first aid review Flashcards
when do neural tube defects occur and what causes them
when the neuropores fail to fuse in the 4th week. associated with low folic acid before conception and during pregnancy.
what does a neural tube defect associated with
elevated alpha fetal protein (AFP) in maternal serum and amniotic fluid. increased acetylcholinesterase (AChE) in amniotic fluid
spina bifida occulta is what
failure of bony spinal canal to close, but does not have a structural herniation. usually seen in the lower vertebra
is the dura in tact in spina bifida occulta
yes.
spina bifida occulta usually has what
tuft of hair or skin dimple a the level of the bony defect.
meningeocele is what
spinal defect in which the meningies herniate through, but not the chord.
meningiomyelocele is what
bony defect in the spinal canal in which the meningies and the spinal cord herniate through.
anencephaly is what and presents how
malformation of the anterior neural tube resulting in no forebrain and an open calvarium (frog-like appearance).
what does serum testing show for anencephaly
increased AFP, polyhydramnios (no swallowing centers in the brain), associated with maternal type I diabetes,
what decreases the risk for anencephaly
maternal folate supplementation
what is holoprosencephaly
failure of the left and right hemispheres to separate and usually occurs during weeks 5-6.
moderate forms have cleft lip and palate. severe with cyclopia.
what gene mutations are associated with holoprosencephaly
sonic hedgehog.
Chiari II
significant cerebellar tonsilar herniation through the foramen magnum. presents with acqueductal stenosis, hydrocephalus, tharacolumbar myelominigiocele that causes paralysis below the defect. dysphagia. arm weakness and syringomyelia and scoliosis also occur —more associated with chiari I. progressive hydrocephalus.
chiari I
syrinx is common due to significant displacement of the cerebellar tonsils through the foramen magnum (>5mm) most common dermatomes affected are C8-T1. syringomyelia highly associated –cape-like bilateral loss of pain and temperature throughout. can cause hydrocephalus.
norepinephrine disease changes and location produced
increased anxiety and decreased in depression.
produced in the locus ceruleus in the pons
dopamine disease changes and location produced
increased in schizophrenia and decreased in Parkinson’s and depression.
produced in the ventral tegmentum and the substantia nigra (midbrain)
5-HT (serotonin) disease changes and location produced
decreased in anxiety and depression. produced in the raphe nucleus (pons)
Acetylcholine disease changes and location produced
decreased in Alzheimers and Huntington’s and increased during REM sleep.
produced basal nucleus of meynert
GABA disease changes and location produced
decreased in anxiety and Huntington’s
produced in the nucleus accumbens
what composes the limbic system
hippocampus, amygdala, cingulate gyrus, fornix, mammillary bodies,
what is the limbic system for
the 5 F’s: feeling, fighting, fucking, fleeing, feeding.
what is the hypothalamus for
TAN HATS: Thirst and water balance, Adenohypophysis control (regulation of pituitary), Neurohypophysis, Hunger, Autonomic response, Temperature regulation, Sexual urges.
what does the posterior pituitary do
receives hypothalamic axonal projections from the supraoptic area (ADH) and oxytocin from the paraventricular nuclei.
way to remember huntingtons
CAG (repeats) Caudate loses ACh and GABA.
What does NMDA have to do with huntingtons
NMDA receptors binding and glutamate toxicity is a cause of neuronal death.
what is a resting tremor caused by and what disease is it associated with?
uncontrolled movement that is alleviated by intentional movement. Parkinson’s.
what is essential tremor caused by and what disease is it associated with?
action tremor exacerbated by holding posture or limb position, genetic predisposition. patients often self-medicate with EtOH which decreases the tremor amplitude.
beta-blockers is a treatment.
dystonia is what
sudden, uncontrollable muscle contractions. writers cramp, blepharospasm.
intentions tremor caused by and what is it associated with?
cerebellar dysfunction. slow zigzag motion when pointing or extending finger toward target.
communicating hydrocephalus
decrease in the CSF absorption by the arachnoid granulations which can lead to increased intracranial pressure, papilledema and herniation.
normal pressure hydrocephalus
wet, wobbly and wacky. results in increased subarachnoid spacer volume but no increase in the CSF pressure. expansion of the ventricles distorts the fibers of the corona radiata and leads to the clinical triad of dementia, urinary incontinence, ataxic gait.
