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Step 1 2019 First Aid Flashcards > Neuro - FA Patho p499 - 520 > Flashcards

Neuro - FA Patho p499 - 520 Flashcards

1
Q

Frontal area lesion - issue?

A

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

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2
Q

Frontal eye fields

A

Destructive lesion such as an MCA stroke: eyes look toward the side of lesion (or at the hemiplegia). Irritative lesion such as seizures: eyes look at the shaking arm and leg

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3
Q

Paramedian pontine reticular formation

A

Eyes look toward side of hemiplegia.
Ipsilateral gaze palsy (inability to look toward side of lesion).

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4
Q

MLF lesion? affected in what disease?

A 
Internuclear ophthalmoplegia (impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction).
Multiple sclerosis.
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5
Q

Lesion of dominant parietal cortex?

A

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

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6
Q

Lesion of nondominant parietal cortex?

A

Agnosia of the contralateral side of the world.

Hemispatial neglect syndrome.

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7
Q

Hippocampus (bilateral) lesion?

A

Anterograde amnesia—inability to make new memories.

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8
Q

Basal ggl lesion affected in which diseases?

A

Parkinson disease

Huntington disease

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9
Q

Contralateral hemiballismus is lesion in what area of brain?/

A

subthalamic nucleus

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10
Q

Sx of Wenicke Korsakoff syndrome - what brain area affected?

A 
Mammillary bodies (bilateral)
Wernicke-Korsakoff syndrome—Confusion, Ataxia, Nystagmus, Ophthalmoplegia, memory loss (anterograde and retrograde amnesia), confabulation, personality changes.
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11
Q

Klüver-Bucy syndrome - sx? assoc with what virus? affects what area of the brain

A

Klüver-Bucy syndrome—disinhibited behavior (eg, hyperphagia, hypersexuality, hyperorality).

Amygdala (bilateral)
HSV-1 encephalitis

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12
Q

Parinaud syndrome - sx?

A

—vertical gaze palsy, pupillary light-near dissociation, lid retraction, convergence-retraction nystagmus.

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13
Q

Parinaud syndrome - affects what area of the brain? causes?

A

Dorsal midbrain

cause - stroke, hydrocephalus, pinealoma

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14
Q

Reticular activating system - lesion causes what sx?

A

Reduced levels of arousal and wakefulness (eg, coma)

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15
Q

Lesion in cerebellar hemisphere

A

Intention tremor, limb ataxia, loss of balance; damage to cerebellum –> ipsilateral deficits; fall toward side of lesion.

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16
Q

Decorticate posturing - what is it?

A

lesion above red nucleus, presents with flexion of upper extremities and extension of lower extremities

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17
Q

Decerebrate posturing

A

lesion at or below red nucleus, presents with extension of upper and lower extremities

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18
Q

Sx of lesions of cerebellar vermis?

A

Truncal ataxia (wide-based, “drunken sailor” gait), nystagmus.

Vermis is centrally located—affects central body.
Degeneration associated with chronic alcohol use

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19
Q

based on below symptoms, what is the location of stroke? dysphagia, hoarseness, dec gag reflex

A

PICA posterior inferior cerebellar artery

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20
Q

stroke in PICA is also called

A

lateral medullary (Wallenberg) syndrome

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21
Q

what are the unique clinical symptoms of AICA lesion?

A

paralysis of face, facial droop (due to facial nucleus)

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22
Q

AICA lesion is also called?

A

Lateral pontine syndrome

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23
Q

what are other symptoms of AICA lesion of CN VII (other than facial droop)?

A

dec lacrimation, dec salivation, dec taste from ant 2/3 of tongue

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24
Q

what stroke lesion will result in ipsilateral hypoglossal dysfunction such as tongue deviating ipsilaterly?

A

ASA

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25
Q

ASA stroke is also known as

A

Medial medullary syndrome

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26
Q

what are the other ASA stroke symptoms (other than ipsilateral hypoglossal dysfunction)?

A
  1. dec contralateral proprioception (due to medial lemniscus) 2. contralateral hemiparesis of the upper/lower limbs (due to lateral corticospinal tract)
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27
Q

pt with contralateral hemianopia with macular sparing, where is the stoke lesion?

A

PCA

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28
Q

clinical symptoms of lenticulostriate artery stroke?

