Neuro 1 USMLE Flashcards
decreased pain and temp sensation over lat. aspects of both arms. where is the lesion
syringomyelia
penlight in pts right eye produces bilateral pupillary constriction. when moved to the left eye, there is paradoxical dilation.
what is the defect?
atrophy of L optic nn
decresassed prick sensation on lateral aspect of leg and foot.
deficit in what mm action can also be expected
dorsiflexion & eversion of foot (common peronial nn)
pt presents w/ tingling over lateral digits of her R hand.
What is the dx
carpal tunnel syndrome.
median nn compression
decreased plantar flexion and decreased sensation over back fo thigh, calf, and latereal half of foot.
what spinal nn
tibial (L4-S3)
pt in MVA can’t turn head to L & has rightt shoulder droop.
What sx is damaged.
R CN XI (inn SCL & trap mm)
pt presents w/ one wild flailing arm. where is the lesion?
contralateral subthalamic nuccleus (hemiballismus)
pt w/ cortical lesion does not know he has a dz. where is the lesion?
right paraietal lobe
pt cannot protrude tongue toward L side and has a R-sided spastic paralysis. Where is the lesion?
L medulla, CN XII
teen falls while rollarblading and hurts his elbow. He can’t feel the medial part of his palm.
What is the nn & what is the injury.
ulnar nn due to broken medial condyle
pt presents to ER after falling on arm. X-ray shows midshaft break of the humerus? Which nn & aa are most lkely damaged?
radial nn & deep brachial aa (run together
pt cannot blink his R eye or seal his lips and has mild ptosis on R side. What is the dx and which nn is affected.
bell’s palsy; CN VII
pt c/o numbness, & tingling sensation. She has wasting of thenar eminence. What is the dx/ What nn is affected?
carpel tunnel syndrome (medial nn)
stage of sleep where there is variable BP, penile tumescence & variable EEG.
REM
person demands only the best & most famous doctor in town.
what personality d/o
narcissistic personality d/o
nurse has episodes of hypoglycemia; blood analysis shows no elevation in C protien. What is the dx.
factitious d/o. self scripted insulin
woman presents w/ headache, visual disturbance, galactorrhea and amenorrhea
what is the dx
prolactinoma
pt experiences dizziness & tinnitis. ct shows enlarged internal acoustic meatus. What is the dx
schannoma
25 y/o female presents w/ sudden uniocular vision loss & slightly slurred speech. She has hx of weekness & parasthesias that have resoved. what is the dx
MS
10 y/o child “spaces out” in class (e.g., stops talking midsentance & then continues as if nothing happened. During spells there is slight quivering of lips. Dx?
absence seizures
man on several meds including antidepressants and antihypertensives, has mydriasis and becomes constipated. What is the cause of his symptoms
TCA
woman on MAO inhibitor has hypertensive crisis after a meal. What did she ingest?
tyramine (wine or cheese)
This CNS support cell helps maintain the blood-brain barrier. It’s cell marker is GFAP
astrocyte
this CNS support cell makes up the inner lining of the ventricles
ependymal cells
this CNS support cell is the macrophage of the brain phagocytosing in areas of inflammation or neural damage. Like the macrophage, this cell is mesodermal in origen.
microglia.
This CNS support cell is responsible for myelin production
oligodendroglia
This pns support cell is responsible for peripheral myelin production
schwann cell
All CNS/ PNS support cells (except the microglia which originates from mesoderm)originate from this primary germ cell layer.
ectoderm
autopsy done on pt w/ HIV shows these support cells transformed into virus filled multinucleated giant cells in CNS
microglia
these CNS support cells are destroyed in MS
oligodendroglia
Acoustic neuroma is a neoplasm of this PNS support cell commonly associated with the internal acoustic meatus (CN VII, VIII)
schwann cell
Give following peripheral nn layers from inner most to outermost : nn fibers endoneurium epineurium perineurium
endoneurium-perineurium-epineurium-nn fibers
this peripheral nn layer must be rejoined in microsurgery for limb reattachment
perineurium
this sensory corpuscle is a small, encapsulated nn ending found in the dermis of palms, soles, and digits of skin. It is involved in light discriminatory touch of glabrous (hairless) skin.
meissner’s corpuscle
this sensory corpuscle is a large, encapsulated nn ending found in deeper layers of skin at ligaments, joint capsules, serous membranes, and mesenteries. It is involved in pressure, coarse touch, vibration, and tension.
pacinian corpuscle
this sensory corpuscle is a cup-shaped nn ending in dermis of fingertips, hair follicles, hard palate. It is involved in light, crude touch
merkel’s corpuscle
when you hear high frequency sound, this part of the cochlea is responding (narrow & stiff)
base
when you hear low frequency sound, this part of the cochlea is responding (wide and flexible)
apex
perilymph in the inner ear is similar to (ECF or ICF)
ECF (high Na+)
when you hear high frequency sound, this part of the cochlea is responding (narrow & stiff)
base
endolymph in the inner ear is similar to (ECF or ICF)
ICF (K+)
Utricle and saccule of the inner ear contain maculae which detect which type of acceleration?
linear
Semicircular canals of the inner ear contain ampullae which detect which type of acceleration?
angular
hearing loss in the elderly usually begins with which type of frequency
high frequencies
blood brain barrier is formed by which 3 structures:
1) astrocyte processes
2) basement membrane
3) tight jx b/n nonfenestrated capillary endothelial cells
glucose and amino acids cross the blood-brain barrier by which method.
carrier mediated transport mechanism
what crosses blood brain barrier more redily. water soluble substances or lipid soluble substances?
lipid soluble
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the T stand for (2 chances to get it right.
either:
1)Thirst
or
2)Temperature
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the A stand for (2 chances to get it right.
