DIT Neuro Mneomonics and Associations and stressed stuff Flashcards
What does nissl look like? Where do you find it?
Blue clumps in dendrite (not in axonal hillock)
Brain mass and GFAP is high. What is it?
GFAP is marker for glial cells, so glioblastoma
What does HIV do to brain?
Glial cells will clump together to make giant cells
What is destroyed in MS? What do these cells look like healthy on his to?
Oligodendrocytes (no myelination). Large clear cytoplasm (also similar appearance in HPV koilocytes and testicular seminomas)
What promotes axonal regeneration in PNS? When ar ethese cell damaged?
Schwann cells.
Guillan barret
Neurofibromatosis type II presents as bilateral acoustic schwannomas
What is mesocortical dopamine pathway? What happens when it is blocked?
It is ventral segmental of midbrain to the cortex.
Think of it as the happy and social pathway with dopamine (booze)
If blocked, you increase negative effects of schizo (typical antipsychotic issue)
What is the mesolimibic pathway? What happens when it is blocked?
Ventral segmental of midbrain to limibic.
THINK LIMBIC AS WHERE FEAR/emotion are, so if it is blocked…
You relieve schizo
What is nigrostriatal dopamine pathway? What happens if blocked?
Substantia nigra to neostriatum
(remember they are in that parkinson pathway)
So parkinsons disease if blocked
Tuberoinfundibular pathway is what? What happens if blocked?
Arcuate nucleus of hypothal to the pituitary
IF blocked: more prolactin from anterior pituitary (yay HRM!)
Paraventricular nucleus of hypothalamus?
Oxytocin production (Paraventricular is near ventricle, so it is wet, like she just had an orgasm and that has oxytocin release.)
Anterior nucleus of hypothalamus?
Cooling and parasymp. Anterior nucleus cool off.
A/C cooling
Preoptic area of hypothal?
GnRH is released to stim LH and FSH of anterior pituitary.
Think raised eyebrow (preoptic) when hot girl walks by (so yeah gonadohormone)
Suprachiasmatic nucleus?
Master clock for circadian rhythm (makes sense b/c location) B/C takes input from retina.
Supraoptic nucleus of hypothal?
Supraoptic nucleus regulates water balance and secretes ADH.
Lesion: Diabetes insipidus
Dorsomedial nucleus?
Stimululates GI. Stimulation causes savage behavior and obesity
(NOTE opposite of ventromedial, is the DORSOmedial)
Lateral nucleus of hypothal?
Stimulation=hunger, eating. Destruction=starvation, anorexia.
Leptin inhibits it
If you lose lateral nucleus, you lose laterally
Ventromedial nucleus of hypothal?
Satiety
Stimulated by leptin
If you lose ventromedial, you will not be medially balanced and will grow ventrally and medially.
Arcuate nucleus of hypthal?
(A for arcuate and A for anterior pituitary)
Releases dopamine and GHRH.
Regulates hunger and satiety
Posterior nucleus of hypothal?
Heating the person, conserves heat. (think opposite of anterior which is A/C or cooling)
Mamillary body of hypothal?
Receives input from hipocampus.
hemorrhagic lesions from wernicke’s encephalopathy
What does leptin do?
Causes satiety. Activates ventromedial, inhibits lateral hypothal
Mnemonic for sleep waves?
BATS Drink Blood
Beta
Alpha
Theta (N1)
Sleep Spindles and K complex. Teeth grinding (bruxism).
Delta waves (slow wave) (bedwetting and night terror. TCA treats it b/c decreasing stage 3 sleep)
Beta for rem again
Night terror tx?
Benzos to decrease stage three (also works for bed wetting)
Nocturnal enuresis can be diagnosed when?
Never before 5. Can try behavioral changes to treat.
Pharm: high likelihood recurrence once yous top.
Imipramine: decrease Stage N3
Desmopressin: orally to decrease urinating
Indomethacin decreases renal blood flow.
Zolpidem MOA? What is the newer alternative for it?
Ambien. Works at GABA/benzo receptor but less addictive (still only short use)
Eszopiclone is alternative and not addictive
What is ramelteon?
Non-addictive and on melatonin receptor (melt eon sounds like melatonin)
What brain structure does extra ocular movements during REM?
Paramedian pontine reticular formation (PPRF)
Facial nerve branches mnemonic?
Ten Zebras Bit My Cervix.
Temporal Zygomatic Buccal Marginal Mandibular Cervical
What offers taste to anterior 2/3 of tongue?