A

contralateral hemiparesis/hemiplegia

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29
Q

contralateral paralysis of the lower limb & contralateral loss of sensation of lower limb is due to what stroke?

A

ACA (anterior cerebral)

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30
Q

name 4 unique clinical symptoms of MCA stroke

A
  1. contralateral paralysis (upper limb/face) 2. contralateral loss of sensation (upper limb/face) 3. aphasia if in dominant (usually Lt) hemisphere 4. hemineglect if lesion affects nondominant (usually Rt. side)
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31
Q

what artery is the common location of lacunar infarct 2’ to HTN?

A

lenticulostriate artery

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32
Q

in what situations do you see therapeutic hyperventilation (dec pCO2) helps dec intracranial pressure?

A

acute cerebral edema (stroke, trauma) via vasoconstriction

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33
Q

what infection is associated with Kluver Bucy syndrome (disinhibited behavior: hyperphagia, hypersexuality, hyperorality)?

A

HSV-1

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34
Q

gerstmann syndrome is associated with what part of the brain lesion?

A

dominant parietal temporal cortex (usually Lt. hemisphere)

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35
Q

what are the symptoms of Gerstmann syndrome

A

agraphia, acalculia, finger agnosia, Lt to Rt. disorientation

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36
Q

what is the consequence of damaging reticular activating system (midbrain)?

A
  1. reduced levels of arousal and wakefulness (coma) 2. loss of consciousness 3. stupor
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37
Q

what lesion will result in limb ataxia and falling toward the side of the lesion?

A

cerebellar hemisphere - lateral in cerebellum, fall laterally

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38
Q

what lesion will result in truncal ataxia and dysarthria? Assoc with use of what drug?

A

cerebellar vermis = vermis is cental –> truncal ataxia Assoc with chronic alcohol use

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39
Q

what is the diff btw aphasia and dysarthria?

A

aphasia is language deficit and dysarthria is movement deficit

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40
Q

what type of aphasia leads to poor repetition, but fluent speech and intact comprehension?

A

conduction

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41
Q

what type of aphasia is associated with prosody?

A

broca (prosody: brief phase w/o intonation)

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42
Q

describe the broca aphasia

A

nonfluent with intact comprehension

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43
Q

describe the Wernicke aphasia

A

fluent with imparied comprehension

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44
Q

infarct of what blood vessel can lead to broca aphasia?

A

infarct of the superior division in MCA

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45
Q

infarct of what blood vessel can lead to Wernicke aphasia?

A

infarct of the inf. division of MCA

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46
Q

what type of aphasia leads to poor comprehension with fluent speech and intact repetition?

A

transcortical sensory (similar to Wernicke except for the poor repetition in Wernicke)

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47
Q

what type of aphasia is associated with nonfluent aphasia (halting speech), good comprehension with intact repetition?

A

transcortical motor

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48
Q

Spastic paralysis UMN or LMN?

A

UWM

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49
Q

Which motor neuron sign is seen in both UMN and LMN?

A

Weakness

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50
Q

UMN or LMN in Werdnig-Hoffmann disease? Where is the distruction? And mode of inheritance?

A

LMN lesions only destruction of anterior horns; flaccid paralysis. Autosomal recessive

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51
Q

Fasciculations are caused by UMN or LMN?

A

LMN

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52
Q

A pt with weakness and fasciculations and spastic paralysis but has no sensory or oculomotor deficits suffers from what spinal cord dz?

A

ALS

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53
Q

Scanning speech, intention tremor, nystagmus are sx of what spinal cord dz?

A

MS

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54
Q

Clasp knife spasticity UMN or LMN?

A

UWM

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55
Q

Reflexes and Tone incr with UMN or LMN?

A

UWM

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56
Q

pt has only impaired sensation and proprioception, progressive sensory ataxia (inability to sense or feel the legs causing poor coordination). What is the spinal cord dz?

A

Tabes dorsalis

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57
Q

Amyotrophic lateral sclerosis involves UMN or LMN? Name the cause?

A

both defect in superoxide dismutase 1.

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58
Q

Lesion to what spinal artery destroys all but spares dorsal columns and Lissauer tract? and why is that part spared?

A

Complete occlusion of anterior spinal artery because gracilis and cuneatus are supplied by Posterior spinal arteries.

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59
Q

MOA of Riluzole and what is treats?

