E5 Flashcards
How does Rett differ from autism?
Rett: universal regression
What is required for autism diagnosis?
Persistent deficits in social interaction across multiple contexts
- -Social-emotional reciprocity
- -Nonverbal communication
- -Developing, maintaining, and understanding relationships
Restricted, repetitive patterns of behavior/interests/activities
What are the four core features of Rett syndrome?
Psychomotor REGRESSION --Language --Hand use Stereotypic movements (hand washing, wringing, squeezing, clapping, tapping, etc) Gait dysfunction
What is the genetic mechanism of Angelman syndrome?
Loss of UBE3A, normally maternally inherited
What is the genetic inheritance of Fragile X?
X-linked dominant
What causes exophthalmos in Graves’ disease?
Accumulation of extracellular matrix proteins, inflammation, and fibrosis
What is caused by tears in bridging veins?
Subdural hematoma
What is the most common intraocular malignancy in adults?
Metastatic carcinoma
What is the most common primary intraocular malignancy in adults?
Uveal melanoma
Where does uveal melanoma typically metastasize to?
Liver
Where does uveal melanoma typically metastasize to?
Liver
Diffuse acute focal suppurative CNS infections can lead to…
Cerebral abscess
How is viral meningo-encephalitis diagnosed?
Increased protein
Normal glucose
Lymphocytes and macrophages in perivascular Virchow-Robbins spaces
Bitemporal encephalitis is ____ until proven otherwise
Herpes simplex
PML is caused by…
JC virus
PML affects what type of patient and what type of cell?
Immunocompromised / oligodendrocytes
What is the main feature of PML?
Demyelination
Histological appearance of HIV encephalitis
Perivascular giant cells in white matter
Protein conformation change in prion diseases
PrP-C to PrP-SC
What are the four ways in which guidance cues can direct connectivity?
- Graded axon guidance cues
- Homophilic adhesion cues
- Axon-axon recognition cues
- Sub-cellular adhesion cues
How are axons guided in the eye?
- Axons are directed to the optic disc (repulsed from periphery of retina, attraction to optic disc)
- Axons are then guided to the optic chiasm, where temporal axons are sent ipsilaterally, and nasal axons are sent contralaterally
- These axons reach the tectum, where a gradient exists to send axons to the proper location
What is a critical period?
Specific time in development in which activity/physiology influences responsiveness
In what order to critical periods open during development?
Vision/sensory –> language/higher function
T/F: Critical periods for language and higher cognition diminish, but don’t ever close
True
What is amblyopia?
Reduced vision in absence of overt ocular pathology
What is the primary cause of amblyopia?
Strabismus (misaligned or crossed eyes)
What is anisometropia and how is it treated?
Unequal focus due to refractive error. Use glasses to correct.
How does anisometropia cause amblyopia?
One eye is out of focus, so other one over-compensates
What causes the most severe form of amblyopia?
Cloudiness in the normal clear eye tissue or lid droop
How do you treat amblyopia?
- Patches
- Eye drops (atropine) –> temporarily blur vision in stronger eye, so patient is forced to use weaker eye
- Glasses –> correct refractive errors
- Surgery (cataracts, extraocular muscles to realign eyes in strabismus)
Which visual functions have relatively short periods of development?
Basic spectral sensitivity functions of rods and cones
3-6 months
Which visual functions have relatively long periods of development?
More complex functions such as monocular spatial vision or resolution
25 months
How long is the period of development for binocular vision?
Long, over 25 months
How does increasing GABA function affect critical periods?
Leads to premature maturation of period (early end of plasticity)
How does decreasing GABA function affect critical periods?
Leads to delayed critical period (extends period of plasticity)
Increased/decreased GABA leads to premature development.
Increased
What is neuroplasticity?
Ability of the brain to reorganize by creating new neural pathways to adapt, as it needs
What is the difference between explicit and implicit memory?
