CNS Pathology Flashcards
What are Down syndrome pt. more at risk for?
1) Early onset dementia presenting with senile plaques and neurofibrillary tangles
2) Acute leukemias
3) Congential heart disease
4) GI defects (duodenal atresai and Hirschsprung dx)
Spontaneous contractions of a single lower motor unit; occur at rest
Fasiculations
How can you differentiate between a benign positional vertigo and a posterior fossa disease using the Baranay maneuver?
1) Latency will be immediate with posterior fossa dx; 2-20 seconds for benign positional vertigo
2) Duration will be persistent with a posterior fossa dx; < 1 min for a benign positional vertigo
3) Adaptation with benign positional vertigo
Treatment for tension headache?
1) NSAID
2) NSAID + Caffeine
3) NSAID + Barbiturate
4) All together
What is the barbiturate used for tension headaches? What are its effects?
1) Butalbital
2) Causes sedation by facilitating GABA neurotransmission
3) Can become dependent and will have rebound headaches after removal of substance
Why is caffeine used in the treatment of tensions headaches?
Caffeine is a competitive antagonist at the adenosine receptor
Headache that has abrupt onset, occurs bilaterally, PE and all other tests are normal; most common cause of headache
Tension Headache
What are aura symptoms?
1) Presence of Zig-zag lines that flash
2) Occur before migraine
3) May also have olfactory hallucinations
What is the difference between communicating and non-communicating hydrocephalus?
1) Communicating = symmetric enlargement of ventricular system
2) Non-communicating = asymmetric enlargement of ventricular system
Herniation that occurs when unilateral expansion of a cerebral hemisphere displaces the cingulate gyrus under the falx cerebri
Subfalcine herniation
Herniation that occurs at the medial aspect of the temporal lobe where it is compressed against the tentorium
Transtentorial herniation
Displacement of the cerebellar tonsils through the foramen magnum
Tonsillar herniation
What are the complications of Transtentorail herniation?
1) Compromise of CN III
2) Compression of posterior cerebral artery
3) Kernohan’s notch- contralateral cerebral peduncle compression (causes ipsilateral paresis)
4) Secondary brainstem (Duret) hemorrhages
What is a complication of a tonsillar hernation?
1) Death due to compression of essential components of the medulla oblongota
What does the presence of alpha-fetoprotein in maternal serum indicate
Neural tube defect
Absence of cortical gyri
Lissencephaly
Small, numerous and irregularly formed cerebral convolutions
Polymicrogyria
Spectrum of malformations characterized by incomplete separation of the cerebral hemispheres across the midline
Holoprosencephaly
What occurs in Dandy-Walker Malformation
1) Agenesis of cerebellar vermis
2) Cystic enlargement of 4th ventricle
Small posteiror fossa with downward extension of the vermis through the foramen magnum
Arnold Chiari malformation (Chiari II malformation)
Low lying cerebellar tonsils that extend down into the vertebral canal
Chiari I malformation
Vertigo caused by free-floating otoconia that have been dislodged form the utricular macula and have been moved into one of the semicircular canal
Benign positional vertigo
What is the location of an acoustic neuroma?
1) Cerebellopontine angle
Headache that presents in young males, is unilateral, and usually retro-orbital, autonomic dysfunctions; duration of 30 min to 2 hours
Cluster Headache
Headache with unilateral lightning bolt pain; 2-20 episodes dilay; normal neurologic exam
Trigeminal Neuralgia
What must occur in order to classify a headache as a migraine?
At least four attack must have occured
What time period in someone’s life are they more likely to get a migraine?
In the first four decades of life
Unilateral throbbing pain associated with photophobia and phonophobia; usually associated with nausea and vomitting; duration: 4-72 hours
Migraine
What is the main cause of an epidural hematoma?
1) Rupture of middle meningeal artery
2) Generally occurs in children with temporal bone displacement
3) Neurosurgical emergency
Main cause of subdural hematoma?
