Neuro - Path Flashcards
What causes communicating hydrocephalus?
Decreased CSF absorption by arachnoid granulations
TIA defined how?
Regional ischemia < 24 hours
Sudden, brief, uncontrolled, muscle contraction?
Myoclonus
Alzheimer’s familial case assoc w/what mutation?
What other syndrome assoc w/it?
Presenilin 1 and 2
Down syndrome by age 40
Pilocytic astrocytoma Mal/B9?
Arises where?
Imaging shows what?
B9 tumor of children (most common)
Cerebellum
Cystic lesion w/mural nodule
Tension HA: U/l or b/l? FM or M?
Duration?
Tx?
Describe
B/l, Females
> 30 min, usually 4-6 hour
NSAID, amitriptyline for chronic pain
Steady pain, no photo/phonophobia
Describe the following type of seizures: tonic-clonic
Tonic
Atonic
Grand mal - alternating stiffening and movement
Stiffening
Drop seizure
What is characterized by regions of necrosis surrounded by tumor cells (pseudopalisading)?
(+) for what?
Glioblastoma
GFP
What histology shows small, round blue cells? What may be present?
Medulloblastoma
Homer-Wright rosettes
Pick disease presents w/what anatomically?
Find what structures?
Frontotemporal lobe degen
Ubq TDP-43
Multifocal infarction due to HTN, atherosclerosis or vasculitis causes what?
2 cause
Vascular dementia
Friedreich ataxia is what?
Mutation?
Assoc with what?
Degen of cerebellum and spinal cord, Loss of DTRs, muscle weakness
AR, trinucleotide repeat of GAA
Hypertrophic cardiomyopathy
Poliomyelitis is damage to what?
AH –> LMN
MMA is a branch off what?
Maxillary artery
What histology shows loss of pigmented neurons in SN?
PD
Embolic stroke most common source is what?
Involves what?
Results in what?
Left side heart (AFib)
MCA
Hemorrhagic infarct at the periphery of cortex
What is a herniation of the cingulate gyrus under the falx cerebri called?
What is compressed?
Subfalcine herniation
ACA
What causes a crescent shaped hemorrhage?
May cause what?
Subdural hematoma
Midline shift
Degen disease of frontal and temporal cortex w/round aggregates of Tau proteins is what?
Progresses to what?
Pick disease
Dementia
Describe the following type of seizures: absence
Myoclonic
Petit mal - no postictal confusion, blank stare
Quick, repetitive jerks
What adult tumor presents as a calcified tumor in the white matter, involves frontal lobe, present w/seizures?
Oligodendroglioma
ALS main sx?
Inherited form has what mutation?
UMN and LMN paralysis
No sensory sx
SOD1
What causes subacute sclerosing panencephalitis?
Characterized how?
Measles virus
Viral inclusions w/in neurons and oligodendrocytes
What makes up leptomeninges?
Pia and arachnoid
Restlessness and intense urge to move is what?
Akathisia
M.S. HLA association?
Is what? Dx?
Tx?
HLA-DR2
Autoimmune destruction of CNS myelin, MRI and LP (oligoclonal IgG bands)
High-dose steroids, IFN-B
What causes locked-in syndrome?
Loss of what eye movements?
Basilar artery infarction
Horizontal but not vertical
What shows histology of eosinophilic inclusions of alpha-synuclein in affected neurons?
Parkinson D
Werdnig-Hoffman is what?
Inherited (AR) degen of AH, floppy baby
Ependymoma Mal/B9?
Arises from where?
Biopsy finding?
Mal
4th ventricle
Perivascular psuedorosettes
Subarachnoid hemorrhage INC risk of developing what?
Communicating and/or obstructive hydrocephalus
Types of focal seizures?
Simple partial - intact consciousness
Complex partial - impaired consciousness
Epilepsy - recurrent
Status epliepticus - continuous > 5-30 min or recurring –> Brain injury
What presents w/period sharp waves on EEG and rapidly progressive dementia assoc. w/ataxia?
CJD
What is metachromatic leukodystrophy? Inheritance?
Def. in arylsulfatase, AR
Subdural hematoma caused by what?
Increased risk in whom?
Tearing of bridging veins due to trauma
Older, due to atrophy
Elevated AFP in the amniotic fluid and maternal blood indicate what?
