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pathophys Flashcards

1
Q

primary HA

A

migraine, cluster, tension, misc - usually subacute presentation

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2
Q

phys of all HAs

A

inflamm or physical traction of pain sens nerve fibers

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3
Q

pain sens structures of the head

A

dura and meninges at base of brain, large arteries at base, meningeal arteries, venous sinuses, scalp muscles, upper cerv muscles, periosteum of skull, facial and head structures (eyes, skin, teeth, sinuses, muscles)

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4
Q

brain parenchyma is ___ to pain

A

insensitive

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5
Q

CNV1 innervates pain sens structures of

A

ant/middle cranial fossa and scalp

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6
Q

CNIX, X and C2/3 innervate

A

posterior fossa and cervical muscles, post scalp

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7
Q

pain sens fibers synapse

A

in trigem nucleus caudalis and dorsal horn of upper cervical cord

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8
Q

central pain fibers synapse

A

in VPL and VPM of thalamus and then head to sensory cortex

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9
Q

migraine

A

frequently unilateral, pulsating, mod/severe, 4-72hr, nausea and possible vomiting, photo and phonophobia, prodromal phase, may have aura (20%), specific triggers, family history

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10
Q

migraine prodrome experienced by ___

A

40%

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11
Q

migraine prevalence

A

15-25%. More common in women, usually begins before age 20. decreased occurrence after age 55

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12
Q

familial hemiplegic migraine

A

dominant gene

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13
Q

vascular changes associated with migraine mediated by

A

aff/eff trigem nucleus caudalis and superior salivatory nucleus

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14
Q

migraine aura phys

A

scintillations - excitation of calcarine cortex with cortical spreading depression following. Hyperemia followed by oligemia.

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15
Q

important NT in pathogen migraine

A

CGRP and SP (vasodilatory properties)

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16
Q

5HT1D R

A

peripheral neuron (trigem)

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17
Q

5HT1B/D/F R

A

central neuron (trigem)

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18
Q

5HT1B R

A

vascular terminals

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19
Q

actions of CGRP

A

dural artery, on mast cells, NT at a central trigem synapse

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20
Q

gepants

A

CGRP antagonists - decrease blood flow in cerebral vessels, block neurogenic inflammation, inhibit pain transmission

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21
Q

cluster HAs

A

unilateral pain, frontal, retro-orbital, unilat conj injection and rhinorrhea, unilat Horners and lacrimation, constant severe, non pulsating, duration ~ 3 mins, daily attacks for weeks then remission for yrs

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22
Q

epidem cluster HAs

A

M>W 4:1, onset ~ 25y/o, alc and tobacco are triggers, rare family hx

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23
Q

cluster HA tx

A

nasal oxygen, subcut sumatriptan. Prophylax with calc chan blockers, lithium, valproic acid, prednisone

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24
Q

Tension HA

A

bilateral/band dist, no aura, no N/V, no photophobia or phonophobia, duration minutes-3 hours. daily attacks <15days/month - episodic. More - chronic

