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Flashcards in Neurology Deck (188):
1

Valproic Acid

Use for generalized epilepsy (eg. Myoclonic seizures)
- Broad-spectrum

2

Carbamazepine

Use for partial seizures
- Narrow-spectrum

3

Phenytoin

All seizures and status epilepticus (NOT absence)

4

Membrane Permeability:

- Resting membrane potential:
- Ligand gated channel permeability: Na+
- Voltage gated channel permeability: Cl-

5

ALS compared to Polio

Loss of neurons in anterior horn (LMN) & atrophy of lateral corticospinal (UMN)
- Polio is only anterior horn damage

6

NE Breakdown

NE converted to E by methylation then E is methylated to Vanillymandelic acid (a metanephrine)

7

Autonomic postganglionic nerve:

Unmyelinated

8

Trigeminal Nerve Exits at _______

Mid-Pons

9

Facial Nucleus Located at ______

Caudal Pons

10

S-100+

Schwannoma
Melanoma
Langerhan's Histiocytosis

11

Friedrich's Ataxia

Spinocerebellar degeneration, kyphoscoliosis, pes cavus, hypertrophic cardiomyopathy

12

Timolol

Beta blocker to treat glaucoma by decreasing aqueous humor production by ciliary epithelium

13

Length Constant

Measure of how far along an axon an impulse can propagate
- Decreased by demyelination

14

Ring Enhancing Lesions in brain

Staph Abscess, Toxoplasma, or Primary CNS Lymphoma

15

Toxoplasma

- from undercooked meat (or cat feces)
- Treat toxoplasma with sulfadiazine and pyrimethamine
- Congenital (torch): macrocephaly and intracranial calcifications

16

Primary CNS Lymphoma

multicentric ring lesions
- MC CNS tumor in immunocompromised

17

Agnosia

- unable to recognize
- temporo-occipital cortex

18

Marcus-Gunn Pupil

swinging flashlight test, both dilate when light moved from normal to affected eye (not actually dilating, just less constricted because the affected eye can’t transmit signal as well)

19

Subacute Sclerosing Panencephalitis

May be caused by measles

20

Hypertensive Hemorrhage

(lenticulostriate aneurysms): MC in basal ganglia and internal capsule

21

Conduction Aphasia

arcuate fasciculus (cannot repeat, but is fluent and has full comprehension)

22

Optic Neuritis aw/:

MS (autoimmune disorder in which CD4 T cells react against myelin via cytokines like IFN gamma)

23

Tx for Status Epilepticus

- Benzodiazepines (lorazepam or diazepam) for active seizure
- Also give Phenytoin to prevent recurrence of seizures or if Benzo doesn't work

24

Tx for Drug-induced parkinsonism

Benztropine and trihexyphenadyl

25

Carbon Monoxide

Necrosis of globus pallidus and substantia nigra

26

Lumbar puncture Contraindications

- High intracranial pressure
- Overlying infection

27

Oculomotor (3) Nerve Lesion

- no up, down, or medial, can't constrict pupils
- Nerve runs between PCA and superior cerebellar arteries
- Isolated 3rd nerve palsy → think actively enlarging intracranial aneurysm

28

Abducens (6) Nerve Lesion

No lateral (lateral rectus)

29

Trochlear (4) Nerve Lesion

No slight down and in (superior oblique)

30

HIV Encephalitis

- multinucleated giant cells in microglial nodules
- w/ CD4 count

31

No Convergence w/:

Oculomotor (CN 3 ) palsy
but can converge w/ INO (MLF lesion)

32

Vertical Diplopia

- double vision going down stairs from a trochlear nerve palsy
- Superior oblique not working so must tilt head to see properly

33

Tongue Innervation: Motor, Sensory, Tasts

Motor: hypoglossal nerve (XII)
- Does all muscles except palatoglossus (done by vagus)
Anterior 2/3:
- Taste: chorda tympani of facial nerve (VII)
- Sensation: V3 branch of trigeminal
Posterior 1/3:
- Taste & Sensation: Glossopharyngeal
Most posterior aspect/epiglottis
- Taste and Sensation: Vagus

