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Patho > Neuro > Flashcards

Neuro Flashcards

1
Q

Most common neuro disease

A

stroke

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2
Q

who gets stroke?

A

people with HTN and diabetics are at the highest risk

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3
Q

how many pairs of cranial nerves do we have?

A

12

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4
Q

how many pairs of spinal nerves do we have?

A

31

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5
Q

important info to gather about headache location

A
  • frontal: could be sinus-related
  • occipital: tension or migraine
  • temporal: brain freeze
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6
Q

what types of headache onset are concerning?

A
  • if it wakes them up in the middle of the night

- if there is no onset, and it has not gone away in three or more weeks

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7
Q

when should you go to the ER for a headache?

A

if it is the worst you’ve ever had- could be aneurysm

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8
Q

what pattern of headaches is not concerning?

A

every 4 weeks or in sync with menstrual cycle

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9
Q

What associated symptoms with headaches are concerning?

A

vision problems, N/V

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10
Q

What do we need to know about seizures?

A

what happened before, during and after

  • before: aura, involuntary articulations like screaming?
  • during: tonic clonic movements, pass out, awake and alert, hit their head, lose bladder function?
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11
Q

what is the biggest concern about seizing?

A

muscle contractions over and over → acidosis builds up in the muscles

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12
Q

Most concerning type of memory loss

A

long term

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13
Q

Cranial nerve mnemonic

A

On Old Olympus Towering Top, A Fin and German Viewed Some Hopps

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14
Q

Sensory or motor mnemonic

A

Some Say Marry Money, But My Brother Says Big Boobs Matter More

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15
Q

CN I

A
  • olfactory

- sensory

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16
Q

CN I test

A

smell two scents

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17
Q

CN II

A
  • optic

- sensory

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18
Q

CN II test

A
  • Snellen (20/20 normal, 20/200 blind)

- Rosenbaum: 14 in away from face

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19
Q

CN III

A
  • oculomotor

- sensory

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20
Q

CN IV

A
  • trochlear

- sensory

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21
Q

CN VI

A
  • abducens

- sensory

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22
Q

CN III, IV, VI function and test

A
  • work together to innervate the eyes and eyelids
  • test extraocular movements: follow finger as it moves
  • test PEARL (pupils eaqual and reactive to light): both eyes constrict when either is stimulated with light
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23
Q

Where should eyelids be when eyes are open?

A

about 2 mm over the iris

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24
Q

If iris is greater than 3mm

A

exopthalmos

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25
Q

CN V

A
  • trigeminal

- sensory and motor

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26
Q

CN V test

A

temporal and masseter muscles: clench jaw while feeling those muscles- should be equal in strength on both sides

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27
Q

CN VII

A
  • facial

- sensory and motor

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28
Q

CN VII test

A

test by smiling, frowning, puffing cheeks, gritting teeth, closing eyes against resistance
-should be equal on both sides

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29
Q

CN VIII

A
  • acoustic/ vestibulocochlear

- sensory

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30
Q

CN VIII test

A
  • cold water test if you’re mean
  • hearing: whisper test
  • Weber: tuning fork on top of head, should hear in both ears
  • Rinne: should hear in front of ear twice as long as behind ear
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31
Q

CN IX

A
  • glossopharyngeal

- sensory and motor

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32
Q

CN X

A
  • vagus

- sensory and motor

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33
Q

CN IX and X test

A
  • uvula and soft palate rise evenly when pt says “ah”
  • gag reflex
  • swallowing symmetrically
  • hoarseness is a bad finding
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34
Q

CN XI

A
  • spinal accessory

- motor

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35
Q

CN XI test

A
  • shrug shoulders against resistance (tests trapezius)

- turn head against resistance (tests sternocleidomastoid)

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36
Q

CN XII

A
  • hypoglossal

- motor

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37
Q

CN XII test

A

-tongue strength

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38
Q

How to evaluate balance

A
  • heel to shin
  • stand on one foot and hop
  • gait: opposite arms swings
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39
Q

Romberg test

A

eyes closed, watch for swaying… test cerebellum function

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40
Q

Tests for meningitis

A
  • Brudzinski’s sign: severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
  • Kernig’s sign: inability to straighten the leg when the hip is flexed to 90 degrees
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41
Q

Brown-Sequard syndrome

A

when half the brain (hemisphere) has an injury and you get ipsilateral weakness and loss of proprioception

