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Flashcards in Neuro Day 2 Deck (70):
1

communicating hydrocephalus

- due to decreased CSF absorption by arachnoid granulations, which can lead to increased intracranial pressure, papilledema and herniation
- ex: arachnoid scarring post-meningitis

2

NPH

- no increase in subarachnoid space volume
- expansion of ventricles distorts the fibers of the corona radiata and leads to clinical triad of urinary incontinence, ataxia and cognitive dysfunction
- urinary incontinence 2/2 stretching of descending cortical fibers

3

noncommunicating hydrocephalus

caused by structural blockage of CSF circulation within the ventricular system (stenosis of the aqueduct of Sylvius)

4

spinal cord - lower extent

goes to L2, so do a LP between L3-L5 to keep the spinal cord alive

5

dorsal column orientation

organized the way you are, legs in the middle, arms on the outside
- decussates in the medulla

6

descending lateral corticospital tract orientation

Legs are Lateral, head is medial
- decussates at the caudal medulla

7

ascending lateral spinothalamic tract orientation

Legs are Lateral, head is medial
- decussates in the anterior white commissure and ascends contralaterally

8

polio and spinal muscular atrophy SC lesion

- affects anterior horns --> flaccid paralysis
LMN lesions only

9

ALS SC lesion, pathogenesis and treatment

- combined UMN and LMN lesions
- affects the anterior horn and lateral corticospinal tract
- can be caused by a defect of copper-zinc superoxide dismutase
- commonly presents with fasciculations,
- riluzole treatment modestly increases survival by increasing presynaptic GABA release
- usually die from aspiration pneumonia

10

ASA stroke SC lesion

- affects everything except the dorsal columns

11

tabes dorsalis SC lesion

- affects dorsal columns and roots
- impaired proprioception --> sensory ataxia and poor coordination
- absence of DTRs and + Romberg

12

Vit B12 or E deficiency

- subacute combined degeneration
- demyelination of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts
- ataxic gait, paresthesias, impaired position and vibratory sense and affects voluntary movement of limbs

13

spinal muscular atrophy (Werdnig-Hoffman Disease)

- congenital degeneration of anterior horns of spinal cord --> LMN lesion
- "floppy baby" with marked hypoxia and tongue fasciculations
- infantile type has median age of death at 7 months
- autosomal recessive inheritance

14

friedreich ataxia

- AR trinucleotide repeat (GAA) on chromosome 9
- gene that encodes frataxin, leads to impairment of mitochondrial functioning
- degeneration of muscle spinal cord tracts leads to muscle weakness and loss of DTRs, vibratory sense and proprioception
- staggering gait, frequent falling, nystagmus, dysarthria, pes cavus (foot abnormality), and hypertrophic cardiomyopathy (cause of death)
- presents in childhood with kyphoscoliosis
- 10% get diabetes
- "frat" brother who is always stumbling, staggering and falling, but has a big heart

15

Brown Sequard syndrome

- loss of contralateral pain and temp
- loss of ipsilateral position and vibration 1-2 levels below the lesion

16

Horner syndrome

- ptosis, anhydrosis and miosis
- associated with a SC lesion above T1
- due to Pancoast tumor, Brown-Sequard syndrome, late-stage syringomyelia

17

landmark dermatomes

T4 nipple, T10 umbilicus, L1 inguinal ligament, S234 keeps the penis off the floor

18

clinical reflexes

S1,2 - achilles - buckle my shoe
L3,4 - patellar - kick the door
T5,6 - biceps - pick up sticks
T7,8 - triceps - lay they straight
L1,2 - cremasteric - testicles move
S3,4 - anal wink

19

parinaud syndrome

- paralysis of conjugate vertical gaze due to lesion in superior colliculi
- can be due to germinoma (most common pineal tumor)

20

which colliculi are which

ears are below your eyes
- superior - vision (conjugate vertical gaze center)
- inferior - auditory

21

CN I - olfactory - S

smell

22

CN II - optic - S

vision

23

CN III - oculomotor - M

- eye movement - SR, IR, MR, IO
- pupillary constriction, accomodation, eyelid opening

24

CN IV - trochlear - M

- eye movement - SO

25

CN V - trigeminal - B

- mastication (V3), facial sensation, somatosensation from ant 2/3 of tongue

26

CN VI - abducens - M

- eye movement - LR

27

CN VII - facial - B

- facial movement, taste to ant 2/3 of tongue, lacrimation, salivation, eyelid closing, stapedius (hyperacusis with palsy)

28

CN VIII - vestibulocochlear - S

hearing, balance

29

CN IX - glossopharyngeal - B

- taste and somatosensation from post 1/3 of tongue
- swallowing, salivation, carotid body chemo and baroreceptors
- stylopharyngeus

30

CN X - vagus - B

- taste from epiglottic region
- swallowing, soft palate elevation
- midline uvula, talking, coughing
- thoracoabdominal viscera, monitoring aortic arch chemo/baroreceptors

