3/25 neuro Flashcards
Retinitis
- seen in who?
- common causes?
- immunosuppressed.
- CMV, HSV, HZV
Central retinal artery occlusion
- painful?
- how about macula?
- not painful
- cherry red macula (has collateral circ).
Diabetic retinopathy
-what are the 2 types?
- Non-proliferative: dmged caps => lipids/fluids leak into retina => hemorrhage & edema => Tx: sugar control + laser.
- Proliferative: chronic hypoxia => neovasc. => messes up retina => Tx: anti-VEGF, periph. retinal photocoag.
Where is aqueous humor thats first made pumped into?
posterior chamber
Glaucoma
-what is it?
- progressive atrophy of optic disc w/characteristic cupping.
- usually w/inc. intraocular pressure (pressure atrophy to optic disc).
- progressive peripheral visual field loss.
Open angle glaucoma
-painful?
no, its painless.
Narrow angle glaucoma:
-secondary: whats the cause?
-hypoxia from retinal disease (e.g., diabetes, vein occlusion) induces vasoproliferation in iris that contracts angle.
Narrow angle glaucoma: acute closure:
- Sxs:
- can you give epinephrine?
- very painful.
- halos around lights.
- rock-hard eye
- frontal headache
- do NOT give epi bc of its mydriatic effects (alpha-1).
Dilator pupillae
-under what receptor control?
alpha-1
Fructose intolerance
-cataracts?
NO cataracts!
Cataract
-risk factors
- excessive sunlight
- alcohol, smoking
- prolonged corticosteroid use
- classic galactosemia, galactokinase deficiency, diabetes.
CN 3 damage
-do you get mydriasis or miosis?
mydriasis
Problems going down stairs, may present with compensatory head tilt in the opposite direction.
-whats the problem?
CN 4 palsy
Sup & inf. rectus
-to have them aligned w/their axis, does eye need to be adducted or abducted?
-abducted about 23 degree.
sup & inf. oblique
-to have them aligned w/their axis, does eye need to be adducted or abducted?
-adducted
Miosis
- whats the muscle?
- run me thru the route of para fibers: nuclei & nerves.
- EW nucleus = para/pre
- CN3
- Ciliary ganglion = para/post
- short ciliary nerves
- pupillary sphincter muscles
ciliospinal center of Budge (C8–T2)
-what is it?
- part of lateral horn
- part of sym. inn. to cause miosis pathway.
- receives input from hypoT.
Nerves involved in miosis of eye?
CN3, short ciliary nerves.
Nerves involved in mydriasis of eye?
long ciliary nerve
Marcus Gunn pupil
- wheres the lesions?
- how do you test?
- afferent pupillary defect—due to optic nerve damage or severe retinal injury.
- both eyes are typically not affected, just one.
- “swinging flashlight test.”
Marcus Gunn pupil
-Sxs:
-dec. bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye.
pupillary light reflex
-order of events?
CN 2 => pretectal nucleus => EW nucleus => CN3 => ciliary ganglion => short ciliary nerves => pupillary sphincter => miosis.
CN3
-components?
motor & para
Problem w/right MLF =
-palsy of right medial rectus w/attempted left lateral gaze.
right INO:
- which eye is paralyzed?
- what will happen w/non-paralyzed, abducting eye?
right.
-Abducting eye gets nystagmus (CN VI overfires to stimulate CN III).
Medial longitudinal fasciculus
-more or less myelin than usual?
highly myelinated
-its gotta work fast.
INO
-convergence affected?
no, convergence is normal.
Familial Alzheimers: early onset
- which proteins?
- which chroms these proteins located on?
- APP (Chr 21)
- presenilin-1 (Chr 14)
- presenilin-2 (Chr 1)
Familial Alzheimers: late onset
- which proteins?
- which chroms these proteins located on?
- ApoE4 (Chr 19)
- ApoE2 (Chr 19) is protective.
Intracranial hemorrhage in Alzheimers
-why?
amyloid angiopathy
Neurofibrillary tangles
- what are they?
- what do they correlate with?
- what disease are they found in?
-intracellular hyperphosphorylated tau protein = insoluble
cytoskeletal elements.
-tangles correlate with degree of dementia.
-Alzheimers disease
*Pick disease also has Tau protein, but not in neurofibrillary tangles.
Alzheimers
-which memory losst? recent or distant?
Begins w/recent memory, progress to distant memory.
ApoE4 allele
-why does it lead to Alzheimers?
-ApoE4 allele inc. conversion of APP to A-beta amyloid.
Pick disease
- which areas of brain affected?
- what are pick bodies?
- frontotemporal dementia
- pick bodies = spherical tau protein aggregates
Pick disease
-major Sxs?
- frontal cortex damage => behavior problems
- temporal cortex damage => language problems.
Pick disease has clinical features similar to the features
of Alzheimer disease, but initially it causes less memory loss and more behavioral changes.
Lewy body dementia
- compared to what disease?
- what are lewy bodies made of?
- presentation:
- Parkinsons disease w/early onset (1-2 yrs) dementia.
- lewy bodies made of α-synuclein.