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42
Q

central cord syndrome

A
  • sacral sparing: lose control of bowels and bladder

- mostly upper etremity

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43
Q

anterior cord syndrome

A

problem with anterior corf artery (compression, tumor, or lytic problem), causes loss of pain and temperature

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44
Q

posterior cord syndrome

A
  • posterior artery issue

- loss of proprioception and variable loss of motor function (upper and lower)

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45
Q

atrophy and fasciculations of the tongue

A

fasciculations- twitching/ rapid, uncontrolled movements

-seen a lot in ALS and parkinsons

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46
Q

Tics

A
  • involuntary muscle contractions, often in face and upper extremities
  • tourettes, drugs like phenethylamines and amphetamines
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47
Q

postural tremors

A
  • activity generated tremors
  • usually benign
  • fatigue, hyperthyroidism
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48
Q

intention tremors

A
  • may or may not go away and the intensity is steady
  • absent at rest
  • when you go to grab something you get a tremor or movement gets bigger
  • MS and parkinsons
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49
Q

congenital unilateral athetosis

A
  • twisting and writhing movements

- cerebral palsy

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50
Q

cerebellar ataxia

A
  • ataxia: irregular movement
  • how you walk when you’re drunk
  • often seen in intoxication
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51
Q

parkinsonian gait

A
  • shuffling, stooped, and cogwheel (moves fast, then stops, fast, then stops)
  • Parkinsons… clearly.
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52
Q

scissors gait

A
  • thighs are overlapping

- partial paralysis

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53
Q

spastic hemiparesis

A
  • hand is flexed very close to them and drag same sided toe or swing it around when they walk
  • stroke
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54
Q

food drop

A
  • also called slap foot
  • pull knee up really high and slap it down
  • cannot land on their heel
  • lower motor neuron diseases
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55
Q

paralysis

A

loss of movement

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56
Q

paresis

A

weakness

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57
Q

plegia

A

stroke or paralysis

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58
Q

mono

A

one limb

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59
Q

hemi

A

both limbs on one side

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60
Q

di- or para-

A

both upper limbs or both lower limbs (divided at the waist)

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61
Q

quadri- or tetra-

A

all four limbs

62
Q

hypotonia

A

less than normal

63
Q

flaccidity

A

absent

-use it or lose it… if you don’t use muscles they will atrophy and become flaccid

64
Q

4 words that mean higher than normal muscle tone

A

hypertonia, rigidity, spasticity, tetany

65
Q

lower motor neuron damage: irritated neurons

A

spontaneous muscle contractions (fasciculations)

66
Q

lower motor neuron damage: death of neurons

A
  • spinal reflexes are lost
  • flaccid paralysis
  • denervation atrophy of muscles
67
Q

Which receptors are involved in lower motor neuron damage?

A

alpha, beta, and gamma receptors

68
Q

3 possible problems with the motor unit

A
  • muscle atrophy or dystrophy
  • neuromuscular junction disorders
  • lower motor neuron lesions or infections (peripheral nerve injury)
69
Q

neuromuscular junction disorders

A

problem with ACH

70
Q

types of skeletal muscle atrophy

A
  • disuse atrophy: muscles begin to atrophy within 24 hrs of disuse (all pts in the hospital)
  • denervation atrophy
71
Q

skeletal muscle dystrophy

A
  • contractile proteins are not properly attached to the cell membrane of the muscle cell
  • protein movement does not effectively contract the muscle cell
72
Q

decreased ACH release

A

botulism, gentamicin toxicity

73
Q

decreased ACH effects on muscle cell

A
  • myasthenia gravis

- curare: plant that is in the amazon that native people use to cause paralysis

74
Q

decreased acetylcholinesterase activity

A

-too much ACH bc enzyme isn’t breaking it down

75
Q

physostigmine

A

antidote to ACH overdose

76
Q

neostigmine

A

antidote to too much ACH in the NMJ (recovering from anesthesia)

