Neuro Flashcards
“Pseudopalisades,” - central necrosis with surrounding cells on brain Bx, crosses the corpus callosum, vascular proliferation
GBM
- # 1 brain tumor
- butterfly glioma = astrocytes
Solid tumor with small blue cells, Homer-wright rossettes (halo of cells surrounding central ball), gait instablity, limb ataxia
Medulloblastoma
- VERMIS
- Primitive neuroectodermal tumors
- # 2 in kids
Rosenthal fibers, spindle cells w/ hair-like glial processes (corkscrew fibers), ataxia, vision loss
Pilocytic astrocytoma
- # 1 kids
- Cerebellum, brainstem, hypothalamic, optic
Pseudorosettes (spoke-wheel cells around a blood vessel), rod shaped blepharoplasts, GFAP+, hydrocephalus
Ependymoma
- Roof of 4th
- # 3 kids
Spindle-shaped cell with concentric whorls, laminated calcifications, tumor on surface of brain
Meningioma
- # 2 adults
- Psammoma bodies
Blue cells, neutrophilic neuritic proceses that stain + for S-100, chromogranin, synaptophysin
Neuroblastoma
Absent cerebellar vermis, global ventricle enlargement, enlargement of posterior fossa
Dandy-Walker
Cerebellar tonsils through foramen magnum, blockage of aqueduct of sylvius, hydrocephalus, apnea, syringomyelia
Arnold-Chiari
Calcifications of white matter in frontal lobes, cells with central nucleus and clear cytoplasm, GFAP +
Oligodendrioglioma
- “chicken wire or fried-egg” appearance
Hemangioblastomas in retina, cerebellum, SC + dermatologic angiomas + RCC, pheo, kidney cysts
Von Hippel-Lindau
- AD
- VHL gene on chr3 –> activates angiogenic factors
Pigmented nodules in iris, optic nerve gliomas, cafe au lait spots
NF-1 (Von Recklinghausen)
Tinnitis in both ears, vertigo, HA, juvenile cataracts, cafe au lait spots
NF-2
Seizures, tram-tracking skull x-ray, facial angioma
Sturge-Weber
Cortical, subependymal hamartomas, acne on face, renal and liver failure, hypopigmented areas, leather-like patch on lower back
Tuberous sclerosis
- Kidney, liver, pancreatic cysts
- cardiac rhabdo, adenoma secaceum, CNS hammartomas
Kid w/ HA, bitemporal hemianopsia, polyuria, polydipsia, fatigue, weight gain
Craniopharyngioma
- Part solid (calcified)
- Part cystic (cholesterol “machine oil”)
- Keratin pearls
- Rathke’s pouch
Posterior communicating artery rupture
CN III down and out
AICA rupture
IL facial paralysis, pain and temp, tinnitus
PICA
CL Pain and temp body
IL Pain and temp face
Lesion to left motor cortex tract to facial muscles - which muscle is paralyzed?
Right orbicular oris (mouth/smiling muscle)
- occipitofrontalis get B/L innervation
Damage to right MLF, what happens when looking to the left?
Fixed R eye, nystagmus in left
- nystagmus in ABducting eye = signal to CN III is lost
Inc Hct, foamy cells with inc vascularity, cerebellar mass in an adult
Hemangioblastoma
Paralysis in left leg, atrophy, areflexia
Polio
- loss of anterior horn cells
- Asymmetrical (vs.GBS)
- PMNs and lymphocytes in CSF
- Fecal-oral = WATER
Paralysis in lower limbs, arms, hyperreflexia, no sensory loss
ALS
- anterior horn and CST –> UMN (vs. polio and GBS)
Paralysis in both legs, elevated protein in CSF with normal cells, absent DTRs
GBS
- campylobacter
- Albuminocytologic dissociation
- SYMMETRICAL (vs. polio)
Floppy baby, areflexia, muscle fibrillations and inc CK from birth
Spinal muscular atrophy
- survival motor neuron (SMN) mutation
- atrophy of LMN anterior horn cells
Consciousness intact, abnormal memory, auditory, visual or sensory hallucinations or “out-of-body” feeling
Simple Partial
- temporal lobe
LOC, repetitive movements of hands, lip smacking, chewing
Complex Partial
Begin as SPS or CPS –> stiffness and clonic jerking
Secondarily generalized tonic-clonic
Alternating stiffness and jerking movements
Tonic-conic
- Tx = Phenytoin or carbamazepine
Behavioral changes, dementia, frontotemoral atrophy, tau protein
Pick Disease
Problems paying attention, visual hallucinations, bradykinesia, tremor, alpha-synuclein inclusions
Lewy body dementia
Loss of caudate, NMDA/GABA receptors
Huntington
Kyphoscoliosis, pes cavus, ataxia, dec vibratory sense, CHF, DM
Freidrich ataxia
- GAA
- hypertrophic cardiomyopathy
Herniation –> cardiopulmonary arrest
Tonsilar
Herniation –> dilated, unreactive pupil, CL hemianopsia, IL hemiparesis, compresses PCA
Uncal - supratentorial
Herniation compresses ACA
Subflacine
Herniation –> tear basilar –> Duret hemorrhage and hyperventilation, Cheyne-Stoke breathing
Central
Fluent speech w/ impaired comprehension
Wernicke = world salad
- superior temporal
Fluent speech, intact comprehension, can’t repeat
Arcuate fasiculus - conduction aphasia
IL UMN, touch loss, CL pain and temp
Brown-sequard
BL pain and temp over back and shoulders, no DTRs
Syringomyelia
- assoc w/ Arnold-chiari
BL pain and temp a few levels below, BL flaccid paralysis
Central cord syndrome - anterior white commissure
Paresthesias a year prior, new onset blurred vision in one eye, scanning speech, intention tremor, bladder incontinence, worse w/ hot showers
MS
- Periventicular white matter
- Tx - beta-interferon
Oligoclonal bands
MS
Dec Ach in Basal nucleus of Meynert
Alzheimer
- Dec choline acetyltransferase
Alzheimer tx
Donepezil (cholinesterase inhibitor)
Memantine (NMDA antagonist)
Startle myoclonus, spike-wave on EEG
CJD
Free nerve endings
Pain and temp
Pacinian
Pressure
Vibration
- deep skin, joints, ligaments
Positional delayed horizontal nystagmus toward left eye
LEFT is affected - peripheral vertigo
Central vertigo
D/T stroke, tumors, MS w/ sx of diplopia, slurred speech, focal weakness + IMMEDIATE nystagmus that may CHANGE DIRECTION
