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220 Cards in this Set
- Front
- Back
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A functional test of the balance system, in which the patient is observed to see if
balance can be maintained with the eyes closed and feet close together. |
Romberg's
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positive romberg implies
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dysfunction of either the vestibular system or proprioception
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Inability to identify a stimulus on the side of the body contralateral to a parietal
lobe lesion, when it is presented simultaneously with a stimulus on the opposite side of the body; sensory neglect. |
extinction to double simultaneous stimulation
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severely infected food ulcer
DM steady deterioration in his ability to use his right arm since he awoke this morning denied pain or numbness in his right arm or any other neurological symptoms mild right facial droop normal tone with decrease in distal muscle bulk and strength right elbow flexion and extension are weak, and he can barely open his right hand fully symmetric decrease in distal-to-proximal gradient: pin, touch, temperature, vibration does not extinguish to double simultaneous stimulation right biceps and knee jerks are brisker than left no ankle jerk right plantar extensor response |
lacunar stroke
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areflexia is common in
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LMN probs
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symmetric distal sensory loss is common in
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peripheral neuropathies (DM)
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hemisensory loss and hyperreflexia suggests
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CNS dysfunction
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what are the 4 brainstem dysfunction signs?
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diplopia
dysphasia dysarthria dysmetria |
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cortical dysfunction signs
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aphasia
apraxia agnosia anopsia |
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where can you get pure motor finding without any sensory abnormalities
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left internal capsule
basis pontis |
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lacunar infarct
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small vessel thrombosis
may be caused by DM and hypertension |
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what is a lacunar stroke?
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small brain infarct caused by occlusion of small deep penetrating arterioles
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where are the 4 most common locations for lacunar strokes?
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internal capsule
pons thalamus basal ganglia |
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egeneration of the nuclei of the lower cranial nerves.
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bulbar palsy
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degeneration of nuclei of corticobulbar tracts bilaterally
dysfunction of pharynx, larynx tongue musculature caused by bilateral UMN lesions involving corticobulbar tracts or primary motor cortex jaw jerk and gag reflexes are typically brisk NO lesion to bulb bulbar musculature may be weak lesion to UMN innervation to bulb |
pseudobulbar palsy
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spontaneous contraction of an individual muscle fiber
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fibrillation
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Spontaneous contraction of all of the muscle fibers belonging to a single motor
unit that does not cause movement at a joint. |
fasciculation
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weakness in legs a yr ago
trouble holding head up if drink too quickly, will cough and choke spastic in upper and lower extremities cannot lift head off bed cannot lift arms above head twitching under triceps and hand muscles reflexes are brisk clonus at knees and ankles bilaterally plantar responses are extensor bilaterally walks with stiff legs and stopped posture chin almost resting on chest |
amyotrophic lateral sclerosis
Lou Gehrig's disease |
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what is the prognosis for amyotrophic lateral sclerosis
Lou Gehrig's disease |
poor
most die of respiratory failure within 3 yrs |
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spasticity (increased muscular tone)
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Transient, velocity-dependent resistance to passive stretch of
muscle, followed by relaxation of the muscle, which results in a "clasp knife" phenomenon. Spasticity may be seen with UMN lesions such as stroke, multiple sclerosis, and motor neuron disease. |
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rigidity (also increased muscular tone)
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Constant resistance to passive stretch of muscle that is
independent of the velocity of movement of the limb, resulting in a "lead pipe" phenomenon. Rigidity may be seen in patients with Parkinson's disease and in patients with other forms of parkinsonism. |
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clonus
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repetitive contraction of muscle
frequently elicited in ankles of patients with extreme hyperreflexia when testing ankle jerk reflex |
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Clonus is due to UMN or LMN lesion?
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UMN
suggests extreme hyperreflexia |
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LMN lesion would do what to tongue?
