Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PATHOLOGY CAM304 > Cranial Nerve and Brain Stem Disorders > Flashcards

Cranial Nerve and Brain Stem Disorders Flashcards

1
Q

What cranial nerves would be involved in : • Diplopia, pupil asymmetry, ptosis

A

3,4,5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What cranial nerves would be involved in • Sensory loss over the face

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What cranial nerves would be involved in Weakness over the face only

A

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What cranial nerves would be involved in vertigo (spinning)

A

8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What cranial nerves would be involved in hearing loss and tinnitus?

A

8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some signs common in brain stem and cranial nerve disorders but not unique to them?

A

Dysphagia (trouble swallowing)

Dysarthria (difficulty speaking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In optic neuropathies, what occurs in OPTIC NEURITIS?

A

Commonest aetiology in the young, treatable
T cell immune mediated inflammation of the nerve, often with demyelination
Rapid onset of progressive visual field loss
Often painful, usually monocular, reds go pale
Disc can look normal (40%) if retrobulbar (ie if inflammation is behind the disc)
Lasts weeks-months, with variable outcomes

Important, as it is associated with eventual MS in 50% (higher change if there are multiple lesions on MRI brain & oligoclonal bands in CSF), and less commonly neuromyelitis optica (another autoimmune demyelinating disorder with spinal cord abnormalities)

When isolated, can be a “postinfectious” immune response following viruses like EBV, measles, mumps, influenze, etc

Common & treatable (steroids help)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What occurs in Ischaemic Optic Neuropathies0 what are the two broad types?

A

Non arteritic- large vessels arent involved- ie. small vessel occlusions, associated with small vessel occlusive diseases like diabetes, HTN, smoking
Arteritic ischaemia - large vessels are involve- can get inflammation of one of the large arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

WHat are some less common causes of optic neuropathies?

A
  • Infections – CMV, HIV, cat scratch disease, toxoplasmosis, syphilis, TB, Cryptococcus
  • Systemic autoimmune & inflammatory diseases – SLE, Sjorgens, Wegener’s, IBD, sarcoidosis
  • Nutritional deficiencies – B1, B12, folate
  • Drugs – cyclosporine, chemotherapies, infliximab, bevacizumab, sildenafil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some helpful tests for optic neuropathies?

A

o MRI brain with gadolinium – nerve enhances if acute & inflammatory
o CSF – inflammatory? Viral PCRs, cultures
o Specialist blood tests if putative cause – antibodies, serology, gene tests etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some of the causes of optic nerve compression and infiltration?

A
  1. Tumour of II nerve – gliomas (associated with neurofibromatosis)
  2. Tumours compressing II n - Meningioma, craniopharyngioma, pituitary adenoma, metastases
  3. Other –
    - Grave’s ophthalmopathy (with hyperthyroidism)
    - Carotid-ophthalmic artery aneurysms, abscess, cerebral venous thrombosis
  4. Idiopathic intracranial HTN
    - Increasingly common, more in females & obese
    - Cause unknown, but factors include impaired CSF absorption, sleep apnoea, elevated venous pressure
    - Visual loss via high pressure on optic nerves
    - Associated with generalized headache, visual obscurations, papilloedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the diagnostic approach to Optic nerve compression and infiltration

A
  • CT or MRI brain will identify most masses
  • Add CTV/MRV where cerebral venous thrombosis is possible
  • LP for opening pressure where imaging normal & idiopathic intracranial HTN suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CNVI palsy

A

horizontal diplopia, cant abduct, turn head towards missing side.

Causes:
idiopathic, traumatic (post head injury), compression via tumour, aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CNIII palsy

A

Vertical and horizontal diplopia
eye sits in a ‘down and out’ position.
Causes: Ischemic; compresison in subarachnoid space (aneurysm of posterior communicating arter), tumour, meningococal etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Other Ophthamogplegias/DDx of nerve palsies you must consider

A

NMJ disorders (seen in myasthenia gravis)

  • occulomotor disorder (graves disease- hyperthyroidism)
  • Internuclear ophthalmoplegia
  • wernickes encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What nerve would you be considering if they had facial numbness?

A

CN V - trigeminal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is trigeminal neuralgia- what is the clinical context?