A

increases modestly the survival of ALS decreases presynaptic glutamate release

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60
Q

demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts i seen in which path?

A

Vit B12 def

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61
Q

Name 3 demyelination paths of the spinal cord?

A

MS Tabes dorsalis vit B12 def

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62
Q

Sx of Syringomyelia? Where is it seen? defect in what path?

A
  • Bilateral loss of pain and temperature sensation (usually C8–T1) - See in Chiari I malformation - white commissure of spinothalamic tract (2nd-order neurons)
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63
Q

What is frataxin and what path is it seen?

A

Iron binding protein; Friedreich ataxia

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64
Q

What test can help dx Polio?

A

CSF shows Inc WBCs and protein, glucose normal

stool sample - Virus recovered from stool or throat.

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65
Q

In Brown-Séquard syndrome which finding in is the only Contralateral finding?

A

pain and temperature loss below level of lesion (due to spinothalamic tract damage)

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66
Q

7 year old child presents with kyphoscoliosis, frequent falling and diabetes has a defect on chromosome 9. What is the pathphys and what will be the cause of death?

A

Friedreich ataxia - defected frataxin causes impairment in mitochondrial functioning. (oxidative stress) MCC of death: hypertrophic cardiomyopathy around 7years trinucleotide repeat disorder (GAA)

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67
Q

In which 6 paths do we find Horner syndrome?

A

Any lesion above T1 -Brown-Séquard syndrome -PICA -Cavernous sinus syndrome -Bronchogenic apical lung tumor -Pancoast tumor -Clustera headaches

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68
Q

In Brown-Séquard syndrome at which levels are UMN sings and at which are there LMN signs?

A

UMN signs below the lesion LMN signs at the lesion

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69
Q

Paralysis of conjugate vertical gaze due to lesion in superior colliculi Describes? What paths can cause that?

A

Parinaud syndrome (“suncken eye syndrome”) stroke, hydrocephalus, pinealoma

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70
Q

Which enzyme def leads to cataracts?

A

galactokinase, galactose 1 phosphate uridyltransferase

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71
Q

Which of the trisomies can lead to cataracts?

A

all of them

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72
Q

What AD disease of chromosome 22 can lead to juvenile cataracts? What other tumors come with?

A

NF2 - comes with bilat acoustic schwannomas, meningiomas, ependymomas

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73
Q

What AD disease of chr 15 lead to cataracts?

A

Marfan syndrome

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74
Q

What disease leads to nephritis, hearing problems, and cataracts later in life? What molecule is affected?

A

Alport syndrome, collagen IV

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75
Q

Diseases with cherry red spots

A

Tay Sachs, Neimann Picks

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76
Q

Disease with Marcus Gunn Pupil

A

glaucoma, or severe retinal disease, or due to Multiple Sclerosis.

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77
Q

Symptoms of SNS denervation of face?

A

ƒƒ Ptosis (slight drooping of eyelid: superior tarsal muscle) ƒƒ Anhidrosis (absence of sweating) and flushing of affected side of face ƒƒ Miosis (pupil constriction)

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78
Q

Horner’s seen with which diseases?

A

Any lesion of spinal cord above T1 –> Pancoast tumor, Brown Sequard, Late stage syringomyelia, Also seen with cluster headaches, Lung cancer, PICA injury, Cavernous sinus syndrome,

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79
Q

What CN innervates sublingual and submandibular glands?

A

CN 7

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80
Q

Jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle is what CN lesion

A

CN V motor lesion

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81
Q

Uvula deviates away from side of lesion

A

CN X lesion

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82
Q

Weakness turning head to contralateral side of lesion

A

CN XI lesion

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83
Q

tongue deviates toward side of lesion

A

CN XII lesion

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84
Q

during an UMN Facial lesion what part of the head is spared due to bilateral UMN innervation

A

Forehead

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85
Q

destruction of motor cortex or connection between motor cortex and facial nucleus in Pons causes what type of lestion

A

UMN facial nerve lesion

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86
Q

Hyperacusis loss of taste sensation in ant tongue is due to lesion of

A

LMN lesion of facial nerve (ipsilateral paralysis of upper and lower muscles of facial expression)

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87
Q

what nerve injury can ixodes tick cause?

