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Neuro Flashcards

1
Q

Neural Development

A

Notochord induce ectoderm to differentiated –> neuroectoderm –> neural plate –> neural tube and NCC
Notochord becomes nucleus pulpsus
Alar plate (dorsal)- sensory, regulated by TGFB (BMP)
Basal plate (ventral: motor, regulated by SHH

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2
Q

Prosencephalon

A

Telencephalon –> cerebral hemispheres and basal ganglia (walls) and lateral ventricles (cavities)
Diencephalon –> Thalamus, hypothalamus, retina (walls) and third ventricle (cavity)

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3
Q

Mesencephalon

A 
Midbrain (walls)
Cerebral aqueduct (cavities)
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4
Q

Rhomboencephalon

A

Metencephalon –> pons and cerebellum (walls) and upper part of fourth ventricle (cavity)
Myelencephalon –> medulla (walls) and lower part of fourth ventricle (cavity)

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5
Q

CNS origin

A

Neuroepithelia in neural tube –> CNS, ependymal cells, oligodendrocytes, astrocytes

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6
Q

PNS origin

A

NCC –> PNS, Schwann cells, glia, melanocytes, adrenal medulla

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7
Q

Microglia origin

A

Mesoderm

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8
Q

Neural tube defects

A

Neuropores fail to fuse (4th week) –> persistent connection between amniotic cavity and spinal canal
Associated with maternal DM and low folate
High AFP and acetylcholinesterase

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9
Q

Spinal bifida occulta

A

Failure of causal neuropore to close, but no herniation
seen at lower vertebral levels
Dura intact
Associated tuft of hair or skin dimple at level of bony defect

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10
Q

Meningocele

A

Meninges herniate through bony defect

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11
Q

Myelomeningocele

A

Meninges and neural tissue herniate through bony defect

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12
Q

Myeloschisis

A

Exposed, unfused neural tissue without skin covering

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13
Q

Anencephaly

A

failure of rostral neuropore to close –> no forebrain, open calvarium
polyhydramnios

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14
Q

Holoprosencephaly

A

Failure of embryonic forebrain to separate into 2 cerebral hemispheres (weeks 5-6)
Mutations in SHH
Associated with other midline defects (cleft lip, cyclopia)
increased risk of pituitary dysfunction
Associated with Patau

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15
Q

Lissencephaly

A

failure of neuronal migration resulting in smooth brain that lacks sulci and gyri
associated with microcephaly, ventriculomegaly

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16
Q

Chiari I malformation

A

Ectopia of cerebellar tonsils inferior to foramen magnum
Congenital, asymptomatic in children
Adult- HA, cerebella symptoms
Associated with syringomyelia

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17
Q

Chiari II malformations

A

Herniation of cerebellar vermis and tonsils through foramen magnum with aqueductal stenosis –> noncommunicating hydrocephalus
Associated with lumbosacral myelomeningocele
MORE SEVERE
presents earlier in life

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18
Q

Dandy Walker malformation

A

agenesis of cerebellar vermis –> cystic enlargement of 4th ventricle that fills the enlarged posterior fossa
Associated with noncommunicating hydrocephalus, spina bifida.

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19
Q

Syringomyelia

A

Cystic cavity within central canal of spinal cord
Fibers crossing in anterior white commissure damaged first
cape like bilateral symmetrical loss of pain and temperature sensation of UE
Associated with Chiari I and scoliosis

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20
Q

Tongue Development

A

1st and 2nd pharyngeal arches for anterior 2/3 (CNV3 and CN VII)
3rd and 4th pharyngeal arches form posterior 1/3 (CNIX and CNX)
motor innervation via CNXII to hyoglossus, genioglossus and styloglossus
Motor innervation via CNX to palatoglossus

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21
Q

Neurons

A

Signal tranmission
Permanent- do not divide in adults
Neuron markers: neurofilament proteins, synaptophysin

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22
Q

Astrocytes

A 
common glial cell type in CNS
Physical support, repair, extracelluar K buffer, remove excess NT
BBB
Derived from neuroectoderm
Marker: GFAP
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23
Q

Microglia

A

Phagocyte cells of CNS
mesoderm
Not stained via Nissl
HIV infected –> dementia

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24
Q

Ependymal cells

A

ciliated columnar glial cells line ventricles and central canal of spinal cord
Apical surfaces are covered in cilia and microvilli
Choroid plexus –> produce CSF

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25
Q

Myelin

A

increase conduction velocity of signals –> saltatory conduction of AP at nodes of Ranvier
Synthesized by oligodendrendrocytes or schwann cells

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26
Q

Schwann cells

A

promote axonal regeneration
NCC
injured in Guillain barre

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27
Q

Oligodendrocytes

A 
Myelinate axons of neurons in CNS
Predominate glial cell in white matter
Neuroectoderm
fried egg appearance
injured in MS, PML and leukodystrophies
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28
Q

Free Nerve endings

A

all skin, epidermis, viscera
sense pain and temp
Adelta- fast myelinated fibers
C- slow unmyelinated

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29
Q

Meissner Corpuscles

A

large myelinated fibers adapt quickly
glabrous skin (no hair)
dynamic, fine/light touch position sense, low frequency vibrations

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30
Q

Pacinian corpuscles

A

large myelinated fibers adapt quickly
deep skin layers, ligaments, joints
high frequency vibration, pressure

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31
Q

Merkel discs

A

large myelinated fibers adapt slowly
finger tips, superficial skin
pressure deep static touch, position sense

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32
Q

Ruffini corpuscles

A

Dendritic endings with capsule, adapt slowly
finger tips, joints
pressure, slippage of objects along surface of skin, joint angle change

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33
Q

Peripheral Nerve structure

A

Endoneurium- thin supportive connective tisse that ensheathes and supports individual myelinated nerve fibers
Perineurium- surround fascicle of nerve fibers
epineurium- dense connective tissue that surrounds entire nerve

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34
Q

Chromatolysis

A

reaction of neuronal cell body to axonal injury
high protein synthesis –> round cellular swelling, displacement of nucleus to periphery, dispersion of Nissl substance throughout cytoplasm
Proximal to injury –> axon retracts and cell body sprouts new protrusions that grow for reinnervation

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35
Q

Wallerian degeneration

A

disintegration of the axon and myelin sheath distal to the site of axonal injury with macrophages removing debris

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36
Q

ACh synthesis

A

Basal nucleus of Meynert

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37
Q

Dopamine synthesis

A

Ventral tegmentum, SNc

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38
Q

GABA synthesis

A

Nucleus acumbens

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39
Q

NER synthesis

A

locus ceruleus

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40
Q

5HT synthesis

A

Raphe nuclei

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41
Q

Dura mater

A

thick outer layer closes to skull
Mesoderm
potential space between dura mater and skull contain fat and blood vessels (epidural space)

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42
Q

Arachnoid mater

A

middle layer, contains web like connections
NCC
CSF flow below arachnoid mater

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43
Q

Pia mater

A

thin fibrous inner layer that adheres to brain and spinal cord
NCC

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44
Q

BBB

A

prevent circulating blood substances from reaching the CSF.CNS
Tight junctions
Basement Membrane
Astrocyte foot processes
Glucose and AA cross slowly by carrier mediated transport
lipid soluble substances cross rapidly

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45
Q

Vomiting center

A

coordinated by NTS in medulla receives info from CTZ , GI tract, vestibular system and CNS
CTZ receive input from muscarinic, DA, histamine, 5HT and NK1 receptors

