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Crack the Core > Neuro > Flashcards

Neuro Flashcards

1
Q

Order of myelination

A
  • inferior to superior
  • posterior to anterior
  • central to peripheral
  • sensory then motor
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2
Q

last structures to myelinate

A

subcortical white matter (occipital at 12 months, frontal at 18 months)

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3
Q

structures that are myelinated at birth

A
  • posterior limb of internal capsule

- brainstem

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4
Q

order of sinus formation

A

maxillary –> ethmoid –> sphenoid –> Frontal

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5
Q

what structures are in the superior orbital fissure

A

CN 3, CN4 ,CN V1, CN6

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6
Q

what structures are in the inferior orbital fissure

A

V2

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7
Q

Segments of the ICA

A

C1: cervical
C2: petrous:
C3: Lacerum
C4: cavernous
C5: clinoid - aneurysm can compress CN2
C6: Supraclinoid (Ophthalmic) - common site for aneurysm; originats at dural ring
C7: communicating/terminal - aneurysm can compress CN3

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8
Q

What structure can get compressed with a subfalcine herniation

A

C

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9
Q

What are signs of an uncal herniation

A

aka descending transtentorial

  • ipsilateral hemiparesis (Kernohan’s notch phenomenon)
  • ipsilateral pupillary dilation and ptosis from CN3 compression
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10
Q

Marchiafava Bignami

A
  • alcoholics
  • edema and T2 bright in corpus callosum (beginning in body, then genu, then splenium); affects central fibers and spares the dorsal and ventral fibers (sandwich sign)
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11
Q

disseminated necrotizing leukoencephalopathy

A
  • seen in leukemia patients getting radiation and chemo
  • severe white matter changes, with ring enhancement
  • can be fatal
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12
Q

Subcortical Arteriosclerotic Encephalopathy

A
  • aka Binswanger disease
  • multi-infarct dementia that only involves white matter
  • favors white matter of centrum semiovale
  • spares subcortical U fibers
  • strong association with HTN
  • older patients 55+
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13
Q

CADASIL

A

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

  • 40 year old with migraines
  • severe white matter disease involving multiple vascular territories in frontal and temporal lobes
  • occipital lobes are usually spared
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14
Q

Primary brain tumors that can be multifocal

A
  • lymphoma
  • GBM - can be multicentric or can be multiple from seeding
  • gliomatosis cerebri
  • Medulloblastoma (from seeding)
  • ependymoma (From seeding)
  • Oligodendroglioma (From seeding
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15
Q

Cortically based tumors

A

PDOG

  • pleomorphic Xanthoastrocytoma
  • Dysembryoplastic Neuroepithelial tumor (DNET)
  • Oligodendrogliomas
  • Gangliogliomas
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16
Q

Pleomorphic Xanthroastrocytoma (PXA)

A
  • ALWAYS supratentorial
  • usually involves temporal lobe
  • often a cyst with a nodule
  • tumor frequently invades leptomeninges
  • looks similar to DIG but does not occur in an infant
  • occurs at age 10-20
  • enhances
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17
Q

DNET (Dysembroplastic Neuroepitheilal Tumor)

A
  • kid (<20 yrs) with drug-resistant seizures
  • temporal lobe
  • focal cortical dysplasia seen in 80%
  • little surrrounding edema
  • Bubbly lesion; high T2 signal
  • does NOT enhance
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18
Q

Oligodendroglioma

A
  • most common in frontal lobe
  • calcifies 90%
  • expands the cortex
  • 1p/19 q deletion - better outcome
  • seen in adults (40-50s)
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19
Q

Ganglioglioma

A
  • low grade; can enhance
  • can occur at any age
  • usually temporal lobe
  • cystic and solid mass with focal calcification
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20
Q

Intraventricular tumors - arising from ventricular wall and septum

A
  • ependymoma (kids)
  • Medulloblastoma (in kids)
  • Subependymal giant cell astrocytoma
  • subependymoma (in adults)
  • central neurocytoma
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21
Q

intraventricular tumors - arising from choroid plexus

A
  • choroid plexus papilloma
  • choroid plexus carcinoma
  • xanthogranuloma
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22
Q

What syndromes are associated with medulloblastomas?