Facial.
Sensation is Trigeminal V3
CN IV innervates what? What does a lesion do?
And VI?
CN IV is Superior Oblique (That is SO 4). so a lesion causes up and in.
CN VI is lateral rectus and lesion causes medial deviation
Physiology of marcus gunn pupil?
Afferent problem in one optic nerve. Signal can’t be related to the eddinger westphal nucleus, so no constriction when light shone in one eye.
BUT WHEN LIGHT IN OTHER EYE, the tract is to both eddinger westphal nuclei and boom, constriction of both eyes.
Nuclei for pupil reflex?
They skip past lateral geniculate nucleus (which would have been used to relay to the primary visual cortex) but instead go to the
pretectal nuclei.
Then to BOTH edinger westphal.
Then to occulomotor nerve to cilliary ganglion to constrict.
What nerves go through cavernous sinus?
3, 4, V1, V2 and 6
What does the nucleus solitaries do?
Solitary is Sensation of baroreceptor and gut dissension and TASTE
VII, IX, X
(it is a vagal nucleus)
What does the Ambiguious nucleus do?
aMbiguus is Motor
Motor innervation of pharynx, larynx, upper esophagus
IX, X, XI
Dorsal motor nucleus does what?
Vagal Autonomic to heart, lungs, upper GI
What is high with neurotube defect? What can this marker mean?
high alpha feto protein (dick..), can also mean anterior abdominal wall defect
Spina bifida oculta?
Only at level of bone. TUFT OF HAIR means get imaging
Meningocele defect?
Just meninges herniated
Myelomningocele?
Meninges and spinal cord ehrniated
what do you see with anencephaly during pregnancy?
Anterior neural tube defect.
Polyhydramnios! b/c lost swallowing center.
Also high AFP (as always with neuro tube defect)
Holoprosencephaly happens when?
FAS
Sonic hedgehog mutations
Patau syndrome (trisomy 13)
Chiari malformation is what, but just look of type 1 and II?
Posterior fossa issue.
Cerebellar tonsils herniate through foramen magnum.
CHIARI 1 is associated with syringomelia
Chiari II is herniation of cerebellar tonsils AND vermis. STENOSIS of aqueduct, hydrocephalus
Associated with thoracolumbar myelomingocele
Dandy walker is what and associated with what?
Agenesis of cerebellar vermis and cystic enlargement of 4th ventricle (to fill posterior fossa). It is associated with hydrocephalus and spin bifid a (makes sense)
NOT ACTUALLY dandy walkers (vermis means can’t balance)
What is the only derivative left from branchial cleft?
External auditory meatus from 1st cleft (ectoderm)
How do you tell difference between branchial cleft cyst and thyroglossal duct cyst?
Branchial cleft cyst is LATERAL and doesn’t move with swallowing.
Mnemonic for branchial pouches?
- Ears
- Tonsils
- Bottom (inferior parathyroid) To (thymus)
- Top superior parathyroids
1st branchial arch can be remembered how?
Chew (T’s and M’s)
M: meckels cartilage: mandible, mandibular ligament, malleus
M: Mastication: Masseter, medial pterygoid, MYLOHYOID
T: Tensor tympani, Tensor veli palatini, anT 2/3 of Tongue
Mandibular and Maxillary Trigem nerves
Treacher Collins if it doesn’t work (might not be worth knowing)
Second branchial arch is remembered how?
S arch (smile)
Cartilage: Stapes, Styloid, leSSer horn of hyoid, Stylohyoid ligment
Muscle: Facial expression, Stapedius, Stylohyoid, platySma, belly of digaStric
Seven CN Seven
Third arch, remember what?
Pharyngeal
Pharyngeocutaneus fistula.
CN IX: glossopharyngeal (stylopharyngeus) SWALLOW STYLISHLY
4 and 6 branchial arch remember what?
Cricothyroid and larynx.
Thyroid cartilage and cricoid cartilage
Muscles of larynx except cricothyroid.
Laryngeal branches of the vagus: Superior laryngeal (swallow) Recurrent laryngeal (speaking)
What do you need to remember about 5th branchial arch?
nothing. it does nothing
What connects wernicke’s to broca’s?
Arcuate fasciculus (not to be confused with arcuate nucleus)
What is at the medial aspect of the brain in the homunculus?
Foot, then works way up body as working around body
anterior cerebral feeds what?
