Unit 3: CNS

Question 1

Meningitis

Answer 1

Inflammation of the meninges

Viral (–> lymphocyte exudate into subarachnoid space) or bacterial (—> neutrophil exudate -pus- into subarachnoid space)

May lead to thrombosis, CSF blockage, increased intracranial pressure

Question 2

Meningitis: Sx

Answer 2

Headache, neck stiffness, fever
Irritability, confusion, lethargy

Kernig’s sign (pain with hip flexion and knee extension)
Brudzinski’s sign (cervical flexion causes hip and knee flexion)

Question 3

Most common cause of bacterial meningitis in adults

Answer 3

streptococcus pneumonia

Question 4

Most common cause of bacterial meningitis in neonates

Answer 4

Group B strep

Question 5

Encephalitis

Answer 5

Inflammation of the brain parynchyma

Localized or diffuse

Primary viral (in US most often HSV1) -- direct viral invasion of brain
Also acute disseminated encephalomyelitis (autoimmune Type 2 ) 1-3 weeks after infection -- multifocal demyelination

Question 6

Encephalitis: Sx

Answer 6

Meningeal signs
Seizures, focal neurological defects, personality changes
Possible GI or respiratory prodrome
May result in paralysis, weakness, movement disorders

Question 7

Brain abscess

Answer 7

Uncommon

Expanding focal infections that act as space-occupying lesions (headache, focal neurological Sx, increased intracranial pressure)

Question 8

Glioma

Answer 8

Most common primary brain tumour
Malignant
Astrocytes (80%), oligodendrocytes, ependymal cells

Astrocytomas – 80% infiltritive
The most common infiltritive astrocytoma is glioblastoma, making it the most common CNS tumour

Question 9

Glioblastoma Multiforme

Answer 9

Grade 4 astrocytoma

Most common and most aggressive primary brain cancer

Question 10

Meningioma

Answer 10

Mostly benign tumour of the meninges

2nd most common intracranial tumour

Question 11

Amyotrophic Lateral Sclerosis

Answer 11

ALS. Lou Gehrig’s Disease

Loss and sclerosing of motor neurons in spinal cord, midbrain, and then cerebral cortex. Especially affects lateral cerebrospinal pathway.
Characterized by motor weakness and progressive wasting

Idiopathic (occasionally familial). Rare

Question 12

Alzheimers

Answer 12

Common
Buildup of beta-amayloid plaque, tau proteins, in brain causing inflammation and destruction, primarily in frontal and temporal lobes.

Memory loss, clinical presentation of demential

4th leading cause of death in the elderly

Question 13

Vascular dementia

Answer 13

Multiple small infarcts over time leading to widespread neural damage

Question 14

Abulia

Answer 14

Lack of motivation

Question 15

Lewy Body Dementia

Answer 15

Dementia caused by Lewy’s bodies, which are pathogenic aggregates of proteins which develop inside nerve cells.

Associated with Parkinson’s Disease. Appear within a year of motor symptoms

Increased sleep, disorganized speech, hallucinations

Question 16

Multiple Sclerosis

Answer 16

Autoimmune demyelination, especially
Oligodendrocytes.

Atrophy of white matter

Progressive; relapse/remission patterns

Question 17

MS: Sx

Answer 17

Often begins with sensory changes

Weakness spasticity

Pain dizziness

Brainstem Sx

Question 18

Four patterns of MS course

Answer 18

Relapse-Remitting (most common)
Primary progressive
Secondary progressive
Progressive relapsing

Question 19

Chorea

Answer 19

Brief, semi-directed, irregular movements

Irregular, migrating contractions

Question 20

Atherosis

Answer 20

Involuntary convoluted, writhing movements of fingers, arms, legs, neck.

Question 21

Choreoathetosis

Answer 21

Combination of chorea and athetosis

Seen in Huntingtons, among other paths

Question 22

Dystonia

Answer 22

Increased muscle tone and spasm, often accompanied by writhing movements

Question 23

Parkinson’s disease

Answer 23

Destruction of dopamine this neurons in substantia nigra

Common

Increased inhibition of movement, decreased facilitation of movement

Question 24

Parkinson’s: Sx

Answer 24

Extrapyramidal type symptoms

Resting tremor
Rigidity
Bradykinesia/akinesia
Mask-like expression

Question 25

Huntington's

Answer 25

Huntington disease is an autosomal dominant disorder characterized by chorea, neuropsychiatric symptoms, and progressive cognitive deterioration, usually beginning during middle age. Atrophy of caudate nucleus

Question 26

Huntington's: Sx

Answer 26

Chorea Dysarthria Neuropsychiatric symptoms (personality change, poor executive function, mood changes)

Question 27

Ischemic stroke

Answer 27

Linked to hypertension and atherosclerotic disease Thrombosis, embolism, hypofusion

