Week 1 - Neuro Diseases / Disorders Flashcards
(133 cards)
1
Q
epidural hemorrhage / hematoma
A
traumatic vascular injury, between dura and bone, ruptured meningeal artery, appears lens shaped and clear on CT scan, person often experiences blow to head with momentary loss of consciousness and then acts normal only to go into a coma hours later, blow to the temple
2
Q
subdural hemorrhage / hematoma
A
traumatic vascular injury, between dura and arachnoid layer, rupture of cerebral vein where it joins sinus, result of deacceleration injury in which the skull comes to a stop but the brain keeps moving, appears more blurred and follows curve of skull on CT scan, elderly falls
3
Q
subarachnoid hemorrhage / hematoma
A
traumatic vascular injury, between arachnoid and pia, rupture of cerebral artery, caused by aneurysm, blood will be found in CSF, worst headache ever, possible berry aneurysm rupture
4
Q
Babinski sign
A
plantar extensor response with fanning of toes when dorsal lateral foot is stroked, present in very young/old or with neurological defect because brain is not able to override reflex
5
Q
Waaredenberg syndrome
A
neural crest cells fail to differentiate properly, white hair patch, pale skin, pale blue eyes, deafness, constipation
6
Q
Hirschsprung disease or congenital megacolon
A
neural crest cells fail to migrate to rectum and sigmoid colon, normal peristalsis does not occur, fecal retention with ballooning, surgically repaired
7
Q
craniorachischisis
A
neural tube defect, failure of the neural tube to close leaving exposed spinal cord
8
Q
anencephaly or meroanencephaly
A
exposed brain or no brain, failure or rostral neuropore to close
9
Q
spina bifida variations
A
failure of caudal neuropore to close
10
Q
occipital encephalocele
A
anterior neural tube defect, brain and meninges protrude in occipital area
11
Q
spina bifida
A
posterior neural tube defect, failure of vertebral arch formation, tuft of hair in lumbar region
12
Q
meningocele
A
posterior neural tube defect, failure of vertebral arch formation, protruding meninges and CSF
13
Q
myelomeningocele
A
posterior neural tube defect, failure of vertebral arch formation, meninges and CSF and spinal cord protuding
14
Q
syringomyelia
A
non-NTD, cavitation of spinal cord in cervical or thoracic region, loss of pain and temp sensation in thoracic and cervical area
15
Q
holoprosencephaly
A
non-NTD, forebrain does not divide into two hemispheres
16
Q
hydrocephalus
A
non-NTD, CSF overproduction dilates ventricles, skull enlarges before sutures fuse
17
Q
Dandy-Walker malformation
A
non-NTD, partial or complete absence of cerebellar vermis
18
Q
Arnold-Chiari malformation
A
non-NTD, bone blocking normal passageway in skull, surgery required
19
Q
Arnold-Chiari malformation type 1
A
asymptomatic until 30s
20
Q
Arnold-Chiari malformation type 2
A
herniation in foramen magnum, myelomeningocele
21
Q
Arnold-Chiari malformation type 3
A
occipital encephalocele, syringomelia
22
Q
Arnold-Chiari malformation type 4
A
lack of cerebellar development
23
Q
fetal alcohol syndrome
A
underdeveloped corpus collosum, very toxic to synpatogenesis 6months - 2 years, underdeveloped cortex
24
Q
testing CN I olfactory (smell)
A
pass odors
25
testing CN II optic (acuity, fields, pupils)
chart, confrontation, eyes individually
26
testing CN III occulomotor (pupils, eye movements)
direct, conjugate, consensual, flash light, MR, IR, SR, IO
27
testing CN IV trochlear (superior oblique)
conjugate
28
testing CN VI abducens (lateral rectus)
conjugate
29
testing CN V trigeminal (facial sensation, corneal response, mastication)
bite down, cotton, pin, tuning fork, compare sides
30
testing CN VII facial (facial movement)
observe, squeeze eyes shut, smile, puff out cheeks, forehead muscle spared with a CNS lesion (stroke)
31
CNS lesion - facial appearance
forehead spared, wrinkles evenly
32
CNS lesion - facial appearance
forehead affected, wrinkles unevenly
33
testing CN VIII vestibulocochlear (hearing, balance)
dizziness, vertigo, finger rubbing, weber, rinne
34
testing CN IX glossopharyngeal
swallow, horseness, palate elevation
35
testing CN X vagus
swallow, horseness, palate elevation
36
neuronal storage diseases
autosomal recessive enzyme deficiency, substrate accumulates, loss of cognitive function, seizures
37
leukodystrophies
myelin abnormality, autosomal recessive, problem with lysosomal or peroxisomal enzymes, loss of motor, spasticity, hypotonia, ataxia, less cognitive problems
