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Neurology Facts > Neuro Facts > Flashcards

Neuro Facts Flashcards

1
Q

Locked-in syndrome – localization

A

Basilar artery stroke

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2
Q

An aneurysm in what vessel causes a CNIII palsy (down and out)?

A

PCom

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3
Q

An aneurysm in what vessel causes visual field defects?

A

ACom

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4
Q

A stroke in what vessel causes contralateral hemianopia with macular sparing?

A

PCA

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5
Q

vomiting, vertigo, nystagmus, ataxia, dysmetria, dysphagia, hoarseness – localization

A

PICA stroke/ lateral medullary (Wallenburg) syndrome (“don’t PICA horse that can’t eat”)

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6
Q

vomiting, vertigo, nystagmus, ataxia, dysmetria, facial droop – localization

A

AICA stroke/lateral pontine syndrome

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7
Q

pure motor stroke – localization

A

posterior limb of internal capsule

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8
Q

pure sensory stroke – localization

A

VPL of thalamus

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9
Q

complications of SAH

A

2-12 days later: vasospasm (not visible on CT, prevent/tx w/ nimodipine) or rebleed (visible on CT)

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10
Q

Acute management of ischemic stroke

A
  • tPA w/in 3-4.5h if no hemorrhage/risk of hemorrhage
  • ASA, clopidogrel
  • control BP, blood sugars, lipids
  • tx conditions that increase risk (AFib)
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11
Q

Ultimate path of venous drainage from brain

A

superior sagittal/inferior sagittal/Galen/occipital –> confluence –> transverse sinus –> sigmoid –> (jugular foramen) –> internal jugular vein

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12
Q

what makes communicating hydrocephalus “communicating”?

A

non-obstructive cause: normal pressure vs. ex vacuo (2/2 AD, Pick’s, etc.)

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13
Q

what makes non-communicating hydrocephalus “non-communicating”?

A

obstructive cause

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14
Q

where is the CSF contained?

A

in the subarachnoid space

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15
Q

where to do a lumbar puncture? why?

A

L3-L5: obtain CSF w/o damaging spinal cord (ends at L1-2)

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16
Q

signs of lower motor neuron lesion

A

everything is LOWER: less muscle mass (bulk), less tone, decreased reflexes, downgoing plantar response

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17
Q

hallmarks of poliomyelitis

A

destruction of anterior horn cells –> flaccid paralysis (ie LMN)

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18
Q

hallmarks of MS

A

demyleniation –> random/asymmetric lesions ~scanning speech, intention tremor, nystagmus (highly myelinated areas)

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19
Q

hallmarks of ALS

A

UMN + LMN –> fasciculations + eventual atrophy/weakness

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20
Q

treatment for ALS

A

riluzole decreases presynaptic glutamate release

mnemonic: Lou Gehrig –> riLOUzole

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21
Q

role of dorsal column (DCML) - 4x

A

ascending: pressure, vibration, fine touch, proprioception

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22
Q

hallmarks of tabes dorsalis

A

2/2 tertiary syphilis;
dorsal column (hence “dorsalis”) –> decreased proprioception –> progressive sensory ataxia;
+Romberg, absence of DTRs 2/2 impaired afferents

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23
Q

hallmarks of syringomyelia

A

anterior white commissure –> b/l loss of pain and temp

~ w/ chiari I malformation

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24
Q

subacute combined degeneration

A

2/2 vitamin B12 or E defic –> ataxic gait, paresthesia, impaired posn and vib sense

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25
Q

mode of polio transmission

A

fecal-oral

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26
Q

dx?
child with staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, hypertrophic cardiomyopathy (COD), kyphoscoliosis

A

friedreich ataxia

AR: GAA on chrom 9 –> encodes frataxin (iron-binding protein) –> impaired mitochondria

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27
Q

What causes Horner syndrome (ptosis, miosis, anhidrosis)?

