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Flashcards in Neuro Deck (77):
1

What causes Wallenberg Syndrome?

S&S Wallenberg Syndrome (Lateral Medullary Syndrome) RIGHT

- Vertebral a. or Post. Inf. Cerebellar A. stroke
- hoarseness

ptosis R eyelid
small R pupil
dysmetria with finger to nose testing on the R
loss of pinprick on the arm and leg L

2

What causes Wallenberg Syndrome?

S&S Wallenberg Syndrome (Lateral Medullary Syndrome) LEFT

- Vertebral a. or Post. Inf. Cerebellar A. stroke
- hoarseness

ptosis L eyelid
small L pupil
dysmetria with finger to nose testing on the L
loss of pinprick on the arm and leg R

3

Vestibular lesions cause

Vertigo and N&V

4

What does the Inferior cerebellar peduncle do?
What do lesions of the Inferior cerebellar peduncle cause?

- Connects cerebellum to medulla
- Ataxia and dysmetria

5

What does the lateral spinothalamic tract lesion at the medulla cause?

Contralat loss of pain and temp

6

What does the nucleus ambiguus do?
What does a lesion in this area cause?

- Brachial efferent motor neuron of the Vagus n. that controls larynx
- Hoarseness

7

Beck's (Ant. Spinal A.) Syndrome S&S

Bilat. flaccid paralysis at level of lesion
Bilat. loss pain and temp and spasms below level

8

What tracts or spinal cord areas are affected in ALS?

Corticospinal
Ventral Horn of spinal cord

9

Vasovagal syncope

triggered by physical/emotional stress
sweating, palpitations, nausea precede episode

"Posture, provoking, prodromal"

10

Lewy Body Dementia trigger words

Location?

Description?

round, dense cells with eosinophilia core surrounded by clear halos

in Basal Ganglia

parkinsonism with dementia and colorful hallucinations

11

Chromosome 21 encodes which Alzheimer's gene?

Amyloid beta precursor protein gene

12

Most common renal lesion in Tuberous Sclerosis (Auto Dom)

Angiomyolipoma

13

Alzheimer Genes

Presenelin I, II (chrom 14, I)
APP (21)
Susceptibility (APOe4)

14

Vascular Dementia keywords

lacunar infarcts
stepwise deterioration
lateralizing signs (spasticity, hemiparesis, ataxia, pseudobulbar palsy)

15

Pick Disease/Frontotemporal dementia keywords

MAPT gene - Tau protein buildup
early onset personality changes
Frontal and Temporal lobe atrophy

Tx: Anticholinesterase inhibitors [Aricept, Tacrine, Rivastigmine]

16

Temporal Lobe epilepsy keywords

strange smells, lilliputian hallucinations

17

Creutzfeldt Jakob Dz. keywords

rapid prion accumulation
myoclonus
sharp waves on slow EEG

18

Global Aphasia (both Broca and Wernicke's Areas affected)

not fluent/no spontaneous speech
no repetition/comprehension

19

Wernicke Aphasia (superior temporal gyrus of temporal lobe)

fluent
no repetition/comprehension

Wernicke's wordy but makes no sense

20

Broca Aphasia (inferior frontal gyrus of frontal lobe)

not fluent
no repeat
intact comprehension

Broca's broken boca

21

Guillain Barre attacks which nerves?

Peripheral nerves

22

Multiple sclerosis keywords

Multiple white matter hyperintensities
Oligoclonal bands in CSF
Tx: IgG, B-IFN, Natalizumab

23

Cerebral AutoDom Angiopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)

Tetrad of: psychiatric disturbance, dementia, multiple white matter strokes, and migraines with aura

24

Bacterial Meningitis CSF findings

Elevated WBCs (1,000 - 20,000 cells/ml)
PMNs
Low Glucose
High Protein

25

Thalamic Hemorrhage (common site of parenchymal hypertensive hemorrhage)

Motor and sensory loss, eye deviation away from side of lesion
Worsening numbness opposite side of lesion
Smoking and HTN hx.
Miotic and nonreactive pupils with gaze preference to opposite side of lesion
4/5 Strength opposite side of side
may extend down to hit reticular activating system to cause coma

26

Vertebral A. Occlusion

leads to infarction of medulla
medial medulla --> flaccid then spastic contralateral hemiparesis, ipsilat tongue paralysis
lateral medulla --> Wallenburg syn.

