Rapid Review Flashcards
The inferior parietal lobule is composed of what two structures?
- supramarginal gyrus and angular gyrus.
Where does the Sylvian fissure terminate and what Brodman area?
- in the supramarginal gyrus (Brodman area 40).
Where does the superior temporal gyrus terminate and what Brodman area?
- in the angular gyrus (Brodman area 39).
Brodman area for the primary motor cortex?
- Area 4.
Brodman area for Broca’s area?
- Area 44.
Brodman area for Wernicke’s area?
- Area 40 and 39.
Brodman area for the primary auditory area?
- Area 41 and 42.
Brodman area for the frontal eye fields?
- Area 8.
Brodman area for the primary somatosensory area?
- Areas 3,1 and 2.
Brodman area for the premotor area?
- Area 6.
Brodman area for the primary visual cortex?
- Area 17.
What is the terminal part of the cingulate sulcus?
- Pars marginalis.
Where does the central sulcus terminate?
- Paracentral lobule.
What bones make up the pterion?
- Frontal.
- Greater wing of the sphenoid.
- Parietal.
- Temporal.
What sutures converge to make up the asterion?
- Lamboid.
- Occipitomastoid.
- Parietomastoid.
What does the asteroid overlie?
- Transverse and sigmoid sinuses.
Where is the external landmark for the angular gyrus?
- Just above the pinna (important as part of Wernicke’s area in the dominant hemisphere).
What cervical levels does the thyroid cartilage lie?
- C4-5.
What cervical levels does the hyoid bone lie?
- C3-4.
What nerves traverse the superior orbital fissure?
- CN III.
- CN IV.
- Nasociliary nerve.
- Frontal nerve ophthalmic division.
- Lacrimal nerve.
- CN VI.
What is another name for the transverse crest in the IAC?
- Crista falciformis.
Vascular supply to the anterior limb of the internal capsule?
- Lateral striate branches of MCA.
Vascular supply to the posterior limb of the internal capsule?
- Lateral striate branches of MCA.
Vascular supply to the ventral posterior limb of the internal capsule?
- Anterior choroidal.
Vascular supply to the genu of the internal capsule?
- Direct branches of the ICA.
Vascular supply to the optic radiations?
- Anterior choroidal.
What ligaments are most important in maintaining atlanto-occipital stability?
- Tectorial membrane and the alar ligaments.
How is the lateral spinothalamic tract somatotopically organized?
- Cervical is medial.
2. Sacral is lateral.
What motor tract facilitates extensor tone?
- Vestibulospinal tract.
What motor tract facilitates flexor tone?
- Rubrospinal tract.
Branches of the cavernous carotid artery?
- Meningohypophyseal trunk.
2. Anterior meningeal artery.
Branches off the meningohypophyseal trunk?
- Dorsal meningeal.
- Inferior hypophyseal.
- Tentorial artery of Bernasconi and Cassinari.
Occlusion of what artery leads to Sheehan necrosis?
- Inferior hypophyseal.
The inferior hypophyseal artery supplies what?
- Posterior lobe of pituitary.
What structures do the anterior choroidal artery supply?
- Globus pallidus.
- Optic tract.
- Genu of IC.
- Optic radiations.
- Uncus.
- Posterior limb of IC.
- Lateral geniculate body.
What 3 segments are included in the carotid siphon?
- Cavernous.
- Ophthalmic.
- Communicating.
Where does the recurrent artery of Heubner typically originate?
- A1/A2 junction.
What structures are supplied by the recurrent artery of Heubner?
- Head of caudate.
- Putamen.
- Anterior limb of the internal capsule.
What percentage of people have a fetal PCOM?
- 15-35%.
What are the branches of the vertebral artery?
- Anterior meningeal.
- Posterior meningeal.
- Medullary.
- Posterior spinal.
- PICA.
- Anterior spinal.
What are the 3 branches of PICA?
- Choroidal.
- Tonsillohemispheric.
- Inferior vermian.
What are the 3 segments of the PCA?
- P1 - peduncular.
- P2 - ambient.
- P3 - quadrigeminal.
What is the artery of Percheron?
