Neuro Flashcards
Narcolepsy sx and signs
Recurrent lapses into sleep or naps >3x a week for 3 months
- cataplexy: brief loss of muscle tone precipitated by strong laughter
- low CSF hypocretin 1
- shortened REM sleep
Associated features
- sleep paralysis
- hypnagogic hallucinations
__________ is a peripheral mononeuropathy caused by compression of the median nerve in the ___________
Carpal tunnel syndrome, carpal tunnel
- long history of dialysis can get beta2 microglobulin (amyloid associated) deposits in carpal tunnel
- 1st three digits and radial half of 4th
Obstruction of the _________ can cause enlarged lateral and third ventricles but a normal 4th ventricle
Cerebral aqueduct
Obstruction of the _________ would cause enlargement of all 4 ventricles
Foramen of magendie and lushka
Symptoms of organophosphate poisoning
“Tool shed”
Lacrimation, bradycardia, diaphoresis, bronchospasm, salivation,miosis
What chromosome is the amyloid precursor protein located on?
Long arm of 21- why Alz is associated with Down syndrome and it encodes transmembrane protein
Halogenated Anesthetics are associated with what side effect from CYP450 system
Acute hepatitis that presents a few days later with fever, Jaundice
Orbital floor fracture sx
Can see loss of sensation CN V because infraoribital nerve is branch of maxillary
Dopamine agonists directly ________ dopamine receptors
Stimulate
- ergot: bromocriotine
- non-ergot: pramipexole, roprinarole
Beta endorphin and ________ are both derived from POMC
ACTH, MSH
Rupture of bridging veins
Subdural hematoma: young- motor vehicle accident, elderly-minor trauma
Blood between dura and arachnoid
Crescent shaped mass
Rupture of berry anurysm or atriovenous malformation
Subarachnoid hemorrhage: WORST HEADACHE OF MY LIFE, anterior communicating artery most common
-blood between arachnoid and pia matter
Rupture of middle meningeal artery
Epidural hemorrhage, typ have a lucid interval followed by loss of consciousness
Biconvex hematoma
- associate with fracture of TEMPORAL bone
- damage between bone and dura matter
Syringomelia
Loss of upper extremity and pain temperature sensations, upper extremity weakness and hyporeflexia, lower extremity weakness and hyoerreflexia, Kyphoscoliosis
Central cystic dilation in Cervical spinal cord and damages ventral white commisure and anterior horns
ALS sx and tx
BOTH UPPER AND LOWER MOTOR NEURONS AFFECTED
- lose neurons in anterior horn and demyelination of lateral corticospinal tract
- loss neurons in motor nuclei: CN 5,9,10,12
Rx: riluzole- dec glutamate release
Facial nerve functions (4 bullets)
- Motor out put to facial muscles
- Parasympathetic to lacrimal, submandibular, and sublingual salivary glands
- special after end for taste of ANTERIOR 2/3 tongue
- somatic afferents from pinna and external auditory canal
Atropine can ________ HR and can lead to _________ in the eye which leads to
Increase, intraocular pressure, Acute closed angle glaucoma “eye pain”
Multiple sclerosis leads to demyelination with leads to ______
Decreased saltatory conduction
The ________ is a paired Brainstem nucleus located in posterior rostral pons near the lateral floor of the fourth ventricle and functions as _________ synthesis
Locus ceruleus, norepinephrine
Diabetics is associated with CN 3 mononeuropathy that is caused by _______ and presents as ______
Ischemic nerve damage, acute onset diplopia and “down and out”
Patients with Down syndrome are likely to get early on set _______. Levels of what are elevated in them?
Alzheimer’s, serum amyloid precursor protein (early onset Alz)
Late onset Alzheimer’s is associated with inc _______
Apolipoprotein E
Hydrocephalus shows enlarged _________ on imaging. Sx are:
Ventricles, macroceohaly and poor feeding, hyperreflexia, development delay, bulging fontanelle
Hemorrhage with CN 3 nerve palsy is common in berry aneurysms. Which side of brain is affected
The ipsilateral posterior communicating artery
HIV associated dementia involves ________ of microglial cells
Inflammatory activation
Temporomandibular disorder
Problems with TMJ joint and muscles of mastication (pterygoid, masseuse, temporalis)
MANDIBULAR nerve affected
Tongue innervation
1) anterior 2/3 taste
2) anterior 2/3 sensory
3) posterior 1/3 taste, posterior 1/3 sensory, posterior motor
1) chorda tympani (of facial nerve)
2) mandibular division of trigeminal nerve
3) glossopharyngeal
Buprenorphine is a partial opioid _______ and in people on long term opioid therapy can precipitate _________
Agonist, withdrawal
Valproate is a great broad spectrum antiepileptic that covers ______
Absence and tonic clonic seizures
Phrenic nerve is levels C ____ and irritation can cause ______,_______, and ________
C3-5, hiccups, referred shoulder pain, dyspnea
What is cushings triad?
