Neurology Flashcards
1
Q
How do neurochord defects formed?
A
Neuropores fail to fuse in 4th week
Have persistant connection between amniotic cavity and spinal canal
Associated with low folic acid intake before the contraception and during the pregnancy
2
Q
How to diagnose neural tube defects?
A
Increased alpha fetoprotein
Increase acetylycholinesterase in amniotic
3
Q
What is spina bifida occulta?
A
Failute of bony spinal canal to close (no herniation)
Usually at the lower vertebral levels
Dura is intact
Associayed with a tuft of hair or skin dimple at the level of bony effect
4
Q
Meningocele?
A
Meniniges (but no neural tissue) herniates through the bony defect
5
Q
Meningomyelocele?
A
Meninges and neural tissue herniate through the bony defect
6
Q
Anencephaly?
A
Malformation of anterior neural tube (no forbrain, empty calvarium)
Increase AFP
Polyhydraminos
Associated with maternal type 1 diabetes
No swallowing center of the brain
Forebrain
7
Q
Holoprosencephaly?
A
Failure of the right and left hemisphere to seperate
Usually occurs during 5-6
Forebrain
8
Q
Chairi II malformations?
A
Herniation of low lying cerebeller vermis through the foramon mangnum
Causes hydrocephalus
Associated with lumbrosacral meninogmyelocele
9
Q
Dandy-Walker syndrome?
A
Agenesis of the cerebellar vermis with cystic enlargement of the 4th ventricles
Enlarged posterior Fossa
10
Q
Syringomyelia?
A
Cystic cavity (syrinx) within the central canal
Fibers crossing anterior white commissure are damaged first
Have cape-like bilateral loss of pain and temperature sensation in the upper extremities
Manifestations: Bilateral loss of pain and temperature sensation in the upper extremities
11
Q
What is Chiari I malformation?
A
Cerebeller tonsillar ectopia (between 3-5mm) cengential, assymptomatic in childhood.
Manifests with headache and cerebellar symptoms
12
Q
What are nerves of the tongue?
Taste
Pain
Motor
A
Taste: CN VII, IX, X
Pain: CN V3, IX, X
Motor: CN X, XII
13
Q
What are neurons?
A
Signal transmitting cells of the nervous system
Permanent cells (do not divide in adulthood)
Have signal relaying dendrites (receive input) cell bodies, axons send cell output
14
Q
What happens when there is an injury to the axon ?
A
Have degeneration distal to the injury and axonal retraction
15
Q
What is the function of astrocytes?
A
Physical support Repair K metobolism Removal excess neurotransmitter Compoenent of blood brain barrier Glycogen fuel reserve buffer
16
Q
what is a microglia
A
Are scavenger cells within the CNS
in HIV fuse to form multinucleated giant cells in CNS
17
Q
What are Myelin cells?
A
Increase conduction of velocity signals transmitted down axons
Saltatory conduction of action potentials at the nodes of Ranvier
(High concentration of Na+ channels), oligodendrocytes
Wraps and insulates the axon
18
Q
What are Schwann cells?
A
Each Schwann cell myelinated only 1 PNS neuron
Promotes axonal regeneration
Increases condution velocity via saltatory conduction at the nodes of Ranvier
There is a high concentration of Na+ channels
19
Q
What are oligodendroglia?
A
Myleinates axons of neurons in CNS Predominate type of glial cell Derived from neuroectoderm Fried egg appearance Injured in multifocal leuckoencephalopathy
20
Q
Free nerve endings?
A
C-slow unmyelinated fibers
A gamma- fast myelinated fibers
Location: all skin, epidermis with some viscera
Senses pain, temperature
21
Q
Meissner corpuscles?
A
Large, myelinated fibers adapt quickly
Location: deep skin layers and ligament joints
Respond to vibration and pressure
22
Q
Pacinian corpuscles?
A
Large myelinated fibers (adapt quickly)
Deep skin layers, ligaments and joints
Respond to vibration and pressure
23
Q
Merkel disks?
A
Large myelinated fibers adapt slowly
Location: finger tips, superficial skin
24
Q
Ruffani corpuscles?
A
Dendritic endings with capsule
Adapt slowly
Fingertips and joints
Senses: Pressure slippage of objects along the skin surface
25
What are portions of the peripheral nerves?
Endoneurium: single nerve fiber layers
Perineurium: surrounds the fascicle nerve fibers
Must be rejoined in microsurgery of the limp
Epineurium:
Dense Connective tissue that surrounds the entire nerve (fascicles and blood vessels)
26
Where are the following neurotransmittors found?
| What happens in their clinical diseases?
Acetylcholine (Basal nucleus Meynett)
Alzeihmer's disease: decrease
Huntington's disease: decrease
Parkinson's disease: increase
```
Dopamine: (Ventral tegmentun SNCP)
Depression: decrease
Schizophrenia increase
Huntington: Increase
Parkinson: decrease
```
GABA (nucleus accumbens): decrease anxiety, decrease huntingtons
Norepinephrine: (locus ceruleus)
Increase in anxiety
Decrease in depression
Serotonin (raphe nucleus)
Decrease in anxiety
Decrease in depression
Increase in Parkinsons
27
Functions of the hypothalamus?
Thirst and water balance
Adenohypophysis (regulates anterior pituitary)
Neurohypophysis:
Hunger
Autonomic regulation Temperature regulation
Sexual urges
28
What does the lateral area do?
Hunger
| destruction will lead to anorexia
29
Function ventromedial area?
Satiety Destruction (craniopharyngioma)
30
Function of anterior hypothalamus?
cooling
| parasympathetic
31
Function of posterior hypothalamus?
Heating
| Sympathetic
32
Function of suprachiasmatic nucleus?
Circadian rhythm
33
What controls sleep?
Circadian rhythm (by the supracharismatic nucleus)
34
What hormones are released by nocturnal controls?
Norepinephrine, pineal gland, melatonin,
35
What are the stages of sleep physiology?
REM and non REM
| REM occurs every 90 minutes and duration of REM increases with release of ACh
36
What substances are associated with decrease REM?
ETOH, benzo, barbiturates
37
How to treat bedwetting?
Sleep enuresis, treated with desmopressin (ADH analog) preferred over imipramine
38
What medication is useful for night terrors and sleep walking?
Benzodiazepines
39
What are the ECG waveforms for the different stages of sleep?A
Awake (eyes open, alery, active mental concentration) Beta waves
Awake (eyes closed) alpha
40
What are stages of NON-REM sleep?
N1 (5%) light sleep (theta)
N2 (45%) deeper sleep when bruxism occurs (sleep spindles and K complexes)
N3 (25%) Deepest non REM sleep (slow wave) when sleepwalking, night terrors, and bed wetting
41
What is REM sleep?
```
Loss of motor tone
Increase in O2 use
Variable pulse pressure
Penile and clitoral tumescence
May serve memory
```
42
Use of Ventral postero-lateral nucleus ?
Input: spinothalamic and dorsal columns
Senses Pain, temperature, touch, vibration and proprioception
Destination: somatosensory cortex
43
Use of the ventral-postero medial nucleus?
Trigeminal and gustatory pathways
Responsible for face sensation and taste
Destination: primary somatosensory cortex
44
Lateral geniculate nucleus?
CN 2
Responsible for vision
Destination: Calcarine sulcus
Lateral=light
45
Medial geniculate nucleus?
Input: superior oliver and inferior colliculusof tectum
Senses:
46
Ventral lateral nucleus?
Input: basal ganglia, cerebellum
Senses: Motor
Destination: Motor Cortex
47
What is the limbic system?
Collection of neural structures involved in emotion, long-term memory, olfaction, and behavior modification
Structures include: hippocampus, amygdala, fornix, mammilary bodies, cingulate gyrus
(responsible for feeding, fleeing, fighting, sex)
48
What happens when the following dopaminergic pathways are damaged?
Mesocortical
Mesolimbic
Nigrostrial
Tuberoiunfundibular
Mesocortical: negative symptoms (flat affect and limited speech, antipsychotic durgs have limited effect)
Mesolimbic: positive symptoms (delusions, hallucinations),primary target of anti-psychotics
Nigrostriatal: decreased activity leads to extrapyramidal symptoms such as dystonia, akathisia, parkinson, tardive dyskinesia
Major Dopinergic pathway in the brain, significantly affected by movement disorders and antipsychoti drugs
Tuberinfundibular: decreased in activity leads to increase in prolactin, galactorreha and gynecomastia
49
Function of the cerebellum?