Implicit (Nondeclarative) – nonconscious – skills/behaviors
Explicit (Declarative) – conscious – facts/events
What type of memory does Korsakoff’s syndrome affect?
Explicit memory (and in some cases implicit)
How does chronic alcohol abuse affect memory?
Causes thiamine deficiency, which leads to cell death in medial thalamus and mammillary bodies
Damage to what structures causes complete loss of ability to form new memories?
Mesial Temporal System –> entorhinal and perirhinal cortices, hippo, parahippo, amygdala
What are two types of plasticity?
Functional: brain can move a function from a damaged area to an undamaged one
Structural: brain can change structure as a result of experience or learning
What structures of the brain are associated with implicit memory?
Cerebellum, basal ganglia
What structures of the brain are associated with Sensory memory?
Where (spatial) - dorsolateral prefrontal cortex
What - orbito-prefrontal cortex
When does consolidation of long term memory occur?
During sleep when serotinergic raphe nucleus neurons are active in their projection to the hippocampus
Where is much of the work associated with memory done in the hippocampus?
CA1/CA3 regions
Which drug blocks NMDA receptors, thereby preventing new LTP and blocking entry of Ca2+?
AP5
What are three mechanisms of synaptic plasticity?
- LTP results in insertion of new AMPA receptors into dendrites
- Increase in GLUT receptors = stronger potentials in active synapse
- Synaptic growth: dendritic spines split after LTP –> new synapses
Stimulation of the Schaffer collaterals generates EPSP in postsynaptic CA1 cells. What is this ideal for?
Facilitating memory formation
Which enzyme in dendrites is activated by Ca2+?
CaM-KII
Ca2+ binds with CaM-KII, linking proteins attached to NMDA receptor
AMPA receptors are linked to NMDA receptor by protein
LTP results in the insertion of new AMPA/NMDA receptors into the dendrite.
AMPA
Which receptors are ionotropic glutamate receptors, thereby creating stronger potentials in an active synapse?
AMPA
AMPA receptors are located inside the _____, but move to _______ after LTP.
dendrite / tips of spines
Additional synthesis of what molecules is required for long term memory?
Proteins
Protein synthesis inhibitors lead to deficits in ____ and _____.
learning / memory
What is GAP43? What is it involved in?
Protein involved in synaptic maintenance and neuritic regeneration.
Which protein is significantly reduced in the frontal cortex and hippocampus of Alzheimer’s patients?
GAP-43
There is a significant positive correlation between GAP-43 and the number of senile plaques in which structure?
Hippocampus (but not frontal cortex)
What is LTP?
Stimulation of excitatory fibers that make connections with hippocampal pyramidal cells?
What causes increased efficiency of CA1 pyramidal cell response?
Short, high-frequency stimulation of entorhinal afferents or Schaffer collaterals to hippocampal pyramidal cells over time
Where is alpha-synuclein predominantly expressed?
Hippocampus, neocortex, thalamus, substantia nigra
Epidermal growth factor favors differentiation into ____, whereas fibroblast growth factors promote _____.
glial cells / neuronal production
What type of gene therapy can induce neurite outgrowth from mammalian auditory neurons?
BDNF
What type of gene therapy can increase sprouting of dopaminergic axons in the striatum?
Glial cell line-derived neurotrophic factor (GDNF)
List the return to play parameters
In order:
- -No activity
- -Light aerobic exercise
- -Sport specific exercise
- -Non contact training drills
- -Full contact practice
- -Return to play
- -Symptomatic for more than 10 days, see doctor
What anti-inflammatory drugs can be used after a concussion?
Cox inhibitors: aspirin, ibuprofen, naproxen
Cytokine blockers/microglia suppressors: minocycline, progesterone
Which neurotrophic drugs are used after concussion?
BDNF agonists: SSRI, TCA, progesterone
Which immune-boosting drugs are used after concussion?
Probiotics, vitamin D, B-glucan
What are the components of the SCAT3?
