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