Modulates movement and aids in coordination and balace
Input: contralateral cortex via middle cerebeller peduncle
ipsilateral cerebellar pununcle from the spinal cord
Output: sends information to the contralateral cortex, via the superior cerebellear peduncle
50
Lateral lesions of the cerebellum?
Voluntary movement of extremitires with propensity to fall toward the injured, ipsilateral side
51
Medial leisions?x3
Involvement of the mideline structures (vermal cortex, fastigial nuclei)
will have truncal ataxia, nystagmus, head tilting, and affect axial and proximal gait.
Will generally have bilateral motor deficits affecting axial and proximal limb musuclature
52
Functions of Basal Ganglia?
Recieves cortical input (provides negative feedback to cortex to modulate movement)
53
What does striatum affect?
putamen (motor) + caudate (cognitive)
54
What does lentiform affect?
Putamen + globus pallidus
55
Movement disorders: athetosis?
Slow, writhing movements of the fingers
| Lesion within the Basal gangla (huntingtons)
56
Movement disorders: Chorea?
Sudden, jerky, purposeless movement
| Basal ganglia lesion
57
Essential tremor?
High frequency tremor with sustained posture (outstrected arms) worsened with movements or when anxious
58
Hemiballismus?
Sudden, wild flailing of 1 arm, +/- ipsilateral leg
| Usually due to contralateral subthalamic nucleus
59
Intention tremor?
slow, zigzagging motion when pointing/extending toward a target
Due to cerebellar dysfunction
60
What is myoclonus?
sudden, brief, uncontrolled muscle contraction
| Will have jerks, hiccups, common abnormalities in the renal and liver failure
61
What is a resting tremor?
Uncontrolled movement of the distal appendages
Tremor is allreviated by intentional movement
Occurs as a pill-rolling tremor (Parkinsons)
62
Characteristics of parkinson's disease?
Degenerative disorder for the CNS associated with Lewy bodies
Loss of dopaminergic neurons
```
Tremor
Rigidity
Akinesia
Postural instability
Shuffling gait
```
63
Characteristics of Huntington's disease?
```
Autosomal dominent
Symptoms manfest between 20-50 years of afe
Chloriform movemebts
agression
Depression
Dementia
Increase dopamine
Decrease dopamine
Decrease GABA
Decrease Ach
```
64
What is aphasia?
Inability to understand, speak, read and write
| higher learning language deficit
65
Dysarthria?
Motor inability to speak (movement deficit)
66
Broca aphasia?
Non fluent speech
Comprehension is intact
Reptition is impaired
Due to inferior frontal gyrus of frontal lobe
67
Wernicke's aphasia?
Speech fluidity: fluent
Comprehension: impaired
Repitition: impaired
Wernicke is wordy but makes no sense
68
Conduction aphasia?
Fluidity: fluent
Comprehension: intact
Repeatition Impaired
Caused by damage to the arcuate fasciculus
69
Global aphasia?
Fluidity: non
Comprehnesion: impaired
Repitition: impaired
Region: arcuate fasciculus (Broca and Wernicke's areas are affected)
70
Transcortical motor aphasia?
Fluidity: nonfluent
Comprehension:intact
Repetition : Intact
Affects the frontal lobe around Broca (but Broca area is spared)
71
Transcortical sensory apahsia?
Fluidity: fluent
Comprehension: impaired
Repitition: Intact
Affects the temporal lobe around the wenicke area, but the wernicke is spared
72
Transcortical mixed
Broca and Wernicke area and arcuate fasciculus remain intact, but surrounding watershed areas are affected
73
Leisions of the brain associated with amygdala?
Kluver-Bucy syndrome (uninhibited behavior: hyperphagia, hypersexuality, hyperorality)
Associated with HSV-1 encephalitis
74
Lesions to the frontal lobe?
Disinhibition and deficits in concentration
| Re-emergence of primitive reflexes
75
Leisions of nondominent parietal cortex?
Hemispatial neglect syndrome (agnosia of contralateral side of the world)
76
Lesions of the dominenet parietal cortex?
Agraphia, acalculia, finger agnosia, left-right disorientation
77
Lesions of reticular activating system (midbrain)
Reduced levels of arousal and wakefulness
78
Mamillarybody lesions?
Wernicke Korosakoff syndrome
Confusion
Ophtalmopelgia, ataxia, memory loss, anterograde and retrograde amnesia
Confabulation, personality changes
Associated with thiamine (B1 deficiency) due to ETOH
Can be associated with ataxia, nystagmus, and confusion
79
Lesions of the of the basal ganglia?
Tremor at rest
Chorea
Athetosis
Parkinsons Disease
Huntington's disease
80
Lesions of the Cerebeller hemisphere?
```
Limb tremore
limn atazia
lose of balance
Ipsilateral deficits
Fall toward side of the lesions
```
Associated with chronic ETOH use
81
Lesions of the cerebellar vermis?
Truncal ataxia
Dysarthria
Vermis is centrally located
82
Lesions of the subthalamic nucleus?
Contralateral hemiballismus
83
Lesions of the hippocampus (bilateral)
Antegrade amnesia (inability to make new memories)
84
Paramedian pontine reticular formation leisions?
Eyes that look away from the side of the leision
85
Frontal eye field leisions?
Eyes look toward the leisions
86
How does cerebral brain perfusion occur?
Relies on autoregulation (driven by PCO2)
| When there is severe hypoxia then (PO2 will modulate perfusion)
87
what does cerebral perfusion rely upon?
The gradient between the mean arterial pressure (MAP)and the ICP
Decrease in BP or increase in ICP leads to decrease cerebral perfusion pressure
88
What is therapeutic hyperventilation?
```
Decrease PCO2:
leads to vasoconstriction
decrease cerebral blood flow
Decrease in ICP
Used to treat acute cerebral edema (due to stroke)
```
89
What is the CPP calculation?
CPP= MAP-ICP
| If the CPP is zero, there is no cerebral perfusion, leading to brain death
90
What is area of distribution for anterior cerebral artery?
Anteromedial surface
91
Area of distribution of middle cerebral artery?
Lateral surface of the brain
92
Area supplied by the posterior cerebral artery?
Posterior and inferior surfaces
93
What are the watershed areas?
Areas between the anterior and middle
Between the posterior and middle cerebral arteries
Damage due to severe hypotension (upper leg/upper arm weakness) defects in higher order visual processing
94
what is the circle of Willis?
Anterior cerebral artery, connects to middle cerebral artery to the posterior cerebral artery, to the internal carotids
95
Stroke in the middle cerebral artery?
Motor and sensory cortices (upper limb and face)
Temporal lobe: Wernicke's area
Frontal lobe (Broca)
Symptoms: contralateral paralysis and sensory loss of the face and upper limb
Aphasia if in the dominenet left hemisphere
Hemineglect if lesion affect non dominant side
96
Lesion of the anterior cerebral artery?
Motor and sensory lower limb
| Contralateral paralysis and sensory loss (lower limb)
97
Lenticulostriate artery?
Striatum and internal capsule
Leads to contralateral paralysis and sensory loss
(face and body(
Will have absence of cortical signs including : neglect, aphasia, visual field loss
This is a common location of the lacunar infarcts, secondary to unmanaged hypertension
98
Lesions of the anterior spinal artery?
```
Contralateral paralysis (upper and lower limbs)
Decreased contralateral proprioception
Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)
```
99
Medial medullary syndrome?
Caused by infarct of the paramedian branches of Anterior spinal artery or the vertebral arteries.
100
Lesions of the posterior inferior cerebral artery
```
will affect:
Lateral medulla
Lateral spinothalamic tract
Spinal trigeminal nucleus
Sympathetic fibers
Inferior cerebral penduncle
```
```
Symptoms:
Vomiting
Vertigo
Nystagmus
Decrease in pain and temperature sensation from ipsilateral face and contralateral body
Dysphagia
Hoarseness
Decrease in gag reflex
Ipsilateral Horner syndrome
```
101
What is the laterl medullary (Wallenberg syndrome)?
