Flashcards in Neuro/Psych 8 Deck (51):
1
Congenital hydrocephalus presentation in an infant
- Poor feeding
- Cannot roll over from supine position or sit unsupported (developmental delay)
- macrocephaly (nl at birth though)
- Bulging fontanelle
2
Imaging of congenital hydrocephalus
Significant dilation of lateral ventricles
3
What happens when congenital hydrocephalus goes untreated?
- Spasticity & Hyperreflexia due to periventricular pyramidal tract stretching
- Developmental delays
- Seizures
4
Go look at a coronal slice of the brain and review anatomy
Including amygdala, caudate nucleus, globus pallidus, internal capsule, and putamen
5
Wilson disease
Cystic degeneration of putamen & other basal ganglia
6
Propionic acidemia presentation
Newborn
- Poor feeding
- Vomiting
- Hypotonia
- Lethargy
- Dehydration
- Anion gap acidosis
Due to inability to breakdown propionic acid
7
Propionyl CoA derivatives (aka propionic acid)
- Valine
- Isoleucine
- Methionine
- Threonine
8
Common peroneal nerve lesion
- Due to injury of lateral neck of fibula (compression fracture)
Wkness on foot dorsiflexion (foot drop) & toe extension --- deep peroneal branch
Impaired foot eversion, sensory loss of lateral leg and dorsolateral foot --- superficial peroneal branch
9
L5 (L5/S1) radiculopathy
Sensory loss:
- buttocks
- posterolateral thigh
- anterolateral leg
- dorsal foot
Weakness:
- Foot dorsiflexion & inversion
- Foot eversion
- Toe extension
No DTR
10
Fragile X
X-linked
- Most common inherited intellectual disability
- CGG expansion on FMR1
Key physical findings:
- Large jaw
- Protruding ears
- Macroorchidism
11
Interscalene nerve block
- Anesthetizes brachial plexus (C5-T1) as it passes through scalene triangle
- Provides anesthesia for shoulder/upper arm
Almost all pts develop transient ipsilateral diaphragmatic paralysis due to involvement of phrenic nerve roots as they pass through the interscalene sheath
12
Treatment for toxoplasmosis
Pyrimethamine & sulfadiazine
13
Charcot-Bouchard aneurysms
- Associated w/ HTN
- Location: basal ganglia, cerebellum, thalamus, pons
-
14
Saccular (berry) aneurysms
- Associated w/ ADPKD, Ehlers-Danlos, HTN
- Circle of Willis
- Variable size (2-25mm)
- Subarachnoid hemorrhage
- Sudden severe HA
- Focal neuro deficits are UNCOMMON
15
Function of morphine on mu receptors
- G protein linked
- Causes activation of K conductance
- K efflux increases and causes hyperpolarization of postsynaptic neurons => blocks pain transmission
16
CNS ischemia in brain after 3-7 days
- Microglia move in
- Phagocytosis begins
17
Shoulder dislocation & strenuous UE activity (baseball pitching) affects which nerve?
Musculocutaneous nerve (C5-C7)
18
Musculocutaneous nerve innervation
Motor:
- Forearm flexors (biceps brachii, brachialis)
- Coracobrachialis (flexes/adducts arm)
Sensory:
- lateral forearm
19
Acute extrapyramidal symptoms and cause
- Dystonic reactions
- Akathisia (restlessness)
- Parkinsonism
D2 blockage in nigrostriatal pathway
20
Which drugs causes acute extrapyramidal SEs?
First-gen high-potency antipsychotics
- Haloperidol
- Fluphenazine
21
Oxidation of very long chain FAs and phytanic acid
Think peroxisomal disease in newborn
Leads to neuro defects from improper CNS myelination
22
Vitamin B12 deficiency
- Presents w/ megaloblastic anemia (impaired DNA synthesis)
- Neuro defects (impaired myelin synthesis)
- Subacute degeneration of dorsal column and lateral corticospinal tract
23
Which molecules are elevated in Vit B12 deficiency?
