Final Review Flashcards
What is area 4?
the motor cortex
What features do extrapyramidal syndromes have in common?
- rigid paralysis
- involuntary movements
- minimal impairment of voluntary movements
- intact reflexes
Describe the vestibulospinal tract anatomy.
vestibular nucleus to ipsilateral horn cells
Describe the anatomy of the tectospinal tract.
superior colliculus projects to the LMNs in the cervical spine
What is the role of the tectospinal tract?
reflexive control of the neck to new visual stimuli
What is decerebrate posture?
excessive extension due to upper brainstem injury
What are the two functions of the premotor cortex?
- motor set
- assembly of motor plans
What is the difference between parietal area 5 and 7?
5 controls arm movements, 7 controls eye movements
What does a supplementary motor area lesion cause?
- speech difficulties
- alien hand syndrome
What is the neural pathway for voluntary saccades?
- frontal eye fields
- superior colliculus
- reticular formation
- oculomotor nucleus
What is the neural pathway for reflexive saccades?
- superior colliculus
- reticular formation
- oculomotor nucleus
What is the neural pathway for smooth pursuit eye movements?
- retinal ganglion cells
- LGN
- visual cortex
- reticular formation
- oculomotor nucleus
What is the cupulla?
the gelatinous mass in which vestibular hair cell stereocilia are embedded
Symptoms of a unilateral lesion to the vestibular nerve.
- fall to ipsilateral side
- nystagmus to the contralateral side
Diffuse axonal injury primarily affects which structures?
- diencephalon
- midbrain
- grey-white junctions
- corona radiata
Which cranial nerves are most susceptible to injury?
1, 7, and 8
What fracture will endanger CN 7 most often?
transverse petrous
What are the symptoms of lateral and central herniation syndromes?
- central: bilateral, mid-range, unresponsive pupils
- lateral: unilateral, dilated, unresponsive pupils
What is coloboma usually due to?
a PAX2 mutation
What are the two parts of the tympanic membrane?
- pars flaccida (less)
- pars tensa (most)
Hemifacial microsomia is a type of what disorder?
1st and 2nd branchial arch anomaly
What are the features of hemifacial microsomia?
- facial asymmetry
- hyoid malformation
- malformed auricle
What kind of defect is thyroglossal duct cyst?
branchial pouch 3 and 4
What kind of defect is a lingual thyroid?
branchial pouch 3 and 4
a sinus leading from the anterior triangle into the external auditory meatus is what kind of defect?
2nd branchial cleft
Delusional Disorder
a non-bizarre delusion lasting one month without other schizophrenic symptoms
What physical changes are associated with schizophrenia?
- enlarged ventricles
- reduced amygdala, hippocampal, and cortical volume
- increased NE and DA in the anterior thalamus
How is childhood trauma thought to contribute to personality disorder?
it sensitizes the HPA axis and prevents synaptic pruning by increasing excitatory NT levels
Rejecting-fearful parenting leads to what type of personality disorder?
cluster C
Terrorizing-disorganized parenting leads to what type of personality disorder?
cluster B
What are the modules of dialectical behavioral therapy?
- mindfulness
- distress tolerance
- emotion regulation
- interpersonal effectiveness
What are the most used migraine abortive therapies?
- NSAIDs/opioids
- triptans
- caffeine
- antiemetics
What are triptans?
5HT agonists used for headache relief
What drugs are used for migraine prophylaxis?
- Botox
- antiepileptics
- antidepressants
- beta blockers
What are the symptoms of pseudo tumor cerebri?
- recurrent headache
- papilledema
- normal imaging
- blurred vision
What are the symptoms of giant cell arteritis?
- age over fifty
- recurrent headaches
- temporal artery tenderness
- elevated ESR
The MD thalamic nucleus receives input from where?
the olfactory system
The MGN thalamic nucleus receives input from where?
the inferior colliculus
What is the role of the pulvinar nucleus in the thalamus?
alert us to new visual stimuli
Which thalamic nucleus is damaged in those with Korsakoff’s?
MD
Which thalamic nuclei are considered to be “motor” in nature?
