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Med School Rotations > Neurology Falcon Review 1 > Flashcards

Neurology Falcon Review 1 Flashcards

1
Q

What are the major structures of the brain

A

From anterior to posterior

  1. Telencephalon
  2. diencephalon
  3. Mesencephalon
  4. Metencephalon
  5. Myelencephalon

Remember the M’s being Alphabetical order.

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2
Q

What develops from the telencephalon

A

Cerebral cortex

basal ganglia

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3
Q

What develops from the diencephalon

A

Thalamus

hypothalamus

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4
Q

What develops from the mesencephalon

A

Midbrain
– cerebral crura
– substantia nigra
– CN’s 3 and 4

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5
Q

What develops from metencephalon

A

Cerebellum
Pons
CN’s 5, 6, 7, 8

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6
Q

What develops from the myelencephalon

A

Medulla oblongata

CN’s 9, 10, 11, 12

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7
Q

What are the main lobes of the cerebral cortex

A

Frontal
parietal
Occipital
temporal

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8
Q

What is the function of the frontal lobe

A 
Motor function
problem-solving (executive function)
spontaneity
language
impulse control
social behavior
largest in humans
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9
Q

What is the general function of the parietal lobe

A
  1. awareness

2. spatial perception

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10
Q

What is neglect syndrome

A

Results in the neglect of part of the body or space on the contralateral side; can impair many self-care skills such as dressing and washing

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11
Q

What is Gerstmann’s syndrome

A 
A left-sided lesion to the parietal lobe causing:
– R/L confusion
– Agraphia
– Acalcula
– Aphasia
– visual agnosia
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12
Q

What will a lesion to one side of the occipital lobe cause

A

Homonymous loss of vision with exactly the same “field cut” in both eyes

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13
Q

What are the effects of a left temporal lobe lesion

A

Disturbs recognition of words

imperative memory of verbal material

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14
Q

What are the effects of a right temporal lobe lesion

A

– can cause a loss of inhibition of talking

– inhibition of recall of music and drawing

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15
Q

What are the functions of the temporal lobe

A

Sensory
language
memory
behavior

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16
Q

What function does the precentral gyrus have

A

Motor strip

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17
Q

What function does the Post Central gyrus serve

A

Somatosensory strip

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18
Q

The central sulcus separates what 2 areas of the brain

A

The frontal from the parietal lobe

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19
Q

What areas of the brain are separated by the lateral sulcus (sylvian fissures)

A

Separates frontal and parietal lobe from the temporal lobe

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20
Q

What should always be identified from a sagittal view MRI

A 
The central sulcus
cerebellum
Pons
Medulla
corpus callosum
tonsils
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21
Q

What may low-lying tonsils cause

A

Increased intra-cranial pressure

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22
Q

Is the genu of corpus callosum anterior posterior

A

Anterior

the splenium of the corpus callosum is posterior

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23
Q

On MRI T1 weighted sequence is CSF black or white

A

Black

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24
Q

On an MRI T2 weighted sequence is CSF black or white

A

White

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25
Q

when is a CT bone window useful

A

For traumatic brain injury and skull fractures

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26
Q

When is a CT brain window useful

A

Hemorrhage and atrophy

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27
Q

What modality is useful for detecting demyelination disease and old infarcts

A

T2 weighted MRI

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28
Q

What 3 things are bright on axial CT brain window

A

Bone
blood
calcifications

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29
Q

What 2 brain regions are derived from the diencephalon

A

Thalamus

hypothalamus

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30
Q

What is the role of the thalamus

A

Central relay station for all sensory and motor information EXCEPT OLFACTION

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31
Q

What is the role the hypothalamus

A

Sympathetic control
parasympathetic control
temperature control
satiety center

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32
Q

What is the Marcus-Gunn pupil

A

– paradoxical dilation of pupil with the light on the pupil
– caused by delay in conduction of the optic nerve typical of demyelinating disease such as MS

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33
Q

What is the only cranial nerve that innervates the contralateral eye

A

Trochlear nerve

– supplies contralateral superior oblique

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34
Q

What will lesion of cranial nerve 7 demonstrate

A

It will affect the entire face on one side. A stroke will affect only the lower part of the face

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35
Q

What direction are afferent fibers traveling

A

Towards the CNS

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36
Q

what direction are efferent fibers traveling

A

Away from the CNS

– effector nerves are efferent

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37
Q

What is cranial nerve 9

A

Glossopharyngeal nerve

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38
Q

What is the function of the glossopharyngeal nerve

A

Palatal muscles
palatal and pharynx sensation
taste of her posterior one 3rd of the tongue

gag reflex (afferent limb)

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39
Q

What is the function of the vagus nerve

A

Palatal muscles
pharynx and larynx sensation
parasympathetic to viscera (heart, G.I. tract)

gag reflex (efferent limb)

