Neuro Flashcards Preview

Step 1 > Neuro > Flashcards

Flashcards in Neuro Deck (194)
Loading flashcards...
1
Q

Benign brain tumor that pushes on the brain tissue without invading it. seen parasaggital or at edges

A

Meningioma

2
Q

“fried-egg appearance”, can have calcifications

A

oligodendroglioma

3
Q

perivascular rosettes, hydrocephalus, 4th ventricle

A

Ependymoma (ependymal cells line ventricles)

4
Q

degeneration of anterior motor horn

A

Poliomyelitis or Werdnig Hoffman

5
Q

Synringomyelia (anterior white commisure)

A

LMN sx i.e. weakness + loss of P/T from UE (because usually at c8-t1)

Can expand to hit Anterior motor horn, as well as lateral horn t1 (horners)

6
Q

UMN and LMN signs

A

ALS

7
Q

Hypertrophic cardiomyopathy + degen of several neural tracks

A

Friedreich ataxia

8
Q

where do you do lumbar puncture

A

L4-L5. spinal cord stops at L2 but cauda equina til s2. subarachnoid space

9
Q

most common cause of Subarachnoid Hemorrhage (bleed on bottom of the brain)

A

Rupture of berry aneurysm (anterior circle of willis –> ACom branch points)

10
Q

why is a Berry aneurysm susceptible to rupture?

A

Lacks a media layer

11
Q

whats the AFP level in neural tube defect

A

HIGH as a fuckin KITE

12
Q

most common cause of hydrocephalus in new born

A

Cerebral aqueduct stenosis (blocks 3–>4)

13
Q

Foramen of Monro

A

Lateral ventricles –> 3rd

14
Q

4th ventricle through Foramen meagendie/luschka into:

A

subarachnoid space

15
Q

Define dandy-walker formation

A

congenital failure of cerebrellar vermis –> presents with absent cerebrelleum and massively dilated 4th ventricle (posterior fossa)

16
Q

massivelyd dilated 4th ventricle

A

Dandy walker formation

17
Q

downward displacement of cerebellar vermis and tonsils through foramen magnum

A

Arnold Chiari (2)

18
Q

name 3 common associations with Arnold-Chiari malformation (type 2)

A

(cerebellar herniation)

Hydrocephalus, Synringomyelia, Meningomyelocele

19
Q

Cystic degeneration of the spinal cord

A

Syringomyelia

20
Q

lose pain and temp in UE

A

Syringomyelia

21
Q

Lateral horn of hypothalamospinal tract

A

Synringomyelia can expand and knock this out = horners (t1)

22
Q

muscle atrophy and weakness in syringomyelia

A

expands to knock out Anterior Horn (LMNs)

23
Q

Polio damages:

A

Anterior motor horn–> LMN signs

24
Q

Floppy baby, autosomal recessive

A

Werdnig-Hoffman; degen of anterior motor horn

25
Q

ALS: Degen of ________

A

UMN and LMN of Corticospinal tract

26
Q

Corticospinal tract is damaged in

A

ALS

27
Q

Enzyme mutation that can cause ALS

A

Superoxide dismutase

28
Q

_____ increases survival in ALS pt by ______

A

Riluzole (“Lou gehrigs”) increases survival by decreasing presynaptic glutamate release

29
Q

Glutamate antagonist

A

Riluzole used to treat ALS (Lou Gehrigs)

30
Q

What are the neural components of Friedreich Ataxia

A

Degenerative disorder of the cerebellum: ataxia

and Spinal cord: loss of MVP, deep tendon reflex, LE muscle strength

31
Q

describe the frataxin gene (lost in freidreich)

A

Mitochondrial iron regulation…loss = iron buildup and thus free radical damage

32
Q

first sign of friedreich ataxia

A

clumsyness

33
Q

Neisseria menigitidis meningitis

A

through the NOSE nigga.

34
Q

signs of meingitis

A

headache, nuchal rigidity, fever; Photophobia, vomiting, altered mental status.

35
Q

where does lumbar puncture sample

A

Subarachnoid space

36
Q

what ischemic neural effects can an Insulinoma have?

