Truelearn cerebrovascular all wrong Flashcards
Treatment for infantile spasm in patients without tuberous sclerosis and with tuberculosis sclerosis
Without ACTH
With Vigabatrin
Perinatal strokes
Term arterial or venous more common?
Preterm arterial or venous more common?
Term: arterial
Preterm: venous
Embryonal tumor (aka PNET) with multilayered rosettes is associated with … amplification on chromosome …
C19MC amplification on chromosome 19.
Where is serotonin produced?
Raphe Nucleus in brainstem
Where is dopamine produced?
substantia nigra pars compacta (SNc)
and
ventral tegmental area (VTA) (reward/pleasure)
Where is histamine produced?
tuberomammillary nucleus (TMN) of posterior hypothalamus
Where is acetylcholine produced?
Nucleus basalis of Meynert in substantia innominata in basal forebrain
Where is norepinephrine produced?
locus coeruleus in the pons
Where is GABA produced?
substantia nigra reticulata
Which three antiemetics are best for migraine?
Which anti-emetic has least evidence to help migraine?
Metoclopramide, chlorpromazine, and prochlorperazine
are antiemetic dopamine receptor
antagonists that can be used as monotherapy for acute migraine headache.
Ondansetron is also commonly used for migraine, there is minimal evidence-based data
supporting its use in this setting. In fact, some evidence has instead found that ondansetron has a
relatively high incidence of headache as an adverse effect.
Metoclopramide, chlorpromazine, and prochlorperazine can cause what side effects? What reduces this risk?
List 3
Chlorpromazine is classified as a low-potency typical antipsychotic. Low-potency antipsychotics have more anticholinergic side effects, such as dry mouth, sedation, and constipation, and lower rates of extrapyramidal side effects, while high-potency antipsychotics (such as haloperidol) have the reverse profile.[16]
Diphenhydramine (antihistamine Benadryl) to prevent akathisia (restless, agitated, need to move) and acute dystonia (involuntary muscle contractions)
Also risk of QT-interval prolongation and torsades de pointes.
Metoclopramide: dopamine receptor antagonist, rx N/V
Chlorpromazine: low potency FGA, dopamine receptor antagonist (and also antagonist to other receptors: serotonin, histamine, adrenergic, muscarinic)
Prochlorperazine: rx nausea, migraines (3x better than metocloperamide), psychosis, anxiety, RX vomiting from chemo
What is MOA of ondansetron?
5HT-3 Serotonin receptor antagonist in area postrema on fourth ventricle floor (chemoreceptor trigger zone)
Acts both centrally and peripherally to prevent and treat nausea and vomiting.
Moderate Diffuse Axonal Injury (DAI) definition and prognosis
LOC > 24 hrs
days of post-traumatic amnesia
mild to moderate memory deficits
chance of good recovery at 3 months is about 40%
Mild Diffuse Axonal Injury (DAI) definition and prognosis
LOC 6-24 hrs
hours of post-traumatic amnesia
mild to moderate memory deficits
chance of good recovery at 3 months about 60%
Post-stroke fatigue is associated with …
impaired processing speed and memory
adrenergic / dopaminergic drugs such as modafinil may help
Ocrelizumab rx MS, MOA?
depletion of B cells with cell surface antigen CD20
Rituximab rx MS, MOA?
depletion of B cells with cell surface antigen CD20
Ofatumumab rx MS, MOA?
depletion of B cells with cell surface antigen CD20
Ublituximab rx MS, MOA?
depletion of B cells with cell surface antigen CD20
Natalizumab rx MS, MOA?
blocks integrin-adhesion molecule interactions and inhibits T cell entry into CNS
FIngolimod rx MS, MOA?
blocks sphingosine 1-phosphate receptor (S1PR) keeping lymphocytes in lymph nodes
Siponimod rx MS, MOA?
blocks sphingosine 1-phosphate receptor (S1PR) keeping lymphocytes in lymph nodes
Glatiramer acetate rx MS, MOA?
skews T cell response to non-inflammatory phenotype in part by inactivating T regulatory cells
interferon beta rx MS, MOA?
