Neuro - FA Patho p499 - 520 Flashcards
(229 cards)
1
Q
Frontal area lesion - issue?
A
Disinhibition and deficits in concentration, orientation, judgment; may have reemergence of primitive reflexes
2
Q
Frontal eye fields
A
Destructive lesion such as an MCA stroke: eyes look toward the side of lesion (or at the hemiplegia). Irritative lesion such as seizures: eyes look at the shaking arm and leg
3
Q
Paramedian pontine reticular formation
A
Eyes look toward side of hemiplegia.
Ipsilateral gaze palsy (inability to look toward side of lesion).
4
Q
MLF lesion? affected in what disease?
A
Internuclear ophthalmoplegia (impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction). Multiple sclerosis.
5
Q
Lesion of dominant parietal cortex?
A
Agraphia, acalculia, finger agnosia, left-right disorientation.
Gerstmann syndrome.
6
Q
Lesion of nondominant parietal cortex?
A
Agnosia of the contralateral side of the world.
Hemispatial neglect syndrome.
7
Q
Hippocampus (bilateral) lesion?
A
Anterograde amnesia—inability to make new memories.
8
Q
Basal ggl lesion affected in which diseases?
A
Parkinson disease
Huntington disease
9
Q
Contralateral hemiballismus is lesion in what area of brain?/
A
subthalamic nucleus
10
Q
Sx of Wenicke Korsakoff syndrome - what brain area affected?
A
Mammillary bodies (bilateral) Wernicke-Korsakoff syndrome—Confusion, Ataxia, Nystagmus, Ophthalmoplegia, memory loss (anterograde and retrograde amnesia), confabulation, personality changes.
11
Q
Klüver-Bucy syndrome - sx? assoc with what virus? affects what area of the brain
A
Klüver-Bucy syndrome—disinhibited behavior (eg, hyperphagia, hypersexuality, hyperorality).
Amygdala (bilateral)
HSV-1 encephalitis
12
Q
Parinaud syndrome - sx?
A
—vertical gaze palsy, pupillary light-near dissociation, lid retraction, convergence-retraction nystagmus.
13
Q
Parinaud syndrome - affects what area of the brain? causes?
A
Dorsal midbrain
cause - stroke, hydrocephalus, pinealoma
14
Q
Reticular activating system - lesion causes what sx?
A
Reduced levels of arousal and wakefulness (eg, coma)
15
Q
Lesion in cerebellar hemisphere
A
Intention tremor, limb ataxia, loss of balance; damage to cerebellum –> ipsilateral deficits; fall toward side of lesion.
16
Q
Decorticate posturing - what is it?
A
lesion above red nucleus, presents with flexion of upper extremities and extension of lower extremities
17
Q
Decerebrate posturing
A
lesion at or below red nucleus, presents with extension of upper and lower extremities
18
Q
Sx of lesions of cerebellar vermis?
A
Truncal ataxia (wide-based, “drunken sailor” gait), nystagmus.
Vermis is centrally located—affects central body.
Degeneration associated with chronic alcohol use
19
Q
based on below symptoms, what is the location of stroke? dysphagia, hoarseness, dec gag reflex
A
PICA posterior inferior cerebellar artery
20
Q
stroke in PICA is also called
A
lateral medullary (Wallenberg) syndrome
21
Q
what are the unique clinical symptoms of AICA lesion?
A
paralysis of face, facial droop (due to facial nucleus)
22
Q
AICA lesion is also called?
A
Lateral pontine syndrome
23
Q
what are other symptoms of AICA lesion of CN VII (other than facial droop)?
A
dec lacrimation, dec salivation, dec taste from ant 2/3 of tongue
24
Q
what stroke lesion will result in ipsilateral hypoglossal dysfunction such as tongue deviating ipsilaterly?
A
ASA
25
ASA stroke is also known as
Medial medullary syndrome
26
what are the other ASA stroke symptoms (other than ipsilateral hypoglossal dysfunction)?