34

Alzheimer's

decreased Ach levels (basal nucleus of meynert) due to deficiency of choline acetyltransferase

35

Innervation of Ear/Ear Canal

- Vagus (auricular branch): posterior external auditory canal
(May experience syncope if stimulated)
- V2 (auriculotemporal branch): remainder of external auditory canal, external tympanic membrane
- Glossopharyngeal IX (tympanic branch): inner surface of tympanic membrane
- Stapedius is innervated by Facial Nerve (CN VII) which if paralyzed causes hyperacusis

36

Cochlea: High and Low Frequency Sounds

- Low Freq at apex (wide and floppy) near Helicotrema
- High Freq at base (narrow and rigid) near oval and round windows

37

Glaucoma Tx: reduce aqueous humor secretion by ciliary epithelium

Timolol, other non-selective Beta blockers, and Acetazolamide

38

Glaucoma Tx: Increased aqueous humor outflow

Prostaglandins and Cholinomimetics (contracting iris sphincter opens up path to trabecular meshwork)

39

Werdnig-Hoffman

(aka SMA, spinal muscular atrophy): floppy child, anterior horn damage

40

Tx for General Tonic-Clonic Seizure

Valproic Acid

41

Internal Capsule Lesion

Motor Deficit

42

Thalamus Lesion

Sensory deficit w/ some difficulty w/ proprioception

43

Pons Lesion

Pinpoint pupils, decerebrate rigidity, bilateral paralysis

44

Caudate Nucleus Lesion

Transient hemiparesis, chorea, dyskinesia, agitation, psychosis

45

Glucose infusion can exacerbate:

Thiamine deficiency

46

Hearing Loss: Rinne Test

Air should be louder than bone
- Abnormal suggests conductive hearing loss (in tested ear)

47

Hearing Loss: Weber Test

Sound should be equal on both sides
- Conductive: lateralizes to affected ear (due to diminished ambient noise)
- Sensorineural: lateralizes to unaffected ear (because impair ear can’t sense vibration)

48

POMC cleaved into:

ACTH, MSH, and B-endorphin (endogenous opioid)

49

Notochord forms at:

3 weeks (day 16)

50

Sympathetics to Sweat glands and Adrenal Medulla

Sympathetic send Ach to sweat glands (via post ganglionic nerve) and to adrenal medulla (preganglionic)
- Everything else is Ach preganglionic, and adrenergic postganglionic

51

Parasympathetic transmits via:

Ach
- Preganglionic is Nicotinic (ligand gated ion channel, fast)
- Postganglionic is Muscarinic (G ptn, slow)

52

______ contraindicated in Glaucoma

Anti-cholinergics

53

Raphe Nucleus

Serotonin

54

Locus Ceruleus

NE (Norepinephrine)

55

Nucleus Basalis of Maynert

Acetylcholine

56

Caudate Nucleus

GABA

57

Substantia Nigra

Dopamine

58

PCP: MC cause of death

Trauma, NOT seizures

59

Only sensory pathway that doesn't pass through thalamus

Olfactory (smell)

60

______ should always be added to cover for Listeria in infants and immunocompromised

Ampicillin

61

Meniere's Disease

Due to decreased absorption of endolymph in vestibular apparatus:
tinnitis, vertigo, and sensorineural hearing loss

62

Neural Tube -->

CNS (brain and spinal cord)

63

Neural Crest -->

PNS and leptomeninges

64

Notochord -->

Nucleus pulposis

65

Prosencephalon (forebrain):

Telencephalon: Cerebral hemispheres + ventricles
Diencephalon: Thalamus + 3rd Ventricle

66

Mesencephalon (midbrain):

Mesencephalon: Midbrain + Aqueduct

67

Rhombencephalon (hindbrain):