- GCS
- Maddocks score
- Symptoms
- Cognitive assessment
- Neck examination
- Balance examination
- Coordination examination
- SAC delayed examination
When is tau protein found in athletes?
In chronic traumatic encephalopathy
When do simple concussions resolve?
7-10 days
After concussions, children should return to ____ before return to _____.
learn / sport
When can SCAT3 be used?
When the patient is 13 years or older
Symptoms immediately following concussion
Blurred/double vision Sensitivity to light or noise Headache Dizziness/balance problems N/V Fatigue Confusion Trouble sleeping
What are post-concussion syndrome symptoms?
Chronic headaches Fatigue Sleep problems Personality changes Dizziness Short-term memory loss Nausea
In most people, when do post-concussion syndrome symptoms begin?
Symptoms occur within first 7-10 days and go away within 3 months, though they an persist for a year or more.
What is the most long-term sequella of a concussion?
Depression
What is CTE?
Accumulation of tau protein in neurons
What does CTE cause?
Dementia pugilistica
Brain atrophy
Most common symptoms of CTE
Aggression Depression Loss of memory Loss of impulse control Impaired judgement Balance difficulties
What are the three components of concussion pathogenesis?
Metabolic, excitotoxic, immunologic
What is resveritrol?
Reduces brain inflammation by calming microglia and macrophages
When should imaging be performed if concussion suspected?
Neuro findings on exam, worsening symptoms, or prolonged disturbed consciousness
What is the pharmacologic therapy for treating concussions?
Currently there is no evidence-based pharm. therapy available for treating concussions
What factors can prevent concussions?
Hydration
Strong neck/shoulders
Genetics
Good technique
What is the immunologic pathogenesis of concussions?
Elevated levels of glutamate
Decreased cerebral blood flow
Transient release of high levels of ROS, lipid peroxidation product, prostaglandins, and NO
Activation of microglia and macrophages –> increased TNF alpha, increased regulation of chemokines
A 65-year- old woman presents today after a massive intracerebral hemorrhage. She is on the ventilator set on Assist Control at a rate of 14. She is breathing 16 times per minute according to the nurse’s flow sheet; the respiratory therapist trouble shoots the ventilator to make sure that the excess breaths are not an artifact.Her physical examination shows no evidence of brain stem function (all the tests are consistent with death). Your next step would be:
A. Declare the patient dead
B. Proceed to apnea testing
C. Counsel the family that she is not going to die
D. Retest the patient in a few hours
D
A 43-year- old man with a history of insulin dependent diabetes presents after a traumatic brain injury. He is 36 C° and has the following laboratory values:
Na 135 mmol/L
K 4.2 mmol/L
Glucose 475 mg/dL
His physical exam shows no brain stem function, he is not breathing over the ventilator. His apnea test shows no effort despite an increase of pCO2 of >20 mmHg (42 mmHg to 65 mmHg).
The next appropriate step would be to:
A. Declare the patient dead
B. Repeat the apnea test
C. Control his blood glucose prior to retesting him
D. Counsel the family that he is likely not going to die
C
A 24-year- old man presents to the ICU in a coma. There are no outward signs of trauma, his head CT done 24 hours after admission is normal without evidence of stroke or hemorrhage. On examination and apnea testing, he meets all the criteria for death. The next appropriate step would be to:
A. Consider drug intoxication
B. Declare the patient dead
C. Increase his body temperature to 38 C°
D. Repeat the apnea test
A
An 18-year-old patient comes to the ICU after a near-drowning episode in the winter. The patient has a core body temperature of 27 C°.The physical examination and apnea test are consistent with brain death. The next appropriate step is to:
A. Declare the patient dead
B. Warm the patient and repeat testing
C. Test for drugs of abuse
D. Do an ancillary test to confirm death
B
A 32-year- old man presents to a trauma ICU after a suicide attempt with a gun where he caused significant damage to the right side of his face and right eye. The exam components that are assessable are consistent with death and his apnea test is also consistent. The next appropriate step is to:
A. Declare the patient dead
B. Talk to the family about whether his face worked normally before the gunshot wound
C. Assess for drugs of abuse
D. Proceed to ancillary testing to confirm the diagnosis
D
Which of the following examination findings is consistent with death?
