Neuro

Question 1

Signs/Symptoms of

epidural hematoma

Answer 1

Previous tramatic injury (temporal bone fx)
lucid interval
transtentorial herniation
CN III palsy
**CT shows biconvex disk, no crossing suture lines

Question 2

Signs/Symptoms of

subdural hematoma

Answer 2

Ruptured bridging veins- slow to progress
elderly, alcoholics, blunt trauma, shaken baby, whiplash
** CT shows crescent-shaping hemorrhage that cross suture lines

Question 3

Signs/Symptoms of

subarachnoid hemorrhage

Answer 3

Rupture of aneurysm or AVM- rapid progression
(Marfans, Ehlers-Danlos, ADPKD)
“worst headache of my life”
bloody or yellow spinal tap

2-3 days later may have vasospasm (from blood breakdown)- NOT visible on CT or rebleed- visible on CT

Question 4

Signs/Symptoms of

intraparenchymal hemorrhage

Answer 4

**Due to systemic hypertension
or amyloid angiopathy, vasculitis, neoplasm
Usually in basal ganglia and internal capsule, but can be lobar

Question 5

Broca’s aphasia

Answer 5

Nonfluent speech with intact comprehension
BROca’s BROken BOCA –> babbles
**L inferior frontal gyrus
(may be seen with R hemiparesis)

Question 6

Wernicke’s aphasia

Answer 6

Fluent speech with impaired comprehension
Wernicke’s Wordy, but What?
**superior temporal gyrus

Question 7

Global aphasia

Answer 7

Nonfluent speech with impaired comprehension

Both Broca’s area (inferior frontal gyrus) and Wernike’s area (superior temporal gyrus) affected

Question 8

Conduction aphasia

Answer 8

Poor repetition but fluent speech, intact comprehension

**Arcuate fasciculus that connects Broca’s and Wernicke’s areas

Question 9

Effects of stroke to MCA

Answer 9

Motor- contralateral paralysis of upper limb and face
Sensory- contralateral loss in upper limb and face
Wernicke and Broca’s area (left)- aphasias
Hemineglect if lesion affects nondominant (right) side

Question 10

Effects of stroke to ACA

Answer 10

Motor- contralateral paralysis of lower limb

Sensory- contralateral loss in lower limb

Question 11

Effects of stroke to lateral striate artery

Answer 11

Striatum/internal capsule- contralaterla hemiparesis/hemiplegia
Common in lacunar infarts or secondary to unmanaged HTN

Question 12

What is the nigrostriatal pathway?

Answer 12

connection from substantia nigra –> caudate and putamen

D1 and D2 receptors

Question 13

What is the mesocortical tract?

Answer 13

VTA –> prefrontal cortex

D1 receptors&raquo_space;> D2

Question 14

What is the mesolimbic tract?

Answer 14

VTA –> amygdala and hippocampus

D1 receptors&raquo_space;> D2

Question 15

g

Answer 15

Arcuate nucleus (hypothalamus) –> pituitary

Question 16

NE pathway in the brain:

Answer 16

locus coeruleus –> all over the brain (cortex, hypothalamus, cerebellum, brainstem)

Question 17

5-HT pathway in the brain

Answer 17

raphe nuclei –> all over the brain (neocortex, basal ganglia, temporolimbic regions, hypothalamus, cerebellum, brainstem)

Question 18

Cholinergic pathway in the brain:

Answer 18

1. Nucleus basalis of Maynert (ventral/medial globus pallidus) –> cortex
2. septal nucleus /diagonal band of Broca –> hippocampus/cingulate gyrus
3. local circuit neurons within the basal ganglia

Question 19

GABA system

Answer 19

caudate/putamen –> globus pallidus and substantia nigra
**inhibitory
GABA agonists: diazepam
loss of function –> choreaform movement (Huntington’s disease)

Question 20

Glutamate system

Answer 20

**excitatory
produced by pyramidal cells in the cerebral cortex and hipocampus
form learning and memory (synapse formation and stabilization)
NMDA receptor blockers: phencyclidine (PCP), ketamine –> psychosis and withdrawal, stupor, disorganized thinking/speech, hallucinations

Question 21

Huntingtons disease

Answer 21

AD, highly penetrant
Chromosome 4
trinucleotide repeats (more copies = earlier onset of sx)