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Neuro Flashcards

1
Q

What does the notochord induce formation of?

A

Notochord causes the overlying ectoderm to differentiate into neuroectoderma nd form the neural plate

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2
Q

What does the neural plate give rise to?

A

neural tube and neural crest cells

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3
Q

What does the notochord give rise to?

A

nucleus pulposus of the intervertebral disc in adults

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4
Q

What does the alar plate give rise to?

A

(dorsal), sensory info

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5
Q

what does the basal plate give rise to?

A

(ventral) motor

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6
Q

What are the 3 primary vesicles of the developing brain?

A

Forebrain (prosencephalon), Midbrain (mesencephalon), and hindbrain (rhombencephalon)

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7
Q

What secondary vesicles does the prosencephalon give rise to?

A

telencephalon and diencephalon

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8
Q

What does the mesencephalon give rise to?

A

Midbrain and Aqueduct

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9
Q

Which secondary vesicles does the rhombencephaol derive?

A

Metencephalon and myelencephaol

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10
Q

What structures come from the telencephalon?

A

cerebral hemisphere and lateral ventricles

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11
Q

What structures come from the diencephalon?

A

thalamus and 3rd ventricle

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12
Q

What structures come from the metencephalon?

A

pons, cerebellum, and upper part of 4th ventricle

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13
Q

What structures come from the myelencephalon?

A

medulla and lower part of the 4th ventricle

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14
Q

Neuroectoderm makes which brain strucutres?

A

CNS neurons, ependymal cells (inner lining of ventricles, makes CSF), oligodendroglia; astrocytes

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15
Q

Neural crest cells make what brain strucutres?

A

PNS neurons, Schwann cells

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16
Q

Mesoderm makes what brain structures?

A

Microglia

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17
Q

Spina bifida occulta?

A

failure of bony spinal canal to close, but no structural herniation. tuft of hair at lower veretbral level where the defect is located.

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18
Q

Meningocele?

A

meninges (but not the spinal cord), herniate through spinal canal defect. Normal AFP

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19
Q

Meningomyelocele?

A

meninges and spinal cord herniate through spinal canal defect

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20
Q

Anencephaly? What condition is it associated with?

A

anterior neural tube malformation, no forebrain, open calvarium “frog-like appearance”. inc AFP, polyhydramnio (cannot swallow amniotic fluid), maternal diabetes type I, supplement with folate to reduce the risk

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21
Q

Holoprosencephaly? What is the mutation?

A

Left and right hemisphere don’t separate during weeks 5-6. mutations of sonic hedgehog signaling pathway. Cyclopia or cleft lip/palate

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22
Q

Chiari II Arnold-Chiari malformation?

A

herniation of cerebellar tonsil and vermis through foramen magnum with aqueductal stenosis and hydrocephalus. Presents with lumbosaral myelomeningocele and paralysis below the defect.

Arnold sounds like a guy who would use a magnum

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23
Q

Dandy-Walker?

A

agenesis of cerebellar vermis with sycystic enlargememnt of 4th ventricles. Hydrocephalus and spina bifida (someone who walks dandy probably has a vermis issue)

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24
Q

Syringomyelia findings? What malformation is associated wtih it?

A

“cape-like” bilateral loss of pain and temperature sensation in upper extremities (fine touch sensation is preserved). Associated with chiari I malformation

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25
Q

Tongue innervations?

A
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26
Q

Medial medullary syndrome?

A

infarct of paramedian branches of ASA and vertebral arteries

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27
Q

Lateral medullary (Wallenberg) syndrome?

A

Stroke of the PICA. Nucleus ambiguus effects are specific to PICA lesions “Dont pick a (PICA) horse (hoarseness) that can’t eat (dysphagia)”

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28
Q

Lateral pontine syndrome?

A

AICA stroke. Facial nucleus effects are specific to AICA lesions. “Facial droop means AICA’s pooped”

Paralysis of face

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29
Q

What diseases commonly present with berry aneurysms?

A

ADPKD, Ehlers’Danlos, and Marfan (also AVM)

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30
Q

Where are charcot-bouchard microaneurysms?

