Neuro Flashcards
in the communicating form of the condition seen in the image, there is dilation of ___
in the communicating form of the condition seen in the image, there is dilation of ALL ventricles
the communicating form of the condition seen in the image can due to scarring/fibrosis of ____ or ____
the communicating form of the condition seen in the image can due to scarring or fibrosis of the arachnoid villi d/t tumors or infxns (TB, meningitis) or subarachnoid hemorrhage
the communicating form of the condition seen in the image is caused by reduced ____, such as in ____
the communicating form of the condition seen in the image is caused by reduced CSF resorption, such as in arachnoid fibrosis
the normal pressure form of the condition seen in the image is characterized by the triad of:
wet = urinary incontinence
wacky = dementia
wobbly = ataxia
the pseudotumor cerebri form of the condition seen in the image is characterized by:
headache and vision loss
_____ is increased ICP with no apparent cause on imaging
psuedotumor cerebri is increased ICP with no apparent cause on imaging
list the risk factors for pseudotumor cerebri
female gender
obesity
vit.A excess
tetracyclin
danazol
in pseudotumor cerebri, ____ reveals ____ and provides headache relief
in pseudotumor cerebri, lumbar puncture reveals opening pressure and provides headache relief
the ex vacuo form of the condition seen in the image causes dilation of ____ due to ____ and causes a compensatory ____
the ex vacuo form of the condition seen in the image causes dilation of all ventricles due to cerebral atrophy and causes a compensatory increase in CSF
- Alzheimer’s
- senile atrophy
- Niemann Pick
the non-communicating form of the condition seen in the image occurs between ____ & ____ or between ____ & _____
the non-communicating form of the condition seen in the image occurs between lateral & 3rd ventricle or between 3rd & 4th ventricle
____ is the most common location of the non-communicating form of the condition seen in the image
foramen of Monro is the most common location of the non-communicating form of the condition seen in the image
the presentation of condition seen in the image in children is increased ____ because ____
the presentation of condition seen in the image in children is increased head circumference because skull bones (fontanelles & sutures) have not fused yet
the presentation of condition seen in the image in adults is increased ____
name 4 symptoms associated with this
the presentation of condition seen in the image in adults is increased ICP
- projectile vomiting
- blurry vision
- headaches
- papilledema
a complication of the condition seen in the image is ___ which is a triad of symptoms indicating an impending ____
a complication of the condition seen in the image is Cushing’s reflex which is a triad of symptoms indicating an impending herniation
- elevated systolic pressure (wide pulse pressure)
- bradycardia
- irregular respirations
a complication of the condition seen in the image is:
___ hernation through ___ causing ____
or
___ hernation causing ____
a complication of the condition seen in the image is:
tonsillar herniation through foramen magnum causing immediate death
or
trans-tentorial/uncal herniation causing ipsilateral pupillary dilation due to compression of CN III
the condition seen in the image is caused by rupture of ____
the condition seen in the image is caused by rupture of bridging veins (low press so gradual onset)
explain how the condition seen in the image is also seen in babies
shaken baby syndrome → rupture d/t thin walls of veins
the condition seen in the image causes an increase in ____ with which 4 signs?