77
Q

organophosphates

A

toxins in the environment that inhibit AChE and cause a buildup of ACh

78
Q

Myasthenia gravis

A
  • autoimmune disease
  • gradual destruction of ACh receptors
  • associated with thymus tumor or hyperplasia
  • gradual development of weakness from proximal to distal portions of body
79
Q

myasthenia crisis

A

respiration is compromised

80
Q

demyelinations

A
  • Schwann cell disorder - damage to the myelin sheath
  • Guillien Barre: caused by virus, starts in the feet which lose neuro function, then moves up to the head and neck…. leaves the opposite way
81
Q

axonal degeneration

A
  • damage to LMN cell bodies in the spinal cord

- damage to axons in the spinal or peripheral nerves

82
Q

mononeuropathies

A
  • damage to one nerve

- carpal tunnel

83
Q

polyneuropathies

A
  • damage to many nerves
  • Guillian-Barre syndrome
  • Diabetics (sugar is irritating to nerves)
84
Q

back pain

A
  • one of the most common reasons people abuse pain meds

- often due to compression of nerve root by vertebrae or the vertebral disk

85
Q

sign of damage to the sciatic nerve

A

pain shooting down the back of the leg

86
Q

vestibulocerebellar disorders

A

difficulty maintaining posture

87
Q

cerebellar ataxia

A

movements divide into separate components

88
Q

How do basal ganglia modulate motor impulses

A
  • upper motor neuron cell bodies are in the the motor cortex
  • send their axons down through the internal capsule
  • basal ganglia inhibit and modulate movement patters
89
Q

basal ganglia dysfunction causes…

A

tremors, tics, hypo and hyperkinetic disorders

90
Q

chorea

A

hyperkinetic disorder; jerky movements

91
Q

athetosis

A

hyperkinetic disorder; contnuous twisting movements

92
Q

ballismus

A

hyperkinetic disorder; violent fighting movements

93
Q

dystonia

A

hyperkinetic disorder; rigidity

94
Q

parkinsonism

A
  • tremor
  • rigidity
  • bardykinesia (slow movement)*
  • loss of postural reflexes
  • autonomic system dysfunction
  • dementia
95
Q

Amyotrophic lateral sclerosis (ALS)

A
  • damages both upper and lower motor neurons
  • UMN damage causes weakness and lack of motor control (loss of control over spinal reflexes= stiffness and spasticity
  • LMN damage: irritation and fasciculations, decreased neuron firing= weakness, denervation atrophy, hyporeflexia)
96
Q

ALS prognosis

A

incurable… respiratory failure kills them about 5 years after diagnosis

97
Q

multiple sclerosis

A
  • destruction of myelin coating on axons
  • demyelinated or sclerotic patches develop through white matter of the CNS
  • decreased conduction velocity, conduction block
98
Q

spinal cord injury: spinal shock

A

temporary complete loss of function below injury

99
Q

spinal cord injury: primary neurologic injury

A

irreversible damage to neurons

100
Q

secondary injury to the spinal cord

A

neurons and white matter in area of initial damage are affected

101
Q

possible causes of secondary injury to the spinal cord

A
  • damage to blood vessels supplying the area
  • decreased vasomotor tone decreasing blood supply
  • local release of substance that cause vasospasm
  • release of digestive enzymes from damaged cells
102
Q

central cord syndrome

A

partial spinal cord injury;

  • central gray or white matter
  • arms are more affected than legs
103
Q

anterior cord syndrome

A

partial spinal cord injury;

  • anterior section of cord
  • motor functions affected; touch sense not affected
104
Q

Brown-Sequard syndrome

A

partial spinal cord injury;

  • one side of cord
  • motor function lost on that side; pain/temp sensation lost from the other side
105
Q

Conus medullaris syndrome

A

partial spinal cord injury;

  • sacral and lumbar
  • bowel, bladder, sexual function defects
106
Q

autonomic dysreflexia

A

your involuntary nervous system overreacts to external or bodily stimuli

107
Q

C1 injury

A

you’re going to die

108
Q

C7 injury

A

tells whether you’ll breathe or not… below C7, breathing is affected

109
Q

spinal cord injury to upper motor neurons (T12 and above)

A
  • spinal reflexes still work
  • no longer modulated by the brain
  • hypertonia, spastic paralysis
110
Q

spinal cord injury to lower motor neurons (T12 and below)

A
  • cells in spinal reflex arcs are damaged

- flaccid paralysis

111
Q

vasogenic brain edema

A
  • extracellular fluid
  • BBB has been disrupted and there is leakage of fluid out of the capillaries
  • tumor, cancer, coumadin, injury, altitude (a little bit of edema makes you sick!)
112
Q

problem with brain edema

A

hypoxia; pressing on brain tissue stop blood flow → ischemia and pain → infarction/stroke

