Neuro 2 Flashcards
superior colliculi vs inferior colliculi
superior - conjugate vertical gaze
inferior - auditory
SIGHT ABOVE SOUND (EYES ABOVE EARS)
which CN nuclei are in midbrain
III, IV
CN nuclei in pons
V, VI, VII, VIII
CN nuclei in medulla
9, 10, 12
where do branches of CN V exit
Standing Room Only
Superior orbital canal v1
foramen rotundum v2
foramen ovale v3
where does middle meningeal artery exit
foramen spinosum
which CN exit out of superior orbital fissure
3, 4, 6…and v1
what exits out of crbiform plat3e
cn 1
what exits out of internal auditory meatus
cn 7 and 8
which bone makes up middle cranial fossa
sphenoid (superior orbital fissure, foramen rotundum, foramen ovale, foramen spinosum)
which bones makes up posterior cranial fossa
temporal and occiptal bone
has internal auditory meatus, jugular foramen hypoglossal canal, and foramen magnum
what exits through jugular foramen
9,10, 11 and jugular vein
what exits through hypoglossal canal
cn 12 duh
what exits through foramen magum
cn 11 and vetebral artries and brainstem
which nuclei handles visceral sensory information (taste, barorecepotrs, gut distension)
nucleus solitarius
which nerves are involved in nucleus solitarius
7, 9, 10
which nucleus handles motor innervation of pharnyx, laynx, upper esophagus
nucleius aMbiguus (Motor) 9,10,11
which nucleus sends autonomic (parasympathetic ibers) to heart, lungs, upper gi
dorsal motor nucleus
corneal reflex input and output
v1 nasociliary branch
vii (temporal branch; obricularis oculi)
lacrimation reflex input and output
v1
viii
jaw jerk reflex in put and output
v3
v3
pupillary reflex input and output
II
III
gag reflex
IX
X
three muscles that closes jaw and innervation
3 M's Masster Medial pterygoid teMporalis all motor innervation V3
what muscle opens jaw and innervation
lateral pterygoid V3
which nerves to herniated discs affect
nerve below disc
where to do spinal tap
l4 - l5 (cauda equina)
spinal cord ends around L1-L2
achilles reflex
s1 s2 (buckle my shoe)
triceps reflex
c7 c8 (hold them straight)
knee jerk reflex (patellar)
L3 L4 kick the door
anal wink reflex
S3 S4 (winks galore)
testicle reflex
L1 L2 (testicles move)
biceps/ brachioradialis reflex
c5 c6 pick up sticks
bilateral loss of pain and temp sensation upper etremity, sparing of fine touch
syringomyelia due to damage in anterior white commisure
associated with chiari 1 malformation
c8-t1
what other things can be affected form syringomyelia if it expans
anterior horn - signs of LMN (decreased tone, hyporeflexia, negative babainski), muscle atrophy
lateral horn - horner’s syndrome (anhydrosis, ptosis, miosis)
lower motor signs (flaccid paralysis, muscle atrophy, imparied reflexes, negative Bainski), increased WBC, fever
polio
destruciton of anterior horn
upper and lower motor lesions with sensation spared
ALS
destruction of lateral corticospinal tract and anterior horn
mutation in ALS
superoxide dismutase 1 mutation
treatment for ALS
rluzole
floppy baby, only LMN (not botulism) presents similarly to polio
werdnig hoffman
polio is typically asymmetric weakness while werdig is symmetric weakness…
due to AR degeneartion of anterior horn
if you lose superoxide dismutase what happens
increaed free radical injury from superoxide (cannot turn into hydrogen peroxide) as seen in ALS
ataxia with loss of ibratory sense and proprioception, muscle weakness in lower extremities
friedreich ataxia
mutation fredrich ataxia
unstable trinucleotide repeat GAA in FRATAXIN GENE (causes iron free radical injury in mitochondria)
cardiac complication of friedrich ataia
hypertrophic cardiomyopathy
UMN plus LMN plus loss of pain and temp, spares fine touch
occlusion of anterior spinal artery
progressive sensory ataxia, charcot joints, shootoing pain, argyll robertson pupils, abseence of DTRs and positive rhomberg
tabes dorsalis from tertiary syphillis
unilateral radicular pain, absent knee and ankle reflex, loss of bladder and anal sphincter control, saddle anesthesia
cauda equina syndrome (compression of L2 and below) from disc hernation or vertebral tumors
SURGICAL EMERGENCY
pupil can accomodate but cannot constrict in presence of light
argyll robertson pupil
tertiary syphillis
meningitis affects what layers of meninges
pia and arachnoid (weak, flexible meninges, leptomeninges)
3 MCC cause of meningitis in neonates
group B strep, E coli, listeria
MCC caue of meningitis in children and teenagers
n meningitiids (enters through nasopharynx respiratory droplets and enters blood)
mcc meningitis in adults and elderly
strep pneumo
