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Focused Memorization > Neuro to Memorize > Flashcards

Neuro to Memorize Flashcards

1
Q

“Cape-like” distribution of pain/temp loss. Dx?

A

Syringomyelia

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2
Q

Hypothalamic lesions: Lateral area

A

Anorexia, failure to thrive (infants_

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3
Q

Hypothalamic lesions: Ventromedial area

A

Hyperphagia

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4
Q

Action of Anterior hypothalamus

A

Cooling, parasympathetic

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5
Q

Action of Posterior hypothalamus

A

Heating, sympathethetic

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6
Q

Action of Suprachiasmatic nucleus

A

Circadia rhythm

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7
Q

Lateral cerebellar lesion

A

Affect voluntary movements of extremities Propensity to fall toward injured side

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8
Q

Medial cerebellar lesion

A

Involvement of midline structures Truncal ataxia (wide-based gait), nystagmus, head tilting,. Bilateral motor deficits affecting axial and proximal limb masculature

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9
Q

Symptoms of altered activity: Mesocortical pathway

A

Decreased activity leads to “Negative” symptoms

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10
Q

Symptoms of altered activity: Mesolimbic

A

Increased activity, leading to “Positive symptoms”

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11
Q

Symptoms of altered activity: Nigrostriatal

A

Decreased activity leads to Extrapyramidal symptoms

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12
Q

Symptoms of altered activity: Tuberoinfundibular

A

Decreased activity leads to an Increase in Prolactin

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13
Q

Cerebellar input

A

Contralateral cortex via middle cerebellar peduncle Ipsilateral proprioceptive information via inferior cerebellar peduncle from spinal cord

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14
Q

Cerebellar output

A

Sends information to contralateral cortex Output nerves = Purkinje cells >> deep nuclei of cerebellum >> contralateral cortex via superior cerebellar peduncle

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15
Q

What are the Deep Nuclei of the Cerebellum?

A

(Lateral to Medial) Dentate Emboliform Globose Fastigial “Don’t Eat Greasy Food”

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16
Q

Components of the Striatum nucleus

A

Putamen (motor) + Caudate (cognitive)

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17
Q

Components of the Lentiform nucleus

A

Putamen (motor) + Globus Pallidus

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18
Q

Kluver-Bucy Syndrome

A

Disinhibited behavior (hyperphasia, hypersexuality, hyperorality) Bilateral Amygdala lesions

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19
Q

Sx: Frontal lobe lesions

A

Disinhibition and defects in concentration, orientation, judgement, May have reemergence of primitive reflexes

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20
Q

Sx: Non-dominant parietal cortex lesion

A

Hemispatial neglect syndrome

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21
Q

Sx: Dominant parietal cortex lesion

A

Loss of ability to write Loss of ability to perform simple calculations Cannot name fingers Left-right disorientation

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22
Q

Sx: Reticular activating system lesion

A

Reduces levels of arousal (ie coma)

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23
Q

Sx: Bilateral Mammillary bodies lesions

A

Wernicke Korsakoff Syndrome! Confusion, opthalmoplegia, ataxia, memory loss, confabulation, personality changes Associated with thiamine (B1) deficiency and excessive alcohol use

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24
Q

Sx: Unilateral Basal ganglia lesion

A

Tremor at rest, chorea, athetosis Seen in Parkinson Disease, Huntington

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25
Q

Sx: Cerebellar hemisphere lesion

A

Intention tremor, Limb ataxia, loss of balance, Ipsilateral defects, fall toward side of lsion Associated with chronic alcohol abuse

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26
Q

Sx: Subthalamic nucleus lesion

A

Contralateral hemiballisum

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27
Q

Sx: Hippocampus lesion

A

Anterograde amnesia- inability to make new memories

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28
Q

Sx: Paramedian pontine recitular formation lesion

A

Eyes look away from the lesion

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29
Q

Sx: Frontal eye field lesion

A

Eyes look toward lesion

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30
Q

Middle Cerebral Artery stroke Area of lesion?

A

Motor and sensory cortices- UPPER limb and face Temporal lobe (Wernicke area) Frontal lobe (Broca area)

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31
Q

Middle Cerebral Artery stroke Symptoms?

A

Contralateral paralysis and sensory loss- face and upper limb Aphasia if in DOMINANT (left) hemisphere Hemineglect if in NONdominant (right) hemisphere

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32
Q

Anterior Cerebral Artery stroke Area of lesion?

A

Motor and sensory cortices- lower limb

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33
Q

Anterior Cerebral Artery stoke Sx?

A

Contralateral paralysis and sensory loss - lower limb

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34
Q

Lenticulostriate Artery stroke Area of lesion?

