NEURO Flashcards
1A. ↑ICP #1
Mech (5)?
MECH:
- Mass effect (ie contusion, hematoma, tumor, edema)
- Generalized brain swelling (ie ischemic state)
- ↑venous pressure (ie ven obstruction, venous sinus thrombosis, HF)
- ↑CSF production (ie SAH, Meningitis, choroid plexus tumor)
- Obstruction to CSF flow / abs (ie Hydrocephalus, meningeal dz)
1B. ↑ICP #2
Mech of Pres (2), Pres (11)?
- High CSF pressure
- Neural tis compression
PRES:
- Htn
- Bradycardia
- Lethargy
- Missile Vomiting
- Vertigo
- Headache
- Neck + Shoulder rigidity/pain
- Facial weakness
- Papilledema, visual field loss + diplopia
- Hearing distortion + tinnitus
- Anosmia
1C. ↓ICP #1
Mech (2, incl 4 sub-mech in 1st)?
MECH:
- CSF leak
- Trauma
- Spontaneous dural tear
- Post-CNS surgery / Lumbar Puncture
- Post-Thoracotomy (leak into pleural space) - CSF fistula
1D. ↓ICP #2
Pres (5, incl 2 sub-divs of 1st)?
PRES: Symptoms range from mild to severe.
- Headache
- Frontal or Occipital (“throbbing”)
- Postural (w/in 30s of assuming erect posture) - Neck stiffness
- Photophobia
- Dizziness
- Nausea
1E. Communicating Hydrocephalus
Mech, Causes (3)?
MECH =↓CSF abs by arachnoid villi (->↑ICP).
CAUSES:
- CONGENITAL IMPAIRMENT of arachnoid villi (ie low #, improper functioning)
- Arachnoid villi
1F. Normal Pressure Hydrocephalus
Pres (3: “Wet, Wacky, Wobbly”)?
PRES:
- Urinary incontinence
- Dementia REVERSIBLE (due to cerebral cortex atrophy)
- Ataxic gait
1G. Hydrocephalus Ex Vacuo
Pres?
PRES: ICP NORMAL
2A. Subfalcine Herniation
Comp?
COMP:
- Compression of ACA -> Infarction
2B. Uncal Herniation
Comp (3)?
COMP:
- Compression of IPSI CN III -> CN III Palsy
- Compression of IPSI PCA -> CONTRA Hemianopsia (w macular sparing)
- Compression of CONTRA Crus Cerebri -> IPSI Paralysis
- > ‘False Localization’ sign (dysfunction distant from expected anatomical location of pathology)
2C. Cerebellar Tonsil Herniation
Assoc, Comp?
ASSOC:
- Chiari II Malformation
COMP:
- Compression of Brainstem -> Coma + Death
3A. Cerebellar Pathologies
General Pres?
Disturbances of balance, gait + coordinated motor actions.
** NO paralysis. NO inability to start/stop movement. **
3B. LATERAL Cerebellar Lesion
General Pres?
Propensity to FALL towards INJURED / IPSILATERAL side.
3C. MEDIAL Cerebellar Lesion
General Pres (5)?
- Bilateral motor deficits
- Truncal Ataxia
- Wide Gait
- Head tilting
- Nystagmus
3D. Cavernous Sinus Sx
CN affected, Etiologies (3), Pres (3)?
CN 6 (Abducens nerve) commonly affected.
ET:
- Mass effect
- Fistula
- Thrombosis
PRES:
- Opthalmoplegia
- ↓Corneal sensation
- ↓Maxillary sensation
3E. Kluver-Bucy Sx
Lesion Location, Pres (5 “Hypers” + 1)?
Bilateral Amygdala lesion.
PRES:
- Hypermetamorphosis: approaching of visual stimuli as if
they were new
- Hyperorality
- Hyperphagia
- Hypersexuality (with loss of sexual preference)
- Hyperdocility
- Anterograde Amnesia
3F. Horner Sx (sympathetic chain lesion)
Def’n, Assoc (2, incl 3 conditions that produce 1st),
Pres (“PAM”)?
Interruption of Sym nerve supply to eye.