A. Fixed right pupil with sluggishly reactive left pupil
B. Extensor posturing in the legs and arms with painful stimulation
C. Eye deviation without nystagmus on oculovestibular (cold-caloric) testing
D. Eyes that remain the midline with lateral head movement
D
Which of the following blood laboratory findings could be considered a confounding factor in the diagnosis of death?
A. Magnesium level of 2.1 mg/dL
B. WBC count of 12 k/L
C. Sodium of 118 mmol/dL
D. Potassium of 4.0 mmol/dL
C
Which medication is most likely to confound the diagnosis of death by neurological criteria?
A. Sodium pentobarbital
B. Ranitidine
C. Acetaminophen
D. Metoprolol
A
Which of the following conditions invalidate all ancillary tests?
A. Facial injuries making complete cranial nerve testing impossible
B. Hypotension on apnea testing causing abortion of the test
C. Patients with left ventricular assist devices
D. Severe Hypothermia
D
Which ancillary test is not validated yet in patients for the diagnosis of death by neurological criteria?
A. CT angiography
B. Digital Subtraction Angiography (convention angiogram)
C. EEG
D. Radionuclide Scintigraphy (nuclear testing)
A
What does MS treatment involve?
Disease modification as well as symptomatic treatment of fatigue, depression, and pain
What is used to treat acute MS exacerbations?
Corticosteroids
In MS, loss of myelin leads to increased intracellular ____ and _____.
calcium / sodium
Which disease-modifying MS drugs are generally safe and well-tolerated, and require self-injection?
IFN-B
Natalizumab
Glatiramer acetate
Which disease-modifying MS drugs are administered orally?
Fingolimod
Teriflunomide
Dimethyl fumarate
*These drugs are not as safe
What corticosteroid is administered for MS exacerbations?
IV methylprednisolone 500 mg/day for five days, followed by optional oral prednisone
What is the mechanism of action of IFN-B in modifying MS?
Interferes with target recognition.
Switches TH1 inflammatory response to TH2 anti inflammatory.
Reducing T-cell activation and BBB crossing
Decreasing metalloproteases (MMPs)
Glatiramer acetate
The Decoy Gladiator:
Wears reversible armor that looks like myelin on the outside so when the relapsers come, he will
be attacked, but the real myelin stays safe. (REDUCES FREQUENCY OF RELAPSE)
The suit is automatic. He just flips a switch and it reverses from type 1 to type 2 (SHIFTS TH1 –> TH2)
The armor is tight around his chest, though, and creates some pain and the TH1/TH2 button is on the inside and leaves a mark on his arm. (CHEST TIGHTNESS AND INJECTION SITE REACTION)
Fingolimod
Fingers Schmingers
Modulates Sphingosine-1-phosphate (S1P1) receptor.
Fingers Schmingers can do things regular fingers can’t like grab the lymphocytes and stick them back where they belong - Like in the lymphoid organs.
Hold up two fingers. Those are the two months this shit stays in yo system. Now check your pulse with them. It’s bradycardia! Let’s do more with our fingers. Can you check your BP with them? I bet it’s high. Fingers Schmingers are actually not under your control any more. They poke your liver with them. Bet that hurt. Now for the final fingers schmingers trick, those fingers jam themselves deep in your macula until it causes edema. The only way to stop them is to give them cancer.
Bradycardia, high BP, macular edema, melanoma
Fingolimod MOA
Makes S1P receptors non-functional –> prevents T-cell invasion of CNS
Dimethyl fumarate
Fumar Mentoles. Translated - smoke menthols.