the condition seen in the image causes an increase in ICP with:
- headaches
- projectile vomiting
- blurry vision
- papilledema
on CT in the condition seen in the image, there is ___ with a ____ because ____
crescent hematoma with a midline shift because it is closer to the brain
a complication of the condition seen in the image is ____
a complication of the condition seen in the image is uncal herniation
the condition seen in the image is caused by rupture of ____ where the blood collects between ____ & ____
the condition seen in the image is caused by rupture of middle meningeal artery → blood collects in epidural space between dura & calvarium
the condition seen in the image is caused by a lateral blow to ___
the condition seen in the image is caused by a lateral blow to temporal side of head
describe the presentation of the condition seen in the image
lose consciousness → lucid interval → death
increase in ICP → headaches, projectile vomiting, blurry vision, papilledema
on CT of the condition seen in the image, there is a ____ shaped hematoma
on CT of the condition seen in the image, there is a biconvex lens shaped hematoma
a complication of the condition seen in the image is ___
a complication of the condition seen in the image is uncal herniation
describe coup vs. contrecoup contusions
- coup: contusion on SAME SIDE as impact
- contrecoup: contusion on OPPOSITE side of impact
- due to acceleration of head
describe diffuse axonal injury
- rotational acceleration
- shearing of axons as they are stretched beyond elastic point w/ rotational force
- low level of consciousness immediately
a predisposition for concussions is the ____ genotype
a predisposition for concussions is the APO-E genotype
the key to detection of concussion is ____
the key to detection of concussion is baseline data
describe the etiology of a pale/bland infarct in the condition seen in the image
thrombotic/ischemic stroke:
HTN → atherosclerosis → unstable plaque → thrombosis → bland infarct
describe the etiology of a red infarct in the condition seen in the image
embolic stroke
atrial fibrillation + mural thrombus in left heart → legs (DVT) or BRAIN (red infarct)
the most commonly affected vessel in the condition seen in the image is the ____
the most commonly affected vessel in the condition seen in the image is the middle cerebral artery
describe the appearance of the brain seen in the condition in the image:
early stroke: ____
old stroke: ____
early stroke: red infarct
old stroke: gliosis, scarring
in the condition seen in the image, ____ is seen during 12-24 hours
in the condition seen in the image, coagulative necrosis is seen during 12-24 hours
in the condition seen in the image, <24 hours is considered ____ while >24 hours is considered _____
in the condition seen in the image, <24 hours is considered TIA while >24 hours is considered stroke (permanent neurological deficit)
in the condition seen in the image, ____ is seen after >48 hours
in the condition seen in the image, microglia → liquefactive necrosis is seen after >48 hours
in the condition seen in the image, ____ is seen after 2 weeks
in the condition seen in the image, astrocytes → gliosis is seen after 2 weeks
the condition seen in the image can be caused by long-standing _____ causing ____ which leads to _____ aneurysm
the condition seen in the image can be caused by long-standing benign HTN causing hyaline arteriosclerosis which leads to Charcot Bouchard aneurysm
describe the 2 types of infarcts that HTN can lead to the condition seen in the image
-
slit hemorrhages
- hemorrhages thought to be secondary to microaneurysm rupture (Charcot Bouchard aneurysm)
-
lacunar infarcts
- bland infarcts, thought to be secondary to thrombosis of a vessel w/ arteriosclerotic changes
describe the 4 types of vascular malformations that can lead to the condition seen in the image
- arterio-venous malformation = greatest potential for hemorrhage
- cavernous hemangiomas
- capillary telangiectasias
- venous angiomas
cerebral amyloid angiopathy is a disease in which the same amyloidogenic peptides seen in ____ accumulate in the walls of ____ and can lead to the condition seen in the image
cerebral amyloid angiopathy is a disease in which the same amyloidogenic peptides seen in Alzheimer’s accumulate in the walls of medium and small caliber meningeal and cortical vessels and can lead to the condition seen in the image
_____ is a disease in which the same amyloidogenic peptides seen in Alzheimer’s accumulate in the walls of medium and small caliber meningeal and cortical vessels and can lead to the condition seen in the image
cerebral amyloid angiopathy is a disease in which the same amyloidogenic peptides seen in Alzheimer’s accumulate in the walls of medium and small caliber meningeal and cortical vessels and can lead to the condition seen in the image
the most common location for the condition seen in the image is ____
the most common location for the condition seen in the image is the basal ganglia
describe the symptoms of the condition seen in the image when it occurs in the most common location
basal ganglia = contralateral hemiparesis + sensory loss
list the 3 conditions associated with the condition seen in the image
Berry aneurysm seen in Marfans, Ehlers Danlos and ADPKD
