Neurology Flashcards
What is cranial nerve 8
Vestibulocochlear
Hearing and balance
What is cranial nerve 9
Glossopharyngeal
taste and sensation from Posterior tounge
Parotid gland salivation
Carotid body and baroreceptors
Vagus nerve (X) functions
Swallowing, cough reflex, parasympathetic to thoracoabdominal and monitor baroreceptors
C1-C7 exit above or below the vertebrae
Above.
High up = above
Where does the spinal cord end in adults?
L1-L2
Subarachnoid space (which holds the CSF) end where?
S2 (Subarachnoid space)
Lumbar puncture is usually performed where?
Below where the spinal cord ends (L1-L2)
So around L3-L4
(To keep the cord alive, puncture between L3 and L5)
The spinothalamic tract senses what?
Pain and temperature
Sensory information going to the spinothalamic tract enter the spinal cord through which root?
Dorsal root
Pain and temperature sensation dessucates where?
At the level of the spinal cord as the anterior white commisure
Ascends contralaterally
Pressure, vibration, fine touch, and proprioception is carried by what tract?
Dorsal columns
Sensation for pressure, vibration, fine touch ender the spinal cord through which root?
Dorsal root
Does the dorsal column ascend ipsilaterally or contralaterally?
Ipsilaterally
Where does the dorsal columns dessicate?
In the medulla and travels upward as the medial lemniscus
The corticospinal tract is responsible for what?
Voluntary movements
Upper motor neurons from the primary motor cortex descend ipsilaterally through what sections of the brain
Posterior limb of the internal capsul and cerebral peduncle
Where does the corticospinal tract dessucate?
At the caudal medulla ( pyramid) then travels contralaterally
Signals from the corticospinal tract exit the spinal cord where?
At the contralateral anterior horn
Lower motor neurons leave the spinal cord where?
At the anterior horn
Signal comes from upper motor neurons on the contralateral side
Plantar reflex
Dorsiflexion of big toe and fanning of other toes
Babinski sign
Presence of plantar reflex (dorsiflexion of big toe and fanning of other toes)
Represents UMN lesion
Diaphragm and gall bladder pain is referred to where via the C3 dermatome
Right shoulder
A tight low collar shirt is touching which dermatome?
C4
The lateral arm and thumbs is which dermatome?
6 (if you do a thumbs up it looks like a 6)
Early appendicitis has referred pain to the umbilicus via what dermatome?
T10 (belly butten)
Inguinal ligamen is what dermatome?
L1 (Inguinal Ligament)
Down the medial leg and knees to the medial foot is what dermatome?
L4 (down on all 4s)
Sensation of penile and anal zones is what dermatomes?
S2, S3, S4
Agraphia (writing), acalculia (math), finger agnosia, and left-right disorientation is indicitative of a brain lesion where?
Dominant parietal cortex
Hemispatial neglect - agnosia of the contralateral side of the world. Where is the brain lesion
Nondominant parietal cortex
Hutington Disease, and Parkinson disease is due to a lesion in which area of the brain
Basal ganglia
B1 thiamine deficiency is the cause of Wernicke-Kosakoff. It results in brain lesions where?
Bilateral mamillary bodies
Anterograde amnesia (not able to make new memories) indicates a brain lesion where?
Hippocampus
Decorticate posturing (flexion) is indicative of a lesion where?
Above the red nucleus (cerebral cortex)
Hands are near the cor (heart)
Upper extremities flexed, lower limb extension
Decerebrate posturing (all extensor) indicates a lesion where?
Between the red and vestibular nuclei
There is a worse prognosis
Vulnerable hippos need pure water
Most vulnerable areas to ischemia in the brain
Hippocampus
Neocortex
Purkinje cells
Watershed areas
What kind of necrosis occurs in the brain
Liquefactive
Anterior cerebral artery stroke results in what symptoms
Contralateral Lower limb motor and sensory deficits
Middle cerebral artery ischemia results in what symptoms
Contralateral lower face and upper limb
The nondominant hemisphere is usually which side?