Serum methylmalonic acid and homocysteine
24
Clinical presentation of epidural hematoma
- "lucid interval" --- doc I feel fine
- Followed by LOC
25
Epidural hematoma blood accumulation is where?
Between bone and dura mater
26
First gen H1-histamine receptor antagonists
- Penetrates BBB and accumulates in CNS
- Do not use with other sedatives (e.g. benzos)
Examples:
- Diphenhydramine (benadryl)
- Chlorpheniramine
27
Phrenic n. nerve roots
C3-C5
innervates the diaphragm (C3, 4, 5 keeps you alive)
28
PTSD
- Exposure to life-threatening trauma
- Nightmares, flashbacks, intrusive memories
- Avoidance of reminders, amnesia for event
- Emotional detachment, negative mood, anhedonia
- Sleep disturbance, hypervigilance, irritability
- >1 month
29
Treatment for PTSD
- SSRIs, SNRIs
- Trauma focused CBT
30
Thiopental
- Short-acting barb
- Used for inducing anesthesia
- Lipid soluble => accumulates in skeletal muscle and adipose tissue
31
lateral geniculate body
Think visual
32
Medial geniculate body
Think auditory
33
Damage to temporal hemiretina
Disrupts info along ipsilateral:
- Optic n
- Lateral optic chiasm
- Optic tract
- Lateral geniculate body
- Optic radiations
- Primary visual cortex
34
Organophosphate poisoning
Farmers
Inhibits muscarinic and nicotinic synapses
Decrease Ach degradation (^ [Ach] at synaptic cleft)
Presentation: DUMBELS (muscarinic), muscle paralysis (nicotinic)
35
DUMBELS
All muscarinic (not nicotinic)
- Diarrhea
- Urination
- Miosis
- Brochospasm
- Emesis
- Lacrimation
- Salivation
36
How to reverse DUMBELS?
Atropine
37
How to reverse all SEs from organophosphate poisoning?
Pralidoxime
Does both muscarinic and nicotinic
38
Paranoid personality disorder
- Pervasive pattern of distrust and suspiciousness
- Begins in early adulthood
- Interprets comments as threats, reacts angrily
- Grudges
- Questions loyalty of partner w/o justification
39
Loss of GABA-containing neurons
Huntington disease
- ^ed trinucleotide repeats on chromosome 4
40
Essential tremor
- Most common movement disorder
- slowly progressive, symmetric postural and/or kinetic tremor
- Commonly affects UEs
- AD inheritance
TX: propranolol
41
Wallerian degeneration
- Axonal degeneration and breakdown of myelin sheath
- occurs at distal injury site
- Does not occur in CNS b/c of persistence of myelin debris, secretion of neuro inhibitory factors, and development of dense glial scarring
42
Normal pressure hydrocephalus
- Occurs in elderly
- TRIAD: ataxic gait, urinary incontinence, then dementia
- Due to periventricular white matter distortion and descending cortical fibers
43
Clinical presentation of measles
Prodrome:
- fever, malaise, anorexia
- Conjunctivitis, coryza, cough, Koplik spots
Exanthem:
- Blanching maculopapular rash
- Cephalocaudal & centrifugal spread
- Spares palms/soles
44
Complications of measles
- Pneumonia
- Secondary bacterial infections
- Neuro crap: encephalitis (days), acute disseminated encephalomyelitis (weeks), subacute sclerosing panencephalitis (years)
45
Tracts affected by Vit B12 deficiency
- Dorsal column
- Lateral corticospinal tracts
Loss of position, vibration sensation, ataxia, spastic paresis
46
HIV associated dementia histopathologic findings
Microglial nodules:
- Groups of activated macros/microglial cells formed around small areas of necrosis
- May fuse to form multinucleated giant cells
47
CN through superior orbital fissure
III, IV, V(1), VI
Also:
- ophthalmic vein
- sympathetic fibers
48
CN through foramen rotundum
V(2) - maxillary
49
CN through foramen ovale
V(3) - mandibular
50
Classic triad for bacterial meningitis
- Fever
- Stiff neck
- Altered mentation
51