skews T cell response to non-inflammatory phenotype in part by inactivating T regulatory cells
Dimethyl fumarate rx MS, MOA?
activates transcription factor Nrf2
rx: RRMS and psoriasis
Nrf2 is a key regulator of antioxidant responses
Alemtuzumab rx MS, MOA?
lymphocyte depletion
Cladribine rx MS, MOA?
impairs DNA synthesis
Teriflunomide rx MS, MOA?
impairs DNA synthesis
Early infantile epileptic encephalopathy (EIEE) or Ohtahara syndrome: age of presentation, type of seizures, typical EEG
first three months of life
tonic seizures, focal seizures,
EEG showing a burst suppression pattern consistent in wake and sleep w periodicity
What is central cord syndrome and what three conditions is it associated with?
weakness and loss of sensation, or pain, tingling, dull ache, in arms and hands > LE, also w bladder dysfunction acutely sometimes
- hyperextension injury
(especially older adults w arthritis, spondylosis), - syringomyelia
- intramedullary tumors
What are MCC intramedullary tumors of spinal cord?
astrocytomas, ependymomas, and hemangioblastomas.
Astrocytomas
Originate from astrocytes, which are star-shaped cells that help nerve cells function
The most common type of spinal cord tumor in children
Ependymomas
Originate from ependymal cells, which line the central canal of the spinal cord
Occur roughly twice as often as astrocytomas in adults
Hemangioblastomas
Contain many blood vessels and can occur anywhere in the spinal cord
What is MCC intramedullary tumor of spinal cord in children?
atrocytomas
what is MCC intramedullary tumor of spinal cord in adults?
ependymomas
Syringomyelia symptoms…
associated w what conditions/events?
loss of pain and temperature in cape-like distribution in UEs (decussating spinothalamic fibers in anterior commissure), Horners syndrome (descending autonomic fibers), central cord syndrome
associated w: Chiari malformations, tumors or trauma
Lamellation of CST and STT from lateral to medial?
legs, trunk, arms
Benign familial infantile seizures
inheritance pattern
Chanel mutations (list 2)
AD
sodium channels SCN2A and SCN8A
Cat woman and Poison Ivy over a baby - catwoman is shaking salt and Ivy is holding up a hen, the baby is laughing and cooing :)
Vascular dementia treatment
control risk factors: BP, LDL, DM, smoking, and taking anti-platelet agents
Lewy body dementia has
- what deposits where?
- clinical features?
alpha synuclein deposits (intracellular) in cortical layers V and VI
REM sleep behavior disorder, fluctuating cognition, visual hallucinations, Parkinsonism
REM sleep behavior disorder
- clinical features
- associated with…
physically act out dreams while in REM sleep
alpha synucleinopathies: PD, DLB, MSA
Progressive supranuclear palsy PSP
Narcolepsy type 1
Frontotemporal dementia
- male vs female?
- inheritance pattern when heritable?
- associated w what other disease?
- pathologic markers?
- key clinical characteristics
- variants
- mostly men
- AD
- 15% cases associated with ALS
- ubiquitin, and tau (Pick bodies) inclusions (intracellular) in paralimbic region
- variants: frontal-behavioral, semantic, progressive non-fluent aphasia
Alzheimers Disease
- clinical characteristics
- variants
- pathologic markers extra and intra cellular
- amnestic mcc (hippocampal)
- atypical forms: posterior cortical atrophy, frontal variant, down syndrome variant
extracellular amyloid plagues
intracellular neurofibrillary tangles
Progressive encephalomyelitis with rigidity and myoclonus (PERM)
- presentation
- associations
- rx
- associated abs
encephalopathy, autonomic instability, rigidity, myoclonus and other upper motor neuron findings
- autoimmune or paraneoplastic
Or thymomas, v rare West Nile virus or brucellosis,
rx: steroids, IVIG, PLEX AND benzodiazepines for rigidity
ABS: GAD-65, glycine, DPPX, amphiphysin
LGI1 limbic encephalitis
- key features
subacute encephalopathy with disturbances in
behavior and short-term memory and with seizures and confusion.
pathognomonic faciobrachial dystonic seizures
hyponatremia or REM sleep behavior changes.
