neuro Flashcards
area of brain/lobe assoc w language devel
wernicke’s/L temporal
area of brain/lobe assoc w speech production
broca’s/L frontal
largest lobe
frontal
microglia vs macroglia fxn
MICRO (macrophages) = clean debris of CNS
MACRO: oligodendrocytes = myelinate CNS, schwann = myelinate PNS, astrocytes = nutrients, support endothelial cells of BBB, repair/scar, ependymal = CSF, radial = progenitors, scaffold for migration
absence sz EEG finding
3Hz spike wave
possible dx of EEG 3Hz spike wave
absence sz
possible dx of EEG slow spike wave or polyspike/wave
akinetic sz, Lennox-Gastaut
possible dx of EEG hypsarrhythmia
status epilepticus, West synd (childhood spasms)
possible dx of EEG phantom spike wave
normal variant
MCC facial pain
dental
% kids who sleepwalk
10-30% (up to 50% of those w sleepwalking or night terrors have OSA??)
parasomnias usually happen in what phase of sleep cycle
slow-phase (earlier)
alcohol causes what type of sleep disorder
insomnia (early sedative effect w deep sleep x3-4h, then inc WAKEFULNESS & restless sleep)
management of TIA
eval, ID, tx all possible risk factors to prevent stroke/vasc events
how much stenosis to do enarterectomy
70%
CSF finding in 95% MS
oligoclonal bands (ltd Ab classes). may also find elev IgG, min elev-nml cell #, nml protein
REM: EEG, % total sleep, when do periods start & last longest
EEG: mixed voltage (~stage 1 sleep w rapid phasic eye mvmts, absent mm tone except intmt phasic mm twitches)
20-25% total sleep
start: 90-120min after onset
longest: 2nd half of night (AM hours, get longer twd end)
area of hypothalamus for wakefulness/sleep, action
VentroLateral PreOptic Nucleus: inhib brainstem wakefulness areas
where melatonin is made
pineal gland
myotonic dystrophy 1 (steinert’s dz) vs 2 presentation + genetic abn
1 = autosomal dom trinucleotide repeat CTG on DMPK gene: weakness of face/neck/forearm/hand (grip myotonia)/foot dorsiflex weakness (foot drop), mm pain, resp mm inv, dysphagia, dysarthria, cataracts, cardiac cond abn, infertility, insulin resist 2 = tetranucleotide repeat CCTG on ZNF9/CNBP gene: mild weakness, mm pain, but rarely resp mm inv, dysphagia, dysarthria
cogn sxs in SCZ
working memory, attn
neuro FDA indications for cymbalta
diabetic periph neuropathy, fibromyalgia, chronic MSK pain (in addition to MDD, GAD)
first line tx for TD
valbenazine/ingrezza
meige synd presentation + tx
blepharospasm, oromandibular dystonia w sore jaw»_space; botox, DBS
most common childhood epilepsy and anatomical source
benign rolandic sz, occur @ night, higher risk fatal aspiration, usually remits by 16yo, central sulcus @centrotemporal area
dx by EEG
4 parasomnias in DSM5
REM sleep behav do, nonREM sleep arousal do, RLS, nightmare do
major neurotransmitters affected in alz & anatomy
n basalis of meynert, ACh
locus ceruleus, NE
binswangers dx
dementia +
>=2:
HTN or vasc dz,
subcortical dsfxn (neurogenic bladder, musc rigidity, gait abn),
bilat leukoaraiosis or attenuation of white matter on MRI/CT
neuro signs: pyramidal (refl asym, rigid, ataxia), syncope due to hypoperf, PB palsy
kluver bucy synd?
hyperorality, hypersexuality, placidity seen in picks/FTD
CT findings in huntingtons
caudate atrophy, enlarged ventricles, gen cortical atrophy
EEG findings in absence sz, CJD, coma/enceph
absence: 3-4hz spikes & slow wave complexes
CJD: bi/triphasic DCs
coma: theta/delta
lead vs mercury poisoning
lead: basophilic stippling, hypochromic microcytic anemia, gum lines, wrist/foot drop, irritability, sz, coma
merc: GI ulcer, renal necrosis/calcif prox conv tubules, proteinuria, stomatitis, CNS
cluster HA vs paroxysmal hemicrania
cluster: M>F, >30min, less freq, tx O2, triptan, verapamil, botox?
