenberg) syndrome cause

PICA stroke
(Don't PICA horse (hoarseness) that can't eat (dysphagia))

65

PICA stroke -
a.area of lesion
b. symptoms

a. Lateral medulla - vestibular nuclei, Lateral spinothalamic tract, Spinal trigeminal nucleus, Nucleus ambiguus, Sympathetic fibers, Inferior cerebellar peduncle
b. Vomiting, vertigo, nystagmus, decreased pain/temp from ipsi face and contra body; dysphagia, hoarseness, decreased gag reflex, ipsi Horner syndrome, ataxia, dysmetria

66

Lateral pontine syndrome

AICA lesions - Facial nucleus effects specific to AICA lesion

67

AICA stroke -
a. area of lesion
b. symptoms

a. lateral pons (vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers) and middle inferior cerebellar peduncles
b. Vomiting, vertigo, nystagmus, paralysis of face, decreased lacrimation, salivation, decreased taste from anterior 2/3 of tongue; Ipsi loss of pain/temp from face, contra loss of pain temp from body; ataxia/dysmetria

68

Where is lesion of stroke causing contralateral hemianopia with macular sparing?

PCA

69

Where is stroke causing locked in syndrome?

Basilar artery

70

Where is stroke causing CN III palsy (down and out with ptosis and mydriasis)?

PCom (lesions typically aneurysms, not strokes)

71

Complication after subarachnoid hemorrhage

Vasospasm due to blood breakdown (treat with Nimodipine)
Rebleed

72

When do you see Xanthochromic spinal tap?

2-3 days after subarachnoid hemorrhage

73

Most vulnerable areas

Hippocampus, Neocortex, Cerebellum, Watershed areas

74

When do you see red neurons after ischemic event?

12-48 hours after

75

When do you see necrosis + neutrophils after ischemic event?

24-72 hours

76

When do you see macrophages and microglia after ischemic event?

3-5 days

77

When do you see reactive gliosis + vascular proliferation after ischemic event?

1-2 weeks

78

After 2 weeks what does an ischemic infarct look like?

Glial scar

79

Most common site of intracerebral hemorrhage

Hemorrhagic stroke

80

Where do the dural venous sinuses drain into?

Internal jugular vein

81

Risk factors for idiopathic intracranial HTN (pseudotumor cerebri)

Woman of childbearing age
Vitamin A excess
Danazol

82

Treatment for pseudo tumor cerebri

Weight loss
Acetazolamide
Topiramate

83

Urinary incontinence, Ataxia, Cognitive dysfunction

Normal pressure hydrocephalus (expansion of ventricles distorts the corona radiate fibers)

84

Where do nerves exit spinal cord corresponding to vertebrae?

Nerves C1-C7 exit ABOVE corresponding vertebrae
C8 spinal nerve exits below C7 and above T1
All other nerves exit BELOW corresponding vertebrae

85

What herniates in vertebral disc herniation?

The nucleus pulposus (soft central disc) herniates through annulus fibrosus (outer ring) - usually posterolaterally

86

Area affected in Werdnig Hoffmann disease

Anterior horn - LMN lesions only
Flaccid paralysis (floppy baby)

87

Defect in superoxide dismutase 1

Amyotrophic Lateral Sclerosis

88

Treatment for ALS

Riluzole - decreases presynaptic glutamate release

89

Occlusion of anterior spinal artery affects which parts of spinal cord?

Spares dorsal column and Lissauer tract (pain pathway in dorsal column)

90

Charcot joints, shooting pain, Argyll Robertson pupils

Tertiary syphilis - Tabes dorsalis

91

Autosomal recessive trinucleotide repeat disorder (GAA)

Friedrich ataxia - on chromosome 9; gene that encodes frataxin (iron binding protein) --> impaired mitochondrial functioning --> degeneration of multiple spinal cord tracts

92

Symptoms of Friedreich ataxia

Muscle weakness, loss of DTRs, vibratory sense and proprioception
Staggering gait, frequent falling, nystagmus, dysarthria, hammer toes, diabetes mellitus, hypertrophic cardiomyopathy

