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Neuro Flashcards

1
Q

Ectoderm differentiates into

A

neuroectoderm –> neural plate –> neural tube and neural crest cells

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2
Q

Notochord becomes

A

nucleus pulposus of intervertebral disc in adults

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3
Q

Alar plate

A

Dorsal

sensory

lateral nuclei

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4
Q

Basal plate

A

Ventral

motor

Medial nuclei

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5
Q

We begin with what three primary vesicles in embryonic development

A

Forebrain (prosencephalon) –> (telencephalon and diencephalon)
Midbrain (mesencephalon) –> Mesencephalon
Hindbrain (rhombencephalon) –> Metencephalon and myelencephalon

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6
Q

The three primary vesicles become these 5 secondary vesicles. What do the 5 secondary vesicles become

A 
Telencephalon (1st) 
Diencephalon (2nd)
(rest is alphabetical order)
Mesencephalon
Metencephalon
Myelencephalon

The 5 secondary vesicles become adult derivatives of walls and cavities

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7
Q

Telencephalon becomes

A

Cerebral hemisphere and lateral ventricles

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8
Q

Diencephalon becomes

A

Thalamus, hypothalamus, third ventricle

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9
Q

Mesencephalon becomes

A

Midbrain and cerebral aqueduct

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10
Q

Metencephalon becomes

A

Pons, cerebellum, upper part of 4th ventricle

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11
Q

Myelencephalon becomes

A

Medulla and lower part of fourth ventricle

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12
Q

Neural crest forms

A

PNS neurons and schwann cells

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13
Q

Mesoderm forms

A

Microglia (like macrophages)

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14
Q

Neural tube defects

A

Neuropores fail to fuse (4th week) and persistent connection between amniotic cavity and spinal canal

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15
Q

What labs can you look at for neural tube defect detection

A 
AFP elevated (except in spina bifida occulta)
Increase in AChE as a confirmatory test
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16
Q

Failure of caudal neuropore to close but no herniation. Usually seen at lower vertebral levels and the dura is intact. Associated with tuft of hair or skin dimple at level of bony defect

A

Spina bifida occulta

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17
Q

Meninges (but no neural tissue) hernaites through bony defect and associated with spina bifida cystica

A

Meningocele

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18
Q

Meninges and neural tissue herniate through bony defect

A

Meningomyelocele

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19
Q

Also known as rachischisis. Exposed unfused neural tissue without skin/meningeal covering

A

Myeloschisis

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20
Q

Failure of rostral neuropore to close. No forebrain, open calvarium. Can see polyhydramnios (no swalling center in brain)

A

Anencephaly

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21
Q

Failure of the left and right hemispheres to separate. Moderate form shows cleft lip/palate, while more severe forms result in cyclopia. MRI can show a monoventricle and fusion of basal ganglia. What mutation and genetic defects is this related to?

A

Mutations in sonic hedgehog signaling pathway
Trisomy 13
Fetal alcohol syndrome

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22
Q

Ectopia/displacement of cerebellar tonsils

A

Chiari I malformation

congenital, usually asymptomatic in childhood and manifests in adulthood with headaches and cerebellar symtoms

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23
Q

Herniation of low lying cerebellar vermis and tonsils through foramen magnum with aqueductal stenosis causing hydrocephalus

A

Chiari II malformation

lumbosacral meningomyelocele is associated

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24
Q

Agenesis of cerebellar vermis leads to cystic enlargement of 4th ventricle that fills the enlarged posterior fossa

A

Dandy-walker syndrome

associated with noncommunicating hydrocephalus, spina bifida

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25
Q

Cystic cavity within central canal of signal cord. Patient presents with cape like, bilateral symmetrical loss of pain and temperature sensation in upper extremities. Fine touch sensation is preserved

A

Syringomyelia - a cyst forms within your spinal cord. As this fluid-filled cyst, or syrinx, expands and lengthens over time, it compresses and damages part of your spinal cord from its center outward

Fibers crossing in anterior white commissure (spinothalamic tract) are typically damaged first

associated with chiari malformation

most common at C8-T1

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26
Q

CN for taste

A

CN VII, IX, X (solitary nucleus)

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27
Q

CN for pain in tongue

A

CN V3,IX, X

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28
Q

CN for Motor in tongue

A

CN X, CN XII

CN XII is to the hyoglossus that retracts and depresses the tongue, genioglossus which protrudes tongue, and styloglossuswhich draws tongue upward to create a trough for swallowing

CN X to the palatoglossus which elevates posterior tongue during swallowing

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29
Q

What brachial arches form the anterior 2/3 of tongue

A

1st and 2nd

sensation CN V3
Taste CN VII

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30
Q

What brachial arches formt he posterior 1/3 of tongue

A

3rd and 4th

Sensation and taste from CN IX
Extreme posterior is CN X

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31
Q

What kind of stain do you use to see the cell bodies and dendrites of neurons

A

Nissl stain which stains the RER

doesnt stain the axon because the axon does not have any RER

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32
Q

Injury to axon causes degeneration of axon distal to site of injury and axonal retraction proximally

A

Wallerian degeneration

allows for potential regeneration of axon (if in PNS)

macrophages remove debris and myelin

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33
Q

Most common glial cell type in CNS.

A

Astrocytes which are responsible for physical support, repair,extracellular K+ buffer, removal of excess NT, component of BBB, glycogen fuel reserve buffer

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34
Q

What are astrocytes derived from

A

neuroectoderm

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35
Q

Astrocyte marker

A

GFAP

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36
Q

Phagocytic scavenger cells of CNS that respond to tissue damage

A

HIV infected microglia fuse to form multiucleated giant cells in CNS

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37
Q

Glial cells with a ciliated simple columnar form that line the ventricles and central canal of spinal cord. Apical surfaces are covered in cilia (which circulate CSF) and microvilli (which help in CSF absorption)

A

ependymal cells

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38
Q

Function of myelin

A

Increase conduction velocity of signals transmitted down an axon

nodes of ranvier have high coentration of Na channels

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39
Q

What type of cells synthesize myelin the CNS (including CN I and II)

A

“COPS”

oligodendrocytes derived from neuroectoderm

1 oligodendrocyte per many CNS axons

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40
Q

What type of cells synthesize myelin in the PNS ( Including CN III-XII)

A

“COPS”

Schwann cells derived from neural crest

1 schwann cell per PNS axon

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41
Q

What type of cell is damaged in Guillian Barre syndrome

A

Schwann cells

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42
Q

What type of cell is damaged in MS, progressive multifocal leukoencephalopathy (PML), leukodystrophies

