Week 1 Flashcards
(116 cards)
1
Q
ST contains which CN?
A
1 and 2
2
Q
PF contains which CN?
A
3-12
3
Q
Headache lesion at which level?
A
ST, PF or both
4
Q
Nuchal rigidity level?
A
Spinal
5
Q
Personality change level?
A
ST
6
Q
ST lesion face? body?
A
face and body: both contralateral
7
Q
seizures usually due to lesion at which level?
A
ST
8
Q
PF lesion face? body?
A
face: ipsilateral
body: contralateral
9
Q
bladder bowel disturbance due to what kind of lesion?
A
spinal, midline
10
Q
glove and stocking distribution is what kind of lesion?
A
peripheral
11
Q
cerebellar lesion leads to deficit on which side?
A
same side
12
Q
Does the cell body reside in white or gray matter?
A
gray
13
Q
Where can we find Nissl bodies?
A
Neurons, and maybe dendrites. NOT in axons
14
Q
MAP2 found where?
A
dendrites
15
Q
What kind of protein is found in axons?
A
Tau
16
Q
What kind of substance can go through the BBB?
A
lipid soluble
17
Q
What is reactive gliosis?
A
scar formation and repair in the brain in response to injury by astrocytes
18
Q
What are ependymal cells responsible for?
A
They line the ventricular surface of the brain and are ciliated to enhance the movement of CSF along the ventricular space
19
Q
What are the main immune cells in the CNS?
A
microglia. Think of them as CNS phagocytes
20
Q
What happens to microglia in HIV patients?
A
They fuse to form multinucleated giant cells in the CNS
21
Q
Microglia embryology origin?
A
from mesoderm
22
Q
Guillain-Barre syndrome destroys what kind of cells?
A
Schwann
23
Q
Name the layers of the nervous system (hint…starts with epineurium)
A
Epineurium Nerve Perineurium (this is the layer that needs to be reattached in microsurgery) Fascicle Endoneurium Nerve fibers
24
Q
BBB is formed by which 3 substances?
A
Tight junctions between capillary endothelial cells
basement membrane
astrocyte foot processes
25
NEural crest eventually forms
PNS neurons and Schwann
26
CNS neurons, ependymal cells, astrocytes, oligodendrocytes derived from what?
neuroectoderm
27
Mesoderm forms?
microglial, meninges, blood vessels
28
central chromatolysis is neuronal cell body reaction to what kind of damage?
axon
29
what are some distinct pathologic findings in central chromatolysis?
cell body swells "ballooned" neuron, nissl and nucleus are displaced
30
Axonal spheroid id also another marker of axonal damage. How does it occur?
axon is damaged, the flow system that shuttles molecules up and down the axon becomes impaired and shuts down. This leads to accumulation of material that results in a swollen profile
31
Amyloid precursor protein in response to axonal damage?
it becomes upregulated and accumulates
32
Distal/wallerian degeneration is due to what kind of damage?
descending tract degeneration secondary to damage upstream
33
"red, dead" neurons seen in which kind of damage?
acute ischemic cell change, which occurs due to ischemia/hypoxia to brain
34
Negri bodies in hippocampus seen in which type of infection?
rabies
35
intranuclear inclussions and reactive astrocytes seen in which disease process
SSPE (measles)
36
Ectoderm layers results in which two structures?
neural tube and neural crest
37
Mesoderm results in which two structures?
notocord and somites
38
Neural tube eventual derivative is...
brain and spinal cord
39
neural crest eventual derivative is...
```
dorsal root ganglia
autonomic ganglia
melanocytes
adrenal medulla cells
craniofacial bone and cartilage
```
40
Somite eventual derivative is...
```
skeletal muscle
catilage
tendons
dermis
endothelium
```
41
Notocord eventual derivative is...
Nucleus pulposus
42
End results of dorsal induction?
neural tube closes
43
Telencephalon includes
cerebrum and lateral ventricle
44
diencephalon includes
thalamus and 3rd ventricle
45
Metacephalon includes
pons, cerebellum, upper part of 4th ventricle
46
mesencephalon includes
midbrain and AS
47
Myelencephalon includes
Medulla and lower portion of 4th ventricle
48
Alar plate vs basal plate gives rise to
Alar: dorsal, sensory
Basal: ventral, motor
49
Migration occurs at weeks 12-20. In what direction do they migrate and what assists them in doing so?