A

Striatum, internal capsule

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35
Q

Lenticulostriate Artery stroke Sx?

A

Contralateral paraylsis and/or sensory loss - face and body Absence of cortical signs Common location of lacunar infarcts (unmanaged hypertension)

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36
Q

Anterior Spinal Artery stroke Area of lesion?

A

Lateral cortical spinal tract Medial lemniscus Caudal medulla - hypoglossal nerve

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37
Q

Anterior Spinal Artery stroke Sx?

A

Contralateral paralysis- upper and lower limbs Decreased contralateral proprioception Ipsilateral hypoglossal dysfunctin (tongue deviates ipsilaterally)

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38
Q

Posterior Inferior Cerebellar Artery (PICA) stroke Area of lesion?

A

Lateral medulla- vestibular nuclei, lateral spinothalalmic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, infterior cerebellar peduncle

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39
Q

Posterior Inferior Cerebellar Artery (PICA) stroke Sx?

A

Lateral medullary (Wallenburg) syndrome Vomiting, vertigo, nystagmus, dysphagia, hoarseness, decrease gag reflex, ipsilateral Horner syndrome, ataxia, dysmetria Decrease in pain and temp sensation from ipsillateral face and contralateral body

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40
Q

Anterior Inferior Cerebellar Artery stroke Area of lesion?

A

Lateral pons- cranial nerve nuclei, spinothalamic tract, corticospinal tract, sympathetic fibers Middle and inferior cerebellar peduncles

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41
Q

Anterior Inferior Cerebellar Artery stroke Sx?

A

Lateral Pontine Syndrome Vomiting, vertigo, nystagmus, PARALYSIS OF FACE, decrease in lacrimation, decrease in salivation, decreased taste from anterior 2/3 of tongue. Ataxia, dementia. Ipsilateral decrease in pain and temp of face Contralateral decrease in pain and temp of the body

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42
Q

Basilar Artery Stroke Area of lesion?

A

Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedial pontine reticular foramen

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43
Q

Basilar Artery Stroke Sx?

A

“Locked-in Syndrome” Preserved consciousness Vertical eye movement, blinking Quadriplegia, loss of voluntary facial, mouth, and tongue movements

44
Q

Posterior Cerebral Artery stroke Area of lesion?

A

Occipital cortex, visual cortex

45
Q

Posterior Cerebral Artery stroke Sx?

A

Contralateral hemianopia with macular sparing

46
Q

“Worst headache of my life” Associated with ADPKD and Ehlers-Danlos syndrome Occurs at bifurcations in the circle of Willis

A

Saccular (Berry) Aneurysm Rupture causes a subarachnoid hemorrhage (worst headache) Other risks include being and old black guy that smokes and doesn’t take care of his hypertension

47
Q

Chronic hypertension, affects small vessels (basal ganglia, thalamus). No signs on angiogram

A

Charcot-Bouchard microaneurysm

48
Q

“Blown pupil”, down and out eye, ptosis

A

Posterior communicating artery aneurysm

49
Q

MCA aneurysm sx

A

Contralateral upper extremity and facial hemiparesis, sensory defects

50
Q

Skull fracture, Lucid interval, CT shows lentiform hyperdence blood collection. No crossing of suture lines

A

Epidural hematoma

51
Q

Crescent-shaped hemorrhage that crosses suture lines

A

Subdural hematoma Associated with mild trauma, cerebral atrophy, elderly, alcoholism

52
Q

“Worst headache of my life” Bloody or yellow spinal tap

A

Yup. Subarachnoid hemorrhage Vasospasm can occur 4-10 days after hemorrhage; use nimodipine for prevention

53
Q

Intraparenchymal hemorrhage

A

Caused by systemic hypertension, amyloid angiopathy, vasculitis, neoplasm. May be secondary to reperfusion injury in ischemic stroke Typically occurs in basal ganglia and internal capsule

54
Q

Histology 12-48 hours after ischemic event

A

Red neurons

55
Q

Histology 24-72 hours after ischemic event

A

Necrosis + neutrophils

56
Q

Histology 3-5 days after ischemic event

A

Macrophages (microglia)

57
Q

Histology 1-2 weeks after ischemic event

A

Reactive gliosis + vascular proliferation

58
Q

Histology >2 weeks after ischemic event

A

Glial scar

59
Q

Dorsal Column: function

A

Ascending: pressure, vibration, fine touch, proprioception

60
Q

Dorsal Column pathway

A

1st-order Neuron: Sensory nerve ending >> cell body in dorsal root ganglion >> enters spinal cord, ascends ipsilaterally in dorsal column Synapse 1: Ipsilateral nucleus cuneatus or gracilis (medulla) 2nd-order Neuron: Decussates in medulla >> ascends contralaterally in medial lemniscus Synapse 2: VPL (thalamus) 3rd-order Neuron: Sensory cortex