A

Oligodendrocytes

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43
Q

Free nerve endings

A

C- slow, unmyelinated fibers
Aδ- fast, myelinated fibers

skin, epidermis, some viscera

pain and temperature

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44
Q

Meissner corpuscles

A

Large myelinated fibers that adapt quickly

Gabrous (hairless)skin

dynamic, fine/light touch, position sense

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45
Q

Pacinian corpuscles

A

Large myelinated fibers that adapt quickly

Deep skin layers, ligaments, and joints

vibration and pressure

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46
Q

Merkel disc

A

Large myelinated fibers that adapt slowly

finger tips and superficial skin

pressure, deep static touch, position sense

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47
Q

Ruffini corpuscles

A

Dendritic ending with capsule; adapt slowly

finger tips, joints

pressure. slippage of objects along surface of skin, joint angle change

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48
Q

Peripheral nerve layers

A

Endoneurium (inner layer) - around single nerve fibers
Perineurium (around, blood nerve permeaility barrier) - surrounds each fasicle of nerve fibers
Epineurium (outer layer) - dense CT that surrounds entire nerve (fasicles and blood vessels)

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49
Q

inflammatory infiltrate in Guillain barre syndrome involves what layer of peripheral nerve

A

Endoneurium

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50
Q

Reaction of neuronal cell body to axonal injury that is concurrent with wallerian degeneration

A

Chromatolysis

changes reflect increased protein synthesis in an effort to repair the damaged axon

  • Round cellular swelling
  • Displacement of the nucelus to the periphery
  • Dispersion of Nissl substance throughout the cytoplasm
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51
Q

Location of synthesis of ACh

A

Basal nucleus of Meynert

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52
Q

Location of synthesis of Dopamine

A

Ventral tegmentum, SNc

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53
Q

Location of synthesis of GABA

A

Nucleus accumbens

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54
Q

Location of synthesis of NE

A

Locus ceruleus

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55
Q

Location of synthesis of serotoning

A

Raphe nucleus

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56
Q

NT levels in anxiety

A

low GABA and serotonin

high NE

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57
Q

NT levels in Depression

A

low dopamine, NE, serotonin

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58
Q

NT levels in schizo

A

high dopamine

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59
Q

NT levels in alzheimers dz

A

low ACh

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60
Q

NT levels in huntington disease

A

low ACh and GABA

high Dopamine

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61
Q

NT levels in parkinson disease

A

low dopamine and serotonin

high ACh

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62
Q

Meninges layers

A 
Dura mater (from mesoderm)
Arachnoid mater (neural crest)
Pia mater (neural crest)
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63
Q

Epidural

A

a potential space between the dura mater and skull containing fat and blood vessels

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64
Q

The blood brain barrier is formed by 3 structures

A
  • tight junctions between nonfenestrated capillary endothelial cells
  • basement membrane
  • astrocyte foot processes
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65
Q

Can glucose and AA cross the BBB

A

yes they cross slowly by carrier mediated transport mechanisms

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66
Q

Can non polar/lipid soluble substances cross the BBB

A

yes rapidly via diffusion

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67
Q

effect of infarction or neoplasm on BBB

A

destroys endothelial cell tight junctions causing vasogenic edema

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68
Q

Hypothalamus

A

maintains homeostasis

TAN HATS

Thirst
Adenohypophysis
Neurohypothysis
Hunger
Autonomic NS
Temperature
Sexual urgers
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69
Q

What parts of the hypothalamus are not protected by the BBB

A

OVLT which senses changes in osmolarity

Area postrema found in medulla and responds to emetics

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70
Q

Lateral nucleus (Hypothalamus)

A

hunger

+ ghrelin
- leptin

injury: lateral injury makes you lean

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71
Q

Ventromedial nucleus (Hypothalamus)

A

Satiety

+ leptin

injury: VentroMedial injury makes you Very Massive

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72
Q

Anterior nucleus (Hypothalamus)

A

Cooling and parasympathetics

“ANTartica”

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73
Q

Posterior nucleus (Hypothalamus)

A

Heating and sympathetics

“Hot Pot”

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74
Q

Suprachiasmatic nucleus (SCN) of Hypothalamus

A

Circadian rhythm

“charismatic people need to sleep”

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75
Q

Supraoptic and paraventricular nuclei (Hypothalamus)

A

Synthesize ADH and oxytocin

which are carried by neurophysins down axons to the posterior pituitary

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76
Q

Preoptic nucleus (Hypothalamus)

A

thermoregulation and sexual behavior

releases GnRH

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77
Q

Kallman syndrome (Hypothalamus)

A

failure of GnRH producing neurons to migrate from olfactory pit

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78
Q

Vomiting is coordinated by what? where is it located? where does it receive information from?

A
  • nucleus tractus solitarius (NTS) in the medulla
  • receives info from the chemoreceptor trigger zone (CTZ within area postrema in 4th ventricle), GI tract via vagus, vestibular system, CNS
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79
Q

The 5 major receptors in the CTZ

A

muscarinic (M1), dopamine (D2), histamine (H1),serotonin (5HT3), and neurokinin (NK-1)

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80
Q

____,____,____ antagonists used to treat chemotherapy induced vomiting

A

5HT3
D2
NK-1

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81
Q

____ and ____ antagonists used to treat motion sickness and hyperemesis gravidarum

A

M1 and H1

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82
Q

Circadian rhythm controls nocturnal release of ___, ____, ____, ____

A

ACTH
Prolactin
Melatonin
NE

SCN –> NE release—> pineal gland –> melatonin

SCN is regulated by the environment

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83
Q

Effect of alcohol, benzos, and barbiturates on sleep cycle

A

decrease REM sleep and delta wave sleep

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84
Q

Sleep cycle stages

A

Awake eyes open –> Beta (high f, low amp)
Awake eyes closed –> Alpha
Non-REM sleep
-Stage N1 (light sleep) –> theta
-Stage N2 (deeper sleep) –> sleep spindles and K complexes
-Stage N3 (deepest non-REM sleep, slow wave) –> Delta
-REM sleep –> Beta waves

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85
Q

What stage of sleep does bruxism occur

A

Stage N2 of non REM sleep

sleep spindles and K complexes

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86
Q

What stage of sleep does sleep walking, night terrors, and bedwetting occur

A

Stage N3 of non REM sleep

Delta wave

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87
Q

Stage of sleep where there is a loss of motor tone, increased brain O2 use, increased and variable pulse and blood pressure, increase ACh

A

REM sleep

occurs every 90 minutes and duration increases through the night

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88
Q

What stage of sleep do you experience dreaming, nightmares, penile/clitoral tumescence, and may serve a memory processing function

A

REM sleep

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89
Q

extraoccular movements are due to activity of

A

PPRF or paramedian pontine reticular formation or conjugate gaze center

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90
Q

Ventralposterolateral nucleus (thalamus)

A

Input: spinothalamic and dorsal columns/medial lemniscus

Senses: vibration, pain, pressure,proprioception, light touch, temperature

Destination: primary somatosensory cortex

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91
Q

Ventralposteromedial nucleus ((thalamus)

A

Input:Trigeminal and gustatory pathway

Senses: Face sensation, taste

Destination: primary somatosensory cortex

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92
Q

Lateral geniculate nucleus ((thalamus))