MRI may show bilateral medial temporal lobe changes, and
treatment is with immunotherapy.
Stiff Person Syndrome
- abs?
GAD-65
NMDAR-associated limbic encephalitis
- associated with…
- key features
- test serum and CSF - which is more sensitive?
autoimmune
ovarian teratoma
behavioral disturbances, abnormal posturing, seizures
CSF and MRI variably normal
CSF more sensitive than serum for autoantibodies
Creutzfeldt-Jakob disease
rapid dementia and death w/in months
MRI: diffusion restriction in BG and or cortex (cortical ribbon sign)
Carbon Monoxide Poisoning
- clinical features
- rx
- location affected
ha, nausea, vomiting, dizziness, malaise, cherry red skin/mucosa
rx: high-flow oxygen
Globus pallidus
Carbon Monoxide (CO) Poisoning: Key Features and Clinical Considerations
Pathophysiology
Carbon monoxide (CO) is a colorless, odorless, tasteless gas that exerts its toxic effects primarily by binding to hemoglobin with an affinity 200–250 times greater than oxygen. This results in carboxyhemoglobinemia (COHb), impairing oxygen delivery and utilization at the tissue level. Additionally, CO binds to myoglobin and cytochromes, further disrupting aerobic metabolism, leading to cellular hypoxia and metabolic acidosis.
Sources of Exposure
• Incomplete combustion of hydrocarbons (fires, vehicle exhaust, gas heaters, furnaces, wood stoves)
• Industrial exposure (steel production, methylene chloride inhalation)
• Indoor exposure (faulty home heating systems, charcoal grills in enclosed spaces)
• Cigarette smoking (chronic low-level COHb elevation)
Clinical Presentation
CO poisoning is often misdiagnosed due to nonspecific symptoms. The classic presentation includes:
1. Mild to Moderate Poisoning
• Flu-like symptoms (headache, dizziness, nausea, vomiting)
• Fatigue, malaise
• Confusion, impaired concentration
• Chest pain, dyspnea (especially in patients with underlying CAD)
2. Severe Poisoning
• CNS dysfunction: Confusion, ataxia, syncope, seizures, coma
• Myocardial ischemia: ST-T wave changes, arrhythmias, hypotension, cardiac arrest
• Metabolic acidosis: Due to lactate accumulation from anaerobic metabolism
• Cherry-red skin/mucosa (late finding, often unreliable)
3. Delayed Neurological Sequelae (DNS)
• Occurs in 10–40% of survivors within days to weeks
• Memory loss, cognitive impairment, mood disorders
• Parkinsonian features, white matter demyelination (MRI: globus pallidus necrosis)
Diagnosis
• Carboxyhemoglobin (COHb) levels via arterial or venous blood gas (ABG/VBG)
• Normal: <2% (non-smokers), <9% (smokers)
• Symptomatic >10–15%, severe poisoning >25%
• Levels may not correlate with symptom severity
• Pulse oximetry is unreliable (cannot distinguish oxy-Hb from COHb)
• Lactate >2.5 mmol/L correlates with severe poisoning
• EKG and troponins in high-risk patients (CO can precipitate MI)
• Neuroimaging (MRI with DWI) for suspected DNS (basal ganglia, subcortical white matter lesions)
Management
1. Immediate 100% Oxygen via Non-Rebreather Mask
• Reduces COHb half-life from ~5 hours (on room air) to ~1 hour
2. Hyperbaric Oxygen Therapy (HBOT)
• Indications:
• COHb ≥25% (>15% if pregnant)
• Neurological symptoms (confusion, LOC, seizures)
• Myocardial ischemia
• Persistent symptoms despite normoxia
• Reduces DNS risk and speeds CO clearance (COHb half-life ~20–30 min in HBOT)
3. Supportive care
• IV fluids, vasopressors for hypotension
• Anticonvulsants for seizures
• Avoid sedatives that can mask neurological deterioration
Prognosis
• Most mild cases recover fully with prompt treatment.
• Delayed Neurological Sequelae (DNS) can be debilitating, requiring cognitive rehabilitation.