A

In the small vessels of the basal ganglia and thalamus. Due to chronic hypertension

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31
Q

Central post-stroke pain syndrome?

A

neuropathic pain due to thalamic lesions. Allodynia (ordinarily painless stimuli cause pain) and dysaesthesia (unpleasant sense of touch)

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32
Q

What is ruptured in an epidural hematoma?

A

middle meningeal artery (branch of the maxillary artery which comes from the 1st aortic arch derivative)

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33
Q

Presenting symtoms of epidural hematoma?

A

Have a lucid interval, then coma. transtentorial herniation and CN III palsy

34
Q

CT shows biconvex (lentiform) hyperdense blood collection not crossing suture lines, but can cross falx, tentorium?

A

epidural hematoma

35
Q

What ruptures in a subdural hematoma?

A

bridging veins

36
Q

Which populations tends to get subdural hematomas?

A

Elderly (alzheimers/brain atrophy), alcoholics, people who have trauma, and babies (shaken baby syndrome)

37
Q

WHat type of intracranial hemorrhage presens as a crescent-shaped hemorrhage that crosses the suture lines resulting in a midline shift?

A

Subdural hematoma. Cannot cross falx, tentorium

38
Q

What is ruptured in a subarachnoid hemorrhage?

A

aneurysm such as a berry/saccular anuerysm.

39
Q

What are the symptoms of sybarachnoid hemorrhage?

A

“worst headache of my life”. Rapid time course with a bloody or yellow spinal tap.

40
Q

What is the major risk following a subarachnoid hemorrhage?

A

risk of vasospasm 2-3 days afterward, due to blood breakdown. WIll have altered mental status and focal neurologic deficits. Tx with nimodipine (CCB)

41
Q

What causes intraparenchymal (hypertensive) hemorrhage?

A

systemic hypertension. Also seen with amyloid angiopathy, vasculitis, and neoplasm.

42
Q

Where does an intraparenchyma hemorrhage occur?

A

basal ganglia and internal capsule. Charcot-Bouchard aneurysm of lenticulostriate vessels, but can be lobar.

43
Q

Which regions of the brain are most vulnerable to hypoxia?

A

hippocampus, neocortex, cerebellum, watershed areas.

hypoxia–hypocampus is most vulnerable

44
Q

How do you exclude hemorrhagic stroke?

A

Absense of bright areas on noncontract CT exclude hemorrhagic stroke (so don’t use tPA!)

45
Q

What are the histological features seen in stroke?

A

12-48 hours–red neurons

24-72 hours–Necrosis + neutrophils

3-5 days–Macrophages

1-2 weeks– Reactive gliosis + vascular proliferation

>2 weeks – glial scar

46
Q

What is the most common site of hemorrhagic stroke?

A

basal ganglia

47
Q

What is communicating hydrocephalus?

A

decreased CSF absorption by arachnoid granulations, leads to increased ICP, papilledema, and herniation (due to arachnoid scaring post-meningitis)

48
Q

What is hydrocephalus ex vacuo?

A

Apparent inc in CSF on imaging due to dec neural tissue due to neuronal atrophy. ICP is normal. Seen in alzheimer disease, advanced HIV, Pick disease

49
Q

Noncommunicating hydrocephalus?

A

Structural blockage of CSF circulation within the ventricular system (stenosis of aqueduct of sylvius)

50
Q

What herniates in a vertebral disc herniation?

A

nucleus pulposus (soft central disc) herniates through the annulus fibrosus (outer ring). Usually occurs posterolaterally at L4-L5 or L5-S1

51
Q

Where is a lumbar puncture performed?

A

TO keep the cord alive, keep the spinal needle between L3-L5. (spinal cord ends at L1-L2 and subarachnoid space extend to S2)

52
Q

Does poliomyelitis present with UMN or LMN symptoms?

53
Q

Spinal muscular atrophy (Werdnig-Hoffmann disease)?

A

Congenital degeneration of anterior horns of spinal cord, LMN lesion. “Floppy baby” with hypotonia and tongus fasciculations. AR and death by 7 months

54
Q

Friedreich Ataxia mnemonic ?

A

Friedreich is Fratastic (frataxin): he’s you’re favorite frat brother, always stumbling, staggering, and falling, but has a big heart.