A

• Common
• Brief episodes of severe shock-like pain along one or more of the V nerve branches (usually V2 or V3 along the jaw)
• Doesn’t usually wake at night
• There are triggers – touching, chewing, brushing teeth or cold air
• Usually no signs (diagnosis based on history)
Causes:
***Compression of trigeminal nerve root by aberrant vessel (80-90%)
• Compression by tumour, aneurysm, AVM
• Multiple sclerosis
Need to MRI

18
Q

Facial Motor Disorders- > eg Bells Palsy

A

CNVII
• Idiopathic unilateral LMN facial paralysis
o (?HSV infection in nerve ganglion)
• Rapid onset (over hours)
• Pain behind the ears rapidly develops into facial palsy
• Often preceding pain behind the ear, hyperacusis (CNVII controls small ear muscles that may have a role in dampening sound) and sometimes also impaired facial sensation (altered perception by droopy muscles, or true V involved)

19
Q

Diagnostic approach to facial motor disorders

A

• Confirm LMN not UMN, but remember a LMN can still be in the brainstem (VII nucleus)
o LMN palsy affects whole side of face
o UMN affects contralateral lower ½ of the face
• Look for vesicles in ear (treatable HZV), parotid mass
• CT/MRI if tract signs, vertigo, diplopia etc

20
Q

Vertigo: Vestibular Disorders- what are some common peripheral causes of Vertigo

A

Benign Paroxysmal Positional Vertigo

Meniere’s Disease.

Vestibular neuronitis and labrynthitis

Infections, drugs, autoimmune, alcohol, trauma etc

21
Q

Describe Benign Paroxysmal Positional Vertigo

A

Benign Paroxysmal Positional Vertigo - commonest chronic and recurent cause: loose CaCo3 crystals in utricular sac in semicircular canal (idiopathic, Meniere’s disease), episodes last 30-40 seconds, chronic.

22
Q

Describe Meniere’s disease

A

• Increase in endolymph fluid in the semicircular canals, with episodes of rupture of membranous labyrinth dumping endolymph into perilymph, but uncertain
• Background of sensorineural hearing loss (effecting the cochlear as well) +/- low pitched tinnitus
o If no hearing loss within 12 months or vertigo onset, unlikely meniere’s
• Episodes of horizontal vertigo for 20 mins – 24 hours, often with decreased hearing, increased tinnitus, and aural “fullness”

23
Q

Describe some common CENTRAL causes of vertigo

A

TIA, stroke, haemorrhage in the brain stem or cerebellum
Encephalitis
Migraine vertigo

24
Q

Describe the diagnostic approach to vertigo

A

Check it is vertigo

  1. Time course helpful
    - acute- more central
    Recurrent but infrequent: menierres, BPPV, etc
    Chronic- BBP, …
  2. Duration helpful
    -seconds: BPPV
    - Minutes: migraine
    Hours: menieres, migraine
    Days: vestibular neuritis, stroke
  3. are brain stem/brain features present: likely central: show changes in speech, nystagmus, sensory loss, etc.
25
Q

Dysphagia- What are the causes?

A

Structural/GIT - ie. not neurological
Myopathies involving pharyngeal/oesophageal mm
NMJ disorder: myasthenia gravis
Neuropathies and lesions involving CNIX, X
Brain stem disorders affecting CNIx//X nucleii
Cerebral disorders

26
Q

Dysphagia

What are structural/GIT causes?

A

• Ie not neurological
• Eg: pharyngeal pouch, oesophageal web, ulcerative oesophagus, tumour etc
• Need gastroscopy &/or barium/video swallow to exclude first
• Note on history: sensation of food getting stuck, whereas neurological/oropharyngeal report difficulty initiating swallowing, with coughing, choking or nasal regurgitation, and that fluids are as problematic as solids!
o Neuro – liquids & solids
o Structural – big solids are the issue

27
Q

Dysphagia

What myopathies involving pharyngeals/oesophageal mm?