A

Input:CN II, optic chiasm, optic tract

Senses: vision

Destination: Calcarine sulcus

lateral …think “light”

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93
Q

Medial geniculate nucleus ((thalamus))

A

Input:superior olive and inferior colliculus of tectum

Senses: Hearing

Destination: auditory cortex of temporal lobe

medial…think “music”

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94
Q

Ventral lateral nucleus (thalamus)

A

Input: Basal ganglia

Senses: Motor

Destination: Motor cortex

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95
Q

Limbic system is responsible for

A

emotion, long term memory, olfaction, behavior modulation, ANS function

5 F: Feeding, Fleeing, Fighting, Feeling, (Fucking)Sex

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96
Q

Structures of the limbic system

A

hippocampus, amygdala, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, entorhinal cortex

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97
Q

Mesocortical (Dopaminergic pathways)

A

decreased activity causes negative symptoms

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98
Q

Mesolimbic (Dopaminergic pathways)

A

inceased activity causes positive symptoms

primary target of antipsychotic drugs which decrease positive symptoms

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99
Q

Nigrostriatal (Dopaminergic pathways)

A

decreased activity causes extrapyramidal symptoms

significantly affected by mvoement disorders and antipsychotic drugs

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100
Q

Tuberoinfundibular(Dopaminergic pathways)

A

decreased activity causes increase in proalctin and decreased libido, sexual dysfunction, galactorrhea, gynecomastia

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101
Q

Input into cerebellum

A

contralateral cortex via middle cerebellar peduncle

ipsilateral proprioceptive info via inferior cerebellar peduncle from spinal cord

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102
Q

Output into cerebellum

A

The only output of cerebellar cortex is the purkinje cells which are always inhibitory –> deep nuclei of cerebellum –> contralateral cortex via superior cerebellar peduncle

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103
Q

Deep nuclei from lateral to medial

A

Dentate, Emboliform, Globose, Fastigial

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104
Q

Lateral lesion to cerebellum

A

Affects LATERAL structure

voluntary movement of extremities

fall toward injured side (ipsilateral)

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105
Q

Medial lesion to cerebellum

A

affects MEDIAL structures

truncal ataxia (wide based cerebellar gait) , nystagmus, head tilting.

Bilateral motor defects affecting axial and proximal limb musculature

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106
Q

Basal ganglia

A

voluntary movements and making postural adjustments

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107
Q

Basal ganglia’s striatum =

A

putamen (motor) + caudate (cognitive)

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108
Q

Basal ganglia’s Lentiform =

A

putamen + globus pallidus

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109
Q

Basal ganglia’s D1 receptor

A

direct pathway

Dopamine binds to D1 to stimulate the excitatory pathway

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110
Q

Basal ganglia’s D2 receptor

A

Indirect
Inhibitory pathway

Dopamine binds to D2 to inhibit the inhibitory pathway and increase motion

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111
Q

Direct (excitatory) pathway

A

Substantia nigra input stimulates the striatum causing GABA release

The release of GABA inhibits GABA release from the GPi (globus pallidus)

This causes DISINHIBITION of thalamus and therefore increased movement

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112
Q

Indirect (inhibitory) pathway

A

Substantia nigra input stimulates the striatum which releases GABA that DISINHIBITS the subthalamic nucleus via GPe inhibition

Subthalamic nucleus stimulates the GPi (globus pallidus) to inhibit the thalamus and therefore decreases movement

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113
Q

What is cerebral perfusion primarily driven by

A

PCO2

hypoxemia increases CPP only if PO2 <50 mmHg
CPP is directly proportional to PCO2 until PCO2>90 mmhg

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114
Q

Cerebral perfusion pressure equation

A

MAP-ICP

if CCP=0 then braindeath

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115
Q

How does therapeutic hyperventilation affect the CCP (cerebral perfusion pressure)

A

It causes a drop in PCO2 which results in vasoconstriction and ultimately decreased cerebral blood flow and drop in intracranial pressure (ICP)

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116
Q

Anterior cerebral artery supplies

A

anteromedial surface

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117
Q

Middle cerebral artery supplies

A

lateral surface

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118
Q

Posterior cerebral artery supplies

A

posterior and inferior surfaces

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119
Q

Watershed zones in the brain

A

between anterior cerebral/middle cerebral (cortical border zone)
between posterior cerebral/middle cerebral (cortical border zone)

Superficial and deep vascular territories of the middle cerebral artery (internal border zone)

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120
Q

circle of willis pathway

A

The vertebral arteries join to form the basilar artery

the basilar artery bifurcates into the posterior cerebral artery

the posterior cerebral artery communicates with the middle cerebral artery with the posterior communicating branch

The middle cerebral artery joins the anterior cerebral artery to form the internal carotids

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121
Q

Dural venous sinuses drain into

A

internal jugular vein

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122
Q

Dural venous sinus drainage pathway

A

Superior sagittal sinus, straight sinus, and occipital sinus. join to form the confluence of sinuses

Then proceeds to drain into the left and right transverse sinuses. –> sigmoid –> jugular foramen –> internal jugular vein

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123
Q

Venous sinus thrombosis

A

Patient presents with the signs and symptoms of increased ICP

can lead to venous hemorrhage

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124
Q

Ventricles

A

The lateral ventricles drain into the third ventricle via the right and left interventricular foramina of monro

The third ventricle (chicken head) then drains into the 4th ventricle via cerebral aqueduct of sylvius

The 4th ventricle drains into the subarachnoid space via the foramina of luschka (lateral) and the foramina of Magendie (medial)

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125
Q

CSF made by

A

ependymal cells of choroid plexus

then reabsorbed by arachnoid granulations and then drains into dural venous sinuses

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126
Q

CNs and where they exit from

A

4 exit above the pons - 1,2,3,4
4 exit the pons-5,6,7,8
4 are in the medulla - 9,10,11,12
4 nuclei are medial - 3,4,6,12 (factors of 12)

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127
Q

Pineal gland

A

melatonin secretion and circadian rhythms

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128
Q

Superior colliculi

A

direct eye movements to stimuli or objects of interest

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129
Q

Inferior colliculi

A

auditory

note: superior is eyes and inferior is ears. The eyes are above the ears

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130
Q

Cranial nerve nucleis

A

located in tegmentum portion of brain stem (between the dorsal and ventral portions)

Midbrain - nuclei of CN 3 and 4
Pons- nuclei of CN 5,6,7,8
Medulla- nuclei of CN 9,10,12
Spinal cord- nuclei of CN 11

131
Q

Cranial nerve pathway: CN I

A

cribriform plate

132
Q

Cranial nerve pathway: CN 2

A

optic canal

133
Q

Cranial nerve pathway: CN 3,4,6,V1

A

Superior orbital fissure

134
Q

Cranial nerve pathway: V2

A

foramen rotundum

135
Q

Cranial nerve pathway: V3

A

foramen ovale

136
Q

Cranial nerve pathway: Middle meningeal A

A

foramen spinosum

137
Q

Cranial nerve pathway: CN 7 and 8

A

internal auditory meatus

138
Q

Cranial nerve pathway: CN 9,10,11 jugular vein

A

jugular foramen

139
Q

Cranial nerve pathway: CN 12

A

hypoglossal canal

140
Q

CN types (sensor vs motor)

A

CN 1-12

Some
Say
Marry
Money
But
My
Brother
Says 
Big
Brains 
Matter
Most
141
Q

CN for taste from anterior 2/3? posterior 1/3?

