Step 1: Neuro Awill's deck Flashcards
(157 cards)
1
Q
Anterior spinal artery deficit
A
medial medullary syndrome - contralateral hemiparesis (lower extremities), medial leminscus (↓ contralateral proprioception), ipsilateral paralysis of hypoglossal nerve
2
Q
PICA deficit
A
(lateral medullary syndrome, wallenberg’s) contralateral loss of pain and temperature, ipsilateral dysphagia, hoarsness, ↓ gag reflex, vertigo, diplopia, nystagymus, vomiting, ipsilateral horner’s, ipsilateral facial pain and temperature, trigeminal nucleus, ipsilateral ataxia
3
Q
AICA deficit
A
(lateral inferior pontine syndrome) - Ipsilateral facial paralysis, ipsilateral cochlear ucleus, vestibular (nystagmus), ipsilateral facial pain and temperature, ipsilateral dystaxia (MCP, ICP)
4
Q
Posterior cerebral artery deficit
A
contralateral homonymous hemianopia w/ macular sparing; supplie occipital cortex
5
Q
Anterior cerebral artery defect
A
supplies medial surface of the brain, leg-foot area of motor and sensory cortices
6
Q
Middle cerebral artery defect
A
Contralateral face and arm paralysis and sensory loss, aphasia (dominant sphere), left-sided neglect
7
Q
Anterior communicating artery deficit
A
most common site of circle of Willis aneurysm; lesions may causes visual field defects
8
Q
PCA deficit
A
common area of aneurysm, causes CNIII palsy
9
Q
Lateral striate deficit
A
Divisions of MCA - supply internal capsule, caudate, putamen, globus pallidus. “arteries of stroke”; infarct of the posterior limb of the internal capsule causes pure motor hemiparesis
10
Q
Watershed zones
A
between ACA/MCA, PCA/MCA. Damage in severe hypotension→ upper leg/upper arm weakness, defects in higher order visual processing
11
Q
Basilar artery defect
A
infarct causes “locked-in syndrome” (CN III is typically intact)
12
Q
Damage of stroke of anterior circle
A
general sensory and motor dysfunction, aphasia
13
Q
Damage from stroke of posterior circle
A
cranial nerve deficits (vertigo, visual deficits), coma, cerebellar deficits (ataxia) dominant hemisphere (ataxia), nondominant (neglect)
14
Q
Berry aneurysms
A
occur at bifurcations in circle of willis (most common ACA) 2. Rupture leads to hemorrhagic stroke/SAH 3. Assoc w/ adult polycystic kidney disease, Ehlers-Danlos syndrome and marfan’s. 4. Risk factors: advanced age, HTN, smoking, race (higher risk in blacks)
15
Q
Charcol-Bouchard microaneurysms
A
associated with chronic hypertension, affects small vessels (in basal ganglia, thalamus)
16
Q
Epidural hematoma CT
A
shows biconvex disk - not crossing suture lines - can cross falx, tentorium
17
Q
Epidural hematoma
A
rupture of middle meningeal artery - often secondary to fracture of temporal bone. Lucid interval. Rapid expansion under systemic arterial pressure→ transtentorial herniation. CNIII palsy
18
Q
Subdural haematoma imaging
A
crescent-shaped hemorrhage that crosses suture lines, Gyri are preserved since pressure is distributed equally. Cannot cross falx, tentorium
19
Q
Subdural haematoma
A
rupture of bridging veins - slow venous bleeding. Delayed onset of symptoms. Seen in elderly individuals, alcoholics, blunt trauma, shaken baby
20
Q
SAH
A
- rupture of an aneurysm or an AVM 2. patients complain of “worst headache of my life” 3. Bloody or yellow spinal tap 4. 2-3 days afterward there is a risk of vaspospasm due to blood breakdown products which irritate vessels (treat w/Ca channel blockers)
21
Q
Parenchymal haematoma
A
caused by HTN, amyloid angiopathy. Lobar strokes all over the brain. DM and tumor. Typically occurs in basal ganglia and internal capsule.
