Week 2 Neuro Flashcards
Cerebellar disorders
Ataxia, decreased tendon reflexes, asthenia, tremor, nystagmus
Spinal cord: ascending tracts
Pain-temp, proprioception, light touch
Spinothalamic tract
Pain-temp, light touch. Crosses over to other side then ascends to thalamus and cerebral cortex on opposite side.
*lesion in this tract –> loss of pain-temp sensation contralaterally, below level of lesion.
Damage to upper motor neurons
Hypertonia/spasticity, decreased motor control, spastic reflexes, +Babinski
Damage to lower motor neuron
Hypotonia, weakness, decreased reflexes in affected areas
+ Babinski
UMN lesion. Abnormal dorsiflexion of great toe and fanning of other toes
Gray matter
Neuronal cell bodies and synapses
White matter
Ascending: sensory info to brain
and descending: motor instructions from brain
Spinocerebellar tract
Does NOT cross the spinal cord therefore ipsilateral symptoms. Receives afferent from periphery.
Spinothalamic tract
Crosses spinal cord immediately, therefore contralateral sxs
Descending tracts
Extends from motor area of cerebral cortex through brain stem, cross at medial lemniscus, synapse in anterior horn of spinal cord
UMNs and LMNs
UMN
Pathway from brain to spinal cord before synapse. Do not directly stimulate target muscle
LMN
Post synaptic pathway from spinal cord to periphery. Directly stimulate target muscle
Diencephalon
All structures with “thalamus”: thalamus, hypothalamus, epithalamus, subthalamus.
Connects endocrine with nervous and limbic systems
Disorders of basal ganglia
Parkinsonism: tremors (degeneration of this and substantia nigra)
Chorea: sudden, jerky, purposeless movements
Athetosis: slow writhin, snake like movements
Hemiballismus: Wild flail of one arm
Review of sys questions for neurological patient
Pain
HEENT: HA, vision chnages, dizziness
Neuro: tremor, weakness or sensory loss, LOC, motor dysfunction, speech/swallowing issue
Mental status exam
Family hx of memory loss
Orientation
General info
Spelling
Cranial nerves
CN 7: have them smile to test for stroke
Basic labs
CBC, CMP, TSH, bedside glucose
Lumbar puncture, CT, MRI
Ischemic stroke
Due to thrombosis (or emboli, lacunar, TIA)
Sxs: embolic– acute onset, during day, headache precedes neuro deficit
Thrombotic–slower onset, during night, without headache/pain/fever
Lacunar–hemiparesis
Risk factors for stroke
Prior stroke, age, male, smoking, cocaine, family history
Labs for ischemic stroke
1st: CT
2nd: MRI
3rd: bedside glucose testing
Hemorrhagic stroke
Intracerebral and subarachnoid. 20% of strokes
Intracerebral hemorrhage
Usu HTN (trauma, brain tumor) Sxs: headache, nausea, impairment of consciousness
Severe presentation!
Subarachnoid hemorrhage
Usu ruptured aneurysm
Sxs: sudden, severe headache with LOC, severe neurologic deficits, seizures
Delirium
Sudden, days-weeks, due to infection/dehydration/drugs, reversible, poor attention
May be changes in personality, confusion
Dementia
Slow, progressive, LOC not impacted
Etiology:
Alzheimer’s, vascular, Lewy Body, Parksinson Dz, HIV assoc dementia, frontotemporal dementia
How to diagnose dementia?
History w mental status, PE with complete neuro, TSH/B12/CBC/LFT/HIV, CT/MRI
Requires:
1. Cognitive or behavioral changes (aphasia, agnosia, apraxia)
2. Decline
3. Rule out delirium
Alzheimer’s Disease
Beta amyloid deposits and neurofibrillary tangles (tau) and Ach def. Must be >40yrs to be diagnosed. Half of people >85 yrs.
Risk factors: age, family history, trisomy 21
To diagnose Alzheimer’s Dz
Dementia established clinically Deficits in > 2 areas of cognition Gradual onset and progressive worsening of memory No disturbance of consciousness Onset after 40, most after 65 yrs No systemic or brain disorders
Risk factors for vascular dementia
HTN, DM, hyperlipidemia, smoking, strokes
Vascular dementia signs and symptoms
Exaggerated DTRs, gait abnormalities, hemiplegias
History: of stroke(s)!
Lewy body dementia
Lewy bodies in cytoplasm of cortical neurons. Cognitive and extra pyramidal Sxs within one year. Rigidity of axial muscles with gait instability, symmetrical deficits, tremors
Parksinson Dz Dementia
Motor Sxs then 10-15years later cognitive Sxs. Psychiatric Sxs uncommon
Definitive diagnosis requires autopsy
