Neuro Review Flashcards
1
Q
Dandy Walker
A
Agenesis of the cerebellar vermis. Leading to massive dilatation of the 4th ventricle. Associated with hydrocephalus and spina bifida. Signs are vomiting and breathing issues.
2
Q
Syringomyelia symptoms.
A
Cystic cavity at C8-T1, associated with Chiari I malformation which is low lying cerebral tonsils. Loss of bilateral loss of pain and temperature sensation in a capelike distribution in upper extremities. Fine touch and position are preserved. This is due to destruction of the anterior white commissure (where spinothalamic tract decussates). If syrinx expands, can compress anterior horn causing motor neuron KO and LMN signs.
3
Q
Which branchial arches form which part of the tongue?
A
1 and 2 form anterior 2/3 (taste VII, sensation V3)
3 and 4 form posterior 1/3 (taste IX, extreme back taste X)
Motor innervation XII.
4
Q
What nerves have cell bodies in NST?
Nucleus ambiguus?
Dorsal motor nucleus
A
VII, IX, X, Cranial part of XI. (Sensory!)
IX, X, XI (motor innervation of pharynx, larynx, esophagus)
X
5
Q
SSPE Symptoms
A
Starts with dementia and personality changes, then progresses to myoclonus.
6
Q
What is the OVLT
A
Input to hypothalamus that is not protected by the BBB and senses plasma osmolality for ADH release.
7
Q
What is made in the supraoptic nucleus? What is made in the paraventricular nucleus Function of lateral hypothalamus Ventromedial hypothalamus Anterior hypothalamus Posterior hypothalamus Suprachiasmatic nucleus
A
ADH Oxytocin Mediates eating (inhibited by leptin) Mediates fasting (stimulated by leptin) Cooling/parasympathetic Heating/sympathetic Circadian rhythms (NE release causes melatonin from pineal)
8
Q
How to treat nocturnal aneuresis?
A
Desmopressin
9
Q
Falling asleep NT?
Rem sleep NT?
A
Serotonin
ACh
10
Q
VPL of thalamus VPM of thalamus LGN of thalamus MGN of thalamus VL of thalamus
A
Inputs from spinothalamic tracts and dorsal columns from body.
Inputs from trigeminal and gustatory pathway. Face sensation and taste.
Sight info
Sound info from superior olive and inferior colliculus
VL from basal ganglia.
11
Q
Deep nuclei of cerebellum
A
From in to out (fastigial, globose, emboli form, dentate)
12
Q
Lateral lesions of cerebellum
A
Voluntary movement of extremities, when injured fall towards the injured side
13
Q
Medial lesions of cerebellum
A
Midline structure lesions cause truncal ataxia.
14
Q
Inputs to cerebellum and corresponding peduncle
Outputs from cerebellum and corresponding peduncle
A
Input from ipsilateral spine via inferior peduncle via mossy/climbing fibers. Input from contralateral cerebral hemisphere via middle peduncle.
Output to contralateral cerebrum via superior peduncle.
15
Q
What substance cause parkinson’s?
A
MPTP
16
Q
Hemiballismus lesion
A
Flailing of arm or leg on one side of body. Caused by lacunar infarct
17
Q
Intention tremor lesion
A
In cerebellum. Characteristic of MS (which is a type IV hypersensitivity reaction).
18
Q
Kluver-Bucy Syndrome
A
Lesion of amygdala associated with HSV-1. Hyperorality, hyper sexuality, disinhibited behavior.
19
Q
How to make Wernicke-Korsakoff syndrome worse?
A
Give the patient glucose without B1.
20
Q
Central pontine myelinolysis
A
Caused by overly rapid correction of HYPOnatremia. Causes dysphagia, diplopia, loss of consciousness and can cause locked in syndrome.
21
Q
Correcting HYPERnatremia too fast?
A
Will cause cerebral edema or herniation syndrome.
22
Q
Where is broca’s area?
Where is wernicke’s area
A
Broca’s Area is the inferior frontal gyrus
Wrenches’ area is the superior temporal gyrus of the temporal lobe.
23
Q
Severe hypotension clinical syndrome?
A
Watershed zones gone. Causes man in barrel syndrome which is upper leg and upper arm weakness. Also agnosia (defect in visual processing).
24
Q
Affect of infarct in lenticulo-striate artery
A
Contralateral hemiparesis without loss of sensation. Also hemiballismus. Usually to secondary hypertension.