1. dec contralateral proprioception (due to medial lemniscus) 2. contralateral hemiparesis of the upper/lower limbs (due to lateral corticospinal tract)
27
pt with contralateral hemianopia with macular sparing, where is the stoke lesion?
PCA
28
clinical symptoms of lenticulostriate artery stroke?
contralateral hemiparesis/hemiplegia
29
contralateral paralysis of the lower limb & contralateral loss of sensation of lower limb is due to what stroke?
ACA (anterior cerebral)
30
name 4 unique clinical symptoms of MCA stroke
1. contralateral paralysis (upper limb/face) 2. contralateral loss of sensation (upper limb/face) 3. aphasia if in dominant (usually Lt) hemisphere 4. hemineglect if lesion affects nondominant (usually Rt. side)
31
what artery is the common location of lacunar infarct 2' to HTN?
lenticulostriate artery
32
in what situations do you see therapeutic hyperventilation (dec pCO2) helps dec intracranial pressure?
acute cerebral edema (stroke, trauma) via vasoconstriction
33
what infection is associated with Kluver Bucy syndrome (disinhibited behavior: hyperphagia, hypersexuality, hyperorality)?
HSV-1
34
gerstmann syndrome is associated with what part of the brain lesion?
dominant parietal temporal cortex (usually Lt. hemisphere)
35
what are the symptoms of Gerstmann syndrome
agraphia, acalculia, finger agnosia, Lt to Rt. disorientation
36
what is the consequence of damaging reticular activating system (midbrain)?
1. reduced levels of arousal and wakefulness (coma) 2. loss of consciousness 3. stupor
37
what lesion will result in limb ataxia and falling toward the side of the lesion?
cerebellar hemisphere - lateral in cerebellum, fall laterally
38
what lesion will result in truncal ataxia and dysarthria? Assoc with use of what drug?
cerebellar vermis = vermis is cental --\> truncal ataxia Assoc with chronic alcohol use
39
what is the diff btw aphasia and dysarthria?
aphasia is language deficit and dysarthria is movement deficit
40
what type of aphasia leads to poor repetition, but fluent speech and intact comprehension?
conduction
41
what type of aphasia is associated with prosody?
broca (prosody: brief phase w/o intonation)
42
describe the broca aphasia
nonfluent with intact comprehension
43
describe the Wernicke aphasia
fluent with imparied comprehension
44
infarct of what blood vessel can lead to broca aphasia?
infarct of the superior division in MCA
45
infarct of what blood vessel can lead to Wernicke aphasia?
infarct of the inf. division of MCA
46
what type of aphasia leads to poor comprehension with fluent speech and intact repetition?
transcortical sensory (similar to Wernicke except for the poor repetition in Wernicke)
47
what type of aphasia is associated with nonfluent aphasia (halting speech), good comprehension with intact repetition?
transcortical motor
48
Spastic paralysis UMN or LMN?
UWM
49
Which motor neuron sign is seen in both UMN and LMN?
Weakness
50
UMN or LMN in Werdnig-Hoffmann disease? Where is the distruction? And mode of inheritance?
LMN lesions only destruction of anterior horns; flaccid paralysis. Autosomal recessive
51
Fasciculations are caused by UMN or LMN?
LMN
52
A pt with weakness and fasciculations and spastic paralysis but has no sensory or oculomotor deficits suffers from what spinal cord dz?
ALS
53
Scanning speech, intention tremor, nystagmus are sx of what spinal cord dz?
MS
54
Clasp knife spasticity UMN or LMN?
UWM
55
Reflexes and Tone incr with UMN or LMN?
UWM
56
pt has only impaired sensation and proprioception, progressive sensory ataxia (inability to sense or feel the legs causing poor coordination). What is the spinal cord dz?
Tabes dorsalis
57
Amyotrophic lateral sclerosis involves UMN or LMN? Name the cause?
both defect in superoxide dismutase 1.
