Quiz 5 Flashcards by Piper Dobner

what is the nerve’s initial response to injury?

calcium influx

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this is a process that results when a nerve fiber is cut or crushed - in which part of the axon separated from the neuron’s cell body degenerates distal to the injury

Wallerian degeneration

**wallerian-like degeneration occurs in many neurological disorders

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what is considered to be a key initiating event for wallerian/wallerian-like degeneration

lack of axonal protein:

NMNAT2

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which three nerves account for the most common CN mononeuropathies clinically?

CN VII - Facial
CN V - Trigeminal
CN III - Oculomotor

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what is the most common cranial nerve neuropathy?

Bell’s Palsy

- acute idiopathic facial nerve neuropathy

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what is the word that means: sensitivity to sound?

hyperacusis

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occasionally, these illnesses can show up as facial neuropathy

Lyme

adult tick - ixodes holocyclus
sarcoidosis
herpes zoster

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this has been implicated as a potential cause of Bell’s palsey

HSV1

the DNA has been successfully sequestered in the facial nerve of some BP pts

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this is a distinctive facial pain syndrome in which the patient experiences intense, paroxysmal pain that may occur very infrequently or up to dozens of times daily.

Trigeminal neuralgia

- tic douloureux

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what is the vessel most often responsible for neurovascular compression upon the trigeminal nerve root?

superior cerebellar artery

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When doing EOMs - H in space - what CNs are being tested?

CN III, IV, VI

along with the EOMs and elevator palpebrae superioris

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oculomotor nerve palsy is also known by it’s?

“down ‘n out” symptoms

lateral downward deviation of gaze

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these are common and most often related to physical compression of the nerve

mononeuropathies of limb nerves

carpal tunnel
ulnar neuropathy
brachial plexus neuropathy

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carpel tunnel compresses which nerve

median

first 3.5 digits anteriorly
digits 2-3.5 posteriorly

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what is commonly seen on physical exam for carpal tunnel?

thenar eminence atrophy

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what are the two most common sites of ulnar nerve entrapment

elbow

2. wrist

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in general, neuropathy or damage of the ulnar nerve will result in symptoms affecting

the fourth and fifth fingers

“CLAW HAND” deformity

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this condition is characterized by sensory symptoms in the distribution of the lateral femoral cutaneous nerve (LFCN) of the thigh

meralgia paresthetica

compression usually due to:
inguinal ligament

more common in obese patients

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patient with this are most commonly noted to have peripheral neuropathy

diabetes mellitus

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What are the most common diabetes related neuropathies?

distal
symmmetrical
sensorimotor

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What is the classic distribution of diabetic polyneuropathy?

glove-and-stocking distribution

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what factors may be the most important underlying cause of diabetic polyneuropathy

ischemia and hypoxia to nerves

hyperglycemia that leads to the accumulation of sorbitol and depletion of inositol in affected nerves

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for this condition, the chief pathologic finding is axonal degeneration - most abundant in the most distal aspects of the PNS

uremic neuropathy

develops in 60% of CRF pts

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this is considered to be the most common cause of ACUTE generalized paralysis in the US

Guillain-Barre syndrome

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what is the most common immune-inflammatory polyneuropathy?

guillain-barre syndrome

what generally triggers Guillain-Barre syndrome to occur?

infection

the fundamental pathologic event of this condition is macrophage stripping of myelin from the axons

chronic inflammatory demyelinating polyradiuloneuropathy (CIDP)

differentiate Guillain-Barre Syndrome from Chronic Inflammatory Demyelinating Polyradiculoneuropathy

GBS - rapid onset, major autonomic/respiratory involvement CIDP - insidious onset, rarely respiratory association, relapsing and remitting course

in this setting of amyloid neuropathy, the amyloid protein is immunoglobulin related

systemic amyloidosis

in the autosomal dominant disorder - familial amyloidosis - the genetic trait results in mutated forms of?

transthyretin - this acts as an amyloid precursor

this condition is believe to have an immunologic basis ,developing as a consequence of the host's attempt to mount an immune response to the cancer

paraneoplastic syndrome related neuropathy

fun beer facts danish beer is supplement with what?

thiamine | pyridoxine

a distal, often painful neuropathy is common in ?

chronic alcoholics | ethanol related neuropathy

what are the characteristic clinical signs of ethanol related neuropathy?

