Neuro Flashcards

Question

Poliomyelitis

Answer 1

- damage incurred by lower motor neurons in the anterior horn due to poliovirus infection - polio is transmitted via the fecal-oral route and infects the oropharynx and small bowel, replicates in the Peyer's patches, and eventually spreads to the CNS - initially, it presents with fever, sore throat, n/v, and abdominal pain; later it presents with asymmetric lower motor neuron signs - CSF will demonstrate elevated WBC, a slight increase in protein, and no change in CSF glucose

Answer 2

- an inherited, autosomal recessive degeneration of the anterior motor horn - presents as "floppy baby" with hypotonia and tongue fasciculations - death occurs within a few years

Answer 3

- a degenerative disorder of the upper and lower motor neurons of the corticospinal tract - presents with asymmetric upper and lower motor neuron signs; atrophy and weakness of the hands is usually the first indicator; importantly, there is no sensory impairment - most cases are sporadic and arise in middle age adults - however, a zinc-copper superoxide dismutase mutation (SOD1) is present in some familial cases and contribute to free radical injury - treat with riluzole

Answer 4

only the upper and lower motor neurons of the corticospinal tract, meaning there are no sensory deficits

Answer 5

a mutation in SOD1, a zinc-copper superoxide dismutase

Answer 6

- spastic paralysis - hyperreflexia - increased muscle tone - positive Babinski sign (upward facing toes) - clasp knife spasticity

Answer 7

- it is the plantar reflex to scraping the bottom of the foot - it is considered positive if the big toe points up - this is physiologic in neonates but indicative of upper motor neuron injury later

Answer 8

- a degenerative disorder of the cerebellum and multiple tracts within the spinal cord - due to an autosomal recessive, unstable trinucleotide repeat of GAA in the frataxin gene on chromosome 9, which is essential for mitochondrial iron regulation - loss of this gene results in free radical damage - presents in early childhood with ataxia, loss of vibratory sense and proprioception, muscle weakness in the lower extremities, and loss of deep tendon reflexes - additional features include staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, diabetes, and hypertrophic cardiomyopathy - patients become wheelchair bound within a few years

Answer 9

an autosomal recessive, unstable trinucleotide repeat of GAA in the frataxin gene

Answer 10

a gene important in mitochondrial iron regulation, which may incur an unstable, trinucleotide repeat of GAA, resulting in Friereich Ataxia

Answer 11

- it carries pain and temperature sensation - the first order neuron is located in the dorsal root ganglion and synapses on a second-order neuron in the posterior horn - this second-order neuron then decussates via the anterior white commissure near at the level where it enters - the second-order neuron then ascends via the spinothalamic tract to the thalamus where it synapses on the third-order neuron - this third-order neuron projects to the cortex

Answer 12

- upper motor neurons descend and decussate in the medullary pyramids - they continue to descend and synapse on lower motor neurons in the anterior horn - these lower motor neurons then project to the NMJ

Answer 13

- first order neurons located in the hypothalamus synapse on the T1 lateral horn - from there, second-order neurons synapse on the superior cervical ganglion (sympathetic chain ganglion) - this third-order neuron then projects to the eyelids, pupil, and skin on the face carrying sympathetic input

Answer 14

- first order neurons enter via the dorsal root and ascend within the ipsilateral dorsal column and project to second order neurons located in the medulla - second order neurons then decussate and ascend via the medial lemniscus to the thalamus where third order neurons are located - third order neurons finish carry pressure, touch, vibration, and proprioception information to the cortex

Answer 15

the arachnoid and pia, collectively known as the leptomeninges

Answer 16

the arachnoid and pia

Answer 17

- neonates are commonly infected by Group B Strep (agalactaie), E. coli, or Listeria monocytogenes - children and teenagers by N. meningitidis - adults by Strep pneumoniae - Coxsackievirus is the most common cause of viral meningitis in children - fungi affect the immunocompromised - H. influenza is common in unvaccinated infants

Answer 18

- inflammation of the leptomeninges (arachnoid and pia) - most often due to Group B strep, E. coli, Listeria monocytogeens, N. meningitidis, S. pneumoniae, H. influenza, Coxsackievirus, or fungi depending on the patient's age and immune competence - presents with a classic triad of headache, nuchal rigidity, and fever; photophobia, vomiting, or altered mental status are also possible - diagnosis is made by lumbar puncture and examining the CSF for neutrophils or lymphocytes and determine the CSF glucose level to determine whether it is fungal, viral, or bacterial - complications are usually seen in those with bacterial meningitis and include death secondary to edema and herniation, hydrocephalus, hearing loss, or seizures

Answer 19

between L4 and L5 at the level of the iliac crest

Answer 20

because the spinal cord ends at L2 but the cauda equina and subarachnoid space continue to S2

Answer 21

- spinal cord ends at L2 | - cauda equina ends at S2

Answer 22

- bacterial: you would expect neutrophils and low CSF glucose - viral: you would expect lymphocytes and normal CSF glucose - fungal: you would expect lymphocytes and low CSF glucose

Answer 23

- skin - supraspinous ligament - interspinous ligament - ligamentum flavum - epidural space - dura - arachnoid - ends in subarachnoid space

Answer 24

⅔ that of the serum glucose

Answer 25

- bacterial more so than either viral or fungal | - includes death due to edema and herniation, hearing loss, hydrocephalus, and seizures

Answer 26

- it enters via the nasopharynx | - then spreads the blood and gets into the CSF

Answer 27

because they rely almost exclusively on glucose for their energy needs

Answer 28

between 3-5 minutes after initiation

Answer 29

- low perfusion (atherosclerosis) - acute decrease in blood flow (cardiac shock) - chronic hypoxia (anemia) - repeated episodes of hypoglycemia (insulinoma)

Answer 30

transient confusion with prompt recovery

Answer 31

diffuse necrosis and either a vegetative state or death

Answer 32

watershed areas are vulnerable as are three select groups of neurons: - pyramidal neurons in layers 3, 5, and 6 of the cortex - pyramidal neurons of the hippocampus - purkinje layer of the cerebellum

Answer 33

- necrosis of the pyramidal neurons in layers 3, 5, and 6 of the cerebral cortex, which are particularly susceptible to ischemia - the result is "laminar" necrosis within the layers of the cortex

Answer 34

- a state of global ischemia within the brain - most often due to low perfusion, acute decrease in blood flow, chronic hypoxia, or repeated episodes of hypoglycemia - presentation depends on the duration and magnitude of the insult - mild insult results in transient confusion with prompt recovery; severe results in diffuse necrosis and death or a persistent vegetative state; moderate damages watershed areas and particularly susceptible populations of neurons

Answer 35

- TIAs have symptoms lasting less than 24 hours | - ischemic strokes have focal neurologic deficits lasting more than 24 hours

Answer 36

- thrombotic - embolic - lacunar

Answer 37

atherosclerosis usually develops at branch points such as the bifurcation of the internal carotid and the middle cerebral artery in the circle of Willis

Answer 38

- it leads to a pale infarct in the periphery of the cortex - it is pale since attempts to lyse the thrombus are unsuccessful; if blood flow is momentarily re-established due to lysis, the ruptured plaque just forms a new one

Answer 39

the left side of the heart

Answer 40

the middle cerebral artery

Answer 41

- it leads to a hemorrhagic infarct at the periphery of the cortex - this is because the embolus causes necrosis but can be lysed and then the re-established blood flow fills the necrotic space

