Neuro Path (mostly blood things) Flashcards
When do primitive reflexes usually disappear?
within 1st year of life
Galant Reflex
Stroke one side of spine while newborn is face down –> lateral flexion of lower body toward that side
Gallbladder pain referral
C3-5 (phrenic nerve) to right shoulder
C2 dermatome
Posterior half of skull
C3 dermatome
Neck brace/turtleneck
C4 dermatome
Low collar shirt
Xyphoid process dermatome
T7
Dermatome of the knee caps
L4
Frontal eye field lesion
Eyes look toward lesion (leader has to be brave)
Paramedian pontine reticular formation lesion
Eyes look away from lesion (buried away in brain-too afraid to look)
Medial longitudinal fasciculus lesion
INO (ipsilateral eye can’t adduct; contralateral eye nystagmus with abduction [hyperactive trying to get friend to come along])
What disease is associated with MLF lesions?
MS
What is Gerstmann syndrome? (4 signs)
Lesion of dominant parietal cortex = agraphia, acalculia, finger agnosia, left-right disorientation
Lesion of the subthalamic nucleus
Contralateral hemiballismus
What type of infection is associated with Kluver-Bucy syndrome?
HSV-1 encephalitis
What is Kluver-Bucy syndrome?
Bilateral lesion of amygdala–> disinhibited behavior (hyperphagia, hypersexuality, hyperorality)
What is Parinaud syndrome?
Lesion of the SC; paralysis of conjugate vertical gaze (eyes can’t nod up and down)
What side will the deficits appear on with cerebellar hemisphere lesions?
Ipsilateral; fall toward side of lesion
When does irreversible damage begin following hypoxia in the brain?
5 minutes
What imaging is used to exclude hemorrhage prior to treating a stroke?
Noncontrast CT
___ can detect ischemia within 3-30 min.
Diffusion weighted MRI
When will you see the following histologic changes following an ischemic event?
- Microglia (often myelin/lipid filled)
- Red neurons (eosinophilic cytoplasm + pyknotic nuclei)
- Glial scar
- 3-5 days
- 12-24 hours
- > 2 weeks
When will you see …?
- Necrosis + neutrophils
- Vascular proliferation + reactive gliosis
- 24-72 hours
- 1-2 weeks
When do you begin to see liquefactive necrosis on a gross scale?
1 wk to 1 mo
Where are direct clots (usually over an atherosclerotic plaque) likely to form?
MCA (thrombotic strokes)
In addition to aspirin, what medical therapy could you give to decrease risk of stroke?
Clopidogrel
What vascular structure is likely damaged?
Intracranial hemorrhage w/:
-Lucid interval
-Rapid expansion under systemic pressure –> transtentorial herniation
-Possible CN III palsy
-Skull fracture (likely at pterion)
Middle meningeal artery (branch of maxillary).
Epidural hematoma biconvex/doesn’t cross suture lines
What does a hypodense crescent-shaped hemorrhage on CT likely indicate?
Chronic subdural hematoma (mild trauma, cerebral atrophy, elderly, alcoholism)
What type of intracranial hemorrhage is associated with shaken babies?
Subdural hematoma
What is “acute on chronic” hemorrhaging?
Varying CT densities associated with a sub-acute subdural hematoma
What vasculature is damaged in subdural hematoma?
Bridging veins
Which type of hematoma is associated with a lucid interval?
Epidural hematoma
What will the spinal tap of a patient with subarachnoid hemorrhage look like?
Xanthochromic (yellow) or bloody
__ is used to prevent/reduce vasospasm following SAH.
Nimodipine
__ is seen with ____ (as recurrent lobar hemorrhagic strokes in elderly).
Intraparenchymal hemorrhage; amyloid angiopathy
Systemic HTN is the most common cause of ___, intraparenchymal hemorrhages into the basal ganglia and internal capsule following microaneurysm of lenticulostriate vessles.
Charcot-Bouchard microaneurysms
NOT VISIBLE ON ANGIOGRAPHY
If significant edema following TBI, (raise/lower) PaCO2 –> vasoconstriction–> (raise/lower) ICP
lower the PaCO2 to lower the ICP
Where’s the lesion: Left sided paralysis and sensory loss of lower limb
Right ACA
Common manifestations of lenticulostriate a. stroke:
CONTRALATERAL paralysis and/or sensory loss- both face and body
ABSENCE of CORTICAL SIGNS (neglect, aphasia, visual field deficits)
Microatheromas and lipohyalinosis are common signs of ______ found in the lenticulostriate arteries due to unmanaged HTN.
lacunar infarcts
Artery damaged in medial medullary syndrome
ASA- anterior spinal artery
Triad of medial medullary syndrome
1) Contralateral upper and lower limb paralysis (LCT)
2) Dec. contralateral proprioception (medial lemniscus)
3) Ipsilateral deviation of tongue (CN XII)
___ supplies the lateral medulla.
PICA
Sx of lateral medulla damage
1) Dysphagia, hoarseness, dec. gag reflex (nuc. ambiguus)
2) Vomiting, vertigo, nystagmus (Vestibular nuc.)
3) Dec. PCT from contra body, ipsi face (Lateral spinothalamic and spinal trigeminal nuc)
4) Ipsi Horner (Symp fibers)
5) Ataxia, dysmetria (Inf. cerebellar peduncle)
1) Facial paralysis w/ dec. lacrimation, salivation, taste from anterior 2/3
2) Vomiting, vertigo, nystagmus
3) Dec. PCT from contra body, ipsi face
4) Ipsi Horner
5) Ataxia, Dysmetria (Middle/inferior cerebellar peduncles)
AICA syndrome = Lateral pontine syndrome
Your face is more anterior than your throat
What artery is occluded in “locked in syndrome”?
Basilar a.
What allows for consciousness to be preserved in “locked in syndrome?”
Sparing of RAS (reticular activating syndrome)
How do you lose horizontal eye movements in “locked in syndrome?”
Damaged PPRF and ocular CN nuclei
Where is/was the lesion in central post-stroke pain syndrome? paresthesias –> allodynia and dysethesia
Thalamus
What is the difference between aphasia and dysarthria?
Higher order inability to speak/comprehend vs. motor defecit
Damage to the ___ can cause conduction or global aphasias.
Arcuate fasciculus
Repetition intact aphasias are caused by ____, but the respective ____ are intact.
transcoritcal injury; broca’s, wernicke, and arcuate areas are intact
PCom compression results in…
ipsilateral CN III palsy –> mydriasis (“blown pupil”), possible ptosis, “down and out”
