NEURO Flashcards
Resistance determined by the angle and velocity of motion
Spasticity
—> corticospinal tract disease
Similar resistance in all angles of motion
Rigidity
—> extrapyramidal disease
Fluctuating changes in resistance
Paratonia
—> frontal lobe
—> normal diff in relaxing
passive motion elicits jerky interruptions in resistance
Cog wheel rigidity
—> Parkinsonism
Unilateral or bilateral weakness of the upper limb extensors and lower limb flexors
Pyramidal weakness
—> pyramidal tract
Superficial Reflexes
Abdominal Reflexes
Primitive Reflexes
Decreased tone
UMN
UMN
Frontal lobe
LMN
Cortical sensation (integration of the primary sensory modalities) is mediated by the
Parietal lobe
A. Identification of an object by touch and manipulation alone
B. identification of numbers or letters written on the skin surface
A. Stereognosis
B. Graphestesia
A. Decreased arm swing on one side
B. Stooped posture and short stepped gait
C. Broad-based unstable gait (ataxia)
D. Scissoring
E. High-stepped, slapping gait
F. Patient appears to be stuck in place
A. corticospinal tract disease
B. Parkinsonism
C. Ataxia
D. Spasticity
E. posterior column or peripheral nerve disease
F. Apraxia with frontal lobe disease
Abnormal motor movements begin in a very restricted region such as the fingers and gradually progress (over seconds to minutes) to include a larger portion of the extremity
Jacksonian March
Localized paresis for minutes to hours in the involved region following the seizure
Todd’s paralysis
Seizures that continue for hours or days
Epilepsia partialis continua
generalized symmetric 3-Hz spike-and-wave discharge that begins and ends suddenly on a normal EEG background
Typical Absence Seizure
- can be provoked by hyperventilation
EEG: generalized slow spike-and-wave pattern with frequency of ≤ 2.5/s + other abnormal activity
Atypical Absence Seizure
progresalve increase generalized low-voltage fast activity —> generalized high-ampitude
polyspike discharges
Initial phase of Generalized, tonic-clonic
> (+) sympathetic response: elevated HR and BP, larger pupillary size
high-amplitude activity interrupted by slow waves to create a spike-and-wave pattern
Clonic Phase of Generalized tonic-clonic
10-20s
EEG: diffuse slowing that gradually recovers as the patient awakens
Post ictal phase
EEG: brief generalized spike-and-wave discharges → immediate diffuse slow waves
Atonic Seizures
EEG: bilaterally synchronous spike-and-wave discharges
Myoclonic
Predominant feature of Juvenile Myoclonic Epilepsy
EEG: hypsarrhythmia (diffuse giant slow waves with a chaotic background of irregular, multifocal spikes and sharp waves) with marked suppression of the EEG background (the “electrodecremental response”) during the clinical spasm
EMG: characteristic rhomboid pattern (distinguishes spasms from brief tonic and myoclonic seizures)
Epileptic spams
Predom in infants
Stroke
A. Primarily increase the risk of cortical vein or cerebral venous sinus thrombosis
B. predispose for acute ischemic stroke due to large-vessel occlusion.
C. venous and arterial occlusive events
A. Hypercoagulable disorders
B. Covid 19
C. DIC
A stroke that involves the lateral or sagittal sinus or small cortical veins
Venous sinus thrombosis
Mgt: ANTICOAGULATION
HEPARIN
Affects cervical arteries, mainly women
multiple rings of segmental narrowing alternating with dilatation in carotid or vertebral arteries
Often asymptomatic but occasionally is associated with an audible bruit, TIAs, or stroke
FMD
Anticoagulation or Aspirin
relatively common in the ELDERLY
Pathology:
- subacute granulomatous inflammation of external carotid system, particularly temporal arteries
- If with occlusion of posterior ciliary arteries (from ophthalmic artery) → blindness (mono or both)
Temporal (giant cell) arteritis
Glucocorticoids
Idiopathic giant cell arteritis involving great vessels arising from the aortic arch
- May cause carotid or vertebral thrombosis (rare in the western hemisphere)
Takayasu’s arteritis
Occurs alone or may be associated with generalized PAN or Wegener’s (granulomatosis with polyanglitis)
囗 Distal small branches (<2 mm diameter) of the main intracranial arteries
口 Small ischemic infarcts in the brain, optic nerve, and spinal cord CSF often shows pleocytosis, and the protein level is elevated
Necrotizing or granulomatous arteritis
rare condition affecting small or medium- sized vessels without apparent systemic vasculitis.
Primary CNS Vasculitis
口 Phenyipropanolamine →
口Cocaine and methamphetamine →
口 intracranial hemorrhage
口 drug-induced vasculopathy
> Occlusive disease of large intracranial arteries (distal ICA, stem of the MCA, ACA)
No vascular inflammation
Lenticulostriate arteries develop rich collateral circulation around the occlusive lesion giving the impression of a “puff of smoke” on conventional x-ray angiography
• Occurs mainly in Asian children or young adults
- Appearance may be identical in adults who have atherosclerosis, particularly in association with DM
- Breakdown of dilated lenticulostriate arteries may produce intraparenchymal hemorrhage
- Progressive occlusion of large surface arteries can occur, producing large-artery distribution strokes
Moyamoya disease
Von-Hippel-Lindau
Pheochromocytoma
Renal cell carcinma
Hemangioblastoma
Chromosomes and diseases
A. Chromosome 3
B. NF2 (Ch 22)
C. NOTCH 3
D. TSC1
A. VHL
B. Neurofibromatosis Type II
C. CADASIL (Cerebral AD arterioparhy with Subcortical Infarcts)
D. Tuberculous Sclerosis (
