Neuro Path (mostly blood things)

Question 1

When do primitive reflexes usually disappear?

Answer 1

within 1st year of life

Question 2

Galant Reflex

Answer 2

Stroke one side of spine while newborn is face down –> lateral flexion of lower body toward that side

Question 3

Gallbladder pain referral

Answer 3

C3-5 (phrenic nerve) to right shoulder

Question 4

C2 dermatome

Answer 4

Posterior half of skull

Question 5

C3 dermatome

Answer 5

Neck brace/turtleneck

Question 6

C4 dermatome

Answer 6

Low collar shirt

Question 7

Xyphoid process dermatome

Answer 7

T7

Question 8

Dermatome of the knee caps

Answer 8

L4

Question 9

Frontal eye field lesion

Answer 9

Eyes look toward lesion (leader has to be brave)

Question 10

Paramedian pontine reticular formation lesion

Answer 10

Eyes look away from lesion (buried away in brain-too afraid to look)

Question 11

Medial longitudinal fasciculus lesion

Answer 11

INO (ipsilateral eye can’t adduct; contralateral eye nystagmus with abduction [hyperactive trying to get friend to come along])

Question 12

What disease is associated with MLF lesions?

Answer 12

MS

Question 13

What is Gerstmann syndrome? (4 signs)

Answer 13

Lesion of dominant parietal cortex = agraphia, acalculia, finger agnosia, left-right disorientation

Question 14

Lesion of the subthalamic nucleus

Answer 14

Contralateral hemiballismus

Question 15

What type of infection is associated with Kluver-Bucy syndrome?

Answer 15

HSV-1 encephalitis

Question 16

What is Kluver-Bucy syndrome?

Answer 16

Bilateral lesion of amygdala–> disinhibited behavior (hyperphagia, hypersexuality, hyperorality)

Question 17

What is Parinaud syndrome?

Answer 17

Lesion of the SC; paralysis of conjugate vertical gaze (eyes can’t nod up and down)

Question 18

What side will the deficits appear on with cerebellar hemisphere lesions?

Answer 18

Ipsilateral; fall toward side of lesion

Question 19

When does irreversible damage begin following hypoxia in the brain?

Answer 19

5 minutes

Question 20

What imaging is used to exclude hemorrhage prior to treating a stroke?

Answer 20

Noncontrast CT

Question 21

___ can detect ischemia within 3-30 min.

Answer 21

Diffusion weighted MRI

Question 22

When will you see the following histologic changes following an ischemic event?

• Microglia (often myelin/lipid filled)
• Red neurons (eosinophilic cytoplasm + pyknotic nuclei)
• Glial scar

Answer 22

• 3-5 days
• 12-24 hours
• > 2 weeks

Question 23

When will you see …?

• Necrosis + neutrophils
• Vascular proliferation + reactive gliosis

Answer 23

• 24-72 hours

- 1-2 weeks

Question 24

When do you begin to see liquefactive necrosis on a gross scale?

Answer 24

1 wk to 1 mo

Question 25

Where are direct clots (usually over an atherosclerotic plaque) likely to form?

Answer 25

MCA (thrombotic strokes)

Question 26

In addition to aspirin, what medical therapy could you give to decrease risk of stroke?

Answer 26

Clopidogrel

Question 27

What vascular structure is likely damaged? Intracranial hemorrhage w/: -Lucid interval -Rapid expansion under systemic pressure --> transtentorial herniation -Possible CN III palsy -Skull fracture (likely at pterion)

Answer 27

Middle meningeal artery (branch of maxillary). *Epidural hematoma* biconvex/doesn't cross suture lines

Question 28

What does a hypodense crescent-shaped hemorrhage on CT likely indicate?

Answer 28

Chronic subdural hematoma (mild trauma, cerebral atrophy, elderly, alcoholism)

Question 29

What type of intracranial hemorrhage is associated with shaken babies?

Answer 29

Subdural hematoma

Question 30

What is "acute on chronic" hemorrhaging?