A

anterior 2/3 - facial

posterior 1/3 -glossopharyngeal

142
Q

Nucleus solitarius (vagal nuclei)

A

visceral sensory info

CN 7,9,10

S=sensory

143
Q

Nucleus ambiguus (vagal nuclei)

A

motor innervation of pharynx, larynx, upper esophagus

CN 9,10,11

M=muscle

144
Q

Dorsal motor nucleus (vagal nuclei)

A

sends autonomic (parasympathetic) fibers to heart, lung, upper GI

CN 10

145
Q

Cranial nerve reflex: corneal

A

afferent: V1 opthalmic (nasociliary branch)
efferent: bilateral VII (temporal branch: orbicularis oculi)

146
Q

Cranial nerve reflex: lacrimal

A

afferent: V1
efferent: VII

147
Q

Cranial nerve reflex: jaw jerk

A

afferent: V3
efferent: V3

148
Q

Cranial nerve reflex: pupillary

A

afferent: II
efferent: III

149
Q

Cranial nerve reflex: Gag

A

afferent: IX
efferent: X

150
Q

Muscles of mastication and their innervation

A

3 muscles needed to close jaw: masseter, temporalis, medial pterygoid

1 muscle opens: lateral pterygoid

nerve: V3

151
Q

Do spinal nerves exit above or below the vertebrae?

A

C1-C7 exit above
C8 below C7
Rest below

152
Q

Where does the spinal cord end for adults

A

at the lower border of L1-L2

but the subarachnoid space extends to lower border of S2 vertebra

153
Q

At what level do you do a lumbar puncture

A

L3-L4 or L4-L5

“to keep the spinal cord alive, keep the spinal needle between L3 and L5”

154
Q

Spinal cord and associated tracts: corticospinal (Descening) and spinothalamic (Ascending)

A

legs (lumbosacral) are lateral in lateral corticospinal, spinothalamic tracts

155
Q

Spinal cord and associated tracts: dorsal colum

A

Dorsal columns - pressure, vibration, fine touch, proprioception

arms outside - fasciculus cuneatus (upper body, arms)
legs insidem - fasciculus gracilis (lower body, legs)

156
Q

Spinothalamic tract

A

lateral spinothalamic tract - pain and temp

Anterior spinothalamic tract - crude touch, pressure

157
Q

Corticospinal tract

A

lateral corticospinal tract - voluntary motor

Anterior corticospinal tract-voluntary motor

158
Q

Dorsal column tract

A

1st order neuron: sensory nerve ending enter dorsal root ganglion and ascend spinal cord ipsilaterally in dorsal column

Synapse: nucleus gracilis, nucleus cuneatus of ipsilateral medulla

2nd order neuron: decussates in medulla and ascends contralaterally as the medial lemniscus

Synapse: VPL (thalamus) –> sensory cortex

159
Q

Spinothalamic tract pathway

A

1st order neuron: sensory nerve ending (Aδ and C fibers) to dorsal root ganglion and enter spinal cord

Synapse: ipsilateral gray matter of spinal cord

2nd order neuron: decussayes in spinal cord as the anterior white commissure ascends contralaterally

synapse: VPL (thalamus) –> sensory cortex

160
Q

Lateral corticospinal tract pathway

A

1st order neuron: UMN ; cell body in primary motor cortex descends ipsilaterally through posterior limb of internal capsule. Decussate at caudal medulla and descend contralaterally

synapse 1: cell body of anterior horn of spinal cord

2nd order neuron: LMN leaves spinal cord

Synapse 2: NMJ –> mm fibers

161
Q

______ tracts synapse and then cross

A

ascending

162
Q

Cremasteric reflex

A

L1 L2

testicles move

163
Q

Anal wink reflex

A

S3 S4

winks galore

164
Q

triceps reflex

A

C7 C8

165
Q

baby reflex where abducts/extends arms when startled and then draw together

A

Moro reflex

166
Q

baby reflex where move head towards one side if cheek or mouth is stroked

A

nipple seeking due to rooting reflex

167
Q

Sucking response when roof of mouth is touched in infant

A

sucking reflex

168
Q

curling fingers if palm is stroked in infant

A

palmar reflex

169
Q

dorsiflexion of large toe and fanning of other toes with plantar stimulation in baby (babinski)

A

plantar reflex

170
Q

Stroking alone one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of lower body toward stimulated side

A

galant reflex

171
Q

Landmarks for dermatomes:

C2,C3,C4,C6,T4,T7,T10,L1,L4,S2,S3,S4

A 
C2 - posterior half of skull
C3- turtle neck shirt
C4-low collar shirt
C6-includes the thumb (thumbs up sign on left hand looks like a 6)
T4-at the nipple
T7-xiphoid process
T10-umbilicus
L1-inguinal ligament
L4-includes the kneecaps
S2,S3,S4-penile and anal zone sensations
172
Q

Eye looks towards (destructive)side of lesion. Location?

A

Frontal eye fields

173
Q

Disinhibition and deficits in concentration, orientation, and judgement. Location?

A

Lesion in frontal lobe

174
Q

Eye looks away from side of lesion during irritative seizure.Location?

A

frontal eye fields

175
Q

Eyes look away from side of lesion. Ipsilateral gaze palsy where they are unable to look towards side of lesion. Location?

A

Paramedian pontine reticular formation

176
Q

Internuclear ophthalmoplegia (impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction). Seen with MS. Location?

A

Medial longitudinal fasciculus

177
Q

Gerstmann syndrome. Agraphia, acalculia, finger agnosia, left/right disorientation. Location?

A

Dominant parietal cortex

178
Q

Hemispatial neglect syndrome - agnosia of the contralateral side of the world. Location?

A

Nondominant parietal cortex

179
Q

Anterograde amnesia - cant make new memories . Location?

A

Hippocampus B/L

180
Q

Parkinsons, huntington dz : tremor at rest, chorea, athetosis. Location?

A

Basal ganglia

181
Q

Contralateral hemiballismus. Location?

A

Subthalamic nucleus

182
Q

Confusion, ataxia, nystagmus, ophthalmoplegia, memory loss as anterograde and retrograde, confabulation, personality changes. Syndrome? Location?

A

wernicke korsakoff syndrome

mammollary bodies b/l

183
Q

Disinhibited behavior related to HSV-1 encephalitis. Syndrome? Location?