Answer 42

liquefactive necrosis

Answer 43

- the mechanisms are obviously different - thrombotic stroke leads to a pale infarct while an embolic stroke leads to a hemorrhagic infarct; this is because the embolus can be lysed and blood flow to the area restored, which isn't possible after a thrombotic stroke - thrombotic strokes most often occur at branch points, namely the bifurcation of the internal carotid and middle cerebral artery in the circle of Willis - embolic strokes most often occur in the middle cerebral artery from clots thrown from the left heart

Answer 44

- a small stroke that occurs secondary to hyaline arteriolosclerosis, a complication of benign hypertension - this most commonly involves the lenticulostriate vessels arising from the MCA and serving the deep structures of the brain - the result is small, cystic areas of infarction

Answer 45

they arise from the MCA and serve the deep brain structures such as the internal capsule and thalamus

Answer 46

one that involves the internal capsule

Answer 47

one that involves the thalamus

Answer 48

- the first thing to arise are eosinophilic, red neurons 12 hours after infarction - necrosis is seen after 24 hours - infiltration by neutrophils in 1-3 days - microglial cell infiltrate in 4-7 days - gliosis (scarring) in the 2-3 weeks that follow - the result is a fluid-filled cystic space surrounded by gliosis

Answer 49

the presence of eosinophilic, red neurons

Answer 50

it is a fluid-filled cystic space surrounded by gliosis

Answer 51

- an aneurysm of the lenticulostriate vessels arising due to hypertension, most often found in the basal ganglia - not visible on an angiogram

Answer 52

- a bleed into the brain parenchyma, classically due to rupture of a Charcot-Bouchard microaneurysm, amyloid angiopathy, vasculitis, or neoplasm - these aneurysms arise as a complication of hypertension and most often in the basal ganglia - presents with severe headache, n/v, and eventual coma - Charcot-Bouchard rupture typically involves the basal ganglia and internal capsule

Answer 53

by treating the underlying hypertension

Answer 54

as a large blood clot/pool at the base of the brain

Answer 55

- a bleed into the subarachnoid space - most frequently due to rupture of a berry aneurysm but it can also be the result of an AV malformation or anti-coagulated state - presents as a sudden headache, classically described as the worst headache of the patients life, with nuchal rigidity - lumbar puncture shows xanthochromia, a yellow hue due to bilirubin - inspection of the brain will reveal a large clot or bloody mass at the base of the brain - may be followed several days later by vasospasm and ischemic infarct, so provide nimodipine for prevention - increases risk for developing communicating or obstructive hydrocephalus - aw/ Marfan and AD-PCKD

Answer 56

it is a yellow hue of the CSF due to the presence of bilirubin, arising due to a subarachnoid hemorrhage

Answer 57

- it is an aneurysm lacking a media layer - most frequently located in the anterior circle of Willis at branch points of the anterior communicating artery; secondarily at the posterior communicating artery or MCA - associated with Marfan syndrome, Ehlers-Danlos syndrome, and ADPKD - other risk factors include advanced age, hypertension, smoking, and African American race

Answer 58

- a collection of blood between the dura and the skull - classically caused by a fracture of the temporal bone, which ruptures the middle meningeal artery - must be an artery because a vein doesn't have enough pressure to open a space between the dura and temporal bone - often presents with a lucid interval before the onset of neurologic signs and progression indicates an abrupt expansion - expansion may cause transtentorial herniation with CN III palsy - seen as a "lens-shaped" lesion on CT which doesn't cross suture lines - herniation is the feared, lethal complication

Answer 59

- epidural appears lens-shaped on CT while subdural appears crescent-shaped - epidural is associated with trauma and fracture of the temporal bone, which injures the middle meningeal artery while subdural is associated with age-related cerebral atrophy and rupture of veins - epidural hematomas often have a lucid period after the injury followed by the onset of neurologic symptoms while subdurals have no associated lucid period

Answer 60

- a collection of blood beneath the dura - due to tearing of the bridging veins that lie between the dura and arachnoid, typically with trauma - presents with the immediate onset of progressive neurologic signs - crescent-shaped lesion on CT that crosses suture lines and which is hyperdense if acute and hypodense if chronic - more common in the elderly as a result of age-related cerebral atrophy stretching the veins that mediate disease - transtentorial herniation is the feared, lethal complication

Answer 61

- displacement of the cerebellar tonsils into the foramen magnum - results in compression of the brainstem and cardiopulmonary arrest - the most common form of brain herniation

Answer 62

displacement of brain tissue due to mass effect or increased ICP

Answer 63

- displacement of the cingulate gyrus under the fall cerebri - results in compression of the anterior cerebral artery, leading to infarction --> lower extremity sensory and motor problems

Answer 64

- displacement of the temporal lobe uncus under the tentorium cerebelli - compresses CN III, leading to a "down and out" positioning of the eye with dilated pupil - also compresses the PCA, leading to infarction of the occipital lobe with contralateral homonymous hemianopsia with macular sparing - Kernohan notch (indentation of the contralateral cerebral peduncle) results in a "false localization" sign with paralysis on the side ipsilateral the primary lesion/herniation

Answer 65

- a autosomal recessive deficiency of arylsulfatase, which prevents normal degradation of sulfatides, allowing them to accumulate in oligodendrocyte lysosomes - leads central and peripheral demyelination with ataxia and dementia - the most common leukodystrophy

Answer 66

- an autosomal recessive deficiency of galactocerebrosidase, leading to accumulation of galactocerebroside in macrophages - demyelination presents with peripheral neuropathy, developmental delay, optic atrophy, and globoid cells

Answer 67

an X-linked defect, which impairs the addition of CoA to LCFAs (long-chain fatty acids), which then accumulate and damage the adrenal glands and white matter

Answer 68

- autoimmune destruction of oligodendrocytes and CNS myelin - risk factors include women with the HLA-DR2 haplotype living far from the equator - primary symptoms are Charcot's triad of SIN: scanning speech, intention tremor (also incontinence, internuclear ophthalmoplegia), and nystagmus - diagnosed by MRI, which reveals plaques that vary in time and space, or a lumbar puncture, which demonstrates lymphocytes, an oligoclonal IgG expansion, and elevated myelin basic protein - gross examination finds gray-appearing plaques in the white matter - treatment for acute attacks is high-dose steroids; IFN-B is preferred for long-term treatment to slow progression

Answer 69

- age 20-30 - women - HLA-DR2 genotype - living further from the equator

Answer 70

- unilateral blurred vision - optic nerve - vertigo or scanning speech mimicking alcohol intoxication - brainstem - internuclear ophthalmoplegia - medial longitudinal fasciculus - hemiparesis or unilateral loss of sensation - cerebral white matter, most often periventricular - lower extremity loss of sensation or weakness - spinal cord - bowel, bladder, and sexual dysfunction - ANS

Answer 71

- MRI is used to identify plaques in the white matter which vary across time and space - lumbar puncture is expected to reveal lymphocytes, an oligoclonal IgG expansion, and myelin basic protein

Answer 72

- long term treatment involves IFN-B to slow progression | - supplemented by high dose steroids during acute attacks

Answer 73

- a progressive encephalitis leading to death - due to persistent infection of the brain by measles - the infection occurs in infancy but neurologic signs arise many years later during late childhood - histology finds viral inclusions within neurons of the grey matter and in oligodendrocytes

