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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

Parksinson Dz Dementia

Motor Sxs then 10-15years later cognitive Sxs. Psychiatric Sxs uncommon
Definitive diagnosis requires autopsy