Witwer Neuro Flashcards by Catherine Atkinson

Defects in neural tube development will produce ______ and ______ _______

anecephaly and spina bifida

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What is a spina bifida?

A birth defect that occurs when the spine and spinal cord don’t form properly. It’s a type of neural tube defect.

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Amniocentesis would show what if the baby will have spina bifida?

Alpha fetoprotein

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When both the cerebellum and the brain stem extend into the foramen magnum, this is called what?

Arnold Chiari Malformation

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A generic term referring to a disorder in which a cyst or cavity forms within the spinal cord (Cervical mc)

Causes pain, muscle weakness, numbness and stiffness

Syringomegaly

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Signs of what?

papilledema
headache and vomiting (no nausea)
bradycardia and hypertension

increased intracranial pressure

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When water moves into cells because of a dysfunctional Na/K-ATPase pump this is intracellular or extracellular cerebral edema?

intracellular

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Increased vascular permeability (vasogenic) refers to intracellular or extracellular cerebral edema?

extracellular

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Which artery is impacted in Cerebral Herniation?

a. anterior
b. middle
c. posterior

a. anterior

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What are two signs of uncal herniation?

a fixed and dilated pupil (PSNS)

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Which cranial nerve is impacted in uncal herniation?

CN III

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Increased CSF production, decreased reabsorption via arachnoid vili, meningitis, tumor and SAH are characteristic of what type of hydrocephalus?

Communicating (non-obstructive)

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Stricture of Aqueduct of Sylvius – most common cause in newborns, Tumor of 4th ventricle and Scarring at base of brain are characteristic of what type of hydrocephalus?

Non communicating- obstructive

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Hydrocephalus is basically ____ on the brain?

water on the brain

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What are the 3 W’s of normal pressure hydrocephalus?

wacky, wobbly, wet

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Normal pressure hydrocephalus causes increase/decreased absorption of CSF?

decreased

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What kind of infection involving pus can be axial (in brain or spinal cord) or extra axial (external to brain or spinal cord)?

Abscesses - Epidural
May bridge dura into subarachnoid space and brain

Mastoiditis > epidural > thrombosis
of Sigmoid sinus > intracranial abscess

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Direct cytotoxic effects on the CNS cells causing HIV encephalopathy, aseptic meningitis, encephalitis, myelopathy, peripheral neuropathy, AIDS dementia is characteristic of what disease?

AIDS

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Suppression of immune system allowing
opportunistic infections with other agents such as Toxoplasmosis (most common), CMV, Herpes simplex, JC virus (Progressive Multifocal Encephalopathy), Shingles, TB, Cryptococcosis is characteristic of what disease?

AIDS

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Eastern Equine Encephalitis is from the _______virus and coincides with ______ outbreaks

arbo (tick), horse

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What are the symptoms of Eastern Equine Encephalitis (West Nile Virus)?

High fever 
Muscle pain 
Altered mental state
Headache 
Meningeal irritation 
Photophobia 
Seizures

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Which lobe of the brain is commonly affected by HSV?

Temporal lobe- in encephalitis

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HSV-1 causes lesions where?

Mouth

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Herpes zoster/shingles is a reactivation of what virus?

Chickenpox

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What disease involves a painful rash with blisters and follows dermatomes?

Herpes zoster/shingles Usually limited but may become Postherpetic neuralgia – months to years

Which nerve can be mc affected by Herpes zoster/shingles?

Trigeminal nerve (CN 5)

What is the tx for shingles?

Shingles vaccine effective in about 50%. Decreases severity if it does occur. Acyclovir for antiviral medication

What disease can be asymptomatic or have mild flu like symptoms?

Toxoplasmosis

___________ happens when people have weakened immune systems or immunocompromised and ccan cause encephalitis, headache, confusion and seizures?

Toxoplasmosis

What eye condition happens in Toxoplasmosis?

Chorioretinitis

Acute infection and/or inflammation of the meninges, especially the pia and arachnoid is what CNS condition?

Meningitis

Acute infection and/or inflammation of the brain is what CNS condition?

Encephalitis

Acute infection and/or inflammation of the spinal cord is what CNS condition?

Myelitis

Any neurological deficit in the spinal cord is what CNS condition?

