other Flashcards
ependymoma - histology
- perivascular rosettes
2. rob-shaped blepharoblasts (basal ciliary bodies) found near nucleus
Migraine treatment
acute: NSAID, triptan, ergot
prophylaxis: topiramate, verapamil, life style, propranolol, amitriptuline, valproate
Multple scleoris - CSF
increased IgG + myelin basic protein
Limbic system - structures
- hippocampus
- amygdala
- formix
- mammilary bodies
- cingulate gyris
extra-ocular movements during REM are due to
Paramedian pontine reticular formation/conjugate gaze center
Cerebellum deep nuclei
lateral to medial
Dentate, emboliform, globuse, fastigial
cns watershed zone damage –>
- upper leg/upper arm weakness
2. defect in higher order visual process
causes of anencephaly
- low follate
2. DM1
Freidreich ataxia - mode of inheritance
AR (GAA on frataxin / ch 9)
penis dermotome
S3
local anesthesia - order sensation loss
- Pain
- Q
- Touch
- pressure
cyclobenzaprine - mechanism of action
centrally acting skeletal relaxant (related to TCA)
MERRE syndrome - meaning and manifestations
myoclonic epilepsy, ragged red fibers
- -> progressive myocl epilepsy
- -> short stature
- -> lactic acidosis
- -> hearing loss
pseudorosetes rosetes are aka
Horner Wright
Collier sign
parinaud syndrome –> bilateral eyelid retraction –> sclera visible aboce the superior corneal limbs
hydrocephalus caused by increased CSF production is due to
papillomas of the choroid plexus
Vernet syndrome
lesion of jugular foramen synftome –> dusfunction of CN IX, X, XI
chemoreceptor zone - location
in the area postrema of the dorsal medulla near the 4th ventricle
horizontal gaze center - location / aka
aka: doll’s reflex
midbrain
MC location of sacculat aneurysm
anterior commun + ACA
Nucleus basalis of Meynert - location
neocortex
anterior 2/3 of the tongue is separated by 1/3 by
ternimal sulcus (and foramen cecum in the middle)
the spinal accessory nerve is vulnerable to injury at
the posterior triangle of the neck
bilateal ACA occlusion
- behavioral problems (abulia)
- urinary incontinence
- primitive reflexes
intraventricular hemorrhage in preterm infants originates from the
germinal matrix, a highly cellular + vascularized layer in the subventricular zone from which neurons + glial cells migrates out during bran development
posterior limb of of the internal capsule carries
anterior 2/3 –> motor fibers
posterior 1/3 sensory fibers
most lesions result in pure motor or combines (rare pure sensor)
visual cortex lesion - macula sparing - why
because macula receive collateral blood flow from MCA
Cavenous sinus thromobisis - due to
mc is due to contiguous spread of an infection from medial 1/3 of the face, sinuses (ethmoidal, sphenoidal), or teeth –> infection goes retrograde (valveless facial venous systme) via superior + inferior opthalmic veins
MC: s. aureus
CNS - histamine is produced at … / role
posterior hypthalamus –> play important role in arousal + weakness
corpus collosum blood supply
anterior 4/5 –> ACA
splenium –> PCA
permeability barrier in nervous system
perineurium
lateral cerebellar hemisphere is aka
neocerebellum or cerebrocelebellum
prosopoagnosia - area of lesion
right inferior temporal lobe (vascular teritorry of the the MCA
endotracheal intubation in a patient with chronic RA –>
sublxation (vertebral malalignment) the atlantoaxial joint –> acute compression of the spinal cord / vert arteries –> spinal shock (paralyisis, decreased reflex below the level of compression), hypotension (due to loss of sympathetic tone, sudden death
glossopharyngeal nerve - parasympathetics
inferior salivatory nulcleus –> CN 9 –> otic ganglion –> travels allong auticulotemporal nerve (V) parotid gland secretion
arcuate nuclei of hypothalamus
secretion of dopamine (inhibits prolactin), GHRH, GnRH
thoracic outlet syndrome is due to compression of ….. in the
lower trunk of plexus + subclavian vessels in the scalene triangle (between anterior + mimiddle scalene muscles + the 1st rib)
interscalene nerve blcok –> side effects
transient ipsilateral dipragmativ paralysis due to involvment of phrenic nerve roots as they pass thorought the interscalene sheath
(should be avoided in COPD or contralateral phrenic nerve lesion)
- CN 9. 10, 11 exit the brainstem through
- CN 12 exits the brainstem through
- CN 3 exits the brainstem through
- postolivary sulcus (posterior to olive)
- sulcus between olive + pyramide
- interpendicular space
