DIT Neuro 2 Flashcards
Lower motor neuron lesion symptom vs upper?
Lower: flaccid paralysis, atrophy and fasciculations (b/c anticipate signal) (hyporeflexive b/c no ark)
Upper lesions: spastic paralysis and hyperreflexive
How does signal get to the deep cerebellar nuclei?
inputs from Mossy and Climbing fibers
to other stuff
To PURKINJE (know those three cells)
To deep nuclei of cerebellum
Where is the major output pathway of cerebellum going?
Ventral Lateral nucleus of thalamus (via superior cerebellar peduncle)
What side of body is affected by left side of cerebellum?
Left side (ipsilateral)
path is to right thalamus, cortex, corticospinal tract which decussates to the left body again
What does Romberg test?
Proprioception (Tabes dorsalis)
What are the three input to cerebellum? What nuclei do they go through?
Nuclei: D E G F (F is in middle)
Vestibulocerebellum is F (middle)
Spinocerebellum is EG and F
Cerebroccerebellum is D
Vermis and peravermis issue causes what?
Postural instability (core of body affected), slurred and slow speech
Spinocerebellum
3 kinds of tremors? Cause for each?
Essential (fam history and always tremor)
Resting: parkinsons and gone with movement
Intention: cerebellar damage with involuntary movement (cerbrocerebellum issue (lateral hemisphere)
Lesion of substantia pars compact?
Lesion of subthalamic nucleus?
Parkinsons
Hemibalismus
Mnemnoic for parkinson drugs?
BALSA
Bromocriptine (ergot, vasoconstrict) pramiproxal and ropinerol
Amantadine more dopa release
Levadopa/carbidopa
Selegiline: stopes monoamine oxidase (pref dopamine)
Antimuscarinic (Benztropine Park my Benz)
Huntington mnemonic? 2 of them
CAG. Caudate loses ACh and GABA
C’s
CAG repeat Chromsome Cuatro Chorea Cognitive decline Caudate
Huntington Tx? 2 types of drugs
tetrabenazine and reserpine (inhibit monoamine transport)
Haloperidol and clozapine
What causes:
Hemiballismus?
Chorea
Athetosis?
Hemiballismus: one half body jerks out: contralateral subthal nucleus (lacunar stroke, its a contralateral lesion)
Chorea: huntington
Athetosis: slow writhing movements in hands and fingers: Huntington again
What does polio hit? What is werdnig hoffmann disease?
LMN b/c destroy anterior horns
What does MS affect in spinal cord?
Random demyelination.
Scanning speech, inanition tremor, internuclear opthalgia (MLF lesion: adduction paralysis ipsilateral and abduction nystagmus)
What does amyotrophic lateral sclerosis affect on spinal cord?
Cause?
Tx?
ALS is upper and motor neuron lesion.
IN TACT sensory and not dumb
Lateral spinal tract
Anterior horn
So lots of symptoms: eventually can’t breath.
Caused by superoxide Dismutase 1 defect.
Tx is riLOUzole for Lou Gerig (not curative, but dampens affect)
Describe Friedrich ataxia?
trinucleotide repeat
Freidriech is Fratastic (fratazxin): FRAT bro always STAGGERINg, FALLINg, but has BIG HEART
Sensory loss b/c iron binding issues in mitochondria. Presents in kids. Chromosome 9
Mnemonic for Ataxia telangiectasia?
A disease ATM gene (double strand break repair)
Ataxia, Angiomas, igA deficiency Afp is high
Ataxia from cerebellar defect
Erb duchenne palsy?
Erber (upper trunk: C5-6) from babies being born who are too big and stretches roots.
Waiter tip.
suprascapular, musculocutaneous, axillary
Will get function back if just distocia.
Klumpke palsy?
KLumpke cause KLaw hand
Look at more brachial plexus
ok
How do you injure femoral nerve? What is consequence?
Pelvic fracture (L2-4)
Loww of hip flexion and extension (loss of sensation to anterior thigh and medial leg)
How do you injure obturator? What is consequence?
Anteriorhip displasion, loss of
Medial thigh sensation
loss of adduction
How do you injure superior gluteal nerve?
Consequence?
