Neuropath Flashcards
Cystic degeneration of spinal cord due to trauma or in association w/ Chiari malformation
Syringomyelia (usually @ C8-T1)
- Sensory loss of pain & temp
- Sparing of fine touch & position sense in UE
Syringomyelia usually presents w/ loss of pain & temp in UE due to anterior commissure. If it expands, what else may it typically include?
Anterior horn causing LMN Sx
Lateral horn (hypothalamal spinal tract) causing Horner’s syndrome
Damage to anterior horn due to infection
Poliomyelitis
Degenerative disorder w/ UMN & LMN Sx
Amyotrophic Lateral Sclerosis (involves anterior horn & lateral corticospinal tract)
How to differentiate ALS vs. Syringomyelia?
ALS doesn’t include any sensory impairment
loss of P & T sensation in Syringomyelia
Degenerative disorder of Cerebellum & SC tracts
Friedreich Ataxia
Ataxia w/ loss of vibratory sense & proprioception, muscle weakness in lower extremities, & loss of DTR
Friedreich Ataxia
Friedreich Ataxia genetic involvement?
- AR
- GAA trinucleotide repeat in Frataxin gene
(Frataxin gene is essential for mitochondrial iron regulation – thus dysregulation causes free radical damage to neurons)
Top 3 causes of meningitis in newborns (0-6 months)?
Group B streptococci
E. coli
Listeria
Top 4 causes of meningitis in children 6 months - 6 yrs?
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae type B
Enteroviruses
Top 4 causes of meningitis ages 6-60 yrs?
Streptococcus pneumoniae
Neisseria meningitidis (#1 cause in teens)
Enteroviruses
HSV
1 cause of meningitis in teens?
N. meningitidis
Top 3 causes of meningitis ages 60+
Streptococcus pneumoniae
Gram-negative rods
Listeria
Dx?
Urinary incontinence, ataxia, & cognitive dysfunction
Normal pressure hydrocephalus
(↑ in subarachnoid space volume but no increase in CSF pressure. Expansion of ventricles distorts fibers of the corona radiata & leads to clinical triad described)
Spinal cord lesion that could be caused by defect in superoxide dismutase 1?
Amyotrophic Lateral Sclerosis
(combined UMN & LMN deficits w/ no sensory, cognitive, or oculomotor deficits. Commonly presents w/ fasciculations w/ eventual atrophy; progressive & fatal)
Achilles reflex nerve root?
S1 (,2)
Patella reflex nerve root?
L4
L3,4
Biceps reflex nerve root?
C5 (,6)
Triceps reflex nerve root?
C7 (,8)
CNs that lie medially @ brainstem?
CN 3, 6, & 12
Dx? Paralysis of conjugate vertical gaze
Parinaud Syndrome
superior colliculi lesion
What goes through the foramen spinosum?
Middle Meningeal Artery
What goes through the Superior Orbital Fissure?
CN 3, 4, V1, 6, Ophthalmic vein, & Sympathetic fibers
Dx?
Ophthalmoplegia & ↓ corneal & maxillary sensation w/ normal vision.
Cavernous Sinus Syndrome
due to mass effect, fistula, thrombosis
What structures pass through the Cavernous Sinus?
CNs 3, 4, V1, V2, 6, postgangionlic sympathetic fibers en route to orbit, & Cavernous portion of Internal Carotid Artery
(CS is lined by Dura)
Dx?
Eye moves upward, particularly w/ contralateral gaze & ipsilateral head tilt (problems going downstairs)
CN 4 damage
Stroke localization?
Left upper quadrantic anopia
MCA - Right Temporal lesion
Stroke localization?
Left lower quadrantic anopia
MCA - Right Parietal lesion
Dx?
Frontal lobe tumor w/ chicken-wire capillary pattern & “fried egg” cells
Oligodendroglioma
“prominent nuclear halos”
Dx?
Primary brain tumor located in the 4th ventricle, causing hydrocephalus
Ependymoma
Dx?
Primary brain tumor w/ characteristic perivascular pseudorosettes & basal ciliary bodies found near nucleus
Ependymoma
Herniation that can compress ACA?
Cingulate (subfalcine) herniation under falx cerebri
What is “anisiocoria”?
Asymmetry of the pupils
How to test CN 11 in PE?
- Shrug shoulders
- Turn head left & right
(both against resistance)
How to test CN 12 in PE?
Stick out tongue (should be straight)
How to test CN 9 in PE?
Open mouth & look for Uvula deviation to opposite side of lesion
Is “Pronator Drift” UMN or LMN sign?
UMN sign
What can cause Uvula deviation to one side?
- CN 9 lesion
2. Peritonsillar abscess
What number grade is normal strength?
5+
What number grade is normal reflex?
2+