pathology II Flashcards
What is conduction aphasia?
Caused by damage to the arcuate fasciculus (connects wernickes and brocas area) - patient can’t repeat what you say
What is global aphasia?
Wernickes, brocas and arcuate fasciculus are all affected
What is transcortical motor aphasia
affected frontal lobe around broca area, but broca is spared
what is transcortical senosry aphasia
affects temporal lobe around wenicke area but wernicke area is spared
what is transcortical mixed aphasia?
broca and wernicke areas and arcuate fasciculus remain intact but surrounding watershed areas are affected
saccular aneurysm aka
berry aneurysm
most common location for a berry aneurysm
junction of Acomm and ACA
how do berry aneurysms prsent
silent until they rupture -> subarachnoid hemorhage
An aneurysm in the Acom may compress surrounding structure resulting in what?
Bitemporal hemianopia (compresses optic chiasm)
An aneurysm in the Pcom may compress surrounding structures resulting in what?
CN III palsy -> mydriasis, down and out eye and ptosis
What presents similarly to a CN III palsy?
Ischemic neuropathy seen in diabetes, however pupil is spared
What are Charcot-Bouchard microaneurysms commonly found?
Small vessels such as lenticulostriate arteries
What are Charcot-Bouchard microaneurysms associated with?
chronic hypertension
What can Charcot-Bouchard microaneurysms result in?
hemorrhagic intraparenchymal strokes
Where do most partial (focal) seizures originate?
medial temporal lobe
Types of partial seizures
simple partial and complex partial
How do simple partial seizures present
consciousness remains, may be motor, sensory, autonomic or psychic
How do complex partial seizures present
impaired consciousness and automatisms
Status epilepticus
continues (>5min) or recurring seizures that may result in brain injury
types of generalized seizures
absence (petit mal) Myoclonic Tonic-clonic (grand mal) Tonic Atonic
What will be seen on a EEG of an absence seizure?
3 Hz spike-and-wave discharges
Atonic seizures are commonly mistaken for…
drop seizures
What is Juvenile Myoclonic epilepsy?
characterized by absence, myoclonic and grand mal seizures. Common in children.
Absence -> myoclonic -> grand mal
Typically myoclonic jerks on awakening from sleep
What is post-ictal state mean?
After a grand-mal seizure, this is a period of brain recovery that presents as confusion/lack of alterness and lasts minutes to hours
Treatment for childhood absence epilepsy
Ethosuxamide
Cause of fever
cytokine activation during inflammation (infection)
Cause of heat stroke
the inability of body to dissipate heat (exertion)
temperature seen in fever
Usually <40 C
temperature seen in heat stroke
usually > 40 C
Complications of fever
febrile seizures (usually benign, self-limiting)
Complications of heat stroke
CNS dysfunction (confusion), end-organ damage, acute respiratory distress syndrome, rhabdomyolysis
Management of fever
acetominaphen or ibuprofen for comfort and antibiotics if necessary
Management of heat stroke
rapid external cooling, rehydration and electrolyte correction
What causes headaches?
pain due to irritation of structures such as the dura, cranial nerves, or extracranial structures
Which type of headache is more common in males?
cluster
Location and duration of cluster headaches
unilateral
15min-3 hours, repetitive
Presentation of cluster headaches
excruciating perioorbital pain (suicide headache) with lacrimation and rhinorrhea
May present with horner syndrome
Treatment of cluster headaches
Acute: sumatriptan, 100% O2
Prophylaxis: verapamil
Migraine location and duration
unilateral, 4-72 hours
presentation of migraine
pulsating pain with nausia, photophobia or phonophobia. May have aura.
Cause of migraine
irritation of CN V, meninges or blood vessels (release of vasoactive peptides such as substance P, calcitonin gene-related peptide).
Acute treatment of migraines
NSAIDS, triptants, dihydroergotamine
Prophylaxis treatment of migraines
lifestyle changes (sleep, exercise, diet), B-blockers, aitriptyline, topiramate, valproate, botox
tension headache location and duration
> 30 minutes, usually 4-6 hours
Bilateral in band like pattern
Presentation of tension headaches
Steady band like pain with NO aura
Acute treatment of tension headaches
analgesics, NSAIDs, acetominaphen
Prophylaxis of tension headaches
TCAs, behavioural therapy
Presentation of trigeminal neuralgia
repetitive, unilateral, shooting/shock like pain in distribution of CN V. Triggered by chewing, talking, touching certain parts of the face. Lasts seconds to minutes. Intensity and frequency increases over time.
Treatment of trigeminal neuralgia
carbamazepine
Common aura
scintillating scotoma
Triptans MOA
5-HT agonists - inhibit trigeminal nerve and decrease vasoactive peptide release.
Also cause vasoconstriction
Triptans are contraindicated for which patients
coronary disease and coronary vasospasm
Akathisia presentation
restlessness and intense urge to move
asterixis
flapping of wrists on extension
athetosis presentation
slow, snake-like, writhing movements, especially in fingers
which disease has athetosis
huntingtons
chorea
sudden, jerky, purposeless movements
which disease has chorea
huntingtons
dystonia
sudden, involuntary muscle contractions
examples of dystonia
writers cramp, blepharospasm, torticollis
what is blepharospasm
abnormal contraction of eyelids
essential tremor presentation
high-frequency tremor with sustained posture. Worsened with movement or when anxious.
Treatment of essential tremor
nonselective beta-blockers or primidone
Hemiballismus presentation
sudden, wild flaing of 1 arm +- ipsilateral leg
a lesion WHERE leads to hemiballismus
contralateral subthalamic nucleus
intention tremor presentation
slow, zigzag motion when pointing/extending toward a target
Myoclonus presentation
sudden, brief, uncontrolled muscle contraction
Myoclonus examples
jerks; hiccups; common in metabolic abnormalities such as renal and liver failure
resting tremor
uncontrolled movement of distal appendages seen in parkinsons
restless legs syndrome
worse at rest/nighttime and releived by movement
What is restless legs syndrome associated with?
iron deficiency and CKD
treatment of restless legs syndrome?
dopamine agonists