They feel good in my mouth (oral). I smoked regular cigarettes but the smell stayed with me like glue. The menthol somehow inhibits the expression of all those adhesion molecules (inhibits adhesion molecule expression) and I don’t taste the chemicals at all (chemokine inhibition). The smell doesn’t grab me like a macrophage (suppresses macrophages). It protects me like, well, a Nerf helmet (increases Nrf2 DNA binding). I even got a little tattoo on the back of my neck at C6 of a star smoking a menthol (suppresses astrocytes and C6 glioma cells). They even give me health benefits, like a nice healthy flush to my face (flushing) and they help me poop (diarrhea).
Which MS drugs should not be given to pregnant women?
Teriflunomide, Mitoxantrone
Which MS drug can cause PML?
Natalizumab
Natalizumab MOA
Monoclonal antibody against alpha-4-integrin
Natalizumab should not be given to which patients?
Immunocompromised
Mitoxantrone
Mitoxantrone is so toxic, nothing can grow around it, no new growth and no abnormal growth. It is double toxic and suppresses B and T immunity. Works for all MS but primary because primary progressive never remits and gives the toxicity a chance. And, it is also the most toxic to the body. Neutropenia, Thrombocytopenia, AML, CHF, Liver, GA, and you sure don’t want to give that to a fetus.
Ocrelizumab
You like okra? I do. I am an expert, see: Funny fact - did you know if you cut okra open, there are exactly 20 seeds (CD20) visible? Pretty cool. (ocrelizumab is a monoclonal antibody for CD20).
You know who taught me about 20 Seeds? My Jamaican GramMa, Tuxxy. She sure had a fatty bum from eatin so much okra! (riTUXimab and oFATUMumab also target CD20)
I crave that shit. My cravings come and go but keep getting worse the longer I don’t eat any. It’s like my cravings are progressive and relapsing.
Ocrelizumab is only FDA approved for Progressive-relapsing MS. So when you see Progressive-Relapsing MS, remember my progressive-relapsing craving for okra
Dalfampridine
Hey, I invented a new word. Hey Poboy, why don’t you dalfamper your ass over here. It’s like dollying and scampering; like how he walks. And when he walks, he says OK OK OK OK. (K+ channel block) Dalfampridine helps speed up gait but when you see the $15,000 a year price, you will certainly have a seizure.
What does brain death diagnosis require?
Demonstration of the absence of both cortical and brainstem activity
What is the medical criteria for diagnosing brain death?
Absence of cerebral function
Absence of brainstem function
Apnea test
What is Lazarus Sign?
Spinal cord reflexes that persist even with diagnosis of brain death
What is the Apnea Test?
Test for absence of respiratory function:
- Preoxygenate 100% –> take baseline ABG –> disconnect ventilator –> administer O2 –> observe respirations –> draw ABG in 8-10 minutes
- pCO2 > 60 mmHg or 20 mm Hg above base
When should you abort an apnea test?
- Patient breathes
- Hemodynamic instability
- Inconclusive if no respiratory movement but pCO2 < 60 mmHg
Brain death: cerebral angiogram findings
No intracerebral filling at level of carotid bifurcation or circle of Willis
Brain death: cerebral blood flow–nuclear scan findings
No uptake of radionuclide in brain parenchyma
“Hollow skull phenomenon”
Brain death: TCD findings
No diastolic flow, systole only retrograde diastolic flow
Brain death: EEG findings
No electrical activity for 30 minutes
Drugs used for episodic migraine prevention
Beta blockers: propanolol, timolol
Also: topiramate, divalproex sodium
Drugs used for chronic migraine prevention
Botulinum toxin A
Botulinum MOA
Blocks release of substance P and CGRP
Drugs used for acute migraine treatment
Triptans
Dihydroergotamine
Diclofenac
Triptans MOA
Agonist of 5-HT1-B/D presynaptic receptor / inhibits terminal excitability / vasoconstrictor
Which drugs should not be used within two weeks of taking MAOIs?
