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232 Cards in this Set
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A newborn should have:
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**symmetric tone and movements.
complete head lag Reflexic grasp-planter and palmar alert to sounds, fixates on face and objects |
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By 2 months an infant should
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**Regard object of face attentively
Lift head and shoulders off off bed Follows past midline Crying 3hrs/day |
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A baby should be able to regard objects or face attentively by?
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2 months
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By 4 months, a baby should
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**Good head control in sitting
holds up head and puts weight on forearms rolls to supine bears weight on legs in stand follows objects 180 degrees coos responsively (vowels) smiles responsively |
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A baby should have good head control in sitting by
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4 months
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A baby starts cooing at what age
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4 months
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A baby reaches with raking grasp-both hands by
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6 months
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By 6 months a baby can
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***Reach with raking grasp-both hands
Transfer object hand to hand Roll both directions No head lag in pull to si sits with support Babbles (vowel-consonants |
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A child sits well alone by
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9 months
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By 9 months a child
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**sits well alone
holds two objects at once bangs two objects together grasps pellet with radial-palmer grasp finger feeds self plays pat-a-cake |
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By 12 months a child can
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neat pincer grasp of pellet
pulls to stand and cruises takes a few steps alone drinks from cup held by another jargons |
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By 15 months a child can
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drink from a cup
stoops and recovers (>80%) walks well (>90) scribbles with crayon (>50) puts cube in cup plays ball with examiner gives and takes a toy |
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A child should be able to walk independently by
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18 months
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A child should be able to point to a desired object by
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18 months
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18 month landmarks include
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**Walk well independently
**Point to desired objec Run (>75%) climb steps holding hands throw or cast a ball stacks 2 cubes (50%) 6 words in addition to mama/dada feeds self with spoon |
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By 24 months a child should be able to
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**combine 2 words
stack 4-6 cubes kick a ball jump with both feet off floor throws a ball overhand (75%) points to pictures in a book remove clothes (>90) wash and dry hands put on a hat use spoon/fork (>90) |
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A child should be able to combine 2 words by
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24 months
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By 36 months a child should be able to
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**uses 3 word sentances
stack 8 cubes imitate vertical stroke with crayon broad jumps stands on 1 foot for 1-2 seconds pedal a tricycle speech is 50% intelligible uses 5-8 word sentances knows simple adjectives puts on tee-shirt and shorts names a playmate |
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a child should be using 3 word sentences by
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36 months
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A child should be asking why, when, how questions by
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4 years
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By 4 years a child should be able to
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**ask questions
name 4 colors speech fully intelligible pretend play relate events |
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A child should be able to separate from parents for several hours at a time
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by 5 years
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By 5 years a child should be able to
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**separate from parents for several hours a day
balance for 5-10 sec copy a circle, square, triangle draw a person speak in full sentences with mostly correct grammer, lots of quesitons play well with kids take turns follow directions relate experiences tell long stories |
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Are there more neurons or glial cells
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More glial cells (10X more)
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motor and sensory myelination
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begins before birth, not completed until 1st birthday
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critical period for vision
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till 5 yrs
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Gowers maneuver
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indication of proximal weakness in children; muscular dystrophy
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hypoperfusion from autonomic dystregulation in premature infants causing white matter lesion near ventricle
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periventricular leukomalacia,
affects legs the most |
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hyperreflexia, clonus and spasticity of legs with normal upper body is a sign of what in premature infants?
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periventricular leukomalacia
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Hypotonic, head lage, no visual tracking, epilepsy, and cherry red spots in eyes are signs of?
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Tay Sachs disease (lipid storage disease)
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If CSF glucose is low without corresponding lactic acid buildup, diagnosis is
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epileptic encephalopathy. Treat with ketogenic diet
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multi-organ issues, brain issues, delay and seizures, maternal pattern of inheritance
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mitochondrial disorders
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Separation of telencephalon is called
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Diverticulation
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nerve cells migrate to cerebral cortex along
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radial glial cells
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Anencephaly
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failure of brain to develop due to lack of closure of anterior neuropore
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Encephalocele
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Outpouching of epithelium enclosed by brain tissue through a cranial defect
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Spina bifida oculta
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failure of posterior neuropore to close
bony defect in vertebral column without dural component. usually a small bit of hair |
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meningocele
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Dura herniates through bony defect
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meningomyelocele
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dura and tissue of spinal cord herniate through defect
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Rachischisis
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spinal cord directly open to air
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Arnold Chiari
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posterior fossa lesion. Formed by herniation of cerebellar tonsils into the foramen magnum
---psudeomicropolygyria ----hydrocephalus (occlusion of foramen magendi, lushka by cerebellar tonsils ----tonsilar gliosis ----flattening of pons ----breaking of tectum ----basicranial bone abnormalities ----lumbar meningomyelocele |
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Dandy-Walker
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Posterior fossa leshion
vermal hypoplasia in cerebellum (usually inferior vermus) outpouching of 4th ventricle ---> hydrocephalus |
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Arrhinencephaly
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failure of olfactory development usually as a part of Kallman's syndrome
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Holoncephaly
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failure of midbrain fusion
1) Lobar (partial division of 2 hemispheres |
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Agenesis of corpus callosum
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can cause mental retardation but is also assymptomatic in many patients
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Lissencephaly
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absence of gyri of the brain
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Pachygyria
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a disturbance of neuronal migration that occurs later, resulting in flattened and enlarged gyri, usually 4 instead of 6 layers
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Micropolygyria
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defect in neuronal migration later than pachygyria ---> 4 layers, small, mulitple gyri.