Anteromedial surface of brain
foot and leg areas. decreased motor and sensation of foot or leg.
Middle cerebral feeds what?
Brocas, facial, hands
posterior cerebral feeds what?
occipital lobe: Visual lobe defects
Broca’s aphagia?
can’t say words. Broca Broken Boca
Wernicke’s aphagia?
Difficulty udnerstandying. Can say words, but not making sense
Wernicke is What?
Conduction aphasia?
Arcuate fasciculus is bad. Poor repition but fluent speech.
Interprate things well. But can’t repeat phrases.
Global aphasia?
Nonfluent with immured comprehension. BOTH BROCA and Wernicke are affected
Nondominant aphasia?
W(right handed person affected on right side).
Broca. Lose inflection!
Wernicke can’t detect it.
What is kluver bucy?
Amygdala lesion.
Gary BUCY is: hyperoral (things in mouth), hypersexual, and disinhibited
Frontal lobe lesion?
(Start acting like little kids who don’t have frontal lobe deco)
Disinhibition
Can’t concentrate
Poor orientation
poor judgement
primitive reflex migh come back
Pariatal lobe of non dominant side?
Hemispatial neglect
What is Gertsmann Syndrome?
THREE OR FOUR STAR TOPIC
Lesion to dominant parietal lobe.
At angular gyrus. Inability to right, inability to calculate
Finger agnosia (can’t identify fingers)
L and R disorientation
Reticular activating system lesion?
Midbrain and can cause coma
Mamillary lesions? What caused it?
Wernicke Korsakoff (thiamine deficiency B1)
Confusion, ataxia, memory loss, CONFABULATION, personality changes
Basal ganglia lesion?
Can see hyperkinesis or hypokinesis depending on lesion
Substantia nigra problem: perkinsons
Cerebellar hemisphere lesion?
Intension tremor, ataxia (fall towards side of lesion)
Control lateral aspects of body, so makes sense controls outside (i think ipsilateral)
Cerebellar vermis?
Middle of cerebellum controls turn of body. So truncal ataxia and dysarthria
Subthalamic nucleus lesion?
Lesion:
hemibalismus (flailing of limbs)
Hippocampus lesion
no memories
PPRF lesion?
Eyes look away from side of lesion
Superior colliculi lesion?
Paralasyis of upward gaze. AKA parinaud’s syndrome
What is central pontine myelinoslysis?
Rapid correction of hyponatremia.
MRI shows increased intensity in pons
Signs, paralysis, dysathria, dysphagia, diplopia and LOC
Do page 44 practice questions
ok
What are the 4 medial structures and associated deficits?
- Motor pathway (corticospinal) - contralateral arm and leg weakness.
- Medial lemniscus: contralateral loss of vin and proprioception of arm/leg
- MLF: ipsilateral internuclear ophthalmoplegia
- Motor nucleus and nerve: ipsilateral defect of affected cranial nerve (3, 4, 6, 12)
What are the 4 Side Structures and associated deficits?
Spinocerebellar pathway: ibsilateral arm and leg ataxia
- Spinothalamic pathway: alteration of pain and temp of contralateral arm and leg (rarely trunk)
- Sensory nucleus of V (ipsilateral alteration of pain and temp of the part of the face supplied by V)
- Sympathetic pathway: ipsilateral horner syndrome
Which cranial nerves are located medially?
the ones that divide equally into twelve (not 1 or 2). 3, 4, 6, 12
What cranial nerves are in midbrain? pons? medulla?
3, 4
5, 6, 7, 8
9, 10, 12
What happens with MLF? What problems do you look for that can cause it?
The eyes don’t track together if there is a lesion to it.
If right MLF lesion, right eye Medial rectus isn’t working, so left eye looks left while right eye is straight forward (while patient tries to track eyes to the right)
If younger than 50: MS
If older than 50: stroke
What are signs of Weber? What is the cause?
Midbrain infarct from paramedic branches of posterior cerebral artery.
Cerebral peduncle lesion: Contral lateral spastic paralysis
- Oculomotor nerve III palsy: ipsilateral down and out (makes sense b/c thats where nucleus is)
What are signs of wallenberg? What is the cause?
Occlusion of PICA that cause infarct to lateral rostral medulla.
