Anderson Neuro Flashcards
Name the pathology:
Congenital communication between artery and vein, may occur anywhere, often cause chronic HA
AVM (arteriovenous malformation)
Name the pathology:
Congenital, anterior middle and posterior communicating arteries (circle of willis), sudden excruciating HA
Berry aneurysm
Name the pathology:
Results from diastolic BP over 120, grade 4 retinal changes, confusion/drowsiness/HA/nausea. Complications include rupture and hemorrhage
Hypertensive encephalopathy
Which two venous sinuses are often responsible for infections leading encephalitis?
Pterygoid plexus and cavernous sinus (drain cellulitis, sinusitis, ear infections)
Name the histology:
Acute necrosis of neurons, change before death of neurons
Red neurons
Name the virus related to the cellular inclusion:
Cowdry body
Negri body
Herpes
Rabies
Name the CN 1-12
Olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, auditory, glossopharyngeal, vagus, spinal accessory, hypoglossal
Which CN stem from midbrain?
3-4
Which CN stem from pons?
5-8
Which CN stem from medulla?
9-12
What is the order of the brain stem top to bottom?
Midbrain, pons, medulla, spinal cord
Which CN provides olfaction to the nose? Sensation/pain stimulus?
CN I
CN V
What secondary messenger is used in olfaction? In vision?
cAMP (most of the brain uses this)
cGMP (unique to vision)
When pupils react to light, what CN is being tested?
CN 2 - afferent fibers respond to light
CN 3 - efferent fibers contract sphincter pupillae muscles
Rods vs. Cones
Rods: night vision, higher sens, lower activity
Cones: color vision, lower sens, high activity
Describe the flow of aqueous humor in the eye.
1) Produced by the ciliary body
2) Flow out to anterior chamber between pupillary sphincter muscle and lense
3) Drain through the trabecular meshwork and out the Canal of Schlemm
Cones and rods face which direction with respect to the retina?
They face the pigmented layer, same direction as the light coming in.
What type of visual defect would occur with the following lesions?
Between the optic chiasm and left eye.
In the optic chiasm.
Between the optic chiasm and the lateral geniculate body on the left.
Anopsia of the left eye
Lateral (temporal) hemianopsia bilaterally
Right sided hemianopsia bilaterally
Accommodation of lens to near and far vision.
Near - ciliary muscle contracted, zonula fibers relaxes, lens rounded, focal length short. (sympathetic)
Far- ciliary muscle relaxed, zonula fibers tense, lens flat, focal length far (parasympathetic)
What muscle does CN4 control and what does it do? CN6?
CN4: Sup Oblique - down and out movement of eye
CN6: Lat Rectus m. - lateral eye movement
What are the three divisions of CN V?
Opthalmic, maxillary, mandibular
What CN are tested in the “Corneal Blink Reflex”?
CN-5: Sensory afferent
CN-7: Motor efferent
What two foramen does CN 7 go through? How does this relate to Bell’s palsy?
Stylomastoid foramen and internal acoustic meatus.
Prior to onset of Bell’s palsy - hyperlacrimation and salivation. Proposed mechanism swelling in and around stylomastoid foramen.
What activities is CN 9 responsible for?
Swallowing, parotid gland, post 1/3 of tongue (touch/taste)
Post tongue usually sour/bitter
What CN is responsible for touching your tongue to the roof of your mouth?
CN 10
What CN provides taste to front 2/3 of tongue? Touch?
CN 7 - taste, ant tongue usually salty/sweet
CN 5 - touch
What are the two branches of CN8?
Vestibular and cochlear
In pathological nystagmus, what causes horizontal nystagmus? vertical nystagmus?
Horizontal - vestibular dz
Vertical - brainstem dz
Na+ rich: perilymph or endolymph
K+ rich: perilymph or endolymph
perilymph
endolymph
Lateral geniculate body: vision or hearing
Medial geniculate body: vision or hearing
Vision
Hearing
CN 10 actions.