Right
A lesion in the nondominant (right) hemisphere results in what?
Hemineglect (parietal)
Where is the Wernicke area?
Temporal lobe
Where is Broca area?
Frontal lobe
The lenticulostriate artery supplies what part of the brain
Striatum, internal capsule
Ischemia of the lenticulostriate artery results in what symptoms
Contralateral Pure motor paralysis due to corticospinal tract traveling in the internal capsule
Anterior inferior cerebellar artery supplies which cranial nerve nuclei
The pons - facial nerve, vestibular nerve, trigeminal nerve (5, 7, 8)
Ischemia of the AICA with damage to the facial nucleus results in what deficits
Loss of taste from anterior tongue, lacrimation, and salavation
Ischemia from the AICA with damage to the vestibular nuclei results in what deficits
Inner ear - vomiting, vertigo, nystagmus
Ischemia of the AICA causing damage to the trigeminal nucleus results in what deficits
IPSILATERAL face deficits of pain and temperature
The anterior cerebral artery supply which cranial nerves?
1-4
Olfactory
Optic
Oculomotor
Trochlear
Ischemia of the posterior inferior cerebella artery causes lesions where?
Cranial nerve 9, 10
Vestibular nerve (8)
Spinothalamaic tract, trigeminal (5)
Cerebellar peduncle
Sympathetic fibers
Dysphagia and hoarseness is indicitave of ischemia of what artery
PICA - posterior inferior cerebellar artery
It supplies the nucleus ambiguus (CN 9 and 10)
9 - glossopharyngeal
10 - vagus
The anterior spinal artery supplies what part of the brain
The caudal medulla
Ischemia of the anterior spinal artery damages what structures
Corticospinal tract
Medial lemniscus
Caudal medulla - CN12 HYPOGLOSSAL
Rupture of middle meningeal artery results in epidural or subdural hematoma?
Epidural
Rupture of middle meningeal artery results in what kind of symptoms
Transient loss of consciousness
Recover
Rapid deteroriation
Epidural hematomas are convex or crescent shaped
Convex (look like an eyeball)
Subdural hematoma is a result of rupture of what vessel
Bridging veins
Subdural hematomas are crescent or convex shaped?
Crescent
Think sub, crescent
Subarachnoid hemorrheades are described as what
Worst headache of my life with bloody or yellow lumbar fluid
Rupture of a saccular aneurysm or AVM results in what kind of hemorrhage
Subarachnoid
Systemic hypertension most commonly results in what kind of hemorrhage
Intraparenchymal
Broca area is associated with what sense
Speaking. Broca = boca (mouth)
Wernicke area
Associated with language comprehension
“word salad”
Where do berry aneurysms occur?
Int he circle of Willis, commonly between anterior communicating and ACA
Berry Aneurysms are associated with which diseases
ADPKD
Ehlers Danlos
Smoking
A bery arryneurys of the anterior communicating effects what cranial nerve structure
CN2 (optic chiasm) - bitemporal hemianopia
A berry aneurysm of the posterior communicating causes compression of what cranial nerve
CN3 - oculomotor
Blown pupil, down and out eye
Cluster headaches occur where
Periorbital pain wit autonomic symptoms (lacrimation, rhinorrhea, conjunctival injection)
Treatment for cluster headaches
Acute: Sumatriptan
Prophylaxis - Verapamil
Describe essential tremor
Tremor with outstretched arms
Worsened with movement
Intention tremor
When trying to point towards something, there is zigzag.
Caused by cerebellar damage
Resting tremor is caused by a lesion in what area of the brain
Substantia nigra
The tremor is alleviated by intentional movement
Hemiballismus is caused by a lesion in what area?
