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Emma H&N II > Neuro Injuries/Random Review Slides > Flashcards

Neuro Injuries/Random Review Slides Flashcards

1
Q

pure sensory stroke of thalamus

A
  • lacunae in VPL, VPM
  • –loss of all sensation in body/face
  • infarct due to small vessel disease
  • associated with HTN, DM

typified by:

  • microatheroma
  • lipohyalinosis
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2
Q

microatheroma

A
  • deposit or degenerative accumulation of lipid-containing plaques on the innermost layer of the wall of an artery
  • typical of a pure sensory stroke of thalamus
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3
Q

lipohyalinosis

A
  • degenerative changes in small blood vessels
  • accumulation of glassy/waxy looking lipid in vessel wall

-typical of pure sensory stroke of thalamus

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4
Q

thalamic hemorrhage

A
  • spontaneous intracerebral hemorrhage
  • associated with HTN
  • involvement of adjacent internal capsule (dominates, adds hemiparesis)
  • also sensory involvement
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5
Q

common sx of thalamic hemorrhage

A
  • numbness, sensory deficits on CONTRAlateral side
  • sometimes developing into thalamic pain
  • hemiparesis
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6
Q

Thalamic coma

A
  • bilateral involvement of reticular activating system

- embolus at top of basilar a., before bifurcation

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7
Q

damage to prefrontal cortex is associated with which disorders?

A

(frontal lobe, social judgement etc.)

  • schizophrenia
  • antisocial PD
  • ADHD

*phineas gage

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8
Q

unilateral lesion to parietal lobe?

A
  • causes contralateral neglect
  • pt fails to pay attention to contralateral side
  • R lesion: only draw numbers on L side of clock
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9
Q

primary sensory cortex lesion

A

cause loss of sensation in corresponding area

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10
Q

prosopagnosia

A
  • “face blindness”
  • disruption of circuits in fusiform gyrus (higher order cortical center)

-poss via bilateral temporal lobe injury
(facial recognition center: underside of temporal and occipital lobes on both sides of the cortex)

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11
Q

Kluver-Bucy syndrome

A
  • behavioral syndrome
  • due to bilateral removal of medial temporal lobes in monkeys
  • fearless/placid
  • hypersexuality
  • excessive sniffing/oral examination

SHOWED IMPORTANCE OF INTACT LIMBIC STRUCTURES AND CONNECTIONS TO APPROPRIATE BEHAVIORAL PATTERNS
(note: amygdala was also taken)

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12
Q

HM research patient

A
  • seizures
  • experimental surgery to take out MEDIAL TEMPORAL structures, amygdala, hippocampus (and surrounding cortex) bilaterally

After

  • few seizures
  • unable to form NEW long-term memories
  • profound retrograde amnesia
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13
Q

hippocampus has been implicated in:

A
  • MEMORY function
  • Alzheimer’s disease
  • SCHIZOPHRENIA
  • hippocampal sclerosis and EPILEPSY
  • AUTISM
  • DEPRESSION
  • modulating endocrine functions (via input to hypothalamus)
  • modulation of aggressive behaviors
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14
Q

amygdala is implicated in:

A
  • temporal lobe epilepsy
  • schizophrenia
  • Alzheimer’s
  • autism
  • anxiety states/PTSD
  • affective disorders
  • panic disorders
  • emotional memory
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15
Q

missing amygdala

A
  • has no fear
  • cannot recognize fear
  • cannot draw fear
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16
Q

Broca’s aphasia

A

motor aphasia

  • unable to form words
  • “broke”, labored speech
  • inferior frontal lobe
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17
Q