Triptans
What are the pros of using beta blockers for migraines?
Widely used
FDA approved: Timolol, Metoprolol, Propanolol
What are the cons of using beta blockers for migraines?
Side effects: fatigue, dizziness, depression, may worsen aura
Which patients should not take beta blockers?
Those with ASTHMA, depression, bradycardia, Raynaud’s, CHF
Common side effects of divalproex sodium
Tremor, bruising, nystagmus
Rare side effects of divalproex sodium
Pancreatitis, alopecia, thrombocytopenia
Drugs used for menstrual migraines
- Frovatriptan
- Naratriptan, Zolmitriptan
- Estrogen
Which menstrual migraine medication is the most long-acting?
Frovatriptan
Drugs used to treat acute migraine
Sumatriptan
DHE
Diclofenac
Diclofenac MOA
COX inhibitor –> reduces PROSTAGLANDINS –> reduced inflammation
Acute headache treatment should be limited to what time frame?
2-3 days per week
Drugs used to treat acute cluster headaches
Oxygen
Sumatriptan
Indomethacin
Drugs used to treat chronic cluster headaches
Verapamil
Lithium
Deep brain stimulation
Drugs used to treat headaches associated with neuralgia
Carbamazepine
Gabapentin
Nerves associated with headaches in the front and back of head
Front: branches of trigeminal
Back: branches of first three cervical nerves
Overuse definition: ergotamines/triptans/opioids
More than 10 days per month for 3+ months
Overuse definition: simple analgesics
More than 15 days per month for 3+ months
Which migraine drug is offered as a generic?
Rizatriptan
What is the only triptan considered superior to sumatriptan?
Eletriptan
Which migraine drugs are teratogenic?
DHE, topiramate
Which NT is depleted during a migraine?
Serotonin
Opioid overdose deaths are most common in which age group?
45-54
Neurotoxic side effects of opioids
Myoclonus, hyperalgesia, delirium, hallucinations
______ should not be given to elderly patients.
Meperidine
What is an indication of hyperalgesia due to opioid use?
Myoclonus during sleep
M6G is more/less potent than M3G
More
Which factors can increase accumulation of morphine metabolites?
Age > 70 years, renal failure, dehydration
Naloxone does/does not reverse neuroexcitatory effects
Does not
What is the only intervention with efficacy for the treatment of chemotherapy-induced peripheral neuropathy?
Duloxetine
Duloxetine MOA
SNRI
All drugs of abuse increase which NT?
Dopamine
What is the mesolimbic dopamine system?
Key component of the brain reward system
MDS neurons originate in _____ and project to neurons in ______
VTA / nucleus accumbens
THC partially binds to ____ receptor
CB1
Clinical manifestations of stroke
Abrupt onset hemiparesis, monoparesis Hemisensory deficits Monocular/binocular visual loss Diplopia Dysarthria Facial droop Ataxia Vertigo
Best imaging method to diagnose CVA
Non-contrast CT
Describe the anatomy of the cavernous sinus
CNs III, IV, V1, V2, VI
ICA
Orbital vein into, out to petrosal sinuses
What is delirium?
Fluctuating LOC +/- cognitive impairment
What are the five most common causes of first time seizures in a patient 15 years or older?
Idiopathic Cerebral infarction Alcohol withdrawal CNS infection Tumor
Von Hippel-Lindau
Hemangioblastoma
Tuberous sclerosis
Subependymal giant cell astrocytoma
NF type I
Optic glioma
Astrocytoma
Neurofibroma
NF type II
Acoustic neuroma
Meningioma
Ependymoma
Astrocytoma
Li-Frumeni
Astrocytoma
PNET
Turcot syndrome
Glioblastoma
Medulloblastoma
What is the Monroe-Kellie Principle?
The cranium is a closed container, so increase in volume in one element must be balanced by decrease in another element.