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46
Q

Sleep physiology

A

suprachiasmatic nucleus regulated by light
control nocturnal release of ACTH, prolactin, melatonin, NE
Alcohol, benzos, and barbs associated with low REM and N3 sleep

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47
Q

Awake eyes open

A

alert active mental concentration

Beta waves

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48
Q

Awake eyes closed

A

alpha waves

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49
Q

N1

A

light sleep

theta waves

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50
Q

N3

A

deepest non REM sleep
sleepwalking, night terrors, bedwetting
delta waves

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51
Q

N2

A

deeper sleep
bruxism
sleep spindles and K complex

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52
Q

REM

A 
loss of motor tone, increase brain O2, ACh
dreaming, nightmares, penile tumescence
memory processing
PPRF --> extraocular movements
every 90 minutes
beta waves
old ppl- decreased REM time and N3
Depression- increased REM time, low REM latency, low N3
Narcolepsy- low REM latency
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53
Q

Hypothalamus

A

Maintain homeostasis by regulating Thirst and water balance, controlling adrenohypophysis and neurohypophysis release of hormones produced in the hypothalamus and regulating hunger, ANS, temperature and sexual urges

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54
Q

Lateral nucleus

A

Hypothalamus
hunger destruction –> anorexia, failure to thrive
Stimulated by ghrelin, inhibited by leptin

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55
Q

Ventromedial nuclues

A

Hypothalamus
Satiety
Destruction –> hyperphagia
Stimulated by leptin

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56
Q

Anterior nucleus

A

Hypothalamus

cooling PNS

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57
Q

Posterior Nucleus

A

Hypothalamus
heating
SNS

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58
Q

Suprachiasmatic nucleus

A

Hypothalamus

circadian rhythm

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59
Q

Supraoptic and paraventricular nuclei

A

Hypothalamus

synthesize ADH and oxytocin

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60
Q

Preoptic nuclei

A

Hypothalamus
Thermoregulation, sexual behavior, Releases GnRH
Failure of GnRH neurons to migrate to olfactory bulb –> Kallmann syndrome

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61
Q

Thalamus

A

Major relay for all ascending sensory information except olfaction

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62
Q

Ventral Posterolateral nucleus

A

Thalamus
input- spinothalamic and dorsal columns medial lemniscus
Vibration, pain, pressure, proprioception, light touch, temp
Destination- Primary somatosensory cortex

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63
Q

Ventral posteromedial nucleus

A

Thalamus
Input- trigeminal and gustatory
Face sensation, taste
Destination- primary somatosensory cortex

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64
Q

Lateral geniculate nucleus

A

Thalamus
Input- CNII, optic chiasm, optic tract
Vision
Destination- primary visual cortex

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65
Q

Medial geniculate nucleus

A

Thalamus
Input- superior olive and inferior colliculus of tectum
Hearing
Destination- auditory cortex of temporal lobe

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66
Q

Ventral lateral nucleus

A

Thalamus
Input- Cerebellum, basal gnaglia
Motor
Destination- motor cortex

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67
Q

Limbic system

A

Emotion, long term memory, olfaction, behavior modulation, ANS function
hippocampus, amygdala, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, entorhinal cortex
Feeding, fleeing, fighting, feeling, sex

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68
Q

Mesocortical DA pathway

A

decreased activity –> negative symptoms

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69
Q

Mesolimbic DA pathway

A

increased activity –> positive symptoms

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70
Q

Nigrostriatal DA pathway

A

decreased activity –> extrapyramidal symptoms (dystonia, akathisia, parkinsonism, tardive dyskinesia)

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71
Q

Tuberoinfundibular DA pathway

A

decreased activity –> increase prolactin –> decrease libido, sexual dysfunction, galactorrhea, gynecomastia

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72
Q

Cerebellum

A

modulate movement, aids in coordination and balance
Lateral lesions –> affect voluntary movement of extremities. Fall toward injured side
Medial lesions –>truncal ataxia, nystagmus, head tilting. Bilateral motor deficits affecting axial and proximal limb musculature

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73
Q

Basal ganglia

A

voluntary movement and adjusting posture
Striatum = putamen (motor) + Caudate (cognitive)
Lentiform= putamen + globus pallidus

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74
Q

Direct Basal ganglia pathway

A

SNc input to the striatum via nigrostriatal DA pathway –> release GABA –> inhibit release from GPi –> disinhibit thalamus –> increase motion

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75
Q

Indirect Basal ganglia pathway

A

SNc input to the striatum via nigrostriatal DA pathway –> release GABA –> disinhibit STN via GPe inhibition and stimulate GPi –> inhibit thalamus –> decrease motion

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76
Q

Cerebral perfusion

A

Relies o tight autoregulation driven by PCO2

Also relies on MAP, ICP (low BP/ high ICP –> decreased cerebral perfusion pressure

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77
Q

Therapeutic Hyperventilation

A

decrease PCO2 –> vasoconstriction –> decrease cerebral blood flow –> decrease ICP
Used to treat acute cerebral edema unresponsive to other interventions

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78
Q

Homunculus

A

Topographic representation of motor and sensory areas in cerebral cortex
Distorted appearance is due to certain body regions being more richly innervated and thus have high cortical representation

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79
Q

Dural venous sinuses

A

Large venous channels that run through the periosteal and meingeal layers of the dura mater. Drain blood from cerebral veins and receive CSF from arachnoid granulations
Empty into internal jugular V

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80
Q

Venous sinus thrombosis

A

high ICP
may lead to venous hemorrhage
Associated with hypercoaguable states

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81
Q

Ventricular system of the brain

A

Lateral –> 3rd via right and left interventricular foramina of monroe
3rd –> 4th via cerebral aqueduct of Sylvius
4th –> subarachnoid space via foramina of Luschka (lateral) and Magendie (medial)

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82
Q

CSF production

A

via choroid plexus in lateral and 4th ventricles
Travel to subarachnoid space
reabsorbed by arachnoid granulations
drain into dural venous sinuses

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83
Q

Cranial Nerves in brain

A

4 CN above pons
4 CN via pons
4 CN in medulla
4 CN medial (3, 4, 6, 12)

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84
Q

Pineal gland

A

melatonin secretion, circadian rhythm

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85
Q

Superior colliculi

A

direct eye movements to stimuli or objects of interest

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86
Q

Inferior colliculi

A

auditory

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87
Q

Olfactory N

A

CN1
Smell
Sensory

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88
Q

Optic N

A

CN2
sight
Senory

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89
Q

Oculomotor

A

CN 3
Eye movement- SR, IR, MR, IO
pupillary constriction, accomodation, eyelid opening
Motor

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90
Q

Trochlear N

A

CN 4
eye movement SO
Motor

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91
Q

Trigeminal

A

CN 5
Mastication, facial sensation, somatosensation from anterior 2/3 tongue, dampen loud noises (tensor tympani)
sensory and motor

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92
Q

Abducens

A

CN6
Eye movement LR
Motor

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93
Q

Facial N

A

CN 7
facial movement, taste from anterior 2/3 tongue, lacrimation, salivation, eye closing, auditory volume modulation
sensory and motor

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94
Q

Vestibulocochlear N

A

CN 8
hearing, balance
sensory

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95
Q

Glossopharyngeal N

A

CN 9
Taste and sensation from posterior 1/3 tongue, swallowing, salivation, monitor carotid body and sinus chemo and baroreceptors and elevation of pharynx
sensory and motor