Either
1) Adenohypophysis control
or
2)Autonomic regulation
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the A stand for (2 chances to get it right.
Either
1) Adenohypophysis control
or
2)Autonomic regulation
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the N stand for
Neurohypophysis hormones (synthesized in hypothalamic nucleii)
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the H stand for
Hunger
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the S stand for?
Sexual urges
destruction of the lateral nucleus of the hypothalamus results in what type of food intake?
anerexia & starvation
destruction of the ventromedial nucleus of the hypothalamus results in what type of food intake?
hyperphagia and obesity
Anterior hypothalamus regulates what division of the ANS.
parasympathetic
Posterior hypothalamus regulates what division of the ANS.
Sypathetic
This nucleus controls circadian rhythms.
suprachiasmatic nucleus
This nucleus controls thirst and water balance
supraoptic nucleus
This part of the hypothalamus (anterior or posterior) kicks in and regulates heat concervation when cold.
posterior hypothalamus
This part of the hypothalamus (anterior or posterior) coordinates cooling when hot.
anterior hypothalamus
When this nucleus of the hypothalmus is destroyed–rage results?
septal nucleus
The posterior pituitary (neurohypophysis) recieves hypothalamic axonal projections from the supraoptic nucleii and releases what hormone?
ADH
The posterior pituitary (neurohypophysis) recieves hypothalamic axonal projections from the paraventricular nucleii and releases what hormone?
oxytocin
this part of the brain is the major relay for ascending sensory informationthat ultimately reaches the cortex?
thalamus
This geniculate nucleus of the thalamus (lateral or medial) is involved in relaying visual sensory information to the cortex.
lateral
This geniculate nucleus of the thalamus (lateral or medial) is involved in relaying auditory sensory information to the cortex.
medial geniculate nucleus (MGN)
This nucleus of the thalamus is involved in relaying BODY sensation information (proprioception, pressure, pain, touch, vibriation) to the cortex via the dorsal columns & the spinothalamic tract.
Ventral Posterior Nucleus, Lateral part (VPL)
This nucleus of the thalamus is involved in relaying FACIAL sensation information to the cortex via CN V
Ventral Posterior nucleus, medial part (VPM)
This nucleus of the thalamus is involved in relaying motor information to the cortex.
Ventral Anterior/Lateral nucleus (VL)
This “system” of the brain is responsible for the 5 Fs. Feeding, Fighting, Feeling, Flight, and Fucking.
limbic system
This part of the brain is important in voluntary movements and making postural adjustments.
basal ganglia
Parkinson’s dz symptoms are do to decreased imput from this part of the basal gangia.
substantia nigra.
In Parkinson’s dz the symptoms are due to decreased input from the substantia nigra of the basal ganglia. This leads to _______ (increased or decreased) stimulation of the direct pathway and _______ (increased or decreased) inhibition of the indirect pathway
decreased
decreased
In the basal ganglia, _________ (D1)facilitates movement
direct pathway
In the basal ganglia, _________ (D2)inhibits movement
indirect pathway
In the cerebral cortex associative auditoritory fx is associated with which area?
Wernicke’s area (22)
In the cerebral cortex speech motor fx is associated with which area?
broca’s area
Your pt has become recently more and more disorganized. He reports problems concentrating and poor social judgement. What lobe of the brain could be involved.
frontal lobe
anterior cerebral artery hemarrage could result in sensory motor problems in which location of the body?
lower extremity
anterior cerebral aa supplies what part of the brain
medial surface
hemhorrage of the middle cerebral aa would involve what part of the brain.
lateral
hemhorrage of the middle cerebral aa could involve what pathologies?
motor & sensory deficits of teh trunk-arm-face, Broca’s and Wernicke’s speech areas
Anterior communicating artery lesion is the most common circle of Willis aneurism. It may cause this deficit.
visual field defect
Posterior communicating artery is also a common area of aneurism. It can result in this cranial nn palsy.
CN III
A stroke in this general part of the circule of wilis can cause general sensory and motor dysfunction and aphasia
anterior circle
A stroke in this general part of the circle of wilis can cause cranial n deficits (vertigo, visual deficits), coma, cerebellar deficits (ataxia)
posterior circle
this division of the middle cerebral aa is a common site of stroke. It feeds the internal capsule, caudate, putamen, & globus pallidus
lateral striate
Cerebral veins drain into the venous sinuses which drain into what?
internal jugular vv
lateral ventricle drains into the 3rd ventricle via the foramen of _______.
monro
3rd ventricle drains into the 4th ventricle via the aquaduct of ________
sylvius
4th ventricle drains into the subarachnoid space via the foramina of ________ (laterally) and the foramina of ________ (medially
Luschka
Magendie
How many spinal nn are there total?