Clinical signs of brain herniation
Brainstem compression (mydriasis, posturing, LOC) Eye findings (e.g. loss of conjugate movement) Cushing reflex
What type of strokes are inoperable?
Basal ganglia
Where are most brain aneurysms located?
Anterior circulation (90-95%)
Brain aneurysm risk factors
Family history Age > 50 years Female Current smoker Cocaine use Binge drinking
CN III palsy + ptosis
Dilated unreactive pupil
Ophthalmoplegia
Posterior communicating aneurysm
Most common cause of spinal epidural abscess
Hematogenous spread
Red flag symptoms of back pain
Trauma
Unexplained weight loss
Neuro symptoms
Age > 50
Fever
IVDU
Steroid use
History of cancer
MRSA + epidural steroid injections = ______
Spinal abscess
What type of injury is most likely to produce a contrecoup injury in the inferior frontal lobes, temporal tips, and inferior temporal lobes?
A fall backward
Basal ganglia putaminal hemorrhage is most likely to occur in _______.
hypertension
Red shrunken neurons are typically seen in response to _____.
Global hypoxia
Histologic finding of rabies
Negri bodies
Immunocompromised
Produces abscesses that organize on the periphery
Bright ring on CT and MRI
Toxoplasma
Pilocytic astrocytomas with _____ mutations tend to be less circumscribed.
BRAF
Negative for GFAP, positive for CD19 and CD20
Diffuse large B-cell lymphomas
GBMs often have ____ alterations.
EGFR
Bilateral acoustic schwannomas
NF 2
The scarring following bacterial meningitis can lead to _____________, or alternatively scarring at the arachnoid granulations to reduce CSF reabsorption and produce communicating hydrocephalus.
obstruction of CSF flow at the foramina of Luschka and Magendie with obstructive non-communicating hydrocephalus
Methanol is metabolized to what toxic compounds?
Formic acid and formaldehyde
_________ loves to invade blood vessels and produce thrombosis. _________ is a risk for aspergillosis.
Aspergillus / Neutropenia
A premature child is at risk for germinal matrix hemorrhage, which often extends into the _______ region
intraventricular
Edema is most likely to be severest in which part of the brain?
White matter
MS: Histology
Perivascular lymphocytes with demyelinated axons in white matter
Foci of multinucleated cells and macrophages in grey and white matter
HIV encephalopathy
Affected brains are typically atrophic, with enlarged ventricles, and show accumulation of tau-containing neurofibrillary tangles in superficial frontal and temporal lobe cortex, which can be similar to Alzheimer disease.
CTE
Berry aneurysms are associated with what condition?
Autosomal dominant polycystic kidney disease
Granulation tissue with fibrosis is a typical healing inflammatory response reaction to ______.
a cerebral abscess
Vincristine MOA
Microtubule inhibition: tubulin molecules fail to polymerize
Paclitaxel MOA
Microtubule inhibition: unusually stable tubulin molecules fail to depolymerize
A 14-year-old boy is brought to the emergency room following an accident in which he hit his head against a concrete wall. He was initially unconscious but then regained alertness 5 minutes later. However, an hour later in the emergency room, he is comatose, and skull radiograph reveals a linear skull fracture of the temporal-parietal region on the left. What is most likely develop in this boy?
Epidural hematoma
The ‘lucid’ interval is classic for an epidural hematoma from a tear of the middle meningeal artery. The hematoma accumulates rapidly, because the bleeding is arterial.
A 45-year-old man has had a severe, intractable headache for a week. Physical examination reveals papilledema on the right. A head CT scan shows marked right to left midline shift. MR imaging shows a 6 cm enhancing mass lesion in the right parietal region with marked surrounding edema. He then develops a dilated pupil on the right. What is the most likely vascular lesion?
Pontine hemorrhage
Too rapid correction of hyponatremia can lead to _____.
CPM: central pontine myelinolysis
