PP Clues Neurology Flashcards
What is the central nervous system?
Brain and spinal cord; oligodendrocytes
What is the peripheral nervous system?
Everything else; Schwann cells
What does the autonomic nervous system do?
Automatic stuff
What is the somatic nervous system
Moving your muscle
What is the parasympathetic
Rest-and-Digest => slows stuff down
How does the parasympathetic system behave?
DUMBBELS”:
Diarrhea
Urination
Miosis “constricts”
Bradycardia
Bronchoconstriction
Erection “point”
Lacrimation Salivation
What is the sympathetic system?
Fight-or-Flight => speeds stuff up
How does the sympathetic system behave
Opposite of Parasympathetics:
Constipation Urinary
retention
Mydriasis “eyes wide with fright”
Tachycardia Bronchodilate
Ejaculation “shoot”
Xerophthalmia (dry eyes)
Xerostomia (dry mouth)
Where is NE synthesized in cns?
Locus coerelues of the pons
globally modulate arousal states and adaptive behavior
what happens to NE in anxiety and depression?
up in anxiety
down in depression
Dopamine in Huntington, parkinson and depression
up in Huntington
down in Parkinson
down in depression
what is serotonin synthesized
pons
Raphe nucleus
part of reticular activating system regulating serotonin
serotonin in Parkinson, anxiety, and depression?
up in parkinson
down in anxiety
down in depression
What nucleus synthesized ach?
Basal nucleus of Meynert
ACh in parkinson
Alzheimer
Huntington
up in parkinson
down in Alzheimer
down in Huntington
what does the forebrain or prosencephalon give rise to?
Telencephalon = Cerebral Hemispheres
Diencephalon=Thalamus
Midbrain or mesencephalon give rise to
midbrain=mesencephalon
hindbrain or rhombencephalon give rise to
mesencephalon =pons and Cerebellum
Myelencephalon=medulla
HTN, Bradycardia and high ICP Triad?
Cushing’s triad
Budd-chiari?
hepatic vein obstruction
Arnold-chiari
foramen magnum obstruction
Anencephaly
Notochord did not make contact w/ brain= only have medulla
Encephalocele
Brain tissue herniation
Dandy walker malformation
no cerebellum, distended 4th/lateral ventricles
Arnold-chiari Malformation
Herniation of cerebellum through foramen magnum
Type I: cerebellar tonsils (asymptomatic)
Type II: cerbellar vermis/ medulla => hydrocephalus, syringomyelia (loss of pain/temp)
s Spina bifida occulta?
Covered by skin w/ tuft of hair
Spina bifida aperta?
Has opening (high AFP)
Meningocele
Sacral pocket w/ meninges in it
Meningomyelocele
Sacral pocket w/ meninges and nerves in it
Open-angle glaucoma?
Overproduction of fluid => painless
ipsilateral dilated pupil, gradual tunnel vision, optic disc cupping
Closed-angle glaucoma?
obstruction of canal of schlemm=>sudden onset, pain, emergency
Watershed areas?
Hippocampus, splenic flexture
CN III, CN IV, CN V(1), CN V (2), and CN VI, and postganglionic sympathetic fibers
What they have in common?
contents of the cavernous sinus?
bug that loves frontal lobe
Rubella
bug that loves temporal lobe
HSV
bug that loves parietal lobe
toxoplasma
bug that loves hippocampus
rabies
bug that loves posterior fossa
TB
bug that loves DCML
Treponema
migraines presentation
Aura, photophobia, numbness and tingling, throbbing HA, nausea
Tension HA presentation
Band-like pain starts in posterior neck, worse as day progresses, sleep disturbance
cluster headaches present
Rhinorrhea, unilateral orbital pain, suicidal, facial flushing, worse w/lying down
temporal arteritis
pain with chewing, blind in one eye
trigeminal neuralgia
sharp, shooting face pain
2 kinds of partial seizures
simple(aware), complex (not aware)
what are the 3 kinds of generalized seizures
Tonic-Clonic “Grand mal”
Absence “Petit mal”
Status Epilepticus
How does an epidural hematoma present?