Hypertension, bradycardia, respiratory depression
Damage to Brainstem at or below the red nucleus leads to ________ posturing due to predominance form unopposed vestibulospinal tract
Extensor
Damage to levels above red nucleus (cerebral hemispheres, internal capsule) leads to _________ posturing
Flexor
_______ ________ is the most common cause of spontaneous lobar hemorrhage esp >60 yrs old
Amyloid angiopathy
Cavernous hemangiomas are associated with
Seizures and intracerebral hemorrhage
Cystic tumor of the cerebellum in a child with hair-like glial processed associated with microcysts, rosenthal fibers, granular eosinophilia bodies
Pilocytic astrocytoma
Primitive neuroectodermal tumor in posterior fossa, scant cytoplasm and little stroma, homer Wright rosettes
Medulloblastoma
Demyelination would decrease the _______ constant and increase the ________ constant
Length (dec the distance an impulse can travel), time ( slower impulse conduction)
Myelin _______ charge dissipation by _________ membrane resistance
Reduces, increasing
Propionyl coA is derived from which four amino acids? Deficiency of propionyl coA carboxylase leads to _______ and sx are?
Valine
Threonine
Isoleucine
Methionine
Propionic acidemia
Sx:Lethargy, poor feeding, vomiting, hypotonia
Optimal location for lumbar puncture is _____ or ___. Use the ______ as a landmark
L3/4 or L4/5, iliac crest
How does opioid abuse affect HR, pupils, and BP?
Miosis, bradycardia, hypotension
__________ are the most common pineal gland tumor
Germinomas,
Sx: obstructive hydrocephalus ( papilledema, headache, vomiting) and dorsal midbrain syndrome: limited upward gaze, bilateral eyelid retraction
Craniopharyngiomas are derived from ______ and show ______ areas. These areas are filled with _______ with the presence of cholesterol
Rathkes pouch, cystic, brownish yellow fluid
Obturator nerve _____ the thigh
Adducts
Dandy walker malformation is characterized by ________ of the cerebellum vermis and ______ of the 4th ventricle. Sx include:
Hyperplasia/ absence, cystic dilation
Developmental delay, progressive skull enlargement
Arnold Chiari malformation is characterized by ______ of the cerebellum vermis and tonsils ____ the foramen magnum
Downward displacement, below
Acute hemorrhage in the cerebellum can lead to
Truncal ataxia, vertigo/nystagmus if flocculonodular lobe is involved
What do you treat restless leg syndrome with?
Dopamine agonist
______ are the most common brain tumors in children and typically present with a cystic mass in the cerebellum
pilocytic astrocytoma
Succinylcholine can cause significant ______and life threatening arrthymias in pts. with burns, myopathies, crush injuries, and denervating injuries or disease
hyperkalemia
in addition to blocking histamine receptors, 1st , gen histamines have anti_______,________, and anti _______ as well
muscarinic, alpha adregergic, serotonergic
so can block ACh receptors—>blurry vision
_________ is the most common brain tumor in old adults and presents with necrosis and hemorrhage in the cerebral hemispheres leading to midline shift
glioblastoma
_______ are small ischemic infarcts involving the deep brain structures and subcortical white matter. Since they are so small they won’t show up on ____.
