NEURO Flashcards
Neurotransmitter that is Used in the neuromuscular junction, and both sympathetic and parasympathetic nervous system; triggers REMsleep
NT secreted by postganglionic sympathetic neurons
NT mainly secreted by the adrenal medulla; has greater B2effect than NE
NT Secreted by substantia nigra to fine tune movement and by the hypothalamus to decrease prolactin
NT that comes from tryptophan; low levels are associated with depression
Permeant gas, inhibitory NT, vasodilator
- Main inhibitory NT of the spinal cord;
- increases Cl· influx
- Main inhibitory NT of the brain;
- increases Cl· influx or K* efflux
Main excitatory NT of the brain; formed from reactive amination of alpha ketoglutarate
NT involved in slow VS fast pain
Cranial nerve for opening of eyelids, contraction of most EOMs, accommodation and pupillary constriction (miosis)
Cranial nerve for special sensation (taste) of the anterior 2/3 of the tongue
Cranial nerve for general sensation (e.g. pain) of the anterior 2/3 of the tongue
Cranial nerve for facial muscles
CN VII (Facial nerve)
Cranial nerve for facial sensation and muscles of mastication
CN V (Trigeminal nerve)
Headache pattern that is Highly characteristic of posterior fossa brain tumors
Vomiting that precedes headache
Dominant symptom in temporal (giant cell) arteritis
headache
Key pathway for pain in migraine
Trigeminovascular input from the meningeal vessels
Most disabling headache
migraine
Most effective drug classes in the treatment of migraine (3)
- Anti-inflammatory agents,
- 5-HT 1B/ 10 receptor agonists (triptans),
- and dopamine receptor antagonists
Most efficacious of the triptans (2)
Rizatriptan and eletriptan
Core feature of cluster headache
Periodicity
Most satisfactory treatment in cluster headache
Administration of drugs to prevent cluster attacks until the bout is over
Most serious cause of secondary headache
Subarachnoid hemorrhage
Classic headache associated with a brain tumor
Most evident in the morning and improves during the day
Preferred diagnostic test for any patient suspected of having a brain tumor, and should be performed with gadolinium contrast administration
cranial MRI
Glucocorticoid of choice for brain tumors because of its relatively low mineralocorticoid activity
Dexamethasone
Established risk factor for primary CNS lymphoma
exposure to ionizing radiation is the established risk factor for these 3 primary brain tumors
True or False. Primary brain tumors..
In adults: usually supratentorial
In children: usually infratentorial
True
Most common primary brain tumor of childhood
vs
Most common orimarv brain tumor overall
Grade I astrocytomas: pilocytic astrocytomas (WHO grade I)
vs
Meningiomas
This virus frequently plays an important role in the pathogenesis of HIV related primary CNS lymphoma
EBV
Most common malignant brain tumor of childhood
vs
Most common malignant brain tumor overall
Medulloblastomas
vs
Grade IV astrocytoma (Glioblastoma)
Meningiomas are most commonly located over the
Cerebral convexities
Main differential diagnosis for meningioma
dural metastasis
Most common schwannomas
Vestibular schwannomas or acoustic neuromas
Most common site of brain metastases
Gray matter-white matter junction
85% of all brain metastases are supratentorial. True or False
True
Most common sources of brain metastases
(2)
- lung cancer
- breast cancer
Malignancy with greatest propensity for brain metastasis, found in 80% of patients at autopsy
vs
Malignancies with propensity to metastasize to the dura and can mimic meningioma
melanoma
vs
prostate and breast cancer
Definitive method and often considered the gold standard to diagnose leptomeningeal metastases
Demonstration of tumor cells in CSF
Part of the spine affected most commonly in epidural metastasis
Thoracic spine, followed by the lumbar and then cervical spine
Presenting symptom of epidural metastasis in virtually all patients
back pain
Best test for epidural metastasis
MRI of the complete spine
Surgical procedure of choice for epidural metastasis
Complete removal of the mass, typically anterior to the spinal canal
Primary radiation oncology approach to brain metastases
Stereotactic radiosurgery
Most serious toxicity from radiotherapy as they are often irreversible
Late delayed toxicity
Second only to myelosuppression as dose-limiting toxicity of chemotherapeutic agents
neurotoxicity
Classic clinical triad of meningitis
- Fever,
- headache,
- and nuchal rigidity
Classic clinical triad of brain abscess
- Headache,
- fever,
- focal neurologic deficit (present 50%)
other term for non-encapsulated brain abscess
cerebritis
Pathognomonic sign of meningeal irritation and is present when neck resists passive flexion
Nuchal rigidity (“stiff neck”)
Most common form of suppurative CNS infection
bacterial meningitis
Most common cause of meningitis in adults >20 years
Strep pneumoniae
Important clue to diagnosis of meningococcal infection
Petechial or purpuric skin lesions
Most common etiologic organisms of community acquired bacterial meningitis (2)
- Streptococcus pneumoniae
- and Neisseria meningitidis
Most common agents in acute viral meningitis
enteroviruses
viruses that cause the ff:
* temporal encephalitis
* thalamic encephalitis
* subacute sclerosing panencephalitis
Most common symptom of brain abscess
headache
Optimal therapy for brain abscess
combination of high dose parenteral antibiotics and surgical drainage