58
Lesion to what spinal artery destroys all but spares dorsal columns and Lissauer tract? and why is that part spared?
Complete occlusion of anterior spinal artery because gracilis and cuneatus are supplied by Posterior spinal arteries.
59
MOA of Riluzole and what is treats?
increases modestly the survival of ALS decreases presynaptic glutamate release
60
demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts i seen in which path?
Vit B12 def
61
Name 3 demyelination paths of the spinal cord?
MS Tabes dorsalis vit B12 def
62
Sx of Syringomyelia? Where is it seen? defect in what path?
- Bilateral loss of pain and temperature sensation (usually C8–T1) - See in Chiari I malformation - white commissure of spinothalamic tract (2nd-order neurons)
63
What is frataxin and what path is it seen?
Iron binding protein; Friedreich ataxia
64
What test can help dx Polio?
CSF shows Inc WBCs and protein, glucose normal
stool sample - Virus recovered from stool or throat.
65
In Brown-Séquard syndrome which finding in is the only Contralateral finding?
pain and temperature loss below level of lesion (due to spinothalamic tract damage)
66
7 year old child presents with kyphoscoliosis, frequent falling and diabetes has a defect on chromosome 9. What is the pathphys and what will be the cause of death?
Friedreich ataxia - defected frataxin causes impairment in mitochondrial functioning. (oxidative stress) MCC of death: hypertrophic cardiomyopathy around 7years trinucleotide repeat disorder (GAA)
67
In which 6 paths do we find Horner syndrome?
Any lesion above T1 -Brown-Séquard syndrome -PICA -Cavernous sinus syndrome -Bronchogenic apical lung tumor -Pancoast tumor -Clustera headaches
68
In Brown-Séquard syndrome at which levels are UMN sings and at which are there LMN signs?
UMN signs below the lesion LMN signs at the lesion
69
Paralysis of conjugate vertical gaze due to lesion in superior colliculi Describes? What paths can cause that?
Parinaud syndrome ("suncken eye syndrome") stroke, hydrocephalus, pinealoma
70
Which enzyme def leads to cataracts?
galactokinase, galactose 1 phosphate uridyltransferase
71
Which of the trisomies can lead to cataracts?
all of them
72
What AD disease of chromosome 22 can lead to juvenile cataracts? What other tumors come with?
NF2 - comes with bilat acoustic schwannomas, meningiomas, ependymomas
73
What AD disease of chr 15 lead to cataracts?
Marfan syndrome
74
What disease leads to nephritis, hearing problems, and cataracts later in life? What molecule is affected?
Alport syndrome, collagen IV
75
Diseases with cherry red spots
Tay Sachs, Neimann Picks
76
Disease with Marcus Gunn Pupil
glaucoma, or severe retinal disease, or due to Multiple Sclerosis.
77
Symptoms of SNS denervation of face?
Ptosis (slight drooping of eyelid: superior tarsal muscle) Anhidrosis (absence of sweating) and flushing of affected side of face Miosis (pupil constriction)
78
Horner's seen with which diseases?
Any lesion of spinal cord above T1 --\> Pancoast tumor, Brown Sequard, Late stage syringomyelia, Also seen with cluster headaches, Lung cancer, PICA injury, Cavernous sinus syndrome,
79
What CN innervates sublingual and submandibular glands?
CN 7
80
Jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle is what CN lesion
CN V motor lesion
81
Uvula deviates away from side of lesion
CN X lesion
82
Weakness turning head to contralateral side of lesion
CN XI lesion
83
tongue deviates toward side of lesion
CN XII lesion
84
during an UMN Facial lesion what part of the head is spared due to bilateral UMN innervation
Forehead
85
destruction of motor cortex or connection between motor cortex and facial nucleus in Pons causes what type of lestion
UMN facial nerve lesion
86
Hyperacusis loss of taste sensation in ant tongue is due to lesion of
LMN lesion of facial nerve (ipsilateral paralysis of upper and lower muscles of facial expression)
87
what nerve injury can ixodes tick cause?