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40
Q

What is cranial nerve 12

A

Hypoglossal nerve

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41
Q

What are the 4 main arteries that carry blood to the brain

A

Carotids X2

Vertebrals

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42
Q

What does the anterior cerebral artery supply to

A

Primarily supplies the frontal and medial aspect of the frontal and parietal lobes

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43
Q

What does the middle cerebral artery supply

A

The vast majority of the brain
– the lateral surface
– is a branch of the internal carotid

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44
Q

What are the 2 main branches of the middle cerebral artery

A

Anterior (Brocha’s area)

posterior (Vernicke’s area)

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45
Q

The posterior cerebral artery is a branch of what vessel

A

Basilar artery

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46
Q

Lacuna stroke in the internal capsule will generate what symptoms

A

Will generally be a pure motor weakness

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47
Q

Lacunar stroke in the thalamus will have what signs and symptoms

A

typically sensory

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48
Q

Discuss the anterior spinal artery

A

It’s a fusion of the vertebral arteries, located in the anterior median fissure, supplies the anterior 2/3 of the spinal cord

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49
Q

Discuss the posterior spinal arteries

A

their smaller arteries, derived from the PICA, they form plexus, and supplies the posterior 1/3 of the spinal cord

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50
Q

Discuss radicular arteries

A

They are from the aorta, send collaterals to the spinal cord, and forms the caudal most portion of the anterior spinal artery

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51
Q

The deep tendon reflexes the biceps test what nerves

A

C5, C6

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52
Q

The deep tendon reflexes for the brachioradialis test what nerves

A

C5, C6

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53
Q

The deep tendon reflexes for the triceps test what nerves

A

C7

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54
Q

The deep tendon reflexes for the knee test what nerves

55
Q

The deep tendon reflexes for the ankle test what nerves

56
Q

What neurons are in the dorsal horn

A

Sensory neurons

57
Q

What neurons are in the ventral horn

A

Motor neurons

58
Q

Discuss the spinothalamic tract

A

Responsible for pain and temperature

crosses shortly after entering the cord

59
Q

What is the function of the dorsal columns

A

joint position sense and two-point discrimination

Crosses in the medulla

60
Q

What is the corticospinal tract

A

Descending motor tract
– extension of internal capsule fibers
– decussate in the lower pyramid
– sends out fibers once it innervates alpha motor neurons

61
Q

What is the dorsal column/medial lemniscus tract

A

Ascending – touch, position and vibration sensory
– Fasiculous cuneatous = arm
– Fasiculous gracilous = leg

– decussates in brainstem

62
Q

what is the anteriolateral or spinothalamic tract

A

A sending – pain and temperature sensory

–decussates immediately upon entering spinal cord

63
Q

What is a brown-Sequard lesion

A

Deficit in pain perception is contralateral to the lesion, the other deficits (weakness, deficit and touch sensation) are ipsilateral

64
Q

what are the symptoms of an upper motor neuron lesion

A 
Weakness
increased reflexes
– Babinski sign
– Hoffman signs
increased tone (spasticity)
muscle hypertrophy
65
Q

What is Babinski sign

A

Big toe dorsi flexes with stroking a bottom of the foot

66
Q

What is Hoffman sign

A

Thumb moving inward with flicking of the middle finger of one hand

67
Q

What are the symptoms of a lower motor neuron lesion

A 
Weakness
decreased/absent reflexes
decreased tone (flaccid paralysis)
fasiculations
muscle atrophy
68
Q

What are the four types of peripheral nerve fibers for motor function

A

Alpha
beta
Gamma
Delta

69
Q

Discuss motor for full nerve fibers

A

Large size

heavily myelinated, very fast conduction (30 to 110 m/s)