38
neuronal ceroid lipofuscinoses
deficient enzymes for protein modification, lipofuscin accumulates, blindness, mental and motor problems, seizures, childhood to adulthood
39
Tay-Sachs disease
hexosaminidase A deficiency, accumulation of gangliosides, Ash. Jews, early infancy, developmental delays, paralysis, blind, deaf, death, born normal, bulging lysosomes, cherry red spot on retina
40
Krabbe Disease
deficiency in galactosylceramidase, galactocerebrosides accumulate, converted to galactosylsphingosine, toxic to oligodendrocytes, loss of myelin and oligodendrocytes in CNS and PNS, fat globoid macrophages in brain, 3-6 months onset, muscle stiffness, weakness, stumbling, trouble swallowing, stiff hand change
41
B1 - thiamine deficiency
chronic, Wernicke encephalopathy, Korsakoff syndrome
42
Wernicke encephalopathy
alcoholism, acute, reversible, hemorrhage and necrosis in mammillary bodies, confusion, ophthalmoplegia, ataxia, nystagmus
43
Korsakoff syndrome
alcoholism, thalamic lesions, prolonged, irreversible, memory problems, confabulation, cystic spaces and hemosiderin macrophages in mammillary bodies
44
B12 deficiency
anemia, reversible, B12 administration
45
B12 deficiency
subacute spinal cord degeneration, numbness, axatia, weakness, reversible until paraplegia, myelin swelling, vacuolization, ascending and descending tracts
46
hypoglycemia
pyramidal neurons most vulnerable = pseudolaminar necrosis, hippocampus and cerebellum vulnerable
47
hyperglycemia
diabetes mellitus, ketoacidosis or hyperosmolar coma, dehydration, confusion, stupor, coma
48
carbon monoxide
hypoxia, forms carboxyhemoglobin preventing O2 from bonding, cortex / hippocampus / Purkinje cells vulnerable, demyellination of tracts, looks pink upon death
49
methanol (antifreeze)
retina, degeneration of ganglion cells, blindness, only 10ml to kill
50
ethanol (alcohol)
acute = reversible, chronic = irreversible, affect cerebellum on midline, truncal ataxia, unsteady gait, nystagmus, Bergmann gliosis - lot of astrocytes
51
Guillain-Barre syndrome
PNS, life threatening, inflammatory, flu-like, acute symmetric ascending paralysis over a week, loss of tendon reflexes and sensation, elevated CSF proteins, immune mediated demyelination (T cells and macrophages) especially in spinal / cranial nerve motor roots, loss of respiratory kills, remyelination follows
52
leprosy (Hansen Disease)
PNS, infectious, slow progressive infection of skin and nerves, mycobacterium leprae, forms granulomas, transmitted by respiratory droplet, tropical countries, deformities
53
Mycobacterium leprae
acid fast (does not gram stain), obligate intracellular bacteria, hard to kill, body forms granulomas around it
54
tuberculoid leprosy
PNS, localized - less severe, dry, scaly skin lesions, nerve degeneration, T-cell response with granulomas
55
lepromatous leprosy
PNS, serve, widespread, skin, nerves, eyes, mouth, testes, hands, feet, no immune response, leonine face, autoamputation of toes, foamy histiocytes
56
varicella-zoster virus
PNS, chickenpox dormant on sensory ganglia, reactivation = painful vesicular rash, neuronal destruction, multinucleate giant cell
57
hereditary neuropathy
progressive, disabling, motor, sensory, or autonomic, possible amyloid deposition or metabolic disorders
58
neuropathy type 1 (Charcot-Marie-Tooth disease)
demyelinating / remyelinating, muscle and sensation loss, pain intact, childhood / early adulthood, high arches, hammer toes, foot drop, legs with inverted bottle appearance, nerves with onion bulb appearance
59
diabetic peripheral neuropathy
common, distal nerves, stocking - glove, symmetric sensory and motor neuropathy, decreased pain sensation in distal extremities, ulcers on ball of foot
60
malignancy related neuropathy
mononeuropathy on one side of body common, ex: brachial plexus = lung neoplasm, obturator palsy = pelvic neoplasm, cranial nerve = brain tumor
61
paraneoplastic effect
polyneuropathy, collection of symptoms with cancer, small cell lung cancer, plasma cell malignancy
62
vasogenic cerebral edema
increased vascular permeability, intercellular spaces, localized or generalized
63
cytotoxic cerebral edema
cell membrane injury, intracellular fluid increased = big cells, hypoxia or metabolic damage, Tx mannitol
64
hydrocephalus
excessive CSF in ventricular system, infancy = head enlarged, after infancy = increased cranial pressure, five kinds: communicating / non-communicating / ex vacuo / increased CSF production / normal pressure
