Neuro Flashcards
bilateral amygdala lesion
Kluver-Bucy syndrome (hyperorality, hypersexuality, disinhibited behavior, extreme curiosity putting things in mouth) Associated with HSV-1
frontal lobe lesion
disinhibition and deficits in concentration, orientation, and judgement; may have reemergence of primitive reflexes
R (non dominant) parietal lobe lesion
spatial neglect (agnosia of contralateral side of world)
Reticular activating system (midbrain)
reduced levels of arousal and wakefulness (ie coma)
Mamillary bodies
Wernicke-Korsakoff syndrome (firs: ataxia, ophthalmoplegia, confusion; korsakoff - memory loss, confabulation, personality change)
Basal ganglia
tremor at rest, chorea, or athetosis
Cerebellar hemisphere
intention tremor, limb ataxia; damage to the cerebellum results in ipsilateral deficits; fall toward side of lesion (cerebellum -> SCP -> contralateral cortex -> corticospinal decussation = ipsilateral)
Cerebellar vermis lesion
truncal ataxia, dysarthria
subthalamic nucleus lesion
contralateral hemibalismus
hippocampus lesion
anterograde amnesion (no new memories)
Paramedian pontine reticular formation (PPRF) lesion
Eyes look away from side of lesion
Frontal eye fields lesion
eyes look toward lesion
Athetosis
slow, writhing movements, especially of fingers. Basal ganglia lesion; often seen in Huntington’s
Myclonus
sudden, brief muscle contraction
Dystonia
Sustained, involuntary muscle contraction
Broca’s aphasia
can’t speak but can understand; inferior frontal gyrus [ on non-dominant side can’t express emotion or inflection in speech ]
wernicke’s aphasia
can’t understand but can speak; superior temporal gyrus [ non-dominant side can’t comprehend emotion or inflection in speech ]
Global aphasia
both broca and wernicke; nonfluent aphasia
Conduction
poor repitition but fluent speech, intact comprehension; acruate fasciculus (can’t repeat pharses such as no ifs, ands, or buts)
Watershed lesion
man in a barrell; higher order visual processing
Wallenberg (PICA lesion
ipsilateral horners, ataxia, vertigo/vomiting, contralateral pain and temp loss, ipsilateral pain and temp loss from face, nucleus ambiguus so loss of swallowing/hoarsness/gag reflex
Anterior spinal artery lesion
Loss of pyramids so contralateral hemiparesis of lower limbs, decreased propriception from loss of medial lemniscus, ipsilateral hypoglossal dysfunction from hypoglossal nucleus lesion
AICA lesion
occurs in lateral pons - hist nucleus VII, VI, Vestiubular nucleus, sympathetics, spinal trigeminal: Facial nerve defects such as paralysis, loss of taste from ant tongue, no corneal reflex, reduced ipsilateral hearing because of cochlear nucleus, ipsilateral horner’s, decreased lacrimation and salivation— facial droop
berry aneurysm of posterior communicating arteries
CN III - palsy due to compression
Weber syndrome (paramedial branches of PCA)
lesions the substantia nigra (contralateral parkinson), corticospinal tract (contralateral paresis), corticobulbar tract (facial muscles), oculomotor nerve fibers (ipsilateral CN III)
wednig hoffman disease
autosomal recessive disease, also known as infantile spinal muscular atrophy; presents with floppy baby, tongue fasciculations at birth, death by 7 months. Degeneration of anterior horns (LMN involvement only just like polio and west nile)
biceps reflex
C5, 6
triceps reflex
C7, 8
Patella reflex
L4, 3
Achilles reflex
S1, 2
Moro reflex
hang on for life newborn reflex
rooting reflex
nipple seeking
sucking reflex
sucking when roof of mouth is touched
palmar and plantar reflexes
curling of fingers or toes on touching palms or soles
gallant reflex
stroking along one side of spine causes lateral flexion of lower body toward stimulated side
Perinaud syndrome
lesion of superior colliculus; disrupts conjugate verticle gaze
cavernous sinus syndrome
Ophthalmoplegia plus V1 and V2 sensory loss. CNs III, IV, V1 V2, VI run through plus the internal carotid
muscles of mastication
lateral pterygoid opens mouth; masseter, temporalis and medial pterygoid closes
Migraine
female, fam history, unilateral, pulsatile/throbbing, 4 to 72 hours, auras, photophobia, nausea
Cluster headache
Male, no fam hx, onset during sl, behind eye, excruiating sharp and steady, 15 to 90 min, sweating, facial flushing, nasal congestion lacrimation, pupillary changes
Tension headache
female, usually from stress, band-like pattern around head (bilateral vs. migrain unilaterality), dull tight and persistent pain (versus throbbing like migraine), 30 min to 7 days, muscle tenderness in head neck or shoulders
Thalamic syndrome
vascular lesion of thalamus results in VPL and VPM nuclei damage causing contralateral sensory loss of both face and body
lipohyalinosi
the primary cause of lacunar infarcts along with microatheromas. They are believed to be priary cause of lacunar infarcts. It is a destructive vessel lesion characterized by loss of normal arterial architecture, mural foam cells.
area postrema
specialized fenestrated capilary region allows brain to sample chemicals and is responsible for vomiting reflex (lies in dorsal medulla near fourth ventricle).
meniere’s disease
disorder of inner ear d/t increased volume of endolymph maybe due to defective resorption of endolymph. Results in vestibular and cochlear components. Triad of tinnitus, vertigo, and sensorineural hearing loss
damaged in wilson’s
lentiform nucleus (globus pallidus and putamen) [remember hepaticolenticular degeneration]; manifestations include wing-beating tremor, psychosis and cirrhosis.