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tongue atrophy with hypoglossal nucleus or nerve lesion
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tongue has normal muscle power but difficulty protruding due to
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UMN lesion
affects cortical control of tongue |
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what muscles are almost never involved in Lou Gehrig's disease/ALS?
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extraocular muscles
urinary and bowel sphincter muscles |
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gene mutation for Lou Gehrig's/ALS
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superoxide dismutase on chr 21
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what happens to skeletal muscle in ALS?
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denervated muscle fibers are reinnervated by adjacent axon colleratl sprouts which all belong to a single motor unit
will be of same muscle fiber type both seen in muscle biopsy specimens from pts with amyotrophic lateral sclerosis |
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diaphoresis
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profuse sweating
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pin sensation
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sharp pain sensation when skin is touched with pt of a pin
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plasmapharesis
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blood is removed from body, cellular components are evacuated by using automatic blood cell separator device and plasma is returned to body by infusion
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progressive limb weakness and numbness
numbness in palms then toes swollen and prickly hands no weakness denied bladder probs numbness inside mouth foods tasted salty inability to bury his eyelashes fully when closing eye unable to rise from chair without pushing with arms weak hand grips bilaterally decreased touch, temp, vibratory perception no knee jerk on right slight response on left no ankle jerk plantar responses are flexor high glucose in CSF high protein in CSF |
Guillain Barre syndrome
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guillain-barre
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acute inflammatory demyelinating polyneuropathy
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prognosis of guillain barre
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good, recover weeks to months
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tx for guillain barre
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plasmapharesis
iv ig close medical support cardiac monitoring |
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demonstrate prolonged distal sensory and motor latencies and diffusely
slowed nerve conduction velocities. These findings are due to the severe demyelination of peripheral nerves, which slows conduction of action potentials in all peripheral nerves. In some patients with mild disease, the result of the nerve conduction study may be normal in the early course of the disease. |
guillain barre syndrome
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what bacteria often is an antecedent to guillain-barre?
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campylobacter
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how do you differentiate Guillain barre from MS?
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Guillain-Barre is acute, monophasic and due to PNS demyelination
MS - chronic disease with exacerbation and remissions and is due to CNS demyelination |
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festinating gait
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narrow based shuffling gate in which pts try to catch up with their center of gravity
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essential tremor
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involve head, outstretched hands, voice
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resting tremor
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involved part is at rest but absent or diminished when active movements are attempted
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more pronounced tremor on right hand
quivering of chin cogwheel rigidity diminished finger taps plantar response bilateral normal cerebellar fxn difficulty initiating/stoppig gait small shuffling arms swing mild postural instability |
TRAP
PD |
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cogwheel rigidity
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resting tremor superimposed on lead pipe rigidity
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A form of increased muscle tone in which there is a
constant resistance to passive stretch of a muscle throughout its range of motion. Rigidity is typically seen with all forms of parkinsonism. |
lead pipe rigidity
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Another form of increased muscle tone in
which resistance to passive stretch of a muscle varies with the velocity of stretch. Spasticity is seen with various upper motor neuron (UMN) disorders such as stroke, multiple sclerosis, and amyotrophic lateral sclerosis. |
clasp-knife spasticity
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spastic (scissor) gait is another narrow-based gait, which may be seen
with |
bilateral UMN lesions
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PD is due to loss of
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dopamine containing neurons in SN
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conventional therapy for PD
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Anticholinergics, dopamine replacement
(carbidopa/levodopa), dopamine agonists (bromocriptine or pergolide), selegiline, and amantadine. |
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experimental therapies for PD
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Transplantation of fetal or adrenal medullary
cells to the caudate nucleus; pallidotomies; thalamotomies. |
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secondary causes of parkinsonism
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drug induced -phenothiazines, haloperiodol, MPTP
degenerative: Striatonigral degernation, progressive supranuclear palsy, multisystem atrophy vascular basal ganglia infarction infectious - postencephalitic |