A

Kluver Bucy syndrome

amygdala b/l

184
Q

Vertical gaze palsy, pupillary light near dissociation, lid retraction, convergence-retraction nystagmus. Syndrome? Location?

A

Parinaud syndrome

Dorsal midbrain

185
Q

reduced levels of arousal and wakefulness. Location?

A

reticular activating system (midbrain)

186
Q

Intention tremor, limb ataxia, loss of balance; damage to cerebellum –> ipsilateral deficits; fall towards side of lesion. Location?

A

Cerebellar lesion

187
Q

Decorticate (flexor) posturing - flexion of UE and extension of LE. Location?

A

Lesion above the red nucleus

188
Q

Decerebrate (extensor) posturing - extension of UE and LE. Location?

A

Lesion below the red nucleus

worse prognosis that decorticate posturing

189
Q

Truncal ataxia (wide based, drunken sailor gait), dysarthria. Location?

A

Cerebellar vermis

vermis is centrally located and affects the central body

chronic alcohol use

190
Q

Irreversible brain damage occurs ____ minutes after hypoxia. Most vulnerable structures?

A

5 minutes

hippocampus (most), neocortex, cerebellum (purkinje cells), watershed area

191
Q

CT or MRI for Ischemia of the brain?

A

CT detects ischemic changes in 6-24 hrs

diffusion weighted MRI within 3-30 min

192
Q

Histologic features of ischemia after:

1) 12-24 hrs
2) 24-72 hrs
3) 3-5 days
4) 1-2 weeks
5) > 2 weeks

A

1) eosinophilic cytoplasm +pyknotic nuclei (red nucleus)
2) necrosis + neutrophils
3) macrophages (microglia)
4) Reactive gliosis (astrocytes) + vascular proliferation
5) glial scar

193
Q

What kind of necrosis do you see in ischemic stroke

A

liquefactive

194
Q

Thrombotic ischemic stroke most commonly occurs at the

A

MCA

195
Q

What is the treatment protocol for tPA

A

if within 3-4.5 hours of onset

and no hemorrhage/risk of hemorrhage

196
Q

Brief reversible episode of foal neurologic dysfunction without acute infarction (neg MRI) with the majority resolving in <15 minutes.

A

Transient ischemic attack

Deficits are due to local ischemia

197
Q

Preterm baby presents with altered level of consciousness, bulging fontanelle, hypotension, seizures, coma

A

Neonatal intraventricular hemorrhage-bleeding in the ventricles

germinal matrix- a highly vascularized layer within the subventricular zone

Due to reduced glial fiber support and impaired autoregulation of BP in premature infants

198
Q

Epidural hematoma is commonly due to ____ at the _____. Presents with scalp hematoma and rapid intracranial expansion, this can result in ___________. CT shows a ______ hyperdense blood collection that _______ suture lines

A

middle meningeal artery trauma at the pterion

Transtentorial herniation –> CN III palsy

biconvex(lentiform)

does not cross suture lines

199
Q

Subdural hematoma is due to rupture of _______ and can be acute due to trauma ( ____ on CT) or chronic due to cerebral atrophy (_______ on CT). ______ shaped hemorrhage that _____ the suture lines

A

bridging veins

hyperdense on CT for acute

hypodense on CT for chronic

Crescent shaped hemorrhage that crosses the suture lines

can cause a midline shift

200
Q

Patient presents with the worst headache of his life and has bloody/yellow (xanthochromic) spinal tap

A

Sub arachnoid hemorrhage

due to trauma or aneurysm

201
Q

This hemorrhage is caused by systemic hypertension which causes a hypertensive hemorrhage.

A

Intraparenchymal hemorrhage

most often at the putamen of basal ganglia due to the lenticulostriate vessels

hypertensive hemorrhage (charcot bouchard microaneurysm –> lacunar strokes)

202
Q

Patient presents with contralateral paralysis and sensory loss - face and upper limbs. What artery is involved and where is the stroke?

A

Middle cerebral artery at the motor and sensor cortices

203
Q

Patient presents with aphasia

A

Middle cerebral artery

Temporal lobe (wernickes area)

dominent left hemisphere

204
Q

Patient presents with hemineglect

A

middle cerebral artery
temporal lobe
nondominant right side

205
Q

Patient presents with contralateral paralysis and sensory loss in lower limb and urinary incontinence

A

Anterior cerebral artery

at motor and sensory cortices

206
Q

Patient presents with contralateral paralysis and absence of cortical signs.

A

Lenticulostriate artery at the striatum and internal capsule

207
Q

Common location of lacunar infarcts due to hyaline arteriosclerosis secondary to unmanaged hypertension

A

lenticulostriate artery at the striatum and internal capsule

208
Q

Patient presents with cotnralateral paralysis of the upper and lower limbs

A

lateral corticospinal tract

anterior spinal artery

209
Q

Patient presents with decreased contralateral proprioception

A

medial lemniscus

anterior spinal artery

210
Q

Patient presents with ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)

A

caudal medulla - hypoglossal nerve

anterior spinal artery

211
Q

Patient presents with dysphagia, hoarseness, and decreased gag reflex

A

Lateral medulla at the nucleus ambiguus (CN 9,10,11)

posterior inferior cerebellar artery

212
Q

Patient presents with vomiting and vertigo and nystagmus

A

vestibular nuclei

posterior inferior cerebellar artery and anterior inferior cerebellar artery

213
Q

Patient presents with decreased pain and temperature sensation from contralateral body and ipsilateral face

A

Lateral spinothalamic tract, spinal trigeminal nucleus

posterior inferior cerebellar artery

214
Q

Patient presents with ipsilateral horner syndrome

A

sympathetic fibers due to posterior inferior cerebellar artery or anterior inferior cerebellar artery

215
Q

Patient presents with ipsilateral ataxia, dysmetria

A

inferior cerebellar peduncle

posterior inferior cerebellar artery

216
Q

Patient presents with paralysis of face (decreased lacrimation, salivation, taste from anterior 2/3 of tongue)

A

Lateral pons; facial nucleus

Anterior inferior cerebellar artery

217
Q

Patient presents with ataxia and dysmetria

A

middle and inferior cerebellar peduncles

anterior inferior cerebellar artery

218
Q

Patient presents with decreased pain and temperature sensation from contralateral body and ipsilateral face

A

spinothalamic tract
spinal trigeminal nucleus

anterior inferior cerebellar artery

219
Q

Patient presents with ipsilateral sensorineural deafness, vertigo

A

labyrinthine artery

anterior inferior cerebellar artery

220
Q

Patient presents with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss.