A

Bells Palsy

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88
Q

ixodes tick is also a vector for …. ( other than in Lyme disease)

A

Babesia, Anaplasma

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89
Q

what are all the causes of bells palsy

A

Lyme disease, herpes zoster (Ramsay Hunt syndrome), sarcoidosis, tumors (eg, parotid gland), diabetes mellitus.

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90
Q

what virus cause Ramsay Hunt syndrome

A

Herpes Zoster

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91
Q

symptoms of cavernous sinus syndrome

A

variable ophthalmoplegia,
dec corneal sensation,
horner syndrome,
dec maxillary sensation

Sx secondary to a pituitary tumor mass effect,
carotid cavernous fistula
or cavernous sinus thrombosis related infection

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92
Q

what cranial nerve is most commonly injured in the cavernous sinus?

A

CN 6

93
Q

conductive bone loss

A

abnormal , Bone > ear (localized to affected ear)

94
Q

Sensorineural hearing loss

Bonus :what Cardio pathology is associated with sensorineural ear loss & what is the mode of inheritance

A

normal (air > Bone) localized to unaffected ear

Jervell and Lange-Neilsen syndrome & AR

Note: Romano ward syndrome is Not associated with deafness & AD (pure cardiac phenotype)

95
Q

a conducting hearing loss which is caused by erosion of ossicles & mastoid hair cells refers to what pathology

A

Cholesteatoma

96
Q

what does zinc deficiency cause

A

Anosmia

97
Q

what bone disease affects the ossicles

A

Osteogenesis Imperfecta

98
Q

Paget disease affect what part of the ear

A

Auditory Tube

99
Q

what is Ramsay Hunt disease?

A

as an acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle (also termed herpes zoster oticus), and/or mucous membrane of the oropharynx.

100
Q

MS more common in what type of population?

A

whites living far from equator

101
Q

What type of bladder incontinence is seen in MS?

A

Urge then overflow

102
Q

What type of hypersensitivity is MS?

A

4

103
Q

charcot triad of MS?

A

SIN -Scanning speech -Intention tremor (also Incontinence and Internuclear ophthalmoplegia -Nystagmus

104
Q

Diagnostic test for MS

A

Oligoclonal bands

105
Q

Gold standard for MS and what do you see

A

MRI and periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)

106
Q

Bonus: Reactive gliosis by what cells

A

Astrocytes

107
Q

where do you see albuminocytologic dissociation?

A

Guillain Barre Increased CSF protein with normal cell count

108
Q

GB associated infections

A

Associated with infections (eg, Campylobacter jejuni, viral)

109
Q

What type of aneurysm AND herniation that can affect sympathetic fibers of CN3?

A

Posterior communicating artery aneurysm Uncal herniation

110
Q

If you have CN IV damage, what are the symptoms?

A

SO4 Function of SO 1. trouble going downstairs ( SO depresses and abduct) 2. Head tilt towards the side of the lesion (So intort, now no SO –> you extort –> so may present with compensatory head tilt in the opposite direction)

111
Q

What will happen to L CN VI palsy when you tell that patient to look L?

A

L eye will not look L

112
Q

What happen to the R eye in Right CN IV palsy with L gaze?

A

R eye looks upward = R hypertropia

113
Q

List the causes of R anopia?

A

Optic neuritis, central retinal A occlusion

114
Q

Tunnel vision, what lesions?

A

Pituitary lesion Optic chiasm

115
Q

Convergence normal or abnormal? 1. MLF 2. CN 3 lesion

A
  1. MLF is normal 2. CN 3 is not
116
Q

Senile plaques and tau, which one is intracellular and which one is extracelluar

A

plaques is extra tau is intra

117
Q

to determine the degree of dementia in Alzheimers, what do you look for?

A

number of tangles

118
Q

What decreases the risk of Alzheimer? What increases?

A

ApoE2 decreases ApoE4 increases

119
Q

Early onset dementia by down why?

A

chr 21 has APP gene on it

120
Q

what are presenilin 1 and 2?

A

gene that increases risk of early onset Alzeheimer’s Disease

121
Q

where do you see spherical tau and what do you stain with

A

Pick, silver

122
Q

Patient with change in personality which type of dementia

A

Pick (FT dimentia)

123
Q

Paitent with visual hallucinations followed by parkinsonian features

A

Lewy

124
Q

How do you DDx Lewy body dementia and Parkinson patient with dementia?