Question 28

Hemorrhagic stroke

Answer 28

Worst headache ever Seizures LO Often subarachnoid bleed from ruptured aneurysm or vascular malformation High mortality rate

Question 29

Middle cerebral artery stroke

Answer 29

Hemiplegia Hemianaesthesia Broca's aphasia

Question 30

Anterior cerebral artery stroke

Answer 30

CL hemiparesis | Lower extremity sensory loss

Question 31

Cerebral palsy

Answer 31

Perinatal brain damage Usually caused by hypoxia, ischemia, or trauma to cerebral blood vessels

Question 32

Four categories of Cerebral Palsy

Answer 32

1 spastic 2 athetoid 3 ataxic 4 mixed (usually 1+2)

Question 33

Fredrick's ataxia

Answer 33

Friedreich's ataxia is an autosomal recessive inherited disease that causes progressive damage to the nervous system, especially sensory neurons necessary for proper limb movement. It manifests in initial symptoms of poor coordination such as gait disturbance; it can also lead to scoliosis, heart disease and diabetes, but does not affect cognitive function. The disease progresses until a wheelchair is required for mobility. Its incidence in the general population is roughly 1 in 50,000.

Question 34

Spinal muscular atrophy

Answer 34

Weakness and wasting due to progressive anterior horn degeneration. Atrophy, hypotonia, weakness, fatigue Often fatal restrictive lung disease.

Question 35

Paresis

Answer 35

Weakness

Question 36

Central cord syndrome

Answer 36

Damage to centre of spinal cord, periphery unaffected Hyperextension injury to c-spine Motor/sensory impairment to Upper Limbs; lower limbs less affected.

Question 37

Brown-sequard syndrome

Answer 37

Damage to one side of the spinal cord Trauma (stabbing, shooting) IL: loss of motor function, proprioception, vibration, 2 point Discrimination CL: loss of pain and temperature perception

Question 38

Anterior cord syndrome

Answer 38

Direct trauma, hyperflexion Damage to corticospinal and spinothalamic tracts BL loss of motor function, pain and temp, crude touch

Question 39

Breathing affects if spinal lesion above

Answer 39

C5

Question 40

Poliomyelitis

Answer 40

Viral Destruction of motor cells; sensory intact Asymptomatic Non-paralytic Paralytic Usually full recovery

Question 41

Postpoliomyelitis

Answer 41

In patients who have had paralytic poliomyelitis, muscle fatigue and decreased endurance, often accompanied by weakness, fasciculations, and atrophy, may develop years or decades later, particularly in older patients and in patients who are severely affected initially. Damage usually occurs in previously affected muscle groups. However, postpoliomyelitis syndrome rarely increases disability substantially. The cause may be related to further loss of anterior horn cells due to aging in a population of neurons already depleted by earlier poliovirus infectio

Question 42

Upper motor neuron lesion

Answer 42

CNS Corticospinal or pyramidal tracts ``` Loss of voluntary movement Hemi/para/quadriplegia Spasticity Hyperreflexia Clonus ```

Question 43

Lower motor neuron lesion

Answer 43

Affects nerves between anterior spinal horn and muscle ``` Flacid paralysis Paresis Fasciculations Hypotonia Hyporeflexia ```

Question 44

Neuropraxia

Answer 44

Nerve injury | Complete recovery with removal of compression

Question 45

Axonotmesis

Answer 45

Disruption of Myelin sheath bun axon intact Wallerian degeneration

Question 46

Neuronotmesis

Answer 46

Damage to sheath and axon body Wallerian degeneration

Question 47

Hyperkinetic disorder

Answer 47

Hyperkinetic disorder is a psychiatric syndrome emerging in early childhood that features an enduring pattern of severe, developmentally inappropriate inattention, hyperactivity and impulsivity across different settings (e.g., home and school) that significantly impair academic, social and work performance. Extreme ADHD, combined type

Question 48

Hyperkinesia

Answer 48

an increase in muscular activity that can result in excessive abnormal movements, excessive normal movements, or a combination of both Basal ganglia damage

Question 49

Hypokinesia

Answer 49

Partial or complete loss of Muscle movement Basal ganglia damage

Question 50

Neuropathy

Answer 50

Damage, pathology involving PNS

Question 51

Neuralgia

Answer 51

Pain along nerve path

Question 52

Neuritis

Answer 52

Inflammation of nerve

Question 53

Radiculopathy

Answer 53

Damage to nerve root

Question 54

Plexopathy

Answer 54

Damage to nerve plexus

Question 55

Herpes zoster

Answer 55

Shingles Post herpetic neuralgia

Question 56

Ramsey Hunt Syndrome

Answer 56

Shingles of the facial nerve Neuralgia Possible hearing loss and facial paralysis