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Neurology Flashcards

1
Q

What type of neuronal cell has a different embryonic origin than the rest?

A

Microglia - from mesoderm; CNS macrophage

Others are from neuroectoderm

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2
Q

Stains for different cells?

A

Nissl substance = dendrites, cell bodies (RER) - NOT axons

GFAP = astrocytes

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3
Q

Blood Brain Barrier

A
  1. tight junctions nonfenestrated endothelial cells
  2. BM
  3. astrocyte foot process

Lipids get through
Glucose/AA need carriers

NOT present in area postrema and neurohypophysis

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4
Q

Lateral Area Hypo

A

Hunger
Inhibited by Leptin
Destruction: anorexia, FTT

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5
Q

Ventromedial Area Hypo

A

Satiety
Stimulated by Leptin
Destruction: obesity, hyperphagia

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6
Q

Anterior Hypothalamus

A

Cooling, PNS

“Anterior nucleus = A/C”

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7
Q

Posterior Hypothalamus

A

Heating, Symp

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8
Q

Suprachiasmatic Nucleus

A

Circadian Rhythm

Stimulates pineal gland -> melatonin

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9
Q

Preoptic Area Hypothalamus

A

GnRH

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10
Q

Dorsomedial Nucleus

A

Stimulates GI - savage behavior, obesity

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11
Q

Arcuate Nucleus

A

Dopamine

GHRH

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12
Q

Supraoptic Nucleus

A

ADH

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13
Q

Paraventricular Nucleus

A

Oxytocin

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14
Q

Stages of Sleep and EEG waveform

A

“BATS Drink Blood”

Awake (open eyes) = beta (highest freq, lowest amp)
Awake (closed eyes) = alpha

N1 light sleep = theta
N2 deeper sleep; bruxism = sleep spindle, K complexes
N3 deepest/slow wave sleep = delta (lowest freq, highest amp)

REM = beta

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15
Q

What stage of sleep associated with night terrors, sleep walking, bedwetting? What drugs treat?

A

N3

EtOH, Benzo, Barb = decreased REM and delta sleep
Bedwetting = DDAVP

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16
Q

What happens during REM sleep?

A 
loss of motor tone 
variable pulse, BP 
dreaming 
penil/clitoral tumescence
memory processing
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17
Q

What characterizes narcolepsy? What stage? Tx?

A

Awake -> REM sleep:

  • excessive daytime sleepiness
  • cataplexy
  • HypnoGOgic (going to sleep); HypnoPOmpic (post sleep) hallucinations

Tx:

  • stimulants: amphetamine, modafinil
  • PM sodium oxybate GHB
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18
Q

Changes in sleep stages in depression?

A
  • dec. slow wave N3 deep sleep
  • inc. total REM
  • rpted PM awakenings
  • early AM awakening
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19
Q

Kallman Syndrome?

A

Dec. GnRH (Hypogonadism) + Anosmia

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20
Q

Corneal & Lacrimation Reflex

A

CN V1

CN VII

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21
Q

Jaw Jerk Reflex CN

A

V3

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22
Q

Pupillary Reflex CN

A

CN II

CN III

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23
Q

Gag Reflex CN

A

CN IX

CN X

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24
Q

Mnemonic for S vs. M in CN?