Neural tube defect
Craniopharyngioma Mal/B9?
Arises from what?
Presents how?
B9
Remnants of Rathke’s pouch
Supratentorial mass in kids
Lateral pontine syndrome caused by what?
Affects what?
Symptoms?
Infarct of AICA
Facial nucleus
Facial droop, Dec lacrimation, Dec salivation, Dec taste from ant. 2/3
Moderate global ischemia damages what areas specifically?
Pyramidal neurons of cortex (3, 5, 6)
Pyramidal neurons of hippocampus (temporal lobe)
Purkinje layer of cerebellum
Early-onset dementia suggest what?
What sx?
Lewy body disease
Dementia, hallucinations, parkinson-like features
Abeta amyloid associated w/what?
What else?
Alzheimer’s
NFT-Tau proteins
Medulloblastoma derived from what?
Mal/b9?
Occurs in whom?
Granular cells of cerebellum (neuroectoderm)
Mal
Kids
LP for CSF where?
Why?
L4 and L5
SC ends at L2, subarachnoid and cauda equina continue to S2
Slow-onset memory loss, changes in behavior and personality, degen of cortex is what disease?
Cause?
Alzheimer’s
Sporadic
Mild global ischemia results in what?
Ex?
Transient confusion
Insulinoma
What is Worst headache of life? cause?
What site most frequently?
Assoc w/what syndromes?
Subarachnoid hemorrhage, berry aneurysm rupture
Anterior circle of Willis at branch points of anterior comm. artery
Marfan, ADPKD (adult polycystic)
Variant CJD in whom?
Younger pts, mad cow
What produces CSF?
Choroid plexus
Craniopharyngioma can compress what?
What is seen on imaging?
Can it recur?
Optic chiasm –> bitemp hemianopsia
Calcifications
YES
Migraine HA: U/l or b/l? FM or M?
Duration?
Tx?
Describe
U/l, Females
4-72 hours
NSAID, triptans, dihydroergotamine
Pulsating pain w/nausea, photophobia, may have aura
Medial medullary syndrome is caused by what?
Causes what?
Infarct of anterior spinal artery
B/l paralysis of arms and shoulders
PCA lesion located where?
Causes what?
Occipital lobe
Contralateral hemianopia w/macular sparing
Cluster HA: U/l or b/l? FM or M?
Duration?
Tx?
Describe
U/l, MALES
15min - 3 hr
Sumatriptan
Excruciating periobital pain w/lacrimation and rhinorrhea
Sustained, involuntary m. Contraction is what?
Dystonia
Oligodendroglioma mal/B9?
What appearance on biopsy?
Malignant
Fried egg
Uncal herniation is what?
Displacement of temporal lobe under the tentorium cerebelli
Give the flow of CSF from start to finish
Lateral ventricles –> 3rd ventricle via Foramen of Monroe –> 4th ventricle via Cerebral aqueduct –> subarachnoid space via foramen of Magendie and Luschka
Epidural hematoma may cause what?
CN3 palsy
Normal pressure hydrocephalus can cause what in adults?
Presents how?
What improves sx? Tx how?
Dementia due to increased CSF and dilated ventricles
Urinary incontinence, gait instability, dementia
LP, therefore tx w/VP shunt
What disease causes relapsing neurologic deficits w/periods of remission?
M.S.
M.S. Symptom triad?
SIN
Scanning speech
INO/Intention tremor
Nystagmus
Where is Broca’s area?
Lesion causes what?
Inferior frontal gyrus of frontal lobe
Pt can’t speak, they are frustrated, CAN comprehend
Moderate global ischemia leads to what?
Where?
Infarct in watershed areas
Area bw ACA and MCA
What presents w/foot deformities (pes cavus, hammer toe), LE weakness (foot drop) and sensory deficits?
Inheritance?
Charcot-Marie-Tooth
AD
Give the microscopic cellular changes of ischemic stroke timeline
Red neurons w/in 12 hours
Necrosis (24 hours) w/ neutrophils (1-3) days and microglia (4-7 days)
Granulation tissue after 1 week
Cyst (gliosis) after 1 month
What causes intracerebral (parenchyma) hemorrhage?
Due to what?
Most common site?