A

Lewy is early onset

125
Q

Dementia with myoclonus

A

Creutzfeldt-Jakob (rapid)

126
Q

What are prions?

A

PrPc—> PrPsc sheet which are Bpleated sheet reisstant to proteases

127
Q

where do you see 14/3/3 protein

A

CJ

128
Q

Where do you see Hirano bodies in hippocampal

A

Alzeheimer

129
Q

Name 2 infections and 2 vaccinations that can cause acute disseminated (postinfectious) encephalomyelitis

A
  1. measles or VZV 2. rabies, small pox
130
Q

Demyelinating disease with Pes cavus and foot drop

A

Charcot-marie-tooth, AD

131
Q

Krabbe what enzyme deificiency

A

Galactocerebrosidase

132
Q

Glucocerebrosidase deficiency

A

Gaucher

133
Q

Metachromatic leukodystrophy enzyme deficiency?

A

Arylsulfatase A

134
Q

JC virus can cause what type of demyelinating diease?

A

Progressive multifocal leukoencephalopathy

135
Q

PML also seen in 2-4% of what patient

A

AIDS

136
Q

explain adrenoleukodystrophy and how do they die?

A

X linked, males very long chain FA cannot be broke down –> built up in CNS, adrenal gland, testes die with adrenal crisis

137
Q

What is partial seizures?

A

it’s a focal seizure, single area

138
Q

what is a generalized seizure

A

Diffuse area

139
Q

Whats the origin of partial seizures?

A

Medial temporal lobe

140
Q

what’s simple partial seizure?

A

simple = consciousness intact complex is not

141
Q

causes of simple partial can be? (4)

A

motor, sensory, autonomic, pyschic

142
Q

the one with no postictal confusion

A

Absence

143
Q

the one with repetitive jerks

A

myoclonic

144
Q

what’s grand-mal seizures?

A

tonic-clonic(stiff and move)

145
Q

atonic is mistaken for what?

A

fainting

146
Q

febrile seizures are epilepsy? T or F?

A

False

147
Q

Define status epilepticus

A

continous or recurring seizures that may result in brain injury (duration is >10-30 min)

148
Q

causes of seizures by age children? MCC

A

genetic, infection, trauma, congenital, metabolic

149
Q

Adults causes of seizures

A

tumor, trauma, stroke, infection

150
Q

stroke, tumor, trauma, metabolic, infection are most common in

A

the elderly

151
Q

NF type 1 is also called

A

von Recklinghausen dz

152
Q

what neurocutaneous dz (ND) is associated with shagreen patches?

A

TS

153
Q

what ND is associated with pheochromocytoma?

A

VHL, NF1

154
Q

what type of multiple endocrine neoplasia is associated with pheochromocytoma?

A

MEN 2B

155
Q

what ND is associated with GNAQ gene mutation?

A

Sturge Weber syndrome

156
Q

which ND is associated with 2’ polycythemia?

A

VHL (hemangioblastoma –> inc EPO)

157
Q

what ND is associated with inc incidence of subependymal astrocytomas and ungual fibroma

A

TS

158
Q

which ND is associated with seizures, epilepsy, and intellectual disability?

A

sturge weber,

TS,
NF1

159
Q

what ND is associated with mitral regurge?

A

TS

160
Q

what path is associated with tram track calcification (opposing gyri)?

A

Sturge Weber

161
Q

what is nevus flammeus and what dz is associated with it?

A

a non neoplastic brithmark in CN V1/V2 distribution, Sturge Weber

162
Q

what neurocutaneous disorder is non-inherited (somatic)?

A

Sturge Weber

163
Q

what neurocutaneous disorder is due to the developmental anomaly of neural crest derivatives?

A

Sturge Weber

164
Q

what is the role of neurofibromin in NF1?

A

a negative regulator of RAS on ch#17

165
Q

what path is associated with cafe au lait spots?

A

NF1

166
Q

what path is associated with hemangioblastomas in retina, brain, cerebellum, spine

A

vHL

167
Q

2 neurocutaneous disorders associated with intellectual disability?

A

sturge weber, TS

168
Q

what is the type of headache associated with repetitive brief headache?

A

cluster

169
Q

describe the characteristics of tension headache

A

steady pain, no photophobia or phnophobia. No aura

170
Q

how would you diff cluster, tension, migraine headache in terms of their location?