ASSOC:
- Lesion of SC ABOVE T1
- Brown-Sequard Sx
- Pancoast tumor
- Syringomyelia (LATE) - Cluster Headaches (may induce)
PRES: * “PAM” *
- Ptosis
- Anhidrosis
- Miosis
4A. “Peripheral neuropathy with sensorimotor dysfunction”
Causes?
CAUSES:
- Vit B12 def
4B. UMN Facial Lesion
Lesion Locations (2 options), Pres?
- Motor Cortex (face area) OR
- Connection b/w cortex + Facial nucleus.
PRES = CONTRALATERAL paralysis of LOWER face.
5A. Syringomyelia
Lesion Location, Assoc, Pres?
Damage to Ant White Commissure of Spinothalamic tract.
MC = C8 - T1
ASSOC:
- Arnold-Chiari II malformation
PRES: “Person with hand on burning hot element not feeling heat and not removing hand.”
- BILATERAL “cape-like” loss of temp + pain sensations
in upper extremities -> Flaccid Paralysis
5B. MS
Lesion Locations (3),
Mech (3 steps), HLA,
Pres (Epi + TRIAD + 5),
DX (2, incl 2 findings for each)?
- Cerebral WM (cervical region) -> Hemiparesis
- Brainstem -> Vertigo + Scanning Speech mimics drunkeness
- ANS -> Incontinence (bladder + bowel)
MECH: Autoimmune infl
Auto-ab against myelin sheath ->Demyelination ->
Random + asymmetric lesions.
HLA-DR2.
PRES: “Young white woman” Relapsing / remitting course
- Charcot’s Triad 1: “Intention tremor, Scanning speech, Nystagmus”
- Vertigo
- Hemiparesis
- Bilateral Internuclear Opthalmoplegia
- Blurred vision in 1 eye
- Incontinence (bladder + bowel)
DX:
- FLAIR MRI: *Gold standard*
-> GREY periventricular plaques (areas of oligo loss)
\+ axon destruction
-> Multiple WHITE matter lesions (areas of demyel)
- Lumbar Puncture:
->↑IgG with IgG bands
->↑Lymphocytes
5C. Tabes Dorsalis
Lesion Locations (2 Tracts), Mech, Causes, Pres (General + 3), Signs (4)?
- Dorsal Column tract nerves
- Lateral Corticospinal tract nerves
MECH: Demyelination -> Subacute combined degeneration.
CAUSES:
- 3ry Syphilis / Neurosyphilis
PRES: BILATERAL signs BELOW lesion
- Impaired sensation + proprioception
- Sensory Ataxia
- “Shooting / lightning” pain
SIGNS:
- Romberg +
- DTRs absent
- Argyll Robertson pupils (reactive to accommodation but not to light)
- Charcot’s joints
5D. Subacute Combined Degeneration
Lesion Locations (3: Column + 2 Tracts), Mech, Causes (2)?
- Dorsal Columns
- Lat Corticospinal Tracts
- Spinocerebellar Tracts
MECH: Demyelination -> Subacute combined degeneration.
CAUSES:
- Vit B12 or Vit E deficiency
- AIDS
5E. Poliomyelitis
Causative Bug, Lesion Location, Path, Pres (5), DX (2)?
Polio virus (fecal-oral transmission).
Ant Motor Horn. (Virus repl in oropharynx + S.I before reaching CNS)
PATH: LMN destruction.
PRES:
- LMN signs
- Fever + malaise
- Headache
- Sore throat
- Nausea + ab pain
DX:
- Virus recovered from throat or stool
- CSF: Lymphocytes present
5F. Werdnig-Hoffman Dz (aka Infantile Spinal Muscular Atrophy)
Lesion Location, Inher, Path, Pres (2), Prog?
Ant Motor Horn.
AR.
PATH: LMN destruction.
PRES:
- “Floppy baby” at birth
- Tongue fasciculations
PROG: Death ~ 7 months, however some live for a few years.
5G. ALS / Lou Gehrig’s Dz
Genetics, Path, Pres (Epi + 2), Prog, RX?
Mutation / defect in Superoxide Dismutase.
(-> Free Radical injury to neurons)
PATH: Free Radical injury to neurons
PRES: Arises in middle-age
- Early sign = atrophy + weakness of HANDS
- Both LMN + UMN signs
PROG: Progressive and fatal
RX:
- Riluzole:↓presynaptic Glutamate release. Modestly lengthens survival.
