Neuro IV

Question 1

lateral medullary syndrome

Answer 1

PICA stroke

• vomiting, vertigo, nystagmus
• loss pain/temp I/L face and C/L body
• dysphagia, hoarseness
• loss gag reflex
• I/L horners syndrome

Question 2

lateral pontine syndrome

Answer 2

AICA stroke

• vomiting, vertigo, nystagmus
• paralysis of face
• decreased lacrimation and salivation
• loss taste anterior 2/3 tongue

facial nucleus

Question 3

medial medullary syndrome

Answer 3

anterior spinal artery stroke

C/L hemiparesis - upper and lower limb
C/L proprioception loss

I/L hypoglossal loss

Question 4

PCA stroke

Answer 4

C/L hemianopia with macular sparing

occipital cortex
visual cortex

Question 5

basilar artery stroke

Answer 5

preserved consciousness and blinking

quadriplegia
loss voluntary face, mouth, tongue movement

Question 6

anterior communicating artery lesion

Answer 6

visual field defect

often aneurysm - not stroke

Question 7

posterior communicating artery lesion

Answer 7

CN III palsy - eye down and out

lesions aneurysm - not stroke

Question 8

berry aneurysm

Answer 8

rupture - subarachnoid bleed
-worst headache of life

bitemporal hemianopia - if compress optic chiasm

Question 9

association berry aneurysm

Answer 9

ehler danlos
ADPKD

risk fx - age, HTN, smoking, AAs

Question 10

charcot bouchard microaneurysm

Answer 10

with chronic HTN

affect small vessels

basal ganglia and thalamus

Question 11

central post stroke pain syndrome

Answer 11

pain from thalamic lesion

initial paresthesia - followed by allodynia

allodynia - ordinary painless not painful

Question 12

epidural hematoma

Answer 12

rupture middle meningeal a
-fx of temporal bone

get lucid interval

football shaped

Question 13

transtentorial hernation

Answer 13

can get CN III palsy

Question 14

subdural hematoma

Answer 14

bridging vein rupture

slow bleed

shaken baby, elderly, alcoholic

crescent shaped

Question 15

subarachnoid hemorrhage

Answer 15

rupture berry aneurysm

ehler danlos, ADPKD

worst headache of my life

bloody spinal tap

Question 16

stop vasospasm after SA hemorrhage

Answer 16

CCB - nimodipine

Question 17

intraparenchymal hemorrhage

Answer 17

HTN hemorrhage

Question 18

timescale ischemia to brain

Answer 18

12-48 hours - red neurons
24-72 hours - necrosis and neutrophils
3-5 days - macrophages - microglia
1-2 weeks - reactive gliosis - vasc proliferation
more than 2 weeks - glial scar

irreversible - 5 minutes

Question 19

stroke imaging

Answer 19

noncontrast CT - before tPA - rule out hemorrhage

Question 20

most susceptible brain to ischemia

Answer 20

hippocampus, neocortex, cerebellum, watershed

Question 21

hemorrhagic stroke

Answer 21

MC site - basal ganglia

Question 22

ischemic stroke of brain

Answer 22

get liquefactive necrosis

1 - thrombotic
2 - embolic
3 - hypoxic

tx - tPA

Question 23

TIA

Answer 23

reversible episode focal neuro dysfxn

no infarction

resolve

Question 24

dural venous sinuses

Answer 24

superior sagittal - top
straight - middle - branch to inferior sagittal
transverse - lateral
occipital - inferior

sigmoid - from transverse - to the jugular foramen
-forms internal jugular vein

Question 25

ventricular system

Answer 25

foramen of monro - lateral to 3rd ventricle
cerebral aqueduct of sylvius - 3rd to 4th ventricle

luschka and magendia - 4th ventricle to SA space
foramen of luschka - lateral
foramen of magendie - medial

Question 26

CSF production

Answer 26

ependymal cells of choroid plexus

Question 27

pseudotumor cerebri

Answer 27

idiopathic intracranial HTN

-HA, diplopia, papilledema

often woman, vit A excess
-high open pressure lumbar puncture - relief

tx - weight loss, acetazolamide, topiramate

Question 28

communicating hydrocephalus

Answer 28

decreased arachnoid granulation absorption

Question 29

normal pressure hydrocephalus

Answer 29

CSF pressure elevated episodic

urinary incontinence, ataxia, cognitive dysfxn

wet wobbly and wacky

Question 30

noncommunicating hydrocephalus

Answer 30

obstructive

colloid cyst -monro
stenosis - sylvius

Question 31

nerve exit spinal cord

Answer 31

cervical - C1 to 7 - exit above vertebrae
C8 - exit below vertebrae

rest of thoracic and lumbar - exit below vertebrae

Question 32

annulus fibrosis

Answer 32

outer ring - vertebral disc

Question 33

spinal cord length

Answer 33

to L1-2

SA space to S2

puncture - L3-L5 - level of cauda equina

Question 34

dorsal column

Answer 34

ascending
pressure, vib, touch, proprio

gracilis - medial - lower body, legs
cuneatus - lateral - upper body, arms

decussate medulla
to VPL

Question 35

lateral corticospinal tract

Answer 35

descending
voluntary motor

medial cervical
lateral sacral

decussate caudal medulla - pyramidal decussation

to NMJ

Question 36

lateral spinothalamic tract

Answer 36

ascending

pain and temp
cervical medial
sacral lateral

decussate anterior white commissure - ascend C/L
to VPL

Question 37

anterior spinothalamic tract

Answer 37

ascending

crude touch, pressure