Migrates from ventricles to cortex. Assisted by radial glial cells
50
Tongue development 1st branchial arch forms what?
anterior 2/3 of tongue (sensation via CN V3, taste via CN VII)
51
tongue development 3rd and 4th arches form?
posterior 1/3 (sensation and taste via CN IX)
52
Taste CN?
7, 9 10
53
Pain CN in tongue?
V3, 9, 10
54
Motor in tongue CN?
12
55
What is used as confirmatory test in neural tube defect?
elevated AChE in amniotic fluid (fetal AChE in CSF crosses defect into amniotic fluid)
56
difference between meningocele and myelomeningfocele?
both have protruding meninges but myelomeningocele also has protruding spinal cord/nerve
57
What is chiari malformation?
cerebellum and brainstem tissue into foramen magnum, usually with myelomeningocele
58
Which type of Chiari is more severe and what are the symptoms?
II. more herniation of cerebellar tonsillar through foramen magnum with aqueduct stenosis and hydrocephalus. Paralysis below defect is often present
59
Tethered cord syndrome is what? What are the symptoms?
congenital attachment of spinal tip, limits movement of cord. This becomes a problem as the child grows
Symptoms include bowel/bladder problems, lower extremity weakness
60
Syringomyelia symptoms?
Cystic enlargement of central canal of spinal cord. spinothalamic tract most often affected due to crossing. Results in cape like bilateral loss of pain/temp sensation in upper extremities.
Associated mostly with Chiari I malformation
61
Ancephaly due to?
malformation of anterior neural tube, no forebrain. brain elements damaged due to exposure to amniotic fluid. associated with DM type I mothers
62
Encephalocele is what?
defect in skull allows herniation of blood tissue
63
What is holoprosencephaly?
brain fails to cleave into two hemispheres. Occurs around week 5-6. No cleavage of prosencephalon during ventral induction
64
Microcephaly due to?
failure of neuronal and glial proliferation. Associated with developmental delays
65
Heterotropic gray matter is due to defect in?
migration. nodules of gray matter where it shouldn't be, such as lining ventricular surface. Common cause of seizures. X linked disorder in girls (males are non-viable)
66
What is lissencephaly
failure of migration of cells to surface, resulting in smooth brain surface without any gyri.
67
Germinal matrix hemorrhage is bad because?
occurs in close proximity o ventricles. Most common cause of 2nd trimester abortions
68
Periventricular leukomalacia is....
intrauterine hypoxia due to white matter infarct
69
Cortical dysplasia is what
cortical neurons are arranged in abnormal way. can cause epilepsy
70
Down syndrome neurons?
same number of neurons but less dendritic complexity
71
Why are some skin problems associated with neuro problems?
skin and nervous system both develop from ectoderm
72
Neurofibromatosis type I vs II?
I: nerve tumors, optic gliomas, pheochromocytomas, skin abnormalities, lisch nodules (pigmented iris). Mutated NF1 gene on chromosome 17
II:bilateral acoustic neuromas (schwannomas)
73
Sturge-weber syndroms if what?
port wine stain typically in V1 distribution of face
abnormal blood vessels, loss of nerve cells and calification of cerebral cortex of brain on same side as birthmark
May cause seizures, mental retardation
74
how to treat trigeminal neuralgia?
carbamazepine
75
caused by blood vessel loop pushing on nerve?
trigeminal neuralgia
76
Referred pain is mediated by what?
dorsal horn neuron
77
Treatment for migraine?
Sumatriptan (5-HT agonist)
| DHE (also a 5-HT agonist)
78
How to triptans work to inhibit migraines?
release of CGRP at trigeminovascular junction is inhibited
79
cluster headache symptoms
severe orbital pain with unilateral autonomic symptoms
80
Whats the difference between cluster headahces and paroxysmal hemicrania?
paroxysmal hemicrania are shorter, maybe more frequent, no cycle pattern, INDOMETHACIN works
81
Trigeminal neuralgia treatment?
Carbamazepine: epileptic drug, sodium channel blocker
82
How to check and treat for temporal arteritis?