Wernicke’s aphasia

A

sensory aphasia, fluent aphasia

  • can talk freely, but makes no sense (“were”-“nick”)
  • no comprehension of what you say or what they are saying
  • “what?”
  • superior temporal lobe
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18
Q

transcortical motor aphasia

A

-looks like Broca’s aphasia, but CAN repeat

  • can repeat
  • cannot initate own
  • adj to Brocas in mid frontal gyrus
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19
Q

transcortical sensory aphasia

A

-looks like Wernicke’s but CAN repeat

  • can repeat
  • cannot understand
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20
Q

global aphasia

A
  • no understanding
  • no naming
  • no repeating
  • no expression

usually due to a larger vessel (proximal occlusion)

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21
Q

conduction aphasia

A
  • fluency relatively intact
  • comprehension impaired
  • arcuate fasciculus
  • inability to repeat (connects wernickes to brocas)

DISCONNECTION SYNDROME

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22
Q

split brain syndrome

A
  • corpus callosum affected
  • disconnect between both sides of brain

Due to:

  • epilepsy surgery
  • tumor
  • EtOH abuse
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23
Q

Balint Syndrome

A

BILATERAL PARIETAL LESIONS

  • simultanagnosia: inability to perceive visual field as a whole (name objects in kitchen but not situation)
  • oculomotor apraxia: difficulty fixating the eyes
  • optic ataxia: inability to move hand to a specific object using vision
  • fail to apprehend all but 1 of simultaneously presented objects at the same location
  • –object based, not location based
  • –multicolored dots seen if connected by lines
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24
Q

Gerstmann Syndrome

A

dominant parietal lobe

  • agraphia
  • acalculia
  • finger agnosia
  • right left confusion
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25
Q

non-dominant parietal signs

A
  • denial of deficits (anosagnosia)
  • visual, tactile, auditory extinction
  • spatial disorganization
  • neglect of left space
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26
Q

frontal lobe syndrome signs

A
  • problems with sequences tasks (Stroop test)
  • grasp reflexes
  • paratonia (Gegenhalten)
  • suck and snout reflex
  • perseveration (repeat self, locked in idea)
  • Luria test (pattern repeat)
  • incontinence
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27
Q

Anton syndrome

A
  • bilateral occipital lobe injury (PCA)
  • CORTICAL BLINDNESS
  • cannot see, but will flinch when confronted
  • confabulation: can see but cannot interpret signal so brain makes something up
  • headache, psychosis

-unawareness and denial of cortical blindness

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28
Q

Alexia w/o agraphia

A

posterior cerebral artery stroke involving SPLENIUM

disconnection syndrome

occipital cortex involved

can write but cannot read what they wrote

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29
Q

Agraphia and acalculia

A

dominant parietal lobe lesion

Gerstmann syndrome

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30
Q
  • problems with sequences tasks (Stroop test)
  • grasp reflexes
  • paratonia (Gegenhalten)
  • suck and snout reflex
  • perseveration (repeat self, locked in idea)
  • Luria test (pattern repeat)
A

frontal lobe syndrome signs

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31
Q

loss of initiative and drive

w/ loss of taste/smell

A

subfrontal meningioma (–> pure frontal lobe syndrome and compresses olfactory nerves)

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32
Q

conditions that affect the temporal lobe bilaterally

A
  • herpes encephalitis

- seizures

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33
Q

fluent aphasia

A

wernicke’s aphasia

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34
Q

lacunar stroke in internal capsule

A

arm and leg equally affected

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35
Q

small lacuna in the internal capsule can disrupt ___ and ___

A

CST and CBT

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36
Q

macular (center) sparing –> indication of lesion in

A

primary visual cortex

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37
Q

frontal lobe behaviors represent a failure of control of ________ impulses

A

frontal lobe behaviors represent a failure of control of LIMBIC impulses

insensitive to consequences
lack of insight
irritable euphoric apathy
crude humor (witzersucht)
slowed motor/mental actions (abulia)
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38
Q

pt has trouble repeating phrase correctly, and does worse w/ more attempts he makes

A

conduction aphasia

arcuate fasiculus –> connects wernickes to brocas

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39
Q

pt lost ability to form new memories and has trouble recognizing faces, which lobe affected?

