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USMLE Neurology > Brain lesions, strokes, aphasia, aneurysms > Flashcards

Brain lesions, strokes, aphasia, aneurysms Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the effects of a frontal lobe stroke?

A
  • Disinhibition + judgement affected
  • Deficits in concentration
  • Orientation affected
  • Possible reemergence of primitive reflexes
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2
Q

What way do the eyes look in a frontal eye field lesion?

A

Toward brain lesion

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3
Q

Where is the paramedian pontine reticular formation?

A

Nuclei in dorsal part of pons

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4
Q

The PPRF talks to the contralateral CNIII via what?

A

MLF

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5
Q

A lesion in the PPRF causes what?

A

Horizontal gaze palsy
- Eyes look away from brain lesion

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6
Q

What clinical finding will be found in a MLF lesion (e.g due to MS)?

A

Internuclear opthalmplegia
- Impaired adduction of ipsilateral eye
- Nystagmus of contralateral eye with abduction

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7
Q

Inability to write and perform maths (agraphia, acalculia) may occur with a lesion to where?

A

Dominant parietal cortex

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8
Q

What are the possible features of a lesion to the dominant parietal cortex?

A
  • Agraphia
  • Acalculia
  • Finger agnosia
  • Left-right disorientation
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9
Q

What syndrome may cause a dom. parietal cortex lesion (agnosia, acalculia)?

A

Gerstmann syndrome

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10
Q

Agnosia to the contralateral side of the world occurs with a lesion to where?

A

Non-dominant parietal cortex
- Hemispatial neglect syndrome (usually after stroke)

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11
Q

Anterograde amnesia or the inability to form new memories is caused by a lesion to where?

A

Hippocampus (bilateral)

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12
Q

What diseases may create lesions in the basal gnaglia?

A
  • Parkinsons
  • Huntington
  • Wilson
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13
Q

A lesion in the subthalamic nucleus will cause what?

A

Contralateral hemiballismus
- Hyperkinetic involuntary movement disorder characterized by intermittent, sudden, violent, involuntary, flinging, or ballistic high amplitude movements in arms, legs

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14
Q

Wernicke-Korsakoff syndrome is due to a lesion where?

A

Mammillary bodies (bilateral)

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15
Q

What are the features of Wernicke-Korsakoff?

A
  • Confusion
  • Ataxia
  • Nystagmus
  • Opthalmoplegia
  • Memory loss (anterograde, retrograde amnesia)
  • Confabulation, personality changes
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16
Q

What part of the brain is affected in Kluver-Bucy syndrome?

A
  • Amygdala (bilateral)
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17
Q

What are the features of Kluver-Bucy syndrome and what causes it?

A
  • Hyperphagia, hypersexuality, hyperorality
  • HSV-1 encephaitis
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18
Q

A lesion of the dorsal midbrain will produce what syndrome with what features?

A

Parinaud syndrome
- Vertical gaze palsy
- Pupillary light-near dissociation
- Lid retraction
- Convergence-retraction nystagmus

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19
Q

A reticular activating system (midbrain) lesion causes what?

A

Reduced levels of arousal and wakefulness (often from coma)

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20
Q

What are the effects of a cerebellar hemisphere lesion?

A
  • Intention tremor
  • Limb ataxia
  • Loss of balance
  • Ipisliateral deficits
  • Fall towards side of lesion
    Affects laterally
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21
Q

What are the effects of a cerebellar vermis lesion?

A
  • Truncal ataxia (wide-based, drunkedn-sailor gait)
  • Nystagmus
    Central lesion -> affects centrally
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22
Q

What is cerebellar vermis lesion associated with?

A

Alcoholism

23
Q

Decorticate (flexor) posturing (flexion of arms, extension of legs) is due to a lesion where?

A

Above the red nucleus

24
Q

Decerebrate (extensor) posturing (extension of arms, flexion of legs) is due to a lesion where?

A

Below red nucleus

25
Q

What are the most vulnerable areas of the brain furing hypoxia (watershed-areas)?

A
  • Hippocampus
  • Neocortex
  • Cerebellum (purkinje) cells
    Vulnerable Hippos Need Pure Water
26
Q

What kind of necrosis occurs in the brain as a result of stroke?