25
ASA stroke
Stroke in anterior spinal arteries affects medial lemniscus (so decreased contralateral proprioception), lateral corticospinal tract (contralateral hemiparesis), and hypoglossal nerve (ipsilateral tongue weakness causing tongue to deviate ipsilaterally).
26
PICA stroke
AKA lateral medullary (Wallenberg) syndrome. Vomiting, vertigo, nystagmus, decreased pain and temp sensation from ipsilateral face and contralateral body, dysphagia and hoarseness. ataxia and dysmetria.
27
AICA stroke
Facial nucleus involved so paralysis of face, decreased sensation from 2/3 of tongue, decreased salivation/lacrimation, also vomiting, nystagmus, vertigo. Also ataxia dysmetria.
28
PCA stroke
Contralateral hemianopsia with macular sparing.
29
Basilar artery infarct
Locked in syndrome.
30
Acom aneurysm causes
bitemporal hemianopsia
31
Pcom aneurysm causes
Saccular aneurysm that supplies hypothalamus and ventral thalamus. Causes CN III palsy, eye is down and out with ptosis and pupil dilation.
32
Most common cause of allodynia?
thalamic lesions post stroke.
33
Epidural hematoma
Convex lesion due to rupture of MMA. Lucid interval followed by rapid decompensation. Doesn't cross suture lines. Causes herniation that kills. Talk and die
34
Subdural hematoma
Crosses suture lines, concave lesion. Cannot cross falx.
35
Why is subarachnoid hemorrhage spinal tap yellow?
Due to blood breakdown, causing bilirubin. Treat with nimodepine to prevent vasospasm.
36
Charcot-Bouchard Aneurysm
Caused by hypertension. Hyaline arteriolosclerosis of lenticulostriate vessels.
37
Highest sensitivity for early ischemia
MRI.
38
Histologic features of infarct
12-48 hours red neurons, then neutrophils and necrosis with macrophages. Then reactive gloss andvastular proliferrations, the glial scars/cyst.
Liquefactive necrosis.
39
Lateral corticospinal tract
| Where cross, where are legs
Pain/temp, crosses immediately, legs are lateral
40
Corticospinal tract
| where cross, where are legs
Crosses in the medullary pyramids, legs are lateral. UMN synapse on LMN in anterior horn.
41
Dorsal Column
Proprioception/touch
| Cross in the medulla after synapse in the nucleus gracilis (legs, MEDIAL), and nucleus cuneatus (arms, LATERAL).
42
Where does polio/werdnig-hoffman affect the spinal cord
Anterior horn. LMN signs.
43
Where does MS affect the spinal cord?
Demyelination of cervical regions.
44
How does ALS affect the spinal cord?
combined UMN and LMN signs with no sensory or cognitive loss. Treat with rilouzole. by decreasing presynaptic glutamate release.
45
What causes ALS?
Could be due to a mutation in SOD1 which prevents generation of H2O2 from O2 radical.
46
Histologic findings in ALS
Bunin bodies (pas+ cytoplasmic inclusions in neurons).
47
ASA occlusion spares...
Dorsal columns.
48
Artery of Adamkiewicz
Supplies ASA below T8, so upper thoracic ASA territory is a watershed.
49
How does Vitamin B12/vitamin E deficiency affect spinal cord
Subacute combined degeneration -- demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts. Ataxia, paresthesias, impaired position and vibration.
50
Werdnig-Hoffman Disease
Spinal muscular atrophy. Congenital degeneration of anterior horn neurons causing LMN symptoms. Floppy baby syndrome with hypotonia and fasciculations. Autosomal recessive inheritance.
51
Friedrich Ataxia
GAA trinucleotide repeat autosomal recessive disease. On chromosome 9 that encodes frataxin. This leads to an impairment in mitochondrial functioning, causing free radical injury. Therefore multiple spinal cord tracts generate causing muscle weakness and loss of DTRs. Staggering, falling, nystagmus, dysarthria, HCM as cause of death.
52
Brown sequard syndrome
Hemisection of spinal cord causes loss of proprioception and vibration, hemiparesis on ipsilateral side. Loss of pain and temp on contralateral side. UMN signs below lesion, LMN signs at lesion.
53
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Landmark dermatomes
C2
T4
T10
L1
L4
S2, S3,S4
```
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Back of head
Nipple
Bellybutton
Inguinal ligament
L4 is knee caps
S2,S3,S4 is penis and anus.