Charcot-Bouchard microaneurysms of lenticulostriate vessels
HTN
Basal ganglia
Alzheimer’s has what inherited increase risk?
Decreased?
APOE4
E2
Where is Wernicke’s area?
Lesion causes what?
Superior temporal gyrus of temporal lobe
Fluent speech that makes no sense (No comprehension)
Pathogenesis of Migraine HA?
Irritation of CN 5, meninges, or blood vessels
What is Krabbe Disease?
Inheritance?
Def. of glactocerbrosidase, accumulates in macrophages –> leukodystrophy
AR
Lesion of MCA affects what?
Symptoms?
Upper limb and face, temporal lobe-Wernicke, frontal lobe-Broca
Contralateral paralysis and sensory loss
Aphasia if dominant hemisphere
Meningioma occurs in whom?
Mal/B9? Of what?
Histology shows what?
Adult female
B9 tumor of arachnoid cells
Whorled pattern, psammoma bodies
Lacunar stroke due to what?
Involves what?
Hyaline arteriosclerosis (from HTN or DM)
Lenticulostriate vessels –> cystic areas of infarction
What causes Lateral medullary (Wallenberg) syndrome?
Sx?
Infarct of PICA
Dysphagia, hoarseness, dec. Gag reflex (Nuc. ambiguus - CN 9-11)
Lenticulostriate lesion affects what?
Sx?
Striatum, IC
Contralateral paralysis and/or sensory loss
Thrombotic stroke due to what?
Most common spot?
What kind of infarct?
Rupture of atherosclerotic plaque
Atherosclerosis at branch points of bifurcation in ICA and MCA
Pale
Glioblastoma occurs in whom?
Mal/B9?
Arises where?
Prognosis?
Adults
Mal
Cerebral hemisphere –> crosses corpus callusum
Poor
Focal seizures most commonly affect what part of the brain?
Often preceded by what?
Medial temporal lobe
Aura
Spongiform encephalopathy due to what?
PrPc converted to Beta-pleated PrPsc
Schwannoma involves what?
+ for what?
B/l tumors seen in what?
CN8, CPA
S100
NF2
Medulloblastoma prognosis?
What can happen?
Poor, metastasis via CSF
Metastasize to cauda equina
PML is caused by what?
Presents how?
JC virus
In immunosuppressed or AIDS, rapidly progressive neurological signs
What adult tumor presents as seizures and compresses but does not invade the cortex?
Meningioma
Syringomyelia main defects?
Cystic degen of SC
Loss of pain/temp in cape like dist (AWC)
Dorsal expan –> destroys AH (LMN)
Horner Syndrome (lateral horn)
Biopsy of what tumor shows thick eosinophilic processes of astrocytes and eosinophilic granular bodies? Aka what?
tumor + for what?
Pilocytic astrocytoma, Rosenthal fibers
GFAP
Congenital failure of cerebellar vermis to develop?
Presents how?
Dandy-walker
Absent cerebellum, dilated 4th ventricle, hydrocephalus
ACA lesion affects what?
Sx?
Lower limb
Contralateral paralysis and sensory loss
Congenital downward displacement of cerebellar vermis and tonsil through foramen magnum is what?
Assoc w/what?
Arnold-Chiari
Meningomyelocele
Tonsillar herniation is what?
Leads to what?
Cerebellar tonsil into foramen magnum
Compression of brain stem –> cardiopulmonary arrest
Most common form of spongiform encephalopathy is what?
Contracted how?
Creutzfeldt-Jakob
Sporadic, or infected via HGH or corneal transplant
What is Adrenoleukodystrophy due to?
Inheritance?
Damages what?
Impaired add. Of CoA to long-chain FA’s
X-linked
Adrenals, white matter of brain
What 3 structures does an uncal herniation compress? What does each one cause?
CN3 - down and out dilated pupil
PCA - contralateral homonymous hemianopsia
Paramedian artery - Duret hemorrhage
Huntington’s is due to what?
Inheritance? W/what?
Degen of GABAnergic neurons in the caudate nucleus
AD, w/CAG repeats
What has morphologic changes of cerebral atrophy, narrowed gyri, widened sulci, dilation of ventricles?
Alzheimer’s
What is Sturge Weber syndrome?
