Pathology IV

Question 1

Cingulate (subfalcine) herniation under the falx cerebri may compress which structure …

Answer 1

anterior cerebral artery - contralateral lower leg symptoms

Question 2

Central/downward transtentorial hernation displaces …

Answer 2

theb brainstem

Question 3

Complications of central/download transtentorial hernation

Answer 3

Brainstem is displaced and there is rupture of paramedian basilar artery branches -> Duret hemoorrages and death

Question 4

Uncal transtentorial hernation early symptoms

Answer 4

Ipsilateral blown pupil and down and out eye (CNIII), contralateral hemiparesis

Question 5

Uncal transtentorial hernation late symptoms

Answer 5

coma

Kernohan phenomenon

Question 6

What is Kernohan phenomenon

Answer 6

the uncal herniation causes compression of kernohans notch on the opposite side, leading to paralysis on the ipsilateral side to the herniation and contralateral blown pupil) — misleading to which side the herniation is on

Question 7

Cerebellar tonsillar hernation complications

Answer 7

Compression of the brain stem -> coma and death

Question 8

which area is affected in spinal muscle atrophy?

Answer 8

anterior horns of spinal cord

Question 9

presentation of spinal muscle atrophy?

Answer 9

LMN lesions only; symmetric weaknes
Floppy baby syndrome
Hypotonia and tongue fasciculations

Question 10

What causes spinal muscle atrophy?

Answer 10

An autosomal recessive mutation in SMN1

Question 11

ALS presentation

Answer 11

combined UMN and LMN degeneration with no sensory or bowel/bladder defects

-dysarthria, dysphagia, asymmetric limb weakness, fasciiculations, atrophy, spastic gait, etc.

Question 12

treatment of ALS

Answer 12

riluzole

Question 13

there may be a defect in WHAT causing ALS

Answer 13

superoxide dismutase 1

Question 14

When there is complete occlusion of the ASA, what is spared?

Answer 14

dorsal columns and lissauer tract.

Also the artery of adamkiewics supplies the ASA below T8

Question 15

Presentation of complete occlosuion of ASA

Answer 15

UMN deficits above the below and LMN at the level of the lesion. Loss of pain and temperature below the lesion. Dorsal columns spared.

Question 16

What is tabes dorsalis?

Answer 16

degeneration of dorsal colums due to tertiary syphilis

Question 17

What causes tabes dorsalis?

Answer 17

Tertiary syphilis

Question 18

Presentation of tabes dorsalis?

Answer 18

progressive sensory ataxia (loss of proprioception->poor coordination)
+romberg sign and absent DTRs

Question 19

Syringomyelia pathophs

Answer 19

syrinx expands and damages anterior whtie commisure of spinothalamic tract

Question 20

presentation of syringomyelia

Answer 20

loss of pain and temp in a cape-like distribution

Question 21

What parts of the spinal cord are damaged in B12 deficiency?

Answer 21

spinocerebellar tracts, lateral corticospinal and dorsal columns

Question 22

Presentation of B12 deficiency

Answer 22

ataxic gait, parasthesia, impaired position/vibration sense

Question 23

Cauda equina syndrome cause

Answer 23

herniation of spinal roots L2 and below, due to tumour or slipped disc

Question 24

presentation of cauda equina syndrome

Answer 24

radicular pain, absent knee and ankle reflexes, loss of bladder and anal sphinctor control and saddle anesthesa

Question 25

What is conus medullaris syndrome ?

Answer 25

perianal anesthesia bilaterally, and impotance

Question 26

How does poliomyelitis effect the spinal cord?

Answer 26

destruction of cells in the anterior horn of spinal cord

Question 27

CSF findings in poliovirus

Answer 27

increased WBCs and slight increased protein with no change in glucose

Question 28

What is brown-sequard syndrome?

Answer 28

Damage to half of the spinal colum from something like a stabbing
-‘hemisection of spinal cord’

Question 29

brown-sequard syndrome presentation

Answer 29

• ipsilateral loss of all sensation at level of lesion (on the same half)
• ipsilateral LMN signs at the level of the lesion
• ipsilateral UMN signs below the level of the lesion
• ipsilateral loss of proprioception, vibration, light touch, etc.
• contralateral loss of pain, temp, crude touch

Question 30

What causes friedreich ataxia (genetics)?

Answer 30

autosomal recessive trinucleotide repeat (GAA) on chromosome nine, which encodes frataxin (iron-binding protein)

Question 31

Pathophys of friedreich ataxia?

Answer 31

gene mutation leads to impaired mitochdondrial function and degeneration of lateral corticospinal tract (spastic paralysis) spinocerebellar tract (ataxia) dorsal columns and dorsal root ganglia

Question 32

presentation of friedreich ataxia

Answer 32

Usually presents in adolescence with staggering gait, falling, nystagus, dysarthria, pes cavus, hammer toes, diabetes mellitus, hypertrophic cardiomyopathy

Question 33

how does friedreich ataxia present in childhood?

Answer 33

with kyphoscoliosis

Question 34

cause of death in people with friedreich ataxia

Answer 34

cardiotrophic cardiomyopathy

Question 35

CN V motor lesion presentation

Answer 35

jaw deviates toward side of lesion (unopposed force from opposite pterygoid)

Question 36

CN X lesion

Answer 36

uvula deviates away from lesion (weak side collapses)

Question 37

CN XI lesion

Answer 37

weakness turning head to contralateral side. Shoulder droop on ipsilateral side

Question 38

CNXII lesion

Answer 38

LMN - tongue deviates toward side of lesion

Question 39

treatment of bells palsy

Answer 39

corticosteroids + acyclovir