Neuro Flashcards
Conversion disorder vs. somatic symptom disorder
Conversion has neurological involvement and often associated with acute stress
SSD: excessive anxiety around 1 or more symptoms
Schizophrenia vs. schizoaffective vs. schizophreniform
Schizophrenia: >2 symptoms for >6months
Brief psychotic d/o: <1month
Schizophreniform d/o: 1-6 months
Schizoaffective d/o: schizo + depression
Glaucoma drugs
Sympathetic drugs (a ag, b antag) decrease Synthesis chOlinomimetics increase Outflow
BimatoprOst, latanoprOst increase Outflow (iris darkening)
Vent treatment of increased ICP especially with trauma or acute
Hyperventilation -> decreased CO2 -> CNS vasoconstriction
CO2 is potent CNS vasodilator
Nissl substance
RER in neurons
Basophilic granules
Loss of nissl = apoptosis
Patterns of neural injury and findings:
Acute damage
Axonal loss
Neuronal atrophy
Acute: red dead, shrunken body/nuc, loss of Nissl, eos cyto
Axonal loss: big body, big nuc/nucleo, Nissl dispersion
Atrophy: loss of fxnal groups, reactive gliosis
POMC derivatives
ACTH
MSH
ß-endorphin (opioid)
Myotonic muscular dystrophy
AD - CTG repeat, anticipation
Abnormally slow relaxation of fibers
Can’t let go of doorknob, can’t let go of handshake
Buspirone
Non-benzo benzo
Slow onset
Good for GAD, bad for Panic Disorder/actue stuff
Mu, delta, and kappa opioid receptors are coupled to?
Inhibitory G protein
Effects of opioid analgesics on 1st and 2nd order neurons
1st (peripheral neuron): binds pre-terminal and inhibits voltage gated calcium
2nd (spinal cord neuron): binds post-terminal and stimulates K+ efflux out of cell
Cavernous malformation
Vascular malformation
Clusters of dilated, thin walled capillaries
Tend to bleed -> intracerebral hemorrhage
Hyperdense, bright mass on CT
Elevated 14-3-3 protein in CSF
Creutzfeldt-Jakob
Elevated hypocretin-1 in CSF
Narcolepsy
Functional anatomy of cerebellum: Lateral hemisphere Intermediate hemisphere Vermis Flocculonodular lobe
Lateral hemisphere = motor planning
Intermediate hemisphere = motor execution via lateral descending systems
Vermis = motor execution via midial descending systems
FL = balance and eye movements
Headache followed by sudden unilateral blindness with a PMH of shoulder/hip pain?
Temporal arteritis
(with polymyalgia rheumatica)
Another sign = jaw claudication
Bilateral spastic paresis with elevated arginine
Arginase deficiency (produce urea, ornithine)
Urea cycle defect
Little to no hyperammonimia
Tx: low protein diet
First area of the brain that is damaged during global cerebral ischemia?
Hippocampus
Opsoclonus-myoclonus syndrome in a kiddo with an abdominal mass
Neuroblastoma (vs. Wilms) Can cross midline Eye stuff = not wilms N-myc Catecholamine metabolites in urine <4 years old
Dandy walker
Vermis agenesis. 4th ventricle dilation.
