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Flashcards in Neurology Deck (85):
1

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

Microglia - from mesoderm; CNS macrophage

Others are from neuroectoderm

2

Stains for different cells?

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

3

Blood Brain Barrier

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

4

Lateral Area Hypo

Hunger
Inhibited by Leptin
Destruction: anorexia, FTT

5

Ventromedial Area Hypo

Satiety
Stimulated by Leptin
Destruction: obesity, hyperphagia

6

Anterior Hypothalamus

Cooling, PNS

"Anterior nucleus = A/C"

7

Posterior Hypothalamus

Heating, Symp

8

Suprachiasmatic Nucleus

Circadian Rhythm
Stimulates pineal gland -> melatonin

9

Preoptic Area Hypothalamus

GnRH

10

Dorsomedial Nucleus

Stimulates GI - savage behavior, obesity

11

Arcuate Nucleus

Dopamine
GHRH

12

Supraoptic Nucleus

ADH

13

Paraventricular Nucleus

Oxytocin

14

Stages of Sleep and EEG waveform

"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

15

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

N3

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

16

What happens during REM sleep?

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

17

What characterizes narcolepsy? What stage? Tx?

Awake -> REM sleep:
- excessive daytime sleepiness
- cataplexy
- HypnoGOgic (going to sleep); HypnoPOmpic (post sleep) hallucinations

Tx:
- stimulants: amphetamine, modafinil
- PM sodium oxybate GHB

18

Changes in sleep stages in depression?

- dec. slow wave N3 deep sleep
- inc. total REM
- rpted PM awakenings
- early AM awakening

19

Kallman Syndrome?

Dec. GnRH (Hypogonadism) + Anosmia

20

Corneal & Lacrimation Reflex

CN V1
CN VII

21

Jaw Jerk Reflex CN

V3

22

Pupillary Reflex CN

CN II
CN III

23

Gag Reflex CN

CN IX
CN X

24

Mnemonic for S vs. M in CN?

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

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