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Neuro Muscular Psych Block 2 > Cerebrovascular Disease and Infections of CNS > Flashcards

Cerebrovascular Disease and Infections of CNS Flashcards

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1
Q

Cerebral Artery Infarct Deficits

Anterior (2) Middle (3) Posterior (1)

A

ACA:
Contralateral leg hemiplegia
Alien hand syndrome: contralateral arm autonomy

MCA:
Aphasia
Face-Arm sensorimotor loss
Gaze toward lesion

PCA:
Contralateral homonymous hemianopia

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2
Q

Ischemia Patterns with Causes

Global (3) and Focal (3)

A

Global is a generalized reduction in perfusion
Caused by cardiac arrest, shock, hypotension

Focal is localized
Caused by embolus, thrombosis, atherosclerosis

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3
Q

Watershed Infarcts
General Description
Specific Examples (2) with Clinical Features (2/1)

A

Sickle shaped band of necrosis

ACA-MCA:
Proximal arm/leg weakness, Transcortical aphasia

MCA-PCA:
Visual processing defects

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4
Q

Carotid Stenosis

Etiology, Clinical Features (4)

A

Atherosclerosis of internal carotid artery

Carotid bruit
Contralateral Face-Arm weakness
Contralateral visual field defects
Aphasia

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5
Q

Thrombosis

Primary Cause, Common Brain Locations (3)

A

Atherosclerosis creating plaques than can rupture and become thrombus

Carotid bifurcation
MCA origin
Ends of Basilar Artery

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6
Q

Paradoxical Embolus

Etiology and Description

A

Patent Foramen Ovale

Thrombus able to pass from left side of heart to right and travel through internal carotid directly to brain

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7
Q

Embolus Types with Descriptions (4)

A

Air: deep sea divers, causes the bends

Septic: from bacterial endocarditis

Fat/Cholesterol: from long bone fracture
Can cause Shower emboli in brain

Marantic: protein from nonbacterial endocarditis

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8
Q 
Transient Ischemic Attacks
Clinical Description (2) Warnings (2)
A

Temporary brain ischemia for ~10 minutes, neurological symptoms gone within 24 hours

Neurological emergency
Often proceeds more serious cerebrovascular event such as stroke

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9
Q

Stroke

Types (2) with Descriptions (2/2)

A

Hemorrhagic (red)
Associated with Embolus
Intra-cerebral or Subarachnoid hemorrhage

Ischemic Infarction (pale)
Associated with Thrombus, especially at MCA
Bloodless, hemorrhage is secondary

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10
Q

Hypertensive Cerebrovascular Disease
Main Complications with Descriptions
Chronic HTN (3) and Malignant HTN (2)
CADASIL (2)

A

Lacunar Infarcts
Charcot Bouchard microaneurysms from Chronic HTN
Lenticulostriate artery infarcts in basal ganglia
Cause motor hemiparesis

Hypertensive Encephalopathy
deep brain parenchymal hemorrhages

CADASIL
Recurrent strokes and Dementia starting at 35 years old
NOTCH 3 gene association

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11
Q

Cerebral Amyloid Angiopathy

Associated Condition, Complication, Morphology

A

Alzheimer’s Disease

Primary Intraparenchymal Lobar Hemorrhage

A-Beta Amyloid deposits in vessels

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12
Q

Subarachnoid Hemorrhage

Pathogenesis, Etiology, Symptom, Sizing (2)

A

Develop over time due to defect in tunic media

Bursting saccular aneurysm in Anterior circulation

“Worst headache of my life”

Giant if >2 cm
Likely to rupture if >10 cm

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13
Q

Arteriovenous Malformations

Description, Common Locations (3) Complication

A

Tangled, pulsating mass of vessels with arteriovenous shunting

Subarachnoid space
MCA and Posterior branches of Circle of Willis

AV shunting causes rupture early in life

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14
Q

CNS Infection Routes
Types with Descriptions
Hematogenous, Direct, Local, PNS, Seeding

A

Hematogenous: most common route

Direct Implantation: trauma or congenital malformations

Local Extension: Oral or sinus infection, osteomyelitis

Peripheral Nervous System: Rabies, Herpes Zoster

Seeding: TB seeds CSF from subepidural/submeningeal granulomas

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15
Q

CSF Lab Results

Bacteria (4) Virus (4) Fungus (4)

A 
Bacteria:
Turbid fluid
Neurtrophilia
Increased protein
Decreased Glucose
Virus:
Clear fluid
Lymphocytosis
Slight protein increase
Normal glucose
Fungus:
Clear fluid
Early neutrophilia, then lymphocytosis
Decreased glucose
Increased protein
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16
Q

Acute Pyogenic Meningitis
Clinical Signs (4)
Common Causes by Age Group
Neonate (2) Unvaccinated Toddler, Adolescent/Adult, Elderly (2)

A

Meningeal Irritation (Brudzinski, Kernig)
High fever
Headache
Waterhouse Friderichsen Syndrome

Neonate: E. coli, Group B Strep
Toddler: H. influenzae
Adolescent/Adult: N. meningitidis (in close quarters)
Elderly: Strep pneumoniae, Listeria monocytogenes

17
Q

Brain Abscesses

Causes (2) CSF Findings (3), Complications (2)