22
Q
Most vulnerable parts to ischaemic brain
A
hippocampus, neocortex, cerebellum, watershed areas
23
Q
Irreversible neuronal injury
A
red neurons (12-48 hours), necrosis+neutrophils (24-72 hours), macrophages (3-5 days), reactive gliosis+ vasc proliferation (1-2 weeks), glial scar (> 2 weeks)
24
Q
Atherosclerosis (re: stroke)
A
thrombi lead to ischemic stroke with subsequent necrosis (red neurons) - forms cystic cavity w/reactive gliosis
25
Haemorrhagic stroke
intracerebral bleeding, often due to aneurysm rupture - may be secondary to ischmic stroke following reperfusion (↑ vessel fragility)
26
Ischaemic stroke
emboli block large vessels 2. Atrial fibrillation, carotid dissection, PFO, endocarditis, lacunar strokes block small vessels - secondary to HTN 3. Tx w/ tPA for 3 hours
27
Transient ischaemic attack
brief, reversible episode of neurologic dysfunction due to focal ischemia. Typically sx last for <24 hours
28
Stroke imaging characteristics
bright on diffusion weighted MRI from 3-30 min post stroke to 10 days. Dark on CT for 24 hours
29
Lateral ventricle to 3rd via
Foramen of Munro
30
3rd ventricle to 4th via
cerebral aqueduct
31
4th ventricle to subarachnoid space via
Foramina of Luschka (lateral), Foramen of Magendie (medial)
32
Normal pressure hydrocephalus
wet, wobbly and wacky - does not result in increase in subarachnoid space volume. Expansion of ventricles distorts the fibers of the corona radiata and leads to the clinical triad of dementia, ataxia and urinary incontinence ( a reversible cause of dementia in the elderly)
33
Communicating hydrocephalus
decreased CSF absorption by arachnoid villi leading to increased ICP, papilledema and herniation
34
Non-communicating (obstructive) hydrocephalus
caused by a structural blockage of CSF circulation within the ventricular system (e.g. Stenosis of the aqueduct of Sylvius)
35
Hydrocephalus ex vacuo
Appearance of increased CSF in atrophy (Alzheimer’s disease, advanced HIV, Pick’s disease) - Intracranial pressure is normal: triad is not seen
36
Lumbar puncture layers punctured
1. Skin/superficial fascia 2. Ligamets (supraspinous, interspinous, ligamentum flavum) 3. Epidural space 4. Dura Mater 5. Subdural space 6. Arachnoid 7. Subarachnoid space (CSF)
37
Dorsal column 1st order neuron
Sensory nerve ending
To DRG cell body
To spinal cord ascend IL dorsal column
38
Dorsal column synapse 1
IL nucleus cuneatus or gracilis (medulla)
| gracilis = lower limb as gracilis muscle is in the leg
39
Dorsal column 2nd order neuron
decussates in medulla
| Then ascends contralaterally in medial lemniscus
40
Dorsal column synapse 2
VPL(ventral posterolateral nucleus) of thalamus
41
Dorsal column third order neuron
Sensory cortex
42
Spinothalamic tract function
Ascending pain and temperature sensation
43
Spinothalamic 1st order neuron
Sensory nerve ending (A-delta and C fibers) (cell body in DRG)
Then enters spinal cord
44
Spinothalamic tract synapse 1
IL gray matter in spinal cord
45
Spinothalamic 2nd order neuron
Decussates at anterior white commissure
| Then ascends contralaterally
46
Spinothalamic tract synapse 2
VPL of thalamus
47
Spinothalamic 3rd order neuron
Sensory cortex
48
Lateral corticospinal tract function
descending voluntary movement of contralateral limbs
49
Lateral corticospinal tract 1st order neuron
UMN (cell body in primary motor cortex)
Descends IL (through internal capsule) until decussating at caudal medulla (pyramidal decussation)
Descends contralaterally
50
Lateral corticospinal tract synapse 1
cell body of anterior horn of spinal cord
51
Lateral corticospinal tract second order neuron
LMN (leaves spinal cord)
52
Lateral corticospinal tract synapse 2
Neuromuscular junction
53
UMN disease signs
weakness, hyperreflexia, increased tone, (babinski, spastic paralysis, clasp knife spasticity)
54
LMN lesion signs
1.weakness, 2. atrophy, 3. fasciculation (twitching) , 4. hyporeflexia, 5. low tone
55
Romberg test
the subject stands with feet together, eyes open and hands by the sides. Then the subject closes the eyes while the examiner observes for a full minute.
56
Brown-Sequard syndrome
1. Ipsilateral UMN signs below hemisection lesion (corticospinal tract) of spinal cord 2. IL loss of tactile, vibration proprioception sense (dorsal column) below lesion 3. CL pain and temp loss below lesion ( spinothalamic) 4. IL loss of all sensation at level of lesion 5. LMN signs at level of lesion. 6. If lesion above T1 = Horner’s syndrome
57
Horner's syndrome
sympathectomy of face 1. Ptosis 2. Anhidrosis 3. Miosis - assoc w/ lesion of spinal cord above T1
58
Muscle spindle monitor
Muscle length
59
Golgi tendon monitor
Muscle tension
60
Biceps reflex
C5 nerve root
61
Triceps reflex
C7 nerve root
62
Patella reflex
L4 nerve root
63
Achilles reflex
S1 nerve root
64
Babinski reflex
dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life.