31

CN XI - accessory - M

- SCM, trap

32

CN XII - hypoglossal - M

- tongue movement

33

corneal and lacrimal reflex

- afferent - CN V1
- efferent - CN VII

34

pupillary reflex

- afferent - CN II
- efferent - CN III

35

gag reflex

- afferent - CN IX
- efferent CN X

36

vagal nucleus solitarius

- visceral Sensry information (taste, baroreceptors, gut distention)

37

vagal nucleus aMbiguus

- Motor innervation of pharynx, larynx, and upper esophagus

38

vagal dorsal motor nucleus

- sends autonomic (parasympathetic) fibers to heart, lungs, upper GI
- bronchoconstriction

39

what goes through the optic canal

CN III, opthalmic artery, central retinal vein

40

what goes through the superior orbital fissure

- CN III, IV, V1, VI, opthalmic vein and sympathetic fibers

41

what goes through the foramen rotundum

- V2

42

what goes through the foramen ovale

- V3

43

what goes through the foramen spinosum

- middle meningeal artery and recurrent branch of V3

44

what goes through internal auditory meatus

- CN VII, VIII

45

what goes through the jugular foramen

- CN IX, X, XI, jugular vein

46

what goes through the hypoglossal canal

CN XII

47

what goes through the foramen magnum

spinal roots of CN XI, brain stem, vertebral artery

48

where are high/low frequency sounds heard best

- low frequency at the apex near the helicotrema (wide and flexible)
- high frequency at the base of the cochlea (thin and rigid)

49

conductive hearing loss

Rinne test abnormal (bone > air)
Weber test localizes to the affected ear

50

sensorineural hearing loss

Rinne test is normal
Weber test localizes to the normal ear
- in sensoriNeural, webber points to Normal

51

noise induced hearing loss

- damage to sterociliated cells in the organ of Corti
- loss of high frequency hearing 1st, sudden extremely loud noises can rupture tympanic membrane

52

facial nerve palsy

- ipsilateral facial paralysis, decreased lacrimation and salivation, hyperacusis and loss of taste sensation to first 2/3 of tongue
- idiopathic or associated with Lyme disease, HSV, herpes zoster, sarcoidosis, tumors or DM

53

hyperopia

- eye to short for refractive power of the cornea and lens--> light focused behind the retina

54

myopia

- eye too long for refractive power of the cornea, light focused in front of the retina

55

astigmatism

- abnormal curvature of cornea resulting in different refractive power at different axes

56

presbyopia

decreased focusing ability during accommodation due to sclerosis and decreased elasticity

57

central retinal artery occlusion

acute, painless monocular vision loss
- retina cloudy with attenuated vessels and "cherry red" spot at the fovea
- often permanent

58

retinal vein occlusion

- blockage of central or branch retinal vein due to compression by nearby arterial atherosclerosis
- retinal hemorrhage and edema in affected area

59

diabetic retinopathy

- non-proliferative: damaged capillaries leak, lipis and fluid seep into retina leading to hemorrhages and retinal edema. treat with blood sugar control and macular laser
- proliferative: chronic hypoxia results in new blood vessel formation with resultant traction on retina. treat with peripheral retina photocoagulation, anti-VEGF injections

60

open angle glaucoma

- associated with increased age, AA race, family history
- painless, more common in US
- primary has unclear etiology, but secondary can be due to blocked trabecular meshwork from WBCs (uveitis), RBCs (vitreous hemorrhage), retinal elements (retinal detachment)

61

primary closed angle glaucoma

- enlargement or forward movement of lens against central iris (pupil margin) leads to obstruction of normal aqueous flow through pupil --> fluid builds up behind the iris, pushing peripheral iris against cornea and impeding flow through trabecular meshwork

62

secondary closed angle glaucoma

- hypoxia from retinal disease (diabetes, vein occlusion) induces vasoproliferation in the iris that contracts the angle

63

miosis (constriction) control

- 1st neuron: Edinger- Westphal nucleus to ciliary ganglion via CN III
- 2nd neuron: short ciliary nerves to pupillary sphincter muscles

64

mydriasis (dilation) control

- 1st neuron: hypothalamus to ciliospinal center of Budge (C8-T2)
- 2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex)
- 3rd neuron: plexus along internal carotid, through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilators

65

Marcus Gunn pupil

- afferent pupillary defect
- due to optic nerve damage (optic neuritis) or severe retinal injury
- both eyes constrict when light shone in healthy eye, neither constrict when light shone in affected eye
- "swinging flashlight test"

66

age-related macular degeneration

- causes distortion and loss of central vision
- dry --> deposition of yellowish extracellular material (fatty tissue) in and beneath Bruch membrane and retinal pigment epithelium with gradual decrease in vision. prevent progression with multivitamin and antioxidant
- wet --> rapid loss of vision due to bleeding 2/2 choroidal neovascularization. "grey subretinal membrane". treat with anti-VEGF

67

Meyer loop lesion (temporal lobe) lesion

pie in the sky

68

Dorsal optic radiation (parietal lobe) lesion

pie on the floor

69

right peri-chiasmal lesion

- R nasal hemianopia, can be due to calcification of the carotid artery

70

INO

MLF lesion
- lack of communication between CN VI and CN III nuclei
- abducting eye gets nystagmus, convergence is normal