Contralateral subthalamic nucleus
Parkinson Disease pathophysiology
Loss of dopaminergic neurons in the substantia nigra
Huntington disease pathophysiology
Loss of GABA neurons in the striatum
Leads to low GABA, low Ach, but high dopamine
Huntington disease is inherited in what pattern
Autosomal dominant
Trinucleotide repeat expansion on chromosome 4
ApoE-2 is protective or increased risk of Alzheimers
Protective
Protwoctive
Amyloid angiopathy found in Alzheimers disease can result in what kind of hemorrhage
Intraparenchymal
Neurofibrillary tangles are intracellular hyperphosphorylated tau proteins. They are associated with what disease?
Alzheimers disease
Spongiform cortex (no inflammation) with rapid progressive dementia with myoclous and ataxia is assocaited with which disease
Creutzfeldt-Jakob (prions) which are resistant to proteases
Does Normal pressure hydrocephalus result in increased volume in the subarachnoid space?
No
Symptoms of episodic elevated ICP in normal pressure hydrocephalus
Wobbly, wacky, wet
Gait apraxia, cognitive, urinary incontinence
Pathophysiology of multiple sclerosis
Autoimmune inflammation and demyelination of CNS
Early symptoms of MS
Optic neuritis, afferent pupillary defect
Cerebellar syndromes
Corticospinal tract deficiency (upper)
Which antibody type is found in the CSF in multiple sclerosis
IgG + myelin basic protein
Guillain-Barre is an autoimmune condition that destroys what kind of cells
Schwann cells which myelinates peripheral nerves
Symptoms of Guillan-Barre
Symmetric ascending muscle weakness
Depressed reflexes
Bilateral facial paralysis
Respiratory failure
Progressive multifocal leukoencephalopathy is demylination of CNS due to destruction of oligodendrocytes. It is linked to what virus
Reactivation of latent JC virus usually in the immunocompromized
NF1 and 2 are inherited in which way
Autosomal dominant
NF1 and NF2 are protooncogenes or tumor suppresors
Tumor suppressors
NF1
Chromosome 17
Encodes neurofibromin, a negative RAS regulator
NF2
Chromosome 22
Merlin gene
Bilateral vestibular schwannomas, juvenile cataracts, meningiomas, and ependymomas is associated with NF1 or NF2
NF2
Von HIppel-Lindau disease (VHL) is associated with which chromosome
chromosome 3
HARP
VHL is associated with what tumors
Hemangioblastomas in retina, brainstem, spine
Angiomatosis
RCC
Phenochromocytomas
Glioblastomas are the most common malignant tumor in adults or children
Adults
Glioblastomas are assocaited with amplication of what?
EGFR
Histology of glioblastomas
Pseudopalisading pleomorphic tumors that border necrosis or vasculature
This brain rare tumor found in the frontal lobes have a “fried egg” appearance on histology
Oligodendroglioma
Which brain tumor has psamomma bodies on histology? and is attached to the brain surface
Meningiomas
Hemangioblastomas (associated with VHL) can produce which hormone
erythropoietin –> secondary polycythemia
Most common brain tumor in children
Pilocytic astrocytoma
Pilocytic astrocytoma is mostly found where?
Posterior fossa (cerebellum). Benign
Upper motor neuron lesions result in lower tone or higher tone/reflexes
Upper
Spastic paresis, babinski sign, tone, reflexes
Lower motor neuron lesions result in higher or lower reflexes
Lower
Atrophy, fasciculations, flaccid paralysis
Poliovirus destroys which part of the spinal cord
Anterior horn (motor)
Results in asymmetric weakness with meningitis symptoms
WBC and increase in protein on CSF
Spinal muscular atrophy is an autosomal recessive mutation of what gene
SMN1
Functions in survival of motor neuron proteins
Spinal muscular atrophy results in bilateral UMN or LMN deficits
LMN, symmetric
ALL or Lou-Gehrig disease is UMN or LMN degeneration?