- Anatomic variant where a solitary trunk arises from one PCA to supply bilateral paramedian thalami and rostral midbrain.
What are the 4 types of persistent fetal anastomoses?
- Trigeminal.
- Otic.
- Hypoglossal.
- Proatlantal.
What are the main contributors to the vein of Galen?
- Precentral cerebellar.
- Basal vein of Rosenthal.
- Internal cerebral vein.
The junction of the septal vein and thalamostriate vein with the internal cerebral vein forms what on angio?
- Venous angle.
Where does the junction of the septal vein, thalamostriate vein and internal cerebral vein occur?
- At the foramen of Monro.
Which cranial nerve is the only one in the cavernous sinus that does not pass through the superior orbital fissure?
- V2.
2. It exits the skull through the foramen rotundum.
Which sites of the brain have no BBB?
- Pituitary.
- Pineal.
- Preoptic recess.
- Tuber cinereum.
- Area postrema.
If unilateral, a Hoffman sign indicates a lesion above which level?
- C8.
Which nucleus is the primary coordinating center for bladder function?
- Nucleus locus coeruleus in the pons.
Which is more common with cauda equina…urinary retention or incontinence?
- Urinary retention is more common with cauda equina although overflow incontinence can occur.
Pure word blindness is caused by what?
- Lesion in the parietooccipital lobe on the dominant side.
What syndrome causes alexia without agraphia?
- Pure word blindness (meaning they can write but cannot read).
What syndrome causes agraphia without alexia?
- Gerstmann syndrome (meaning they can read but cannot write).
Symptoms in Weber syndrome?
- CN III palsy.
2. Contralateral hemiparesis.
What is the syndrome of the Sylvian aqueduct?
- Parinaud’s syndrome combined with downgaze palsy.
What is the posterior pituitary derived from?
- Derived from downward evagination of neural crest cells from the floor of the third ventricle.
What is the anterior pituitary derived from?
- Derived from evagination of epithelial ectoderm which is also called Rathke’s pouch.
Presentation of Waterhouse-Friderichsen syndrome?
- Large petechial hemorrhages in the skin and mucous membranes.
- Fever.
- Septic shock.
- Adrenal failure.
- DIC.
Seen in children with disseminated meningococcal infection.
Empiric antibiotics used for spinal epidural abscess?
- Ceftriaxone or cefepime.
- Vancomycin.
- Metronidazole.
- +/- rifampin.
What percentage of patients with SCI with no function on initial exam will develop some recovery within 24 hours?
- 3%.
Central cord syndrome usually results from hyperflexion or hyperextension?
- Hyperextension.
Which type of incomplete SCI has the best prognosis?
- Brown-Sequard.
What are some indications for surgery in central cord syndrome?
- Spinal instability.
2. Continued cord compression in a patient who fails to improve or progressively worsens.
What is the normal atlantodental interval (ADI) in adults?
- Less than 3mm.
Describe the 3 types of atlanto-occipital dislocation.
- Type 1 - anterior.
- Type 2 - superior.
- Type 3 - posterior.
What structure is the cephalad extension of the ALL?
- Anterior antlanto-occipital membrane.
What structure is the cephalad extension of the PLL?
- Tectorial membrane.
What two structures are most important in maintaining atlanto-occipital stability?
- Tectorial membrane.
2. Alar ligaments.
AOD is suspected if the atlanto-occipital interval is greater than what?
- 2 mm.
What are 4 causes of atlanto-axial rotatory subluxation?
- Spontaneous.
- Trauma.
- Upper respiratory tract infection (Grisel syndrome).
- RA.
What are 3 causes of vertical nystagmus?
- Posterior fossa pathology.
- Sedatives.
- AEDs.
Seesaw nystagmus occurs with a lesion where?
- Diencephalon.
Nystagmus retractorius occurs with a lesion where?
- Upper midbrain tegmentum.
Where is the lesion that results in ocular bobbing?
- Pontine tegmentum.
How long does it take for papilledema to develop?
- 24-48 hours.
DDx for unilateral papilledema?
- Foster-Kennedy syndrome.
- Inflammation.
- Optic glioma.
- Multiple sclerosis.