113
Q

cytotoxic brain edema

A
  • intracellular fluid

- Na+k+ pump… too much sodium in the brain, water join it and you get edema

114
Q

intracranial pressure (ICP)

A

increased brain tissue, CSF, or blood in the skull

115
Q

intracranial pressure compensation

A

decreased brain tissue, CSF, or blood in the skull

116
Q

intracranial pressure herniation

A
  • the brain pushes from higher to lower pressure regions

- brain stem can herniate down the spinal tract- causes death instantly

117
Q

hydrocephalus

A

progressive enlargement of the ventricular system from increased CSF

118
Q

primary traumatic brain injuries are due to…

A
  • focal lesions: contusions, hemorrhages

- diffuse injuries: concussions, diffuse axonal injuries

119
Q

secondary traumatic brain injuries are due to…

A
  • brain swelling
  • infection
  • ischemia
120
Q

hematomas in the epidural space

A

meningeal arteries

121
Q

rapid bleeding with hematomas

A

unconsciousness may be followed by brief lucid period

122
Q

hematomas in the dura mater

A
  • subdural space: bridging veins

- slower bleeding; gradual development over days or weeks

123
Q

signs of a stroke

A
  • word salad
  • one sided muscle weakness
  • loss of sight in one eye
124
Q

ischemic stroke

A
  • transient ischemic attacks (“brain angina”)
  • large vessel (thrombotic): carotid
  • small vessel (lacunar infarct)
  • embolic: air embolus
125
Q

hemorrhagic stroke

A

bleeding- an artery or vein has become compromised and there’s a lot of blood

126
Q

is hemorrhagic or ischemic stroke worse?

A

hemorrhagic

127
Q

Aneurysmal Subarachnoid Hemorrhage: aneurysm

A

sudden-onset headache with nausea, vomiting, dizziness

128
Q

Aneurysmal Subarachnoid Hemorrhage: hemorrhage

A

sudden, severe headache, neck stiffness, photophobia, vision and motor problems

129
Q

complications of Aneurysmal Subarachnoid Hemorrhage

A

rebleeding, vasospasm and ischemia, hydrocephalus, hypothalamic dysfunction, seizures

130
Q

primary intracranial tumors of neuroepithelial tissue

A

neuroglia, neurons

131
Q

Primary intracranial tumors originating in the cranium

A

Meninges, primary CNS lymphoma, pituitary gland tumors

132
Q

Metastatic tumors

A

become metastatic quickly because the brain serves every part of the body
-low survival rate

133
Q

focal disturbances

A
  • Dysfunction of particular brain areas

- Seizures, hallucinations, weakness or palsies in specific areas, sensory deficits

134
Q

generalized disturbances

A

Increased intracranial pressure: headache, vomiting, visual problems

135
Q

seizures

A

abnormal, excessive nerve firing

136
Q

provoked siezures

A

fever, metabolic disturbances, brain injury (tumors, drug abuse, vascular lesions)

137
Q

unprovoked (epileptic) seizures

A

cause unknown

138
Q

focal seizures

A
  • without impairment of consciousness or awareness: limited to one hemisphere
  • with impairment of consciousness or awareness: one hemisphere to the other
139
Q

generalized seizures

A

involve both hemispheres

140
Q

tonic-clonic seizures

A

muscle contraction, loss of consciousness

141
Q

absence seizures

A

disturbances in consciousness

142
Q

myoclonic seizures

A

muscles of the face, trunk, and extremities contract

143
Q

tonic seizures

A

voluntary muscles of the legs and arms contract

144
Q

clonic seizures

A

bilateral, symmetric, rhythmic muscle contractions

145
Q

atonic seizures

A

loss of muscle tone

146
Q

alzheimer disease brain inclusions

A

neuritic plaques and neurofibrillary tangles, decreased ACH

147
Q

pick disease brain inclusions

A

pick bodies

148
Q

stages of alzheimers disease

A
  • initial: short-term memory loss
  • moderate: global cognitive impairment: language, spatial relationships, problem solving, depression, confusion, disorientation, lack of insight, inability to carry on daily activities
  • severe: loss of ability to respond to environment, require total care, bedridden
149
Q

vascular dementia

A

ischemic, hemorrhagic

150
Q

frontotemporal dementia

A

atrophy

151
Q

Wernicke-Korsakoff syndrome

A

vitamin b12 deficiency

152
Q

huntington disease

A

autosomal dominant inheritance

Patho (10 decks)

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