Bells Palsy
88
ixodes tick is also a vector for .... ( other than in Lyme disease)
Babesia, Anaplasma
89
what are all the causes of bells palsy
Lyme disease, herpes zoster (Ramsay Hunt syndrome), sarcoidosis, tumors (eg, parotid gland), diabetes mellitus.
90
what virus cause Ramsay Hunt syndrome
Herpes Zoster
91
symptoms of cavernous sinus syndrome
variable ophthalmoplegia,
dec corneal sensation,
horner syndrome,
dec maxillary sensation
Sx secondary to a pituitary tumor mass effect,
carotid cavernous fistula
or cavernous sinus thrombosis related infection
92
what cranial nerve is most commonly injured in the cavernous sinus?
CN 6
93
conductive bone loss
abnormal , Bone \> ear (localized to affected ear)
94
Sensorineural hearing loss
Bonus :what Cardio pathology is associated with sensorineural ear loss & what is the mode of inheritance
normal (air \> Bone) localized to unaffected ear
Jervell and Lange-Neilsen syndrome & AR
Note: Romano ward syndrome is Not associated with deafness & AD (pure cardiac phenotype)
95
a conducting hearing loss which is caused by erosion of ossicles & mastoid hair cells refers to what pathology
Cholesteatoma
96
what does zinc deficiency cause
Anosmia
97
what bone disease affects the ossicles
Osteogenesis Imperfecta
98
Paget disease affect what part of the ear
Auditory Tube
99
what is Ramsay Hunt disease?
as an acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle (also termed herpes zoster oticus), and/or mucous membrane of the oropharynx.
100
MS more common in what type of population?
whites living far from equator
101
What type of bladder incontinence is seen in MS?
Urge then overflow
102
What type of hypersensitivity is MS?
4
103
charcot triad of MS?
SIN -Scanning speech -Intention tremor (also Incontinence and Internuclear ophthalmoplegia -Nystagmus
104
Diagnostic test for MS
Oligoclonal bands
105
Gold standard for MS and what do you see
MRI and periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
106
Bonus: Reactive gliosis by what cells
Astrocytes
107
where do you see albuminocytologic dissociation?
Guillain Barre Increased CSF protein with normal cell count
108
GB associated infections
Associated with infections (eg, Campylobacter jejuni, viral)
109
What type of aneurysm AND herniation that can affect sympathetic fibers of CN3?
Posterior communicating artery aneurysm Uncal herniation
110
If you have CN IV damage, what are the symptoms?
SO4 Function of SO 1. trouble going downstairs ( SO depresses and abduct) 2. Head tilt towards the side of the lesion (So intort, now no SO --\> you extort --\> so may present with compensatory head tilt in the opposite direction)
111
What will happen to L CN VI palsy when you tell that patient to look L?
L eye will not look L
112
What happen to the R eye in Right CN IV palsy with L gaze?
R eye looks upward = R hypertropia
113
List the causes of R anopia?
Optic neuritis, central retinal A occlusion
114
Tunnel vision, what lesions?
Pituitary lesion Optic chiasm
115
Convergence normal or abnormal? 1. MLF 2. CN 3 lesion
1. MLF is normal 2. CN 3 is not
116
Senile plaques and tau, which one is intracellular and which one is extracelluar
plaques is extra tau is intra
117
to determine the degree of dementia in Alzheimers, what do you look for?
number of tangles
118
What decreases the risk of Alzheimer? What increases?
ApoE2 decreases ApoE4 increases
119
Early onset dementia by down why?
chr 21 has APP gene on it
120
what are presenilin 1 and 2?
gene that increases risk of early onset Alzeheimer's Disease
121
where do you see spherical tau and what do you stain with
Pick, silver
122
Patient with change in personality which type of dementia
Pick (FT dimentia)
123
Paitent with visual hallucinations followed by parkinsonian features
Lewy
124
How do you DDx Lewy body dementia and Parkinson patient with dementia?
