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neurology 2 Flashcards

1
Q

what is anisocoria

A

asymmetry of pupils. one needs to determine which pupil is abnormal, It can be done by observing pupils in bright and dim light settings

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2
Q

For anisocoria evaluation the dim light should increase oculosympathetic input and cause pupillary dilatation

A

so if in dim light the asymmetry increases—- it means smaller pupil is paralysed —- unable to dilate and normal one dilates increasing the difference.
In bright light asymmetery will reduce because parasympathetic CN3 induced miosis woulld still occurs in both eyes.

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3
Q

if asymmetry in anisocoria increases in bright light —it indicates ?

A

it indicates larger pupil which should ideally constrict in bright light is paralysis ie CN3 is not working properly

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4
Q

what is relative afferent pupillary defect

A

afferent pathway problem in pupillary reflex – ie retina or optic nerve abnormal.
it is decreased bilateral pupillary constriction in response to light in affected eye
associated with mono-ocular vision loss.

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5
Q

which part is affected most in alzheimers disease

A

hippocampus and then temporoparietal lobes

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6
Q

what is clasp knife rigidity

A

seen in UMN lesions- spasticity
passive flexion should relax extensors because of stretch reflex.
However in UMN extensors are having increased tone and resists passive stretch
can be overcomed by continuing the movement. This is mediated by golgi tendon

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7
Q

nissls bodies in neurons are

A

rough endoplasmic reticulum

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8
Q

what are red neurons

A

disappearence of nissls granules (blue) from cytoplasm of neurons gives it red colour.
Seen in acute irreversible ischemic injury.

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9
Q

what is axonal reaction

A

seen in nerve transection.
Cell body enlarges, nucleus pushed to periphery, nucleolus enlarges and nissles bodies are dispersed. in an effort for protein and lipid synthesis to regenerate the transected axon.

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10
Q

normal function of trochlear nerve

A

supplies superior oblique muscle– it intorts the eye and depresses it when adducted.

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11
Q

signs of trochlear nerve palsy

patients say they cannot see FLOOR

A

eye is in extortion and hypertropia (visual axis above the normal eye) . Patient has vertical diplopia
patient usually chin tucks and head tilts away from the side affected to compensate.

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12
Q

signs of abducens palsy

A

horizontal diplopia and invard deviation (esotropia)

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13
Q

aneurysm of ICA can impinge

A

lateral fibres of optic chiasma leading to ipsilateral nasal hemianopsia.

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14
Q

aneurysm of PCA can impinge and compress

A

3rd CN

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15
Q

contralateral homonymous hemianopsia with macular sparing

A

right primary visual cortex- occipital lobe. due to occlusion of PCA
macula is supplied by MCA and PCA and hence spared.

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16
Q

what is dialysis associated nerve compression?

these compressions affects hands bilaterally

A

beta2 microglobulin accumulates in carpal tunnel leading to median nerve compression

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17
Q

convergence pathway and pupillary light reflex in eyes bypasses

A

MLF medial longitudinal fasciculus

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18
Q

what is lateral geniculate nucleus

A

it is visual information (sensory) relaying centre. It relays vision to cortex.
damage to lateral geniculate thalamic nucleus causes contralateral homonymous hemianopia

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19
Q

upward (vertical gaze palsy - superior colliculus), absent pupillary light reflex and absend / impaired convergence

A

tectal midbrain lesions where superior colliculus is there- parinaud syndrome.

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20
Q

examples of dystonia

A

spasmodic torticollis, blepharospasm, writers cramps etc

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21
Q

what causes hemiballism

A

contralateral injury in or near subthalamic nucleus… flinging of limbs on one side of body.

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22
Q

signs of spinal accessory nerve injury distally in posterior triangle of neck

A

shoulder drooping
no overhead abduction above 100 degrees
lateral displacement of scapula.

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23
Q

middle meningeal artery branch of maxillary artery - terminal branch of ECA enters skull via?

A

foramen spinosum

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24
Q

decreased acetylcholine levels in hippocampus and NUCLEUS BASALIS OF MEYNERT

A

ALZHEIMERS DISEASE

because of deficiency of choline acetyl transferase enzyme.

