vascular, CN / ophtho and ICU buzz phrases Flashcards
vasogenic edema
extracellular edema. Blood brain barrier damage (brain tumor)
cytotoxic edema
intracellular edema. associated with cellular membrane damage (ischemia)
plateau waves or lundberg A waves
increased intracranial pressure
crescentic hematoma
subdural hematoma. rupture of bridging veins
biconvex hematoma
epidural hematoma. rupture of the middle meningeal artery
angular acceleration and shear injury
diffuse axonal injury
CSF with xanthochromia
SAH
neurologic worsening in SAH with unsecured aneurysm
suspect rebleeding
neurologic worsening with secured aneurysm, and between 3 and 15 days
suspect vasospasm
hydrocephalus and intraventricular hemorrhage
consider external ventricular drain if ICP needs to be monitored or treated
pinpoint pupils, apneustic breathing pattern
pontine lesion
ataxic breathing pattern
medullary lesion
decorticate posture
lesion above the red nucleus
decerebrate posture
lesion between the red nucleus and the vestibular nucleus
petechial hemorrhages in the brain after trauma with bone fractures
consider fat embolism
brain injury and anisocoria
consider uncal herniation
state of pathologically reduced consciousness from which the patient can be aroused to purposeful response only with external stimulation
stupor
deep sleep cannot be aroused, may grimace or have stereotyped movements but does not localize to the stimulus
coma
awake and conscious, but quadriplegic, paralysis of lower cranial nerves and horizontal gaze. preserved vertical gaze and blinking
locked in state
previously comatose, but with return of the sleep wake cycles. lack cognitive function
unresponsive wakefulness
alteration of consciousness with poor attention and fluctuation
delirium
ipsilateral third nerve palsy and contralateral hemiplegia
weber’s syndrome (midbrain lesion)
ipsilateral third nerve palsy and contralateral involuntary movements
benedikt’s syndrome (lesion in the ventral portion of the mesencephalic tegmentum)
ipsilateral seventh nerve palsy with contralateral ataxia and tremor
claude’s syndrome (lesion in the dorsal portion of the mesencephalic tegmentum)
ipsilateral seventh nerve palsy with contralateral hemiplegia
millard gubler syndrome (lesion in the pons)
limited upward gaze, convergence retraction nystagmus light-near dissociation, lid retraction, and skew deviation of the eyes
parinaud’s syndrome (lesion affecting the quadrigeminal plate)
quadriplegia, inability to speak, limited horizontal gaze, with preserved consciuosness, vertical gaze, and blinking
locked in sydrome
vertigo, nystagmus, nausea, hiccups, hoarseness, dysphagia, ipsilateral paralysis of the palate and vocal cord, decreased gag reflex, impaired sensation on the ipsilateral hemiface, loss of sensation to pain and temperature in the contralateral hemibody, ipsilateral ataxia and lateropulsion, and ipsilateral horner’s syndrome
wallenberg’s syndrome
caused by a lateral medullary infarction associated with posterior inferior cerebellar artery or vertebral artery occlusion
ipsilateral hearing loss, vertigo, ipsilateral ataxia, ipsilateral horner’s syndrome, sensory deficit in the ipsilateral hemiface and contralateral hemibody
anterior inferior cerebellar artery infarct
contralateral hemibody sensory loss with subsequent development of pain, allodynia, and paresthesias. Results from a thalamic lesion
dejerine-roussy syndrome
finger agnosia, right-left disorientation, agraphia, and aculculia
gerstman’s syndrome
normal variant with vascular supply to both medial thalami
artery of percheron
deep branch from ACA that supplies anterior limb of the internal capsule, inferior part of head of caudate nucleus, and anterior part of globus pallidus
recurrent artery of Huebner
infarct in the posterior circulation from thrombus lodging in the distal basilar. Symptoms: behavioral abnormalities, altered level of consciousness, and abnormalities of ocular motion
top of the basilar syndrome
thalamus, contralateral hemisensory loss
pure sensory lacunar s/o
posterior limb of internal capsule, contralateral motor deficits. also described with ventral pons lacunes.
pure motor lacunar syndrome
paramedian pons, “clumsy hand” and dysarthria
clumsy hand dysarthria lacunar syndrome
dilated thin walled vessels with no smooth muscle or elastic fibers, and no intervening brain parenchyma.
cavernous malformation
thin walled venous structure with normal intervening brain tissue
venous angioma
abnormally dilated capillaries, normal intervening brain tissue
capillary telangiectasia
nidus, with arteries and veins communicating without an intervening normal capillary bed in between
AVM
hemorrhage in the putamed, caudate, thalamus, pons, cerebellum, and deep white matter. Associated iwth lipohyalinosis and charcot-bouchard microaneurysms
hypertensive ICH
lobar hemorrhages on MRI gradient echo. congo red positive amyloid material, seen as apple green birefringence with polarized light
cerebral amyloid angiopathy
central nystagmus
nonfatiguing, absent latency, not suppressed by visual fixation, duration of nystagmus greater than 1 minute, any direction, but purely torsional or vertical direction is classically central. (pure torsional BPPV can mimic)
central vertigo
subjectively less severe vertigo than peripheral, more prominent gait impairment, other neurologic signs coexist, absent hearing changes and tinnitus
peripheral nystagmus
fatiguable, latency present, suppresion by visual fixation duration of nystagmus is less than 1 minute, direction is unidirectional and usually horizontal with a torsional component.
peripheral vertigo
subjectively more severe, walking typically preserved, hearing changes and tinnitus common
taste anterior two thirds of tongue
facial nerve
tactile sensation anterior two thirds of tongue
trigeminal nerve
taste posterior one third of tongue
glossopharyngeal nerve
parasympathetic source to head and neck
superior salivatory nucleus
motor nuclei to pharanyngeal and laryngeal muscles
nucleus ambiguus
provides innervation to the parotid gland by glossopharyngeal nerve
inferior salivatory nucleus
nuclei for taste sensation
rostral nucleus solitarius
nuclei for baroreceptor reflex
caudal nucleus solitarius
nuclei for parasympathetic output to chest, thorax, and GI tract
dorsal motor nucleus of vagus
corneal reflex
afferent: trigeminal nerve, efferent: facial nerve
gag reflex
afferent: glossopharyngeal nerve, efferent: vagus nerve
pupil sparing third nerve palsy
diabetic pupil/diabetic cranial nerve palsy
ptosis, miosis, anhidrosis - (location along carotid)
Horner’s syndrome - proximal to carotid bifurcation
fourth nerve palsy (compensatory action)
contralateral head tilt
argyll robertson pupil
neurosyphillis, accomodation reflex present, pupillary reflex absent
marcus gunn pupil
afferent pupillary defect, no response to firect light, but response to consensual light in contralateral eye present
down and out pupil
third nerve palsy
hydroxyamphetamine 1% eye drops - response: Horner’s pupil dilates
horner’s pupil dilates
first or second order neuron lesion
hydroxyamphetamine 1% eye drops - response: horner’s pupil does not dilate
third order neuron Horner’s pupil
