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Brain Flashcards

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1
Q

Normal pressure hydrocephalus triad

A
  1. Gait
  2. Cognitive impairment
  3. Urinary incontinence
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2
Q

Thrombin time is only recommended in patients with ICH who…

A

Taking DOAC

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3
Q

Aneurysm of what artery can affect CN 3?

A

Posterior communicating artery

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4
Q

Aneurysm of what artery can affect CN 2?

A

Internal carotid
Anterior communicating

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5
Q

Aneurysm of what artery can affect CN 4?

A

Superior cerebellar

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6
Q

Aneurysm of what artery can affect CN 6?

A

Anterior inferior cerebellar

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7
Q

Cavenous sinus thrombosis affects which CN?

A

CN 3, 4, 6

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8
Q

Lateral medullary syndrome - signs

A

Ipsilateral face sensation, contralateral extremity sensation, possible Horner

Due to vertebral or posterior inferior cerebellar artery stroke

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9
Q

Lesion in cerebellar hemispheres vs vermis

A

Hemispheres: dysdiadochokinesia, dysmetria, limb ataxia, intention tremor
Vermis: gait and truncal ataxia, dysmetria, saccadic eye movements, horizontal nystagmus

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10
Q

Blood pressure control in ischemic stroke

A

Thrombolytics: <185/110 before, <180/105 for 24h after

No thrombolytics: Permissive; lower extreme HTN (SBP >220, DBP >120) by 15% in first 24h

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11
Q

How does cortical laminar necrosis (from prolonged status epilepticus) appear on MRI?

A

Cortical hyperintensity

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12
Q

When is anticoagulation use in ischemic stroke?

A

Parenteral is not used due to risk of hemorrhagic conversion
Oral should only be used in later management if cardioembolic source

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13
Q

Pathognomic sign of abusive head trauma

A

Retinal hemorrhage

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14
Q

Accessory nerve injury presentation

A

CN XI: scapular winging as it innervates SCM and trapezius muscles

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15
Q

Where is cortical inhibition of the micturition reflex?

A

Frontal micturition center in medial frontal lobe

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16
Q

Creutzfeldt-Jakob imaging and EEG

A

Hyperintensity of cortex (cortical ribboning), putamen, and head of caudate (hockey stick sign)

Sharp, triphasic, and synchronous discharges on EEG

17
Q

Wernicke encephalopathy MRI signs

A

Mamillary body atrophy
Periaqueductal gray matter hyperintensity

18
Q

Jaw jerk reflex

A

Pathologic reflex of CN V, result of bilateral UMN lesion
Seen in ALS
Jaw jerks forward when chin is tapped with mouth slightly open

19
Q

Sturge-Weber brain manifestations

A

Leptomeningeal capillary-venous malformation

Intellectual disability
Seizures (often focal with subsequent generalization)
Glaucoma

20
Q

Pineal gland tumor effects

A

Mass effect - Parinaud syndrome (dorsal midbrain syndrome)
Close to CN III

Downward gaze preference
Light-near dissociation (reactive to accommodation but not light)
Eyelid retraction (Collier sign)

Block CSF flow in aqueduct of Sylvius, causing obstructive hydrocephalus

21
Q

Dopamine antagonism in the following tracts affects what?
Mesolimbic
Nigrostriatal
Tuberoinfundibular

A

Mesolimbic: antipsychotic
Nigrostriatal: extrapyramidal
Tuberoinfundibular: hyperprolactinemia

22
Q

Most common cause of LOBAR ICH

A

Cerebral amyloid angiopathy

Most often spares ventricles and deep brain structures, distinguishing from hypertensive ICH

23
Q

Pick cells and Pick bodies are seen in…

A

Frontotemporal dementia

24
Q

What is needed to diagnose trigeminal disorder headache?

A

MRI with contrast - to rule out secondary causes

25
Q

When does thrombectomy require perfusion analysis?

A

Between 6-24h after stroke; otherwise, only CT angiogram is needed

26
Q

What to do for stroke with unknown time of onset and just woke from sleep?

A

Advanced perfusion imaging to determine benefit of tPA

27
Q

Which brain tumor lacks isocitrate dehydrogenase mutation?

A

Glioblastoma

28
Q

How does oligodendroglioma differ from astrocytoma genetically?

A

Oligodendroglioma has 1p/19q deletion; both have IDH mutant

29
Q

Glioblastoma treatment

A

Radiation + temozolomide, followed by maintenance temozolomide

If poor functional status:
MGMT unmethylated: RT only
MGMT methylated: temozolomide

30
Q

IIH - how does treatment differ based on symptoms?

A

If vision loss is progressive and sustained, or if symptoms proceed while already on acetazolamide, then both acetazolamide and surgery needed

Acetazolamide inhibits carbonic anhydrase in choroid plexus and reduces CSF production

31
Q

Alcoholic cerebellar degeneration most affects which part?

A

Purkinje cells of the vermis

32
Q

Labyrinthitis and vestibular neuritis - tests

A

Head impulse test - cannot maintain visual fixation during impulse toward side of lesion (vestibulo-ocular reflex), with compensatory saccade; horizontal nystagmus away from side of lesion

Compare to BPPV, where torsional nystagmus is toward size of lesion

33
Q

Intranuclear ophthalmoplegia - which eye is affected and which displays nystagmus?

A

Horizontal gaze palsy - abducting eye fires signal, but other side cannot adduct; the working eye displays nystagmus due to CN VI overfiring

If left eye cannot adduct, it is left INO, and nystagmus is opposite

Neuro/Psych (7 decks)

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