Spinal thalamic is out so contralateral is fine
Pain and temp of ipsilateral face (b/c trigemniothalamic tract runs ipsilateral)
Hoarseness, difficulty swallowing and no gag b/c ambiguus is there (IX and X)
Ipsilateral horner b/c dexcending symp
Vertigo b/c VIII nucleus
Ipsilateral cerebellar deficits (ataxia)
What is the cause of locked in syndrome? What are the symptoms?
Basilar occlusion: locked in syndrome
What causes lateral inferior pontine syndrome? What are the symptoms?
Anterior inferior cerebellar artery.
Lateral: so we have S issues:
Spinothal is out (no pain and temp of contralateral)
Spinal trigem is out, so no pain and temp on ipsilaeral
Sympathetic tract (so ipsilateral horner will happen)
Lateral pontine nerves knocked out: (5, 7, 8)
Ipsilateral loss of face movement and taste (7)
NORMAL sensation and strength b/c thats medial
Ipsilateral horner syndrome
What about problems with lateral superior pontine syndrome?
AICA again, but superior
So light touch of face is lost b/c main sensory trigeminal is lost.
Ipsilateral jaw weakness b/c trigeminal motor nucleus and nerves are lost
Then all the other stuff like STT, TST, sympathetic tract are all out
What causes medial medullary syndrome? What are the symptoms?
Anterior spinal artery is occluded. Unilateral infarct of medial portion of rostral medulla.
Contral lateral spastic (pyramid/corticospinal tract issue)
Contralateral tactile and kinetic defects (medial lemniscus)
Tongue deviates toward lesion hypoglossal nerve
Pain and temp are fine!!!
Risk factor of berry aneurism?
ADPK, Ehlers-Danlos (Type III collagen), marfans is debatable
HTN
Smoking
advanced age
More common in black (black have HTN)
What are charcot-bouchard micro aneurysm?
Chronic HTN affecting basal ganglia and thalamus
What do you give to people with subarachnoid hemorrhage?
Nimodipine, improves outcome. It is calcium channel blocker to stop the vasospasm from blood breakdown
Shape of epidural? Risk?
Eye shaped is Epidural
It is risk of herniation, CN III paralysis
Shape of subdural?
Crescent. Bridging veins cause it. Whiplash or shaken baby
Who is at risk of intraventricular hemorrhage?
Premature/low birth weight newborns (first 72 hours of life)
Can you give TPA to a person who woke up with stroke?
No, assume it happened when he fell asleep
3 things in carotid sheeth
vagus
internal jugular
carotid
What can cause communicating hydrocephalus?
Arachnoid granulations aren’t absorbing CSF, oftn from arachnoid scarring post-meningitis
What is normal pressure hydrocephalus? What is the mnemonic for symptoms?
Wet, Wobbly, Wacky.
Urinary incontinence, dementia, ataxia
REVERSIBLE! b/c you can put shunt in to get fluid out and it resolves (you saved a person who had a type of demensia!)
idiopathic
Hydrocephalus ex vacuo is what?
Atrophied tissue around brain, happens with alzheimer’s especially.
Also HIV, and Pick disease.
Normal intracranial pressure, so no triad of normal pressure hydrocephalus is seen.
Pseudotumor cerebra happens to who? and what are symptoms? What is the scariest thing?
Young obese women, headaches, eye pain, papilledema WEIRD b/c no ventricular dilation or tumor or mass (which is why it got its name). Most worrisome sequelae is blindness
CSF is elevated to more than 200 or 250 if obese!!!! Patient always lay down for CSF.
How do you treat pseudo tumor cerebra?
CT t rule out tumor and mass, then discontinue inciting agents:
Discontinue:
Vit A
Tetracycline
Corticosteroid withdrawal
Weight loss is good
Tx: acetazlamide
Serial punctures
optic nerve sheath decompression
Shunting
(need to know treatment!)
Who gets tension headaches? Describe it. How do you treat?
Women slightly more than men.
Bilateral, frontal or occipital involvement (muscles pulling and causing tension)
None of these symptoms: light sensitivity, vision issue, N/V, focal neural chagnes
Tx: NSAID
Who gets migraines? Describe it. Treatment?
Women 2-3X more common (tyrannies make it worse)
Unilateral pain, otherwise, Kinda like a hangover:
throbbing, pulsating, aggravated by physical activity, intense,4-72 hours, Must have either N/v or photo/phonophobia. Inhibits daily activities
At least 5 attacks
Can have aura, but not always
Tx:
Triptans, (5HT agonists to vasoconstrict), NSAIDs
prophylactic with topiramate, calcium channel blockers (weird, dilate until it happens then constrict), amitryptaline
What is a cluster headache? who gets them? HOW DO YOU TREAT IT?