A

Streptococci
Staphylococci

High WBC
High protein
Normal glucose

Venous sinus thrombosis
Ventriculitis/Meningitis from rupture

18
Q

Subdural Empyema Complications (3)

A

Thrombophlebitis causing bridging vessel infarct

Thickened dura

Extradural abscess, associated with osteomyelitis

19
Q

Neisseria meningitidis

Main Risk Factor, Symptoms (4)

A

Crowded living conditions (dorm, barracks, jail)

Petechiae
Purpura
Purpura Fulminans: gangrene
Waterhouse Friderichsen Syndrome

20
Q

Chronic Meningitis

Timeline, Symptoms (5) CSF Findings (3), Causes (3)

A

4+ weeks

Fever
Headache
N/V
Confusion
Stiff neck

Elevated Protein
Lymphocytic Pleocytosis
Low Glucose

Tuberculosis
Neuroborreliosis (borrelia burgdorferi)
Neurosyphilis (treponema pallidum)

21
Q

Mycobacterium tuberculosis

Complications (4) Staining

A

Obliterative Endarteritis
Arachnoiditis
CN Palsies
Tuberculoma with central caseating necrosis

(+) Acid Fast Stain

22
Q 
Borrelia burgdorferi (Lyme Disease)
Symptom Progression (4), CSF Finding
A

Bullseye rash
4 weeks later, neurological symptoms
CN palsies
Peripheral neuropathy

Abs in CSF

23
Q

Treponema pallidum

Complications (5) Morphology (1) Symptoms (4)

A 
Communicating hydrocephalus
Heubner Arteritis (Obliterative endarteritis)
Paretic Neurosyphilis
Granular Ependymitis
Tabes Dorsalis

Thickening and fibrosis of meninges

Delusions of grandeur
Lightning pain
Absent reflexes
Charcot joints

24
Q 
West Nile Virus
CSF Findings (4) Symptom, Morphology (2)
A

Neutrophil pleocytosis initially, then Lymphocytosis
Clear
Elevated protein
Normal glucose

Polio-like syndrome with paralysis

Neuronophagia
Microglial nodules

25
Q

Herpes Simplex Virus

Complication (2), Morphology (2)

A

Necrotizing and Hemorrhagic encephalitis of the Inferior and Medial Temporal Lobes

Cowdry A intranuclear inclusions
Ground glass cytoplasm

26
Q 
Herpes Zoster Virus
Clinical Phases (3) with Symptoms (1/1/2)
A

Latent phase: no symptoms, virus in Trigeminal ganglia

Reactive: single dermatome painful vesicular rash (Shingles)

Persistent: Postherpetic neuralgia syndrome, pain to nonpainful stimuli

27
Q

Cytomegalovirus
At Risk Populations (2) with Complications (2/1)
Morphology

A

Fetuses
Periventricular necrosis
Microcephaly

Immunocompromised patients
Subacute encephalitis

Owl-eye inclusions

28
Q 
Poliomyelitis
Clinical Presentations (2) with Symptoms (2/3)
A

Acute
Anterior horn motor neuron neuronophagia
Flaccid paralysis

Post-Polio Syndrome
25-35 years later
Decreased muscle mass and pain

29
Q

Rabies (Lyssavirus)

Incubation, Infection Pathway, Symptoms (4), Mophology

A

1-3 months

Ascends into CNS via motor neurons

Paresthesias around wound
Hydrophobia: mouth foaming
Flaccid paralysis
Respiratory center failure

Negri bodies in purkinje cells

30
Q 
HIV
Pathological Signs (3) Complications (4)
A

Perivascular inflammation (acute)
Microglial nodules with multinucleated giant cells
Myelin pallor, axonal swelling, gliosis

Immune Reconstitution Inflammatory Syndrome
Dementia
Primary CNS Lymphoma

31
Q

Progressive Multifocal Leukoencephalopathy

Pathogenesis, Pathological Signs (2)

A

JC Polyomavirus reactivation in immunodeficient person

Oligodendrocyte demyelination
Subcortical demyelination with lipid laden macrophages

32
Q

Subacute Sclerosing Panencephalitis

Etiology, Symptoms (3) and Pathological Findings (3)

A

Paramyxovirus (measles)

Cognitive decline
Spasticity of limbs
Seizures

Widespread gliosis and demyelination
Viral inclusions
Neurofibrillary tangles

33
Q

Cryptococcus Neoformans

At Risk Populations, Complication, Morphology, Testing (2)

A

Immunocompromised

Fungal Meningoencephalitis

Parenchymal soap bubbles

India Ink Prep
Cryptococcal Polysaccharide Antigen

34
Q 
Toxoplasmosis
Risk Factors (2) Morphology, Pathologic Findings (4)
A

HIV
Pregnancy

Ring enhancing lesion

Brain abscess with central necrosis
Free tachyzoites and encysted bradyzoites
Petechial hemorrhage
Vessel proliferation

35
Q

Creutzfeldt-Jakob Disease
Morphology, Symptoms (2)
Pathologic Finding with Tests (2)

A

Spongiform change with intracellular vacuoles
Beta pleated sheet isoform proteins

Progressive neurodegenerative disease
Myoclonus

Kuru Plaque
Congo red stain and PAS (+)

Neuro Muscular Psych Block 2 (7 decks)

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