neuro 3 Flashcards
3 most cmmon metastaes to brain
lung, breast, kidney
MCC tumor of astrocytes in children
pilocytic astrocytoma
benign
malignant high tumor of astrocytes, MCC seen in adults , high grade
glioblastoma multiforme
distribution of glioblastoma
CAN CROSS CORPUS CALOSUM
histologic hallmark glio
edge of necrosis “psudopallisaiding” peomorphic tumors
ENDOTHELIAL CELL PRLIFERATION
intermdediate filament present in glioblastoma
GFAP
adult arachnoid cell atumor
meningioma
more often in females
round mass attached to dura assocaied with seizures
meningioma
whirled appearance of cells and psamomma bodies
meningioma
schwannoma
benign tumor of schwanna cells
MCC cranial nerve and location of schwanomma
CN 8 at cerebellopontine angle
loss of hearing tinnitus
schwanomma
bilateral vestibular schwanomma found in what disease
NF2
what marker is positive in schwanomma
S100
fried egg appearance (round nuclei with clear cytoplasm()
oligodendroglioma
calcified tumor white matter usually involving frontal lobe and presents with seizures
oligodendroglioma
most common CNS tumor in children
pilocytic astrocytoma
cystic lesion with nodule growing on wall
pilocytic
“PILOCYSTIC” astrocytoma
key finding in pilocytic astrocytoma
rosenthal fibers (eosinophilic corkscrew fibers) GFAP positive
most common MALIGNANT tumor in children
medullobastoma
small round blue cells, homer wright rosettes…origin of tumor
medulloblastoma
NEUROECTODERM
feared complication of medulloblastoma
compress 4th venticle causing noncommunicating hydrocephalus and can send “DROP METASTASES” into spinal cord
“drop metastaes” in spinal cord
medulloblastoma
not medulloblastoma but presents with hydrocephalus
ependyomoma
key finding in ependymoma
perivascular pseudorosettes
typically in 4th ventricle
bitemporal hemianopsia in CHILD
craniopharyngioma
origin of craniopharyngioma
rathke’s pouch (same as adrenals)
typically assocaited with califications and CHOLESTEROL CRYSTALS
vertigal gaze palsy, obstructive hydrocephalus, PRECOCIOUS PUBERTY in males
pineal gland tumor (pinealoma)
consequences of cerebellar tonsillar hernation into foramen magnum
coma and death due to brain stem compression
consequences of uncal hernation
uncus = medial temporal lobe
compresses ipsilateral CNII (blown pupil, down and out gaze)
as well as ipsilateral PCA homonymous hemianopia with macular sparing
consequence of transtentorial (central downward hernation)
paramedian basilar artery branch rupture DURECT hemorrhages
cingulate (herniation under falx cerebri) hernation consequence
compresses anterior cerebral artery
tumor assocaited with VHL
hemangioblastoma
usually found with retinal angiomas
epo producing tumor tumor
hemangioma
brain tumor assocaited with bHCG production
pinealoma
LP shows increased CSF protein with norlmal to low WBC (albuminocytologic dissociatoin)
guillan barre
how does campylobacter cause autoimmune attack of peripherla mylen
molecular mimicry
what will cause osmotic demyelination and what will cause cerebral edema/herniation
correcting hyponatremia - osmotic demyelination
correcting hypernatremia - cerebral eema
kinesin responsible for whta process in cells
MICROTUBULE assocaited TP power motor protein that facilitates ANTERIOGRADE (down axon) transport of NT containting secretory vesicles
fuction of nerve that exits pelivs through obdurator foramen
obdurater nerve (L2 L4) adducts thigh and sensory to distal medial thigh
nerve that provides motor function to aterolateral abdominal wall muscles and provies sensation of suprapubic region
iliiohypogastric nerve (L1 nerve root)
differencein eye defecit between PCA and MCA stroke
PCA - damages occipital cortex, results in contralateral homonymous hemianopia with MACULAR SPARING
MCA - homonymous hemianopia WITH macular INVOLVEMENT, usually presents with contralateral motor and sonsory loss
nipple dermatome
T4
what nerve roots responsible for erection and sensation of penil and anal zones
s2 s3 s4
s2 3 4 keeps dick off floor
muscarinic effecton detrusor msucle of bladder
detosor CONTRACTION
causes peeing
one week after stroke what will be prominent in cell ischemic tissue
MICROGLIA (1 week granulataion tissue phase)
MCC cause of spontaanoues lobar hemorrhage in elderly
cerebral amyloid angiopathy (usually affects occipital and parietal lobes)
non rhythmic conjugate eye movements and myoclonus in child with abdominal mass
neuroblastoma
djet o increased number of N-myc gene
most common extra cranial neoplasm in children
neural crest origin
microscopic findings neuroblastoma
solid sheets small cells dark nuclei and scant cytoplasm
CNX lesion where does uvula deviate
away from lesion (weak side collapses and points uvula away)
how does left CN XI lesion present
weakness in left shoulder (trapezius) and weakness turning head to RIGHT
ipsilateral shoulder weakness in contralateral turn
(left SCM helps turn head to right)
cn v motor lesion
jaw deviates TOWARDS lesion due to uonopposed force form opposite pterygoid muscle
UMN lesion what happens to forehead
spared (due to bilatral forehead UMN innervation
LMN lesion in face forehead
not spared (desttuction of CN 7 anywhere leads to ipsilateral paralysis of upper andlower muscles, hyperacusis, loss of taste to anterior tongue
tuberous clerosis mutation