A

temporal lobe

hippocampus, fusiform gyrus

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40
Q

pt has change in personality and shows grasp reflex when finger in hand, which lobe affected?

A

frontal lobe

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41
Q

capsular lacunes, if situated in region of CST…

A

contralateral hemiparesis (involving arm, leg, face equally)

“pure motor hemiplegia”

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42
Q

internal capsule lesion

A

pure motor stroke

leg=arm=face(CBT)

no other signs

all effects CONTRALATERAL to lesion

small vessel disease, lacunes

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43
Q

Corticospinal tract lesion

A

Spastic paralysis, hyperreflexia, and other upper motor neuron signs are present

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44
Q

CST lesion in spinal cord

A

There is a spinal cord level and there is weakness or paralysis from that level and below

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45
Q

CST lesion in brainstem

A

Hemiparesis (C) and cranial nerve signs (I)

Medulla: XII; Pons VI, Midbrain III

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46
Q

in brainstem, corticospinal tract always ventral or dorsal?

A

ventral

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47
Q

hemiparesis combined with

paralysis of the tongue

A

medial medulla

48
Q

paralysis of abducens

A

medial pons

49
Q

paralysis of medial rectus

A

medial midbrain

50
Q

superior MCA-ACA lesion

A

paralysis + loss of sensory info on side opposite the lesion

51
Q

hyperkinesia

–> disease?

A

Huntington’s

Hemiballismus

52
Q

damage to contralateral subthalamic nucleus

A

hemiballismus

53
Q

degeneration of caudate nucleus

A

Huntington’s disease

54
Q

loss of DA neurons in substantia nigra

A

Parkinson’s

55
Q

hypokinesia

–> disease?

A

Parkinson’s

56
Q

cerebellar pathology

A
  • dysmetria (over/undershoot)
  • intention tremor
  • truncal ataxia
  • incoordination (ataxia)

-dysdrochokinesis (difficult rapid alt movements)

57
Q

nuclei involved in medial brainstem strokes

A

III
IV
VI
XII

58
Q

nuclei involved in lateral brainstem strokes

A

motor V
sensory V
ambiguus (IX, X)
spinal accessory XI

59
Q

intalaminar nuclei

A

to cortex

(arousal) reticular activating system

60
Q

profound anterograde amnesia occurs w/ damage to the

A

hippocampal formation

entorhinal cortex involved in process

61
Q

UE tends to be flexed, LE tends to be extended

A

stroke pt

62
Q

amaurosis fugax

A

ipsilateral monocular vision loss

ICA blockage (ophthalmic)

63
Q

pure motor hemiplegia

A

internal capsule or ventral pons

Small Vessel (Lacunar) Syndrome

64
Q

pure hemisensory loss

A

thalamus

Small Vessel (Lacunar) Syndrome

65
Q

sensorimotor

A

thalmocapsular

Small Vessel (Lacunar) Syndrome

66
Q

clumsy hand-dysarthria and ataxia hemiparesis are types of

A

Small Vessel (Lacunar) Syndromes

67
Q

most common region of intracerebral hemorrhages due to HTN

A

basal ganglia

68
Q

aneurysm common locations

A

ACOMM and MCA bifurcations

69
Q

simple partial seizures

A

consciousness preserved

70
Q

complex partial seizures

A

consciousness altered

71
Q

generalized seizures are more likely due to

A

underlying seizure disorder

72
Q

absence seizures

A
  • staring, lack of awareness
  • generalized spike and wave EEG

“petit mal”

73
Q

myoclonic seizure

A

diffuse jerking

74
Q

generalized clonic tonic etc

A

tonic–> stiff
clonic–> rhythmic jerking

“grand mal”

75
Q

dysembryonic neuroepithelial tumor (DNET)