Taste around epiglottis, swallowing, lifts palate, larynx (speech), gag reflex, elevates tongue
What two muscles are supplied with efferent CN 11?
SCM, trapezius
What CN supplies motor function to tongue?
CN 12
Wernicke’s area causes ________ aphasia.
Broca’s area causes ________ aphasia.
Sensory - difficulty understanding written/spoken language. Word Salad.
Motor - speech/writing affected, understanding intact
Tongue is broken.
Dorsal horn carries ______ afferents.
Ventral horn carries ______ efferents.
Sensory
Motor
Name the muscle: C5 C6 C7 C8 T1 L4 L5
Biceps/Deltoid Brachioradialis Triceps Finger flexors Interossi Patellar Foot dorsiflex
Which nerve fibers are the largest and fastest?
A-alpha fibers
Which nerve fibers are small and slow and are often a part of the autonomic nervous system?
B fibers
Which nerve fibers are the slowest and smallest responsible for pain and temperature?
C fibers
What is the action of the golgi tendon organ?
Measures tension and inhibits alpha-motor neurons. Protects against stretch
Name the specialized receptor:
Vibration
Movement
Pressure
Pacinian
Meissner’s
Merkel
UMN or LMN: Spastic paralysis and little atrophy Fibrillation and hyporeflexia Positive babinski Flaccid Paralysis
UMN
LMN
UMN
LMN
Which nerve system is responsible for pain, thermal, crude touch/sensation, tickle, itch, sexual sensation?
Antrolateral - “anything the dorsal does with lower sensitivity”
Name the sensory pathway:
Pain/Temp
Conscious proprioception
Light touch
Spinothalamic
Fasciculus Cuneatus Gracilis (to Medial Lemniscus)
Spinothalamic and Medial Lemniscus
Where do “fast” pain fibers end up? “slow” pain fibers?
Somatic sensory areas
Thalamus
Where is CSF synthesized?
Choroid plexus epithelium
Does an UMN or LMN decussate in the spinal cord at the level of action?
UMN
Which amines are directly excitatory?
Glutamate, aspartate
Which amines are directly inhibitory
GABA, glycine, serine, alanine, cystathionine
Which amines are directly inactive?
Glutamine, lysine, threonine, leucine.
What brain transmitters are considered uppers?
Serotonins, Ach, NE, Epi, Dopa, Glycine
What brain transmitters are considered downers?
GABA, NO, Histamine, Histamine, Neurosteroids, Glycine
Is sulfite or sulfate the toxic metabolite?
Sulfite (often problem converting in people with sulfite sensitivity)
Requires Molybdenum
What vitamins are required for methylation steps?
B9 and B12
What enzymes creates Ach? What enzyme metabolizes Ach?
Choline acetylase
Acetylcholinesterase - most pesticides are inhibitors of this enzyme
In the diencephalon, serotonin can be converted to…
Melatonin - in the pineal gland, requires B5, B12/B9
What are the steps of converting tryptophan to Serotonin?
Tryptophan (tryptophan hydroxylase)
5-HTP (requires B6)
Serotonin
Circadian periodicity is driven by what what part of the hypothalamus that receives input from the retina?
Superchiasmatic nucleus
What enzyme converts phenylalanine to tyrosine? What cofactors does it require?
Phenyl-Hydroxylase
Cofactors: B3, Fe, Biopterin
What enzyme deficiency causes phenylketonuria?
Phenyl-Hydroxylase
Normal at birth, develops high levels of phenylalanine through diet leading to retardation.
What are three major products of tyrosine?
Dopa/NE/Epi, Thyroid Hormone, Melanin
*can also go into Kreb’s cycle
What cofactors are required for conversion of NE to Epi (in the periphery)? L-Dopa to Dopamine (in brain)? Tyrosine to L-Dopa (in brain)?
SAMe, B12, Folate
B6, B1
B3, Fe, Biopterin
What is the main enzymes that metabolize catecholamines?