A

Liquefactive

27
Q

How soon after onset of stroke is tPA given?

A

3-4.5 hrs after onset (if no risk of hemorrhage)

28
Q

How soon after an attack do tPAs usually resolve within?

A

15 mins

29
Q

Where does a neonatal intraventricular hemorrhage occur?

A

Germinal matrix (highly vascularised layer within subventricular zone)

30
Q

What will be seen on US in neonatal hemorrhage?

A

Blood in ventricles

31
Q

Why are neonates vulnerable to intraventricular hemorrhage?

A

Reduced glial supprt
Impaired autoregulation of BP
Decreased vit K

32
Q

What is the most common site for a thrombus to form in the brain?

A

MCA

33
Q

What kind of hematoma may cause transtentorial herniatio and CN III palsy?

A

Scalp hematoma

34
Q

What kind of hematoma causes a biconvex (lentiform) blood collection which does not cross suture line?

A

Epidural hematoma

35
Q

What kind of hematoma causes a crescent shaped hemorrhage crosses suture lines?

A

Subdural

36
Q

What kind of hematoma will have a bloody or yellow (xanthochromic) LP?

A

Subarachnoid

37
Q

What kind of hemorrhage will may cause vasospasms due to blood breakdown or rebleed 3-10 days after infarction?

A

Subarachnoid

38
Q

What drug is used to prevent vasospams?

A

Nimodipine

39
Q

What can intraparenchymal hemorrhages be caused by? (6)

A
  • Systemic HTN (most commonly)
  • Amyloid angiopathy (recurrent lobar hemorrhagic stroke in elderly)
  • Vascular malformations
  • Vasculitis
  • Neoplasms
  • May be secondary to repurfusion injury in ischemic stroke
40
Q

Where do intraparenchymal hypertensive (Charcot-Bouchard) hemorrhages most often occur?

A
  • Putamen of BG (lenticulostriate vessels)
    Then:
  • Thalamus, pons, cerebellum
41
Q

What are the symptoms of a lenticulostriate artery stroke?

A
  • Contralateral paralysis
  • Absence of cortical signs (e.g. neglect, aphasia, visual field loss)
42
Q

What is Central postroke pain syndrome?

A

Neuropathic pain due to thalamic lesions
- Initial paresthesias followed in weeks and months by:
- Allodynia (pain w/o stimuli)
- Dysthesia (altered sensation) on contralateral side

43
Q

How common is central postroke pain syndrome?

A

~ 10% of stroke patients

44
Q

What is Diffuse axonal injury due to? (what kind of injury -> what does this cause)

A

Rapid acceleration/deceleration of the brain i.e motor vehicle accident

Causes:
- Traumatic shearing of white matter tracts -> vegatitive state / coma

45
Q

What will be seen on MRI in Diffuse axonal injury?

A

Multiple lesions (punctate hemorrhages) involving white matter tracts

46
Q

What is the difference between aphasia and dysarthria?

A
  • Aphasia: higher order language deficit
  • Dysarthria: motor inability to produce speech
47
Q

A patient is speaking in a ‘word salad’ that makes no sense what kind of aphasia do they have?

A

Wernicke (receptive) aphasia
- Sup temporal lobe of gyrus

48
Q

Conduction aphasia is due to a lesion where>

A

Arcuate fasiculus

49
Q

What conditions are associated with saccular aneurysms?

A
  • Aut Dom Polycystic Kidney Disease
  • Ehlers-Danlos syndrome
50
Q

What kind of aneurysm will not be visible on angiography?

A

Charcot-Bouchard microaneurysm
- Hemorhagic intraparenchymal stokes

51
Q

What temperatures will heat stroke occur at usually?

A

> 40 deg C (104F)

52
Q

What are the complications of heat stroke?

A
  • CNS dysfunction (eg confusion)
  • End-organ damage
  • Acute respiratory distress syndrome
  • Rhabdomyolysis
53
Q

What is the management of heat stroke patients?

A
  • Rapid external cooling
  • Rehydration
  • Electrolyte correction
54
Q

When can a seizure be considered status epilepticus?

A

> 5 mins or recurring seizures that may result in brain injury

USMLE Neurology (19 decks)

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