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68 Cards in this Set
- Front
- Back
craniopharyngioma visual defects - what do you expect?
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bitemporal hemianopsia
tumors of the sella turcica (craniopharyngiomas, pituitary adenomas) apply pressure to the optic chiasm |
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what are craniopharyngiomas?
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suprasellar tumors arising from remnants of Rathke's pouch
present in 2nd-3rd decade w/headaches, papilledema, signs of pituitary failure, cranial nerve dysfxn |
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small posterior fossa, caudal displacement of medulla, hydrocephalus, lumbar myelomeningocele?
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Arnold-chiari malformation
downward displacement of elongated cerebellar tonsils thru foramen magnum |
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pt w/multiple brown spots on body since birth develops 2 soft, flesh colored, non tender papules on upper chest - are they malignant? What are they composed of?
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pt has NF-1
these are benign neurofibromas, growth of Schwann cells & other neural elements |
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how do you explain a child NF1 whose biological parents do not exhibit signs?
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germline mosaicism/new mutation - NF1 is AD 100% penetrant, but does have variable expressivity
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what kind of vision impairment do macular lesions cause?
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central scotoma
note - neural fibers transmitted macular vision go to different area of the cortex than peripheral vision |
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65 yo w/bilateral visual difficulty progressing over last year
fundoscopy --> "small yellow retinal lesions clustered in the macula" |
Macular Degeneration
progressive loss of central vision due to deposition of fatty tissue (drusen) behind retina (dry MD) and neovascularization of the retina (wet MD) |
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MCC blindness in ppl over 50?
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macular degeneration
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46 yo female w/subarrachnoid hemorrhage
few days later develops weakness in rt arm & leg? |
vasospasm
occurs 4-12 days after subarrachnoid hemorrhage, causes cerebral ischemia - new onset confusion, FOCAL DEFICITS tx w/nimodipine distinguish from rebleed - rebleed CT would show bleeding, focal deficits are characteristic of ischemic insult vasospasm more common than rebleeding |
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9 yo girl w/complex partial seizures, prescribed med, 3 mos later has bone marrow suppression - what med? What MOA? What other adverse effects?
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Carbamazepine (used for - simple partial, complex partial - generalized tonic-clonic seizures)
blocks voltage gated Na+ channels in neuronal membranes can cause: bone marrow suppression, hepatotoxicity, siADH |
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elevated acetylcholinesterase levels on 25 week amniocentesis?
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Neural Tube defect (4th week)
also alpha-fetoprtns are raised |
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light microscopy shows neurons w/shrunken nuclei, no detectable nissl substance, & intensely eosinophilic cytoplasms
these findings indicate? |
irreversible damage
this is a red neuron (12-24 hours) characterized by: -shrinkage of the cell body, -pyknosis of the nucleus, -loss of Nissl substance, and -eosinophilic cytoplasm |
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pt in status epilepticus, IV benzos started
what is started IV concurrently to prevent recurrence? |
phenytoin
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8 yo male w/hx recurrent pulm infections has unsteady gait, "eyes don't move steadily", has numerous superficial blanching nests of distended capillaries on sun-exposed areas, gene defect?
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Ataxia telangiectasia
ATM gene involved in DNA break repair, immunodeficiency relates to IgA classic triad: -cerebellar ataxia, telangiectasia, increased sinopulmonary infections |
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MC location of acoustic neuroma? Sx of unilateral CN V & VII involved?
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cerebellopontine angle
between cerebellum & lateral pons |
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where (physically identify) is post-chemo nausea mediated?
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chemoreceptor trigger zone
area postrema of the dorsal medulla, near the 4th ventricle |
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what nerve innervates salivary secretion from submandibular & sublingual gland?
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parasympathetics from superior salivatory nucleus
carried on CN VII via chorda tympani (taste) |
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what nerve innervates salivary secretion from parotid gland?
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CN IX
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what is the space constant? What changes it?
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measure of ability of impulse to travel down an axon, low space constant decreases length impulse will travel
decreased by demyelination |
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med recommended for motion sickness prevention? Main SE?
