Neuro to Memorize Flashcards
1
Q
“Cape-like” distribution of pain/temp loss. Dx?
A
Syringomyelia
2
Q
Hypothalamic lesions: Lateral area
A
Anorexia, failure to thrive (infants_
3
Q
Hypothalamic lesions: Ventromedial area
A
Hyperphagia
4
Q
Action of Anterior hypothalamus
A
Cooling, parasympathetic
5
Q
Action of Posterior hypothalamus
A
Heating, sympathethetic
6
Q
Action of Suprachiasmatic nucleus
A
Circadia rhythm
7
Q
Lateral cerebellar lesion
A
Affect voluntary movements of extremities Propensity to fall toward injured side
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
9
Q
Symptoms of altered activity: Mesocortical pathway
A
Decreased activity leads to “Negative” symptoms
10
Q
Symptoms of altered activity: Mesolimbic
A
Increased activity, leading to “Positive symptoms”
11
Q
Symptoms of altered activity: Nigrostriatal
A
Decreased activity leads to Extrapyramidal symptoms
12
Q
Symptoms of altered activity: Tuberoinfundibular
A
Decreased activity leads to an Increase in Prolactin
13
Q
Cerebellar input
A
Contralateral cortex via middle cerebellar peduncle Ipsilateral proprioceptive information via inferior cerebellar peduncle from spinal cord
14
Q
Cerebellar output
A
Sends information to contralateral cortex Output nerves = Purkinje cells >> deep nuclei of cerebellum >> contralateral cortex via superior cerebellar peduncle
15
Q
What are the Deep Nuclei of the Cerebellum?
A
(Lateral to Medial) Dentate Emboliform Globose Fastigial “Don’t Eat Greasy Food”
16
Q
Components of the Striatum nucleus
A
Putamen (motor) + Caudate (cognitive)
17
Q
Components of the Lentiform nucleus
A
Putamen (motor) + Globus Pallidus
18
Q
Kluver-Bucy Syndrome
A
Disinhibited behavior (hyperphasia, hypersexuality, hyperorality) Bilateral Amygdala lesions
19
Q
Sx: Frontal lobe lesions
A
Disinhibition and defects in concentration, orientation, judgement, May have reemergence of primitive reflexes
20
Q
Sx: Non-dominant parietal cortex lesion
A
Hemispatial neglect syndrome
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
22
Q
Sx: Reticular activating system lesion
A
Reduces levels of arousal (ie coma)
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
24
Q
Sx: Unilateral Basal ganglia lesion
A
Tremor at rest, chorea, athetosis Seen in Parkinson Disease, Huntington
25
Sx: Cerebellar hemisphere lesion
Intention tremor, Limb ataxia, loss of balance, Ipsilateral defects, fall toward side of lsion Associated with chronic alcohol abuse
26
Sx: Subthalamic nucleus lesion
Contralateral hemiballisum
27
Sx: Hippocampus lesion
Anterograde amnesia- inability to make new memories
28
Sx: Paramedian pontine recitular formation lesion
Eyes look away from the lesion
29
Sx: Frontal eye field lesion
Eyes look toward lesion
30
Middle Cerebral Artery stroke Area of lesion?
Motor and sensory cortices- UPPER limb and face Temporal lobe (Wernicke area) Frontal lobe (Broca area)
31
Middle Cerebral Artery stroke Symptoms?
Contralateral paralysis and sensory loss- face and upper limb Aphasia if in DOMINANT (left) hemisphere Hemineglect if in NONdominant (right) hemisphere
32
Anterior Cerebral Artery stroke Area of lesion?
Motor and sensory cortices- lower limb
33
Anterior Cerebral Artery stoke Sx?
Contralateral paralysis and sensory loss - lower limb
34
Lenticulostriate Artery stroke Area of lesion?
Striatum, internal capsule
35
Lenticulostriate Artery stroke Sx?
Contralateral paraylsis and/or sensory loss - face and body Absence of cortical signs Common location of lacunar infarcts (unmanaged hypertension)
36
Anterior Spinal Artery stroke Area of lesion?