chronic liver disease memory impairment gait ataxia

this is common, especially in a hospital-based practice

drug-induced neuropathy

this neuropathy is predominantly motor, associated with abdominal pain, contipation, anemia and is generally upper limbs

metal exposure related neuropathy

a deficiency in one of these is assumed to be critical to the development of vitamin related neuropathies

b vitamins

botulism is caused by

clostridium botulinum presynaptically blocks the release of acetylcholine equine anti-toxin is the only therapy

this condition is characterized clinically by cranial nerve palsies, descending flaccid muscle paralysis which can involve the muscles of respiration

botulism

what are the most common infectious disease associated with secondary neuropathies?

leprosy HIV/AIDs Lyme disease Varicella zoster

this is one of the most common causes of polyneuropathy worldwide

leprosy

what is the bugger that causes leprosy

mycobacterium leprae cases in the US have been seen secondary to armadillo interactions

this is characterized by the presence of non-necrotizing granulomas in the dermis and peripheral nerves

tuberculoid leprosy (less severe lesion of leprosy)

this is characterized by the presence of seheets of foamy macrophages in the dermis (and other sides) - granulomas are absent

lepomatous leprosy (most severe lesion of leprosy)

lyme disease is caused by the spirochete

borrelia burgdorferi transmitted by ixodides ticks phases: target lesion (erythema migrans) arthritis chronic neurological sxs

what are the early neurologic features of lyme disease?

``` CN neuropathies (CN VII is the most common neuropathy - like Bells Palsey however, more often BL for Lyme) spinal nerve radiculopathies ```

what is the most common viral pathogen affecting the PNS?

Varicella-zoster virus rash begins in the central and spreads to the extremities

when varicella-zoster is reactivated later in life, what is it called?

``` herpes zoster (shingles) - unilateral, 1-3 dermatomes ```

what dermatomes are most commonly affected in herpes zoster?

- thoracic | - trigeminal dermatome (especially ophthalmic branch)

with herpes zoster, after the lesions have resolved, the pain generally improves, except in patients with this?

postherpetic neuralgia (PHN)

this presents with a characteristic Tzank smear containing multinucleate giant cell w. accentuation of nuclear material at the periphery of the nuclei

herpes zoster

a skin lesion on the tip of the nose may precede the development of ophthalmic herpes zoster

Hutchinson's sign - nasociliary branch innervates the cornea and tip of the nose - aka: herpes zoster ophthalmicus

what is another term for multidermatomal shingles?

disseminated

this condition is characterized by severe otalgia and associated cutaneous vesicular eruptions (external ear, tragus, skin above TMJ)

herpes zoster oticus | - when associated with facial paralysis - called Ramsay Hunt syndrome

corneal ulcerations can commonly be due to

herpes zoster infection

this is a benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (CN VIII)

vestibular schwannoma | - acoustic neuroma

what can occur as part of neurofibromas and what are the two main forms of neurofibroma

vestibular schwannoma - NF type 1: rare, adult, BL acoustic neuromas rare - NF type 2: BL acoustic neuromas hallmark,

what are the most common form of schwannomas affecting CNs

trigeminal neuromas

acoustic neuromas may occur idiopathically or in some cases occur as part of

von Recklinghausen neurofibromatosis

for this condition, look for cutaneous neurofibromas and characteristic cafe au late spots

neurofibromatosis type 1

in this condition, BL acoustic neuromas are the hallmark

neurofibromatosis type 2 | - typically present before the age of 21

schwannomas are tumors (almost always benign) that commonly occur in individuals with

Neurofibromatosis | Schwannomatosis

these are common, benign, spindle cell tumors of peripheral nerves

neurofibromas - solitary tumor development, suggests NOT neurofibromatosis

NF1 occurs following the mutation of what?

neurofibromin - tumor suppressor gene * suppresses ras oncoprotein

NF2 results as a mutation of

merlin protein | - neurofibromin 2/schwannomin in chromosome 22q2

for this condition - the hallmark is hearing loss due to acoustic neuromas around the age of 20

Neurofibromatosis type 2 or central neurofibromatosis

these are characterized by elongated cells in parallel bundles

- perineuroma | rare, benign, may resemble neurofibroma

these are also known as malignant schwannomas

MPNST - malignant peripheral nerve sheath tumor high clinical suspicion of this if NF1 patient

what are the most common birth defect leading to death in infancy

birth defects of the heart

this is the absence of brain development , a form of neural tube defect

anencephaly absence of telencephalon

this is diminished forebrain size with several potential etiologies including?