A

Some Say Marry Money But My Brother Says Big Brains Mean More

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25
CN Pathway
``` 1 Cribiform Plate 2 Optic Canal 3, 4, 6, V1 Superior Orbital Fissure V2 Foramen Rotundum V3 Foramen Ovale 7, 8 Internal Auditory Meatus 9, 10, 11 Jugular Foramen 12 Hypoglossal Canal ``` Foramen Magnum = spinal roots of Cn XI, Brain stem, VA V = Standing Room Only
26
Damage to CN III vs. IV vs. VI?
CN III: "Down and out," ptosis, mydriasis, loss of accommodation CN IV: - eye moves upward - esp with contralateral gaze - compensatory head tilt TOWARD side of the lesion CN VI: - medial eye, can't abduct * Obliques move the eye in the Opposite direction"
27
Afferent vs. Efferent Pupillary Eye Defect?
Afferent = Marcus Gunn Pupil = Optic N. damage - affected eye: nothing constricts with light - unaffected eye: both will constrict with light Efferent = Oculomotor N. - affected eye UNABLE to constrict with light in EITHER eye
28
Meyer vs. Dorsal Optic Radiation?
Meyer = temporal loop | Dorsal Optic = parietal loop
29
Forebrain (Prosencephalon)
``` Telencephalon = Cerebral Hemispheres; Lateral ventricles Diencephalon = Thalamus; 3rd ventricle ```
30
Midbrain (Mesencephalon)
Mesencephalon = Midbrain; aqueduct
31
Hindbrain (Rhomboencephalon)
``` Metencephalon = Pons, Cerebellum, upper 4th ventricle Myelencephalon = Medulla, lower 4th ventricle ```
32
Screening for NT defects When do neuropores normally fuse?
Elevated AFP in maternal serum or amniotic fluid 4th week
33
Spina Bifida Occulta vs. Meningocele vs. Myelomeningocele
Spina Bifida Occulta - opening in bone spinal canal, tuft hair/dimple, nl AFP Meningocele - meninges out Myelomeningocele - meninges + spinal cord out
34
Anencephaly associated with what condition?
Failure of anterior NT to close - inc. AFP | Polyhydramnios (no swallowing center)
35
Holoprosencephaly due to what?
Failure of L and R hemispheres to fuse. Sonic Hedgehog Pathway Midline deformities - cleft lip/palate, cyclopia
36
Chiari I vs. II
``` I = tonsils -> syringomyelia II = vermis & tonsils -> hydrocephalus, assoc. myelomeningocele ```
37
Dandy-Walker
Agenesis of cerebellar vermis Enlargement of 4th ventricle (to fill posterior fossa) -> Hydrocephalus -> Assoc. spina bifida
38
Jaw, Uvula, Tongue, Neck Deviate towards or away lesion?
``` Tongue = Towards "licking the lesion" CN XII Uvula = Away - good side works CN X Jaw = Towards CN V3 Neck = Weakness turning head towards CONTRALAT side of lesion. (SCM). Droop of ipsilateral shoulder (Trapezius) CN XI ```
39
Kluver-Bucy
hyperorality hypersexuality disinhibition Bilateral Amygdala
40
Right Parietal-Temporal (non-dom)
Hemineglect
41
Left Parietal-Temporal (dom)
Gerstmann Syndrome - agraphia - acalculia - finger agnosia - L and R disorientation
42
Mammillary Bodies - lesion leads to?
Wernicke-Korsakoff - ataxia, confusion - opthalmoplegia, CN VI palsy - memory loss, confabulation CAN of beer = confusion, ataxia, nystagmus Give thiamine!
43
Cerebellar vermis vs. cerebellar hemisphere lesions?
IPSILATERAL defects Hemisphere = "Hemispheres are lateral, affect lateral limbs" - lateral limb ataxia - intention tremor - fall TOWARD side of lesion Vermis = "Vermis is centrally located; affect central body" - truncal ataxia - dysarthria
44
Subthalamic Nucleus lesion?
Hemiballismus
45
PPRF vs. Frontal eye field lesions?
PPRF: AWAY from side of lesion | Frontal Eye Field: TOWARD lesion
46
Superior Colliculi lesion?
Paralysis of upward gaze (Parinaud's Syndrome)
47
Central Pontine Myelinolysis causes?
Locked In Syndrome Correct HypoNa too fast "If you go from low to high, your pons will die" "If you go from high to low, your brain will blow"
48
Broca vs. Wernicke vs. Conduction
``` Broca = expressive aphasia Wernicke = comprehensive aphasia Conduction = can't repeat; arcuate fasiculus ```
49
Cavernous Sinus Structures
CN 3, 4, 6, V1, V2 Internal Carotid Internal Jugular Vein
50
Weber Syndrome?
Midbrain Infarction - PCA - CN III palsy - contralateral spastic hemiparesis (cerebellar peduncle)
51
What artery supplies the pons?
AICA
52
Medial Inferior vs. Lateral Pons
Medial Inferior - Motor - contralateral - ML - DC contralateral - PPRF - gaze towards side of lesion - CN VI Lateral: 4 "S" + 7,8 - spinocerebellar - ipsi - spinothalamic - ALS contra - sympathetic - ipsi Horners - sensory nuclei of V - CN VII - CN VIII "Facial droop = AICA's pooped"
53
4 Ms and 4 S of brainstem lesions?
M: - Motor - ML - MLF - Motor CN S: - spinocerebellar - ipsi - spinothalamic - ALS contra - sympathetic - ipsi Horners - sensory nuclei of V
54
Wallenberg Syndrome?
