"Neuro Gold" Flashcards
3 components of blood-brain barrier
Endothelial cells, basement membrane, astrocytic end feet
Conditions associated with proximal symmetric weakness but no sensory loss
Myopathies
Symptoms associated with peripheral neuropathies
Distal asymmetric weakness with atrophy, fasciculations, sensory loss and pain
Two most common conditions that result in peripheral neuropathies
Diabetes and alcoholism
Distribution of sensory loss in polyneuropathies
Stocking/glove pattern
Symptoms of Guillan-Barre syndrome
Ascending symmetric muscle weakness, areflexia and paresthesias in hands and feet 1-3 weeks following a viral respiratory or GI infection
CSF findings in Guillan-Barre syndrome
CSF has elevated protein without elevated WBC
Motor neuron disease characterized by UMN and LMN lesions
Amyotrophic lateral sclerosis
MRI and CSF findings of MS
MRI: white matter lesions
CSF: oligoclonal bands on electrophoresis
Conditions that cause pain/loss in a dermatomal pattern
Radiculopathies
Signs of UMN lesions
Spastic paralysis, hyper-reflexia, positive Babinksi, Hoffman sign, and clonus
With an acute UMN lesion, there may be hyporeactive reflexes and flaccid paralysis
Cause of lower facial paralysis (can wrinkle their forehead but cannot smile)
Sign of damage to the corticobulbar tract in the pons or higher (internal capsule or crus cerebri)
Signs of LMN lesions
Flaccid paralysis, hyporeflexia, fasciculations, atrophy
Symptoms of spinal shock
Temporary flaccid paralysis, hyporeflexia, sensory loss and loss of bladder tone
Hyper-reflexia develops over a period of days to weeks
Cause and symptoms of anterior spinal artery syndrome
Cause: occlusion of the artery of Adamkiewicz
Symptoms: bilateral weakness, loss of pain and temperature and hyper-reflexia below the lesion
Symptoms of cauda equina syndrome
Weakness and sensory loss in the lower extremities, radicular pain, saddle anesthesia, and urinary incontinence
Cause and symptoms of syringomyleia/hyromelia
Cause: cavitation of the central spinal cord
Symptoms: impinges the anterior white commissure producing bilateral loss of pain and temperature in a dermatomal pattern
Cause and symptoms of Brown-Sequard syndrome
Cause: hemisection of the spinal cord
Symptoms: ipsilateral UMN paralysis and loss of discriminative touch and contralateral loss of pain and temperature
Cause and symptoms of anterior cord syndrome
Cause: compression of anterior spinal artery
Symptoms: affects the neurons of the anterior horn, spinothalamic tract and lateral corticospinal tract
Symptoms of tabes dorsalis
Loss of posterior columns (discriminative touch, proprioception, and vibration)
Cause and symptoms of subacute combined degeneration
Cause: B12 deficiency
Symptoms: peripheral neuropathy that can progress to cord (posterior columns and lateral corticospinal tracts)
Cause and symptoms of medial medullary syndrome
Cause: infarct within anterior spinal artery
Symptoms: contralateral spastic hemiparesis (corticospinal tract), ipsilateral deviation of the tongue on protrusion (hypoglossal nucleus or nerve) and contralateral loss of discriminative touch, proprioception and vibration (medial lemniscus)
Cause and symptoms of lateral medullary syndrome
Cause: infarct within posterior inferior cerebellar artery
Symptoms: ipsilateral loss of pain and temperature on face (spinal trigeminal tract), contralateral loss of pain and temperature on body (spinothalamic tract), nystagmus, dizziness, nausea (vestibular nuclei), hoarseness, ipsilateral sagging palate, dysphagia (nucleus ambiguous), loss of taste (solitary nucleus), ataxia (restiform body, inferior cerebellar peduncle), Horner syndrome (hypothalamospinal fibers)
Cause and symptoms of Foville syndrome
Cause: infarct within paramedian branches of basilar artery
Symptoms: contralateral spastic hemiparesis (corticospinal tract), diplopia, paralysis of abduction (CN VI; maybe also intranuclear ophthalmoplegia), ataxia (middle cerebellar peduncle), contralateral loss of discriminative touch, proprioception, and vibration (medial lemniscus)
Cause and symptoms of Gubler syndrome
Cause: infarct within paramedian branches of basilar artery
Symptoms: contralateral spastic hemiparesis (corticospinal tract), ipsilateral facial paralysis (facial nerve or nucleus), ipsilateral loss of pain and temperature on face (CN V), contralateral loss of pain and temperature on body (spinothalamic tract)
Cause and syndrome of midpontine base syndrome
Cause: infarct within paramedian or short circumferential branches of basilar artery
Symptoms: contralateral spastic hemiparesis (corticospinal tract), paralysis of jaw muscles (CN V), loss of sensation on face (CN V), ataxia (middle cerebral peduncle)
Symptoms of tonsillar herniation
Central apnea, hypertension, hyperventilation, loss of consciousness
Injury to the facial nerve (or nucleus) results in complete or lower facial paralysis
COMPLETE facial paralysis
Corticonuclear lesions (at pons or above) results in complete or lower facial paralysis
Lower facial paralysis
Cause and symptoms of Parinaud syndrome
Cause: lesion of the midbrain
Symptoms: paralysis of vertical gaze (vertical gaze center), obstructive hydrocephalus (pinealoma)
Cause and symptoms of Weber syndrome
Cause: infarct within branches of the posterior cerebral artery within the midbrain