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Antimuscarinics & antihistamines-with antimuscarinic action are most effective
warn of dry mouth (& other such): ex - scopolamine, or meclizine & dimenhydrinate |
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how does NDMA relate to morphine tolerance?
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activation of NMDA receptors by glutamate is believed to enhance morphine tolerance by increasing phosphorylation of opioid receptrs, increasing nitric oxide levels
ketamine |
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how do beta blockers effect glaucoma?
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decrease aqueous humor production by CILIARY EPITHELIUM
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44 yo man recently dx w/AIDS following PCP, c/o pain in arms & legs, PE - irregular unequal pupils that do not respond to light, do constrict
romberg sign positive, DTRs absent - what is causing neuro sx? |
Tabes dorsalis
found in neurosyphillis (AIDS or immigrants) - affects dorsal columsn & dorsal roots of spinal cords - loss of position, vibration, & pain sensation argyll-robertson pupil is characteristic |
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tell me about neurosyphillus signs?
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Argyll robinson pupil
TABES DORSALIS - dorsal columns & roots of spinal cord affected - loss of position, vibration, & pain sensation |
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pt w/NF1 (what is eponym for this?) found to have "rubbery cutaneous tumors on his neck", what cells comprise these? Orginiated from what embryologic tissue?
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Schwann cells, from neural crest
eponym is "von Recklinghausen's dz" |
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random ass associations of carpal tunnel syndrome?
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fluid retention (renal failure, hypothyroidism, pregnancy)
diabetes mellitus, acromegaly, rheum arthritis and ofc chronic repetitive stress |
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lady on dialysis develops carpal tunnel syndrome?
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dialysis associated amyloidosis
w/long hx hemodialysis may develop beta-microglobulin deposition |
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PE maneuvers useful in carpal tunnel syndrome?
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Tinel's sign - sx reproduced by tapping on flexor surface of wrist
Phalen's sign - sx occur after flexion of wrist |
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seizures occuring in the morning, aggrevated by sleep deprivation
never lost conciuosness, sudden-onset arrhythmic jerking movements - type? Tx? |
Myoclonic seizures
1st line tx is Valproic acid |
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24 yo male w/headache & visual changes, intracranial calcified mass on MRI, gross inspection shows cystic spaces w/thick brownish fluid rich in cholesterol?
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cranyiopharyngioma = calcified mass, young ppl, usually yellow viscous fluid filled (cholesterol crystals)
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5 yo male w/persistent food seeking behavior, obsese, sometimes aggressive/bizzarre behaviors - what part of brain is lesioned?
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Ventromedial thalamic nucleus, where satiety centers reside
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42 yo female w/bouts of spinning sensation w/nausea & ringing in left ear, diminished hearing
"feels fine" between episodes - what condition? Pathophys? |
Meniere's dz, increased volume of endolphym from defective resporption
triad - tinnitus, vertigo, sensorineural hearing loss |
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total sensory loss on one side of the body & face with no motor involvement indicates lesion where?
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thalamus
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lesion of internal capsule can result in what isolated deficits?
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motor
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patient w/hx of sensory stroke affecting 1 side of the body w/no motor involvement dies of unrelated cause years later
brain shows two 5-6 mm cavities in deep structures of the brain - what are these? What pathophys explains them? |
Lacunar infarcts
occlusion of small penetrating arteries caused by small vessel lipohyalinosis & atherosclerosis 2ndary to HTN or diabetes |
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foci of hemorrhage & necrosis in mamillary bodies & gray matter around 3rd & 4th ventricle? Dx by testing what enzyme?
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Wernicke syndrome
thiamine deficiency --> inbaility to utilize glucose dx thiamine deficiency by measuring erythrocyte transketolase activity triad -opthalmoplegia, -ataxia, -confusion |
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right non-pupil-sparing 3rd nerve palsy arises from what lesion? (unilateral headache, eye pain, diplopia, dilated nonreactive pupil, ptosis w/ipsilateral eye in down & out position(
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aneurysm of right posterior or superior cerebellar arteries --> compression
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how long do baby's have a positive babinski reflex? Why?
