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82 Cards in this Set

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Thalamic Nuclei
VPL
--incoming from Spinothalamic (pain & temp) tract and Medial Lemniscus (position, proprioception),
---relays to Somatosensory Cortex (Brodman's areas 1-3)

VPM Ventral Posteromedial Nucleus
---incoming from Trigeminal & Gustatory pathways
---relays to same

Lateral Geniculate
--Relay for Vision

Medial Geniculate: relay for audition
--input from superior olivary nucleus & inferior colliculus

NB: smell not relayed through thalamus
#neurology #cns #anatomy
VPL Nucleus
Thalamic Nucleus

--incoming from Spinothalamic (pain & temp) tract and Medial Lemniscus (position, proprioception),
---relays to Somatosensory Cortex (Brodman's areas 1-3)

NB: does not relay face/pharynx that is VPM
#neurology #cns #anatomy
VPM Nucleus
Ventral Posteromedial Nucleus iof the Thalamus

---incoming from Trigeminal & Gustatory pathways
---relays to Somatosensory Cortex (Brodman's areas 1-3)
#neurology #cns #anatomy
Lateral Geniculate Nucleus
Thalamic Nucleus Responsible for Vision
#neurology #cns #anatomy
Medial Geniculate Nucleus
Thalamic Nucleus Responsible for Audition

input from superior olivary nucleus & inferior output to temporal lobe
#neurology #cns #anatomy
Myasthenia Gravis vs Lambert Eaton Sro
MG:
Begins with Optic Muscles
Worsens at End of Day & after effort
Risk of Thymoma
Anti-ACh receptor antibodies
Edrophonium improves weakness
Nerve Stimulation → decrementalresponse

LE:
Begins with proximal muslces
improves through day & w/ exercise
2° to an already existing malignancy
Anti-Pre-Synaptic Ca2+ channel Antibodies
Edrophonium does not improve
Nerve Stimulation → incremental response
#neurology #neoplasia #pathology
Preventing Morbidity of Subarachnoid Hemorrhage
Calcium Channel Blockers

Nimodipine

prevents vasospasm → ischemia, the real cause of morbidity
#neurology #pharmacology
Nimodipine
calcium channel blocker

used both for hypertension and uniquely used to prevent mobidity following SubArachnoid Hemorrhage
#neurology #cardiovascular #pharmacology
most important strx/molecular defects in Alzhemiers
↓ ACh in Nucleus Basalis and Hippocampus
#pathology #neurology #dementia
The first portion of the brain damaged during global ischemia
The Hippocampus goes first, within 5 minutes

Then watershet ischemia follow LATER
#neurology #pathology #shock
First sign of uncal herniation

sequelae thereof
ipsilateral dilated pupil from compression of CN3

sequelae:
down & out eye
PCA compression → homonymous hemianopia
contralateral cerebral peuncle → ipsilateral hemiparesis
alternatively isilateral " " → contralateral
brainstem duret hemorrhages 2° rupture of basilar artery → fatal
#neurology #pathology
unilateral dilated pupil
uncal herniation compressing CN3
#neurology #pathology
describe mechanism of hearing in the inner ear
3 chambers: scala vestibuli: Na+ rich, onnected to oval window
scala media: K+, organ of corti
basilar membrane separates media from tympani
scala tympani: Na+: connected to round window

scala vestibuli and scala tympani meet at helicotremma at top

low freq's cause vibration at top near helicotremma
high freqs at base near oval window
#neurology #physiology
Cystic degeneration of putamen likely 2° to
Wilson's Dz
#pathology #neurology
Pick's Dz: brain region
frontotemoral specificty

inappropriate behavior and speach decline

unknown genetic basis
#neurology #pathology
Vitamin E deficiency
anti-oxidant which preserves cell membranes

most affected:
neurons (large surface area)
RBC's (poor antioxidant fnx)

manifestation:
Friederick's ataxia-like neuropathy w/ ataxi a & loss of proprioception and vibration +
hemolytic anemia
#pathology #nutrition #neurology #hematology
Familial QT prolongation
predisposes to TdP

accompanied by neurosensory deafness
#pathology #cardiovascular #neurology #geneticdzs
Familial Neurosensory Deafness