31 8-C 12-T 5-L 5-S 1-coccygeal
Vertibral disk herniation usually occurs between what levels_______
L5-S1
At what levels do you want do a LP
L3-L5
spinal cord extends to lower border of L2; Subarachnoid space extends to lwer border of S2
You perform an LP at the level of L4/L5 (iliac crest levels). List the following sx in the order that you will pierce them?
Ligaments Arachnoid Epidural space Subdural space skin/superficial fascia Dural matter Subarachnoid space CSF
skin/superficial fascia Ligaments Epidural space Dural matter Subdural space Arachnoid Subarachnoid space CSF
Should you pierce the Pia matter in a lubar puncture?
No
These columns relay sensation of pressure, vibration, touch, and proprioception to the cerebral cortex.
dorsal columns
This fasciculus within the dorsal column relays the sensation of pressure, vibration, touch, and proprioception from the upperbody and extremities to the cerebral cortex.
fascciculus cuneatus
This fasciculus within the dorsal column relays the sensation of pressure, vibration, touch, and proprioception from the lower body and extremities to the cerebral cortex.
fasciculus gracilis
These tracts relay sensation of pain and temperature up the spinal cord to the cerebral cortex
spinothalamic tract
These tracts relay motor signals from the brain down teh spinal cord.
lateral corticospinal tract
what is more lateral in the dorsal columns the fasciculus cuneatus or fasciculs gracilis
fasciculus cuneatus
Describe the path of a vibratory (or pressure, touch, proproceptive) sensation as after it signals a sensory nn up until its first synapse (must get 3 key points)
Sensation enters the DORSAL ROOT GANGLION to ascent the spinal cord IPSILATERALLY in the DORSAL COLUMN.
Describe the location of the first synapse of that vibratory (or pressure, touch, proproceptive) sensation (must give nucleus and brain location)
NUCLEUS CUNEATUS or GRACILIS in the MEDULLA
Describe the 2nd order neuron of that vibratory (or pressure, touch, proproceptive) sensation. (decussation & ascention)
decussates in the MEDULLA and ascends CONTRALATERALLY in the MEDIAL LEMNISCUS
Describe the 2nd synapse of that vibratory (or pressure, touch, proproceptive) sensation. (Nucleus and brain location)
VPL of the THALAMUS
Describe the final destination of the 3rd order neuron of that vibratory (or pressure, touch, proproceptive)sensation
SENSORY CORTEX
Describe the path of an ascending pain (or temperature) sensation after it signals a sensory nn up until its first synapse
travels from sensory nn endigns (A-delta and C-fibers)and enters spinal cord ipsilaterally.
Describe the first synapse of ascending pain and temperature sensation
IPSILATERAL synapse with gray matter in spinal cord.
Describe the 2nd order neuron transmission of the ascending pain and temperature sensation. (decussation & ascention)
Decussates at the ANTERIOR WHITE COMMISSURE and ascends CONTRALATERAL in the SPINOTHALAMIC TRACT
Describe the 2nd synapse of the ascending pain and temp sensation?
VPL of thalamus
Describe the 3rd order neuron final destination of the ascending pain and temperature sensation.
sensory cortex
You want to move you’re right arm? Describe the 1st order neuron pathway.
begin in the LEFT HEMISPHERE PRIMARY MOTOR CORTEX. The UPPER MOTOR NEURONS descends IPSILATERALLY until decussating at CAUDAL MEDULLA (PYRAMIDAL DECUSSATION) and then descend CONTRILATERALLY.
You want to move you’re right arm? Describe where the 1st synapse occurs.
CELL BODY OF THE ANTERIOR HORN (SPINAL CORD)
You want to move you’re right arm? Describe the 2nd order neuron.
LOWER MOTOR NEURON leaves the spinal cord.
You want to move you’re right arm? Describe where the 2nd synapse occurs.
neuromuscular jx
Give the brachial plexus dx from the BP damage: Upper trunk (C5, C6)
waiters tip
Give the diagnosis from the location of Brachial Plexus damage: Lower trunk (T1,C8)
claw hand
Give the diagnosis from the location of Brachial Plexus damage: Posterior chord (C5-T1)
Wrist drop
Give the diagnosis from the location of Brachial Plexus damage:
Long Thoracic Nerve
Winged scapula
Give the diagnosis from the location of Brachial Plexus damage:
Axillary nn
Deltoid paralysis
Give the diagnosis from the location of Brachial Plexus damage:
Radial nn
Sadurday night palsy
Give the diagnosis from the location of Brachial Plexus damage:
musculocutaneous nn
difficulty flexing elbow, variable sensory loss
Give the diagnosis from the location of Brachial Plexus damage:
Median nn
decreased thumb fx-Pope’s blessing
Give the diagnosis from the location of Brachial Plexus damage:
Ulnar branch
Intrinsic mm of hand, claw hand
What mm protects brachial plexus from injury in the case of the relatively common clavicle fracture
subclavius
This nn is known as the “great extensor nn” it provides innervation of the Brachioradialis, Extensors or the wrist and fingers, Supinator, and Triceps.