A

Repeated bouts of hypoglycemia –> global cerebral ischemia (brai needs glucose)

37
Q

Pt has a stroke…whats the protocol for tx

A

give tPA–> have to do CT (noncontrast) to RULE OUT HEMORRHAGE!! tPA within 1st 4 hours

aspirin/clopidogrel can be given to reduce risk

38
Q

does TIA register on MIA?

A

Nope, its a reversible thang less than 15 minutes of focal neuro dysf(x)

39
Q

hypoxia and irreversible damage

A

irreversible damage after 5 minutes of hypoxia.

Hippocampus (pyramidal neurons/temporal lobe), Cerebral cortex (laminar necrosis layers 3 5 6)
Cerebellum (purkinje layer)

40
Q

hyaline arteriolosclerosis (HTN) leads to what type of stroke?

A

Lacunar stroke

41
Q

Describe lacunar stroke

A

involves lenticulostriate vessels = small lacunar infarcts (cystic areas)

Thalamus: pure sensory
Internal capsule: pure motor

42
Q

earliest change in ischemic stroke

A

Liquefactive necrosis 1st sign = red neuron = eosinophilic change of neuron cytoplasm

43
Q

which cells are responsible for gliosis post storke

A

astrocytes

44
Q

in stroke, neutrophils are day 1-3, which cell is day 4-7?

A

Microglia (MQ of the brain)

45
Q

what are the 2 aneurysms in the brain?

A

Berry aneurysm (subarachnoid space) and Charcot-Bouchard (parenchymal space)

46
Q

Describe charcot-bouchard aneurysm

A

due to HYPERTENSION.

LENTICULOSTRIATE vessels going to BASAL GANGLIA (look in the center where the cord would attach)

intracerebral hemorrhage/bleeding into PARENCHYMA (so not lobar)

47
Q

sudden headache + nuchal rigidity

A

subarachnoid hemorrhage

48
Q

LP indicating SAH

A

Xanthochromia (yellow due to bilirubin)

49
Q

what does yellowish LP indicate

A

Subarachnoid Hemorrhage.

Can be a bloody or yellowish tap = SAH

50
Q

Berry aneurysm can cause

A

Bitemporal hemianopia by compressing optic chiasm
Subarachnoid hemorrhage
Hemorrhagic stroke

51
Q

lens shaped lesion on CT

A

Epidural hematoma

52
Q

lucid interval after bleed

A

Epidural hematoma

53
Q

crescent shaped lesion on CT

A

subdural hematoma

54
Q

Uncal herniation

A
  1. CNIII: eye moves down and out + dilated pupil
  2. PCA: contralat homonymous hemianopsia – infarction of occipital lobe
  3. Paramedian artery: Duret (brainstem) hem
55
Q

deficiency of Arylsulfatase

A
Metachromatic Leukodystrophy (demyelination)
-->sulfatides accumulate in lysosomes. ataxia/dementia
56
Q

defeciency of galactocerebrosidase

A

Krabbe (buildup of galactocerebrosidase and psychosine). demyelination. Peripheral neuropathy, optic atrophy, developmental delay

57
Q

Leukodystrophies (inherited mutations fuck up myelin)

A

AR: Metachromatic leukodystrophy (arylsulfatase) and Krabbe (galactocerebrosidase)

X-linked: Adrenoleukodystrophy (long chain fatty acids–> brain and adrenals)

58
Q

Clining features of MS

A

Blurred vision in one eye (optic nerve)
vertigo and scanning speech (brainstem)
internuclear opthalmoplegia (MLF)
Hemiparesis (periventricular white matter)
Bowel bladder and sexual dysfunction (ANS)

59
Q

Lumbar puncture MS

A

Increased lymphocytes, increased Ig’s with OLIGOCLONAL IgG bands on electrophoresis
Myelin basic protein (because destroyed myelin)

60
Q

Astrocytes

A

Neuroectoderm

GFAP = astrocyte marker

61
Q

Microglia vs macroglia

A

Microglia: phagocytes. mesodermal
Macroglia: astrocytes, oligo, ependymal. Neuroectoderm

62
Q

Guillain Barre: injury to

A

schwann cells!!