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25
location and function of nucleus basalis of meynert
it is located in basal forebrain. widely projects into neocortex functions for memory and cognition. impaired in alzheimers disease
26
where is raphe nucleus located, what is its primary neurotransmitter
located in medial portion of reticular formation in ENTIRE brainstem. neurons are serotonergic impaired anorexia, depression and CIRCARDIUM RHYTHM -sleep disturbances,
27
WHERE IS RETICULAR ACTIVATING SYSTEM LOCATED
THROUGHOUT THE BRAIN STEM
28
WHAT ARE THE 4 COMPONENTS / SUBPORTIONS OF RETICULAR ACTIVATING SYSTEM
LOCUS COERULEUS RAPHE NUCLEUS POSTERIOR TUBERO-MAMILLARY HYPOTHALAMUS PEDUNCULO-PONTINE TEGMENTUM
29
FUNCTIONS OF RAS RETICULAR ACTIVATING SYSTEM
ATTENTION AROUSAL ABILITY TO FOCUS MODULATES THE MUSCLE TONE
30
HOW IS RAS ACTIVATED
WHEN IT RECIEVES SIGNALS FROM LATERAL HYPOTHALAMUS | LATERAL HYPOTHALAMUS IN TURN RELEASES OREXIN WHEN LIGHT STRIKES EYE THAT IS WHN THE PATIENT IS AWAKE
31
WHERE IS LOCUS COERULUS LOCATED HOW DOES IT GET ACTIVATED WHAT DOES IT SECRETE
DORSOLATERAL PONS UPPER PART OREXIN FROM LATERAL HYPOTHALAMUS ACTIVATES IT IT SECRETES NOR EPINEPHRINE
32
WHAT DOES TUBEROMAMILLARY NUCLEI IN HYPOTHALAMUS SECRETE
HISTAMINE-- THEY ARE PRIMARY HISTAMINE PRODUCING REGION
33
CAUSE OF PATIENT DEATH IN HUNTINGTONS DZ
SUICIDE | RESPIRATORY ASPIRATION
34
CAUSES OF NEURONAL DEATH IN HUNTINGTON DZ-- ATROPHY OF CAUDATE AND PUTAMEN
DOPAMINE INCREASES ACH AND GABA DECREASES HENCE GLUTAMATE EXCITOTOXICITY --- NMDA-R BINDING NEURONS EXCITED TOO MUCH AND DEATH because mutated huntingtin protein contains numerous glutamate residues due to CAG repeats -- more excitotoxicity
35
what inclusions are found in frontotemporal dementia
picks inclusions these are intracytoplasmic round inclusions of hyperphosphorylated tau protein or ubiquitinated TDP-43 proteins
36
visual hallucinations are seen in which dementia
lewy body dementia
37
lewy body intracellular eosinophillic inclusions are seenn in
parkinsons disease | lewy body dementia (will be associated with visual hallucinations and REM sleep disturbances)
38
startle myoclonus is seen in
CJD disease
39
symptoms of CJD
``` startle myoclonus dementia ataxia with periodic sharp waves on EEG and elevated 14-3-3 protein in CSF highly specific ```
40
elevated 14-3-3 protein in CSF is diagnostic of
creutzfeldt jacob disease
41
opsoclonus myoclonus syndrome is
paraneoplastic syndrome associated with 1. small cell lung ca 2. neuroblastoma in babies
42
what is the pathophysiology of papilloedema
raised ICT causes break or obstruction in axoplasmic flow of optic nerve
43
papilloedema is seen on visual field mapping as
optic disc edema- -ie enlarged blind spot and peripheral visual field constriction.
44
what is optic nerve sheath fenestration surgery
nicks / incision on optic nerve meninges to relieve intracranial tension effects
45
triad of normal pressure hydrocephalus
``` gait apraxia (magnetic gait- patient loses concentration over walking- tendency to freeze unable to initiate gait) urinary incontinence cognitive dysfunction ```
46
painful unilateral vision loss with marcus gunn pupil is associated with
acute optic neuritis | seen in MS
47
Internuclear ophthalmoplegia is commonly seen with
MULTIPLE SCLEROSIS
48
WHAT IS THE MNEMONIC TO REMEMBER INTERNUCLEAR OPHTHALMOPLEGIA INO
INO ipsilateral eye has adduction failure nystagmus in opposite eye eg in patient with right INO-- the right eye remains central shows adduction failure and left normal eyes goes into nystagmus on lateral gaze