Radial nn.
mneu:RAD=BEST
Brachioradialis, Extensors or the wrist and fingers, Supinator, and Triceps.
Thenar mm (3)
Hypothenar mm (3)
Opponens pollicis, Abuctor pollicis brevis, Flexor pollicis brevis
Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi
Both groups perform the same fx: Oppose, Abduct, and Flex (OAF)
Clinically important Landmarks:
- Ischial spine?
- 2/3 of the way from the umbilicus to the anterior superior Iliiac Spine
- Iliac Crest
Pudendal nn block
McBurney’s Pt-Appendix
Lumbar puncture
Landmark Dermatomes:
Posterior half of the scull “cap”
C2
Landmark Dermatomes: high turtle neck shirt
C3
Landmark Dermatomes: low collar shirt
C4
Landmark Dermatomes: T4
nipple
T4 at the “teat pore”
Landmark Dermatomes: xyphoid process
T7
Landmark Dermatomes: Umbilicus
T10
T10 at the belly butTEN
Landmark Dermatomes: Inguinal ligament
L1
L1 is IL
Landmark Dermatomes: includes the kneecaps
L4
down on L4s (all 4s)
Landmark Dermatomes:
erection, and sensation of penile and anal zones
S2,3,4
S2,3,4 keeps the penis off the floor
Gallbladder pain is referred to the right shoulder via this nn
phrenic nn
This work in prallel w/ mm fibers. When a mm is stretched it causes the intrafusal to stretch which stimulates the Ia afferent which in turn stimulates the alpha motor neuron which causes a reflex muscle (extrafusal ) contraction
muscle spindle
these monitor mm lenth. For example help you pick up a heavy suitcase when you didn’t know how heavy it was.
muscle spindles
This senses tension and provides inhibitory feedbach to alpha motor neurons
golgi tendon organs
These monitor mm tension. For example make you drop a heavy suitcase you’ve been holding for too long
golgi tendon organs
CNS stimulates the gamma motor neuron which contracts intrafusal fiber and causees an increased sensitivity of the reflex arc
gamma loop
Clinical reflexes:
- Achillies:
- Patella:
- Biceps:
- Triceps:
S1,2
L3,4
C5,6
C7,8
Dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life
Babinski
Primitive Reflexes:
extension of limbs when startled
(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
moro reflex
Primitive Reflexes:
nipple seeking
(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
rooting reflex
Primitive Reflexes:
grasps objects in palm
(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
palmar reflex
Primitive Reflexes:
large toe dorsiflexes w/ plantar stimulation
(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
babinski reflex
CNs that lie medially at brainstem
III, VI, XII
mneu: 3(x2)=6(x2)=12
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
smell
CNI-olfactory(S)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Sight
CN II: Optic (S)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Eye movement (up(lateral & medial) down (lateral), pupil constriction, accommodation, eyelid opening
CN III: Oculomotor (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Eye movement (down & medial)
CN IV: Trochlear (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Mastication, Facial sensiation
CN V: Trigeminal (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Eye movement (lateral)
CN VI: Abducens (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Facial mvmt, taste from anterior 2/3 of tongue, lacrimation, salivation (submaxillary and sublingual glands, eyelid closing.
CN VII: Facial (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Hearing, balance
CN VIII: Vestibulocochlear (S)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Taste from post 1/3 of tongue, swallowing, salivation (parotid gland), monitoring carotid body and sinus chemo-and baroreceptors
CN IX: Glossopharyngeal (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Tastte from epiglottic region, swallowing, palate elevaton, talking, throacoabdominal viscera, monitoring aortic arch chemo-and baroreceptors
CN X: Vagus (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Head turning, shoulder shrugging
CN XI: Accessory (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
tongue mvmt
CN XII: Hypoglossal (M)
Cranial nn nucleii located in the Midbrain
CN III, IV
Cranial nn nucleii located in the Pons
CN V-VIII
Cranial nn nucleii located in the Medulla
IX-XII
Cranial nn nucleii located in the Midbrain
CN III, IV
Cranial nn more lateral in the brainstem tend to be ______; those more medially tend to be _______
sensory
motor
This vagal nucleii recieves visceral sensory information (e.g., taste baroreceptors, and gut distension) from cranial nn VII, IX, & X
Nucleus Solitarius
This vagal nucleii is responsible for Motor inervation of the pharynx, larynx and upper esophagus (e.g, swallowing, palate elevation)via CN IX,X,XI.
