Neurology Flashcards
Primitive reflexes should not persist beyong _______.
3-5 months
What is the Galant reflex?
stroking one side of the back of the infant causes lateral curvature of the
What is the Moro reflex?
when support is lost, the arms will abduct (swing out) and extend and hands will open followed by adduction and flexion
Stuttering affects what percent of children?
2%
What improves fluency in stuttering?
ethanol and singing
Mental retardation affects what percent of births?
3%
What generally separates delirium from other confusional states?
typically has autonomic symptoms (dilated pupils, tachycardia, hyperthermia, increased sweating)
What percent of Alzheimer’s disease is sporadic? What is the life expectancy following the diagnoses of Alzheimer/s?
95% usually progress to death in 7 to 10 years
What type of cortical atrophy is seen in Alzheimer’s?
general cortical atrophy, most pronounced in parietal and temporal lobes
What histologic features are seen in Alzheimer’s?
- Neurofibrilary tangles- Senile Plaques-Hirano’s bodies
What are neurofibrilary tangles?
intraneuronal inclusion
Paired helical filaments formed by hyperphosphorylation of microtubule- associated protein tau
What are senile plaques?
extracellular accumulation
Comprised of amyloid β peptides, proteolytic product of amyloid precursor protein (APP)
What are two scenarios that lead to increased accumulation of amyloid?
Trisomy 21 (Down’s syndrome)
ApoE4 mutation
APP is on what chromosome?
Ch 21
What are Hirano’s bodies?
intraneuronal inclusion
eosinophilic intracellular aggregates of actin and associated proteins in neurons
What neurotransmitter changes are seen in Alzheimer’s disease?
decreased ACh and increased glutamate
Name three AChEi.
donepizil, galantamine, rivastigmine
What histologic features are seen in Pick’s disease?
Pick’s bodies and Pick’s cells
What are Pick’s bodies?
intracellular inclusions of tau protein
What are Pick’s cells?
swollen neurons
What clinical picture typifies Lewy Body Disease?
alzheimer like patient with early onset hallucinations and parkinsonian features
What neurotransmitter changes are seen in Lewy Body Disease?
Loss of ACh and dopamine producing neurons
What histologic feature is characteristic of Lewy Body Disease?
a-synuclein cytoplasmic inclusions (Lewy Bodies)
What cerebral structure is affected in Wernicke-Korsakoff Syndrome?
atrophy of the mammillary bodies
What is apraxia? What cortical lesion can cause apraxia?
inability to perform complex movements in the absence of paralysis
premotor lesion (lateral portion of BA 6)
Frontal Eye fields are located in BA ___. Stimulation causes _____ whereas lesioning causes ______.
BA 8
contralateral eye movement
impaired contralateral gaze
Broca’s speech is associated with what BA and what anatomical structures?
BA 44 and 45pars opercularis and pars triangularis
What is abulia? What cortical lesion can cause it?
decrease in thought, movement, speech, will, or initiative
b/l frontal lobe lesions can cause it
Akinetic mutism can be seen in adults with what cortical lesion?
b/l cingulate lesions
What are the symptoms of pseudobulbar palsy?
unable to close their eyes or move their mouth ortongue, but are able to yawn, cry, cough, etc., which are reflexes of the pons and medulla
What leads to pseudobulbar palsy?
damage to cortical motor fibers projecting to lower brainstem
Stimulation to supplementary motor cortex leads to _______.
gross b/l movements
What is the function of the ventromedial pathway? What composes it?
controls axial movements and posture
tectum, vestibular nuclei, and pontine and medullary reticular nuclei to the interneurons in the ventromedial spinal cord
Dominant parietal lobe is involved in ________ and non-dominant parietal lobe is involved in ________.
mathematical calculations and language
visuospatial relationships and geographic memory
The secondary somatosensory area is located on ______ and is BA ______.
supramarginal gyrus
area 40
Primary gustatory cortex is located on ______ and is BA _______.
anterior portion of parietal operculum
43
What causes Gerstmann’s syndrome?
dominant parietal lobe lesion at angular gyrus (area 39)
Gerstmann’s syndrome is characterized by what symptoms?
right/left dissociation, finger agnosia, acalculia, and agraphia
The uncinate fasciculus connects the ______ to the ______,
anterior temporal lobe to the orbitofrontal gyrus
Arcuate fasciculus connects ______ and ________.
