Neuro 1 Flashcards
What is dysarthria
Condition in which the muscles you use for speech are weak or you have difficulty controlling them
What is apraxia
Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex), in which the individual has difficulty with the motor planning to perform tasks or movements when asked, provided that the request or command is understood and he/she is willing to perform the task
What is aphasia
A language disorder that affects a person’s ability to communicate
What is catatonia
A behavioral syndrome marked by an inability to move normally
What is Keppra
Levetiracetam
Damage to what part of the brain causes hemispatial neglect
Non-dominant parietal cortex
Damage to dominant parietal cortex causes what?
Gerstmann syndrome = agraphia (inability to write), acalculia (inability to calculate), finger agnosia (inability to distinguish fingers), left-right disorientation
What is the reticular activating system
Located in the midbrain
Mediates consciousness and alertness
Damage to basal ganglia causes what?
♣ Resting tremor, chorea, athetosis
Damage to lateral cerebellum causes what?
♣ Occurs with chronic alcohol use
♣ Intention tremor, limb ataxia
Damage to medial cerebellum causes what?
♣ Truncal ataxia, dysarthria
Damage to PPRF causes what?
♣ Eyes look away from side of lesion
What are the 4 midline columns in the brainstem and presentation of damage to each
- Motor pathway (corticospinal tract) – Contralateral weakness
- Medial lemniscus – loss contralateral proprioception/vibration
- Medial longitudinal fasciculus – Ipsilateral intranuclear ophthalmoplegia
- Motor nucleus and nerve – Ipsilateral CN motor loss (3, 4, 6, 12 – midline motor divide into 12)
What are the 4 lateral (side) columns in the brainstem and presentation of damage to each
- Spinocerebellar pathway – Ipsilateral ataxia
- Spinothalamic – Contralateral pain/temp sensation loss
- Sensory nucleus of CN 5 – Ipsilateral pain/temp loss in face
- Sympathetic pathway – Ipsilateral Horner’s syndrome
Blood supply of medial and lateral midbrain
Posterior cerebral artery
Blood supply of medial and lateral pons
Medial = basilar Lateral = AICA
Blood supple of medial and lateral medulla
Medial = anterior spinal Lateral = PICA
Parts of brain most vulnerable to ischemic damage
Cerebellum
Neocortex
Hippocampus
Watershed areas (between ACA and MCA; MCA and PCA)
What is hydrocephalus
increased CSF leading to ventricular dilation (+/- increased ICP)
What is pseudotumor cerebri
♣ Aka idiopathic intracranial HTN
♣ Increased intracranial pressure without hydrocephalus
Presentation of pseudotumor cerebri
- Headache, diplopia, papilledema
* Lumbar puncture shows increased opening pressure with headache relief
Describe migraine HA
♣ Usually 4 – 72 hours
♣ Unilateral pulsing, throbbing headache
♣ Associated with nausea, photophobia, phonophobia, and aura
Tx of migraine HA
Triptans
Describe tension HA
♣ Usually 4 – 6 hours
♣ Bilateral headache with constant, steady pain (non-throbbing)
♣ Usually in frontal or occipital lobe
♣ No throbbing, no photophobia, no phonophobia, no aura
Tx of tension HA
NSAIDs, Acetaminophen
Describe cluster HA
♣ 15 min – 3 hours
♣ Repetitive (often occur daily at the same time)
♣ Unilateral, non-throbbing heading
♣ Excruciating pain, usually perioribital
♣ Associated with lacrimation, rhinorrhea, and Horner syndrome (ptosis and miosis, not anhidrosis)
Tx of cluster HA
100% O2, sumatriptan
Presentation of fetal hydantoin syndrome
o Caused by exposure to anticonvulsants (e.g. Phenytoin and Carbamazepine)
o Midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism, and developmental delay
Presentation of fetal alcohol syndrome
o Midfacial huypoplasia, microcephaly and stunted growth
o CNS damage may manifest as hyperactivity, mental retardation, or learning disability
What will you see in motor function, pain & temp, and vibration & proprioception in Brown Sequard syndrome
Contralateral loss of pain and temp (beginning 2 levels below lesion)
Ipsilateral motor and vibratory/proprioception
What are the nerve roots of the reflexes?
- Biceps and brachioradialis reflexes = C5, C6 (“pick up sticks”)
- Triceps reflex = C7, C8 (“lay them straight”)
- Achilles reflex = S1, S2 (“buckle my shoe”)
- Patellar reflex = L3, L4 (“kick the door”)
- Cremasteric reflex = L1, L2 (“testicles move”)
- Anal wink reflex = S3, S4 (“winks galore”)
Describe acute intermittent porphyria
♣ Deficiency of Porphobilinogen (PBG) deaminase
• THINK: Acute intermittent = guys hollering “damn” (deam-inase) intermittently at A CUTE pretty big girl (PBG) walking by
♣ Symptoms – 5 P’s
• Painful abdomen, Port wine colored urine (due to increase PGB), Polyneuropathy, Psychological disturbances, Precipitated by drugs (CYP450 inducers), alcohol, and starvation
Describe disorder of the splenium of the corpus collusum in the dominant occupital lobe
Can write but can’t read
You read with the occipital lobe but write with broca’s area. So if dominant occipital lobe is damaged, you need to get reading info from the R side of the brain but can’t if the corpus collosum is damaged. But Broca’s is still intact so you can still write
Tx of status epilepticus
- IV Benzo (e.g. Diazepam, Lorazepam)
- Phenytoin
- IV Phenobarbital
What is Keppra
Levetiracetam
What is Lyrica
Pregabalin (anticonvulsant; GABA analog)
What is Versed
Midazolam
What is Depakote
Valproate
What is Fioricet
Caffeine, Acetaminophen, Butalbital
Used for tension or muscle contraction HA
What is Addison’s disease
♣ Primary adrenal insufficiency problem of the adrenal gland - Aka Addison disease
• Most commonly due to autoimmune destruction of adrenal gland
Presentation:
o Lack of cortisol = Weakness, fatigue, weight loss
o Lack of aldosterone = hypotension, hyponatremia, hyperkalemia
o Increased ACTH = skin hyperpigmentation (due to POMC)
What is AED
Automated external defibrillator
Portable device that checks the heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm
What is a bulbar palsy
Refers to a range of different signs and symptoms linked to impairment of function of the cranial nerves IX, X, XI and XII, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem
Symptoms: dysphagia (difficulty in swallowing), difficulty in chewing,
nasal regurgitation,
slurring of speech,
difficulty in handling secretions, choking on liquids, dysphonia (defective use of the voice, inability to produce sound due to laryngeal weakness), dysarthria (difficulty in articulating words due to a CNS problem)
Describe presentation of Myasthenia gravis
Autoantibody against post-synaptic ACh receptor
Clinical features:
♣ Ptosis, diplopia, weakness
♣ Worsens with muscle use
Cause of MS
o Due to autoimmune demyelination of CNS
o Most often affects women in 20s-30s
Presentation of MS
♣ Charcot triad of symptoms SIN: • Scanning speech • Intention tremor, Incontinence, Internuclear ophthalmoplegia • Nystagmus ♣ Hemiparesis, hemisensory symptoms
Diagnosis of MS
o MRI gold standard ♣ Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis) o Lumbar puncture ♣ Increased protein ♣ Oligoclonal IgG bands
Describe ALS
o Aka Lou Gehrig disease
o Damage to anterior motor horn and lateral corticospinal tract
o Presents with both UMN and LMN deficits
o Lack of sensory impairment distinguishes from syringomyelia
o Caused by defect in superoxide dismutase (O2- H2O2)
