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3rd year_Neurology > Neurology > Flashcards

Neurology Flashcards

1
Q

Define “Stroke”

A

Sudden onset of a neurological deficit from the death of brain tissue

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2
Q

Stroke is the _____ leading cause of death in the US

A

3rd

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3
Q

Risk factors for stroke?

A

HTN, Diabetes, Hyperlipidemia, Tobacco smoking

same as for MI

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4
Q

Possible origins of emboli?

A

Heart: A. fib, valvular heart disease, paradoxical DVT passing through PFO

Carotid Stenosis

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5
Q

Stroke: most common artery affected?

A

MCA (>90% of cases)

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6
Q

MCA stroke presentation?

A
  • Contralateral hemiparesis (weakness/sensory loss)
  • Contralateral Homonymous hemianopsia (so eyes “look toward side of lesion”)
  • Aphasia if on same side as speech center (left in 90% of patients)
  • Hemineglect if on non-dominant hemisphere
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7
Q

Brain region involved in pure motor lacunar stroke?

A

Contralateral Internal Capsule

Lateral Striate Artery

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8
Q

Brain region involved in pure sensory lacunar stroke?

A

Contralateral Thalamus

Lateral Striate Artery

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9
Q

Where is the stroke?

Contralateral paralysis & loss of sensation, both in the lower limb

A

Anterior Cerebral Artery

motor & sensory cortex of lower limbs

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10
Q

Where is the stroke?

Contralateral hemiparesis/hemiplegia

A

Lateral Striate Arteries

Striatum, Internal Capsule
– common location of lacunar infarcts 2/2 unmanaged HTN

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11
Q

Locate Stroke:
Contralateral: hemiparesis of lower limbs & dec’d proprioception
Ipsilateral: hypoglossal dysfunction (tongue deviates ipsalaterally)

A

Anterior Spinal Artery (commonly bilateral)

Medial Medullary Syndrome
- infarct of Paramedian branches of the AS & vertebral arteries

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12
Q

When do you use Diffusion-weighted imaging?

A

When you want to highlight “extravasation” or inflammatory processes i.e. tumor, infection, breakdown of BBB, etc.

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13
Q

Stroke:
Contralateral: homonymous hemianopia

A

Post. Cerebral Artery
(Occipital Lobe)
- macular sparing also

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14
Q

If PCA stroke involves thalamus, what other Sx would you expect?

A

Thalamic involvement: Sensory loss to all modalities or pain

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15
Q

Sx of Lateral Pontine Syndrome? Artery involved?

A

•Contralateral:
- Loss of P & T from trunk & limbs (Lat SpThlmic)

•Ipsilateral:

  • Loss of P & T from face (Spinal CN5 Nuc)
  • Facial hemiparalysis, loss of lacrimation/salivation, taste from ant. ⅔ tongue, corneal reflex efferent (CN7)
  • Hearing Loss (CN8)
  • Limb & Gait ataxia (Mid & Inf Cer Peduncles)
  • Horner’s syndrome (ptosis, miosis, & anhydrosis) (Symp Tract)
  • Nystagmus, nausea, vomiting, & vertigo (Vestibular Nuclei)

Anterior Inferior Cerebellar Artery

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16
Q

Stroke Localization:
• Contralateral: hemibody pain & temperature loss
• Ipsilateral: facial pain, hemifacial pain & temperature loss, ataxia, nystagmus, nausea/vomiting, vertigo, Horner’s syndrome, dysphagia
• Hiccups

A

Posterior Inferior Cerebellar Artery (PICA)

– Lateral Medulla (Wallenburg Sydrome)

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17
Q

Artery involved in Wallenburg Syndrome? Sx?

A

PICA (lateral medulla)
– or can also be Vertebral Artery (less common)

  • Contralateral: hemibody pain and temperature loss
  • Ipsilateral: facial pain, hemifacial pain and temperature loss, ataxia, nystagmus, nausea/vomiting, vertigo, Horner’s syndrome, dysphagia
  • Hiccups
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18
Q

Stroke Localization:
•Bilateral: progressive quadriplegia, facial weakness
•Lateral gaze weakness with sparing of vertical gaze

A

Basilar Artery

– Pons (Locked-in syndrome)

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19
Q

Dx?

Acute quadriparesis, loss of consciousness, & respiratory failure

A

Basilar Artery Thrombosis – urgent & potentially devastating

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20
Q

The anterior limb of the internal capsule separates what 2 subcortical structures?

A

Caudate nucleus & Lenticular nucleus

Lenticular nucleus = Putamen + Globus Pallidus

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21
Q

The posterior limb of the internal capsule separates what 2 subcortical structures?