rupture of the condition seen in the image can lead to _____
rupture of the condition seen in the image can lead to subarachnoid hemorrhage
the condition seen in the image causes the “____” because blood ____
the condition seen in the image causes the “the worst headache of their life” because blood irritates leptomeninges and mimics meningitis (nuchal rigidity, photophobia, LOC, seizures)
investigations for the condition seen in the image includes seeing blood in ___ and after 12 hours, seeing ____ which is also called ____
investigations for the condition seen in the image includes seeing blood in CSF and after 12 hours, seeing bile in the CSF which is also called xanthochromia
list the 2 complications of the condition seen in the image
-ischemic stroke from cerebral vasospasms
-communicating hydrocephalus
name the 3 most common causes of the condition seen in the image in neonates
- E. coli
- Group B Strep. (S. agalactiae)
- Listeria
name the 3 most common causes of the condition seen in the image in children
- S. pneumoniae
- Neisseria
- H. influenzae
name the 2 most common causes of the condition seen in the image in adolescents
- N. meningitides
- S. pneumoniae
name the 2 most common causes of the condition seen in the image in adults
- S. pneumoniae
- Listeria
in the condition seen in the image, there is exudate covering ____ & engorgement of ____
in the condition seen in the image, there is exudate covering the leptomeninges & engorgement of meningeal vessels
describe CSF levels in the condition seen in the image
increased WBCs and protein
decreased glucose (bacteria are using it)
list the 2 fungi that cause the meningeal form of meningitis
- Cryptococcosis = soap bubble abscesses
- Candida = microabscesses
list the 2 fungi that cause the vasoinvasive form of meningitis
- Aspergillus
- Mucormycosis
viral encephalitis is characterized by:
perivascular ___ infiltrate
individual ___ necrosis
focal collections of ____
viral encephalitis is characterized by:
perivascular lymphocytic infiltrate
individual neuronal necrosis
focal collections of microglia
the most common cause of viral encephalitis worldwide is ____
the most common cause of viral encephalitis worldwide is HIV-E
____ causes aggressive encephalitis in immunocompromised hosts and causes asymmetric involve of ___ lobes
Herpes virus causes aggressive encephalitis in immunocompromised hosts and causes asymmetric involve of temporal lobes
HIV infects ___ cells and ____ leading to patchy loss of ____
HIV infects microglial cells and macrophages leading to patchy loss of myelin
in AIDS patients, there can be reactivation of ____ which leads to ____
in AIDS patients, there can be reactivation of JC virus (polyomavirus) which leads to progressive multifocal leukoencephalopathy (PML)
CJD is ___ while variant CJD is associated with _____
CJD is sporadic while variant CJD is associated with bovine spongiform encephalopathy (BSE) meat consumption
in prion diseases, there is accumulation of altered form of prion protein which leads to ____ death, ____, accumulation of ____, and vacuolization of ___
in prion diseases, there is accumulation of altered form of prion protein which leads to neuronal death, gliosis, accumulation of extracellular amyloid (kuru plaques) and vacuolization of grey matter
describe the presentation of CJD vs. variant CJD
CJD = rapidly progressive dementia & myoclonus
variant CJD = slower onset, more personality changes
describe the 2 etiologies of the condition seen in the image
-
hematogenous
- usually d/t sepsis or septic emboli from left-sided endocarditis
-
contigual__/direct spread = more common
- sinusitis, mastoiditis, otitis media, dental infxns
the condition seen in the image is characterized by a collection of infection in ____ with ____ necrosis w/ _____
the condition seen in the image is characterized by a collection of infection in the parenchyma with liquefactive necrosis w/ PMNs & cellular debris
describe the presentation of the condition seen in the image
spiking fever, confusion, projectile vomiting, focal neurological deficits
describe what is seen in lumbar puncture in the condition seen in the image
increased protein and neutrophils
NORMAL glucose (infection NOT in CSF, unlike in meningitis)
how does the lumbar puncture results differ in the condition seen in the image vs. meningitis
brain abscess = NORMAL glucose
meningitis = LOW glucose
CT scan of the condition seen in the image would show ____
CT scan of the condition seen in the image would show ring-enhancing lesions
list the 5 conditions where ring-enhancing lesions are seen on CT scan
GMALT
G = gliobastoma multiforme
M = metastasis
A = abscess
L = lymphoma
T = Toxoplasmosis
describe a complication of the condition seen in the image
rupture into ventricles → ventriculitis → obstruction of ventricles → hydrocephalus
the early onset form of condition seen in the image is caused by ___ located on chr. ___ and ____ located on chr. ____
the early onset form of condition seen in the image is caused by APP located on chr. 21 and Presenilin (which codes for gamma-secretase) located on chr. 1 & 14
the late onset form of the condition seen in the image is caused by a mutation in ___ located on chr. ____