mcc cause meningitis in unvaccinated children
h flu
MCC viral meningitis
coxsacakie
what layers will you pass during LP
skin, ligament epidural space, dura, arachnoid…DO NOT PIERCE PIA
CSF bacterial meningitis
neutrophils low glucose, high protein
CSF viral meningitis
lymphocyte predominance, normal glucose
CSF funga/TB meningitis
lymphocyte predominance low glucose, high protein
complications meningitis besides death
hydrocephalus, hearing loss, seizures
mostly seen in bacterial meningitis
how to get global cerebral ischemia
lower perfusion (atherscleorsis), shock, chornic hypoxia, repeated episodes of hypoglycemia (insulinoma…glucose is vital to brain nutrition)
how does mild global ischemia present
mild confusion which resolves after you give glucose (insulinoma)
vulnerable regions in moderate global ischemia
pyramidal region of hippocampus, pyramidal neurons in cortex (cortical laminar necrosis, lines of necrosis in layers 3,5,6)
focal neurologic deficit less than and greater than 24 hours
less than - TIA
more than 24 - stroke
thrombotic stroke vs embolic stroke
thrombotic - atherosclerosis, results in pale infarct athte periphery of cortex
embolic - usually frm afib, thromboemboli from left heart travels to brain and results in hemorrhagic infarct at periphery of cortex, usu. involves MCA
lacunar stroke
secondary to hyaline arteriosclerosis (uncontroeld HTN, DM)
commonly afefcts lenticulostriate arteries (present in deep structures in brain)…small lake like areas in brain
ischemic stroke leads to what kind of necrosis in brain
liquefactive necrosis (neutropphils release enzymes that destroy tissue)
early finding in ischemic stroke
red neurons
fluid filled cystic space surrounded by gliosis
late change in ischemic stroke (final stage happens months)
red neurons are present for how long
first 12-24 hours after stroke
charcot bouchard microaneurysm
associated with chronic hypertension affects small vessels (lenticulostriate arteries, basal ganglia, thalamus
presents as headache, nausea, vomiting, eventual coma
sudden headachce “worst headache of my life” and nuchal rigidity
subarachnoid
what does LP show on subarachnoid hemorrhage
xanthochromia (yellow tinge due to blood breakdown products in CSF)
bleed on bottom of brain
subarachnoid hemorrhage
MCC subarachnoid hemorrhage
rupture of berry aneurism
MCC site berry aneuryms
anterior circle of willis (branch points of anterior communicating artery
which layer do berry aneurysms lack
media = weak wall and saccular outpouching
what inherited conditions are berry aneurysms assocaied with
ADPKD
marfans
loss of pain temp and light touch on contralateral side, loss of motor function, vibration, positioin and deep touch sensation on ipsilateral side
brown sequard syndrome
increased sensitivity to sound is due to injury to what nerve
stapedius nerve (branch of FACIAL NERVE)
FRACTURE OF ORBITAL FLOOR LEADS TO WHAT MANIFESTATIONS
infraorbital nerve injury (branch of v2) which will result in paresthesia of upper cheeck/lip, also damage to inferior rectus muscle which will limit vertical gaze
lens shaped lesion on CT NOT CROSSING SUTURE LINES
epidural hematoma
MMA
what veins are involved in subdural
BRIDGING VEINS between dura and arachnoid usu due to trauma
crescent shaped hemorrhage tha crosses suture lines
subdural
adrenoleukodystrophy
disrupted metabolism of longcahin fatty acids leading to excessive buildup in nervous system adrenal gland, testse, pcan lead to coma death or ADRENAL GLAND CRISIS
deficiency of arylsulfatase A, and buildup of sulfatides leading to destruciton of myelin sheath
metachromatic leukodystrophy
presents as impaired production and destruction of myelin sheath
buildup of galactocerebroside in lysosomes
krabbe disease
autommune destruction of CNS myelin and OLIGODENDROCYTES
multipe sclerosis
charcot triad of MS
SIN
scanning speech
intention tremor (intonence, internuclear ophthalmoplegai)
nystagmus
example of intranuclear opthamopleagia
mediated by cn 6 and 3
imagine looking left with both eyes
so cn 6 on left eye will pull left lateral rectus and will tell MLF of RIGHT cn3 to pull right eye to left
INO is damage to MLF so when left eye looks left, right eye cannot
MRI of MS
periventricular plaques
GOLD STANDARD
what will LP of MS show
increased lymphocytes, increased IG with OLIGOCLONAL IG BANDS myelin basic protein
how to treat MS acutely and chronically
acute - IV steroids and sympomatic treatment
chronic - binterferon, glatiramer, natalizumab…THESE ALL SLOW DISEASE PROGRESSION
NATALIE HAS MS!!! OH NOO!!!!?!?!
