Neuro Flashcards
(188 cards)
1
Q
Labs on neural tube defects?
A
Increased AFP
Increased AChE
2
Q
What maternal disease is anencephaly associated with?
A
Maternal type 1 diabetes
3
Q
What mutation is holoprosencephaly associated with?
A
Sonic headgehog
4
Q
What conditions is holoprosencephaly associatd with?
A
Patau syndrome
FAS
5
Q
How does syringomyelia present?
A
“Cape-like” bilateral loss of pain and temp sensation in UE (C8-T1)
- Ciari I malformation
6
Q
Neuron staining?
A
Nissl (RER) - only in dendrites
7
Q
Astrocyte staining?
A
GFAP
8
Q
Where is Ach produced?
A
Basal nucleus of Meynert (degernation in Alzheimers)
9
Q
Where is DA produced?
A
Ventral tegmentum
SNpc
10
Q
Where is GABA prodcued?
A
Nucleus accumbens
- Made from glutamate and vit B6
11
Q
Where is NE produced?
A
Locus ceruleus
12
Q
Where is serotonin produced?
A
Raphe nucleus
13
Q
Function of supraoptic nucleus of hypothalamus?
A
Makes ADH
14
Q
Function of paraventricular nucleus of hypothalamus?
A
Makes oxytocin
15
Q
Function of lateral area of hypothalamus?
A
Hunger
- Damage –> anorexia
- Stimulated by: ghrelin
- Inhibited by: leptin
16
Q
Function of ventromedial area of hypothalamus?
A
- Satiety
- Damage (craniopharyngioma) –> hyperphagia
- Stimulated by: leptin
17
Q
Function of anterior hypothalamus?
A
- Cooling (PS)
18
Q
Function of posterior hypothalamus?
A
- Heating (S)
19
Q
Function of suprachiasmatic nucleus?
A
- Circadian rhythm
- SCN releases NE –> pineal gland –> melatonin
20
Q
Extraocular movements during REM due to?
A
PPRF
21
Q
Treatment for bedwedding?
A
Oral desmopressin (1st line) Imipramine (TCA) 2nd line
22
Q
Treatment for night terrors and sleepwalking?
A
Benzos
23
Q
Function of VPL of thalamus?
A
Sensory from body
24
Q
Funciton of VML of thalamus?
A
Sensory from face
25
Function of lateral geniculate nucleus of thalamus?
Vision
26
Function of medial geniculate nucleus of thalamus?
Hearing
27
Function of ventral lateral nucleus of thalamus?
Motor
28
Mesocortical DA Pathway
Negative sx
29
Mesolimbic DA pathway
Positive sx
| - Antipsychotics
30
Nigrostriatal DA pathway
EPS
| - Movement disorders, antipsychotic drugs
31
Tuberoinfundibular DA Pathway
Prolactin --> galactorrhea, gynecomastia
32
Lateral Cerebellum Lesion
Fall toward injured (ipsilateral) side
33
Medial Cerebellum Lesion
```
Truncal ataxia (wide-based cerebellar gait), nystagmus, head tilting
- Bilateral motor deficits
```
34
Athetosis (snake-like movement)
Basal ganglia (Huntington)
35
Chorea (dancing)
Basal ganglia (huntington)
36
Dystonia
Writer's cramp, belpharospasm, spasmodic torticollis, EPS due to antipsychotic meds
37
Essential Tremor (rest + movement)
Familial, self-medicate with alcohol
| - Rx: nonselective beta-blocker (propanolol), primidone
38
Hemiballismus
Contralateral STN (lacunar stroke)
39
Intention tremor (w/ movement)
Cerebellar dysfunction
40
Resting tremor (at rest)
Parkinson
41
Brain findings in Parkinsons?
- Lewy bodies (alpha-synuclein - IC eosinophilic inclusions)
| - Loss of DA neurons of SNPC
42
Type of gait in Parkinsons?