Symptoms: contralateral spastic hemiparesis (corticospinal tract), diplopia, dilated pupil (CN III), paralysis of lower face, deviation of tongue to contralateral side, weakness of ipsilateral SCM and trapezius (corticonuclear tract), tremor (substantia nigra)
Cause and symptoms of Claude syndrome
Cause: infarct within branches of the posterior cerebral artery within the midbrain
Symptoms: diplopia, dilated pupil (CN III), tremor, hyperkinesia (red nucleus), ataxia (cerebellothalamic fibers)
Symptoms of an uncal herniation
Diplopia, dilated pupil (CN III), contralateral hemiparesis (corticospinal tract), paralysis of lower face, deviation of tongue to contralateral side, weakness of SCM and trapezius (corticonuclear tract)
Findings for Weber test
Tests bone conduction
Normally localizes to midline
Sensorineuronal loss - localizes to good ear
Conductive loss - localizes to bad ear
Findings for Rinne test
Compares air and bone conduction; air conduction is normally better than bone conduction
Sensorineuronal loss - air > bone
Conductive loss - bone > air
Cause of anisocornia (unequal pupils)
Lesion to CN III or sympathetics
A dilated pupil indicates injury to CN III
Cause of ipsilateral blindess
Lesion to retina or optic nerve
Cause of bitemporal hemianopsia
Lesion to optic chiasm
Cause of contralateral homonymous hemianospia
Lesion to optic tract
Cause of contralateral homonymous hemianopsia, maybe quantrantopia
Lesion to optic radiations
Marcus-Gunn pupil
Pupil that appears to dilate with direct stimulation of light on a swinging light test
Indicates lesion to optic nerve
Cause and symptoms of intranuclear ophthalmoplegia
Cause: lesion of the medial longitudinal fasciculus (in the pons or caudal midbrain)
Symptoms: eye that fails to adduct on lateral gaze (but convergence is intact)
Cause and symptoms of one-and-a-half syndrome
Cause: lesion involving both the medial longitudinal fasciculus and abducens nucleus
Symptoms: on testing horizontal gaze, one eye can only abduct and other eye cannot abduct or adduct
Cause of Argyll-Robertson pupil
Tabes dorsalis
Decorticate posturing
UL flexed, LL extended (rubrospinal tract intact)
Decerebrate posturing
All limbs in extension (rubrospinal tract damaged)
Damage to what structure results in coma
Reticular formation
Cause and symptoms of Meniere’s syndrome
Cause: excess endolymph in the scala media
Symptoms: episodic vertigo, tinnitus and hearing loss
Cause and symptoms of benign positional vertigo
Cause: free otoliths in the semicircular canals
Symptoms: outbursts of vertigo and nystagmus with particular positions of the head
Caloric testing
Cold=nystagmus to Opposite side
Warm=nystagmus to Same side
COWS
Cause of ballismus
Lesion to subthalamuc nucleus
Cause of hemiballismus
Lesion to subthalamic nucleus on opposite side
Differentiate between sensory vs cerebellar ataxia with the Romberg test
In sensory ataxia, the patient sways considerably when eyes are closed
In cerebellar ataxia, the patient sways with eyes open
Cause and symptoms of Friedreich’s ataxia
Cause: autosomal recessive disorder, degeneration of posterior columns and spinocerebellar tracts
Symptoms: progressive limb and gait ataxia, dysarthria, loss of joint position and vibration senses, absent tendon reflexes in the lower extremity and Babinski sign
Symptoms resulting from blockage of anterior choroidal artery
Contralateral hemiparesis (corticospinal tract) and contralateral homonymous hemianopsia (optic tract)
Symptoms resulting from blockage of lenticulostriate arteries
Contralateral hemiparesis and hemianesthsia (posterior limb of internal capsule)
Symptoms resulting from blockage of MCA: superior division
Motor and sensory symptoms involving the contralateral face (lower facial paralysis), upper limb and trunk (lower extremity is spared); on the left will produce expressive (Broca’s) aphasia
Symptoms resulting from blockage of MCA: inferior division
Contralateral homonymous hemianopsia; on left receptive (Wernicke’s ) aphasia
Symptoms resulting from blockage of ACA
Motor and sensory symptoms involving the contralateral trunk and lower limb (upper limb and face are spared) with frontal lobe signs (magnetic gate, personality changes, release of primitive reflexes [grasp, root, suck])
Symptoms resulting from blockage of PCA
Produces visual symptoms - contralateral homonymous hemianopsia, macular sparring is possible; may infarct thalamus (thalmogeniculate and thalamoperforating) = contralateral homonymous hemianopsia/somoatosensory loss
Symptoms of Broca’s aphasia
Impaired comprehension, repetition, naming and speech output
Symptoms of Wernicke’s aphasia
Fluent speech full of nonsense words and phrases
Cause and symptoms of conductive aphasia
Cause: damage to the arcuate fasciculus
Symptoms: poor repetition
Symptoms of anterior watershed strokes
Expressive aphasia and lower limb affects
Symptoms of posterior watershed strokes
Receptive aphasia and visual loss
Definition of apraxia
Loss of the ability to perform a learned and familiar motor task
Definition of agnosia
Inability to recognize a familiar object regardless of intact sense
Cause and symptoms of Gerstmann syndrome
Cause: damage to the angular gyrus in the dominant hemisphere
Symptoms: acalculia, agraphia, finger agnosia, and left-right confusion
Cause and symptoms of Kluver-Bucy syndrome
Cause: bilateral lesions of the amygdala
Symptoms: docility, placidity, hypersexuality, hyperorality, and hypermetamorphosis
