important neuro Flashcards
What is hemiballismus? what brain lesion causes hemiballismus?
= sudden flailing of one side of the body
-damage to contralateral subthalamic nucleus (STN) of basal ganglia (responsible for the indirect motor pathway that sends signals to GPi to send GABA to thalamus and decrease motion) often due to lacunar stroke (in lenticulostriate vessels often secondary to hyaline ateriolosclerois from unmanaged HTN)
what syndrome causes sx of vertical gaze palsy, pupillary light-near dissociation, lid retraction, convergence retraction nystagmus? common to injury of ___ caused by ____
Parinaud syndrome
-dorsal midbrain lesion due to pinealoma
damage to _____ causes ____ aphasia where the patient is unable to repeat words (no if and or buts) but can understand words and speak fluently
arcuate fasciulus (connects brocas to wernickes area) -conduction aphasia
damage to cerebellar hemispheres vs cerebellar vermis?
hemispheres- ipsilateral loss of proproception (finger to nose), intention tremor, loss of balance (fall to side of lesion)
vermis- truncal ataxia, (wide based “drunken sailor” gait) and nystagmus
in an MCA stroke where there is damage to the frontal eye fields, eyes will look ____ in reference to the lesion
towards the side of lesion, and away from the time of hemiplegia
-MCA stroke involves facial muscle weakness as well as UE/LE
damage to the MLF is common in ____ and causes _____
common in MS and causes internuclear opthalmolegia
**IMPAIRED ADDUCTION OF IPSILATERAL EYE (right lesion means right eye cant look left) and NYSTAGMUS OF CONTRALATERAL EYE WITH ABDUCTION (right lesions means left eye nystagmus when look left)
(MLF is responsible for CN6 connection to CN3 to induce LR and MR movement of eyes to look in same direction)
-pt will present with inability of the the MR to move (if you ask patient to look left, only left eye will look left, but right eye will look straight)
which lesion causes eyes to look opposite of that of the lesion but towards the side of hemiplegia
paramedian pontine reticular formation (PPRF)
hypothalamus controls what? and has what nuclei?
-hunger, temp, sexual urges, hormones, thirst , ANS
- lateral nucleus ( hunger - makes you lateral +ghrelin)
- ventromedial nucleus (satiety- makes your waist medial +leptin)
- supra chiasmatic nucleus (circadian rhythm)
- anterior nucleus (cooling - AC) - PNS
- posterior nucleus (heating - hot pot) SNS
- SON - ADH
- PVN- oxytocin
- preoptic nucleus - thermoregulation and sexual urges (hot and heavy = preoccupied mind)
thalamus is major relay for all ascending sensory information except for
olfaction (smell)
spinothalamic (pain and temp) and dorsal column (pressure, proprioception, vibration) synapse in what THALAMIC nucleus
VPL
-ventral postero-lateral nucleus
what is the input into the THALAMIC nuclei VPM (ventral-posters-medial nucleus)
trigeminal (face sensation)
gustatory (taste)
lateral and medial geniculate nuclei from thalamus carries what information
lateral-vision
medial - hearing
ventral lateral nucleus in the thalamus carries what input
motor information from cerebellum and basal ganglia
damage to ___ in the ____ causes reduced level of arousal and wakefulness
RAS (reticular activating system) in the midbrain
define medial medullary syndrome
- effect of stroke to anterior spinal artery (ASA)
- supplies the pyramids, ML, hypoglossal nucleus)
- damage to corticspinal tract -C/L paralysis of UE LE
- damage to medial lemniscus (dorsal column after decussation) C/L loss of proprioception, vibration, discrimination
- hypoglossa N. l damage - motor tongue damage therefore TONGUE DEVIATES IPSILATERALLY)
define Wallenburg syndrome
(lateral medullary syndrome)
- stroke effects of PICA (posterior inferior cerebellar a.)
