Neuro 3

Question 1

where are astrocytomas MC located

Answer 1

infratentorial in kids
supratenortial in adults

Question 2

types of astrocytomas

Answer 2

pilocytic astrocytoma - grade 1 - most common in kids and young adults; most benign

diffuse astrocytoma - grade 2

anaplastic astrocytoma - grade 3 - rare but aggressive

grade 4 - glioblastoma multiforme in the MC CNS tumor in adults

Question 3

sx astrocytoma

Answer 3

focal deficits MC - HA, may wake patients up at night, may be positional, cranial nerve deficits, AMS

increased intracranial pressure due to mass effect – HA, N/V, PAPILLEDEMIA, ATAXIA

Question 4

dx astrocytoma

Answer 4

CT scan or MRI with contrast - grade I and II and non enhancing; grade 3 and 4 are enhancing

brain bx:
pilocytic - grade 1 - form sacs of fluid (cystic) Rosenthal fibers (eosinophilic corkscrew fibers)

diffuse astrocytoma - micro cysts and mucus like fluid

anaplastic - tentacle-like projections that grow into surrounding tissue

glioblastoma - may contain cystic material, calcium deposits, blood vessels; malignant astrocytes + necrotizing, hemorrhagic center surrounded by pseudo palisading (tumor cells lining area of necrosis)

Question 5

tx astrocytoma

Answer 5

surgical excision

+ radiation for anaplastic and glioblastoma

Question 6

brain MRI with contrast for glioblastoma

Answer 6

varian ring enhancement w central necrosis, surrounded by edema and irregular (serpiginous) margins

may cross the corpus callosum (butterfly glioma)

Question 7

meningioma

Answer 7

usually benign, slow growing tumor arising from arachnoid meningothelial cells of meninges

most commonly arises from dura

Question 8

MRI with contrast meningioma

Answer 8

intensely enhancing well defined lesions often attached to the dura (resembling a snow ball)

may have calcifications

Question 9

histology meningioma

Answer 9

spindle cells concentrically arranged in a whorled pattern

psammoma bodies (concentric round calcifications)

Question 10

tx meningioma

Answer 10

asx - observe if small

sx - surgical excision

Question 11

CNS lymphoma

Answer 11

variant of extra nodal non-hodgkin lymphoma

diffuse large B cell lymphoma

epstein barr virus positive in 90%

Question 12

CT scan or MRI contrast with CNS lymphoma

Answer 12

hypointense ring-enhancing lesion in deep white matter on CT

Question 13

tx CNS lymphoma

Answer 13

methotrexate most effective chemo

Question 14

ependymoma - in what population is it most common and where does it come from

Answer 14

MC in kids
most commonly arise from 4th ventricle, spinal cord, medulla

Question 15

bx ependymoma

Answer 15

perivascular pseudo rosettes (tumor cells surrounding a blood vessel)

Question 16

bx hemangioma

Answer 16

well defined borders
does not invade surrounding healthy tissue
foam cells with high vascularity

Question 17

what is the MC type of dementia

Answer 17

alzheimer disease

Question 18

pathophys alzheimer dz

Answer 18

extracellular amyloid beta protein deposition
neurofibrillary tanges (hyperphosphoslated tau proteins)
acetylcholine deficiency

Question 19

sx alzheimer dz

Answer 19

short term memory loss (first sx)
long-term memory loss and cognitive deficits

Question 20

dx alzheimer dz

Answer 20

clinical dx
MRI preferred - cortex atrophy (medial temporal lobe atrophy), reduced hippocampal volume, white matter lesions

Question 21

tx alzheimer dz

Answer 21

acetylcholinesterase inhibitors - Donepezil, Rivastigmine, Galantamine

NMDA antagonist - memantine

Question 22

most important RF for vascular dementia

Answer 22

HTN

Question 23

sx vascular dementia

Answer 23

sudden decline in fx w a stepwise progression of sx (infarct –> decline –> stable –> infarct –> decline)

cortical sx - may affect executive function, cause aphasia, hemineglect

motor deficits including urinary difficulties and gait abnormalities

Question 24

frontotemporal dementia is also called

Answer 24

pick’s disease

Question 25

histology for frontotemporal dementia

Answer 25

pick bodies - round or oval aggregates of tau protein

Question 26

sx frontotemporal dementia

Answer 26

marked changes in social behavior, personality, language (aphasia) disinhibition or socially inappropriate behaviors hyperorality apathy

Question 27

what is diffuse Lewy body dz and what proteins make up lewy bodies

Answer 27

progressive dementia characterized by diffuse presence of lewy bodies (alpha-synuclein proteins) in comparison to PD where Lewy bodies are localized

Question 28

sx diffuse Lewy body disease

Answer 28

recurrent visual hallucinations cognitive fluctuations Parkinsonism autonomic dysfunction dementia is a late finding

Question 29

focal seizure - include simple vs complex

Answer 29

abnormal neuronal discharge from one discrete section of one brain hemisphere simple - retained awareness complex - impaired awareness

Question 30

sx focal / partial seizure

Answer 30

focal sensory, motor, or autonomic sx depending on lobe affected motor - jerky rhythmic movements Jacksonian march - start in one area and spread to other aparts Todd's paralysis - followed by a Neurologic deficit lasting up to 24h < 3 min automatisms - repetitive behaviors post ictal phase - somnolence, HA, confusion

Question 31

when is absence / petit Mal seizures MC seen

Answer 31

childhood 4-10 years

Question 32

sx absence (petit mal)

Answer 32

pause/stare - sudden marked impairment of consciousness and low of awareness without loss of body tone bank staring episodes with unresponsiveness 5-10 s eyelid twitching and automatisms

Question 33

dx absence / petit mal

Answer 33

EEG - b/l synchronous and symmetrical 3 hz (3 cycles per second) spike and wave discharges

Question 34

tx absence / petit mal

Answer 34

ethosuximide - first line valproic acid - second line

Question 35

what is a generalized seizure

Answer 35

simultaneous neuronal discharge of both hemispheres (diffuse brain involvement)

Question 36

tonic clonic (grand mal)

Answer 36

sudden LOC with tonic activity (contraction and rigidity) followed by 1-2 minutes of clonic activity (repetitive, rhythmic, symmetric jerking < 3 min) post-ictal confusion phase

Question 37

clonic

Answer 37

repetitive rhythmic jerking associated w post-ictal

Question 38

myoclonic

Answer 38

involuntary twitching of one muscle or a group of muscles without LOC

Question 39

tonic

Answer 39

LOC + rigidity

Question 40

atonic

Answer 40

drop attack

Question 41

what is decreased immediately after seizures and helps to rule out pseudo seizures

Answer 41

prolactin lactic acid

Question 42

what is status epilepticus

Answer 42

single continuous epileptic seizure lasting 5 min or greater or > 1 seizure within 5 min period without recovery

Question 43

tx status epilepticus

Answer 43

benzos are preferred initial (lorazepam)