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dystonia
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forceful, sustained contraction of group of muscles
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palmomental reflex
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A contraction of the superficial muscles of the chin produced on the same side as
the palmar area that is stimulated (also called “palm-chin reflex”). |
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glabellar reflex
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A frontal release sign elicited by tapping the forehead repeatedly between the
eyebrows over the glabella and by observing for persistent blinking. It is important to note that when this maneuver is performed, a normal individual will blink once or twice. |
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snout reflex
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frontal release sign elicited by repeated tapping upper lip and by observing the puckering of lips
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chorea
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irregular unpredictable brief jerky movements that flit from one body part to another in a continuous random sequence
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myoclonus
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spontaneous twitches of a group of muscles that moves a limb across a joint
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tic
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quick stereotypic jerk of a group of facial/limb muscles
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athetosis
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slow writhing involuntary movements of proximal limbs and trunk
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hemiballism
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spontaneous ballistic irregular movements of arm and leg on one side of body
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suicide gesture
violent outbursts marked emotional lability periods of depression and apathy suicide attempts poor calculations and visuospatial skills poor modulation of speech eyebrow elevation grimacing pursing dystonic posturing of neck and upper body normal bulk and power in all 4 extremities reflexes are brisk -jaw jerk flexor plantar responses bilaterally bilateral palmomental, glabellar, snout reflexes erratic and lurching gate |
Huntington's
autosomal dominant on chr 4 |
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5 causes of chorea
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Drug-induced (levodopa [L-dopa], cocaine, phenothiazines)
• Neurodegenerative (Huntington's disease [HD], benign senile chorea) • Infectious (Sydenham's chorea—poststreptococcal) • Cerebral infarction (involving the basal ganglia) inflammatory - systemic lupus erythematosis, chorea gravidarum |
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clinical triad for HD
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chorea, dementia, psychosis
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what will cause atrophy of the head of caudate?
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HD
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27 yo dizzy, difficulty walking
episodes of numbness in legs, poor handwriting, staggering gait deteriorating gait double vision off to right side pale right optic disc horizontal nystagmus increased muscle tone in lower extremities right ataxia loss of vibratory perception and proprioception at toes relapsing and remitting neuro symptoms |
Multiple sclerosis. She has more than one lesion and at least
one previous episode. This illustrates dispersion of lesions in time and space, which is the crucial criterion for diagnosing MS. optic neuritis INO cerebellar ataxic gait sensory ataxic gait |
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what is the prognosis of MS?
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Variable. Her course may continue to be relapsing and
remitting, she may stabilize, or she may develop the chronic progressive form of the disease. |
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lipohyalinosis
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The neuropathologic changes noted in the small arteries that result in small
cerebral infarctions. |
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intention tremor
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tremor is intensified/exhibited when attempting coordinating movements
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dizziness
difficulty walking nausea, dizziness, vertigo flat optic discs with copper wiring pupils are equal and symmetrically reactive to light intention tremor on right finger to nose and heel to shin testing reflexes are normoactive and symmetrical gait is broad based |
stroke
brainstem compression which may lead to cerebellar tonsillar herniation |
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Horner’s syndrome results from a denervation of the postganglionic sympathetic nerve in the eye. As such, which of the following drugs would be unable to cause mydriasis in the eye of a Horner’s patient?
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amphetamine
loss of sympathetic stimulation means that amphetamine, an indirect (prejunctional) sympathomimetic cant use its usual sympathetic pathway |
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which is NOT mediated by PNS?
lacrimation contraction of trigone sphincter in bladder slowing of AV nodal conduction urinary frequency accomodation |
contraction of trigone sphincter in the bladder
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all of the following are muscarinic receptor mediated responses except:
bronchial dilation miosis bradychadia diaphoresis (sweating) defecation |
bronchial dilation
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this vascular effect is PNS-mediated:
1. dilation of skeletal muscle vasculature 2. drop of diastolic pressure 3. drop in venous pressure 4. penile erection 5. dilation of cardiac coronary arteries |
penile erection
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which of the following receptor mediated baroreceptor reflex at the level of both sympathetic ganglia and adrenal medulla?