Nucleus aMbiguous
This vagal nucleii sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI
Dorsal motor nucleus
Crandial nn and vessel pathways:
Cribiform plate
CN I
Crandial nn and vessel pathways:
optic canal
CN II, opthalmic artery, central retinal vein
Crandial nn and vessel pathways:
Superior orbital fissure
(CN III, IV, V1,VI, opthalmic vv)
Crandial nn and vessel pathways:
Foramen Rotundum
CN V2
Crandial nn and vessel pathways:
Foramen Ovale
CN V3
Crandial nn and vessel pathways:
Foramen spinosum
middle meningeal aa
Crandial nn and vessel pathways:
Internal auditory meatus
CN VII, VIII
Crandial nn and vessel pathways:
Jugular foramen
CN IX,X,XI, jugular vv
Crandial nn and vessel pathways:
Hypoglossal canal
CN XII
Crandial nn and vessel pathways:
Foramen magnum
Spinal roots of CN XI, brainstem, vertebral arteries
a collectionof venous sinuses on either side of the pituitary
cavernous sinus
nn that pass through cavernous sinuses
nn that control extaocular mm (CN III, IV, VI) plus V1 & V2
pt presents w/ opthalmoplegia, & opthalmic and mandibular sensory loss
what is a possible dx?
Cavernous sinus syndrome (e.g., due to mass effect
Muscles of mastication:
3 mm that close the jaw
innervated by?
Masseter, teMporalis, Medial pterygoid.
inn: V3
mneu: Ms Munch
Muscles of mastication:
1 mm opens the jaw
innervated by:
Lateral pterygoid.
inn: V3
mneu: Lateral Lowers
All mm with the root glossus in their names are innervated by?
Except one exception. What is it and what is the innervation.
hypoglossal.
palatoglossus (inn by vagus)
All mm with the root palat in their names are innervated by this.
One exception what is it innervated by?
vagus
exception: tensor veli palatine (inn by Mandibular branch of CN V)
CN IV innervates what mm? What direction would you look?
SO–towards your nose
CN VI innervates what mm. What direction would you look
LR-laterally
What reflex? Light in either retina sends a signal via CN III to PRETECTAL nucleii in midbrain that activate bilateral EDINGER-WESTPHAL nucleii;pupls contract bilaterally (consensual reflex)
Pupillary light reflex
Saying KLM outloud tests what three CNs?
K (vagus) palate elevation
L (hypoglossal) tongue
M (facial) lips
What waveform?
awake (eyes open), alert, active mental concentration
Beta (highest frequency, lowest amplitude)
What waveform?
awake (eyes closed)
alpha
What waveform?
light sleep
What stage of sleep is this? What percentage of total sleep time is this in young adults?
Theta
1
5%
What waveform?
deeper sleep
What stage of sleep is this? What percentage of total sleep time is this in young adults?
Sleep spindles and K complexes
2
45%
What waveform?
Deepest sleep; sleepwalking; night terrors, bed wetting
What stage of sleep is this? What percentage of total sleep time is this in young adults?
Delta (lowest frequency, hightest amplitude)
3-4
25%
What waveform?
dreaming, loss of motor tone, possibly memory procesing fx, erections, increase brain oxygen use
What stage of sleep is this? What percentage of total sleep time is this in young adults?
Beta
REM
25%
mneu: At night, BATS Drink Blood
What type of sleep is this?
increase variable pulse, rapid eye movements, inceased and variable blood pressure, penile/clitoral tumenescence. Occurs every 90 min; duration increases throughout the night.
REM
principle neurotransmitter involved in REM sleep
Ach
REM sleep _______ (increases or decreases) with age
decreases
neural tube defects are associated with lack of this vitamen intake during pregnancy
folic acid
neural tube defects are associated with elevated levels of this in amniotic fluid and maternal serum
alpha fetoprotein levels
This describes failure of bony spinal canal to close, but no structural herniation. Usually seen at lower vertebral levels
spinal bifida occulta
This describes when the meninges herniate throgh a spinal canal defect
meningocele
This describes when meninges and spinal cord herniate through spinal canal defects
meningiomyelocele
Give the area of the brain lesion?
motor (nonfluent/expressive) aphasia with good comprehension
broca’s area
Give the area of the brain lesion?
sensory (fluent/receptive) aphagia with poor comprehension
Wernicke’s area
Give the area of the brain lesion?
conduction aphagia; poor repitition with good comprehension, fluent speech
Arcuate fasciculus
(connects Wernicke’s to Broca’s area
Give the area of the brain lesion?
Kluver-Bucy Syndrome (hyperorality, hypersexuality, disinhibited behavior)
Amygdala (bilateral)
Give the area of the brain lesion?
Personality changes and deficits in concentration, orientation, and judgement; may have reemergence of primitive reflexes
frontal lobe
Give the area of the brain lesion?
Spacial neglect syndrome (agnosia of the contralateral side of the world)
Right parietal lobe
Give the area of the brain lesion?
coma
reticular activating system
Give the area of the brain lesion?
wernicke-korsakoff syndrome
mamillary bodies (bilateral)
Give the area of the brain lesion?
tremor at rest, chorea, or athetosis
basal ganglia
Give the area of the brain lesion?
Intention tremor, limb ataxia
cerebellar hemisphere
mneu: cerebellar hemispheres are LATERALLY located–affect LATERAL limbs. Vermis is CENTRALLY located-affects CENTRAL body
Give the area of the brain lesion?
truncal taxia, dysarthria
cerebellar Vermis
mneu: cerebellar hemispheres are LATERALLY located–affect LATERAL limbs. Vermis is CENTRALLY located-affects CENTRAL body
Give the area of the brain lesion?
contralateral hemiballismus
subthalamic nucleus
Chorea–sudden, jerky, purposeless movements are characteristic of a lesion in this part of the brain. Give the classic dz example.