Ring enhancing lesion differential
metastases, abscesses, toxoplasmosis, primary CNS lymphoma
essential tremor
samilial tremor. AD. Often improves with alcohol consumption. First line treatment is beta blockers
diabetic CN III neuropathy
CN III neuropathy is ischemic and does not involve the parasympathetics due to their alternative blood supply
S-100
Schwann cell and melanocyte because of neural crest origin
subacute sclerosing encephalitis
complication of measles from recovered disease years later. May be caused by virus that is missing antigen which allows them to avoid immune clearance and persists in CNS. CHILDREN have progressive dementia and neurologic deficits, slowly progressive but fatal. High antibody titer in CSF. Oligoclonal bands, but NO antibodies to M-component (antigen) of virus.
Progressive multifocal leukoencephalopathy
caused by JC virus. Papova family (circular DNA)
Hyperpyrexia
temp greater than 40 C. can lead to permanent brain damage. Emergent treatment is cold blankets. Can be triggered by inflammation via exogenous pyrogens or drugs or malignancy. IL-1 and IL-6 and TNF mediated. Stimulate arachidonic acid from cell membranes by PL-A2 synthsis of PGE2 leads to increase in thermoregulatory set point (this is why aspirin and acetomenonphin are fever reducers). Purkinje cells of cerebellum especially sensitive to high temps.
Cerebral amyloid angiopathy
recurrent lobar hemorrhages in elderly patients. Beta amyloid deposited into arterial wall leading to weakening of the wall and predisposition to rupture. Cerebral amyloid angiopathy is associated with advanced age and is not related to systemic amyloidosis. Recurrent hemorrhagic stroke is most common presentation. Less severe than hemorrhages via HTN. Occur in cerebral hemispheres (Vs HTN that involve basal ganglia)
Nucleus ceruleus
NE- secreting neurons; fight or flight response. Dorsal pons
Raphe nucleus
Serotonin neurons in brainstem Project throughout CNS. Sleep-wake cycle, arousal. Lesions lead to insomnia and depression. Antidepressants work by prolonging amount of time that serotonin spends in synaptic cleft.
Nucus basalis of Meynert
Ach neurons. Destroyed in alzheimers
Red nucleus
anterior midbrain. Motor coordination of upper extremities
Caudate nucleus
motor activities. Atrophy in huntington, loss of cholinergic and GABA-releasing neurons
Substantia Nigra
Dopaminergic neurons
caudate nucleus blood supply
deep branches of the ACA
Lentiform nucleus blood supply
inferior division of the MCA
Anterior and posterior limbs of the internal capsule
anterior limb is supplied by ACA deep branches (located next to caudate); posterior limb is supplied by the choroidal artery which is a branch off the internal carotid (also supplies optic tract, lateral geniculate body, choroid plexus, uncus, hippocampus and amygdala)
PCA supplies
CN III and IV and other mdibrain structures. Thalamus, mesial temporal, corpus callosum, parahippocampal gyrus, fusiform gyus, and occipital lobe
nerve physiology; time constant
the amount of time it takes for the membrane to change potential. Measure of capacitance; myelination decreases time constant thus allowing membrane potential to change more rapidly
Nerve physiology; length constant
measure of how far along an axon an electrical impulse can propagate; Myelination increases the length constant.
acetylcholinesterase in amniotic fluid
Neural tube defects along with AFP
POMC
proopiomelanocortin. A polypeptide precursor that goes through enzymatic cleavage and modification to produce not only beta-endorphins but also ACTH and MSH (this suggests a possibly close linkage between stress axis and opiod system)
Mu receptor action
morphine and opioid agonists activate G-protein Mu receptor which one of its many effects is to hyperpolarize a cell by increasing K efflux.
Paralysis of upward gaze
Parinaud syndrome (a dorsal midbrain syndrome) occurs in tumors of pineal region
Germinoma
most common tumor of the pineal gland, from embryonic germ cells, patients present with precocious puberty via hCG production. Aqueductal compression may result in hydrocephalus, and parinaud syndrome which includes paralysis of upward gaze and convergence (this is due to compression of tectal area)
polyhydramnios
excessive aumulation of amniotic fluid due to decreased swallowing or increased urination. Impaired swallowing can be due to gi obstruction and anencephaly.
synaptophysin
found in presynaptic vesicles of neurons, neuroendocrine and neuroectodermal cells. CNS tumors of neuronal origin stain positive for synaptophysin. Neoplasms of glial origin (astrocytomas, ependymomas, and oligodendrogliomas) stain GFAP
germinal matrix
common area of bleeding in prematrue babies into the lateral ventricles. It is a highly cellular and vascularized layer in the sventricular zone from which neurons and glial cells migrate out during brain development. Matrix contains numerous thin-walled vessels lacking glial fibers that support other blood vessels throughout brain