A

lesions of spinal cord above T1 that interrupt first neuron in the superior cervical (sympathetic) ganglion pathway, ie in the intermediolateral column of the spinal cord

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28
Q

spinal cord level: posterior half of skull

A

C2

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29
Q

spinal cord level: high turtleneck shirt

A

C3

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30
Q

spinal cord level: low-collar shirt

A

C4

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31
Q

spinal cord level: nipple

A

T4 (“teat pore”)

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32
Q

spinal cord level: xiphoid process (lower part of sternum)

A

T7

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33
Q

spinal cord level: umbilicus

A

T10 (belly butTEN)

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34
Q

spinal cord level: inguinal ligament

A

L1 (L1 = IL)

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35
Q

spinal cord level: kneecaps

A

L4 (on aLL 4’s)

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36
Q

spinal cord level: penile erection + penile/anal sensation

A

S2-4 (…keep the penis off the floor)

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37
Q

mnemonic for clinical reflexes

A

S1,2 “buckle my shoe” (achilles)
L3,4 “kick the door” (patellar)
C5,6 “pick up sticks” (biceps - flexion)
C7,8 “lay them straight (triceps - extension)

L1,2 “testicles move” (cremaster)
S3,S4 “winks galore” (anal wink)

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38
Q

pineal gland

A

melatonin, circadian rhythm; located above superior colliculi

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39
Q

superior and inferior colliculi

A

conjugate vertical gaze and auditory, respectively

“your eyes are above your ears”

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40
Q

corneal reflex: afferent/efferent

A

V1, VII

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41
Q

lacrimation reflex: afferent/efferent

A

V1, VII

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42
Q

jaw jerk reflex: afferent/efferent

A

V3, V3

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43
Q

pupillary reflex: afferent/efferent

A

II, III

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44
Q

gag reflex: afferent/efferent

A

IX, X

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45
Q

what structures pass through the cavernous sinus?

A

CN III, IV, V1, V2, VI, ICA

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46
Q

CN V lesion

A

jaw deviates toward lesion (unopposed pterygoid: pushing muscle)

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47
Q

CN X lesion

A

uvula points away from lesion

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48
Q

CN XI lesion

A

weakness turning head to contralateral side (SCM: pushing muscle)

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49
Q

CN XII lesion

A

tongue deviates toward lesion (“lick your wounds”: pushing muscle)

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50
Q

Conditions associated with Bell’s palsy

A

Lyme, HSV, herpes zoster, sarcoidosis, tumors, diabetes

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51
Q

Bell’s palsy: defn + tx

A

peripheral ipsilateral facial paralysis w/ inability to close eye on involved side
tx: corticosteroids

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52
Q

acute, painless monocular vision loss; retina cloudy w/ attenuated vessels and “cherry-red” spot at the fovea

A

central retinal artery occlusion

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53
Q

retinal hemorrhages and edema in affected area

A

retinal vein occlusion 2/2 arterial atherosclerosis compressing on retinal vein

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54
Q

retinal edema and necrosis leading to scar

A

retinitis; often 2/2 virus (CMV, HSV, HZV) ~immunosuppression

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55
Q

path of aqueous humor in eye

A

secreted by ciliary epithelium (beta-receptors) –> posterior chamber –> anterior chamber –> trabecular meshwork –> canal of schlemm

iris forms barrier between anterior and posterior chambers

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56
Q

very painful, sudden loss of vision w/ halos around lights, rock-hard eye, frontal headache

A

closed/narrow angle glaucoma = EMERGENCY!

(according to the interwebs) tx w/ acetazolamide 500 mg IV followed by 500 mg PO + topical beta-blocker (ie, carteolol, timolol) + topical steroids

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57
Q

enlarged blind spot and elevated optic disc w/ blurred margins

A

papilledema 2/2 mass effect

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58
Q

to test INFERIOR oblique, have patients ???

A

look up!