patients with temporomandibular disorder due to V3 can have –>
boh jaw + otologic symptoms
infraorbital nerve is the continuation of the
maxillary nerve (V2)
binocular visual field - in degrees
bnocular field - 120
monocular field - 40 in each eye
all: 200
orbital floor damage –>
- sensation of upper cheek, upper lip, upper gingiva numbness + paresthesia (infraorbital nerve)
- exopthallmos (etrapment of the inferior rectus muscle) –> impaired vertical gaze
optic track lesions - Marcus Gunn pupil
optic tract lesions can also cause relative afferent pupillary defect in the pupil contralateral to the tract lesion, as the nasal portion of the retina contributes more inputo to pretectal nucleus than the temporal lesions
trapezius paralysis –>
- drooping of shoulder
- impaired abduction above horizontal
- winging scapula
general features that aid in localizing a transverse spinal cord section
- moving rostrally –> increased amount of white matter, decreased gray, more oval
- lower cervical + limbosacral regions have large ventral horns
- thoracic + early lumbar have intermediolateral cel columns
- gracile + uneate fasciculi are present above T7 spinal levels, hhere only gracili fasciculis below this level
CN 7 exits the skull through …. and ….
stylomastoid foramen –> course within parotid gland –> terminal 5 branches:
- temporal
- zygomatic
- buccal
- mandibular
- cervical
cerebellum area that control balance + eye movemets
flocculonodular
radial nerve enter forearm anterior to lateral epicondyle - after?
divides into
superficial–> somatic sensory innervation to the radial half of the dorsal hand
deep –> innervates the extensor muscles of forerm
radial nerve trauma in the supinator trauma
due to repetitive pronation/sunipation of forearm (screwdriver), dirct, dislocation of radius –> finger drop, not wrist drop, and not sensory symptoms
(between superficial + deep parts of supinator muscle
locus ceruleus
paired of PIGMENTED brainstem nucleus –> located in the posterior rostral pons near the lateral floor of the 4th ventricle + functions as the principal site for norepinephrine syntheisis –> projects to all parts of CNS –> control mood, arousal (reticular activating system), sleep-wake states, cognition, autonomic function
implicated in the pathogenesis of anxiety disorders
the CN 3 arises (level)
rostral midbrain at the level of superior colliculis + red nucleus, exits at the interpenducular fossa
the CN 4 arises (level)
caudal midbrain + exits the dorsal midbrain just below the inferior colliculis) –> decussates
facial nucleus is located
in the dorsalateral aspect of the caudal pon and extis at the ventrolateral pontomedullary junction (below the middle cerebellar peduncles
primary visual cortex is aka … / divided to
striate cortex. Divided to:
- cuneus gyrus –> upper retina/lower field
- lingual gyrus –> lower retina/upper visual field
Optic tract fibers project mainly to the
- lateral geniculate nucleus
- superior colliculus (reflex gaze)
- pretectal area (light reflex)
- surachiasmatic nucleus (cyrcadian rhythms)
causes of CN 7 trauma
fractures of temporal bone after lateral head trauma or zygomatic orbit fractures
2 mc symptoms of PCA stroke
- contralateral hemianopia with macular sparing
2. paresthesia + numbness on face, trank + limbs (lateral thalamu)
anterior choroidal artery
last branch of internal carotid –> posterior limb of internal capsule, optic tract, lateral geniculate body, choroid plexus, uncus, hippocampus, amygdala
artery of Percheron
branches off either the right or left PCA and supplies the bilateral thalami + dorsal midbrain
it is a rare normal variant and consider in patients bilateral thalami or dorsal midbrain strokes
muscle spindle system vs Golgi tendon system
spindle –> monitors + maintains muscle length (intrafusal muscle fibers connected in paraller)
Golgi –> monitors + maintains muscle force (in series arrangement) –> ib sensory axons from here contact inhibitory interneurons
from carotid sinus to medullary center
CN 9 –> Hering nerve (a branch of CN 9)
direct vs inderect sympathomimetics according to CNS
indirect enter more readily
blood solubility of an anesthetic is indicated by
its blood/gas partition coefficient:
higher blood solubility –> larger coefficient –> dissolve more easily in the blood –> larger amounts must be absorbed before becomes saturated –> slower induction
–> if lower coefficient (eg. N20) –> rapidly saturated
Caspaicin?