Shuffling gait (festinating gait)
43
Huntington DZ Genetics
AD w/ 100% penetrance
Trinucleotide CAG repeat on Chr 4
Anticipation (spermatogenesis)
44
NT in Huntington
Increased DA
| Decreased GABA and ACh
45
Pathogenesis of Huntington
NMDA-R binding --> glutamate excitotoxicity --> neuronal death
46
Brain findings of Huntingtons
Atrophy of caudate and putamen w/ hydrocephalus ex vacuo
47
Kluver-Bucy Syndrome
| - Hyperphagia, hypersexuality, hyperorality
- AMYGDALA
| - HSV-1 encephalitis
48
Nondominant Parietal Cortex (R) Lesion
Hemispatial neglect on L
49
Gerstmann Syndrome
- Dominant parietal cortex lesion
| Agraphia, acalculia, fingeragnosia, left-right disorientation
50
Cerebral perfusion driven by/
PCO2
51
ACA Stroke
Motor and sensory loss of LOWER LIMB (contralateral)
52
MCA Stroke
Motor and sensory loss of FACE and UPPER LIMB (contralateral)
Aphasia (if L hemisphere)
Hemineglect (if R hemisphere)
53
Lenticulostriate Artery Stroke
- Lacunar infarcts
- Secondary to unmanaged HTN
Motor and sensory loss of FACE and BODY
| Like MCA but not aphasia/hemineglect
54
PCA Stroke
Contralateral hemianopia with macular sparing
55
Anterior Spinal Artery Stroke = MEDIAL MEDULLARY SYNDROME
- Motor loss of UPPER and LOWER LIMBS (lateral CST)
- Decreased contralateral proprioception (ML)
- Tongue points ipsilateral (hypoglossal, CN XII) (caudal medulla)
56
PICA Stroke = LATERAL MEDULLARY (WALLENBERG) SYNDROME
- Vomiting, vertigo, nystagmus
- Decreased pain and temp sensation from IPSILATERAL FACE (CN V) and CONTRALATERAL BODY (STT)
- ***DYSPHAGIA, HOARSENESS (CN X - nucleus ambiguus)
- Decreased gag reflex
- Ipsilateral Horner Syndrome
- Ataxia, dysmetria
57
AICA Stroke = LATERAL PONTINE SYNDROME
- Vomiting, vertigo, nystagmus
- ***PARALYSIS OF FACE, DECREASED LACRIMATION, SALIVATION, and TASTE from anterior 2/3 of tongue (CN VII - facial nucleus)
- Ipsilateral decreased pain and temp of face, contralateral decreased pain and temp fo body
- Ataxia, dysmetria
58
Basilar Artery Stroke = LOCKED IN SYNDROME
- Preserved consciousness, vertical eye movement, blinking
- QUADRIPLEGIA
- LOSS OF VOLUNTARY FACE/MOUTH/TONGUE MOVEMENT
59
Where do saccular aneurysms most commonly occur?
ACA
60
Rupture of saccular aneurysmleads to?
Subarachnoid hemorrhage
61
Epidural hematoma is rupture of which artery
Middle meningeal (branch of maxillary)
62
cause of epidural hematoma?
Skull fracture (temporal)
63
CT of epidural hematoma?
BICONVEX (lens shaped), doesn't cross suture lines
64
Subdural hematoma is rupture of which vessels?
Bridging veins
65
What patients are subdural hematomas seen in?
- Trauma
- elderly, alcoholism
- SHAKEN BABIES
66
Cause of subarachnoid hemorrhage?
Rupture of berry aneurysm of AV malformation
67
Spinal tap of subarachnoid hemorrahge?
Bloody or yellow xanthochromic
68
What can occur after subarachnoid hemorrhage?
VASOSPASM
| Prevent with nimlodipine (Ca2+ channel blocker)
69
Intraparenchymal hemorrhage caused by?
systemic HTN
Amyloid angiopathy (recurrent lobar hemorrhagic stroke in elderly)
Vasculitis
Neoplasm
70
CT of subdural hematoma?
CRESCENT SHAPED, crosses suture lines
71
Where does intraparenchymal hemorrahge usually occur?
Basal ganglia and internal capsule
| Can be lobar
72
Charcot-Bouchard aneurysm implicated in which type of bleed?
Intraparenchymal hemorrhage in internal capsule
73
Flow through ventricles
Lateral ventricle --> foramina of Monro --> 3rd ventricle --> cerebral aqueduct of Sylvius --> 4th ventricle --> foramina of Luschka (lateral) or Magendie (medial) --> subarachnoid space
74
Pseduotumor Cerebri (Idiopathic Intracranial HTN) RF
- Woman of childbearing age, Vit A excess, danazol, tetracycline
75
Pseduotumor Cerebri (Idiopathic Intracranial HTN) Rx
- LP provides HA relief
- Weight loss
- Acetazolamide (decrease CSF production)
- Topiramate
- Repeat LP, CSF shunt, optic nerve fenestration
76
Communicating Hydrocephalus
Decreased CSF absorption by arachnoid granulations (post-meningitis)
77
Normal Pressure Hydrocephalus
- ELDERLY
- Expansion of entricles --> distorts fibers of corona radiata --> triad of urinary incontinence, ataxia, and cognitive dysfunction
- Magnetic gait (feet stuck to floor)
78
Noncommunicating Hydrocephalus
Structural blockage (stenosis, colloid cyst, tumors)
79
Ex vacuo ventriculomegaly
- Looks like increased CSF on imaging but it's actually decreased brain
- Alzheimers, HIV, Pick DZ
80
What levels is intermediate horn (sympathetic) seen?