lacunar, CT
Lacunar strokes involve the ________ and are typically caused by chronic _____ which can lead to ___________
small penetrating arterioles, HTN, hypertensive arteriolar sclerosis
The infusion of ______ without thiamine in wernicke’s encephalopathy worsens the condition and precipitates encephalopathy
glucose
Proliferation of astrocytes in an area of neuron degeneration is called _____. It leads to the formation of a _______ which compensates for the volume loss that occurs after neuronal death
gliosis, glial scar
_______ is the most common complication after a subarachnoid hemorrhage. A _______ is typically given to prevent this
vasospasm, calcium channel blocker
______ is a potent dilator of cerebral vasculature, tachypnea causes hypocapnia and cerebral ______, thereby _____ cerebral blood volume and intracranial pressure
CO2, vasoconstriction, decreasing
__________ occurs in the elderly and presents as ataxia, urinary incontinence, dementia. Bladder control is influenced by descending _______ that run in the distended paraventricular area
normal pressure hydrocephalus, cortical fibers
Pontine micturition center coordinates the ______ of the external urethral sphincter and the _________ of the bladder
relaxation, contraction
Current 3 Alzhemier’s specific drugs
Donepezil (cholinesterase inhibitor), antioxidants (vit E), Memantine (NMDA antagonist)
_____ causes rapidly progressive dementia with myoclonic jerks. Multiple vacuoles are seen in the gray matter of brain
Creutzfeldt Jakob disease
Opsoclonus-myoclonus is a paraneoplastic syndrome associated with _______ that presents as an abdominal mass with ______ catecholamine breakdown products. This tumor typically arises from neural crest cells of the ________
neuroblastoma, increased, adrenal medulla
_______ has perivenular inflammatory cells directed against myelin components
multiple sclerosis
flushed skin and dilated pupils signal
muscarinic antagonism (H1 blocks can lead to antimuscarinic effects)
What are 5 drug classes known for anti-muscarinic effects
H1 receptor antagonists, atropine, tricyclic antidepressants, anti parkinsonian drugs, neuroleptics
What neurotransmitter is commonly lost in Huntingtons
GABA
Radial nerve injury is typically from a _______ fracture and affects the ______ artery
mid-humerus, deep brachial
neuromyelitis optics presents similarly to MS but has normal brain MRI and at 3 contiguous segments on spinal cord lesions and what do you see in CSF?
anti-aquaporin 4 antibodies
______ can be used to prevent vasospasm after subarachnoid hemorrhage. What are these sx?
calcium channel blockers, headaches/confusion
Difference between parkinson’s and essential tremor
- parkinsons has a resting tremor
- essential tremor is worse when holding an object and is familial (Autosomal dominant)
What do you treat essential tremor with?
propanolol
Extra cellular gradient drives which two icons into the cell that leads to a more positive membrane potential
Ca, Na
Extracellular gradient drives ____ into the cell, making the membrane potential more negative
Cl-
Intracellular gradient drives ____ out of the cell making membrane potential more negative
K+
Normal pressure hydrocephalus is the result of ___________ resorption by the arachnoid granaulations. What is the classic triad? What do you see on imaging?
decreased cerebrospinal fluid
- gait difficulties
- cognitive disturbances
- urinary incontinence
ventriclar enlargement that is out of proportion to sulk enlargement
Obstructive hydrocephalus is between the _______ and the _______. Congenital abnormalities or a tumor can lead to this. What sx?
ventricles, subarachnoid space
-n/v, headache
Homebox genes encode __________ that play an important role in segmental organization of the embryo along the _________
DNA binding transcription factors, cranio-caudal
The pupillary light reflex is assed by shining light in an eye and observing the response in that eye (direct) and the opposite eye (consensual). Which nerve controls what
the optic nerve controls the consensual response (afferent), the oculomotor nerve controls the direct(efferent)
What is myopia
near sightedness (image focuses in front of retina)
What is presbyopia
far sightedness (denaturation of lens proteins--> loss accommodation) from REDUCTION in length of ciliary muscles -image focuses behind retina
Presbyopia and wrinkles are _______ changes
age related
latanoprost is _____ that _____ the outflow of aqueous humor and treats open angle glaucoma
prostaglandin, inc
Wet age related macular degeneration is characterized by retinal neovascualrization and inc levels of what? What color do you see on the sub retinal membrane. Tx with what?
Vascular endothelial growth factor (VEGF), gray-greenish, VEGF inhibitor
aqueous humor is produced by the _______ cells of the ciliary body
epithelial
timolol and other non-selective beta blockers work by diminishing the aqueous humor secretion by the
ciliary epithelium
prostaglandins (latanoprost), cholimomimetics (pilocarpine, carbachol) dec intraocular pressure by ____________
inc outflow of aqueous humor
topical preparations of alpha agonists cause vasoconstriction of of nasal mucosa and makes them work as ________. However, overuse of this drug causes _________ feedback, resulting in _____ norepinephrine synthesis which diminishes their effects. This phenomenon is known as what and what other med shows the same effect?
decongestants, negative, dec, tachyphylaxis, nitroglycerine
In conductive hearing loss, ____ conduction will be greater than ____ conduction (abnormal Rienne test) and the Weber test will lateralize to the affected ear(put on middle of forehead)
bone, air
______ lobe lesions lead to personality lesions. ______ sided tend to lead to apathy and depression and ________ sided tend to lead to disinhibited behavior
frontal, left, right
The metencephalon gives rise to what?