Lewy is early onset
125
Dementia with myoclonus
Creutzfeldt-Jakob (rapid)
126
What are prions?
PrPc---\> PrPsc sheet which are Bpleated sheet reisstant to proteases
127
where do you see 14/3/3 protein
CJ
128
Where do you see Hirano bodies in hippocampal
Alzeheimer
129
Name 2 infections and 2 vaccinations that can cause acute disseminated (postinfectious) encephalomyelitis
1. measles or VZV 2. rabies, small pox
130
Demyelinating disease with Pes cavus and foot drop
Charcot-marie-tooth, AD
131
Krabbe what enzyme deificiency
Galactocerebrosidase
132
Glucocerebrosidase deficiency
Gaucher
133
Metachromatic leukodystrophy enzyme deficiency?
Arylsulfatase A
134
JC virus can cause what type of demyelinating diease?
Progressive multifocal leukoencephalopathy
135
PML also seen in 2-4% of what patient
AIDS
136
explain adrenoleukodystrophy and how do they die?
X linked, males very long chain FA cannot be broke down --\> built up in CNS, adrenal gland, testes die with adrenal crisis
137
What is partial seizures?
it's a focal seizure, single area
138
what is a generalized seizure
Diffuse area
139
Whats the origin of partial seizures?
Medial temporal lobe
140
what's simple partial seizure?
simple = consciousness intact complex is not
141
causes of simple partial can be? (4)
motor, sensory, autonomic, pyschic
142
the one with no postictal confusion
Absence
143
the one with repetitive jerks
myoclonic
144
what's grand-mal seizures?
tonic-clonic(stiff and move)
145
atonic is mistaken for what?
fainting
146
febrile seizures are epilepsy? T or F?
False
147
Define status epilepticus
continous or recurring seizures that may result in brain injury (duration is \>10-30 min)
148
causes of seizures by age children? MCC
genetic, infection, trauma, congenital, metabolic
149
Adults causes of seizures
tumor, trauma, stroke, infection
150
stroke, tumor, trauma, metabolic, infection are most common in
the elderly
151
NF type 1 is also called
von Recklinghausen dz
152
what neurocutaneous dz (ND) is associated with shagreen patches?
TS
153
what ND is associated with pheochromocytoma?
VHL, NF1
154
what type of multiple endocrine neoplasia is associated with pheochromocytoma?
MEN 2B
155
what ND is associated with GNAQ gene mutation?
Sturge Weber syndrome
156
which ND is associated with 2' polycythemia?
VHL (hemangioblastoma --\> inc EPO)
157
what ND is associated with inc incidence of subependymal astrocytomas and ungual fibroma
TS
158
which ND is associated with seizures, epilepsy, and intellectual disability?
sturge weber,
TS,
NF1
159
what ND is associated with mitral regurge?
TS
160
what path is associated with tram track calcification (opposing gyri)?
Sturge Weber
161
what is nevus flammeus and what dz is associated with it?
a non neoplastic brithmark in CN V1/V2 distribution, Sturge Weber
162
what neurocutaneous disorder is non-inherited (somatic)?
Sturge Weber
163
what neurocutaneous disorder is due to the developmental anomaly of neural crest derivatives?
Sturge Weber
164
what is the role of neurofibromin in NF1?
a negative regulator of RAS on ch#17
165
what path is associated with cafe au lait spots?
NF1
166
what path is associated with hemangioblastomas in retina, brain, cerebellum, spine
vHL
167
2 neurocutaneous disorders associated with intellectual disability?
sturge weber, TS
168
what is the type of headache associated with repetitive brief headache?
cluster
169
describe the characteristics of tension headache
steady pain, no photophobia or phnophobia. No aura
170
how would you diff cluster, tension, migraine headache in terms of their location?
cluster: unilateral tension: bilateral migraine: unilateral
171
what type of headache is associated with excruciating periorbital pain with lacrimation and rhinorrhea with potential Horner syndrome?