VL and VA
What causes thalamic pain?
occlusion of the thalamogeniculate artery
What fibers run in the genu of the internal capsule?
corticobulbar fibers
What fibers run in the posterior limb of the internal capsule?
- corticospinal fibers
- somatosensory fibers
- visual and auditory fibers
Which brainstem nuclei and cranial nerves are involved in swallowing?
- CN IX brings afferent information to the solitary nucleus
- CN X innervates laryngeal and pharyngeal muscles from the ambiguus nucleus
- CN XII innervates the tongue muscles from the hypoglossal nucleus
PPV Equation
(sensitivity) (pretest)
- —————————————————-
(sensitivity) (pretest) + (1-pretest)(1-specificity)
NPV Equation
(specificity) (1-pretest)
- ————————————————-
(specificity) (1-pretest) + (1-sensitivity)(pretest)
Where are cerebral thrombi most common?
- carotid bifurcation
- MCA origin
- top and bottom of basilar artery
Where are emboli most common in the cerebral vasculature?
the MCA
Where are berry aneurysms most common?
- the anterior communicating artery
- the MCA (distal and proximal)
What microscopic changes follow brain ischemia?
- 12-24 hours: red neurons
- 12-48 hours: neutrophils
- 2 days - 2 weeks: macrophages, necrosis
- 1 week - 4 weeks: astrocytic proliferation
- chronic: scar/cyst, wallerian degeneration
Where are lacunar infarcts most likely?
- putamen/globus pallidus
- thalamus
- internal capsule
Where are intraparenchymal hemorrhages most likely?
- striatum
- thalamus
- pons
What are the two major complications of a cavernoma?
- hemorrhage
- seizure
How is HIV encephalitis diagnosed?
the presence of HIV p24+ multinucleate giant cells in microglial nodules
What are the criteria for PDD?
2 or more symptoms for 2 years
What change is believed to mediate mania?
changes in the phospholipid bilayer that make depolarization more likely
What are tricyclics?
drugs that block NE and 5HT reuptake
4 drugs used to treat bipolar disorder
- lithlium
- valproic acid
- carbamazepine
- lamotrigine
Which brainstem nuclei can be found in the medulla?
- hypoglossal
- dorsal motor of V
- ambiguus
- solitary
- vestibular
- cochlear
- spinal trigeminal
Which brainstem nuclei can be found in the pons?
- abducens
- motor trigeminal
- motor facial
- principal sensory
- spinal trigeminal
Which brainstem nuclei can be found in the midbrain?
- oculomotor
- dinger-westphal
- trochlear
- mesencephalic
Dorsal Motor Nucleus
preganglionic parasympathetics that exit via CN X
Principal Sensory Nucleus
secondary DCML neurons for the face that enter via CN V
Spinal Nucleus
secondary ALS neurons for the face that enter via CN V
Solitary Nucleus
- rostral receives taste from CN VII, IX, X
- caudal receives visceral afferent from CN VII, IX, X
Facial Motor Nucleus
LMNs that exit via CN VII to supply facial muscles
Trigeminal Motor Nucleus
LMNs that exit via CN V to supply masticator muscles
Mesencephalic Nucleus
receives info for unconscious proprioception via CN V to mediate the jaw reflex
The medial and lateral medulla are supplied by which arteries?
- medial: anterior spinal
- lateral: PICA
The medial and lateral pons are supplied by which arteries?
- medial: paramedian branches of basilar
- lateral: long circumferential branches of basilar and AICA
The medial midbrain is supplied by which artery?
the paramedian branches of the basilar and P1 of the PCA
Signs of trochlear ophthalmoplegia?
head tilt to the contralateral side
Signs of oculomotor ophthalmoplegia?
- eye down and out
- mydriasis
- ptosis
What is the horizontal conjugate gaze center?
a region in the pons that coordinates eye movements
The left frontal eye field directs our gaze where?
to the right
What is the medial longitudinal fasiculus?
- a tract between the abducens nucleus and contralateral oculomotor nucleus that coordinates eye movements
- damage results in inter-nuclear ophthalmoplegia
Name the three alternating hemiplegia.