Both
Amyotrophic lateral atrophy is associated with motor or sensory deficits
Motor only but both UMN and LMN deficit
Tabes dorsalis is a complication of what disease
Tertiary syphilis (Treponema pallidum)
There is degeneration of the dorsal columns
Subacute combined degeneration is degeneration of what tracts
Spinocerebellar - gait
Corticospinal (lateral) - UMN
Dorsal columns - vibration
Subacute combined degeneration is due to a deficiency of what vitamin
Vitamin B12
Friedreich ataxia results in degeneration of what tracts
Lateral corticospinal - UMN
Dorsal columns - proprioception
Dorsal root ganglia - reflexes
A trigeminal nerve lesion would cause the jaw to deviate to what side?
Towards the side of the lesion
Vagus nerve lesion would cause the uvula to deviate to what side?
Uvula moves away from the lesion
Accessory nerve (11) would cause weakness when turning head toward or away from lesion
Turning head away from the lesion would be weak
Hypoglossal nerve lesion would cause deviation of the tongue to which side
Towards the lesion (like your wounds)
Upper motor neuron lesions causes weakness in the ipsilateral or contralateral face
Contralateral. The corticalbulbar tract is after the dessucation in the pons
UMN lesions results in deficits in upper or lower face?
Lower face only because the upper face is supplied by the ipsilateral side
Lower motor neuron lesions results in ipisilateral or contralateral facial drooping
Ipsilateral forehead and lower muscles
Lesion is in cranial nerve 7, after the dessucation from the cortical tract
Normal agin hearing loss is a form of sensorineural or conductive hearing loss
Presbycusis - progressive bilateral symmetric sensorineural hearing loss of higher frequencies due to destruction of hair cells at the cochlear base
Horner syndrome pathophysiology
Sympathetic denervation of face
1. Ptosis
2. Miosis
3. Anhidrosis
GABA is inhibitory in the brain. It causes hyperpolarization of the membrane via what movement of ions
Influx of chloride and bicarb
or
Efflux of potassium
Glutamate is excitatory and binds to what post synaptic receptors?
NMDA receptors. It causes depolarization via influx of sodium and calcium
Dopamine, serotonin, histamine, and norepinephrine act through what kind of receptors?
G-coupled protein receptors
Oxidation of VLCFa occurs in which membranous structure
Peroxisomes
Amebic meningitis by Naegeria fowleri gains access to CSF via which nerve
Olfactory (CN1)
Stimulation of beta 2 receptors on the myometrium would result in increased or decreased contraction
Decreased
B2 adrenergic receptor stimulation results in stimulation or inhibition of NaK ATPase
Stimulation
Excessive –> hypokalemia as potassium goes inside of cells
If there is motor and sensory deficits along a dermatome, that indicates a lesion where?
Compression/damage of a nerve root
Syringomylia results in what deficits
Bilateral upper extremity weakness and sensory (pain/temp) issues in a cape fashion
Does muscle fatigue improve or worsen with use in myasthenia gravis?
Myasthenia gravis is an autoimmune reaction to postsynaptic Ach receptors.
As the muscle continues to get used, the Ach runs out –> worsening weakness
Acetylcholine is high or low in Alzheimers disease
Low
Treatment with acetylcholinesterase inhibitors helps
HIV dementia is associated with viral replication in what kind of cells
Macrophages
What ions enter the presynaptic neuron at the NMJ causing release of acetylcholine?