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54
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Reflexes
Biceps
Triceps
Patella
Achilles
```
C7, C8- Lay them straight (triceps)
C5, C6 -- pick up sticks (biceps)
L3, L4- Kick the door
S1,S2 Buckle my shoe
55
Cranial nerve that arises dorsally and decussates
Trochlear
56
Cranial nerves that lie medially
III, VI, XII (3x2=6x2=12)
57
Parinaud Syndrome
Paralysis of conjugate vertical gaze (can't look up and down) due to lesion in superior colliculus. Due to pinealoma or hydrocephalus.
58
Which nerve innervates the parotid gland
The glossopharyngeal nerve.
59
Which nerve controls the stapedius muscle?
Facial nerve.
60
Where are sensory cranial nerve nuclei located?
| Where are motor cranial nerve nuclei located
Laterally (ALAR plate= laterally)
| Centrally (Medial = motor, from basal plate)
61
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Cranial nerve and vessel pathways:
CN I
CNII
CN III, IV, V1, VI, ophthalmic vein
CN V2
CN V3
MMA
CN VII, VIII
CN IX, X, XI, jugular vein
XIII
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Cribiform plate
Optic canal
Superior orbital fissure
Foramen Rotundum
Foramen Ovale
Foremen Spinosum
Internal auditory meatus
Jugular foramen
Hypoglossal canal
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62
Cavernous sinus syndrome
Due to mass effect, fistula, thrombosis. Ophthalmoplegia and decreased maxillary sensation with normal visual acuity. Because nerves that control extra ocular muscles plus V1 and V2 travel here.
63
CN V motor lesion
CN X lesion
CN XI Lesion
Jaw deviates to the side of the lesion due to unopposed action of medial pterygoid.
Uvula deviates away from lesion due to uneven palatal elevation. Weak side collapses
Weakness turning head to the contralateral side of the lesion. Shoulder droop on the side of the lesion. SCM is a pushing muscle.
64
Stroke affect on forehead
Forehead is spared in stroke because of bilateral innervation of UMN.
65
Hyperopia
| Myopia
Eye too short, light behind retina
| Eye too long, light in front of retina (near sighted).
66
Retinitis Caused by...
Viruses like CMV (cotton wool spots), HSV, HZV. In immunosuppressed.
67
Central retinal artery occlusion
Retinal Vein occlusion
Acute painless monocular vision loss, cloudy retina with attenuated vessels and cherry red spot at fovea.
Retinal vein occlusion causes retinal hemorrhage and edema at area.
68
Nonproliferative Diabetic retinopathy
Proliferative Diabetic retinopathy
Damaged capillaries leak blood, lipids and fluids leak into area too. Treat with glycemic control.
Chronic hypoxia results in new blood vessel formation. Treat with VEGF inhibitors
69
Effect of Beta receptors on glaucoma
Alpha?
M3?
Beta induces aqueous humor production
Alpha induces iris dilation
M3 contracts ciliary muscle and increases drainage
70
What shouldn't you give during acute angle closure in glaucoma
DO not give epinephrine because it will cause extensive mydriasis and angle will close more.
71
Superior oblique moves the eye...
down and in
72
CNIII palsy eye looks...
Down and out due to trochlear and abducens.
73
Miosis Control
Mydriasis Control
Miosis is parasympathetic via edinger westphal nucleus to ciliary ganglion to CNIII, short ciliary nerves to pupillary sphincter.
Mydriasis is sympathetic, hypothalamus to ciliospinal center of budge, T1 exit and superior cervical ganglion, plexus along internal carotid, through cavernous sinus.
74
Pupillary light reflex
CNII active, signal to pretectal nuclei, bilateral innervation to both edinger westphal nuclei, each send out projection to respective eye for contraction.
75
Marcus Gunn pupil
Due to optic nerve damage or retinal injury. When light in shown in affected eye, it doesn't constrict as much.
76
Structure of cranial nerve III
Motor control of eye in middle, parasympathetic at periphery. Vascular disease affects eye movement, compression affects parasympathetics.
77
Retinal detachment
Like a curtain being drawn down, surgical emergency.
78
Macular degeneration
Central area of retina is messed up, loss of central vision. Causes distortion. Dry has drusen (yellow deposits). Wet has rapid loss of vision due to neovascularization.
79
Study the visual field defects
Do it!
80
INO
Happens in MS, MLF is paralyzed. If right MLF degenerated, right eye can't look medially.
81
Chromosome of APP?
Presenilin 1?
Presenilin 2?
ApoE4
```
21- that's why downs people get it so much.