- medulla: hypoglossal
- pons: abducens
- midbrain: oculomotor
Edinger Westphal Nucleus
a nucleus of preganglion parasympathetics that project to the pupil
Where is the preganglionic sympathetic nucleus for pupil diameter located?
the intermediolateral column in the thoracic cord
What is the importance of the inferior cerebellar peduncle?
input from the spinocerebellar tract to the cerebellum
What is the importance of the superior cerebellar peduncle?
output from the cerebellar tract
Ambiguus Nucleus
LMNs that supply the larynx via CN IX and X
The PCA supplies what brain structures?
- undersurface of temporal lobe
- occipital lobe and visual cortex
- P1 to medial midbrain
- thalamogeniculate arteries to internal capsule
The internal capsule is supplied by which artery?
the thalamogeniculate off the PCA
The ophthalmic artery is a branch off what larger vessel?
the internal carotid
Tau tangles preferentially affect which brain structures?
amygdala, hippocampus, and LGN
Sporadic PD is linked to what gene?
glucocerebrosidase
ALS is linked to which gene?
C9orf72
Name two drugs used in the treatment of AD?
- memantine: an NMDA antagonist
- dopenezil: centrally acting AChE inhibitor)
ApoE4 is a risk factor for which dementias?
DLB and AD
ALS is characterized by what protein aggregate?
TDP-43
AD is linked to which genes?
ApoE4 and presenilin-1
Which receptor mediates LTP?
glutamate
Which brain structures are particularly sensitive to thiamine deficiency?
- dorsal medial thalamic nucleus
- maxillary bodies
What are the features of Korsakoff’s?
- amnesia
- confabulation
What are the features of Wernicke’s encephalopathy?
- confusion
- truncal ataxia
- CN VI paralysis
Which cranial nerves mediate taste?
CN VII, IX, X
What is the role of the central amygdala?
autonomic regulation
What is the role of the corticomedian amygdala?
sex and feeding behavior
What is the role of the basolateral amygdala?
assign emotional value
Describe the neurohypophyseal system.
- supraoptic and paraventricular nuclei
- project to the posterior pituitary
- and release vasopressin and oxytocin
What are the tuberoinfundibular nuclei?
- arcuate nucleus
- periventricular
What is the purpose of the anterior hypothalamic nucleus?
sense heat
What is the purpose of the posterior hypothalamic nucleus?
sense cold
What is the purpose of the pre-optic hypothalamic nucleus?
regulate the temperature set point
What is the purpose of the lateral hypothalamic nucleus?
sense hunger
What is the purpose of the ventromedial hypothalamic nucleus?
sense satiety
Which hypothalamic nucleus regulates the ANS?
the paraventricular system
What are the early symptoms of opioid withdrawal?
- lacrimation
- anxiety
- pilorection
- yawning
What are the late symptoms of opioid withdrawal?
- diarrhea
- abdominal cramps
- myalgia
- insomnia
Which alcohol dehydrogenase allele has a higher metabolic rate?
ADH2*3
Name for effects alcohol has on NT systems.
- reduces NMDA
- increases opioids
- increases GABAergic activity
- indirectly increases DA
What are the four criteria on which substance use disorders are diagnosed?
- impaired control
- social impairment
- risky use
- physical dependence
Alcoholic Polyneuropathy
a vitamin B deficiency-induced peripheral neuropathy that affects the lower extremities more and is describe by many as “burning feet” sensation
What are the elements of brief alcohol use intervention?
- feedback
- advice
- commitment
- tracking
Naltrexone
opioid receptor antagonist use to attenuate alcohol relapses
Acamprosate
a GABA agonist and NMDA antagonist used to help maintain alcohol abstinence
Buprenorphine
a partial opioid agonist used to treat opioid and alcohol withdrawal
Crista Ampullaris
a ridge of tissue in the semicircular canals in which vestibular hair cells are embedded
What are three functions of the inner ear?
- impedence matching
- pressure equalization
- gain control of vibrations reaching inner ear
Tensor Tympani
dampens the tympanic membrane
Stapedius muscle
dampens the stapes
Stia Vascularis
part of the membranous labyrinth in the cochlea that pumps potassium ions into the scala media
Tectorial Membrane
sits on and rubs auditory hair cells
Describe the passage of sound waves through the inner ear.