1. nicotinic 2. muscarinic 3. alpha1 4. beta1 5. dopamine |
nicotinic
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which of the following is under control SNS?
a. sweating b. miosis c. bronchoconstriction d. bradycardia e. peptic acid secretion |
sweating
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receptor mediating sympathetic dilation of renal vascular bed
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DOPAMINE
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currently touted as a new treatment for excessive sweating
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Botulinum toxin
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dilation of vessels in skeletal muscle contraction of cutaneous vessels and positive inotropic and chronotropic responses on the heart are actions of:
Ach Epi Iso NE Reserpine |
Epi
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how would you increase kidney perfusion? what drug?
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dopamine
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cocaine overdose
which CV response is expected? |
cocaine is indirect adrenergic agonist that blocks the reuptake of NE and dopamine by blocking NET
INCREASE cardiac force of contraction |
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following reserpine tx, which drug would have NO EFFECT?
isoproterenol albuterol amphetamine ephedrine aspirin |
amphetamine - bc indirect mechanism
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healthy adult man accidently takes metoprolol orally
about 1 hr later, he begins very actively participating in a basketball game. most likely reflex response expected would be: |
increased arterial pressure
metaprolol is a beta1 blocker |
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A new drug blocks the release of neurotransmitter at sympathetic ganglia. The mechanism of action is most likely similar to
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botulinum toxin
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A patient is concerned that she might have taken too many diet pills that have hydrocyamphetamine (an indirect-acting sympathomimetic agent that does not enter the CNS) What would you check for to determine if she has?
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tachycardia
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a 15 yo old female is diagnosed with asthma
which of the following would be best to prescribe for treatment? |
albuterol
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A 62 year old male is in surgery for knee replacement. His systolic and pulse pressure drop dramatically. Which of the following might be best administered to treat this?
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dopamine (intropin) - dose dependent, increase renal blood flow, cardiac stimulant
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A 35 year old woman is in the ER with symptoms of anaphylaxis following a bee sting. Her medical history includes mild hyperthyroidism. She is not taking any medications. Epinephrine is administered. Which of the following might concern you
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untreated hyperthyroidism makes the heart more sensitive to epinephrine
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12 yo old male needs local anesthetic for a minor surgery. which of the following is most likely to be administered with local anesthetic?
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epinephrine
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85 yo male presents with dizziness upon standing. history of BPH. take prazosin
you suggest he change to tamsulosin. why? |
tamsulosin works best in the prostate so he probably will not have dizziness
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25 yo female with no symptoms. she is an actress but gets very nervous and shaky. which of the following would relieve shakiness?
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propanolol
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pt presents with prolactin secreting adrenoma. which of the following would you prescribe?
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bromocriptinea
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a 62 yo male presents with complaint urinating every 20 minutes esp at night. prescibe
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tamsulosin - uroselective alpha1a
blocks alpha1 -decreasing smooth muscle contraction in blood sphincter also used to treat BPH (more selective than Prazocin) |
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female found to have excess IOP, come about gradually. what would you use to treat?
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propanolol - used to treat wide angle glaucoma
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contraindication of using propanolol
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COPD
bc it can cause bronchospasms, bronchoconstriction contraindicated in asthma, COPD |
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adverse effect of most concern when taking Prazosin
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Syncope
why? alpha 1 blocker can cause orthostatic hypotension therefore may cause dizziness |
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A 48 yr-old male has begun to experience progressive difficulty walking and also complains of progressive muscle weakness that affects his speech and swallowing. His motor exam reveals spasticity and clonus when testing his ankle jerk reflex, bilateral plantar extensor responses, and fasciculations and atrophy in some muscle groups
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UMNs M
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Mass lesions that displace nervous system structure so severely that they are shifted from one compartment to another produces a condition called
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Herniation
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tonsillar herniation causes
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respiratory and cardiovascular collapse
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brain herniations include
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subfalcine
uncal tonsillar central |
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common symptoms and signs of elevated ICP include
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headache
papilledema altered mental status cushing triad nausea and vomiting |
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Cushing triad
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hypertension
bradycardia irregular respiration |
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which of the following herniation sites causes mydriasis and ptosis?