1. Check ESR
2. treat with steroids (prednisone)
3. Confirm with temporal artery biopsy
83
Describe transduction of pain
Step 1. Upregulation of voltage gated Na channels results in increased activity of Vanilloid receptor (TRPV1)-->calcium influx
84
What's step 2 of pain?
Transmission.
Calcium influx in presynaptic terminal of DRG neuron causes release of glutamate into synaptic cleft.
Glutamate binds AMPA receptors on postsynaptic dorsal horn neurons which triggers opening of Na channels and depolarization
85
What contributes to vasodilation and increased vascular permeability of pain?
retrograde release of substance P and other NTs (such as CGRP) at site of injury
86
What is the gate control theory?
Non-nocicpetive inputs (pressing on temples when you have a HA) blocks transmission of painful inputs, likely activating inhibitory interneurons
87
What is the wind up phenomenon
repetitive firing of peripheral nociceptive fibers leads to increased activity of dorsal horn neurons
88
What does substance P bind and what does that result in?
NK1 receptors. Results in inhibition of K efflux, which increases neuronal exitability
89
Mechanism of opiods?
inhibit presynaptic calcium channels, activate post synaptic K channels
90
Na/K ATPase pumps what in and what out?
3 Na out, 2 K in
91
RMP becomes more positive if you open __ or ___channelas
Ca, Na
92
RMP becomes more negative if you open ___or ____channels
K, Cl
93
Increased extracellular (serum) K results in hyper or depolarization?
depolarization
94
NT in synaptic cleft eliminated in what 3 ways?
1. metabolism/degradation
2. reuptake by astrocytes in CNS
3. reuptake into nerve terminal via endocytosis or transporter
95
L glutamate inhibitory or excitatory?
excitatory
96
L glutamate binds what kind of receptor?
AMPA, NMDA
97
What is te most important inhibitor?
GABA
98
what does NMDA look like at resting state?
calcium channel that is blocked by Mg
99
NMDA receptors need what to happen for activation to occur?
Glutamate binds AND
Glyine binds allosteric site AND
membrane depolarization to relieve Mg blockade
100
Energy failure (hypoxia ex) leads to what?
ATP depletion results in failure of Na/K ATPase. RMP moves more positive and eventually Na channels inactivate so cells cannot initiate action potential. Depolarization also kick Mg out of NMDA receptor so that becomes activates. Loss of Na gradient leads to impaired reuptake of NTs by astrocytes. Glutamate still in synapse, binds NMDA receptor, Ca influx, cells accumulate Ca, results in cell death because Ca activates degrading enzymes
101
Carbamazepine mech?
Na channel blocker
102
LIdocaine mechanism
Na channel blocker
103
Benzodiazepine mech
GABA agonist
104
How do K channel blockers work?
slow/prolong repolarization, increase refractory period
105
3,4 DAP mech
K channel blocker
106
What is CSF made of
ependymal cells of choroid plexus
107
What is papilledema?
increased intracranial pressure through ventricular system results in optic disc becoming enlarged
108
When do you see papilledema?
sign of hydrocephalus
109
What is normal pressure hydrocephalus?
increased subarachnoid space volume but no increase in CSF pressure
110
Classic triad seen in normal pressure hydrocephlus?
```
gait change (CSF stretches legs in motor cortex)
dementia
urinary incontinence (bladder regulation fibers affected)
```
111
Hydrocephalus ex vacuo is what?
increased CSF in atrophy (think alzheimer's)
112
How does hydrocephalus ex cavuo differ from normal pressure hydrocephalus?
intracranial pressure is normal, triad not seen in hydro ex vacuo
113
NEVER do a LP in what?
non communicating hydrocephalus or suspected intracranial mass
114
Ventriculoperitoneal shunt may correct what kind of hydrocephalus?
communicating and non communicating. Dratin CSF via tube from ventricule to peritoneum of abdomen
115
Third ventriculostomy shunt corrects what kind of hydrocephalus?
Non comunicating downstream from 3rd ventricles. Typically in cerebral aqueduct. Poke hole in floor of 3rd ventricle to drain CSF
116
Layers that LP passes through?
```
skin
superficial fascia
paraspinal mucle
ligamentum flavum
dura mater
arachnoid mater
```