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96
Q

Vagus N

A

CN 10
taste from supraglottic region, swalloing, soft palate elevation, midline uvula, talking, cough reflex, PNS to thoracoabdominal viscera, monitor aortic arch chemo and baroreceptors
sensory and motor

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97
Q

Accessory N

A

CN 11
Head turning, shoulder shrug
Motor

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98
Q

Hypoglossal N

A

CN 12
tongue movement
motor

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99
Q

Nucleus Tractus Solitarius

A

Vagal nuclei
visceral sensory information
CN 7, 9, 10

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100
Q

Nucleus ambiguous

A

Vagal nuclei
motor innervation of pharynx, larynx, upper esophagus
CN 9, 10, 11

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101
Q

Dorsal motor nucleus

A

Vagal nucleus
sends PNS to heart, lungs, upper GI
CN 10

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102
Q

Corneal reflex

A

V1 ophthalmic (nasociliary) to bilateral CN 7

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103
Q

Lacrimation reflex

A

V1 –> 7

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104
Q

Jaw jerk

A

V3 (sensory from masseter) –> V3 (motor- masseter)

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105
Q

Pupillary reflex

A

CN 2 –> CN 3

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106
Q

Gag reflex

A

CN 9 –> CN 10

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107
Q

Cough reflex

A

CN 10 –> CN 10

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108
Q

Mastication Muscles

A

Close jaw- Masseter, temporalis, medial pterygoid
Open jaw - lateral pterygoid
Innervated by V3

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109
Q

Spinal cord ends in adults at

A

lower border of L1-L2 vertebrae

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110
Q

Subarachnoid space extends to

A

lower border of S2

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111
Q

Lumbar puncture

A 
between L3-L4 or L4-L5
Skin
Fascia, fat
supraspinous L
interspinous L
Ligamentum Flavum
Epidural space
dura mater
arachnoid mater
subarachnoid space
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112
Q

Dorsal Column

A

Ascending
Pressure, vibration, fine touch, propiception
Sensory N ending –> bypass pseudounipolar cell body in DRG –> enter spinal cord –> ascend IPSILATERAL in dorsal column –> NUCLEUS GRACILIS, NUCLEUS CUNEATUS –> decussates in medulla –> ascends CONTRALATERALLY as medial lemniscus –> VPL

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113
Q

Spinothalamic tract

A

Ascending
Lateral - pain, temperature
Anterior- crude touch, pressure
Sensory N ending –> bypass pseudounipolar cells body in DRG –> enter spinal cord –> IPSILATERAL gray matter –> decussates in spinal cord as the anterior white comissure –> ASCEND CONTRALTERALLY –> VPL

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114
Q

Lateral Corticospinal tract

A

Descending
Voluntary movement of contralateral limb
UMN: cell body in primary motor cortex –> descend IPSILATERALLY, most fibers decusssate at caudal medulla –> DESCEND CONTRALATERALLY –> cell body of anterior horn –> LMN (leave spinal cord)

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115
Q

Achilles reflex

A

S1

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116
Q

Patellar reflex

A

L4

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117
Q

Biceps and brachioradialis reflex

A

C5

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118
Q

Triceps reflex

A

C7

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119
Q

Cremasteric reflex

A

L1, L2

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120
Q

Anal wink reflex

A

S3, S4

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121
Q

Primitive reflexes

A

CNS reflexes present in a healthy infant but absent in adults
disappear within first year
Inhibited by mature frontal lobe

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122
Q

Moro reflex

A

Primitive reflex
hang on for life
abduct/extend arm when startled then draw together

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123
Q

Rooting reflex

A

Primitive reflex

movement of head toward one side if cheek or mouth in stroked

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124
Q

Sucking reflex

A

Primitive reflex

sucking response when rook of mouth is touched

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125
Q

palmar reflex

A

Primitive reflex

curling fingers if palm is stroked

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126
Q

Plantar reflex

A

Primitive reflex
dorsiflexion of large toe and fanning of other toes with plantar stimulation
Babinski sign in adults = lesion in UMN

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127
Q

Galant reflex

A

Primitive reflex
stroking along one side of spine while newborn is in ventral suspension causes lateral flexion of lower ody toward stimulated side

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128
Q

C2 Dermatome

A

Posterior half of skull

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129
Q

C3 Dermatome

A

High turtleneck shirt

Diaphragm, gallbladder pain referred to right shoulder via phrenic

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130
Q

C4 Dermatome

A

low collar shirt

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131
Q

C6 Dermatome

A

thumbs

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132
Q

T4 Dermatome

A

Nipple

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133
Q

T7 Dermatome

A

xiphoid process

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134
Q

T10 Dermatome

A

umbilicus

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135
Q

L1 Dermatome

A

Inguinal L

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136
Q

L4 Dermatome

A

kneecaps

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137
Q

S2, S3, S4 Dermatomes

A

sensation of penile and anal zones

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138
Q

Frontal lobe lesion

A

Disinhibition and deficits in concentration, orientation, judgement
may have reemergence of primitive reflexes

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139
Q

Frontal eye fields lesions

A 
Destructive lesions (MCA stroke)
eyes look toward brain lesion
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140
Q

Paramedian pontine reticular formation lesion

A

Eyes look away from brain lesion

141
Q

Medial longitudinal fasciculus lesion

A 
internuclear ophthalmoplegia (impaired adduction of ipsilateral eye, nystagmus of contralateral eye with abduction)
Multiple sclerosis
142
Q

Dominant parietal cortex lesion

A

Agraphia, acalculia, finger agnosia, left- right disorientation
Gerstmann syndrome

143
Q

Nondominant parietal cortex Lesion

A

Agnosia of the contralateral side of he world

Hemispatial neglect syndrome

144
Q

Hippocampus lesion

A

anterograde amnesia, inability to make new memories

145
Q

Basal ganglia lesion

A

May result in tremor at rest, chorea, athetosis

Parkinsons, huntington, wilson

146
Q

Subthalamic nucleus lesion

A

Contralateral hemiballismus

147
Q

Mammillary bodies lesion

A

Wernicke Korsakoff syndrome- confusion, ataxia, nystagmus, ophthalmoplegia, memory loss, confabulation, personality changes
Alcoholics

148
Q

Amygdala lesion

A

Kluver Bucy Syndrome- disinhibited behavior

HSV 1 encephalitis

149
Q

Doral Midbrain lesion

A

Parinaud syndrome- vertical gaze palsy, pupillary light near dissociation, lid retraction, convergence retraction nystagmus
stroke, hydrocephalus, pinealoma

150
Q

Reticular activating system lesion

A

reduced levels of arousal and wakefulness

Coma

151
Q

Cerebellar hemisphere lesion

A

intention tremor, limb ataxia, loss of balance, damage to the cerebellum –> ipsilateral deficits

152
Q

Cerebellar vermis lesions

A

truncal ataxia, nystagmus

chronic alcohol use

153
Q

Red nucleus lesion

A

decorticate posturing- lesion above red nucleus –> flexion of upper extremities and extension of lower extremities
Decerebate posturing- lesion at or below red nucleus –> extension of upper and lower extremities (WORSE PROGNOSIS)