the late onset form of the condition seen in the image is caused by a mutation in APO-E located on chr. 19
homozygous APOE4 = greatest risk
APOE2 = decreased risk
the pathogenesis of the condition seen in the image arises from defective ___ of ____
the pathogenesis of the condition seen in the image arises from defective cleavage of transmembrane cellular proteins
on histology of the condition seen in the image, ____ proteins accumulate intracellularly, while ____ accumulate extracellularly
on histology of the condition seen in the image, Tau proteins (neurofibrillary tangles) accumulate intracellularly, while A-B amyloid plaque accumulate extracellularly
describe the presentation of the condition seen in the image
slowly progressive dementia (impaired cognition) but motor & sensory intact
start with short-term memory loss (temporal) → paralysis & bed-ridden (frontal & parietal)
on CT scan of the condition seen in the image, there is flattening of ___ with enlarged ____
on CT scan of the condition seen in the image, there is flattening of sulci & gyri with enlarged ventricles
the most common cause of death in the condition seen in the image is ____
the most common cause of death in the condition seen in the image is aspiration pneumonia
describe how a complication of the condition seen in the image is lobar hemorrhages
cerebral amyloid angiopathy = deposition of amyloid in the walls of cerebral vessels
patients with Parkinson’s disease have an increased risk for developing ____
patients with Parkinson’s disease have an increased risk for developing Alzheimer’s disease
Parkinson’s disease can be caused by a mutation in ____
Parkinson’s disease can be caused by a mutation in the synnuclein gene (synuclein is a component of Lewy bodies)
Parkinson’s disease can be caused by ____ abuse
Parkinson’s disease can be caused by cocaine abuse
Parkinson’s disease is caused by atrophy of ___ (which contains the nucleus of ____) with a presence of ___ later
Parkinson’s disease is caused by atrophy of substantia nigra (which contains the nucleus of dopaminergic neurons in the midbrain) with a presence of Lewy bodies in the atrophied neurons
describe the presentation of Parkinson’s disease
tremor
rigidity
akinesia
shuffling gait
Huntington’s disease is caused by ___ repeats that interfere with ____
Huntington’s disease is caused by CAG repeats that interfere with nucleic acid or protein regulations
Huntington’s disease displays genetic ____ which means that an increased number of repeats indicates ____
Huntington’s disease displays genetic anticipation which means that an increased number of repeats indicates an earlier onset in successive generations
Huntington’s disease is caused by atrophy of ____
Huntington’s disease is caused by atrophy of caudate & putamen
which 2 mutations are associated with ALS?
Chr. 9 hexanucleotide repeat
SOD
ALS is characterized by neuronal loss in _____
ALS is characterized by neuronal loss in spinal cord anterior horns (motor cortex)
describe the 2 cytoplasmic inclusions seen in ALS
ubiquitin (deposited in response to cell injury)
TDP-43, FUS (DNA/RNA binding/stabilizing proteins)
where do ALS symptoms first begin?
usually begins with subtle asymmetric distal extremity weakness
what is the most common cause of death in ALS?
when the disease involves the resp. muscles, there are recurrent bouts of pulm. infection which is the usual cause of death
what is spared in ALS?
intellect, sensation, sphincter control & eye movements
list risk factors for the condition seen in the image
- smoking
- low vit. D
- EBV
- maternal history
- moving to endemic area before puberty
HLA-___ and HLA-___ are associated with the condition seen in the image, which leads to antibodies destroying ____
HLA-DR2 and HLA-DR15 are associated with the condition seen in the image which leads to antibodies destroying oligodendrocytes
the condition seen in the image is caused by immune-mediated patchy loss of ____
the condition seen in the image is caused by immune-mediated patchy loss of myelin in grey and white matter
___ is the most commonly affected nerve, which can lead to:
CN II is the most commonly affected nerve, which can lead to optic neuritis → pain on eye movement, blurred vision and diplopia
in the condition seen in the image, there is destruction of the MLF; what can this cause?
ipsilateral eye cannot adduct while contralateral eye undergoes nystagmus
“young Caucasian female in temperate climate……recurrent UTIs”
explain
MS → bladder affected → stasis of urine → UTIs
describe what is seen on MRI in the condition seen in the image
periventricular demyelination of white matter
describe what is seen on lumbar puncture in the condition seen in the image
oligoclonal bands of IgG in the CSF
histology of the condition seen in the image would show abundant ____ containing ____
histology of the condition seen in the image would show abundant macrophages containing PAS-positive debris
central pontine myelinolysis massive axonal ____ in ____ white matter secondary to ____
central pontine myelinolysis massive axonal demyelination in pontine white matter secondary to osmotic changes, as seen in rapid correction of hyponatremia
“patient had viral infection and now presents with rapidly progressive neurologic symptoms and altered mental status”
dx?
