Flashcards in Week 2 Neuro Deck (34)
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1
Cerebellar disorders
Ataxia, decreased tendon reflexes, asthenia, tremor, nystagmus
2
Spinal cord: ascending tracts
Pain-temp, proprioception, light touch
3
Spinothalamic tract
Pain-temp, light touch. Crosses over to other side then ascends to thalamus and cerebral cortex on opposite side.
*lesion in this tract --> loss of pain-temp sensation contralaterally, below level of lesion.
4
Damage to upper motor neurons
Hypertonia/spasticity, decreased motor control, spastic reflexes, +Babinski
5
Damage to lower motor neuron
Hypotonia, weakness, decreased reflexes in affected areas
6
+ Babinski
UMN lesion. Abnormal dorsiflexion of great toe and fanning of other toes
7
Gray matter
Neuronal cell bodies and synapses
8
White matter
Ascending: sensory info to brain
and descending: motor instructions from brain
9
Spinocerebellar tract
Does NOT cross the spinal cord therefore ipsilateral symptoms. Receives afferent from periphery.
10
Spinothalamic tract
Crosses spinal cord immediately, therefore contralateral sxs
11
Descending tracts
Extends from motor area of cerebral cortex through brain stem, cross at medial lemniscus, synapse in anterior horn of spinal cord
UMNs and LMNs
12
UMN
Pathway from brain to spinal cord before synapse. Do not directly stimulate target muscle
13
LMN
Post synaptic pathway from spinal cord to periphery. Directly stimulate target muscle
14
Diencephalon
All structures with "thalamus": thalamus, hypothalamus, epithalamus, subthalamus.
Connects endocrine with nervous and limbic systems
15
Disorders of basal ganglia
Parkinsonism: tremors (degeneration of this and substantia nigra)
Chorea: sudden, jerky, purposeless movements
Athetosis: slow writhin, snake like movements
Hemiballismus: Wild flail of one arm
16
Review of sys questions for neurological patient
Pain
HEENT: HA, vision chnages, dizziness
Neuro: tremor, weakness or sensory loss, LOC, motor dysfunction, speech/swallowing issue
17
Mental status exam
Family hx of memory loss
Orientation
General info
Spelling
18
Cranial nerves
CN 7: have them smile to test for stroke
19
Basic labs
CBC, CMP, TSH, bedside glucose
Lumbar puncture, CT, MRI
20
Ischemic stroke
Due to thrombosis (or emboli, lacunar, TIA)
Sxs: embolic-- acute onset, during day, headache precedes neuro deficit
Thrombotic--slower onset, during night, without headache/pain/fever
Lacunar--hemiparesis
21
Risk factors for stroke
Prior stroke, age, male, smoking, cocaine, family history
22
Labs for ischemic stroke
1st: CT
2nd: MRI
3rd: bedside glucose testing
23
Hemorrhagic stroke
Intracerebral and subarachnoid. 20% of strokes
24
Intracerebral hemorrhage
Usu HTN (trauma, brain tumor)
Sxs: headache, nausea, impairment of consciousness
Severe presentation!
25
Subarachnoid hemorrhage
Usu ruptured aneurysm
Sxs: sudden, severe headache with LOC, severe neurologic deficits, seizures
26
Delirium
Sudden, days-weeks, due to infection/dehydration/drugs, reversible, poor attention
May be changes in personality, confusion
27
Dementia
Slow, progressive, LOC not impacted
Etiology:
Alzheimer's, vascular, Lewy Body, Parksinson Dz, HIV assoc dementia, frontotemporal dementia
28
How to diagnose dementia?
History w mental status, PE with complete neuro, TSH/B12/CBC/LFT/HIV, CT/MRI
Requires:
1. Cognitive or behavioral changes (aphasia, agnosia, apraxia)
2. Decline
3. Rule out delirium
29
Alzheimer's Disease
Beta amyloid deposits and neurofibrillary tangles (tau) and Ach def. Must be >40yrs to be diagnosed. Half of people >85 yrs.
Risk factors: age, family history, trisomy 21
30
To diagnose Alzheimer's Dz
Dementia established clinically
Deficits in > 2 areas of cognition
Gradual onset and progressive worsening of memory
No disturbance of consciousness
Onset after 40, most after 65 yrs
No systemic or brain disorders
31
Risk factors for vascular dementia
HTN, DM, hyperlipidemia, smoking, strokes
32
Vascular dementia signs and symptoms
Exaggerated DTRs, gait abnormalities, hemiplegias
History: of stroke(s)!
33
Lewy body dementia
Lewy bodies in cytoplasm of cortical neurons. Cognitive and extra pyramidal Sxs within one year. Rigidity of axial muscles with gait instability, symmetrical deficits, tremors
34