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DT2 Exam 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

pain sensitive cranial structures

A 
scalp
sinuses (periosteum)
meninges
pial arteries
arteries and major veins
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2
Q

pain insensitive cranial structures

A

ventricles
choroid
brain parenchyma (except portion of midbrain)
small parenchymal and dural veins

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3
Q

vascular etiology of pain

A

distension/traction/dilation

traction or displacement of a larger caliber vein

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4
Q

nerve etiology of pain

A

traction or compression of a nerve

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5
Q

meningial etiology of pain

A

traction, displacement, irritation, inflammation of dura

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6
Q

muscular etiology of pain

A

abnormal contracture, spasm, irritation or inflammation of cranial or cervical musculature

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7
Q

brainstem etiology of pain

A

activation of area near dorsal raphe nucleus

induces migraine type pain

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8
Q

pathophysiology of migraine

A

abnormal instability or activation of cells which stimulate the trigeminal system
-causes stimulation of chemoreceptors and autonomic nervous system

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9
Q

diagnosis of common migraine

A 
headache lasting 4-72 hours
unilateral
pulsating
moderate or severe pain intensity
aggravation or causing avoidance of physical activity 
nausea and/or vomiting
photophobia and phonophobia
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10
Q

diagnosis of classic migraine

A

presence of aura-develops gradually over 5-20 minutes and lasts for less than 60 minutes
common auras-visual change, paresthesia, confusion

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11
Q

common visual auras

A

scintillating scotoma

central scotoma

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12
Q

diagnosis of basilar migraine

A

aura consisting of no motor weakness and dysarthria, vertigo, tinnitus, hypacusia, diplopia, visual symptoms in both temporal and nasal fields, ataxia, decreased consciousness, bilateral paresthesias
at least one aura gradually over 5 min (lasting no longer than 60 min)

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13
Q

common migraine triggers

A 
red wine
chocolate
cheese
MSG
heavy nitrite containing food
hunger from missing meals
sleep deprivation
irregular sleep patterns
stress
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14
Q

migraine abortive pharmacology

A

NSAIDs-ibuprofen, naprosyn, ketorlac
5HT1 agonists-triptans and ergots
Dopamine antagonists-metoclopramide, prochlorperazine

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15
Q

prophylactic phrmacology for migraine

A 
beta adrenergic blockers
calcium channel blockers
TCA
anticonvulsants-gabapentin, valproic a cid, topiramate
serotonergic drugs-cyproheptadine
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16
Q

most effective in children

A

cyproheptadine

serotonergic drugs

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17
Q

pathophysiology of cluster headaches

A

derived from hypothalamus

secondary activation of trigeminal-autonomic reflex

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18
Q

diagnosis of cluster headaches

A

episodic headache
attacks of severe unilateral stabbing periorbital or temporal pain
clusters for 3-6 weeks (at least 5 headaches lasting 15-180 min)
associated with autonomic symptoms (ipsilateal lacrimation, congestion, rhinorrhea, eyelid edema, facial sweating, miosis, ptosis)

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19
Q

abortive pharmacology of cluster headaches

A

oxygen-12L/min for 15 minutes most effective abortive agent
triptans-short onset (sumatriptan)
intranasal lidocaine

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20
Q

prophylactic pharmacology of cluster headaches

A

high dose steroids-prednisone
calcium channel blockers-adjuvant of choice
lithium

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21
Q

tension headache diagnosis

A

squeezing or pressure around head
may complain of light and sound sensitivity
never associated with nausea or vomiting
lasts 30 min-7 days
bilateral location
not aggravated by routine physical activity

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22
Q

non-pharmacological treatment of tension headaches

A

stress reduction
biofeedback
cognitive behavioral therapy
improved sleep hygiene

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23
Q

abortive therapy of tension headaches

A

acetaminophen
NSAIDs
Aspirin

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24
Q

prophylactic therapy of tension headaches

A

TCA

Antiepileptic-Gabapentin

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25
Q

pathophysiology of idiopathic intracranial hypertension

A

obstructive segments in the distal transverse sinus and presence of increased arterial inflow
stenosis of transverse sinus
obesity causes increase intra-abdominal pressure and increases cardiac filling pressures