14
1
These are all early onset variants.
Ch19 (late onset)
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82
Which gene variant is protective against AD?
ApoE2
83
Histopathology of AD
Extracellular Beta amyloid (may cause intracerebral hemorrhage due to angiopathy.)
Neurofibrillary tangles of hyperphosphorylated tau protein. (microtubule associated)
84
Pick's Disease
Frontotemporal dementia. APHASIA. Personality changes followed by dementia. Tau protein aggregates
85
Dementia with Lewy Bodies
Initially dementia and visual hallucinations followed by symmetric PD like changes. Due to alpha syn.
86
Vascular dementia
Second most common cause of dementia in the elderly due to many infarcts.
87
Spongiform encephalopathy
Rapid onset of dementia caused by prion protein.
88
MS
Associated with HLA-DR2 and living away from the equator. Destruction of myelin and oligodendrocytes. Can present with optic neuritis and marcus Gunn pupils. INO due to mL block. Relapsing and remitting course. Affects women mostly in 20's and 30s. Scanning speech, intention tremor nystagmus.
89
Signs of MS
| Treatment?
IgG in CSF, oligoclonal bands are diagnosis.
| Treat with IFN Beta, natalizumab (monoclonal antibody against A4 integrin, baclofen which is a gaba agonist.
90
Acute inflammatory demyelinating polyradiculopathy
Variant of Guillain Barre Syndrome. Autoimmune condition that destroys schwann cells. Symmetric ascending muscle weakness. Can involve face and autonomics eventually. Findings include increased CSF protein with normal cells (THIS IS CALLED ALBUMINOCYTOLOGIC DISSOCIATION).
Associated with campy. CMV, influenza. IVIG speeds recovery, usually takes months.
91
Progressive multifocal leukoencephalopathy
Demyelination in CNS due to reactivation of JC virus (polyomavirus) mediated destruction of oligodendrocytes. Use of natalizumab increases incidence. Is rapidly progressive and usually fatal. Causes nonenhancing lesions.
92
Acute disseminated (infectious) encephalomyelitis
Multifocal perivenual inflammation and demyelination after infection (Measles or VZV) or vaccines (rabies). Seems like MS in kids with only one time point.
93
Charcot-Marie Tooth Disease
Causes foot drop because it affects the common perennial nerve. Autosomal dominant usually. Can cause scoliosis too.
94
Krabbe Disease
Autosomal recessive lysosomal storage disease that is caused by a lack of glucocerebrosidase. Causes glucocerebrocide and psychocine to build up. Causes peripheral neuropathy, developmental delay, globoid cells.
95
Adrenoleukodystrophy
Due to a mutation in ABCD1 gene. X linked disorder usually affecting males where metabolism of very long chain fatty acids goes wrong, fatty acids accumulate and damage adrenal glands and white matter. Can cause adrenal gland crisis.
96
Sturge-Weber Syndrome
Sporadic congenital activating mutation in the GNAQ gene that controls migration of neural crest cells. Causes port wine stain in V1/V2 distribution, can cause epilepsy/intellectual disability, tram track calcium (leptomeningeal angioma), and glaucoma.
STURGE- Sporadic, Tram track Ca, unilateral, retardation, GNAQ, glaucoma, epilepsy
97
Tuberous Sclerosis
Due to a mutation in Hamartin on CH9 or tuberin on Ch16..
Hamartomas in skin and CNS, angiofibromas on face, mitral regurgitation, ash-leaf spots, cardiac rhabdomyomas, retardation, autosomal dominant
98
NF1 (von Recklinghausen)
Autosomal dominant mutation in NF1 which is a tumor suppressor that normally inactivates Ras on Chromosome 17. Causes cafe au lait spots, neurofibromas in skin, pheochromocytomas, also optic gliomas and litch nodules on iris.
99
NF2
Mutation in Merlin on Ch 22 which normally mediates contact inhibition. Acoustic neuromas, gliomas, meningiomas. Cafe au last spots.
100
Von hippel lindau syndrome
Mutation in VHL tumor suppressor on chromosome 3 that is autosomal dominant. HIF is constitutively active so angiogenesis occurs. Renal cell carcinoma is very common, also hemangiomas in skin, lots of hemangioblastomas in CNS, pheochromocytoma.
101
Gerstmann syndrome (lesion in left parietotemporal cortex)
Agraphia, acalculia, finger agnosia, left right disorientation.
102
PPRF lesion
Look away from lesion.
103
FEF lesion
Look towards lesion
