Neuro - FA Patho p499 - 520 Flashcards
Frontal area lesion - issue?
Disinhibition and deficits in concentration, orientation, judgment; may have reemergence of primitive reflexes
Frontal eye fields
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
Paramedian pontine reticular formation
Eyes look toward side of hemiplegia.
Ipsilateral gaze palsy (inability to look toward side of lesion).
MLF lesion? affected in what disease?
Internuclear ophthalmoplegia (impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction). Multiple sclerosis.
Lesion of dominant parietal cortex?
Agraphia, acalculia, finger agnosia, left-right disorientation.
Gerstmann syndrome.
Lesion of nondominant parietal cortex?
Agnosia of the contralateral side of the world.
Hemispatial neglect syndrome.
Hippocampus (bilateral) lesion?
Anterograde amnesia—inability to make new memories.
Basal ggl lesion affected in which diseases?
Parkinson disease
Huntington disease
Contralateral hemiballismus is lesion in what area of brain?/
subthalamic nucleus
Sx of Wenicke Korsakoff syndrome - what brain area affected?
Mammillary bodies (bilateral) Wernicke-Korsakoff syndrome—Confusion, Ataxia, Nystagmus, Ophthalmoplegia, memory loss (anterograde and retrograde amnesia), confabulation, personality changes.
Klüver-Bucy syndrome - sx? assoc with what virus? affects what area of the brain
Klüver-Bucy syndrome—disinhibited behavior (eg, hyperphagia, hypersexuality, hyperorality).
Amygdala (bilateral)
HSV-1 encephalitis
Parinaud syndrome - sx?
—vertical gaze palsy, pupillary light-near dissociation, lid retraction, convergence-retraction nystagmus.
Parinaud syndrome - affects what area of the brain? causes?
Dorsal midbrain
cause - stroke, hydrocephalus, pinealoma
Reticular activating system - lesion causes what sx?
Reduced levels of arousal and wakefulness (eg, coma)
Lesion in cerebellar hemisphere
Intention tremor, limb ataxia, loss of balance; damage to cerebellum –> ipsilateral deficits; fall toward side of lesion.
Decorticate posturing - what is it?
lesion above red nucleus, presents with flexion of upper extremities and extension of lower extremities
Decerebrate posturing
lesion at or below red nucleus, presents with extension of upper and lower extremities
Sx of lesions of cerebellar vermis?
Truncal ataxia (wide-based, “drunken sailor” gait), nystagmus.
Vermis is centrally located—affects central body.
Degeneration associated with chronic alcohol use
based on below symptoms, what is the location of stroke? dysphagia, hoarseness, dec gag reflex
PICA posterior inferior cerebellar artery
stroke in PICA is also called
lateral medullary (Wallenberg) syndrome
what are the unique clinical symptoms of AICA lesion?
paralysis of face, facial droop (due to facial nucleus)
AICA lesion is also called?
Lateral pontine syndrome
what are other symptoms of AICA lesion of CN VII (other than facial droop)?
dec lacrimation, dec salivation, dec taste from ant 2/3 of tongue
what stroke lesion will result in ipsilateral hypoglossal dysfunction such as tongue deviating ipsilaterly?
ASA
ASA stroke is also known as
Medial medullary syndrome
what are the other ASA stroke symptoms (other than ipsilateral hypoglossal dysfunction)?
- dec contralateral proprioception (due to medial lemniscus) 2. contralateral hemiparesis of the upper/lower limbs (due to lateral corticospinal tract)
pt with contralateral hemianopia with macular sparing, where is the stoke lesion?
PCA
clinical symptoms of lenticulostriate artery stroke?
contralateral hemiparesis/hemiplegia
contralateral paralysis of the lower limb & contralateral loss of sensation of lower limb is due to what stroke?
