Neurology Flashcards
what is the Central Nervous System?
Brain and spinal cord, Myelination by the oligodendrocytes
What is the Peripheral Nervous System?
Everything except the brain and spinal cord. Myelination by the schwann cells
What is the Autonomic Nervous System?
Automatic stuff… i.e. breathing, heartbeat
What is the Somatic Nervous System?
Moving your muscles
What is the Parasympathetic System?
Rest and digest, slows stuff down
How does the Parasympathetic System behave?
"DUMBBELS" Diarrhea Urination Miosis "Constrict" Bradycardia Bronchoconstriction Erection "Point" Lacrimation Salivation
What is the Sympathetic System?
Fight -or- Flight, speeds stuff up
How does the Sympathetic System behave?
Opposite of Parasympathetic: Constipation Urinary retention Mydriasis - "Eyes wide with fright" Tachycardia Bronchodilate Ejaculation "Shoot" Xerophthalmia (dry eyes) Xerostomia (Dry mouth)
What is Cushing’s Triad?
Impaired brainstem function
Systolic Hypertension, Bradycardia, irregular breathing
What is Budd-Chiari syndrome
Hepatic vein obstruction
(The condition is caused by occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites, and liver enlargement. The formation of a blood clot within the hepatic veins can lead to Budd–Chiari syndrome)
What is Arnold-Chiari?
Foramen Magnum obstruction
(Arnold-Chiari malformation is a structural defect in the cerebellum that leads to herniation through foramen magnum (into spinal cord), can lead to non-communicating hydrocephalus)
What is Anencephaly?
Notochord did not make contact with the brain - only have the medulla
What is an Encephalocele?
Brain tissue herniation
What is a Dandy Walker malformation?
Agenesis of cerebellar vermis leads to cystic enlargement of 4th ventricle, that fills the
enlarged posterior fossa. Associated with noncommunicating hydrocephalus, and spina bifida.
Most commonly seen in children– vomiting first thing in the morning ( hits the CTZ: chemo-tactic trigger zone)
What is an Arnold-Chiari Malformation?
Herniation of cerebellum through Foramen Magnum
Type 1: Cerebellar tonsils (asymptomatic)
Type 2: Cerebellar vermis/ medulla – Hydrocephalus, Syringomyelia (loss of pain and temerature)
What is Spina bifida occulta?
Covered by skin with a tuft of hair
What is Spina bifida aperta?
Has opening; High AFP (alpha fetoprotein)
What is a Meningocele?
Sacral pocket with meninges in it
What is a Meningomyelocele?
Sacral pocket with meninges and nerves in it
What is open-angle glaucoma?
Overproduction of fluid, painless Ipsilateral dilated pupil, gradual tunnel vision, optic disc cupping
What is Closed-angle glaucoma?
Obstruction of canal of Schlemm, there is a sudden onset pain, emergency
What are the Water shed areas?
Hippocampus, splenic flexure
What bug loves the frontal lobe?
Rubella
What bug loves the temporal love?
HSV (Herpes Simplex Virus)
What bug loves the parietal lobe?
Toxoplasma
What bug loves the hippocampus?
Rabies
What bug loves the posterior fossa?
TB
What bug loves the DCML tract?
dorsal column–medial lemniscus pathway
Treponema
How do migraines present?
Photophobia, numbness and tingling, throbbing headache, nausea
How do tension headaches present?
“Band-like” pain starts in posterior neck, increases throughout the day, sleep disturbance
How do cluster headaches present?
Rhinorrhea, unilateral orbital pain, suicidal, facial flushing, worse with lying down
How does temporal arteritis present?
Pain with chewing, blind in one eye
How does trigeminal neuralgia (Tic Douloureux) present?
Sharp, shooting face pain, recurrent episodes
trigeminal nerve in the face
What are the 2 kinds of partial seizures?
Simple (aware), complex (not aware)
What are the 3 kinds of generalized seizures?
Tonic-clonic “Grand Mal”
Absence “Petit Mal”
Status Epilepticus
How does an epidural hematoma present?
Intermittent consciousness (lucid interval)
How does a Subarachnoid hemorrhage present?
“Worst headache of my life”, hx. of Berry aneurysm
How does a Subdural Hematoma present?
Headache 4 weeks after trauma, elderly (loose brain)
What is Pilocytic Astrocytoma?
1 benign kids tumor
Rosenthal fibers - #1 in kids with occipital headache (tumor in posterior fossa– cerebellum)
Glial cells- astrocytes “Star shaped” (They regulate the transmission of electrical impulses within the brain)
What is an Ependymoma?
Kids
Rosettes present in the 4th Ventricle, can cause Hydrocephalus
Rod-shaped blepharoplasts (basal ciliary bodies) found near the nucleus
What is a Craniopharyngioma?
Kids
Craniopharyngioma: brain tumor derived from pituitary gland, embryonic tissue that occurs most commonly in children, but also affects adults.
