anatomy Flashcards
T1W brain MRI
CSF dark
white matter white
grey matter grey
gandolinium BRIGHT
good view of anatomy
T2W
CSF bright
inflammation or injury bright
white and grey matter SWAPPED
good to look at inflammation and injury, but not the best since CSF is also bright
T2W Flair
T2W but CSF is blacked out making it SUPER easy to see pathology (strokes, inflammation, white matter disease) - this is the go to!
DWI
STROKE view, will be BRIGHT; pair with ADC image, will make acute stroke lesion dark - if bright in both then it is a chronic process
T2 series
microhemorrhages
dural sinus thrombosis
essentially DVT surrounding the brain; evaluate with venography
CTA
arteries of head and neck
limitation of CTA
pt with poor renal function GFR < 30
how long for ischemic stroke to be visualized in CT
up to 6 hrs; best used to evaluate hemorrhagic
subdural hemorrhage
bridging veins
old patient
epidural hemorrhage
middle meningeal artery
risk of herniation
surgical drainage
skull fracture/trauma
what makes an enhanced CT?
Is there contrast in the blood vessels?
Which structure on MRI can you look to determine type?
Corpus collosum - should be white; cortex should be grey
achilles reflex
S1 + tibial
patellar reflex
L2,3,4 + femoral
brachioradialis reflex
C5,6
biceps reflex
C 5,6 + musculocutaneous
triceps reflex
C 6,7
finger jerk
C8
pectoral reflex
C5
medial hamstring reflex
L5
carpal tunnel syndrome is impingement of this nerve
median
shoulder abduction
C5 + axillary
elbow flexion
C5,6 + musculocutaneous
elbow extension
C6,7 + triceps
wrist extension
C6,7 + radial
finger extension
C7,8 + radial
wrist flexor/pronato
C6,7 + medial/ulnar
distal thumb flexors
C8 + median
finger abduction
C8,T1 + ulnar
hip flexion
L1,2 + femoral
hip abduction
L5 + superior gluteal
hip adduction
L2,3,4 + obturator
knee extension
L2,3,4 + femoral
knee flexion
L5, S1 + sciatic
ankle dorsiflexion
L4,5 + deep fibular
plantar flexion
S1,2 + tibial
toe extension
L5 + deep fibular
ankle inversion
L5 + tibial
NMJ disease, automimmune, CXR to evaluate thymus, attack of ACh receptor, fatigable weakness - diplopia and ptosis, scary risk of breathing issues, worsened by many abx
Myasthenia Gravis
dysfunctional peripheral nerve myelin; weakness, atrophy and sensory loss; foot deformity
CMT; type 1A is common AD type w/ loss of intrinsic hand and foot muscles
sporadic myopathy, weakness, elevated CK, muscle tenderness and atrophy, dx with muscle biopsy and EMG
inclusion body myositis (if rash, would need to rule out dermatomyositis)
immune mediated inflammation, peripheral nerve myelin of spinal nerve roots, recent GI or respiratory infx, ascending weakness, tx with IVIG and plasma exchange, CSF with cytoalbuminologic dissociation, EMG/NCS 2wks following
Guillan Barre
fatigue, focal onset weakness, muscle wasting, brisk reflexes, fasiculations that progress over time; UMN and LMN, EMG/NCS critical to dx, Riluzole to delay symptoms + symptom mgmt
ALS
progressive muscle weakness, X-linked genetic conditions, dysfunction in muscle protein leading to breakdown and replacement by fatty tissue, elevated CK, cardiomyopathy, prednisone delays progression
muscular dystrophy; Duchenne develops YOUNG, whereas Becker can present later and progress slower
initial labs for peripheral neuropathy
B12, A1C, Thyroid function, serum electrophoresis + immunofixation, ESR
causes to consider if rapid onset of neuropathy, 1 month or less
toxin/drug, GBS, infection, vasculitis, prophyria
rx to lessen neuropathy
tricyclics (amitryptaline), venlafaxine/duloxetine, gabapentin/pregabalin, topical lidocaine/capsaicin, carbamazepime
pernicious anemia and nitrous oxide are common causes of _____ deficiency
B12
B12 deficiency leads to high levels of ____
Methylmalonic acid (MMA) - toxic to nerves
low B12/high MMA causes
peripheral neuropathy + degeneration of dorsal colums ( ataxia, proprioceptive loss) + corticospinal tract degeneration ( weakness)
corticospinal tract
motor
ventral horn
motor tracts
sudden onset right hemiplegia and aphasia
left cerebral hemspheric infarction
papilledema and subacute onset amenhorrhea and bitemporal hemianopia
pituitary tumor
weakness of right abductor pollicis brevis and numbers of the first 3 1/2 digits of hand
median neuropathy/CTS
progressive diffuse weakness, atrophy, fasciulation, spasticity + loss of anterior horn cells and degeneration of corticospinal tracts
ALS
progressive loss of virbation and propriocipeton in B12 deficiency is due to syfunction in
posterior colum
delirium, mydriasis, hypertension, dry mouth, urinary retention, constipation
atropine overdose, blockade of muscarinic cholinergic receptors
these sx are due to damage where?
CN deficits, imparied LOC, crossed or bilateral mortor or sensory deficits
brainstem
lesion here would cause ataxia, tremor, nystagmus
cerebellum
lesion here would cause LOC or memory disturbances, hemisensory loss and/or pain, hemiataxia, neglect or aphasia
thalamus
lesion here would cause chorea, athetosis, dystonia, tremor, rigidity
basal ganglia
symptmos of enecephalopathy (cerebral cortex)
hemilgeia and/or hemisensory loss, apphasia, neglect, hemianpia, dementia, seziure
if patient has apahasia, where can you locate the lesion
dominant hemisphere (left for 95% of people)
where is fascial nerve nucleus located
pons
if patient has upper and lower fascial weakness, where could lesion sbe
pontinue or peripheral nerve
these two CN pass through cerebelloponinte anlge which could be compromised by a tumor
VII and VIII
weakness, twitching and cramping are the most common symptoms of this motor neuron disease
ALS
motor neuron diseases that affect LMN older
spinal muscular atrophy, spinobulbar muscular atrophy, viral (polio, HIV, westnile), rare paraneoplastic syndromes
motor neuron disease affecting mixed LMN and UMN
ALS
motor neuron disease that affects UMN only
primary lateral sclerosis
ALS Crorf72 can also have
frontotemporal dementia
difficulty swallowing due to neuromuscular etiology likely to present as difficulty swallowing _____
liquids
if mechanical cause of swallowing, will have difficulty with ____
solids
dementia associated with ALS
frontotemporal dementia
3 sites of pathology in ALSO
loss of anterior horn cells, degeneration of corticospinal tract, loss of betz cells in the cortex
OTC migraine sx tx
naproxen, excedrin, advil
DHE is what type of abortive migraine tx
ergotamine