61
Q

Spinal thalamic tract: Function

A

Ascending Lateral: pain, temp Anterior: Crude touch, pressure

62
Q

Spinal thalamic tract: pathway

A

1st-order Neuron: Sensory nerve ending >> cell body in dorsal root ganglion >> enters spinal cord Synapse 1: Ipsilateral gray matter (spinal cord) 2nd-order Neuron: Decussates at anterior white commissure >> ascends contralaterally Synapse 2: VPL (thalamus) 3rd-order Neuron: Sensory cortex

63
Q

Lateral corticospinal tract: function

A

Descending: Voluntary movement of contralateral limbs

64
Q

Lateral Corticospinal tract: pathway

A

1st-order Neuron: UMN: cell body in motor cortex >> descends ipsilaterally, decussate at caudal medulla (pyramidal decussation) >> descends contralaterally Synapse 1: Cell body of anterior horn 2nd-order Neuron: LMN: leaves spinal cord Synapse 2: NMJ 3rd-order Neuron: N/A

65
Q

CN above the pons

A

I, II, III, IV

66
Q

CN in pons

A

V, VI, VII, VIII

67
Q

CN in medulla

A

IX, X,XI, XII

68
Q

CN V motor lesion

A

Jaw deviates toward side of lesion

69
Q

CN X lesion

A

Uvula deviates away from side of lesion

70
Q

CN XI lesion

A

Weakness turning head to contralateral side of lesion (SCM). Shoulder droop on side of lesion (trapezius) The SCM contracts to help turn the head to the right

71
Q

CN XII lesion

A

LMN lesion. Tongue deviates toward the side of the lesion

72
Q

Upper motor neuron lesion, face

A

Contralateral paralysis of lower muscles of facial expression Forehead is spared

73
Q

Lower motor neuron lesion, face

A

Ipsilateral paralysis of upper and lower muscles of facial expression, loss of taste sensation to anterior tongue

74
Q

Dx?

A

Poliomyelitis and Werdnig-Hoffmann disease

LMN lesions only

Congenital: “Floppy Baby” with marked hypotonia and tongue fasciculations

Polio: Asymmetic weakness

Werdnig-Hoffmann disease: Symmetric weakness

75
Q


Dx?

A

Multiple Sclerosis

76
Q


Dx?

A

ALS

Combined UMP and LMN deficits with no sensory or bowel/bladder deficits

Can be caused by defect in superoxide dismutase

Tx: riluzole

77
Q


Dx?

A

Tabes Dorsalis

Caused by tertiary syphilis. Impaired sensation and proprioception, progressive sensory ataxia (inability to sense or feel the legs)

Associated with charcot joints, shooting pain, Argyll Roberston pupils

78
Q


Dx?

A

Complete Occlusion of Anterior Spinal Artery

Spares dorsal columns and Lissauer tract

79
Q


Dx?

A

Syringomyelia

Syrinx expands and damages anterior white commissure of spinothalamic tract (2nd order neurons), causing bilateral loss of pain and temp senstion

Usually C8-T1

Seen in Chiari I malformation

80
Q


Dx?

A

B12 Deficiency

Ataxic gait, paresthesia, impaired position and vibration sense

81
Q


Dx?

A

Brown-Sequard Syndrome

Ipsilateral UNM signs below level of lesion

Ipsilateral loss of tactile, vibration, proprioception sense below level of lesion

Contralateral pain and temp loss below level of lesion

Ipsilateral loss of all sensation at level of lesion

Ipsilataral LMN signs at leve of lesion

If lesion occurs above T1, patient may presnt with Horner syndrome

82
Q

Ptosis, Anhidrosis, Miosis

A

Horner Syndrome

Associated with lesion of spinal cord above T1 (ie Pancoast tumor, Brown-Sequard, late-stage syringomyelia)

PICA stroke

83
Q

CN III:

What does it innervate, what does it do?

What happens when its damaged?

A

All eye muscles except Lateral Rectus and Superior Oblique

All eye movements except Lateral gaze and “down and in”

Damage:

Motor output damage causes ptosis, “down and out” gaze

Parasympathetic output damage causes diminished or absent pupillary light reflexes, “blown pupil”, often with “down and out
gaze”

84
Q

CN IV:

What does it innervate? What does it do?

A

Innervates teh Superior Oblique

Moves eye “down and in” (cross eye)

Damage: eyes move upward with contralateral gaze, head tilt toward side of lesion, problems going down stairs

85
Q

CN VI:

What does it innervate? What does it do?

