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Neurology > Brain > Flashcards

Brain Flashcards

1
Q

Bulbar is? Nucleus included?

A

MEDULLA

9 10 11 12 nerve nucleus

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2
Q

What is pseudo bulbar palsy

A

Lesion above the bulbar region— CORTICOBULBAR TRACT

UMN

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3
Q

Bulbar vs Pseudobulbar palsy

A

Both have Dysphagia and Dysarthria
But Bulbar palsy ++++ severe (flaccid)

Rest features are only seen in Pseudobulbar palsy

LABILE EFFECT**
(Uncontrolled emotions)

GAG REFLEX +++ (brisk)
(Sensory by 9th nerve- Coughing motor by 10th nerve)

JAW JERK +++

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4
Q

Which conditions Jaw jerk is brisk?

A

MS
Neurodegenerative disorders
Pseudobulbar palsy

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5
Q

Trigeminal nerve Sensory and Motor functions

A

Sensory- CORNEA (V1)
FACE (V2)

Motor- MASTICATION (Mandible-V3)

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6
Q

Lemniscus if Trigeminal nerve and Auditory pathway

A

Trigeminal lemniscus

Lateral lemniscus

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7
Q

End nucleus of Trigeminal nerve pathway

A

VPM nucleus of THALAMUS

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8
Q

Where are nuclei (Sensory and motor ) of TGN located

A

PONS

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9
Q

Total nuclei of TGN

A

4

Spinal nucleus

Primary sensory nucleus

VPM

Primary Motor nucleus

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10
Q

Lemniscus of any tract, nature of affected side?

A

ALWAYS CONTRALATERAL

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11
Q

Motor nuclei examples

A

7th—SMILE (Rizorius)

5th—Masticate

10th—Deglutition

12th— Articulation

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12
Q

Jaw jerk root

A

CN5

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13
Q

Tic doloreux

A

Trigeminal NEURALGIA

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14
Q

Mc branch involved in TGN

A

Maxillary&raquo_space; Mandible

Lc= Opthalmic

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15
Q

Clf TGN

A

Lips Cheek Gums

30s-2min

Mc complaint- Pain while washing face

Attack ppt on chewing

Pt is lucid in between attacks

DOC- CBZ

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16
Q

UMN facial paralysis features

A

C/L lower 1/3 gone

FRONTALIS AND O.OCULI SPARED

BUCCONATOR/ZYGOMATICUS/ORIS GONE

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17
Q

LMN facial palsy features

A

7th nerve gone at the tip

I/L half face gone

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18
Q

U/L Etiology if FNP

A

Trauma

HZV (RAMSAY HUNT***)

Idiopathic (BELLS PALSY)

MELKERSON-ROSENTHAL SYNDROME***
-recc FNP with permanent Facial edema

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19
Q

B/L etiology of FNP

A

GBS
HIV
SARCOIDOSIS

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20
Q

Lacrimal glands receive parasympathetic supply from which nerve

A

FACIAL

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21
Q

Cranial nerve nuclei location

Motor= medial

A 
3 = sup col— Midbrain
4 = Inf col—Midbrain

5s&m—Pons
6 -Pons
7- Pons

8- Lateral junction of Pons and medulla

9-10-11= NAmbiguus—Lateral Medulla
12= Medial medulla

7-9s = NTS—- Lateral medulla

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22
Q

Lateral midbrain damage which nuclei compromised

A

NA + NTS + 5th sensory

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23
Q

Midbrain syndromes

WCB

A

WEBER

CLAUDE

BENEDIKT

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24
Q

Pons Syndromes

MFM

A

Miillard Gubler

Fov-illes

Marie fox

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25
Q

Medulla syndromes

A

Medial medullary

Lateral medullary (WALLENBERG)

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26
Q

WEBER SYNDROME

A

CN3 I/L

FrontoPontine fibres—7th CN UMN

CST — C/L weakness (As crosses below at medulla)