microcephaly - fetal alcohol syndrome - trisomy 18 (Edward's synd) - congenital rubella - congenital HIV

this is caused by abnormalities in either cerebrospinal fluid production, C.S.F flow or C.S.F reabsorption

hydrocephalus

what is the most common cause of hydrocephalus

obstruction of normal CSF flow

this condition is characterized by enlarged cerebral ventricles and only intermittently elevated cerebrospinal fluid pressure

normal pressure hydrocephalus

this is the failure of normal closure of the vertebral column and/or overlying skin over the dorsal aspect of the spinal cord

spina bifida

this refers to a condition of a missing portion of a posterior vertebral body

spina bifida occulta

refers to herniation of the meninges but not the cord

meningocele

this is herniation of the meninges and the spinal cord

menigomyelocele

abnormally elevated levels of this is associated with neural tube defects, abdominal wall defects

maternal alpha fetal protein (AFP) mothers with methylenetetrahydrofolate reductase genetic variants have more frequently elevated AFP

when these levels are LOW associated with a smaller number of conditions like downs and trisomy 18

MAFP - maternal alpha fetal protein

this is caused by damage to the motor control centers of the brain and can occur.. when?

cerebral palsy **More common in pre-mature infants 75% occur during pregnancy 10% during birth 15% post birth

this is a reparative response of neurons following damage to the axon

neuronal chromatolysis

cerebral palsy have been associated with maternal infections such as"

strep throat | maternal CNS infxn

what is the most common type of cerebral palsy?

spastic cerebral palsy - inhibits NS ability to receive GABA

what is the most common finding on autopsy of newborns and infants with cerebral palsy

periventricular leukomalacia - necrosis around the ventricles

this condition presents with bilateral, roughly symmetrical foci of white matter necrosis develop around the lateral ventricles, especially in the frontal and occipital lobes

periventricular leukomalacia - calcification makes the lesion look white - cystic cavitates, non-cystic does not

what is the most common cause of meningitis? second most common?

viral infections - resolve without tx bacterial (2nd MC) - result in death if not tx'd quickly - cause: e.coli, strep

which bacterial is most common for cause of bacterial meningitis in the: neonates, infants, adolescents/adults, elderly?

neonates: e.coli infants/kiddos/adolescents/adults: neisseria meningococci elderly: strep pneumonia

patients without a spleen are at particular high risk for infection by:

encapsulated organisms such as: - neisseria meningitis - h. flu

latex agglutination is most sensitive for identifying:

H. influenza

what is the most common cause of bacterial meningitis in children, while also being the second most common in adults?

neisseria meningitidis (meningococcal meningitis) - gram negative diplococci within a neutrophil - yellow-tan clouding of the meninges due to exudate

this presents with a rapidly-spreading petechial rash is typical and may precede to other symptoms

meningococcal meningitis

this is characterized by: h/a, fever and inflammation of the meninges that is NOT caused by bacteria

aseptic meningitis

these two lovelies account for 50% of the cases of aseptic meningitis

coxsackie virus echovirus Herpes 1/2 can also cause in infants HIV esp. soon after exposure - acute HIV syndrome

this is a yeast found in soil around the world and most often affects people with..

cryptococcal meningitis - compromised immune systems

this is the most common life threatening fungal pathogen that infects patients with AIDS

cryptococcal neoformans - India ink reveals the presence of encapsulated, circular yeast bodies with CSF stains - granuloma may be present on retinal screening

which virus is seasonal to spring/summer months; late summer; and spring

spring/summer - arboviruses late summer - enterovirus spring - mumps and varicella

what is the most common cause of viral meningitis in kiddos? Adults?

kiddos: enterovirus adults: enterovirus - coxsackie b accounts for most cases followed by echovirus

what is the most common cause of sporadic encephalitis in developed countries?

HSV (1 MC in infants) HSV2 is the agent in almost ALL adult cases of herpes meningitis and herpes encephalitis

this condition characteristically involves the temporal lobes

HSV encephalitis

these are the most common non-hematologic cancers that metastasize to the CNS

lung breast melanoma carcinomatous meningitis - many tumors arising inside and outside NS

what is the most common histological type of carcinomatous meningitis?

adenocarcinoma h/a mc symptom dipolpia mc CN symptom

Quiz 5 Flashcards

(102 cards)