A

Thalamus & Lenticular nucleus

Lenticular nucleus = Putamen + Globus Pallidus

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22
Q

The ________ arteries are small penetrating blood vessels that supply blood flow to most of the subcortical structures.

A

Lenticulostriate

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23
Q

What is meant by Lenticular or Lentiform nucleus?

A

Globus Pallidus + Putamen

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24
Q

What are the calcified structures seen in the lateral ventricles on CT?

A

Choroid Plexus

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25
Q

Most, but not all, of the Thalamus is supplied by Thalamoperforating branches of the ______.

A

PCA

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26
Q

Is the Internal Capsule lateral or medial to the Lentiform nucleus?

A

Medial to it

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27
Q

What structures are included in the Basal Ganglia?

A

Caudate, Putamen, & Globus Pallidus

Caudate + Lenticular nucleus

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28
Q

What nerve & artery travel through the optic canal?

A

Optic nerve & Ophthalmic artery

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29
Q

Suture that separates Occipital from Temporal bone?

A

Lambdoid suture

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30
Q

What type of imaging is FLAIR Imaging?

A

T2 MRI w/ the CSF removed

so CSF looks black, but the tissue is stained T2, i.e. white matter is dark

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31
Q

What type of imaging is most sensitive to measure acute changes in ischemic stroke?

A

DWI MRI

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32
Q

How do you confirm that a bright spot on DWI is indeed an ischemic lesion?

A

ADC image – the same area should appear dark

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33
Q

What type of imaging is good for looking at deposition of minerals in the brain (i.e. iron, Ca)

A

Gradient ECHO MRI sequence

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34
Q

How are shades of black/gray/white described on MRI vs. CT?

A

CT: Hyper or Hypo - Dense

MRI: High or Low - intensity signal

35
Q

What does it mean if a lesion is “contrast enhancing” on MRI?

A

That it has a dark signal on T1 and bright signal with gadolinium

(can be homogeneously- or ring- enhancing)

36
Q

Which is better to view brain parenchyma - T1 or T2?

A

T1

37
Q

Which is better to view CSF - T1 or T2?

A

T2

38
Q

What is the 1 purpose of DWIs?

A

To visualize an area of acute ischemia

39
Q

In what type of lesion is brain CT the go-to study?

A

Brain Hemorrhage

can also see calcifications

40
Q

If the lateral & 3rd ventricles appear large on CT, consider what pathology?

A

Normal-pressure hydrocephalus

41
Q

If the temporal horns of the lateral ventricles are enlarged, consider what pathology?

A

Acute obstructive hydrocephalus

42
Q

When does an ischemic stroke appear on CT?

A

Not until 24-48 hrs after the stroke

43
Q

Approach to reading a CT scan?

A

Bone - Air - Water - Brain

44
Q

Loss of pain & temp sensation in the LEFT half of face & RIGHT half of body suggests lesion where?

A

Left lateral medulla or caudal pons

Face & body would be on same side (contralateral) if lesion were in midbrain

45
Q

Where is CN 3 nucleus?

A

Medial midbrain

46
Q

Where is CN 4 nucleus?

A

Medial midbrain

47
Q

Which CNs are found in the Pons?

A

Pons = 5
Pontomedullary junction = 6, 7, 8

  • 6 is medial, 5 & 7 are lateral, w/ 5 superior to 7. 8 is lateral to 7.
    (5 spinal nucleus partly in both Pons & Medulla)
48
Q

Stroke: What structure is injured? Artery?

Contralateral hemiparesis of lower limbs

A

Lateral corticospinal tract (in brain)

- ASA

49
Q

Stroke: What structure is injured? Artery?

Dec’d contralateral proprioception

A

Medial Lemniscus

- ASA

50
Q

Stroke: What structure is injured? Artery?

Ipsilateral tongue dysfunction

A

Caudal medulla – CN 12

- ASA

51
Q

Stroke: What structure is injured? Artery?

Vomiting, Vertigo, Nystagmus

A

Vestibular nucleui

- PICA or AICA

52
Q

Stroke: What structure is injured? Artery?

Ipsilateral Ataxia, Dysmetria, Dysdiadochokinesia

A

Inferior Cerebellar Peduncle (Lat Med synd)
- PICA
or
Middle & Inferior Cerebellar Peduncle (Lat Pon synd)
- AICA
(dysdiadochokinesia = problems doing rapid alternating movement)

53
Q

Stroke: What structure is injured? Artery?

Dysphagia, Hoarseness, diminished Gag Reflex

A

Nucleus Ambiguus
- PICA
(distinguishes this from AICA in Lat Pon Synd)

54
Q

Stroke: What structure is injured? Artery?