Wernicke’s area and Broca’s area
Heschl’s gyrus is the _______, located in ______, and is BA ________.
primary auditory cortex
posterosuperior temporal lobe deep to Sylvian fissure
41, 42
Kluver Bucy syndrome results from ________.
b/l amygdala injuries
Kluver Bucy syndrome is characterized by _______.
Absence of emotional response, compulsion to explore all objects visually, tactilely, and orally; hypersexuality and visual agnosia
The Band of Gennari is located in ________.
the fourth layer of the occipital lobes
Cortical blindness is characterized by what on EEG?
absence of a-waves on EEG in the occipital waves
What is Anton’s syndrome?
an anosognosia; cortical blindness with an affected association area such that the patient denies that he or she is blind
What is Balint’s syndrome?
caused by a bilateral lesion in the parietooccipital cortices
Ocular ataxia and apraxia with normal extraocular function. Associated with inattention to the peripheral visual field and simultanagnosia
<p>What connects the receptive and expressive speech areas of the brain?</p>
<p>arcuate fasciculus</p>
What is the concept of kindling in regards to seizures?
seizures beget seizures
What is the irritative zone?
area of cortex that generates interictal spikes
What is the ictal onset zone?
area of cortex where seizures are generated
What is an epileptogenic lesion?
structural abnormality that is direct cause of epileptic seizures
What is a symptomatogenic lesion?
area of the brain that first manifests seizure symptoms
What is the functional deficit zone?
cortical area of nonepileptic dysfunction
What is the epileptogenic zone?
area of brain necessary and sufficient for initiating seizures; removal or disconnection required for amelioration of seizures
What is Todd’s paralysis? What causes it?
post ictal paralysis, could be due to decreased glucose or increased lactate
What EEG findings are seen on Absence seizures?
3 Hz Spike and Wave
What does pathology show on mesial temporal lobe sclerosis?
hippocampal atrophy with gliosis and neural loss in CA1, CA4, and dentate gyrus
What is West’s syndrome?
infantile spasms; repeated extension and flexion of the neck, trunk, and extremities
What is characterizes West’s syndrome (infantile spasms) on EEG?
hypsarrhythmia (chaotic background with random high voltage, slow spike and wave)
What is the treatment for infantile spasms (West syndrome)?
ACTH, vigabatrin, and ketogenic diet
What are Benign epilepsy of childhood with Rolandic spikes? What is the typical clinical course?
focal motor seizures typically of the face during sleep-wake transitions; conscious but aphasic post ictally
remits spontaneously by adolescences
What is Juvenile myclonic epilepsy?
myoclonus in the morning without loss of consciousness, affects upper > lower
What is the inheritance pattern of Juvenile myoclonic epilepsy?
Autosomal dominant
What is the treatment of juvenile myoclonic epilepsy?
valproic acid for life
What characterizes Lennox-Gastaut syndrome?
multiple seizure types with mental retardation
What surgical options are available for patients with Lennox Gastaut syndrome?
VNS and corpus callosotomy
What is the mechanism of action of phenytoin?
Na Channel blockade
There are many side effects to phenytoin. What are some of the most serious ones?
Steven Johnson syndrome, cerebellar degeneration
What is the mechanism of action of Carbamazepine/Oxacarbazepine?
Na channel blockade
What are the side effects of Carbemazepine/Oxacarbazepine?
Pancytopenia and SIADH
What is the MOA of Lacosamide?
Na channel blocker
What is the MOA of Ethosuximide?