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up to 12 months
incomplete myelination of corticospinal tracts |
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the corneal limb reflex is mediated by what nerves - afferent? Efferent?
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afferent - nasociliary branch of CN V1
efferent - temporal branch of CN VII |
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ear ossicles attach to which window? Where are low frequency sounds heard?
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oval (think ossicles - oval
or think the shape of the ossicle is oval like), round window is after the sound transmits all through low frequency best heard at apex of chochlea, near helicotrema |
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cherry red macula in setting of monocular vision loss?
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retinal artery occlusion
time course will be sudden macula has separate supply of blood from choroid artery so stays red |
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"cotton wool" exudates on fundoscopic exam?
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diabetic retinopathy
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sudden brief shock-like mm contraction?
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Myoclonus
physiologic - hiccups & hypnotic jerks (while falling asleep) pathologic - epilepsy, CJD |
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what does ___ relay?
-VPL -VPM -lateral geniculate body -medial geniculate body |
Thalamus relay
VPL - spinothalamic (pain & temp) and medial lemniscus (position & proprio) -to primary somatosensory cortex, brodmann 3, 1 &2 VPM - trigeminal & gustatory (to primary sensory cortex, Brodmann 1,2,3) lateral geniculate - light (from optic nerve to optic radiations to visual cortex, calcarine sulcus) medial geniculate - sound (from superior olivary & inferior colliculus to auditory cortex temporal lobe, Brodmann 41 & 42) |
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ALS genetic implication? Clinical findings? Tx?
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Genetic - mutation of gene for copper-zink superoxide dismutase (SOD1)
LMN (dmg to anterior horns) & UMN (demyelination of tracts) sx tx - Riluzole, decreases glutamate release |
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friedrich ataxia - presentation? Associations?
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autosomal recessive, 5-15 yo
difficulty walking hypertrophic cardiomyopathy, kyphoscoliosis,foot abnlities, diabetes mellitus |
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what do you see on MRI with MS? What's going on there?
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characteristic plaques, variable distribution of the slcerotic plaques accounts for the variety of neurologic manifestations
main pathologic process is demyelination, with the following changes in the plaques 1.) axon demyelination 2.) depletion of oligodendrocytes (myelin producing cells of CNS) 3.) Accumulation of lipid-laden macrophages (phagocytize products of myelin breakdown) 4.) Fibrillyar astrocytes (astrocyte proliferation rxn to injury) 5.) infiltration by lymphocytes & monocytes |
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unilateral periorbital/temporal pain w/nasal congestion, lacrimation, and ptosis?
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Cluster headache
M 7x more often than females 30min-2 hrs, around same time each day (often after going to sleep) pain free interval of ~1 year between each series of attacks |
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rehydrate an alcoholic, gets ataxia, nystagmus, ophthalmoplegia, & anterograde amnesia? What happened?
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Wernicke encephalopay, typically necrosis of mamillary body part of papez circuit, involved in cortical control of emotion & memory
alcoholics are malnourished and low thiamine dextrose w/o prior thiamine adminstration results in acute thaimine level drop, resulting in Wernicke encephalopathy |
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recurrent small lobar hemorrhages in right occipital & left parietal areas?
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cerebral amyloid angiopathy
-deposition of beta-amyloid into arterial wall unlike HTN strokes are less severe, and located in cerebral hemispheres & involve smaller areas of brain (HTN strokes tend to involve basal ganglia - lenticulostriate arteries) |
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unilateral ptosis & "down & out" gaze - where is lesion? MC cause?
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CN III paralysis
compression (berry aneurysm, uncal herniation) or nerve ischemia (diabetes) |
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15 yo male has kyphoscoliosis & high plantar arch, what will he experience? He did have a brother that died of heart failure at 25
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Friedreich ataxia (autosomal recessive)
"frataxin" gene (nl mitochondria fxn) gat ataxia degeneration of dorsal column & dorsal root ganglia (position & vibration) kyphoscoliosis & foot abnormalities (pes cavus) hypertrophic cardiomyopathy & CHF diabetes |
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hemibalismus from stroke - what brain area?