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26
Q

symptoms of idiopathic intracranial hypertension

A
  • nonspecific headache
  • throbbing that worsens with valsalva
  • pulsatile tinnitus-audible whooshing
  • vision impairment-flashes and floaters, diplopia, decreased acuity and impaired visual fields, visual dimming with valsalva
  • bilateral disc edema due to increased intracranial pressure
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27
Q

possible MRI findings for idiopathic intracranial hypertension

A

small slitlike ventricles
enlarged optic nerve sheaths
occasionally an empty sella
neuroimaging to rule out mass or dural venous sinus thrombosis

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28
Q

lumbar puncture in IIH

A

localize at L3-L4 (corresponds to superior iliac crest)

if obese, find sacral promontroy-L5-S1 interspace

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29
Q

CSF pressures

A

diagnosis of IIH >250mmH2O

normal pressure typically 120-170mmH2O

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30
Q

non-pharmacological treatment of IIH

A

diet

bariatric surgery

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31
Q

pharmacological treatment of IIH

A

diuretis-acetazolamide, furosemide
corticosteroid
anticonvulsants-topiramate (CA inhibitor, side effect is weight loss)

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32
Q

surgical indications for IIH

A 
failed medical management
-increased ICP
-visual deterioration
-worsening disc edema 
shunts-ventriculoperitoneal or lumboperitoneal
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33
Q

giant cell arteritis (temporal arteritis) pathophysiology

A

inflammatory response of internal elastic lamina
release of cytokines attracts macrophages and multinucleated giant cells
CD4T responsible for diseased vessel on histology
patchy manner

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34
Q

characteristics of temporal arteritis

A

headache-unilateral, temporal location
vision impairment-transient, intermittent
neck, torso, shoulder, and pelvic girdle pain consistent with polymyalgia rheumatic
fatigue and malaise
jaw claudication
mild fever

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35
Q

diagnosis of temporal arteritis

A

ESR and CRP elevated

temporal artery biopsy-large segment required

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36
Q

treatment of temporal arteritis

A

high dose steroids relieve headache within 3 days

most remain on low dose steroid for a couple of years

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37
Q

consequences of long term steroids

A

diabetes, vertebral compression fractures, steroid myopathy, steroid psychosis, immunosuppression

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38
Q

clinical presentation of brain tumors

A 
increased ICP
headaches, NV, CN3 and CN 6 palsy
papilledema
hemiparesis, aphasia, seizures
tumors in ventricles present with hydrocephalus
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39
Q

diagnosis of brain tumors

A

MRI with contrast
BBB prevents contrast from entering healthy brain
leaky vessels allow tumor contrast to enter-contrast enhancing lesion

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40
Q

risk factor for brain tumors

A

ionizing radiation

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41
Q

characteristics of infiltrating astrocytoma

A

range from well differentiated to undifferentiated

can progress to glioblastoma with accumulation of mutations

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42
Q

grade I astrocytoma

A

pilocytic astrocytoma

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43
Q

grade II astrocytoma

A

diffuse or fibrillary astrocytoma

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44
Q

grade III astrocytoma

A

anaplastic astrocytoma

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45
Q

grade IV astrocytoma

A

glioblastoma

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46
Q

presentation of diffuse astrocytoma

A

younger patients
seizure, HA, focal neurologic deficits
median survival 5 years

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47
Q

histology of diffuse astrocytoma

A

increase in glial cells

GFAP positive

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48
Q

histology of anaplastic astrocytoma

A

more densely cellular
greater nuclear pleomorphism
mitotic figures

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49
Q

diagnosis of diffuse and anaplastic astrocytoma

A

non-enhancing lesion

may not be seen on CT

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50
Q

treatment of diffuse and anaplastic astrocytoma

A

surgical resection
often cannot be resected due to size and location
radiation-most effective nonsurgical treatment