Answer 74

- a JC virus infection of oligodendrocytes - arises from reactivation of latent virus in a newly immunosuppressed or immunocompromised patient - presents with rapidly progressive neurologic signs and death - there is an increased risk associated with use of natalizumab and rituximab

Answer 75

- aka osmotic demyelination syndrome - a focal demyelination of the pons caused by rapid IV correction of hyponatremia - results in an acute bilateral paralysis, commonly referred to as "locked in" syndrome because the patient is often only able to move his or her eyes

Answer 76

- the cortex leads to dementia | - degeneration of deep structures like the brainstem and in particular the basal ganglia lead to movement disorders

Answer 77

- a degenerative disease of the cortex, causing dementia - arises due to B-secretase degradation of the APP protein, which can't be processed like the A-secretase product and is deposited in the brain tissue instead - presents with slow-onset memory loss (beginning with short-term loss and then long-term), progressive disorientation, loss of learned motor skills and language, and changes in behavior or personality - patients often become mute and bedridden to die later of infection - may be complicated by cerebral amyloid angiopathy - degree of dementia correlates with the number of neurofibrillary tangles - most cases are sporadic and arises in the elderly (risk doubles every 5 years after age 60) but early onset AD is seen in association with presenilin 1 and 2 mutations as well as in those with Down syndrome - gross examination of the brain reveals central atrophy, narrowing of the gyri, widening of the sulci, and dilation of the ventricles - histology reveals neuritic plaques with an AB amyloid and entangled neuritic processes in addition to the presence of intracellular, hyperphosphorylated tau protein deposits - it is a clinical diagnosis and can only be confirmed by histology at autopsy

Answer 78

Alzheimer's disease

Answer 79

- normally a-secretase degrades the APP gene product to a structure that can be turned over by cells and properly handled - in those with Alzheimer's B-secretase has degraded the APP protein to a different product that can't be properly handled and is instead deposited as AB-amyloid

Answer 80

- the ApoE4 allele increases risk while the ApoE2 allele lowers it - the presenilin 1 and 2 genes are associated with familial, early onset Alzheimer's - most with Down syndrome have Alzheimer's by age 40

Answer 81

a vascular disease of the brain seen in patients with Alzheimer's disease as AB amyloid is deposited around vessels, increasing the risk for hemorrhage

Answer 82

- a dementia that arises from multifocal infarction and injury secondary to hypertension, atherosclerosis, or vasculitis - constituting the second most common cause of dementia

Answer 83

because you can treat the underlying condition and slow or stop the progression of the dementia

Answer 84

- a degenerative disease of the frontal and temporal lobes - presents primarily with behavioral and language symptoms in the early stages and then progresses to dementia - characterized histologically by round aggregates of tau protein in neurons of the cortex

Answer 85

- it is a microtubule-associated protein that normally helps organize microtubules - it is clinically important because when it becomes hyperphosphorylated, it is a marker or mediator of Alzheimer's disease - it is also the protein that forms Pick bodies

Answer 86

- in Alzheimer's they form whispy, flame-like intracellular structures - in Pick disease they form actual aggregates

Answer 87

Alzheimer's disease and Pick disease

Answer 88

- the degenerative loss of dopaminergic neurons in the substantia nigra of the basal ganglia, which is partly responsible for initiating movement - related to aging or in rare cases to MPTP exposure - presents with TRAP: tremor (pill rolling), rigidity (cog wheel), akinesia (or bradykinesia), and postural instability with shuffling gait - dementia is a feature of late disease - histology reveal the loss of the neuromelanin-pigmented neurons as well as Lewy bodies (eosinophilic inclusions of a-synuclein)

Answer 89

the dopaminergic neurons in the substantia nigra of the basal ganglia

Answer 90

a disorder resembling Parkinson disease

Answer 91

it is called a pill rolling tremor and it appears at rest, disappearing with movement

Answer 92

it is called cogwheel rigidity and it is a rigidity that can be observed with passive movement of the limbs

Answer 93

neuromelanin

Answer 94

- cytoplasmic eosinophilic inclusions of a-synuclein that are visible on histology - seen in those with Lewy body dementia (cortical) and Parkinson disease (substantia nigra) - have a halo surrounding them

Answer 95

dementia is a late feature of Parkinson disease whereas Lewy body has parkinsonian features with early onset dementia and hallucinations

Answer 96

- a degenerative disorder most similar to Parkinson disease - presents with early-onset dementia (which distinguishes it from Parkinson disease), Parkinsonian features, and hallucinations - histology reveals cortical Lewy bodies

Answer 97

- a degeneration of GABAergic neurons in the caudate nucleus of the basal ganglia - due to an autosomal dominant trinucleotide expansion of CAG in the huntingtin gene on chromosome 4 - this repeat demonstrates anticipation, specifically in spermatogenesis - presents at age 40 with chorea, including athetosis, and can progress to dementia and depression - suicide is a common cause of death - grossly, you can identify atrophy of the caudate and putamen with hydrocephalus ex vacuo

Answer 98

GABAergic neurons in the caudate nucleus of the basal ganglia

Answer 99

a CAG trinucleotide repeat in the huntingtin gene on chromosome 4, which demonstrates anticipation in spermatogenesis

Answer 100

- an increase in CSF that results in dilated ventricles, which subsequently stretches the surrounding corona radiata - presents in the elderly with triad of urinary incontinence, gait instability, and dementia ("wet, wobbly, and wacky") - have a characteristic gait known as "magnetic gait" because their feet appear stuck to the floor - characteristically, lumbar puncture improves symptoms and treatment is ventriculoperitoneal shunting

Answer 101

normal pressure hydrocephalus

Answer 102

- a group of degenerative diseases due to prior protein - this protein is normally expressed in an a-helical configuration but disease arises with conversion to a B-pleated conformation - the resulting protein cannot be degraded and converts normal protein into the pathologic form, damaging neurons and glial cells - can be sporadic, inherited, or transmitted - Creutzfeld-Jakob disease is the most common but familial fatal insomnia is an inherited form - histology reveals spongy degeneration (intracellular vacuoles)

Answer 103

an inherited form of prion disease/spongiform encephalopathy characterized by severe insomnia and an exaggerated startle response

Answer 104

- the most common spongiform encephalopathy - usually sporadic but can arise from exposure to prion-infected human tissue via human GH or corneal transplant - presents as a very rapidly progressing dementia associated with ataxia and startle myoclonus - death arises within one year - "spike wave" complexes are seen on EEG - variant CJD is a special form known as "mad cow" disease which arises from exposure to prion-infected bovine tissue

Answer 105

Creutzfeldt-Jakob Disease

Answer 106

metastatic tend to be multiple, well-circumscribed lesions located at the gray-white junction

Answer 107

lung, breast, and kidney

Answer 108

- adults tend to have supratentorial primary tumors | - children tend to have infratentorial primary tumors

Answer 109

- a malignant, high-grade, GFAP-positive astrocyte tumor - characteristically crosses the corpus callosum, forming a "butterfly lesion" - histologically there are regions of pseudopalisading with tumor cells surrounding areas of necrosis - the most common primary malignant CNS tumor in adults and they have a poor prognosis

Answer 110

- a benign tumor of arachnoid cells - the most common benign CNS tumor in adults and more common in women than men - presents with seizures since the tumor compresses, but does not invade, the cortex - imaging reveals a round mass attached to the dura - histology shows a very distinctive whorled pattern with psammoma bodies