T1-L2/3
81
Dorsal Column
- P, vibration, fine touch, proprioception
- Decussates in medulla
- ROMBERG
82
Sinothalamic tract
- Lateral: pain, temp
- Anterior: crude touch, P
- Decussates at anterior white commissure
83
Lateral Corticospinal Tract
- Voluntary movement of contralateral limb
| - Decussates at caudal medulla (pyramidal decussation)
84
Atrophy and fasciculations - UMN or LMN?
LMN lesion
85
Babinski - UMN or LMN?
UMN lesion
86
Polio - presentation and spinal cord?
- ANTERIOR HORN - LMN LESION ONLY
- Plus nonspecific sx
- CSF: increased WBCs and protein, no change in glucose
- ASSYMETRIC WEAKNESS
- Fecal to oral transmission --> replicates in oropharyns and small intestine --> spreads via bloodstream into CNS
87
Werdnig-Hoffman
- ANTERIOR HORN - LMN LESION ONLY
- "Floppy baby" + hypotonia + tongue fasciculations
- AR
- SYMMETRIC WEAKNESS
88
ALS
- UMN (LATERAL CORTICOSPINAL) AND LMN (ANTERIOR MOTOR HORN NEURON)
- NO SENSORY OR BOWEL/BLADDER DEFICITS
- Defect in superoxide dismutase 1 --> free radical injury
- Rx: riluzole
89
ALS Enzyme Defect
Superoxide dismutase 1 --> free radical injury
90
ALS Rx
Riluzole extends survival (decreases glutamate)
91
Tabes Dorsalis
- DORSAL COLUMN
- Tertiary syphilis
- PROGRESSIVE SENSORY ATAXIA
- Charcot joints, shooting pain, Argyll Robertson Pupils
- Absence of DTRS, + Romberg
92
Syringomyelia
- ANTERIOR WHITE COMMISSURE OF SPINOTHALAMIC TRACT --> bilateral loss of pain and temp in "cape-like" distribution
- Chiari I
93
Vit B12 Def
- SPINOCEREBELLAR TRACTS
- LATERAL CORTICOSPINAL TRACTS (UMN signs)
- DORSAL COLUMNS (bilateral loss of position and vibration, gait abnormalities)
94
Friedrich Ataxia Genetics
AR trinucleotide repeat disorder (GAA) on Chr 9
- FRATAXIN (iron binding protein) --> impaired mt functioning
- Staggering gait, frequent falling, nystagmus, pes cavus, hammer toes, DM, HYPERTROPHIC CARDIOMYOPATHY
- Kyphoscoliosis in kids
95
Cremaster Reflex
L1, 2
96
Anal Wink Reflex
S3, S4
97
Exits skull - CN I
Cribiform plate
98
Exits skull - CN II, ophthalmic artery
Optic canal
99
Exits skull - CN 3, 4, 6, V1
Superior orbital fissure
100
Exits skull - CN V2
Foramen rotundum
101
Exits skull - CN V3
Foramen ovale
102
Exits skull - middle meningeal artery
Foramen spinosum
103
Exits skull - CN 7, 8
Internal auditory meatus
104
Exits skull - CN 9, 10, 11
Jugular foramen
105
Exits skull - CN 12
Hypoglossal canal
106
Exits skull - brainstem
Foramen magnum
107
Which CN constricts pupil?
- CN III (oculomotor) - sphincter pupillae [Edinger-Westphal nucleus, muscarinic R]
108
Which CN is in charge of accommodation?
CN III
109
Which CN in charge of eyelid opening (levator palpebra)e?
CN III
110
Which CN in charge of lacrimation?
CN VII
111
Which CN in charge of salivation?
- CN VII *submandibular, sublingual
| - CN IX *parotid
112
Which CN in charge of closing eylid?
CN VII *orbicularis oculi
113
Which CN involved with hearing?
- CN VIII (hearing)
| - CN VII (auditory volume modulation via stapedius)
114
Which CN involved with monitoring carotid body chemo/baroreceptors?
CN IX
115
Which CN monirots aortic arch chemo/baroreceptors?