Paralysis of face, dec’d lacrimation & salivation, loss of taste from ant 2/3 tongue, dec’d corneal reflex (efferent)

A

Facial nucleus
- AICA
(distinguishes this from PICA in Lat Med Synd)

55
Q

Hemiballismus

A

Contralateral Subthalamic nucleus

56
Q

Eyes look away from side of lesion

A

Paramedian pontine reticular formation

57
Q

Reduced levels of arousal & wakefulness (e.g. coma)

A

Reticular activating system (midbrain)

58
Q

Spacial neglect (agnosia of 1 side of the world)

A

Contralateral Right Parietal Lobe

59
Q

Acute paralysis, dysarthria, dysphagia, diplopia, & LOC

A

Central Pontine Myelinolysis (can cause “locked in syndrome)

- Massive axonal demyelination in pontine white matter tracts

60
Q

Common cause of Central Pontine Myelinolysis?

A

Iatrogenic – overly rapid correction of Na+ levels (hyponatremia)

61
Q

What is the goal BP when using tPA?

A

< 185/100

62
Q

Platelets < ______ = c/i of using tPA

A

Platelets < 50,000

63
Q

Seizure descriptive word that refers to loss of consciousness?

A

Complex

“Simple” = no loss of consciousness

64
Q

What is Amaurosis Fugax?

A

A sudden, temporary, partial or complete loss of vision lasting a few seconds to several minutes before returning to normal. It is usually of vascular etiology.

65
Q

What are Hollenhorst plaques?

A

Cholesterol emboli lodged in the retinal vessels that can be seen on dilated fundoscopic exam
(such as those following TIA w/ ocular symptoms)

66
Q

Where do nerves from the Posterior Column cross to the other side?

A

Caudal Medulla
(they cross & become the Medial Lemniscus on their way to the Thalamus. The ML is located medially @ first & moves somewhat lateral as it heads rostrally)

67
Q

What CN nucleus received input from afferent jaw jerk reflex? Where is this nucleus located?

A

Mesencephalic Nucleus of CN 5

- location = superior to Main Sensory N. of CN 5

68
Q

Discriminative touch of the face goes to which CN nucleus? Where is this nucleus located?

A

Main Sensory Nucleus of CN 5

- location = mid-Pons

69
Q

Proprioception of the jaw goes to which CN nucleus? Where is this nucleus located?

A

Main Sensory Nucleus of CN 5

- location = mid-Pons

70
Q

Pain & Temp sensation of the face afferents go to which CN nucleus? Where is this nucleus located?

A

Spinal Nucleus of CN 5 (caudal)

mid-Pons & goes inferior, sometimes until C2

71
Q

Which is the only CN whose motor output from the brainstem goes to contralateral skeletal muscle?

A

Trochlear Nerve

72
Q

Brainstem nuclei general arrangement of motor nuclei vs. sensory nuclei

A

Motor Nuclei tend to be located medial & anterior to Sensory Nuclei

73
Q

Which CN nuclei are located in the medulla?

A

9, 10, 12

74
Q

Which branch of CN 5 receives input from the nose?

A

V1 - Ophthalmic

75
Q

Where are the vestibular & cochlear CN nuclei located?

A

Lateral Ponto-Medullary junction

  • Vestibular stretches & spans both
  • Cochlear sits more lateral & just in caudal Pons
76
Q

Afferent of Corneal Reflex inputs to what CN nuclei?

A

Spinal Nuclei of CN 5

77
Q

Reduced pain and temperature sensation on one side of the face but the opposite side of the body implies a lesion where?

A

Lateral brainstem between the mid-pons & the cervical spinal cord

78
Q

Reduced pain and temperature sensation on one side of the face and on the same side of the body implies a lesion where?

A

Midbrain or above (for instance, in the cerebral cortex)

79
Q

Stroke Localization?

Nonfluent (Broca’s) Aphasia + R UMN face/arm

A

Superior branch of MCA

80
Q

Stroke Localization?

Fluent (Wernicke’s) aphasia + R visual field deficit

A

Inferior branch of MCA

81
Q

Incontinence:
a) usually a spastic, hyperreflexic bladder w/ longstanding bilateral lesions where?

b) Usually a flaccid, areflexic or acontractile bladder with lesions where?

A

a) Above S2-4 (UMN)

b) At S2-4 (LMN)

82
Q

@ what spinal level would complete transection = quadriplegia?

A

C4-5

83
Q

Lesions at what locations can produce the same cerebellar Sx as if the lesions were in the cerebellum itself?

A

Any of the Cerebellar peduncles or the Pontine nuclei

3rd year_Neurology (8 decks)

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