ACA (anterior cerebral)
name 4 unique clinical symptoms of MCA stroke
- 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)
what artery is the common location of lacunar infarct 2’ to HTN?
lenticulostriate artery
in what situations do you see therapeutic hyperventilation (dec pCO2) helps dec intracranial pressure?
acute cerebral edema (stroke, trauma) via vasoconstriction
what infection is associated with Kluver Bucy syndrome (disinhibited behavior: hyperphagia, hypersexuality, hyperorality)?
HSV-1
gerstmann syndrome is associated with what part of the brain lesion?
dominant parietal temporal cortex (usually Lt. hemisphere)
what are the symptoms of Gerstmann syndrome
agraphia, acalculia, finger agnosia, Lt to Rt. disorientation
what is the consequence of damaging reticular activating system (midbrain)?
- reduced levels of arousal and wakefulness (coma) 2. loss of consciousness 3. stupor
what lesion will result in limb ataxia and falling toward the side of the lesion?
cerebellar hemisphere - lateral in cerebellum, fall laterally
what lesion will result in truncal ataxia and dysarthria? Assoc with use of what drug?
cerebellar vermis = vermis is cental –> truncal ataxia Assoc with chronic alcohol use
what is the diff btw aphasia and dysarthria?
aphasia is language deficit and dysarthria is movement deficit
what type of aphasia leads to poor repetition, but fluent speech and intact comprehension?
conduction
what type of aphasia is associated with prosody?
broca (prosody: brief phase w/o intonation)
describe the broca aphasia
nonfluent with intact comprehension
describe the Wernicke aphasia
fluent with imparied comprehension
infarct of what blood vessel can lead to broca aphasia?
infarct of the superior division in MCA
infarct of what blood vessel can lead to Wernicke aphasia?
infarct of the inf. division of MCA
what type of aphasia leads to poor comprehension with fluent speech and intact repetition?
transcortical sensory (similar to Wernicke except for the poor repetition in Wernicke)
what type of aphasia is associated with nonfluent aphasia (halting speech), good comprehension with intact repetition?
transcortical motor
Spastic paralysis UMN or LMN?
UWM
Which motor neuron sign is seen in both UMN and LMN?
Weakness
UMN or LMN in Werdnig-Hoffmann disease? Where is the distruction? And mode of inheritance?
LMN lesions only destruction of anterior horns; flaccid paralysis. Autosomal recessive
Fasciculations are caused by UMN or LMN?
LMN
A pt with weakness and fasciculations and spastic paralysis but has no sensory or oculomotor deficits suffers from what spinal cord dz?
ALS
Scanning speech, intention tremor, nystagmus are sx of what spinal cord dz?
MS
Clasp knife spasticity UMN or LMN?
UWM
Reflexes and Tone incr with UMN or LMN?
UWM
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?
Tabes dorsalis
Amyotrophic lateral sclerosis involves UMN or LMN? Name the cause?
both defect in superoxide dismutase 1.
Lesion to what spinal artery destroys all but spares dorsal columns and Lissauer tract? and why is that part spared?
Complete occlusion of anterior spinal artery because gracilis and cuneatus are supplied by Posterior spinal arteries.
MOA of Riluzole and what is treats?
increases modestly the survival of ALS decreases presynaptic glutamate release
demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts i seen in which path?
Vit B12 def
Name 3 demyelination paths of the spinal cord?
MS Tabes dorsalis vit B12 def
Sx of Syringomyelia? Where is it seen? defect in what path?
- Bilateral loss of pain and temperature sensation (usually C8–T1) - See in Chiari I malformation - white commissure of spinothalamic tract (2nd-order neurons)
What is frataxin and what path is it seen?
Iron binding protein; Friedreich ataxia
What test can help dx Polio?
CSF shows Inc WBCs and protein, glucose normal
stool sample - Virus recovered from stool or throat.
In Brown-Séquard syndrome which finding in is the only Contralateral finding?
pain and temperature loss below level of lesion (due to spinothalamic tract damage)
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?