- affects CN 9, 10, 11 (nucleus ambigus) = DYSPHAGIA , HOARSENESS, decreased GAG REFLEX , hiccups
- other sx such as ipsilateral Horner syndrome, and vertigo, nystagmus, etc nonspecific)
WALLENBURG HORSE
define the lateral pontine syndrome
- stroke effects of AICA (anterior inferior cerebellar a.)
- facial nucleus damage = paralysis of face (damage UMN and LMN) , decreased lacrimation, salivation, and taste from anterior 2/3 tongue
- damage to labryrinthie a. in CN8- ipsilateral deafness and vertigo
- other sx non specific
when do you see “locked in syndrome”
(bilateral paralysis of everything but eyes)
- damage to central pons via:
- central pontine demyelinosis/osmotic demyelination syndrome
- basilar a. damage via stroke
what results in contralateral homonymous hemianopia with macular sparing
PCA (posterior cerebral a.) damage via stroke
can also write but cant read
diffuse axonal injury often leads to
coma or persistent vegatative state
what happens if there is damage to the arcuate fasciculsus
(connection between wernickes and brooks area)
-conduction aphasia (can not repeat - “no ifs ands or buts”)
a-com compression (by berry aneurysm) causes what sx
bitemporal hemianopia via compression of optic chasm (cant see lateral)
p-com compression causes
ipsilateral CN 3 palsy (down and out eye) with “blown” pupil
restless leg syndrome is associated with what 2 conditions
iron deficiency
chronic kidney disease
tx: ropinerole or pramipexole
tuberous sclerosis
- HAMARTOMAS , AD
- TSC1 (hamartin) and TSC2 (tuberin) mutations
- hamartomas in CNS and skin and RETINA
- angiofibromas
- ASH-LEAF spots (hypo pigmentation)
- cardiac Rhabdomyoma
- renal angiomyolipomas
- SHAGREEN PATCHES (cutaneous thickenings)
NF1
- AD NF1 mutation of chr 17 for neurofibromin (negative RAS regulator)
- cutanoues neurofibromas (macules)
- cafe au last spots (hyper pigmented)
- lisch nodules (pigmented iris hamartomas)
- optic gliomas
- pheochromocytomas
- sciolosis
NF2
-AD NF2 mutation of chr22 (merlin)
-bilateral vestibular schwannomas -deafness / tinnitus
-cataracts in kids
-meningiomas and ependymomas
(affects 2 eyes and 2 ears )
VHL disease
-AD VHL deletion on chr3 (n: decreases HIF which regulates VEGF)
-HEMANGIOBLASTOMAS in retine, brain, spine
-Angiomatosis (can be retinal)
-bilateral Renal cell carcinomas
-pheochromocytomas
*neoplastic INCREASE EPO -> POLYCYTHEMIA
HARP
*also pancreatic and kidney cysts
wilsons dz is one what gene ? is it a brady kinetic or hyperkinetic movement do?
chr 13 - ATP7B gene involved in copper transport
features of both brady kinetic and hyperkinetic
sturge weber syndrome
- congenital anomaly of NCC- GNAQ mutation mosacicism
- portwine stain on face (V1, V2 distribution)
- early onset glaucoma (Increased IOP from episcleral hemangioma)
- seizures/epilsey ( leptomeningeal angioma)
what is an autoimmune destruction of Schwann cells
acute inflammatory demyelinating polyradiculopathy
- subtype of Guilian Barre syndrome
- ascending muscle weakness/paralysis and No DTRS
- increased CSF protein but NL cell count
- *respiratory support is critical bc respiratory failure is common (along with bilateral facial paralysis )
tx: plasmapheresis or IV IG
ataxia-telangiectasia triad
- ataxia
- telengiectasias (spider web like- in CNS, conjunctiva, skin, face neck arms)
- IgA deficiency (recurrent sinopulmonary infections)
-AR, presents early childhood, die in early 20s