Nucleus ambiguous effects are specific to posterior inferior cerebellar artery
"Don't pick a horse (hoarseness) that can't eat (dysphagia)
102
Lesions of the anterior, inferior cerebellar artery?
Lateral pons (cranial nerve nuclei, vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei)
Spinothalamic tract
Corticalspinal tract
Sympathetic fibers
Middle and inferior cerebellar peduncles
```
Symptoms:
Vomiting
Vertigo
Nystagmus
Paralysis of the face
Decrease lacrimation
Decrease salivation
```
103
Lesions of the basal artery?
Pons
Medulla
Lower midbrain
Corticospinal, corticobulbar tracts (ocular cranial nerve nuclei)
Preserved consciousness
Vertical eye movement
Lost off voluntary facial, mouth, and tongue movements
Loced in syndrome
104
Lesions in the posterior cerebral artery?
Area of leision: occipital cortex and visual cortex
| Leads to contralateral hemianopia with macular sparing
105
Lesions of the middle cerebral artery?
Rupture may cause ischemia in the MCA distribution (contralateral upper extremity, facial hemiparesis and sensory deficits)
106
Central post stroke pain syndrome?
Neuropathic pain due to thalamic lesions
Initial parestheisis followed in weeks to months by allodynia and dysesthesia
Occurs in 10% of stroke patients
107
Epidural hematoma?
Rupture of middle meningeal artery (branch of maxillary artery) usually due to skull fracture
Lucid interval followed by rapur expansion under systemic arterial pressure
Can cause transtentoria herniation
CN III palsy
CT will show biconvex (lentiform) hyperdense blood collection that doesn't
108
Subdural hematoma?
Rupture of the bridging viens
Can be acute, will have traumatic, high energy impact or chronic due to to mild trauma, cerebral atrophy, elderly , ETOH
Seen in shaking babies
Predisposing factors: brain atrophy and trauma
109
Subarachnoid hemorrhage?
Rupture of aneurysm (such as saccular aneurysm) or AV malfomation
Rapid time course
Starts with the worst headache of their lives
Will have a bloody or yellow spinal tap
Can occur with ischemic infarct
110
How to prevent transformation of subarachnoid hemorrhage from an ischemic stroke?
Give nimodipine
111
What is intraparenchymal hemohage?
Commonly caused by systemic hypertension
Also seen with amyloid angiopathy
Vasculitis or neoplasm
May be secondary to reperfusion injury within ischemic stroke
Typically occurs in basal ganglia and internal capsule
(Charcot-Bouchard aneurysm of the lenticulostriate vessels
Can be lobar
112
When does irreversible damage to the brain occur?
After 5 minutes of hypoxia
113
What are regions most vulnerable for damage in the brain?
Hippocampus
Neocrotex
Cerebellum
Watershed areas
114
What type of test is required for a stroke?
Non contrast CT to exclude hemorrhage (before tPA can be given)
CT detects ischemic changes 6-24 hours after
MRI can detect ischemia within 2-30 minutes
115
What are the three types of ischemic stroke?
Thrombotic :due to clot formation directlyat the site o infarction (commonly MCA) over atherosclerotic plaque
Embolic : embolus from other part ofthe body, obstructs the vessel (Can affect multiple vascular territories)
For example: afib, DVT or presence of PFO
Hypoxic: due to hypoperfusion or hypoxemia
(Common during cardiovascular surgery) tends to affect watershed areas
116
When can TPA be used for stroke?
If within 3-4.5 hours of onset
| No risk of hemorrage
117
How to reduce the risk of stroke?
```
ASA and Plavix
Optimum control of blood pressure
Control blood sugar
Control lipids
Treat A fib
```
118
Definition of TIA?
Brief, reversible episode of neuro dysfunction without acute infarct (MRI -) usually resolves within 15 minutes
119
What are dual venous sinuses?
Large venous channels that run through the dura
Drain blood from cerebral veins and recieve CSF from arachnoid granulations
Empty into the internal jugular vein
120
What is a venous sinus thrombosis?
Presents with signs/symptoms of increase ICP
| Headache, seizure, focal neurological deficits.
121
what conditions are associated with Venous sinus thrombosis?
Hypercoagulable states (pregnancy, OCP, factor V Leiden)
122
Idiopathic intracranial HTN?
Symptoms?
Risk?
Increase in ICP with no cause on imaging ( no hydrocephalus, or obstruction of CSF flow)
Symptoms: headache, diplopia (CN V1 palsy)
No change in mental status
Papilloedema
Lumber puncture has increased opening pressure and provides headache relief
Treatement: weight loss, acetazolamide, topimarate, invasive procedures for refractory cases
(repeat lumber puncture
CSF shunt placement
Optic nerve fenestration
123
What does hydrocephalus mean?
Increase in CSF volume with ventricular dilation and increase in ICP
124
What is communicating hydrocephalus>
Decrease CSF asbsorption by arachnoid granulations
| Increase in ICP leading to pailledema and herniation
125
What is normal pressure hydrocephalus?
```
Elderly
Idiopathic
CSF pressure only periodically elevated
Expansion of the ventricles
Distorts fibers of the corona radiata
```
126
What are the triad of normal presssure hydrocephalus?
Urinary incontinence
Ataxia
Cognitive dysfunction
127
What is the cause of non communicating (obstructive hydrocephalus)
Caused by structural blockage of CSF circulation within the ventricular syste
Usually caused by stenosis of aqueduct of Sylvius
Colloid cyst blocking foraman of Monroe
Tumors
128
What are conditions of hydrocephalus mimics?
Increase appearance on CSF imaging, but actually due to decreased brain tissue
Causes neuronal atrophy
(Alzheimer disease, advanced HIV, Pick disease)
ICP is normal
Triad is not seen
129
How mant spinal nerves are there?
There are 31 pairs of spinal nerves
```
8 cervical
12 thoracic
5 lumbar
5 saccral
1 coccygeal
```
130
Where do the spinal nerves exit?
C1-C7 above the corresponding vertebraw
131
Where does the subarachnoid space extend to?
The lower border of the S2 vetebrae
132
Where do lumber puncture usually performed?
L3 and L4
or
L4 and L5
133
Describe the anatomy of the spinal cord?
```
white matter on the outside
Grey matter is butterfly on the inside
CSF directly in the middle
Venticle fissue
Dorsal median sulcus
```
134
what are the parts of the dorsal column?
Gracile
| Cuneate
135
What is the dorsal column responsible for?
Proprioception
| Fine touch
136
Briefly describe the Dorsal Column Tract?
Responsible for: fine touch and proprioception
There are 3 axon bodies
Sensory and nerve endings in dorsal root ganglion---> entrs the spinal cord---> ascends ipsilaterally and synapses in the cuneatus or gracilus medulla ---> decussates in medulla (at this point contralaterally) ---> synapses in the thalamus
137
Briefly describe the spinothalamic tract?
Responsible for : Pain, temperature (anterior for crude touch and pressure)
Sensory nerve ending ---> to the dorsal root ganglions--> enters the spinal cord--->ipsilateral in the spinal cord---> decussates in the anterior white commisure----> ascends contralaterally ---> ends in the sensory cortex
138
Briefly describe the lateral corticospinal tract?
Responsible for: Voluntary movement of the contralateal limbs
Upper motor neuron: descends ipsilaterally (through internal capsule) ---> decussade at the caudal medulla---> descends contralaterally---> cell body in the anterior horn---> lower body neuron leaves the spinal cord
139
What are characteristice of lower moter neuron leision vs upper motor neuron?
```
Lower Motor Neuron:
Atrophy
Fasciulations Flaccid paralysis
Decrease of reflexes
Decrease of Tone
```
```
Signs of Upper Motor Neuron Leison:
Increase reflexes
Increase tone
Babinsky _
Spastic paralysis +
Clasp knife spascitiy
```
140
Characteristics of Poliomyelitis and Werdnig-Hoffmann disease?
Congential degeneration of the anterior horn of spinal cord
Usually have lower motor neuron leisions
Floppy baby
Have hypotonia and tongue fascilations
Usually death at 7 months
Difference between Poliomyelitis and Werdning Hoffmann- symmetric weakness
141
Characteristics of amyotrophic lateral sclerosis?