Friedreich ataxia - defected frataxin causes impairment in mitochondrial functioning. (oxidative stress) MCC of death: hypertrophic cardiomyopathy around 7years trinucleotide repeat disorder (GAA)
In which 6 paths do we find Horner syndrome?
Any lesion above T1 -Brown-Séquard syndrome -PICA -Cavernous sinus syndrome -Bronchogenic apical lung tumor -Pancoast tumor -Clustera headaches
In Brown-Séquard syndrome at which levels are UMN sings and at which are there LMN signs?
UMN signs below the lesion LMN signs at the lesion
Paralysis of conjugate vertical gaze due to lesion in superior colliculi Describes? What paths can cause that?
Parinaud syndrome (“suncken eye syndrome”) stroke, hydrocephalus, pinealoma
Which enzyme def leads to cataracts?
galactokinase, galactose 1 phosphate uridyltransferase
Which of the trisomies can lead to cataracts?
all of them
What AD disease of chromosome 22 can lead to juvenile cataracts? What other tumors come with?
NF2 - comes with bilat acoustic schwannomas, meningiomas, ependymomas
What AD disease of chr 15 lead to cataracts?
Marfan syndrome
What disease leads to nephritis, hearing problems, and cataracts later in life? What molecule is affected?
Alport syndrome, collagen IV
Diseases with cherry red spots
Tay Sachs, Neimann Picks
Disease with Marcus Gunn Pupil
glaucoma, or severe retinal disease, or due to Multiple Sclerosis.
Symptoms of SNS denervation of face?
Ptosis (slight drooping of eyelid: superior tarsal muscle) Anhidrosis (absence of sweating) and flushing of affected side of face Miosis (pupil constriction)
Horner’s seen with which diseases?
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,
What CN innervates sublingual and submandibular glands?
CN 7
Jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle is what CN lesion
CN V motor lesion
Uvula deviates away from side of lesion
CN X lesion
Weakness turning head to contralateral side of lesion
CN XI lesion
tongue deviates toward side of lesion
CN XII lesion
during an UMN Facial lesion what part of the head is spared due to bilateral UMN innervation
Forehead
destruction of motor cortex or connection between motor cortex and facial nucleus in Pons causes what type of lestion
UMN facial nerve lesion
Hyperacusis loss of taste sensation in ant tongue is due to lesion of
LMN lesion of facial nerve (ipsilateral paralysis of upper and lower muscles of facial expression)
what nerve injury can ixodes tick cause?
Bells Palsy
ixodes tick is also a vector for …. ( other than in Lyme disease)
Babesia, Anaplasma
what are all the causes of bells palsy
Lyme disease, herpes zoster (Ramsay Hunt syndrome), sarcoidosis, tumors (eg, parotid gland), diabetes mellitus.
what virus cause Ramsay Hunt syndrome
Herpes Zoster
symptoms of cavernous sinus syndrome
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
what cranial nerve is most commonly injured in the cavernous sinus?
CN 6
conductive bone loss
abnormal , Bone > ear (localized to affected ear)
Sensorineural hearing loss
Bonus :what Cardio pathology is associated with sensorineural ear loss & what is the mode of inheritance
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)
a conducting hearing loss which is caused by erosion of ossicles & mastoid hair cells refers to what pathology
Cholesteatoma
what does zinc deficiency cause
Anosmia
what bone disease affects the ossicles
Osteogenesis Imperfecta
Paget disease affect what part of the ear
Auditory Tube
what is Ramsay Hunt disease?
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.
MS more common in what type of population?
whites living far from equator
What type of bladder incontinence is seen in MS?
Urge then overflow
What type of hypersensitivity is MS?
4
charcot triad of MS?
SIN -Scanning speech -Intention tremor (also Incontinence and Internuclear ophthalmoplegia -Nystagmus
Diagnostic test for MS
Oligoclonal bands
Gold standard for MS and what do you see
MRI and periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
Bonus: Reactive gliosis by what cells
Astrocytes
where do you see albuminocytologic dissociation?