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51
Q

primary vs secondary glioblastoma

A

primary-most common, onset in older people

secondary-younger patients, due to progression of lower grade astrocytoma

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52
Q

classic glioblastoma genetics

A

PTEN mutations
deletion of chromosome 10
most common primary

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53
Q

genetics proneural glioblastoma

A

TP53
point mutations in IDH1 and IDH2
most common secondary

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54
Q

genetics mesenchymal glioblastoma

A

deletions or lower expression of NF1 on chromosome 17

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55
Q

histology glioblastoma

A

densely cellular
necrosis
vascular proliferation
pseudopalisading

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56
Q

diagnosis and treatment glioblastoma

A

MRI-ring enhancing lesion
surgery, radiation, chemotherapy
mean survival 15 months

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57
Q

characteristics of pliocytic astrocytoma

A

children and young adults
often cystic with mural nodule in wall of cyst
grows slowly, recurrence involves cyst enlargement rather than growth of solid component

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58
Q

locations of pliocytic astrocytoma

A

cerebellum

third ventricle

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59
Q

histology of pliocytic astrocytoma

A

cells with hair-like processes

Rosenthal fibers from long standing gliosis

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60
Q

characteristics of oligodendroglioma

A

adults in 40-50
slow growing
in cerebral hemispheres
calcifications!

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61
Q

histology of oligodendroglioma

A

sheets of regular cells with spherical nuclei, surrounded by clear halo of cytoplasm (poached egg appearance)

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62
Q

genetics of oligodendroglioma

A

mutations in IDH1 and IDH2

deletions in chromosome 1p and 19q

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63
Q

treatment of oligodendroglioma

A

surgery, radiation, chemotherapy

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64
Q

characteristics of ependymoma

A

tumor of children and young adults

occur in ependymal lined ventricular system

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65
Q

locations of ependymoma

A

adults-spinal cord

children and young adults-fourth ventricle

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66
Q

presentation of ependymoma

A

hydrocephalus

CSF dissemination

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67
Q

histology of ependymoma

A

small dark cells, variably dense fibrillary background between nuclei, form perivascualr pseudorosettes, benign appearing

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68
Q

genetics of ependymoma

A

spinal cord-NF2 mutation chromosome 22

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69
Q

prognosis ependymoma

A

posterior fossa lesions-5 years

resected supratentorial and spinal cord lesions have a better prognosis

70
Q

myxopapillary ependymoma

A

occurs in filum terminale

may extend into subarachnoid space and surround roots of cauda equina-difficult to resect

71
Q

characteristics of choroid plexus papillomas

A

papillary growth with connective tissue stalk
looks like normal choroid plexus
presents with hydrocephalus

72
Q

locations of choroid plexus papillomas

A

children-lateral ventricle

adults-fourth ventricle

73
Q

characteristics of colloid cyst of third ventricle

A

young adults
attached to roof of the ventricle
can obstruct the foramina of monro-hydrocephalus
can be rapidly fatal

74
Q

headache of colloid cyst of third ventricle

A

positional headache

75
Q

histology colloid cyst

A

spherical mass filled with mucinous material

simple epithelial lining which may contain ciliated or goblet cells

76
Q

embryonal tumors or PNET

A

medulloblastoma

77
Q

characteristics of medulloblastoma

A

cerebellum only-midline
tumor of children
drop metastasis-dissemination through CSF, spreads down spine to cauda equina
radiosensitive

78
Q

histology of PNET/medulloblastoma

A

small round blue cell tumor, rosettes or perivascualr pseudorosettes

79
Q

genetics of medulloblastoma

A

WNT-chromosome 6 monosomy, expression of B catenin
SHH-sonic hedgehog pathway
Group 3-MYC ch 17 amplifications
Group 4-ch 17 without MYC amplifications

