Neurology Flashcards
成人中CNS的肿瘤按常见程度排序?良、恶性? Leading CNS/PNS tumors in children? spinal cord?
》50%是转移(lung, breast, kidney, skin melanoma),多个病灶 In adults: 如果是CNS原发,多为solitary tumor. 按常见程度排序 1. GBM (glioblastoma multiforme): 高度恶性,locate within the hemisphere. soft and poorly defined, necrosis + hemorrhage 2. memingiomas: 良性,locate on the brain surface (attached to dura) 3. acoustic neuroma (Schwannoma): arise from CN VIII, locate at cerebellopontine angle In children: 1. astrocytoma; 2. medulloblastoma; 3. ependymoma 室管膜瘤 In spinal cord: 室管膜瘤
CNS/PNS origin: neuroectoderm: give rise to ? Neural crest cells? microglia起源?
neuroectoderm: give rise to 1) CNS neurons, 2) ependymal cells; 3) astrocytes, 4) oligodendrocyte Neural crest cells - 1) PNS neurons, 2) Schwann cells microglia起源: mesoderm (like Macrophage)
neural tube defects: 孕第几周? AFP change? confirmative Dx? 哪几种形式?
孕第几周: 4th week AFP ↑ in amniotic fluid and maternal serum confirmative Dx: ↑ AchE in amniotic fluid 哪几种形式: 1. spina bifida occulta 隐性脊柱裂 no herniation, dura intact ; lower vertebral levels; often tuft hair 2. meningocele 脑(脊)膜突出: meninges (but not spinal cord) herniate through spinal canal [AFP normal!!!!} 3. meningomyelocele 脊髓脊膜突出 both meninges and spinal cord herniate through spinal canal
anencephaly: Cx? associated with ? what can ↓ risk?
Cx: AFP ↑; polyhydramnios (no swallowing center in the fetus brain) associated with type I DM what can ↓ risk: maternal folate intake
holoprosencephaly: 定义?发生孕期?signaling pathway affected? moderate form Cx? severe form Cx?
前脑无裂畸形 定义: failure of left and right hemisphere to separate 发生孕期: 5 - 6th wks signaling pathway affected: Shh moderate form Cx: cleft lip/palate severe form Cx: cyclopia 独眼[畸形]
Arnoid-Chiari malformation: type I vs II? 各自的association?
congenital downward displacement of the cerebellar tonsils through the foramen magnum, sometimes causing non-communicating hydrocephalus as a result of obstruction of cerebrospinal fluid (CSF) outflow. Type I; mild, may be asymptomatic in infants, onset in adults as headache and ataxia (UW考的病例是22岁出现头疼+步态不稳 association: syringomyelia Type II: more severe, significant herniation of cerebellar tonsils and vermis through foremen magnum association: aquaductal stenosis, hydrocephalus Cx: infact lumbosacral myelomeningocele + paralysis below the defect MRI demonstration of type II may include: beaking of the tectal plate (顶盖), aqueductal stenosis, kinking and transforaminal herniation of the medulla into the vertebral canal, and herniation and unrolling of the cerebellar vermis into the vertebral canal
Dandy-Walker: 定义? association?
agenesis (发育不全)of cerebellar vermis + cystic enlargement of 4th ventricle (fills the enlarged posterior fossa) associated with hydrocephalus and spina bifida
syringomyelia: 起病时间?association? 好发脊髓节段?MRI? 横切面上最常累及部位? 什么感觉丧失?
congenital, 起病时间: usually asymptomatic in childhood, manifests with headaches + cerebellar symptoms (起病和Chiari I非常类似,2个病也有association) 好发脊髓节段: C8- T1 MRI: fluid -filled cavity in spinal cord 横切面上最常累及部位:ventral while commissure and ventral horns 什么感觉丧失: bilateral loss of PAIN + Temprature sensation in Upper extremes (fine touch is spared - “dissociated anesthesia”) 常考的情况是病人不能感觉到burn, 被烫伤
Nissl substance -can’t detect which cell type in CNS?
stain RER (cell bodies and dendrites, not in axon) can’t detect microglia
以下neurons的形态?有无髓鞘? 1、 olfactory N 2. auditory N 3. cutaneous N? 4. motor N?
1、 olfactory N: bipolar, nonmyelinated 2. auditory N: bipolar, myelinated 3. cutaneous N (in DRG): pseudounipolar myelinated 4. motor N: multipolar myelinated
which structure ↑ conduction velocity? have high cenc. of which ion channel?
Nodes of Ranvier (on oligodendrites) high cenc. of Na+ ion channel
Oligodendrocytes: in CNS? myelinate how many axons? exist where? origin? in PNS?myelinate how many axons? origin? morphology in H&E staining? injured in which diseases?
in CNS: oligodendrocytes myelin ate how many axons?: > 30 exist where: predominately in white matters origin: neuroectoderm in PNS:Swchann cells myelin ate how many axons?: 1 origin: neural crest!!! morphology in H&E staining: “fried egg” injured in which diseases: MS, PML (progressive multifocal leukoencephalopathy 进行性多病灶脑白质病), leukodystrophies 脑白质营养不良
MS: neurological deficits associated with MS: Patho? 好发在什么节段? Cx? MRI? CSF finding?