Derived from Rathke’s Pouch
Motor oil biopsy, tooth enamel (calcification), ADH problem, Bitemporal Hemianopsia (tumor compressing optic chiasm- lateral vision loss in both eyes)
What is Glioblastoma multiforme?
Adults
Malignant tumor of brain/spinal cord
(cerebral hemispheres– can cross corpus callosum “butterfly glioma”)
Pseudopalisading necrosis (worst prognosis),
intralesional hemorrhage
What is a Hemangioblastoma?
Adults
In the cerebellum, associated with VHL
(Von Hippel-Lindau syndrome (VHL) is a hereditary condition associated with tumors arising in multiple organs. Tumors in VHL are blood vessel tumors of the brain, spinal cord, and eye. The eye tumors are also called retinal angiomas)
What is a Meduloblastoma?
1 malignant Kids tumor (cerebellum).
Can compress 4th ventricle– noncommunicating hydrocephalus, papilledema.
Can send “drop metastases” to spinal cord.
Homer-Wright Rosettes compressing the brain (small blue cells).
Early morning vomiting (gait instability/ataxia)
What is Meningioma?
Common Adult Tumor (Females)
Typically Benign (best prognosis)
Occurs near surface of brain in parasagittal region.
Psammoma bodies present (calcification+ whirling pattern)
Displaces brain
What are the most common places to metastasize to the brain?
From the lung, breast, and skin, present at the White-Grey Junction
What is an Oligodendroglioma?
Adult (rare)
Most often tumor of frontal lobes “chicken-wire” capillary pattern.
Fried egg appearance (round nuclei with clear cytoplasm)
Nodular Calcification
What is a Pinealoma?
Kids
Tumor of Pineal Gland
Loss of upward gaze (Parinaud syndrome– compression of tectum)
Loss of circadian rhythms lead to precocious puberty in males (beta-hCG production)
Obstructive hydrocephalus (compression of cerebral aqueduct)
Similar to germ cell tumors (testicular seminoma)
What is a Schwannoma?
Adults
CN-7+8 tumor, unilateral deafness (CN-8)
Classically presents at cerebellopontine angle
Schwann cell origin S-100
What is Neurofibromatosis?
Cafe’ au laut spots (hyperpigmentation)
Peripheral nerve tumors, axillary freckles
Type 1: Von Recklinghausen’s– Chromosome 17, peripheral, optic glioma, Lisch nodules, scoliosis
Type 2: Acoustic Neuroma, Central, Chromosome 22, cataracts, bilateral deafness
What is Sturge-Weber?
Port wine stain (big purple spot) on forehead
angioma of retina (CN5= Trigeminal nerve: ophthalmic branch)
Epilepsy
Mental retardation
What is Tuberous Sclerosis?
Ashleaf spots (hypopigmentation) Primary brain tumors Heart Rhabdomyolysis Renal cell CA Shagreen spots (leathery)
What is Benign Positional Vertigo?
Sensation of room spinning
Nausea/Vomiting
Nystagmus without hearing loss or tinnitus
Onset of symptoms when change position
What is Vestibular Neuritis?
Inflammation of the vestibular portion (CN8), Could be associated with viral infection, characterized by vertigo and dizziness
What is Labyrinthitis?
Inflammation of the Cochlear portion of the inner ear, present with hearing loss and tinnitus
What is Meniere’s Disease?
Same presentation as Labyrinthitis but is a chronic condition with remitting and relapsing episodes (Inflammation of the Cochlear portion of the inner ear, present with hearing loss and tinnitus)
What is most common brain intracranial tumor?
Meningioma
What is most common primary brain tumor?
Astrocytoma
Specific types: Glioma, Oligodendriglioma, and ependymoma
What is most common primary brain cancer?
Astrocytoma grade 4 or Glioblastoma Multiforme
What is most common cancer?
Metastasis (usually found at grey-white matter junction where blood vessels transverse)
What is most common pituitary tumor?
Pituitary adenoma
tunnel vission, loss of peripheral area
What is the most common functional pituitary tumor?
Prolactinoma
What is the most common Pituitary cancer?
Adenocarcinoma
What is most common pineal tumor?
Pineal adenoma (Pinealoma)
What is most common pineal cancer?
adenocarcinoma
If rib notching is seen with presence of neurofibromatosis, what can be assumed?
Specifically seen in Peripheral Neuromas: chromosome 17 (type 1)
Cafe-au-lait spoits (hyperpigmented macules) Peripheral neuromas: chromosome 17 (type 1)
Central neuromas: chromosome 22 (type 2)
What can lead to monocular visual loss?
Glioma that damages the optic nerve
- If there is an acute retinal artery occlusion, what will be seen?
- Acute retinal vein occlusion?
- White retina, red macula (macula will be fine because it has its own blood supply)
- Bluish retina
Bitemporal hemanopsia means?
optic chiasm lesion which leads to later visions loss (side vision on both eyes)
usually a result of pituitary tumor 90% (just beneath chiasm)
or pineal tumor (midline to chiasm)
what is contralateral homonymous hemianopia?