🍋
Intermittent consciousness, “lucid interval
How does a subdural hematoma present
Biconvex Lens, crossing suture lines
🍌
Headache 4wks after trauma, elderly (loose brain)
subdural hematoma
fragile vessel
How does a subdural hematoma look on CT?
🌙🌛
crescent shape, crosses suture lines, midline shift
subarachnoid hemorrhage presentation
worst headache of my life, h/o berry aneurysm
Astrocytoma
Rosenthal fibers, #1 in kids w/ occipital
Ependymoma
Rosettes, in 4th Ventricle, hydrocephalus
Craniopharyngioma
motor oil biopsy, tooth enamel, rathe’s pouch, ADH problem, bitemporal hemianopsia
glioblastoma multiforme
pseudopalisading, necrosis, worst prognosis, intrapersonal hemorrhage
Meningioma
parasagittal, psammoma bodies, whorling pattern, best prognosis
MC place to metastasize to the brain
lung,
breast,
skin
seen at white grey junction
oligodendroglioma
nodular calcification and fried-egg appearance
pinealoma
loss of upward gaze, loss of circadian rhythms=>precocious puberty
Schwannoma
CN8 tumor, unilateral deafness
Neurofibromatosis
Café au lait spots (hyperpigmentation) => peripheral nerve tumors, axillary freckle
Sturge-Weber?
Port wine stain (big purple spot) on forehead, angioma of retina
Brain: inhibitory NT
GABA: Chloride influx
NT inhibitory for Spinal cord
Glycine: chloride influx
Drug causing chloride influx
Benzo
Barbiturates
Alcohol
Opiates
Affecting glycine
Tetanus
Strychnine
Over stimulation of nerve
Excitotoxicity
Mediates reinforcement of addictive behavior
NMDA Pathway
aspartate
Uses ach for pre and post ganglionic fiber
Depolarize head/neck and belt
Parasympathetic
Has longer preganglion and shorter post ganglionic
Hyper-polarizes thoracolumbar
ACH
Excitatory NT
Glutamate
Aspertate:NMDA
Memantine n Riluzole moa
Block glutamate
Catacholamines excitatory neurotransmitter
Dopamine
Norepinephrine
Epinephrine (Hormone)
Monoamines excitatory NT
Serotonin • Dopamine • Norepinephrine
Sympathetic in the CNS • Parasympathetic in the PNS • Made from tryptophan
Serotonin
Control Reticulate activating system (raphe nucleus0
Ands hallucinations
Helps focus on one thing at a time
Serotonin
Serotonin syndrome treat with
(5HT)-1a and 5HT-2 receptors
Cyproheptadine
altered mental status, autonomic instability, and tremor, hi reflex
Carcinoid syndrome
treatment
Octriotide
Used in making Nor-epi, and made from tyrosine
Dopamine
Used by basal ganglia and vomitting center
Dopamine
Control urges(mesolimbic system)
Vomiting control
CNS chemotactic trigger zone area postrema
Promethazine
Perchloromethazine
GI- ondensitron
MCC of autonomic dysfunction
Diabetes
Riley-day syndrome
Shy-dragger
Sick sinus syndrome
Drugs
Catacholemine/monoamin that control sympathetic, no methyl group, made from tyrosine
Nor epi
Short acting adrenal stress hormone
Receptors
Epi-beta
Beta 2…1..then alpha 1&2
Beta 2 effects on bp
Lower BP
Polypeptides
Cck
Substance P
Neuropeptide
Neuropeptide Y
most abundant
Response to stress; circadian rhythms; controls cardiovascular system; inhibits release of glutamate; increases appetite
what are the endo-opioids
Beta endorphins
Enkaphalins
Dynorphins
pain relief and behavior reinforcemnt pathways
only retrograde neurotransmitter
endocannabinoids
What does NO and CO have in common
cGMP
NO> vasodilator
CO> help with smell (CN1)
L-Arginine makes NO
preganglionic fibers for SNS releases
ACH
Primary postganglionic fibers
Nor Epi
some pathways use DA or Serotonin
SNS
sympathetic system depolarize and hyperpolarizes?
brain and thoracolumbar
Sacral
long postganglionic fibers
second Messengers
parasympathetic:
Sympathetic:
parasympathetic: c-GMP
Sympathetic: c-AMP
2nd msg
smooth muscle contraction by neurotransmitter or hormone
IP3/DAG
2nd msg
smooth muscle contraction by distention
Calcium-calmodulin
use to diagnose pheochromocytomas and neuroblastomas
VMA
HVA
Metanephrines
neuroblastomas signs
opsoclonus
myoclonus
Raccoon sign with no trauma
used to diagnose Carcinoid syndrom
5-HIAA
txt: ceproheptadine
Parasympathetic receptor
mostly Muscarinic
Nicotinic at Ske. mm and ganglia
competitive inhibitor of choline with fight/flight response
Hemicholinium
block vesiculation
vesamicol
ACH
causes sympathetic SE
Block vesiculation
Reserpine
DA, NE
hypertention with autonomic dysfunction and parkinson-like
promotes parasympathetic: relax
Cholinergic Agonists
ACH
pilocarpine
Bethanechol
Carbachol
methacholine
Reversible
AchE Inhibitor
Edrophonium
Neostigmine
Pyridostigmine
Physostigmine(cns)
Rixastigmine
promotes more parasympathetic
Irreversible
AchE Inhibitors
Everything relaxes
Echothiophate
DUMBELLS/SLUDGE
remove clothing, Atropine and pralidoxime
promotes sympathetic (antiparasympathetic)
Anticholinergic
Atropine
Homatropine
Tropicamide
Benztropine
Scopolamine
Ipratropium
Methylscopolamine
amplify Dopamine
COMT inhibitor
Tolcapone
Betalcapone(entacapone)
serotonin agonists
metoclopramide
high incident of drug induce parkinson
serotonin agonists
methysergide
used for magrine but too strong
causes Retroperitoneal fibrosis
serotonin agonists
Traptans
Magrine
causes stroke and MI
serotonin agonists
affect P450 dependents
warfarin
estrogen
phenytoin
Theophyline
Digoxin
Migraine management
Prophylaxis: propranolon, topiramate
Abortive: Oxygen, Triptans
Chronic: Botox injections
sympathetic receptors are
nicotinic except of sweat glands which are muscarinic
sympathetic
anticholinergic
can’t sweat:
Hot dry skin
Status Epilepticus
Continuous seizures for more than 20 min
treatment
Lorazepam
Diazepam
Lennox Gastaut Syndrome
TXT
Lobectomy
Myotonic seizures treatment
valproic acid
Na/ca blocker
Infantile spasm treatment
ACTH injections
absence seizures treatment
ethosuximide
Ca++
Febrile seizure treatment
acetaminophen
Temporal seizure treatment
carbamazepine
Generalized seizures treatment
children: phenobarbital
in adults: phenytoin
children with hundrends of seizures each day
Lennox Gastaut syndrome
myotonic seizure present
sudden contraction of abdominal muscles
Infantile spasms
sudden contration of abdominal muscle
Benign Rolandic seizures
child wakes up, eyes fluttering, falls back to sleep, no memory
Atonic seizure origin
frontal cortex
Febrile seizures last for
<20min
complex recurrent last >20min
EEG and neurological exam in febrile seizure
normal or abnormal
normal
mc seizure in children
staring spells
absence seizures
Three per second spike and wave pattern on EEG
absence seizures
change in muscle follow by shaking and jerking
Tonic clonic seizure
pre-seizure hallucination
smell, hearing or visceral
temporal lobe seizure
epilepsy management
treatment: least 2 years
must be seizure free : 6 months
mcc of seizure
uncontrolled depolirazation
Ischemia
mass, CNS infection, metabolic disorders
unknown seizure etiology is called
seizure disorder
spinal cord lesion present with
pain and temp on opposite side of all other deficits
location 2 dermatones above pain/temp
only 2 CN that crosses midline
CN 7 and 12
CN 7: lower .5 of opposite face, LMN @ ganglion, entire .5 face droop