What are 3 causes of non-pupil sparing oculomotor palsy?
- Tumor.
- Aneurysm (Pcom, basilar tip).
- Uncal herniation.
Where does the trochlear nucleus lie in relation to the aqueduct?
- Ventral at the level of the inferior colliculi.
A trochlear nerve palsy results in the eye deviated in what direction?
- Up and in.
What side does the head tilt in a trochlear nerve palsy?
- The opposite side of the lesion.
What is Tolosa-Hunt syndrome?
- Nonspecific inflammation of the superior orbital fissure.
What are two components of Raeder’s paratrigeminal neuralgia?
- Unilateral oculosympathetic paresis.
2. Homolateral trigeminal nerve involvement.
What is Gradenigo’s syndrome?
- Apical petrositis.
What is the classic triad of Gradenigo’s syndrome?
- Abducens palsy.
- Retro-orbital pain.
- Drainage from the ear.
Ocular bobbing is associated with bilateral paralysis of what?
- Horizontal gaze.
What is opsoclonus?
- Rapid, conjugate, irregular, non-rhythmic eye movement.
What is oscillopsia?
- Visual sensation that stationary objects are vibrating or swaying from side to side.
What is a type 1 occipital condyle fracture?
- Comminuted fracture.
What is a type 2 occipital condyle fracture?
- Extension of basilar skull fracture.
What is a type 3 occipital condyle fracture?
- Avulsion fracture.
What are the indications for halo or fusion in occipital condyle fractures?
- Craniocervical misalignment.
2. Occipital-C1 interval > 2mm.
What are 4 possible causes of atlanto-axial dislocation?
- Spontaneous.
- Trauma.
- Upper respiratory tract infection (Grisel syndrome).
- Rheumatoid arthritis.
What mechanism causes Hangman’s fractures?
- Hyperflexion and axial loading.
What determines disc disruption in Hangman’s fractures?
- Subluxation of C2 on C3 by more than 3mm.
Myelopathy correlates with an AP canal diameter of less than what?
- 13mm.
What is another name for Paget’s disease?
- Osteitis deformans.
What CN is most commonly affected in Paget’s disease as it exits through its bony foramina?
- CN VIII.
Most common symptom in Paget’s disease?
- Bone pain.
How does Paget’s disease present in the spine?
- Spans several contiguous levels and has thickened pedicles/lamina, dense vertebral bodies, and discs are replaced by bone.
What is another name for ankylosing spondylitis?
- Marie-Strumpell disease.
What is the first site usually affected by ankylosing spondylitis?
- SI joint.
What site of the spine is usually spared in DISH?
- SI joint.
What is Scheuermann’s kyphosis?
- Anterior wedging of at least 5 degrees of 3 or more adjacent thoracic vertebral bodies.
What are 4 upper C-spine abnormalities associated with rheumatoid arthritis?
- Basilar impression.
- Atlantoaxial subluxation.
- Subaxial subluxation.
- Vertebral artery insufficiency - due to changes at the craniocervical junction.
Most common presentation of a spinal AVM?
- Onset of back pain.
2. Progressive LE weakness and sensory loss.
What is the eponym for acute onset of SAH and sudden excruciating back pain from a spinal AVM?
- Coup de Poignard of Michon.
What is a Tarlov’s cyst?
- Spinal meningeal cyst.
What percentage of aSAH patients die before reaching the hospital?
- 10-15%.
What is the risk of rebleeding from an aSAH within 2 weeks?
- 15-20%.
What is the risk of death from vasospasm after aSAH?
- 7%.
What is the risk of severe deficit from vasospasm after aSAH?
- 7%.
What is the 30 day mortality rate after aSAH?
- About 50%.
What is the incidence of sentinel hemorrhage in aSAH?
- 30-60%.
What percentage of aSAH patients will have acute onset of hydrocephalus?
- 21%.
What is the most sensitive sequence on MRI for detecting blood in the subarachnoid space?
- FLAIR.
To call an angiogram negative for aneurysm, you must see what two areas?
- Take off both PICAs and ACOM.
What are the three criteria about an infundibulum?
- Triangular shape.
- Size of mouth is less than 3mm.
- Vessel at apex.
