Nuero II

Question 1

Contralateral

Answer 1

Affecting the opposite sides of the brain

Question 2

Ipsilateral

Answer 2

Same side

Question 3

Homonymous hemianopsia

Answer 3

Loss of same visual field bilaterally

Question 4

Primary brain tumors

Answer 4

Diverse group of neoplasms arising from different cells of the CNS

• benign or malignant

Question 5

Cancers and primary brain tumors

Answer 5

Lung, melanoma, breast, colon

Question 6

Brain tumor presentations

Answer 6

Symptoms are related to increase in intracranial pressure

Vary depending on size, growth rate, location of tumor

Question 7

Generalized symptoms

Answer 7

Headaches, seizures, n/v, depressed level of con, neurocognitive dysfunction

Question 8

Focal presentation

Answer 8

Seizures 
Weakness
Sensory loss
Aphasia 
Visual spatial dysfunction

Question 9

Papilledema

Answer 9

Blurred disk margins

Normal is : sharp margins, orangey red in color

Question 10

Gliomas

Answer 10

15-18 % of primary brain tumors - 80%malignant - most common type of Brain tumor

Question 11

Meningiomas

Answer 11

Not technically a brain tumor b/c they occur in meninges

36 % of all brain tumors

Females more than men, middle age adults ( 35-54)

Most are benign and slow growing Tx depends on grade and growth

Question 12

Acoustic Neuromas - vestibular schwannomas

Answer 12

Schwann cell-derived tumors that commonly arise from the vestibular portion of 8 th CN

Benign slow-growing tumors

• slow growing, w , older 40-50

Question 13

Acoustic neuromas s/s

Answer 13

Asymmetric sensorineural hearing loss
Tinnitus, balance difficulty, facial numbness, weakness, taste changes if tumor large enough to cause pressure on 5th, 7th CN

Watch and wait, serial MRI

** look up PE findings **

Question 14

Pituitary tumors

Answer 14

Result in under or over production of hormones procedure by that cell type

Most common case of stellar masses from 30- on

Most are benign

Classified according to size < 1cm micro >1 macro

Question 15

Pituitary gland location

Answer 15

Located inside the skill just below the brain and above the nasal passages ie the soft palate

Question 16

Pituitary tumor - manifestations

Answer 16

Nuerological symptoms - visual defects , temporal field deficits / dilopia /vision loss, headaches

Caused by hormonal excess / deficiencies such as
- oxytocin, and vasopressin

Question 17

ACTH hormone

Answer 17

Excess production of cortisol leads to weight gain / buffalo hump, infertility, thinning of skin and easy bruising, muscle weakness, decrease bone density, Cushing syndrome

Question 18

Growth hormone excess

Answer 18

Acromegaly

Increase dimensions of head - face- hands - feet

Question 19

Prolactin excess

Answer 19

Female - infertility , amenorrhea,

Male - impotence, gynecomastia, decrease libido

Question 20

Metatatic brain tumors

Answer 20

Most common brain tumor
Sites of origin : lung, breast, colon and melanoma

Symptoms : headache, vomiting, seizures, focal weakness, personality changes

Question 21

TIA

Answer 21

Temporary focal nuerologic deficit caused by brief interruption of blood flow

Stroke occurs in 1/3 of pts who have TIA

Question 22

TIA S/S the carotid territory

Answer 22

Opthalmic

Middle cerebral artery :

Anterior cerebral artery

Question 23

TIA S/S the vertebrobasilar territory

Answer 23

Posterior cerebral
- dysarthria, dysphasia, diplopia, bilateral blindness

Cerebellar
- ataxia, vertigo, dizziness

Question 24

TIA treatment

Answer 24

Reduce risk factors, refer to ER

Question 25

ABCS score

Answer 25

Estimate the risk of ischemic stroke in the first two days after TIA Higher - more likely

Question 26

Ischemic stroke

Answer 26

80 % of stroke - due to thrombotic ( clot within brain ), embolic ( somewhere else in body)

Question 27

Hemorrhagic

Answer 27

20 % of strokes due to Subarachnoid Intracerebral

Question 28

Thrombotic stroke

Answer 28

Thrombus forms in narrows vessel - can occur in a large or small vessel, caused by atherosclerosis in situation - resulting in inadequate blood supply May fluctuate, remit or progress - weakness, arm numbness, visual changes, speech difficulty

Question 29

Embolic stroke

Answer 29

Particles of debris originating elsewhere travel to and block recipient site Abrupt on set Cardiac arrthymias = high risk

Question 30

Intracerebral stroke

Answer 30

Usually caused by rupture of tiny arteries within the brain tissue. As blood collects, a hematoma or blood clot forms causes increase ICP Gradual onset and progression over minutes to house Headaches, vomiting , decreased LOC

Question 31

Subarachnoid hemorrhage (SAH)

Answer 31

Rupture of arterial aneurysms into subarachnoid space, resulting in bleeding in the areas between the brain and thin tissues that cover the brain Abrupt onset with thunder clap , vomiting after onset of headache

Question 32

TBI

Answer 32

A disruption in the normal function of the brain that can be caused by a bump, blow or jolt in head

Question 33

Coup/ contrecoup injures

Answer 33

The coup injury happens when head stops aburptly because of an impact and brain then crashes into the skull Contrecoup - occurs when the brain then bounces inside the skull and impacts the opposite side of the skull

Question 34

Mild TBI

Answer 34

Symptoms may appear immediately after a traumatic event, while other may appear days or weeks later Loc - few seconds , few min No loc Memory or concentration problems

Question 35

Moderate - severe TBI

Answer 35

Symptoms may appear within the first hours to days after head injury - should be in hospital ``` Loss of C few min to hours Confusion Agaitiation Loss of coordination Loss of bladder Dilation of pupils ```

Question 36

TBI treatment

Answer 36

Initial 1-2 days rest, monitor LOC every 3-4 hours, avoid reading, strenuous activity Mild headache for weeks / months

Question 37

Second impact syndrome

Answer 37

A rare condition in which a second concussion occurs before a first concussion has healed, causing rapid and severe brain swelling Dilated pupils, loss of eye movement, resp failure, death

Question 38

Post - concussion syndrome

Answer 38

A complex disorder in which a combination of symptoms can last months to years after initial injury

Question 39

Cranial Nerve mnemonic

Answer 39

On Old Olympus’s Towering Tops A Fin And German Viewed Some Hops

Question 39

Aphasia

Answer 39

Loss of ability to comprehend and or / produce language

Question 39

Apraxia

Answer 39

Loss of information about how to perform an activity

Question 39

Agnosi

Answer 39

Inability to recognize familiar objects, faces, smells

Question 40

TIA Opthalmic

Answer 40

Loss of vision - transient blurred vision, sensation of shade pulled down

Question 41

TIA middle cerebral artery

Answer 41

Hemiparesis: face, arm and leg Contralateral motor and sensory deficits

Question 42

TIA Anterior cerebral artery

Answer 42

Classically hemiparesis and hemianesthesia predominate in the contralateral leg Cognitive, behavioral and emotional disorder

Question 43

TIA Posterior cerebral

Answer 43

Dysarthria, dysphagia, diplopia, bilateral blindness, unilateral motor and sensory weakness

Question 44

TIA Cerebellar

Answer 44

Ataxia, vertigo Dizziness