cerebellum and pons
The myelencephalon gives rise to what?
medulla
The telencephalon gives rise to what?
cerebral hemispheres (frontal, temporal, parietal, occipital)
The mesencephalon gives rise to what?
midbrain and cerebral peduncles
The diencephalon gives rise to what?
thalamus and hypothalamus
Hyperactivity of the _______ pathway is associated with positive symptoms of schizophrenia
mesolimbic
Low activity of the ________ pathway is associated with negative symptoms of schizophrenia
mesocortical
__________ presents as bilateral wedge shaped strips of necrosis and can occur from shock
hypoxia ischemic encephalopathy
________ typically involves rupture that causes hemorrhage in deep brain structures
charcot bouchard aneurysm
Abusive head trauma in babies can lead to what?
retinal hemorrhages, rib fractures, subdural hematoma
The _________ is the first area damaged during global cerebral ischemia
hippocampus,
also purkinje fibers vulnerable as well
In Alzheimer’s diseases there is dec levels of ________ in the nucleus basilis of Maynert and hippocampus . Diminished activity of _________ in these cerebral is the cause
acetylcholine, dec choline acteyltransferase
A deficiency in __________ leads to hypopigmentation of catecholaminergic brain nuclei
phenylalanine hydroxylase
vitamin ____ deficiency mimics Fredrich’s ataxia with lose of which spinal tracts?
E, spinocerebellar and dorsal columns
Path of CSF flow
lateral ventricles–>inter ventricular foramen of Monro–>third ventricle–> cerebral aqueduct–>4th ventricle–>foramina of Lushka and Magendie–>subarachnoid space
In the subarachnoid space, what is CSF absorbed by?
arachnoid granulations and then it enters the venous sinuses
In _________ the ventricles are symmetrically dilated and it typically is from dysfunction or obliteration of ________ secondary to meningeal infections
communicating hydrocephalus, subarachnoid villi
-there’s no obstruction to CSF flow
In __________ the flow of CSF from the ventriculi to the subarachnoid space is disrupted. What is this typically from?
non-communicating hydrocephalus
-congenital anomalies (aquedeuctal stenosis),
The optimal site for femoral nerve block is the ___________
inguinal crease
neural tube defects can lead to inc levels of what two in amniocentesis
alpha feto protein, acetylcholinesterase
otic ganglion innervates the _____ gland
parotid
what is cerebellar degeneration from alcohol use?
long term alcohol use >10 years, lose Purkinje cells(most prominent in cerebellar vermis
Wernicke encephalopathy triad
encephalopathy, oculomotor dysfunction, ataxia
Be cautious of adding ____ blockers in patients with parkinson’s disease
D2 (like metoclopromide)
tissue ischemia leads to an inc in extracellular ____ concentration and reduces extracellular __,__,___. Cytoplasmic accumulation of ____ is a hallmark of ischemic injury
K+,
Na, Ca, HCO3-
Ca (from dec Na gradient to send Ca out of cell)
What are three typical findings with pineal gland tumors
upward gaze palsy, absent pupillary light reflex, impaired convergence
_______ equilibrium potential contributes the most to neuronal action potential during ________. So a decrease in _______ concentration outside the cell will lead to its equilibrium potential to be closer to 0
Sodium, depolarization, sodium
what brain structure plays a role in subjective emotional experience, pain, body representation, and conscious cravings
insula
Tardive dyskinesia is a _______ induced disorder characterized by abnormal involuntary movements of the mouth, tongue, chorea, trunk. It is due to prolonged exposure to ________ blocking agents causing the _________ of dopamine
medication, dopamine, upregulation and supersensitivity
Dopamine beta hydroxylase is responsible for the synthesis of what to what? what happens in you lack this enzyme
dopamine—>norepinephrine
-impaired SNS activity so get orthostatic hypotension
Neurofibromas are from ________ cells and are numerous fleshy skin nodules and other pigmented lesions
Schwann
Langerhans cell histiocytosis are proliferation of immature ___________ cells with seborrheic rash and pruitic papule involving groin and genital region. Common in what age group?
