NEUROLOGY Flashcards
subarachnoid haemorrhage
type of hydrocephalus
communicating
(CSF cant be absorbed via arachnoid granulations)
subarachnoid space widening
usually inflammatory or trauma cause
blood is inflammatory if leaked i.e. leaking aneurysm
causes of communicating hydrocephalus
subarachnoid haemorrhage
post-meningitis
scarring
causes of non-communicating hydrocephalus
Dnay Walker
Arnold Chiari II
Medulloblastoma
chorioretinitis,
hydrocephalus
intracranial calcifications
+/− “blueberry muffin” rash
toxoplasma gondii
mother asymptomatic or lymphaenopathy
cat faeces or undercooked meat
in regionalisation of the neural tube, where does basal ganglia develop from (___cephalon)
prosencephalon –> telencephalon
in regionalisation of the neural tube, where does the retina develop from
prosencephalon –> diencephalon
what are derived from neural crest cells
Melanocytes
Odontoblasts
Tracheal cartilage
Enterochromaffin cells
Laryngeal cartilage
Parafollicular (C) cells of the thyroid
Adrenal medulla & autonomic ganglia
Schwann cells
Spiral (aorticopulmonary) septum
MOTEL PASS
what mutation is holoprosencephaly associated with
SHH
(sonic hedgehog)
SHH is crucial for
embryonic patterning
(brain and limbs)
Holoprosencephaly (failure of forebrain division)
Midline defects (cleft lip/palate, cyclopia)
Polydactyly (abnormal limb patterning)
CNS malformations (affecting dorsal-ventral axis formation)
what are Chiari I and II each associated with
I = syringomyelia
II = myleomeningocele
what actions do these tongue muscle do
styloglossus
genioglossus
And what innervates them
stylo = draws sides upward
genio = protudes
XII
what is present in cell bodies and dendrites but not axons that stains on Nissl staining
RER
(not present in axon)
stained by Nissl stain
what are (2) neuron cell markers
neurofilament protein
synaptophysin
neuro cell derived from mesoderm
not dissernible on nissl stain
microglia
neuro cell positive for GFAP+
astrocyte
glial fibrillary acidic protein
neuro cell with marker S100
injured in Guillian Barre
Schwann cell
round cellular swelling
displacement nucleus to periphery
dispersion nissl substance in cytoplasm
chromatolysis
reaction of neuronal cell body (soma) to axonal injury
increased protein sysnthesis aimed to repair
disintegration of axon/myelin sheath distal to site of axonal injury.
wallerian degeneration
macrophages remove debris
proximal to injury - axon retracts and sprouts new protrusions
injury to middle meningial artery often bleeds into what space
epidural space
lucid interval, rapid deterioration
epidural haematoma
haematoma expansion
injury to bridging veins
subdural
shaking baby
midline shift
crosses suture lines
conductive aphasia caused by damage to
arcuate fasciculus
repetition
saccular aneurysms assocaited with
ADPKD
elher danlos
common site ACA, AComm
gait instability
cognitive disturbance
urinary incontinence
normal pressure hydrocephalus “wet, wacky, and wobbly”
develops faster than vascvular dementia
reversible
mood changes, amnesia, aphasia
seen in
Alzheimers disease
neurofibrillary tangle
hyperphosphorylates tau protein
area of brain critial for memory formation
hippocampus
medial temporal lobe
affected in Alzhiemers diease
AD
early-onset alzhiemers overproduction of b-amyloid
amyloid plaques
mutation causing
presenilin 1
Alzhiemers characterised by loss of -? neurons
cholinergic
decreased Ach
prosopagnosia can occur due to
artery
PCA stroke
‘face blindness’
familial (early-onset) alzhiemers associated with
genes
Presenilin 1 (PSEN1) Ch 14
Presenilin 2 (PSEN2) Ch 1
Amyloid precursor protein (APP) Ch 21
increased Aβ (beta-amyloid) deposition, amyloid plaque formation
late onset alzhiemers is associated with
gene
APOE (apolipoprotein E) Ch19
Damage to the DRG disrupts -? that rely on -? input
reflex arcs
sensory
would see hyporeflexia
DTR diminished
dorsal root gangion carries
afferent sensory info
periphery to SC
affects reflex arc
MDD
SSRI
Na 122mEq/L
what might be seen in this patient
SAIDH
(adverse effect of SSRI)
hyponatremia - dilutional effect of ADH (H20 retained)
older patient
acute confusional state
memory or language deficit
fluctuating consciousness, lethargy
disorientation, hallucinations
perceptual awareness, cognition changes
delirium
deficient Ach signalling suggested
causes: infection, medications, withdrawal, or electrolyte imbalances* i.e. SIADH from SSRI*
dementia + hallucinations
lewy body dementia
dementia + personality changes
pick disease
(frontotemporal dementia)
50yo
huntingtons disease demonstrates what characteristic
anticipation
each future generation is affected at a younger age & more severely
AD
One copy of the mutated gene is sufficient to cause the disease
CAG repeats
localised motor or sensory symptoms
oral/manual automatisms - lip smacking, picking
auras
altered consciousness
postictal confusion
rhythmic slowing on EEG
complex partial seizure
(focal onset impaired awareness)
Blank stare
3Hz spike EEG
no postictal confusion
rapid blinking, mouth twitching
absense seizure
often children
motor or sensory symptoms
no impaired consciousness
no postictal confusion
simple partial sensory seizure
numbness, paraesthesias, pain (sensory)
label A, C, E
right inferior cerebellar peduncle (vestibular)
right medial lemnisci (sensation)
right medullary pyrimidal tract (motor)
identify the vessel
PCA
will see: contralateral visual field defecf
contralateral homonymous hemianopsia with macular sparing
originates rostral end, near basilar artery
what would an anesthesiologist change to increase intracranial pressure?
decreasing RR
decrease RR or TV = increased CO2 = increase PaCO2 = increase CBF + ICP
autoregulation between 10-160mmHg
CBF increases with:
increased metabolic demand
hypercarbia (biggest effect)
hypoxemia
hyperthermia
increased central venous pressure (CVP)
CO2 combines with H2O to form carbonic acid –> disolves to H+ and HCO3 –> pH decreased (H+) –> causes vasodilation in arteries/arterioles brain –> increases blood flow to flush out co2, deliver O2
loss of pain & temperature on Left LL. Where in SC is injured
(D)
right spinothalamic tract
will see symptoms 2-3 levels below SC decussation (Lasseurs tract).
see s/s CONTRALATERLAL
CST and DC will see ipsilateral