27

Primary Progressive Aphasia

Variant of Frontotemporal Dementia:

Erosion of language skills (difficulty finding words and producing speech) with preservation of cognitive and behavioral function

28

CSF Findings in Viral Meningitis

Increase Mononuclear cells
Normal Glucose
Mildly elevated Protein

29

Tx. CNS Melanoma

Radiation therapy plus stereotactic radiosurgery

30

Functions of the Hypothalamus

TAN HATS

Thirst and water balance
Anterior pituitary
Neurohypophysis releases hypothalmic hormones

Hunger
Autonomic regulation
Temp regulation
Sexual urge

31

If the lateral cerebellum is damaged, what is usually seen?

Tendency to fall toward injured side

32

Hemiballismus keywords

wild arm flailing
contralateral subthalamic nucleus lesion

33

Chorea

dance-like, jerky, purposeless movement
lesion of basal ganglia

34

Athetosis

slow writing snake-like movement
lesion of basal ganglia

35

Dystonia

sustained involuntary mm. contraction
e.g. writer's cramp, blepharospasm

36

Intention tremor keywords

slow, zigzag motion when pointing toward a target
indicative of a cerebellar lesion

37

What happens at lesion of Right Parietal lobe?

Spatial neglect syndrome: agnosia of contralateral side

38

What happens at lesion of Reticular Activating system?

Decreased wakefulness

39

What happens at lesion of Mammillary Bodies?

Wernicke-Korsakoff Syndrome

40

What happens at lesion of cerebellar hemisphere?

Intention tremor, limb ataxia, loss of balance

41

What happens at lesion of cerebellar vermis?

Truncal ataxia

42

What happens at lesion of subthalamic nucleus?

Contralateral hemiballismus

43

What happens at lesion of frontal eye fields?

Eyes look toward lesion

44

What is cerebral perfusion primarily driven by?

PCO2

45

Middle Cerebral a.

What does it supply?

S&S?

Supplies lateral cortex

Motor and sensory to Upper Limb and face, Wernicke's Temporal and Broca's Frontal

Homonymous Hemianopsia
Paralysis of Gaze
Global aphasia
Contralateral Hemispatial Neglect

46

Anterior Cerebral a.

What does it supply?

Supplies anteromedial cortex

Motor and sensory to Lower Limb

Contralateral paralysis and loss of sensation lower limb

47

Anterior Spinal A.

What does it supply?

Lateral Corticospinal Tract, Medial Lemniscus, Caudal medulla/Hypoglossal n.

Contralateral hemiparesis Lower Limb, proprioception, ipsilateral tongue deviation

48

Posterior Inferior Cerebellar a.

What does it supply?

Lateral medulla

Dysphagia, hoarseness, (nucleus ambiguus lesions, essentially), ipsilateral Horner's, decreased pain and temp contralateral limb, ipsilateral face

Lateral Medullary Wallenberg's Syndrome. The side of the face is the side that PICA is involved.

49

Anterior Inferior Cerebellar a.

What does it supply?

Lateral pons (Cranial n. nuclei, Vestibular nuclei, Facial Nucleus, Spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers)

- facial paralysis, dec. lacrimation, dec tongue taste ant. 2/3, decreased corneal reflex

Lateral Pontine Syndrome "Facial droop means AICA's pooped"

50

Posterior communicating a.

common site of berry aneurysm

CN3 palsy (eye down and out with ptosis and mydriasis)

51

Werdnig Hoffman Disease

AR degeneration anterior horn of spinal cord --> LMN lesion

"Floppy baby", death by 7 mo

52

Friedreich's Ataxia

AR GAA repeat encoding Frataxin --> impaired mitochondrial functioning -->

staggering gait, frequent falls, loss of proprioception and vibration, very high foot arch, loss of DTRs

53

What nuclei are located in the midbrain?