49
why does normal eye go into nystagmus in INO internuclear ophthalmoplegia
because opposite MLF is damaged leading to no cn 3 and medial rectus function and hence adduction failure to over come it -- normal eye overfires cn6 -- lateral recuts over works -- nystagmus
50
what is the name of symptom-- electric shock like sensation in cervical spine on neck flexion
LHERMITTE PHENOMENON | SEEN IN MS
51
WHAT ARE DISEASE MODIFYING DRUGS IN MULTIPLE SCLEROSIS
BETA INTERFERON GLATIRA-MER NATALI-ZUMAB
52
SPASTICITY OF MULTIPLE SCLEROSIS IS TREATED WITH
BACLOFEN | GABA -B RECEPTOR AGONISTS
53
WHAT IS AIDP
ACUTE INFLAMMATORY DEMYELINATING POLYRADICULOPATHY | SUBTYPE OF GBS
54
what is CSFhallmark of AIDP or GBS
albuminocytologic dissociated albumin is raised cell count is normal
55
if GBS symptoms stay for more than 2 months it is called
chronic IDP inflammatory demyelinating polyneuropathy
56
autoantibodies diagnositic in CIDP
GM1 gangliosides
57
hereditory motor and sensory peripheral nerve neuropathy is
charcot marie tooth disease
58
key clues in charcot marie tooth disease
``` pes cavus hammer toes inverted bottle shaped atrophy in legs foot drop sensory deficits ```
59
which is the most common charcot marie tooth diease and its gene
CMT 1a | caused by PMP22 gene duplication
60
PML progressive multifocal leukoencephalopathy is seen in
aids | natalizumab rituximab and immunosuppression recieving patients
61
episcleral hemangioma is seen in
sturge weber syndrome--- | can lead to increased IOP and early onset glaucoma
62
genetic mutation in sturge weber syndrome
one copy of GNAQ (guanine nucleotide G(q) binding protein -alpha subunit) this one copy undergoes somatic mosaicism activating mutation
63
when GNAQ gene one of the copy gets activating mutation it lead to
sturge weber syndrome--- proliferation of capillary sized vessels --- leptomeningeal angiomatosis why -- GNAQ-- alpha subunit binds GTP and causes signalling for regulation and development of blood vessels. a mutated GNAQ cannot be turned off... leads to angiomas.
64
which tumor supressor genes are affected in tuberous sclerosis
TSC1 on chr 9 | TSC2 on chr16
65
sphenoid wing dysplasia leading to exophthalmos and facial asymmetry is seen in
NF 1
66
what 4 diseases / characteristics can be seen in NF2
bilateral vestibular schwannoma meningioma ependymoma juvenile cataracts AD usually family history of meningioma or bilateral SNHL present
67
two neurocutaneous syndrome which can have pheochromocytoma
VHL disease | NF1
68
genetics of VHL mutation
VHL produces a protein which ubiquitinates (tags or marks) another protein HIF hypoxia inducible factor for degradation. Normally HIF senses hypoxia and causes RBC proliferation by regulating erythropoeitin when VHL is mutated. It cannot stop HIF and hence more erythropoeitin and BV proliferation tumour (hemangioblastomas) develop
69
VHL gene mutation and hemangioblastoma has which hormone increase
erythropoietin --- hence polycythemia
70
three most common primaries metastatising to brain
lung breast kidney
71
function of astrocytes
``` physical support and BBB repair and reactive gliosis formation extracellular K buffer glycogen fuel reserve removes excess neurotransmitter ```
72
why is meningioma common in female
because meningioma pathogenesis has positive growth role of estrogen
73
pseudopalisading cells around necrosis is one feature of GBM what is the other important features
endothelial cell proliferation- microvascular proliferation-- these tumours have bleed areas on cut section
74