65
Moro reflex
"hang on for life" reflex —abduct/extend limbs when startled, and then draw together - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
66
Rooting reflex
movement of head toward one side if cheek or mouth is stroked (nipple seeking) - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
66
Suckling reflex
sucking response when roof of mouth is touched - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
67
Palmar/plantar reflexes
curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
68
Pineal gland
melatonin secretion, circadian rhythms.
69
Superior colliculi
conjugate vertical gaze center.
70
Inferior colliculi
auditory.
71
Palmar/plantar reflexes
curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
72
Spinothalamic tract function
Ascending pain and temperature sensation
73
Spinothalamic 1st order neuron
Sensory nerve ending (A-delta and C fibers) (cell body in DRG)
Then enters spinal cord
74
Pineal gland
melatonin secretion, circadian rhythms.
75
Spinothalamic tract synapse 1
IL gray matter in spinal cord
76
Superior colliculi
conjugate vertical gaze center.
77
Spinothalamic 2nd order neuron
Decussates at anterior white commissure
| Then ascends contralaterally
78
Inferior colliculi
auditory.
79
Spinothalamic tract synapse 2
VPL of thalamus
80
Dorsal column synapse 1
IL nucleus cuneatus or gracilis (medulla)
| gracilis = lower limb as gracilis muscle is in the leg
81
Spinothalamic 3rd order neuron
Sensory cortex
82
Dorsal column 2nd order neuron
decussates in medulla
| Then ascends contralaterally in medial lemniscus
83
Dorsal column synapse 2
VPL(ventral posterolateral nucleus) of thalamus
84
Lateral corticospinal tract function
descending voluntary movement of contralateral limbs
85
Lateral corticospinal tract 1st order neuron
UMN (cell body in primary motor cortex)
Descends IL (through internal capsule) until decussating at caudal medulla (pyramidal decussation)
Descends contralaterally
86
Dorsal column third order neuron
Sensory cortex
87
Spinothalamic tract function
Ascending pain and temperature sensation
88
Lateral corticospinal tract synapse 1
cell body of anterior horn of spinal cord
89
Lateral corticospinal tract second order neuron
LMN (leaves spinal cord)
89
Spinothalamic 1st order neuron
Sensory nerve ending (A-delta and C fibers) (cell body in DRG)
Then enters spinal cord
90
Lateral corticospinal tract synapse 2
Neuromuscular junction
91
Spinothalamic tract synapse 1
IL gray matter in spinal cord
92
UMN disease signs
weakness, hyperreflexia, increased tone, (babinski, spastic paralysis, clasp knife spasticity)
93
Spinothalamic 2nd order neuron
Decussates at anterior white commissure
| Then ascends contralaterally
94
LMN lesion signs
1.weakness, 2. atrophy, 3. fasciculation (twitching) , 4. hyporeflexia, 5. low tone
95
Spinothalamic tract synapse 2
VPL of thalamus
96
Romberg test
the subject stands with feet together, eyes open and hands by the sides. Then the subject closes the eyes while the examiner observes for a full minute.
97
Spinothalamic 3rd order neuron
Sensory cortex
98
Brown-Sequard syndrome
1. Ipsilateral UMN signs below hemisection lesion (corticospinal tract) of spinal cord 2. IL loss of tactile, vibration proprioception sense (dorsal column) below lesion 3. CL pain and temp loss below lesion ( spinothalamic) 4. IL loss of all sensation at level of lesion 5. LMN signs at level of lesion. 6. If lesion above T1 = Horner’s syndrome
99
Lateral corticospinal tract function
descending voluntary movement of contralateral limbs
100
Horner's syndrome
sympathectomy of face 1. Ptosis 2. Anhidrosis 3. Miosis - assoc w/ lesion of spinal cord above T1
101
Lateral corticospinal tract 1st order neuron
UMN (cell body in primary motor cortex)
Descends IL (through internal capsule) until decussating at caudal medulla (pyramidal decussation)
Descends contralaterally
102
Muscle spindle monitor
Muscle length
103
Lateral corticospinal tract synapse 1
cell body of anterior horn of spinal cord
104
Golgi tendon monitor
Muscle tension
105
Lateral corticospinal tract second order neuron
LMN (leaves spinal cord)
106
Biceps reflex
C5 nerve root
107
Lateral corticospinal tract synapse 2
Neuromuscular junction
108
Triceps reflex
C7 nerve root
109
Patella reflex
L4 nerve root
110
UMN disease signs
weakness, hyperreflexia, increased tone, (babinski, spastic paralysis, clasp knife spasticity)
111
Achilles reflex
S1 nerve root
112
LMN lesion signs
1.weakness, 2. atrophy, 3. fasciculation (twitching) , 4. hyporeflexia, 5. low tone
113
Babinski reflex
dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life.