Likely Accompanying Condition?
Familial QT prolongation

predisposes to TdP
#pathology #cardiovascular #neurology #geneticdzs
Brief uncontrollable jerky movements which occur episodically
Myoclonic Seizures

DOC: Valproate
#neurology #pharmacology
DOC: Tourettes
Haloperidol
#neurology #pharmacology
Neurophysiology of Urination
Sacrial mMicturation center S2-4

Pontine center: coordinates sphincter relaxn

Cerebral corteex: inhibits sacral center

normal pressure hydrocephalus (elderly) ↑ ventricular area stretches descending cortical fibers → urinary incontenence
#neurology #physiology
Urinary incontenence of demention: pathophysiology
Sacrial mMicturation center S2-4

Pontine center: coordinates sphincter relaxn

Cerebral corteex: inhibits sacral center

normal pressure hydrocephalus (elderly) ↑ ventricular area stretches descending cortical fibers → urinary incontenence
#neurology #pathology
Where do the respiratory drive signals originate
Hypercapnea (normal individuals):
-Medulla detects pH

Hypoxia (<60 mmHg or chronic hypercapnics)
-Chemoreceptors in aotic arch and carotid bodies via CN9
#cardiovascular
#pulmonary
#neurology
#physiology
Horner's Sro + UE LMN signs
pancoast tumor esp adenocarcinoma from apex of lung
#pathology #neurology #neoplasia
Organ of Corti
The actual part of the inner ear that takes mechanical sound and turns it into energy signals
#neurology
Cupula of the Cochlea
the very apex of the cochlea

houses the cells that sense rotation
#neurology
What exacerbates Multiple Sclerosis?
heat leads to worsening fatigue and deficits

heat = ↓ axona transmission
#pathology #neurology
neurologic condition worsened by heat
Multiple Sclerosis

heat = ↓ axona transmission
#pathology #neurology
Rining Ears, Dizziness, and Difficulty Hearing
Meniere's Dz: failure to resporb endolymph
#pathology #neurology
Failure to resporb endolymph in the inner ear
Meniere's Dz:

Triad of Tinnitus, Vertigo and Hearing Loss
#pathology #neurology
NF-2
Autosomal Dominant

Tumor suppressor gene merlin on chrom 22

--bilateral accoustic shwannomas
--few cutaneous signs
#pathology #neurology #neoplasia
merlin protein
Autosomal Dominant

NF-2

Tumor suppressor gene merlin on chrom 22

--bilateral accoustic shwannomas
--few cutaneous signs
#pathology #neurology #neoplasia
Neurons with eosinophilic cytoplasm, no nisssl substance, and pyknosis of nucleus
Red Neuron

Transient Severe Insult which Will Result in Death
#pathology #neurology
Neuron with enlarged body, dispersed nissl substance, and eccentric nucleus
Axonal Reaction, about to regrow axon
#pathology #neurology
Anti-epileptic drug metzd to barbituate
Primidone

metabolized to phenobarbital and PEMA (phenylethylmalonamide)

All 3 compounds are anticonvulsants
#pharmacology #seizures #neurology
Primidone
Anti sieizure drug Primidone

metabolized to phenobarbital and PEMA (phenylethylmalonamide)

All 3 compounds are anticonvulsants
#pharmacology #seizures #neurology
Lipid containing cells 1 week post stroke
M∅'s arrive day 3-5
#pathology #neurology
Rx: Alzhemier's Demetia
Central acting Cholinergic enhancers:
Donepezil, Rivastigmin

NMDA antagonists: memantidine

Antioxidants: Eitamin E
#pharmacology #neurology
Lewy Bodies
Parkinsons & Lewy Body Dementia
#pathology #neurology #dementia
Hypotonic Baby dies at 7 mo
Werdnig Hoffman

infantile spinal muscular atrophy
AR degeneration of anterior horn cells
LMN involvment only

Floppy at birth, dies w/in year
#pathology #genetics #neurology
Werdnig Hoffman
Werdnig Hoffman

infantile spinal muscular atrophy
AR degeneration of anterior horn cells
LMN involvment only