63
Q

Endoneural inflammation

endomysial inflammation

A

GBS

polymyositis

64
Q

ADH and oxytocin synthesis

A

made in hypothalamus but stored in PP

65
Q

Lateral hypothalamus

A

Lose lateral = lose weight

66
Q

Ventromedial hypothalamus

A

Satiety. Lose ventromedial = verymuch hungry

67
Q

Tau protein

A

Neurofibrillary tangle: Alzheimer

Round aggregates = pick bodies: Pick disease

68
Q

Sx of Pick disease

A

Language (temporal) and behavior (frontal) deficits

69
Q

Parkinsons, loss of ________ neurons in the _________ of the basal ganglia

A

dopaminergic

substantia nigra

70
Q

Sx of Parkinsons

A

Tremor (pill rolling) at rest, disappears with movement
Rigidity (cogwheel) in extremities
Akinesia is slowing of voluntary movement
Postural instability/shuffling gait

71
Q

Expressionless face and tremor that disappears with movement

A

Parkinsons: Akinesia = expressionless face. Pill rolling tremor.

72
Q

dementia in Parkinsons vs Lewy body

A

Lewy body: early dementia

Parkinsons: late dementia

73
Q

Subtantia nigra vs caudate nucleus disorder

A

SN: Parkinsons (dopaminergic)
CN: Huntington’s (GABAergic. trinucleotide = anticipation)

74
Q

When and why do you see Chorea (disorder)

A

See it in Huntingtons (loss of GABAergic neurons in caudate nucleus)

Normally, GABA from BG to Cortex has an inhibitory hold on neurons. loss of GABA = random firing/movement = chorea

75
Q

Increased CSF = expanded/dilated ventrilces = sretching of the _________ fibers = Normal P Hydrocephalus

A

Corona radiata fibers

76
Q

Sx of NPH

A

Wet, wobbly, wacky

77
Q

Lumbar puncture improves Sx

A

NPH (because removes some csf)

78
Q

intracellular vacuoles

A

Spongiform encephalopathy

79
Q

Dementia + ataxia + startle myoclonus (involuntary contractions with mild stimuli)

A

Spongiform encephalopathy

80
Q

layer of gray matter in between internal capsule and ventricle

A

Caudate –> lost in Huntington = hydrocephalus ex vacuo

81
Q

striatum

A

Caudate + Putamen (internal capsule in between them)

82
Q

name a tumor that can cross the corpus callosum

A

GBM “butterfly lesion”

83
Q

pseudopalisading and GFAP +

A

GBM (also, endothelial cell prolif)

84
Q

benign tumor of ARACHNOID Villi/Cells

A

Meningioma

85
Q

psamomma bodies + may present as seizure/focal neuro deficits

A

Meningioma

86
Q

spindle cells in a concentrically whorled pattern

A

Meningioma

87
Q

loss of hearing, tinnitis, s-100 +

A

schwannoma = benign tumor of schwann cells

88
Q

neurofibromatous 2 brain tumor

A

bilateral schwannomas

89
Q

calcified tumor in white matter, usually frontal lobe, seizures

A

Oligodendroglioma

90
Q

where do you see a Pilocytic astrocytoma

A

posterior fossa/cerebellum

91
Q

Cystic and solid components to neural tumor

A

Pilocytic astrocytoma: cystic lesion + mural nodule

92
Q

Eosinophilic fibers of astrocytes on brain tumor biopsy

A

Rosenthal fibers –> Pilocytic Astrocytoma

93
Q

Primitive neuroectodermal tumor (PNET): Name + Histo

A

Medulloblastoma: small blue cells

94
Q

Homer-wright rosettes vs perivascular pseudorosettes

A

Homer-wright: Medulloblastoma, Neuroblastoma (AM)

Perivascular: Ependymoma

95
Q

high mitotic index child brain tumor (posterior fossa)

A

Medulloblastoma = highly malignant

96
Q

neuroblastoma

A

tumor of adrenal medulla in kids
neural crest origin
homer wright rosettes

97
Q

brain tumor from epithelial origin

A

epithelial remnants of Rathke’s pouch = Craniopharyngioma

98
Q

Bitemporal hemianopsia in a child vs adult

A

child: consider Craniopharyngioma
adults: Pituitary adenoma

99
Q

how dos ectoderm become neuroectodorm = neural plate

A

Notochord (which becomes Nucleus polposus)

100
Q

Neural plate gives rise to

A

Notochord and neural crest cells

101
Q

Telencephalon and Diencephalon

A

Part of Forebrain (Football has TDs)

Telencephalon: cerebral hem/lateral ventricles
Diencephalon: thalamus/3rd ventricle

102
Q

Midbrain/aqueduct come from which layer

A

Mesencephalon

103
Q

AFP in spina bifida occulta

A

no structural herniation, just failure of bony spinal to close. intact dura. hair/skin simple.