A

medial medullary syndrome

anterior spinal artery - paramedian brances

and or vertebral arteries

221
Q

Patient presents with facial droop

A

Lateral pontine syndrome

facial nucleus affects are specific to AICA (anterior inferior cerebellar artery)

222
Q

Patient presents with hoarseness and dysphagia

A

Lateral medullary (wallenberg) syndrome

nucleus ambiguus effects are specfic to PICA lesions (posterior inferior cerebellar artery)

223
Q

Patient presents with locked in syndrome

A

Basilar artery

lesion at pons, medulla, lower midbrain

(RAS) reticular activating system spared and therefore preserved consciosness

224
Q

Patient presents with quadriplegia and loss of voluntary facial,mouth, and tongue movements

A

corticospinal and corticobulbar tracts

basilar artery

225
Q

Patient presents with loss of horizontal but not vertical eye movements

A

Ocular cranial nerve nuclei, paramedian pontine reticular formation

basilar artery

226
Q

Patient presents with contralateral hemianopia with macular sparing. Alexia without agraphia (dominant hemisphere)

A

Occipital lobe

posterior cerebral artery

227
Q

Central post stroke pain syndrome

A

Neuropathic pain due to thalamic lesions

initial paresthesias followed in weeks to months by allodynia (oridinarily painless stimuli cause pain) and dysesthesia ont he contralateral side

228
Q

This injury is caused by traumatic shearing forces during rapid acceleration and or deceleration of the brain

A

Diffuse axonal injury

coma, vegetative state

can have punctate hemorrhages

229
Q

What hemisphere does aphasia usually involve

A

left hemisphere (dominant)

230
Q

Broca

A

expressive aphasia

Broken speach “broca”

inferior frontal gyrus of frontal lobe

231
Q

Wernicke

A

Receptive aphasia

Wordy but makes no sense

Superior temporal gyrus of temporal lobe

also associated with right superior quadrant visual field defect

232
Q

Conduction aphasia

A

poor speech repetition

damage to arcuate fasciculus

233
Q

Global aphasia

A

arcuate fasciculus, broca an wenicke areas affected

234
Q

Saccular/berry aneurysms commonly occur at

A

junction of the anterior communicating artery and anterior cerebral artery

associated with ehlers danlos syndrome and autosomal dominant polycystic disease

235
Q

Rupture of berry aneurysms

A

subarachnoid hemorrhage causing focal neurologic deficits

236
Q

anterior communicating artery compression

A

bitemporal hemianopia due to compression of optic chiasm

237
Q

anterior communicating artery rupture

A

ischemia in anterior cerebral artery

contralateral lower extremity hemiparesis sensory deficits

238
Q

Middle cerebral artery rupture

A

contralateral UE and Lower facial hemiparesis sensory deficits

239
Q

Posterior communicating artery compression

A

ipsilateral CN III palsy causing mydriasis or blown pupils

“down and out eye”

ptosis

240
Q

Where do partial (focal) seizures commonly originate. What are the different types

A

medial temporal lobe

simple partial - consciousness intact

complex partial - impaired consciousness and automatism

241
Q

status epilepticus

A

> = 5 min or recurring

242
Q

Generalized (diffuse) seizures types

A

absence (petit mal) - 3 hz, no postictal

myoclonic - quick repetitive jerks

tonic-clonic - grand mal alternating stiffening and movement

tonic-stiffening

atonic-drop seizures, like fainting

243
Q

Migraines are due to irritation of what?

A

CN V
meninges
blood vessels (release of substance P, calcitonin gene related peptide, vasoactive peptides)

244
Q

Akathisia

A

Restlessness and intense urge to move

245
Q

Asterixis is due to

A

due to hepatic encephalopathy or wilson disease

246
Q

Slow snake like writhing movements ,especially in the fingers

A

Athetosis

basal ganglia

247
Q

Chorea is due to a lesion in the

A

basal ganglia

248
Q

Sustained involuntary muscle contractions

A

dystonia

i.e. writers cramp

249
Q

High frequency tremor with sustained posture. Worse with movement or when anxious

A

Essential tremor

250
Q

Slow zigzag motion when pointing/extending toward a target

A

intention tremor

due to cerebellar dysfunction

251
Q

Uncontrolled movement of distal appendages (esp in hands). tremor alleviated by intentional movement and occurs at rest

A

substantia nigra (parkinsons disease)

252
Q

Parkinsons disease involves the ________. ______ is a drug that is metabolized to _____ which is toxic to the same structure

A

Loss of dopaminergic neurons of the substantia nigra pars compacta

MPTP –> MPP +

253
Q

Parkinsons symptoms

A

TRAPs

Tremors (pill rolling)
Rigidity 
Akinesia or bradykinesia
Postural instability
Shuffling gait

also see lewy bodies (alpha synuclein)

254
Q

Trinucleotide repeat and gene affected in huntingtons dz

A

CAG

HTT gene on chromosome 4

“hunt has 4 letters”

255
Q

huntington disease involves atrophy of ____ via binding of _____ and _____ excitotoxicity. Lab values consist of

A

caudate and putamen with ex vacuo ventriculomegaly. Neuronal death via NMDA-R binding and glutamate excitotoxicity

high dopamine
low GABA and ACh

256
Q

Why do downs pts have a higher risk of alzheimers

A

APP (amyloid precursor protein) is cleaved to make amyloid beta

APP is coded on chromosome 21

257
Q

alzheimers disease involves widespread cortical atrophy ,especially the ________. There is a ______ in ACh and _____ increases the risk of sporadic form.

A

hippocampus w/e narrowing gyri and widening sulci

decrease in ACh

APOE4 increases risk of sporadic
APOE3 decreases risk of sporadic

258
Q

Alzheimers pathology

A

senile plaques due to amyloid beta plaques
Neurofibrillary tangles - intracellular hyperphosphorylated tau protein = insoluble cytoskeletal elements (number of tangles correlates with degree of dementia)

259
Q

This dementia presents with early changes in personality and behavior (behavioral variant) or aphasia (primary progressive aphasia)

A

frontotemporal dementia/picks disease

inclusions of hyperphosphorylated tau (round pick bodies) or ubiquitinated TDP-43

260
Q

This dementia presents with cognitive and motor symptoms onset < 1 year apart

A

lewy body dementia

lewy bodies composed of alpha synuclein (intracellular eosinophilic inclusions)

if not <1 year apart then it is dementia secondary to parkinsons disease

261
Q

Vascular dementia

A

result of multiple arterial infarcts and or chronic ischemia

stepwise decline in cognitive impairment and then late onset memory impairment

262
Q

Rapidly progressive dementia with myoclonus and ataxia. Periodic sharp waves on EEG and increase in 14-3-3 protein in CSF

A

Creutzfeldt-jakob disease

spongiform cortex

Prions

263
Q

Increased ICP without cause on imaging. Lumbar puncture shows increased opening pressure and provides temporary headache relief. Diplopia due to CN 6 palsy and impaired optic nerve axoplasmic flow

A

idiopathic intracranial hypertension or pseudotumor cerebri

risk factors: female, tertracyclines, obesity, vitamin A excess, danazol

264
Q

communicating hydrocephalus

A

decreased CSF absorption by arachnoid granulations

265
Q

Normal pressure hydrocephalus

A

elderly

elevated only episodically

expansion of ventricles destorys the fibers of the corona radiata –> triad of urinary incontinence, gait apraxia, cognitive dysfunction

266
Q

noncommunicating hdrocephalus

A

structural blockage of CSF circulation due to tumor etc

267
Q

ex vacuo centriculomegaly

A

appearance of increased CSF but is actually due to decreased brain tissue and neuronal atrophy

ICP is normal and normal pressure hydrocephalus triad (urinary incontinence, gait apraxia, cognitive dysfunction) is not seen

268
Q

Autoimmune inflammation and demyelination of CNS (brain and spinal cord) with subsequent axonal damage. What disease? what are common symptoms?