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multicystic encepthalopathy
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multi-ischemis insults during gestation ---> liquefactive necrosis
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Hydrencephaly
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complete occlusion of cartoid arteries, no brain tissue grows and you just get a sac of water
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Ulegyria
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perinatal vascular injury (thined out, glyotic gyri)...usually due to ischemic injury
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Status Marmoratus
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premature mylination in deep grey structures...marbled area in basal ganglia
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Syringomyelia
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Hole in spinal cord, can be developmental (arnold chiari) or post-traumatic.
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WADA procedure
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Assesses where dominant language side of the brain is located
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Anomia
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Difficulty recalling names of objects
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Dysarthria
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Cant speak bc muscles don't work
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Pure word deafness
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Sensory disconnection from language processing area
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Left primary visual cortex plus splenium of corpus callosum lesion
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alexia without agraphia
right homonymous hemianopia |
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conduction aphasia
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lesion to arcuate fasciculous
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myelitis
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inflammation of spinal cord
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Modes of entry of CNS infection
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- Hematogenous (blood brain barrier, sometimes via circumventricular organs)
- Neural Route - Continuous spread - Direct inoculation |
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LP:
High pressure high neutrophils low glucose high protein |
Bacterial meningitis
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Lp:
High pressure high WBC (leukocytes) normal protein and glucose |
Viral meningitis
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Increased intercranial pressure
focal deficits that progress signs of systemic infection suppuration surrounded by fibrous capsule |
abscess
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Histology of HSV encephalitis
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perivascular lymphocytic cuffing
microglial profliferation intranuclear inclusions |
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Perivascular lymphocytic cuffing
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HSV encephalitis
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Confusion and behavioral abnormalities along with fever point to
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Encephalitis
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When do you do a CT before an LP with suspected meningitis
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Abnormal focal neurologic exam
elderly, h/o CNS disease, immunocompromised, seizures |
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What virus is found in all MS patients
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EBV
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Current MS hypothesis
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T cells enter into CNS, Increase expression of adhesion molecules, matrix metalloproteinases, proinflammatory cytokines. This aids migration of immune cells, and you get an autoimmune response against myelin
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Focal weakness, numbness, tingling, loss or blurry vision, spinal cord syndromes (bladder disfunciton, paraparesis
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MS
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What test do you use to evaluate MS
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Gd-MRI
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Acute Disseminated Encephalomyelitis
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Neurologic symptoms develop over a few days, associated iwth a viral infection or vaccination.
Widespread CNS involvement Headahc |
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Raccoon signs/Battles signs, CSF rhinorrhea/CSF Otorrhea area sign of
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Basilar skull fracture
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With diffuse axonal injury, CT may be? It is caused by?
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normal or small hemorrhage;
shear force---> COMA |
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CPP=
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MAP-ICP
(Cranial profusion pressure = mean arterial pressure - ICP) |
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According to the Monro-Kellie doctrine, additional brain volume causes
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decreased blood, decreased CSF
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As blood flow decreases, the brain does what?
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extracts oxygen more efficiently until it fails
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Secondary injury cascade causes what to happen to lactate, ATP, gluatmate, Adenosine
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Decreased ATP due to Anaerobic glycolysis
Increased Glutamate --> increased calcium which leads to Free radicals, mitocondrial swelling, via mitochondrial transition pore Increased Lactate |
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Vasculitis and hemhorrages in brain
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Acute Pyogenic meningitis
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Perivascular lymphocytic infiltrate,
Neuronophagia microglial nodule eosinophilic nuclear inclusion |
acute lymphocytic meningitis
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what causes chronic meningitis?
what is its gross presentation? |
basilar exudate; tb, shyphilis,
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Obliterative endarteritis with intimal hyperplasia and Giant cells
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Chronic meningitis
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White Brain, what else do you see?