Cluster
172
how is trigeminal neuralgia diff from cluster headache?
TN produces repetitive shooting pain in the distribution of CN5 that lasts for less than 1 min
173
how would you diff cluster, tension, migraine headache in terms of duration?
cluster: 15 min - 3 hours tension: more than 30 min (typically 4-6hr) migraine: 4-72 hrs
174
explain the pathophysio of migraine
due to irritation of CN V, meninges, or blood vessels
175
in migraine, what substances are released from blood vessels, for ex?
substance P, calcitonin gene related peptide,
176
mnemonics for migraine headache?
POUND Pulsatile One day duration Unilateral Nausea Disabling
177
in terms of the location of the lesion, how can you diff peripheral vs ventral vertigo?
peripheral: inner ear etiology central: brain stem or cerebellar lesion
178
how would you test peripheral vertigo?
positional testing to see if there is any delayed horizontal nystagmus
179
how would you test central vertigo?
positional testing will reveal immediate nystagmus in any direction
180
name 3 inner etiologies that can cause peripheral vertigo
1. semicircular canal debris 2. vestibular nerve infection 3. Meniere dz
181
what brain tumor is associated with chick wire capillary pattern?
oligodendroglioma
182
what brain tumor is associated with drop metastases to spinal cord?
medulloblastoma
183
in uncal herniation, you get 2 unique clinical symptoms (other than CN3 symptoms), what are they? Explain.
1. contralateral crus cerebri at the Kernohan notch --\> ipsilateral paresis, a false localization sign 2. ipsilateral PCA --\> contralateral hmonymous hemianopia
184
what type of hernia can cause coma or death as a result of compressing brain stem?
cerebellar tonsillar herniation into the foramen magnum
185
what cranial nerve is affected by uncus herniation?
CN 3
186
2 clinical symptoms from CN3 lesion?
blown pupil, down and out gaze
187
what type of hernia leads to duret hemorrhages?
downward transtentorial (central) herniation due to caudal displacement of the brain stem
188
duret hemorrhage is due to a rupture of what blood vessel?
paramedian basilar artery branches
189
what type of hernia compresses anterior cerebral artery?
cingulate (subfalcine) herniation under falx cerebri
190
pts with cingulate (subfalcine) herniation will present what types of focal neurological deficits?
contralateral paralysis of the lower limbs contralateral loss of sensation of the lower limbs
191
childhood tumors occur normally in infratentorial. what is the exception?
craniopharyngioma (occurs in supratentorial)
192
which brain tumor is associated with small blue cell (Homer Wright rosetts)?
medulloblastoma
193
what other 2 paths are associated with small blue cells?
1. Ewing (anaplastic small blue cells) 2. Neuroblastoma (neural crest cells --\> Homer Wright rosette)
3. Carcinoid
4. Small cell lung cancer
(neuroendocrine cells)
194
what 2 childhood brain tumors can affect the 4th ventricle?
medulloblastoma, ependymoma
195
what tumor is associated with rosenthal fibers?
pilocytic astrocytoma
196
what is rosenthal fibers?
eosinophilic, corkscrew fibers
197
what 2 brain tumors are GFAP positive?
glioblastoma multiforme (grade 4 astrocytoma) pilocytic astrocytoma
198
what is athetosis? lesion in? seen in what?
writhing, snake-like movement -Basal ggl -Huntington
199
What is Dystonia?
substained, involuntary muscle contractions
200
treatment of essential tremor
BB, primidone
201
intentional tremor, lesion in what?
cerebellum
202
Which posturing has a worse prognosis?
Worse prognosis with decerebrate posturing. In decorticate posturing, your hands are near the cor (heart).