154
Q

Ischemic brain disease/ stroke

A

irreversible injury begins after 5 minutes of hypoxia

most vulnerable = hippocampus, neocortex, cerebellum, watershed areas

155
Q

12- 24 hours post stroke

A

eosinophilic cytoplasm and pyknotic nuclei

156
Q

24-72 hours post stroke

A

necrosis and neutrophils

157
Q

3-5 days post stroke

A

macrophages

158
Q

1-2 weeks post stroke

A

reactive gliosis and vascular proliferation

159
Q

> 2 weeks post stroke

A

glial scar

160
Q

Ischemic stroke

A

block vessels –> infarction –> liquefactive necrosis
Thrombotic- clot formation at site of infarction (MCA), atherosclerotic plaque
Embolic- embolus from another part of body. A- fib, carotid artery stenosis, DVT, infective endocarditis
Hypoxic- hypoperfusion. Cardiovascular surgery. watershed areas
T(x): tPA within 3-4.5 hours, aspirin

161
Q

Transient ischemic attack

A

brief, reversible episode of focal neruo dysfunction without acute infarction with resolution in <15 minutes

162
Q

Neonatal intraventricular hemorrhage

A

bleeding into ventricles
increased risk in premature, low birth weight infants
originate in germinal matrix.
Due to reduced glial fiber support and impaired autoregulation of BP in premature infants
altered level of consciousness, bulging fontanelle, hypotension, seizures, coma

163
Q

Epidural hematoma

A

rupture of middle meningeal A
secondary to skull fracture (pterion)
transient loss of consciousness –> recovery –> rapid deterioration
Scalp hematoma and intracranial expansion –> transtentorial herniation –> CN III palsy

164
Q

Subdural hematoma

A

Rupture of bridging veins
shaken babies
crescent shaped hemorrhage that crosses the suture lines

165
Q

Subarachnoid hemorrhage

A

bleeding due to trauma or rupture of an aneurysm or arteriovenous malformation
WORST HA OF LIFE
bloody or yellow lumbar puncture
Vasospasm or rebleed can occur, use nimodipine

166
Q

Intraparenchymal hemorrhage

A

caused by systemic HTN, amyloid angiopathy, vasculitis, neoplasm
secondary to reperfusion injury
Putamen of basal ganglia, thalamus, pons and cerebellum

167
Q

Middle cerebral A

A

motor and sensory cortices- upper limb and face –> CONTRA paralysis and sensory loss in face and upper limb
Temporal lobe and frontal lobe- aphasia and right superior quadrant visual defect if in dominant hemisphere. Hemineglect if affects nondominant

168
Q

Anterior cerebral A

A

motor and sensory cortices- lower limb–> CONTRA paralysis and sensory loss- lower limb, urinary incontinence

169
Q

Lenticulostriate A

A

Striatum, internal capsule –> CONTRA paralysis. Absence of cortical signs
Lacunar infarcts

170
Q

Anterior spinal A

A

Corticospinal tract –> CONTRA paralysis- upper and lower limbs
Medial lemniscus –> decreased CONTRA propioception
Caudal Medulla- hypoglossal N –> IPSI hypoglossal dysfunction

171
Q

Medial Medullary syndrome

A

caused by infarct of paramedian branches of ASA or vertebral A

172
Q

Posterior Intferior Cerebellar A

A

Lateral medulla
Nucleus ambiguous –> dysphagia, hoarseness, no gag reflex, hiccups
Vestibular nuclei –> vomiting, vertigo, nystagmus
Lateral spinothalamic tract, spinal trigeminal nucleus –> decrease pain and temperature sensation from CONTRA body and IPSI face
Sympathetic –> IPSI horner syndrome
Inferior cerebellar peduncle –> IPSI ataxia, dysmetria

173
Q

Lateral medullary syndrome (Wallenberg)

A

Nucleus ambiguus effects are specific to PICA lesions

174
Q

Anterior inferior cerebellar A

A

Lateral pons
Facial nucleus –> paralysis of face, low lacrimation, salivation and taste in anterior 2/3 of tongue
Vestibular nuclei –> vomiting, vertigo, nystagmus
Spinothalamic tract, spinal trigeminal nucleus –> decrease pain and temperature from CONTRA body and IPSI face
Sympathetic –> IPSI Horners
Middle and inferior cerebellar peduncles –> IPSI ataxia, dysmetria
Labryinthine A –> IPSI sensorineural deafness, vertigo

175
Q

Lateral pontine syndrome

A

facial nucleus effects are specific to AICA

176
Q

Basilar A

A

Pons, medulla, lower midbrain –> if RAS spared consciousness is preserved
Corticospinal and corticobulbar tracts –> quadriplegia, loss of voluntary facial, mouth and tongue movement
Ocular CN nuclei, paramedian pontine reticular formation –> loss of horizontal eye movements

177
Q

Posterior cerebral A

A

occipital lobe –> CONTRA hemianopia with macular sparing, alexia without agraphia

178
Q

Central poststroke pain syndrome

A

Neuropathic pain due to thalamic lesions

initial paresthesias followed in weeks to months by allodynia and dysethesia on CONTRA side

179
Q

Diffuse axonal injury

A

via traumatic shearing forces during rapid acceleration- deceleration of the brain
devastating neuro injury –> coma, persistent vegetative state
MRI= multiple lesions involving white matter tracts

180
Q

Broca’s aphasia

A

Broca area in inferior frontal gyrus of frontal lobe

Patient appears frustrated insight intact

181
Q

Wernicke’s aphasia

A

superior temporal gyrus of temporal lobe
Patients do not have insight
Word salad

182
Q

Conduction aphasia

A

can be caused by damage to arcuate fasciculus

183
Q

Global aphasia

A

Broca + Wernickes

184
Q

Transcortical motor aphasia

A

affects frontal lobe around Broca’s are. Broca is spared

185
Q

Transcortical sensory aphasia

A

affects temporal lobe around Wernickes, Wernicke’s is spared

186
Q

Transcortical mixed

A

Broca and Wernickes areas and arcuate fasciculus remain intact, surrounding watershed areas affected

187
Q

Saccular aneurysm

A

Bifurcation in circle of willis (Acom and ACA)
Assoicated with ADPKD, Ehlers Danles
Risk- age, HTN, smoking , AA
Silent until rupture –> subarachnoid hemorrhage –> focal neuro deficits

188
Q

Berry aneurysm in A com

A

Compression bitemporal hemianopia –> visual acuity deficits

Rupture –> ischemia in ACA distribution –> CONTRA lower extremity hemiparesis, sensory deficits

189
Q

Berry Aneurysm MCA

A

Rupture –> ischemia to MCA –> CONTRA upper extremity and lower facial hemiparesis, sensory deficits

190
Q

Berry aneurysm Pcom

A

compression –> IPSI CN III palsy –> mydriasis, ptosis and down and out

191
Q

Charcot Bouchard Microaneurysms

A

Associated with chronic HTN
affects small vessels (lenticulostriate)
cause hemorrhagic intraparenchymal strokes
Not visible in angiography

192
Q

Partial Seizure

A

Simple- consciousness intact

complete- impaired consciousness

193
Q

Epilepsy

A

disorder of recurrent, unprovoked seizures

194
Q

Status epilepticus

A

continuous or recurring seizures that may result in brain injury

195
Q

Generalized seizures

A

Absence- no postictal confusion, blank stare
myoclonic- quick, repetitive jerks
Tonic clonic- alternating stiffening and movement, postictal confusion, urinary incontinence, tongue biting
Tonic- stiffening
Atonic- drop seizures

196
Q

Fever

A

cytokine activation during inflammation
<40C
febrile seizures
T(x) Acetaminophen or ibuprofen

197
Q

Heat Stroke

A

inability of body to dissipate heat
>40C
CNS dysfunction, end organ damage, acute respiratory distress, rhabdomyolysis
T(x) rapid external cooling, rehydration and electrolyte correction