Myelopathy (When inflammatory it is know as a myelitis)

A meningitis in which there is a source of infection, but it is not a pyogenic (pus forming) bacteria is called what? Name two examples

Aseptic or sterile meningitis Examples are TB and viruses

What is the mc form of transmission of meningitis?

Hematogenous (blood)

What are three signs of meningitis?

- Fever - Nuchal rigidity - Headache

A spinal tap for BACTERIAL meningitis will show an ______ (increase/decrease) CSF protein, ______ (increase/decrease) CSF white count, pus and will be _____ for gram stain

increase, increase +positive gram stain

Do neutrophils or lymphocytes predominate in bacterial meningitis?

Neutrophils

Do neutrophils or lymphocytes predominate in TB?

neutrophils for 24-48 hours then lymphocytes after 48 hours

A spinal tap for VIRAL meningitis will show an ______ (increase/decrease) CSF protein and a ______ gram stain

increase -negative gram stain

What are the two mc forms of bacterial meningitis in prematures and newborns?

E. coli and listeria monocytogenes Also Group B strep

What are the three mc forms of bacterial meningitis in children?

Neisseria meningitidis S. pneumo H. flu B

Waterhouse-Friderichsen syndrome is

Is a group of symptoms resulting from the failure of the adrenal glands to function normally as a result of bleeding into the gland. Fulminant meningococcemia is a life-threatening infection that occurs when the bacteria Neisseria meningitidis invades the blood stream. *causes a rash

Wernicke’s Encephalopathy is secondary to a ________ deficiency

thiamine

These are examples of what? Arboviruses Mosquito vector, birds reservoir

west nile virus

What virus may be neonatal, in newborns, and result in developmental disabilities and death?

Cytomegalovirus

What affects the temporal lobes | and results in hemorrhagic necrosis?

Herpes Simplex virus

Altered mental state, loss of cognitive function, personality change, lethargy, depressed consciousness, involuntary movements, asterixis, nystagmus, tremor, seizures are signs of?

Encephalopathy

What type of encephalopathy presents with jaundice and is mc in alcoholism and hep C?

Hepatic encephalitis

A patient in liver failure (possible from hepatic encephalitis) will have what four findings?

Jaundice, ascites (abdominal swelling), peripheral edema, GI bleeding (esophageal varices)

Hepatic encephalopathy is due to an

excessive nitrogen load

This type of encephalopathy has a defining feature of uriney smelling breath

Uremic encephalitis Strep pharangitis and gangrene

Destruction of myelin sheath in MS is due to what types of CNS cells/

oligodendrocytes

Lesions separated by time and space are a characteristic of what disease?

A rapidly progressive, invariably fatal neurodegenerative disorder believed to be caused by an abnormal isoform of a cellular glycoprotein known as the "prion" protein.

Creutzfeld-Jakob Disease

What test helps distinguish between a hemorrhagic and ischemic stroke?

CT without contrast to determine if hemorrhage is present or not

What type of hematoma is associated with lucid interval?

Epidural

Neurodegenerative disorder caused by “cumulative long- term neurological consequences of repetitive brain concussive and sub-concussive blows to the head”

CTE (Chronic Traumatic Encephalopathy) Characterized by delayed (8-10 years later) cognitive decline, deteriorating executive function, mood and behavioral disorders, impulsive behavior, depression, apathy, dementia (dementia pugilisitica) and Parkinsonism

What is the mc type of pediatric brain malignancy and where does it occur?

Medulloblastoma Posterior fossa (where cerebellum is- back part of skull)

What is the mc Most common and most aggressive brain tumor?

Glioblastoma | Multiforme/Grade IV Astrocytoma

A syndrome that is the consequence of a | neoplasm/malignancy is called what?

A paraneoplastic syndrome

Small cell lung, pancreatic, | neural tumors, thymoma are characteristic of what disease?

Cushing's

Squamous cell lung, breast, | Renal, multiple myeloma, ovarian are characteristic of what disease?

Hypercalcemia

Secretes serotonin and bradykinin, Bronchial adenoma, pancreatic ca are characteristic of what disease?

Carcinoid syndrome

Adrenal, Ovarian are characteristic of what disease?

Hyperaldosteronism

What type of encephalitis? Anti-NMDA receptor encephalitis is a disease occurring when antibodies produced by the body's own immune system attack NMDA receptors in the brain. NMDA receptors are proteins that control electrical impulses in the brain.