NORMAL AFP

104
Q

maternal diabetes and messed up brain development

A

Anencephaly

105
Q

Clinical findings of anencephaly

A

Polyhdramnios, increased AFP, no forebrain.

106
Q

failure of L and R hemispheres to separate

A

Holoprosenchepaly

107
Q

Conditions that cause Holoprosencephaly (failure R/L sep)

A

Patau, Fetal alcohol syndrome, Sonic hedgehog signaling pathway

108
Q

Lumbosacral myelomeningocele

A

Arnold Chairi II (herniation through foramen magnum)

109
Q

aquedecutal stenosis + hydrocephalus after cerebellar tonsillar herniation

A

Arnold Chiari II

110
Q

cystic dilation of the 4th ventricle (posterior fossa)

A

Dandy walker

111
Q

congenital hydrocephalus

A

structural: Aqueductal stenosis, Dandy walker, Chairi
infectious: CMV, toxoplasmosis, meningitis

112
Q

Sx of infantile hydrocephalus

A
Macrocephaly
Poor feeding ("trouble latching while breast feeding")
Muscle hypertonicity 
Hyperreflexia
Seizures/developmental delay
113
Q

why does infantile hydrocephalus cause hyperreflexia and hypertonicity (muscular)

A

UMN damage –> stretching of the periventricular pyramidal tracts

114
Q

sensation/taste anterior 2/3 tongue

1/2 branchial arches

A

Sensation: V
Taste: VII

115
Q

sensation/taste posterior 1/3 tongue

3/4 branchial arches

A

IX (CN 9 = Glossopharyngeal)

116
Q

role of Glossopharyngeal (CN9) and Hypoglossal (CN12) to tongue

A

9: taste and sensation of posterior 1/3
12 (Hypoglossal): Motor innervation to everything except for

palatoglossus (X; elevates posterior tongue during swallowing)

117
Q

Locus ceruleus (pons)

A

Norepinephrine

Increased in anxiety
Decreased in depression

118
Q

Ventral tegmentum and Substantia nigra pars compacts (midbrain)

A

Dopamine

119
Q

Basal nucleus of Meynert

A

ACh

Increased in Parkinson
Decreased in Alzheimers (AD = low ACh)

120
Q

GABA (Nucleus Accumbens) levels in

anxiety and hungtingtons

A

Decreased in both

121
Q

Stress and panic

A

Locus Ceruleus (NE)

122
Q

Nucleus accumbens

A

GABA. Reward/pleasure/addiction/fear

123
Q

Thalamic fibers going to primary somatosensory cortex

A

VPL (pain temp, MVP)
VPM (face…sensation and taste)

Damage to either = complete contralateral sensory loss

dont be a peasant –> my impulse is “ventral” so has to be motor and not sensory

124
Q

VPL nucleus of thalamus

vs in hypothalamus its like “ventromedial area”

A

Spinothalamic tract: Pain and temp

DC/ML: MVP (proprioception, touch, vibration, pressure)

125
Q

Patient has unsteady gait/difficulty walking. which track/nucleus of thalamus

A

VPL –> DC/ML = MVP = lost proprioception

126
Q

VPM nucleus of thalamus

A

VPM –> Makeup goes on the Face

Face sensation and taste

127
Q

LGN and MGN of thalamus

A

LGN: “Light” = vision
MGN: “Music” = hearing

128
Q

VL nucleus of thalamus

A

Motor to Basal ganglia/cerebellum

129
Q

The famous 5 F’s = Limbic system

A

Feeding, Fleeing, Fighting, Feeling, Fucking

emotion, long term memory, behavior, ANS

130
Q

structures of Limbic System

A
Hippocampus
Amygdala
Mammillary Body 
Fornix
Cingulate Gyrus
131
Q

Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness

A

Osmotic demyelination syndrome aka central pontine myelinolysis

132
Q

Cerebral edema/herniation related to Sodium

A

High to low, your brain will blow

133
Q

Romberg

A

+: Ataxia is sensory = DC-ML fucked up

-: Ataxia is cerebellar

134
Q

alpha synuclen intracellular eosinophilic inclusions

A

Lewy bodies –> Parkinsons and Lewy body dementia

135
Q

resting tremor, shuffling gait

A

Parkinsons

136
Q

Angry man with choreo (dancing movements), wheres the damage?