198
Q

Cluster HA

A 
unilateral
15 minutes - 3 hours repetitive
excruciating periorbital pain with lacrimation and rhinorrhea
Males
T(x): sumatriptan, O2, verapamil
199
Q

Migraine

A

unilateral
4-72 hours
pulsating pain with nausea, photophobia, phonophonia, +/- aura
T(x): NSAIS, triptans, dihydroergotamine

200
Q

Tensino HA

A 
bilateral
>30 min constant
steady band like pain
No photophobia, phonophobia or aura
T(x): analgesics, NSAIDs acetaminophen
201
Q

Akathisia

A

restlessness and intense urge to move

neuroleptic use or side effect of parkinson treatment

202
Q

Asterixis

A

extension of wrists causing flapping motion

hepatic encephalopathy, Wilson

203
Q

Athetosis

A

slow, snake like writhing movements
basal ganglia
Huntington

204
Q

Chorea

A

Sudden jerky purposeless movements
Basal Ganglia
Huntington and acute rheumatic fever

205
Q

Dystonia

A

sustained involuntary muscle contraction
Writers cramp, blepharospasm, torticollis
T(x): BOTOX

206
Q

Essential tremor

A

high frequency tremor with sustained posture worsened with movement or when anxious
familial
self medicated with alcohol
T(x): nonselective B blockers

207
Q

Intention tremor

A

slow zigzag motion when pointing

cerebellar dysfunction

208
Q

Resting tremor

A

Uncontrolled movement of distal appendages alleviated by intentional movement
substantia nigra
Parkinsons (pill rolling)

209
Q

Hemiballismus

A

sudden, wide flailing of one side of the body

CONTRA subthalamic nucleus

210
Q

Myoclonus

A

sudden brief uncontrolled muscle contraction

renal and liver failure

211
Q

Restless leg syndrome

A

Worse at rest/ night
relieved by movement
iron deficiency, CKD
T(x) DA agonists

212
Q

Parkinson Disease

A

Pill rolling, rigidity, akinesia, postural instability, shuffling gait, small handwriting
loss of HA neurons and lewy bodies (a synuclein)

213
Q

Huntington Disease

A

AD CAG repeat in HTT gene (Chr 4)
20-50 years
chorea, atheosis, aggression, depression, dementia
Anticipation
Atrophy of caudate and putamen with ex vacuo venticulomegaly
high DA, low GABA, ACh
Neuronal death via NMDA-R binding and glutamate excitotox

214
Q

Alzheimers

A

dementia in elderly
increased risk in Downs
low ACh
Altered ApoE, APP
widespread cortical atrophy (hippocampus), narrow wide gyri and wide sulci
Senile plaques with B amyloid core
Neurofibrillary tangles (tau), Hirano bodies(protein rods in hippocampus)

215
Q

Frontotemporal dementia

A

Early changes in personality and behavior or aphasia
associated movement disorders
frontotemporal lobe degeneration
tau (+)

216
Q

Lewy body dementia

A

visual hallucinations, dementia with fluctuating cognition/ alertness
REM sleep behavior disorder and parkinsonism
onset < 1 year apart
Intracellular Lewy bodies in CORTEX

217
Q

Vascular dementia

A

multiple arterial infarcts or chronic ischemia
decline in cognitive ability with late onset memory impairment
MRI/ CT multiple cortical/ subcortical infarcts

218
Q

Creutzfeldt- Jakob Disease

A

rapidly progressive dementia with myoclonus and ataxia
periodic sharp waves on EEG
spongiform cortex
prions

219
Q

Idiopathic intracranial HTN

A

high ICP with no obvious findings
risk- female, tetracyclines, obese, high vit A, Danazol
Associated with cerebral venous sinus stenosis
HA, tinnitus, diplopia, no AMS
papilledema
Lumbar puncture –> HA relief
T(x) weight loss, acetazolamide

220
Q

Communicating Hydrocephalus

A

low CSF absorption by arachnoid granulations –> high ICP, papilledema, herniation

221
Q

Normal Pressure Hydrocephalus

A

elderly, idiopathic
CSP pressure elevated episodically
Expansion of ventricles distorts the fibers of the corona radiata –> urinary incontinence, gait apraxia, cognitive dysfunction
Reversible with CSP drainage via lumbar puncture

222
Q

Noncommunicating Hydrocephalus

A

caused by structural blockage of CSF circulation within ventricular system

223
Q

Ex vacuo ventriculomegalu

A

appearance of high CSF on imaging but due to low brain tissue and neuronal atrophy
Alzheimers, HIV, Pick, Huntington
ICP normal

224
Q

Multiple sclerosis

A

Autoimmune inflammation of demyelination of CNS
Acute optic neuritis, brain stem/ cerebellar syndromes, pyramidal tract demyelination, spinal cord syndromes
symptoms exacerbate with increased body temp
Relapsing and remitting
Women 20-30
low vit D
High IgG and myelin basic protein in CSF, oligoclonal bands
Periventricular plaques, multiple white matter lesions disseminated in space and time

225
Q

Osmotic Demyelination Syndrome

A

massive axonal demyelination in pontine white matter secondary to rapid osmotic changes (hyponatremia correction)
acute paralysis, dysarthria, dysphagia, diplopia, locked in syndrom

226
Q

Acute inflammatory demyelinating polyradiculopathy

A

Guillain Barre
autoimmune condition that destroys schwann cells via inflammation and demyelination of motor fibers, sensory fibers and PNS
Symmetric ascending muscle weakness and depressed DTRs in lower extremities, facial paralysis and respiratory failure]high CSF protein with normal cell count
Plasmapheresis or IVIg

227
Q

Acute disseminated encephalomyelitis

A

multifocal inflammation and demyelination after infection or vaccination
rapidly progressive multifocal neuro symptoms, AMS

228
Q

Charcot Marie Tooth

A

hereditary motor and sensory neuropathy
defective production of proteins involved in the structure and function of PNS or myelin sheath
AD PMP22 gene duplication
associated with foot deformities, lower extremity weakness and sensory deficits

229
Q

Progressive multifocal leukoencephalopathy

A 
Demyelination of CNS via destruction of oligodendrocytes
rapidly progressive, usually fatal
involve parietal and occipital areas
visual symptoms
high risk associated with natalizumab
230
Q

Sturge Weber

A

Anomaly of NCC derivatives
activating mutation of GNAQ
capillary vascular formation –> port wine stain, IPSI leptomeningeal angioma –> seizures, intellectual disability, early onset glaucoma

231
Q

Neurofibromatosis 1

A

AD mutation of NF1 (Chr 17)
cafe au lait spots, intellectual disability, cutaneous neurofibromas, lisch nodules, optic gliomas, pheochromocytoma, seizures, neuro signs

232
Q

Tuberous Sclerosis

A

AD mutation of TSC1 (Chr 9) TSC 2 (Chr16)
Hamartomas in CNS and skin, angiofibroma, mitral regurgitation, ash-leaf spots, cardiac rhabdomyoma, mental retardation, angiomyolipoma, seizure, shagreen patches
increased incidence of subependymal giant cell astrocytoma and ungal fibromas

233
Q

Neurofibromatosis 2

A

AD mutation of NF2 (chr 22)

bilateral vestibular schwannoma, juvenile cataracts, meningiomas, ependmomas

234
Q

von hippel landau

A

AD deletion of VHL (chr 3p)

hemangioblastoma in retina, brainstem, cerebellem, spine, angiomatosis, bilateral RCC, pheochromocytoma