A

Innervates Lateral Rectus

Lateral gaze

Damage: Medially directed eye that cannot abduct

86
Q

Adult with a brain tumor. Imaging shows a “butterfly” shape. Histology shows “Pseudopalisading” pleomorphic cells. GFAP+

A

Glioblastoma multiforme (grade IV astrocytoma)

Common, highly malignant, ~1year survival

87
Q

Adult female with brain tumor. Presents with siezures. Histology shows spindle cells in a whorled pattern. Psammoma bodies present

A

Meningioma.

Typically benign

Has an estrogen receptor!

88
Q

Adult with a brain tumor. Presents with hearing loss and ringing. Stains S-100.

A

Schwannoma

Benign

Often localized to CN VIII. Bilateral vestibular schwannomas found in NF-2

89
Q

Adult with brain tumor in frontal lobe. Imaging shows calcified lesion with “chicken wire” capillary pattern. Histology shows “fried egg” cells (round nuclei with clear cytoplasm)

A

Oligodendroglioma

Tumor in white matter

90
Q

Child with brain tumor. Well circumscribed and looks cystic. GFAP+. Histology shows Rosenthal fibers (eosinophilic, corkscrew fibers)

A

Pilocytic (low-grade) Astrocytoma

Benign, good prognosis

91
Q

Child with a brain tumor. Presents with noncommunicating hydrocephalus. Imagaing show “drop matatases” to the spinal cord. Histology shows Homer-Wright rosetts, small blue cells

A

Medulloblastoma

Highly maligant

Primitive neuroectodermal tumor. Most commonly found in 4th ventricle

92
Q

Child with a calcified brain tumor. Presents with bitemporal hemianopia. Within the tumor is “motor oil” like fluid

A

Craniopharyngioma

Most common childhood supratentorial tumor

Derived from remnants of Rathke pouch

93
Q

Treatment for Partial Seizures (simple an coplex)

A

Carbamazepine

94
Q

Treatment for Tonic-Clonic seizures

A

Phenytoin, Fosphenytoin, Valproic acid

95
Q

Treatmentfor Absence seizures

A

Ethosuximide

96
Q

Treatment of Status Epilepticus

A

Benzodiazepines (eg, lorazepam, diazepam, midazolam): First-line agents

Anticonvulsant agents (eg, phenytoin, fosphenytoin)

Barbiturates (eg, phenobarbital, pentobarbital)

Anesthetics (eg, propofol)

97
Q

Ethosuximide: MOA, Uses, SI

A

Absence seizures

Blocks T-type Ca channels

GI issues, fatigue, headache, urticaria, SJS!

98
Q

Benzos: MOA, Uses in siezures, SI

A

Increase GABA

Status Epilepticus

Sedation, Tolerance, Dependence.

Also for eclampsia seizures

99
Q

Phenobarbital: MOA, Uses, SI

A

Increase GABA action

Good for Partial and tonic-clonic seizures. 1st line for neonates

Cardiorespiratory depression. Induction of P450

100
Q

Phenytoin, Fosphenytoin: MOA, Uses, SI

A

Blocks Na channels, zero-order kinetics

First line for Tonic-clonic. Also for Partial and Status Epilepticus

Neurologic: Nystagmus, diplopia, ataxia, sedation, peripheral neuropathy

DRESS syndrome

Steven-Johnson Syndrome

Hirsutism

Gingival hyperplasia

Megaloblastic anemia

P450 inducer

101
Q

Carbamazepine: MOA, Uses, SI

A

Blocks Na channels

For Partial seizure, Tonic-clonic

Diplopia, ataxia, Liver toxicty, Teratogen

P450

Steven Johnson Syndrome

102
Q

Valproic Acid: MOA, Uses, SI

A

Na channel inactivation. Increase GABA by inhibiting GABA transaminase

Frist line for Tonic-clonic. ALso good for partial and absence

GI distress, rare but fatal hepatotoxicity, pancreatits, neural tube defects, tremor, weight gain

Also for myoclonic seizures, bipolar disorder, migraine prophylaxis

103
Q

Gabapentin: MOA, Uses, SI

A

Inhibits high-voltage Ca channels, designed as GABA analog

For partial seizues

Sedation, ataxia

Also used for peripheral neuropathy, postherpatic neuralgia

104
Q

Topiramate: MOA, Uses, SI

A

Blocks Na channels, Increase GABA action

Good for Partial and Tonic-clonic

Sedation, mental dulling, kidney stones, weight loss

105
Q

Levetiracetam: MOA, Uses, SI

A

Unknown MOA

Good for partial, tonic-clonic

Stevens Johnson Syndrome! titrate slowly

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