1) Tearing of the bridging veins in elderly or infants
What region of the brain is at greatest risk of a border zone infarct in a hypotensive state?
1) edges of the cerebral vascular supply that mainly receives adequate supply due to overlap
What are the stages of global cerebral ischemia?
1) Presentation of red neurons (12-24 hrs)
2) Infiltration of neutrophils (1-3 days)
3) Influx of macrophages (3-5 days)
4) Reactive gliosis (1-2 weeks)
5) Scar formation/repair (months)
How does hypertension affect the brain?
1) Lacunar infarcts
2) Slit Hemorrhages
3) Hypertensive Encephalopathy
What are the two major causes of intracranial hemorrhage?
1) Hypertension
2) Cerebral amyloid angiopathy (CAA)
What mendelian disorders are at greater risk for a berry aneurysm?
1) Autosomal dominant polycystic kidney disease
2) Ehlers-Danlos syndrome
3) Neurofibromatosis type 1
4) Marfan syndrome
Extension of only the meninges herniating into the spinal canal defect
Meningocele
Meninges and spinal cord herniate through the spinal canal defect
Meningomyelocele
Malformation of the anterior neural tube resulting in no forebrain and an open calvarium; polyhydramnios and frog-like appearance
Anencephaly
Lake-like spaces that occur in the lenticular nucleus, thalamus, internal capsule, caudate nucleus, and pons? What is the most common cause?
1) Lacunar Infarct
2) Caused by hypertension
Most common location of a berry aneursym?
1) Bifuraction of the anterior communciating artery and anterior cerebral artery
Describe the bacterial cause of meningitis according to age. Neonate (0-6 mos)? Children (6mos-6years)?
6 years to 60 years? Elderly (>60 years)?
1) Group B streptococcus agalactae, E. coli, Listeria
2) Streptococcus pneumonaie, Neisseria meningitidis, Haemophilus influenzae type B
3) Streptococcus pneumoniae, Neisseria meningitidis
4) Streptococcus pneumoniae and Listeria monocytogenes
What are the findings of CSF for an acute purulent meningitis?
1) Increased neutrophils (>90,000)
2) Increased protein
3) Decreased glucose
4) Findings on gram stain
What are the findings of CSF for an acute aseptic meningitis?
1) Lymphocytosis
2) Moderately increased protein
3) Normal glucose level
4) No findings on gram stain
Describe the progression of an infarct in the brain.
1) At 12 hours red neurons with cytotoxic and vasogenic edema
2) After 24 hours the tissue appears pale, soft and swollen
3) 1-3 days infiltration of neutrophils
4) 3-7 days infiltration of macrophages (microglia)
5) Liquefaction occurs at 2-3 weeks
6) After several months there is separation from the cavity forming a gliotic cyst
Dilation of the ventricular system with a compensatory increase in CSF volume due to loss of a brain parenchyma
Hydrocephalus ex vacuo
What are the causes of Hydrocephalus ex vacuo?
1) Parkinson’s
2) Alzheimer
What are Duret Hemorrhages caused by? What is their appearance?
1) Transtenorail (uncal) hernia
2) Linear, flame shaped lesions caused by tearing of arteries supplying the upper brain stem
Failure of bony spinal canal to close, but no structural herniation
Spina Bifida Occulta
Diverticulum of malformed CNS tissue extending through a defect in the cranium
Encephalocele
Collection of neurons in inapporpirate locations. How does this present?
1) Neuronal heterotopias
2) epilepsy
Infarct at the supratentorial periventricular white matter that consists of a chalky yellow plaque
Periventricular Leukomalacia
What are Charcot-Bouchard microaneurysm associated with?
1) Intracerebral hemorrhage
2) Caused by hypertension
Sensory loss of pain and temperature with sparing of fine touch and position in the upper extremities in a cape like distribution
Syringomyelia
Formation of a fluid filled cleft-like cavity in the inner portion of the cord that occurs from C8-T1
Syringomyelia
Discontinuous multi-segmental expansion of the ependymal lined central canal of the cord
Hydromyelia
What is the difference between Creutzfeldt-Jakob Disease and vCJD?