Answer 111

- a benign tumor of Schwanna cells - can involve cranial nerves, spinal nerves, or CNS tissue - most frequently involves CN VIII at the cerebellopontine angle and presents with a loss of hearing and tinnitus - tumor cells stain S-100+ - bilateral tumors are a feature of neurofibromatosis 2

Answer 112

- a malignant tumor of oligodendrocytes - a slow growing, calcified tumor in the white matter, most often involving the frontal lobe - histology reveals cells with a "fried egg" appearance and a "chicken-wire" pattern of capillaries - may present with seizures

Answer 113

- a benign tumor of astrocytes - this is the most common CNS tumor in children and is typically located in the cerebellum - arises as a cystic lesion with a mural nodule, which is easily identifiable on imaging - histology shows Rosenthal fibers and eosinophilic granular bodies - the section will be GFAP positive

Answer 114

- a malignant tumor derived from the granular cells of the cerebellum, which are neuroectoderm - usually arises in children - histology reveals small, round but cells forming Homer-Wright rosettes - the tumor grows rapidly and spreads via the CSF; therefore it has a poor prognosis - a metastasis to the cauda equina is known as a "drop metastasis"

Answer 115

- a malignant tumor of the ependymal cells lining the ventricles - most often in the fourth ventricle of children - may present with hydrocephalus if the tumor forms an obstruction - histology reveals perivascular pseudorosettes

Answer 116

- a tumor arising from the epithelial remnants of Rathke's pouch (oral ectoderm) left behind on it's way to form the anterior pituitary - presents as a supratentorial mass in a child or young adult and may compress the optic chasm leading to a bitemporal hemianopsia - calcifications can be seen on imaging and cholesterol crystals are found in "motor oil-like" fluid within the tumor - most common childhood supratentorial tumor - although benign, it tends to recur

Answer 117

a medulloblastoma metastasis to the cauda equina via the CSF

Answer 118

- pilocytic astrocytoma - ependymoma - medulloblastoma

Answer 119

- glioblastoma multiforme - meningioma - Schwannoma

Answer 120

- pituitary adenoma | - craniopharyngioma

Answer 121

a portion of mesoderm, which induces overlying ectoderm to differentiate into neuroectoderm and later gives rise to the nucleus pulposus

Answer 122

- alar: dorsal portion, which is associated with sensory information - basal: ventral portion, which is associated with motor activity

Answer 123

- prosencephalon gives rise to the telencephalon and diencephalon - mesencephalon to the mesencephalon - rhombencephalon to the metencephalon and myelencephalon

Answer 124

- telencephalon: cerebral hemispheres and lateral ventricles - diencephalon: thalamus, hypothalamus, and third ventricle - mesencephalon: midbrain and aqueduct - metencephalon: pons, cerebellum, and upper part of 4th ventricle - myelencephalon: medulla and lower part of the 4th ventricle

Answer 125

- CNS neurons - ependymal cells - oligodendroglia - astrocytes

Answer 126

PNS neurons and Schwann cells

Answer 127

microglia (macrophages)

Answer 128

- a failure of the left and right hemispheres to separate, usually during weeks 5-6 of gestation - thought to be related to mutations in the sonic hedgehog signaling pathway - moderate form presents with a cleft lip/palate and the most severe form results in cyclopia (failure of the eye to separate) - seen in associate with Patau syndrome (trisomy 13) and fetal alcohol syndrome

Answer 129

- the anterior tongue is derived from the 1st and 2nd arches, thus sensation is mediated by CN V3 and taste by CN VII - the posterior ⅓ is derived from the 3rd and 4th arches, thus sensation and taste are mediated by CN IX (and X in the most posterior aspect) - motor innervation is via CN X to the palatoglossus and via CN XII to the hyoglossus, genioglossus, and styloglossus

Answer 130

- the anterior tongue from branchial arches 1 and 2 | - the posterior tongue from branchial arches 3 and 4

Answer 131

- taste: CN VII, IX, X - sensation: CN V3, IX, X - motor: CN X, XII

Answer 132

- hyoglossus (XII): retracts and depresses tongue - genioglossus (XII): protrudes tongue - styloglossus (XII): draws sides of tongue upward to create a trough for swallowing - palatoglossus (X): elevates posterior tongue during swallowing

Answer 133

a stain for RER used to identify neuronal cell bodies and dendrites (the axon does not contain any RER)

Answer 134

axonal degeneration distal to an injury with axonal retraction proximal to the injury, which allows for potential regeneration of the axon if in the PNS

Answer 135

- component of the BBB - supply glycogen fuel buffer - mediate reactive gliosis - provide physical support - repair - potassium metabolism - remove excess NT

Answer 136

an intermediate filament expressed by astrocytes and ependymal cells, which can be used for immunohistochemical purposes

Answer 137

they are phagocytic scavengers activated in response to tissue damage

Answer 138

they form when HIV infects microglia, which then fuse to form these cells

Answer 139

sodium channels

Answer 140

saltatory conduction

Answer 141

- oligodendrocytes myelinated multiple cells at one time in the CNS - Schwann cells myelinated a single axon in the PNS

Answer 142

- they myelinated axons | - they promote axonal regeneration

Answer 143

Schwann cells

Answer 144

oligodendrocytes

Answer 145

oligodendrocytes

Answer 146

- they are located throughout all skin in the epidermis and in some viscera - they sense pain and temperature - they are carried by both C and Ad fibers

Answer 147

- they are located in the dermal papillae of glabrous (hairless) skin, most concentrated in the finger tips - they sense dynamic, fine touch, specifically low frequency vibration - they adapt quickly and are linked to large, myelinated AB fibers

Answer 148

- they are located in the deep skin layers of thin skin - they sense higher frequency vibration and pressure - they adapt quickly and are linked to large, myelinated AB fibers

Answer 149

- they are located in the epidermis of glabrous skin - they sense pressure, deep static touch, and position sense - they adapt slowly and are linked to large, myelinated AB fibers

Answer 150

- they are located in the dermis of thin skin - they sense pressure on the skin in a specific direction (aka slippage of objects), joint angle change, and pressure - they adapt slowly and are innervated by AB fibers

Answer 151

- the delicate layer of connective tissue that invests a single myelinated nerve fiber layer - an inflammatory infiltrate is seen in this layer of tissue in those with Guillan-Barre

Answer 152

- a layer of connective tissue that surrounds a fascicle of nerve fibers - they must be rejoined in microsurgery for limb reattachment

Answer 153

a layer of dense connective tissue that surrounds an entire nerve and contains several fascicles and blood vessles

Answer 154

the basal nucleus of Meynert

Answer 155

ventral tegmenjtum and substantia nigra pars compacta

Answer 156

the nucleus accumbens

Answer 157

the locus ceruleus

Answer 158

raphe nucleus

Answer 159

low serotonin and GABA, excess NE

Answer 160

low serotonin, dopamine, and NE

Answer 161

increased dopamine

Answer 162

low acetylcholine

Answer 163

low acetylcholine and GABA, excess DA

Answer 164

low DA, excess acetylcholine and serotonin

Answer 165

- tight junctions between non-fenestrated capillary endothelial cells - the basement membrane - astrocyte foot processes

Answer 166

non polar, small, lipid-soluble substances

Answer 167

glucose and amino acids

Answer 168

via carrier-mediate transport

Answer 169

via carrier-mediated transport

Answer 170

a type of cerebral edema that results from disruption of the BBB, usually by infarction or neoplasms which damage endothelial tight junctions