used topical –> loss of membrane potential in noniceptive fibers + depletion of Sub P –> initial application results in burning + stinging sensation –> chronic exposure leads to reduced pain + transmission
(FOUND IN CHILLI PEPPER FAMILY)
Drugs for neuropathic pain
- tricyclic antidepressants
- Anticonvulsants
- opioids
- Caspaicin
- Lidocaine
side effects of levodopa that persist after carvidopa administration
behavioral symptoms (eg. anxiety + agitation) –> more with carvedipa –> decrease the dose –> if not possibl, add atypical antipsychotics (such as clozapine)
fever above 42.2 –>
oxidative phosphorylation ceases –> ATP depleted -> end-organ damage
Heat stroke - everything
caused by environmental exposure (eg. children left in hot cars –> requires treatment with active cooling
febrile seizures - active cooling?
have not been shown to reduce the risk of seizres and may induce seizures by shivering + a transient rise in core body Q
phenytoin causes gingival hyperplasia - mechanism
phenytoin –> increased PDGF –> macrophages activation –> stimulate proliferation of gingival cells
juvenile myoclonic epilepsy?
a form of idiopathic generilized epilepsy that may be familial –> both arms are typically affected (both cerebra hemispheres are involved) –> sympotms espc by sleep deprivation + 1st h after awaking
treatment: broad spectrum anticonvulsant (like valproic)
Ramelteon?
Ramelteon?melatonin agonists –> safe + effective in reducing time to sleep onset in elderly (benzodiaz, antihistamines, sedating antidepressants should be avoided in elderly)
halothane mediated hepatitis - biopsy
centrilobular hepatic necrosis
CN V neuralgia - location / treatment
particulary V2/3
carbamazepine is 1st choice (2nd: baclofen + valproic)
opiodis induces euphoria / mood alternations - mechanism
involve dopaminergic pathways in the nucleus accumbens
antiemetic drugs
- antimuscarinics (scopolamine) –> motion sickness
- antihistamines –> motion sickness
- Dopamine antagonists (metoclopraminde, prochloroperazine –> chemo
- 5-HT3 inhibitors –> chemo
- Neurokinin receptor antagnosits –> inhibits Substance P (Aprepitant, fosaprepitant) –> chemo
train-of-4 stimulation
used during anesthesia to assess the degree of paralysis induced by NMJ agents –> peripheral nerve is stimulated 4 times in quick succession and the muscular response is recorded:
- nondepolarizing blocker –> progressive reduction of each of the 4 responses (fading pattern) as a result of less ach being releasd in each subsequent impulse due to the additional effect of presynaptic ach receptor blockage)
- depolarizing blocker –> initially equal reduction of all 4 twitches. Persisten exposure (phase 2) like nondepolarizing
bupropion is preferred compare other antidepressants because
- no sexual dysfunction
2. less weight gain
- smoking cessation drug that reduce craving + attenuate rewarding effect of nicotine
- alcohol cessation drug that reduce craving + attenuate rewarding effect of nicotine
- varenicline
2. naltrexone
1st generation antipsychoticis: low vs high portency according to side effect
low (chlorpromazine, tioridazone) –> anti-hist, chol, a1
high potenecy –> neurologic (eg. extrapyramidal)
paradox antipsychotics mediated akathisia
frequently misdiagnosed becaue misinterpreted as worsening psychotic symptom –> increased dose rather than decrease –> exacerbation of akathesia
Neonatal abstinence syndrome
Withrawal from transplacental OPIATES due to maternal use –> neurologic, GI, autonomic symptoms
opioid receptors - effects
Mu: Physical dependence, Euphoria, Resp + cardiac depress, reduced GI motility, sedation, analgesia
Kappa: Miosis, dysphoria, sedation, analgesia
Delta: antidepressants analgesia
(ALL at MU except miosis (k) and antidepressant (delta))
ALL ARE ANALGESIC
CNS lymphomas - chemotherapy
poor respond
carvenous hemangioma –> increased risk for
- intracarebral hemorrhage
2. seizure
another clue for VHL
congenital cysts and/pr neoplasms in the kidney, liver, pancreas
Guillain-Barre syndrome - cranial nerves?