Optic tract lesion on one side, causing vision loss on same side of both eyes
MCC: cancer or tumors (temporal lobe)
what is Contralateral superior quadrantanopia?
1/4 vision loss in both eyes, same area in both eyes, (top left quadrant if damage is on right side) do to damage to Meyer’s loop (lower part)
what is contralateral inferior quadrantanopia?
1/4 vision loss in both eyes, same area in both eyes, (bottom left quadrant if damage is on right side) do to damage to Meyer’s loop (higher part)
what is contralateral homonymous hemianopia with macula sparring?
half eye vision loss, left side of both eyes if damage is on right side (damage to Optic radiation)
Huntingtons is loss of?
Caudate Nucleus
Ventricles can take a “box-car shape”
Bells palsy can affect which part of the face?
which disease/virus can be involved?
both upper and lower face
Herpes (#1) affects one side of face
Lime disease (#2) affects both sides of face
Frontal Lobe lesions can be associated with?
Atonic seizures (generalized knock out of corticospinal tract) Dementias (Alzheimers, Picks disease) Schizophrenia: loss of asymmetry (memory loss)
Temporal lesions can be associated with?
hearing
balance
hallucinations (released by serotonin) (PCP, LSD= affect temporal lobes, vivid dreams)
Posterior temporal lobe: Wernicke’s area (talk a lot but don’t make any sense)
Parietal Lobe lesions can be associated with?
Memory (long term) Left side dominant in 90% of people nondominant lobe (apraxia/hemineglect- cant perform certain actions due to brain damage; forget half body exists)
what is the most common location of berri aneurism?
Anterior Communicating artery (ACA)
What symptoms can be seen in AICA (Anterior inferior cerebellar artery) occlusion?
CN7 ipsilateral facial paralysis
CN8 hearing loss
What symptoms can be seen in PICA (posterior inferior cerebellar artery) occlusion?
- Cerebellar peduncle- ipsilateral limb ataxia (loss of limb control)
- Descending hypothalamic- ipsilateral horners (ptosis-droping of eye, miosis- constriction, anhydrosis- cant sweat)
- Nucleus ambiguus-dyshpagia CN10 problem with swallowing/ coughing
- Also possible loss of pain/temp of face, and contralateral loss of pain/temp on body
What symptoms can be seen in medial medullary syndrome?
occlusion of vertebral artery
Pyramid- contralateral spastic hemiparesis
CN12- tongue deviates toward the lesion
What symptoms can be seen in Median Midbrain Synrome (Weber)?
Occlusion of posterior cerebral artery (PCA)
Corticospinal tract- contralateral spastic hemiparesis (upper limbs only!)
Corticobulbar tract (contralateral lower face)
CN3- eye down and out (macula sparing)
What is epidural hematoma?
middle meningeal artery rupture fracture of temporal bone lucid intervals (loss of constiousness, come back) lenticular shape DO NOT GIVE: Mannitol
What is subdural hematoma?
Bridging veins rupture venous bleed (slow pressure) delayed onset Commonly seen: shaken baby syndrome, elderly Crescent shape in mid brain region
What is subarachnoid hemorrhage?
aneurysm rupture
worst headache of their life
boody spinal tap
small hemorrhages can be seen all over brain
Which sections of brain are responsible for all sensory in/out?
Thalami= sensory Epithalamus (only nucleus with no known function) Thalamus (all sensory goes through here: lateral=arms; medial= legs) Hypothalamus Subthalamic nucleus (fine motor movements)
Which system is not working properly in ADD or ADHD?
RAS system (Reticular Activating System)
Stimulus like NE and Serotonin increase RAS
cAMP is the second messenger
Substantia Nigra is responsible for what?
initiating movement
uses dopamine for neurotransmitter
recieves inhibitory signals from basal ganglia via ACH or GABA
What is Parkinsons disease? How to treat?
loss of dopamine fibers from substania nigra to striatum (caudate and putamen)
unable to initiate activity
Treatment:1st line= L-dopa/carbidopa
2nd line= bromocryptine (dopamine agonist)
Others to consider:
Amantadine (Tx influenza A)= increases DA release from nerve terminal
Selegyline (MAO-B inhibitor) prevents DA breakdown)
corticospinal tract is responsible for?
fine motor activity (has to inhibit extension so that smooth flexion can occur) spasticity (can not flex) Babinski (extension of toes) Hyperreflexia Clonus (large motions)
What disease is associated with CAG trinucleotide repeat?
Huntington disease (caudate has decreased ACh and GABA) AD
What disease is associated with CTG trinucleotide repeat?
Myotonic dystrophy (Cataracts, Toupee-- early balding in men, and gonadal atrophy) AD
What disease is associated with CGG trinucleotide repeat?
Fragile X syndrome (chin protruding, Giant Gonads)
XD
What disease is associated with GAA trinucleotide repeat?
Friedreich ataxia (Ataxic GAAit) AR
What is Syringomyelia?
A chronic progressive disease where cysts with fluid are formed in the spinal cord; can result in muscle wasting and loss of sensation in the hand.
(loss of pain and temperature)