Answer 171

Sensory Organs - the area postrema is a medullary structure that must sample the blood because it controls vomiting - the organum vasculosum of the lamina terminalis sense osmotic changes Secretory Organs - neurohypophysis releases vasopressin and oxytocin

Answer 172

TAN HATS - thirst and water balance - adenohypophysis control - neurohypophysis release of hormones - hunger - autonomic regulation - temperature regulation - sexual urges

Answer 173

a circumventricular organ that senses changes in osmolarity and communicates those changes to the hypothalamus

Answer 174

a circumventricular organ in the medulla that responds to emetics via output to the hypothalamus

Answer 175

make and release ADH

Answer 176

make and release oxytocin

Answer 177

- it mediates hunger and is therefore stimulated by ghrelin and inhibited by leptin - destruction leads to anorexia and failure to thrive

Answer 178

- it mediates satiety and is therefore stimulated by leptin | - destruction leads to hyperphagia

Answer 179

because it could invade and destroy the ventromedial area of the hypothalamus

Answer 180

- it senses temperature by monitoring the surrounding fluid temperature and receiving somatic input - it promotes cooling via activation of the parasympathetic system in response to heat

Answer 181

- it senses temperature by monitoring the surrounding fluid temperature and receiving somatic input - it promotes heating via activation of the sympathetic system in response to cold

Answer 182

it mediates circadian rhythm via direct input from melanopsin-containing retinal ganglion cells along the retino-hypothalamic tract

Answer 183

the paraventricular

Answer 184

- the suprachiasmatic nucleus receives input from the retinal ganglion cells to regulate the circadian rhythm - in responses to changes in light, the SCN releases NE onto the pineal gland, which releases melatonin

Answer 185

the the pineal gland in response to norepinephrine released from projections originating in the suprachiasmatic hypothalamic nucleus

Answer 186

the paramedian pontine reticular formation

Answer 187

- frontal eye field (area 8) - superior colliculus - paramedian pontine reticular formation - oculomotor nuclei - eye muscles & movement

Answer 188

- retinal ganglion cells - superior colliculus - paramedian pontine reticular formation - oculomotor nuclei - eye muscles & movement

Answer 189

- retinal slip of image on retina - retinal ganglion cells - LGN - visual cortex - paramedian pontine reticular formation - oculomotor nuclei - eye muscles & movement

Answer 190

- it is used to keep the eyes still in response to head movements - begins with displacement of vestibular hair cells, AP along CN VIII to the vestibular nucleus, projecting to the oculomotor nucleus, which then controls eye movement

Answer 191

the rate of depolarization within the 8th nerve increases

Answer 192

- initially, during acceleration to the right, there is an increase in right CN 8 activity because the endolymph moves to the left relative to the head and bends the hair cells toward the more medial kinocilium - once rotation becomes constant, the endolymph is equilibrated and there is no signal - during deceleration, there is an increase in left 8 nerve activity compared to right because the individual stops but the endolymph continues flowing - this causes the patient to fall to the right or for their eyes to drift right and rapidly correct left

Answer 193

it occurs every 90 minutes but the duration increases later in the night

Answer 194

REM is dependent on a rise in acetylcholine and fall in norepinephrine

Answer 195

they decrease REM and slow wave sleep

Answer 196

with oral desmopressin

Answer 197

benzodiazepines

Answer 198

they are high frequency (>12 Hz), low amplitude waves seen when awake with eyes open

Answer 199

both are seen when awake but alpha waves are slower and larger in amplitude and are associated with having one's eyes closed

Answer 200

- light sleep | - EEG demonstrates theta waves

Answer 201

- deeper sleep - EEG demonstrates sleep spindles and K complexes - this is when bruxism (teeth grinding) occurs

Answer 202

it is teeth grinding and it occurs during stage 2 sleep

Answer 203

- deepest non-REM sleep - EEG demonstrates delta waves, which are low frequency, high amplitude - this is the stage during which sleepwalking, night terrors, and bedwetting occur

Answer 204

during stage 3

Answer 205

- the thalamic reticular nucleus receives collateral input from the thalamocortical and corticothalamic tracts - GABAergic neurons from the thalamic reticular nucleus then project to the thalamus as does the reticular activating system - the balance in the thalamus modulates the thalamocortical projections, which then synchronize the activity of the cortex

Answer 206

- beta waves - loss of motor tone - increase O2 demand from the brain - fluctuating pulse and blood pressure - this is also when dreaming and nightmares occur - penile/clitoral tumescence

Answer 207

- alert: beta - eyes closed: alpha - stage 1: theta - stage 2: spindles and K complexes - stage 3: delta - REM: beta

Answer 208

it is the location of tertiary neurons in the spinothalamic and DC/ML pathways

Answer 209

- it relays somatosensory information from the face, including taste - it receives input from the trigeminal and gustatory pathway (solitary nucleus) and projects to the somatosensory cortex

Answer 210

- it is a relay for visual information | - it receives input from CN II and projects to the calcarine sulcus (aka primary visual cortex)

Answer 211

- it is a relay for auditory information - it receives input from the superior olive and inferior colliculus - and projects to the auditory cortex of the temporal lobe

Answer 212

- it helps with coordination and planning of motor activity - it receives input from the basal ganglia and cerebellum - and projects to the motor cortex

Answer 213

- hippocampus - amygdala - fornix - mammillary bodies - cingulate gyrus

Answer 214

- involved in emotion, long-term memory olfaction, behavior modulation, and ANS functioning - said to mediate the 5 F's: feeding, fleeing, fighting, feeling, and sex

Answer 215

- mesocortical - mesolimbic - nigrostriatal - tuberoinfundibular

Answer 216

a decrease in activity results in the negative symptoms of schizophrenia

Answer 217

an increase in activity results in the positive symptoms of schizophrenia

Answer 218

they decrease activity in the mesolimbic pathway

Answer 219

- a decrease in activity leads to extrapyramidal symptoms such as those seen in Parkinson's disease - it is significantly affected by movement disorders and antipsychotic drugs

Answer 220

an increase in activity increases prolactin levels resulting in reduced libido, sexual dysfunction, galactorrhea, and gynecomastia

Answer 221

it supplies the dopaminergic input to the anterior pituitary, which inhibits the release of prolactin

Answer 222

- superior: output of deep nuclei of the cerebellum to the contralateral cortex - middle: input from the cortex to the contralateral cerebellum - inferior: propioceptive input from the ipsilateral spinal cord

Answer 223

purkinje cells

Answer 224

- dentate - emboliform - globose - fastigial

Answer 225

they affect primarily the neocerebellum and thus affect movement of the extremities; when injured, they increase the propensity for falling toward the ipsilateral side

Answer 226

such a lesion would involve the vermal cortex and fastigial nuclei, resulting in truncal ataxia (a wide-based cerebellar gait), nystagmus, and head tilting with bilateral motor deficits affecting axial and proximal limb musculature

Answer 227

- neocerebellum: receives input form the cortex and regulates initiation and programming of movement via the dentate nucleus - spinocerebellum: includes the vermis and paravermis; the paravermis is more lateral receives spinocerebellar input and then helps with correction of extremity movement; the vermis is more midline and receives spinocerebellar as well as vestibular input to help with correction of axial movement - vestibulocerebellum