Basal ganglia
Huntington’s dz
Athetosis are slow, writhing movements, especially of the fingers. This is characteristic of a lesion in this part of the brain
basal ganglia
hemiballismus involves the sudden wild flailing of 1 arm. What kind of lesion does this indicate (& on what side)
contralateral subthalamic nucleus
results in loss of inhibition of thalamus through globus pallidus
Broca’s lesion is nonfluent aphagia with intact comprehension it involves this gyrus
inferior frontal gyrus
Wernicke’s aphagia is fluent aphagia with impared comprehension it involves this gyrus
superior temporal gyrus
most common cause of dementia in the elderly. Associated w/ senile plaques (extracellular, Beta amyloid core) and neuro fibrillary tangles (intracellular, abnormally phosphorylated tau protiein)
Alzheimers dz
Familial form of alziemers is associeted w/ genes on chromosomes 1, 14, 19 (APOE4 allele), and 21 (p-App gene) is thought to be responsible for this percent of alzheimers cases
10%
What is the 2nd most common cause of dementia in the elderly
multi-infarct dementia
may cause amyloid angiopathy
pt presents with dementia, aphasia, parkinsonian aspects; associated with intracellular aggregated tau protien and is specific for frontal and temporal lobes.
Pick’s dz
pt presents with chorea and dementia. Autopsy shows atrophy of caudate nucleus (loss of GABAergic neurons).
Huntinton’s dz
Dz associated with chromasome 4–expansion of CAG repeats.
Huntinton’s dz
mneu: CAG-Caudate loses ACh & GABA.
dz associated w/ Lewy bodies and depigmentation of the substantia nigra pars compacta (loss of dopaminergic neurons) Rare cases have been linked to exposure to MPTP, a contaminant in illicit sreet drugs.
Parkinson’s dz
mneu: TRAP=Tremor (at rest), Rigidity, Akinesia, and Postural instability (you are TRAPped in your body.
Dz associated with BOTH LMN & UMN signs, no sensory defect. Also known as Lou Gehrig’s dz
Amyotrophic lateral Sclerosis (ALS)
presents as birth as a “floppy baby”, tongue fasciculations; median age of death is 7 months. Associated w/ degeneration of anterior horns. Autosomal-recessive inheritance.
Werdnig-Hoffmann dz
dz follws infection with poliovirus; LMN signs. Associated with degeneration of anterior horns.
Polio
Pt presents w malaise, headache, fever, nausea abdominal pain, sore throught. Progreses to signs of LMN lesions–mm weakness & atrophy, fasciculations, fibrillation, & hyporeflexia.
LP of CSF shows lymphocytic pleocytosis w/ slight elevation of protein.
What do you suspect?
Poliomyelits
this dz is causesd by the poliovirus, which is transmitted by the fecal-oral route. It replicates in the oropharynx and small intestine before spreading through the bloodstream to the CNS where it leads to the destruction of cells in the anterior horn of the spinal cord, leading in turn to LMN destruction.
poliomyelitis
This dz shows increased prevalence with increased distance from the equator.
MS
This dz shows periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)with preservation of actions. There is an increase in protein (IgG) in CSF.
MS
dz associated with a relapsing-remitting course.
MS
With this dz pts often present w/ optic neuritis (sudden loss of vision) MLF syndrome (internuclear ophtalmoplegia), hemiperesis, hemisensory symptoms, or bladder/bowel incontinence.
MS
This dz classically presents with scanning speech, intension tremor, and nystagmus. It most often affects women in their 20s and 30s. And is more common in whites. Tx is Beta interferon or immunosuppressant therapy.
MS
This demyelinating dz is associated with the JC virus and is seen in 2-4% of AIDS pts.
Progressive multifocal leukoencephalopathy (PML)
This dz is associated with inflammationand demyelination of peripheral nn and motor fibers of the ventral roots (sensory effects are less severe than motor). This results in symmetric ASCENDING mm weakness begining in distal and lower extremities.
LP of CSF shows elevated protein with normal cell count (albuminocytologic dissociation). Elevated protien levels may lead to papilledema.
Pts usually recover completely.
Guillian-Barre Syndrome (acute idiopathic polyneuritis)
Guillian-Barr has been associated with certain infections including (2)
herpesvirus or Campylobacter jejuni
seizures involving only one area of the brain
partial seizures
simple partial seizures
1 area of the brain
conciousness intact
complex partial seizures
1 area of the brain
impaired consciousness
generalized seizures
diffuse areas of brain
generalized siezures involving a blank stare
absence (petit mal)
generalized siezures involving quick repetitive jerks
myoclonic
Generalized siezure involving alternating stiffening and movement
tonic-clonic
Pt hit in the side of the head with a baseball and fracturs his temperal bone. Rupture of the middle meningeal aa results. CT shows a “bioconvex disk” that does not cross suture lines. What is your dz of the Intracranial hemorrhage?
epidural hematoma
Alcoholic presents to the ER. He fell and hit his head the previous night but thought he was fine until neurological symptoms appeared the next morning. MRI shows a crescent-shaped hemorrhage that crosses suture lines. You suspect a venous bleed. What is your dx of this intracranial hemorrhage?