What two poisonings classically affect the Globus Pallidus?
CO and manganese
Thiamine deficiency from alcohol abuse classically affects what location?
mammillary bodies
Pyridoxine (B6)
toxicity affects what location?
Dorsal root ganglia causing neuronopathy
(Usually sensory neuronopathy in stocking glove distriubtion)
Methanol toxicity affects what location?
Basal Ganglia
bilateral putamen nuclei (black arrows) and can extend to other BG (white arrows)
What commonly causes copper deficiency?
excess zinc consumption
what locations are affected by B12 and copper deficiency?
Dorsal columns and lateral CST, and spinocerebellar tract
Carpal Tunnel Syndrome
- KNOW details of it WELL
NCS gold standard
Meige Syndrome
- clinical features
- associations
- rx
a craniocervical dystonia
blepharospasm (forced eye closure), oromandibular dystonia (lower face and jaw)
sporadic or w Parkinsonism syndromes, other dystonias, essential tremor
rx botox
Pramipexole
MOA
RX
dopamine receptor agonist
rx PD, restless leg syndrome
Trihexyphenidyl
MOA
RX
MOA: anticholinergic
RX: PD and anti-psychotic associated extra pyramidal sxs (tremors, rigidity, akathisia, dyskinesia, dystonia, bradykinesia)
Extrapyramidal symptoms w anti-psychotics
and the RX for them
List 3
tremors, rigidity, and muscle contractions
rx: trihexyphenidyl (anti-cholinergic)
Gelastic seizures
- clinical presentation, age of onset
- associated w…
- rx:
uncontrolled laughing, approx 10 months old
hypothalamic hemartoma (HH) (devleop in-utero)
surgery
MRI: HH near mammillary body
Rivastigmine
MOA
RX
SE
AChE inhibitor
Dementia w AD or PD
SE: nausea and vomiting, decreased appetite and weight loss
(more nausea and vomiting during the titration phase of oral rivastigmine treatment)
Galantamine
MOA
RX
SE
AChE inhibitor and nicotinic receptor modulator
Dementia w AD or PD
SE: nausea and vomiting, decreased appetite and weight loss
Donepazil
MOA
RX
SE
AChE inhibitor
Dementia w AD or PD, all stages of AD
SE: nausea and vomiting, decreased appetite and weight loss
Three AChE inhibitors rx for dementia (AD and PD)
we need Really Good Drugs for dementia
rivastigmine, galantamine, donepazil
Torticollis rx
botox
it is a form of cervical dystonia
Topiramate
MOA
RX
SE
inhibition of AMPA (glutamate) receptors and VG sodium channels, and weak inhibition of carbonic anhydrase
FDA-Approved
- Monotherapy or adjunct therapy for partial-onset seizures in adults and children (2 years and older).
- Adjunct therapy for primary generalized tonic-clonic seizures.
- Adjunct therapy Lennox-Gastaut syndrome.
- Migraine Prophylaxis adults and adolescents
OFF LABEL:
Weight Management / Weight Loss
Bipolar Disorder (Mood Stabilization)
Alcohol Use Disorder (Alcohol Dependence)
Binge Eating Disorder & Bulimia Nervosa
PTSD (Post-Traumatic Stress Disorder) w Nightmares
SE:
brain fog
nausea, decreased appetite
kidney stones
Metabolic and Electrolyte Issues
Metabolic acidosis (low bicarbonate levels in the blood)
Hyperammonemia (elevated ammonia levels in the blood),
Vision and Eye Problems
Acute myopia (sudden nearsightedness)
Secondary angle-closure glaucoma (rare but serious; presents with eye pain and vision changes)
Possible blurred vision or difficulty focusing
Decreased sweating (hypohidrosis), especially in children, heat intolerance
Birth Defects: cleft lip and/or cleft palate
Skin rash, itching, or hives
Rare severe reactions (e.g., Stevens-Johnson syndrome)
suicidality
Zonisamide
MOA
RX
SE
inhibits voltage dependent sodium and T-type calcium channels, weak carbonic anhydrase inhibitor (topiramate does not inhibit T type calcium channels)
FDA: adjunctive partial onset seizures in adults
brain fog
nausea, decreased appetite
kidney stones
Metabolic and Electrolyte Issues
Metabolic acidosis (low bicarbonate levels in the blood)
Hyperammonemia (elevated ammonia levels in the blood),