Answer 228

Page 460 of FA

Answer 229

- the direct is excitatory and promotes positive feedback to the motor cortex - the indirect is inhibitory and promotes negative feedback to the motor cortex

Answer 230

the putamen and caudate

Answer 231

the putamen and globes pallidus

Answer 232

- cortical inputs stimulate the striatum, stimulating release of GABA - this inhibits GABA release from the GPi, which disinhibits the thalamus - the thalamus then promotes further motor activity

Answer 233

- cortical inputs stimulate the striatum, stimulating release of GABA into the GPe - the GPe then releases less GABA itself, disinhibiting the subthalamic nucleus - the sub thalamic nucleus stimulate the GPi, which then released more GABA onto the thalamus - the thalamus is inhibited and sends fewer stimulatory signals to the cortex, inhibiting movement

Answer 234

- the SNc releases dopamine, which binds D1 receptors in the striatum of the direct pathway and D2 receptors in the striatum of the indirect pathway - as a result it up regulates the direct pathway and down regulates the indirect pathway, stimulating movement

Answer 235

a slow, writhing movement, especially seen in the fingers, which arises from a basal ganglia lesion (e.g. Huntington's disease)

Answer 236

a sudden, jerky, purposeless movement that arises from a basal ganglia lesion (e.g. Huntington's disease)

Answer 237

a sustained, involuntary muscle contraction that is often painful

Answer 238

- a high-frequency tremor that occurs with sustained posture and is worsened with movement or when anxious - often familial - often self-medicated with alcohol - treat with a nonselective beta-blocker or primidone (a barbiturate)

Answer 239

- a sudden, wild flailing of 1 arm with or without flailing of the ipsilateral leg - caused by a lesion in the contralateral subthalamic nucleus most often from a lacunar stroke

Answer 240

- it is a slow, zigzag motion that arises when pointing or extending toward a target - signifies cerebellar dysfunction

Answer 241

a sudden, brief, uncontrolled muscle contraction common in renal and liver failure which result in metabolic abnormalities

Answer 242

it is a region in the frontal cortex responsible for controlling visual attention and generating voluntary eye movements

Answer 243

a direct connection between Wernicke's area and Broca's area that allows for repetition without comprehension

Answer 244

- Broca's is responsible for motor speech and is located in the inferior frontal gyrus of the frontal lobe - Wernicke's is responsible for speech comprehension and is located in the superior humoral gyrus of the temporal lobe

Answer 245

- dorsal is for recognition of the relationship between objects - ventral is for recognition of objects

Answer 246

that which is responsible for symbolic reasoning (including language) and is typically contralateral to your dominant hand

Answer 247

with a test of "construction"

Answer 248

a higher-order language deficit (inability to understand, speak, read, or write)

Answer 249

the motor inability to speak

Answer 250

- results from a lesion to Broca's area - intact comprehension - non-fluent speech and impaired repetition

Answer 251

- results from a lesion to Wernicke's area - impaired comprehension and impaired repetition - fluent speech

Answer 252

- caused by damaged to the arcuate fasciculus - speech comprehension is intact and the individual will have fluent speech - the only thing impaired is repetition

Answer 253

- results from damage to the arcuate fasciculus, Broca's area, and Wernicke's area - presents with non-fluent speech, impaired comprehension, and impaired repetition

Answer 254

- results from a lesion in the area surrounding Broca's area but not Broca's area itself - speech comprehension and repetition are intact - speech is non-fluent

Answer 255

- results from a lesion to the temporal lobe around Wernicke's area but spares Wernicke's area itself - speech comprehension is impaired - speech is fluent and repetition is intact

Answer 256

- damage to the watershed areas surrounding Wernicke's and Broca's area but without damage to either area or the arcuate fasciculus - results in impaired speech comprehension and non-fluent speech - repetition is left in tact

Answer 257

one damaging the connection between the primary visual cortex and Wernicke's area

Answer 258

one damaging the connection between the motor cortex and Broca's area

Answer 259

- a syndrome that arises from a lesion affecting the amygdala bilaterally - presents with disinhibited behavior such as hyper sexuality, hyperorality, and hyperplasia - associated with HSV-1 encephalitis

Answer 260

- arises due to a lesion in the non dominant parietal cortex - characterized by an inability to respond to stimuli on the contralateral side of the body or in the contralateral visual field - contralateral apraxia and astereognosis are also seen as are errors in the accuracy of arm movements

Answer 261

hemispatial neglect syndrome

Answer 262

known as Gerstmann syndrome: - agraphia - acalculia - finger agnosia - left-right disorientation

Answer 263

reduced levels of arousal and wakefulness

Answer 264

- a syndrome that arises most commonly in alcoholics - associated with a B1 (thiamine) deficiency; in particular, it can be precipitated by giving glucose without B1 to a B1-deficient patient - presents with confusion, opthalmoplegia, ataxia, memory loss (anterograde and retrograde), confabulation, and personality changes - associated with damage to the mammillary bodies

Answer 265

Wernicke-Korsakoff syndrome

Answer 266

either a hypokinetic disorder like Parkinson's disease or a hyperkinetic disorder like Huntington's disease

Answer 267

ipsilateral

Answer 268

ipsilateral intention tremor, limb ataxia, loss of balance

Answer 269

truncal ataxia and dysarthria

Answer 270

a contralateral hemiballismus

Answer 271

anterograde amnesia

Answer 272

eyes look away from the side of the lesion

Answer 273

eyes look toward the lesion

Answer 274

- ipsilateral: frontal eye field lesion | - contralateral: paramedian pontine reticular formation

Answer 275

the feet are medial and with the head and hands more laterally

Answer 276

changes in the PCO2

Answer 277

CPP = MAP - ICP

Answer 278

- hyperventilation is induced to lower PCO2, causing vasoconstriction in the cerebral arteries, limiting cerebral blood flow and reducing ICP - used to treat acute cerebral edema and quickly lower ICP

Answer 279

- affects the motor and sensory cortices of the upper limb and face including the region of the temporal lobe including Wernicke's area and the region of the frontal lobe including Broca's area and frontal eye fields - presents with contralateral paralysis and sensory loss more so in the face and upper limb than lower - aphasia if in dominant hemisphere, hemineglect if in non-dominant - ipsilateral deviation of eyes and superior quadrantanopsia - if only involves the superior division: there is greater damage to Broca's than Wernicke's - if only involves the inferior division: there is greater damage to Wernicke's

Answer 280

- superior supplies the lateral aspect of the frontal and parietal lobes above the lateral sulcus, including frontal eye fields and Broca's area - inferior supplies the lateral aspect of the parietal and temporal lobes below the lateral sulcus, including Wernicke's area and Meyer's loop radiating from the LGN

Answer 281

- affects the medial portions of the motor and sensory cortices as well as some frontal lobe areas involved in executive functioning - presents with contralateral paralysis and sensory loss more so in the leg than in the arm or face - may also present with frontal lobe syndrome and urinary incontinence

Answer 282

- affects the striatum and internal capsule - results in contralateral paralysis and/or sensory loss equally throughout the body (arms=legs=face) - absence of cortical signs - often in the setting of unmanaged hypertension as a lacunar infarct - can occur if a MCA is extremely proximal

Answer 283

- supplies the medial medulla - damages the lateral corticospinal tract, medial lemniscus, and hypoglossal nerve - defining feature is ipsilateral deviation of the tongue