1) vCJD has behavioral changes early in onset
2) vCJD has plaques in the cortical regions with surrounding spongiform change
3) No alterations in PRNG gene
What has been found to be connected genetically to CJD?
1) Homozygous state at the 129 codon of the PRNG gene
What are the two microscopic findings in CJD?
1) Spongiform transformation
2) Presence of uniform empty vacuoles within the neuropil and perikaryon of neurons
Autoimmune attack on the myelin sheath; results in plaques within the white matter; characterized by distinct episodes of neurologic deficits separated in time
Multiple Sclerosis
What is HLA-DR2 associated with?
Multiple Sclerosis
What is used to diagnose MS?
1) MRI - shows plaques in white matter
2) Lumbar puncture- shows increased lymphocytes and oligoclonal IgG bands
Bilateral optic neuritis and spinal cord demyelination
Neuromyelitis Optica
Diffuse, monophasic demylinating disease that follows a viral infection; there is myelin loss with relative preservation of axons
Acute Disseminated Encephalomyelitis (ADEM)
Fulminant syndrome of CNS demyelination affecting younger adults and children; preceded by a URI
Acute necrotizing hemorrhagic encephalomyelitis
Spherical collections of dilated, neuritic processes around a central amyloid core; found in Alzhemier disease
Neuritic plaque
What is the abnormal protein found within the amyloid core of a neurtic plaque?
1) A-beta
What are the two major microscopic findings in Alzheimer disease?
1) Neuritic plaques
2) Neurofibrillary tangles
Bundles of filaments in the cytoplasm of the neurons that displaces the nucleus; elongated flame shape
Neurofibrillary tangles
Elongated, glassy, eosinophilic bodies consisting of paracrystaline arrays of beaded filaments; what is this associated with?
1) Hirano bodies
2) Alzheimer disease
What is the major protein deposited in Alzheimer disease derived from? How does it come about?
1) Aβ is derived from Amyloid precursor protein (APP)
2) Aβ is only formed when APP undergoes beta cleavage
What cleave must APP undergo to make Aβ?
Beta cleavage
What chromosome is APP found on?
Chromosome 21
What is another complication of the abundant amyloid protein found in Alzheimers?
1)Cerebral amyloid angiopathy which could cause intracerebral hemorrhage due to weakening of the wall
What protein is hyperphosphorylated in the neurofibrillary tangles found in Alzheimer
1) Tau protein is hyperphosphorylated
Group of disorders that have progressive degeneration of temporal and frontal lobes resulting in deterioration of language and changes in personality
Frontotemporal Dementias
Frontotemporal dementia that occurs progressively; Atrophy is so severe that it causes wafer thin gyri; presence of cytoplasmic round filamentous inclusions that are weakly basophilic
Pick Disease
Dementia caused by multifocal infarction and injury due to hypertension, atherosclerosis, or vascultis; step by step decline
Vascular dementia
What are the clinical features of Parkinsonism?
Think: your body becomes a TRAP
1) Tremors (pill rolling tremor)
2) Rigidity (Diminished facial expression)
3) Akinesia (slowness of voluntary movment ie bradykinesia)
4) Posutral instability (Stooped posture and festinating gait)
With a microsopic finding of neurons that have a single or multiple, cytoplasmic, eosinophilic inclusions with a dense core and a pale halo you should think what? What is the disease?
1) Lewy bodies
2) Parkinson disease
What are the filaments in Lewy bodies made up of?
Alpha-synuclein
focal demyelination of the pons; presents as acute bilateral paralysis “locked in syndrome”; due to overly rapid correction of Na levels
Central Pontine Myelinolysis
Deposition of alpha-synuclein inclusions found in oligodendrocytes
Multiple System Atrophy
Degeneration of dopaminergic neurons? Degeneration of GABAnergic neurons?