Guillain Barre Increased CSF protein with normal cell count
GB associated infections
Associated with infections (eg, Campylobacter jejuni, viral)
What type of aneurysm AND herniation that can affect sympathetic fibers of CN3?
Posterior communicating artery aneurysm Uncal herniation
If you have CN IV damage, what are the symptoms?
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)
What will happen to L CN VI palsy when you tell that patient to look L?
L eye will not look L
What happen to the R eye in Right CN IV palsy with L gaze?
R eye looks upward = R hypertropia
List the causes of R anopia?
Optic neuritis, central retinal A occlusion
Tunnel vision, what lesions?
Pituitary lesion Optic chiasm
Convergence normal or abnormal? 1. MLF 2. CN 3 lesion
- MLF is normal 2. CN 3 is not
Senile plaques and tau, which one is intracellular and which one is extracelluar
plaques is extra tau is intra
to determine the degree of dementia in Alzheimers, what do you look for?
number of tangles
What decreases the risk of Alzheimer? What increases?
ApoE2 decreases ApoE4 increases
Early onset dementia by down why?
chr 21 has APP gene on it
what are presenilin 1 and 2?
gene that increases risk of early onset Alzeheimer’s Disease
where do you see spherical tau and what do you stain with
Pick, silver
Patient with change in personality which type of dementia
Pick (FT dimentia)
Paitent with visual hallucinations followed by parkinsonian features
Lewy
How do you DDx Lewy body dementia and Parkinson patient with dementia?
Lewy is early onset
Dementia with myoclonus
Creutzfeldt-Jakob (rapid)
What are prions?
PrPc—> PrPsc sheet which are Bpleated sheet reisstant to proteases
where do you see 14/3/3 protein
CJ
Where do you see Hirano bodies in hippocampal
Alzeheimer
Name 2 infections and 2 vaccinations that can cause acute disseminated (postinfectious) encephalomyelitis
- measles or VZV 2. rabies, small pox
Demyelinating disease with Pes cavus and foot drop
Charcot-marie-tooth, AD
Krabbe what enzyme deificiency
Galactocerebrosidase
Glucocerebrosidase deficiency
Gaucher
Metachromatic leukodystrophy enzyme deficiency?
Arylsulfatase A
JC virus can cause what type of demyelinating diease?
Progressive multifocal leukoencephalopathy
PML also seen in 2-4% of what patient
AIDS
explain adrenoleukodystrophy and how do they die?
X linked, males very long chain FA cannot be broke down –> built up in CNS, adrenal gland, testes die with adrenal crisis
What is partial seizures?
it’s a focal seizure, single area
what is a generalized seizure
Diffuse area
Whats the origin of partial seizures?
Medial temporal lobe
what’s simple partial seizure?
simple = consciousness intact complex is not
causes of simple partial can be? (4)
motor, sensory, autonomic, pyschic
the one with no postictal confusion
Absence
the one with repetitive jerks
myoclonic
what’s grand-mal seizures?
tonic-clonic(stiff and move)
atonic is mistaken for what?
fainting
febrile seizures are epilepsy? T or F?
False
Define status epilepticus
continous or recurring seizures that may result in brain injury (duration is >10-30 min)
causes of seizures by age children? MCC
genetic, infection, trauma, congenital, metabolic
Adults causes of seizures
tumor, trauma, stroke, infection
stroke, tumor, trauma, metabolic, infection are most common in
the elderly
NF type 1 is also called
von Recklinghausen dz
what neurocutaneous dz (ND) is associated with shagreen patches?
TS
what ND is associated with pheochromocytoma?
VHL, NF1
what type of multiple endocrine neoplasia is associated with pheochromocytoma?
MEN 2B
what ND is associated with GNAQ gene mutation?
Sturge Weber syndrome
which ND is associated with 2’ polycythemia?
VHL (hemangioblastoma –> inc EPO)
what ND is associated with inc incidence of subependymal astrocytomas and ungual fibroma
TS
which ND is associated with seizures, epilepsy, and intellectual disability?
sturge weber,
TS,
NF1
what ND is associated with mitral regurge?