Floppy at birth, dies w/in year
#pathology #genetics #neurology
infantile spinal muscular atrophy
Werdnig Hoffman

infantile spinal muscular atrophy
AR degeneration of anterior horn cells
LMN involvment only

Floppy at birth, dies w/in year
#pathology #genetics #neurology
GABAa
GABAb
GABAc
GABAa in brain Cl- Ion Channel

GABAb in brain G protein
K+ efflux
↓ Ca2+ influx
inhibis cAMP

GABAc in Retina
Cl- Ion Channel
#biochemistry #pharmacology #neurology
GABA synthesis and metzm
Gluatamte Decarboxylase +B6 (Glutamate → GABA)

GABA transaminase +B6 (GABA → nonfnx something)
#biochemistry #pharmacology #neurology
Ventral Spinothalamic Tract
Light Touch and Pressure Sensation
#neurology
Part of Spinal Cord Responsible for Light Touch and Pressure Sensation
Ventral Spinothalamic Tract
#neurology
Lateral Spinothalamic tract
Pain and Temperature Sensation
#neurology
Pain and Temperature Sensation in the Spinal Cord
Lateral spinothalamic tract
#neurology
Stroke: ataxia-hemiplegia
base of pons
#neurology #strokes
Stroke: dysarthria, clumsy hands
base of parns, or genu of internal capsule
#neurology #strokes
Stroke: base of pons
ataxia-hemiplegia

or

dysarthria, clumsy hands (may be genu of internal capsule)
#neurology #strokes
Stroke: genu of internal capsule
dysarthria, clumsy hands (may be base of pons)
#neurology #strokes
Distinguishing Neuroleptic Malignant Sro from Serotonin Sro
Serotonin Sro: Myoclonus

NMS: Rigidity s Myoclonus
#pharmacology #toxicity
#neurology
route of median nerve
C6-T1

with brachial artery between biceps brachii and brachialis muscle

medial aspect of antecubital fossa

crosses between humeral and ulnar heads of pronator teres muscle

between flexor digitorum superficialis and flexor digitorum profundus muscles

enters hand within flexor retinaculum

denervation → thenar atrophy, ape hand deformity lost sensation on palmar surface of first 3.5 digits
#anatomy #neurology
route of the ulnar nerve
between olecranon and medial epicondyle "funnybone" injury

between flexor carpi and flexor digitorum profundus

injury paralyses intrinsic muscles of hand → claw hand
#anatomy #neurology
Gram positive rods found in CSF tap
Listeria monocytogenes
#microbiology #neurology
Gram negative rods found in CSF tap
E coli
#microbiology #neurology
Precocious puberty + Paralysis of Upward Gaze
Paralyzis of upward gaze = parinaud sro aka dorsal midbrain sro

consistent with tumor in pineal region and germinomas are most common tumor of pineal gland

precocious puberty induced by βHCG prodxn

may proceed to obstructive hydrocephalus
#pathology #neoplasia #neurology
Pineal Tumor
germinomas are most common tumor of pineal gland

precocious puberty induced by βHCG prodxn

Paralyzis of upward gaze = parinaud sro aka dorsal midbrain sro consistent with mass occupying lesion

may proceed to obstructive hydrocephalus
#pathology #neoplasia #neurology
Spontaeous Intraranial Hemorrhage in a young adult
likely cocaine (or sympatheticomimetics)

coarctation of aorta → berry aneurysm (htn)

[AV malformation]
#pathology #cardiovascular #neurology
Characterize eosinophil fnx
Antibody-dependent cytotoxicity

Eosinophils have an IgE Fx

degranulation releases major basic protein

eosinophils also contain histaminase which degraes histamine and decreases severity of atopy also leukotrienes and peroxidases which ↑ inflammation
#immunology
Hydrocephalus ex vacuo
hydrocephalus which exists not because of a Δpressure, but rather because the brain has shrunk
#pathology #neurology
Nerve Injury

