Neuro Review- First Aid- pg 480-485 Flashcards
This is the central area of the retina.
the macula
What is the motor component of CNIII?
- output to ocular muscles
- defect –> ptosis, down and out gaze
- damage caused from vascular disease (ie DM)
What are the histologic/gross findings in Alzheimer’s disease?
- widespread cortical atrophy
- widening of sulci, narrowing of gyri
- decreased ACh
- senile plaques (beta-amyloid)
- neurofibrillary tangles (tau protein)
Dx?
- rapidly progressive (weeks-months) dementia
- startle myoclonus
- spongiform cortex
- prion disease (beta-pleated sheets)
Creutzfeldt-Jakob disease
What is the Charcot classic triad of MS?
SIN
- s = scanning speech
- I - intention tremor/incontinence/internuclear opthalmoplegia (INO)
- n = nystagmus
Lewy body dementia
- dementia
- visual hallucinations
- parkinsonian features
- alpha-synuclein defect
Dx?
- dementia
- visual hallucinations
- parkinsonian features
- alpha-synuclein defect
Lewy body dementia
normal pupillary light reflex
light enters retina –> CNII signals pretectal nuclei in midbrain –> activate Edigner-Westfall nuclei BILATERALLY –> pupils contract BILATERALLY
Dx?
- separation of neurosensory layer (rods/cones) from outermost layer (pigmented epi) of retina
- causes photoreceptors to degenerate –> vision loss
- due to retinal breaks, diabetic traction, inflammatory effusions
- “like a curtain drawn down”
- surgical emergency!
retinal detachment
CNIII: sensory, motor, or both?
motor
light enters retina –> CNII signals pretectal nuclei in midbrain –> activate Edigner-Westfall nuclei BILATERALLY –> pupils contract BILATERALLY
normal pupillary light reflex
MS spinal tap findings
- increased IgG
- oligoclonial bands
MS MRI findings
- periventricular plaques (oligodendrocyte loss and reactive gliosis)
- destruction of axons
- multiple white matter lesions separated in space and time
What neurons and CNs control miosis (pupillary constriction)?
- Edinger-Westfall nucleus –> ciliary ganglion via CNIII
- short ciliary nerves –> pupillary sphincter muscles
Dx?
- dementia
- aphasia
- parkinsonians
- change in personality
- pick bodies (tau protein)
- frontotemporal atrophy
Pick disease (frontotemporal dementia)
Tx for MS
- beta-interferon
- immunosuppression
- natalizumab
What is the NT change in Alzheimer’s disease?
decreased ACh
retinal detachment
- separation of neurosensory layer (rods/cones) from outermost layer (pigmented epi) of retina
- causes photoreceptors to degenerate –> vision loss
- due to retinal breaks, diabetic traction, inflammatory effusions
- “like a curtain drawn down”
- surgical emergency!
MS definition
- autoimmune inflammation and demyelination of CNS
- optic neuritis (Marcus Gunn pupils)
- internuclear ophthalmoplegia (INO)
- hemiparesis
- hemisensory symptoms
- bladder/bowel incontinence
- white women 20-30yo
What is a Marcus Gunn pupil? What’s is assoc. with?
- an afferent pupillary defect (APD)
- optic nerve damage or severe retinal injury- MS***
- decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye
- test with swinging flashlight test
What is the parasymp. component of CNIII?
- output, esp. on periphery
- defect –> diminished/absent pupillary light reflex, blown pupil, down and out gaze damage due to compression (PCA aneurism, uncal herniation)
Dx?
- autoimmune inflammation and demyelination of CNS
- optic neuritis (Marcus Gunn pupils)
- internuclear ophthalmoplegia (INO)
- hemiparesis
- hemisensory symptoms
- bladder/bowel incontinence
- white women 20-30yo
MS
Dx?
- widespread cortical atrophy
- widening of sulci, narrowing of gyri
- decreased ACh
- senile plaques (beta-amyloid)
- neurofibrillary tangles (tau protein)
Alzheimer’s disease
What is the macula?
the central area of the retina
What protein is protective for Alzheimer’s? What chromosome is it found on?
ApoE2 (Ch.19)
Dementia
a decrease in cognitive ability, memory, or function with intact consciousness
Creutzfeldt-Jakob disease
- rapidly progressive (weeks-months) dementia
- startle myoclonus
- spongiform cortex
- prion disease (beta-pleated sheets)
Dx?
- disorder of conjugate lateral gaze
- medial longitudinal fasciculus (MLF) lesions
- CN III and VI
- affected eye adducts minimally, if at all
- contralateral eye abducts with nystagmus
- divergence of the eyes leads to horizontal diplopia
- convergence preserved
- common in MS
internuclear opthalmoplegia (INO)
Pick disease (frontotemporal dementia)
- dementia
- aphasia
- parkinsonians
- change in personality
- pick bodies (tau protein)
- frontotemporal atrophy
Name the finding.
- an afferent pupillary defect (APD)
- optic nerve damage or severe retinal injury- MS***
- decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye
- test with swinging flashlight test
Marcus Gunn pupil
What does damage to CNIII result in?
- diminished/absent pupillary light reflex
- blown pupil
- ptosis
- down and out gaze
Alzheimer’s disease altered proteins and associated chromosomes
- early onset =
- APP (Ch21)
- presenilin-1 (Ch14)
- presenilin-2(Ch1)
- late onset = ApoE4 (Ch19)
a decrease in cognitive ability, memory, or function with intact consciousness
dementia
SIN
- s = scanning speech
- I - intention tremor/incontinence/internuclear opthalmoplegia (INO)
- n = nystagmus
Charcot classic triad of MS
How is amyloid-beta synthesized?
cleaving amyloid precursor protein (APP) by gamma-secretase
What is internuclear opthalmoplegia (INO)?
- disorder of conjugate lateral gaze
- medial longitudinal fasciculus (MLF) lesions
- CN III and VI
- affected eye adducts minimally, if at all
- contralateral eye abducts with nystagmus
- divergence of the eyes leads to horizontal diplopia
- convergence preserved
- common in MS
What neurons and CNs control mydriasis (pupillary dilation)?
- hypothalamus –> ciliospinal center of Budge (C8-T2)
- exit at T1 –> superior cervical ganglion
- plexus along internal carotid –> cavernous sinus –> orbit as long ciliary nerve –> pupillary dilator muscles