235
Q

Glioblastoma multiforme

A

Adult primary brain tumor
Grade IV astrocytoma
Cerebral hemisphere, can cross corpus callosum
GFAP +, pseudopallisading, hemorrhage and microvascular proliferation

236
Q

oligodendeoglioma

A 
Adult primary brain tumor
slow growing
frontal lobes
calcifies
fried egg cells. chicken wire capillary pattern
237
Q

Meningioma

A

Adult primary brain tumor
benign
females
near surfaces of brain and parasagittal region
Arachnoid cell origin
spindle cells concentrically arranged in whorled pattern, psammoma bodies

238
Q

Hemangioblastoma

A

Adult primary brain tumor
cerebellar
associated with VHL when with retinal angioma
Secondary polycythemia
blood vessel origin
closely arranged, thin walled capillaries with minimal intervening parenchyma

239
Q

Pituitary adenoma

A

Adult primary brain tumor
silent or hormone producing
Bitemporal hemianopia
prolactinoma –> galatorrhea, amenorrhea, low bone density due to suppression of estrogen, low libido, infertility in men
T(x) DA agonists, transspenoidal resection

240
Q

Schwannoma

A 
Adult primary brain tumor
Cerebellopontine angle
CN 5, 7, 8 involved
S 100 +
biphasic dense hypercellular areas with spindle cells alternating with hypocellular myxoid areas
241
Q

Pilocytic astrocytoma

A 
Childhood primary brain tumor
well circumscribed
posterior fossa
astrocyte origin GFAP+
rosenthal fibers (corkscrew)
242
Q

Medulloblastoma

A

Childhood primary brain tumor
cerebellum
compress 4th ventricle –> noncommunicating hydrocephalus
Neuroectodermal tumor, Homer Wright rosettes, small blue cells
synaptophysin +

243
Q

Ependymoma

A

Childhood primary brain tumor
4th ventricle –> hydrocephalus
Ependymal cell origin
Perviascular pseudorosettes, rod shaped blepharoplasts

244
Q

Craniopharyngoima

A 
Childhood primary brain tumor
supratentorial tumor
bitemporal hemianopia
Remnants of Rathke pouch
calcifications, cholesterol crystals found in fluid within tumor
245
Q

Pinealoma

A

Childhood primary brain tumor
pineal gland
parinaud syndrome (vertical gaze palsy), obstructive hydrocephalus, precocious puberty in males

246
Q

Cingulate herniation

A

under falx cerebri

compress ACA

247
Q

Transtentorial herniation

A

causal displacement of brain stem –> rupture paramedial basilar artery –> Duret hemorrhages
FATAL

248
Q

uncal transtentorial herniation

A

uncus is medial to temporal lobe
Early- IPSI blow pupil (CN3), CONTRA hemiparesis
Late- coma, Kernohan phenomenon

249
Q

Cerebellar tonsillar herniation

A

into foramen magnum

coma and death when herniation compress brainstem

250
Q

Spinal muscular atrophy

A

congenital degeneration of anterior horns
LMN ONLY, symmetric weakness
floppy baby, tongue fasciculations
AR SMN1 mutation

251
Q

Amyotrophic lateral Sclerosis

A 
UMN and LMN degeneration
so sensory or bowel deficits
SOD1 defect
flaccid limb weakness, fasciculations, atrophy, bulbar palsy, spastic limp weakness, hyperreflexia, clonus, pseudobulbar palsy
T(c) Rilouzole
252
Q

Complete occlusion of anterior spinal A

A

spares dorsal columns and Lissauer tract
mid thoracic ASA territory is watershed area
Can be caused by aortic aneurysm repair
UMN deficit below lesion and LMN deficit at lesion, loss of pain and temperature sensation below lesion

253
Q

Tabes dorsalis

A

Tertiary syphilis
Degeneration/ demyelination of dorsal columns and roots –> progressive sensory ataxia
+ Romberg and absent DTRs
Associated with Charcot joints, shooting pain, Argyll Robertson pupils.

254
Q

Syringomyelia

A

syrinx expands and damages anterior white commissure of spinothalamic tract –> bilateral symmetric pain and temperature sensation in capelike distribution
Chiai 1 malformation

255
Q

Vitamin B12 deficiency

A

Subacute combined degeneration –> demyelination of spinocerebellar tracts, lateral corticospinal tracts and dorsal columns
ataxic gait, paresthesia, impaired position/vibratory sense, UMN symptoms

256
Q

Cauda equina

A

compression of spinal roots L2 and below via intervertebral disc herniation or tumor
radicular pain, absent knee and ankle reflexes, loss of bladder and anal sphincter control, saddle anesthesia

257
Q

Poliomyelitis

A

Polio replicate in oropharynx and small intestine before spreading via blood stream to CNS
Causes destruction of cells in anterior horn (LMN)
asymmetric weakness, hypotonia, flaccid paralysis, fasciculations, hyporeflexia, muscle atrophy, respiratory failure
CSF high WBC, slight high protein

258
Q

Brown Sequard

A

Hemisection of spinal cord
IPSI loss of all sensation at level of lesion
IPSI LMN signs at level of lesion
IPSI UMN signs below level of lesion
IPSI loss of proprioception, vibration, light and tactile sense below level of lesion
CONTRA loss of pain, temperature and crude touch below level of lesion

259
Q

Friedrich Ataxia

A

AR GAA repeat on Chr 9
impaired mitochondrial functioning
Degeneration of lateral corticospinal tract, spinocerebellar tract, dorsal column and DRG
staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, DM, hypertrophic cardiomyopathy

260
Q

CN V motor lesion

A

jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid M

261
Q

CN X motor lesion

A

uvula deviates away from the side of lesion

weak side collapses

262
Q

CN XI lesion

A

weakness in turning head to CONTRA side. Shoulder droop on side of lesions

263
Q

CNXII motor lesion

A

LMN lesion

tongue deviates toward side of lesion

264
Q

Bell Palsy

A

Post HSV reactivation, lyme disease, herpes zoster, sarcoidosis, tumors, DM
T(x) corticosteroids and acyclovir

265
Q

UMN lesion facial N

A

at motor cortex, connection from motor cortex to facial nucleus in pons
CONTRA
lower muscles of facial expression
forebrain is spared

266
Q

LMN lesion Facial N

A

facial nucleus CNVII
IPSI
upper and lower muscles of facial expression
forebrain affected
incomplete eye closure, hyperacusis, loss of taste sensation to anterior tongue

267
Q

Outer ear

A

visible portion of ear (pinna)
auditory canal and tympani membrane
Transfer sound waves via vibration of tympanic membrane

268
Q

Middle ear

A

air filled with bones (malleus, incus, stapes)

ossicles conduct and amplify sound from tympanic membrane of inner ear

269
Q

Inner ear

A

snail shaped, fluid filled cochlea
contain basilar membrane that vibrates secondary to sound waves
vibration transduced via hair cells –> auditory N signaling –> brainstem

270
Q

Low frequency

A

heard at apex near helicotrema

271
Q

High frequency

A

heard at base of cochlea

272
Q

Weber test

A

Normal: no localization
Conductive: localizes to affected ear, low transmission of background noise
Sensorineural: localized to unaffected ear, low transmission of all sound