Metencephalon: Pons, Cerebellum, + Upper 4th ventricle
Myelencephalon: Medulla + Lower 4th ventricle

68

Gene aw/ Holoprosencephaly

SHH (sonic hedgehog) gene

69

Syringomyelia

usually bilateral pain and temp loss of upper extremity
- May also see Upper LMN signs and Lower UMN signs

70

Wallerian Degeneration

degeneration distal to injury and proximal axon retraction

71

Meissner Corpuscle and Merkel Discs

Superficial
Meissner: light touch, fast adapting
Merkel: pressure, slow adapting

72

Pacinian Corpuscle and Ruffini

Deep
Pacinian: vibration and pressure, fast adapting
Ruffini: stretch, slow adapting

73

Nucleus Accumbens

GABA

74

Neurotransmitters in Huntingons

Decreased GABA and Ach
Increased Dopamine

75

Neurotransmitters in Alzheimers

Decreased Ach

76

Neurotransmitters in Parkinsons

Decreased Dopamine and Serotonin
Increased Ach

77

Neurotransmitters in Depression

Decreased NE, Dopamine, Serotonin

78

Cytogenic vs Vasogenic Edema

Cytogenic: extra to intracellular (failed membrane pump after ischemic insult)
Vasogenic: intra to extracellular (increased permeability of barrier with neoplastic or inflammatory disorders)

79

Benzodiazepines, Barbiturates, Alcohol, and NE: effect on REM

ALL decrease REM

80

Treatment for Bedwetting

DDAVP or imipramine

81

REM induced by

Ach

82

NREM induced by

Serotonin

83

EEG Waves in Sleep

Awake: alpha and beta
N1: Theta
N2: sleep spindles and K complexes
N3: delta
REM: beta, sawtooth

84

Papez's Circuit

Cingulate gyrus --> hippocampus --> fornix --> mammillary bodies --> thalamus

85

Medial Cerebellar Lesions

Truncal ataxia, wide gait, bilateral (axial and proximal musculature)

86

Lateral Cerebellar Lesions

Problem with voluntary movement of extremities
- fall towards injured side

87

Peduncles and Cerebellum:

Superior: contra output
Middle: contra input
Inferior: ipsi input

88

Cerebellar Nuclei: lateral to medial

Dentate, Emboliform, Globose, Fastigial (don't eat greasy foods)

89

Striatum

Putamen + Caudate

90

Lentiform

Putamen + Globus pallidus

91

Direct and Indirect Pathways: Dopamine

Direct: disinhibits thalamus --> movement
Indirect: inhibits thalamus --> no movement
Dopamine facilitates movement by:
(from Substantia Nigra pars compacta)
D1: activates direct
D2: inhibits indirect

92

D2 agonists to treat Parkinson's

Pramipexole and Ropinerole

93

Lewy Bodies composed of:

a-synuclein

94

Kluver-Bucy Syndrome

- Hyperorality, hypersexual, disinhibited behavior
- aw/ HSV 1 or trauma
- lesion in amygdala (bilateral temporalectomies)

95

Gerstmann Syndrome

Finger agnosia, acalculia, agraphia
- Left parietal-temporal cortex

96

Confusion, Ataxia, Nystagmus

Wernicke's Encephalopathy

97

PRPP vs FEF Lesion

PRPP: look AWAY from side of lesion
FEF: look TOWARDS lesion

98

Intracranial Pressure and CO2

Therapeutic hyperventilation helps to decrease CO2 and cerebral pressure by vasoconstricting

99

Medial Medullary Syndrome

ASA infarct (anterior spinal)
- contra hemiparesis
- ipsi hypoglossal dysfunction

100

Lateral Medullary Syndrome (Wallenberg)

PICA infarct
- dyphagia, hoarseness
- Horner
- vomiting, vertigo, nystagmus
- impaired pain/temp from ipsi face and contra body