Combined upper and lower motor deficits wih no sensory/bowel/bladder defects
(loss of cortical and spinal cord neurons respectively)
Have assymetric weakness, with fascilations and eventual atrophy
Known as Lou Gehrig's disease
142
Characteristics of complete occulsion of the anterior spinal artery?
Spares dorsal column
| Anterior spinal artery is a watershed area.
143
Charactersitics of Tabes dorsalis?
Caused by 3 syphilis
| Degeneration or demyelination of dorsal columns and roots leading to ataxia and poor coordination
144
Characteristics of Syringomyelia?
Syrinx can expand and damage anterior commisure of spinothalamic tract
Bilateral loss of pain and temperature sensation in cape-like distribution
145
Characteristics of Vitamin B deficiency?
Sub acute degeneration (demyelination of Spinocerebeller tracts), lateral corticospinal tracts, and dorsal column.
Leads to ataxia, paresthesia, impaired position/vibration
146
What is poliomyelitis?
Caused by poliovirus (fecal-oral transmission)
Replicates in the oropharynx and small intestine before spreading via bloodstream to the CNS
Infection causes destruction of the cells in anterior horn of the spinal cord (LMN death)
Signs of polio: weakness, hypotonia, flaccid paralysis, fasciculatios, hyporeflexia, muscle atropy
Signs of infection: malaise, headache, fever, nausea
CSF shows: increased WBC with increase in protein
147
What is Friedereich's ataxia?
Autosomal recessive trinuclotide repeat (GAA) on chromosome 9
Impingement in mitochrondiral functioning
Degeneration of multiple spinal chord tracts
Muscle weakness and loss of DTR (vibratory sense, proproception, staggerring gait, frequent failing, nystagmus. dysarthrai, hammer toes, diabetetes, hypertrophic cardiomyopathy
In childhood presents with kyphoscoliosis
148
What is Brown-Sequard syndrome?
Hemisection of the spinal chord
Ipsilateral UMN signs below the level of the leision (due to corticospinal tract damage)
Ipsilateral loss of tacitile vibration, proprioception sense below the level of the leision due to dorsal column damage
Contralateral pain and temperature loss below the level of the leision (due to spinothalamic tract damage)
Ipsilateral loss of all sensations at level of the leision
Ipsilateral LMN signs (flaccid paralysis) at the level of leision
If leision occurs above the T1, patient may present with ipsilateral Horner syndrome due to damage of the oculosympathetic pathway
149
dermatome C2?
Posterior half of the skull cap
150
dermatome of C3?
High turtleneck shirt
151
dermatome of C4?
Low coller shirt
152
dermatme of C6?
arm and includes the thumbs
153
T4?
at the nipple
154
T7?
at the xiphoid process
155
T10?
at the umbolicus
156
L1?
At the inguinal ligametn
157
L4?
Includes the kneecaps
158
S2, S3, S4?
erection and sensation of penile and anal zones
159
Where does diaphgram and gallbladder pain refer?
Referred pain to the shoulder via the phrenic nerve
160
reflexes of the biceps?
C5 nerve root
161
Reflexes of the triceps?
C7
162
Reflexes of the patallea?
L4
163
Reflexes of the achilles?
S1 nerve root
164
when do primitive reflexes occur?
Inhibited by mature developing frontal lobe
Can reemerge if the adult has frontal lobe leisions
Leads to loss of inhibition of the reflexes
165
Moro reflex?
Hang on for life
| Abduct and extend arms when startled (and then draw together)
166
Rooting reflex?
Movement of the head toward one side if cheek or mouth is stroked
167
Sucking reflex?
Sucking response when roof of the mouth is touched
168
Palmar reflex?
Curling fingers if palm is stroked
169
Plantar reflex?
Dorsiflexion of large toe and fanning of other toes with plantar stimulation
Babinski sign: presence of this reflex in an adult (UMN)
170
Galant reflex?
Stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of the lower body toward simulated side
171
Which cranial nerves are above the pons?
I
II
III
IV
172
Cranial nerves in the pons?
V
V1
V11
V111
173
Cranial nuclei that are medial?
III
IV
VI
X11
174
function of the pineal gland?
Melatonin secretion
| Circadian rhythms
175
Superior colliculi?
Conjugate vertical gaze center
| note, your eyes are above your ears, and the superior colliculus are above the inferior colliculus..ears
176
Inferior colliculi?
Auditory
177
Parinaud syndrome?
Paralysis of conjugate vertical gaze due to leision of superior colliculli (stroke, hydrocephalus
178
Cranial nerve I?
Olfactory
179
Cranial nerve II
Optic
180
Cranial nerve III
Oculomotor (eye movement), pupillary constriction, accomodation
181
Cranial nerve IV?
Trochlear
| eye movement
182
Cranial nerve V?
Trigeminal
| Mastication, facial sensation (opthalmic, maxillart, mandibular, diviison) somatosensation of anterior 2/3 of the tongue
183
Cranial nerve VI
Abducens (eye movement)
184
Cranial nerve VII
```
Facial movement
Taste from anterior of the 2/3 of the tongue
lacrimation
salivation
eyelide closing
Auditory volume
```
185
Vestibulocochlear VIII?
Hearing and balance
186
Glossopharyngeal IX?
Taste and sensation from posterior 1/3 tongue, swallowing, salivation (parotid gland)
Monitoriing carotid body, sinus, chemo and baroreceptors
187
Vagus X?
Taste from supraglottic region
Swallowing
Soft palate elevation
talking, coughin, parasympathetics to thoracoabdominal viscera
188
Accessory XI
Head turning, shoulder shrugging, SCM, trapezius
189
Hypoglossal XII
Tongue movement
190
What are the vagal nuclei *nucleus solitarius*?
Responsible for visceral sensory information
(taste, baroreceptors, gut distention)
Cranial nerve VII, IX, X
191
Nuclue ambigous?
Motor innervation of the pharynx, larynx, upper esophagus
| IX, X, XI
192
Dorsal motor nucleus?
Sends autonomic parasympathetic fibers to the heart,lung, and upper GI
193
Corneal nerve reflex?
Afferent: V1 opthalmic
Efferent:V2 (temporal branch)
194
Lacrimation reflex?
```
Afferent V1 (loss of V1 does not preculude emotional tears)
Efferent: V11
```
195
Jaw jerk reflex?
Afferent: V3 (sensory-muscle spindle from masseter)
Efferent: motor-masseter
196
Pupillary reflex?
Afferent II
| efferent: III
197
Gag reflex?
Afferent IX
| Efferent X
198
CN 5 lesion?
Jaw deviates toward the side of the leision due to unopposed force from the opposite ptergoid muscle
199
CN X lesion?
Uvula deviates awat from the side of the leision (weak side collapses_
200
CN X1 lesion?
weakness turning head to contralateral side of the leision (SCM)) shoulder droop on side of lesion (trapezius)
201
CN XII leision?
LMN leision (tongue deviates toward the side of the leision) lick your wounds
202
What are the mastication muscles?
Masseter
Temorarlis
Medial pterygoid
203
Facial nerve leision (upper motor neuron)
Destruction of motor cortex or connection between motor cortex and facial nucleus in the pons
Contralateral paralysis of lower muscles of facial expression
Forehead is spared due to bilateral UMN innervation
204
Lower motor neuron leision?
Destruction of facial nuclues or CN VII anywhere along it's course
Ipsilateral paralysis of upper and lower muscles (facial exoression)
hyperacusis (loss of taste and sensation to the anterior tongue)
205
Clinical syndrome of CN VII leision?
Causes partial or complete loss of function depending on location or severity of the leision
Can cause partial or complete loss of function
206
What is Bell's palsy?
Caused by Lyme diseas, herpes, herpes zoster, sarcoidosis trauma, DM
207
What is treatment of Bell's palsy?
Corticosteroids
Acyclovir
Most have gradual return of function
208
What are cavernous sinus?
| What is cavernous sinus syndrome?
Collection of sinus on either side of the pituitary gland
Blood from eye and superficial cortex lead to the cavernous sinus, to the internal jugular vien
Cavernous sinus syndrome: variable ophtalmoplegia, decreased corneal sensation, Horner syndrome, decreased maxillary sensation
```
Can be caused by pituitary mass effect
Sinus thrombosis (due to infection)
```
209
What is the outer ear?
visible portion (pinna) includes
auditory canal
eardrum
Transfers waves via vibration of the eardrum
210
What is the middle ear?
Air filled space with three bones, ossicles, malleus, incus, stapes
Ossicles conduct and ampligy sound from eardrum to inner ear
211
what is the inner ear?
Snail shaped, fluid filled cochlea
Have basilar membrane that vibrates 2 to sound waves
Vibration is transduced via special hair cells ---> auditory nerve signalling to the brain stem
212
Where is low frequency heard?
Apex near the helicotrema
213
Where is high frequency heard?
At the base of cochlea
214
What is conducive hearing loss?
Rinne test abnormal (put a tuning fork on mastoid), the air should be better then the bone (512 HZ)
(bone more then air)
Webber test: localized to affected ear (on forehead) and both ears should hear the same
215
What is sensorineural hearing loss?
```
Rhine test (air more then bone) NORMAL
Weber test (localized to the affected ear)
```
216
What is noise induced hearing loss?
Damage to sterociliated cells in organ of Corti
Loss of high frequency hearing lost first
Sudden extremely loud nosed can result in hearing loss due to tympanic membrane rupture
217
Cholestetoma?
Overgrowth of desquamated keratin debris within the middle ear
This can lead to conductive hearing loss
218
What is the pathway of aqueous humor?
Produced by non pigemneted epithelium of the ciliary body
Travels over the trabecular meshwork, through canal of
Schlemm (90%)
10% goes through the uveoscleral outflow
219
How to decrease aqueous humor?
Decrease production by B-blockers, alpha agonsits and carbonic anhydrase inhibitors
alpha agonists
Can also work on the uveoscleral outflow:
Drainage into the uvea and sclera (increase prostaglandin agonsit
220
Hyperopia?
eye too short for refractive power of cornea and lens
| (light focused behind the retina
221
Myopia?
eye too long for refractive power of the cornea and lens (focused in front of the retina)
222
Astigmatism?i
abnormal curvature of the cornea, with refactive power at different axis
223
Presbyopia?
Age related impaired accomadation (diffculty focusing on near objects due to decreased lens elasticity
224
Characteristics of cataract?
Painless, bilateral opacification of the lens
Results in decrease of vision
Increased with age, smoking, ETOH, sunlight exposure
DM
Trauma
Infection
225
What are congential causes of catacts?
```
TORCH (rubella)
Marfan sundrome
Alport Syndrome
Myoptonic dystrophy
Neurofibromatosis 2
```
226
What is glaucoma? What are the treatment?
Optic disc atrophy with charactersitic thinning of the outer rim of optic nerve
Usually due to elevated intra-ocular pressire and progressive loss of periphereal vision
227
Open angle glaucoma?
Increase with age
Increase with African American race
Family history
More common in US
228
what are secondary causes of glaucoma?
Blocked trabecular meshwork from WBC (uvetis)
RBC (vitroud hemorrage)
Retinal detachement
229
What is closed angle glaucoma?
Enlargement or movemebt of the lens agains the central iris
Obstuction of the normal aqeous flow through the pupil
Fluid builds up behind the iris (pushing periphereal iris against the cornea) and impedes flow through the trabecular network
230
What are secondary causes of closer or narrow angle glaucoma?
Hypoxia from retinal disease (DM, vein occlusion)
| Induces vasoproliferation in iris, that contracts angle
231
What is chronic vs Acute angle glaucoma?
Chronic: often assymptomatic with damage to the optic nerve and periphereal vision
Acute closure: opthalmic emergenvy, the IOP pushes the iris foreward---> angle closes abruptly
Very painful, red eye, sudden vision loss, halos around lights
Rock hard eye
Frontal headache
DO NOT give epinephrine because of the mydraitic effect
232
Characterstics of conjunctivitis?
Inflammation of the conjunctiva (red eye)
Allergic: itchy, bilateral
Bacterial: pus, treat with antibiotics
Viral: most common (usually adenovirus) mucos discharge with swollen preauricular node. Usually self resolving
233
What is uveitis?
Inflammation of the uvea
| names are specific to the location within the affected eye
234
What are the different areas?
```
Anterior uveitits
Intermediate uveitisi
Pars planitis
Posterior uveitis
Chorioditis or retinitis
```
235
What is a hypopyon?
Accumulation of pus within the anterior chamber
Conjunctoval redness
Associated with systemic inflammatory disoders (sarcoidosis, rheumatoid arthritis, juvenile idopathic arthritis, HLA-B27 associated conditions
236
Characteristics of age-related macular degeneration?
Degeneration of the macula (central area of retina)
| Causes distortion and eventul loss of vision
237
What is dry macular degeneration?
Dry: nonexudative > 80% depositions of yellow extracellular material in and between Bruch membrane and retinal pigment
238
what is wet macular degeneration?
Rapid loss of vision due to bleeding 2nd to choroidal neovascularization
Treat with anti-VEGF (injections, ranibizumab)
239
What is diabetic retinopathy?
Neoproliferative (damaged capillaries, leak blood)
Lipids and fluids seep into the retina
Can lead to hemorrages.
240
What is retinal vein occlusion?
Blockage of central or branch retinal vein due to compression from nearby arterial atherosclerosis
Leads to retinal hemorrhage and venous engorgement and edema
241
What is retinal detachement?
Seperation of neurosensory layer of the retina (photorecepter layer with rods and cones from outermost pigmented epithlium) normally shields light
Leads to degeneration of photorecpetors and leads to vision loss.
242
What causes retinal detachement?
Retinal breaks
Diabetic traction
Inflammatory effusions
Visualized on fundoscopy
243
Breaks are more common in which ?
Patients with high myopia or history of head trauma
Usually oreceded by posterior vitrous detachment (flashes or floaters) and eventual loss of vision (like a curtain drawn down).
244
What is central artery occlusion?
Acute, painless, monocular vision loss
The retina is cloudy with attenuated vessels and cherry red fovea
Evaluate for embolic sources.
(carotid artery atheroscleoris, cardiac vegetation, PFO)
245
What is Retinitis pigmentosa?
Inherited retinal degeneration
Painless, progressive vision loss, starting with night blindness
Bone spicule shaped deposit arund macula
246
What is retinitis?
Retinal edema and necrosis (leading to scar)
Often viral *CMV, HSV, VSV)
Can be bacterial or parasitic
247
what is papilledema?
Optic disc swelling (usually bilateral) due to increased ICP
Enlarged blind spot and elevated optic disc with blurred margins
248
What is responsible for pupillary control?
Miosis
Constriction is parasympatetic
1st neuon is Edinger-Westphal nucleus to ciliary ganglion via CN III
2nd neuron: short ciliary nerves to pupillary sphincter muscle
249
what is the pupillary light reflex?
Light enters the reinta
Sends a signal via CN II
Enters the brain and activates bilateral Edinger-Westphal nuclei
Pupils contract bilateral
(Illumination of 1 eye, results in bilateral pupillary constriction)
250
What is responsible for mydriasis?
dilatation (sympathetic)
1st neuron: hypothalamus to ciliospinal center C8-T2
2nd neuron: exit T1 to superior cervical ganglion
3rd neuronL plexus along the internal carotid
(through cavernous sinus, and enters the orbit)
251
What is a Marcus Gunn Pupil?
afferent nerve defect (due to optic nerve damage or severe retinal injury)
Decrease in bilateral pupillary constriction when light is shone to the affected eye.
Tested with the swinging flashlight test
252
What is Horner's syndrome?
1) Sympathetic denervation of the face
a) Ptosis : slight drooping of the eyelid (superior tarsal muscle)
b) Anhidrosis (absence of swearing) and flushing on affected side of the face
c) Miosis (pupil constrcition)
253
What are the conditions associated with the Horner syndrome?
Pancoast tumore
Brown- Sequrd syndrome
Late stage syringmyelia
254
What are the muscles of the eye?
```
Superior rectus muscle
Lateral rectus muscle
Inferior oblique muscle (inferior rectus muscle)
Medial rectus muscle
Trochlea
Superior oblique muscle
```
255
What is the formula to remember what nerves innervate which muscle?
LR6 SO4 R3
Lateral rectus CN 6
Superior Oblique CN 4
Rest: CN 3
256
What affects CN 3 (motor and parasympathetic output)?
Motor: affected by vascular disease (DM, soribital)
Due to decrease diffusion of O2 and nutrients
Leads to ptosis
Parasympathetic: fibers on the periphery are first affected by compression.
Posterior communicating artery aneurysm
Uncal herniation
Will have diminsihed or absent pupillary reflex
Blown pupil or down and out gaze
257
What is CN IV damage?
Eye move upward, particularly with contralateral gaze
| And head tilt toward the side of the leision
258
CNVI damage?
Medially directed eye that cannot abduct
259
Lesion causing bitemporal anopia?
Pituitaty lesion (chiasm)
Defect normal normal \defect
(Leasions on outside of both eyes)
260
Left homonymous hemaniopia?
defect - normal defect-normal
261
left upper quadrant anopia?
1/4 of both upper eyes (facing to the left)
| Right temporal lesion MCA
262
Left lower quadrant anopia?
Right parital lesion, MCA
263
Left hemainopia with with macular sparing>
PCA infarct
264
Central Scotoma?
Macular Degeneration
265
what is internuclear ophtalmoplegia?
Lesion in the medial longitudinal fasiculus (pair of tracts that allow crosstalk between CN V1 and CN 3
The MLF coordinates both eyes to move in the same horizontal direction
Highly myelinated (must communicate quickly)
Leisions can be unilateral or bilateral
Usually seen in multiple sclerosis
Will have one eye that has imparied adduction, while the other one has nystagmus
266
What are characteristics of Alzeihmers?
Associated with Apo E2 (decrease in risk of the sporadid form)
Apo E4: increase the risk of the sporodic form
APP presenilin-1 and presenilian-2 (famililal forms 10%) with earlier onset.
267
What are histological findings of Alzehiemers?
```
Widespread cortical atrophy
Decrease in ach
Senile plaques in the grey matter
Intracranial hemorrhage (Amyloid B)
Neurofibrillary tangles
```
268
Characteristics of early fronto-temoporal dementia?
Early changes in personality and behavior
Can have progressive aphasia
May have associated disorders like parkinsonian, ALS like (UMN/LMN) degeneration
269
What is Lewy body dementia?
Dementia with visual hallucinations
| Has parkinson features
270
Vascualar dementia?
Due to multiple arterial infarcts
Step wise decline in cognitive dysfunction
Second most common demntia in the elderly
271
Creutzfeldt-Jakob disease?
Rapidly progressing demntia
Has startle myoclonus
Has spongiform cortex
Presence of prions
272
What are other causes of dementia?
```
Syphilis
HIV
hypothyroidism
B3 and B12 deficiency
Wilson's disease
Hydrocephalus
```
273
What is osmotic demylination?
| Causes?
```
Acute paralysis
Dysarthria
Dysphagia
Diplopia
Loss of consciousness
Massive axonal demylination
```
```
What are causes of demylination?
Usally iatrogenic (caused by overly rapid correction of hyponatremia)
```
Overly quickly correcting hypernatremia too quickly lead to cerebral edema
274
What is multiple scleorosis?
Autoimmune and demyelination of CNS (brain and spinal cord)
Can present with optic neuritis (sudden loss of vision resulting in Marcus Gunn pupils)
Usually affects women in their 20s and 30s
275
What is the Charcot Triad of MS?
1) Scanning Speech
2) Intention Tremor
3) Nystagmus
276
What are the findings of MS (pathologically)
Increased IgG and myelin basic protein CSF
Oligoclonal bands are diagnostic
MRI is gold standard
Periventricular plaques
Have multiple leisions seperated in space and time
277
How is MS treated?
B interfearon
Glatiramer
Natalizaumab
Acute flares treated with IV steroids
278
Acute inflammatory demyelinating polyradiculopathy?
Subtype of Gillian Barre syndrome
Autoimmune (destroys Scwhann cells)
Have symmetric ascending muscle weakness/ paralysis
Facial parlysis in 50% of the cases
Can have autoimmune dysregulation (cardiac, hypertension, hypotension)
Majority will recover completely after weeks and months
279
What are findings with acute inflammatory demylinating polyradiculopathy?
Increased CSF protein
Normal cell count
Increase protein causing papilledema
280
What are causes of acute inflammatory demylinating syndrome?
```
Infections (Campylobacter jejuni, viral)
(may be due to autoimmune mimicry)
May require respiratory support
Plasmapheresis
IV immunoglobulins
No role for steroids
```
281
Acute dessiminated encephalomyelitis?
Multifocal, periventricular inflmmation and demylination after infection or vaccination (presents with altered mental status)
282
Charcot-Marie-Tooth disease?
Hereditary motor and sensory neuropthy
Progressive
The proteins involved in the structire and function of periphereal nerves of the myelin sheath
Usually autosomal dominent
283
Krabbe disease?
Autosomal recessive due to deficiency of galactocerbrosidase
Buildup pf galatocerebroside amd psychosine destroy the myelin sheath
Findings: central and periphereal demylination with ataxia and dementia
284
Progressive multifocal leukoencephalopathy?
Demylination of CNS due to destruction of oligodendrocytes
Seen in 2-4% of AIDS patients
Reactivation of latent JC infection
Rapid progrression, usually fatal
Increase risk associated with natalizumab, rituximab
285
Adenoleukodystrophy?
X linked genetic disorder affecting males
Disrupts metabolism of very-long-chain fatty acids
Excessive buildup in the nervous system, adrenal glan, and testes
Can lead to long term coma/death
286
Characteristics of Partial Seizures?
Affect a single area of the brain
Usually originate in the temporal lobe
Usually have an aura
287
What is a simple, partial seizure?
The consciousness is left intact
288
What is a complex partial seizure?
Impaired consciousness
289
epilepsy?
Disorderes of recurrent seizure
290
Status epilepticus?
Continuous or reccurrent seizures
| Can result in brain injury if more then 5 minutes
291
What are common causes of seizures by age?
Children: Genetic, infection, trauma, congenital, metabolic
Adults: tumor, trauma, stroke, infection
Elderly: stroke, tumor, trauma, metabolic infection
292
What is a generalized seizure disorder?
Absense (petit mal) : 3Hz, no postictal confusion
Myoclonic -quick and repetitive jerks
Tonic-clonic (grand mal) alternating stiffaning and movement
Tonic: stiffening
Atonic: Drop seizures, fall to the floor (appears like fainting(
293
Characteristics of Cluster Headaches?
Unilateral (15 minutes to 3 hour)
Repetitive brief headaches
Periorbital pain with lacrimation and rhinorrhea
May present with Horner's syndrome
Treatment: Sumatriptan
O2
Porphylaxis: verapamil
294
Tension headache ?
Bilateral
> 30 minutes (typically 4-6) constant
photophobia or phonophobia (no aura)
Medications:
Analgesics
NSAIDS
Amitryptilline for the chronic pain
295
Migraine headache?
Unilateral (4-72 hours)
Pulsating with nausea, photophobia or phonophobia
May have an aura
Irritation to CN V
Treatment:
NSAIDS
Triptans
Prophylaxis: lifestyle change (sleep, exercise, diet)
Can also use:
B Blocker, Calcium Channel blockers
Amitryptiline
296
What is Trigeminal neuralgia?
Repetitive, unilateral shooting pain in the destributin of CN V that typically lasts < 1 minute
297
What is Vertigo?
Sensation of spinning while sedentary
Subtype of dizziness
Distinct from lightheadedness
298
Periphereal vertigo?
```
More common
Inner ear etiology
Semi-circular canal debris
Vestibular nerve infection
Meniere's disease
```
Positional testing: delayed horizontal nystagmus
299
Central vertigo?
```
Brain stem
Cerebeller lesion (stroke, vestibular nuclei, posterior fossa tumor)
```
Findings: directional change of nystagmus, skew deviation, diplopia, dysmetria
Positional testing: intermediate nystagmus in any direction
Focal neurological testing
300
Sturge-Weber syndrome?