Youngish male smokers
STRICYLY unilateral and behind eye and super painful.
No throbbing, can cause nasal symptoms, partial horner, and happens daily at same time for weeks
TREAT WITH OXYGEN! boom, its better. tripton may help
Contraindications for sumatriptan?
CAD
Prinzmetal angina
Pregnancy
Halothane damages what?
hepatic
What does high lipid solubility do for inhaled anesthetics?
What does low blood solubility do for inhaled anesthetics?
High lipid: more potent (less drug for desired results)
Low blood solubility: faster action!
What IV anesthetics decrease blood flow, which increases?
Barbs are less blood flow (nice for brain surgery)
Ketamine causes more blood flow
What is thiopental? how does it act?
It is a benzo, the only one without a barbital suffix.
Potentiates GABA channel. Stabilizes membrane potential. KEEPS the channel open longer
How do benzos work? whats the mnemonic?
Benzos open GABA more frequently
vs barbs that keep it open.
Ben likes it more frequently, barb likes it longer.
How do you treat hypotention from OD with benzo? SUPER HIGH YIELD!
Flumazenil (Florance says no to Ben who likes it more frequently)
What is great about fentanyl?
No histamine release like with morphine
Butorphanol is what?
An opioid that hcauses less resp depression
What is dextromethorphan?
cough suppressant with mild opioid effects
What is tramadol?
“Non-addictive” opioid, shitty use other than helps ween people off drugs
What is loperamide and diphenoxylate?
Antidiarrheals (opioids)
Suffix for nondepolarizing muscle blockers?
curarine, curium, curonium
How does tubocurarine work?
Competes with ACh for receptor.
Neostigmine is reversal
How does succinylcholine work?
Binds nicotinic receptors on neuromuscular junction, but it causes muscle contraction (muscular fasciculations will happen)
Then the succinylcholine stays there until it moves away from receptor.
2 different blocks from succinylcholine?
Phase 1: normal block. RAPID onset. Can’t be antagonized.
Phase 2 block: Larger block: characteristic similar to non depolarizing, NEOSTIGMINE is tx.
What can cause malignant hyperthermia? How do you treat it?
Inhaled anesthetic with succinylcholine in
Ryanodine receptor mutation RYR1 mutation. IF there is a history of it, use non polarizing
Tx: cool patient, and dantrolene. DANTROLENErevents sarc reticulum from releasing Ca++
How do local anesthetics work?
Go inside cell, block open Na channels so can’t depolarize
What is order of nerves affected by local anesthetics?
Size prevails, then myelinated is important.
So order is small myelinated before small unmyelinated before large myelinated
Which means TO STOP Motor activity (large myelinated) you need a shit ton of anesthetic, but pain doesn’t need as much
What do you do if tissue is infected and you want local anesthetic?
well it will be acidic tissue, which stops effectiveness, so use a shit ton of it!
What is an absence seizure?
Genralized seizure blank stare
What is a myoclonic seizure?
Generalized siezure.
brief twitching of muscles
What is a tonic-clonic seizure?
Generalized seizure. grand mal (dramatic twitching)
What is a tonic seizure?
generalized seizure, just stiff
What is an atonic seizure?
generalized seizure, can be confused for fainting. You fall.
What is status epileptics?
5 or more minutes or recurring seizures without regaining consciousness between them
Genetics of tuberous sclerosis?
Autosomal dominance but variable expression (complete penetrance)
TSC1 or 2 (Tuberosclerosis) Hamartin or tuber in respectively
Triad:
Seizures
Mental retardation
Angiofibromas (small papules on nose)
Findings of tuberous sclerosis? Are there cancer concerns?
Mnemonic: HAMARTOMAS
Hamartomas in CNS and skin Angiofibromas (nose papules) Mitral regurgitation Ash-leaf spots!!! Rhabdomyoma Tuberus sclerosis (thats the disease) dOminant inheritance Mental retadation Angiomyolipoma (renal cancer) Seizures (seizure lecture)
More supendymal astrocytoma, rhabodmyoma,
Sturge Weber Syndrome?
STURGE Sporadic inheritace Stain (port-wine ASHLEY Sturg Weber( Tram track Ca++ Unilateral Retardation Glaucoma EPILEPSY (seizure video)
Trigem neuralgia treatment:
Anticonvulsant