101

Lateral Pontine Syndrome

AICA infact
- Facial paralysis
- loss of pain and temp in face
- Ipsi hearing and horners of face

102

Locked In Syndrome

Basilar artery infarction or CPM (central pontine myelinosis from rapid correction of hyponatremia)

103

PComm Saccular Aneurysm

- may cause CN III palsy

104

AComm Saccular Aneurysm

- MC location
- visual field defects (bitemporal hemianopia)

105

Intraparenchymal Hemorrhage

Usually due to hypertension
- in basal ganglia and internal capsule
(can be a Charcot Bouchard Aneurysm, whereas a subarachnoid hemorrhage is usually due to a berry/saccular aneurysm)

106

Irreversible damage to brain after ____ hypoxia

5 minutes

107

Neonatal Intraventricular Rupture

In the germinal matrix
- increased risk with low birth weight or prematurity

108

Wet, Wobbly, Wacky

Normal Pressure Hydrocephalus
- ventricles englarged
- incontinence due to stretching of the descending cortical fibers that control the bladder

109

Riluzole

NMDA antagonist used for ALS

110

Tabes Dorsalis

Tertiary syphilis
dorsal column degeneration
- charcot joints, argyll robertson pupils (prostitute pupil)

111

Hammer Toes

Friedreich Ataxia

112

Long ciliary nerve

Sympathetic
- innervates pupillary dilator

113

Moro Reflex

Gone by 3 months (startle reflex)

114

Rooting reflex

Gone by 4 months (nipple seeking)

115

Plantar/Babinski Reflex

Gone by 1 year (fanning of toes up)

116

Biceps and Triceps Reflexes

Biceps: C5
Triceps: C7

117

CN III comes out:

Above Pons (medial) (between the PCA and superior cerebellar artery)

118

CN IV comes out near:

Upper Pons

119

CN V comes out near:

Middle to Inferior Pons

120

CN VI comes out by:

Top of pyramids just below pons (medial)

121

CN VII and VIII exit at:

Cerebellopontine angle

122

CN IX, X, and XI exit:

Below Cerebellopontine angle

123

CN XII exits:

On top of pyramids (medial)
hypoglossal --> tongue motor nerve problems

124

Parinaud Syndrome

Paralysis of conjugate vertical gaze
- lesion in superior colliculi
(eg. germinomas such as a pinealoma)

125

Inferior Collicus

Auditory

126

Alar plate and Basal plate

Alar: sensory, lateral nuclei
Basal: motor, medial nuclei

127

Cranial Nerve Nuclei

Midbrain: 3, 4
Pons: 5-8
Medulla: 9, 10, 12
Spinal Cord: 11

128

Nucleus Ambiguus

CN 9, 10, 11
PICA lesion
Motor innervation of pharynx, larynx and upper esophagus

129

Nucleus Solitarius

CN 7, 9, 10
Visceral sensory information

130

CN V Motor Lesion

Jaw deviates towards lesion (unopposed force from opposite pterygoid)

131

Face UMN Lesion

Only bottom half of contra face is paralyzed

132

Face LMN Lesion

Entire ipsi half of face paralyzed (Bell's Palsy)

133

Presbyopia

Decrease in focusing during accommodation due to decreased elasticity and sclerosis
- may appear to correct myopia due to decrease in focusing

134

Flexner Wintersteiner Rosettes

Retinoblastoma

135

Open Angle Glaucoma

Caused by blocked absorption by trebecular meshwork (by WBCs, RBCs, or retinal elements)

136

Acute Closed Angle Glaucoma

Emergency, very painful, rock-hard eyes, lens is abruptly pushed forwards, may see halos or have vision loss, and headache
- Do not use epinephrine (which would dilate)

137

Parasympathetic and Sympathetic to Pupil

Para: constricts via Short Ciliary (Edinger westphal to ciliar ganglion via CN 3, 2nd neuron is short ciliary)
Symp: dilates via Long Ciliary (hypothalamus --> exits at T1 to sup cerv ganglion and then along internal carotid and enters orbit as long ciliary)