Congenital non-ingerited anomaly of neural crest
Have a port sized stain on the face
Will have seizures/epilepsy, intellectual disability and episceleral hemangioma
Increased intra-ocular pressure
early onset glaucoma
301
What is Tuberous Sclerosis?
```
Harmatomas in CNS and skin
Angifibromas
Mitral Regrugitation
Cardiac Rhabdomyoma
Autosomal dominenet
Intellecutal disability
```
302
Neurofibromatosis?
```
Cafe au lait spots
Lisch nodules
Cutaneous neurofibromas
Optic glinomas
Pheochromocytoma
Chromosome 17
Neurofibromas are derived from neuro crest cells
```
303
Von Hippel-Lindau disease?
Hemangioblastomas (high vascularity with hyperchromic nuclei)
Retina, brainstem, cerebellum
Angiomatosis (cavernous hemangiomas in skin, mucosa, organs, bilateral renal cell carcinoma, pheochromocytomas)
304
Glioblastoma?
```
Highly malignant
About 1 year survival
Found in cerebral hemisphere
Can cross the corpus callosum
Stain astrocytes for GFAP
```
305
Meningioma?
Typically beign tumor
Most often near surface of the brain and parasaggital region
Often assymptomatic (may present with seizures or focal neurological signs)
306
Hemanioblastoma?
Often cerebeller
Associated Von Hippel-Lindau syndrome
Associated with retinal agniomas
Can produce erythropeitin (with resultant polycythemia)
307
Schwannoma?
Cerebellopontine Angle
Usually localized to CN 111
Bilateral schwannoma found in NF-2
Resection or Stereotactic radiosurgery
308
Oligodendroglioma?
Relatively slow growing
Most often found in frontal lobes
Often calcified
309
Pituitary adenoma?
Most commonly pituitary prolactinoma or non functioning adenoma
Bitemporal hemianopia due to pressure of the optic chasm (shows normal visual field due to pressure on optic chasm)
Hyper or hypopitiotarism are sequlae
Hyperplasia of a single type of endocrine cell in the pituitary
310
Pilocytic astrocytoma?
Well circumscribed
Posterior fossa
Rosenthal fibers; eosinophile, corkscrew, cystic
Benign, good prognosis
311
Medulloblastoma?
Highly malignant cerebeller tumor
Primitive neuroectodermal tumor
Can be in 4th ventricle
Can cause non communicating hydrocephalus
Can send drop metastatsis in the spinal chord
312
Ependymona?
Ependymal cell tumors found in the 4th venticle
Can cause hydrocephalus
Poor prognosis
Characteristic perivascular rosettes
313
Craniopharyngioma?
Childhood tumor
May be confused with pituitary Adenoma (both cause bitemperal hemianopia)
Most common supratentorial tumor
Dervived from remmanents of Rathke pouch
314
Pinealoma?
Tumor of the pineal gland
Can cause Parinaud syndrome (compression of tectum leading to vertical gaze palsy)
Obstructive hydrocephalus
Precocious pubert in males due to B-HCG production
Histoogically similar to germ cell tumors (testitcular seminoma)
315
Cingulate herniation?
Under falx cerebri (compresses the anterior cerebral artery)
316
Transtentorial (central herniation)
Caudal displacement of the brainstem
Rupture of the paramedian basilar artery branches
Duret hemorages, usually fatal
317
Uncal herniation?
Uncus: median temporal lobe
Compression ipsilateral CN III (blown pupil, down and out gaze)
Ispilateral PCA (contralateral homonymous hemaniopia with macualar sparing
Contalateral crus cerebri at the Kernohan notch (ipsilateral paraisis, a false location sign
318
Cerebeller tonsilar herniation into the foramen magnum?
Coma and death result when these herniations compress the brain stem
319
Glaucoma drugs?
Epinephrine (alpha 1) decrease aqeous humor synthesis via vasoconstriction
Decrease aqueous humor synthesis
Adverse effects: mydraisis (alpha 1) do not use in closed angle glaucoma
Blurry vision
Hyperemia
Foreign body sensation
Ocular allergic reactions
Ocular pruritis
B blockers (timolol, betaxolol, carteolol)
Decrease in aqueous humor synthesis
adverse effects: no pupillary or vision changes
Diuretics:
Acetazolamide: decrease in aquaous humor synthesis via inhibition of carbonic anhydrase
No pupillary or vision changes
Direct (pilocarpine carbachol) : increase outflow of aqeous humor via contraction of cilary muscle and opening of trabecular meshwork
Use pilocarpine in emergencies (very effective at opening meshwork) into canal of Schlemm
Adverse effects: Miosis (contraction of pupillary sphincter muscles and cytoplasm)
Prostaglandin (bimatoprost), latanoprost
Increase in outflow of aqueous humor
320
What are opiod analgesics ?
Morphine, fentanyl, codiene, loperamide, methadone, meperidine, desrromethorphan
Mechanims: agonsit at opiod receptors (B-endorphn, enkephalin) to modulate synaptic transmission
Inhibit release of Ach
Adverse effect: addiction, respiratory suppression, constipation, miosis
Toxicity treated with naloxone or naltrexone (opiod recpetor antagonist)
321
What is pentazocine?
K-opiod receptor agonist and u-opiod receptor
Used for analgesia for moderate to severe pain
Adverse effects: Opiod withdrawl symptoms (if patients is also taking full opiod antagonsit
322
Butorphanol?
K-opiod receptor agonist an u-opiod receptor partial agonist
Produces analgesia
Clinical use: severe pain, causes respiratory depression
Adverse effect: Can cause opiod withdrawl symptoms if patient is taking full opiod agonist (competition for opiod receptors, overdose not easily reversed with naloxone
323
What is tramadol?
Mechanism: very weak opiod agonist, also inhibits 5-HT and norepinehprine uptake (works on multiple neurotransmittors)
Clinical use: Chronic pain
Decreases Serotonin syndrome
324
Ethosuximide (uses, mechanism, sideeffects)
Used in absense
Mechanism: blocks thalamic T-type Ca channels
Side effects: GI, fatigure, headache, urticaria, Steven-Johnson
325
Benzodiazepines?
For status epilepticus
Increase of GABA action
Side effects: sedation, tolerance, dependence, respiratory depression
326
Phenytoin ?
Simple, complex, tonic-clonic seizures
Blocks Na 2+ channels
Neurologic: nystagmus, diplopia, ataxia, sedation, periphereal neuropathy
Hirutism
Steven's Johnson syndrome
gingival hyperplasia
DRESS syndrome
Osteopenia
SLE-like syndrome
Hematologic: megloblastic anemia
Reproductive: teratogenesis
327
Carbamazepine?
Simple, complex and tonic-clonic seizures
Blocks Na 2+ channels
```
Diplopia
Ataxia
Blood dyscrasias
agranulocytosis
Aplastic anemia
Liver toxicity
```
328
Valporic acid?
Simple, Complex, Tonic-Clonic
Increases Na+ channel inactivation
Increase in GABA concentration (inhibits GABA transaminase)
```
GI distress, rare but fatal
Hepatotoxicity
pancreatitis
Neural tube defects
Tremor
Weight gain
Contra-indication in pregnency
```
Can also be used for myoclonic seizures, bipolar disorder, migraines
329
Vigabatrin?
for simple and complex seizures
Increase GABA by irreveribiliy inhibiting GABA transaminase
330
Gabapentin?
Simple and complex seqizures
| Primarily inhibits voltage activated CA 2+ channels, designed as GABA analog
331
Topiramate?
Simple and Complex seizures
Blocks Na 2+ channes
Increase GABA action
Side effects: Sedation, mental dullness, kidney stones, weight loss
332
Lamotrigine?
Simple, complex, tonic-clonic, absense,
Mechanism: blocks voltage gated Na+ channels
Adverse effects: Stevens-Johnspm syndrome
333
Levetiracetam?
Simple
Complex
Tonic-clonic
Unknown mechanism
May modulate GABA and glutamate release
334
Tiagabine?
Simple
Complex
Increase GABA by inhibiting reuptake
335
What are uses of barbiturates?
Example: Phenobarbitol, pentobarbitol, thiopental, secobarbital
Mechanism: facilitate GABA, increase duration of Cl-
thus decreasing neuron firing
Clinical uses: sedation for anxiety, seizures, insommia, induction of anesthesia
Adverse effects: overdose treatment is supportive
336
What are the uses of barbituates?