273
Q

Rinne test

A

AC > BC = normal
BC > AC = conductive
AC > BC = sensorineural

274
Q

Noise induced hearing loss

A

damage to stereociliated cells in organ of Corti
loss of high frequency hearing first
sudden extremely loud noises can produce hearing loss due to typanic membrane rupture

275
Q

Presbycusis

A

age related progressive bilateral/ symmetric sensorineural hearing loss due to destruction of hair cells at the cochlear base

276
Q

Cholesteatoma

A

overgrowth of desquamated keratin debris within the middle ear space
may erode ossicles, mastoid air cells. –> conductive hearing loss
painless otorrhea

277
Q

Peripheral vertigo

A

inner ear etiology
Meniere, vestibular N infection, BPPV
T(x) antihistamines, anticholinergic, antiemetics, low salt diet

278
Q

Central vertigo

A

Brainstem or cerebellar lesions
stroke, demyelinating disease, posterior fossa tumor
directional or purely vertical nystagmus, skew deviation, diplopia, dysmetria

279
Q

Conjunctivitis

A

inflammation of conjunctiva
Allergic- itchy bilaterally
Bacterial- pus treat with Abx
Viral (most common)- adenovirus, sparse mucous discharge, swollen preauricular node, increased lacrimation, self resolving

280
Q

Hyperopia

A

farsightedness
eye too short for rereactive power of cornea and lens –> light focused behind retina
correct with convex lens

281
Q

Myopia

A

nearsightedness
eye too long for refractive power of cornea and lens –> light focused in from of reina
correct with concave lens

282
Q

Astigmatism

A

abnormal curvature of cornea –> different refractive power at different axes
correct with cylindrical lens

283
Q

Presbyopia

A

age related impaired accommodation due to decreased lens elasticity, changes in lens curvature, decrease strength of the ciliary M
need reading glasses

284
Q

Cataracts

A

painless, bilateral opacification of lens –> glare and decrease vision
old age, smoking, alcohol, sunlight, corticosteroid use, DM, trauma, infection
Congenital- galactosemia, galatokinase deficiency, Trisomies, TORCH, Marfan, Alport, myotonic dystrophy, NF2

285
Q

Aqueous humor pathway

A

produced by nonpigmented epithelium on ciliary body –> trabecular outflow –> canal of schlemm –> episcleral vasculature
or
Uvesleral outflow –> uvea or sclera

286
Q

Glaucoma

A

optic disc atrophy with characteristic cupping

elevated IOP and progressive visual field loss if untreated

287
Q

open angle glaucoma

A

old age, AA, FHx
painless
Primary- unclear
Secondary- blocked trabeculae meshwork from WBCs, RBCs, retinal elements

288
Q

Closed angle glaucoma

A

Primary- enlargement or anterior movement of lens against central iris –> obstruct normal aqueous flow –> fluid buildup behind iris
Secondary- hypoxia from retinal disease induces vasoproliferation
Chronic: asymptomatic with damage to optic N and peripheral vision
Acute: emergency, high IOP pushes iris forward. Painful, red eye, sudden vision loss, halos around lights, frontal HA

289
Q

Uveitis

A

inflammation of uvea
anterior- iritis
posterior- choriditis, retinitis
systemic inflammatory disorders

290
Q

Age related macular degeneration

A

distortion and eventual loss of central vision
Dry: deposition of yellowish extracellular material. gradual loss of vision. Prevent progression with multivitamin and antioxidants
Wet: rapid los of vision due to bleeding secondary to choroidal neovascularization. Treat with anti VEGF injections

291
Q

Diabetic retinopathy

A

Retinal damage due to chronic hyperglycemia
Nonproliferative: damages capillaries leak blood –> lipids and fluids seep into retina –> hemorrhage and macular edema
Proliferative: chronic hypoxia –> new blood vessel formation –> traction on retina –> retinal detachment

292
Q

Hypertensive retinopathy

A

flame shaped retinal hemorrhages, arteriovenous nicking, microaneurysms, macular star, cotton wool spots
papilledema

293
Q

Retinal V acclusion

A

blockage of central or branch retinal V due to compression from nearby arterial atherosclerosis
Retinal hemorrhage and venous engorgement

294
Q

Retinal detachment

A

separation of neurosensory layer of retina from outermost pigmented epithelium –> degeneration of photoreceptors –> vision loss
crinkling retinal tissue

295
Q

Central retinal A occlusion

A

acute, painless, monocular vision loss

retina cloudy with attenuated vessels and cherry red spot of fovea

296
Q

Retinitis pigmentosa

A

inherited progressive retinal degeneration
Nyctalopia –> peripheral vision loss
bone spicule shaped depositis

297
Q

Papilledema

A

optic disc swelling due to increased ICP

enlarged blind spot and elevated optic disc with blurred margins

298
Q

Leukocoria

A

loss of red reflex

retinoblastoma, congenital cataract, toxocariasis

299
Q

Miosis

A

constriction, PNS
Edwinger-Westphal nucleus to ciliary ganglion via CN III
short ciliary N to sphincter pupillae muscles

300
Q

Pupillary light reflex

A

light in either retina sends a signal via CN II to pretectal nuclei in midbrain that activates bilateral edinger westphal nuclei
pupils constrict bilaterally

301
Q

Mydriasis

A

dilation, SNS
hypothalamus to ciliospinal center of Budge C8-T2
exit T1 to superior cervical ganglion
plexus along internal carotid through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilator muscles

302
Q

Marcus Gunn pupil

A

when light shines into a normal eye constriction of the ipsilateral and contralateral eye is observed
when light is sprung to the affected eye, both pupils dilate instead of constrict due to impaired conduction of light signal along the injured optic N
optic neuritis, early MS

303
Q

Horner Syndrome

A

SNS problem in face
Ptosis, anhidrosis, miosis
pontine hemorrhage, lateral medullary syndrome, spinal cord lesion above T1, stellate ganglion compression, carotid dissection

304
Q

Ocular motility

A

CN 6- Lateral rectus
CN 4- Superior oblique
CN3- everything else

305
Q

CN3 palsy

A

ischemia, uncal herniation, Pcom aneurysm, cavernous sinus thrombosis, midbrain stroke
Motor output to extraocular muscles –> ptosis, down and out
PNS output–> diminished or absent pupillary light reflex, blown pupil, down and out

306
Q

CN 4 palsy

A

pupil is higher in the affected eye

head tilt to contralateral/ unaffected side to compensate for lack of intorsion in affected eye

307
Q

Cn 6 palsy

A

affected eye unable to abduct and is displaced medially in primary position of gaze

308
Q

Cavernous sinus syndrome

A

presents with variable ophthalamoplegia, decreased corneal sensation, Horner syndrome and occasional decreased maxillary sensation
secondary to pituitary tumor mass effect, carotid cavernous fistula, or cavernous sinus thrombosis

309
Q

Internuclear ophthalmoplegia

A

medial longitudinal fasciculus- crosstalk between CN 6 and CN3. coordinate both eyes to move in same horizontal direction.
Lesion- INO, horizontal gaze palsy. abducting eye has nystagmus. convergence normal

310
Q

Barbiturates

A

barbital
GABAa action decrease via increased duration of Cl- channel
used for sedation for anxiety, seizures, insomnia, anesthesia
Adverse: respiratory and CV depression, dependence, drug interactions.
Contra in porphyria

311
Q

Benzos

A

-pam
GABAa, increase frequency of Cl- channel opening, decrease REM
used for anxiety, pain, spasticity, status elipticus, eclampsia, detox, night terrors, sleepwalking, anesthetic, insomnia
Adverse: dependence
T(x) OD with flumazenil