neurological deficits associated with MS: 1) Marcus Gunn pupil (relative afferent pupil) - swinging flash test ; 2) MLF sym (medial longitudinal fasciculus sym, 内侧纵束综合症):inter-nuclear opthalmoplegia, 对侧外展神经核与同侧动眼N内直肌核失去fiber 联系, cause medial rectus palsy on attempted lateral conjugate gaze and nystagmus in the abducting eye;[impaired eye adduction during lateral gaze] convergence remains intact 3. Optic neuritis: visual disturbance, painful eye movement 4. cerebellar and motor syn: bowel and bladder dysfunction MS的病理基础是:immune-related demyelinating disease: myelin formed by oligodendrocytes undergoes an inflammatory reaction that impairs impulse transmission in axons in the CNS 常常是exacerbation and remission交替, 2 or more sensory or motor systems are affected in separate attacks. The only cranial or spinal nerve affected is the optic nerve (because all of the myelin sheathes of its axons are formed oligodendrocytes) MRI: scattered, periventricular, plaque-like lesions CSF finding: ↑ IgG (“oligoclonal band” on PAGE) Case: 34-yr female, diplopia; clumsiness of left hand and right foot; clumsiness of right hand before but resolved spontenously
Dx: ascending paralysis several wks after febrile illness? association? affect what cells? microscope? CSF?
Guillain-Barre syn, after respiratory or GI infection; autoimmune ascending paralysis can affect respiratory muscles, and CN VII (Bell’s palsy) strong association with C. jejune affect what cells: Schwann cells demyelinate microscope: Peripheral N demyelination, endoneural inflammatory infiltrate (lymphocytes, macrophages) CSF: ↑ protein + normal or even low cell count [albumino-cytological dissociation]
Bilateral acoustic neuroma associate with?
neurofibromatosis type 2
4 sensory corpuscles各自传导什么感觉? 1. free ending 2. Meissner 3. Pacinian 4. Merkel discs
- free ending: Pain, T 2. Meissner: light touch, position sense 3. Pacinian: pressure, vibration 4. Merkel discs: pressure, deep touch, position sense
Which layer of peripheral N needs to be rejoined in microsurgery for limb attachment? What’s its function?
Perineurium (Permearbility barrier)
神经递质在哪些情况上升?下降? 在哪里合成? NE, DA, 5-HT, Ach, GABA
NE, 蓝斑 DA: Ventral tegmentum 被盖, and SNc 5-HT,: Raphe nucleus Ach: basal nucleus of Meynert GABA: nucleus accumbens 伏核
BBB3大成分? 哪些部分没BBB?
BBB3大成分: 1. tight junction of endothelial cells 2. basement mem 3. astrocyte foot processes 哪些部分没BBB: 1. area postrema 【下丘脑】最后区 - vomit afte chemo 2. OVLT (Organum vasculosum laminae terminalis 【下丘脑】终板血管器) - osmotic sensing 3. neurosecretory products to enter circulation (eg. ADH release) 4. hypothalamic inputs/outputs permeate the BBB
hypothalamus 10 nuclei: function总结? neurohypophysis makes 2 hormones, transport them into posterior pituitary: what are these 2 H, and they are made by which nuclei? ADH made by? oxytocin made by? 调节食欲和肥胖的核团? 调节体温的核团? 调节昼夜节律的核团?
hypothalamus wears TAN HATs T: thirst (ADH - supraoptic nucleus) A: adenohypophysis control anterior pituitary N: neurohypophysis releases hormones into posterior pituitary H: hunger (lateral nucleus); destruction ⇒ anorexia 厌食症; inhibited by leptin A: automonic regulation T: temperatura (anterior nucleus = cooling [A/C]; posterior nucleus: heating) S: sexual urges neurohypophysis makes 2 hormones: 1) ADH made by: supraoptic nucleus 2) oxytocin made by: paraventricular nucleus 调节食欲和肥胖的核团: 1) lateral nucleus: cause hunger; destruction ⇒ anorexia 厌食症; inhibited by leptin [If you zap lateral nucleus, you shrink laterally] 2) Ventromedial nucleus: satiety; destruction ⇒ hyperphagia [临床联系:craniopharyngioma颅咽管瘤中导致肥胖】 stimulated by leptin [If you zap ventramedial nucleus, you grow ventrally and medially] 调节体温的核团: 1) anterior nucleus = cooling [A/C]; Parasympathetic 2) posterior nucleus: heating; sympathetic 调节昼夜节律的核团: suprachiasmatic nucleus (SCN) - circadian rhythm
sleep: controlled by ? driven by? involved neurotransmitters? phases? 每个阶段特点?EEG waveforms?
sleep: controlled by circadian; driven by: SCN (suprachiasmatic nucleus of hypothalamus) involved neurotransmitters: NE (made at SCN), ⇒ pineal gland to release melatonin phases? 每个阶段特点?EEG waveforms? At night, BATS Drink Blood 1. Awake, eyes open: beta (highest frequency, low amplitude) 2. Awake, eyes closed: Alpha 3. Non-REM, stage 1 (5%): Theta - light sleep 4. Non-REM, stage 2 (45%): sleep spindles + J complexes - deeper sleep [bruxism, 磨牙] 5. Non-REM, stage 3 (25%): Delta- lowest frequency, high amplitude; deepest sleep [sleep walking, night terrors, bedwetting] 6. REM (25%): beta; ↑ O2 use, dream, penile/clitoral tumescence 肿胀,memory processing
Which thalamic nucleus controls sensation of pain + Temperature? what else does it mediate? input? output?
VPL also for pressure, touch, vibration, proprioception input: spinothalamic and dorsal columns, medial lemniscus output: primary somatosensory cortex
Which thalamic nucleus controls sensation of face + taste? input? output?
VPM input: trigeminal + gustatory pathway output: primary somatosensory cortex “makeup goes to Face”
Which thalamic nucleus controls sensation of vision? input? output?
LGN (lateral geniculate body) 外侧膝状体 input: CN II output: Calcarine sulcus 距状沟 “Lateral = Light”