*Initially dementia and visual hallucinations followed by parkinsonian features.
Creutzfeldt-Jakob disease
- which protein is elevated & in what compartment?
- Sxs:
-elevated levels of 14-3-3 protein in CSF.
-Rapidly progressive (weeks to months) dementia
with myoclonus (“startle myoclonus”).
Spongiform cortex
-seen in what disease?
Creutzfeldt-Jakob disease
vascular dementia
- layers 3, 5, 6 of cortex = vulnerable to ischemia
- hippocampus also = vulnerable to ischemia
- knocking either of these out => dementia.
MS
-which HLA?
HLA-DR2
MS
- CSF findings?
- MRI findings?
- inc. protein (IgG) in CSF. Oligoclonal bands are diagnostic.
- Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis) with destruction of axons.
MS
-Tx:
-b-interferon, immunosuppression, natalizumab.
natalizumab
- what is it?
- what disease is it used in?
- risk of what?
- Ab against α4-integrin
- MS, Crohns
- Risk of PML in patients with JC virus
MS: Neurogenic bladder
- what is it? peeing too much or too little?
- tx:
- peeing too much, cant control bladder. “genic” means produce. So its a problem w/nervous system where you can’t control your bladder.
- catheterization, muscarinic antagonists
MS: spasticity
-Tx:
Baclofen
- only drug that uses GABAb (not GABAa) receptor complex. GABAb causes potassium efflux which also hyperpolarizes the cell.
- its an anti-spasmodic.
Baclofen
- only drug that uses GABAb (not GABAa) receptor complex. GABAb causes potassium efflux which also hyperpolarizes the cell.
- its an anti-spasmodic.
Charcot classic triad of MS:
- mnemonic?
- whats the triad?
SIIIN
- scanning speech
- INO
- intention tremor
- incontinence
- nystagmus
Guillain-Barré
- which cells are destroyed?
- mechanism?
- symmetric or asymmetric?
Schwann cells
- autoimmune attack of peripheral myelin due to molecular mimicry, inoculations, and stress.
- symmetric ascending paralysis
Guillain-Barré
-lab findings?
- inc. CSF protein with normal cell count (albuminocytologic dissociation).
- inc. CSF protein => papilledema.
Guillain-Barré
-Tx:
-plasmapheresis, IV immune globulins.
plasmapharesis
-what is it?
-plasma is what contains the Abs. So plasmapharesis removed the pts plasma and replaces it w/donor plasma.
surfical neck of humerus fx
-which nerve?
axillary n.
midshaft fx of humerus
-which nerve?
radial n.
head of radius
- where is this?
- what nerve is here?
- where radius connects to humerus
- radial n.
radial head subluxation
-what deficits?
wrist drop but no sensory deficits
-only damages the deep radial nerve, not the superficial.
meningioma or medulloblastoma
-which one is in kids?
medulloblastoma
which brain tumor has a fried egg histological appearance?
oligodendroglioma
Most common manifestation of alcohol withdrawal?
the “shakes”.
-tremulousness
Why does CNS undergo liquefactive necrosis?
large amount of lipids & lysosomal enzymes in nervous cells.
-also a lack of substantive supportive stroma in the CNS.
CN3: motor output:
-affected primarily by what?
vascular disease/ischemia.
-compromised vascular that resides on the outside of the nerve.
*as opposed to parasym output of CN3 which is usually affected by compression.
CN3: para output
-affected primarily by what?
compression
Brain infarcts
-usually resolve into cystic spaces filled w/what?
CSF
carotid atherosclerosis
-can cause what brain lesion?
embolic stroke!
hypoxic encephalopathy
- what is this?
- aka?
global cerebral ischemia
Why are neurons so sensitive to ischemia?
they dont store glycogen.
Global cerebral ischemia
-aka?
ischemic-hypoxic encephalopathy
Cardiac embolism to brain
-what would occur?
multiple infarcts in different vascular territories.
endoneural inflammatory infiltrate
-what disease?
Guillain barre
Senile plaques & amyloid angiopathy
-can these be seen in healthy elderly adults?
yes
Most common causes of dementia #1= #2=
#1 = Alzheimers #2 = Vascular dementia = multi-infarct dementia
Vascular dementia
-what is it?
multi-infarct dementia
diabetic distal peripheral neuropathy
- bilateral?
- symmetric?
yes, both bilateral and symmetric.
Vitamin E
- function?
- def can lead to what?
-primary fcn = protect membrane fatty acids from oxidation.
-hemolytic anemia, acanthocytosis, muscle weakness,
DC/ML & spinocerebellar demyelination.
temporal lobe encephalitis
-cause?
HSV-1
23 year old male w/bilateral hemorrhagic necrosis of temporal lobes.
HSV-1 temporal lobe encephalitis
tender scalp & pain when combing hair
-think of what?
temporal arteritis
*check the sed rate.
PML: inc. risk of reactivation JC virus w/what med?
-and whats that med for?
- natalizumab
- MS
Acute disseminated (postinfectious) encephalomyelitis
- what happens?
- associated w/what?
- Multifocal perivenular inflammation and demyelination after infection.