infection in infancy, neurologic signs arise years later
SSPE
viral inclusions in both gray and white matter
progressive multifocal leukoencaphalopathy
demyelination of CNS due oto destruction of lymphocytes
assocaited with JC virus reactivation…seen in AIDS, immunosuppressed
“locked in syndrome” after correction of hyponatremia
central pontine myelinolysis
besides age what is the other risk factor for sporadic alzheimers
increased e4 ApoE…
this leads to more beta amyloid deposition
what decreases risk for sporadic alzheimers
decreased expression E2 apo E (increased e4 is more risk(
familial early alzheimers mutation
mutation in presinilin 1
Why are down syndrome patients are icreaes risk of early Alzheiers
APP is on chromosome 21 so trisomy means more accumulation of beta amyloid
pathologic features alzheimers
diffuse cerebral atrophy (narrowing gyri, widening sulci), increased ventricle size….hydrocephalus ex vacuo
neuritic plaque (a betaamyloid,extracellular with neuritic processes)
cerebral amyloid angiopathy (beta amyloid accumulation around blood vessels which increases risk of hemorrhage)
neurofibrillary tanglesof hyperphosphorylated TAU
multifocal infarcton and injury due to HTN, atherosclerosis,
vascular dementia
2nd MCC dementia
frontnal and temporal lobes sparng parietal occiptal lobes dementia
pick disease
leads to behavioral and language symptoms
round aggregates of tau protein
PICK DISEASE (NOT NEUROFIBRIAILLARY TANGLES)
histologic hallmark parkinsons
round eosiniophilic inclusions
LLEWY BODIES coposed of alpha synuclein
loss of dopaminergic neurons in what part of brain during parkinsons
substantia nigra pars compacta
what illegal drug contaominant is associated with parkinsons
MTPT (metaboliszed to MPP+)
how long before parkinsons dementia occurs
LATE IN DISEASE YEARS
if dementia is seen early after development of parkinson symptoms in disease is probably Lewy body
parksinsonian features + dementia and visual hallucinations early in disease
lewy body dementia
where are lewy bodies found in LBD
primarily in cortex
knockout of Gabanergic neurons in caudate
huntingons
lab values in huntingtons
increse dopa, decrease gaba, decrease Ach
how do neurons die in huntingonts
death via NMDA R bidning and glutamate excitotoxicity
where is there atrophy in huntingtons
caudate and putamen with excavuo ventriculomgaly
when does trinucleotide expansion occur
SPERMATOGENESIS
trinucleutide repeat seen in huntingtons
CAG
Caudote loses
Ach and
Gaba
why does urinary continence, gait instability, and dementia occur in normal pressure hydrocephalus
stretching of corono radiata
what gives relief in normal pressure hydrocephalus
LP
ultimately treat with VP shunt
why is there so much CSF in normal hydrocephalus
decreased reabsorption of CSF by arachnoid granulations
what patholgic conformation of prion in spongiform encephalopathy
PrpSc BETA PLEATED SHEET resistant to proteases
histologic hallmark spongiforme enceph
white SPONYGY vaculoes in brain parenchyma
rapidly progressive dementia assocaited with ataxia and STARTLE MYOCLONUS (involuntary movement wiht little stimulus)
CJD
patinet dying less than 1 year
EEG reading on CJD
periodic sharp waves on EEG
increased 14-3-3 proteins in CSF
histologic hallmark Pick disease
ubiquinated TDP 43 and round Pick bodies
dementia involving early personality changes, aphasia and may have associated movement disorders
Frontal temporal dementia
atheosis
slow snake like movements, writhing, especially in fingers
dystonia
sustained involuntary muscle conctraction
how to treat high frequency tremor wiht sustained posture *outstretched arms) worsensed with movement or anxious
betablockers (non selective) like propanolol or pirmidone
sudden wild flaliilng of 1 arm and contralateral leg due to injury to what structure
hemiballismus
contralateral subthalamic nuclues lacunar stroke)
intention tremor due to dysfunction where
cerebellum
how to characterize migrain headaches
POUND pulsatile ONE DAY DURATION unilateral nausea/photophobia Disabling
steady headahce pain bilateral no photophobia no aura
tension headache
repeptitive brief unilateral headaches associated with periorbital pain
cluster headaches
prophylaxis against cluster headaches
verapamil