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27
Q

CLAUDE SYNDROME

A

Red Nucleus—C/L ATAXIA

3CN I/L

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28
Q

Benedikt syndrome

A

Claude + Weber

29
Q

Millard Gubler syndrome

A

6th CN I/L

7th CN LMN

CST —C/L weakness

CROSSED HEMIPARESIS*****
(Half face-CN7 ; and other half body-Cst)

30
Q

Fov Illes syndrome

A 
Millard Gubler
         \+
Medial lemniscus- C/L loss of DC tract
         \+
MLF lesion - INO+
31
Q

Marie Fox Syndrome

A

ST traxt

5th sensory (I/L face sensation)

MCP(Middle cerebellar peduncle)- ATAXIA

32
Q

Medial medullary syndrome

A

CST- C/L weakness

Medial Lemniscus- C/L DC tract

12th CN- I/L : TONGUE TOWARDS LESION

33
Q

WALLENBERG SYNDROME cause and features

A

Occlusion of
Vertebral A > PICA

8th CN (I/L) - ATAXIA & Vertigo

ICP- Ataxia

5th sensory- I/L

N. ambiguus- Hoarseness

ST- C/L loss of pain and temp

Sympathetic trunk- HORNERS (I/L)

CROSSED HEMIANESTHESIA***
(TGN face ; Other half of body ST tract)

34
Q

Function of Spino cerebellar tract

A

SUBCONCIOUS PROPRIOCEPTION
(Unknowing flexion and extension of Knee while walking)

Posterior SCT- FINE** movement

Anterior SCT- GROSS** Movement

35
Q

Types of ataxia

A

Friedrich Ataxia

Tabes dorsalis

SACD

36
Q

Friedrich’s Ataxia tracts involved?
DTR?
BABINSKI?

A

DC
CST(UMN)
SCT

DTR -ve (As 1st involved = DRG-Prevents ‘VIBRATION’ of sensory component of reflex from reaching the cortex)

Babinski +ve (Superficial reflex—Crude touch is taken up by STT and thus reflex +)

37
Q

Titubation (Tamhankar) and frequent falls are characteristics of which ATAXIA

A

FREIDRICH

38
Q

Diseases a/w FA

HOS-DVP

A

HOCM (mc)

Optic Atrophy

SCOLIOSIS***

DM

Vit E deficiency

Pes Cavus

39
Q

Genetics of FA

A

Trinucleotide repeats- GAA > 200

AR

Chr 9- FRAXATIN gene***

40
Q

Tracts involved jn TABES (emaciated) DORSALIS

DTr?
Babinski?

A

DC only

DTR -ve

Babinski -ve

41
Q

TD a/w which diseases

A

Neurosyphillis (ARGYLL-Rob pupil)

Bladder disturbances

Acute abdomen& Visceral symptoms

HIGH STEPPAGE GAIT
(typical of DC lesion)

42
Q

SACD Tracts?
DTR?
Babinski?

A

DC
CST (UMN)
Peripheral Nerves (late)

DTR: +ve —> -ve

Babinski: +ve

43
Q

SACD diseases

A

B12 def

Megaloblastic anemia

44
Q

D/D SACD

A

HYPOCUPRIC MYELOPATHY

Causes reversible dementia

45
Q

Neuropathies list?

A

GBS- AIDP , AMAN , AMSAN , MFS

CIDP

CMT

46
Q

Organisms causing GBS

A

Campylobacter (mc)

HIV
HHV
EBV
CMV
HepE
Zika
47
Q

Vax causing GBS

A

Rabies

Influenza

48
Q

Cl/f GBS

A 
Ascending paralysis (Flaccid/Symmetrical)
-Max at 4wks

Arreflexia

Minor sensory loss

Mc CN affected= 7th (LMN) (B/L) —50% pt

Bladder involvement 
(ONLY in severe cases/ transient)
49
Q

AIDP features (Acute inflamm Demy Polymeuropathy)

A

MC type

Motor»Sensory

Ab= Anti GM1 Antibodies—> attack shwann cells (cross reaction)

