neuro Flashcards
causes of Intracranial htn aka pseudotumor cerebri
vit a derivatives, tetracycline abx, hormonal contraceptives, lithium, minocycline, tamoxifen, coricosteroid withdrawal.
parkinson’s dz
loss of dopamime-producig neurons in the substantia nigra
Creutzfeld jakob dz
myocloic jerks, rapid progression towards dementia, akinetic mutism with specific EEG findings.
mean duration of illness: 4-5 mo
prions, small infections particouls that continu protein replace normal proteins over time, causing neurotoxicity.
dx: diffusion weigted MRI- see hyperintense lesions of corpus striatum, caudate head, putamen, cerebral cortex
dx requires positive real time quaking induced conversion RT-AQuIC test Or progressive dementia with MRI findings, EEG findings
EEG- periodic sharp wave complexes
subacute combined degeneration of spinal cord
degeneration of posterior and lateral columns of spinal cord due to b12 dficieny.
sx limb weakness, ataxia, megoblastic anemia, GI sx, neuro sx like dementia, depression, muscle weakness
anterior trigeminothalamic tract
pain and temperature info from the face, head, and neck.
prosopagnosia
facial recognition
fusiform gyrus
-ventral stream on ventral surgace of temporal lobe on lateral side of fusiform gyrus
gerstmann’s syndrome
right to left confusion, finger agnosia, dysgraphia and dyslexia, dyscalculia, contralateral hermianoia, lower quadrantanopia
inferior parietal lobule
associated iwth brain lesions in dominant (usually left) hemisphere, including angular and supramarginal gyri near temporal and parietal lobe junction
frontal lobes
motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, social and sexual behavior
L frontal lobe
language related movement
R frontal lobe
non verbal abilities
increases risk for MCI and dementia
HTN, HLD, DM
adrenoleukodystrophy
x linked dz of peroxisomal fatty acid beta oxidation
very long chain fatty acids accumulate in tissues, such as myein in CNS and adnrenal cortex.
adrenal failure
sx vision and hearing impairment, aphasia, hyperactivity, paralysisi, seizures, muscle weakness, adrenal failure, coma
level increases after seizures
prolactin.
within 20 minutes of generalized tonic clonic.
increased by 5-30x
can exclude pseudoseizures
Meige syndrome
often misdiagnoses as tmj dysfunction
sx incresed forceful blinking (blepharospasm) tongue/jaw contractions (oromandibular dystonia). occaussional tongue protrusions, cervical dystonia,
botox helps, no treatment
parkinson’s dz
shaking, stiffness, difficulty walking, balance, coordination
whipple disease
caused by gram + bacterium, tropheryma whippelii.
malabsorption syndrome with small intestine involvement, joint pain, CNS and CV sx
sleep
stages 1-3 NREM
REM
adults sleep s 75% NREM
stage 1: light sleep, 5%
alpha and theta waves
2: little deeper, 50% sleep time
sleep spindles and k complexes on EEG
3: deeper sleep of slow delta wave on eeg, 10-20%
REM: 20-25%, eeg resembles wake time.
each REM and NREM cycle is ab 90-120 minutes with REM periods increased in 2n half of night.
Newborns get circadian rhythym at 3 mo
-REM at sleep onset
-increased REM time with dec NREM time
-get NREM at 3 mo
aging adults: stage 3 of NREM decreased, slee time in stage 1 NREM increases.
10x increase risk of Alzhemer’s DZ
hx of TBI and associated apolipoprotein E epsilon 4 allele
dementia pugilistica aka punch syndrome
subtye of chronic traumatic encephalopathy, nuerodegenerative dz with features of dementia
associated with buildupof beta amyloid deposits.
kluver-bucy syndrome
lesions to amygdala cause hypersexualitiy, hyperphagia, hyperorality, visual agnosia, docility
Ethosuximide MOA
lowers T type calcium currents
absence seizures
SE nausea, HAs, dizziness, hyperactivity
MS diagnosis
can be MRI + clinical findings or clinical findings alone
2 or more attacks involving different parts of CNS, separated by at least 1 month, and lasting minimum of 24 hours.
hypothalamus function
sleep, hydration, temperature.
works with pons to control sleep wake cycle
anterior: cooling and parasympathetic
(a/c=anterior cooling)
posterior: heating, sympathetic
thalamus
body’s sensory relay station
blood brain barrier cells
endothelial
astrocyte end feet
pericytes
black curtain coming down over eye,
amaurosis fugax
internal carotic artery occlusion, TIA
naps for narcolepsy
10-20 min 2x/day
HARP Syndrome
Hypobetalipoproteinemia- disorder of lipoprotein metabolism characterized by decreased plasma concentrations of low-density lipoprotein (LDL)-cholesterol and apolipoprotein B (apoB).
Acanthocytosis- misshaped RBCs
Retinitis pigmentosa
Pallidal degeneration- Neurodegeneration involving the globus pallidus,a part of the basal ganglia that is involved in the regulation of voluntary movemen
frontotemporal dementia
aka pick dz
behavioral changes,
increase in disinhibition
atrophy of BL frontal lobes
forebrain, prosencephalon, gives rise to telencephalon and diencephalon.
what does diencephalon give rise to?
thalamus
hypothalamus
epithalamus
retina
pineal gland
3rd ventricle
alzheimer’s dz
amyloid plaques: consist of amyloid beta which is generated from amyloid precursor protein
neurofibrillary tangles- formed from hyperphospholylated tau protein
amyloid deposits, neuritic plaques, neurofibrillary tangles from tau protein
APP on chromosome 21 is cleaved by proteases, producing insoluble beta-amyloid.