hydrocephalus ex vacuo
appearance of increased CSF in Alzheimers disease. advanced picks. intracranial pressure is normal. the triad is not seen.
noncommunicating hydrocephalus
caused by structural blockage of the CSF flow. stenosis of the cerebral aqueduct.
poliomyelitis spinal cord and presentation
LMN lesions only. due to destruction of the anterior horns of the spinal cord, causing flaccid paralysis.
werdnig-hoffman disease spinal cord and presentation
this is a form of spinal muscular atrophy. FLOPPY BABY. presents the same as poliomyelitis. LMN lesions only. due to destruction of the anterior horns of the spinal cord, causing flaccid paralysis.
multiple sclerosis spinal cord and presentation
mostly cervical white matter. random and asymmetrical lesions duets demyelination. presents with scanning speech, urinary incontinence, INO, intention tremor, nystagmus.
SIIIN
ALS spinal cord and presentation
combined UMN nd LMN with no sensory or cognitive or oculomotor signs. can be caused by superoxide dismutase 1.
spinal artery occlusion
anterior cord syndrome: spares the dorsal columns and lissauers tracts. loss of motor below the lesion (corticospinal), loss of pain and temperature at the level of the lesion (sopinothalamic tracts), autonomic dysfunction.
tabes dorsalis spinal cord and presentation
caused by tertiary syphillis, impaired sensation and proprioception and progressive sensory ataxia. charots joints, Robertson-argyll pupil, positive rhomberg and lack of DTR.
vitamin B12 or E deficiency
subacute combined degernation –demyelinaton of the dorsal columns (sensory tracts), lateral corticospinal tracts, and spinocerebellar tracts. presents with ataxic gait, paresthesia, impaired position and vibration sense.
brown-sequard syndrome
hemisection of the spinal cord. loss of all sensation immediately below the level of the lesion; below the lesion ipsilateral impaired proprioception, vibrations, 2-point discrimination, and joint and position sense; contralateral below the lesion, impaired pain and temperature sensation.
how does brown-sequard syndrome present if at level of T1
Horners syndrome as well. due to damage of the sympathetic ganglion.
what are primitive reflexes
reflexes that are present in an infant but absent in an intact adult. these are inhibited by intact frontal cortex. they may reemerge if frontal lobe is damaged
moro refelx
hang on for life reflex. abduct/extend limbs when startled and then draw them together.
rooting reflex.
movement of the head toward one side if the face is stroked. looking for nipple.
sucking reflex
sucking response when the roof of the mouth is touched
palmar reflex
curling of fingers if palm is touched
plantar relfex
dorsiflexion of big toe and fanning of other toes when plantar stimulation. babinski sign presence of this in adult due to UMN lesion.
what is the nucleus solitarius
visceral sensory information. taste baroreceptors and gut distention. CN VII, IX, X
nucleus ambiguus
motor innervation o f the pharynx, larynx, an upper espophagus. CN IX, X
dorsal motor nucleus
sends autonomic fibers to the heart and lungs and upper GI CN X
what nerves pass through the cavernous sinus?
CN III, IV, V1, V2 and VI. as well as postganglionic sympathetic
cavernous sinus syndrome
due to mass effect, fistula, thrombosis. ophthalmoplegia, and decreased corneal and maxillary sensation with normal vision.
How does a CN V lesion present
jaw deviates toward the lesion due to unopposed force front he opposite pterygoid muscle.
How does a CN X lesion present
uvula deviates away from the side with the lesion. weak side collapses and the uvula points away.
How does a CN XI lesion present
weakness turning head to the contralateral side of the lesion. shoulder droop on the side of the lesion.
(the left SCM contracts to help turn the head to the right
How does a CN XII lesion present
lick the lesion. the tongue deviates toward the side with the lesion.l
UMN lesion of the face presents how
contralateral paralysis of the lower face.. forehead spared because the UMN has bilateral contribution.