Vision and Eye Problems
Acute myopia (sudden nearsightedness)
Secondary angle-closure glaucoma (rare but serious; presents with eye pain and vision changes)
Possible blurred vision or difficulty focusing
Decreased sweating (hypohidrosis), especially in children, heat intolerance
Birth Defects: cleft lip and/or cleft palate
Skin rash, itching, or hives
Rare severe reactions (e.g., Stevens-Johnson syndrome)
suicidality
blood dyscrasia
Lacosamide
MOA
RX
SE
MOA: enhancing the slow inactivation of voltage-gated sodium channels
FDA:Monotherapy or adjunctive therapy in patients aged 4 years and older for the treatment of partial-onset (focal) seizures, adjunctive Primary Generalized Tonic-Clonic Seizures
Common Off-Label Uses: status epilepticus, neuropathic pain (incl diabetic neuropathy)
Warnings: cardiac: PR prolongation, AV block; CNS: depression and dizziness; suicidality, DRESS, schedule V controlled substance, renal and hepatic, headache, n/v, diplopia or blurred vision, mood (euphoria), tremor, abrupt stop increases seizure risk
Regular labs
Levetiracetam
MOA
RX
SE
binds to synaptic vesicle protein 2A (SV2A)
broad spectrum uses
SE: agitation and aggression
sleep apnea is associated with what cardiac condition?
heart failure associated with central sleep apnea, especially w cheyne-stokes breathing pattern (crescendo-decrescendo)
Diagnosis of sleep apnea should prompt search for underlying causes, especially ….(3)
heart failure, stroke, opioid use
EMG distinguishing between myopathies and motor neuropathies
myopathies: fibrillations, small complex MUP
motor neuropathies: fibrillations, fasciculations, large varying MUPs with reduced recruitment
Recurrent thunderclap headache, consider
reversible cerebral vasoconstriction syndrome RCVS
Reversible cerebral vasoconstriction syndrome (RCVS)
key features
triggers
Thunderclap headaches
multifocal narrowing of the cerebral arteries followed by dilatation, resolve 1-3 months
triggers:
Postpartum, Vasoactive Substances:
Illicit drugs (cocaine, marijuana)
Certain prescription medications (e.g., triptans, SSRIs, pseudoephedrine)
Over-the-counter decongestants
Stress/Emotional Factors: High catecholamine states (though less well-defined as a trigger).
Posterior Reversible Encephalopathy Syndrome (PRES)
presentation
causes
diagnosis
Headache, visual changes (blurred vision, visual field defects), confusion, altered mental status, seizures, nausea, vomiting, focal neurological deficits.
Causes:
uncontrolled high blood pressure
Eclampsia (pregnancy complication)
Severe infections
Kidney disease
Autoimmune diseases
Certain medications (chemotherapy drugs, immunosuppressants)
Diagnosis:
Based on clinical presentation, neurological examination, and brain imaging (MRI) showing characteristic pattern of white matter edema in the posterior brain regions.
Treatment:
Primarily focuses on managing the underlying cause, usually by rapidly lowering blood pressure with appropriate medications.
What cranial nerves are in the ambient cistern?
Located lateral to the midbrain and medial to the temporal lobe.
CN 3,4,5
PCA
SCA
Choroidal arteries
5 AEDs that cause DRESS
• Carbamazepine
• Phenytoin
• Lamotrigine
- lamictal
• Phenobarbital
Transcortical motor aphasia definition
Transcortical Motor Aphasia
Transcortical motor aphasia is a rare syndrome that is due to a small subcortical lesion superior to Broca’s area or to a lesion outside of the anterior language areas of the left hemisphere.19,32 Because of the location of the lesion in the frontal lobe, transcortical motor aphasia includes both language and cognitive components. The cognitive failures that result in limited and disorganized output are most evident in the patient’s failure to initiate speech.76 In contrast, effortless and accurate repetition of even long sentences is preserved