1) Parkinson Disease
2) Huntington Disease
Atrophy of GABAnergic neurons in the Caudate nucleus of the basal ganglia?
Huntington Disease
What is the cause of Huntington disease?
1) Autosomal dominant expansion of a trinucleotide repeat in the huntingtin gene
Autosomal recessive spinocerebellar, dorsal root ganglion, posterior column, and th distal positions of the corticospinal tract degenaration
Friederic Ataxia
What are findings in Friederic ataxia?
1) Loss of position and vibratory sense
2) DTRs are absent
3) Pes Cavus develops
4) Enlarged heart
5) Intentional tremor
Autosomal recessive disorder causing ataxia and the development of telangiectasia in the conjunctiva and skin; immunodeficiency also observed
Ataxia-Telangiectasia
Degenerative disorder of both the lower and upper motor neurons of the corticospinal tract; degeneration of the anterior horn neurons and the precentral gyrus
Amyotrophic Lateral Sclerosis
Mutation of SOD1 gene on chromsome 21 results in what disease? What is characteristic of this disease?
1) Amyotrophic Lateral Sclerosis
2) Degeneration of both the upper and lower corticospinal tract
PAS positive cytoplasmic inclusions in remaining neurons found in Amyotrophic Lateral Sclerosis? What are they remnants of?
1) Bunina bodies
2) Remnants of autophagic vacuoles
X-linked adult onset due to an expanding trinucleotide in the androgen receptor; results in lower motor neuron loss and androgen insensitivity/gynecomastia/ testicular atrophy
Bulbospinal Atrophy (kennedy syndrome)
Autosomal recessive deficiency of galactocerebroside β-galactosidase ; what is the pathologic result of this deficiency?
1) Krabbe Disease
2) Increase in alternative catabolic pathway producing galactosylsphingosine and loss of myelin and oligodendrocytes
What is pathognomonic for Krabbe disease?
Globoid cell
Engorged macrophages that aggregate in the parenchyma and blood vessels
Globoid cell
How does fat embolism classically present in the brain?
1) Petechial hemorrhage throughout the white matter
What should you think wit a pure motor stroke?
Lacunar infarct
Development of psychotic symptoms or ophthalmoplegia due to thiamine deficiency
Wernicke encephalopathy
Development of memory distrubances and confabulation due to deficiency of thiamine deficinecy
Korsakoff syndrome
Course is off syndrome = memory and confabulation
Non-progressive neurologic motor defiicit characterized by combinations of spasticity, dystonia, and paresis
Cerebral palsy
Inherited mutations in enzymes involved with the maintenance or production of myelin
Leukodystrophies
Deficiency in the lysosomal enzyme arylsulfatase A? What is the result?
1) Metachromatic leukodystrophy
2) Demeylination due to increased cerebroside sulfate
How does metachromatic leukodystrophy get its name?
1) It gets its name from its metochromasia property which occurs when toluidine blue has its dye absorbance changed
In ability to catabolize very long chain fatty acids resulting in myelin loss and adrenal insufficiency? What gene is mutated?
1) Adrenoleukodystrophy
2) Mutation of ALD gene on X chromosome
X linked mutation for myeling proteins resulting in fatal leukodystrophy and complete loss of meylin in cerebral hemispheres; occurs early in life and is fatal
Pelizaeus-Merzbacher disease
Disease characterized by megalocephaly, severe mental deficits, blindness, and white matter injury in infancy; due to mutation in aspartoacylase
Canavan disease
Disease characterized by megalocephaly, seizures, progressive psychomotor retardation; due to GFAP mutaitons
Alexander disease
Most common nuerological syndrome caused by mitochondrial abnormality; presents with neurologic deficits, muscle involvement with lactic acidosis, and stroke like episodes
Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke like episodes (MELAS)
Maternally inherited mitochondrial disease that results in myoclonus and myopathy
Myoclonic Epilepsy and Ragged Red Fibers (MERRF)
What causes foci hemorrhage and necrosis in the mamillary bodies and the walls of the third and fourth ventricles?