80
Q

supratentorial primitive neuroectodermal tumors characteristics

A

children
cerebral hemispheres
resemble medulloblastoma but differ in location

81
Q

primary brain lymphoma

A

most common CNS neoplasm in immunosuppressed patients
patient has multiple tumor masses, rarely spreads outside the brain
majority are B cell lymphomas

82
Q

viral association of primary brain lymphoma

A

EBV genes

83
Q

treatment primary brain lymphoma

A

no role for resection, does not respond well to chemotherapy

median survival 4-5 years

84
Q

metastatic tumor sites

A 
lung
breast
skin
kidney
GI
85
Q

meningioma

A

not actually brain tumor
majority found in adults as asymptomatic tumors discovered incidentally at autopsy
dural based tumor, present as headache or with neurologic symptoms

86
Q

multiple meningioma with genetic basis

A

neurofibromatosis type 2

87
Q

meningioma on MRI

A

adjacent to bone
dural tail-anchored to the dura
contrast enhancing lesion

88
Q

histology of meningioma

A

syncytial-whorls of bland cells

psammomatous-psammoma bodies

89
Q

genetics meningioma

A

loss of ch 22, deletions of NF 2

90
Q

role of NF2

A

merlin-restricts cell surface expression of growth factor receptors

91
Q

treatment for meningioma

A

small lesion-just follow
surgery is definitive therapy (20% recur)
radiation risk factor

92
Q

craniopharyngioma characteristics

A

usually suprasellar arising in pituitary stalk
arise from remnants of Rathke’s pouch
bimodal distribution (young and >65)
slow growing

93
Q

transformation of craniopharyngioma

A

squamous cell cancer

94
Q

adamantinomatous histology of cranipharyngioma

A

children
stratified squamous epithelium in nests or chords
spongy reticulum
calcifications
lamellar keratin formation
cysts with thick brownish-yellow fluid contents

95
Q

papillary histology of craniopharyngioma

A

adults
solid sheets and papillae lined by squamous epithelium
no keratin, calcifications or cysts

96
Q

clinical presentation of craniopharyngioma

A

visual symptoms from pressure on optic chiasm

growth retardation secondary pituitary hypofunction and GH deficiency in children

97
Q

treatment of craniopharyngioma

A

surgery and/or radiation

98
Q

schwannoma

A

arise from peripheral nerves, do not invade nerve
commonly seen at cerebellopontine angle attached to vestibular branch of 8th nerve-acoustic neuroma (tinnitus and hearing loss)

99
Q

genetic schwannoma

A

neurofibromatosis type 2 (ch 22)

inactivating mutations in NF2 gene on chromosome 22

100
Q

Antoni A schwannoma

A

moderate to high cellularity with nuclear palisadng, nuclear free zones called Verocay bodies

101
Q

Antoni B schwannoma

A

less cellular area, more myxoid

102
Q

neurofibromas

A

benign spindle cell lesions

superficial, diffuse or plexiform

103
Q

superficial neurofibromas

A

occur in skin or peripheral nerve
never malignant
sporadic or associated with NF1

104
Q

diffuse neurofibromas

A

large, plaque-like elevation

NF1 associated

105
Q

plexiform neurofibromas

A

only in patients with NF
potential for malignant transformations
associated with large nerves-cannot be separated from the nerve

106
Q

histology of neurofibromas

A

neoplastic schwann cells
perineurial like cells
CD34+ spindle cells
fibroblasts

107
Q

NF1

A

AD
multiple neurofibromas-superficial, diffuse, plexiform
gliomas of optic nerve
pigmented nodules of iris (Lisch nodules)
cafe au lait spots

108
Q

genetics NF1

A

neurofibromin on ch 17

109
Q

NF2

A

AD

bilateral acoustic neuromas, multiple meningiomas, ependymomas of spinal cord

110
Q

genetics NF2

A

merlin on ch 22

111
Q

tuberous sclerosis

A

AD but 70% spontaneous
develop hamartomas and benign neoplasms involving brain and other tissues
in CNS abnormal, broad, firm gyri (haphazardly arranged neurons which lack normal neural organization)
seizures, mental retardation