5H. Brown-Sequard Sx
Def’n, Pres (6: 2 LEVEL of lesion + 3 BELOW lesion + 1)?
‘Hemisection’ injury of SC = injury of 1/2 SC.
PRES:
- AT LEVEL of lesion:
- IPSI loss of all sensation
- LMN signs - BELOW lesion:
- CONTRALAT pain + temp loss (ST tract)
- IPSI proprioception, tactile + vibration loss (Dorsal Column)
- IPSI UMN signs (CS tract) - Horner Sx if lesion above T1
6A. Epidural Hematoma
Arterial = High P
Anatomy, Etiology, Mech,
Pres (CLUE + 2), Appearance on CT (2)?
Rupture of Middle Meningeal art due to fracture of Temporal bone.
ET = Trauma
MECH: High P = rapid expansion = Transtentorial Herniation
(Dura mater SEVERED from skull).
PRES = “Lucid interval” followed by “progressive↓in consciousness.”
** Death within 6 hrs **
CT:
- “Lens / “biconvex disk”-shaped hematoma- b/w suture pts / not crossing suture lines.
- CAN cross falx + tentorium
6B. Subdural Hematoma
Venous = Low P
Anatomy, Etiology, Mech,
Pres (4 Epi + 2 CLUES),
Appearance on CT (3)?
Rupture of Bridging Veins.
ET = Deceleration Injuries: Brain crashes into skull.
MECH: Low P = Slow bleeding.
Gyri preserved since P distributed equally
PRES: MC in elderly, patients on Anticoagulants, Alcoholics, Shaken Babies (all have smaller and more fragile bridging veins).
- “Gradual onset / Progressive s + s”
- “Fluctuating L.O.C.”
CT:
- “Crescent-shaped” hematoma- crosses suture lines.
- “Midline shift”
- CANNOT cross falx + tentorium
6C. SAH
Anatomy, Etiology (2), Mech,
Pres (CLUE), Micro Finding,
Comp (2)?
Aneurysm in Circle of Willis. Spreads throughout SA space.
ET: ** NO Trauma **
- Arterial / Venous Malformation
- Berry Aneurysm rupture
MECH =↑ICP
PRES = “Worst headache of my life” (sudden headache with nuchal rigidity)
Rapid time course
FINDING = Xanthochromea (RBCs in lumbar puncture with yellow on top).
COMP: 2-3 days afterward, risk of:
- Vasospasm (due to bl breakdown)
- Rebleed
6D. Intraparenchymal / Intracerebral Hemorrhage (ICH)
MC Lesion Locations (2), Causes (4), Mech,
Pres (Epi + 1)?
MC in Basal Ganglia + Internal Capsule.
CAUSES:
- Systemic Htn
- Amyloid angiopathy
- Vasculitis
- Neoplasm
MECH = Microaneurysm rupture
PRES: MC in Hypertensive patients
- Neuro deficits
6E. Berry Aneurysm
RF (4), Seen In (3), Comp?
RF:
- Advanced age
- Black
- Smokers
- Htn
SEEN IN:
- ADPKD
- Ehlers-Danlos Sx
- Marfan’s Sx
COMP: Rupture -> SAH or Hem Stroke
6F. Cerebrovascular Disease due to ISCHEMIA
Most Vulnerable Lesion Locations (4)?
- Hippocampus
- Neocortex
- Cerebellum
- Watershed areas
6G. Ischemic Stroke
RX (incl 2 Indications)?
RX:
- tPA
* If NO risk of hem
* Within 3 - 4.5 hrs of onset
6H. Lacunar Ischemic Stroke
Lesion Locations (2), Mech (3 steps, incl vessels involved), Imaging, Comp?
- Thalamus -> Pure SENSORY Stroke
- Internal Capsule -> Pure MOTOR Stroke
MECH: Lenticulostriate vessels:
Htn -> Hyaline Arteriosclerosis -> Infarction (small cystic areas).
IMAGING: Small cystic areas of infarction
COMP:
- Hemibalism
6I. Thrombotic Ischemic Stroke
Mech, Imaging?
MECH: Clot formation, usually over atherosclerotic plaque,
at site of infarction.
IMAGING: PALE infarct (ie non-hem) at periphery of cortex
