merchut handouts Flashcards
mononeuropathy vs polyneuropathy- what comes first? demyelination or axonal degeneration?
mono- demyelination
poly- axonal degeneration
when sural nerve is biopsied, where is there permanent numbness?
along lateral foot
in GBS, immune system attacks what?
peripheral nerve myelin
are there loss of reflexes in myopathy?
later in the game after severe atrophy
diagnosis of myopathy
CK
EMG- confirms- r/o neuropathy, motor neuron dz
muscle biopsy in some patients
dx and tx of polymyositis
dx: clinical, EMG supports, muscle biopsy shows inflamm cells amidst necrotic and regenerating muscle fibers
tx: corticosteroids, immunsopressants
myotonia
impaired relaxation of muscle after contraction (cant let go shaking hands)
myotonic dystrophy 1 cause
aut dom- excessive trinucletodie repeats- chrom 19
–> abnl protein kinase in muscle fibers
myotnic dystrophy presentation
weakness- distal limbs, neck, jaw
somatic sxs- cataracts, bald, infertile, arrythmias
spinal muscle atrophy is a group of disorders affecting…
anterior horn cells (LMN weakness)
primary lateral sclerosis is …
familial degeneration of CST in lateral columns
–> UMN signs
pseudobulbar palsy presentation
only CBT involved- facial weakness
jaw (jaw jerk inc), , dysarthria, dysphagia, hoarse
pseudobulbar palsy etiologies
infarct
tumor
MS
brain trauma
The first REM period occurs about _____ after sleep begins, and reoccurs about every _____ thereafter, lasting only ______ at first, and subsequently lengthening in duration to _____ or so.
90 minutes
90 minutes
few minutes
an hour
does REM increase or decrease with age?
decrease
ascending reticular activating system (ARAS), important for arousal, arises from these 4 places
rostral pons,
caudal midbrain,
posterior hypothalamus
basal forebrain nuclei
ARAS suppresses the
ventrolateral preoptic area of the hypothalamus- where REM and NREM are promoted
what activates the brain stem gaze centers responsible for the characteristic rapid, conjugate eye movements during REM, and induces hypotonia and increased autonomic activity by descending reticulospinal pathways?
pontine REM center
overnight sleep study includes what monitoring
EEG, EKG, oximetry, respiratory and videotape monitoring.
cause of narcolepsy
deficiency of certain neurons in the dorsolateral hypothalamus which release the excitatory peptide hypocretin (also called orexin), and project to the locus ceruleus and cholinergic neurons of the basal forebrain.
night terrors and sleep walking occurs in what stage of sleep?
stage 4
REM behavior disorder presentation
older male patients lack the normal hypotonia of REM. They appear to be “acting out” their dreams, vigorously kicking, punching or running during REM, to the point of injuring themselves or their bedpartner
REM behavior disorder often precedes the onset of
Parkinson’s disease or Lewy body dementia.
where are oligodendrogliomas located?
frontal lobe in adults
where are medulloblastomas located?
roof of 4th ventricle?
where are ependymomas located
4th ventricles- kids
filum terminale- adults
Meningeal carcinomatosis
where cancer cells spread throughout the CSF, depositing over different areas of cerebral cortex, cranial nerve or spinal nerve roots
dx and tx of Meningeal carcinomatosis
dx: someone with known malignancy has mental status change or focal neuro deficits. confirm with CSF cytology
tx: intrathecal chemo
whats the the most common benign brain tumor?
meningioma
CNS tumors affecting the spinal cord are often which types?
meningiomas or ependymomas.