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25
Tx of tension HA
if chronic - refer to neurologist or HA expert. Episodic - usually OTC
26
Pseudotumor Cerebri - idiopathic intracranial hypertension
HA variable, papilledema, transient visual obscurations, diplopia secondary to CN VI paresis, tinnitus, visual field defects
27
Epi of Pseudotum cerebri
W>M 9:1 age 20-45. overweight individuals
28
pathogenesis of pseudotumor
primary idiopathic - inc CSF prod, dec reabsorption primary symptomatic - hypervitaminosis A, antibiotics (tetracycline), steroid withdrawal secondary - venous sinus thrombosis, chronic meningitis, chiari malformation
29
dx pseudotumor
MRI, LP - opening pressure >250 mm H2O, measure visual fields.
30
tx pseudotumor
weight loss! most effective but difficult, acetazolamide or furosemide to decrease CSF production, repeat LPs, optic nerve fenestrations, shunts, monthly f/u for visual system analysis.
31
Giant cell arteritis
autoimmune, systemic vasculitis causing granulomatous infiltration and occlusion of med/small elastic arteries. Associated with polymyalgia rheumatica
32
Giant cell arteritis sx
HA- unilateral, point scalp tenderness, visual sx
33
Giant cell arteritis dx
increased ESR, CRP elev, biopsy (inflamm and multinuc giant cells in elastic lamina)
34
Giant cell arteritis tx
start corticosteroids right away - emergency! perform bx ASAP
35
CNS tumor cure rate
65%
36
NF1 gene
chrom 17
37
NF2 gene
chrom 22
38
tuberous sclerosis gene
9q/16p
39
VHL gen
chrom3
40
Turcot
germline mut in APC
41
tumor in turcot
medulloblast, GBM
42
tumor in VHL
hemangioblast
43
tumor in tuberous scle
subependymal giant cell
44
tumor in NF1
optic glioma, meningioma, ependymoma
45
tumor in NF2
bilateral vestibular schwanomma
46
cowden gene
PTEN, leading to hyperactive mTOR path
47
tumor cowden
dysplastic gangliocytoma of the cerebellum
48
tumor li fraumeni
astrocytoma and medulloblast
49
li fraumeni gene
p53 mut
50
nevoid basal cell carcinoma AKA gorlin syndrome gene
PTCH mut on chrom 9
51
tumor in gorlin
medulloblastoma
52
increased ICP triad
AM vomiting, HA, lethargy
53
MC childhood brain tumor
low grade astrocytoma
54
malignant astrocytoma
glioblastoma multiforme
55
juvenile pilocytic astrocytoma histology
eosinophilic rosenthal fibers and hyalination of blood vessels
56
juv pilo ast genetics
activating MAPK pathway, KRAS act, BRAF act etc.
57
mut location for juv pilo ast
BRAF fusion - cerebellar; BRAF V600E - extracerebellar; NF1 loss in optic pathway
58
medulloblast age peak
3-4 yrs
59
medulloblast more common in
males
60
if in cerebrum medulloblast is called
PNET
61
medullo blast are 40% of
post fossa tumors
62
medulloblast tend to spread
through CSF, also hard to get full resection, adjuvant therapy beneficial
63
medulloblast hist
densely cellular, round, oval or angulated, low vascular, homer wright rosette
64
pathways in medulloblast
SHH and Wnt, B cat can travel to nuc and is a trans activator. Wnt tumors have good prognosis, SHH tumors involving PTCH mut good prog in infants and intermediate if older. Myc amplification is very poor prognosis.
65
brainstem glioma is
uniformly fatal in 18-24 months
66
tx brainstem glioma
sx is contraind. radiation provides temp improvement, supportive care
67
diffuse intrinsic pontine glioma prognosis
dismal, median age is 7
68
sx of DIPG
long tract signs, ataxia, CN6,7,8 defecits
69
dx of DIPG
MRI - engulfs basilar artery diffuse extension into pons
70
tx DIPG
sx not possible, radiation prolongs life
71
bx DIPG
No!
72
ependymoma sites
60% post fossa, SC 10%
73
highest incidence of ependymoma
first 7 yrs of life
74
ependymoma hist
perivasc pseudorosettes of glial tumor cells radially arranged around blood vessels and true rosettes with tumors forming a lumen
75
M:F ependymoma
1:1
76
staging of ependymoma includes
CSF examination and spinal MRI
77
absence seizure can be induced by
hypervent
78
gen 3 Hz spike and wave discharges
absence seizure
79
mc childhood seizure
febrile - 2-5% of kids in US
80
peak febrile seziures
18 months age
81
dx for first simple febrile seizure
LP, EEG, blood studies maybe. Don't neuroimage
82
febrile Status Epilepticus at increased risk
acute hippocampal injury
83
febrile SE associated with
HHV-6B infection, HHV7 less often
84
1st afebrile seizure
get EEG, bloodwork/tox maybe, LP if meningeal signs,
85
epilepsy
occurrence of multiple unprovoked seizures separated by more than 24 hrs
86
hypsarrhythmia
infantile spasms - high voltage chaotic activity between seizures. may have diffuse voltage dep during seizure
87
West Syndrome
triad of infantile spasm, hypsarrhythmia, developmental arrest or regression
88
what to give if infantile spasm is due to tuberous sclerosis?
vigabatrin (inhibits catab of GABA)
89
Tx infantile spasm
ACTH, vigaba, topiramate, zonisamide, valproic, bnzs, ketogenic diet
90
Lennox-Gastaut
onset 1-8 yrs, some pts have infantile spasms, triad of at least 2 seizure types (atypical), slowing of mental devel, slow spike and wave EEG
91
EEG of Lennox-Gastaut
slow background, burst of diffuse slow spike and wave 1.5-2.5 Hz
92
Lennox-Gastaut tx
valpro, lamo, topir, zoni, felb, bnzs, ketogenic diet, corpus callosotomy, vagus n stimulator
93
childhood onset absence
3 Hz spike and wave, normal EEG background, occur mult times a day, onset 4-8yrs,
94
absence tx
ethosux preferred, maybe valproic acid or lamo
95
juvenile myoclonic epilepsy
adolescent onset, can be tonic clonic, myoclonic, or absence. myoclonic jerks worse in the morning. Lots of stim including photo, sleep dep, stress. req lifelong tx
96
juvenile myoclonic epilepsy tx
valpro, topir, levetiracetam, lamo, zoni
97
juvenile myoclonic epilepsy gen
thought to be au dom - chrom 6
98
Benign rolandic epilepsy
mc form of benign partial ep in childhood, discharges from lower rolandic area. onset 4-12 yrs peaks at 9.
99
Benign rolandic epilepsy presentation
nocturnal gen tonic clonic seizures
100
Benign rolandic epilepsy respond to
carbamezepine or valproate, remit by 14-16 yrs old
101
Benign rolandic epilepsy EEG
central temporal spikes

Neuro2 (6 decks)

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