- associated w/measles or VZV or certain vaccinations (e.g., rabies, smallpox)
Metachromatic leukodystrophy
- cause:
- Sxs:
- inheritance pattern?
- Lysosomal storage disease = arylsulfatase A deficiency.
- Buildup of sulfatides => impaired production of myelin sheath.
- central and peripheral demyelination with ataxia, dementia.
Metachromatic leukodystrophy
-inheritance pattern
-Autosomal recessive
Charcot-Marie-Tooth disease
- aka?
- what is it?
- inheritance pattern?
- Hereditary motor and sensory neuropathy (HMSN).-
- inherited peripheral neuropathy.
- auto dom.
Charcot-Marie-Tooth disease
- problem?
- associated w/?
- commonly involved nerve?
- mutation in myelin protein gene.
- scoliosis & foot deformities
- common peroneal nerve
- PED: peroneal = evert & dorsiflex.
Krabbe disease
- what is it?
- deficiency of what enzyme?
- whats built up & what does it damage?
- lysosomal storage disease
- deficiency of galactocerebrosidase
- Buildup of galactocerebroside and psychosine destroys myelin sheath.
Krabbe disease
- inheritance?
- Sxs/findings:
- auto recessive
- peripheral neuropathy, developmental delay, optic atrophy, globoid cells.
Krabbe disease
-aka
-globoid cell leukodystrophy
Adrenoleukodystrophy
-whats the problem?
Disrupts metabolism of very-long-chain fatty acids => excessive buildup in nervous system, adrenal gland, and testes.
-Progressive disease that can lead to long-term coma/death and adrenal gland crisis.
Partial (focal) seizures
- most commonly originate where?
- often preceded by what?
- medial temporal lobe.
- often preceded by seizure aura.
Partial (focal) seizures
-what are the 2 types?
1) Simple partial (consciousness intact)- motor, sensory, autonomic, psychic
2) Complex partial (impaired consciousness) - lose memory of the event.
Partial (focal) seizures
-Tx: 1st line:
-carbamazepine = 1st line Tx for partial-simple & partial-complex.
Generalized seizures
-name the 5 types
- Absence (petit mal)
- Myoclonic
- Tonic-clonic (grand mal)
- Tonic
- Atonic
Which type of seizure = grand mal?
-tonic-clonic
tonic = stiff clonic = movement
Most common cause of seizure
- child:
- adult:
- elderly:
- child: genetic
- adult: tumor
- elderly: stroke
Which headache is preceded by an aura?
migraine
*not cluster
Horner syndrome
-may be induced by what headache?
cluster
chronic pain from tension headaches
-Tx:
amitriptyline (TCA)
Migraine headache
-release of which chemicals?
Substance P, CGRP, vasoactive peptides.
*Calcitonin gene-related peptide
Migraine
-prophylactic therapies:
propranolol, topiramate, calcium channel blockers, amitriptyline.
Irritation of which CN can lead to migranie?
CN V
Peripheral vertigo
- wheres the lesion?
- Positional testing shows:
- inner ear pathology
- delayed horizontal nystagmus.
Ménière disease
-peripheral or central vertigo?
- peripheral
- too much endolymph.
Central vertigo
- wheres the lesion?
- Positional testing shows:
- cerebellar or brainstem lesion.
- immediate nystagmus in any direction; may change directions.
Ménière disease
-what freq of hearing loss? high or low?
low freq hearing loss
Which muscle attaches to the malleus & whats its innervation?
- tensor tympani
- V3
Kyphoscoliosis & high plantar arch.
-his brother had neuro problem & died at 25 of heart problem.
Friedreich Ataxia
spinocerebellar lesion
-Sx:
gait ataxia
-messes up proprioception.
myotonia
-define
abnormally slow relaxation of muscle.
-seen in myotonic dystrophy
myotonic dystrophy
- whats the repeat?
- whats the gene?
- gene product?
- CTG
- DMPK gene
- myotonin protein kinase
myotonia, muscle wasting, frontal balding, cataracts, testicular atrophy, arrythmia
-whats the disease?
myotonic dystrophy
myotonic dystrophy
-inheritance pattern?
auto dom
fatal familial insomnia
-example of what kind of disease?
prions
PML
-which cells are preferentially destroyed?
oligodendrocytes
Normal Pressure Hydroceph vs Alzheimers
-similar image, how to differentiate?
- NPH begins w/gait abnormality & urinary incontinence before the dementia kicks in. This is crucial to differentiating it vs. Alzheimers.
- Alzheimers can cause hydroceph. ex vacuo which can look similar to NPH on imaging.
communicating hydroceph vs NPH
-difference?
- NPH = chronic, happens in elderly. Gradual dec. in CSF resorption. So no inc. in ICP.
- CH = acute, so there is an inc. in ICP.
superior tarsal muscle
-aka?
Muller muscle
pyknosis
-irreversible condensation of chromatin in a cell undergoing necrosis or apoptosis.
what the active form of vitamin D called?
calcitriol
anticonvulsant to use in pregnancy?
phenobarbital
-high plasma protein binding
