NEURO Flashcards
peripheral tissues vs CNS repair
- peripheral:
- fibroblasts migrate to area of injury and help with tissue repair
- CNS:
- astrocytes migrate to area of necrosis within 2 weeks
- necrotic tissue resorbed, cystic space formed (surrounded by astrocytes) + newly formed capillaries
- GLIOSIS=enlargment and proliferation of astrocytes peripherally a/r the area of necrosis
supraoptic (hypothalamic nuclei)
secretion of ADH and oxytocin
paraventricular (hypothalamic nuclei)
- ADH, CRH, oxytocin, TRH secretion
- corticotropin, thyrotropin
arcuate (hypothalamic nuclei)
secretes:
- DA (inhibits prolactin)
- GHRH (growth hormone)
- GRH (gonadotropin)
venttromedial vs. lateral hypothalamic nuclei
vent: “Im full” (fatty without me)…lat: “im hungry” (ano without me)
CO2 and cerebral vaculature
- CO2 is a POTENT vasoDILATOR
- tachypnea causes hypocapnia and cerebral vasoCONSTRICTION…thereby DEC cerebral blood volume and ICP
bacterial meningitis termed
- classic triad:
- stiff neck
- altered mentation
- **fever
- eval requires:
- prompt blood cultures
- empiric AB
- lumbar puncture
- CSF analysis
- eval helps:
- confirm diagnosis
- id offending organism
- determine AB susceptibility
What is the mc primary cerebral neoplam in adults?
- GLIOBLASTOMA-arises from astrocytes, located within cerebral hemispheres
- can enlargen and cause mass effect with midline shift
- may cross corpus callosum (butterfly glioma)
glioblastoma CP
- weeks of episodic HA, nausea, progressive weakness
- seizures
schwannomas CP
- sensorineural hearing loss
- tinnitus
normal pressue hydrocephalus in elderly patients
- triad:
- ataxic gait
- urinary incontinence
- dementia
- PP: distortion of paraventricular area
- later: loss of cortical inhibition on the sacral micturition center causes development of urge incontinence
what is spared by nml pressure hydrocephalus
- cerebellar
- basal ganglia
- pontine reticular formation
ataxia-telangiectasia
CEREBELLAR ATROPHY LEADS TO ATAXIA
peroxismla disease (NOT MIT) termed
- very long chain and some branched chain FA cant undergo mit beta-oxidation..theyre special, need PEROXISOMES
- s/s: hypotonia, seizures, hepatomegaly, mental retardation,e arly death
- get neuro defects d/t improper CNS myelination
SAH and saccular berry aneuryms
two peas in a pod
Fod poisoning (C botulinum toxin) CP
-
nicotinic blockade (diplopia, dysphagia) and muscarinic blockade (dry mouth)
- three ds: diplopia, dyspahgia, dysphonia
- mech: toxin inhibits acetylcholine release from pe-synaptice nerve terminals at NMJ=prevent muscular contraction
- partially overcome by high-rate repetitive nerve stim
- toxin is produced by vegetative bacteria, remains intracellular until autolysis releases it into food
UMN sign
- spastic paralysis
- clasp-knife rigidity
- HYPER-reflexia
- babinski sign
LMN signs
- flaccid paralysis
- hypo-tonia
- hypo-reflexia
- muscle ATROPHY ND FASCI-CULATIONS
Pupillary Light Reflex Pathway
- upper midbrain contains naural structures taht mediate the direct and consensual papillary light reflex:
- optic nerve
- pretectal nuclei
- EW nuclei
- oculomotor nerve
occipital lobe
- contains primary visual cortex
- unilat damage=contralat homonymous hemianopia
- bilat lesions=cortical blindness
parietal lobes
- process and interpret visual, auditory, and motor signals reeived from other brain areas
- damage=difficulties with spatial and visual perception
- nondominant lesion=hemi-neglect and constructional apraxia
- dominant lesions: Gerstmann syndrome (R-L confusion, agraphia, acalculia)
pons
- contains horizontal gaze center
- helps mediate the oculocephalic (dolls eye) reflex
- contains CN5 & 7 nerves (afferent and efferent limbs of corneal reflex)
- bilat pontine injury=pinpoint pupils d/t damage of descending sympathetic fibers
temporal lobe injury
- memory-hippocampus
- speech-Wernicke in dominant
- vision-Meyer loop
- hearing-primary auditory cortex
- bilat amygdala damage: Kluver Bucy
- hyperphagia, hperorality, hypersexuality
thalamus
- majory sensory relay station
- VPL nucleus-somatic sensation of the body
- VPM nucleus-facial sensation and taste
- lategal geniculte-vision
- medial geniculate-hearing
medulloblastoma (#2 kiddies)
- # 2 mc brain neoplasm of childhood
- mc location: cerebellar vermis
- s/s: INC ICP (morning HA, vom, lethargy)
- cerebellar dysfunction as tumor compresses adjacent structures
- histo: sheets of small, blue cells
- PNET tumor, poorly differentiated, bad prognosis
pilocytic astrocytoma (#1 kiddies)
- also located in the cerebellum, like medulloblastomas
- micro: pilocytic astrocytes and Rosenthal fibers
- low grade tumors, better prognosis
ependymomas (#3 kiddies)
- walls of ventriculi
- can hamper CSF flow, cause hydrocephalus
- micro: ependymal cells form gland-like structures-ROSETTES
p450 INHIBITORS
AAA Racks in GQ magazine
- acute alcohol abuse
- RITONAVIR (Isoniazid)
- AMIODARONE
- CIMETIDINE
- KETOCONAZOLE (also: fluconAZOLE, omeprAZOLE…azole antifungals)
- SULFONAMIDES
- Grapefruit juice
- Quinidine
- MACROLIDES (except Azithro)
p450 INDUCERS
chronic alcoholics steal Phen-phen and never refuse greasy carbs…enhance metab of X and DEC its serum concentration
- chronic alc use
- St. John’s wort
- PHENYTOIN
- PHENOBARBITAL
- Nevirapine
- Rifampin
- Griseofulvin
- Carbamazepine
p450 substrates
- OCP
- warfarin
- theophylline
- anti-EPILEPTICS
- metronidazole
migraine vs. cluster vs. tension
- migraine (POUND)
- female, unilat, pulsatile/throb, 4-72h, assoc: aura, phobias, nausea
- cluster
- men, start d/r sleep, behind one EYE, excruciating sharp, 15-90 MINS
- assoc s/s: sweating, flushing, congestion, lacrimation
- tension
- female, under stress, band like pattern, 30min-7d
- assoc s/s: muscle tenderness in head, neck, shoulders
LEMS vs MG
- LEMS: prox mu weakness, better with use
- assoc: SCLC
- MG: ab vs AChR, worse during day–extraocular mu (ptosis, diplopia); THYMOMA and anterior mediastinal mass
nml pressure hydrocephalus CP
- d/t DEC CSF resorption
- s/s progressive, d/t disruption of perventricular white matter tracts
- gait difficulties early-magnetic gait
- UMN sings (spasticity, hyperreflexia)
- cognitive disturbances (difficulty concentrating, lack of attn)
- urinary incontinence late (urgency d/t DEC inhibitory control of bladder contractions by the frontal lobe)
frontotemporal dementia
young-onset dementia, CP personality changes and aphasia
NON-communicating (obstructive) hydrocephalus
obstruction of CSF flow between vntricles and subarachnoid space
d/t: congenital abnml (aqueductal stenosis), tumors
cp: HA, N/V