1) Thiamine deficiency
Subacute combined degeneration of the spinal cord?
B12 deficinecy
Charcot’s triad of MS
(MS is a SIIN)
1) Scanning speech
2) Intention tremor and Incontinence
3) Internuclear opthalmoplegia
4) Nystagmus
What structures are at greatest risk for damage with focal cerebral ischemia? Why?
1) Thalamus, basal ganglia, and deep with matter
2) There is not high collateral flow as seen in Watershed areas (less affected)
What is the most common location for a thromboembolism?
1) Middle cerebral artery
Cerebral hemorrhagic infarcts are caused by? non-hemorrhagic?
1) Emboli and CAA
2) Thrombi
What is the gross progression of a non-hemorrhagic infarct?
1) No change during first 6 hours
2) After 48 hrs brain becomes pale, soft, and swollen
3) By 2-10 days brain becomes gelatinous
4) 10 days- 3 weeks tissue liquefies
5) Results in the formation of a fluid filled cystic space surrounded by gliosis
Edge of infarction
Penumbra
What is Cerebral Amyloid Angiopathy? What causes it?
1) Weakening of of vessel walls creating an increased risk for hemorrhage
2) Caused by a deposition of Abeta protein (found in Alzheimer)
Causes of intracerebral hemorrhage
1) Hypertension –> Charcot-Bouchard microaneurysm
2) Cerebral Amyloid Angiopathy
Focal neurologic deficit due to a temporary reduction in blood flow to a part of the brain that lasts less than 24 hours
Transient Ischemic Attack
What are the three types of pathological tremors?
1) Resting tremors
2) Postural tremors
3) Intentional Tremors
Tremor associated with rigidity and slowness
Resting tremor
Tremor with normal neuro exam; treated with beta blockers and benzodiazopine
Postural tremor
Tremor with signs of cerebellar dysfunction
Intentional tremor
How can you tell the difference between Parkinson and Progressive supranuclear palsy?
1) Progressive supranuclear palsy has rigidity on extension
2) SPS also has speech and swallowing distrubances and difficulty with eye movements
Random, irresistible, asynchronous movements
Tics
Tics with corprolallia
Tourettes syndrome
- Absent DTRs
- Impaired joint position and vibratory sense
- Ataxia
Friederich ataxia
Dementia, gait disturbance, and urinary incontinence
Normal Pressure Hydrocephalus
What protein is low in Friedreich ataxia?
Friedreich is Fratastic
1) Frataxin
2) Primary symptoms are staggering and falling
What are the symptoms of normal pressure hydrocephalus
Think: wild, wobbly and wet
1) Dementia
2) Gait disturbances
3) Urinary incontinence
Disturbances of muscle tone
Dystonia
What is the most common cause of dystonia?
1) Idiopathic
2) Iatrogenic (dopaminergic treatment)
Constant headache with visual disturbances; found in obese females; elevated opening LP; normal CT; papilledema present
Idiopathic intracranial hypertension (pseudotumor cerebri)
Gait instability, dysphagia and swallowing disturbances, difficulty with eye movements (espc. vertical); rigidity with extension
Progressive Supranuclear Palsy (PSP)
Loss of pain and temperature sensation in the right leg; loss of vibratory sense and sensation on the left; hyper activity DTRs on the left
Brown sequard syndrome on the left
What does Horner’s syndrome consist of? What is the cause?
1) Ptosis (drooping eyelid), miosis (pupil constriction, anhidrosis (absence of sweating)
2) Lesion in spinal cord above T1
What is the most common cause of a thoracic radiculopathy
Infarction, atherocsclerosis, or vasculitis of the nerve root
Numbness of ipsilateral face, contralateral in body; Horner syndrome on ipsilateral side, ataxia ipsilateral side
Wallenberg’s syndrome
What is the cause of Wallenberg syndrome?