Answer 284

- serves the lateral medulla - including the nucleus ambiguous (CN IX, X, XI), trigeminal, spinothalamic tract, vestibular, sympathetics, inferior cerebellar peduncle - defining feature is dysphagia, hoarseness, diminished gag reflex, and contralateral uvula deviation - other symptoms include vomiting and vertigo, loss of pain and temp on the contralateral body and ipsilateral face, ipsilateral horner syndrome, and ipsilateral ataxia

Answer 285

- damages the lateral pons (CN V, VI, VII, VIII) - including the facial nucleus, vestibular nuclei, spinothalamic tract, spinal trigeminal nucleus, sympathetics, and middle and inferior cerebellar peduncles - facial nucleus damage is unique and causes ipsilateral bell's palsy - other symptoms include vomiting and vertigo, loss of pain and temp on the contralateral body and ipsilateral face, ipsilateral horner syndrome, and ipsilateral ataxia

Answer 286

- damages the pons, medullar, lower midbrain - including the corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, and paramedian pontine reticular formation - preserved consciousness, vertical eye movement, and blinking but nothing else

Answer 287

- damages the occipital cortex and visual cortex | - leading to a contralateral hemianopia with macular sparing

Answer 288

the internal carotid

Answer 289

- may rupture and cause an anterior cerebral artery stroke | - may compress the optic chasm and cause a bitemporal hemianopia with visual acuity deficits

Answer 290

compression may cause ipsilateral CN III palsy with mydriasis, ptosis, and "down and out" eye

Answer 291

- neuropathic pain due to a thalamic lesion - presents with an initial period of paresthesia followed in weeks to months by allodynia and dysesthesia - seen in 10% of stroke patients

Answer 292

- allodynia: an ordinarily painless stimuli causes pain | - hyperalgesia: a painful stimuli elicits more pain than it should

Answer 293

noncontrast CT

Answer 294

- CT detects ischemic changes in 6-24 hours | - diffusion weighted MRI can detect ischemia in 3-30 minutes

Answer 295

- tPA if within 3-4.5 hours of onset and there is no risk of hemorrhage - reduce risk with medical therapy, including control of BP, blood sugars, and lipids - treat conditions that increase risk such as atrial fibrillation

Answer 296

the internal jugular vein

Answer 297

the superior sagittal sinus

Answer 298

- signs and symptoms of increased ICP such as headache, seizures, and focal neurologic deficits - may lead to hemorrhage - associated with hypercoagulable states

Answer 299

- also known as idiopathic intracranial hypertension, it is an increase in ICP with no apparent cause on imaging - presents with headache and diplopia (usually from CN VI palsy) without mental status change - fundoscopy reveals papilledema and lumbar puncture demonstrates an increase in opening pressure and provides headache relief - risk factors are women of childbearing age, excess vitamin A, danazol, ad tetracycline - treat with weight loss, acetazolamide, topiramate, and invasive procedures for refractory cases

Answer 300

- an increase in CSF volume with ventricular dilation due to a decrease in reabsorption by arachnoid granulations - papilledema is seen on fundoscopy with increased ICP - danger is herniation

Answer 301

an increase in CSF volume with ventricular dilation caused by a structural blockage of CSF

Answer 302

the appearance of increased CSF on imaging that is actually due to decreased brain tissue rather than an abnormal or pathologic increase in CSF

Answer 303

there are 31 in total - 8 cervical - 12 thoracic - 5 lumbar - 5 sacral

Answer 304

C1 exits above the atlas (C1) while the rest exit below their corresponding vertebra

Answer 305

below their vertebrae (except C1, which exits above)

Answer 306

herniation of the nucleus pulpous through the annulus fibrosus that normally surrounds it

Answer 307

posterolaterally at L4-L5 or L5-S1

Answer 308

- in the dorsal column, more sacral input is organized more medially - in the lateral spinothalamic tract, more sacral input is organized more laterally - in the lateral corticospinal tract, more sacral output is carried more laterally

Answer 309

- corticospinal: descending motor information - dorsal column: ascending pressure, vibration, touch, and proprioception - spinothalamic tract: ascending pain and temperature

Answer 310

- the fasciculus gracilis medially (lower body) | - the fasciculus cuneatus laterally (upper body)

Answer 311

- carries pressure, vibration, fine touch, and proprioception - first order neuron is located in the dorsal root ganglion and enters the spinal cord via the dorsal root - it ascends in the ipsilateral dorsal column with more sacral information organized more medially in the gracilis and more rostral information laterally in the cuneatus - second order neuron is located in the ipsilateral nucleus (gracilis or cuneate) of the medulla - decussate in the medulla as the internal arcuate fibers of the medial lemniscus - ascend in the contralateral medial lemniscus to the VPL of the thalamus where the third-order resides - third order neurons project from the VPL to the sensory cortex

Answer 312

- carries pain and temperature - first order neuron is located in the dorsal root ganglion and enters the spinal cord via the dorsal root - it synapses on a second order neuron in the posterior horn at the level it entered - decussates via the anterior white commissure and ascends in the contralateral spinothalamic tract with sacral input more laterally - third order neuron is located in the VPL of the thalamus and projects to the sensory cortex

Answer 313

- carries descending motor commands - first order neuron (aka UMN) is located in the primary motor cortex and descends ipsilaterally through the internal capsule - then they decussate at the caudal medulla as the pyramidal decussation - from there they descend contralaterally to lower motor neurons in the anterior horn - the anterior horn projects via the ventral root to the NMJ

Answer 314

it contains the corticobulbar tract fibers and can be affected by lenticulostriate strokes

Answer 315

a sign of upper motor neuron injury in which there is a sudden, rapid decrease in resistance after enough force is applied at a joint

Answer 316

lower motor neuron

Answer 317

- results from a hemisection of the spinal cord - presents with ipsilateral UMN signs below the lesion; ipsilateral loss of tactile, vibration, proprioception below the lesion; contralateral loss of pain and temp below the lesion; ipsilateral loss of all sensation at the level of the lesion; ipsilateral LMN signs at the level of the lesion - potential for ipsilateral Horner syndrome if the lesion occurs above T1

Answer 318

damage to the descending hypothalamospinal tract above T1

Answer 319

- they both affect the anterior horns and LMNs | - but poliomyelitis presents with asymmetric weakness and Werdnig-Hoffmann disease presents with symmetric weakness

Answer 320

the tract at the tip of the posterior horn, which contains projections from first order neurons of the spinothalamic tract

Answer 321

- damages everything except the dorsal columns and Lissauer's tract - common because the upper thoracic ASA territory is a watershed area since the artery of Adamkiewicz supplies the ASA below T8

Answer 322

- degeneration of the dorsal columns and roots due to tertiary syphilis - results in progressive sensory ataxia, charcot joints, shooting pain, and Argyll Robertson pupils - exam with demonstrate the absence of DTRs and a positive Romberg sign

Answer 323

- it is based on the idea that you need at least two of the following to maintain balance: vision, proprioception, or vestibular function - asks patient to close their eyes and walk - a positive sign is when they lose their balance and it indicates a sensory ataxia (problem with proprioception)

Answer 324

- small pupils that constrict in response to a nearby object but not in response to light - indicative of neurosyphilis

Answer 325

- called subacute combined degeneration - causes demyelination of spinocerebellar tracts, lateral corticospinal tracts, and dorsal columns - presents with ataxic gait, paresthesia, and impaired position/vibration sense