93

Cause of death in Friedreich ataxia

Hypertrophic cardiomyopathy

94

Child with kyphoscoliosis

Friedreich ataxia - AR GAA trinucleotide repeat - chr. 9 that encodes frataxin iron binding protein

95

Reflexes:
a. Biceps
b. Triceps
c. Patella
d. Achilles

a. C5
b. C7
c. L4
d. S1

96

Galant reflex

Stroking along one side of spine while baby is face down causes lateral flexion of lower body toward stimulated side

97

CN nuclei that lie medially at brainstem

III
IV
VI
XII

98

Function of each:
a. Pineal gland
b. Superior colliculi
c. Inferior colliculi

a. Melatonin secretion, circadian rhythms
b. Conjugate vertical gaze center
c. Auditory
(Your eyes are above your ears and superior is above inferior colliculus)

99

What is Parinaud syndrome?

Dorsal midbrain syndrome; Paralysis of conjugate vertical gaze (inability to move eyes UP or down) due to lesion in superior colliculi (stroke, hydrocephalus, pinealoma)

100

What CNs go through the following
a. Cribriform plate

a. CN I

101

Middle cranial fossa - which CNs go through the following?a. Optic canal
b. Superior orbital fissure
c. Foramen rotundum
d. Foramen ovale
e. Foramen spinosum

a. CN II, ophthalmic artery, central retinal vein
b. CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers
c. V2
d. V3
e. Middle meningeal artery

102

Posterior cranial fossa - which CNs go through the following?
a. Internal auditory meatus
b. Jugular foramen
c. Hypoglossal canal
d. Foramen magnum

a. CN VII, VIII
b. CN 9, 10, 11, jugular vein
c. CN 12
d. spinal roots of CN 11, brain stem, vertebral arteries

103

Functions of oculomotor nerve

Motor - superior rectus, inferior rectus, medial rectus, inferior oblique
Pupillary constriction (sphincter pupillae, Edinger Westphal nucleus, muscarinic receptors)
Accommodation
Eyelid opening (elevator palpebrae)

104

Functions of trigeminal nerve

Motor - mastication
Facial sensation
Somatosenation from anterior 2/3 of tongue

105

Functions of facial nerve

Facial movement
Taste from anterior 2/3 tongue
Lacrimation
Salivation (submandibular, sublingual)
Eyelid closing (orbicularis oculi)
Stapedius muscle in ear

106

Does Facial nerve innervate parotid gland?

No but it courses THROUGH it; parotid is innervated by CN 9

107

Glossopharyngeal nerve functions

Taste and sensation to posterior 1/3 tongue
Swallowing
Salivation (parotid gland)
Monitoring carotid body and sinus chemo and baroreceptors
Stylopharyngeus (branchial arch 3)

108

Vagus nerve functions

Taste from epiglottic region
Swallowing
Soft palate elevation
Midline uvula
Talking
Coughing
Thoracoabdominal viscera
Monitoring aortic arch chemo and baroreceptors

109

Which nerves innervate Nucleus solitarius and what info does it provide?

CNs 7, 9 and 10 --> visceral SENSORY information

110

Which nerves innervate nucleus aMbiguus and what info does it provide?

CNs 9, 10 and 11 --> MOTOR innervation of pharynx, larynx, upper esophagus

111

Which nerve innervates dorsal motor nucleus and what info does it provide?

CN 10 --> sends autonomic (PARASYMPATHETIC) fibers to hear, lungs, upper GI

112

Which nerves make up gag reflex?

Afferent - CN 9
Efferent - CN 10

113

Lacrimation reflex?

Afferent - V1
Efferent - 7

114

Pupillary reflex?

Afferent - 2
Efferent - 3

115

CN 5 motor lesion

Jaw deviates TOWARD side of lesion due to unopposed force from the opposite pterygoid muscle

116

CN 10 lesion

Uvula deviates AWAY from side of lesion (weak side collapses and uvula points away)

117

CN 11 lesion

Weakness turning head to contralateral side of lesion
Shoulder droop on side of lesion

118

CN 12 lesion

Tongue deviates TOWARD side of lesion

119

Weber - lateralizes to left ear
Rinne - normal

Sensorineural hearing loss in right ear

120

Weber - lateralizes to left ear
Rinne - can't hear it in left ear

Conductive hearing loss in left ear

121

Rinne - normal in both ears
Weber - lateralizes to right ear

Sensorineural hearing loss in left ear

122

What is cholesteatoma?

