Neuro First Aid

Question 1

NE location of synthesis

Answer 1

locus ceruleus (pons)

Question 2

NE changes in anxiety and depression

Answer 2

dec in depression

inc in anxiety

Question 3

DA location of synthesis

Answer 3

ventral tegmentum and Substantia nigra pars compacta (midbrain)

Question 4

DA changes in schizophrenia, PD, depression

Answer 4

inc schizophrenia
dec PD
dec depression

Question 5

5-HT synthesis

Answer 5

raphe nucleus (pons)

Question 6

5-HT disease changes in anxiety and depression

Answer 6

dec in both

Question 7

ACh synthesis

Answer 7

Basal nucleus of Meynert

Question 8

ACh changes in Alzheimer’s, Huntington’s, REM

Answer 8

dec in Alzheimer’s
dec in Huntington’s
inc in REM

Question 9

GABA synthesis

Answer 9

nucleus accumbens

Question 10

GABA changes in anxiety and Huntington’s

Answer 10

dec in both

Question 11

primary driver of cerebral perfusion

Answer 11

PCO2

cerebral perfusion pressure is directly proportional to PCO2 until PCO2 > 90 mmHg

hypoxemia inc cerebral perfusion pressure only when PO2

Question 12

Therapeutic hyperventilation

Answer 12

dec PCO2 –> dec ICP in cases of acute cerebral edema (stroke, trauma)

Question 13

Medial medullary syndrome

Answer 13

ASA stroke, often b/l

contralateral hemiparesis of lower limbs, ipsi hypoglossal dysfunction

Question 14

Lateral medullary (Wallenberg’s) syndrome

Answer 14

nucleus ambiguus effects

“Don’t pick a (PICA) horse (hoarseness) who can’t eat (dysphagia)”.

also dec gag reflex, ipsi Horner’s, vomiting, vertigo, nystagmus

Question 15

AICA stroke

Answer 15

“Facial droop means AICA’s pooped”

paralysis of face, dec taste from anterior 2/3 of tongue (bc trigeminal nucleus affected, V3)

Question 16

PCA stroke

Answer 16

CL hemianopia with macular sparing

Question 17

PComm berry aneurysm

Answer 17

CN III palsy - eye is “down and out” with ptosis and pupil dilation

Question 18

AComm berry aneurysm

Answer 18

visual field defects

Question 19

Charcot-Bouchard Microaneurysm

Answer 19

a/w chronic HTN; affects small vessels (eg in basal ganglia, thalamus)

Question 20

Poliomyelitis and Werdnig-Hoffman disease

Answer 20

destruction of anterior horns of spinal cord

• polio = ssRNA, +sense
• Werdnig-Hoffman disease = congenital, “floppy baby”, AR

Question 21

Amyotrophic lateral sclerosis (ALS)

Answer 21

no sensory, cognitive, or oculomotor deficits

mx in superoxide dismutase 1

tx Riluzole - dec presynaptic glutamate release; modest survival inc

Question 22

Artery of Adamkiewicz

Answer 22

supplies ASA below T8 hence above it is susceptible to occlusion and infarction

Question 23

Tabes dorsalis

Answer 23

demyelination of dorsal columns

• charcot joints
• argyll robertson pupils
• absent DTRs
• positive Romberg

Question 24

Friedrich’s ataxia mutation

Answer 24

GAA in gene that encodes frataxin –> impaired mitochondrial functioning

Question 25

Brown-Sequard syndrome above T1

Answer 25

p/w Horner’s in addition to ipsi UMN signs at lesion level, CL pain and temp loss, ipsi sensation at level of lesion, ipsi LMN signs below lesion and ipsi proprioception loss

damage to sympathetic ganglion

Question 26

sympathetic stimulation as involved in horner’s

Answer 26

signal goes down from hypothalamus via intermediolateral column of spinal cord –> synapse at T1 –> up sympathetic trunk to C2 –> travel along carotid arteries

Question 27

Parinaud syndrome

Answer 27

compression of supperior colliculus, eg by pinealoma

paralysis of conjugate vertical gaze