Fourth Fills Fossa
Non-communicating hydrocephalus
Chiari II (Arnold-Chiari)
Vermal herniation
Hydrocephalus (aqueductal stenosis)
Meningomyelocele
Chiari I
Tonsillar herniation
Associated with syrinx
Syringomyelia
Cape-like sensory loss (fine touch preserved)
Normal pressure hydrocephalus
Wet wobbly and wacky:
Urinary incontinence
Magnetic gait/ataxia
Cognitive dysfxn
Affects elderly, dilated ventricles, episodic
Communicating hydrocephalus
Decreased CSF absorption by arachnoid granulations
Ex. scarring post-meningitis
Non-communicating hydrocephalus
= obstructive
Friedreich ataxia
AR -> (GAA)n frataxin gene
Loss of DTR’s, vib, prop
Staggering gait, falling, nystag, pes, DM, HCM, scoli
Staggering FRAT brother with a BIG, SWEET HEART
Kinda looks like vitamin E deficency
Three elements of aphasia
Speech Fluidity
Comprehension
Repetition
Aphasia basics
Arcuate fasciculus connects Broca’s and Wernicke’s
Any problem with AF = impaired repetition
Transcortical occur AROUND Broca’s (motor) and Wernicke’s (seonsory) therefore AF is fine
SIG E CAPS
Sleep disturbance Interest (anhedonia) Guilt, feeling worthless Energy loss Concentration problems Appetite Psychomotor retardation Suicidal ideation
DIG FAST
Distractibility Irresponsibility Grandiosity Flight of ideas Activity/agitation no Sleep Talkativeness
Adult primary brain tumors
Glioblastoma Meningioma Hemangioblastoma Schwannoma ODG pituitary Adenoma
Old MEN Go Home After School
Childhood primary brain tumors + one in the abdomen
Pilocytic astrocytoma Medulloblastoma Ependymoma Craniopharyngioma Pinealoma
Also:
Neuroblastoma - but not 1˚ brain (abdomen)
MEDium Pinetrees Excite People’s Christmas
Structure affected with hemiballism
Hemiballism = wild, involuntary, unilateral movements
Damage to the subthalamic nucleus (lacunar stroke) which modulates BG output
Lambert-Eaton Syndrome
Myasthenic syndrome
Antibodies against presyn Ca channels
Associated with lung cancer
Increase in muscle response with repetitive stim
Extensor vs. flexor posturing
At or below red nucleus = extensor (midbrain, pons)
Above red nucleus = flexor (hemispheres, int. cap)
Herniation syndromes
Subfalcine (ACA damage)
Central (basilar artery rupture, Duret hemorrhage)
Uncal (Blown pupil, down and out)
Tonsillar (Brain stem compression)
Speeding Colorado To Utah
Brain findings post MI and v-fib death
Watershed zones = wedge shaped necrosis caused by hypoperfusion
Hypoxic-ischemic encephalopathy
ACA/MCA
MCA/PCA
Frontal lobe syndromes
Changes to executive fxn/personality
Left side = more apathy and depression (Left=Lame)
Right side = disinhibited behavior (Right=Risky)
Tetrodotoxin binds to?
Na channels preventing depolarization
Group B personality disorder
Historically, Bad Ass Narcisstists (Wild)
Histrionic (attention seeking)
Borderline (unstable, suicide, splitting)
Antisocial (>18 -> <18=conduct d/o)
Narcissistic
Personality disorders
Weird (paranoid, schizoid [d=distant], schizotypal [t=magical thinking]
Wild (histrionic, borderline, antisocial, narcissitic)
Worried (avoidant, OC, dependent)
Globus sensation
Functional disorder
“feels like something stuck in throat”
Intermittent/persistent
Nothing on eval
Craniopharnyomas arise in who?
From what?
Cause what classic symptom?
In kids
From Rathke’s pouch (calcified on exam)
Bitemporal hemianopsia
Difference between acute and post-traumatic stress disorder?
Acute <1 month
PTSD >1 month
Causes of Lhermitte’s sign
MS
Cobalamin deficiency
Broca’s vs. Wernicke’s aphasia
Broca = broken boca (mouth), comprehension okay Wernickes = word salad, impaired comprehension
Unmyelinated axons
Group C fibers
Autonomic postganglionic fibers
Heat sensation
Burning/dull visceral pain
Normal pressure hydrocephalus
Triad
Expansion of ventricles, elderly Wet, wobbly, wacky Urinary incontinence Ataxia Cognitive dysfunction
Many many lobar hemorrhages?
Amyloid angiopathy
ALS treatment?
Riluzole
HIV dementia path findings
Microglial nodules
May fuse to form giant cells
First sign of uncal herniation
Ipsilateral down and out eye
Hypertensive brain bleeds at initial presentation:
Clean CT
Hyperdense area on CT
Both involve lenticulostiate vessels
Clean CT = arteriosclerosis, small rupture, will be present on CT later
Immediate CT changes = CB rupture, intraparenchymal hemorrhage
Cerebellar lesions/bleeds
Lateral = limbs Medial/vermal = truncal ataxia (wide based gait)
Hydrocephalus due to cortical loss?
Not increased CSF, but cortical atrophy
Hydrocephalus ex-vacuo
Alz dz:
Neurotransmitter changes (where)
Atrophied regions
Decreased Ach in the nuclus basalis
Atrophied cortical and hippocampal areas
Crutzfield Jakob
Prion dz
Rapidly progressive
Grey matter changes
Spongiform encephalopathy
Cerebellar degeneration with extra-CNS cancer
Autoimmune attack
Classic: Small cell lung
Also: Breast/ovarian/uterine
Anti-Yo, anti-P/Q, anti-Hu