Subdural hematoma
Pt complains of “worst headache of their life.” You worry it may be a rubture of a berry aneurism. Spinal tap is bloody. What is the d of this intracranial hemorrhage?
Subarachnoid hemorrhage
This type of aneurism often occurs at the bifurcation in the circule of Willis. The most common site is the bifurcation of the anterior communicating artery. Risk factors include adult polycystic kidney dz, Ehlers-Danlos syndrome, & Marphan’s syndrome.
Berry aneurysms
most _______ (childhood v. adult) tumors are supratentorial, while most ________childhood v. adult) tumors are infratentorial.
adult
childhood
Note: 50% of brain tumors are metastases
This tumor has an adult peak incidence. It is the most common primary brain tumor and it has a grave prognosis ( tumor cells border central areas of necrosis and hemorrhage. Stain astrocytes with GFAP.
Glioblastoma multiforme (grade IV astrocytoma)
This tumor has an adult peak incidence. It is the second most common primary brain tumor. It most often occurs in the convexities of hemispheres and parasagital region. It arises from arachnoid cells external to the brain. It is usually resectable.
Meningioma
On pathology this primary brain tumor shows spindle cells concentrically arranged in a whorled pattern and psammoma bodies (laminated calcification) What is it?
Meningioma
This brain tumor has an adult peak incidence. It is the 3rd most common primary brain tumor. It is of Schwann cell origin and is often localized to the 8th nerve. It is resectable. What is it?
Schwannoma
Bilateral schwannoma is often found in what condition?
neurofibromatosis type 2
This primary brain tumor with an adult peak incidence is relatively rare. It is slow growing and most often occurs in the frontal lobes.
Oligodendroma
On pathology this tumor has “fried egg” cells-round nucleii with clear cytoplasm. They are often calcified.
Oligodendroma
This priary brain tumor that has an adult peak incidence most commonly comes in a prolactin secreting form. Often it occurs with bilateral hemianopia (due to pressure on optic chiasm)
pituitary adenoma
This primary brain tumor has a peak incidence in childhood. It is a diffusely infiltrating glioma. It is most often found in the posterior fossa. It is benign and carries a good prognosis.
Pilocytic (low grade) astrocytoma)
On pathology this primary brain tumor shows Rosenthal fibers (eosinophilic, corkscrew fibers)
Pilocytic (low grade )astrocytoma
This primary brain tumor that occurs with a peak incidence in children is a highly malignant cerabellar tumor. It is a form of primitive neuroectodermal tumor (PneT). It can compress the 4th ventricle causing hydrocephalus. It is highly radiosensitive.
Medulloblastoma
On pathology this tumor shows Rosettes or perivascular pseudorosette pattern of cells
medulloblastoma
This primary brain tumor that occurs with a peak incidence in children is an ependymal cell tumor most commonly found in the 4th ventricle. It can cause hydrocephalus and carries a poor prognosis.
ependymoma
On pathology this tumor has characteristic perivascular pseudorosettes. Rod shaped blepharoplasts (basal ciliary bodies) found near the nucleus
ependymoma
This primary brain tumor that occurs with a peak incidence in children is most often cerebeller. It is associated with Von Hippel-Lindau syndrome when found with retinal angiomas. Can produce EPO and lead to secondary polycythemia.
On pathology: Foamy cells and high vascularity are characteristic.
Hemangioblastoma
This primary brain tumor that occurs with a peak incidence in children is a benign tumor which can be confused with pituitary adenoma (can also cause bitemporal hemianopia). This is the most common childhood supratentorial tumor. It is derived from remnants of Rathke’s pouch and calcification is common.
Craniopharyngioma
Sign of UMN or LMN lesion or both?
Weakness
Both
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?
Atrophy
LMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?
Fasciculation
LMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?
Increased Reflexes?
Decreased Reflexes?
UMN
LMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?
Increased tone?
Decreased tone?
UMN
LMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?
Babinski?
UMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
These diseases result in lower motor neuron lesions only. They are due to destruction of the anterior horns and result in flacid paralysis. [pic]
Poliomyelitis & Werdinig Hoffman dz
This dz effects mostly the white matter of the cervical region. Random and asymmetrical demyelinating lesions are seen. Often pt presents with scanning speech, intention tremor, and nystagmus [pic]
MS
These diseases result in lower motor neuron lesions only. They are due to destruction of the anterior horns and result in flacid paralysis. [pic]
Poliomyelitis & Werdinig Hoffman dz
This dz involves combined UMN and LMN deficits with no sensory deficit. Pt often presents with both UMN & LMN neuron signs [pic]
ALS
When this happpens the only thing spared are the dorsal columns and tract of Lissauer[pic]
complete occlusion of ventral artery
This results in degeneration of the dorsal roots and dorsal columns. Pt presents with impared proprioception and locomotor ataxia.