A
  • Dermatomyositis & polymyositis
  • Myotonic dystrophy
  • Oculopharyngeal muscular dystrophy
28
Q

Dysphagia

What are some neuropathies & lesions involving CNIX, X

A
  • Guillian-Barre syndrome
  • Motor neuron disease, polio
  • Head & neck masses (tumours, LNs, abscesses)
29
Q

WHat are brain stem disorders affecting CNIX/X

A
  • Multiple sclerosis
  • Strokes, tumours
  • Rhombencephaliis etc
  • i.e. look for other signs of brain stem dysfunction
30
Q

Multiple Cranial Nerve Disorders
There are many regions where cranial nerves group together, so masses, trauma or infection (of nerves or mennges) at these sites produce combined problems – eg:

hich nerves are in the RETROSPHENOID SPACE?

A 
II
III
IV
VI
V1
31
Q

Multiple Cranial Nerve Disorders
There are many regions where cranial nerves group together, so masses, trauma or infection (of nerves or mennges) at these sites produce combined problems – eg:

which nerves are in the CAVERNOUS SINUS

A

III
IV
VI
V1-2

32
Q

Multiple Cranial Nerve Disorders
There are many regions where cranial nerves group together, so masses, trauma or infection (of nerves or mennges) at these sites produce combined problems – eg:

which nerves are in the JUGULAR FORAMEN

A

IX
X
XI

33
Q

BRAIN STEM DISORDERS

General

A
  • Brain stem includes cranial nerve nuclei, but also multiple sensory & motor tracts, connections to cerebellum & vital centres for attention, cardiac & respiratory centres
  • Therefore, multiple symptoms/signs, plus can be coma & cardiorespiratory dysfunction
34
Q

BRAIN STEM DISORDERS

Common Symptoms/Signs

A
  • Reduced conscious state – via dysfunction of reticular activating state, although any diffuse severe cerebral disorder can produce this
  • Nausea/vomiting – dysfunction of area postrema of medulla, but also occurs by cerebral disorder
35
Q

BRAIN STEM DISORDERS

Uniqu signs and symptoms

A

Locked in syndrome – where bilateral motor tracts to limbs, trunk & face are affected, except can blink & move eyes → via base of pons lesion

‘Ataxic‘ irregular breathing
o If with hypertension & bradycardia → Cushing’s Triad of herniation of brain onto brainstem by increased ICP

Abnormal limb/trunk positioning
o Involuntary flexion or extension of the arms & legs, indicating severe brain injury
o Occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus ie pain causes the working set of muscles to contract

Decorticate position
o Lesion above the red nucleus in midbrain
o Flexion of elbows & wrists + Adduction of arms
o Extension of legs, plantar flexion of feet + Feet turned inward

Decerebrate position
o Lesion below red nucleus in midbrain
o Arms adducted, extended, pronated & wrists flexed
o Legs extended, plantar flexed

36
Q

AGAINST BRAIN STEM PATHOLOGY

A

COGNITIVE DEFECTS- eg dysphagia

SEIZURES

37
Q

Name some Brain stem disorders

A 
Brain stem strokes
Brain Stem tumours
Brain stem rhombencephalon- encephalitis
Other (effect also lesion elsewhere)
- MS
- Osmotic demyelination
38
Q

Common Brainstem tumours

A

o Glioma – usually unresectable
o Acoustic neuroma – actually a tumour of the Schwann cells of VIII nerve, present with SN hearing loss, tinnitus, unsteadiness (vertigo unusual as grow slowly)
• Curative resection possible
• Diagnose via CT/MRI (+/- Biopsy if able, as risky)

39
Q

Describe Brainstem/rhombencephalon encephalitis?

A 
•	Inflammation of the brainstem +/- cerebellum via:
o	Infections (often with fever)
•	Listeria, enterovirus 71, HSV, EBV, VZV
o	Paraneoplastic antibodies
•	From SCLC, testicular CA, breast CA
o	Other autoimmune (SLE)
•	Diagnose via MRI & CSF (inflammatory)
•	DDX often tumour, lymphoma, MS
40
Q

Describe brain stem/ rhombencephalon encephalitis

A 
•	Inflammation of the brainstem +/- cerebellum via:
o	Infections (often with fever)
•	Listeria, enterovirus 71, HSV, EBV, VZV
o	Paraneoplastic antibodies
•	From SCLC, testicular CA, breast CA
o	Other autoimmune (SLE)
•	Diagnose via MRI & CSF (inflammatory)
•	DDX often tumour, lymphoma, MS

PATHOLOGY CAM304 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions