Neurology Flashcards
The ______ forms the thalamus and the third ventricle
The ______ forms the cerebral hemispheres and lateral ventricles
Telencephalon
Diencephalon
The pons and cerebellum (and upper part of 4th ventricle) are formed from the ___________
The Medulla and lower part of the 4th ventricle are formed from the ____________
Metencephalon
Myelencephalon
Holoprosencephaly
Failure of…
Related to mutations in….
Failure of left and right hemispheres to separate
Mutations in sonic hedgehog signaling pathway
What are the sensory deficits associated with syringomyelia?
Cape like bilateral loss of pain and temperature sensation in upper extremities (crossing anterior spinal commissural fibers damaged first)
Which branchial arches form the anterior 2/3 of the tongue? the posterior 1/3?
1st and 2nd branchial arches form anterior 2/3
3rd and 4th branchial arches form posterior 1/3
Oligodendrocytes are derived from _______
Schwann cells are derived from _______
Neuroectoderm
Neural crest
Meissner corpuscles sense…
Pacinian corpuscles sense…
Meissner: Dynamic, fine/light touch; position sense
Pacinian: Vibration, pressure
What neurotransmitters are increased in Parkinson disease?
5-HT
ACh
What are two areas of the brain where there is no blood-brain barrier (fenestrated capillaries)?
Area postrema (vomiting after chemo) OVLT (organum vasculosum of the lamina terminalis) - senses osmolarity and determines ADH release
What are the functions of the following areas of the hypothalamus? Lateral area: Ventromedial area: Anterior hypothalamus: Posterior hypothalamus: Suprachiasmatic nucleus:
Lateral area: Hunger
Ventromedial area: Satiety
Anterior hypothalamus: Cooling, parasympathetic (A/C)
Posterior hypothalamus: Heating, sympathetic
Suprachiasmatic nucleus: Circadian rhythm
What causes the eye movements during REM sleep?
PPRF (paramedian pontine reticular formation)
What are the functions and inputs of the following areas of the thalamus? VPL: VPM: LGN: MGN: VL:
VPL: Pain and temperature; pressure, touch, vibration, propioception (Spinothalamic and dorsal columns)
VPM: Face sensation and taste (trigeminal and gustatory pathway)
LGN: Vision (CNII)
MGN: Hearing (Superior olive and inferior colliculus of tectum)
VL: Motor (Basal ganglia, cerebellum)
What is the difference in presentation of a lateral lesion of the cerebellum and a medial lesion of the cerebellum?
Lateral: Propensity to fall toward injured side (controls voluntary movement of extremities)
Medial: Wide based gait and deficits in truncal coordination; bilateral motor deficits affecting proximal limb musculature
What causes neuronal death in Huntington disease?
Neuronal death via NMDA-R binding and glutamate toxicity
How is an essential tremor treated?
β-blockers and primidone
What type of tremor is due to cerebellar dysfunction?
Intention tremor (slow, zigzag motion when pointing/extending toward a target)
Anterograde amnesia is due to bilateral lesion of the ________
Hippocampus
Where is the lesion if the patient looks away from the side of the lesion?
Looks toward the lesion?
Away: Paramedian pontine reticular formation
Toward: Frontal eye fields
What are the differences between the following types of aphasia?
Transcortical motor:
Transcortical sensory:
Mixed transcortical:
Transcortical motor: Non-fluent aphasia with good comprehension and repetition
Transcortical sensory: Poor comprehension with fluent speech and repetition
Mixed transcortical: Non-fluent speech, poor comprehension, good repetition
Cerebral perfusion is proportional to PCO2 until PCO2 is >__mmHg
How can breathing rate help decrease intracranial pressure?
90 mmHg
Hyperventilation decreases PCO2 via decreased cerebral perfusion by vasoconstriction
What is Lateral Medullary syndrome (Wallenberg)?
Lesion of the PICA (lateral medulla/nucleus ambiguus) - Dysphagia, hoarseness, vomiting, vertigo, nystagmus
What is Median medullary syndrome?
Infarct of paramedian branches of ASA and vertebral arteries - tongue deviates ipsilaterally and decreased contralateral propioception
What is lateral pontine syndrome?
AICA lesion leading to paralysis of the face, decreased taste from anterior 2/3 of tongue, and decreased lacrimation and hearing (facial nerve effects)
A lesion of the anterior communicating artery leads to…
A lesion of the posterior communicating artery leads to…
ACom: visual field defects
PCom: CNIII palsy - eye is down and out with ptosis and pupil dilation
What are three associations with a Berry aneurysm?
ADPKD, Ehlers-Danlos syndrome, and Marfan syndrome
How do you visualize an ischemic stroke in the first 3-30 minutes?
How do you visualize between 12-24 hours?
3-30 minutes: diffusion weighted MRI
12-24 hours: dark abnormality on non-contrast CT
What happens in a normal pressure hydrocephalus?
What are the symptoms?
Expansion of ventricles → Distorts the fibers of the corona radiata
Symptoms: Urinary incontinence, ataxia, and cognitive dysfunction (“wet, wobbly, and wacky”)
What are the names of tracts for the following sensations…
Pressure, vibration, touch, proprioception:
Pain temperature:
Crude touch, pressure:
Pressure, vibration, touch, proprioception: Dorsal column
Pain temperature: Lateral spinothalamic tract
Crude touch, pressure: Anterior spinothalamic tract
Which diseases cause lower motor neuron lesions due to destruction of the anterior horns (flaccid paralysis)?
Poliomyelitis and spinal muscular atrophy (Werdnig-Hoffman disease)
What is seen in an infant with Spinal muscular atrophy? What is the prognosis?
“Floppy baby”
Median age of death is 7 months (autosomal recessive)
Friedreich ataxia: Gene (function): Impairment in \_\_\_\_\_\_ function: Cause of death: Presentation:
Gene (function): Frataxin (iron binding protein)
Impairment in mitochondrial functioning
Cause of death: Hypertrophic cardiomyopathy
Presentation: Staggering, falling, nystagmus, hammer toes
In Brown-Sequard syndrome what type of lesion is present?
What are the findings?
Hemisection of spinal cord
Ipsilateral: loss of tactile, vibration, proprioception (1-2 levels below lesion), UMN signs below level of lesion
Contralateral: Loss of pain and temperature below level of lesion
Diaphragm and gallbladder pain referred to the right shoulder via the ______ ____
Phrenic nerve
Which CN’s lie medially at the brain stem?
CNIII, CNVI, CNXII (Motor = medial)
What is the function of…
Superior colliculi:
Inferior colliculi:
Bonus: what is a lesion of the superior colliculi called?
Superior colliculi: Conjugate vertical gaze center
Inferior colliculi: Auditory
Bonus: Parinaud syndrome
Which CN causes eyelid opening?
Which CN causes eyelid closing?
Opening: Occulomotor (CNIII)
Closing: Facial (CNVII)
The gag reflex is due to afferent input from CN__ and efferent action of CN__
CNIX; CNX
Vagal nuclei:
What is the function of the nucleus solitarius?
What is the function of the nucleus ambiguus?
Solitarius: Visceral sensory information
Ambiggus: Motor innervation of pharynx, larynx, and upper esophagus
CNV1 exits through:
CNV2 exits through:
CNV3 exits through:
CNV1: Superior orbital fissure
CNV2: Foramen Rotundum
CNV3: Foramen Ovale
What structures pass through the cavernous sinus?
What happens in cavernous sinus syndrome?
CNIII, IV, V1, V2, and VI and postganglionic sympathetic fibers en route to the orbit
CSS: opthalmoplegia and ↓ corneal and maxillary sensation with normal visual acuity
Low frequency vibrations are heard at _____ near ______
High frequency vibrations are heard best at _____ of _____
Low frequency vibrations are heard at apex near helicotrema
High frequency vibrations are heard best at base of cochlea
If a Rinne test is abnormal, hearing loss is ______
and the Weber test localizes to the ______ ear
conductive; affected
Noise induced hearing loss is due to damage to ________ cells in….
stereocilliated; Organ of corti
A UMN facial lesion causes what effect on the facial muscles?
LMN facial lesion?
UMN: Contralateral paralysis of lower face
LMN: Ipsilateral paralysis of upper and lower face
What is the difference between closed/narrow angle glaucoma and open angle glaucoma?