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transtentorial-uncal (CN3)
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69 yo presents with headache
physician notices that his right pupil is dilated and his right eye deviates down and out. which of the following represents the most likely location of the lesion? |
right oculomotor nerve
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a patient arrives in ER with paresis of right lower facial muscle and right upper extremity, inability to adduct left eye, left ptosis, left mydriasis
tongue deviates to right when protruded. where is the most likely lesion? |
left midbrain
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tongue deviates to contralateral side
right lower face suggest what kind of lesion? |
right lower face
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what explains the symptoms of oculomotor nucleus? UMN or LMN?
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LMN
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term for all motor neurons innervating a single muscle
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motor neuron pool
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global description of cerebellum function
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coordination achieved by error detector, consultant, and corrector
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synonym for monosynaptic reflex
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myotatic
deep tendon reflex stretch reflex |
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size principle dictates that these motor units will be recruited first during a muscle contraction
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Type I
small, slow motor units |
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motor disorder in which levels of muscle sarcolemma protein called dystrophin are low and defective leading to pseudohypertrophy of calf muscles and muscle weakness
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Duchenne's Muscular dystrophy
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Language disorder that carries the common name “word salad”
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Wernicke's aphasia
fluent aphasia |
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Used in skeletal muscles to detect the tension force of muscle contraction and found in series with extrafusal fibers
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Golgi tendon organ
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utosomal dominant neurodegenerative condition characterized by progressive choreiform movements, dementia, and psychiatric disturbances and affected area
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Huntington’s Chorea and atrophy of striatum
Nucleus Accumbens |
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Term that decribes clumsy and irregular execution of rapidly alternating movements
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dysdiadochokinesis
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The region labeled A receives input from these neurons in this region/structure
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Dentate nucleus – receives input from cerebrocerebellum pathway
Purkinje neurons from the lateral cerebellar hemisphere |
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region of cerebellum associated with right sided dysmetria, intention tremor, scanning speech
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right hemisphere
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Division of the cerebellum that influences balance and vestibuloocular reflexes and the two motor paths influenced by this region
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flocculonodular lobe and LCST and MLF
VOR-ascending MLF |
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muscle tone following a long term LMN lesion
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hypotonia, flaccid
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Name of a repetitive reflex contraction of muscle, frequently elicited in ankles of patients with extreme hyperreflexia indicative of uMN lesion
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clonus
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function of muscle spindle
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senses velocity and length of stretch
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decorticate posturing another name is
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flexor bias
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Ultimate action of Ib afferent fibers from Golgi tendon organs on a motor neurons
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inhibition
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muscle groups controlled by motoneurons in region (cross section of spinal cord)
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medial trunk muscles
proximal (truncal muscles) |
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The lateral descending motor pathways have their major motor influence on this musculature
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distal extremity musculature
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event that sustains the sensitivity of the sensory region of the intrafusal fibers
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coactivation
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this efferent neuron adjust the gain of the stretch reflex
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gamma
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State of reflexes following a long term UMN lesion
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hyperreflexia
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Name of disease characterized by masked expression, shuffling gati, difficulty in initiating movements, pill rolling tremor of hands, and rigidity of limbs
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parkinson's
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In the motor system referred to as the final common pathway, and when damaged will cause these chronic signs
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alpha motor neuron
weakness atrophy fasciculations decreased tone and reflexes (LMN characteristics) |
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Disorder characterized by violent flinging movements of right limbs and flaccid muscles between movements and the nucleus and side affected
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Hemiballism
Left subthalamic nucleus |
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The structure central to imparting emotional significance to a sensory experience
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amygdala
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Damage to these structures results in anterograde amnesia
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Hippocampus
And parahippocampus gyrus (medial temporal lobe) and or medial diencephalic system and mammillary bodies |
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Synaptic mechanism strongly considered to be a cellular substrate of learning and memory
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LTP
LTD |
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Four psychiatric disorders putatively attributed to limbic system dysfunction
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schizophrenia
anxiety depression OCD |
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Sensory hallucinations, automatisms, impaired consciousness, aphasias, and memory problems are indicative of dysfunction in these specific areas
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Temporal lobe seizures or stroke
Possibly Cingulate cortex and or orbitofrontal cortex |
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3 categorical functions and associated areas of association cortices
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Recognition-temporal
attention-parietal planning-pre-frontal |
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what lobe involved in recognition?