Overgrowth of desquamated keratin debris within middle ear space - may erode ossicles or mastoid air cells --> conductive hearing loss

123

gray white pearly lesion behind tympanic membrane, conductive hearing loss and vertigo

Cholesteatoma

124

Facial nerve palsy associations

Lyme disease
Herpes simplex or Herpes zoster (ramsay hunt)
Sarcoidosis
Tumors
Diabetes
AIDS

125

Which mastication muscle is responsible for opening jaw?

Lateral pterygoid

126

What produces aqueous humor?

Ciliary epithelium of eye

127

a. Innervation of dilator pupillae muscle
b. Innervation of sphincter pupillae muscle

a. alpha 1 receptors (IP3) - parasympathetic
b. M3 receptors (IP3) - parasympathetic

128

a. Loss of peripheral vision
b. Loss of central vision

a. Glaucoma
b. Age related macular degeneration

129

Causes of secondary closed angle glaucoma

Diabetes or vein occlusion -> induces vasoproliferation in iris that contracts angle

130

Rock hard eye, frontal headache, vision loss

Acute closure glaucoma = EMERGENCY
DON'T give epinephrine because of mydriasis effect

131

Treatment of glaucoma
a. Increase outflow
b. Decrease aqueous humor production
c. acute angle closure

a. Prostaglandins, alpha agonists, cholinergic agonists (Pilocarpine)
b. Beta blockers, carbonic anhydrase inhibitors, alpha agonists
c. add Mannitol

132

Types of Diabetic nephropathy

1. Nonproliferative - damaged capillaries leak blood --> lipids and fluid seep into retina --> hemorrhages and macular edema (treat with blood sugar control and macular laser)
2. Proliferative - chronic hypoxia results in formation of new vessels with resultant traction of retina --> treat with peripheral retinal photocoagulation or anti-VEGF (bevacizumab)

133

Schwannomas and Meningiomas

Neurofibromatosis 2

134

Painless monocular vision loss with cherry red spot at fovea

Central retinal artery occlusion

135

Risk of early ONSET alzheimers

APP, Presenilin 1 and Presenilin 2

136

Increased risk of alzheimers

ApoE4

137

Where is there decreased Ach activity in Alzheimers?

Decreased choline acetyltransferase activity in nucleus baseless of Meynert and hippocampus

138

What makes up neurofibrillary tangles? What do they correlate with?

They are intracellular hyperphosphorylated tau protein; number of tangles correlates with degree of dementia

139

Silver staining spherical tau protein aggregates

Pick bodies

140

alpha synuclein defect

Lewy body dementia

141

Increased protein (IgG) in CSF
Oligoclonal bands

Multiple sclerosis
(Oligoclonal bands are diagnostic)

142

Mechanism of Baclofen

Inhibits GABAb receptors at spinal cord level --> leads to skeletal muscle relaxation
-Can treat MS, spasticity

143

LP findings for Guillain Barre syndrome

Increased CSF protein with NORMAL cell count

144

Most common cause of viral meningitis

Coxsackievirus A virus

145

LP with increased lymphocytes and low glucose

Fungal

146

Scoliosis and foot deformities

Charcot Marie Tooth disease (autosomal dominant)
=hereditary motor and sensory neuropathy

147

Galactocerebrosidase deficiency

Krabbe disease (autosomal recessive lysosomal storage disease) Build up of galactocerebroside destroys myelin sheath

148

Peripheral neuropathy, developmental delay, optic atrophy, globoid cells

Krabbe disease

149

Arylsulfatase A deficiency

Metachromatic Leukodystrophy (autosomal recessive) buildup of sulfates destroys myelin sheath; central AND peripheral demyelination with ataxia, dementia

150

Central and peripheral demyelination with ataxia, dementia

Metachromatic Leukodystrophy

151

Progressive multifocal leukoencephalopathy

Demyelination of CNS due to destruction of oligodendrocytes; associated with JC virus

152

Drugs that cause increased risk of PML

Natalizumab (anti alpha 4 integrin), Rituximab (anti CD20)