Sign: Flattened Deltoid

Nerve, Levels, Cause, Motor & Sensory Deficits?
Axillary Nerve
C5- C6

Injury: Fx surgical neck of humerus or dislocated humoral head

Motor: detloid
Sensory: skin over deltoid

Sign: Flattened Deltoid
#anatomy #neurology
Charcot-Bouchard pseudoaneurysms v Berry Aneurysms
Charcot-Bouchard
Hypertension
Small arteries of basal ganglia & internal capsule
<1mm
sudden onset of focal deficits from intracerebral hemorrhage in basal ganglia, itnernal capsule, thalamus, and pons

Berry (saccular aneurysms)
ADPKD, Marfan, Ehlrs-Danlos sros
Circle of Willis, APC, or middle cerebral artery
Size variable 2-25 mm
sudden onset of headache and AMS from subarachnoid hemorrhage
#pathology #neurology #strokes
Aseptic Meningitis in Children
Most commonly Enteroviruses:

Coxsackie virus, echovirus, poliovirus and enterovirus
#microbiology #neurology
Otherwise healthy pt unable to tolerate everyday sounds?
Which cranial nerve has been injured?
Faical: stapedius muscle paralysis → no mitigation of sound "hyperacusis"
#pathology #neurology
Describe the neurologic pathway by which the eyes accomodate to light
optic nerve branches branches to ispilateral pretectal nucleus in superior colliculus

fibers project to both ipsilateral and cotnralateral Edinger-Westphal nuclei, the site of preganglionic PSNS neurons

neurons project out within CN3 to ciliary ganglion and then into the eye
#neurology
DOC: narcolepsy
Modafinil
non-amphetamine stimulant

not sympatheticomimetic,
lower risk for dependency
#pharmacology #drugs #neurology
Modafinil
DOC: narcolepsy
non-amphetamine stimulant

not sympatheticomimetic,
lower risk for dependency
#pharmacology #drugs #neurology
DOC: Trigeminal Neuralgia
carbapamazine
#pharmacology #drugs #neurology
DOC: Absence + Tonic-Clonic
Valproate

Ethosuximide DOC for Absence, but does not help Tonic CLonic
#pharmacology #neurology
Recurrent Lobar Hemorrhagic CNS Strokes
Lobar = cerebral hemispheres ie not lacunar

most common presentation of cereberal amyloid angiopathy

low mortality rate

2° to β amyloid deposition, not related to systemic amyloidosis

NB: β amyloid is from amyloid precursor protein, cause of late onset alzhemiers
#pathology #neurology #rheumatology
Parkinsoner on levodopa carbidopa

some good days
some lock ups

wants better medicine routine
on-off phenomenon

unpredictable and dose independent

higher doses have no benefit, nor do drug holidays

best prevention: maintaining a constant dose
#pharmacology #neurology
Parkinsoner

medicine not working as well as before
continued destruction of striatonigral DA neurons
#pharmacology #neurology
Night Blindness DDx
Most common cause: hereditary retinitis pigmentosa

Acquired:
1. toxic retinopathy 2° phenothiazines or chloroquine
2. vitamin A deficiency
3. Congenital rubella, syphilis, or infx
4. diabets
#pathology #neurology
Internal Capsule Stroke
Unilateral Motor Deficit
Thalamus Stroke
Unilateral Sensory Deficit

dmage to the VPL and VPM nuclei
Caudate Nucleus Stroke
Transietn Hemiparesis and Frontal Lobe Syndromes
Pons Strok
Coma, Bilateral Paralysis, Decerebrate Ridigity, Pinpoint Pupils, often death
1° cause of Lacunar infarcts
lipohyalinosis and microatheromas

lipohyalinosis is a desctructive vessel lesion characterized by loss of normal architecture, mural foam cells, and fibrinoid vessel wall necorsis

microatheromas are masses of lipid laden M∅in intimal layer
microatheromas
with lipohyalinosis, the 1° cause of lacunar infarcts

microatheromas are masses of lipid laden M∅in intimal layer
lipohyalinosis
with microatheromas, the 1° cause of lacunar infarcts

lipohyalinosis is a desctructive vessel lesion characterized by loss of normal architecture, mural foam cells, and fibrinoid vessel wall necorsis