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temporal
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what lobe is involved in planning?
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pre-frontal
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what lobe is involved in attention?
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parietal
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Lesion of the non-dominant hemisphere produces _____________ while lesions of the dominant hemisphere produce _________________
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Neglect (spatial attention)
Aphasia and apraxia (impairment of language, analytical skills, complex motor skills) |
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a lesion limited to just the angular gyrus on dominant hemisphere can produce this deficit
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alexia with agraphia
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lesion of this pathway is necessary to get alexis WITHOUT agraphia
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splenium of the corpus callosum
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Symptoms of prefrontal cortex lesions
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Disinhibition
Abulia Inappropriate affect Impulsivenes Emotionally labile Limited insight Poor planning and judgment Altered personality (self) |
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An elderly woman is brought to the ER by her friend because of sudden onset of nausea, dizziness, vertigo, and difficulty walking. History reveals a 15 year history of hypertension. The neurological exam revealed the following:
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1. PEERL
2. Nystagmus 3. Decreased muscle tone on the right arm and leg. 4. Intention tremor on right. Difficulty performing the finger-to-nose and hell-to –shin testing. 5. Reflexes normal, no Babinski sign 6. Leans to the right when walking, unsteady tandem gait. |
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This extrampyramidal area when damaged causes truncal ataxia and an unsteady tandem gait
Midline area of the cerebellum |
If damaged, these medullary nuclei can be responsible for development of vertigo, nausea, and dizziness
Vestibular complex in medullar (vestibular |
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This spinal nucleus and tract provides cerebellar proprioceptive input from the lower leg and trunk
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Clark’s nucleus and the dorsal spinocerebellar tract
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Difficulty in performing on the right side the finger to nose and heel to shin testing (appendicular ataxia) indicates a lesion to this region
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right intermediate (right cerebellar hemisphere)
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PICA infarction causes what syndrome?
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lateral medullary syndrome
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How do you different PICA from SCA?
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PICA has more brainstem involvement
SCA if extensive might affect CN6 SCA is more restrictive and usually does not have any brainstem signs |
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A 60 yo dock worker was brought to the ER unconscious after he had collapsed while loading a truck. After regaining consciousness severl days later, an exam was performed with following:
Weakness of both R limbs Hypertonicity of both R limbs Increased Deep Tendon Reflexes on R side Dysarthria Deviation of tongue to L when protruded Loss of position sense, pressure and 2 pt discrim touch on the R side of body |
left medial medullary syndrome aka laternating hemiparesis
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what infarcts can cause medial left medullary syndrome?