50
Q

AMAN (Acute Motor Axonal Neuropathy) features

A

Only motor involvement

Ab= Anti GM1b & Ga1a (IgG)— attack Node of Ranvier

51
Q

AMSAN (Acute Motor Sensory axonal Neuropathy)

A

Motor and sensory involvement

Ab = Gm1b Ga1a GD1a—Attack NOR

WORST PROGNOSIS***

52
Q

MFS (Miller Fischer Syndrome) features

A

5% GBS pt

Arreflexia + Opthalmoplegia + Ataxia

WEAKNESS is -ve ***

Ab = GQ1b— Attack shwann cells

53
Q

Ix in GBS

A

Brighton Criteria

1) NERVE CONDUCTION STUDY
- Slow velocity
- Dec AP
- F waves absent***

2) CSF Analysis
- Albumin INCREASE**
- Pleocytosis -ve

ACD+ (ALBUMINO-CYTOLOGICAL DISSOCIATION)—48 hrs after onset of weakness

54
Q

Rx GBS

A

IVIG- 2g/kg over 5 days

Plasma pheresis

Both equally effective— given within 14 days

STEROIDS ARE NOT RECOMMENDED

55
Q

CIDP definition

A

Progression of weakness beyond 9 weeks

> 3 relapses

56
Q

CIDP C/f

A

WEAKNESS

  • symmetrical
  • Asymmetrical : LEWIS SUMNER SYNDROME***

Multifocal Acq Demyelinating Sensory Motor Neuropathy (MADSAM) = Lewis Sumner syndrome

57
Q

Ix CIDP

A

CSF- ACD+

Nerve Bx- ONION BULB APP***

58
Q

Rx CIDP

A

IVIG

PLASMAPHERESIS

STEROIDS

59
Q

CMT (Charcot Marie FOOT Neuropathy)

A

4 types present

CMT1:

  • AD
  • 10-30 y
Symptoms :
FOOT DROP** (mc)
Paresthesias
DTR reduced
Sensory loss +

ATROPHY BELOW KNEE (inverted Champagne bottle)

Nerve conduction rate reduced to 20-25m/s

ONION BULB APP***

60
Q

Genetics DMD

A

XLR

Dystrophin protein misfold (Sub-sarcolemmal protective protein)

61
Q

Pathology of DMD

A

Deletion at 5’ end of SHORT ARM OF X Chr—-x Dystrophin gene —-No dystrophin—-2° loss of SARCOGLYCAN & DEXTROGLYCAN—Muscle atrophy

62
Q

C/F of DMD at 6y 8y 12y 18y 25y

A

Onset at 3-5 y

HEEL CORD THICKEN**
LORDOTIC POSTURE. @ 6 y

Braces for walking @ 8 y

Wheelchair bound @ 12 y

Pulmonary infection @ 18y

Death @ 25y

PSEUDO MUSCLE HYPERTROPHY ***
(Collagen deposits in DELTOID/CALVES/INFRASPINATUS)

Gower sign
Valley sign (infraspinatus)
63
Q

Ix DMD

A

Creatine Kinase increases 20-200 times!

Bx of muscle

64
Q

Rx DMD

A

STEROIDS

65
Q

BMD features

A

XLR

Dystrophin gene -ve

PSEUDOHYPERTROPHY- Early/ Prominent

Onset 3-4th decade

Mental retardation DMD»BMD

CARDIAC ABNORMALITIES**
(BMD»DMD)

Weakness/ Wasting LL»UL

66
Q

MC adult muscular dystrophy?

A

MYOTONIC DYSTROPHY

67
Q

Inheritance of MD

A

AD

Trinucleotide CTG repeats

Chr 19

68
Q

C/F MD

PATW-MFM

A

Palatal Pharyngeal Tongue muscle weakness (Dysarthria/dysphagia)

Atrophy of TEMPORALIS (HATCHET FACE APP***)

Testicular Atrophy

Weakness (distal»Proximal)

Myotonia (Delayed relaxation of Handgrip)

FRONTAL ALOPECIA**

Mental Retardation

69
Q

Rx MD

A

MEXILITENE

Improves myotonia

Neurology (11 decks)

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