112
Q

extracranial lesions in tuberous sclerosis

A

renal angiomyolipomas
pulmonary lymphangiomyomatosis
cardiac myomas
skin rash (angiofibromas)

113
Q

genetics of tuberous sclerosis

A

hamartin-9q
tuberin-16p
suppress mTOR when functional

114
Q

von-Hippel-Lindau

A

AD
capillary hemangioblastomas in cerebellum, retina, spinal cord-highly vascualr tumor, mural nodule associated with fluid filled cyst
associated with polycythemias (EPO)

115
Q

non CNS characteristics of von-Hippel-Lindau

A

cysts in pancreas, liver, kidney

increased risk of renal cell carcinoma and phenochromocytoma

116
Q

inflammation in MS

A

antigen presentation to T cells, secretion of inflammatory cytokines, B cell activation, migration of B and T cells across BBB
axonal loss due to cytokine damage and antibody activity

117
Q

MS risk factors

A

Northern climates-vitamin D deficiency
females
first degree relatives

118
Q

optic neuritis

A

most common presentation of demyelinating disease
complaints of progressive vision loss over days
mild pain with extraocular movements
optic disc swelling

119
Q

acute treatment of MS

A

treat with IV methyl-prednisone

120
Q

clinically isolated syndrome

A

does not fulfill MacDonald criteria
does not have additional lesions on MRI for MS
risk of MS-not started on disease modifying therapy

121
Q

CSF for MS

A

oligoclonal banding
high IgG/albumin ratio
elevated IgG synthesis rate

122
Q

goals of long term treatment for MS

A 
reduce clinical relapses
reduce new and enlarging lesions on MRI
reduce disability accumulation
achieve a tolerable side effect profile
monitor for long term safety
123
Q

platform agents for MS

A

beta interferon

Glatiramer acetate

124
Q

side effects of beta interferon

A

malaise, headache, fevers, myalgias, elevated liver enzymes

125
Q

side effects of Glatiramer

A

injection site reactions, lipoatrophy, injection related chest tightness, dyspnea, flushing

126
Q

oral therapies for MS

A

fingolimod
teriflunomide
dimethyl fumarate

127
Q

fingolimod

A

sequesters lymphocytes into lymphnodes

128
Q

teriflunomide

A

limits an enzyme in pyrmidine synthesis pathway in lymphocytes which blocks proliferation of activated T and B cells which are responsible for inflammation in MS

129
Q

dimethyl fumarate

A

actives Nrf2 pathway involved in cellular response to oxidative stress

130
Q

natalizumab

A

humanized monoclonal antibody target alpha4 integrin, blocks leukocytes trafficking across BBB

131
Q

risk of natalizumab

A

risk of PML

caused by JC virus-can lead to disability or death

132
Q

transverse myelitis

A

demyelination of spinal cord

symptoms-hemi sided weakness, sensory deficit, bowel/bladder dysfunction

133
Q

primary progressive MS

A

fails to respond to disease modifying therapy
<10% of all MS cases
made in retrospect after trying and failing multiple agents

134
Q

neuromyelitis optica

A

relapsing inflammatory demyelinating disease that affects optic nerves and spinal cord leading to sudden loss or weakness in one or both eyes, loss of sensation, loss of bladder function

135
Q

diagnosis of neuromyelitis optica

A

serum NMO IgG antibody

antibody to aquaporin 4 chloride channel

136
Q

treatment of neuromyelitis optica

A

Rituxumab
-Ab binds to CD20 on B cells
induces CD20 expressing B cells to enter apoptosis

137
Q

definition of epilepsy

A

defined as two unprovoked seizures at least 24 hours apart

138
Q

definition of seizure

A

manifestation of abnormal hypersynchronous discharges of cortical neurons

139
Q

etiology of seizure in children

A

genetic>infection>trauma>congenital>metabolic

140
Q

etiology of seizure in adult

A

tumors>trauma>stroke>infection

141
Q

etiology of seizure in elderly

A

stroke>tumor>truama>metabolic>infection

142
Q

subsets of seizures

A

partial onset

generalized onset

143
Q

simple partial seizure

A

focal ictal discharge that does not spread
patient remains completely aware of surroundings, no change in level of consciousness
may present as an aura
may be isolated motor or sensory activity