70
Q

What type of sensation or motor function are associated with type A fibers

A

Various size a A fibers

– proprioception, light touch, sharp pain, vibration

71
Q

What type of motor sensation is associated with C fibers

A

Slow pain fibers

– small size, no myelination, slow conduction

72
Q

What kind of fibers are associated with autonomic’s

A

B size fibers, some on nation, intermediate speed

73
Q

what is an in the endoneurium

A

The peripheral nerves covering just outside of the neurilemma

74
Q

What is the perineurium

A

The peripheral nerve covering around the fascicle

75
Q

What is the epineurium

A

The peripheral nerve covering around the entire nerve

76
Q

What is the function of the musculocutaneous nerve

A

Motor function
– elbow flexion
– supination

sensory field
– lateral forearm

77
Q

What is the function of the radial nerve

A

Motor function
– forearm extension
– wrist extension
– finger extension

sensory field
– dorsal hand/thumb

78
Q

What is the function of the median nerve

A

Motor function
– abductor pollicis brevis
– wrist flexion
– finger flexion

sensory
– ventral fingers/thumb exceptlateral fourth and fifth digit

79
Q

What is the function of the ulnar nerve

A

Motor function
– Interossei

sensory
– fourth and fifth digits

80
Q

What is the function of the femoral nerve

A

Motor
– iliopsoas
– quadriceps

sensory
– upper lateral thigh

81
Q

What is the function of a sciatic nerve

A

Motor
– knee flexion
– plantar flexion

sensory
– back of the thigh
– sole of the foot

82
Q

What is the function of the common peroneal nerve

A

Motor
– peroneous brevis
– tibialis anterior
– extension hallicus

sensory
– anterior lower leg
– dorsumof foot

83
Q

What cranial nerves are associated with the parasympathetic nervous system

A

Craniosacral outflow
– III, VII, IX, X
– sacral 2 through 4

84
Q

What enables the diffuse, nonselective generalization of the sympathetic nervous system

A

Adrenal medulla

85
Q

What is the sympathetic effects on eye physiology

A

Contracts the radial muscle (alpha-1)

relaxes the ciliary muscle (B-2)

86
Q

What are the parasympathetic effects on eyephysiology

A

Contracts the sphincter muscle

contracts the ciliary muscle

87
Q

What is the autonomic influence to the ventricles

A

Sympathetic’s
– increase contractility, conduction and automaticity

parasympathetic’s
– there is no parasympathetic innervation to the ventricles

88
Q

What is the parasympathetic influence on the bladder

A

The contracts the detrusor muscle

relaxes the trigone and sphincter

89
Q

What is the third leading cause of death

90
Q

What is the difference between a stroke and a transient ischemic attack (TIA)

A

Stroke: infarction of brain tissue due to lack of blood flow

TIA: temporary neurologic deficit due to relative ischemia that improves with blood supply is restored (symptoms usually lasting less than one hour typically 20 minutes)

91
Q

What is the pathophysiology of a stroke

A

Ischemic – 85%

hemorrhagic – 15%

92
Q

What are the causes of a focalcerebral ischemia

A
  1. Embolic
  2. Thrombotic
  3. Cryptogenic
93
Q

What is the cause of global cerebral ischemia

A

Hypotension

94
Q

What is the number one risk factor for an ischemic stroke

A

Hypertension

other risk factors include diabetes, tobacco, prior stroke, heart disease, hypercholesterolemia, age

95
Q

What is CADASIL

A

Cerebral autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy

– notch 3 gene
– associated with a stroke at a younger age

96
Q

Was the major cause of thrombosis

A

Atherosclerosis

97
Q

What are the risk factors for atherosclerosis

A 
Age
male
hypertension
smoking
diabetes
hypercholesterolemia
98
Q

One of the common sites affected by thrombosis

A

Carotid bifurcation
origin of middle cerebral artery
Basilar artery

99
Q

What is aphasia

A

Inability to use or understand language due to a lesion in the brain

100
Q

What isAlexia

A

Inability to perceive written words

101
Q

What is agraphia

A

Inability to write words, not related to weakness or sensory deficit

102
Q

What is dysarthria

A

Slurred or stuttering speech due to motor weakness of incoordination, while language is intact

103
Q

What is apraxia

A

Inability to carry out a large motor tasks, not due to motor or sensory deficits or inability to understand

104
Q

What is ataxia

A

Impairment in the performance and coordination of movements, not due to weakness

105
Q

What is dysphagia

A

Difficulty swallowing due to motor weakness or incoordination

106
Q

Where is the lesion generally associated with a pure motor hemiplegia

A

Contralateral pons or internal capsule lacune

107
Q

Where is the lesion with a pure sensory stroke

A

Contralateral thalamus lacune

108
Q

what is the presentation of a middle cerebral artery syndrome

A

Hemiparesis (face and arm greater than the leg), aphasia (left; neglect syndrome more common on the right) sensory loss, hemianopsia, eye deviation

109
Q

What is the anterior cerebral artery syndrome presentation

A

Lower extremity weakness and sensory loss, incontinence, limb apraxia

110
Q

What is the posterior cerebral artery syndrome

A

Homonymous hemianopsia

sensory loss

111
Q

What imaging modality is better for determining cranial bleeds

A

CT is better

112
Q

What criteria is used for grading of a stroke

A

NIH stroke scale

113
Q

How soon after stroke will MRI be positive

A

Within five minutes of a stroke and will stay positive for up to two weeks

114
Q

When should CADASIL testing be done

A

In a patient less than 40 years old with no risk factors
– skin biopsy
– hypercoagulable workup