CN 3, 4

54

What nuclei are located in the pons?

CN 5 - 8

55

What nuclei are located in the medulla?

CN 9, 10, 12

56

Cavernous Sinus Syndrome S&S

What CN run through?

ophthalmoplegia and decrease corneal and maxillary sensation

CN 3, 4, V1, V2, 6

57

What happens in a CN V motor lesion?

Jaw deviates toward side of lesion

58

What happens in a CN X lesion?

Uvula deviates AWAY from side of lesion

59

Conductive Hearing Loss
e.g. otitis media, cerumen impaction, osteoma, neoplasm

Rinne abnormal (bone>air), Weber localizes to affected ear

60

Sensorineural Hearing Loss
e.g. trauma, Meniere's, presbycusis, Ototoxicity

Rinne normal (air>bone), Weber localizes to UNaffected ear

61

Charcot-Marie-tooth Disease (Hereditary Motor and sensory Neuropathy)

progressive hereditary nerve disorders d/t defective myelin sheath protein production

62

Most common 1mary brain tumor?

Glioblastoma Multiforme (GBM): p53 mutation, crosses corpus callosum "butterfly" and "pseudopalisading" tumor cells, contrast enhancing lesion within cerebral hemispheres on MRI

63

Meningioma keywords

whorled
psammoma bodies
near brain surface

64

Oligodendroglioma keywords

frontal lobe
chicken-wire capillary
"fried egg"

65

Most common childhood brain tumor?

Pilocytic astrocytoma: @ post. fossa, GFAP+, Rosenthal corkscrew fibers, benign

66

Medulloblastoma keywords

hydrocephalus
Homer-Wright rosettes
small blue cells

Tx: Radiation

67

Uncal (medial temporal lobe) Herniation keywords

fixed dilated pupil ipsilaterally
contralat. homonymous hemianopsia
ipsilateral hemiparesis

68

S&S of Posterior Cerebral A. occlusion (LEFT)

RIGHT hemianopsia
RIGHT sensory deficits
Alexia without agraphia
Difficulty forming new memories
Anomic aphasia
Gerstman's Syndrome (acalculia, agraphia, finger agnosia, right-left disorientation)

69

Atypical meningitis can be caused by what immunosuppressive medication?

MTX: causes myelosuppression leading to neutropenia

70

Empiric Tx. for Meningitis

"Be a life SAVeR"

Steroids
Acyclovir & Ampicillin
Vancomycin
Rocephin (Ceftriaxone)

71

Ataxia-Telangiectasia

S&S

Labs

Ataxia (wide based gait and instability)
Telangiectasia (dilated tortuous conjunctiva) in skin, eyes
Recurrent sinopulmonary infections

Almost ZERO IgA with Elevated IgM, Normal IgG

72

Dx of Benign Paroxysmal Positional Vertigo?

Tx?

Dx: Dix-Hallpike

Tx: Epley maneuver

73

S&S of Internal Carotid A. dissection

v. Vertebral a. dissection

ipsilateral cranial nerve deficits (e.g. ptosis, miosis, weak shoulder raise)

while a Vertebral a. dissection will show Horner's Syn.

74

Tx. Trigeminal Neuralgia

Carbamazepine

75

Meniere's Disease

Ppx?

HCTZ + Triamterene reduce endolymph in the semicircular canals

76

Common migraine

S&S

Ppx

Tx

Frequent constant headache that doesn't come with flashing lights, motor weakness, aura, or dizziness

PPx: Propranolol, Verapamil

Tx: Sumatriptan

77

Most common cause meningitis in people >35 y.o.

Strep pneumo ( G+ diplococci)