- stapes
- oval window
- scala vestibuli
- vestibular membrane
- scala media
- basilar membrane
Endolymph has high concentration of what?
potassium ions
How is tonotopic organization of the cochlea achieved?
the basilar membrane varies in width and stiffness
Describe the basilar membrane at the base of the cochlea.
narrow and stiff
What do outer hair cells do?
modify the stiffness of the basilar membrane to sharpen frequency tuning
Superior Olivary Nucleus
nucleus with efferent innervation of the outer hair cells
Otoacoustic Emissions
generated by OHCs
Middle ear problems contribute to what kind of hearing loss?
conductive
Three common causes of conductive hearing loss
- otitis media
- otosclerosis
- impacted cerumen
What is otosclerosis?
an overgrowth of bone in the middle ear that contributes to conductive hearing loss
What commonly used drug is ototoxic?
aspirin
High intensity sound causes what kind of hearing loss?
sensorineural
Meniere’s Disease
- a fluctuating sensorineural hearing loss, vertigo, and tinnitis
- caused by an excessive amount of endolymph
- treated with diuretics and a low salt diet
Tinnitis most commonly accompanies what?
auditory hair cell loss
What is objective tinnitis?
tinnitis due to pulsation of a blood vessel
Name four causes of sensorineural hearing loss.
- perinatal infection
- high intensity sound
- long-standing otitis media or otosclerosis
- ototoxic drugs
What are climbing fibers?
those with direct innervate purkinje cells in the cerebellum
Pontine Nucleus
relay station between cortex and cerebellum
Red Nucleus
a relay station between the cerebellum and spinal cord
The vestibulocerebellum projects to what structures outside the cerebellum?
- vestibulospinal tract
- reticulospinal tract
The vestibulocerebellum commonly has what effect on the vestibulospinal tract?
an inhibitory one to allow for tracking of objects with our head
Ataxia with a normal Romberg test means what?
the problem is in the cerebellum
Cerebrocerebellum lesion
- dysdiadochokinesis
- decomposition of movement
Cerebrocerebellum, Spinocerebellum, and Vestibulocerebellum
- cerebro: initiation and programming of movement
- spino: ongoing correction of movement errors
- vestibulo: control vestibular reflexes
Parkinson’s Disease targets which neuronal population?
dopaminergic neurons in the SNc
Huntington’s chorea targets which neuronal population?
GABAergic neurons from the putamen to the GPe
Parkinsonism
- bradykinesia
- postural instability
- rigidity
What clinical findings suggest a non-Parkinson’s disease cause of parkinsonism?
- symmetry at onset
- early autonomic dysfunction
- abrupt onset or rapid progression
- early dementia
What damage leads to Shy-Drager syndrome?
damage to both the SNc and striatum
What is the primary cause of vascular parkinsonism?
ischemic damage to the striatum
Four pharmacologic therapies for PD
- levodopa
- COMT inhibitors
- MAO-B inhibitors
- dopamine agonists
Carbidopa
inhibits peripheral COMT inhibitors to increase the action of levodopa
Complications of L-DOPA
- motor fluctuations
- dyskinesias
- mental status change
MAO-B
enzyme that metabolizes DA in the synaptic cleft
Selegiline and Rasagiline
MAO-B inhibitors
Entacapone and Tolcapone
COMT Inhibitors
Dystonia
a sustained involuntary movement
Chorea
a ballistic movement (agonist, antagonist, agonist)
Athetosis
a type of dystonia that appears as a writhing movement
What causes dystonia?
a lack of reciprocal inhibition
Tardive Dyskinesia
involuntary movements seen after the use of DA blocking agents
Common etiologies of myoclonus
- idiopathic
- primary generalized epilepsy
- post-anoxia
How do we treat tardive dyskinesia?
anticholinergics
How do we generally treat hyper-kinetic movement disorders?
anticholinergics and dopaminergics
Describe the pathogenesis of MS
CD4 cells react to self-myelin and secrete cytokines
Which genes are linked to MS?