Triad of Lennox-Gastaut Syndrome
First clue of typical absence seizures
Daydreaming and a decline in school performance recognized by the teacher
Electrophysiologic hallmark of typical absence seizures
Main seizure type in 10% of all persons with epilepsy
GTCS
Most common seizure type resulting from metabolic derangements
GTCS
Most common syndrome associated with focal seizures with dyscognitive features
Mesial Temporal Lobe Epilepsy Syndrome
Most common seizures arising in late infancy and early childhood
febrile seizures
First goal in the approach to seizure
Determine if event was truly a seizure
Drugs of choice approved for the initial treatment of focal seizures (4)
- Carbamazepine (or a related drug, oxcarbazepine),
- lamotrigine,
- phenytoin,
- and levetiracetam
Best initial choice for the treatment of primary generalized tonic-clonic seizures (3 )
- Valproic acid
- Lamotrigine
- Levetiracetam
Most recurrences of seizure occur when
First 3 months after discontinuing therapy
Refers to infarction following atherothrombotic lipohyalinotic occlusion of a small artery
Lacunar Infarction
Decrease in cerebral blood flow to zero causes death of brain tissue within how many minutes
4-10 mins
Most common cause of cerebral embolism overall
Nonrheumatic atrial fibrillation
Most common source of artery to artery embolism
Carotid bifurcation atherosclerosis
Most significant risk factor of stroke and TIA
hypertension
Principal side effect of dipyridamole
headache
Only antiplatelet agent that has proven effective for the acute treatment of ischemic stroke
aspirin
Hallmark of top of the basilar artery occlusion
Sudden onset of bilateral signs, including ptosis, papillary asymmetry or lack of reaction to light and somnolence
Endarterectomy for carotid is most beneficial atherosclerosis when performed within ____ weeks of symptom onset
Within 2 weeks of symptom onset (benefit is more pronounced in men>75 years)
Gold standard for identifying and quantifying atherosclerotic stenoses of cerebral arteries
Conventional x-ray cerebral angiography
Bleeding into subdural and epidural spaces is principally produced by
trauma
Most common sites of hypertensive intraparenchymal hemorrhage (4)
- Basal ganglia (especially putamen},
- thalamus,
- cerebellum,
- pons
Most common cause of lobar hemorrhage in the elderly
Cerebral amyloid angiopathy
Most cerebellar hematomas of this diameter will require surgical evacuation
> 3 cm diameter
Most common cause of peripheral neuropathy
DM
Most common diabetic mononeuropathies
Median neuropatby at the wrist and ulnar neuropathy at the elbow
Most common cranial mononeuropathies in DM
Seventh nerve palsy,
followed by third nerve, sixth nerve, and, less frequently, fourth nerve palsies
Most common cranial mononeuropathies in scleroderma
Trigeminal nerve
Most common cranial nerve involved in sarcoidosis
Seventh nerve
Most common mononeuropathies in uremia
Carpal tunnel syndrome
Most common form of peripheral neuropathy associated with HIV infection & usually seen in patients with AIDS
Distal symmetric polyneuropatby
Most common associated malignancy with neuropathies
lung cancer
Manifests as a rapidly evolving symmetric, ascending. areflexic motor paralysis with or without sensory disturbance, associated with Campylobacter jejuni found in undercooked chicken
Guillain Barre Syndrome (GBS)
GBS is associated with what bacteria
Campylobacter jejuni
Neuromuscular disorder characterized by weakness and fatigability of skeletal muscles, caused by a decrease in the number of available acetylcholine receptors (AChRs) at neuromuscular junctions due to an antibody-mediated autoimmune attack, associated with diplopia
Myasthenia Gravis (MG)
Most common form of Parkinsonism
Parkinson’s Disease (PD)
Most common cause of Familial PD
Mutations of the LRRK2 gene
Most common cause of secondary Parkinsonism
Dopamine blocking agents
Most significant pathogenic mechanism in Parkinsonisrn
Protein misfolding and accumulation and mitochondrial dysfunction
Mainstay of therapy for PD
Levodopa-carbidopa
Major clinical effect of central-acting anticholinergic drugs
tremors
Most widely used antidyskinesia agent in patients with advanced PD and the only oral agent that has been demonstrated in controlled studies to reduce dyskinesia
amantadine
Most common cause of nursing home placement in Parkinson disease patients
dementia
Most common movement disorder
essential tremor
Standard drug therapies for essential tremors (2)
beta blockers or
primidone
Most common forms of dystonia
focal dystonia
Most commonly seen dystonia with neuroleptic drugs or after chronic levodopa treatment in PD patients
Drug-induced dystonia
Most common systemic disorder that causes chorea
SLE
Most common acute hyperkinetic drug reaction
vs
Most common subacute drug reaction
dystonia
vs
akathisia
Gold standard for diagnosis of Wilson’s disease
liver biopsy
Most common psychogenic movement disorder
Tremor affecting tbe upper limbs
Date-rape drug
flunitrazepam
Antidote to benzodiazepine overdose
flumazenil
Most frequently abused drug, causes Wernicke-Korsakoff syndrome in overdose and delirium tremens in withdrawal
ethanol
Used for prevention of Wernicke-Korsakoff syndrome
thiamine
first line drugs for GTCS (2)
Used for treatment of alcohol withdrawal
Diazepam
first line drugs for focal seizures (5)
first line drugs for Typical Absence Seizures(3)
vs
Atypical Absence (3)