A

neuronal tumor

favors temporal lobe

presents as seizures

76
Q

meningioma is an ____-axial tumor

A

meningioma is an EXTRA-axial tumor

slow growing, good prognosis

77
Q

astrocytoma

A

pilocytic –> peds, benign
low grade
anaplastic
glioblastoma multiforme –> likes to cross corpus callosum

78
Q

ependymoma

A

originates in ventricles

hydrocephalus common

lots of HA if elevated ICP

79
Q

oligodendroglioma

A

slow growing
good prog
FRIED EGG
seizures common

80
Q

pseudopallisading necrosis

A

histo feature in GLIOBLASTOMA MULTIFORME (astrocytoma)

so agressive, outgrow and obstruct blood supply

81
Q

which tumor presents w/ bitemporal hemianopia?

A

SELLA MASSES

82
Q

sella masses - 2 types?

A

pituitary adenoma

craniopharyngioma

83
Q

very cystic tumor, tends to be filled w/ “crank case” oil (black viscous fluid)

A

craniopharyngioma

type of sella mass

84
Q

heterotopias

A

disorder of MIGRATION

extra layer of gray matter, etc.

85
Q

relapsing-remitting MS

A

reverts to baseline between attacks

86
Q

relapsing-progressive

A

reverts not quite back to baseline between attacks

87
Q

secondary progressive

A

eventually, instead of relapsing episodes, just get steady accumulation of disability

88
Q

primary progressive

A

progressive course from onset

89
Q

MS is a ____ matter disorder

A

MS is a WHITE matter disorder

90
Q

lesions within corpus callosum, kind of perpendicular to it

seen in MS

A

Dawson’s fingers

91
Q

MS dx requires …

A

demonstration of lesions disseminating in space and time

need hx and new lesions in a different neuro axis in a different time frame

92
Q

optic neuritis is typical in ___

how is it tested?

A

optic neuritis is typical in MS

how is it tested?
evoked potentials (light checkerboard thing, measure how optic n. is receiving info)
93
Q

MS pt CSF findings

A

> 2 oligoclonal bands (MOST IMP)

inc IgG synthesis

not much WBC elevation

94
Q

lewy body dementia

A

first hallucinations

also Parkinson’s sx

95
Q

dementia w/ stepwise progression of cognitive decline

A

vascular dementia

96
Q

senile plaques

A

beta-amyloid

97
Q

neurofibrillary tangles

A

tau protein

98
Q

abnormal genes in familial Alzheimer’s

A

APP, presenillin 1 (gamma secretase)

AD inheritance

99
Q

normal pressure hydroceophalus

A

wet
wacky
wobbly

(impaired CSF absorption –> normal pressure hydroceophalus)

100
Q

metabolic causes of dementia

A

thyroid

B12 deficiency

101
Q

responds to voice, pain but clearly not fully aware of environment

A

stuporous

102
Q

subcortical comas show less

A

subcortical comas show less EYE MOVEMENT

103
Q

bilateral thalamic injury can lead to coma due to damage of

A

reticular formation

104
Q

PVS dx after

A

1 mo.

1 year in trauma cases

105
Q

locked-in syndrome

A

ventral pontine lesion

106
Q

minimally conscious state

movement?

A

demonstrates purposeful behavior rather than reflexive

107
Q

lucid interval

A

epidural hematoma

biconvex

always acute

108
Q

subdural hematoma

A

acute or chronic

109
Q

glasgow coma scale score indicating serious head injury

A

8 or less

110
Q

inducing barbiturate coma can help manage …

A

elevated ICP

111
Q

early sign of medial temporal lobe (uncal) herniation

A

dilated, fixed pupil

112
Q

abulia

A

frontal lobe syndrome

slowed response to envio

113
Q

superior temporal gyrus

A

heschl’s gyrus

auditory

114
Q

supramarginal gyrus

A

language function

115
Q

angular gyrus

A

language function

reading

116
Q

frontal eye fields

A

cortical control of eye movements

middle frontal gyrus

Emma H&N II (49 decks)

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