- IL-2RA
- IL-7RA
- HLA-DR15
MS preferentially affects which white mater tracts?
- periventricular
- optic
- superficial pons and spinal cord
Marburg Variant MS
an acute, early onset, rapidly progressing, refractory form of MS
Aquaporin-4
Neuromyelitis Optica
Most leukodystrophies have what mode of genetic transmission??
autosomal recessive
What causes Alexander’s disease?
a GFAP mutation
What causes ALD?
mutation in ABCD1, a peroxisomal membrane transporter that yields defects in VLCFA metabolism
Signs of an ophthalmic artery occlusion
transient blindness, unresponsive pupil
Signs of an MCA superior division stroke
- gaze preference
- Broca’s aphasia
- contralateral hemisensory loss and hemiplegia arm=face>leg
arm=face>leg
MCA
arm=face=leg
lenticulostriate
leg>face=arm
ACA
Signs of an MCA inferior division stroke
- neglect syndrome or Wernicke’s aphasia
- superior quadrantanopsia
Basilar artery occlusion
bilateral long tract and brainstem nuclei signs
Lentinculostriate occlusion
- face=arm=leg hemiparesis and hemiplegia
- contralateral ataxia
Thalamogeniculate artery occlusion
- hemiparesis
- hemisensory loss with burning sensation
- ataxia
- intention tremor
PCA cortical occlusion
- contralateral homonymous hemianopia with macular sparing
- acute memory disturbance
Bilateral ACA occlusion
- paraplegia
- frontal lobe syndrome
- urinary incontinence
Internal Carotid occlusion
- visual disturbance
- stupor
- Horner syndrome
- global aphasia
- gaze preference
14-3-3 protein
Elevated in CJD
EEG periodic sharp waves
CJD
Extremely rapid dementia
CJD
Who is most affected by myasthenia gravis?
women in their 20s, men in their 50s
CADASIL
- an AD vascular dementia with onset between 20-30 years of age, usually beginning with migraines with aura
Notch3 mutation
CADASIL
Blood vessels stain with PAS
CADASIL
Symptoms for DLB
fluctuating dementia, REM sleep disorder, parkinsonism, visual hallucinations
Who is affected by Taxoplasmosis?
immunocompromised individuals with exposure to cats
What is the pathophysiology of poliomyelitis?
neuronophagia of anterior horn cells
Measles is associated with what encephalitis?
subacute sclerosing panencephalitis
What causes Shy-Drager Syndrome?
damage to the striatum and substantia nigra
Features of Shy-Drager Syndrome
- early postural and speech deficits
- autonomic dysfunction
- peripheral neuropathy
- parkinsonism
Lateral brainstem syndromes have what in common?
- contralateral loss of pain/temp on body
- ipsilateral loss of pain/temp on face
- Horner syndrome
- ipsilateral ataxia
What distinguishes lateral medullary syndrome from lateral pontine syndrome?
- medullary: dysphagia, poor gag reflex, hoarseness
- pontine: vertigo, deafness, facial and masticatory muscle paralysis
Medial midbrain syndrome
- oculomotor alternating hemiplegia
- damage to corticobulbar tracts cause contralateral lower facial paralysis
Symptoms of Parkinson’s disease
- parkinsonism
- autonomic dysfunction
- neuropsychiatric signs
- resting tremor
How do we treat Alzheimer’s disease?
AChE inhibitor and NMDA antagonists
Mucoid encapsulated yeast
cryptococcus neoformans
What organism causes meningitis, thickening of the meninges, and hydrocephalus?
cryptococcus neoformans
What causes Alexander’s disease?
a GFAP mutation
How does Alexander’s present?
- young patients: seizures, megaloencephaly, developmental delay
- older patients: brain stem lesions
Who does MS affect most?
women between 15 and 45
How does central pontine myelinosis present?
with rapid onset paraplegia
Rapid sodium correction
central pontine myelinosis
Myelin disorder associated with a recent viral illness
ADEM and AHEM
Lesions of the same age is a characteristic of what demyelinating disorder?
ADEM
JC virus is associated with which demyelinating disease?
progressive multifocal leukoencephalopathy