Binswanger’s dz
dementia + 2 of the following: htn, vascular dz, cerebral vascualar dz, subcortical dysfuntion (neurogenic bladder, muscle rigidity, gait abnormalities), BL CT/MRI abnormalties like leukoaraisis or attenuation of white matter on CT or MRI
sx: reflex asymmetries, rigidity, limb ataxia, syncope, pseudobulbar palsy
temporal lobe epilepsy
mc focal epilepsy in adults.
mc cause is mesial temporal sclerosis with hippocampal sclerosis and temporal lobe atrophy.
mc etiology- prolonged febrile seizures and anoxia at birth, temporal lobe infections, masses
complex partial seizures: focal with impaired awareness are common
periodic sharp waves on eeg
Creutzfeldt jakob dz
mamillary body lesions
psychosis, memory deficits, confabulation
amygdala lesions
hypersexuality, hyperorality, hyperphagia
thalamus lesions
medial- language
right- visual memory
mood,
sleep wake cycle-anterior and medial thalamus
lateral geniculate nucleus receives projections from retina
lateral= light (vision)
medial geniculate nucleus is involved in auditory processing
medial=music (auditory)
jacksonian march
simple focal seizure that begins in finger, toe and corner of the mouth then spreads to ipsilateral area of body.
from distal part of limb, towards ipsi face, through primary motor cortex in succession
internuclear opthalmoplegia
Multiple sclerosis
injury to Medial Longitudinal fasciculus (MLF)
adduction + CL abduction with nystagmus , diplopia
synringomyelia
atrophy in hands, weakness, senory loss. pain and temp in a shawl-like distribution across shoulders
diminished reflexes.
tx- surgical
prosopagnosia
cannot recall visual stimulation that requrires memory
fusiform gyrus lesions associated with face recognition
basilar migraine
transient headache, quadriplegia, stupor, blindness, coma
Alzheimers dz treatment
REVERSIBLE cholinesterase inhibitiors-donepezil, rivastigmine, galantamine
-they increase vagal tone, cardiac patients should avioid.
-donepezil and rivastigmine are associated with vivid dreams.
-SEs of reversible cholinesterase inhibitors are GI upset
nmda receptor antagonist- memantine
–decreases excitotoxicity
subclavian syndrome
L ARM claudication
stenosis of subclavian artery causing reversal of blood flow in vertebral artery
“stealing blood flow:
MRI in schizophrenia
abnormalities of dorsolateral prefrontal cortex.
reduced vol in prefrontal, thalamic, hippocampal, superior temperoal gyrus.
increased lateral and 3rd ventricle volume and basal ganglia
decreased blood flow in frontal lobes
chronic lead poisoning
CNS deficits, peripheral neuropathy, nephropathy, htn, anemia, short term memroy loss, depression, nausea, abdominal pain.
myotonic dystrophy aka DM2 aka proximal myotonic myopathy
mild grip or percussion myotonia and weakness in the neck flexors, elbow extensors, finger flexors, hip flexors.
tetranucleotide repeat
CCTG
zinc finger protein 9 gene
DM1 is more severe-auto dominant, cataracts, conduction abnormalities, respiratory muscle involvement.
DM1 is autodominant trinucleotide repeat of CTG in Dystrophia myotonica protein kinase gene (DMPK)
DM1 aka steinert’s dz
Myotonic dystrophy type 1
Muscle dz causing multi organ damage
cranial muscle wasting/weakness.
distal limb weakness
percussion and grip myotonia, muscle weakness in the face, neck, forearm, intrinsic hand and foot dorsiflexors. muscle pain, respiratory muscle involvement, dysphagia, dysarthria.
cataracts, cardiac conduction abnormalities, infertility, insulin resistance.
autosomal dominant
CTG trinucleotide repeat region
cluster headache abortive therapy
sumatriptan
with supplemental O2
for prophylaxis and treatment- verapamil
eeg monitoring for potential SEs
unilateral orbital pain, temple pain; associated with autonomic sx like rhinorrhea, conjunctival injection, lacrimation , miosis, ptosis
other treatment:
galcanezumab, lithium, topiramate
subacute lead exposure
asymmetric primary motor neuropathy
primary progressive aphasia (PPA)
subtype of frontal temporal dementia.
clinical diagnosis. atrophy of frontal lobes.
signs of meningitis + periodic lateralized epileptiform discharges (PLEDs)
HSV
tx acyclovir
pattern of atonic seizures
slow spikes and waves
this is typical in Lennox-Gastaut syndrome as well.
Gastaut Geschwind syndrome
hyperreligiosity, circumstantiality, hypergraphia, hyposexuality, intense emotional responses.
focal seizures with impaired awareness (complex partial seizures)
temporal lobe epilepsy, left side comon
spongiform encephalopathy
prion protein carred on short arm of chromosome 20