Lateral cortical spinal tract Medial lemniscus Caudal medulla - hypoglossal nerve
37
Anterior Spinal Artery stroke Sx?
Contralateral paralysis- upper and lower limbs Decreased contralateral proprioception Ipsilateral hypoglossal dysfunctin (tongue deviates ipsilaterally)
38
Posterior Inferior Cerebellar Artery (PICA) stroke Area of lesion?
Lateral medulla- vestibular nuclei, lateral spinothalalmic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, infterior cerebellar peduncle
39
Posterior Inferior Cerebellar Artery (PICA) stroke Sx?
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
40
Anterior Inferior Cerebellar Artery stroke Area of lesion?
Lateral pons- cranial nerve nuclei, spinothalamic tract, corticospinal tract, sympathetic fibers Middle and inferior cerebellar peduncles
41
Anterior Inferior Cerebellar Artery stroke Sx?
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
42
Basilar Artery Stroke Area of lesion?
Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedial pontine reticular foramen
43
Basilar Artery Stroke Sx?
"Locked-in Syndrome" Preserved consciousness Vertical eye movement, blinking Quadriplegia, loss of voluntary facial, mouth, and tongue movements
44
Posterior Cerebral Artery stroke Area of lesion?
Occipital cortex, visual cortex
45
Posterior Cerebral Artery stroke Sx?
Contralateral hemianopia with macular sparing
46
"Worst headache of my life" Associated with ADPKD and Ehlers-Danlos syndrome Occurs at bifurcations in the circle of Willis
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
Chronic hypertension, affects small vessels (basal ganglia, thalamus). No signs on angiogram
Charcot-Bouchard microaneurysm
48
"Blown pupil", down and out eye, ptosis
Posterior communicating artery aneurysm
49
MCA aneurysm sx
Contralateral upper extremity and facial hemiparesis, sensory defects
50
Skull fracture, Lucid interval, CT shows lentiform hyperdence blood collection. No crossing of suture lines
Epidural hematoma
51
Crescent-shaped hemorrhage that crosses suture lines
Subdural hematoma Associated with mild trauma, cerebral atrophy, elderly, alcoholism
52
"Worst headache of my life" Bloody or yellow spinal tap
Yup. Subarachnoid hemorrhage Vasospasm can occur 4-10 days after hemorrhage; use nimodipine for prevention
53
Intraparenchymal hemorrhage
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
Histology 12-48 hours after ischemic event
Red neurons
55
Histology 24-72 hours after ischemic event
Necrosis + neutrophils
56
Histology 3-5 days after ischemic event
Macrophages (microglia)
57
Histology 1-2 weeks after ischemic event
Reactive gliosis + vascular proliferation
58
Histology \>2 weeks after ischemic event
Glial scar
59
Dorsal Column: function
Ascending: pressure, vibration, fine touch, proprioception
60
Dorsal Column pathway
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
Spinal thalamic tract: Function
Ascending Lateral: pain, temp Anterior: Crude touch, pressure
62
Spinal thalamic tract: pathway
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
Lateral corticospinal tract: function
Descending: Voluntary movement of contralateral limbs
64
Lateral Corticospinal tract: pathway
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
CN above the pons
I, II, III, IV
66
CN in pons
V, VI, VII, VIII
67
CN in medulla
IX, X,XI, XII
68
CN V motor lesion
Jaw deviates toward side of lesion
69
CN X lesion
Uvula deviates away from side of lesion
70
CN XI lesion
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
CN XII lesion
LMN lesion. Tongue deviates toward the side of the lesion
72
Upper motor neuron lesion, face
Contralateral paralysis of lower muscles of facial expression Forehead is spared
73
Lower motor neuron lesion, face
Ipsilateral paralysis of upper and lower muscles of facial expression, loss of taste sensation to anterior tongue
74
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Dx?
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
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Dx?
Multiple Sclerosis
76
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Dx?
ALS
Combined UMP and LMN deficits with no sensory or bowel/bladder deficits
Can be caused by defect in superoxide dismutase
Tx: riluzole
77
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Dx?