65
noncommunicating hydrocephalus
block in ventricular system (tumor, abcess, malformation), only part of ventricular system enlarged, CSF is not able to leave part of ventricular system and circulate in subarachniod space
66
communicating hydrocephalus
block in subarachnoid space, entire ventricular system enlarged, meningitis, hemorrhage, dural thrombosis
67
hydrocephalus ex vacuo
no ventricular block, ventricular system dilates due brain atrophy, Alzheimer's Pick disease, massive hypoxia
68
hydrocephalus due to increased CSF
uncommon, choroid plexus papilloma
69
normal pressure hydrocephalus
elderly, gait problems, incontinence, dementia, large ventricles, no cortical atrophy, reversible, like communicating hydrocephalus, misdiagnosed as Alzheimer's
70
increased intracranial pressure
brain volume increases, mass effect, compromised blood flow, herniation
71
brain herniation
part of brain gets pushed into another compartment, headache, vomiting, decreased consciousness, papilledema, fatal, tumor, abscess, hematoma, edema, encephalitis, hemorrhage, types - subfalcine, transtentorial, tonsilar
72
subfalcine herniation
cingulate gyrus under falx, compression of anterior cerebral artery, limb weakness, aphasia, speech problems
73
transtentorial herniation
uncinate, temporal lobe against tentorium, CN III - pupil dilation and ocular movement, brainstem - impaired consciousness, posterior cerebral artery - ischemia to visual cortex, contralateral cerebral peduncle
74
case - football player knocked out, normal CT scan, headaches all week, collapsed Friday night
left subdural hematoma, midline brain shift, decreased vision in right eye, limited left ocular motility, ptosis of left eye, caused a tentorial herniation with compression of CN III and posterior cerebral artery
75
tonsillar herniation
cerebellar tonsils through foramen magnum, compressed medulla, compromised vitals, life threatening
76
linear skull fracture
common, straight, not serious, heals
77
depressed skull fracture
inward, comminuted, damage brain
78
diastatis skull fracture
across a suture, suture widens, children
79
basal skull fracture
more force, distant hematoma, CSF from ear or nose, raccoon eyes, battle sign bruise behind ear, ex: temporal bone fracture in petrous part
80
concussion
parenchymal injury, altered consciousness, change in momentum, amnesia, confusion, headache, nausea, vomiting, dizziness, Grade 1 - 15 min, Grade 3 - LOC
81
direct parenchymal injury
tearing or bruising of parenchymal tissue, ex: laceration from bullet, contusion, coup injury, countercoup injury
82
diffuse axonal injury
twisting / shearing of axons in deep white matter of brain, angular acceleration / deceleration, persistent deficits or coma, shaken baby, boxers, can cause small hemorrhages and axonal spheroids
83
second-impact syndrome
second concussion before first one heals, brain swells rapidly, young athletes
84
chronic traumatic encephalopathy
killed Derek Boogard, progressive, degenerative, repetitive brain trauma, behavior and personality changes, dementia, tau proteins deposited
85
coup injury
contusion on brain at point of contact with fixed object, happens second
86
countercoup injury
contusion opposite point of impact with fixed object, often worse, happens first becaause brain remains suspended in CSF when skull deaccelerates into object
87
berry aneurysm
aneurysm at branch point in circle of Willis, most anterior cerebral artery, some middle cerebral artery, few posterior cerebral artery, Tx with coils
88
ischemia
local anemia due to lack of blood flow
89
infarction
severe ischemia leading to cell death and necrosis
90
thrombus
clot that blocks blood flow, can lead to ischemia or infarction, often extracranial
91
embolus
clot that forms in another location and travels to the brain and blocks blood flow, can lead to ischemia or infarction, often intracranial
92
hemorrhage
bleeding from blood vessel, can be associated with hypertension, can be intracerebral or aneuryism
93
middle cerebral artery syndrome
affects supratentorial structures supplied by middle cerebral artery
94
anterior cerebral artery syndrome
affects supratentorial structures supplied by anterior cerebral artery
95
lateral medullary syndrome (PICA)
effects infratentorial structures supplied by the inferior posterior cerebellar artery
96
medial medullary syndrome