Posterior dislocation
Hip abduction and medial rotation of thigh
Polio can do it Tradelenberg gate (Teri Ache) and hip drop when standing on injured leg (THE NONINJURED SIDE DROPS b/c gluts can't keep body level)
How do you hurt inferior gluteal nerve?
What do you see?
Gluteus maximus is out, so can’t stand up or extend hip
Sciatic is lost? what happens?
How does it happen?
Intervertebral disc herniation, spinal stenosis, spondylolisthesis
Hammis out
Sensation to posterior thigh and lower leg
How do you diagnose which nerves are out for branches of sciatic?
PED: Perioneal Everts and Dorsiflexes, if injured, foot is dropPED (deep perioneal)
TIP: Tibial Inverts and Plantarflexes; if injured: can’t stand on TIPtoes
Type 1 muscle vs type 2? mnemonic
Type 1: 1 slow red ox
slow twitch are red and lots of mitochondria so great at ox phosph
Type2 is fast twitch, white muscle building muscle
Bilateral facial paralysis: consider what?
CSF findings with one of the diseases? (nothing was mentioned for the other disease)
Guillain barre: Elevated CSF protein with normal cell count
Lyme disease
What is progressive multifocal leukoenephalopathy presentation?
any associations?
Demylenation b/c oligodendrocyte destruction
JC virus association (AIDs) and usually rapidly progressive and fatal
What is metachromatic leukodystrophy?
Findings?
Autosomal rec lysosomal storage from arylsulfatase A def.
Sulfatides build up and impair myelin sheath production.
Central and peripheral demyelination with ataxia/dementia
What is charcot marie tooth disease?
Findings?
hereditary motor and sensory neuropathy b/c defective protein production or sheath production.
Autosomal dominant
Various parts of body affected but LOOK FOR HIGH or FLAT foot arches
If you have a pic on the test of a retina with an optic disk having a big ring in it, what is it showing?
Optic cup >50% of optic disk diameter is glaucoma
What are the two kinds of macular degeneration? What happens?
How do you treat it?
Loss of macula vision (central fields)
Dry: STOP FUCKING SMOKING deposition of drusen in eye. Multivitamin and antioxidants slow progression
Wet: rapid loses from vascularization and treat with antiVEGF
Glaucoma tx? 5 classes
Increase outflow:
Alpha agonists
Prostaglindins
Cholinergic agonists
Reduce production:
beta blockers
acetazolamide
What is a risk of chronic middle ear infection? How do you treat what we are worried about?
Cholestatoma. Overgrowth of keratin debris that erodes ossicles and mastoid air cells.
Gray white pearly lesion behind TM and remove it!!!
WHAT IS MENIERE DISEASE? (ACCIDENTAL CAPS LOCK, SORY)
ENDOLYMPHATIC HYDROPS. IMBALANCE OF FLUID AND ELECTROLYTE COMP IN ENDOLYMPH CAUSE TRIAD OF:
INTERMITTENT VERTIGO
HEARING LOSS
TINITIS
What are findings of alzheimer intracellularilyh and extracellularily?
intracellular tau proteins
Extracellular beta amyloid
Neurofibrillary tangles have intracellular tau
Depletion of acetylcholine
Why are down syndrome higher risk for dimensia?
Extra chromosome 21
Code for amyloid precursor protein
Alzheimer tx?
Cholinest inhib: Donepezil, galantamine, rivastigmine
Memantine: NMDA (NMDgay) receptor antag (glutamate receptor which would otherwise be overstim)
What is dementia with Lewy bodies?
VISUAL hallucinations, parkinsonian features, repeated syncope
Lew bodies are in the cortex instead of substantial nigra
What do you see with pick disease?
Pick bodies are spherical tau protein aggregates. They may PICK ON YOU b/c personality change
Frontotemporal atrophy
dimentia, aphasia, parkinsoinan aspects with change in personality. THEY GET CRABBY.
Pariatal lobe is spared and superior 2/3 of temporal features.
Rapid on course of dementia with change in personality?
Creutzfeldt jakob. May have startle clonus
Prion disease (beta pleated sheets)
Brain starts to make vacuoles (spongioform encephalopathy)
Intracellular spherical aggregates of tau on silver stain?
Silver means Pick.