Ca Channel blocker
What is the MOA of acetazolamide?
carbonic anhydrase inhibitor
What is the MOA of lamotrigine?
inhibit presynaptic glutamate release
What is the MOA of Topiramate?
affects Na channels, GABA, and Glutamate receptors
What is the MOA of Valproic acid?
inhibits Na and Ca channels
increases GABA synthesis and activity
What are the side effects of Valproic acid?
Thrombocytopenia, hyperammonemia (hepatotoxicity in < 2 years)
What is the MOA of Felbamate?
NMDA receptor antagonist
What are the side effects of Felbamate?
aplastic anemia and hepatic failure
Absence seizures are thought to originate/involve what cerebral structure?
thalamus
What is the go to treatment for absence seizures?
Ethosuximide
WADA testing determines _______.
laterality of speech and memory
What is injected in a WADA test?
sodium amobarbital
Corpus callosotomy can be used for _______ and _______.
atonic seizures (drop attacks)
seizures with secondary generalization
What HLA type is associated with MS?
HLA-DR2
What causes an oligoclonal band pattern in MS?
elevated IgG in the CSF
What is Schilder’s disease?
massive demyelination in children and adolescents, affecting bilateral hemispheres, brainstem, and cerebellum
Malignant course
What is Balo’s concentric sclerosis?
alternating spared and damaged white matter progressing in concentric ring like fashion from the ventricles outward
typically fatal
What is the pathophysiology of neuromyelitis optica (Devic’s disease)?
IgG autoantibodies versus aquaporin 4 on astrocytes
What are the imaging findings for neuromyelitis optica?
MRI shows optic nerve/chiasm enhancement and/or spinal cord lesion affecting more than three segments in length
Describe the tremor seen in Parkinson’s disease.
resting tremor of 4-5 per second in the lips, head, and fingers (pill rolling)
Where is the mutation in primary dystonia?
DYT1 TOR1A gene
What is the other name for Wilson’s Disease?
hepatolenticular degeneration
What tests are indicative of Wilson’s disease?
LFTs, slit lampe test (Kayser-Fleischer rings), decreased ceruloplasmin, elevated urine copper
What defines Tourette’s syndrome?
multiple motor tics with at least one vocal tic
Name two COMT inhibitors.
entacapone, tolcapone
Name two Monoamine oxidase B inhibitors.
selegiline, rasagiline
What is olivopontocerebellar degeneration?
multiple system atrophy associated with ataxia
What is Striatonigral degneration?
form of MSA in which Parkinsonian features predominate although autonomic and cerebellar symptoms can be seen
What is Shy-Drager syndrome?
MSA with autonomic dysfunction predominating; Orthostatic hypotension is the key finding
What is Progressive Supranuclear Palsy?
triad of :
- progressive supranuclear ophthalmoplegia (impaired voluntary vertical gaze, but preserved doll’s eyes)
- pseudobulbar palsy
- axial rigidity
What is the inheritance of Huntington’s disease?
AD
What is the genetic abnormality seen in Huntington’s disease?
great than forty tri-nucleotide CAG repeat on Ch 4
Where is degeneration seen in Huntington’s disease?
Frontal lobe and caudate
Autonomic dysfunction is associated with what type of headache?
cluster headaches
What procedure can be used to treat refractory cluster headaches?
sphenopalatine ganglion lesioning
What is Tolosa-Hunt syndrome?
nonspecific inflammation of the cavernous sinus or superior orbital fissure
ocular and retro-orbital pain, ocular motor paralysis (pupil may be involved), and possibly sensory loss over the forehead (CNs III, IV, V1, and VI, sympathetics)
Where is the area of compression/demyelination of the Trigeminal nerve in Trigeminal neuralgia?
Obersteiner-Redlich zone
Steroids help prevent what complication of temporal arteritis?
Blindness
What is Ramsay Hunt syndrome?
geniculate ganglion (CN VII) herpes infection with ear pain and vesicles (in the external auditory meatus), facial weakness, possible hearing deterioration, vertigo, and tinnitus
Climbing fibers enter via the ________ and mossy fibers enter via the _______.
inferior cerebellar peduncle
middle cerebellar peduncle