A
  • Basal cell nevus
  • Turcot’s syndrome
  • Gorlin syndrome
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23
Q

Gorlin syndrome

A
  • medulloblastoma
  • dural calcification
  • basal skin cancer after radiation
  • odontogenic cysts
24
Q

most common intraventricular mass in an adult 20-40 years old

A

central neurocystoma

25
Q

Cerebellopontine angle masses

A

schwannoma (75%)
menignioma
epidermoid

26
Q

Infratentorial tumors

A
  • AT/RT
  • medulloblastoma
  • ependymoma
  • JPA
  • Hemangioblastoma
  • ganglioglioma
  • Diffuse Pontine glioma
27
Q

Supratentorial tumors

A
  • Mets
  • Astrocytoma
  • Gliomatosis cerebri
  • oligodendroglioma
  • primary CNS lymphoma
28
Q

hemangiopericytoma

A

soft tissue sarcoma that can mimic an aggressive meningioma because both enhance homogeneously

  • will not calcify or cause hyperostosis
  • will invade the skull
29
Q

signal of blood on MRI

A
  • hyperacute (<24 hours): T1 iso, T2 bright
  • acute (1-3 days): T1 iso, T2 dark
  • early subacute (3-7 days): T1 bright, T2 dark)
  • late subacute (7-14 days): T1 bright, T2 bright)
  • chronic (> 14 days): T1 dark, T2 dark)
30
Q

most sensitive sequence for subarachnoid hemorrhage

A

FLAIR

31
Q

Iniencephaly

A

star gazing fetus: upturned face, hypextended C-spine, short neck
- deficit of occipital bones, resulting in an enlarged foramen magnum

32
Q

Joubert syndrome associations

A
  • elongated superior cerebellar peduncles
  • small or aplastic vermis
  • absence of pyramdial decussation
  • strong assocaition with retinal dysplasia
  • association with multicystic dysplastic kidney
33
Q

Meckel Gruber syndrome

A
  • occipital encephalocele
  • multiple renal cysts
  • polydactyly
  • strong association with holoprosencephaly
34
Q

Associations with holoprosencephaly

A
  • single midline monster eye
  • solitary median maxillary incisor
  • pyriform aperture stenosis (From nasal process overgrowth)
35
Q

schizencephaly associations

A
  • optic nerve hypoplasia
  • absent septum pellucidum
  • epilepsy
36
Q

Chiari 1 malformation association

A

Klippel Feil syndrome

37
Q

Apert’s

A

brachycephaly + fused fingers

38
Q

Crouzon’s

A

brachycephaly + first arch (maxilla and mandible) hypoplasia

39
Q

Cleidocranial dysostosis

A

brachycephaly + wormian bones + absent clavicles

40
Q

MELAS

A

mitochondrial encephalomyopathy, lactic acidosis, and stroke like episodes
on MR spectroscopy: increased lactate; decreased NAA

41
Q

most common leukodystrophy? what does it look like?

A

Metachromatic

- diffuse white matter involvement with tigroid apperance

42
Q

High NAA peak

A

Canavan’s disease

43
Q

TE needed to invert the lactate peak

A 
intermediate TE (140)
at long TE (280) - lipid and lactate double peak seen
44
Q

elevated myoinositol peak

A

Alzheimer’s disease

45
Q

elevated alanine peak

A

meningiomas

46
Q

elevated glutamine

A

hepatic encephalopathy

47
Q

high grade tumor: what does the MRS look like?

A
  • elevated choline, lactate, and lipids

- decreased NAA

48
Q

low grade tumor: what does the MRS look like?

A
  • decreased choline, NAA

- elevated inositol

49
Q

MRS in radiation necrosis

A
  • decreased choline and NAA

- increased lactate

50
Q

Gradenigo syndrome

A 
complication of Apical petrositis, when Dorello's canal is involved
triad of:
1) otomastoiditis
2) facial pain (trigeminal neuropathy)
3) lateral rectus palsy (CN 6)
51
Q

what is the main blood supply to the posterior nose

A

sphenopalatine artery (terminal internal maxillary artery)

52
Q

most common masticator space “Mass”

A

odontogenic abscess

53
Q

order of muscle involvement in Grave’s orbitopathy

A

inferior rectus –> Medial rectus –> superior rectus –> lateral rectus –> superior/inferior obliques (IM SLO)

54
Q

ACR recommendations prior to lumbar puncture (regarding anticoagulation)

A
  • stop Plavix 7 days prior
  • stop coumadin 4-5 days prior
  • stop LMW heparin 24 hours prio
  • hold heparin for 2-4 hours and document normal PTT
  • ASA and NSAIDS are fine
55
Q

Currarino triad

A
  • sacrococcygeal osseous defect (scimitar sacrum)
  • anorectal malformation
  • anterior sacral meningocele
56
Q

Foix Alajouanine syndrome

A

myelopathy associated with a dural VF

Crack the Core (12 decks)

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