CN X
116
Corneal Reflex
- Afferent: V1
| - Efferent: VII
117
Lacrimation Reflex
- Afferent: V1
| - Efferent: VII
118
Jaw Jerk Reflex
- Afferent: V3
| - Efferent: V3
119
Pupillary Refelx
- Afferent: II
| - Efferent: III
120
Gag Reflex
- Afferent: IX
| - Efferent: X
121
CN V Lesion
Jaw TOWARDS lesion (unopposed pterygoid)
122
CN X Lesion
Uvula AWAY (weak side collapses)
123
CN XI Lesion
Can't turn head to opposite side (SCM)
| Shoulder droop on side of lesion (trap)
124
CN XII Lesion
LMN Lesion
| Tongue deviates TOWARD lesion ("lick your wounds")
125
CN VII UMN Lesion (Motor Cortex)
CONTRALATERAL paralysis of lower facial muscles
| FOREHEAD SPARED
126
CN VII LMN Lesion (Nucleus/Nerve)
IPSILATERAL paralysis of upper and lower facial muscles, hyperacusis (stapedius), loss of taste sensation to anterior tongue
127
Rx of Bells Palsy
Corticosteroids, acyclovir (HSV)
128
Conductive Hearing Loss
- Weber (top of head) --> AFFECTED EAR
| - Rinne --> abnormal (bone > air) on side that Weber localized to
129
Sensorineural Hearing Loss
- Weber (top of head) --> UNAFFECTED EAR
- Rinne - normal
- Hearing loss is on side opposite of Weber
130
Noise-Induced Hearing Loss
ORGAN OF CORTI
131
Cholesteatoma
Desquamated keratin debris within middle ear
- Conductive hearing loss
- Pearly mass
- Painless otorrhea
132
What do you NOT give to someone with closed/narrow angle glaucoma?
Epinephrine (mydriatic)
133
Most common viral cause of conjuntivitis?
Adenovirus
134
What is uveitis associated with?
Sarcoid, RA, JIA, HLA-B27 related conditions
135
Dry Macular Degeneration
DRUSEN
| Prevent with multivitamin and antioxidant
136
Wet Macular Degeneration
Choroidal neovascularization
| Rx: anti-VEGF and smoking cessation
137
Nonproliferative Diabetic Retinopathy
Hemorrhages and macular edema
| Rx: blood sugar control
138
Proliferative Diabetic Retinopathy
Chronic hypoxia --> new blood vessel formation
| Rx: peripheral retinal photocoagulation, surgery, anti-VEGF
139
Retinal Vein Occlusion
Arterial atherosclerosis
| - Retinal hemorrahge, venous engorgement, edema
140
Central Retinal ARtery Occlusion
- Acute, painless
| CHERRY RED SPOT
141
Retinitis pigmentosa
Night blindness
| Bone spicule-shaped deposits
142
Marcus Gunn pupil
CN II defect
143
CN III Damage
- Motor output (vascular DZ, DM): ptosis, "down and out" pupil
- PS output (compression): absent pupillary light reflex, "blown pupil"
144
CN IV Damage
- Upward gaze
- HEAD TILT TOWARD SIDE OF LESION
- Problems going down stairs --> compensatory head tilt in opposite direction
145
CN VI Damage
- Medially directed eye
| - Horizontal diplopia
146
Function of MLF?
Coordinate VI and III --> eyes move in same horizontal direction
147
Internuclear Ophthalmoplegia
- Lesion in R MLF --> when you look to the L the L eye gets nystagmus (abducting eye) and the R eye looks straight ahead (impaired adduction)
148
Who has an increased risk of developing Alzheimers?
- Down patients (APP is on Chr 21)
- ApoE4 (sporadic) [ApoE2 has decreased risk]
- App, presenilin-1/2 (familial)
149
Brain Findings in Alzheimers
- Senile plaques (EC beta-amyloid from APP) [may cause amyloid angiopathy]
- Neurofibrillary tangles (IC hyperphosphorylated tau)
150
Frontotemporal Dementia Presentation
Personality/behavior probs + Aphasia
151
FT Dementia Brain Findings
- Hyperphosphorylated tau (round Pick bodies)
| - Ubiquinated TDP-43
152
Lewy Body Dementia Presentation
Dementia + visual hallucinations --> parkinsonian features
153
Lewy Body Dementia Brain Findings
Lewy bodies (insoluble aggregates of alpha-synuclein)
154
Vascular Dementia causes
HTN, atherosclerosis, vasculitis
| - Elderly
155
Creutzfeldt-Jakob Brain Findings:
Spongiform cortex
| PRPc --> PRPsc (beta-pleated, resistant to proteases)
156
HLA associated with MS?
HLA-DR2
157
Presentation of MS?
- Optic neuritis (sudden loss of vision, Marcus Gunn pupils)
- INO (MLF)
- Hemiparesis
- Hemisensory sx
- Bladder/bowel dysfunction
- Women in 20-30s, relapsing/remitting, whites living further from equator
158
Charcot triad of MS?