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
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Dx?
Complete Occlusion of Anterior Spinal Artery
Spares dorsal columns and Lissauer tract
79
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Dx?
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
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Dx?
B12 Deficiency
Ataxic gait, paresthesia, impaired position and vibration sense
81
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Dx?
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
Ptosis, Anhidrosis, Miosis
Horner Syndrome
Associated with lesion of spinal cord above T1 (ie Pancoast tumor, Brown-Sequard, late-stage syringomyelia)
PICA stroke
83
CN III:
What does it innervate, what does it do?
What happens when its damaged?
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
CN IV:
What does it innervate? What does it do?
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
CN VI:
What does it innervate? What does it do?
Innervates Lateral Rectus
Lateral gaze
Damage: Medially directed eye that cannot abduct
86
Adult with a brain tumor. Imaging shows a "butterfly" shape. Histology shows "Pseudopalisading" pleomorphic cells. GFAP+
Glioblastoma multiforme (grade IV astrocytoma)
Common, highly malignant, ~1year survival
87
Adult female with brain tumor. Presents with siezures. Histology shows spindle cells in a whorled pattern. Psammoma bodies present
Meningioma.
Typically benign
Has an estrogen receptor!
88
Adult with a brain tumor. Presents with hearing loss and ringing. Stains S-100.
Schwannoma
Benign
Often localized to CN VIII. Bilateral vestibular schwannomas found in NF-2
89
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)
Oligodendroglioma
Tumor in white matter
90
Child with brain tumor. Well circumscribed and looks cystic. GFAP+. Histology shows Rosenthal fibers (eosinophilic, corkscrew fibers)
Pilocytic (low-grade) Astrocytoma
Benign, good prognosis
91
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
Medulloblastoma
Highly maligant
Primitive neuroectodermal tumor. Most commonly found in 4th ventricle
92
Child with a calcified brain tumor. Presents with bitemporal hemianopia. Within the tumor is "motor oil" like fluid
Craniopharyngioma
Most common childhood supratentorial tumor
Derived from remnants of Rathke pouch
93
Treatment for Partial Seizures (simple an coplex)
Carbamazepine
94
Treatment for Tonic-Clonic seizures
Phenytoin, Fosphenytoin, Valproic acid
95
Treatmentfor Absence seizures
Ethosuximide
96
Treatment of Status Epilepticus
Benzodiazepines (eg, lorazepam, diazepam, midazolam): First-line agents
Anticonvulsant agents (eg, phenytoin, fosphenytoin)
Barbiturates (eg, phenobarbital, pentobarbital)
Anesthetics (eg, propofol)
97
Ethosuximide: MOA, Uses, SI
Absence seizures
Blocks T-type Ca channels
GI issues, fatigue, headache, urticaria, SJS!
98
Benzos: MOA, Uses in siezures, SI
Increase GABA
Status Epilepticus
Sedation, Tolerance, Dependence.
Also for eclampsia seizures
99
Phenobarbital: MOA, Uses, SI
Increase GABA action
Good for Partial and tonic-clonic seizures. 1st line for neonates
Cardiorespiratory depression. Induction of P450
100
Phenytoin, Fosphenytoin: MOA, Uses, SI
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
Carbamazepine: MOA, Uses, SI
Blocks Na channels
For Partial seizure, Tonic-clonic
Diplopia, ataxia, Liver toxicty, Teratogen
P450
Steven Johnson Syndrome
102
Valproic Acid: MOA, Uses, SI
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
Gabapentin: MOA, Uses, SI
Inhibits high-voltage Ca channels, designed as GABA analog
For partial seizues
Sedation, ataxia
Also used for peripheral neuropathy, postherpatic neuralgia
104
Topiramate: MOA, Uses, SI
Blocks Na channels, Increase GABA action
Good for Partial and Tonic-clonic
Sedation, mental dulling, kidney stones, weight loss
105
Levetiracetam: MOA, Uses, SI
Unknown MOA
Good for partial, tonic-clonic
Stevens Johnson Syndrome! titrate slowly