NMDA receptor antibody encephalitis

What disease causes ptosis and is due to antibodies that block Ach receptors at the synaptic jxn?

M gravis

These are signs of what disease? - Polymyalgia rheumatica - Found in 50% - Stiffness in neck, shoulders, upper arms, - Hips, and morning muscular pain.

Temporal Arteritis

What disease causes Ascending paralysis?

Guillian barre *predominantly motor involvement but variants can be sensory or motor

Does arnold chiari malformation cause communicating or non-communicating hydrocephalus?

Non-communicating

These are all signs of what? ``` Headaches aggravated by valsalva maneuvers Tinnitus Lhermitte's sign Vertigo Muscle Weakness Syrinx ```

Arnold chiari malformation

Signs of what? (intracell or extracell edema) - Global hypoxia - Hyponatremia causing osmotic shift- inappropriate ADH secretion

Intracellular

Acute inflammation- meningitis, encephalitis | and tumor, trauma & lead poisoning are all signs of what? (inta/extracellular edema)

extracellular edema

Is uncal herniation related to transtentorial herniation?

Yes - Uncal herniation is a subtype of transtentorial downward brain herniation that involves the uncus, usually related to cerebral mass effect increasing the intracranial pressure.

The eye will be deviated _____ and _____ in uncal herniation

down, out

Non-communicating hydrocephalus occurs when...

Occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles.

Communicating hydrocephalus occurs when...

Refers to the fact that CSF can still flow between the ventricles, which remain open.

What is the most common cause of non-communicating hydrocephalus in newborns?

Stricture (narrowing) Aqueduct of sylvius

Brain mass decrease secondary to atrophy (mc in Alzheimer's) is what type of hydrocephalus?

Hydrocephalus Ex Vacuo

Which type or viral encephalitis is endemic in the mouse population and involves the meninges, choroid plexus and brain?

lymphocytic choriomeningitis

This type of encephalitis has a long incubation period. It causes fever, paresthesias at would site and can be accompanied by hydrophobia secondary to spasms of throat muscles when swallowing. Can lead to flaccid paralysis and death *Andre said only one person survived this

Rabies

Plaques on the brain, inflammation and destruction of the myelin sheath are all examples of

What disease does this describe? As a result of the "prion" infection, spongiform changes occur as well as amyloid accumulation

CJD

This is an area of ischemia with still viable cerebral tissue, at the edge of the non-viable infarcted area

Penumbra

This is an area of ischemia with still viable cerebral tissue, at the edge of the non-viable infarcted area

Penumbra -This is the rationale for evaluating strokes quickly by means of a perfusion evaluation with CT or MRI

A diffuse axonal injury is what type of injury?

Acceleration-deceleration

This stroke presents with ipsilateral peripheral facial nerve deficits with loss of facial pain and temperature, ipsilateral hypacusis, ipsilateral Horner syndrome

Vertebrobasillar stroke

Post auricular hematoma, raccoon eyes and rhinorrhea are signs of what?

Head trauma- skull fractures

What condition shows a tauopathy, neurofibrillary tangles and glial tau inclusions preferentially in cortical sulci

Chronic Traumatic Encephalopathy- (CTE)

A neurological disorder marked by a distinctive port-wine stain on the forehead, scalp, or around the eye. This stain is a birthmark caused by an overabundance of capillaries near the surface of the skin. Blood vessels on the same side of the brain as the stain may also be affected.

Sturge Weber Syndrome

Guillian barre will have an (increased/decreased) CSF protein?

Increased

An inflammation of both sides of one section of the spinal cord. This neurological disorder often damages the insulating material covering nerve cell fibers (myelin). It interrupts the messages that the spinal cord nerves send throughout the body

Transverse myelitis

The glascow coma score tests for what three things?

Eye (4), Verbal (5), Motor (6)

Extensor or flexor response is an abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward. The muscles are tightened and held rigidly.

Extensor

Extensor or flexor response is A stimulus that causes abnormal flexion of limbs (adduction of arm, internal rotation of shoulder, pronation of forearm, wrist flexion - decorticate posture. ... Localising response to pain: purposeful movements towards changing painful stimuli is a 'localising' response.

Flexor

What two diseases do we see uremic encephalopathy in?

Strep pharangitis and gangrene