A

cluster: unilateral tension: bilateral migraine: unilateral

171
Q

what type of headache is associated with excruciating periorbital pain with lacrimation and rhinorrhea with potential Horner syndrome?

A

Cluster

172
Q

how is trigeminal neuralgia diff from cluster headache?

A

TN produces repetitive shooting pain in the distribution of CN5 that lasts for less than 1 min

173
Q

how would you diff cluster, tension, migraine headache in terms of duration?

A

cluster: 15 min - 3 hours tension: more than 30 min (typically 4-6hr) migraine: 4-72 hrs

174
Q

explain the pathophysio of migraine

A

due to irritation of CN V, meninges, or blood vessels

175
Q

in migraine, what substances are released from blood vessels, for ex?

A

substance P, calcitonin gene related peptide,

176
Q

mnemonics for migraine headache?

A

POUND Pulsatile One day duration Unilateral Nausea Disabling

177
Q

in terms of the location of the lesion, how can you diff peripheral vs ventral vertigo?

A

peripheral: inner ear etiology central: brain stem or cerebellar lesion

178
Q

how would you test peripheral vertigo?

A

positional testing to see if there is any delayed horizontal nystagmus

179
Q

how would you test central vertigo?

A

positional testing will reveal immediate nystagmus in any direction

180
Q

name 3 inner etiologies that can cause peripheral vertigo

A
  1. semicircular canal debris 2. vestibular nerve infection 3. Meniere dz
181
Q

what brain tumor is associated with chick wire capillary pattern?

A

oligodendroglioma

182
Q

what brain tumor is associated with drop metastases to spinal cord?

A

medulloblastoma

183
Q

in uncal herniation, you get 2 unique clinical symptoms (other than CN3 symptoms), what are they? Explain.

A
  1. contralateral crus cerebri at the Kernohan notch –> ipsilateral paresis, a false localization sign 2. ipsilateral PCA –> contralateral hmonymous hemianopia
184
Q

what type of hernia can cause coma or death as a result of compressing brain stem?

A

cerebellar tonsillar herniation into the foramen magnum

185
Q

what cranial nerve is affected by uncus herniation?

A

CN 3

186
Q

2 clinical symptoms from CN3 lesion?

A

blown pupil, down and out gaze

187
Q

what type of hernia leads to duret hemorrhages?

A

downward transtentorial (central) herniation due to caudal displacement of the brain stem

188
Q

duret hemorrhage is due to a rupture of what blood vessel?

A

paramedian basilar artery branches

189
Q

what type of hernia compresses anterior cerebral artery?

A

cingulate (subfalcine) herniation under falx cerebri

190
Q

pts with cingulate (subfalcine) herniation will present what types of focal neurological deficits?

A

contralateral paralysis of the lower limbs contralateral loss of sensation of the lower limbs

191
Q

childhood tumors occur normally in infratentorial. what is the exception?

A

craniopharyngioma (occurs in supratentorial)

192
Q

which brain tumor is associated with small blue cell (Homer Wright rosetts)?

A

medulloblastoma

193
Q

what other 2 paths are associated with small blue cells?

A
  1. Ewing (anaplastic small blue cells) 2. Neuroblastoma (neural crest cells –> Homer Wright rosette)
  2. Carcinoid
  3. Small cell lung cancer

(neuroendocrine cells)

194
Q

what 2 childhood brain tumors can affect the 4th ventricle?

A

medulloblastoma, ependymoma

195
Q

what tumor is associated with rosenthal fibers?

A

pilocytic astrocytoma

196
Q

what is rosenthal fibers?

A

eosinophilic, corkscrew fibers

197
Q

what 2 brain tumors are GFAP positive?

A

glioblastoma multiforme (grade 4 astrocytoma) pilocytic astrocytoma

198
Q

what is athetosis? lesion in? seen in what?

A

writhing, snake-like movement -Basal ggl -Huntington

199
Q

What is Dystonia?

A

substained, involuntary muscle contractions

200
Q

treatment of essential tremor

A

BB, primidone

201
Q

intentional tremor, lesion in what?

A

cerebellum

202
Q

Which posturing has a worse prognosis?

A

Worse prognosis with decerebrate posturing. In decorticate posturing, your hands are near the cor (heart).