115
Q

What is the treatment for an ischemic stroke

A
  1. ABC’s
  2. Blood pressure control
    – SBP less than 180
    – DBP less than 140
  3. Anti-platelets
    – aspirin
  4. Anticoagulation
    – heparin (use only in afib and dissection)
  5. Thrombolytics
    – tPA (only use in first three hours)
  6. Rehabilitation
    – continued for months to years
116
Q

What is the criteria to use tPA

A

– Clinical diagnosis of the stroke
– age greater than 18
– time to TP administration less than three hours from onset of symptoms
– head CT without evidence of hemorrhage or large stroke

117
Q

What are the contraindications for the use of tPA

A

any indication for the potential of increased bleeding

118
Q

What are some approaches to secondary prevention of a stroke

A
  1. Antiplatelet agents
    – Aspirin
    – clopidogrel
    – dipyridamol
  2. Anticoagulation for atrial fibrillation or clot
  3. Carotid endartectomy In appropriate patients
  4. Correcting high-risk causes
119
Q

What are the causes for intracerebral hemorrhage

A 
Hypertension
mass lesions
vascular malformations
amyloid angiopathy
cocaine/amphetamine use
120
Q

Were the causes for a subarachnoid hemorrhage (SAH)

A

Aneurysms

trauma

121
Q

What is the most common site for hypertensive hemorrhage

A 
Basal ganglia (50-60%)
thalamus
pons
cerebellum
lobar (cortex)
associated with atherosclerosis and diastolic blood pressure greater than 110
122
Q

What is the treatment for hemorrhagic stroke

A 
1. Reverse coagulopathy
– FFP for elevated PT/PTT
– platelets for thrombocytopenia
2. Control blood pressure
– labetalol is the drug of choice
3. Identify underlying structural abnormalities
– tumors (MRI with contrast)
– AVM's (cerebral angiography)
123
Q

What are the clinical features of the subarachnoid hemorrhage

A

thunderclap headache
meningismus
altered mental status

124
Q

What are the common sites for cerebral aneurysms

A 
Anterior communicating
posterior communicating at the ICA
MCA (distal greater than proximal)
ICA at ophthalmic
Basilar apex
125
Q

What are the clinical features of a berry aneurysm

A

Most frequently complication during the fifth decade
– large aneurysms can present as mass lesion with symptoms related to compression of neurologic structures
– third nerve palsy (involving the pupil) the eye will be down and out

– if the pupil’sis spared, then likely infarction of the nerve, seen in diabetics

126
Q

What imaging should be done for a patient suspected of a subarachnoid hemorrhage

A
  1. Noncontrast CT of the head
  2. If CT scan is negative, lumbar puncture is indicated
    – examined tubes one and four for red blood cell count
  3. Patients with positive CT scan or lumbar puncture should have cerebral angiogram
127
Q

What is the Hunt and Hess scale

A

Measure of clinical status for hemorrhagic patients

I: asymptomatic or mild headache
II: moderate to severe headache, nuchal rigidity, cranial neuropathies
III. Confusion, lethargic, mild focal deficits
IV: stupor or hemiparesis
V: comatose or posturing

128
Q

What is the treatment for an SAH/aneurysm

A

– Clip or coil identified aneurysm
– treatment vasospasm
– treatment hydrocephalus

129
Q

What is hydrocephalus

A

Dilation of ventricular system with increase cerebrospinal fluid volume
– communicating or not communicating

130
Q

What is the difference between nine communicating and non-communicating hydrocephalus

A

Communicating: third ventricle is open, the fourth ventricle is proportionally dilated
– blockage of CSF exit, either at arachnoid granulation’s or foramen’s of Magendi or Luska

non-communicating: 4th ventricle not involved
– compression of third or lateral ventricles by mass or mass effect from edema

both can results in herniation is not treated

131
Q

What is the Monroe doctrine with regards to increased intracranial pressure

A

“Brain in a box”
– skull contains brain, CSF, blood
– there’s no room for expansion and an increase in pressure displaces something

132
Q

what are the herniations associated with an increased cranial pressure

A
  1. Subfalcine
    – cingulate gyrus displaced underneath the falx to opposite side
  2. Transtentorial (Uncal)
    – medial aspect of temporal lobe is compressed against the tentorium cerebelli
  3. Tonsillar herniation (most serious)
    – displacement of cerebellar tonsils through the foramen magnum. Compression of medullary respiratory centers leading tocommaand death
133
Q

What is the treatment for increased intracranial pressure

A
  1. Raise head of bed 45°
  2. Hyperventilation (PCO2 25-30 mm Hg) normal is 40
  3. Mannitol (2 g/kg)
  4. Hypertonic saline
  5. IV steroids if due to a tumor
  6. Intraventricular drain.
134
Q

What a factor will hyperventilation have on intracranial pressure

A

Hyperventilation will reduce ICP

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