Neuro Cards 1 Flashcards
Maternal Diabetes leads to what birth defect?
Anencephaly, Dextrocardia, Transposition GV Colobamina. Increased risk for nearly all cardiac and neural defects
Causes of polyhydramnios in utero
Anencephaly, TE fistula, Duodenal Atresia
Oxytocin is made in what hypothalamic structure
Paraventricular
ADH is made in what hypothalmic structure
Suprachiasmatic
Most common S/E with TCA related to what actions
Anticholinergic. Most common cause of death is arrythmias
Pt has damage to thalamus, BG, and Cortical Ribbon. EEG shows bursts of high voltage slow waves. What is the diagnosis
-Crutzfeld-Jacob disease. Progression over 6 months. BG, Thalamus, and cortical ribbon are Gray matter, which is preferentially targeted. EEG bursts are indicative of myoclonus.
Pt comes in with hyperphagia, hyperexuality, and docility. What is the diagnosis
-Kluver Bucy. Damage to amygdala. Most commonly with HSV. Commonly seen in AIDS pts.
What is the mechanism behind visual disturbances and anosmia
-Foster Kenedy: Increased ICP leads to damage to optic nerve and olfactory tracts.
Anterior Cerebellar outputs vs Posterior Cerebellar Outputs
- Anterior is to descending tracts (rubrospinal, reticulospinal) balance (alcohol stumbling gait)
- Posterior is to cerebral cortex and coordination (dysdiadechkinesis)
Cause of neuronal cell death in huntingtons. Levels of NT
- Glutamate excitotoxicity.
- Reduced GABA and Ach
Sensation innvervation of Oropharynx
V3- Anterior tongue general sensation. Taste via lingual nerve and chorda tympani (VII)
XI- posterior tongue and superior pharynx including eustachian tube
X- Inferior pharynx and larynx
Most Common tumor of pineal gland
-Germinoma: Can lead to precocious puberty in childhood. Also will see paralysis of upward gaze.
Newborn with Rhinorrhea, Diahrrea, Tremors, Siezures
-Neonatal opiate withdrawl. Treat with small dose of opium and wean off
Pramipexole, Ropimerole
-D2 agonists used to treat parkinsons. Non Ergot. Ergot agonists like bromocriptine and pergolide also exist
Use of ampicillin in meningitis emperical treatment
-Covers Listeria Monocytogenes. Used in infants and immunocompromised
Physiologic adaptaions to alcohol
- Decrease GABAa R, Increase, Increase excitatory NT
- Can treat withdrawls with BZ and centrally acting alpha2 agonists
Sequence of alcohol withdrawl
Initially tachycardia, tremors, HTN
Progress to hallucinations, siezures, hypersomnolence
RAS
-Located in midbrain, has cholinergic and adrergic projections, one to intralaminar nuclei.
Damage to hippocampus symptoms
Anterograde amnesia (rich in NMDAR)
Internal Capsule Structures
Anterior-Relay between Cerebellum, BG, Cortex
- Genu: Corticobulbar
- Posterior: Motor
- Occlusion of lenticulostriate arteries and lacunar infarcts
Spinal 5 damage
PICA, AICA. Pain and Temp to face
Inferior Cerebellar peduncle
PICA, AICA (Horners in both)
Distinguish PICA from AICA
PICA- Gag (9,10)
-AICA (Facial and Cochlear)
PCA Paramedian Branches
- 3,4, UMN 7
- Occular palsy (eye will be abducted, also loss of contralateral face)
Abducens damage
-Anyerusism of Superior Cerebellar or PCA, also from medial pontine (Basilar)
Anteiror Communicating Anyeurism Symptoms prior to rupture
-Compress chiasm. Bitemporal Hemianopia
Posterior Communicating Anyeurism Symptoms prior to rupture
-Compress CN3
Subarachnoid Hematoma and complications
- Berry Anyeurism (AVM)
- 2-3 days post bleed can cause vasospasm and rebleed (Tx with nimodipine (ca channel blockers).
Risk Factors for intraparenchymal hemorrhage
- HTN, Diabetes, Vasculitis, Neoplasia
- Amyloid angiopathy
Bright on noncontrast CT
-Areas of hemorrhage. tPA is contraindicated
Symptoms in NPH caused by
-Stretching of the corona radiata (continuation of internal capsule)
Organization of Spinothalamic Tract anc Corticospinal
Legs are lateral arms are medial
-DCML (gracilus is medial (Legs) and cuneatus is lateral (arms)
Divisions of the spinothalamic tract
-Anterior is pressure, crude touch, Lateral is pain/temp
Riluzole
ALS, Na channels and decrease glutamate release
Tract involved in subacute combined degenerations
Corticospinal, Spinocerebellar, Dorsal Columns
-Ataxia and parethesias, usually no pain
Tabes Dorsalis Symptoms
- Loss of DTR, Charcot joint, Shooting pain,
- Sensory Ataxia with positive rhomberg
- Dorsal columns and dorsal roots
Newborn with tongue fasiculations and hypotonia
-Werdnig Hoffman (SMA). Death of LMN in anterior horn.
Freidrichs ataxia
- Trinucleotide repeat in frataxin (Fe-S mitochondria)
- Pez cavus, kyphoscoliosis, ataxia
- Die of hypertrophic cardiomyopathy
- Degeneration of cerebellum and spinocerebellar tracts.