Answer 326

- a reflexive contraction of the cremasteric muscle (elevation of testicles) in response to brushing the inner thigh - tests L1-L2

Answer 327

- testicular torsion disrupting the innervation | - L1-L2 injury

Answer 328

- contraction of the external sphincter in response to touching the skin around the anus - tests S3, S4

Answer 329

includes the thumb

Answer 330

the nipple

Answer 331

xiphoid process

Answer 332

the inguinal ligament

Answer 333

includes the kneecaps

Answer 334

genitals and anal zones

Answer 335

the right shoulder via the phrenic nerve

Answer 336

the right shoulder via the phrenic nerve

Answer 337

within the first year of life

Answer 338

- disappear due to inhibition by a mature frontal lobe | - reappear following frontal lobe damage

Answer 339

abduction of the arms when startled and then drawing together after feeling like they're falling

Answer 340

move head toward one side if cheek or mouth is stroked

Answer 341

sucking in response to contact with the roof of the mouth

Answer 342

curling of fingers if the palm is stroked

Answer 343

- aka the Babinski sign | - dorsiflexion of large toe and fanning of others with plantar stimulation

Answer 344

stroking along one side of the spine while a newborn is face down causes lateral flexion of the lower body toward the ipsilateral side

Answer 345

- above pons: I, II, III, IV - pons: V, VI, VII, VIII - medulla: IX, X, XI, XII

Answer 346

- herniation caused by a supratentorial mass - results in caudal displacement of the brain stem - potential for rupture of the paramedian artery leading to a brainstem hemorrhage (aka Duret hemorrhage) - usually fatal

Answer 347

- an adult primary brain tumor most often found in the cerebellum - may be capable of producing EPO and causing a secondary polycythemia - histology reveals closely arranged, thin-walled capillaries with minimal intervening parenchyma - associated with VHL when found with retinal angiomas

Answer 348

- a tumor of the pineal gland - can cause parinaud syndrome (vertical gaze palsy) if it compresses the tectum, obstructive hydrocephalus, or precocious puberty in males (via B-hCG production) - histology is similar to germ cell tumors

Answer 349

there is cerebral edema and possible herniation

Answer 350

- the most common subtype of Guillain-Barre syndrome - associated with an earlier infection and mediated by autoimmune attack of peripheral myelin due to molecular mimicry (specifically, destruction of Schwann cells) - results in symmetric, ascending muscle weakness or paralysis beginning in the lower extremities; may also see autonomic dysregulation or sensory abnormalities - exam findings may include papilledema and increased CSF protein with normal cell count - complete recovery is expected after weeks to months but respiratory support is critical until that time; additional therapy includes plasmapheresis and IVIG but there is no role for steroids

Answer 351

- a multifocal periventricular inflammation and demyelination after infection or vaccination - presents with rapidly progressive multifocal neurologic symptoms and altered mental status

Answer 352

- also known as hereditary motor and sensory neuropathy - a group of, primarily autosomal dominant, progressive hereditary nerve disorders - caused by defective production of proteins critical for the structure and function of peripheral nerves or myelin sheath - associated with foot deformities (pes caves), lower extremity weakness, and sensory deficits

Answer 353

synchronized, high-frequency neuronal firing

Answer 354

- seizures affecting a single area of the brain - most commonly originating in the medial temporal lobe and often preceded by an aura - include simple partial (consciousness remains intact) and complex partial (impaired consciousness) - can secondarily generalize

Answer 355

simple refers to a partial seizure in which consciousness remains intact while complex refers to a case in which consciousness is impaired

Answer 356

a disorder of recurrent seizures, excluding febrile seizures

Answer 357

a continuous or recurring seizure that may result in brain injury, typically defined as those lasting longer than 5 minutes

Answer 358

- children: genetic, infection, trauma, congenital, and metabolic - adults: tumor, trauma, stroke, infection - geriatrics: stroke, tumor, trauma, metabolic, infection

Answer 359

- myoclonic: generalized seizure characterized by quick, repetitive jerks - tonic-clonic: generalized seizure characterized by alternating stiffening and movement

Answer 360

a generalized seizure characterized by stiffening

Answer 361

a generalized seizure in which the individual drops to the floor, commonly mistaken for fainting

Answer 362

the sensation of spinning while actually stationary

Answer 363

- the more common form of vertigo - caused by an inner ear etiology such as semicircular canal debris, vestibular nerve infection, etc. - positional testing will reveal delayed horizontal nystagmus

Answer 364

- that arising from a brain stem or cerebellar lesion - findings include directional change of nystagmus, skew deviation, diplopia, and dysmetria - positional testing reveals immediate nystagmus in any direction and may change directions

Answer 365

- a syndrome of tumors due to a deletion of VHL on chromosome 3, which normally ubiquitinates hypoxia-inducible factor 1a - syndrome includes HARP: Hemangioblastomas of the retina, brain stem, cerebellum, and spine; Angiomatosis; bilateral Renal cell carcinomas; and Pheochromocytomas

Answer 366

- a neurocutaneous disorder arising from a mutation of the NF1 tumor suppressor gene on chromosome 17, which encodes a negative regulator of RAS called neurofibromin - presents with cafe-au-lait spots, Lisch nodules (pigmented iris hamartomas), cutaneous neurofibromas, optic gliomas, and pheochromocytomas - the neurofibromas are derived from neural crest cells

Answer 367

- a neurocutaneous disorder due to a TSC1 mutation on chromosome 9 or TSC2 mutation on chromosome 16 - features follow the HAMARTOMASS acronym: Hamartomas in CNS/skin, Angiofibromas, Mitral regurgitation, Ash-leaf spots, cardiac Rhabdomyoma, (Tuberous sclerosis), autosomal dOminant, Mental retardation, renal Angiomyolipoma, Seizures, and Shagreen patches - also have an increased incidence of subependymal astrocytomas and ungal fibromas

Answer 368

- a somatic mosaicism for an activating mutation of GNAQ causes congenital, non-inherited neural crest anomalies - affects small blood vessels to cause a port-wine stain of the face in a CN V1/V2 distribution - also presents with ipsilateral leptomeningeal angioma causing seizures and epilepsy, intellectual disability, and episcleral hemangioma causing increased IOP and early onset glaucoma - STURGE: Sporadic, port-wine Stain, Tram track calcifications (opposing gyri), Unilateral, Retardation, Glaucoma, GNAQ gene, Epilepsy

Answer 369

- repetitive brief headaches with excruciating periorbital pain with lacrimation and rhinorrhea - unilateral and may also present with Horner syndrome - last 15min-3hr and occur in clusters - treat with sumatriptan acutely and verapamil for prophylaxis

Answer 370

- those with constant, steady pain, no photophobia, no photophobia, and no aura - tend to bilateral and lasting more than thirty minutes - treat with analgesics, NSAIDs, and acetaminophen; use amitriptyline for chronic pain

Answer 371

- those with pulsating pain and nausea, photophobia, or phonophobia; many are preceded by an aura - arise from irritation of CN V, meninges, or blood vessels - mediated by substance P, CGRP, and vasoactive peptides - unilateral and lasting between 4-72 hours - treat acutely with NSAIDs, triptans, and dihydroergotamine - use lifestyle changes, beta-blockers, CCBs, amitriptyline, topiramate, and valproate for prophylaxis

Answer 372

- meningitis - hydrocephalus - subarachnoid hemorrhage - neoplasia - arteritis

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