A

Multiple sclerosis

acute optic neuritis or painful unilateral visual loss associated with marcus gunn pupil

Brain stem/cerebellar syndromes

pyrimidal tract weakness - pattern of weakness in the extensors (upper limbs) or flexors (lower limbs)

symptoms are exacerbated with increase body temp (i.e. during exercise)

269
Q

Multiple sclerosis has increased ____ and ____ in the CSF. What is the gold standard test? What is diagnostic?

A

IgG and myelin basic protein in CSF

gold standard test is the MRI

oligoclonal bands are diagnostic. Periventricular plaques (Areas of oligodendrocyte loss and reactive gliosis)

270
Q

Massive axonal demyelination in pontine white matter secondary to rapid osmotic changes. Results in acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness

A

Osmotic demyelination syndrome or central pontine myelinolysis

can cause locked in syndrome

271
Q

If you correct Na too fast from low to high

A

osmotic demyelination snydrome

272
Q

If you correct Na too fast from high to low

A

cerebral edema/herniation

273
Q

Acute inflammatory demyelinating polyradiculopathy is a subtype of ? affects what nerves? what are labs like?

A

most common subtype of guillian barre syndrome

affects peripheral nerves including CN 3- 12 and motor fibers

Increased CSF protein with normal cell count (albuminocytologic dissociation)

274
Q

Acute disseminated (postinfectious) encephalomyelitis

A

multifocal inflammation and demyelination after infection or vaccination

rapidly progressive multifocal neurologic symptoms that alter mental status

275
Q

Hereditary motor and sensory neuropathy. Defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath. Associated with foot deformities, lower extremity weakness, and sensory deficits. What disease is this?

A

Charcot marie tooth disease

276
Q

What is the most common type of charcot marie tooth disease

A

CMT1A caused by the PMP22 gene duplication

277
Q

Demyelination of CNS due to destruction of oligodendrocytes. Rapidly progressive, usually fatal and dominates the parietal and occipital areas. Visual symptoms are common

A

Progressive multifocal leukoencephalopathy

278
Q

_________ is a neurological disorder indicated at birth by a port-wine stain birthmark on the forehead and upper eyelid of one side of the face. The birthmark is caused by an overabundance of capillaries around the _________ just beneath the surface of the face. Neurological symptoms include seizures (side of the body opposite the birthmark) that begin in infancy and may worsen with age. There may be intermittent or permanent muscle weakness on the same side.

A

Sturge-Weber syndrome aka encephalotrigeminal angiomatosis

trigeminal nerve

abnormal blood vessels on the brain surface and the loss of nerve cells and calcification of underlying tissue in the cerebral cortex of the brain on the same side of the brain as the birthmark. –> neurological symptoms

ipsilateral leptomengeal angioma –> seizures/epilepsy
episcleral hemangioma –> increased IOP –> glaucoma

279
Q

What is the pathophys of sturge weber syndrome

A

developmental anomaly of neural creast derivatives due to somatic mosaicism for an activating mutation in one copy of the GNAQ gene

280
Q

What is tuberous sclerosis and what is the genetic mutation that causes it

A

tuberous sclerosis is a disorder that results in growth of numerous benign tumors in many parts of the body

due to TSC1 mutation on chromosome 9

OR TSC2 on chromosome 16

which is a tumor suppressor gene

281
Q

Clinical presentation of tuberous sclerosis

A

HAMARTOMAS

Hamartomas in CNS and skin
Angiofibromas
Mitral regurg
Ash leaf spots
Cardiac Rhabdomyoma
Autosomal dominant
Mental redardation
Renal angiomyolipoma
Seizures
Shagreen patches
Subependymal giant cell astroctomas and ungual fibromas
282
Q

Neurofibromatosis type 1 clinical presentation? genetic mutation?

A

condition that causes tumors to form in brain, spinal cord, nerves. Cafe au lait spots, cutaneous neurofibromas, optic gliomas, pheochromocytomas, lisch nodules

mutation in NF1 tumor suppressor gene on chromosome 17

aka Rechlinghausen disease

283
Q

What is defective in neurofibromatosis type 1

A

mutation in NF1 tumor suppressor gene which normally codes for neurofibromin, a negative regulator of RAS

284
Q

Neurofibromatosis type 2

A

mutation in NF2 tumor suppressor gene on chroosone 22

bilateral acoustic schwannomas, juvenile cataracts, meningiomas, ependymomas

285
Q

Disease that results in tumors and fluid filled sacs (cysts) in different parts of the body. Especially the kidney and pancreas. What disease is this? what is the mutation?

A

Von hippel lindau disease

deletion of VHL gene on chromosome 3p

pVHL ubiquitinates hypoxia inducible factor 1a

  • Hemangioblastomas in retina, brainstem, cerebellum, spine
  • Angiomatosis
  • renal cell carcinomas,Bilateral
  • pheochromocytomas
286
Q

Glioblastoma multiforme

A

Grade 4 astrocytoma

common and highly malignant. Found in cerebral hemispheres and can cross corpus callosum.

GFAP+

on histology there are pseudopalisading pleomorphic tumor cells

287
Q

Oligodendroglioma is most often in the ___ and has a ______ capillary pattern?

A

frontal lobes

chicken wire

288
Q

Primary adult brain tumor that is extra axial (external to the brain parenchyma) and may have a dural attachment. What tumor is this? what is the cell of origin? histology?

A

meningioma

Arachnoid cell origin

spindle cells concentrically arranged in whorled pattern

psammoma bodies(laminated calcifications)

289
Q

Hemangioblastoma is most often found in ___ and is associated with ______ when found with retinal angiomas. Can also result in secondary polycythemia due to ______ production

A

cerebellum

Von hippel lindau syndrome

Erythropoietin

290
Q

Hemangioblastoma cell of origin

A

blood vessel origin. Closely arranged, thin walled capillaries with minimal intervening parenchyma

291
Q

Hyperplasia of only one type of endocrine cells found in pituitary

A

pituitary adenoma

most commonly lactotrophs –> prolactinoma
somatotrophs (GH) –> acromegaly/gigantism
Corticotrophs (ACTH) –> cushings disease
Thyrotrophs (TSH)
Gonadotrophs (FSH,LH)

292
Q

Nonfunctioning pituitary adenoma presents with

A

mass effect

bitemporal hemianopia due to pressure on optic chiasm, hypopituitarism, headache

293
Q

Prolactinoma in women presents with

A

galactorrhea, amenorrhea and decreased bone density due to suppression of estrogen

294
Q

Prolactinoma in men presents with

A

low libido and infertility

295
Q

Schwannomas are classically at the ________ and involve CNs ____ and ____ but can be along any peripheral nerves

A

cerebellopontine angle

CNS 8 and 7 (often localized to CN8 in internal acoustic meatus –> vestibular schwannomas found in NF-2)

296
Q

Schwannoma cell origin? and marker?