Daizepam, loazepam, traizolam, temazepam
Mechanism: facilitate GABA (increase frequency of Cl- channel opening)
decrease of REM sleep
Have long half lives
NOTE: all benzos bind on GABA receptor which is ligand gated CL
Clinical use:
Anxiety, Spasticity, status epileticus, eclampsia, detoxification, night terrors, sleepwalking, general anesthesia, hypnotic insommnia
Adverse effects:
Dependence, CNS depression (withETOH)
Overdose treated with flumazenil (can precipitate seqizures by causing acute benzodiazepine withdrawl
337
Non benzodiazepine hypnotics?
Zolpidem, zaleplon,
zoplicone
Mechanism: act via BZ1
Clinical use: Insomnia
Adverse effects: ataxia, headaches, confusion, short duration (metabolism by liver enzymes)
modest psychomotor depression and few amnestic effects
338
what are characteristics of anesthetsic drugs?
CNS must be lipid soluable and cross the blood-brain barrier
Can be actively transported
339
What characteristics of drugs allow for rapid induction ?
Decrease soluability within the blood
However, increased soluability in lipids will increase the potency (1/MAC)
MAC = minimal alveolar conctration (of inhaled anesthestics) required to prevent 50% of subjects from moving due to noxious stimulus
340
Comment on potency of Nitrous oxide and halothane?
Nitrous oxide has decreased blood and lipid soluability and thus fast induction and low potency
Halothane: has high lipid and blood solubility, slow induction, and high potency.
341
Which are the inhaled anesthetics?
Deslurane, halothane, enflurane, sevoflurane, methoxyflurane
effects: mechanism unknown
effects: myocardial depression, respiratory depression, nausea, emesis, increase cerebral blood flow
Adverse effects: hepatoxicity, nephrotoxicity, proconvulsant, expansion of trapped gas in the body cavity
Malignany hyperthermia
342
Describe malignant hyperthermia?
| How to treat?
rare, life threatening condition in which inhaled anesthetetics or succinycholine induce fever and severe muscle contractions
Susceptibility is inherited as autosomal dominant with variable penetrance
Can be due to mutations in voltage sensitive ryanodine receptor cause increase in Ca 2+ from sarcoplasmic
Treat with: dantrolene
343
Intravenous anesthestics: barbituates (thiopental)?
High potency
High solubility
Rapid entry into the brain
Used for induction of anesthesia and short surgical procedures
Effect terminated by rapid distribution into the tissue
344
Intravenous anesthetics: midazolam
Used for endoscopy (can use with gaseous anesthetics and narcotics)
can cause severe postoperative respiratory depression
Decrease in BP (treat overdose with flumenzanil)
Antegrade amnesia
345
Intravenous anesthestics: ketamine (arycyclohlamines)
PCP analogs that act as disassociative anesthestics
Blocks NMDA receptors
Cardiovascular stimulants
Cause deterioration, hallucination, bad dreams
Increase cerebral blood flow
346
Propofol ?
Used for sedation in ICU
Rapid anesthsia induction
Short procedures
Less postoperative nausea then thipental
347
Opiods as anesthestics?
Morphine, fentanyl, and other CNS depressants during general anesthesia
348
What are the two classes of local anesthetics?
Esters: prociane, cocaine, tetracaine,
Amides: lidocainem mepivaine, buvicaine
349
How do local anesthetics work?
Block Na channels
350
why are they given with vascoconstrictors?
To enhance local action, and decrease bleeding, increase anesthesia, and decrease systemic concentration
351
What happens when there is infected tissue?
acidic tissue, prevents the alkaline anesthetic from penetrating, and therefore you need more.
352
How does the nerve blockade work?
small fibers, more then large fibers
myelinated fibers, before non myelinated
size is more important then myelination
353
what is the order of loss for local anesthetics?
pain, then temperature, then touch, then pressure
354
What are the side effects of local anesthetics?
```
CNS excitation
Severe cardiovascular toxicity
Hyptertneion
Hypotension
arrythmia
Methemogloinemia
```
355
Neuromuscular blocking drugs?
Muscle paralysis in surgery or mechanical ventilation (selective for nicotinic receptors)
Can be depolarizing
Or non -deploarizing
356
example of deploarizing drug?
succinylocholine (strong Ach receptor agonist) produces sustained depolarization and prevents muscle contraction
Reversal of blockade:
Phase I: prolonged depolarization (no antidote)
Phase II (repolarized but blocked) reversed with cholinesterase inhibitors
Complications include: hypercalcemia, hyerpkalemia, malignant hyperthermia
357
Examplses of non depolarizing drugs?
Tubercuranine, atracurium, mivacurium, rocuronuim Competitive antagonists
reversal of blockade: neostigmine (given with atropine) to prevent muscurininc effects such as bradycardia
358
What is dantrolene?
mechainsm: prevents release of calcium from sarcoplasmic reticulum of skeletal muscle
Clinical use: malignant hyperthermia and neuroleptic malignant syndrome
359
Balofen?
Atiates GABA reeptora
360
Cylobenzapine?
Central ating skeletal musle relaxantStrutrually
361
What isthe cause of Parkinson?
Loss of doaminergic neurons and excess cholinergic activitiy:
Bromocriptne
Amantadine
Levodopa with carbidopa
Selegiline
362
How to dopamine agonist work?
```
Ergot (Bromocriptine)
Non ergot (preferred) pramipexole, ropinirole
```
363
What increases dopamine availability?
Amantadine (increase dopamine release) and decrease dopamine reuptake
toxicity results in ataxia and reticularis
364
What are agents that increase L-dopa availability?
Agents prevent periphereal pre-BBB
L-dopa degeneration (block peripheral conversion of L-DOPA to Dopamine by inhibiting Decarboxylase
Increase L-Dopa entering CNS
Increase Central L-Dopa available for conversion to dopamine
365
How to prevent dopamine breakdown?
Agents act centrally (post BBB) to inhibit breakdown of dopamine
Selegoline blocks conversion of dopamine into DOPAC by selectvely inhibiting MAO-B
Tolcapone blocks conversion of dopamine 3 OMD by inhibiting central COMT
366
How to curve excessive cholinergic activity?
Benztropine (anti-muscarinic, improves tremor and rigidity but has little affect on braykinesis in Parkinsons
367
How does L-Dopa work?
Combination of levodopa/carbidopa
L- Dopa (levodopa) Increase level of dopamine in the brain
Unlike dopamine, it can cross the blood-brain barrier
Converted to dopa-carboxylase in the CNS to dopamine
Carbidopa periphereal DOPA (decarboxylase inhibitor) is given with L-Dopa in the brain to limit periphereal side effects
Sideeffects:
Arrythmias from peripheral formation of catecholamines
Long term use can have dyskinesia
368
What are the mechanisms of selegilline, rasagiline?
Mechanism: selectively inhibit MAO-B (metabolize dopamine, increase dopamine availability
Clinical use: adjunctive agent to L-Dopa in treatment of Parkinsons
Side effect: May enhance adverse effects of L-Dopa
369
Alzheimers drug, memantine?
Mechanism: NMDA receptor agonist (helps prevent excitotoxiciy) mediated by Ca 2+
Adverse effects: dizziness, confusion, hallucinations
370
Alzheimers drugs donepezil, galantamine, rivastigmine, tacrine?
```
Acetylcholine (AChe inhibitors)
Adverse effect (nausea, dizziness, insomnia)
```
371
What are huntington drugs?
Tetrabenzine and reserpine
Inhibit the vesicular monamine tranporter (VMAT) decrease dopamine vesicle packaging and release
Haloperidol : D2 receptor antagonist
372
Riluzole?
Treatment of ALS that increases survival by decreasing glutamte excitotoxicity via unknown mechanicm
(Lou Gehig's disease)
373
What are triptans used for?
Example is sumatriptan.
%-Ht agonist (inhibits trigeminal nerve activation)
Prevents vasoactive peptide release
Clinical use: Acute mirgraine and cluster headache attacks
Adverse effects: Coronary vasospasm (therefore contraindicated in patients with CAD or Prinzmetal angina)
Can result in mild paresthesia