A

Caudate nucleus –> huntingtons

137
Q

Neuronal death via NMDA-R binding and glutamate toxicity

A

Huntingstons: NMDA - Hunt with Glutamatate gun (NRA)

138
Q

CAG Repeats and loss of ACh and GABA

A

Caudate loses ACh and GABA = Hungtingtons

139
Q

No ifs, ands or buts (can’t repeat)

A

Conduction Aphasia: damage to Arcuate Fasciculus. (poor repetition)

140
Q

Disinhibited behavior: Hyperphagia, hypersexuality

A

Kluver-bucy –> amygdala lesion

Frontal lobe damage (R side = disinhibited behavior)

141
Q

Reemergence of primitive reflex, difficulty concentration, poor judgement

A

Frontal lobe damage

142
Q

Eye looks toward side of lesion

A

FEF

143
Q

Eye looks away from lesion

A

PPRF

144
Q

Stroke: Motor/Sensory to Upper Limb and Face

A

MCA

145
Q

temporal lobe (wernicke) and frontal lobe (Broca) stroke

A

MCA

146
Q

Lower limb motor and sensory loss

A

ACA

147
Q

after stroke, can’t walk

A

ACA (lower limb sensorimotor)

148
Q

dysphagia, hoaseness, woming, decreased pain and temp from ipsilat face and cl body

A

PICA: lateral medulla (wallenberg)

149
Q

Paralysis of face

A

AICA: Facial droop means AICAs pooped

150
Q

intracranial hemorrhage that can cross suture lines

A

Subdural hematoma

i.e. shaken baby, alcoholics, blunt trauma/whiplash

151
Q

intracranial hemorrhage that cross falx/tentorium

A

epidural hematoma

152
Q

hemorrhagic stroke/intracerebral hemorrhage

A

Basal ganglia

153
Q

lateral corticospinal tract (UMN)

A

voluntary movement of contralateral limbs

154
Q

positive Romberg, absence of deep tendon reflexes, Latent bacteria

A

Tabes dorsalis

155
Q

Tracts affected by vit b12 def

A

Subacute combined degeneration:
DC-ML (lose mvp)
Lateral corticospinal tract (UMN signs)
Spinocerebellar tract

Ataxic gait, parestheia, impaired position and vibration

156
Q

KYPHOSCOLIOSIS, HCM, Staggering gait, frequent falling, PES CAVUS (high plantar arches)

A
Friedreich ataxia (trinucleotide repeat GAA)
-->death by cardiomyopathy
157
Q

Brown Sequard syndrome

A

hemisection of spinal cord
CL pain and temp loss
Ipsilateral loss of MVP, and UMN signs
Ipsilateral loss of all sensation at level of lesion

158
Q

UMN vs LMN face lesion

A

UMN: CL lower face paralysis
LMN: ipsilat paralysis of upper and lower face

159
Q

Neuroleptic Malignant Syndrome (after antipsychotic overdose)

A

diffuse muscle rigitidity
high fever/ANS instability
High Creatine kinase (rhabdomyolysis)

Tx = Dantrolene (block Ca rel from RyR of SR) or Bromocriptine (dopamine agonist)

160
Q

2 most common causes of intellectual disability

A
Down syndrome (most common overall)
Fragile X (most common inherited)
161
Q

CNIII is motor/sensory/both?

A

Pure MOTOR

Some Say Marry Money But My Brother Says Big Boobs Matter Most

162
Q

Radial Nerve Damage (include vs spare triceps reflex)

A

In Axilla (crutches/saturday night palsy) = Proximal injury = lose finger extensors, get wrist drop, absent triceps reflex

Injury to proximal radial nerve as it crosses posterior humerus (MIDSHAFT HUMERUS) spares triceps reflex, lose extensors of hand.

