Flashcards in Neuro path Deck (159)
What is Brown-Sequard and what are its symptoms?
Hemisection of the spinal cord
-UMN paralysis: ipsilateral below level of lession
-Ipsilateral pain / temp sensory loss below level of lesion
-CONTRALATERAL pain / temp sensory loss below level of lesion
What is anterior cord syndrome?
Dorsal columns are spared
UMN paralysis and loss of pain / temp below lesion
What are the symptoms of central cord syndrome?
Bilateral loss of spinothalamic tracts below lesion
UMN paralysis of upper limbs more than lower limbs
Assoc. w/ cervical injury, often -> bladder dysfunction
Cauda Equina syndrome
Saddle distribution of sensory loss
LMN paralysis below lesion
What causes superior quadrantopia?
lesion of Meyer's loop: ventral projection from LGN. contains fibers representing superior visual field
Why is there macular sparing in an infarct of PCA?
Macular area of visual cortex receives dual blood supply from PCA and MCA
What is Weber's syndrome (superior alternating hemiplegia)?
Lesion of rostral midbrain affecting crus cerebri and CNIII
Contralateral UMN syndrome
Ipsi CNIII palsy
Loss of consensual response when light shone in contra eye
What is Foville's syndrome? cause?
Lesion of caudal pons
CN VI and VII affected: Ipsi loss of lateral eye movement, facial expression
MLF: internuclear opthalmoplesia
Pyramidal tract: contralateral hemiparesis
Medial lemniscus: contralateral fine touch, conscious proprio, deep pressure
thrombosis of basillar artry, pontine tumor
What is Millard-Gubler?
Lesion of CN VI, VII and corticospinal tract (pons)
thrombosis of paramedian branches of basillar artery
What is Wallenberg's syndrome?
Occlusion of PICA - mid medulla
Ipsi: loss of pain / temp in face (CN V)
Ipsi: Horner's (sympathetic damage)
Ipsi: Soft palate, phraygeal paralysis, dysphagia (nucleus ambiguous of CN X)
Contra: loss of pain / temp in body (spinothalamic)
spinocerebellar tract: ataxia
The following are indications of damage to what brain regions?
Large fixed pupils
Unilateral dilated pupil
Mid position fixed pupil
Small pupil with ptosis and anhydrosis
Large fixed pupils : tectum (dorsal midbrain)
Unilateral dilated pupil: CN III paralysis
Mid position fixed pupil: midbrain
Pinpoint pupil : pons
Small pupil with ptosis and anhydrosis : sympathetic lesion (Horner's syndrome)
What functions are intact in a persistent vegetative state?
When should a neurologic exam to determine brain death be performed?
More than 24-48 hrs. post MI or severe brain injury
24 hrs after withdrawal of sedative drugs or those that could contribute to comatose state
What are the 2 main types of astrocytoma?
-astrocytoma (WHO II)
-anaplastic astrocytoma (WHO III)
-glioblastoma multiforme (WHO IV)
2. Pilocytic (WHO I)
Distinguishing feature of pilocytic astrocytoma
Occurs in children
Rosenthall fibers in tumor cells (composed of alpha B crystallin)
What is PNET? Most common form?
Primitive Neuroectodermal tumors
Medulloblastoma (WHO IV) is most common, usually cerebellar tumor in children.
From what cells do mengiomas typically arise?
Cells of arachnoid layer - may become attached to dura
What is the viral association with primary CNS lymphoma?
EBV in patients with HIV / AIDS
Example of germ cell tumors and common locations
Generally arise in pineal or hypothalamus
Teratoma - benign
Yolk sac tumor (AFP)
Genetic factors associated w/ the following:
Astrocytoma: TP53 ; IDH 1
Oligodendroglioma: 1p and 19q
Medulloblastoma: 17p loss ; PTCH 1
Meningioma: 22 mutation
What is the timeframe for maximal post-infarct cerebral edema?
What is encephalomalacia?
liquefaction of brain tissue following infarct: "brain softening"
Where do lacunar infarcts most commonly occur?
Basal ganglia, thalamus, white matter
What area of the hippocampus is particularly vulnerable to ischemic damage?
CA1: Sommer's sector
possible CNS effects of chronic HTN
1. lacunar infarcts: usually basal ganglia, <1cm
2. Charcot-Buchard aneurisms: small vessel aneurisms, often in BG
3. Etat-Crible: loss of tissue w/o infarction around small BVs
***chronic hypertensive encephalopathy / multi-infarct dementia***
In diffuse hypoxic / ischemic injury what cell populations are injured first?
1. Hippocampus (CA1)
2. Cerebral cortex (laminar necrosis - middle cortical layers 3-4)
3. Watershed zones
4. Purkinje cells of cerebellum
What is the most common type of head injury?
What is a diastatic fracture?
Separation along a suture line
What is a commuted skull fracture?
One w/ many small fragments