Wernicke-Korsakoff is seen in ___ patients due to ___ deficiency
Wernicke-Korsakoff is seen in chronic alcoholic patients due to thiamine (B1) deficiency
Wernicke-Korsakoff syndrome is caused by destruction of ____
Wernicke-Korsakoff syndrome is caused by destruction of mamillary bodies
describe the presentation of Wernicke-Korsakoff
“Wernicke problems come in a CAN’O beer”
C = confusion
A = ataxia
N = nystagmus
O = ophthalmoplegia
the most common cause of hypoglycemia encephalopathy is ____
the most common cause of hypoglycemia encephalopathy is excessive exogenous insulin
the condition seen in the image originates from ____
the condition seen in the image originates from glial cells/astrocytes
there is a ____ appearance on gross in the condition seen in the image
there is a butterfly appearance on gross in the condition seen in the image
histology of the condition seen in the image would show a central ____ surrounded by ____
histology of the condition seen in the image would show a central area of necrosis surrounded by pseudo-palisading of the malignant cells
presentation of the condition seen in the image is recurrent ____ that is worse in the ____ and while ____
presentation of the condition seen in the image is recurrent headaches that is worse in the mornings and while straining
describe the presentation of the condition seen in the image
sudden onset
recurrent headaches that are worse in the mornings & while straining
seizures
papilledema
contralateral hemiparesis
____ is a tumor marker for the condition seen in the image
GFAP is a tumor marker for the condition seen in the image
the condition in the image has a better prognosis if there is a mutation is in ____ or ____
the condition in the image has a better prognosis if there is a mutation is in IDH-1 or IDH-2
list factors that lead to a good prognosis of the condition seen in the image
younger
(-) EGFR
(+) IDH-1, IDH-2
(+) p53
(+) MGMT methylation
list 3 factors that make the condition seen in the image have a poor prognosis
infiltrate
unresectable
resistant to treatment
oligodendroglioma has a ____ appearance
oligodendroglioma has a fried-egg appearance
the etiology of an oligodendroglioma is loss of heterozygosity for chr. ___ & ___
the etiology of an oligodendroglioma is loss of heterozygosity for chr. 1 & 19
the origin of the condition seen in the image is ___ cells
the origin of the condition seen in the image is arachnoid cells
oligodendroglioma has a better prognosis if it there is a ____ or ____ deletion
oligodendroglioma has a better prognosis if it there is a 1p and/or 19q deletion
the condition in the image is associated with ____
the condition in the image is associated with NF2 (vestibuloschwannoma + meningioma)
the condition seen in the image is a ___-shaped tumor of meningothelial cells of the ____ that attaches to ____
the condition seen in the image is a dome-shaped tumor of meningothelial cells of the arachnoid that attaches to the underside of the dura
the ___ type of the condition seen in the image is the most common and contains ___ bodies
the papillary type of the condition seen in the image is the most common and contains psammoma bodies
in the condition seen in the image, there is a ___ pattern of cell growth with ____
in the condition seen in the image, there is a whorled pattern of cell growth with psammoma bodies
____ is the most common primary CNS tumor in childhood
pilocytic astrocytoma is the most common primary CNS tumor in childhood
pilocytic astrocytoma is a (well-differentiated or poorly-differentiated?) tumor in the ___ & ____
pilocytic astrocytoma is a well-differentiated tumor in the cerebellum & hypothalamus
the condition seen in the image arises from ____
the condition seen in the image arises from the vermis of the cerebellum
describe the histology of the condition seen in the image
Homer-Wright rosettes (pseudorosettes) with small round blue cells
the condition seen in the image is mainly seen in (children or adults?)
the condition seen in the image is mainly seen in children
describe the presentation of the condition seen in the image
cerebellar signs = ataxia, slurred speech, intention tremor, nystagmus + 3 Ds (dysmetria, dysdiadochokinesia, dysarthria)
the condition seen in the image is a malignant tumor and spreads via ____
the condition seen in the image is a malignant tumor and spreads via CSF
the condition seen in the image has a better prognosis if there is _____ expression
the condition seen in the image has a better prognosis if there is beta-catenin expression