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subthalamic nucleus on contralateral side
(NOT caudate, that is Huntington's) |
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long term sequelae of hydrocephalus in an infant?
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LE spasticity from stretching of periventricular pyramidal tracts
visual disturbances learning disabilities |
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66 yo man w/recently discovered lung mass develops dizziness, dysarthria, limb ataxia worsening over 2 weeks, is admitted ot the hospital but worsens and dies. Autopsy shows extensive cerebellar purkinje cell degeneration - what's going on?
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A paraneoplastic, autoimmune phenomenon where antibodies against the tumor cells are cross-reacting with the body's own healthy organs and tissues
paraneoplastic cerebellar degeneration MC seen w/cancers of lung, breast, ovary, uterus, & lymphoma |
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what specific effects does B12 deficiency have on the CNS?
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abnormal myelin synthesis, with degradation of:
1.) Dorsal columns of spinal cord - bilateral loss of position & vibration sense 2.) Lateral corticospinal tracts - UMN signs, spastic paresis, hyperreflexia, pathologic reflexes (babinski) 3.) Axon degeneration of peripheral nn - numbness or paresthesias "subacute combined degeneration" - both ascending (dorsal columns) and descennig (corticospinal tract) pathways |
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Wernicke vs CPL?
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Wernicke - confusion, ataxia, ophthalmoplegia
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pure motor lacunar infarct?
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posterior limb internal capsule
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pure sensory lacunar infarct?
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VPL or VPM of thalamus
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ataxia-hemiplegia lacunar infarct?
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base of pons
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dysarthria-clumsy hand lacunar infarct?
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base of pons or genu of internal capsule
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charcot-bernard vs lacunar vs berry?
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charcot bernard - hemmorhagic, aneurysm, lenticulostriate
lacunar - ischemic, lenticulostriate berry - hemmorhagic, weak media, circle of willis (larger than charcot bernard) |
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lateral inferior pontine syndrome vs lateral medullary syndrome?
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lat infer pontine - anterior inferior cerebellar artery
-contralateral loss pain & temp -ipsilateral deficits in CN V & VIII -Horner's syndrome -Cerebellar sx Lateral medullary (wallenberg) syndrome - posterior inferior cerebellar artery (PICA) -contralateral loss pain & temp -ipsilateral deficits of CN V, VIII, IX, X, & XI -Horner's syndrome |
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lesion causing upward gaze palsy? Structure? Location? Name?
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pineal gland
midline structure dorsal to superior colliculus & between thalamic bodies Parinaud syndrome - tumors of pineal gland may lesion midbrain in region of superior colliculus due to mass effect upward gaze palsy, absent pupillary light reflex, failure of convergence & wide-based gait damage is to oculomotor & trochlear nn, as well as Edinger-Westphal nucleus |
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what can chronic alcoholism do to cerebellum?
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atrophy of anterior lobes & cerebellar vermis
results in gait ataxia, truncal instability, intention tremor, & rhythmic postural "Parkinsonian" tremor of fingers & hands |
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flat affect, inappropriate sexual behavior, hyperphagia, constant food seeking? Where's the damage?
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Kluver-Bucy
bilateral dmaage to temporal lobes, particularly AMYGDALA (down in inferomedial part of lobe) potentially caused by HSV encephalitis or traumatic brain injury |
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67 yo w/hx uncontrolled HTN sudden weakness in extremities & face, loses conciousness few minutes later, has extended upper & lower extremities & pinpoint pupils, dies a few hours later - what's going on?
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Pontine hemmorhage
pinpoint pupils, loss of horizontal gaze, quadriparesis, decerebrate posturing & rapidly evolving coma culminating in death w/in hours |
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in CNS tumor what is vasogenic edema?
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disruption of blood-brain barrier leading to increased vascular permability, plasma filtration into cerebral interstitium causing vasogenic edema
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