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Cryptococcal meningitis
bubbles of damage |
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pseudohyphae are found in what
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Candida Albicans
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hyphae
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found in aspergillus, looks sea sponge
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What is found in brain abscess having to do with blood vessles?
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reticulin
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Microglial stab cells
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HIV (and tertiary sphyilis)
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What are the four syndroms arising directly from HIVq
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acute meningitis or encephalitis
subacute encephalistis vacuolar myelopathy peripheral neuropathy |
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multinucleated giant cell can be found with what virus
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HIV
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Taxoplasmosis
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HIV, necrotizing cerebritis, Mulberry appearance of Toxo Cyst.
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Crutzfelt-Jakob disease histology
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white bubbles cause by protein accumulations
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spongiform transformation is found in
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Prion disease
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histopathologic signs of MS
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perivascular
oligodendrocytes are diminished myelin loss axons spared macrophage formation with sudanophilic breakdown concentric spread |
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Devic's Disease gross symptoms
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plaques on spinal cord due to Aquoporin IV gene defect
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Baro's Concentric Schlerosis
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Concentric lesions.
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ADEM
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multi-focal perivenular demyelination that is reversible, after a vaccine or a virus
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overcorrection of hyponatremia causes
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central pontine myelinolysis
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Progressive multifocal leukoencephalopathy is different from MS how? Histologically?
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no sharp lines of demarcation of white matter degradation.
usually in immunocompromised people. Histologically: bizarre astrocytes and decreased numbers of olgliodendrocytes |
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sulfer molecules in macrophages
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metachromic leuokodystrophy
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intra-axial vs extra-axial
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Intra: origin in brain or spinal cord, small or no dural contact
extra: origin in meninges or skull, broad dural base. |
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Diffusion weighted MRI can tell you?
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If it is an abscess bc pus has high viscosity so will appear brighter
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Fever, back pain, radicular pain
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spinal epidural abscess, rim enhancing epidural fluid.
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multifocal lesions seen
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MS (young patient), Metastasis or small vessel ischemic disease in older patients.
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where do you see MS plaques?
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Corpus Callosum
Middle Cerebellar Peduncle Temporal and Occipital WM Optic Neuritis |
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Cord demylination is usually found in the
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cervical part of the cord
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FLAIR shows?
Gd shows? |
FLAIR = all plaques
Gd = acute plaques |
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The aging brain shows
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Small Vessel ischemic WM disease
Atrophy of frontal lobes, thalamus, cerebellum Decreased Cerebral Blood Flow/metabolism |
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Hypercellularity can be assessed through
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MR spectroscopy (increased choline - myelin breakdaown - and increased NAA (neuronal and axonal marker)
Increased Lactate bc of necrosis |
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MR Perfusion image for brain tumers shows
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increased cerebral blood flow at site of tumor
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Capillary permeability of brain tumors can be seen on
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contrast enhanced MRI
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Glioblastoma multiforme spreads via
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WM tracks
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Metastases are usually found where
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GM/WM junction
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PET show what?
SPECT? |
PET = glucose
SPECT = blood flow |
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most common cause of epilepsy
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medial temporal schlerosis
neoplasm |
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medial temporal schlerosis
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hippocampal neuronal loss and gliosis
risk factors: provoked generalized seizure, prolonged febrile seizure |
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Ictal seizure phase sees what glucose activity, blood flow
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Increased.
decreased post-ictal |
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are high or low grade tumors a more likely cause of seizures
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low grade
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what is the name of the parasitic pork tapeworm?
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Neurocysticercosis
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Wernicke's encephalopathy has what gross findings
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mammilary and hypothalamus lesions that look hemhorragic but really are just an increased proliferation of vessels
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confabulations associated with Korakoffs is found where?
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Dorsomedial thalamus
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Loss of vermal tissue in cerebellum can result from?
This would be seen histologically as what? |
EtOH
Phenytoin Loss of purkinje cells and atrophy of the molecular layer |
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Hepatic encephalopathy results from?
What is the histological hallmark? |
increased ammonia levels which cause WM swelling
Alzheimer type II astrocytes |
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VIT B12 deficiency causes what neurological condition?