Cause of symptoms in pinealoma
- Compression of superior colliculus causes upward gaze palsy.
- Most common is germinoma which can secrete hormones and cause precocious puberty.
PPRF Lesion
Deviation away from side
-Medial pons
Frontal Eye fields
-Deviation towards lesion
Causes of Cranial Nerve 3 Palsy
- Infarction of paramedian PCA that supplies the midbrain
- Transtentorial (uncal herniation) mass occupying lesion including epidural hematoma
- Anyeurism of posterior communicating and carotid in cavernous sinus.
- Compression between superior cerebellar and posterior cerebral arteries
CN IV Pathology
- Arises from the dorsal aspect and crosses over
- Vulnerable to head trauma
CNV injury
- Towards lesion (lateral pterygoid)
- Tensor tympani paralysis leads to hyperascusis
- Spinal trigeminal with pain will cross over, contralateral in AICA and PICA lesions
CN VI injury
- Long course leaves it vulnerable to many insults (meningitis, trauma, syphilis) most common
- Horizontal diplopia and medial strbismus
Hereditery Stroke
-CADASIL, Notch 3 mutation. Seen in young people
Fixed Dilated pupil
Cavernous Sinus
Causes of Retinitis
CMV, HSV, HZV, Toxo
Central Retinal artery occlusion
-Painless, cherry red spot
Vision changes in open angle glaucoma
-Slowly and progressive. Loss of peripheral vision before central
Risk Factors for glaucoma
-African American, Steroid use
Cataract Risk factors
- Trisomies
- Congenital infections
Pathways of pupillary dilation and constriction
- Constriction: Ed west to ciliary ganglion to short ciliary
- Dilation: Post hypothalamus to IML (Center budge), To superior cervical ganglion, then on IC to long cilliary
Pupillary light reflex pathway
- CN2 to pretectal nuclei to bilateral Ed West.
- Defect (retinal detachment or damage) there will not be consensual
Cause of damage to CN3 motor neurons
Diabetes (sorbitol pathway)
Retinal Detachment
- More common in myopia, detachment of retina from pigment epithelium. Curtain drawn down.
- increase risk with diabetes and myopia
Location of Drusen
Below pigment epithelium
Measure of Alzhiemers severity
- Neurofibrillary Tangles
- Tx: Donepazil
How to detect Tau and NF tangles
Silver Stain
Lewy Body
- Hallucinations
- Personality before parkinson effects
- Lewy Bodies (a synuclein in cortex)
Picks Dementia
- Frontotemporal
- Early change in personality progressing to aphasia and other dementia signs
- Spherical tau aggregates (not NF tangles) balooned neurons
- Effects layers 2,4 not 3,5,6
CSF Findings in guillan bare
-Increased protein without cells (albuniocytologic dissociation)
Treatment of Guillan Bare
- IVIG and Plasmaphoresis if severe and indicated
- Generally treatment is supportive
Adrenoleukodystrophy
-Defect in peroxisome formation, leads to accumulation of long chain FA and leukodystrophy
Charcot Marie Tooth (hereditery sensory and motor)
- Defect in myelin protein leads to demylination
- Effects motor neurons and posterior colums (proprioception)
- Pez Cavus and foot drop.
Acute Demhyelinating Encephalopathy
- Scattered demylination following viral illness
- Idiopathic
Metachormatic Leukodystrophy
- AR defect in arylsulfatase A leads to accumulation of sulfatides.
- sulfatides cause breakdown of myelin sheath
Krabbes
-Defect in galactocerebrosidase, leukodystrophy
Position Testing in vertigo
- Central Vertigo will show immediate, strong, and variable direction nystagmus
- Peripheral vertigo will be delayed and unidireectional
Port Wine Stain following CNV1
- Sturge Webber: De novo sporadic mutation allowing for proliferation of capillaries
- Occurs in brain and eyes causing mass effect.
- Can lead to siezures, glaucoma.
Lack of melanin in spots on face and mitral regurgitation
- Tuberous Sclerosis
- AD hamartomas throughout body and lack of melanin on face (Ash leaf spots)
- Focal neurological findings (siezures)
Bilateral Renal Cell Carcinoma
- VHL. AD mutation in TSG leads to cavernous hemangioma formation
- Focal neurologic signs and polycythemia (HIF 1a metabolism)
Cafe Au Lait Spots, Lisch Nodules
- AD defect in RAS associated gene
- cutaneous neurofibromas (100% penetrant with variable expressivity)
Estrogen R positive brain tumor (more common in women)
-Meningioma
Calcified intraparenchymal tumor in adults
-Oligodendroglioma
Cystic and Solid Brain Tumor in kids
-Pilocytic astrocytoma
Drop Metastasis
Medulloblastoma
-May also compress 4th ventricle and cause hydrocephalus (less common than ependymoma, but possible)
Highly vascularized foamy cells in brain tumor
- Hemangioblastoma
- Most commonly associated with VHL. Polycythemia common in these cases.
- More common in kids
Oily mass with tooth enamel
Craniopharyngoma
Rathkes pouch
Bitemporal hemianopia
Trauma causes herniation of cerebellum through foramen magnum
-Death due to compromise of respiratory and cardiac centers
Anorexia and failure to thrive (hypothalamus)
Lateral Area (normally inhibited by leptin)
Hyperphagia and aggresion
Ventromedial (activated by leptin)