Scanning speech, intention tremor, nystagmus
159
CSF in MS
Increased IgG and myelin basic protein
| Oligoclonal bands
160
Gold standard for MS dx
MRI
| - Periventricular plaque (oligodendrocyte loss + reactive gliosis)
161
MS Rx
- Disease-modifying: beta-interferon, glatiramer, natalizumab
- Acute flares: IV steroids
- Neurogenic bladder: muscarinic antagonists
- Spacticity: baclofen, GABA R antagonists
- Pain: opioids
162
Guillain Barre Syndrome cells affected?
Schwann cells --> PNS (endoneural)
163
GBS CSF findings??
Increased CSF protein with normal cell count (albuminocytologic dissociation)
164
Infections associated with GBS?
Campylobacter, viral
| Molecular mimicry
165
Charcot-Marie-Tooth DZ
```
AD
Foot deformities (pes cavus), LE weakness, sensory deficits
```
166
Krabbe DZ
AR lysosomal storage DZ - deficiency fo galactocerebrosidase --> buildup of galactocerebroside in macs and psychosine --> destroys myelin sheath
167
Metachromatic Leukodystrophy
- AR lysosomal storage DZ due to arylsulfatase A deficiency --> buildup of sulfatides --> impaired production and destruction of myelin sheath
168
Progressive Multifocal Leukoencephalopathy
Destruction of oligodendrocytes
AIDS patients
Due to reactivation of JC virus
Increased risk with natalizumab, rituximab
169
Adrenoleukodystrophy
X-linked
| - Disrupted metabolism of very-long-chain FA --> build up in nervous system, adrenal glands, testes
170
Rx for cluster HA
Acute: sumatriptan, 100% O2
Prophylaxis: verapamil
171
Rx for tension HA
Analgesics, NSAIDs, acetaminophen, amitriptyline
172
Rx for migraine
Acute: NSAIDs, triptans, dihyroergotamine
Prophylaxis: lifestyle changes, beta-blockers, calcium channel blockers, amitryptiline, topiramate, valproate
173
Meniere DZ Presentation
- Vertigo, unilateral hearing loss, tinnitus
174
BPPV caused by?
Otoliths
175
Sturge-Weber Syndrome
- Activating mutation of GNAQ --> neural crest probs
- Port-wine stain of face
- Ipsilateral leptomeningeal angioma (seizures)
- Intellecutal disability
- Episcleral hemangioma (early onset glaucoma)
- Tram track calcification
176
Tuberous Sclerosis
- Hamartomas
- Angiofibromas
- Mitral regurg
- Ash-leaf spots
- Cardiac rhabdomyoma
- AD
- Intellectual disability
- Renal angiolypoma
- Seizure
- Shagreen patches
177
NF 1
- Cafe au lait
- Lisch nodules (iris hamartomas)
- Cutaneous neurofibromas
- Optic gliomas
- Pheochromocytomas
- Mutated NF1 tumor suppression gene (RAS) on Chr 17
- NEURAL CREST
178
Von Hippel Lindau DZ
- Hemangioblastomas in retina, brain stem, cerebellum, spin
- Angiomatosis in skin, mucosa, organs
- Bilateral RCC
- Pheochromocytoma
179
Glioblastoma Multiforme
- Astrocytes, GFAP +
| - Pseudopalisading necrosis
180
Meningioma
- Arachnoid cells
| - Whorled pattern, psammoma bodies
181
Hemangioblastoma
- Von-Hippel Lindau (+ retinal angiomas)
| - Secondary polycythemia (ectopic EPO)
182
Schwannoma
- NF-2 = bilateral vestibular schwannomas
| - S-100+ (neural crest)
183
Oligodendroglioma
Calcified, fried-egg, capillary chicken wire pattern
184
Pilocytic Astrocytoma
- GFAP +
| - Rosenthal fibers, cystic + solid
185
Medulloblastoma
Primitive neuroectoderm tumor
- NOncommunicating hydrocephaus
- Drop mets to spinal cord
- Homer-Wright rosettes, small blue cells
186
Ependyoma
- Hydrocephalus (4th ventricle)
- Pervascular rosettes
- Rod-shaped belpharoplasts
187
Craniopharyngioma
- Bitemporal hemianopia
- Supratentorial tumor
- Rathke pouch
- Calcifications
- Cholesterol crystals in "motor oil" like fluid
188
Pinealoma
- Parinaud syndrome (vertical gaze palsy)
- Obstructive hydrocephalus (cerebral aqueduct)
- Precocious puberty in males (beta-hCG)