Finger/thumb drop (loss of extension) without wrist or tricep deficits = damage in supinator canal, i.e. mechanic doing lots of screwdriving

163
Q

B12 deficiency rxns

A

MMA —MMA CoA mutase –> Succinyl-CoA (not succinylcholine)

Homocysteine –Methionine synthase/THF–>Methionine

164
Q

rxn in PKU

A

lose PH or its cofactors tetrahydroBiopterin (BH4)

Phenylalanine–Phenylalanine Hydroxylase (PH) –>Tyrosine

165
Q

Cerebellar lesions are different from cerebral because:

A

the cerebellum double crosses you! so ends up being ipsilateral.

  • ->dysdiadochokinesia (loss of rapidly alt movements)
  • ->limb dysmetria (over/undershoot)
  • ->intention tremor (tremor during movement)
166
Q

2 CAN pneumonics

A

Whipples: Cardiac, Arthralgia, Neuro sx
Wernicke: Confusion, Ataxia, Nystagmus

(this is wernicke encephalopathy, not aphasia; and nystagmus interhcangable with opthalmoplegia. due to Thiamine b1 def)

Note: Thiamine def = periph neuropathy, high-output cardiac failure, and Wernickes (ataxia, confusion, nystagmus)

167
Q

Dx of Thiamine deficiency

periph neuropathy + cardiac failure aka wet beri beri DCM + Wernicke encephalopathy aka confusion ataxia nystagmus

A

Increased rbc TRANSKETOLASE activity after giving thiamine

168
Q

Synaptophysin vs GFAP

A

GFAP = Astrocytes (NeuroGlia–>hence responsible for reactive GLIOSIS)
–>Gliomas (non-neuronal tissue) =
Astrocytoma, Ependymoma, Oligodendroglioma
(still part of brain so still all neuroectoderm)

Synaptophysin = neurons, neuroectodermal cells, neuroendocrine

169
Q

Von Hippel Lindau (4)

A
  1. Hemangioblastoma of cerebellum/retina (vascular)
  2. Renal Cell Carcinoma (bilateral)
  3. Pheochromocytomas
  4. Angiomatosis (Cavernous hemangiomas all over)
170
Q

difficulty removing hand from handshake

A

Myotonia (seen in myotonic dystrophy)

171
Q

Frontal balding, cataracts, myotonia, testicular atrophy, arrythmia

A

Myotonic Dystrophy (type 1 fibers. auto dom trinuc rpt)

172
Q

AICA vs PICA

A

Both: Ips P/T Face, CL P/T Body. Vomit/vertigo/nystag

AICA: Lateral Pons. Facial paralysis. Taste ant 2/3 tongue
(Facial droop means AICA pooped)

PICA: Lateral Medulla. Dysphagia/hoarseness
(dont pica horse that can’t eat)

173
Q

Locked-in syndrome

A
  1. Osmotic Demyelination (central pontine myelinolysis)
    - ->correct hyponatremia (low to high pons will die) rapid
  2. Basilar artery stroke

Osmotic demyelination more likely to present with loss of consciousness

174
Q

ACom or PCom: CNIII palsy

A

PCom.

Both can cause visual defects.
Both sites are more likely to be aneurysm than stroke. Both sites = Berry (saccular) aneyrums, with ACom #1

175
Q

Motor and PNS component of CNIII

A

Motor in Middle: Affected by ischemia/ vascular dx (DM)
–>Ptosis, Down-and-out gaze, Horizontal/vert diplopia

PNS outside: Affected by compression (PCA aneurysm)
–>dec Pupillary light reflex, Blown pupil with down/out

176
Q
Vertical diplopia (can't go down the stairs)
"With Cranial Nerve \_\_\_\_\_ its hard to walk down to the bottom floor"
A
CN IV (Trochlear = SO4)
head tilts toward side of lesion, can compensatory tilt in other direction while going down stairs
177
Q

Kid has MVP, autism, and intellectual disability. He has a problem in gene ________

A

Methylation ( Fragile X)

178
Q

Kid has ASD, duodenal atresia, palmar crease, sandal gap. His b-HCG is ________, and his condition is a result of ______ _______

A

bHCG INCREASED in Down (dec in 18 and 13)

Meiotic Nondisjunction

179
Q

Elderly patient comes in with insomnia, can we give him Benzo?

