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All the things > Trauma and Demyelination Disorders > Flashcards

Trauma and Demyelination Disorders Flashcards

1
Q

What is the usual cause of an epidural hematoma?

A

Fracture of the temporal bone with rupture of the middle meningeal artery

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2
Q

Lens shaped lesion on CT = ?

A

epidural hematoma

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3
Q

Why are epidural hematoma called the “talk and die” syndrome?

A

Patients can be asymptomatic for a few hours, before suddenly collapsing

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4
Q

What is the classic presentation of a epidural hematoma

A

Lucid interval, followed by quick death

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5
Q

What is the major lethal consequence of an epidural hematoma?

A

Herniation of the brain

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6
Q

What usually causes a subdural hematoma?

A

Rupture of a bridging vein 2/2 trauma

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7
Q

What are the usual s/sx of a subdural hematoma?

A

Slow progression of neurological signs, with potential herniation of the brain

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8
Q

What is a tonsillar herniation?

A

Herniation of the cerebellar tonsils through the foramen magnum, compressing the brainstem

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9
Q

What is a subfalcine herniation? What is the major consequence of this?

A
  • Cingulate gyrus herniates underneath the falx cerebri

- Compression of the anterior cerebral artery leads to infarction

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10
Q

What is an uncal herniation?

A

Herniation of the uncus of the temporal lobe, into the tentorium cerebelli

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11
Q

What are the three structures that are compressed with an uncal herniation?

A
  • CN III
  • Posterior cerebral artery
  • Paramedian artery
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12
Q

Where is the paramedian artery located?

A

arteries which supply part of the thalamus and other structures in the region

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13
Q

What is a Duret hemorrhage?

A

small lineal areas of bleeding in the midbrain and upper pons of the brainstem. They are caused by a traumatic downward displacement of the brainstem

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14
Q

What are the two basic etiologies of demyelinating disease?

A

Attack against myelin or schwann/oligodendrocytes

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15
Q

True or false: with demyelinating disease, the axons are destroyed

A

False–axons are preserved, but the myelin, and thus the conduction of impulses are impaired

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16
Q

What, generally, are leukodystrophies?

A

Inherited mutations in enzymes necessary for production or maintenance of myelin

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17
Q

What is metachromatic leukodystrophy?

A

Deficiency in arylsulfatase, causing an inability to degrade myelin. Thus it accumulates within lysosomes

18
Q

What is the most common leukodystrophy?

A

Metachromatic leukodystrophy

19
Q

What is Krabbe disease?

A

Deficiency of galactocerebroside beta-galactosidase, causing a buildup of galactocerebroside in macrophages

20
Q

What is adrenoleukodystrophy?

A

Impaired addition of coenzyme A to long chain fatty acids, causing FAs to accumulate and damage adrenal glands and white matter

21
Q

What is the pathogenesis of MS?

A

Autoimmune destruction of CNS myelin and oligodendrocytes

22
Q

What is the haplotype that is associated with MS?

A

HLA-DR2

23
Q

MS is more commonly seen where (geographically)?

A

Higher latitudes

24
Q

Which gender more commonly gets MS?

A

Women

25
Q

What is Charcot’s pentad of MS?

A
  1. Scanning speech
  2. Internuclear ophthalmoplegia
  3. Intention tremor
  4. Incontinence
  5. Nystagmus
26
Q

What causes the intranuclear ophthalmoplegia with MS?

A

Involvement of the Medial longitudinal fasciculus

27
Q

What is the medial longitudinal fasciculus?

A

Connection between CN VI on one side, and the contralateral CN III. This allows gaze to move in the same direction

28
Q

What causes the hemiparesis seen in MS?

A

Cerebral white matter loss

29
Q

What causes the lower extremity loss of sensation with MS?

A

Spinal cord involvement

30
Q

What will an MRI of a MS patient show?

A

Plaques

31
Q

What are the CSF findings of MS? (2)

A
  • Ig with oligoclonal IgG bands

- Myelin basic protein

32
Q

What are the gross characteristics of MS?

A

Graying of the white matter in the brain

33
Q

What is the treatment for an acute attack of MS? Chronic?

A
  • Acute = high dose steroids

- Chronic = IFN-beta

34
Q

True or false: IFN-beta has been shown to slow the progression of MS

A

True

35
Q

What is subacute sclerosing panencephalitis?

A

Progressive, debilitating encephalitis leading to death d/t slowly progressing infection of measles virus

36
Q

What is the virus that causes subacute sclerosing panencephalitis (SSPE)?

A

Measles virus

37
Q

What is the general course of SSPE?

A

Infection occurs in infancy, with neurological signs arising years later

38
Q

What are histological characteristics of SSPE?

A

Viral inclusions within neurons and oligodendrocytes

39
Q

Why is it called subacute, sclerosing PANencephalitis?

A

Both white and gray matter tracts are affected

40
Q

What is progressive multifocal leukoencephalopathy? S/sx?

A

Latent Infection of oligodendrocytes with JC virus is reactivated by immunosuppression.
-Presents with rapidly progressive neurological signs, leading to death

41
Q

What is central pontine myelinolysis, and what causes it?

A

Focal demyelination of the pons, 2/2 rapid IV correction of hyponatremia

42
Q

What is the usual presentation of central pontine myelinolysis?

A

Locked in syndrome (only eyes are spared)

All the things (36 decks)

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