A

Schwann cell origin

S-100 marker

297
Q

Pilocytic astrcoytoma - location, gross and histological findings

A

most common primary brain tumor in childhood. Cystic + solid

usually in the posterior fossa

glial cell origin, GFAP+, Rosenthal fibers, corkscrew fibers

298
Q

Medulloblastoma - location, gross, and histological findings

A

most common malignant brain tumor in childhood

usually in the cerebellum and can compress the 4th ventricle. Can send drop metastases to spinal cord

on histology see homor wright rosettes

299
Q

Ependymoma are most commonly found in the ______ and can cause ________. They are of _____ cell origin

A

4th ventricle

hydrocephalus

ependymal

300
Q

on histology for ependymoma you see

A

perivascular pseudorosettes

rod shaped blepharoplasts (basal ciliary bodies) found near nucleus

301
Q

This tumor is derived from the remnants of the rathke puch (ectoderm)

A

Craniopharyngioma - supratentorial tumor

can cause bitemporal hemianopia
calcification is common
cholesterol crystals found in motor oil like fluid within tumor

302
Q

Tumor of pineal gland that can result in vertical gaze palsy

A

pinealoma

parinaud syndrome (compression of tectum causes vertical gaze palsy)

can also cause obstructive hydrocephalus

Precocious puberty in males due to beta hCG production

303
Q

Cingulate (subfalcine)hernaition under falx cerebri can compress ?

A

anterior cerebral artery

304
Q

Transfentorial (Central/downward) hernaition can cause caudal displacement of?

A

brain stem and thus rupture of paramedian basilar artery branches –> duret hemorrhages

usually fatal

305
Q

Uncal (medial temporal lobe) herniation can cause compression of

A

ipsilateral CN III and contralateral crus cerebri against kernohan notch

causes contralateral CN III palsy and/or ipsilateral hemiparesis

306
Q

Cerebellar tonsillar herniation into foramen magnum

A

coma and death if compress brainstem

307
Q

LMN lesion vs UMN lesion

A 
LMN = everything lowered
UMN = everything up
308
Q

Congenital degeneration of anterior horns of psinal cord causing a LMN lesion that causes symmetric weakness. What disease is this? what is the clinical presentation? what is the mutation?

A

Spinal muscular atrophy / Werdnig-Hoffmann disease

“floppy baby” with marked hypotonia (flaccid paralysis) and tongue fasciculations

Mutation in SMN1

309
Q

Lou Gehrig disease/ amyotrophic lateral sclerosis (ALS) is due to a defect in ________

A

superoxide dismutase 1

UMN and LMN deficits (LMN due to anterior horn involvement)

310
Q

Complete occlusion of anterior spiinal artery

A

UMN deficit below lesion due to corticospinal tract
LMN at level of lesion due to anterior horn

loss of pain and temp sensation below the lesion due to spinothalamic tract involvement

311
Q

due to tertiary syphilis –> degeneration of dorsal columns and roots resulting in progressive sensory ataxia (impaired proprioception –> poor coordination)

A

Tabes dorsalis

+ Romberg sign and absent DTRs

associated with cahrcot joints, shooting pain, argyll robertson pupils

312
Q

Syrinx expands and damages anterior white commissure of spinothalamic tract and causes

A

syringomyelia - bilateral symmetrical loss of pain and temperature sensation in cape like distribution.

seen with chiari I malformation

313
Q

Vitamin B12 deficiency causes ________ which is the demyelination of spinocerebellar tracts, lateral corticospinal tracts, and dorsal columns

A

subacute combined degeneration (SCD)

Ataxic gait, paresthesia, impaired position/vibration sense

314
Q

Cauda equina syndrome

A

compression of spinal roots L2 and below, often due to intervertebral disc herniation or tumor

unilateral radicular pain, absent knee and ankle reflex, loss of bladder and anal sphincter control, saddle anesthesia

315
Q

Pt presents with LMN lesion symptoms due to a _____ virus that replicates in the oropharynx and small intestine before spreading via bloodstream to the CNS. CSF shows increased WBC and slight increase in protein. Glucose unchanged in CSF

A

poliomyelitis due to poliovirus

infection causes destruction of cells in anterior horn of spinal corn (LMN death)

316
Q

Brown -sequard syndrome

A

hemisection of spinal cord

1) ipsilateral loss of all sensation at level of lesion
2) ipsilateral LMN signs at level of lesion
3) ipsilateral UMN signs below level of lesion due to corticospinal tract damage
4) ipsilateral loss of proprioception, vibration, light touch, and tactile sense below level of lesion due to dorsal column damage
5) contralateral loss of pain, temperature, and crude touch below level of lesion due to spinothalamic tract damage
6) if lesion above T1 then may have ipsilateral horners syndrome

317
Q

Genetic pathophys in Friedreich ataxia

A

GAA on chromosome 9 in gene that encodes frataxin (iron binding protein)

leads to impairment in mitochondrial functioning

318
Q

Patient presents with staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammar toes, diabetes mellitus, hypertrophic cardiomyopathy. Patient had kyphoscoliosis as child

A

Friedreich ataxia

degeneration of lateral corticospinal tract (spastic paralysis),spinocerebellar tract (Ataxia), dorsal columns (decrease vibratory sense, proprioception), and dorsal root ganglia (loss of DTRS)

319
Q

CN V motor lesion

A

jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle

320
Q

CN X lesion

A

uvula deviates away from side of lesion

321
Q

CN XI lesion

A

weakness turning head to contralateral side of lesion

shoulder droop on side of lesion

322
Q

CN XII lesion

A

LMN lesion

tongue deviates toward side of lesion due to weakened tongue mm on affected side

“lick your wounds”

323
Q

Patient presents with facial paralysis affecting the contralateral side and only involves the lower fascial muscles. Forehead spared

A

UMN lesion

motor cortex, connection from motor cortex to facial nucleus in pons

324
Q

Patient presents with facial paralysis affecting the ipsilateral side and involves the upper and lower muscles of facial expression. The forehead is not spared and so the patient cannot wrinkle their forehead

A

LMN lesion

facial nucleus or anywhere along the CN 7

patient will present with incomplete eye closure resulting in dry eyes, corneal uclerations

hyperacusis,loss of taste sensation to anterior tongue

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