Degeneration of dorsal column and spinocerebellar tracts. Presents with loss of reflexes, impaired vibratory and proprioception, staggering gait, failling, nystagmus, dysarthria, pes cavus, hammer toes and hypertrophic cardiomyopathy

55
Q

Horner syndrome mnemonic?

A

PAM is horny

ptosis, anhidrosis, and miosis

loss of sympathetics to the face

56
Q

What are the common causes of horner syndrome?

A

pancoast tumor, Brown-Sequard syndrome, late-stage syringomyelia. Anything assoaited with lesion of spinal cord above T1.

57
Q

Mnemonic for the clinical reflexes?

A

S1, 2–“buckle my shoe” achilles reflex

L3,4– “kick the door” patellar reflex

C5, 6– “pick up sticks” biceps reflex

C7, 8 – “lay them straight” triceps reflex

L1, 2– “testicles move” cremaster reflex

S3, 4 “winks galore” anal wink reflex

58
Q

What structure is the conjugate vertical gaze center?

A

superior colliculi

59
Q

What structure is the auditory center?>

A

Inferior colliculi

60
Q

What cranial nerve nuclei develop in the midbrain?

A

CN III, IV

61
Q

What cranial nerve nuclei develop in the pons?

A

CNV, VI, VII, VIII

62
Q

What cranial nerve nuclei are in the medulla?

A

CN IX, X, XII

63
Q

What cranial nerve nuclei are in the spinal cord?

64
Q

What is the corneal reflex?

A

Afferent: V1 nasociliary

Efferent: VII

65
Q

What is the lacrimation reflex?

A

Afferent: V1

Efferent: VII

66
Q

What is the jaw jerk reflex?

A

V3 afferent and efferent

67
Q

What is the pupillary reflex?

A

Afferent: CNII

Efferent: CNIII (parasympathetics)

68
Q

What is the gag reflex?

A

Afferent: CN IX

Efferent: CN X

69
Q

Cavernous sinus syndrome?

A

Due to mass effect, fistula, thrombosis. Causes ophthalmoplegia and dec corneal and maxillary sensation with normal visual acuity. CN VI commonly affected.

70
Q

What is subacute combined degeneration?

A

Due to B12 deficiency and results in degeneration of dorsal columns, descending lateral corticospinal tracts (UMN signs), and spinocerebellar tracts.

71
Q

What presents with both UMN and LMN lesions?

A

Amytrophic lateral sclerosis

72
Q

What type of hydrocephalus is common in Alzheimers?

A

Hydrocephalus ex vacuo (apparent increase in CSF due to atrophy of cortex. Normal pressure)

73
Q

What is pseudotumor cerebri?

A

inc ICP with normal CSF and normal neuro imaging. Manifests as headache and papilledema, common in young obese women.

74
Q

What is the first sign of an uncal lesion?

A

fixed, dilated pupil on the same side of the lesion

75
Q

Is there a loss of consiousness in a myoclonic seizure?

A

No, just jerking repetitive meovements. No post-ictal state

76
Q

How do you treat generalized seizures (myoclonic, tonic-clonic, tonic, atonic)?

A

Broad spectrum anti-convulsants (lamotrigine, levetiracetam, topiramate, valproic acid)

77
Q

Treatment of focal seizures?

A

Narrow spectrum anticonvulsants (carbamazepine, gabapentin, phenobarbital or phenytoin)

78
Q

What fibers does CN7 (facial nerve) carry?

A
  1. Motor output to facial muscles
  2. Parasympathetic innervation to lacrimal, submandibular, and sublingual salivary glands
  3. Special afferent fibers for taste (chorda timpani) to anterior 2/3 of tongue
  4. Somatic afferents from pinna and external auditory canal
79
Q

What is entacapone?

A

Prevents dopamine breakdown. COMT inhibitors that prevent L-dopa breakdown, inc dopamine availability

80
Q

What nerve is messed up in Bell Palsy?

A

CN7- idiopathic lesion. Peripheral ipsilateral facial paralysis, with inability to close eye on affected side. May also have dec tearing, hyperacusis and loss of taste sensation over anterior 2/3 of tongue

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