138

Pupillary Light Reflex Path

Light in through CN 2 --> pretectal nucleus --> E-W nuclei --> Ciliary ganglion --> sphincter pupillae

139

CN III Motor and Parasympathetic

Diabetes will not affect the parasympathetic (only motor) because its a central problem, and parasympathetics run along outside (Diabetic Mononeuropathy)
- Parasympathetic are the first to be affected by compression
- Motor inside/central so affected by ischemia

140

MLF

Crosstalk between CN 6 and CN3 to coordinated horizontal movement of eyes
CN 6 --> 6 nucleus --> contra CN 3 nucleus --> CN3 --> medial rectus
- Lesion in MLF (INO)- abducting eye will get nystagmus in its attempt to fire stronger to get the other eye to move
- aw/ MS
- right INO refers to paralyzed eye
- left MLF (comes from right cn VI nucleus)

141

Amyloid Angiopathy can cause:

Intracranial Hemorrhages

142

Prion Disease Histology

Spongiform

143

Guillian Barre (AIDP- Acute Inflammatory demylinating polyradiculopathy): Lab Findings

Increased CSF protein (albuminocytologic dissociation)
- autoimmune attack due to molecular mimicry

144

Multiple Sclerosis

disseminated in time and space
- autoreactive CD4 cells against myelin proteins
- aw/ DON or INO
- Increased protein IgG in CSF, oligoclonal bands, and periventricular plaques

145

ADEM

postinfectious encephalomyelitis
multifocal perivenular inflammation and demyelination
- after measles, vzv or vaccine

146

Metachromatic Leukodystrophy

LSD, arylsulfatase deficiency; ataxia and dementia

147

Krabbe Disease

LSD, globoid cell leukodystrophy
deficiency of galactocerebrocidase
peripheral neuropathy

148

Charcot Marie Tooth

hereditary motor and sensory neuropathy
AD, scoliosis, foot deformities, stork legs (champagne bottle), tripping/clumsy, onion bulb pathology

149

Adrenoleukodystrophy

Peroxisomal disorder due to decreased metabolism of very long chain FA
- adrenal gland crisis
- progressive disease of nervous system, adrenal gland, and testes
- X-linked

150

Lenox Gaustaut

severe (rare) debilitating "drop" seizures

151

Peripheral Vertigo

Delayed horizontal nystagmus
More common (inner ear problem)

152

Central Vertigo

Immediate nystagmus in any direction
(brainstem or cerebellar problem)

153

Sturge Weber Gene

GNAQ mutation

154

Constitutive expression of HIF and angiogenic growth factor activation

VHL

155

Adult vs Children Brain Tumor Location

Adult: supratentorial
Child: posterior fossa

156

Pseudopalisading cells w/ necrosis and vascular proliferation in brain

GBM (adult)

157

Benign tumor w/ spindle cells, whorled, psammoma bodies

Meningioma (adult)
(also has dural attachment)

158

Hemangioblastoma

aw/ VHL if w/ retinal angioma
- can produce EPO and cause secondary polycythemia

159

S100+ tumor at cerebellopontine angle

Schwannoma (adult)
(aw/ NFT2)

160

Fried egg appearance and often calcified

Oligodendroglioma (adult)

161

Benign tumor (GFAP+) in posterior fossa (rosenthal fibers, Cystic + Solid)

Pilocytic Astrocytoma (child)
- MC tumor

162

Tumor w/ Homer-Wright Rosettes, small blue cells, synaptophysin + that can compress 4th ventricle, also has drop metastases

Medulloblastoma (child)
(rod shaped blepharoplasts [basal ciliary bodies] as well)

163

Tumor w/ Perivascular and true rosettes that is found in the 4th ventricle

Ependymoma (child)