Neural crest anomaly
Sporadic, port wine Stain Tram track calcification Unilateral Retardation Glaucoma, GNAQ gene Epilepsy
Tuberous Sclerosis on what chromosome?
Inheritance?
CFs?
16
AD
Ash-leaf spots, Shagreen patches, renal angiomyolipoma
VHL on what ch.? Inheritance?
What tumors assoc w/it?
3, AD
HARP
Hemangioblastoma, angiomastosis, RCC, Pheos
NF1 on what ch.?
NF2?
17
22
What tumor has perivascular rosettes w/rod-shaped blepharoplasts?
Prognosis?
Ependymoma
Poor
“Motor oil” fluid from tumor?
What characteristic about it?
Craniopharyngioma
Most common childhood supratentorial tumor
What childhood tumor can cause precocious puberty in males?
Due to what?
Pinealoma –> cause Parinaud syndrome (Vertical gaze palsy)
B-hCG production
Subfalcine herniation may compress what structure?
ACA
What causes Tabes Dorsalis?
Results from what?
Sx?
Tertiary syphilis
Demyelination of dorsal columns and roots
Shooting pain, Argyll Robertson pupil, loss of DTRS
What has a + Romberg sign?
Tabes Dorsalis
Vit B12 def causes what?
Demyelination of spinocerebellar tracts, LCST, and dorsal columns
What has unilateral sx including radicular pain, absent knee and ankle reflex w/loss of bladder control, may cause saddle anesthesia?
Often caused by what?
Cauda equina syndrome
intracerebral disk herniation or tumor
Name the 5 pathologic findings in Brown-Sequard syndrome
1 - ipsilateral loss of all sensation at level of lesion
2 - ipsilateral LMN loss at level
3 - Ipsilateral UMN loss below lesion
4 - Ipsilateral loss of 2pt tactile below lesion
5 - contralateral loss of pain/temp below lesion
CN 10 lesion results in what?
Ex. Lesion on Right side
Uvula deviates AWAY from side of lesion
Uvula deviates to the left
Where are high frequency sounds heard? Describe
Base of cochlea (thin and rigid)
Where are low frequency sounds heard? Describe
Apex near helicotremma (wide and flexible)
LA helicopter
Most common cause of viral conjuctivitis?
Adenovirus
What is myopia?
How to correct?
Nearsightedness, eye too long for refractive power
Diverging lens (concave)
What is hyperopia?
How to correct
Farsightedness, eye too short
Converging (convex) lens
What is an astigmatism?
How to correct?
Abnormal curvature of retina, diff refractive power at diff axes
Cylindrical lens
Where is aqueous humor of the eye made?
How do you decrease it?
nonpigmented epithelium of ciliary body
Beta blockers, a2 agonists, CAI’s
What are 3 causes of secondary open-angle glaucoma?
More common in whom?
Blocked trabecular mesh work from wbc’s (uveitis)
From rbc’s
From retinal elements
Older nyukkas
Primary cause of closed-angle glaucoma?
Enlargement or forward movement of lens against central iris -> obstruction of normal aqueous flow through pupil, impedes flor through trabecular meshwork
Secondary cause of closed-angle glaucoma?
Hypoxia from retinal disease
Acute closure glaucoma sx?
Do not give what? Why?
Very painful, red eye, sudden vision loss, frontal HA, dilated pupil
Epi, due to mydriasis effect
Describe the pathway of the pupillary light reflex
Light sends signal via CN2 to pretectal nuclei
In midbrain it activates b/l Edinger-Westphal nuclei
Pupils constrict b/l
An afferent pupillary defect due to optic nerve damage or retinal injury results in what?
Called what?
DEC b/l pupillary constriction when light is shone in affected eye
Marcus Gunn pupil
Describe pathway of miosis
1st neuron in EW nucleus to ciliary ganglion of CN 3
2nd neuron in short ciliary nerves to sphincter pupillae muscles
What nerves are in the cavernous sinus? Which artery?
Which is most susceptible to injury?
How does blood from the eye and sup. Cortex drain?
CN 3, 4, V1, V2, 6, ICA
CN 6
Cavernous sinus –> IJV
What causes disinhibited behavior (hyperphagia, hypersexuality, hyperorality)?
Due to what lesion?
Example of inciting cause?
Kluver-Bucy syndrome
amygdala b/l
HSV-1 encephalitis