Caused by rupture of the posterior inferior cerebral artery
What is the results of a Thalamic syndrome?
Contralateral numbness and pain sensation with no motor deficits
What nerve acts as the efferent pathway for the pupillary reflex?
CN III
What is the pathway for the pupillary reflex?
1) Receptor (retina)
2) Afferent = CN II
3) Synapes = Edinger-Westphal in midbrain
4) Efferent = CN III
5) Pupil constrictor muscle
Pt. has abnormal horizontal gaze. Eyes deviate to the right. Where is the lesion?
1) Right FEF
2) Pons on the Left
Pt. has abnormal horizontal gaze. Eyes move right normally, however the right eye does not move left. Where is the lesion?
1) Right MLF (Right INO)
How do you differentiate between a simple and a complex partial seizure?
1) Simple partial maintains consciousness, complex partial does not
Pt. seems to disengage from current activity and “stare into space” then returns to activity feeling absent minded; often confused with day dreaming. What is this seizure type?
Absence seizure
What are the different types of primary generalized epilepsy?
1) Absence
2) Myoclonic
3) Clonic
4) Tonic
5) Tonic-clonic
6) Atonic
Musculature jerking of the limbs and body for at least 30 seconds; incontinence, eyes roll, involuntary contraction/relaxation
Clonic seizure
Pt. becomes rigid with loss of consciousness, vocalizations; skeletal muscles tense
Tonic seizure
Impairment of consciousness with seizure; epileptic discharge is from the temporal lobe
Complex partial (focal) epilepsy
Prolonged, sustained, unconsciousness with persistent convulsive activity in a seizing pt.
Status epilepticus
Acute episode of delirium associated with severe form of alcohol withdrawal?
Delirium tremens (DT)
Stroke syndrome that results in stupor with hemiplegia and sensory loss contralaterally, and monocular blindness ipsilaterally
Occlusions of the internal carotid
Stroke syndrome that results in paralysis of contralateral LE, lesser degree of paralysis to contralateral UE; urinary incontinence
Occlusions of the anterior cerebral artery
Stroke syndrome that results in paralysis of contralateral face and body; motor and conduction aphasia; paralysis of conjugate gaze to ipsilateral side
Occlusions of the middle cerebral artery
Stroke syndrome that results in loss of vision; thalamic syndrome
Occlusions of the posterior cerebral artery
Stroke syndrome that results in vertigo and CN dysfunction
Occlusions of the vertebro-basilar arterial system
What is the definition of Orthostatic Hypotension?
1) Drop in systolic bp >20 OR drop in Diastolic >10 within 3 min of standing
Most common cause of meningitis in the 6-60 age group?
Streptococcus pneumonia!
What tests can be done to determine if there is a neural tube defect during pregnancy?
1) Amniotic fluid and maternal serum for alpha fetoprotein (elevated)
2) Look for elevated acetycholine essterase in amniotic fluid
What neurotransmitters are low in Huntington’s disease?