Ca2+
Glucose
Protein
Cell type
In viral meningitis
Normal glucose
Elevated protein
Leukocytes
Glucose
Protein
Cell type
In bacterial meningitis
Low glucose
Very high protein
Neutrophils
ACE inhibitors cause what abnormalities in babies
Fetal renal damage
Antiepileptic drugs cause what kind of deformities in fetus
Neural tube defects
Valproate, carbamazepine, phenytoin phenobarbitol (all epileptic medications) cause what kind of fetal abnormalities
Neural tube defects
Cleft palate
Skeletal abnormalities
Lithium causes what kind of fetal abnormalities
Ebstein anomaly where the tricuspid valve falls into the right ventricle
Chorea vs hemiballism
Chorea - jerky movements that move from one group to another
Hemiballism - flinging motions
Dystonia
Involuntary muscle contractions
Is opening pressure increased or decreased in the CSF with bacterial meningitis
Increased
Meningitis caused by yeast shows what levels of
Glucose
Protein
Both are low
Local anesthetics MOA
Blockage of voltage gated sodium channels
Opioid MOA
- Blocks calcium influx in presynaptic vesicles which then decreases Ach release
- Open potassium efflux channels on the postsynaptic neuron = hyperpolarization
Botulism toxin MOA
Inhibits SNARE proteins in the presynaptic terminal which inhibits the release of Ach
Which vitamin can be used as a neuroprotective effect in Alzheimers?
Antioxidants. Vitamin E
They don’t give improvement in cognition
Acetylcholine esterase inhibitors effects on congnition and disease
Improves cognition
Does not change disease course
NMDA receptor antagonists effects on Alzheimers
Decreases excitability of NMDA receptor which can delay disease progression (metamantine)
In methylmalonic acidemia, which amino acids are accumulated?
VIMT
Valine
Isoleucine
Methionine
Threonine
Common fibular nerve function
Dorsiflexion and eversion of the foot
Sensory - lateral calf and dorsal aspect of foot
Tibial nerve function
Plantar flexion, inversion
Sensory - plantar foot
Achilles reflex
First line treatment for essential tremors (occur while doing activities and improved with alcohol)
Beta blockers
In poorly controlled HTN, which arteries are most at risk for rupture?
Lenticulostriate which supplies the basal ganglia
Symptoms: Contralateral motor and sensory, dysarthria
Cranial nerve 5 (V3) exits the skull through which opening
Foramen ovale
CNV V2 exits the skull through which opening
Foramen rotundum
Pancoast tumor symptoms
Compression of brachial plexus - shoulder pain
Ptosis - compression of sympathetic tract in the neck
Miosis - lack of sympathetic tract in the neck
What does decerebrate posturing look like?
Upper and lower extremities extended
Due to a lesion of the brain stem
Decorticate posturing
Upper extremities flexed near the heart
Due to damage above the red nucleus (usually the cortex)
TMJ pain is usually due to overaction of which nerve?
Trigeminal nerve V3 (mandibular)
Symptoms of congenital rubella
hearing loss
cataracts
congenital heart defects
Trisomy 18 (Edwards) Symptoms
PRINCE
Prominant occipitus
Rocker bottom feet
Intellectual disability
Clenched fists
Ears low
Trisomy 18 fetal markers
All Decreased
(eDward)
Is methylmalonic acid decreased or increased in patients with vitamin B12 deficiency?
It is increased because B12 is needed to convert methylmalonic acid to succinyl coA for the TCA cycle
Does NADH increase or decrease during ethanol metabolization?
Increase
Is serum lactate level increased or decreased in alcohol intoxication
Increased
In huntington disease, there is a decrease in which neurotransmitters?
GABA and Ach in the caudate nucleus (basal ganglia)
Atrophy of the basal ganglia in Huntington disease causes what on brain scan
Enlargement of frontal horns of the lateral ventricle
Common cause of neuro injury after subarachnoid hemorrhage (berry aneurysm rupture)
Vasospasms of the endothelium = delayed ischemia
This can be prevented by treatment with calcium channel blockers (vasodilation)
Substance P function
Topical capsacin results in depletion of substance P which is a neurotransmitter that tranmits pain signals
Interventricular bleeding in premature babies usually originate from where?
Germinal matrix
Premature baby with UMN motor deficits and motor delay
Cerebral palsy.
Premature = less blod perfusion around the ventricles
Schwannomas and melanoma are positive for what marker?
S-100
Neural crest derived
The middle meningeal artery is a branch of what artery?
External carotid –> maxillary –> middle meningeal
The radial nerve could be injured at what part of the humerus?
Mid shift