COMT - Catecholomethyltransferase
MAO - Monoamine oxidase
What is the most important intermediate in the breakdown of catecholamines?
VMA - vanillylmandelic acid
Excreted in urine.
If does not go through VMA, glucuronidation/sulfation in liver.
What two amino acids form NO? What is the enzyme?
Arginine (donates the NO) and Citrulline
NO synthase
What secondary intermediate is associated with NO? What systems does it affect?
cGMP
Retina- photoreception
Vascular SM- vasodilation
AMPA- desensitization
What enzyme and cofactors are required to convert histidine to histamine?
Histidine decarboxylase
B1
What are the steps of histamine metabolism? What cofactors are required?
Histamine methyltransferase (requires B12/Folate) MAO Aldehyde dehydrogenase (requires B1)
What enzyme is required to convert glutamic acid to GABA?
Glutamic acid decarboxylase (requires B1)
What are two components of the motor afferent that filter information coming from the motor cortex?
Basal ganglia (nucleus) Cerebellum
Where does pathology in movement disorders often lie?
In the filtration: basal ganglia/cerebellum
Name the function:
Vestibulocerebellum
Pontocerebellum
Spinocerebellum
Balance, eye movement (Romberg’s test)
Planning and initiation of movement
Controls rate, force, range, and direction of movement
What two neurotransmitters are used primarily by the basal nucleus?
Dopamine (excitatory)
GABA (inhibitory)
Pathogenesis of Huntington’s
Loss of GABA containing neurons
Genetic, 20-50yo
SSX: choreaform, uncontrolled hyperkinetic movements, dementia
Pathogenesis of Parkinson’s
Damage to substantia nigra (AI or toxic)
SSX: Festinating (wide, shuffling) gait, cog-wheel rigidity, pill-rolling resting tremor
Pathogenesis of ALS
Loss of both UMN and LMN.
Autosomal dominance
SSX: muscular atrophy, weakness, hyper-reflexia, mixed presentation, flaccid paralysis.
What neuro condition is associated with Tabes Dorsalis?
Tertiary Syphilis - spirochetes destroy dorsal roots
Can also cause asymptomatic meningitis
What is the M/C organism in the following age groups: 0-4wks 4-12wks 3mo-18y 18y-50y >50y
E. Coli, L. monocytogenes, grp B streptococcus
S. pneumoniae, grp B streptococcus, E. coli, L. monocytogenes
N. meningitidis, H. influenzae, S. Pneumoniae
N. meningitidis, S. pneumoniae
S. pneumoniae, N. meningitidis, L. monocytogenes, gm -
Children or adults:
Above the tentorium cerebelli
Below the tentorium cerebelli
Adults
Children
Most aggressive/malignant primary brain tumor in adults.
Glioblastoma Multiforme
Autoimmune CNS demyelinating disorders.
MS
Ascending paralysis after viral infection. Peripheral demyelination.
Guillain-Barre Syndrome
List three dysmyelination disorders (leukodystrophies)
Adrenoleukodystrophy
Metachromic leukodystrophy (MC)
Krabbe’s disease
What deficiency causes Wernicke-Korsakoff syndrome?
B1 - usually due to alcoholism (alcohol dehydrogenase, B1 dependent)
What deficiency causes Pellagra?
Niacin (B3)
What are some SSX of B12 deficiency?
Macrocytic anemia, dementia, degeneration of the spinal cord
Name the disease: cortical atrophy, neurofibrillary tangles, plaque deposition. MC cause of dementia.
Alzheimer’s Disease
Name the lysosomal storage disease:
Hexosaminidase A deficiency, death by 4y
Can’t degrade mucopolysaccharides, death by 6-10y
Alpha-glucosidase deficiency - can’t break down glycogen
Tay-Sachs Dz
Hurler’s Dz
Pompe’s Dz
Name the pathology: Autosomal recessive, toxic levels of copper storage, deposition in liver/brain/eye, Kaiser-Fleisher rings.
Wilson’s disease