Open angle: Blocked trabecular meshwork from WBCs, RBCs, or retinal elements (secondary)
Closed angle: Enlargement or forward movement of lens against central iris leading to obstruction of normal aqueous flow through the pupil → fluid builds up behind iris, pushing peripheral iris against cornea and impeding flow through trabecular meshwork (primary)
Why is epinephrine not given during acute close/narrow angle closure glaucoma?
Because of its mydriatic effect
What is the pathway of miosis?
What is the pathway of midriasis?
Miosis: Edinger-Westphal→ciliary ganglion (CNIII)→short ciliary nerves → pupillary sphincter muscles
Mydriasis: Hypothalamus → Ciliospinal center of Budge → Superior cervical ganglion → plexus along internal carotid, through cavernous sinus → long ciliary nerve (enters orbit) → pupillary dilator muscles
What allows bilateral pupillary constriction when light is shone in only one eye?
Pretectal nucleus
What is dry ARMD?
What is wet ARMD?
Dry: deposition of drusen (yellow extracellular material) in and beneath Bruch membrane and retinal pigment epithelium
Wet: Rapid loss of vision due to bleeding 2° to choroidal neovascularization
What is a rapidly progressive dementia with myoclonus?
Creutzfeldt-Jakob disease (spongiform cortex)
What finding is diagnostic of multiple sclerosis? What protein is increased?
Oligoclonal bands
Increased IgG
Acute disseminated encephalomyelitis is demyelination common after what infections?
Measles or VZV
Charcot-Marie Tooth disease is a group of nerve disorders related to…
What are the clinical findings?
Related to defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath
Associated with scoliosis and foot deformities (high or flat arches)
What proteins buildup in Krabbe disease?
What builds up in Adrenoleukodystrophy?
Krabbe: Galactocerebroside and psychosine (destroy myelin)
Adrenoleukodystrophy: Very-long chain fatty acids
What is the difference between a simple partial seizure and a complex partial seizure?
Simple: Consciousness intact
Complex: Impaired consiousness
What is the POUND mnemonic for migraines?
Pulsatile, One-day, Unilateral, Nausea, Disabling
Sturge-Weber syndrome is due to an activating mutation of the _____ gene
What is the STURGE mnemonic?
GNAQ gene port wine Stain Tram track Ca2+ Unilateral Retardation Glaucoma Epilepsy
What is seen with Tuberous sclerosis?
Hamartomas in CNS and skin Angiofibromas (morgan freeman) Mitral regurgiation Ash leaf spots Rhabdomyoma
What is seen in VHL?
Cavernous hemangiomas in skin
Bilateral renal cell carcinomas
Pheochromocytomas
Hemangioblastomas in retina, brain stem, cerebellum
Give one or two associations for each of the following adult brain tumors... Glioblastoma: Meningioma: Hemangioblastoma: Schwannoma: Oligodendroglioma:
Glioblastoma: Pseudopalisading; crosses corpus callosum
Meningioma: Spindle cells in a whorled pattern; psammoma bodies
Hemangioblastoma: Can produce erythropoietin; VHL
Schwannoma: cerebellopontine angle; S-100
Oligodendroglioma: Fried egg cells, chicken wire capillary pattern
Give one or two associations for each of the following childhood brain tumors... Pilocytic astrocytoma: Medulloblastoma: Ependymoma: Craniopharyngioma:
Pilocytic astrocytoma: Rosenthal fibers, cystic
Medulloblastoma: drop metastases, homer-wright rosettes
Ependymoma: 4th ventricle, perivascular rosettes
Craniopharyngioma: Rathke pouch, calcification possible
What is the MAC?
Minimal alveolar concentration of inhaled anesthetic required to prevent 50% of subjects from moving in response to noxious stimulus
Potency = 1/MAC
What is a Charcot-Bouchard aneurysm?
An aneurysm in the basal ganglia, cerebellum, thalamus or pons that can rupture, leading to hemorrhage within the brain
What is the only bilateral type of headache?
Which headache is repetitive?
Which headache presents with periorbital pain and lacrimation?
Bilateral: Tension (steady pain)
Repetitive: Cluster
Periorbital pain: Cluster
How is a cluster headache differentiated from trigeminal neuralgia?
Based on duration: Trigeminal neuralgia produces shooting pain in the distribution of CN V that lasts 15 minutes)