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left branch ASA in caudal medulla
paramedian branches of VA |
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Synaptic effect elicited by DA in striatum when acting on D1 (direct path) and D2 (indirect path) receptors
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D1-stimulatory
D2-inhibitory |
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striatum directly projects fibers to these 2 major nuclei
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GP and SNpr
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2 major brainstem descending nuclear groups that increase extensor tone
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pontine reticulospinal nuclei
LVS nuclei |
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The striatum directly projects fibers to these two major nuclei
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neocortex
SNpc |
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This region of CNS degenerates in Wilson’s disease, a defect in metabolism of Cu that results in tremor, rigidity, and choreiform, athetotic movements, wing beating tremor and a characteristic brown ring around iris (Keiser-Fleshcher ring)
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basal ganglia
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6. A 74 yo woman with hx of atrial fibrillation suddenly develops slurred speech and dysarthria, R side weakness, weak movements of R face, while sparing the forehead. Rightward tongue deviation was evident. No evidence of sensory deficits including cortical. Name the dx and only two sites possible to explain symptoms of this case
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a. Pure hemiparesis and L post limb of IC or Left ventral pons anterior to CN 7 (lacunar infarct likely lenticulostriate [common] anterior choroidal or thalamoperforator artery)
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N2O methoxyflurane
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agent associated with highest risk of hepatitis
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Halothane
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agent associated with tonic-clonic seizures
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Enflurane
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agent that maintains CO, systemic and coronary vasodilation and has reduced risk of catecholamine-dependent arrythmias
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isoflurane
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agent with highest risk of nephrotoxicity and the metabolite responsible for damage
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methoxyflurane, F-
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IV agent that has CNS excitatory effects but produces the least adverse CV effects
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etomidate
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IV agent that requires a lipid diluent (emulsidicant) because it is water soluble
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propofol
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IV agent that causes cardiac stimulation leading to increased blood pressure, heart rate and CO
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ketamine
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Agent that in large doses produces general anesthesia requiring mechanical ventilation but frequently used to provide analgesia with other anesthetics
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fentanyl
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agent that is associated with emergence phenomena of hallucinations and vivid dreams
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ketamine
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agent causing vasodilation resulting in a decline in BP
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propofol
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agent used to treat malignant hypothermia
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dantrolene
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agent used to reverse Versed (midazolam) anesthesia
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Flumazenil
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Agent that can be used for mask induction due to not being pungent
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Sevoflurane
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Agent associated with Compound A generation at low flow rates
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A cortical electrical discharge producing a neurological symptom
or sign. |
seizure
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a seizure associated with motor activity
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convulsion
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A chronic neurological disorder manifested by recurrent seizures.
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epilepsy
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A cortical electrical discharge producing a neurological symptom
or sign. |
seizure
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A seizure limited to a single focal area of brain;
consciousness is typically preserved. The symptoms of a partial seizure reflect the part of the brain that is discharging |
partial (focal) seizure
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a seizure associated with motor activity
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convulsion
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A seizure involving both hemispheres; consciousness
is lost. |
generalized seizure
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A chronic neurological disorder manifested by recurrent seizures.
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epilepsy
|
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A seizure limited to a single focal area of brain;
consciousness is typically preserved. The symptoms of a partial seizure reflect the part of the brain that is discharging |
partial (focal) seizure
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A seizure involving both hemispheres; consciousness
is lost. |
generalized seizure
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aura
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simple partial seizure without motor movements; it is usually
the initial symptom of a complex partial seizure. |
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what is the cause of seizures?
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A seizure represents an abnormal electrical discharge of the brain, usually
arising from an area of injured cortex. |
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why sweat and dilate pupils during seizure?