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59
Q

scotomas

A

loss of central vision (as in macular degeneration)

60
Q

2 forms of macular degeneration

A

dry (drusen) has gradual decrease in vision; prevent w/ multivit and antioxidants
vs.
wet = rapid 2/2 choroidal neovasc; tx w/ anti-VEGF

61
Q

medial longitudinal fasciculus (MLF): role and effect of lesion

A

crosstalk between CN VI and III; INO (direction refers to the eye that is paralyzed, ie cannot move medially in tandem w/ lateral gazing eye)

62
Q

a decrease in cognitive ability, memory, or fcn w/ intact consciousness

A

dementia

63
Q

ApoE4 (chrom 19)

A

late onset familial AD

64
Q

APP (chrom 21), presenilin-1 (chr 14), presenilin-2 (chr 1)

A

early onset familial AD

65
Q

spherical tau protein aggregates

A

pick disease (frontotemporal dementia)

66
Q

senile plaques, amyloid angiopathy, neurofibillary tangles, hyperphosphorylated tau protein

A

AD

67
Q

alpha-synuclein defect

A

Lewy body dementia
(Although the function of alpha-synuclein is not well understood, studies suggest that it plays an important role in maintaining a supply of synaptic vesicles in presynaptic terminals)

68
Q

initial dementia and visual hallucinations, followed by parkinsonian features

A

Lewy body dementia

69
Q

rapidly progressive dementia with myoclonus

A

CJD

70
Q

“spongiform cortex”

A

CJD

71
Q

sudden loss of vision –> Marcus Gunn pupil/Relative Afferent Pupillary Defect (RAPD)

A

optic neuritis; ~MS

Relative afferent pupillary defect (RAPD) is a medical sign observed during the swinging-flashlight test[1] whereupon the patient’s pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.

72
Q

scanning speech, intention tremor, incontinence, INO, nystagmus

A

MS

73
Q

oligoclonal bands (IgG) in the CSF, periventricular plaques (~reactive gliosis)

A

findings associated with MS

74
Q

tx for MS

A

beta-interferon, immunosuppression, natalizumab

NB: Interferon beta balances the expression of pro- and anti-inflammatory agents in the brain, and reduces the number of inflammatory cells that cross the blood brain barrier.[5] Overall, therapy with interferon beta leads to a reduction of neuron inflammation.[5] Moreover, it is also thought to increase the production of nerve growth factor and consequently improve neuronal survival.[5] In vitro, interferon beta reduces production of Th17 cells which are a subset of T lymphocytes believed to have a role in the pathophysiology of MS.

75
Q

ascending paralysis associated w/ campulobacter jejuni and CMV

A

GBS

76
Q

tx for GBS

A

IVIg and plasmapheresis

77
Q

demyelinating disease associated with JC virus; rapidly progressive, usually fatal; seen in 2-4% AIDS patients

A

progressive multifocal leukoencephalopathy (due to destruction of oligodendrocytes)

increased risk of reactivation when tx w/ natalizumab

78
Q

impaired production of myelin due to arylsulfatase A deficiency –> ataxia, dementia

A

metachromatic leukodystrophy (lysosomal storage dz)

79
Q

defective production of proteins required for myelin production + peripheral nerve function; ~scoliosis and foot deformaties

A

Charcot-Marie-Tooth disease; autosomal dominant

80
Q

excess galactocerebroside and psychosine (due to ineffecient breakdown) –> destruction of myelin sheaths –> peripheral neuropathy, developmental delay, optic atrophy, globoid cells

A

Krabbe disease; autosomal recessive

81
Q

genetics of adrenoleukodystorphy

A

X-linked (males!)