dendritic mononuclear, children
-S100, CD1a pos
An ____ herniation is when the temporal lobe goes through the tentorium cerebella and leads to _______ pupil
uncal, down and out
Cerebellar tonsilla herniation occurs when the contents of the ________ are forced out the foramen magnum
posterior fossa
neoplastic lesions can lead to midline shift and ___________ by disrupting the blood brain barrier
vasogenic edema
-present with n/v, papilledema
neuronal apoptosis can lead to hydrocephalus ________
ex vacuo
timolol/ other nonselective beta blockers and acetazolamide treat glaucoma by ____
dec aqueous humor from the ciliary epithelium
cholinomemetics treat glaucoma by _________
miosis—>contraction of sphincter of iris–>wider anterior chamber angle and makes trabecular meshwork more accessible to outflow of aqueous humor
Sumatriptan is abortive therapy for what headache?
migraine
What are 3 prophylactics for migraine headaches?
verapamil, propanolol, amitryptiline
What is abortive tx for cluster headache
oxygen
hallucinations signal what dementia?
Lewy body
What do you see on path for frontotemporal dementia?
silver staining intranuclear inclusions
a destructive expanding mass of keratinizing squamous epithelium within the middle ear
cholesteatoma
characterized by abnormal bone deposition at the footplate that leads to fixation of the stapes at the oval window, preventing normal vibration, presents as bilateral conductive hearing loss
otosclerosis
unilateral vision loss and pt. says that it seems like a curtain is over their eye and see “floaters”
retinal detachment
In Huntington’s _____ dopamine and _____ GABA leads to chorea
inc dopamine, dec GABA
In Parkinson’s there is ____ dopamine in what two areas
dec, substantia nigra and pars compacta of the basal ganglia
In the ear, high frequency sounds are sensed at the ______ of the basilar membrane and low frequency sounds are sensed at the ______ of the basilar membranr
base, apex
Whatever ear the Weber test localizes to is the normal ear so if CN 8 is messed up, it will be for the _______ nerve
opposite
Both the sympathetic and parasympathetic nervous systems have ______ receptors on the postganglionic neurons
nicotinic AcH
auditory pathway:
lateral leminscus contains fibers from contralateral nuclei and both superior olivary nuclear complexes—> inferior colliculus in midbrain—>medial geniculate nucleus in the thalamus
lesions of the right parietal lobe often cause left sided ________
hemineglect
-the left hemisphere is responsible for awareness of the right visual field, where the right hemisphere is responsible for awareness of both left and right visual fields
(only shaving right side of face, only drawing half clock on right side)
Guillan Barre attacks _________
between myelin sheath of axons
The __________cerebellum is responsible for rapid eye movements, posture and balance,
vestibulocerebellum
The _________cerebellum is most damaged by chronic alcohol abuse and is responsible for trunk balance and helps regulate limb movements
spinocerebellum
The __________cerebellum is responsible for the fine movements of the hands/face, motor planning, coordination of complex motor tasks
cerebrocerebellum
The ________ nucleus of the thalamus receives input form the trigeminal and gustatory pathways and is responsible for sensation of face as well as taste
ventral poster-medial nucleus (VPM)
The _______ nucleus of the thalamus receives input from spinothalamic and DCML tracts. It’s the primary output to the somatosensory cortex
ventral postero-lateral nucleus (VPL)
The ________ receives input from CN 2 and is responsible for sense of vision and its output so to calcimine sulcus
lateral geniculate nucleus
The ________ receives input from superior olive and inferior colliculus and is responsible for sense of hearing and gives auditory output to auditory cortex of temporal lobe
medial geniculate nucleus
decorticate posturing is the same as
spastic flexion of upper extremities
decerebrate posturing is the same as
spastic extension of the upper extremities
The corticospinal tract normally inhibits the ____ nucleus (_______ tract) and when not inhibited leads to _________ posturing
red, rubrospinal tract, decorticate
Tau protein is an element of the _______ and is the primary constituent of __________. This is more likely when Tau is _________phosphorylated
cytoskeleton, neurofibrillary tangles, hyper–>aggregates
________ presents with sudden onset of vestibular symptoms (vertigo, peripheral nystagmus) and nausea, vomiting, imbalance
Vestibular neuritis
-the nystagmus worsens by gaze to healthy side and diminishes with gaze to affected side
____________ is a sudden cause of vestibular dysfunction. However, it’s intermittent and attacks are precipitated by a change in the head
Benign positional vertigo
ConVEX hyperdensity on Brain CT
Epidural hematoma
CONCAVE hyperdensity on Brain CT
Subdural hematoma
If Brown Sequard occurs above T1, can see ipsilateral
Horner’s syndrome
-damage to hypothalamus has potential to cause
lysosomal rupture is a ________ part of cell death
irreversible