203
Q

lists the tremor alleviated by intentional movement

A

resting tremor

204
Q

Patient with Hemiballismus. Lesion where? ipsi or contralateral?

A

contralateral subthalamic nucleus

205
Q

Hemiballismus caused by what kind of stroke?

A

Lacunar

206
Q

Disinhibition and deficits in concentration, orientation, judgment; may have reemergence of primitive reflexes.

A

Frontal lobe lesion

207
Q

Difference between frontal eye field lesion and PPRF lesion?

A

Frontal eye field - eyes look toward lesion PPRF - eyes look away from lesion

208
Q

impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction - where is the issue? assoc with which disease?

A

MLF ; MS

209
Q

can’t process sensory information from controlateral side? Where is the lesion - name?

A

Lesion in non dom parietal cortex - Hemispatial neglect syndrome.

210
Q

Confusion, Ataxia, Nystagmus, Ophthalmoplegia indicates what lesion? Other Sx assoc with these?

A

Wernicke Korsakoff - damage in mamillary bodies memory loss (anterograde and retrograde amnesia), confabulation, personality changes.

211
Q

Most vulnerable areas to ischemic stroke?

A

Most vulnerable: hippocampus, neocortex, cerebellum, watershed areas.

212
Q

How to test for ischemic stroke?

A

non-contrast CT to elimate bleeding. CT will show ischemia in 6-24 hours. Diffusion weighted MRI will show it in 3 - 30 min.

213
Q

Histo features of ischemic stroke w/in 24 hours?

A

Red neurons - eosinophilic cytoplasm with pyknotic nuclei

214
Q

Post stroke - reactive gliosis and new blood vessel formation seen? How long post stroke is it?

A

1-2 weeks

215
Q
A
216
Q

3 types of stroke? which areas is affected by what?

A

Thrombotic—due to a clot forming directly at site of infarction (commonly the MCA A), usually over a ruptured atherosclerotic plaque.

ƒ Embolic—embolus from another part of the body obstructs vessel. Can affect multiple vascular territories. Examples: atrial fibrillation, carotid artery stenosis, DVT with patent foramen ovale, infective endocarditis.

ƒ Hypoxic—due to hypoperfusion or hypoxemia. Common during cardiovascular surgeries, tends to affect watershed areas.

217
Q

Ischemic stroke - leads to what type of necrosis?

A

Acute blockage of vessels –> disruption of blood flow and subsequent ischemia –> liquefactive necrosis.

218
Q

Tx of Ischemic stroke

A

: tPA (if within 3–4.5 hr of onset and no hemorrhage/risk of hemorrhage) and/or thrombectomy (if large artery occlusion).

219
Q

TIA - define

A

Brief, reversible episode of focal neurologic dysfunction without acute infarction (⊝ MRI), with the majority resolving in < 15 minutes; deficits due to focal ischemia

220
Q

What is this a photo of?

A

Neonatal intraventicular hemorrhage

221
Q

Neonatal intraventicular hemorrhage - originates where? sx?

A

Originates in germinal matrix, a highly vascularized layer within the subventricular zone. Due to reduced glial fiber support and impaired autoregulation of BP in premature infants.

Sx. Can present with altered level of consciousness, bulging fontanelle, hypotension, seizures, coma

222
Q

You correct hyponatremia too quickly…what patho?

A

Central Pontine Myelinolysis now called Osmotic Demyelination Syndrome

223
Q

Overcorrecting Hypernatremia too quickly (drop to hypo)

A

cerebral edema/ herniation

224
Q

what is pseduobulbar palsy and give one example of syndrome associated with it

A

Pseudobulbar palsy is CN 9,10,11 affected but not their actual nuclei. Just their axons are demyelinated. symptoms: head and neck muscle weakness, dysphagia, dysarthria DDx: Bulbar palsy: nuclei of 9,10,11

225
Q

describe the NTs change in Huntington

A

Increased DA Decreased GABA and Ach

226
Q

Huntington genetics

A

AD Trinucleotide repeat on chr 4

227
Q

Huntington patients are usually misdiagnosed for what?

A

substance abuse

228
Q

Atrophy of which nucleus seen in Huntington

A

caudate and putamen

229
Q

Ex vacuo hydrocephalus is seen in Huntington why?

A

frontal horns of lateral ventricles. atrophy of striatum

Step 1 2019 First Aid Flashcards (63 decks)

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