PH: F:M 2:1, 2-30min, multiple daily, autonomic (horner, conj inj, lacrimation), neck movements trigger, tx indomethacin
LBD clinical vs biomarker dx
clnical: cogn imp + >2 fluctuating fluctuating cogn, VH, parkinsonism (later), REM sleep behav (can be before cogn imp)
biomarker: dec DA transporter uptake @basal gang on SPECT/PET, low 123iodine-MIBG uptake on myocardial scintigraphy, REM sleep w/o atonia on polysomnogram
interaction w tramadol + SSRIs?
sz, serotonin synd
med complications of catatonia, nonmalignant vs malign
nonmal: aspiration, burns, cachexia, dehydration, PNA, clot, urinary incont/ret
mal: limb strictures, arrhythmias, MI
age of peak prevalence of sleepwalking do
8-12yo
MCC & MC etiological factor assoc w temp lobe epilepsy
MCC: mesial temp + hippocampal sclerosis & temp lobe atrophy
etiological: prolonged febrile convulsion of childhood, anoxia @birth….. less common temp lobe infxn ie herpes & mass ie astrocytoma
chronological criteria for narcolepsy
3x weekly x3m
prevalence of sleep terror do in adults
<1%
sxs basilar migraine
transient HA, quadriplegia, stupor, psychosis, blindness, several hour coma
trigeminal neuralgia tx
CBZ, phenytoin, GPN
what is damaged in WK & why
malnut/starvation commonly from etoh > thiamine/B1 defic > mamillary body damage
thiamine/B1 deficiency, causes + clinical features
etoh > neurop, weakness, mm wasting, cardiomeg, ophthalmoplegia, confab (beriberi)
niacin/B3 deficiency, causes + clinical features
etoh, B6 defic (etoh, INH), riboflavin/B2 defic, tryptophan defic > Ds Dermatitis of sun exposed skin, Disorientation, Dementia/memory, Diarrhea, red tongue
pyridoxine/B6 deficiency, causes + clinical features
etoh, INH > seb derm, infl tongue, neurop, confusion, depr, micro anemia
folate/B9 deficiency, causes + clinical features
etoh, sulfasalazine, pyrimethamine, triamterene > shrunken tongue, meg anemia, high homocysteine
cobalamin/B12 deficiency, causes + clinical features
gastric bypass/atrophy, ilial dz, vegan > DORSAL (post + lat) column white matter w loss of vib/position (subacute combined degen of spinal cord), ataxia, dementia, bowel incont, ED, meg anemia
FDA approved meds for tourettes
haldol, abilify, pimozide
OFF label clonidine, prolixin, risperdal, tetrabenazine
*seroquel assoc w tics
describe homeostatic/circadian sleep drive levels
homeostatic SD lowest on waking & increases through day then lessens again once asleep. as it decreases during sleep, circadian SD increases to maintain sleep 2nd half of night, REM increased as well
MRI SCZ
fMRI of working memory in SCZ
MRI: dec vol prefrontal, thalamic, hippocampal, sup temp gyrus. inc lat/3rd vent vol & BG
fMRI: abn DL PFC, dec blood flow in frontal lobes
pathophys of huntingtons
huntingtin (synaptic vesicle assoc protein) overprod > NMDA rec med excitotox > neostriatum (caudate + putamen) degen
chronic selenium poisoning
garlic breath, GI do, hair loss, nail sloughing, fatigue, irritability, neuro damage
chronic arsenic poisoning
HA, conf, diarrhea, drowsiness then convulsions, leukonychia striatae nail pigment, mees lines (leuchoparnychia = while bands over width of nails)
chronic mercury poisoning
periph neurop, skin discoloration (pink cheeks, fingers/toes), edema, desquamation
chronic lead poisoning
lead thru GI/resp tracts ie batteries, paint > enz inhib & interferance w essential cations ie Ca Fe Zn to alter memb structure > CNS deficits, periph neurop, nephrop, HTN, anemia, short term mem loss, depr, nausea, abd pain, burton/lead lines
chronic iron poisoning
stomach pain, n/v, liver failure
fxn of post/lat dorsal columns of spinal cord
vibration/position
fxn of tectospinal tract
midbrain tectum to cervical spinal cord»_space; head/eye movement coordination
fxn of ant trigeminothalamic tract
pain/temp from face/head/neck
fxn of ant corticospinal tract
weakness
MCD criteria cognitive domains
complex attn, exec fxn, learning/memory, language, perceptual motor, social cogn
alz early v late onset mutations
early: presenilin I/II, amyloid precursor protein (APP)
late: apolipoprotein (ALP) E4