Lateral Medulla - PICA ``` 4 S + Nucleus Ambiguus + - hoarseness - dysphagia CN VIII - n/v, vertigo, ataxia ```
55
Medial Medulla Syndrome?
ASA - Motor, ML - CN XII
56
Acom vs. Pcom presentation?
Both are usually saccular aneurysm ``` ACom = Bitemporal Hemianopsia PCom = CN III palsy ```
57
Right INO sx
MLF - coordinates abducens with CN III to move eyes in same direction Right INO = Right MLF messed up On leftward gaze, - R eye can't adduct - L eye nystagmus "MLF in MS"
58
Areas of brain most vulnerable to ischemic stroke? What about hemorrhagic stroke?
``` Ischemic: Hippocampus Neocortex Cerebellum Watershed! ``` "ischemic HYPOxia - "HIPPOcampus" most vulnerable Hemorrhagic: Basal Ganglia
59
Imaging type to show changes in ischemic stroke earliest?
Diffusion Weighted MRI: bright Note: NCHCT: dark
60
Communicating vs. Noncommunicating Hydrocephalus? Sx?
``` Communicating = dec. CSF absorption Noncommunicating = structural blockage ``` H/A, papeilledema, uncal herniation - CN III palsy, death
61
NPH
"wet, wobbly, wacky"
62
Triptan - MOA, Toxicity?
Serotonin agonist - inhibits CN V activation, vasoconstrict Toxicity: coronary vasospasm (contraindicated in CAD, Prinzmetal angina)
63
Acronym for Brain Tumors: Adult vs. Child
Adult: MGM Studios: Metastatic, GBM, Meningioma, Schwannoma Child: Animal Kingdom, Magic Kingdom, Epcot: Pilocytic Astrocytoma, Medulloblastoma, Ependymoma
64
Histologic Features of Adult Brain Tumors
GBM (Malig, Astrocytoma IV): pseudopalisading, GFAP Meningioma (Benign): dural tail, whorled pattern, psamomma bodies Schwannoma: S-100(+), cerebellarpontine angle Hemangioblastoma: thin-walled capillaries, with minimal interweaving parenchyma Oligodendroma = fried egg
65
Hemangioblastoma associated what condition?
von Hippel Lindau: 1. hemangioblastoma - CNS, retina 2. erythropoietin -> polycythemia 3. renal cell carcinoma
66
Histologic Features of Child Brain Tumors
Pilocytic Astrocytoma: GFAP, Rosenthal fibers (corkscrew eosinophilic) Medulloblastoma: Homer-Wright Rosettes (rosettes around just fibers) Ependymoma: Perivascular Rosettes (rosettes around capillary Craniopharyngioma: Calcifications
67
Uncal Herniation Features
Uncus = medial temporal lobe 1. CN III - down and out 2. ipsi PCA - contralat homonymous hemianopsia 3. contral cerebral peduncle = ipsilateral paralysis
68
IV Benzo used for anesthesia?
Thiopental
69
IV Benzo used for anesthesia?
Midazolam
70
Toxic effect of inhaled anesthetics?
Malignant Hyperthermia (All except NO) Halothane is Hepatotoxic
71
What anesthetic can cause dissociation, disorientation, hallucination?
Ketamine
72
Why shouldn't we keep someone in the ICU on propafol drip?
Rapid induction, but HIGH TAG content
73
Local Anesthetic: two organic molecule types?
- caine Esters Amides: two I's
74
What do you give to enhance local anesthetics?
Epinephrine vasoconstrict
75
What situation would you probably need more local anesthetic?
infected (acidic) tissue - can't get thru membrane as effectively since alkaline anesthetics will be charged
76
Toxicity of Local anesthetics?
CNS excitation, Arrhythmias
77
What are the two types of Neuromuscular blocking drugs?
1. Depolarizing = Succinylcholine - depolarizes, so Ach agonist but its sustained so no muscle contraction 2. Nondepolarizing = -curarine, curium - competitive antagonist to Ach
78
Order of loss with local anesthetics
1. pain 2. temperature 3. touch 4. pressure Small > Large Myelinated > Non
79
How do you reverse nondepolarizing NM agents?
Neostigmine + Atropine (prevent Muscarinic effects like bradycardia)
80
Toxic Effects of Succinylcholine
HyperCa HyperK Malignant Hyperthermia
81
STURGE-weber
``` Sporadic; Stain - port wine Tram Track Ca Unilateral Retardation Glaucoma/GNAQ gene Epilepsy ```
82
Tuberous Sclerosis
HAMARTOMAS: ``` Hamartomas in CNS and skin Angiofibromas on the skin (reddish brown papules) MR Ash-leaf spots Rhabdomyoma cardiac (Tuberous Sclerosis) autosomal dOminant Mental Retardation Angiomyolipoma renal Seizures/Shagreen patches/SEGA ```
83
NF I
ADom: Chr 17 ``` cafe au lait lisch nodules neurofibromas pseudoarthrosis meningioma, astrocytoma, glioma, pheo ```
84
vHL
autosomal dominant: 1. cavernous hemangioma 2. bilateral renal cell carcinoma 3. hemangioblastoma 4. pheo vHL = tumor suppressor
85
``` NT - location of synthesis NE Dopa 5HT Ach GABA ```
``` NE - locus ceruleus (pons) Dopa - substantia nigra (midbrain) 5HT - raphe nucleus (pons, medulla, midbrain) Ach - Basal nucleus of Meynert GABA - nucleus accumbens ```

First Aid/DIT (5 decks)

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