Answer 30

Varying CT densities associated with a sub-acute subdural hematoma

Question 31

What vasculature is damaged in subdural hematoma?

Answer 31

Bridging veins

Question 32

Which type of hematoma is associated with a lucid interval?

Answer 32

Epidural hematoma

Question 33

What will the spinal tap of a patient with subarachnoid hemorrhage look like?

Answer 33

Xanthochromic (yellow) or bloody

Question 34

__ is used to prevent/reduce vasospasm following SAH.

Answer 34

Nimodipine

Question 35

__ is seen with ____ (as recurrent lobar hemorrhagic strokes in elderly).

Answer 35

Intraparenchymal hemorrhage; amyloid angiopathy

Question 36

Systemic HTN is the most common cause of ___, intraparenchymal hemorrhages into the basal ganglia and internal capsule following microaneurysm of lenticulostriate vessles.

Answer 36

Charcot-Bouchard microaneurysms *NOT VISIBLE ON ANGIOGRAPHY*

Question 37

If significant edema following TBI, (raise/lower) PaCO2 --> vasoconstriction--> (raise/lower) ICP

Answer 37

lower the PaCO2 to lower the ICP

Question 38

Where's the lesion: Left sided paralysis and sensory loss of lower limb

Answer 38

Right ACA

Question 39

Common manifestations of lenticulostriate a. stroke:

Answer 39

CONTRALATERAL paralysis and/or sensory loss- both face and body ABSENCE of CORTICAL SIGNS (neglect, aphasia, visual field deficits)

Question 40

Microatheromas and lipohyalinosis are common signs of ______ found in the lenticulostriate arteries due to unmanaged HTN.

Answer 40

lacunar infarcts

Question 41

Artery damaged in medial medullary syndrome

Answer 41

ASA- anterior spinal artery

Question 42

Triad of medial medullary syndrome

Answer 42

1) Contralateral upper and lower limb paralysis (LCT) 2) Dec. contralateral proprioception (medial lemniscus) 3) Ipsilateral deviation of tongue (CN XII)

Question 43

___ supplies the lateral medulla.

Answer 43

PICA

Question 44

Sx of lateral medulla damage

Answer 44

1) Dysphagia, hoarseness, dec. gag reflex (nuc. ambiguus) 2) Vomiting, vertigo, nystagmus (Vestibular nuc.) 3) Dec. PCT from contra body, ipsi face (Lateral spinothalamic and spinal trigeminal nuc) 4) Ipsi Horner (Symp fibers) 5) Ataxia, dysmetria (Inf. cerebellar peduncle)

Question 45

1) Facial paralysis w/ dec. lacrimation, salivation, taste from anterior 2/3 2) Vomiting, vertigo, nystagmus 3) Dec. PCT from contra body, ipsi face 4) Ipsi Horner 5) Ataxia, Dysmetria (Middle/inferior cerebellar peduncles)

Answer 45

AICA syndrome = Lateral pontine syndrome *Your face is more anterior than your throat*

Question 46

What artery is occluded in "locked in syndrome"?

Answer 46

Basilar a.

Question 47

What allows for consciousness to be preserved in "locked in syndrome?"

Answer 47

Sparing of RAS (reticular activating syndrome)

Question 48

How do you lose horizontal eye movements in "locked in syndrome?"

Answer 48

Damaged PPRF and ocular CN nuclei

Question 49

Where is/was the lesion in central post-stroke pain syndrome? paresthesias --> allodynia and dysethesia

Answer 49

Thalamus

Question 50

What is the difference between aphasia and dysarthria?

Answer 50

Higher order inability to speak/comprehend vs. motor defecit

Question 51

Damage to the ___ can cause conduction or global aphasias.

Answer 51

Arcuate fasciculus

Question 52

Repetition intact aphasias are caused by ____, but the respective ____ are intact.

Answer 52

transcoritcal injury; broca's, wernicke, and arcuate areas are intact

Question 53

PCom compression results in...

Answer 53

ipsilateral CN III palsy --> mydriasis ("blown pupil"), possible ptosis, "down and out"