TS
what path is associated with tram track calcification (opposing gyri)?
Sturge Weber
what is nevus flammeus and what dz is associated with it?
a non neoplastic brithmark in CN V1/V2 distribution, Sturge Weber
what neurocutaneous disorder is non-inherited (somatic)?
Sturge Weber
what neurocutaneous disorder is due to the developmental anomaly of neural crest derivatives?
Sturge Weber
what is the role of neurofibromin in NF1?
a negative regulator of RAS on ch#17
what path is associated with cafe au lait spots?
NF1
what path is associated with hemangioblastomas in retina, brain, cerebellum, spine
vHL
2 neurocutaneous disorders associated with intellectual disability?
sturge weber, TS
what is the type of headache associated with repetitive brief headache?
cluster
describe the characteristics of tension headache
steady pain, no photophobia or phnophobia. No aura
how would you diff cluster, tension, migraine headache in terms of their location?
cluster: unilateral tension: bilateral migraine: unilateral
what type of headache is associated with excruciating periorbital pain with lacrimation and rhinorrhea with potential Horner syndrome?
Cluster
how is trigeminal neuralgia diff from cluster headache?
TN produces repetitive shooting pain in the distribution of CN5 that lasts for less than 1 min
how would you diff cluster, tension, migraine headache in terms of duration?
cluster: 15 min - 3 hours tension: more than 30 min (typically 4-6hr) migraine: 4-72 hrs
explain the pathophysio of migraine
due to irritation of CN V, meninges, or blood vessels
in migraine, what substances are released from blood vessels, for ex?
substance P, calcitonin gene related peptide,
mnemonics for migraine headache?
POUND Pulsatile One day duration Unilateral Nausea Disabling
in terms of the location of the lesion, how can you diff peripheral vs ventral vertigo?
peripheral: inner ear etiology central: brain stem or cerebellar lesion
how would you test peripheral vertigo?
positional testing to see if there is any delayed horizontal nystagmus
how would you test central vertigo?
positional testing will reveal immediate nystagmus in any direction
name 3 inner etiologies that can cause peripheral vertigo
- semicircular canal debris 2. vestibular nerve infection 3. Meniere dz
what brain tumor is associated with chick wire capillary pattern?
oligodendroglioma
what brain tumor is associated with drop metastases to spinal cord?
medulloblastoma
in uncal herniation, you get 2 unique clinical symptoms (other than CN3 symptoms), what are they? Explain.
- contralateral crus cerebri at the Kernohan notch –> ipsilateral paresis, a false localization sign 2. ipsilateral PCA –> contralateral hmonymous hemianopia
what type of hernia can cause coma or death as a result of compressing brain stem?
cerebellar tonsillar herniation into the foramen magnum
what cranial nerve is affected by uncus herniation?
CN 3
2 clinical symptoms from CN3 lesion?
blown pupil, down and out gaze
what type of hernia leads to duret hemorrhages?
downward transtentorial (central) herniation due to caudal displacement of the brain stem
duret hemorrhage is due to a rupture of what blood vessel?
paramedian basilar artery branches
what type of hernia compresses anterior cerebral artery?
cingulate (subfalcine) herniation under falx cerebri
pts with cingulate (subfalcine) herniation will present what types of focal neurological deficits?
contralateral paralysis of the lower limbs contralateral loss of sensation of the lower limbs
childhood tumors occur normally in infratentorial. what is the exception?
craniopharyngioma (occurs in supratentorial)
which brain tumor is associated with small blue cell (Homer Wright rosetts)?
medulloblastoma
what other 2 paths are associated with small blue cells?