whorled pattern of cells with psammoma bodies (laminated calcification)
meningioma
75
s-100 positive tumour
schwannoma --- s for s
76
histology of schwannoma
dense and light cellular areas dense cellular areas -- have spindle cells (antoni A) hypocellular areas have myxoid matrix (antoni B)
77
fried egg cells--- round nuclei with clear cytoplasm | chicken wire capillary pattern
oligodendroglioma | eggs and chicken
78
most common tumour in children GFAP positive tumour in children
pilocytic astrocytoma- cystic with enhancing mural nodule
79
histology of pilocytic astrocytoma
origin is astrocyte with shows pink thick ROSENTHAL CORKSCREW fibres.
80
CELL WHICH GIVES RISE TO MOST COMMON TUMOUR IN CHILD AS WELL AS ADULT IS
ASTROCYTES CHILD - PILOCYTIC ASTROCYTOMA ADULT - GBM
81
BELLS PALSY CAN BE PERIPHERAL OR CENTRAL | HOW TO ASCERTAIN
IN CENTRAL - pt is able to wrinkle forehead | in peripheral no wrinkling of forehead
82
bilateral bells palsy is also known as facial diplegia. It is seen in
lymes disease neurosarcoidosis GBS melkerson rosenthal syndrome--- (lip and mouth swelling from granulomatosis, tongue furrows and recurrent bilateral facial palsy)
83
what are homer wright rosettes
seen in medulloblastoma (type of PNET round cell tumour) | round blue cells rosette around pink areas of neuritic processes
84
in exam histo shows palisading pattern with central vessel
ependymoma
85
in exam histo ----palisading pattern with central acellular pink area ie necrosis
GBM
86
patho signs of ependymoma
perivascular pseudorosettes and rod shaped basal ciliary bodies near nucleus (blepharoplasts)
87
pituitary region tumour in a child gross cut surface shows motor oil like fluid what is it
they are cholesterol crystals in craniopharyngioma
88
pinealoblastoma is associated with
precocious puberty because it secretes Bhcg vertical gaze palsy - tectal compression parinaud syndrome obstructive hydrocephalus because of aqueductal compression.
89
pineal tumour closely resembles which other germ cell tumour
testicular seminoma
90
grandfather gets huntingtons at 60 father gets at 50 and son gets at 40 what is this phenomenon of earlier onset in subsequent generations
ANTICIPATION BECAUSE GERM CELLS CONTINUE AND HAVE INCREASED TRINUCLEOTIDE REPEATS MORE IN SPERMATOGENESIS HENCE FATHER TO SON TO SON WOULD HAVE ANTICIPATION PHENOMENON
91
WHAT IS THE CAUSE OF SPONGIFORM ENCEPHALOPATHY
PRION PROTEINS B SHEETS WHICH CANNOT BE DEGRADED AND ACCUMULATES IN NEURONS AND GLIAL CELLS LEADING TO INTRACELLULAR VACUOLES b sheets cause more conversion of pre-existing normal alpha sheet proteins to B sheets- hence are considered infection. Once a B sheet --- exponential b sheet production due to this phenomenon
92
WHAT IS VARIANT CJD
YOUNGER PATIENTS | BY CONSUMPTION OF MEAT OF COWS HAVING SPONGIFORM ENCEPHALOPATHY-- MAD COW DISEASE-- BOVINE SPONGIFORM ENCEPHALOPATHY
93
WHAT IS FAMILIAL FATAL INSOMNIA
INHERITED PRION DISEASE HAVING 1 INSOMNIA 2 EXAGGERATED STARTLE RESPONSE
94
WHAT IS LISSAUER TRACT
spinal cord posterolateral tract is also known as lissauer tract it is just before the nerve from dorsal root ganglion enters posterior horn.
95
what two tracts are the only ones spared in anterior spinal artery occlusion
dorsal column and posterolateral tracts (lissauer tract)
96
what is artery of adamkiewicz
it is a dominant radiculomedullary artery (usually radicular ie nerve root arteries disappear post natally) but adamkeiwics is a named normally persistent artery supplying cord below T8. It is largest spinal artery. arises from left posterior intercostal artery
97