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degeneration of axons and demyelination of dorsolateral regions of spinal cord, usually sparing anterior columns
Spongy demyelination |
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Grade II astrocytoma: histological features
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poorly defined
infiltrative clumping of astrocytes to form satellites around neurons Enlarged WM, does not enhance on MRI |
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Grade III astrocytoma: pathology
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hypercellularity, more mitotic figures, pleomorphism
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Glioblastoma Multiformi:
pathology |
pseudopalisading necrosis
appears hemhorragic and cystic HISTO: hyperchiamatic nuclei endothelial proliferations (blood vessles) |
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Pseudopalisading necrosis is seen in
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Glioblastoma multiformi
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Rosenthal fibers are sign of?
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pilocystic astrocytoma
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Pilocytic astrocytoma has what kind of cells?
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Rosenthal fibers (eosinophilic bodies formed in astrocyte processes)
and protoplasmic astrocystes (bipolar cells with hair like processes |
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characteristics of oligodendroglioma
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well circumscribed, focally hemhorragic, calcification
HISTO: fried egg like cells |
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Ependymoma: pathology
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4th ventricle, presents with hydrocephalus
spinal cord in middle age solid or papillary masses Perivascular pseudorosettes |
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Perivascular pseudorosettes
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Ependymoma
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Choroid plexus papilloma is found where?
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children - lateral ventricles
adults - fourth ventricle |
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Medulloblastoma:
Location pathology |
Vermis of cerebellum
Disseminate through CSF Microscopic: densely cellular pleomorphic nuclei, Homer Wright Rosettes |
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Homer Wright Rosettes
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Medulloblastoma
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Meningioma:
Location Pathology |
From arachnoid cap cells
Location: Convexities, Falx Cerebri, Lesser wing of sphenoid, olfactory groove HISTO: Psammoma bodies |
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Metastases:
Most are? From where? |
Carcinomas
Lung, breast, Skin, kidney, gastrointestinal NEVER prostate |
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What is carcinomatous meningitis
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irritation of meninges from tumor
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A Na channel blocker extends or limits the refractory period
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prolonges
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Gingival hyperplasia is a sign of what toxicity
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phenytoin
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Absense seizures have medications that work on what type of receptor
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Calcium
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What disease do you need to rule out when treating ICH bc it has a different treatment
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venous sinus thrombosis (use an anticoagulant)
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Most common ICH locations
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Putamen and internal capsule
thalamus WM of temporal, parietal, frontal lobes cerebellar hemisphere pons |
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what is the most common cause of ICH in people over 60
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Amyloid angiopathy
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Most common cause of subarachnoid hemhorrage
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Aneursyms
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Complication of subarachnoid bleed
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vasospasms, 3-13 days after incident
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Low grade astrocytoma treatment
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gross surgical resection, no radiation
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Anaplastic astrocytoma treatment
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GSR and post-op radiation
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Glioblastoma multiformi treatment
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GSR, radiation, chemo
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chemo choice drug for brain tumors
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temozolomide
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Oligodedroglioma prognosis determined how
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whether it has a 1p or 19q deletion, responds to chemo
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most meningiomas are
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typical and low grad
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treatment of meningioma
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total surgical resection and xrt or radiosurgery
little success with chemo after reoccurence |
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treatment for CNS lymphoma
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high dose methaltrexate and leukovorin
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treatment for cerebellar astrocytoma
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surgical resection, no adjuvant therapy
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Pontine glioma is
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deadly childhood tumor, black pons
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medulloblastoma
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4th ventricle, seeds,
treatment is surgery, craniospinal XRT, and cheo |
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motor-oil like fluid
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craniopharyngioma
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occlusion of large arteries is what kind of stroke? what causes it
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cardioembolic stroke, caused by atrial fibrillation, valvular heart disease
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small vessel disease is caused by?
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hypertension, we saw in corpus callosum
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large vessel disease is caused by
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cholesterol, occlusion of vessles
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transient sensory aphasia is
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Wernickes plus repetition
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transient motor aphasia is
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Brocas plus repetition
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conduct aphasia results from a lesion is the
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arcuate faciculus. cannot repeat
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eyes deviate toward or away from lesion in a stroke
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toward lesion
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in spinal cord infarction, you usually have preserved
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position and vibration sense
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small vessel disease is caused by?
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hypertension, we saw in corpus callosum
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large vessel disease is caused by
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cholesterol, occlusion of vessles
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you can give tpa in 3-4.5 hour range if
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no hypodensity greater than 1/3 MCA territory
no diabetes no warfarin not over 80 |
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transient sensory aphasia is
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Wernickes plus repetition
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What is the best treatment for non-afib stroke?