Think: CAG (Caudate loses ACh and GABA)
1. Degeneration of GABAnergic nuerons in the caudate nucleus
Sudden wild flailing of 1 arm
1) Hemiballismus
2) Lacunar stroke of the subthalamic nucleus on contralateral side
Name what occurs if a lesion were in the following areas:
1) Amygdala
2) Frontal lobe
3) Right Parietal lobe
4) Reticular activating system
5) Mammillary bodies
6) Basal ganglia
7) Cerebellar vermis
8) Cerebellar hemisphere
9) Hippocampus
10) Paramedian pontine reticular formation
11) Frontal eye field
1) Kluver Bucy syndrome (hypersexuality, disinhibited behavior, hyperorality)
2) Behavioral changes and loss of judgment
3) Spatial neglect syndrome
4) Coma
5) Wernicke-Korsakoff syndrome
6) Ataxia
7) Truncal ataxia, dysarthria
8) Intention tremor, limb ataxia on ipsilateral side
9) Memory loss (anterograde)
10) Eyes deviated away from lesion
11) Eyes deviated toward lesion
Contralateral hemiparesis
Decreased contralateral proprioception
Ipsilateral hypoglossal dysfunction (tongue deviates ipsilateral)
1) medial medullary syndrome
2) Caused by occlusion of the anterior superior artery
Vomiting, vertigo, nystagmus
Dysphagia, hoarseness
Ipsilateral Horner’s sydnrome
Ataxia
Think: don’t PICA Hoarse that can’t eat (dysphagia)
1) Lateral medullary (Wallenberg’s) syndrome
2) Occlusion of the Posterior inferior cerebral artery
Vomiting, vertgio, nystagmus Paralysis of the entire face Decreased lacrimation Decreased taste on anterior 2/3 of tongue Decreased corneal reflex Ipsilateral horner's
1) Lateral pontine syndrome
2) Occlusion of the AICA (anterior inferior cerberal artery
Pt. comes in with extremely bad headace. Spinal tap is blood and xanthochromic. What should you think?
Suarachnoid hematoma
How do you differentiate cerebral amyloid angiopathy from Charcot-Bouchard pseudoaneurysm?
1) CAA causes lobar parenchymal hemorrhage
2) Charcot bouchard is more common in the basal ganglia and internal capsule
What causes the neurological symptoms of Normal Pressure Hydrocephalus?
1) Stretching of the corona radiata
Treatment for trigeminal nueralgia?
Carbamazepine
Neuron with shrunken nuclei, no detectable Nissl substance, and intensely eosinophilic cytoplasm; What happened?
1) Red neuron
2) Ischemia
Gram positive rod with tumbling motility that can causes meningitis
Listeria monocytogenes
What does Vitamin E deficiency cause?
Degeneration of spinocrebellar tracts, dorsal column and peripheral nerves
First area of damage during global cerebral ischemia
Hippocampus
Cause of hemiballism
Damage to the subthalamic nucleus
Where is the defect for impaired ability to oxidize very long chain fatty acids occur?
Peroxisome
Complete destruction of the facial nucleus itself; Ipsilateral facial paralysis of entire face
Bell’s palsy
Demyelination of CNS due to destruction of oligodendrocytes. What is the cause?
1) Progressive multifocal leukoencephalopathy (PML)
2) JC virus infection
3) Fatal
Horner-Wright Rosettes; poorly differentiated tumor in the posterior fossa; highly mitotic
Medulloblastoma
Pseudorossetes with GFAP positive
Ependymoma
What is pathognuemonic for a neuroblastoma? Where are these tumors located?
1) Neuropil; small blue cells; elevated HVA and/or VMA
2) Adrenal gland
Paralysis of upward gaze
Parinaud syndrome (dorsal midbrain syndrome)
What test would a patient with frontotemporal dementia have difficulty performing?
1) Pt. naming more than 12 animals in one minute
What disease has an increased startle response and startle myoclonus; patients have rapidly progressive dementia
Creutzfeldt-Jakob disease
What tests differentiate Alzheimer’s from frontotemporal dementia?
1) Alzheimer’s generally has short term memory loss and frontotemporal does not
2) Frontotemporal has personality changes
Neurologic scale that provides an objective assesment for the conscious state of a patient with head injury
Glascow coma scale
What are the three aspects of the Glascow coma scale?
1) Eye response (4 grades)
2) Verbal response (5 grades)
3) Motor response (6 grades)
What is the graded eye response in glascow scale?
1) no eye movement
2) eye movement to pain
3) eye movement to verbal response
4) spontaneous
What is the graded verbal response in glascow scale?
1) no response
2) Incomprehensible
3) Inappropriate
4) Confused
5) Orientated
What is the motor response in glascow scale?
1) no response
2) Extension to pain
3) Flexion to pain
4) Flexion and withdrawal
5) Localize pain
6) Obeys command