114
Romberg test
the subject stands with feet together, eyes open and hands by the sides. Then the subject closes the eyes while the examiner observes for a full minute.
115
Moro reflex
"hang on for life" reflex —abduct/extend limbs when startled, and then draw together - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
116
Brown-Sequard syndrome
1. Ipsilateral UMN signs below hemisection lesion (corticospinal tract) of spinal cord 2. IL loss of tactile, vibration proprioception sense (dorsal column) below lesion 3. CL pain and temp loss below lesion ( spinothalamic) 4. IL loss of all sensation at level of lesion 5. LMN signs at level of lesion. 6. If lesion above T1 = Horner’s syndrome
117
Rooting reflex
movement of head toward one side if cheek or mouth is stroked (nipple seeking) - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
118
Horner's syndrome
sympathectomy of face 1. Ptosis 2. Anhidrosis 3. Miosis - assoc w/ lesion of spinal cord above T1
119
Suckling reflex
sucking response when roof of mouth is touched - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
120
Muscle spindle monitor
Muscle length
121
Palmar/plantar reflexes
curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
122
Golgi tendon monitor
Muscle tension
123
Pineal gland
melatonin secretion, circadian rhythms.
124
Biceps reflex
C5 nerve root
125
Triceps reflex
C7 nerve root
126
Superior colliculi
conjugate vertical gaze center.
127
Patella reflex
L4 nerve root
128
Inferior colliculi
auditory.
129
Achilles reflex
S1 nerve root
130
Babinski reflex
dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life.
131
Moro reflex
"hang on for life" reflex —abduct/extend limbs when startled, and then draw together - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
132
Rooting reflex
movement of head toward one side if cheek or mouth is stroked (nipple seeking) - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
133
Suckling reflex
sucking response when roof of mouth is touched - primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
134
Palmar/plantar reflexes
curling of fingers/toes if palms of hands/feel arc stroked -primitive reflex - usually disappear within first year of life, may reappear with frontal lobe lesion
135
Pineal gland
melatonin secretion, circadian rhythms.
136
Superior colliculi
conjugate vertical gaze center.
137
Inferior colliculi
auditory.
138
Cranial nerve nuclei
located in tegmentum portion of brain stem (b/w dorsal and ventral portions 2. Lateral nuclei are sensory Medial are motor 3. Midbrain III,IV, 4. Pons - V, VI, VII, VIII 5. Medulla IX, X, XI, XII
139
Corneal reflex
afferent V1 ophthalmic (nasociliary branch: levator palpebrae), efferent VII (temporal branch: obicularis oculi)
140
Jaw jerk reflex
afferent V3 (sensory-muscle spindle of masseter) efferent V3 (motor of masseter)
141
Pupillary reflex
Afferent II, efferent III
142
Gag reflex
afferent IX, efferent IX and X
143
Nucleus AMbiguous
M is for Motor
Vagal nucleus - motor innervation of pharynx, larynx and upper esophagus (swallowing, palate elevation) - IX, X, XI
144
Dorsal Motor Nucleus
sends autonomic (Parasympathetic) fibers to heart, lungs, upper GI
145
Nerve through cribiform plate
CN I
146
Passes through optic canal
CN II, ophthalmic artery
147
Passes through SoF
CN III, IV, V1, VI, sympathetic fibers
148
Passes through foramen rotundum
V2
149
Passes through foramen ovale
V3
150
Passes through foramen spinosum
middle meningeal artery
151
Passes through internal auditory meatus
VII, VIII
152
Passes through jugular foramen
CNIX, X, XI, jugular vein
153
Passes through foramen magnum
spinal roots of CNXI, brain stem, vertebral arteries
154
Passes through cavernous sinus
CNIII, IV, V1,V2 and VI and postganglionic sympathetic fibers en route to the orbit.
155
Cavernous sinus syndrome
opthalmoplegia, ophthalmic and maxillary sensory loss - due to mass effect