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anti-platlets such as aspirin
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transient motor aphasia is
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Brocas plus repetition
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best choice for afib stroke
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anticoagulants
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conduct aphasia results from a lesion is the
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arcuate faciculus. cannot repeat
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eyes deviate toward or away from lesion in a stroke
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toward lesion
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in spinal cord infarction, you usually have preserved
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position and vibration sense
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you can give tpa in 3-4.5 hour range if
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no hypodensity greater than 1/3 MCA territory
no diabetes no warfarin not over 80 |
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What is the best treatment for non-afib stroke?
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anti-platlets such as aspirin
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best choice for afib stroke
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anticoagulants
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small vessel disease is caused by?
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hypertension, we saw in corpus callosum
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large vessel disease is caused by
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cholesterol, occlusion of vessles
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transient sensory aphasia is
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Wernickes plus repetition
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transient motor aphasia is
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Brocas plus repetition
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conduct aphasia results from a lesion is the
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arcuate faciculus. cannot repeat
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eyes deviate toward or away from lesion in a stroke
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toward lesion
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in spinal cord infarction, you usually have preserved
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position and vibration sense
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you can give tpa in 3-4.5 hour range if
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no hypodensity greater than 1/3 MCA territory
no diabetes no warfarin not over 80 |
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What is the best treatment for non-afib stroke?
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anti-platlets such as aspirin
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best choice for afib stroke
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anticoagulants
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carotid artery repair if
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>70% occlusion on the same side of the stroke
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What increases risk for alzheimers
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ApoE4 allels.
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pathological hallmarks of dementia
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AD-amyloid plaques and tau neurfibillar tangels
DLS-Lewy bodies VaD large or small vessle infarcts FTD-tau tangles, pick bodies, intranuclear inclusions |
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vascular dementia hallmarks
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step wise progression
executive dysfunction, apathy, depression |
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Lewy bodies are
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Alpha synaclein in cortex
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episodic memory in teh
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medial temporal lobe, diencephalon
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semantic memory in the
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temporoparietal association cortex
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procedural memory in the
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basal ganglia
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seratonin and sleep
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promotes sleep
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raphe neurons are active/inactive during REM
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inactive during REM
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nonadrenergic cells and sleep
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promote arousal in the nucleus cerculleus.
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Pontine lesions do what to sleep
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REM without atonia and dream enhancement
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synchronized means?
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low frequency and high amplitude
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cholinergic system and sleep
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promotes REM
muscarinic antagonists - supress REM |
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synchronized when? unsynchronized when?
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synchronized during NREM,
unsynchronized during REM, awake |
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what causes narcolepsy
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hypocretin/orexin degeneration of cells
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Encephalopathy clinical features
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delirium
autonomic instability abnormal movement (myoclonus, tremor, asterixis) dysarthria focal neurological signs and seizures |
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sodium imbalance
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less than 127, greater than 150
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glucose
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greater than 450 or less than 40
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BUN range
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>60 is a problem
apathy, fatigue, inattention, irritability |
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B12 deficiency
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degeneration of the lateral and dorsal columns
ataxia mental deterioration |
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Localization of conciousness, place key for arousal
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ascending reticular activating system
in paramedian mesopontine tegmentum |
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small reactive pupils
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diencephalon
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hyperventilation
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midbrain
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For coma to be present you need
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bilateral cortical lesion
upper brainstem lesion |
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If you have a blown pupil
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CN III; due to lateral uncal herniation
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pinpoint pupils
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pontine hemhorrage
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Rubrospinal
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arm flexion
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two types of edema
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vasogenic: damage from blood-brain barrier
cytotoxic: at cellular level |
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spongiform encephalopathy
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prion disease
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Hirano body
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intranuclear inclusion of cytoskeleton breakdown product
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Neurofibrillary tangles contain
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Hyperphosphorylated Tau
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senile plaques
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extracellular accumulations of B-amyloid protein
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Granulovascular degneration
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pathonumonic for AD
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trisomy 21 pathology
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small brain with abnormal gyral pattern
decreased neuronal populations abnormality of neuronal structure |
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what genes have been linked with early onset alzheimers
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Precillin genes
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in picks disease you see
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pick bodies
balloon cells |
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where do you see lewy bodies
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lewy body dementia
parkinsons disease |
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vertical gaze palsy,
resistant to parkinsons meds instability |
supranuclear palsey with neurofibrillary tangles in many subcortical structures...tangles instead of lewy bodies
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In ALS you see
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atrophy of anterior spinal roots
loss of lateral corticospainl tract degeneration |
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olivopontocerebellar atrophy
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swollen purkinje cells - torpedos
loss of white matter in cerebellum parkinsons symptoms ataxia first in legs and then in arms/hands and bulbar musculature |
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whats the difference between freidreichs ataxia and vit b12 deficiency
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no vaculated structures in friedreichs ataxia
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