LMN lesion of the face presents how
complete ipsilateral paralysis unilaterally.
how does complete facial nerve present
peripheral ipsilateral facial paralysis with the inability to close the effected eye.
what is Ramsay-Hunt syndrome
facial nerve and vestibular nerve palsy from varicella zoster infection
what are the treatments for MS
beta-interferon, immunosuppression, natalizumab. symptomatic treatment of neurogenic bladder with catheters and muscarinic antagonists. treat spasticity with baclofen. and pain with opioids.
what is charcot-marie-tooth syndrome
also known as hereditary motor and sensory neuropathy HMSN, progressive nerve disorder related to the defective production of nerve proteins involved in the structure and function of peripheral nerves or myelination.
what are the most common causes of seizure in children
genetic, infection (febrile), trauma, congenital, metabolic
what are the most common causes of seizure in adults
tumors, trauma, stroke, infection
what are the most common causes of seizure in elderly
stroke, tumor, trauma, metabolic, infection
what is sturge-Weber syndrome
congenital disorder with port wine stains typically in the distribution of V1 ophthalmalogic distribution. ipsilateral leptomeningeal angiomas, pheochromocytomas. Can cause glaucoma, seizures, hemiparesis, and mental retardation
what is the presentation of tuberous sclerosis
HARMARTOMAS hamartomas in the skin and CNS, adenoma sebaceous, mitral regurgitation, ash-leaf spots, cardiac rhabdomyoma, tuberous sclerosis, autosomal dominant, mental retardation, angioyolipoma, seizures.
what is the most common primary brain tumor in adults
glioblastoma multiforme. (grade IV astrocytoma) <1 year survival, stains for GFAP
this is a pseudopalisading pleomorphic tumor cells. border central areas of necrosis.
what is the second most common primary brain tumor in adults
meningioma.
what is the presentation of meningioma
typically asymptomatic. patients may present with seizure or FND from compression
what do meningiomas look like pathologically
spindle cells with concentrically arranged whorled patterns. psammoma bodies with laminated calcification
what is the third most common brain tumor in adults
schwannoma
what are the characteristics of schwannoma
often localized to CNVIII acoustic neuroma. usually found in the cerebellopontine junction. stereotactic radio surgery.
what is the molecular signature of schwannoma
usually S100 positive.
Are oligodendrogliomas common?
No. they are rare.
are oligodendrogliomas fast growing
no. they are typically slow growing.
what are the characteristics of olgiodendroglioa
fried egg cells with round nuclei with clear cytoplasm. often calcified.
where are oligodendrogliomas usually found
in the frontal lobes.
what are the characteristics of pilocytic astrocytoma
these are low grade tumors found in children most often in the posterior fossa. GFAP positive. they are benign and typically have a good prognosis.
what are the characteristics of medulloblastoma
highly malignant cerebellar tumor. this is a form of primitive neuralectodermal tumor. this can compress the 4th ventricle and cause hydrocephalus. Can have drop metastases in the spinal cord.
what are the histological characteristics of pilocytic astrocytoma
Rosenthal fibers –eosinophilic, corkscrew fibers. cystic and solid appearance.
what are the histological characteristics of medullaoblastoma
homer-wright rosettes. small blue cells. radiosensitive.
ependymoma characteristics
most commonly found in the fourth ventricle and can cause hydrocephalus.
what is the prognosis for ependymoma?
poor
what are the histological characteristics of ependymoma
perivascular rosettes rod-shaped blepharoplasts (basal cilliary bodies) found near the nucleus.
what are the characteristics of hemangioblastoima
most often cerebellar, can produce secondary EPO and thus polycythemia.
what syndrome is hemangioblastoma associated with
von hippel Lindau –found with retinal angiomas.
craniopharyngioma characteristics
benign childhood tumor often confused with pituitary adenoma. can also cause bitemoporal hemianopsia. This is the most common childhood supratentorial tumor. calcification is common –tooth
where are craniopharyngioma derived from
rathkes pouch.
what are the histological characteristics of hemangioblastoima
foamy cells with high vascularity
what are the symptoms of caudal equina
bilateral radiculopathy, saddle anesthesia, late onset bowel bladder loss, hyporeflexia (areflexia), asymmetric motor
what are the symptoms of conus medularis
perianal anesthesia, early onset bowel bladder dysfunction, hyperrefexia, symmetric motor weakness. sudden onset severe back pain
provide the course of the eye movements neurons abducens and oculomotor
cortex - paramedian pontine reticular formation - abducens nucleus - medial longitudinal fasiculus - oculomotor nucleus.
what do you do for someone with acute closure glaucoma
tonometry –examining the intraocular pressure.
if bone conduction is greater than air then what
then there is conductive hearing loss.