TSC1/TSC2 mutation on chromosome 16 AD
cardiac rahbdomyoma, mental retardation, angiomyoplipoma, angiofibromas, mitra regurg
tuberous sclerosis
hamartomas CNS and skin, ashleaf spots, shagreen patches
tuberous sclerosis
somatic mosaicims for actiating mutaiton in one copy of GNAQ gene
sturge weber (encephalotrigeminal angiomatosis)
port wine stain, tram track calcificaiotns, glaucoma
sturge webber
birth mark in CN V1,V2 disribution
neus flammeus port wine stain seen in sturge webber
NF1 mutation in what type of gene
tummor suppressor gene on chrom17
besides bilateral acoustic schwanommas what other findings in NF2
juvenile cataracs, meningiomas, ependymomas (2 ears, 2 eyes, 2 parts of brain)
bilateral renal cell carcinoma, pheochromocytomas
VHL
mutated gene von hippel lindau
VHL gene DELETION
hemangioblastomas with angiomatosis (cavernous hemangiomas in skin
VHL
where are low frequency sounds heard
apex near helicotema (wide and felxible)
where are high frequency hsounds hear
base of chochlea (thin and rigid)
these usually go first in presbyacusis
choleastoma is conductive hearing loss due to overgrowth of what in middle ear space
desquamated karatin (erodes ossicles and mastoid air cells)
very painful red eye, sudden visoin loss, halos around lotes, frontal headache, fixed and mid dilated pupil
ACUTE CLOSURE glaucoam
emergency
do not give epinephirine because it casues mydriasis
accumulation pus anterior chamber, conjucivitis
uveitis
associated with HLAb27 conditions
deposition of yellowish extracellular material in retinal pigment epitheliam on pigment exam
age related dry macular degeneration
wet vs dry macular degen
dry - non exudative, has those yellow drussen deposits,
wet - exudative has rapid loss of vision due to choroidal NEOVASCULARISATION treat with anti VEGF
f=what to look for in DM retinopatyh
look for damaged capillaries on fundoscopic, black hemorhagges (dark spots)plus macular edema
dilated retinal artery plus compression
retinal vein occlusion
crinkling retinal tissue
retinal detachment
flashes floaters, curtai drawin down in one eye
retinal detachment
which nerve mediates miosis and nucles
CN III via edinger westphal nucleus
parasympathetic
marcus gunn pupil
APD (optic nerve damage or retinal injuyr
decreased constriction when light is shined on affected eye compared to unaffced eye
Horner syndrome assocaied with what psinal location
anything above T1
eyes move upwad particularly with contralateral gaze, toruble moving down stairs, needs to tilt head opposite direction
cn iv damage trochlear nerve
ptosis down and out gaze
cn III motor injyr (usually form vascular dises)
blown pupil down and out gaze, absent pupillar light reflex
cn III parasympathetic lesion from compression or aneurysm, PCOM, uncal hernation
rihgt tempora lesion or MCA results in what
left upper quadrantanopia
right parietal lesion, MCA results in
left lower qudrantinopia
how to differentiate between temporal and parietal lesion
tempora - upper
paraietal - lower qudrantanipa
central scotoma
macular degneration
hemanopia with macular SPARING
PCA infarct
decreased maxillary sensaiton, variable ophtalmoplegia, decreased corneal sensation, horner syndrome,
cavernous sinus snydomre
secondary to pituatary tumor mass effect or cavernous sinus thrombois
CN VI most suspectibel to injury
sturcute injured in INO
medial longitudinal fasiculas
happens in MS
treatment for absence seizures
ethosuximide
SUX TO HAVE SILENT SEIZURES
sie effects ethosux
EFGHIJ Ethosux causes Fatigue GI edisress Headache Itching and stevenJohnson syndrome
sensory impairment in palmar surface of first 3 digits and radial half of 3 digits often bilateral
nerve compression Carpal tunnel syndrome of median nerve
HIV patient with CD4 count 158 presents with weakness, visual chagnes, and speech difficulties which has been getting worse over past few weeks
MRI shows multiple NONenhancing lesions in brain
JC virus (polyoma)
renal transplant patient presents with gross hematuria nd fever
hemorrhagic cystiitis from BK virus (polyoma)
what to adminster with levodopa
cabidopa (inhibits DOPA decarboxylase
this incraesse bioavailability of L-dopa and limit peripheral side ffects
MOA capsaicin
release and DEPLETION o fubsstance P…defunctionalization o f nociceptive nerve fibers
surgery patient develops acute hepatitis in post op period (days- weeks after) due to what med
halogentaed inhaled anesthetics (halothane, enflurane, isoflurane, desflurane
ANE drugs
patient coems in with organophosphate toxicity and given atropine…why must you also give pralidoxime
atropine is a muscarinic blocker only at MUSCARINIC affects but doesn’t block NICITONIC effects like MUSCLE PARALYSIS….pralidoxime hasmuscarinic and nicotinic effects
MOA barbituates (thiopental) vs benzos
barbituates increase DURATION of CL channels opening, longer acting
benzos - increase FREQUENCY of opening of GABA chloride channels….more short acting
TB med that causes optic neuropathy
ethambutol
TB med that cauess red orange pee discoloration
rifampin
why is tazobactam added to pipercillin
decrease destruction by beta lactamase enzyme of bacteria
MOA acyclovir valacyclor famciciclovir
nucleoside analog which is incoporated into virus DNA by thymidine kinase which competes for viral DNA polymerase…