Brain Flashcards
Normal pressure hydrocephalus triad
- Gait
- Cognitive impairment
- Urinary incontinence
Thrombin time is only recommended in patients with ICH who…
Taking DOAC
Aneurysm of what artery can affect CN 3?
Posterior communicating artery
Aneurysm of what artery can affect CN 2?
Internal carotid
Anterior communicating
Aneurysm of what artery can affect CN 4?
Superior cerebellar
Aneurysm of what artery can affect CN 6?
Anterior inferior cerebellar
Cavenous sinus thrombosis affects which CN?
CN 3, 4, 6
Lateral medullary syndrome - signs
Ipsilateral face sensation, contralateral extremity sensation, possible Horner
Due to vertebral or posterior inferior cerebellar artery stroke
Lesion in cerebellar hemispheres vs vermis
Hemispheres: dysdiadochokinesia, dysmetria, limb ataxia, intention tremor
Vermis: gait and truncal ataxia, dysmetria, saccadic eye movements, horizontal nystagmus
Blood pressure control in ischemic stroke
Thrombolytics: <185/110 before, <180/105 for 24h after
No thrombolytics: Permissive; lower extreme HTN (SBP >220, DBP >120) by 15% in first 24h
How does cortical laminar necrosis (from prolonged status epilepticus) appear on MRI?
Cortical hyperintensity
When is anticoagulation use in ischemic stroke?
Parenteral is not used due to risk of hemorrhagic conversion
Oral should only be used in later management if cardioembolic source
Pathognomic sign of abusive head trauma
Retinal hemorrhage
Accessory nerve injury presentation
CN XI: scapular winging as it innervates SCM and trapezius muscles
Where is cortical inhibition of the micturition reflex?
Frontal micturition center in medial frontal lobe
Creutzfeldt-Jakob imaging and EEG
Hyperintensity of cortex (cortical ribboning), putamen, and head of caudate (hockey stick sign)
Sharp, triphasic, and synchronous discharges on EEG
Wernicke encephalopathy MRI signs
Mamillary body atrophy
Periaqueductal gray matter hyperintensity
Jaw jerk reflex
Pathologic reflex of CN V, result of bilateral UMN lesion
Seen in ALS
Jaw jerks forward when chin is tapped with mouth slightly open
Sturge-Weber brain manifestations
Leptomeningeal capillary-venous malformation
Intellectual disability
Seizures (often focal with subsequent generalization)
Glaucoma
Pineal gland tumor effects
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
Dopamine antagonism in the following tracts affects what?
Mesolimbic
Nigrostriatal
Tuberoinfundibular
Mesolimbic: antipsychotic
Nigrostriatal: extrapyramidal
Tuberoinfundibular: hyperprolactinemia
Most common cause of LOBAR ICH
Cerebral amyloid angiopathy
Most often spares ventricles and deep brain structures, distinguishing from hypertensive ICH
Pick cells and Pick bodies are seen in…
Frontotemporal dementia
What is needed to diagnose trigeminal disorder headache?
MRI with contrast - to rule out secondary causes
When does thrombectomy require perfusion analysis?
Between 6-24h after stroke; otherwise, only CT angiogram is needed
What to do for stroke with unknown time of onset and just woke from sleep?
Advanced perfusion imaging to determine benefit of tPA
Which brain tumor lacks isocitrate dehydrogenase mutation?
Glioblastoma
How does oligodendroglioma differ from astrocytoma genetically?
Oligodendroglioma has 1p/19q deletion; both have IDH mutant
Glioblastoma treatment
Radiation + temozolomide, followed by maintenance temozolomide
If poor functional status:
MGMT unmethylated: RT only
MGMT methylated: temozolomide
IIH - how does treatment differ based on symptoms?
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
Alcoholic cerebellar degeneration most affects which part?
Purkinje cells of the vermis
Labyrinthitis and vestibular neuritis - tests
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
Intranuclear ophthalmoplegia - which eye is affected and which displays nystagmus?
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