effects infratentorial structures supplied by the anterior spinal artery and penetrating branches of the vertebral arteries
97
Weber's syndrome
effects infratentorial structures
98
multiple sclerosis presentation
white female, 30s, light-headed, problems concentrating, forgetful, symptoms worse in summer (channels closer faster), problems typing, numb fingers, dizziness, depression
99
multiple sclerosis physical exam findings
normal EKG, orthostatic hypotension (BP lower and HR higher when standing), hyperreflexive 3+ = CNS problem (hyporeflexive = PNS), positive Babinski (CNS no longer inhibits reflex - extensor plantar reflex), struggle with rapid hand movement
100
multiple sclerosis lab results
normal - WBC, Hb, platelets, ESR, B12, folate, syphilis, TSH, electrolytes; lumbar puncture CSF - normal pressure, color, protein con, RBC, WBC - abnormal high IgG, high albumin, oligoclonal bands (shows IgG presence), abnormal visual evoked potential (slower and weaker), plaques on MRI
101
multiple sclerosis tx
prednisone, interferon B 1a (avonex); side effect immunosuppression
102
multiple sclerosis cause
autoimmune demyelinating disease, blood brain barrier become more leaky, immune cells - macrophages - attack myelin in CNS
103
multiple sclerosis areas affected
Cognitive function (esp. memory loss) - frontal and temporal lobes
Mood (especially depression) - limbic system
Sensory systems - vision occipital, hearing temporal, somatosensory postcentral
Motor control and coordination - precentral and cerebellum
Autonomic nervous system function (esp. cardiovascular system) - parasympathetic and sympathetic control of BP in heart and vessels
104
myasthenia gravis
autoimmune attack of nicotinic ACh receptors
105
trigeminal neuralgia
acute, excruciating, lightning like facial pain, near nose, lips, eyes, or ears, usually involves V2, pain caused by touch to lips or nose, nerve is compressed by superior cerebrellar artery, tx putting sponge between them
106
bell palsy
paralysis of facial muscles on affected side, facial nerve in distal facial canal or stylomastoid foramen, drooping lips and lower eyelid, loss of facial expression
107
craniosynostosis
premature closure of one or more sutures in the skull produces a misshapen skull
108
craniosynostosis
premature closure of one or more sutures in the skull produces a misshapen skull
109
brachycephaly
fusion of coronal suture, skull shortened front-to-back, flat head
110
brachycephaly
fusion of coronal suture, skull shortened front-to-back, flat head
111
oxycephaly, turricephaly, acrocephaly
fusion of coronal and lambdoidal sutures, tower skull
112
oxycephaly, turricephaly, acrocephaly
fusion of coronal and lambdoidal sutures, tower skull
113
plagiocephaly
fusion of coronal and lambdoidal sutures unilaterall, asymmetrical skull
114
plagiocephaly
fusion of coronal and lambdoidal sutures unilaterall, asymmetrical skull
115
scaphocephaly
fusion of sagittal suture, long skull front-to-back
116
scaphocephaly
fusion of sagittal suture, long skull front-to-back
117
trigonocephaly
premature fusion of metopic suture, forehead looks pointed
118
lambdoidal suture positional flattening
back of skull flattens from baby sleeping on their back, will self correct
119
microcephaly
small head due to brain that failed to grow, may be NTD, genetic, obstructed blood supply, prenatal drugs, maternal rubella / chicken pox
120
cranioschisis
meninges and / or brain herniate through skull defect, more common in occipital bone
121
meningocele
meninges only herniated
122
meningoencephalocele
meninges plus brain herniated
123
meningohydroencephalocele
meninges plus brain and ventricle herniated
124
Apert syndrome
autosomal dominant, craniosynostosis plus other defects like syndactyly of hands/feet and retardation, mutation of fibroblast growth factor receptor 1 and 2
125
acrania
no skull
126
anencephaly
no brain
127
meroanencephaly
poorly formed brainstem tissue present
128
hydrocephalus
enlarged ventricles due to too much CSF, if before sutures close = large head
129
congenital hydrocephalus
associated with spina bifida and Dandy-Walker malformation
130
acquired hydrocephalus
associated with hemorrhage, stroke, infection, tumor, and TBI
131
brachial cyst
form from remnants of brachial arch
132
syncope
fainting, problem in intermedolateral cell column, can be seen with MS
133
subarachnoid hemorrhage
image with axial CT, shows blood pooled in lateral ventricles and hemorrahge interhemispheric fissure