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The seizure spreads to involve the hypothalamus, the head nucleus for the
sympathetic nervous system. The seizure causes excitation of the hypothalamus, thereby increasing sympathetic outflow. Both sweating and pupillary dilatation are symptoms of increased sympathetic activity. |
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most common side effects of elevated phenytoin are
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nystagmus and gait ataxia
when the dosage of phenytoin is lowered, these symptoms will be reversed |
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postictal state
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period of disorientation and fatigue (and occasionally
focal weakness) that follows a seizure. |
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EEG
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recording of cortical electrical activity from the surface of the
scalp. Most of the activity recorded in the EEG consists of extracellular current flow associated with summated postsynaptic potentials in synchronously active pyramidal cells of the cerebral cortex. |
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simple partial seizure
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consciousness if fully preserved
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complex partial seizure
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consciousness is altered but not lost entirely
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primarily generalized seizure
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involve both hemispheres from the start of seizure
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secondarily generalized seizure
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begins focally then spread through corpus callosum to involve both hemisphere
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pathophysiology of absence seizures
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Absence seizures are subcortical, centrencephalic seizures that are thought
to originate in the brain-stem reticular formation or intralaminar thalamic nuclei. Absence seizures are primary generalized seizures that do not have a focal onset. |
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absence seizures are frequently proceeded by what?
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hyperventilation
Absence seizures are commonly precipitated by hyperventilation because the resultant hypocapnea activates thalamocortical pathways. |
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why no aura for absence seizure?
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Absence seizures are generalized from the outset and have an abrupt onset
without an aura. Only partial seizures can start with an aura. |
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paraphasia
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The misuse of spoken words or word combinations; a form of aphasia.
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anomia
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inability to remember the names of objects
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perseveration
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Continued repetition of a word or phrase, or repetition of answers that are not
related to successive questions asked |
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aphasia, acalculia
dysfunction of what? |
left hemisphere
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geographic disorientation
dysfunction of what? |
right hemisphere
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impaired memory and cognitive
function dysfunction of what? |
bihemispheric
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long term memory resides in the
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association cortex
includes large areas of the parietal, temporal, occipital, and frontal lobes that associate and integrate primary motor, sensory, visual, and auditory modalities. This integrative function also includes the storage of long-term information. |
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short term memory resides in the
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hippocampus
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The inability to perform tasks or activities in the presence of
preserved motor, sensory, and cerebellar functions (e.g., dressing, gait, grooming). |
apraxia
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he inability to recognize familiar or common environmental
stimuli in the presence of preserved motor, sensory, and cerebellar functions (e.g., colors, faces, body parts). |
agnosia
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paratonic rigidity
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The inability to relax a limb when it is
passively moved |
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short term memory resides in the
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hippocampus
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The inability to perform tasks or activities in the presence of
preserved motor, sensory, and cerebellar functions (e.g., dressing, gait, grooming). |
apraxia
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he inability to recognize familiar or common environmental
stimuli in the presence of preserved motor, sensory, and cerebellar functions (e.g., colors, faces, body parts). |
agnosia
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paratonic rigidity
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The inability to relax a limb when it is
passively moved |
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what do frontal release signs suggest?
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Frontal release signs suggest diffuse forebrain dysfunction; they are
typically seen in Alzheimer's disease and in bihemispheric strokes. |
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confabulation
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A behavioral reaction to memory loss in which the patient fills in memory gaps
with inappropriate words. |
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heel-to-shin testing
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A test of leg coordination in which the heel of one leg is run smoothly down the
other shin, and speed, accuracy, and any tremor are noted. |
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lesion site of broca's aphasia
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left frontal region
limited to posterior part of inferior frontal gyrus |
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lesion site of wernicke's aphasia
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posterior superior temporal regions of left hemisphere with extension into inferior parietal lobule
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lesion site of conduction aphasia
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arcuate fasciculus in left hemisphere
often involve supramarginal and lower postcentral gyri |
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lesion site of global aphasia
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large lesion of left middle cerebral artery territory that includes frontal, temporal, parietal lobes
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lesion site of left frontal lobe anterior/superior/below Broca's
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transcortical motor aphasia
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transcortical sensory aphasia lesion site
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left posterior temporal occipital lobe
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mixed transcortical phasia (isolation of speech area) lesion site
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extensive cortical damage to both cerebral hemispheres with relative preservation of perisylvian cortex
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transcortical aphasia-lesions are ____in location
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extrasylvian in location
the primary language cortex is not damagd but the areas of the brain that project to language cortex are damaged |