82
Q

most common location of partial (focal) seizure

A

medial temporal lobe

83
Q

“simple” partial sz

A

consciousness intact

84
Q

“complex” partial sz

A

impaired consciousness

85
Q

status epilepticus

A

sz for >30m or multiple w/o regained donsciousness over >30m

medical emergency! tx w/ benzos (“zepam”, increase frequency of GABA) or phenytoin (block Na channels)

86
Q

generalized sz

A

diffuse; by definition, lack consciousness

87
Q

name that sz: 3 hz, no posictal confusion, blank stare, usually in kiddos

A

absence (EEG-dx)

88
Q

name that sz: quick, repetitive jerks

A

myoclonic

89
Q

name that sz: stiffening

A

tonic (think: increased TONE)

90
Q

name that sz: alternating stiffening and movement

A

tonic-clonic/grand mal

91
Q

name that sz: drop sz (falls to floor), commonly mistaken for syncope

A

atonic

92
Q

tx for cluster headache

A

inhaled oxygen, sumatriptan

93
Q

duration of trigeminal neuralgia vs. cluster headache

A

<1m vs. 15m-3h

94
Q

distinct features of central vertigo (ie 2/2 brainstem or cerebellar lesion)

A

immediate nystagmus in any direction; focal neurologic findings

95
Q

port-wine stain, sz, early-onset glaucoma

A

Sturge-Weber syndrome (neurocutaneous disorder)

96
Q

hamartomas in CNS and skin, heart problems, dz

A

tuberous sclerosis (neurocut. d/o)

97
Q

cafe-au-lait spots, lisch nodules (pigmented iris hamartomas), pheochromocytoma

A

NF type I (von Recklinghausen) - (neurocut. d/o)

98
Q

b/l RCC; cavernous hemangiomas of skin, mucosa and organs; pheochromo

A

VHL dz (neurocut. d/o)

99
Q

Tx for refractory schizophrenia? Most concerning side effect?

A
  • clozapine

- agranulocytosis

100
Q

classic triad of brain abscess

A

fever, severe headache (nocturnal or morning), focal neurologic changes

101
Q

risk factors for brain abscess

A

otitis media/mastoiditis, frontal or ethmoid sinusitis, dental infection, bacteremia from other sites of infection/cyanotic heart dz

102
Q

dx? gradual loss of peripheral vision over yrs

A

open angle glaucoma; more common in blacks

103
Q

buzzwords: microatheroma and lipohyalinosis

A

deep lacunar stroke; more likely thrombotic than embolic (“small vessel dz”)

104
Q

flumazenil = antidote for ?

A

benzos

105
Q

bilateral acoustic neuromas and cataracts

A

NF2 (2 eyes and 2 ears)

106
Q

tx for central retinal artery occlusion

A

ocular massage and high flow O2

107
Q

buzzwords: yellow-white batches of retinal opacification and retinal hemorrhages

A

CMV retinitis (opportunistic infection when CD4 < 50)

108
Q

sxs associated with cluster headache (other than wretched pain)

A

redness of ipsilateral eye, tearing, stuffed or runny nose, and/or ipsilateral Horner’s

109
Q

prophylaxis for cluster headache

A

verapamil, lithium, ergotamine

110
Q

adult brain tumor with pseudopalisading, pleomorphic cells located in cerebral hemisphere; often with central areas of necrosis and hemorrhage

A

glioblastoma multiforme (grade IV astrocytoma)

111
Q

adult brain tumor specimen: astrocytes that stain positive for GFAP

A

glioblastoma multiforme (grade IV astrocytoma)

112
Q

adult brain tumor with spindle cells concentrically arranged in a whorled pattern; contains psammoma bodies

A

meningioma (benign)

113
Q

adult brain tumor associated with VHL, often cerebellar; can produce EPO –> secondary polycythemia

A

hemangioblastoma

114
Q

adult brain tumor often located at the cerebellopontine angle

A

schwannoma

115
Q

adult brain tumor: S-100 +

A

schwannoma

116
Q

rare, slow-growing adult brain tumor often located in the frontal lobe; “fried egg” appearance

A

oligodendroglioma

117
Q

benign, well-circumscribed cerebellar brain tumor of childhood; GFAP+

A

pilocytic (low-grade) astrocytoma <– good prognosis

118
Q

eosinophilic, corkscrew fibers found in childhood primary brain tumor

A

rosenthal fibers in pilocytic (low-grade) astrocytoma (posterior fossa tumor) <– good prognosis