Tabes dorsalis (tertiary syphilis)
This resultswhen the crossing fibers of the corticospinal tract are damaged. Pt presents with bilateral loss of pain and temperature sensation
syringomyelia
This results in demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts. Pt often presents with ataxic gait, hyperreflexia, impared position and vibration sense
vit B neuropathy and Friedreich’s ataxia
This results when the central canal of the spinal cord is enlarged for some reason. The crossing fibers of spinothalamic tract are thus damaged. Pt shows bilateral loss of pain and temperature sensation in upper extremities with preservation of touch sensation.
Syringomyelia
Syringomyelia often presents with this congenital malformation.
Arnold-Chiari malformation
Syringomyelia is most common at this spinal level
C8-T1
This disorder is due to degeneration of the dorsal columns and dorsal roots due to tertiary syphilis. It results in impared proprioception and locomotor ataxia. Pt often presents with Charccot’s joints (neuropathy of the joint), Argyll Robertson pupils (reactive to accommidation but not to light), and absensce of DTRs
Tabes dorsalis
Brown Sequard syndrome is a complete hemisection of the spinal cord. Give the findings.
- Ipsilateral UMN signs(corticospinal tract) below lesion
2) Ipsilateral loss of tactile, vibration, proprioception sense (dorsal column) below lesion
3) Contralateral pain and temperature loss (spinothalamic tract) below the lesion
4) Ipsilateral loss of all sensation at the level of lesion
5) LMN signs at the level of the lesion
*note: if the lesion occurs above T1 the pt will present with Horner’s syndrome
What are the symptoms of Horner’s syndrome?
What spinal levels is it associated with?
What is a common cancer that may result in it?
1) Ptosis (droopy eyelid)
2) Anhydrosis (no sweating or flushing of effected side of face
3) Miosis (pupil constriction)
HS is associated with lesion of spinal cord above T1
Pancoast tumor
The 3 neuron OCULOSYMPATHETIC PATHWAY projects from 1)hypothalamus to the 2)intermediolateral column of the spinal cord, then to the 3) superior cervical (sympathetic) ganglion, and finally to the 4) pupil, the smooth mm of the eyelids, and the sweat glands of the forehead and face. Interruption of these pathways results in _________
Horner’s syndrome
What nerve was injured?
Pt fractures the shaft of humerus. He presents with “wrist drop” ( extensor carpi radialis longus damage), loss of triceps and brachioradialis reflexes.
Loss of sensation on posterior surface of arm and forearm (posterior brachial cutaneous and posterior antebrachial cutaneous)
Radial nn
The 3 neuron OCULOSYMPATHETIC PATHWAY projects from 1)hypothalamus to the 2)intermediolateral column of the spinal cord, then to the 3) superior cervical (sympathetic) ganglion, and finally to the 4) pupil, the smooth mm of the eyelids, and the sweat glands of the forehead and face. Interruption of these pathways results in _________
Horner’s syndrome
What nerve was injured?
Pt reports hitting his “funny bone” (medial epicondyle) hard! He now has impared wrist flexion and adduction. He can’t adduct his thumb or the 4th and 5th digits resulting in a “claw hand”.
He has a loss of sensation over the medial palm and his pinky finger.
ulnar
What nerve was injured?
pt experiences a break through the surgical neck of the humerus or has an anterior shoulder dislocation. He now has trouble abducting his arm above 30 degrees.
Axillary
What nerve was injured?
Pt presents with a loss of function of biceps, coracobrachialis, and brachialis muscle. He has no biceps reflex?
musculocutaneous
This nerve passes through the supinator
radial
this nerve passes through the pronator teres
median
this nerve passes through the flexor carpi ulnaris
ulnar
Child presents with “waiter’s tip” appearance: arm hanging to one side (paralysis of abductors), medially rotated (paralysis of lateral rotators), and forarm is pronator (loss of biceps.
What is the dx? What are the nerve roots and what are you concerned about?
Erb-Duchenne palsy
traction tear of the upper trunk of the brachial plexis (C5 & C6 roots) often follows blow to shoulder,could be due to trauma during delivery or child abuse.
What nerve was injured?
Pt presents with loss of dorsiflexion resulting in “foot drop”
Common peroneal nerve (L4-S2)
PED= Peroneal Everts & Dorsiflexes; if injured, foot is dropPED
Deep peroneal nn innervates _______ compartment
Superficial peroneal nn innervates _______ compartment
anterior
lateral
What nn is injured?
pt presents with loss of plantar flexion.
Tibial (L4-S3)
TIP=Tibial Inverts & Plantarflexes; if injured, cant stand on TIPtoes.
What nn is damaged?
Pt presents with loss of knee extension and deminished pateller reflex.
Femoral (L2-L4)
What nn is injured?
Pt presents with a loss of hip adduction?
Obturator
Pt presents with:
1) atrophy of the thenar and hypothenar eminences
2) atrophy of the interosseous mm
3) sensory deficits on the medial side of the forearmand hand
4) disappearance of the radial pulse upon moving the head towards the opposite side
What do you suspect? Discribe this disorder?
Thoraci outlet syndrome (Klumpke’s palsy)
Compression of subclavian aa and inferior trunk of brachial plexus (C8,T1)