164

Cingulate (subfalcine) herniation

compress ACA

165

Uncal Herniation

- Ipsi CN III palsy
- Ipsi PCA (contra homon. hemianopsia)
- Contra crus cerebri (ipsi paralysis
- Duret hemorrhage

166

Cerebellar Tonsil Herniation

Cardiorespiratory arrest due to compression of brain stem
- Due to symmetric expansion of supratentorial contents

167

Cholinomimetics for Glaucoma

Contract ciliary muscle to open up trebecular meshwork and increased outflow of aqueous humor

168

Latanaprost

PGE analog that increases outflow of aqueous humor for glaucoma
- darkens iris color

169

AFP and AchE in amniotic fluid

Suggests Neural Tube Defect (failed fusion)

170

Age Related Macular Degeneration

Dry: drusen, gradual
Wet: neovascularization (due to VEGF), worse, shows grayish green discoloration of retina with adjacent edema or hemorrhage

171

Bell's Palsy: Symptoms aside from Facal Paralysis

Decreased lacrimation, hyperacusis, and loss of taste over anterior 2/3 of tongue
- all done by Facial nerve (CN VII)

172

Cauda Equina Syndrome

Saddle Anesthesia
- Fecal Incontinence
- Late urinary retention

173

Subarachnoid Hemorrhage caused by:

Berry Aneurysm or AVM

174

Recurrent intracerebral hemorrhage (multiple small areas)
- MC cause of spontaneous lobar/cortical hemorrhage in elderly

Cerebral Amyloid Angiopathy

175

Small intracerebral hemorrhage in basal ganglia, cerebellar nuclei, or thalamus in a patient with chronic HTN
- intraparenchymal hyperdensity on CT (visible on imaging)

Charcot-Bourchard Aneurysm

176

Tuberculous Meningitis may cause:

Communicating hydrocephalus due to decreased absorption of CSF by subarachnoid granulations (often seen with meningeal infections)

177

Pharm Tx for Restless Leg Syndrome

Dopamine Agonists ( eg. pramipexole)

178

Tardive Dyskinesia

Rhythmic involuntary movements of mouth and tongue
- Due to long term use of antipsychotics (typical)
- Due to upregulation of Dopamine Receptors and hypersensitivity
- concomitant decrease in cholinergic tone of striatum

179

Neurofibromas

Fleshy skin nodules that contain Schwann Cell proliferations

180

Pontine Intracerebral Hemorrhage

Pinpoint pupils, loss of horizontal gaze, quadriplegia, decerebrate posturing
- often die soon after

181

On-Off phenomenon

Long term use of parkinson's treatments w/ levodopa can be complicated with periodic and sometimes unpredictable fluctuations in motor function
- nigrostriatal neurodegeneration makes the response unpredictable

182

Hemi-Ballism

Damage to the subthalamic nucleus
- usually due to lacunar infarct

183

Effect of PCO2 on Cerebral Blood Flow

Direct relationship
As PCO2 increases, so does cerebral blood flow
As PCO2 decrease, cerebral blood flow decreases
PO2 has a less strong effect, only when it is below 50 will it cause an increase in cerebral blood flow

184

Progressive headache and nausea/vomiting followed by nonlocalized neurologic symptoms

Hypertensive Encephalopathy

185

Abrupt onset headache and hyperattenuation of sulci on CT

Saccular aneurysm rupture

186

Lacunar infarcts

small ischemic infarcts involving deep brain structures (basal ganglia, pons), and subcortical white matter (internal capsule)
- MC due to hypertensive arteriolosclerosis of small, penetrating arterioles
- Will not see on imaging right away
- Lakelike cavity a few weeks later

187

Old Ischemic Infarcts

Cystic appearance
- macrophages phagocytize the fragments and debris and the wall of the cyst is by astrocytes (gliosis)

188

Rapidly progressive dementia w/ myoclonic jerks

Creutzfeldt-Jakob disease (prion)
- multiple vacuoles/spongiform encephalopathy