144
Q

complex partial seizure

A

focal which may spread
level of consciousness is impaired
automatisms are often seen
often accompanied by post ictal confusion

145
Q

generalized seizures

A

no clear localizable onset on EEG
appear as abrupt loss of consciousness with generalized convulsions
almost always associated with postictal confusion or lethargy (except absence)

146
Q

types of generalized seizures

A

tonic clonic
myoclonic
atonic
staring (absence)

147
Q

characteristics of myoclonic seizures

A

rapid brief muscle jerks that can occur bilaterally with or without synchrony
small movements in focal areas or massive involving bilateral spasms

148
Q

characteristics of atonic drop attacks

A

results in sudden loss of muscle tone

appear as total truncal collapse (generalized atonic) or simply head drops (fragmented atonics)

149
Q

neonatal seizures

A

most common in newborns

greater frequency in preterm <36 weeks

150
Q

patterns in neonatal seizure

A

subtle
clonic
tonic
myoclonic

151
Q

etiologies in neonatal seizure

A 
genetic
infectious
hypoxic
metabolic
trauma
152
Q

characteristics of infantile spasms (West syndrome)

A

etiologies-cerebral dysgenesis, tuberous sclerosis, PKU, intrauterine infections, hypoxic-ischemic injury
spasms of head, trunk, arms-appear like clasp knife extension

153
Q

EEG in infantile spasms

A

hypsarrthymia

154
Q

treatment of infantile spasms

A

does not work with anti-epileptic drugs

can teat with ACTH

155
Q

childhood absence epilepsy

A

often outgrown
seizures last seconds and can occur hundred of times per day
confused with ADHD

156
Q

EEG in childhood absence epilepsy

A

3Hz spike and wave

157
Q

treatment of childhood absence epilepsy

A

ethosuximide

158
Q

Lennox-Gastaut syndrome

A

mental retardation
uncontrolled seizures (atonic seizures common)
characteristic EEG pattern
begin by 4, refractory to medications

159
Q

febrile seizure

A

convulsions which occur with fever
typically seen between 6 months and 6 years
from how rapidly a fever rises

160
Q

benign focal epilepsy of childhood

A

daytime-focal with twitching on one side of face, speech arrest, drooling from a corner, paresthesia of tongue
night-appears as global tonic clonic activity
seizures disappear in late adolescence

161
Q

drug of choice for benign focal epilepsy of childhood

A

carbamazepine

162
Q

juvenile myoclonic epilepsy

A

myoclonic jerks, usually in the morning
8-20
not outgrown

163
Q

treatment of juvenile myoclonic epilepsy

A

valproic acid-treatment of choice

carbamazepine-will make it worse

164
Q

temporal lobe epilepsy

A

most common in adults

zone coming from mesial temporal lobe-especially hippocampus

165
Q

auras before temporal lobe epilepsy

A

epigastric rising, odd smell, feeling of detachment or reality, deja vu

166
Q

frontal lobe epilepsy

A

diverse array of clinical appearance
-dancing, singing, hoping, walking aimlessly
at night appears like parasomnia
status epilepticus of frontal can be missed

167
Q

non-epileptic spells

A

usually a stress response and frequently are not consciously controlled
-association with previous sexual trauma, PTSD, bipolar, personality disorders

168
Q

optimal EEG conditions

A

within 24-48 hour of seizure
done with sleep deprivation
recorded sleep state
right even, left odd

169
Q

CT in epilepsy

A

only indicated in emergent setting to determine if there is hemorrhage, stroke, hydrocephalus, large space occupying lesion

170
Q

MRI in epilepsy

A

modality of choice

almost always obtained unless subdral hematoma, subarachnoid hemorrhage

DT2 Exam 2 (6 decks)

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