Bell palsy
Micturation reflex (urination) is regulated by the following ceters
- Sacral micturation center (S2-4): bladder contraction (parasympath)
- Pontine mictiration center: ponitne reticular foramtion –> coordinated relaxation of ecternal urethral sphincter
- cerebral cortex - inhibits sacral micturation center
Amyloid precursors protein - function
transmembrane protein (found throughout the body)
acute cerebellitis
post-viral cerebellar ataxia –> in children –> 2-3 weeks aftere varicella, measles or RBV infection -> resolve in 3 weeks
the special charactersitic of C1 spinal nerve
the only spinal nerve carries only motor fibers
Lissencephaly?
aka: agyria –> congnital absence of gyri –> severe mental retardation + seizures
decerebrate vs decorticate
decerebrate –> damage to brainstem at or BELOW red nucleus (midpbrain tegmentum, pons) –> extensor posturing due to loss of descending excitation of the UPPER flexors
decorticate –> damage above red nucleus (hemisph, internal capsule) –> flexor due to loss of descending inhibition of the red nucleus –> hyperactivity of upper flexors
neurons are highly sensitive to iscemia - mechanism
they do not store glycogen
Prgressive supranuclear palsy
form of parkinsonisn resulting from neurodegeneration of the midbrain and frontal subcortical white matter –> rapidly progressive gait dysfunction and falls, exetutive function loss, and vertical gaze palsy
biopsy: deposition of phosphorylated tau proteins
MS - hot shower
exacerbate fatigue due to decreased axonal transmission associated with increased heat
tetanus toxin - detection
there is no available assay to detect it.
THE DIAGNOSIS OF TETANUS IS CLINICAL
osmotic demyelination - manifestation
- quadriplegia due to demyelination of corticospinal tracts
- pseudobulbar palsy due to demyelination of the corticobulbar tracts of CN 9, 10, 11
vascular vs Alzheimer dementia according to manifestation
vascular is more acute
Red nucleus - location / function
located at anterior midbrain. Participate in motor coordination of the upper extremities
raphe nucleus - location and function
located in the brainstem
role in sleep-wake cycle, anxiety, mood, psychosis, sexuality, eating behavior, impulsivity
hypocretin functiuon
promote wakefulness + inhibit REM sleep-related phenomena
Stages of grief - terminal illness
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
adolescents are less less able to wiegh the risks and benefits of their decisions or anticipate that negative consequences may occur - mechanism
prefrontal cortex (center of executive function ) does not fully develop until 3rd decade of life
first symptom of alcohol withdrawal
tremulousness
Medical conditions linked to premature ejaculation
- prostatits
2. thyroid disease
frontal lobe lesions
executive dysfunction + personality changes 2ry to impairment of the organisational, restrain + motivational systems:
left side –> apathy + depression
right side –> disinhibition
Dmage to corpus callosum
split brain damage –> lack of interhemispheric transfer of informations (eg. unable to retrieve by one hand an object palpated with the other)
dominant temporal lobe lesion
dominant: verbal memory (world recognition)
nondominant: nonvebral memory, including musical ability
methadone adverse effect
- long QT
2. Resp depression
Schwannoma histology
- Antoni A: spindle cells + palisading nuclei surrounding pink areas (+verocey bodies: interspersing nuclear free zones)
- Antoni B: looser stroma, fewer cells, and myxoid change
- S100
cricothryrotomy - passes through
skin –> superficial cervical facia (including fat + platyasma) –> investing and pretracheal layers of the deep cervical fascia –> cricothyroid membrane
(the 3rd layer of deep cerical fascia, the prevertebral, is not penetrated)