A

NO!! Drugs to avoid in elderly:
Benzo’s: cognitive impairment/delirium/falls

TCAs (amytriptyline) and antihistamines (Diphenhydramine) due to strong anticholinergic effects and delirium/falls

180
Q

Temporal lobe herniation =

A

Uncal aka transtentorial herniation! Uncus = medial temporal lobe;

181
Q

Uncal Herniation Manifestations

A
  1. Ipsilateral CNIII = Ipsilat blown pupil/downandout
  2. Ipsilateral PCA = contralat homonymous hemianopia
  3. Compress CL Peduncle = CL Corticospinal tract = IPSILAT HEMIPARESIS
  4. Duret hemorrhages: brainstem (pons/midbrain) due to stretching of Paramedian Basilar Artery (fatal)
182
Q

Recurrent Lobar Hemorrhages in Elderly

A

Cerebral AMYLOID angiopathy

183
Q

Endomysial inflammatory infiltrate
Endoneural hyaline arteriolization
Endoneural inflammatory infiltrate

A

Polymyositis (proximal mm weakness)
Diabetic neuropathy
GBS

184
Q

Headache that gets worse with Valsalva (they will say its worse when he coughs or bears down during MM)

A

Suggests increased ICP aka tumor (and NOT a migraine)

185
Q

contralateral Hemiparesis loss

contralateral Hemisensory loss

A

Corticospinal tract lesion (cortical/brainstem)

Ascending somatosensory = DC-ML and Anterolateral

186
Q

Posterior Communicating Artery (PCom)
Posterior Cerebral Artery (visual/occipital cortex)
PICA (Lateral medulla)

A

PCom: saccular Aneurysm = COMPRESSES CNIII so see ipsilateral down and out + ptosis and myDRiasis

PCA: Contralateral homonymous hemianopia w/macular sparing

PICA: Dec P/T ipsilateral face and CL body; dysphagia, hoarseness, ipsilateral Horner; vomiting/vertigo/nystagmus

187
Q

Parasympathetics vs Sympathetics eye

A

CNIII has PNS fibers on outside….so damage = MYDRIASIS
(seen with compression= PCA aneurysm/Uncal herniation…won’t really be seen with diabetic/vascular/ischemic damage unless severe)

Horners = SNS damage = MIOSIS, ptosis, anhydrosis ——->any lesion above T1 i.e. Syringomyelia (c8-t1), Pancoast tumor, Brown-Sequard (hemisection resulting in CL P/T and Ipsi

PICA: involves ipsilateral Horner (b/c knocks out SNS fibers)

188
Q

Cerebellum Peduncles

A

Input:
Inferior - ipsilateral info
Middle - contralateral cortex info

Output:
Superior - Sends info to contral cortex to modulate movement (via output fibers = Purkinje fibers)

189
Q

Lateral vs Medial Cerebellar Lesion (Romberg is - b/c cerebellar)

A

Lateral: Limb dysmetria (fall to ipsilat side)
Medial: Truncal ataxia/nystagmus

lose Rapid alt movements = dysdiadochokinesia
also lose tandem walking in cerebellar lesion

190
Q

Lesion location :
Chorea (sudden, jerky movements. Huntington)
Hemiballismus (sudden flailing of 1 arm, +/- Ipsi leg)
Intention Tremor (zigzag when extending to target. MS)

A

Chorea: Basal Ganglia

Hemiballismus: Contralat Subthalamic (Basal Ganglia –>Lacunar STROKE)

Intention Tremor: Cerebellum

191
Q
  • Sudden uncontrolled muscle contraction(hiccups/jerks)
  • Sustained, involuntary muscle contraction (writer cramp)
  • High freq tremor w/sustained posture (outstretchedarm)
  • Tremor alleviated by intentional movement
A

Myoclonus
Dystonia (also the eyelid thing. can manual suppress)
Essential Tremor (relieve with EtOH)
Resting tremor (parkinson)

192
Q

Essential tremor tx

A

“Extremely tiring to keep my arm up”
Have some EToH, bETa - blocker
-pt self medicates with EtOH
-Tx with Beta blocker or primidone

193
Q

Dementia and visual hallucinations, followed by parkinsonian features

A

Lewy body dementia (Halewycinations) –> alpha-synuclein defect

194
Q

Autoimmune myelin destruction (demyelinating)

A
Guillain Barre (PNS)
Multiple Sclerosis (CNS). Can feel fatigue after hot shower