153

Build up of very long chain fatty acids in nervous system, adrenal gland and testes

Adrenoleukodystrophy (X linked recessive)

154

Treatment for focal (partial) seizures

Carbamazepine
Gabapentin
Phenobarbital
Phenytoin

155

Drugs that treat broad spectrum of seizure disorders

Valproic acid
Topiramate
Lamotrigine

156

Cause of migraine

Irritation of CN V, meninges or blood vessels --> release of Substance P, calcitonin gene related peptide, vasoactive peptides

157

Prophylatic treatment of migraines

Propranol
Topiramate
Ca channel blockers
Amitriptyline

158

Abortive treatment of migraines

Triptans
NSAIDs

159

Delayed horizontal nystagmus

Peripheral vertigo

160

Tinnitus, vertigo, hearing loss

Meniere disease (Increased volume of endolymph)

161

Developmental anomaly of neural crest derivatives due to activating mutation of GNAQ gene

Sturge Weber syndrome

162

Port wine stain of face
Seizures/epilepsy
Intellectual disability
Episcleral hemangioma

Sturge Weber Syndrome (non-inherited)

163

Nevus flammeus, a non-neoplastic birthmark in V1-V2 distribution

Port Wine stain (seen in Sturge Weber syndrome)

164

STURGE mmnemonic

Sporadic, port wine Stain
Tram track calcifications (opposing gyri)
Unilateral
Retardataion
GNAQ mutation, Glaucoma
Epilepsy

165

Tuberous Sclerosis findings (HAMARTOMAS)

Hamartomas in CNS, skin
Angiofibromas
Mitral regurgitation
Ash-leaf spots
cardiac Rhabdomyoma
Tuberous sclerosis
autosomal dOminant
Mental retardation
renal Angiomyolipoma
Seizures, Shagreen patches

166

Cafe au lait spots
Lisch nodules
Optic gliomas
Pheochromocytomas

Neurofibromatosis type 1 (von Recklinghausen)
Also see cutaneous neurofibromas

167

Mutation in Neurofibromatosis type 1

Neurofibromin - a negative regulator of RAS - on chromosome 17

168

von Hippel Lindau findings

Hemangioblastomas
Bilateral renal cell carcinoma
Pheochromocytoma
Angiomatosis (hemangioblastomas in skin, organs)

169

What does histology of hemangioblastoma look like?

High vascularity with hyperchromatic nuclei

170

Pseudopalisading pelomorphic tumor cells with necrosis and hemorrhage - brain tumor

Glioblastoma multiforme (grade 4 astrocytoma)

171

Brain tumor - spindle cells arranged in whorled pattern; psammoma bodies (laminated calcifications)

Meningioma

172

Brain tumor arising from arachnoid cells and has dural attachment

Meningioma

173

Location of hemangioblastomas

Most often cerebellar

174

Histology of hemangioblastomas

Closely arranged, thin walled capillaries with minimally intervening parenchyma

175

S-100 +

Schwannoma

176

Synaptophysin stain

in CNS tumors of NEURONAL origin

177

Brain tumor with rosenthal fibers

Pilocytic astrocytoma

178

Highly malignant cerebellar tumor seen in childhood

Medulloblastoma (primitive neuroectodermal tumor)

179

Drop metastases to spinal cord

Medulloblastoma

180

Brain tumor with Homer Wright rosettes

Medulloblastoma

181

Brain tumor with perivascular rosettes

Ependymoma

182

Supratentorial tumor with cystic spaces filled with brownish fluid rich in cholesterol

Craniopharyngioma

183

Herniation that compresses anterior cerebral artery

Cingulate herniation (subfalcine) under falx cerebri

184

Herniation causing duret hemorrhage (rupture of paramedian basilar artery branches)

Downward transtentorial herniation

185

Herniation causing ipsilateral blown pupil, contralateral homonymous hemianopia, ipsilateral paresis

Uncal herniation
CN III = ipsilateral blown pupil
ipsilateral PCA = contralateral homonymous hemianopia
contralateral crus cerebri = ipsilateral paresis

186

Herniation causing coma and death

Cerebellar tonsillar herniation into foramen magnum compressing brainstem