119
Q

highly malignant cerebellar brain tumor of childhood; complications include compression of 4th vent + drop mets to spinal cord

A

medulloblastoma

120
Q

cystic + solid brain tumor of childhood

A

pilocytic (low-grade) astrocytoma

121
Q

solid brain tumor of childhood w/ small blue cells and Homer-Wright rosettes

A

medulloblastoma

122
Q

childhood brain tumor located within 4th ventricle; poor prognosis

A

ependymoma

123
Q

perivascular rosettes are foundin which childhood brain tumor?

A

ependymoma (poor prognosis)

124
Q

most common supratentorial tumor of childhood

A

craniopharyngioma

125
Q

cingulate herniation passes under the ??? and may compress ???

A

falx cerebri

anterior cerebral artery

126
Q

uncal herniation passes under the ??? and may cause ???

A

tentorium cerebelli
CN III palsy (blown pupil, down-and-out gaze); ipsilateral PCA compression (contralateral homonymous hemianopsia), contralateral crus cerebri compression (ipsilateral paralysis)

127
Q

cerebellar tonsillar herniation passes through the ??? and can cause ???

A

foramen magnum

brain stem compression –> impaired respiration –> coma or death

128
Q

glaucoma meds: mechanism of epinephrine

A

decrease aqueous humor synthesis (alpha-agonist)

129
Q

glaucoma meds: mechanism of brimonidine

A

decrease aqueous humor synthesis (alpha-agonist)

130
Q

glaucoma meds: mechanism of timolol/betaxolol/carteolol

A

decrease aqueous humor synthesis (beta-blocker)

131
Q

glaucoma meds: mechanism of acetazolamide

A

decrease aqueous humor synthesis (carbonic anhydrase inhibitor)

132
Q

glaucoma meds: mechanism of pilocarpine/carbachol

A

increase outflow of aqueous humor (direct cholinomimetic)

133
Q

glaucoma meds: mechanism of physostigmine

A

increase outflow of aqueous humor (indirect cholinomimetic)

134
Q

glaucoma meds: mechanism of echotiophate

A

increase outflow of aqueous humor (indirect cholinomimetic)

135
Q

glaucoma meds: mechanism of latanoprost

A

increase outflow of aqueous humor (PGF-2alpha)

136
Q

mechanism of opioid analgesics

A

agonists at opioid receptors –> open K+ channels, close Ca2+ channels –> decreased synaptic transmission

137
Q

mechanism of tramadol

A

weak mu-opioid receptor (+ other shit)

138
Q

side effects of tramadol

A

decreases seizure threshold, serotonin syndrome

139
Q

first-line treatment for status epilepticus

A

acute - benzos (diazepam, lorazepam); prophylaxis - phenytoin

140
Q

first-line treatment for simple partial sz

A

carbamazepine

141
Q

first-line tx for complex partial sz

A

carbamazepine

142
Q

first-line tx for generalized tonic-clonic (GTC, grand mal) sz

A

phenytoin, carbamazepine, valproic acid

143
Q

first-line tx for generalized absence sz

A

ethosuximide (blocks thalamic T-type Ca2+ channels)

144
Q

barbiturates are cytochrome P-450 ???

A

inducers

145
Q

treat benzo overdose with ???

A

flumazenil (competitive antagonist at GABA benzo receptor)

146
Q

Parkinson’s drugs

A

BALSA

Bromocriptine (D2 agonist)
Amantadine (increases endogenous DA release)
Levodopa/carbidopa (exogenous DA)
Selegiline (MAO-B/COMT inhibitor –> decreased DA breakdown)
Antimuscarinics, eg Benztropine or trihexyphenidyl (decrease ACh effect)

147
Q

Alzheimer’s drugs: Mechanism of donepezil, galantamine, rivastigmine

A

AChE inhibitors

s/e’s: nausea, dizziness, insomnia

Neurology Facts (1 decks)

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