312
Q

Nonbenzo hypnotics

A

zolpidem, zaleplon, eszopiclone
act via BZ. Reversed by flumazenil
used for insomnia
adverse: ataxia, HA, short duration

313
Q

Suvorexant

A

orexin antag
used for insomnia
Adverse: CNS depression, HA, abnormal sleep related activities
Contra: narcolepsy, with CYP3A4 inhibitors

314
Q

Ramelteon

A

melatonin receptor agonist. bind MT1 and 2 in SCN
used for insomnia
aderse: dizzy, nausea, fatigue, HA

315
Q

Triptan

A

5HT agonist. Inhibit trigeminal N activation, prevent vasoactive peptide release induce vasoconstriction
used for acute migraine, cluster HA
adverse: coronary vasospasm, mild paresthesia, serotonin syndrome

316
Q

Parkinson Disease Therapy

A

Bromocriptine, Amantadine, Levodopa, Selegiline, Antimuscarinics

317
Q

DA agonists

A

Bromocriptine- Ergot
Non-ergot- pramipexole, ropinirole (tox= nausea, impulse control disorder, postural hypotension, hallucinations, confusion)

318
Q

Increase DA availability

A

Amantadine
increase DA release and decrease DA reuptake
Tox- peripheral edema, livedo reticularis, ataxia

319
Q

Increase L DOPA availability

A

Levodopa/ carbidopa- carbidopa block peripheral conversion of L DOPA to DA by inhibiting DOPA decarboxylase. Reduce side effects of peripheral L DOPA conversion into DA
Entacapone and tolcapone prevent peripheral L DOPA degradation to 3-OMD by inhibiting COMT (use with levodopa)

320
Q

Prevent DA breakdown

A

selegiline, rasagiline- block conversion of DA to DOPAC by inhibiting MAO
Tolcapone- crosses BBB and blocks conversion of DA to 3 MT in the brain by inhibiting COMT

321
Q

Curb excess cholinergic activity

A

Benzotropine, trihexylphenidyl

improve tremor and rigidity but has little effect on bradykinesia in Parkinson

322
Q

Carbidopa/ Levodopa

A

increase DA in brain. L DOPA can cross BBB and is converted by DOPA decarboxylase to DA. Carbidopa is peripheral and given with L DOPA to increase bioavailability
used for parkinson
Adverse: nausea, hallucination, postural hypotension. on off phenomenon

323
Q

Selegiline and rasagiline

A

selective inhibit MAO B –> increase DA availability
use for adjunctive agent to L DOPA in parkinsons
adverse: may enhance adverse effects of L DOPA

324
Q

Alzheimer Therapy

A 
AChE inhibitor (Doneprezil, rivastignmine, galantamine)- first line, adverse is nausea, dizziness and insomnia
NMDA antagonist (Memantine)- moderate to advanced dementia, adverse is dizzy, confusion, hallucinations
325
Q

ALS treatment

A

riluzole

decrease neuron glutamate excitotoxicity

326
Q

Huntington Treatment

A

tetrabenazine
inhibit VMAT –> decrease DA
chorea and tardive dyskinesia

327
Q

Anesthetics general

A

must be lipid soluble to cross BBB
decrease solubility in blood –> rapid induction and recovery
Increase solubility in lipids –> increased potency –> lower MAC

328
Q

Inhaled anesthetics

A

-ane, N2O
myocardial depression, respiratory depression, post op nausea and vomiting, increased cerebral blood flow, decreased cerebral metabolic demand
Adverse: hepatotox, nephrotox, proconvulsant, expansion of trapped gas in body

329
Q

Malignant hyperthermia

A

lige threatening condition in which inhaled anesthetics or succinylcholine induce severe muscle contractions and hyperthermia.
AD mutation in RYR1 gene
Treat with Dantrolene

330
Q

Thiopental

A

IV anesthetic
facilitate GABAa
used for anesthesia induction, short surgery
high lipid solubility

331
Q

Midazolam

A

IV anesthetic
facilitate GABAa
procedural sedation, anesthesia
cause post op respiratory depression, low BP, anterograde amnesia

332
Q

Propofol

A

IV anesthetic
potentiate GABAa
rapid anesthesia induction, short procedures
cause respiratory depression, hypotension

333
Q

Ketamine

A

IV anesthetic
NMDA antagonist
dissociative anesthesia, sympathomimetic
increase cerebral blood flow, disorientation, hallucination, vivid dream

334
Q

Local anesthetics

A

esters= -caine amides= have two I’s
block Na+ channels by binding receptors
enhanced when given with vasoconstrictors
used in minor surgical procedures, spinal anesthesia
adverse: CNS excitation, CV tox, hypertension, hypotension, arrhythmias, methemoglobinemia

335
Q

Depolarizing NMJ block

A

succinylcholine- strong AChR agonist –> sustained depolarization and prevent muscle contraction
reversal of blockade via AChE inhibitor
Complications- hypercalcemia, hyperkalemia, malignant hyperthermia

336
Q

Nondepolarizing NMJ block

A

-cur-
competitive ACh antagonist
reversal of blockade via AChE inhibitors with anticholinergics to prevent muscarinic effects

337
Q

Baclofen

A

GABAb receptor agonist in spinal cord

use for muscle spasticity, dystonia, MS

338
Q

cyclobenzaprine

A

Brainstem

use for muscle spasticity

339
Q

Dantrolene

A

prevent Ca2+ release from SR of skeletal M by inhibiting RyR

used in malignant hyperthermia and neuroleptic malignant syndrome

340
Q

Tizanidine

A

a2 agonist for CNS

used in muscle spasticity, MS, ALS, cerebral palsy

341
Q

Opioid analgesics

A

close presynaptic Ca2+ channels, open postsynaptic K+ channels –> decrease synaptic transmission
inhibit release of ACh, NE, 5HT, glutamate, substance P
used in moderate to severe pain, diarrhea, acute pulmonary edema, maintenance programs for heroin addicts
Adverse: nausea, vomiting, pruritis, addiction, respiratory depression, constipation, sphincter of Oddi spasm, miosis
Treat tox with naloxone

342
Q

Pentazocine

A

K opioid receptor agonist and mu opioid receptor antagonist

used for analgesia for moderate/severe pain

343
Q

Butorphanol

A

K opioid agonist and mu opioid partial agonist

used in severe pain

344
Q

Tramadol

A

weak opioid agonist, NE and 5HT reuptake inhibitor
used in chronic pain
decrease seizure threshold, serotonin syndrome

345
Q

B blockers in glaucoma

A

timolol, betaxolol, cartelol
decrease aqueous humor synthesis
adverse- no pupillary or vision changes

346
Q

a agonists in glaucoma

A

epi, apraclonidine, brimonidine
decrease aqueous humor synthesis
adverse: mydriasis, blurry vision, ocular hyperemia, foreign body sensation, allergy, pruritis

347
Q

Diuretics in glaucoma

A

acetazolamide
decrease aqueous humor synthesis via carbonic anhydrase inhibition
adverse- no pupillary or vision changes

348
Q

Prostaglandins in glaucoma

A

Bimatoprost, Iatanoprost
increase outflow of aqeous humor
Adverse: darken color of iris, eyelash growth

349
Q

Cholinomimetics M3 in glaucoma

A

Direct- pilocarpine, carbachol
indirect- physostigmine, echothiopate
increase outflow of aqueous humor
adverse: miosis and cyclospasm

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