medulla CN
breathing and HRT rate control
9,10,11,12
12 midline
Pons CN
lock in syndrome
5,6,7,8
6 midline:
midbrain CN
3,4
3 midline
dorsal root ganglion dz
Polio-2 wks post GI enteritis
varicella-zoster
Rabies
sensitive to osmotic shifts
pons
slowly correct glucose and Na
contains pneumotactic and apneustic center
pons
dz affecting spinocerebellar pathway
alcohol(vermis)
friedrieck’s ataxia
ataxia telangiectasia
adrenoleukodystrophy
GI malabsorption, IgA, skin cancer, cerebellum symptom
ataxic telengiectasia
CAT 1 enzyme defficiency
adrenoleukodystrophy
scoliosis, telangiectasia
Friedrieck’s Ataxia
intention tremor
dysmetria
dysdiodokinesis
romberg sign
spinocerebella lesion
crosses twice: ipsilateral always
fibers enter S. cord assend 2 levels cross at antirior white commisure
spinothalamic tract
Pain and temp
Dorsal column pathology
syphilis
B-12 def(type A gastritis)
Brown-sequard(hemisection)
medulla pushed through foramen magnum
all extremity extend
decerebrate posturing
herniation goes beyond the red nucleus
extensors activated
CST, corticobulbar and rubrospinal tract lost
Decerebrate posturing
first sign of herniation(trauma)
compression of CST & Corticobulbar
CN III paralysis
loss of pupillary reflex
anisocoria
herniate just above the red nucleurs
Decorticate presentation
second sign of herniation
CN III compressed, still above red nucleus
Hi ICP u first see
papilledema
headache
Hi ICP 2nd sign
esotropia
diplopia/blurred vision
CST pathology
ALS
B-12 deficiency
Atonic seizure:frontal cortex
CST fibers originate from
frontal lobes and precentral gyri
which fibers descend the internal capsule and cross at medullary pyramids
CST
responsible for fine motor activity
inhibit extension
smooth flexion
Corticospinal tract
drug that decrease REM sleep
benzo and barbiturates
REM rebound when drug are stopped
NT in REM
ACH
ADD/ADHD
treatment
methylphenidate
promoline
dexadrine
adderall
night terrors
restless legs syndrome
bruxism
somnambalism
Delta wave
sleep spindles and k-complex
Theta:light sleep
maintains focus on 1 activity
require NE & serotonin
Reticular activating system
2nd msg of Reticular activating system
c-AMP
lacunar hemorrhage: HTN
lenticulostriate arteries
Internal capsule
Parkinson DZ treatment
L-dopa/carbidopa
Bromocriptine/carbergeline
Amantadine
selegiline
increases Dopamine
initiates movement
substantia Nigra
what NT in Substantia Nigra
Dopamine
how is Substantia Nigra inhibited
Basal ganglia via ACH or GABA
subthalamic nucleus function
final relay for coordinating fine motor movements
lesion: Ballismus and Hemiballismus
curling’s ulcers
Burn
cushing’s ulcers
brain
IBS: sym/parasym/both?
Parasym: Diarrhea
Sympathetic: constipations
drug causing hallucination
LSD: coloful
PCP:Strong
Ecstasy: strong/thrsty
amphetamines
vertical nystagmus
Amphetamines
hallucination B4 seizure
schizo
dementias
Temporal lobe lesions
Drugs: SSRI, amphetamines
Dementia: alzheimer& pick’s dz
Schizo: loss of asymmetry
frontal lobe
lesion in calcarin fissure
quadrantanopia
pie in the sky deficit
inferior or superior
monocular blindness in newborns
cataracts or retinoblastoma
monocular blindness children
optic nerve gliomas
NF
MEN 2b
monocular blindness adults
TIA
Acute retinal artery occlusion
acute retinal vein occlusion
monocular blindness Elderly
Macular degeneration
Newborn white reflex
Retinoblastoma
RB gene
Cancer
Ewing’s sarc
90% idiopathic
diabetes or galactosemia
Rubella
effect on eye
Opacification of the lens