where is spinal cord water shed area
mid thoracic ASA territory. Because below it there is artery of adamkeiwicz supplying at T8 to L2 level taking care of blood supply
98
major and only feeder of anterior spinal artery below T8
artery of adamkeiwicz.. need to safeguard it during thoracic aortic repairs
99
Dorsal column decussates in
Medulla | And then ascends contralaterally as the medial lemniscus
100
Muscles of mastication which close jaw
Munchies Temporalis Medial pterygoid Masseter
101
Lateral pterygoid muscle action
Only muscle to open the jaw Lateral pterygoid Remember chewing is hard work hence needs more 3 muscles
102
Components of corneal reflex
Afferent - nasociliary branch V1 of trigeminal n Efferent is eye closure- facial nerve temporal branch supplying orbicularis oculi
103
Name the three vagal nuclei
Nucleus tractus solitarius - visceral sensory— 7 9 10 Nucleus ambiguus— motor to pharynx larynx and upper esophagus—-9 10 11 Dorsal motor nucleus— parasympathetic to heart lungs upper GI— 10
104
Mixed cranial nerve are
5 7 9 10 | Are both motor and sensory
105
Elevation of pharynx and larynx is by which muscle and nerve supply
Stylopharyngeus— glossopharyngeal nerve
106
Which cranial nerve maintains uvula in midline
Vagus Vagus also elevates soft palate
107
Monitoring of carotid body receptors
9 th cranial nervd
108
Monitoring of aortic arch receptors
Vagus
109
Salivation in parotid gland is by Salivation in submandibular and sublingual gland is by
Glossopharyngeal nerve Smg and slg —seventh nerve facial
110
Which cranial nerve arise medially
3 4 6 | 12
111
Which cranial nerve arises dorsally
Cn4 | Dorsal and medially
112
Man in barrel syn
Bilateral proximal muscle weakness in both upper and lower limb Due to bilateral watershed infarcts in ACA-MCA territories Site of shlder arm and hip thigh region
113
Location of wernickes area
Posterior portion of superior temporal gyrus
114
Location of brocas area
Lower portion of left frontal lobe
115
What is conduction aphasia
Lesion in perisylvian region affects arcuate fasciculus Which are curved fibres connecting broaca and wernickes area Pt is unable to repeat phrases but his own speech and comprehension is otherwise clear
116
What are areas 44 and 45
Broaca speech area | Motor
117
Area 22 broadmans is
Wernickes area
118
PO2 regulates cerebral perfusion only in cases of
severe hypoxia. when PO2 falls below 50mmhg | Rest of the times PCo2 is the one maintaing perfusion
119
two factors causing reduction in cerebral perfusion
reduced mean arterial pressure | increased intracranial pressure
120
what is the effect of therapeutic hyperventilation
wash out of CO2 vasoconstriction intracranially reduced blood flow and reduction in ICT used to treat acute cerebral edema secondary to stroke
121
at what level of hypoxemia does CPP increase
when Po2 falls below 50 mmHg | CPP increases
122
Pco2 directly affects Cerebral perfusion untill a threshold--- after which no increase in CPP occurs. That value of pCO2 is
more than 90 mm Hg. ie increase in PCO2 causes increase in cerebral blood flow and hence perfusion only till 90 mm Hg. After this value further increase in CPP is prevented to avoid raised ICT.
123
5F OF LIMBIC SYSTEM
``` FEEDING FLEEING FIGHTING FEELINGS SEX-- FUCK ```
124
PARTS OF LIMBIC SYSTEM
HIPPOCAMPUS AND AMYGDALA MAMILLARY BODIES AND ANTERIOR THALAMIC NUCLEI CINGULATE GYRUS ENTORHINAL CORTEX
125
Where is entorhinal cortex
in medial temporal lobe below hippocampus it acts as an interface between hippocampus and neocortex

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