203
lists the tremor alleviated by intentional movement
resting tremor
204
Patient with Hemiballismus. Lesion where? ipsi or contralateral?
contralateral subthalamic nucleus
205
Hemiballismus caused by what kind of stroke?
Lacunar
206
Disinhibition and deficits in concentration, orientation, judgment; may have reemergence of primitive reflexes.
Frontal lobe lesion
207
Difference between frontal eye field lesion and PPRF lesion?
Frontal eye field - eyes look toward lesion PPRF - eyes look away from lesion
208
impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction - where is the issue? assoc with which disease?
MLF ; MS
209
can't process sensory information from controlateral side? Where is the lesion - name?
Lesion in non dom parietal cortex - Hemispatial neglect syndrome.
210
Confusion, Ataxia, Nystagmus, Ophthalmoplegia indicates what lesion? Other Sx assoc with these?
Wernicke Korsakoff - damage in mamillary bodies memory loss (anterograde and retrograde amnesia), confabulation, personality changes.
211
Most vulnerable areas to ischemic stroke?
Most vulnerable: hippocampus, neocortex, cerebellum, watershed areas.
212
How to test for ischemic stroke?
non-contrast CT to elimate bleeding. CT will show ischemia in 6-24 hours. Diffusion weighted MRI will show it in 3 - 30 min.
213
Histo features of ischemic stroke w/in 24 hours?
Red neurons - eosinophilic cytoplasm with pyknotic nuclei
214
Post stroke - reactive gliosis and new blood vessel formation seen? How long post stroke is it?
1-2 weeks
215
216
3 types of stroke? which areas is affected by what?
Thrombotic—due to a clot forming directly at site of infarction (commonly the MCA A), usually over a ruptured atherosclerotic plaque.
Embolic—embolus from another part of the body obstructs vessel. Can affect multiple vascular territories. Examples: atrial fibrillation, carotid artery stenosis, DVT with patent foramen ovale, infective endocarditis.
Hypoxic—due to hypoperfusion or hypoxemia. Common during cardiovascular surgeries, tends to affect watershed areas.
217
Ischemic stroke - leads to what type of necrosis?
Acute blockage of vessels --\> disruption of blood flow and subsequent ischemia --\> liquefactive necrosis.
218
Tx of Ischemic stroke
: tPA (if within 3–4.5 hr of onset and no hemorrhage/risk of hemorrhage) and/or thrombectomy (if large artery occlusion).
219
TIA - define
Brief, reversible episode of focal neurologic dysfunction without acute infarction (⊝ MRI), with the majority resolving in \< 15 minutes; deficits due to focal ischemia
220
What is this a photo of?
Neonatal intraventicular hemorrhage
221
Neonatal intraventicular hemorrhage - originates where? sx?
Originates in germinal matrix, a highly vascularized layer within the subventricular zone. Due to reduced glial fiber support and impaired autoregulation of BP in premature infants.
Sx. Can present with altered level of consciousness, bulging fontanelle, hypotension, seizures, coma
222
You correct hyponatremia too quickly...what patho?
Central Pontine Myelinolysis now called Osmotic Demyelination Syndrome
223
Overcorrecting Hypernatremia too quickly (drop to hypo)
cerebral edema/ herniation
224
what is pseduobulbar palsy and give one example of syndrome associated with it
Pseudobulbar palsy is CN 9,10,11 affected but not their actual nuclei. Just their axons are demyelinated. symptoms: head and neck muscle weakness, dysphagia, dysarthria DDx: Bulbar palsy: nuclei of 9,10,11
225
describe the NTs change in Huntington
Increased DA Decreased GABA and Ach
226
Huntington genetics
AD Trinucleotide repeat on chr 4
227
Huntington patients are usually misdiagnosed for what?
substance abuse
228
Atrophy of which nucleus seen in Huntington
caudate and putamen
229
Ex vacuo hydrocephalus is seen in Huntington why?
frontal horns of lateral ventricles. atrophy of striatum