- Ewing (anaplastic small blue cells) 2. Neuroblastoma (neural crest cells –> Homer Wright rosette)
- Carcinoid
- Small cell lung cancer
(neuroendocrine cells)
what 2 childhood brain tumors can affect the 4th ventricle?
medulloblastoma, ependymoma
what tumor is associated with rosenthal fibers?
pilocytic astrocytoma
what is rosenthal fibers?
eosinophilic, corkscrew fibers
what 2 brain tumors are GFAP positive?
glioblastoma multiforme (grade 4 astrocytoma) pilocytic astrocytoma
what is athetosis? lesion in? seen in what?
writhing, snake-like movement -Basal ggl -Huntington
What is Dystonia?
substained, involuntary muscle contractions
treatment of essential tremor
BB, primidone
intentional tremor, lesion in what?
cerebellum
Which posturing has a worse prognosis?
Worse prognosis with decerebrate posturing. In decorticate posturing, your hands are near the cor (heart).
lists the tremor alleviated by intentional movement
resting tremor
Patient with Hemiballismus. Lesion where? ipsi or contralateral?
contralateral subthalamic nucleus
Hemiballismus caused by what kind of stroke?
Lacunar
Disinhibition and deficits in concentration, orientation, judgment; may have reemergence of primitive reflexes.
Frontal lobe lesion
Difference between frontal eye field lesion and PPRF lesion?
Frontal eye field - eyes look toward lesion PPRF - eyes look away from lesion
impaired adduction of ipsilateral eye; nystagmus of contralateral eye with abduction - where is the issue? assoc with which disease?
MLF ; MS
can’t process sensory information from controlateral side? Where is the lesion - name?
Lesion in non dom parietal cortex - Hemispatial neglect syndrome.
Confusion, Ataxia, Nystagmus, Ophthalmoplegia indicates what lesion? Other Sx assoc with these?
Wernicke Korsakoff - damage in mamillary bodies memory loss (anterograde and retrograde amnesia), confabulation, personality changes.
Most vulnerable areas to ischemic stroke?
Most vulnerable: hippocampus, neocortex, cerebellum, watershed areas.
How to test for ischemic stroke?
non-contrast CT to elimate bleeding. CT will show ischemia in 6-24 hours. Diffusion weighted MRI will show it in 3 - 30 min.
Histo features of ischemic stroke w/in 24 hours?
Red neurons - eosinophilic cytoplasm with pyknotic nuclei
Post stroke - reactive gliosis and new blood vessel formation seen? How long post stroke is it?
1-2 weeks
3 types of stroke? which areas is affected by what?
Thrombotic—due to a clot forming directly at site of infarction (commonly the MCA A), usually over a ruptured atherosclerotic plaque.
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.
Hypoxic—due to hypoperfusion or hypoxemia. Common during cardiovascular surgeries, tends to affect watershed areas.
Ischemic stroke - leads to what type of necrosis?
Acute blockage of vessels –> disruption of blood flow and subsequent ischemia –> liquefactive necrosis.
Tx of Ischemic stroke
: tPA (if within 3–4.5 hr of onset and no hemorrhage/risk of hemorrhage) and/or thrombectomy (if large artery occlusion).
TIA - define
Brief, reversible episode of focal neurologic dysfunction without acute infarction (⊝ MRI), with the majority resolving in < 15 minutes; deficits due to focal ischemia
What is this a photo of?
Neonatal intraventicular hemorrhage
Neonatal intraventicular hemorrhage - originates where? sx?
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
You correct hyponatremia too quickly…what patho?
Central Pontine Myelinolysis now called Osmotic Demyelination Syndrome
Overcorrecting Hypernatremia too quickly (drop to hypo)
cerebral edema/ herniation
what is pseduobulbar palsy and give one example of syndrome associated with it
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
describe the NTs change in Huntington
Increased DA Decreased GABA and Ach
Huntington genetics
AD Trinucleotide repeat on chr 4
Huntington patients are usually misdiagnosed for what?
substance abuse
Atrophy of which nucleus seen in Huntington
caudate and putamen
Ex vacuo hydrocephalus is seen in Huntington why?
frontal horns of lateral ventricles. atrophy of striatum
